Fatty acid-binding protein 4 circulating levels in non-segmental vitiligo^*

Abstract

Background:

Vitiligo is an acquired and progressive mucocutaneous disease resulting from the loss of active epidermal melanocytes. Metabolic syndrome (MetS) affects about 25% of the world’s population and is linked to inflammatory skin diseases including vitiligo. Fatty AcidBinding Protein 4 (FABP4) is an intracellular lipid chaperone. FABP4 is closely associated with MetS.

Objectives:

To evaluate the serum level of FABP4 in vitiligo patients and its relation to MetS in the investigated cases.

Methods:

This case control study was conducted on 45 patients having non segmental vitiligo and 45 matched controls. Their lipid profile, blood glucose and serum FABP4 levels were measured.

Results:

There were significant elevations in FABP4 (p < 0.001), cholesterol (p < 0.001), triglycerides (p = 0.005), and glucose (fasting [p = 0.001] and 2 hours post prandial [p < 0.001]) levels in patients in comparison with controls. MetS was significantly more prevalent among vitiligo patients (p < 0.001) and associated with high FABP4 serum levels (p = 0.037). In vitiligo patients, there were significant positive correlations between FABP4 serum levels and triglycerides (p = 0.047), cholesterol (p = 0.001) and LDL (p = 0.001) levels and negative correlation regarding HDL level (p = 0.009). FABP4 level was a significantly good diagnostic test for early detection of vitiligo (p < 0.001).

Study limitations:

The small number of studied subjects.

Conclusions:

FABP4 may play an active role in the disease process of vitiligo that could be mediated through associated dyslipidemia and hyperglycemia. FABP4 may be a marker of vitiligo helping in its early diagnosis, but it does not appear to be useful for determining vitiligo severity, activity or associated MetS.

KEYWORDS
Fatty acid-binding proteins; Metabolic syndrome; Vitiligo

Introduction

Vitiligo is an acquired and idiopathic progressive mucocutaneous disease characterized by damage of working epidermal melanocytes. In nearly half of the patients, vitiligo develops before the age of 20 years however it can be also seen at any age with a non-significant sex difference.¹

Vitiligo was categorized as Segmental Vitiligo (SV) and Non-Segmental Vitiligo (NSV). In NSV genetic factors of increased risk to autoimmunity were discovered by genomewide study.² Regulation of innate immune response plus B cell differentiation as well as its activation was demonstrated in NSV,³ and were reported to be more prominent in NSV than SV.⁴

Fatty Acid-Binding Protein 4 (FABP 4) is a member of a family of 14-15 kDa proteins, known as intracellular lipid chaperones. They regulate lipid trafficking in cells.⁵ The

FABP4, also termed adipocyte protein 2, is formed of 132 amino acids. It represents around 1% of all soluble proteins in adipose tissue.⁶ FABP4 has the ability to bind reversibly to hydrophobic ligands, such as unsaturated and saturated long-chain fatty acids as well as eicosanoids and other lipids protecting organisms against their harmful accumulation.⁷ FABP4 is secreted from adipocytes and macrophages. It is closely associated with obesity and MetS.⁸

MetS is a condition in which insulin resistance is developed and eventually leads to cardiovascular problems.⁹ Around 25% of the population all over the world is affected by MetS, with a substantial subpopulation linked to many inflammatory skin diseases¹⁰ including vitiligo.¹¹

Zhang et al.¹² found that there were high levels of systemic and local FABP4 in osteoarthritic patients. In the field of dermatology, Baran et al.¹³ reported that serum FABP4 levels were significantly increased in patients with psoriasis. As vitiligo is considered one of the inflammatory diseases, the authors proposed that, in vitiligo, FABP4 may act at the interface of inflammatory and metabolic pathways. Therefore, the aim of this study was to evaluate the serum level of FABP4 in vitiligo patients and its relation to MetS.

Patients and methods

This is a case-control study that was conducted on 90 subjects. They were 45 patients having different clinical types of NSV and 45 age and gender-matched healthy subjects (control group). They were selected from Dermatology Outpatient Clinic. The diagnosis of vitiligo was made on the basis of the patient’s history and the typical clinical features (discrete, well-circumscribed, de-pigmented macules and patches).

