Immunophenotypic Analysis Reveals Differences in Circulating Immune Cells in the Peripheral Blood of Patients with Segmental and Nonsegmental Vitiligo

Marcella Willemsen,Nicoline F Post,Nathalie O.P Van Uden,Vidhya S Narayan,Saskia Chielie,E Helen Kemp,Marcel W Bekkenk,Rosalie M Luiten

doi:10.1016/j.jid.2021.05.022

Marcella Willemsen, Nicoline F Post + Show 6 more

Open Access

https://doi.org/10.1016/j.jid.2021.05.022

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Abstract

Accumulating studies have indicated immune-based destruction of melanocytes in both segmental vitiligo (SV) and non-SV (NSV). Whereas SV often occurs unilaterally during childhood and stabilizes after an initial period of activity, the disease course of NSV is usually slowly progressive, with new lesions occurring bilaterally during life. This suggests an involvement of distinct pathophysiology pathways, specifically increased systemic immune activation in patients with NSV but not in patients with SV. This research aimed to identify the differences in immune cells in the blood of patients with SV and NSV through immunophenotyping of circulating cells. Regulatory T cells were unaffected in patients with SV compared with that in healthy controls but decreased in patients with NSV. In patients with NSV, the reduction in regulatory T cells was associated with the presence of other systemic autoimmune comorbidities, which were less present in SV. Similarly, the absence of a melanocyte-specific antibody response in patients with SV suggests less involvement of B-cell immunity in SV. These data show that in contrast to patients with NSV, no increased systemic immunity is found in patients with SV, indicating that SV pathogenesis is associated with a localized cytotoxic reaction targeting epidermal melanocytes.

Highlights

Vitiligo is the most common skin depigmenting disorder characterized by white patches resulting from the loss of pigment-producing cells, melanocytes (Bergqvist and Ezzedine, 2020)
We found that regulatory T cell (Treg) are less abundant in patients with NSV than in healthy controls but did not differ in patients with segmental vitiligo (SV)
Previous studies have shown the presence of melanocytespecific antibodies in some patients with NSV (Kemp et al, 2007), whereas this remained largely unstudied in patients with SV

Summary

Introduction

Vitiligo is the most common skin depigmenting disorder characterized by white patches resulting from the loss of pigment-producing cells, melanocytes (Bergqvist and Ezzedine, 2020). It affects approximately 0.5% of the general population with no apparent differences in rates of occurrence according to sex, skin type, or ethnicity (Boniface et al, 2018). The commonest form, nonsegmental vitiligo (NSV), shows symmetrical depigmentation of the body. NSV shows an unpredictable disease course, whereas SV typically stabilizes a few months after onset.

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