A review of key topics discussed on the first day of the 2018 Alopecia Areata Research Summit, Forging the Future, held December 4-5 in New York City.

1. Alopecia Areata Research Summit
“Forging the Future”
Summary of Day 1
DAVID A. NORRIS MD
PROFESSOR AND CHAIRMAN
DEPARTMENT OF DERMATOLOGY
UNIVERSITY OF COLORADO

2. Alopecia Areata Research Summit
“Forging the Future”
Summary of Day 1
-Ten Years of Research Summits have focused the basic,
clinical and translational research program
-Based on clinical trials present at the last research summit, JAK
inhibitors have been used widely in practices specializing in
AA, with impressive effect.
-Partnerships with multiple pharmaceutical companies promise
to lead to a new generation of systemic and topical treatments
for AA.
- The historic success of NAAF in partnership with NIAMS has
been expanded to include the partnership with the FDA , and
clinical research organizations such as the International
Dermatology Outcomes Measures and the Patient Reported
Outcomes Consortium

3. Elaine Fuchs
Coping with Stress: Stem Cells in Injury and Inflammation
Stem Cells in the Hair Follicle bulge are susceptible to damage
by multiple stresses: Mechanical, microbes and other
pathogens, toxins insects and oncogenic wounds.
The HF bulge and inner bulge are susceptible to damage that
may stimulate the DP to initiate cycling of the HF and
proliferation of the bulge stem cells.
Damage to inner bulge adherens junctions may lead to
inflammation involving Dendritic cells and Tregs, mediated
by chemokines and NFkB.
Similar inflammation and epithelial repair may also occur in
the IFE.
If this inflammation/immunity related to initiating AA?

4. Natasha Mesinkovska
Summary of Preceding Alopecia Areata
Research Summits
-Founding Principle: Organize the NAAF-funded research
program , coordinate with the NIH, get new hair
investigators working on AA.
-Results:
1. Research Summits communicate and facilitate research
program
2. NIAMS-funded Registry for 20 years helped to organize
basic and clinical research program
3. Results of genetics and immunologic research provided the
bases for translational research program
4. New investigators , a clinical and translational research
network were developed
5. Close organizational ties with NIH, FDA, Pharma

5. Angela Christiano
Genetics and Immunology of Alopecia Areata
Genetics and Immunology are central to understanding AA
3 new areas of research:
1. JAK critical in initiation of AA and in acquired immunity
involving NKG2D+T cells , IL15 and IFNg
2. JAki may induce” immune exhaustion” (what a tumor
does to T cell); k/o Jak 1/3 – increase markers of
exhaustion including IFNg
3. Gut microbiome
– Oral antibiotics block AA in C3H HeJ mice – affect gut
microbiome, not skin microbiome
-New AA pts show bidirectional dysbiosis
• Firmicutes up, Bacteroides down
•

6. Maria Hordinsky
Current Treatment of Alopecia Areata
A concise and knowledgeable review of treatment in
AA
JAKi becoming mainstream Rx
Warmed about the long-term toxicities of chronic
JAKi

7. Ralf Paus
AA: Autoimmune Disease or Hair Follicle
Response Pattern to Immunological Disease
Alternative Mechanisms of AA:
1. Not all AA is due to Autoimmunity, Cytotoxic T cells,
genetic control of acquired immunity
2. Do NKG2D+ NK cells respond to local triggers, causing
gamma interferon storm, induction of Catagen, loss of
Immune Privilege, and further cytotoxicity as a response
to NK initiated inflammation?
3. Or is there only a subset of AA patients in whom there is
autoimmunity?

8. Amos Gilhar
Pre-Clinical Research in Vivo: Pros and Cons
of the C3H/HEJ models versus the
Humanized Mouse Model
-C3H HeJ: TLR 7
-Humanized mouse: Human skin, Human NKG2D+
or C56+ cells
Use humanized mouse model to screen drugs
E.g. Apremilast protective but not therapeutic

9. Brittany Craiglow
Jak INH for the Treatment of AA in the
Pediatric Population
-5 Publications addressing use of JAKi in AA
Using Tofacitinib, Ruxolitinib, or Baracitinib
- Effective in at least 50% of cases
-Multiple ongoing trials now enrolling
subjects 12-17 years old
- Safety and efficacy needs to be determined
in future investigations

10. Brett King
Responses of Eyebrows and Eyelashes
to Tofacitinib I Patients with Severe AA
-Involvement of Brows and/or lashes in 76% of AA
Patients
-Reviewed records of AA patients treated with
tofacitinib from 2014-2018
-98 patients with total scalp loss- 86% had
improvement of eyebrows and lashes; complete
regrowth of all sites in 16%
- Regrowth of brows and lashes variable; can occur
in subjects with AA > 10 years.