The study was approved by the Committee of Human Rights of Research in the present study’s University. An informed written consent form was obtained from every participant or his and/or her parent (if <18 years) prior to initiation of this study.

The present study included NSV cases from both sexes. Any included patient should stop any systemic (6 weeks) or topical (2 weeks) treatment of vitiligo.

Subjects having immune-inflammatory cutaneous (e.g., psoriasis, atopic dermatitis) and/or systemic (e.g., thyroid, and connective tissue) diseases, and those receiving systemic corticosteroids and/or other immune suppressants within the last one month were excluded from this study.

The studied patients were subjected to history. The Body Mass Index (BMI) was calculated by dividing the body mass (kilograms) by the square of the body height (meters).¹⁴ Measurement of arterial blood pressure (ABP) was done using a standard mercury sphygmomanometer after the subjects had rested at least for 10 minutes with the arm at heart level.

The dermatological examination was done to ensure the diagnosis of NS vitiligo, determine its site and identify its type (acrofacial, mucosal, generalized, universal, and mixed). Disease severity and activity were evaluated using Vitiligo Area Scoring Index (VASI) and Vitiligo Disease Activity (VIDA) scoring.

To calculate the VASI score, the body was divided into 5 regions: the hands, upper extremities (excluding hands), trunk, lower extremities (excluding the feet), and feet. The axillae were included with the upper, while the buttocks and inguinal regions were included with the lower extremities. One hand unit (the palm plus the volar surface of all digits) was used as a guide to estimate the percentage of vitiligo involvement (1%) of each body region. Depigmentation within each area was estimated regarding the following percentages: 0 (normal pigmented skin), 10% (specks of depigmentation), 25% (pigmented area exceeds the depigmented area), 50% (depigmented and pigmented areas are equal), 75% (depigmented area exceeds the pigmented area), 90% (specks of pigment) and 100% (no pigment). VASI was calculated using this formula: VASI = (all body sites) (hand units)×(depigmentation).¹⁵

VIDA score was based on the patient’s own opinion of his/her disease activity over time. Active vitiligo includes either extension of existing skin lesions or appearance of new ones. The score was graded from +4 (active in the past 6 weeks), +3 (active in the past 3 months), +2 (active in the past 6 months), +1 (active in the past 1 year), 0 (stable for at least 1 year) to -1 (stable for at least 1 year and spontaneous repigmentation).¹⁶

After overnight fasting, the skin over the vein was sterilized with 70% alcohol, and then 5 mL of venous blood was withdrawn from every subject. Three mL of venous blood was transferred into the plain tube, left to stand for a half-hour, and then centrifuged for 10 min at 4000 R.P.M. The serum was obtained for the determination of lipid profile and FABP4. While 2 mL of blood were transferred into sodium fluoride-containing tubes, centrifuged for 10 min at 4000 R.P.M. The plasma was obtained for the determination of fasting glucose. Another blood sample was obtained for determination of 2 h postprandial glucose. The samples were kept frozen at -20^◦C till analysis.

Lipid profile including Triglycerides (TG), cholesterol level, and lipoproteins as High-Density Lipoproteins (HDL) and Low-Density Lipoproteins (LDL), in addition to fasting and 2 hours postprandial blood sugars were measured by an automatic chemistry analyzer (AU480 system from Beckman Coulter, USA).

Diagnosis of MetS was done according to evaluated TG, LDL, FBS level, and blood pressure as follows; TG ≥ 150 mg/dL, HDL-C level <40 mg/dL in men, or <50 mg/dL in women, blood pressure ≥130/85 mm. Hg and fasting hyperglycemia (glucose level >100mg/dL.¹⁷

Serum FABP4 was analyzed using Enzyme-Linked Immunosorbent Assay (ELISA) (kit, Quantikine^® ELISA, R&D Systems, Inc., USA & Canada).

Results

Personal and clinical data of the studied subjects

The included 45 patients were 20 (44.4%) females and 25 (55.6%) male. Their age ranged from 11 to 65 years. They had BMI ranged from 19 to 37kg/m². Their systolic and diastolic blood pressure ranged from 100 to 150 and from 60 to 90 mmHg, respectively. Patients and the control group were matched as regards their ages, sex, systolic and diastolic blood pressure (p > 0.05 for all). However, BMI was significantly higher in patients than controls (p < 0.001) (Table 1).

