SERUM LEVELS OF IFN-Γ, COMPLEMENT
COMPONENT C3 C4 AND VITAMIN D3 IN
THE PROGNOSIS OF PATIENTS WITH
ALOPECIA AREATA PROSPECTIVE
TEACHERS
Teeba T. Khudair
College of Nursing, National University of Science& Technology, Iraq
taiba.th.khudair@nust.edu.iq
Wala’a H. Hadi
College of Nursing, National University of Science& Technology, Iraq
Haneen Kadhim Zaid
College of Nursing, National University of Science& Technology,Iraq
Reception: 14/11/2022 Acceptance: 06/01/2023 Publication: 21/01/2023
Suggested citation:
T. K., Teeba, H. H., Wala’a and K. Z., Hanene. (2023). Serum levels of ifn-γ,
complement component c3 c4 and vitamin d3 in the prognosis of
patients with alopecia areata prospective teachers. 3C Empresa.
Investigación y pensamiento crítico, 12(1), 290-299. https://doi.org/
10.17993/3cemp.2023.120151.290-299
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ABSTRACT
Background: Alopecia areata is a prevalent autoimmune skin disorder. The current
investigation aims to evolve the function of serum IFN-, complement component C3
C4, and vitamin D3 levels in the prognosis of patients with alopecia areata. The blood
sample was taken from twenty AA patients and twenty healthy controls. Interferon
(IFN-) levels in serum were evaluated using the ELISA method, V.D3 was detected
using the Roche electrochemiluminescence method, and C3 and C4 were detected
using the immunoturbidimetry method. . In the current study observed elevated levels
of IFN-γ (299±115.7 Pg/ml), while the control group was lowest 73±10.84 Pg/ml .This
funding was highly significantly different (p-value 0.00). The Mean±SD Level of
components C3 and C4 in the current study were (1.37±0.903) (0.29±0.029) Alopecia
Areata cases were not statistically different from the usual range, however vitamin D3
levels were severely deficient. (6.86±4.03) when compared to normal range.
Distribution of AA among male was highly observed in age group NO = 10 (50%) 1 -
19years follow by age group NO = 4(20%) 20-39 and (40-50) respectively while
Alopecia Areata among females was the lowest distribution.
KEYWORDS
Alopecia Areata, AA, IFN-γ, C3, C4, V.D3, HF.
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PAPER INDEX
ABSTRACT
KEYWORDS
1. INTRODUCTION
2. MATERIAL AND METHOD
2.1. STUDY DESIGNED
2.2. SAMPLE COLLECTION
2.3. ALOPECIA AREATA -RELATED BIOMARKERS
2.4. STATISTICAL ANALYSIS
3. RESULT
3.1. AGE GROUP OF PATIENTS INCLUDED IN THE STUDY.
3.2. DISTRIBUTION OF C3, C4 AND V.D3 AMONG ALOPECIA
AREATA CASES
3.3. MEAN ± SD SERUM LEVELS OF IFN-Γ IN CONTROLS AND
PATIENTS GROUP.
3.4. The Mean±SD of complement component (C3 and C4) , IFN-γ
and V. D3 among cases group.
4. DISCUSSION
4.1. DEMOGRAPHIC PROPERTY
4.2. IFN-Γ
4.3. COMPLEMENT COMPONENT C3 AND C4.
4.4. VITAMIN D AND AA
5. CONCLUSION AND RECOMMENDATION
REFERENCES
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1. INTRODUCTION
Alopecia areata is an autoimmune disease of specific – organ that causes
nonscarring hair loss by targeting hair follicles. Most frequently observed as circular
regions of hair loss, but may also be widespread throughout the entire scalp or body
(1) . Alopecia areata is categorized as patchy alopecia areata, alopecia areata totalis,
and alopecia areata Universalis (2). Several different forms of hair loss can be used to
identify it, including: patchy, ophiasis (band-like hair loss in the parieto-temporal-
occipital area), ophiasis inversus-sisaipho (band-like hair loss in the fronto-parieto-
temporal area), reticulate, and diffuse (2In the general community, the condition
affects between 1% and 2% of people (3.4) Perifollicular and intrafollicular infiltrates,
which are mostly composed of CD4+ T helper 1 (Th1) cells and CD8+ cytotoxic T
cells, respectively, are features of alopecia areata. (5) . The disorder is thought to be
an autoimmune, T-cell-mediated disease with a hereditary predisposition and an
environmental trigger. (5) Interferon-gamma (IFN-) induce the ectopic expression of
MHC class antigens and the over-expression of adhesion molecules in keratinocytes
of hair follicles and dermal papilla cells (6) Other reasons include vitamin
abnormalities such as excessive retinoic acid and low vitamin D, immune system
problems with hair follicle damage, and autoantibodies against tyrosine hydroxylase
and retinol-binding protein 4. (7) complement component have been implicated in a
variety of autoimmune dermatologic pathologies, including angioedema systemic
lupus erythematous, and blistering diseases
The aim of the study is to investigate the effect of serum IFN-, complement
component C3 C4, and vitamin D3 levels in the prognosis of patients with alopecia
areata.