11. Melissa Peck Piliang
Long-Term Treatment for Severe AA with
Oral Tofacitinib
-retrospective cohort of 20 patients
-20% with AA totalis
-60% received tofacitinib for at least 12 months
-94% some regrowth; 60 % achieved SALT 50; 24%
SALT 90
-35% had lab abnormalities; six clinical adverse
events

12. Hind Almohanna
Platelet-Rich Plasma in the Treatment of AA
-Platelet derived GF, bind to stem cells
-Increase BC-2; Bcat promote melanoblast, FGF7
-No consensus of standard approach
5 studies and some case reports
IL PRP plus IL TAC produced hair regrowth in AA;
not very useful in AA totalis or universalis
-More larger studies needed

13. Jessica Lin
In Vivo Imaging in Alopecia Areata
Patients Using Multiphoton Microscopy
MPM may be useful in non-invasive
following of AA

14. Emma Guttman-Yassky
Cytokine Targeted Treatments of Alopecia
Areata
-Th1 is believed to be central to AA; recent evidence
suggests Th2 and IL-23 might contribute
- AA and atopic dermatitis (AD) have phenotypic
similarities
- AD is highest comorbidity of AA
- Initiating a new treatment paradigm for AA, using
small molecules and targeted therapies for IL-4, IL-
13, IL31, IL23
- Dupilumab works, Ustekinumab does not

15. Mark Lebwohl
AA: Lessons from Other Inflammatory
Skin Diseases
-Psoriasis has been a great model to dissect the
immune pathways in inflammatory skin disease.
Many similarities (but also differences) between
immune response in Psoriasis and AA.
-Cyclosporine
-TNFa inh
-IL 12/23
IL-17

16. T Cell Cytotoxicity Versus Inhibiting
Cellular Pathways
Pathway blockade
JAKi – Inhibit IFN-g and IL15 pathways
Cellular Cytotoxicity
-Prednisone
-Methotrexate
-Ultraviolet radiation

17. Industry Panel
-Representatives from 7 pharmaceutical companies:
Aclaris, Bioniz, Concert, Lilly, Legacy, Leo,
Pfizer
- Committed to eliciting patient input in study
design and outcomes and to help access
- Discussion of problems in American Medicine;
important dialogue for the future

18. Pfizer: 2 PDE4 inh for skin dz
Jak1 Phase 3
Jak3 Phase 2 “Breakthrough”
Tyk2/Jak1 : PS and AA
Lilly: Severe AA
Legacy: Botanicals Phase 2
Concert: TP543
Ruxolitinib Phase IIa
Aclaris: “Soft JAKs”
Topical JAKs Phase IIb
Looking at sequence of Rx Bioniz: BN7-1 inh IL2, IL15, IL7
Industry Panel

19. Elise Olsen
Objective Outcome Measures: Collecting
Meaningful Data on AA
-Discussed problems with developing
accurate data on alopecia areata
-Salt I
-Salt II
-ALODEX
Canfield has made a tool for this
-Global Score

20. Justin Ko
The Importance of Eyebrows in the
Treatment of Alopecia Areata
Online survey of 1,741 AA patients
Satisfaction with scalp and eyebrow regrowth
is non-linear
More subjects satisfied having complete
eyebrows with no scalp hair (69%) than
partial scalp hair (51%)

21. Dory Kranz
AA: Patient Reported Outcome
Consortium
-Bringing patients into drug development process
-AA PRO Industry Partners
Leo Science and Technology Hub
Aclaris
Lilly
PATIENT DERIVED OUTCOME MEASURE
•PHASE I CONCEPT ELICITATION INTERVIEW
•PHASE II TEST IN COMMUNITY
•PHASE III VALIDATE IN CLINICAL TRIAL

22. Alice Gottlieb
Lessons From the International Dermatology
Outcomes Measure (IDEOM)
“Don’t Get Mad…Get Data”
• Develop validated and patient generated outcome measures;
these must be included in clinical trials
• Payers want outcomes that lead to lower cost; effects on
patient productivity; make outcomes predictable; biomarker
indicating response
• Needs to decrease data input on EMR
• Derm needs to demonstrate quality of the care we provide
• Social media score
• “If you are not at the table you are on the menu”.

23. Alopecia Areata Research Summit
“Forging the Future”
Summary of Day 1
-Ten Years of Research Summits have focused the basic,
clinical and translational research program
-Based on clinical trials present at the last research summit, JAK
inhibitors have been used widely in practices specializing in
AA, with impressive effect.
-Partnerships with multiple pharmaceutical companies promise
to lead to a new generation of systemic and topical treatments
for AA.
- The historic success of NAAF in partnership with NIAMS has
been expanded to include the partnership with the FDA , and
clinical research organizations such as the International
Dermatology Outcomes Measures and the Patient Reported
Outcomes Consortium