151
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Nguyen JK, Austin E, Huang A, Mamalis A, Jagdeo J. The IL-4/IL-13 axis in skin fibrosis and scarring: mechanistic concepts and therapeutic targets. Arch Dermatol Res 2020; 312:81-92. [PMID: 31493000 PMCID: PMC7008089 DOI: 10.1007/s00403-019-01972-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/22/2019] [Accepted: 08/29/2019] [Indexed: 02/06/2023]
Abstract
Skin fibrosis, characterized by excessive fibroblast proliferation and extracellular matrix deposition in the dermis, is the histopathologic hallmark of dermatologic diseases such as systemic sclerosis, hypertrophic scars, and keloids. Effective anti-scarring therapeutics remain an unmet need, underscoring the complex pathophysiologic mechanisms of skin fibrosis. The Th2 cytokines interleukin (IL)-4 and IL-13 have been implicated as key mediators in the pathogenesis of fibroproliferative disorders. The goal of this article is to summarize the current understanding of the role of the IL-4/IL-13 axis in wound healing and skin fibrosis. We conducted a literature search to identify research studies investigating the roles of IL-4 and IL-13 in fibrotic skin diseases. While transforming growth factor-beta has long been regarded as the main driver of fibrotic processes, research into the cellular and molecular biology of wound healing has revealed other pathways that promote scar tissue formation. IL-4 and IL-13 are important mediators of skin fibrosis, supported by evidence from in vitro data, animal models of fibrosis, and clinical studies. Overactive signaling of the IL-4/IL-13 axis contributes to the initiation and perpetuation of fibrotic skin diseases. Further insights into the IL-4/IL-13 axis may reveal potential targets for the development of novel therapies that prevent or treat fibrotic skin diseases.
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Affiliation(s)
- Julie K Nguyen
- Department of Dermatology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 46, Brooklyn, NY, 11203, USA
| | - Evan Austin
- Department of Dermatology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 46, Brooklyn, NY, 11203, USA
| | - Alisen Huang
- Department of Dermatology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 46, Brooklyn, NY, 11203, USA
| | - Andrew Mamalis
- Department of Dermatology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 46, Brooklyn, NY, 11203, USA
| | - Jared Jagdeo
- Department of Dermatology, SUNY Downstate Medical Center, 450 Clarkson Avenue MSC 46, Brooklyn, NY, 11203, USA.
- Dermatology Service, VA New York Harbor Healthcare System, Brooklyn, NY, USA.
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152
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Eyerich S, Metz M, Bossios A, Eyerich K. New biological treatments for asthma and skin allergies. Allergy 2020; 75:546-560. [PMID: 31444793 DOI: 10.1111/all.14027] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023]
Abstract
Allergies are typically endemic, complex and heterogeneous diseases with a high impact at quality of life. Mechanistically, type 2 immune responses involving eosinophil and basophil granulocytes, mast cells and humoral factors such as IgE are key drivers of allergic diseases. Fighting allergic diseases knows three strategies: prevention, symptomatic and causative therapy. While remarkable progress was made in understanding molecular events in allergies as a prerequisite for effective prevention and desensitization, this review article focuses on the most efficient symptomatic treatments-that is using more and more specific antibodies neutralizing particular immune pathways. We highlight and classify recent and upcoming developments in the three prototype chronic allergic diseases allergic asthma, chronic spontaneous urticaria and atopic eczema. In all three examples, biologics such as dupilumab or omalizumab become reliable and efficient therapeutic options. Finally, we give an outlook how a diagnostic and therapeutic workflow might look like in the near future for these three major burdens of society.
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Affiliation(s)
- Stefanie Eyerich
- Center of Allergy and Environment (ZAUM) Helmholtz Center and Technical University of Munich Munich Germany
| | - Martin Metz
- Dermatological Allergology Department of Dermatology and Allergy Charité‐Universitätsmedizin Berlin Germany
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy Karolinska University Hospital, Huddinge, and Department of Medicine, Huddinge Karolinska Institutet Stockholm Sweden
- Centre for Allergy Research Karolinska Institutet Stockholm Sweden
| | - Kilian Eyerich
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
- Unit of Dermatology and Venerology Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm Sweden
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153
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Loh TY, Hsiao JL, Shi VY. Therapeutic Potential of Lebrikizumab in the Treatment of Atopic Dermatitis. J Asthma Allergy 2020; 13:109-114. [PMID: 32104006 PMCID: PMC7023853 DOI: 10.2147/jaa.s211032] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background Atopic dermatitis (AD) is a chronic, relapsing skin condition with a wide disease spectrum. Moderate-to-severe cases often need systemic treatment. Conventional immunosuppressants have extensive side effect profiles and require close monitoring. In recent decades, there has been increasing interest in developing targeted systemic immunomodulators for AD, as they have been shown to have efficacy for AD as well as favorable safety profiles. Herein, we review the recent data on lebrikizumab, an interleukin (IL)-13 inhibitor, and its potential role in the treatment of AD. Objective Review the mechanism of action, and available data on the efficacy and safety of lebrikizumab for the treatment of AD. Methods PubMed, Google Scholar, and clinicaltrials.gov searches were performed with the following terms: “atopic dermatitis,” “dermatitis,” “eczema,” “lebrikizumab,” “IL-4,” and “IL-13.” Results Two Phase II randomized controlled clinical trials have been conducted to evaluate the use of lebrikizumab in a total of 289 patients with moderate-severe AD and inadequate response to topical corticosteroids. Patients treated with lebrikizumab experienced significantly more improvement in their AD compared to placebo, as measured by Eczema Area and Severity Index (EASI)-50 and EASI-75 scores, pruritus scores, and reduction in body surface area (BSA). Its clinical efficacy appears to be dose-dependent, and it has a favorable side effect profile and is generally well tolerated. Conclusion Lebrikizumab appears to be a promising emerging targeted biologic for the treatment of moderate-to-severe AD. Further Phase III studies investigating optimal dosing regimens and safety profile are needed.