Table 1
Personal and clinical data of the studied subjects.

Demographic data	Patients (n = 45)	Controls (n = 45)	Test of significance	p-value
Sex Male	25 (55.6)	27 (60.0)	χ2 = 0.18	0.670
Female	20 (44.4)	18 (40.0)
Age (years) Mean ± SD Median	35.51 ± 15.98 34	32.89 ± 13.56 30	U = 0.84	0.404
Range	11-65	14-65
BMI (kg/m2) Mean ± SD Median	29.53 ± 5.02 29	23.89 ± 2.40 24	t = 6.80	<0.001a
Range	19-37	20-28
SBP (mmHg) Mean ± SD Median	119.78 ± 15.15 120	117.56 ± 14.79 120	t = 0.70	0.483
Range	100-150	100-150
DBP (mmHg) Mean ± SD Median	75.33 ± 8.69 70	77.11 ± 8.43 80	t = 0.99	0.327
Rage	60-90	60-90
Age of disease onset (years) Mean ± SD Median	30.96 ± 15.35 29
Range	7-63
Duration of disease (years) Mean ± SD Median	4.69 ± 4.89 4
Range	1-30
VASI score Mean ± SD Median	26.42 + 25.44 18
Range	1-90
Type	n (%)
Acrofacial	7 (15.6)
Focal	15 (33.3)
Universalis	4 (8.9)
Vulgaris	19 (42.2)
VIDA score 0	13 (28.9)
1	4 (8.9)
2	7 (15.6)
3	10 (22.2)
4	11 (24.4)
VASI score Mean±SD Median	26.42 + 25.44 18
Range	1-90
Leucotricia Positive	3 (6.7)
Negative	42 (93.3)
Koebnerization Positive	6 (13.3)
Negative	39 (86.7)
Family history Positive	10 (22.2)
Negative	35 (77.8)

²tt
• ^a
  Significant.

The clinical data of vitiligo patients in this study was shown in Table 1.

Lipid profile and blood sugar levels of the studied groups

There were significant high levels of cholesterol (207.16 ± 64.51 vs. 171.36 ± 38.05) and TG (143.84 ± 55.80 vs. 117.44 ± 27.44) as well as fasting (89.44 ± 15.93 vs. 80.11 ± 8.36) and 2 hours post prandial blood sugar (122.89 ± 27.10 vs. 106.00 ± 11.56) levels in vitiligo patients than controls (p < 0.001, p = 0.005, p = 0.001 and p < 0.001, respectively) (Table 2).

Table 2
Comparison between vitiligo patients and control group regarding lipid profile and blood glucose levels.

Variables	Patients (n = 45)	Controls (n = 45)	Test of significance	p-value
Cholesterol (mg/dL)
Mean ± SD	207.16 ± 46.51	171.36 ± 38.05	t = 4.00	<0.001a
Median	208	165.7
Range	121-300	114.0-270.9
TG (mg/dL)
Mean ± SD	143.84 ± 55.80	117.44 ± 27.44	U=2.85a	0.005a
Median	140	117
Range	35-268	70.9-111.0
LDL (mg/dL)
Mean ± SD	125.24 ± 49.40	110.18 ± 36.89	U = 1.64	0.105
Median	111	113
Range	26-214	35.5-203.0
HDL (mg/dL)
Mean ± SD	42.27 ± 14.06	45.53 ± 4.90	t = 1.47	0.145
Median	40	45
Range	13-105		32-57
Fasting blood sugar (mg/dL)
Mean ± SD	89.44 ± 15.93	80.11 ± 8.36	t=3.48	0.001a
Median	90	80
Range	65-120		70-95
2 h post prandial blood sugar (mg/dL)
Mean ± SD	122.89 ± 27.10	106.00 ± 11.56	t = 3.85	<0.001a
Median	120	100
Range	90-190		90-130

ttU
• ^a
  Significant.

MetS among vitiligo patients and the control group

MetS was significantly more prevalent among the studies vitiligo patients (13, 28.9%) than the control group (0%) (p < 0.001) (Table 3).

