# Immunomonitoring and Microbiome Analysis in Alopecia Areata Patients Undergoing Fecal Microbiota Transplantation

> **NIH NIH R21** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2021 · $77,975

## Abstract

ABSTRACT from Parent R21
Alopecia areata (AA) affects as many as 6.8 million people in the U.S. and 147 million worldwide, with a lifetime
risk of 2.1%, making it one of the most common autoimmune diseases. AA causes significant disfigurement and
psychological distress to affected individuals and carries one of the highest emotional burdens amongst all skin
diseases, particularly among children and adolescents whose self-image is so closely linked to their appearance.
At present, the prognosis is unpredictable and there is no FDA approved treatment for AA. AA shows several
genetic and immunopathogenic similarities to other autoimmune conditions, suggesting that similar
environmental triggers as well as the inflammatory responses leading to damage in the end-organ, the hair follicle
(HF), may have common mechanisms. While our group and others have made significant advances in
understanding the genetic architecture of AA, the environmental triggers of systemic autoimmune response in
AA have not been identified. Therefore, we recently turned our attention to determining potential environmental
triggers, in particular, the microbiome. In our Preliminary Studies we analyzed the gut microbiome composition
of a cohort of 26 AA patients and 10 healthy subjects, and found striking dissimilarities between the composition
of the gut microbiome of AA patients and those of healthy controls. We observed an overrepresentation of
firmicutes and an underrepresentation of bacteroides in AA patients, findings which are also seen in other
autoimmune diseases. Our additional Preliminary Studies on the well-established C3H/HeJ mouse model of AA
demonstrated that pre-treatment with a wide-spectrum antibiotic cocktail results in protection against AA after
skin grafting, suggesting the gut microbiome is required for the onset of AA. In addition, three cases have been
reported in the literature of patients with chronic alopecia areata/universalis who were treated with a fecal
microbiota transplant (FMT) for unrelated conditions, who subsequently experienced significant regrowth of hair.
Taken together, these findings suggest an unexpected role of the gut microbiome in alopecia areata, and
provided the rationale for the Parent Study of this Ancillary Studies Grant, entitled “Fecal Microbiota
Transplantation as a Potential Treatment for Patients with Alopecia Areata”. The purpose of this Ancillary Studies
grant is to conduct microbiome analysis and immunological studies in AA patients undergoing FMT, in order to
understand the pathogenic role of environmental factors, such as changes in the composition of the gut
microbiome, in the reversal of AA by FMT.

## Key facts

- **NIH application ID:** 10414461
- **Project number:** 3R21AR076764-01A1S1
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Angela M Christiano
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $77,975
- **Award type:** 3
- **Project period:** 2021-07-01 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10414461

## Citation

> US National Institutes of Health, RePORTER application 10414461, Immunomonitoring and Microbiome Analysis in Alopecia Areata Patients Undergoing Fecal Microbiota Transplantation (3R21AR076764-01A1S1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10414461. Licensed CC0.

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