الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Vitiligo is an acquired pigmentary disorder of unknown etiology that is clinically characterized by the development of white macules related to the selective loss of melanocytes. The prevalence of the disease is greater than 1-2 % worldwide. The course of the disease is unpredictable and the response to treatment varies. Depigmentation may be the source of severe psychological distress, diminished quality of life, and increased risk of psychiatric morbidity.
There are different clinical types of vitiligo; generalized type, which spreads widely over the body; segmental type, which spreads along the course of a nerve and localized type, which is unclassifiable and can develop into either generalized or segmental type in the future.
Tumour necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) is a member of the TNF superfamily and has some pleiotropic effects, including stimulation of cell growth, apoptosis, angiogenesis and the modulation of immune responses. Recent studies have showed that TWEAK may play a crucial role in the pathogenesis of a variety of inflammatory disorders and autoimmune diseases such as lupus, rheumatoid arthritis and multiple sclerosis. Additionally, it has been offered that TWEAK blockade could be of therapeutic benefit in inflammatory conditions.
Interleukin (IL)-9, a member of the IL-2 cytokine family. It is secreted by naïve CD4+ T cells in response to TGF-β and IL-4 (Th9 pathway). IL-9 is also produced by activated Th2 lymphocytes and is involved in Th2-associated diseases. IL-9 is a growth factor for mast cells and T-cells that help facilitate the Th9 immune response of allergic inflammatory diseases. IL-9 can also induce Th17 cells to differentiate and mediate autoimmune and inflammatory diseases. IL-9 is also produced by Th17 cells, which secrete mainly IL-17A and IL-17F.
IL9 is a pleiotropic cytokine affecting many cells, IL-9 was described as an anti-apoptotic factor as it induces the expression of BCL3 mRNA and protein and enhances the DNA binding of p50 homodimers, also BCL3 induction by IL-9 appears to be STAT-dependent and leads to repression of tumor necrosis factor (TNF)-induced NF-kB transactivation. Findings implicate IL9 in the development of autoimmune diseases.
This study was done in the Alexandria Main University Hospital during the period from December 2018 to July 2019.
The study sample was divided into 2 groups; group I included 30 non segmental vitiligo patients and group II included 30 healthy individuals as control group.
The aim of this study is to evaluate the levels of TWEAK and IL9 in serum and suction blister fluid in patients with non-Segmental Vitiligo and determine their relation to disease activity and severity.
Serum samples and suction blister fluids were taken from non-Segmental Vitiligo patients and serum from control to measure TWEAK and IL9.
Level of TWEAK and IL9 in serum and suction blister fluid were determined using Enzyme linked immunosorbent assay (ELISA).
Our results showed that,
Tweak level in patient’s serum was significantly higher than in the control group (p<0.0001). Comparison between level of Tweak in blister fluid in patients with its level in control group serum revealed no statistically significant difference (P=0.14).
IL9 in patient’s serum was statistically significantly higher than in the control group (P<0.0001). Comparing between level of IL9 in blister fluid in patients and its serum level in control showed no statistically significant difference (P=0.26).
Statistically significant positive correlation between serum level of Tweak and IL9 with VASI score was found. There was also highly statistically significant positive correlation between Tweak and IL9 levels in serum. In addition there was statistically significant positive correlation between serum level of IL9 and duration of disease.
Serum Level of TWEAK could significantly predict and discriminate cases of non-segmental vitiligo disease at AUC (95%CI) = 1 (0.94 to 1), p=0.0001 and cut of point > 17.8 with 100% sensitivity and 100% specificity. serum IL9 can significantly predict and discriminate cases of non-segmental vitiligo disease with AUC (95%CI) = 1(0.94 to 1), p=0.0001 at cut of point <32.2 with 100% sensitivity and 100% specificity. According to our knowledge, no previous study reported the cut off of IL-9 in vitiligo diagnosis.