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Original Investigation |

Clinical Significance of Serum Soluble CD Molecules to Assess Disease Activity in Vitiligo ONLINE FIRST

Reinhart Speeckaert, MD, PhD1; Jo Lambert, MD, PhD1; Nanja van Geel, MD, PhD1
[+] Author Affiliations
1Department of Dermatology, Ghent University Hospital, Ghent, Belgium
JAMA Dermatol. Published online August 24, 2016. doi:10.1001/jamadermatol.2016.2366
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Importance  It is difficult to determine disease activity in vitiligo owing to the absence of inflammatory signs, such as erythema or scaling. A biomarker that could confirm active disease and indicate likely future disease progression would therefore be of considerable value.

Objective  To investigate whether soluble CD27 (sCD27), sCD25, or sCD40L could be valuable biomarkers to determine disease activity in vitiligo and indicate likely future progression.

Design, Setting, and Participants  A combined cross-sectional and prospective study was conducted at the department of dermatology at Ghent University Hospital between February 24, 2012, and December 12, 2015. Ninety-three patients with vitiligo were enrolled, including 83 individuals with nonsegmental vitiligo and 10 with segmental vitiligo. Blood sampling was performed, and sCD25, sCD27, and sCD40L were measured in serum.

Main Outcomes and Measures  The associations between sCD levels, disease activity, and future progression were investigated.

Results  Of the 93 patients included in the study, 51 were women (55%); median (interquartile range) age was 36.5 (26.0-49.8) years. Both sCD27 (21.5 ng/mL [16.1-30.0 ng/mL] vs 18.4 ng/mL [12.5-22.1 ng/mL]; P = .006) and sCD25 (2.6 ng/mL [2.1-3.4 ng/mL] vs 2.2 ng/mL [1.7-2.4 ng/mL]; P = .002) levels were associated with active disease. Moreover, a statistically significant link with disease progression after 3 to 6 months was found for sCD27 (21.7 [17.0-29.1] vs 16.6 [13.5-23.7]; P = .02) but not for sCD25 (2.8 ng/mL [2.2-3.4 ng/mL] vs 2.3 [1.9-2.8 ng/mL]; P = .053). Further in vitro experiments showed a correlation between sCD25 and interferon γ (r = 0.562, P = .005), interleukin 10 (r = 0.453, P = .03), and sCD27 secretion (r = 0.549, P = .007). No associations were found for sCD40L levels.

Conclusions and Relevance  This study demonstrates increased levels of sCD27 and sCD25 in patients with active vitiligo. Moreover, these results provide the first evidence that these markers have a capacity to indicate the probability of future disease progression, which supports their role as biomarkers in vitiligo.

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Figure 1.
Levels of Soluble CD25 (sCD25) and sCD27 in Patients With Active and Nonactive Vitiligo

Levels of sCD25 (A) and sCD27 (B) in active and nonactive vitiligo. Patient-reported detailed disease activity is shown according to sCD25 (C) and sCD27 (D) concentrations as well as correlation between sCD25 and sCD27 values (E). Dots represent all patients values; bars, means; and error lines, 95% CI.

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Figure 2.
Soluble CDs as Indicators of Disease Activity and Progression and Association With Topical Treatment

Soluble (s)CD25 values according to disease activity and topical treatment (A), receiver operating characteristic (ROC) curves for sCD25 and sCD27 (B), and prospective follow-up showing patients with progressive vs nonprogressive vitiligo 3 to 6 months after measuring sCD25 (C) and sCD27 (D). Dots represent all patients values; bars, means; and error lines, 95% CI.

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Figure 3.
Correlation Between Soluble CD25 (sCD25) Release in Supernatant and Interferon γ (IFN-γ)

Interleukin 1β (IL-1β), IL-3, IL-4, IL-6, IL-10, granulocyte-macrophage colony-stimulating factor (GM-CSF), and sCD27 after stimulation of peripheral blood mononuclear cells with CD3CD28 beads. Dots represent all measured values.

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