388 Natural history and management of basal cell nevus syndrome: Updates from the gorlin syndrome registry

Abstract

Alopecia areata (AA) is a common nonscarring hair loss disorder with a lifetime risk of 2%. Although AA is characterized by Th1/IFN-skewing, with additional Th2 and IL-23 activation in scalp tissues, little is known about its systemic profile in blood. To evaluate the blood proteomic signature of AA and determine serum biomarkers associated with increased disease severity, we assessed w350 inflammatory and cardiovascular proteins using OLINK high-throughput proteomics in 35 moderate-to-severe AA patients (>30% scalp involvement, mean age¼43.17 years; mean SALT¼74.98), in comparison with age-matched healthy individuals, and as a point of reference also to moderate-to-severe psoriasis (n¼19, mean PASI¼20.43), and atopic dermatitis/AD patients (n¼36, mean SCORAD¼61.35). 74 proteins were significantly differentially expressed between AA and controls (FCH>1.3, FDR<.05) including innate immunity (IL-6, IL-8), Th1 (CXCL9/CXCL10/CXCL11/IFNG), Th2 (CCL13/ CCL17/CCL7), and Th17 markers (CCL20/PI3/S100A12). 86 biomarkers were correlated with clinical severity in AA patients (P<.05) including Th1 (CCL3), Th2 (CCL11/CCL13), innate (IL8) and Th17 markers (S100A12). Many cardiovascular/atherosclerosis-related proteins were significantly higher in AA compared to controls, and also correlated with severity, including SELP, SRC, AXIN1, MPO, IL18, and OSM (P<.05). Pathway analysis showed significant increases in cardiovascular/atherosclerosis, and immune pathways compared to controls (FCH>4.0, FDR<.001), which also correlated with clinical severity (P<.05). This study defined the abnormalities of moderate-to-severe AA and associated circulatory biomarkers. It shows that AA is a systemic disease with immune, cardiovascular and atherosclerosis dysregulation, highlighting the need for systemic treatment approaches.