Clinical characteristics and immune profiles of patients with immune-mediated alopecia associated with COVID-19 vaccinations

Chuang-Wei Wang; Ming-Ying Wu; Chun-Bing Chen; Wei-Chen Lin; Jennifer Wu; Chun-Wei Lu; Wei-Ti Chen; Fang-Ying Wang; Rosaline Chung-Yee Hui; Min-Hui Chi; Tsu-Man Chiu; Ya-Ching Chang; Jing Yi Lin; Yang Yu-Wei Lin; Wan-Ting Tsai; Shuen-Iu Hung; Wen-Hung Chung

doi:10.1016/j.clim.2023.109737

Clinical characteristics and immune profiles of patients with immune-mediated alopecia associated with COVID-19 vaccinations

Clin Immunol. 2023 Oct:255:109737. doi: 10.1016/j.clim.2023.109737. Epub 2023 Aug 14.

Authors

Chuang-Wei Wang¹, Ming-Ying Wu², Chun-Bing Chen³, Wei-Chen Lin², Jennifer Wu⁴, Chun-Wei Lu⁵, Wei-Ti Chen⁶, Fang-Ying Wang⁷, Rosaline Chung-Yee Hui², Min-Hui Chi⁸, Tsu-Man Chiu⁹, Ya-Ching Chang², Jing Yi Lin², Yang Yu-Wei Lin¹⁰, Wan-Ting Tsai¹⁰, Shuen-Iu Hung¹¹, Wen-Hung Chung¹²

Affiliations

¹ Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China.
² Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
⁴ Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan.
⁵ Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁶ Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁷ Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Biomedical Engineering, College of Medicine, College of Engineering, National Taiwan University, Taiwan.
⁸ Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Molecular Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁹ Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁰ Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan.
¹¹ Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou, Taiwan; Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: hungshueniu@gmail.com.
¹² Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Tucheng and Keelung, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Taiwan; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan; Allergology Consortium, Xiamen Chang Gung Hospital, Xiamen, China; Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan. Electronic address: chung1@cgmh.org.tw.

PMID: 37586672
DOI: 10.1016/j.clim.2023.109737

Abstract

Background: The clinical characteristics and pathomechanism for immune-mediated alopecia following COVID-19 vaccinations are not clearly characterized.

Objective: We investigated the causality and immune mechanism of COVID-19 vaccines-related alopecia areata (AA).

Study design: 27 new-onset of AA patients after COVID-19 vaccinations and 106 vaccines-tolerant individuals were enrolled from multiple medical centers for analysis.

Results: The antinuclear antibody, total IgE, granulysin, and PARC/CCL18 as well as peripheral eosinophil count were significantly elevated in the patients with COVID-19 vaccines-related AA compared with those in the tolerant individuals (P = 2.03 × 10^-5-0.039). In vitro lymphocyte activation test revealed that granulysin, granzyme B, and IFN-γ released from the T cells of COVID-19 vaccines-related AA patients could be significantly increased by COVID-19 vaccine excipients (polyethylene glycol 2000 and polysorbate 80) or spike protein (P = 0.002-0.04).

Conclusions: Spike protein and excipients of COVID-19 vaccines could trigger T cell-mediated cytotoxicity, which contributes to the pathogenesis of immune-mediated alopecia associated with COVID-19 vaccines.

Keywords: Alopecia areata; Autoimmune disease; COVID-19 vaccine; Granulysin; Lymphocyte activation test; Polyethylene glycol; Spike protein.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Alopecia Areata* / etiology
Alopecia Areata* / pathology
COVID-19 Vaccines / adverse effects
COVID-19*
Humans
Spike Glycoprotein, Coronavirus
Vaccination / adverse effects

Substances

COVID-19 Vaccines
Spike Glycoprotein, Coronavirus
spike protein, SARS-CoV-2

Supplementary concepts

Diffuse alopecia