title: Suction blistering the lesional skin of vitiligo patients reveals useful biomarkers of disease activity.
abstract: BACKGROUND
  Vitiligo is an autoimmune disease of the skin with limited treatment options; there is an urgent need to identify and validate biomarkers of disease activity to support vitiligo clinical studies.
  
  
  OBJECTIVE
  To investigate potential biomarkers of disease activity directly in the skin of vitiligo subjects and healthy subjects.
  
  
  METHODS
  Patient skin was sampled via a modified suction-blister technique, allowing for minimally invasive, objective assessment of cytokines and T-cell infiltrates in the interstitial skin fluid. Potential biomarkers were first defined and later validated in separate study groups.
  
  
  RESULTS
  In screening and validation, CD8+T-cell number and C-X-C motif chemokine ligand (CXCL) 9 protein concentration were significantly elevated in active lesional compared to nonlesional skin. CXCL9 protein concentration achieved greater sensitivity and specificity by receiver operating characteristic analysis. Suction blistering also allowed for phenotyping of the T-cell infiltrate, which overwhelmingly expresses C-X-C motif chemokine receptor 3.
  
  
  CONCLUSIONS
  A small number of patients were enrolled for the study, and only a single patient was used to define the treatment response.
  
  
  CONCLUSIONS
  Measuring CXCL9 directly in the skin might be effective in clinical trials as an early marker of treatment response. Additionally, use of the modified suction-blister technique supports investigation of inflammatory skin diseases using powerful tools like flow cytometry and protein quantification.
authors.affiliation: Department of Medicine, Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: James P
authors.initials: JP
authors.lastname: Strassner
authors.affiliation: Department of Medicine, Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Rashighi
authors.affiliation: Department of Medicine, Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Dermatology, Sohag University, Sohag, Egypt.
authors.forename: Maggi
authors.initials: M
authors.lastname: Ahmed Refat
authors.affiliation: Department of Medicine, Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Jillian M
authors.initials: JM
authors.lastname: Richmond
authors.affiliation: Department of Medicine, Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: john.harris@umassmed.edu.
authors.forename: John E
authors.initials: JE
authors.lastname: Harris
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001768:Blister / Q000378:metabolism*; D018414:CD8-Positive T-Lymphocytes; D016022:Case-Control Studies; D054357:Chemokine CXCL10 / Q000378:metabolism; D054371:Chemokine CXCL11 / Q000378:metabolism; D054370:Chemokine CXCL9 / Q000378:metabolism*; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D054367:Receptors, CXCR3 / Q000378:metabolism*; D013396:Suction; D014820:Vitiligo / Q000276:immunology* / Q000378:metabolism*; D055815:Young Adult
chemical_list: D015415:Biomarkers; C114753:CXCL10 protein, human; C515202:CXCL11 protein, human; C080810:CXCL9 protein, human; D054357:Chemokine CXCL10; D054371:Chemokine CXCL11; D054370:Chemokine CXCL9; D054367:Receptors, CXCR3; D007371:Interferon-gamma
keywords: CD8; CXCL10; CXCL9; autoimmunity; biomarkers; biopsy; blisters; inflammatory skin disease; suction blister; vitiligo