R = 0.25), whereas controls showed no correlation (R = 0.0) (see Data S1: Supporting information).Along with these results, higher antimelanocyte antibody and LPO levels in AV patients signify equal contribution of both oxidative stress and autoimmunity in disease progression. Various antioxidant enzymes can be induced by inflammatory cytokines such as TNF-a and IFN-c, which in turn increase ROS levels in vitiligo patients (18). Our recent studies also showed increased transcript levels of SOD2, SOD3 (13), TNFA (19), TNFB (20) and IFNG (21) in vitiligo patients. There are reports showing the generation of free radicals during melanogenesis which hydroxylate tyrosinase and other proteins, thereby increasing their antigenicity (22,23). Elassiuty et al., showed upregulation of heme oxygenase-1 in patients' melanocytes due to high oxidative stress (24). The build-up of ROS along with possible immune system defects allows for the inappropriate autoimmune response against melanocytes. ROS are involved in specific early events in T-cell activation and antioxidants are involved in reducing T-cell proliferation (25). We showed decreased regulatory T cells and CD4 + /CD8 + ratio in GV patients, which were positively correlated with disease onset and progression (26). High oxidative stress can lead to the breakdown of self-tolerance by releasing plethora of sequestered autoantigens and generation of neoantigens (1).
ConclusionFor the first time, our study suggests that oxidative stress may be the initial triggering event to precipitate vitiligo in Gujarat population, which is then exacerbated by contribution of autoimmune factors together with oxidative stress.
AcknowledgementsNCL, MD, MSM, MS, ARG, APY, VNP, FK, DJD, AP and EMS performed the experiments; NCL, MD and RB designed the research study; RB contributed essential reagents and tools; YSM, RG and ZM arranged for the blood samples; NCL, MD and RB analysed the data; NCL and MD wrote the manuscript and RB edited it. NCL and MSM thank CSIR and UGC, New Delhi, for awarding SRF and JRF, respectively.
Conflict of interestsThe authors have declared no conflicting interest.
Supporting InformationAdditional Supporting Information may be found in the online version of this article: Table S1. Demographic characteristics of vitiligo patients and unaffected controls.Data S1. Supporting information. Letter to the Editor repartition is unknown. Here, we found LCs in back skin, footpads and tail skin of C57BL/6, BALB/c, 129/Sv and CBA/J mice. Langerin+ dDCs were readily observed in back skin of all strains, but only in footpads and tail of BALB/c and CBA/J mice. Similarly, while LCs were equally present in all LNs and strains, Langerin+ dDCs were found in popliteal LNs (draining footpads) only in BALB/c and CBA/J mice. The sciatic LNs, which we identified as the major tail-draining lymphoid organ, were devoid of Langerin+ dDCs in all strains. Thus, functionally different DCs reside in different skin areas, with variations among mouse strains, implying a potential impact on the c...