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Affiliation(s)
- Tiffany Y Loh
- University of Arizona, Division of Dermatology, Tucson, AZ, USA
| | - Jennifer L Hsiao
- University of California Los Angeles, Division of Dermatology, Los Angeles, CA, USA
| | - Vivian Y Shi
- University of Arizona, Division of Dermatology, Tucson, AZ, USA
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Ardeleanu M, Shumel B, Rossi AB, Graham NMH. Response to R. Waldman et al.: 'Does IL-4 inhibition play a role in dupilumab-associated conjunctivitis?'. Br J Dermatol 2020; 182:1310-1312. [PMID: 31853960 PMCID: PMC7317488 DOI: 10.1111/bjd.18808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Linked Article: Waldman et al. Br J Dermatol 2020; 182:251. Bakker et al. Br J Dermatol 2019; 180:1248–9.
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Affiliation(s)
- M Ardeleanu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - B Shumel
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - N M H Graham
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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155
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Andreasen T, Christensen M, Halling A, Egeberg A, Thyssen J. Placebo response in phase 2 and 3 trials of systemic and biological therapies for atopic dermatitis—a systematic review and meta‐analysis. J Eur Acad Dermatol Venereol 2020; 34:1143-1150. [DOI: 10.1111/jdv.16163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/19/2019] [Indexed: 12/30/2022]
Affiliation(s)
- T.H. Andreasen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - M.O. Christensen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - A.‐S. Halling
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - A. Egeberg
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin CORGIS Hellerup Denmark
| | - J.P. Thyssen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin CORGIS Hellerup Denmark
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156
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Jackson K, Bahna SL. Hypersensitivity and adverse reactions to biologics for asthma and allergic diseases. Expert Rev Clin Immunol 2020; 16:311-319. [PMID: 31994421 DOI: 10.1080/1744666x.2020.1724089] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: The development of new biologic agents has provided definite therapeutic advances but, like with any new medications, safety remains a concern.Areas covered: Using PubMed, we reviewed the literature on the adverse effects (AE) to five biologics approved for asthma and/or allergic diseases: one anti-IgE (omalizumab), three anti-IL5 (mepolizumab, reslizumab, benralizumab), and one anti-IL4 (dupilumab).Expert opinion: Biologic agents approved for asthma and allergic diseases are generally safe. Most common AE are benign and tolerated, though long-term safety is lacking for most of them. A slightly increased risk of anaphylaxis to omalizumab and reslizumab required the inclusion of a black box warning, informing the patient, the need for post-injection observation period, and the provision of epinephrine autoinjectors for self-administration when needed. Hypersensitivity reactions, mainly urticaria and very rarely serum sickness have occurred.
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Affiliation(s)
- Kim Jackson
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Sami L Bahna
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a brief discussion on the differential diagnosis for peripheral eosinophilia. We will then focus on targeted immunotherapies for atopic disease, their effects on absolute peripheral eosinophil counts, and use of peripheral eosinophils as a predictor of treatment response. RECENT FINDINGS In atopic disease, lower absolute peripheral eosinophil counts are typically associated with improved outcomes. Much of the current evidence on eosinophils as a biomarker comes from post hoc analyses in therapeutic immunotherapy. While changes in eosinophilia were not the primary outcome of interest in many studies, some patterns did emerge. Cytolytic monoclonal antibodies AK002 and benralizumab completely reduce peripheral and tissue eosinophil numbers. Dupilumab may have paradoxical transient eosinophilia despite observed clinical efficacy. Atopic inflammation is complex largely due to the various cytokines which affect eosinophil activation, proliferation, differentiation, and survival. This demonstrates the challenges of using peripheral eosinophilia alone as a biomarker for atopic disease activity. More attention should spotlight how different immunotherapy modalities affect eosinophil-driven responses.
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158
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Leonard A, Wang J, Yu L, Liu H, Estrada Y, Greenlees L, McPhee R, Ruzin A, Guttman-Yassky E, Howell MD. Atopic Dermatitis Endotypes Based on Allergen Sensitization, Reactivity to Staphylococcus aureus Antigens, and Underlying Systemic Inflammation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:236-247.e3. [DOI: 10.1016/j.jaip.2019.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
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Bieber T. Interleukin-13: Targeting an underestimated cytokine in atopic dermatitis. Allergy 2020; 75:54-62. [PMID: 31230370 DOI: 10.1111/all.13954] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/10/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022]
Abstract
Atopic dermatitis (AD) is a common inflammatory skin condition that has traditionally been considered a paradigmatic type 2 immunity (T2)-driven disease. Interleukin (IL)-4 and IL-13 are both pivotal cytokines involved in the generation of allergic diseases. Currently, besides dupilumab, which blocks the binding of both cytokines to their receptors, a number of new pharmacologic entities have been designed to target both T2 cytokines and/or their receptors and/or receptor-associated signal transduction machinery such as Janus kinases. Recently, IL-13 has been suggested to be the key T2 cytokine driving inflammation in the periphery, while IL-4 may merely have a central effect. There is increasing evidence that this concept holds true for the inflammatory reaction underlying AD, where IL-13 is overexpressed locally and has a significant impact on skin biology, including the recruitment of inflammatory cells, the alteration of the skin microbiome, and the decrease in the epidermal barrier function. This review provides an update on the role of IL-13 in AD and discusses the different strategies aimed at interfering with its biologic activity as well as their potential in a precision medicine approach in the management of AD.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, Christine Kühne—Center for Allergy Research and Education (CK‐CARE) University Medical Center Bonn Germany
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160
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Agache I, Cojanu C, Laculiceanu A, Rogozea L. Critical Points on the Use of Biologicals in Allergic Diseases and Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2020; 12:24-41. [PMID: 31743962 PMCID: PMC6875478 DOI: 10.4168/aair.2020.12.1.24] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022]
Abstract
Improved understanding of the contribution of immune-inflammatory mechanisms in allergic diseases and asthma has encouraged development of biologicals and small molecules specifically targeting the innate and adaptive immune response. There are several critical points impacting the efficacy of this stratified approach, from the complexity of disease endotypes to the effectiveness in real-world settings. We discuss here how these barriers can be overcome to facilitate the development of implementation science for allergic diseases and asthma.