Table 3
Prevalence of MetS among vitiligo patients and the control group.

Variables	Patients (n = 45) n (%)	Controls (n = 4) n (%)	χ2	p-value
MetS Positive	13 (28.9)	0	15.20	<0.001a
Negative	32 (71.1)	45 (100.0)

²
• ^a
  Significant.

FABP4 serum levels in vitiligo patients and the controls

There was a significant elevation of FABP4 serum levels in vitiligo patients (46.78 ± 14.54 ng/mL) than controls (27.67 ± 7.65 ng/mL) (p < 0.001) (Fig. 1).

Figure 1
FABP4 levels in vitiligo patients and the control group.

Role of FABP4 in early diagnosis of vitiligo

Receiver Operating Characteristic (ROC) curve showed that FABP4 level was a significant-good diagnostic test for early detection of vitiligo with best cut off point 33.0 ng/mL, the sensitivity of 82%, specificity of 76%, and 0.863 area under the curve (p < 0.001) (Fig. 2a).

Figure 2
ROC of FABP4 levels for (A), early diagnosis of vitiligo [best cut off point 33.0 ng/mL, sensitivity of 82%, specificity of 76% and 0.863 area under the curve (p < 0.001)]. (B), detection of MetS in vitiligo patients [sensitivity of 77%, specificity of 28% and 0.590 area under the curve (p = 0.348)].

Role of FABP 4 level in the diagnosis of MetS in vitiligo patient

ROC curve showed that FABP4 was a poor diagnostic test to detect metabolic syndrome in vitiligo patients having 0.590 area under the curve (p = 0.34) (Fig. 2b).

The relationship between FABP4 levels and studied parameters in vitiligo patients

In vitiligo patients, the high FABP4 serum levels were significantly associated with the presence of MetS (p=0.037). However, FABP4 was not different according to the severity of vitiligo, as FABP4 serum level was not significantly correlated with VASI score (r =-0.21; p = 0.162) (Table 4).

Table 4
FABP4 levels in relation to VASI score and MetS in the studied vitiligo patients.

Variables	FABP4 (ng/mL) in patients (n = 45)	t-test	p-value
MetS	Mean ± SD
Positive	55.85 ± 15.87
Negative	45.53 ± 14.04	2.15	0.037a
VASI score	r		p-value
	-0.21		0.162

tt
• ^a
  Significant.

There were significant positive correlations of FABP4 serum levels with TG, cholesterol and LDL levels (r = 0.39; p = 0.047) (r = 0.83; p = 0.001) (r = 0.66; p = 0.001) respectively] and a significant negative correlation regarding HDL level (r = -0.39; p = 0.009) (Fig. 3).

Figure 3
Correlations between FABP4 serum levels and lipid profile levels in vitiligo patients: (A), total cholesterol (r = 0.83; p = 0.001); (B), TG levels (r = 0.39; p = 0.047); (C), LDL (r = 0.66; p = 0.001); (D), HDL (r =-0.39; p = 0.009).

Discussion

In the present study, the authors investigated, for the first time, the possible role of FABP4 in vitiligo development through evaluation of its serum level in patients having NSV versus controls. The present study reported a significant increase in FABP4 circulating levels in vitiligo patients than matched peers, and these high concentrations were significantly associated with MetS in the studied cases, confirming that the pathogenesis of vitiligo has an immune-metabolic background.¹⁸

As the authors’ reported, Tanacan and Atkan¹⁹ revealed that the risk of developing MetS is increased in patients with NSV. The pathogenesis of vitiligo is not well known, but autoimmunity plus oxidative stress represents two important mechanisms responsible for vitiligo an etiopathogenesis.²⁰ Oxidative stress is one of the main reasons for MetS development and can have a relation to the pathogenesis of some diseases like psoriasis and vitiligo.¹¹ Additionally, an increased level of homocysteine, which is a tyrosinase inhibitor, may also be a contributing factor to the development of MetS in vitiligo patients.²¹

MetS increases the risk of developing diabetes mellitus type 2 and cardiovascular diseases by about 5 and 2 folds respectively.²² Therefore, the authors of the present study advocated that it is essential to prevent these associated serious complications of MetS by changing patients’ lifestyles. Additionally, optimal management of MetS may improve the clinical course of vitiligo.