2. MATERIAL AND METHOD
2.1. STUDY DESIGNED
This study was conducted at the dermatology department of al Nasiriya teaching
hospital in Iraq Thi Qar from January 2022 to May 2022., The study included 20
patients with AA and 20 healthy individuals as a control for all data of age ,and
gender . Family history, exposure to some chemical substances were recorded in our
study . All patients were diagnosed with AA based on clinical signs, medical history
and dermoscopic examination . Patients diagnostic with fungal examination or signs of
bacterial infection and patients with a history of using systemic or topical treatment
within the one month were excluded from the study.
2.2. SAMPLE COLLECTION
A total of4 ml of blood was drawn from the controls and patient groups. Blood
samples were centrifuged at 4000 R.P.M and sera were stored at -20 C°. were
obtained from all the Patients for (IFN-γ, C3 , C4 ,V.D3 assay) .
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2.3. ALOPECIA AREATA -RELATED BIOMARKERS
Complement C3, C4 , IFN-γ
, V.D3 were measured in both case and controls
group. ELISA Technique detected IFN-γ according to the manufacturer’s instructions.
Complement component V.D3 were detected by the Roche electrochemiluminescence
method. C3, C4 were detected by immune turbidimetry method.
2.4. STATISTICAL ANALYSIS
The data were analyzed using description statistic (mean and standard deviation)
independent sample t test the level significant was set at p < 0.05 SPSS (Statistical
Packing for Social Sciences ) version 20
3. RESULT
3.1. AGE GROUP OF PATIENTS INCLUDED IN THE STUDY.
The current study comprised forty patients with Alopecia Areata; the male age
group had the highest prevalence of A A. NO = 10 (50%) 1 – 19 years follow by age
group NO = 4(20%) 20-39 and (40-50) respectively while Alopecia Areata among
females was lowest distribution as shown in Table 1.
Table 1. Show distribution of Alopecia Areata among males and females for different age
group.
3.2. DISTRIBUTION OF C3, C4 AND V.D3 AMONG ALOPECIA
AREATA CASES
The Mean±SD Level of complement components C3 and C4 in the current study
were (0.37±0.103) and (0.09±0.029) show within the range of normal value in
Alopecia Areata cases while the level of vitamin D3 recorded sever deficiency
(6.86±4.03) when compared to the normal range as showed in below table.
Patients
No = 20
Gender Males Females
Age group
Frequency
Percent (%)
Frequency
Percent (%)
1 - 19 10 50% 2 10%
20-39
4
20%
1
5%
40-50 3 15% 0 0%
Total
17
85%
3
15%
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Table 2. Distribution of C3, C4 ,and V.D3 among Alopecia Areata cases.
3.3. MEAN ± SD SERUM LEVELS OF IFN-Γ IN CONTROLS AND
PATIENTS GROUP.
The level of IFN-γ in patients was 299±115.7 Pg/ml, this value showed to be in AA
while the control group was 73±10.84 Pg/ml
. This funding was highly significantly
different (p-value 0.00) as shown in table (4.3).
Table 3. The mean level of interferon_gamma inpatient controls health group .
3.4. THE MEAN±SD OF COMPLEMENT COMPONENT (C3 AND
C4) , IFN-Γ AND V. D3 AMONG CASES GROUP.
The Mean±SD level of C3 and C4 were not a significantly different level of C3 , C4
current study than the normal range, the Mean±SD level of IFN-γ
for A A was
significantly higher when compared to the control healthy group, however the mean
SD level of vitamin D3 in the cases group was lower when compared to the normal
value, and the gap between cases and controls was acceptable. P value=0.00
Patients
NO=20
C3
C4
Vitamin D3
(1.37±0.903) (0.29±0.029) 6.86±4.03
Normal Range
(0.9-1.8)g/L
(0.1-0.4) g/L
Deficiency : < 10
Insufficiency: 10 – 30 ng/ml
Sufficiency : 30 - 100
No
IFN-
γ
Pg/ml
P value
Patients
20 299±115.7
0.00
Controls 20 73±10.84
Total
40
Biochemical test
C3
C4
V.D3
IFN-γ
Case
group
Controls group
Value
(1.37±0.903)
(0.29±0.029)
6.86±4.03 ng/ml
299±115.7
pg/ml
73±10.84 pg/
ml
Normal range (0.9-1.8)g/L (0.1-0.4) g/L Deficiency : < 10
Insufficiency: 10 – 30
Sufficiency : 30 - 100
P value 0.00
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4. DISCUSSION
4.1. DEMOGRAPHIC PROPERTY
Individuals with AA showed higher levels of IFN-, C3, and C4 in their blood, while
having severe V.D3 insufficiency, according to the current study.. Comparison of the
values in the normal range in AA patients. case-control research was conducted to
identify the relationship between regulation of the IFN-, C3, and C4 of AA as it relates
to age groups. According to Alkhalifah (1), who found that 60% of patients are under
the age of 20 at initial presentation, and patients with ages 1 to 19 had a higher risk of
AA.