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Affiliation(s)
- Ioana Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania.
| | - Catalina Cojanu
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - Alexandru Laculiceanu
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - Liliana Rogozea
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
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161
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Lee HH, Patel KR, Rastogi S, Singam V, Vakharia PP, Chopra R, Silverberg JI. Placebo responses in randomized controlled trials for systemic therapy in atopic dermatitis: A systematic review and meta-analysis. J Am Acad Dermatol 2020; 82:62-71. [DOI: 10.1016/j.jaad.2019.05.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/10/2019] [Accepted: 05/30/2019] [Indexed: 12/27/2022]
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Fishbein AB, Silverberg JI, Wilson EJ, Ong PY. Update on Atopic Dermatitis: Diagnosis, Severity Assessment, and Treatment Selection. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:91-101. [PMID: 31474543 PMCID: PMC7395647 DOI: 10.1016/j.jaip.2019.06.044] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis (AD) is one of the most common inflammatory skin diseases affecting children and adults. The intense pruritus and rash can be debilitating, significantly impairing quality of life. Until recently, treatment was largely nonspecific and, in severe disease, sometimes ineffective and/or fraught with many side effects. Now, multiple agents targeting specific disease pathways are available or in development. Two new therapies, crisaborole and dupilumab, have become available since 2016, and dupilumab has dramatically improved outcomes for adults with severe AD. This article provides an overview of AD, including strategies for differential diagnosis and assessment of disease severity to guide treatment selection. Key clinical trials for crisaborole and dupilumab are reviewed, and other targeted treatments now in development are summarized. Two cases, representing childhood-onset and adult-onset AD, are discussed to provide clinical context for diagnosis, severity assessment, and treatment selection and outcomes.
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Affiliation(s)
- Anna B Fishbein
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Jonathan I Silverberg
- Northwestern University Feinberg School of Medicine, Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Ill
| | | | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, Calif
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163
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Granuloma annulare skin profile shows activation of T-helper cell type 1, T-helper cell type 2, and Janus kinase pathways. J Am Acad Dermatol 2019; 83:63-70. [PMID: 31870914 DOI: 10.1016/j.jaad.2019.12.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Granuloma annulare (GA) is an inflammatory skin disorder. Localized GA is often self-resolving, but generalized GA is often recalcitrant to treatments. There are no targeted treatments for GA, largely due to lack of mechanistic understanding. Recently, tumor necrosis factor antagonism showed promise in GA, suggesting an underlying immune pathogenesis. OBJECTIVE To elucidate the immune pathogenesis and identify potential therapeutic targets for GA. METHODS Lesional and nonlesional skin biopsy samples were obtained from patients with GA and evaluated for a large array of inflammatory markers compared with inflammatory markers from normal skin of healthy individuals. RESULTS We found differential expression of many inflammatory genes compared with normal skin. These genes were associated with T-helper (Th) cell type 1/innate immunity (tumor necrosis factor-α, interleukin [IL]-1β, IL-12/23p40, signal transducer and activator of transcription 1, chemokine [C-X-C motif] ligand 9/10), Janus kinase signaling, and Th2 (IL-4, IL-31, chemokine (C-C motif) ligands 17 and 18; P < .05). Unexpectedly, IL-4 showed significant upregulation in GA lesional skin vs control skin (15,600-fold change). LIMITATIONS Limited sample size. CONCLUSIONS Our findings shed light on the inflammatory pathways of GA, supporting the notion that immune mechanisms could be driving disease, as suggested by the promising data of tumor necrosis factor-α inhibitors in GA. The significant Janus kinase and particularly Th2 signaling in GA advocates for the investigation of specific Janus kinase- and Th2- targeted drug therapy.
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164
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Solimani F, Meier K, Ghoreschi K. Emerging Topical and Systemic JAK Inhibitors in Dermatology. Front Immunol 2019; 10:2847. [PMID: 31849996 PMCID: PMC6901833 DOI: 10.3389/fimmu.2019.02847] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
Accumulating data on cellular and molecular pathways help to develop novel therapeutic strategies in skin inflammation and autoimmunity. Examples are psoriasis and atopic dermatitis, two clinically and immunologically well-defined disorders. Here, the elucidation of key pathogenic factors such as IL-17A/IL-23 on the one hand and IL-4/IL-13 on the other hand profoundly changed our therapeutic practice. The knowledge on intracellular pathways and governing factors is shifting our attention to new druggable molecules. Multiple cytokine receptors signal through Janus kinases (JAKs) and associated signal transducer and activators of transcription (STATs). Inhibition of JAKs can simultaneously block the function of multiple cytokines. Therefore, JAK inhibitors (JAKi) are emerging as a new class of drugs, which in dermatology can either be used systemically as oral drugs or locally in topical formulations. Inhibition of JAKs has been shown to be effective in various skin disorders. The first oral JAKi have been recently approved for the treatment of rheumatoid arthritis and psoriatic arthritis. Currently, multiple inhibitors of the JAK/STAT pathway are being investigated for skin diseases like alopecia areata, atopic dermatitis, dermatomyositis, graft-versus-host-disease, hidradenitis suppurativa, lichen planus, lupus erythematosus, psoriasis, and vitiligo. Here, we aim to discuss the immunological basis and current stage of development of JAKi in dermatology.