FABP4 function has been linked to insulin sensitivity, lipid metabolism, and inflammation,²³ as well as glucose production that contributed to the pathogenesis of immunemetabolic diseases.²⁴ In agreement with these data, the authors reported a significant state of hyperglycemia and dyslipidemia in vitiligo cases, that was significantly associated with high FABP4 serum levels (significant positive correlations with TG, cholesterol, and LDL levels, and a significant negative correlation regarding HDL level).

Therefore, the present study suggested that FABP4 may have an active role during the disease process of vitiligo that could be mediated through associated dyslipidemia and hyperglycemia.

As vitiligo is considered one of the inflammatory diseases, FABP4 may act at the interface of inflammatory and metabolic pathways.²⁵

FABP4 induces inflammatory responses through activation of the IκB Kinase-Nuclear Factor-kabba B (IKK-NF-κB) and jun N-terminal Kinase-Activator Protein-1 (JNK-AP1) pathways,²⁶ as well as for Tumor Necrosis Factor-alpha (TNF-α).²⁷ The effect of TNF-α on cultured human skin melanocytes plays important role in vitiligo through NF-B activation.²⁸

The aberrant activation of innate immune cells in the skin of vitiligo patients includes inflammatory dendritic cells that migrate from the skin to draining lymph nodes presenting melanocyte antigens to T-cells and activate them. These cells also secrete cytokines which recruit and stimulate auto-reactive T-cells and then kill melanocytes directly.²⁹ The FABP4 in dendritic cells has been shown to regulate T-cell priming.³⁰

The auto-reactive tissue-resident memory T-cells inhibit melanin production and affect the regeneration of melanocytes by blocking regulatory T-cells locally.³¹ Recent outcomes confirm the presence of auto-reactive CD8⁺ cells with CD103⁺CD69⁺CD49a⁺ T phenotype within the skin of vitiligo patients. The auto-reactive tissue-resident memory CD8+ demonstrates overexpression of FABP4 in vitro studies.³²

Regarding the role of endothelial cells in vitiligo, human dermal microvascular endothelial cells secrete copious amounts of clusterin. This clusterin, through paracrine crosstalk between endothelial cells and melanocytes, can inhibit melanogenesis.³³ The FABP4 has a potential role in endothelial cell growth by promoting cell proliferation, migration, survival, and morphogenesis.³⁴

Based on the mentioned data, the authors postulated that the role of FABP4 in vitiligo pathogenesis could be mediated not only through its metabolic function (demonstrated hyperglycemia and dyslipidemia) but also via its immunemediated mechanisms including up-regulated inflammatory cytokines,²⁷ over-expressed auto-reactive tissue-resident memory T-cells³² and stimulated endothelial cells.³⁴

FABP4 acts as an important mediator in the crosstalk between adipocytes and macrophages in adipose tissue. FABP4 knock-out mice were protected from the development of obesity, insulin resistance, and impaired glucose tolerance, and their adipocytes showed reduced lipolysis.³⁵ In line with their findings, the authors observed a significant association between high FABP4 levels and the presence of MetS in present study’s vitiligo patients. Also, Terra et al.³⁶ found a relationship between circulating FABP4 levels and the presence of obesity and MetS.

Although the present study demonstrated that FABP4 cannot predict MetS development in the studied vitiligo patients (that may be attributed to small sample size in this work), the authors revealed that FABP4 level was a significant good diagnostic test for early detection of vitiligo that could help in the diagnosis of vitiligo in confusing cases. Large-scale studies are needed to confirm this result.

Conclusions

FABP4 may play an active role in vitiligo development and its targeting may have an appraising effect in clinical application in vitiligo management. The role of FABP4 in the disease process of vitiligo could be mediated through associated dyslipidemia and hyperglycemia. FABP4 may be a marker of vitiligo helping in its early diagnosis, but it does not appear to be useful for determining vitiligo severity, activity, or associated MetS.

Study limitations

The small number of the studied subjects was the main limitation of the current study.

• Financial support
  None declared.

