title: Serum granulysin as a possible key marker of the activity of alopecia areata.
abstract: BACKGROUND
  Alopecia areata (AA) is an organ-restricted autoimmune condition of the hair follicles (HFs) that presents as nonscarring hair loss. A collapse of immunoprivilege for cell-mediated cytotoxicity and following attacks by cytotoxic T cells to anagen HFs are considered to play a major role in the pathogenesis of AA. However, there has been no useful marker for the activity of AA to date.
  
  
  OBJECTIVE
  The aim of this study is to examine whether granulysin, which is known to reflect the activity of cytotoxic immune responses, is related to the disease activity of AA.
  
  
  METHODS
  We evaluated serum granulysin levels in acute and chronic AA patients compared to healthy controls in the perspective of bald skin areas, prognosis, and co-existence of other allergic diseases. In addition, immunohistochemical analysis for granulysin-, CD4-, CD8-, and CD56-positive cells in the lesional skin of acute and chronic AA patients was performed.
  
  
  RESULTS
  Serum granulysin levels were significantly elevated in both acute and chronic AA patients (p=0.00081 and p=0.0012, respectively). Intriguingly, serum granulysin levels were significantly associated with the broader bald skin areas (Spearman's r=0.59, p=0.017), and poorer prognosis in acute AA patients (p=0.0080). They were also associated with co-existence of allergic disorders in AA patients (p=0.026). Immunohistochemical staining demonstrated that perifollicular granulysin-bearing cells were mainly detected in acute AA lesions with dense lymphocytic infiltration, and that these granulysin-bearing cells were consistent with CD8(+) T cells.
  
  
  CONCLUSIONS
  The serum granulysin level may be a useful and novel marker for the disease activity in the acute phase of AA.
authors.affiliation: Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ono
authors.affiliation: Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: otsukamn@kuhp.kyoto-u.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Otsuka
authors.affiliation: Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Tatsuki R
authors.initials: TR
authors.lastname: Kataoka
authors.affiliation: Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Itsuko
authors.initials: I
authors.lastname: Koyanagi
authors.affiliation: Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Miyachi
authors.affiliation: Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: kaba@kuhp.kyoto-u.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kabashima
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000506:Alopecia Areata / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D000945:Antigens, Differentiation, T-Lymphocyte / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002908:Chronic Disease; D015897:Comorbidity; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012867:Skin / Q000276:immunology; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D000945:Antigens, Differentiation, T-Lymphocyte; D015415:Biomarkers; C075005:GNLY protein, human
keywords: Activity; Allergic disorders; Alopecia areata; Cell-mediated cytotoxicity; Granulysin; Prognosis