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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165
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166
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Quoi de neuf en thérapeutique dermatologique ? Ann Dermatol Venereol 2019; 146:12S46-12S51. [DOI: 10.1016/s0151-9638(20)30106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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167
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Bieber T. Neuartige Therapien auf der Grundlage der Pathophysiologie der atopischen Dermatitis. J Dtsch Dermatol Ges 2019; 17:1150-1163. [PMID: 31765109 DOI: 10.1111/ddg.13965_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Thomas Bieber
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum, Rheinische Friedrich-Wilhelms-Universität Bonn, Erklärung zu nicht-finanziellen Interesse: Organisation: Klinik und Poliklinik für Dermatologie und Allergologie Position in dieser Organisation: Direktor Mitgliedschaft und Position in wissenschaftlichen Gesellschaften/Berufsverbänden/Vereinigungen: Direktor bei Christine-Kühne Center for Allergy Research and Education (CK-CARE) der Kühne-Stiftung; Sprecher beim Zentrum für Translationale Medizin (Med. Fakultät Bonn und Bundes -Institut für Arzneimittel und Medizinprodukte (BfArM), Bonn; Vorsitzender des Wissenschaftlichen Beirates des BfArM, Bonn; Stellvertretender Vorsitzender des gemeinsamen Wissenschaftlichen Beirates der Bundesoberbehörden am Bundesministerium für Gesundheit (BMG), Berlin; Mitglied der Nationalen Akademie der Naturforscher, Leopoldina Halle; Ehrenamtliches Mitglied folgender Aufsichtsräte: Hochgebirgsklinik (Davos) sowie Davos Biosciences (Davos, Schweiz). Mitglied und Ehrenmitglied zahlreicher nationaler und internationaler wissenschaftlicher Gesellschaften
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168
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Yosipovitch G, Berger T, Fassett MS. Neuroimmune interactions in chronic itch of atopic dermatitis. J Eur Acad Dermatol Venereol 2019; 34:239-250. [PMID: 31566796 PMCID: PMC7027518 DOI: 10.1111/jdv.15973] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022]
Abstract
Itch is a defining symptom of atopic dermatitis. Crosstalk between keratinocytes, the immune system and non‐histaminergic sensory nerves is responsible for the pathophysiology of chronic itch in atopic dermatitis. An expanding understanding of the contribution of the nervous system and its interaction with immune pathways in atopic itch are helping to identify new therapeutic strategies.
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Affiliation(s)
- G Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - T Berger
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - M S Fassett
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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169
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Egholm C, Heeb LEM, Impellizzieri D, Boyman O. The Regulatory Effects of Interleukin-4 Receptor Signaling on Neutrophils in Type 2 Immune Responses. Front Immunol 2019; 10:2507. [PMID: 31708926 PMCID: PMC6821784 DOI: 10.3389/fimmu.2019.02507] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/07/2019] [Indexed: 12/13/2022] Open
Abstract
Interleukin-4 (IL-4) receptor (IL-4R) signaling plays a pivotal role in type 2 immune responses. Type 2 immunity ensures several host-protective processes such as defense against helminth parasites and wound repair, however, type 2 immune responses also drive the pathogenesis of allergic diseases. Neutrophil granulocytes (neutrophils) have not traditionally been considered a part of type 2 immunity. While neutrophils might be beneficial in initiating a type 2 immune response, their involvement and activation is rather unwanted at later stages. This is evidenced by examples of type 2 immune responses where increased neutrophil responses are able to enhance immunity, however, at the cost of increased tissue damage. Recent studies have linked the type 2 cytokines IL-4 and IL-13 and their signaling via type I and type II IL-4Rs on neutrophils to inhibition of several neutrophil effector functions. This mechanism directly curtails neutrophil chemotaxis toward potent intermediary chemoattractants, inhibits the formation of neutrophil extracellular traps, and antagonizes the effects of granulocyte colony-stimulating factor on neutrophils. These effects are observed in both mouse and human neutrophils. Thus, we propose for type 2 immune responses that neutrophils are, as in other immune responses, the first non-resident cells to arrive at a site of inflammation or infection, thereby guiding and attracting other innate and adaptive immune cells; however, as soon as the type 2 cytokines IL-4 and IL-13 predominate, neutrophil recruitment, chemotaxis, and effector functions are rapidly shut off by IL-4/IL-13-mediated IL-4R signaling in neutrophils to prevent them from damaging healthy tissues. Insight into this neutrophil checkpoint pathway will help understand regulation of neutrophilic type 2 inflammation and guide the design of targeted therapeutic approaches for modulating neutrophils during inflammation and neutropenia.
