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Transfer to Human Scalp Explants on Prkdc^scid Mice

Amos Gilhar, MD; Marina Landau, MD; Bedia Assy, BS; Raya Shalaginov, MSc; Sima Serafimovich, MD; Richard S. Kalish, MD, PhD

Arch Dermatol. 2002;138:916-922.

Objective  To determine the role of CD4⁺ and CD8⁺ T lymphocytes in the pathogenesis of alopecia areata.

Design  Relapse of alopecia areata was induced in autologous human scalp grafts on Prkdc^scid mice by injection of activated T lymphocytes derived from lesional skin. CD4⁺ and CD8⁺ T cells were separated by magnetic beads before injection.

Setting  University-based dermatology practice.

Participants  Eleven patients with either alopecia totalis or severe alopecia areata.

Main Outcome Measures  Hair regrowth, hair loss, and immunohistochemical findings of scalp explants.

Intervention  Transfer of scalp T cells to autologous lesional scalp explants on Prkdc^scid mice.

Results  Injection of unseparated T cells and mixed CD4⁺ plus CD8⁺ T cells resulted in significant hair loss (P<.01) in 5 of 5 experiments. However, injection of purified CD4⁺ or CD8⁺ T cells alone did not result in reproducible hair loss. CD4⁺ and CD8⁺ T cells induced follicular expression of intercellular adhesion molecule 1 (CD54), HLA-DR, and HLA-A, HLA-B, and HLA-C after injection into scalp grafts.

Conclusions  CD4⁺ and CD8⁺ T cells have a role in the pathogenesis of alopecia areata. It is hypothesized that CD8⁺ T cells act as the effector cells, with CD4⁺ T cell help. It is now necessary to look for HLA-A, HLA-B, and HLA-C associations with alopecia areata. Therapeutic manipulations that interfere with CD8⁺ activity should be examined.

From the Skin Research Laboratories, Flieman Medical Center and B. Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (Drs Gilhar and Serafimovich and Mss Assy and Shalginov); the Department of Dermatology, Elias Sourasky Medical Center, Tel Aviv, Israel (Dr Landau); and the Department of Dermatology, State University of New York at Stony Brook (Dr Kalish).

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