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2016 ; 5
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Recent advances in understanding vitiligo
#MMPMID27635239
Manga P
; Elbuluk N
; Orlow SJ
F1000Res
2016[]; 5
(ä): ä PMID27635239
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Vitiligo, an acquired depigmentation disorder, manifests as white macules on the
skin and can cause significant psychological stress and stigmatization. Recent
advances have shed light on key components that drive disease onset and
progression as well as therapeutic approaches. Vitiligo can be triggered by
stress to the melanin pigment-producing cells of the skin, the melanocytes. The
triggers, which range from sunburn to mechanical trauma and chemical exposures,
ultimately cause an autoimmune response that targets melanocytes, driving
progressive skin depigmentation. The most significant progress in our
understanding of disease etiology has been made on three fronts: (1) identifying
cellular responses to stress, including antioxidant pathways and the unfolded
protein response (UPR), as key players in disease onset, (2) characterizing
immune responses that target melanocytes and drive disease progression, and (3)
identifying major susceptibility genes. The current model for vitiligo
pathogenesis postulates that oxidative stress causes cellular disruptions,
including interruption of protein maturation in the endoplasmic reticulum (ER),
leading to the activation of the UPR and expression of UPR-regulated chemokines
such as interleukin 6 (IL-6) and IL-8. These chemokines recruit immune components
to the skin, causing melanocytes to be targeted for destruction. Oxidative stress
can further increase melanocyte targeting by promoting antigen presentation. Two
key components of the autoimmune response that promote disease progression are
the interferon (IFN)-?/CXCL10 axis and IL-17-mediated responses. Several
genome-wide association studies support a role for these pathways, with the
antioxidant gene NRF2, UPR gene XBP1, and numerous immune-related genes including
class I and class II major histocompatibility genes associated with a risk for
developing vitiligo. Novel approaches to promote repigmentation in vitiligo are
being investigated and may yield effective, long-lasting therapies.
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