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Affiliation(s)
- Cecilie Egholm
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Lukas E M Heeb
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | | | - Onur Boyman
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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170
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Renert-Yuval Y, Guttman-Yassky E. New treatments for atopic dermatitis targeting beyond IL-4/IL-13 cytokines. Ann Allergy Asthma Immunol 2019; 124:28-35. [PMID: 31622669 DOI: 10.1016/j.anai.2019.10.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/25/2019] [Accepted: 10/06/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Atopic dermatitis (AD) is an increasingly common inflammatory skin disease undergoing significant revolution in recent years. New data on disease pathogenesis advanced the developments of novel therapeutics, mainly for patients with moderate to severe conditions, for whom treatment options have been largely insufficient for many years. DATA SOURCES Review of recent studies investigating systemic treatments for AD. STUDY SELECTIONS Relevant literature concerning novel therapeutics for AD beyond targeted monoclonal antibodies antagonizing selectively interleukin (IL)-4 or IL-13 was obtained from a PubMed and clinicaltrials.gov search and summarized. RESULTS Multiple clinical trials of both nonspecific as well as specific agents revealed favorable outcomes in AD, including JAK inhibitors, a dual JAK/SYK inhibitor, a histamine H4R antagonist, antagonists of the TSLP/OX40L axis, an IL-22 inhibitor, and IL-33 and IL-17C antagonists. Importantly, negative trials were published as well (eg, phosphodiesterase 4 inhibitor, apremilast). CONCLUSION In this rapidly evolving field of AD treatments, a completely new treatment paradigm will be available in the near future.
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Affiliation(s)
- Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
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171
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Waldman RA, DeWane ME, Sloan SB. Does interleukin-4 inhibition play a role in dupilumab-associated conjunctivitis? Br J Dermatol 2019; 182:251. [PMID: 31437304 DOI: 10.1111/bjd.18450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R A Waldman
- Department of Dermatology, University of Connecticut, Farmington, CT, U.S.A
| | - M E DeWane
- School of Medicine, University of Connecticut, Farmington, CT, U.S.A
| | - S B Sloan
- Department of Dermatology, University of Connecticut, Farmington, CT, U.S.A.,VA Connecticut Department of Dermatology, Newington, CT, U.S.A
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172
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Pathophysiology of Atopic Dermatitis and Psoriasis: Implications for Management in Children. CHILDREN-BASEL 2019; 6:children6100108. [PMID: 31590274 PMCID: PMC6826460 DOI: 10.3390/children6100108] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022]
Abstract
Atopic dermatitis (AD) and psoriasis are chronic inflammatory skin diseases associated with a significant cutaneous and systemic burden of disease as well as a poor health-related quality of life. Here, we review the complex pathophysiology of both AD and psoriasis and discuss the implications for treatment with current state-of-the-art and emerging topical and systemic therapies. Both AD and psoriasis are caused by a complex combination of immune dysregulation, skin-barrier disruption, genetic factors, and environmental influences. Previous treatments for both diseases were limited to anti-inflammatory agents that broadly suppress inflammation. Emerging insights into relevant pathways, including recognition of the role of T-helper type 2 driven inflammation in AD and T-helper 1 and 17 driven inflammation in psoriasis, have led to a therapeutic revolution. There are a number of novel treatment options available for AD and psoriasis with many more currently under investigation.
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173
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Lebwohl M. A new era in the treatment of atopic dermatitis. Br J Dermatol 2019; 181:658. [DOI: 10.1111/bjd.18349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M. Lebwohl
- Kimberly and Eric J. Waldman Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY, U.S.A
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174
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Treister AD, Kraff-Cooper C, Lio PA. Risk Factors for Dupilumab-Associated Conjunctivitis in Patients With Atopic Dermatitis. JAMA Dermatol 2019; 154:1208-1211. [PMID: 30167653 DOI: 10.1001/jamadermatol.2018.2690] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Clinical trials of dupilumab for atopic dermatitis (AD) have reported an increased incidence of conjunctivitis in patients who received dupilumab compared with those who received placebo. Objective To describe the characteristics of patients who develop conjunctivitis secondary to dupilumab treatment for AD. Design, Setting, and Participants Case series of 12 patients who reported development of conjunctivitis from a cohort of 142 patients treated with dupilumab for AD at a secondary care center from March 14, 2017, to March 29, 2018. Exposures Patients received a 600-mg injection of dupilumab as a loading dose and a 300-mg injection every 2 weeks thereafter. Main Outcomes and Measures Primary outcome measures were severity of AD as measured by the Investigator Global Assessment (IGA) score, a 5-point scale from 0 (clear) to 4 (severe), at the time of dupilumab initiation and at conjunctivitis onset. Results Of the 12 patients included in this series, 7 (58%) were male. The mean (SD) age of patients was 30 (8.1) years at the time conjunctivitis developed. All patients showed improvement of their AD at the time of conjunctivitis diagnosis, with a mean (SD) 1.9 (0.8)-point decrease in IGA score and 47.8% (11.2%) decrease in body surface area affected. Nine of the 12 patients (75%) had severe baseline AD with an IGA score of 4. All patients who discontinued treatment had severe AD at the time of initial dupilumab administration and had at least 1 atopic condition in addition to AD. Conclusions and Relevance Conjunctivitis that develops after administration of dupilumab to treat AD may be severe enough to necessitate stopping therapy. Severe conjunctivitis was more likely to develop in patients with more severe baseline AD who had a good response to dupilumab and an increased atopic phenotype. Studies are needed to confirm risk factors associated with development of conjunctivitis and to determine effective treatment.
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Affiliation(s)
- Alison D Treister
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Peter A Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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175
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Rademaker M, Agnew K, Andrews M, Baker C, Foley P, Gebauer K, Gupta M, Rubel DM, Somerville C, Sullivan J, Wong LC. Managing atopic dermatitis with systemic therapies in adults and adolescents: An Australian/New Zealand narrative. Australas J Dermatol 2019; 61:9-22. [PMID: 31529493 DOI: 10.1111/ajd.13141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022]
Abstract
With the rapid development of new, targeted therapies for the treatment of moderate/severe atopic dermatitis, it is opportune to review the available conventional systemic agents. We assess the published evidence for systemic therapies for atopic dermatitis and amalgamate this with real-world experience. Discussions are centred on when systemic therapy should be considered, which drug(s), what dose, how to sequence or combine these therapies, how long they should be continued for and what is considered success.