References

• ¹
  Boniface K, Seneschal J, Picardo M, Tieb A. Vitiligo: Focus on Clinical Aspects, Immunopathogenesis, and Therapy. Clin Rev Allergy Immunol. 2018;54:52-67.
• ²
  Roberts GHL, Santorico SA, Spritz RA. The genetic architecture of vitiligo. Pigment Cell Melanoma Res. 2020;33:8-15.
• ³
  Wang P, Li Y, Nie H, Zhang X, Shao Q, Hou X, et al. The changes of gene expression profiling between segmental vitiligo, generalized vitiligo and healthy individual. J Dermatol Sci. 2016;84:40-9.
• ⁴
  Speeckaert R, Lambert J, Bulat V, Belpaire A, Speeckaert M, Geel N. Autoimmunity in Segmental Vitiligo. Front Immunol. 2020;11:568447.
• ⁵
  Furuhashi M, Ishimura S, Ota H, Miura T. Lipid chaperones and metabolic inflammation. Int J Inflam. 2011;2011:642612.
• ⁶
  Ning H, Tao H, Weng Z, Zhao X. Plasma fatty acid-binding protein 4 (FABP4) as a novel biomarker to predict gestational diabetes mellitus. Acta Diabetol. 2016;53:891-8.
• ⁷
  Rodriguez-Calvo R, Girona J, Alegret JM, Bosquet A, Ibarretxe D, Masana L. Role of the fatty acid-binding protein 4 in heart failure and cardiovascular disease. J Endocrinol. 2017;233:173-84.
• ⁸
  Ishimura S, Furuhashi M, Watanabe Y, Hoshina K, Fuseya T, Mita T, et al. Circulating levels of fatty acid-binding protein family and metabolic phenotype in the general population. Plos One. 2013;8:81318.
• ⁹
  Sinha PK, Nigam P, Swain JP. Association of Metabolic Syndrome with Vitiligo- A Case Control Study. J Evolution Med Dent Sci. 2019;8:2278-4802.
• ¹⁰
  Huling LB, Baccaglini L, Choquette L, Feinn RS, Lalla RV. Effect of stressful life events on the onset and duration of recurrent aphthous stomatitis. J Oral Pathol Med. 2012;41:149-52.
• ¹¹
  Sabir AA, Bilbis LS, Saidu Y, Jimoh A, Iwuala SO, Isezuo SA, et al. Oxidative stress among subjects with metabolic syndrome in Sokoto, North-Western Nigeria. Niger J Clin Pract. 2016;19:128-32.
• ¹²
  Zhang C, Li T, Chiu KY, Wen C, Xu Yan CH. FABP4 as a biomarker for knee osteoarthritis. Biomark Med. 2018;12:107-18.
• ¹³
  Baran A, Swiderska M, Bacharewicz-Szczerbicka J, My´sliwiec H, Flisiak I. Serum Fatty Acid-Binding Protein 4 is Increased in Patients with Psoriasis. Lipids. 2017;52:51-60.
• ¹⁴
  who.int [Internet]. World Health Organization; c2021 [cited 2019 Feb 5]. Available from: https://www.who.int/data/gho/data/themes/theme-details/GHO/body-mass-index-(bmi) .
  » https://www.who.int/data/gho/data/themes/theme-details/GHO/body-mass-index-(bmi)
• ¹⁵
  Hamzavi I, Jain H, McLean D, Shapiro J, Zeng H, Lui H. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative tool: the Vitiligo Area Scoring Index. Arch Dermatol. 2004;140:677-83.
• ¹⁶
  Gamil HD, Assaf MI, Khater MH, Fowzy MH. Histopathological findings in lesional and perilesional skin of vitiligo patients before and after narrow band ultraviolet B phototherapy. Zagazig Univ Med J. 2019;25:326-34.
• ¹⁷
  Ma CM, Yin FZ, Liu XL, Wang R, Lou DH, Lu Q. How to Simplify the Diagnostic Criteria of Metabolic Syndrome in Adolescents. Pediatr Noeonatol. 2017;58:178-84.
• ¹⁸
  Sabat R, Wolk K, Loyal L, Döcke WD, Ghoreschi K. T cell pathology in skin inflammation. Semin Immunopathol. 2019;41:359-77.
• ¹⁹
  Tanacan E, Atakan N. Higher incidence of metabolic syndrome components in vitiligo patients: a prospective cross-sectional study. An Bras Dermatol. 2020;95:165-72.
