Metabolic and Vascular Inflammation in Alopecia Areata: Linking Uric Acid, Lipid Imbalance and ICAM-1 Upregulation

This study explores the metabolic and vascular inflammation in alopecia areata (AA), an inflammatory hair loss disorder. Using a metabolomics-based approach, researchers identified 32 metabolites significantly altered in AA-affected scalp, with notable findings including decreased 13-HODE and increased uric acid (UA), which is linked to vascular dysfunction. Elevated UA levels were also found in the serum of AA patients, suggesting systemic endothelial dysfunction. The study demonstrated increased vascular inflammation and endothelial cell activation in AA scalp through CD31+/ICAM-1+ immunofluorescence analysis. Additionally, the fructose-generating polyol pathway enzymes, AKR1B1 and SORD, were found in hair follicles, with increased AKR1B1 in lesional AA follicles, indicating local fructose production may elevate UA levels. These findings suggest UA-linked microvascular dysfunction in AA and propose that improving endothelial function and regulating UA could be potential management strategies for AA.