4.2. IFN-Γ
Is one sort of proinflammatory process that, among other things, robs dermal
papilla cells of their capacity to sustain anagen hair development. It causes various
types of cytokines to be produced at the site of inflammation. perifollicular or follicular
antigen-presenting cells. (8) We discovered a considerably elevated level of IFN- in
our study, and this funding was in agreement with research done by (9) that confirmed
E. Arca's findings that patients with AA had considerably higher blood levels of IFN-,
(10) Research demonstrated considerably increased serum IFN- levels in individuals
with alopecia totalis or alopecia universalis compared to controls, However, there is no
discernible difference in IFN- levels between individuals with localized alopecia areata
and those with more severe types. Damage to hair follicles (HF) is mediated by IFN-
(11) IFN-γ
can induce another cytotoxic effector molecule, inducible nitric oxide
synthase iNOS (12) . CD4+ Th1 mediated response aberrantly expressed IFN-γ
in
alopecia areata . Despite the aforementioned, individuals with severe types of
alopecia areata may have higher blood levels of the inflammatory protein IFN-, which
might indicate the existence of inflammation. Serum IFN- levels may be used as a
prognostic sign or to distinguish between those who are more prone to develop
alopecia universalis and those who just have the local condition. It is suggested that
future study will be able to measure how IFN- levels fluctuate in people who undergo
spontaneous regression or disease progression. (10).
4.3. COMPLEMENT COMPONENT C3 AND C4.
Complement is important in the development of AA., Our findings reveal that the
levels of C3 and C4 are not considerably different, and this result is consistent with
previous studies (13). Findings reveal no difference in levels between patients with AA
and healthy controls, and contradiction with the research of (14) that show
Complement C4 and C3 were decreased in 67.4% (56/83) and in 9.6% (8/83) of
patients, respectively. There were no statistically significant differences between the
two groups. C3 deposits in the hyaline membrane of the hair bulb, as well as the
connective tissue sheath of anagen hair follicles in both normal and AA-affected scalp,
led to the hypothesis that C3 regulates the hair cycle (15) and is not acceptable with
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another study of Ribeiro (14) Complement C4 and C3 levels were reduced. in 67.4%
(56/83) and in 9.6% (8/83) of patients, respectively.
4.4.VITAMIN D AND AA
The current study discovered that AA patients had considerably decreased blood
vitamin D levels when compared to the normal range, which is consistent with other
studies.. Aksu. (16), Yilmaz ( 17) that revealed considerably lower levels of vitamin D
in AA patients compared to the control group (17-20) Low calcium and vitamin D
levels cause transitory noncicatricial alopecia, implying a role for calcium and
potentially vitamin D in postnatal HF cycling Several investigations have found that
patients with AA had a much greater frequency of vitamin D deficiency than the control
group.. V.D has a vital role in the hair cycle and suppresses the development of
dendritic cells which in turn reduces the activation of T-cells and the T-cells mediated
immune response. Vitamin D also increases the production of regulatory of CD4+
CD25+ regulatory T cells and enhances their inhibitory function which plays a very
important role in self-tolerance and therefore in the prevention of autoimmunity (21)
(Gorman et al.2007) Hair loss in AA is caused by the destruction of HF cycle. The
significance of vitamin D in HF cycling, on the other hand, is unclear .VDR may
function as a selective suppressor/de-repressor of gene expression in the absence of
1,25(OH)2D3 (22) (Lee SM et al.2016) . Wnt/β
-catenin signaling is a key player in
inducing the onset of anagen and maintaining the cycling transition during the
initiation and regeneration of HFs (23) Reduced VDR expression in AA might be
linked to diminished hair cycle-related signals. -Wnt/β-catenin signals (24) vitamin D
may affect the HF cycling through its impact on autoimmunity in AA pathogenesis .
5. CONCLUSION AND RECOMMENDATION
The role of complement was a contributor to the diagnosis of AA. And the presence
of a high level of IFN in the study played a role in increasing the infection due to its
effectiveness, as its presence in a large percentage works to deprive the dermal
papillary cells of their ability to maintain hair growth and the presence of a percentage
of it works to stimulate cytokines in the sites of inflammation. It is also possible to
stimulate a cytotoxic molecule called iNOS, and due to this role and its effect on injury,
this helps in the future on how these values may change among individuals suffering
from the development of the disease. The presence of the role of vitamin D is an
influential factor in the role of hair cycling, and its deficiency leads to hair loss. Vitamin
D supplementation may play a therapeutic role in reducing disease.
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