• ²⁰
  Xie H, Zhou F, Liu L, Zhu G, Li Q, Li C, et al. Vitiligo: How do oxidative stress-induced autoantigens trigger autoimmunity? J Dermatol Sci. 2016;81:3-9.
• ²¹
  Atas H, Gonul M. Increased Risk of Metabolic Syndrome in Patients with Vitiligo. Balkan Med J. 2017;34:219-25.
• ²²
  Kaur J. A Comprehensive review on metabolic syndrome. Cardiol Res Pract. 2014;2004:943162.
• ²³
  Makowski L, Hotamisligil GS. Fatty acid binding proteins --the evolutionary crossroads of inflammatory and metabolic responses. J Nutr. 2004;134:2464-8.
• ²⁴
  Hotamisligil GS, Bernlohr DA. Metabolic functions of FABPs --mechanisms and therapeutic implications. Nat Rev Endocrinol. 2015;11:592-605.
• ²⁵
  Furuhashi M, Saitoh S, Shimamoto K, Miura T. Fatty Acid-Binding Protein 4 (FABP4): Pathophysiological Insights and Potent Clinical Biomarker of Metabolic and Cardiovascular Diseases. Clin Med Insights Cardiol. 2015;8:23-33.
• ²⁶
  Hui X, Li H, Zhou Z, Lam KSL, Xiao Y, Wu D, et al. Adipocyte fatty acid-binding protein modulates inflammatory responses in macrophages through a positive feedback loop involving c-Jun NH2-terminal kinases and activator protein-1. J Biol Chem. 2010;285:10273-80.
• ²⁷
  Kralisch S, Fasshauer M. Adipocyte fatty acid binding protein: a novel adipokine involved in the pathogenesis of metabolic and vascular disease? Diabetologia. 2013;56:10-21.
• ²⁸
  Wan J, Lin F, Zhang W, Xu A, Lu H, DeGiorgis J, et al. Novel approaches to vitiligo treatment via modulation of mTOR and NF-B pathways in human skin melanocytes. Int J Biol Sci. 2017;13:391-400.
• ²⁹
  Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE. New discoveries in the pathogenesis and classification of vitiligo. J I Am Acad Dermatol. 2017;77:1-13.
• ³⁰
  Hansson GK, Hermansson A. The immune system in atherosclerosis. Nat Immunol. 2011;12:204-12.
• ³¹
  Boniface K, Seneschal J. Vitiligo as a skin memory disease: The need for early intervention with immunomodulating agents and a maintenance therapy to target resident memory T-cells. Exp Dermatol. 2019;28:656-61.
• ³²
  Pan Y, Kupper TS. Metabolic reprogramming and longevity of tissue-resident memory T-cells. Front Immunol. 2018;9:1347.
• ³³
  Kim M, Lee J, Park TJ, Kang HY. Paracrine crosstalk between endothelial cells and melanocytes through clusterin to inhibit pigmentation. Exp Dermatol. 2018:98-100.
• ³⁴
  Lee D, Wada K, Taniguchi Y, Al-Shareef H, Masuda T, Usami Y, et al. Expression of fatty acid binding protein 4 is involved in the cell growth of oral squamous cell carcinoma. Oncol Rep. 2014:1116-20.
• ³⁵
  Boord JB, Maeda K, Makowski L, Babaev VR, Fazio S, Linton MF, et al. Adipocyte fatty acid-binding protein, aP2, alters late atherosclerotic lesion formation in severe hypercholesterolemia. Arterioscler Thromb Vasc Biol. 2002;22:1686-91.
• ³⁶
  Terra X, Quintero Y, Auguet T, Porras JA, Hernández M, Sabench F, et al. FABP4 is associated with inflammatory markers and metabolic syndrome in morbidly obese women. Eur J Endocrinol. 2011;164:539-47.

Publication Dates

• Publication in this collection
  18 Feb 2022
• Date of issue
  2022

History

• Received
  05 Mar 2021
• Accepted
  17 Apr 2021
• Published
  25 Nov 2021