Macrophage Migration Inhibitory Factor in Vitiligo: Pathogenesis and Potential Therapeutic Aspects

Abstract

Vitiligo is an acquired skin disorder that is characterized by a gradual loss of skin pigmentation when melanocytes, the skin's pigment-producing cellsis lost. Pathogenicmechanisms are not well understood. Genetic, abnormal biochemical pathways, autoimmune, melanocyte adhesion deficits and nervous system imbalances are among the pathogenic triggers. Vitiligo lesions have  also been shown to have macrophage infiltration.Macrophagemigration inhibitory factor (MIF) is a lymphokine that concentrates macrophages at inflammatory sites and is involved in cell-mediated immunity.MIF enhances chemotaxis and macrophage infiltration and upregulates inflammatory responses by inducing the expression of proinflammatory mediators such as TNF-α, nitric oxide and prostaglandin E2.Therapyfor vitiligo includes corticosteroids, immunomodulatory agents, vitamin D nalogues, antioxidants, phototherapy, laser and surgical therapy.However, no single treatment for vitiligo produces consistently good results and treatment response is variable.  Narrow-band ultraviolet (NB-UVB, 311–313nm) phototherapy is viewed as backbone of treatment. Systemic therapies such as systemic corticosteroids and methotrexate were previously used to treat vitiligo which was assumed to be auto-immune nature.Pathogenic mechanisms, role of MIF and various treatment guidelines are discussed in this review