Immunometabolism in Alopecia Areata

Aims and objectives

The primary aim of this research was to understand how changes in the way hair follicles process and use energy might contribute to the development of alopecia areata (AA), a condition that causes hair loss due to an attack by the body's immune system on the hair follicles. We set out to explore how metabolism, or the way cells generate and use energy, of both immune cells and hair follicles is altered in people with AA. We also wanted to see if these changes could explain why the immune system targets hair follicles in this condition.

Results

We found that in AA, there are changes in the levels of certain substances involved in metabolism in the scalp skin. Specifically, uric acid and other substances were changed in scalp affected by AA. These findings suggest that the way hair follicles handle metabolites is altered in AA, which might influence how the immune system responds to them. In addition, we found that there may be damage to scalp skin blood vessels in those affected in AA.   

We also discovered that hair follicles possess the machinery to make fructose which was not previously known. This ability to use fructose might help hair follicles meet their high energy demands, but it could also play a role (linking with uric acid levels) in the development of AA by affecting blood vessels in the scalp.  

Although some parts of our research, particularly those involving advanced imaging techniques, were delayed, we still made significant progress in understanding the metabolic changes in AA. Our findings open new possibilities for developing treatments that target these metabolic pathways to prevent hair loss and promote hair regrowth. 

Publications and other outputs

This work was presented at the European Hair Research Society (EHRS) meeting in Sheffield in 2023, and the British Hair and Nail Society: UK Symposium on Hair and Scalp Disorders in Manchester in 2023. We also presented a poster detailing preliminary findings in relation to metabolic marker expression in alopecia areata at the International Societies for Investigative Dermatology 2023 meeting in Tokyo. 

Strengths and weaknesses of the research 

One of the strengths of this research was its innovative approach to studying AA by focusing on metabolism, which is a relatively unexplored area in this context. Our use of advanced techniques and novel approaches allowed us to make important discoveries that could lead to new treatments.  

However, the research also faced some challenges. Technical issues and equipment delays hindered our ability to fully explore certain aspects of the study, particularly the detailed examination of metabolism within immune cells in the AA scalp. Despite these setbacks, the project adapted by focusing on other promising areas, which still led to important findings. 

In addition, the numbers of samples used to measure the substances (metabolites) in AA scalp skin was lower than desired, yet still yielded important findings. To support this going ahead, we will look at the levels of substances of interest using AA patient serum to confirm these findings and gain greater insight into our findings. 

Overall, the research has made significant contributions to understanding the role of metabolism in AA, and while there were challenges, the findings have opened new doors for future research that could ultimately benefit people affected by this condition.