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Affiliation(s)
- Marius Rademaker
- Waikato Clinical Campus, University of Auckland's Faculty of Medical and Health Sciences, Hamilton, New Zealand
| | - Karen Agnew
- Dermatology Department, Greenlane Clinical Centre, Auckland, New Zealand.,Starship Children's Hospital, Auckland, New Zealand
| | | | - Christopher Baker
- St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Skin & Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Peter Foley
- St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Skin & Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia.,Probity Medical Research, Freemantle, Western Australia, Australia
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,The Skin Hospital, Darlinghurst, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Diana M Rubel
- Woden Dermatology, Phillip, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - Colin Somerville
- The Allergy West Clinic - Immunology, Perth, Western Australia, Australia
| | - John Sullivan
- Kingsway Dermatology, Miranda, New South Wales, Australia
| | - Li-Chuen Wong
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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176
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Wu KK, Borba AJ, Deng PH, Armstrong AW. Association between atopic dermatitis and conjunctivitis in adults: a population-based study in the United States. J DERMATOL TREAT 2019; 32:455-459. [DOI: 10.1080/09546634.2019.1659480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kevin K. Wu
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Andrea J. Borba
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Pierce H. Deng
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - April W. Armstrong
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
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177
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Chu C. Keeping an eye on the ocular problems in dupilumab clinical trials. Br J Dermatol 2019; 181:436-437. [DOI: 10.1111/bjd.18255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Chia‐Yu Chu
- Department of Dermatology National Taiwan University Hospital and National Taiwan University College of Medicine 7 Chung‐Shan South Rd. Taipei 10002 Taiwan
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178
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Yang TLB, Kim BS. Pruritus in allergy and immunology. J Allergy Clin Immunol 2019; 144:353-360. [PMID: 31395149 PMCID: PMC6690370 DOI: 10.1016/j.jaci.2019.06.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/20/2022]
Abstract
Although evolutionarily conserved to expel ectoparasites and aid in the clearance of toxins and noxious environmental stimuli from the host, the type 2 immune response can become pathologic in the setting of a variety of allergic disorders. Itch can be a behavioral extension of type 2 immunity by evoking scratching and, in the setting of disease, can become chronic and thus highly pathologic as well. Classically, our understanding of itch mechanisms has centered around the canonical IgE-mast cell-histamine axis. However, therapies aimed at blocking the histaminergic itch pathway have been largely ineffective, suggesting the existence of nonhistaminergic itch pathways. Indeed, recent advances in itch biology have provided critical new insight into a variety of novel therapeutic avenues for chronic itch in the setting of a number of allergic disorders. Here we highlight how these new developments will likely inform the problem of pruritus in a variety of well-established and emerging conditions in the field of allergy.
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Affiliation(s)
- Ting-Lin B Yang
- Center for the Study of Itch, Washington University School of Medicine, St Louis, Mo; Division of Dermatology, Department of Medicine, Washington University School of Medicine, St Louis, Mo
| | - Brian S Kim
- Center for the Study of Itch, Washington University School of Medicine, St Louis, Mo; Division of Dermatology, Department of Medicine, Washington University School of Medicine, St Louis, Mo; Department of Anesthesiology, Washington University School of Medicine, St Louis, Mo; Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Mo.
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179
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Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by pruritus, inflammatory erythematous skin lesions, and skin-barrier defect. Current mainstay treatments of emollients, steroids, calcineurin inhibitors, and immunosuppressants have limited efficacy and potentially serious side effects. Recent advances and understanding of the pathogenesis of AD have resulted in new therapies that target specific pathways with increased efficacy and the potential for less systemic side effects. New FDA-approved therapies for AD are crisaborole and dupilumab. The JAK-STAT inhibitors (baricitinib, upadacitinib, PF-04965842, ASN002, tofacitinib, ruxolitinib, and delgocitinib) have the most promising results of the emerging therapies. Other drugs with potential include the aryl hydrocarbon receptor modulating agent tapinarof, the IL-4/IL-13 antagonists lebrikizumab and tralokinumab, and the IL-31Rα antagonist nemolizumab. In this review, new and emerging AD therapies will be discussed along with their mechanisms of action and their potential based on clinical study data.
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Affiliation(s)
- Henry L Nguyen
- Department of Dermatology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA
| | - Katelyn R Anderson
- Department of Dermatology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA
| | - Megha M Tollefson
- Department of Dermatology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.
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180
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Russkamp D, Aguilar‐Pimentel A, Alessandrini F, Gailus‐Durner V, Fuchs H, Ohnmacht C, Chaker A, Angelis MH, Ollert M, Schmidt‐Weber CB, Blank S. IL-4 receptor α blockade prevents sensitization and alters acute and long-lasting effects of allergen-specific immunotherapy of murine allergic asthma. Allergy 2019; 74:1549-1560. [PMID: 30829405 DOI: 10.1111/all.13759] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Allergen-specific immunotherapy (AIT) is the only causal treatment for allergy. However, success rates vary depending on the type of allergy and disease background of the patient. Hence, strategies targeting an increased therapeutic efficacy are urgently needed. Here, the effects of blockade of IL-4 and IL-13 signaling on different phases of AIT were addressed. METHODS The impact of the recombinantly produced IL-4 and IL-13 antagonist IL-4 mutein (IL-4M) on allergic sensitization and AIT outcome in experimental allergic asthma were analyzed in a murine model. The effects of IL-4M administration were assessed prior/during sensitization, immediately after AIT under allergen challenge, and two weeks post-treatment. RESULTS Intervention with IL-4M prior/during sensitization led to strong induction of IgG1, IgG2a, IgG2b, and IgG3, decrease of specific and total IgE, as well as of IL-5 in serum. Similar effects on the serum immunoglobulin levels were observed immediately after IL4M-supplemented AIT during allergen challenge. Additionally, IL4M markedly suppressed type-2 cytokine secretion of splenocytes beyond the effect of AIT alone. These effects were equaled to those of AIT alone two weeks post-treatment. Intriguingly, here, IL-4M induced a sustained decrease of Th2-biased Tregs (ST2+ FOXP3+ GATA3intermediate ). CONCLUSIONS IL-4 and IL-13 blockade during experimental AIT demonstrates beneficial effects on immunological key parameters such as immunoglobulin and cytokine secretion immediately after AIT. Although two weeks later these effects were dropped to those of AIT alone, the number of potentially disease-triggering Th2-biased Tregs was further significantly decreased by IL-4M treatment. Hence, IL-4/IL13-targeting therapies prime the immune memory in therapy success-favoring manner.
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Affiliation(s)
- D. Russkamp
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
| | - A. Aguilar‐Pimentel
- German Mouse Clinic Institute of Experimental Genetics Helmholtz Center Munich Neuherberg Germany
| | - F. Alessandrini
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
| | - V. Gailus‐Durner
- German Mouse Clinic Institute of Experimental Genetics Helmholtz Center Munich Neuherberg Germany
| | - H. Fuchs
- German Mouse Clinic Institute of Experimental Genetics Helmholtz Center Munich Neuherberg Germany
| | - C. Ohnmacht
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
| | - A. Chaker
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
- Department of Otolaryngology Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - M. H. Angelis
- German Mouse Clinic Institute of Experimental Genetics Helmholtz Center Munich Neuherberg Germany
- Chair of Experimental Genetics School of Life Science Weihenstephan Technical University of Munich Freising Germany
- German Center for Diabetes Research (DZD) Neuherberg Germany
| | - M. Ollert
- Luxembourg Institute of Health (LIH) Esch‐sur‐Alzette Luxembourg
- Department of Dermatology and Allergy Center Odense Research Center for AnaphylaxisUniversity of Southern Denmark Odense Denmark
| | - C. B. Schmidt‐Weber
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
| | - S. Blank
- Center of Allergy and Environment (ZAUM) Technical University of Munich and Helmholtz Center Munich Member of the German Center of Lung Research (DZL) Munich Germany
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181
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Pharmacotherapies for the Treatment of Eosinophilic Esophagitis: State of the Art Review. Drugs 2019; 79:1419-1434. [DOI: 10.1007/s40265-019-01173-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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182
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Affiliation(s)
- Hiraku Suga
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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183
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Matthias J, Zielinski CE. Shaping the diversity of Th2 cell responses in epithelial tissues and its potential for allergy treatment. Eur J Immunol 2019; 49:1321-1333. [PMID: 31274191 DOI: 10.1002/eji.201848011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/14/2019] [Accepted: 07/04/2019] [Indexed: 12/21/2022]
Abstract
Th2 cells have evolved to protect from large helminth infections and to exert tissue protective functions in response to nonmicrobial noxious stimuli. The initiation, maintenance, and execution of these functions depend on the integration of diverse polarizing cues by cellular sensors and molecular programs as well as the collaboration with cells that are coopted for signal exchange. The complexity of input signals and cellular collaboration generates tissue specific Th2 cell heterogeneity and specialization. In this review, we aim to discuss the advances and recent breakthroughs in our understanding of Th2 cell responses and highlight developmental and functional differences among T cells within the diversifying field of type 2 immunity. We will focus on factors provided by the tissue microenvironment and highlight factors with potential implications for the pathogenesis of allergic skin and lung diseases. Especially new insights into the role of immunometabolism, the microbiota and ionic signals enhance the complexity of Th2 cell regulation and warrant a critical evaluation. Finally, we will discuss how this ensemble of established knowledge and recent breakthroughs about Th2 immunobiology advance our understanding of the pathogenesis of allergic diseases and how this could be exploited for future immunotherapies.
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Affiliation(s)
- Julia Matthias
- Institute of Virology, Technical University of Munich, 81675, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site, Munich, Germany
| | - Christina E Zielinski
- Institute of Virology, Technical University of Munich, 81675, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site, Munich, Germany.,TranslaTUM, Technical University of Munich, 81675, Munich, Germany
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184
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Moyle M, Cevikbas F, Harden JL, Guttman‐Yassky E. Understanding the immune landscape in atopic dermatitis: The era of biologics and emerging therapeutic approaches. Exp Dermatol 2019; 28:756-768. [PMID: 30825336 PMCID: PMC6850480 DOI: 10.1111/exd.13911] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/28/2019] [Accepted: 02/14/2019] [Indexed: 12/15/2022]
Abstract
Atopic dermatitis (AD) is a chronic, systemic, inflammatory disease that affects the skin and is characterized by persistent itch and marked redness. AD is associated with an increased risk of skin infections and a reduced quality of life. Most AD treatment options to date were not designed to selectively target disease-causing pathways that have been established for this indication. Topical therapies have limited efficacy in moderate-to-severe disease, and systemic agents such as corticosteroids and immunosuppressants present with tolerability issues. Advances in the understanding of AD pathobiology have made possible a new generation of more disease-specific AD therapies. AD is characterized by the inappropriate activation of type 2 T helper (Th2) cells and type 2 innate lymphoid (ILC2) cells, with a predominant increase in type 2 cytokines in the skin, including interleukin (IL)-13 and IL-4. Both cytokines are implicated in tissue inflammation and epidermal barrier dysfunction, and monoclonal antibodies targeting each of these interleukins or their receptors are in clinical development in AD. In March 2017, dupilumab, a human anti-IL-4Rα antibody, became the first biologic to receive approval in the United States for the treatment of moderate-to-severe AD. The anti-IL-13 monoclonal antibodies lebrikizumab and tralokinumab, which bind different IL-13 epitopes with potentially different effects, are currently in advanced-stage trials. Here, we briefly review the underlying pathobiology of AD, the scientific basis for current AD targets, and summarize current clinical studies of these agents, including new research to develop both predictive and response biomarkers to further advance AD therapy in the era of precision medicine.
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185
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Abstract
Atopic dermatitis (AD) is caused by complex interactions between a variety of genetic and environmental factors that contribute to the maintenance of the chronic inflammatory skin condition. Most conventional treatments have been designed for the so-called 'average patient'. In recent years however, many previously unknown details pertaining to the mechanisms of the pathogenesis of AD have been elucidated, and novel treatments based on these pathological mechanisms or on subgroup classifications have been developed. Herein, how future treatment strategies for AD can be developed is described.
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Affiliation(s)
- Ken Igawa
- a Department of Dermatology , Dokkyo Medical University, School of Medicine , Tochigi , Japan
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186
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Ring J, Zink A, Arents BWM, Seitz IA, Mensing U, Schielein MC, Wettemann N, de Carlo G, Fink-Wagner A. Atopic eczema: burden of disease and individual suffering - results from a large EU study in adults. J Eur Acad Dermatol Venereol 2019; 33:1331-1340. [PMID: 31002197 DOI: 10.1111/jdv.15634] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atopic eczema (AE, atopic dermatitis) is one of the most common non-communicable inflammatory skin diseases affecting 1-5% of the adult population in Europe with marked impairment in quality of life. In spite of great progress in understanding the pathophysiology of disturbed skin barrier and immune deviation, AE still represents a problem in daily clinical practice. Furthermore, the true impact of AE on individual suffering is often not recognized. OBJECTIVES With a large European study, we wanted to provide insights into the actual suffering and individual burden of disease in adult patients with AE. METHODS A total of 1189 adult patients (18-87 years, 56% female) with moderate to severe AE were recruited in nine European countries by dermatologists or allergists together with the help of patient organizations. A computer-assisted telephone interview was performed by experienced interviewers between October 2017 and March 2018. The following instruments were used to assess severity or measure quality of life: Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS-D) and a newly developed Atopic Eczema Score of Emotional Consequences (AESEC). Patients were also asked to self-assess the severity of their disease. RESULTS Despite current treatment, 45% of participants still had actual moderate to very severe AE in POEM. Due to their skin disease, 57% missed at least 1 day of work in the preceding year. DLQI showed moderate to extremely large impairment in 55%. According to HADS-D, 10% scored on or above the threshold of eight points with signs of depressive symptoms. Assessed with AESEC, 57% were emotionally burdened with feelings such as 'trying to hide the eczema', 'feeling guilty about eczema', having 'problems with intimacy' and more. Of persons actually suffering from severe AE, 88% stated that their AE at least partly compromised their ability to face life. CONCLUSIONS This real-life study shows that adults with a moderate to severe form of AE are suffering more than what would be deemed acceptable. There is a need for increased awareness of this problem among healthcare professionals, policymakers and the general public to support research in the development of new and more effective treatments and provide access to better and affordable health care for affected patients.
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Affiliation(s)
- J Ring
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - B W M Arents
- European Federation of Allergy and Airway Diseases Patient's Associations, Brussels, Belgium
| | | | | | - M C Schielein
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | | | - G de Carlo
- European Federation of Allergy and Airway Diseases Patient's Associations, Brussels, Belgium
| | - A Fink-Wagner
- European Federation of Allergy and Airway Diseases Patient's Associations, Brussels, Belgium
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187
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Simon D, Simon HU. Therapeutic strategies for eosinophilic dermatoses. Curr Opin Pharmacol 2019; 46:29-33. [DOI: 10.1016/j.coph.2019.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/17/2022]
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188
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Thyssen JP, de Bruin-Weller MS, Paller AS, Leshem YA, Vestergaard C, Deleuran M, Drucker AM, Foelster-Holst R, Traidl-Hoffmann C, Eyerich K, Taieb A, Su JC, Bieber T, Cork MJ, Eichenfield LF, Guttman-Yassky E, Wollenberg A. Conjunctivitis in atopic dermatitis patients with and without dupilumab therapy - international eczema council survey and opinion. J Eur Acad Dermatol Venereol 2019; 33:1224-1231. [PMID: 31056788 PMCID: PMC6619239 DOI: 10.1111/jdv.15608] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
Background Conjunctivitis is common in patients with atopic dermatitis (AD) in general and a commonly reported adverse event in AD clinical trials with dupilumab. Objective To survey opinions and experience about conjunctivitis occurring in AD, including those during dupilumab treatment in a group of AD experts from the International Eczema Council (IEC). Methods Electronic survey and in‐person discussion of management strategies. Results Forty‐six (53.5%) IEC members from 19 countries responded to the survey. Consensus was reached for several statements regarding diagnostic workup, referral and treatment. IEC members suggest that patients with AD should (i) routinely be asked about ocular complaints or symptoms, (ii) obtain information about the potential for conjunctivitis before starting dupilumab therapy and (iii) if indicated, be treated with dupilumab despite previous or current conjunctivitis. In cases of new‐onset conjunctivitis, there was consensus that dupilumab treatment should be continued when possible, with appropriate referral to an ophthalmologist. Limitations The study relies on expert opinion from dermatologists. Responses from few dermatologists without dupilumab access were not excluded from the survey. Conclusion The IEC recommends that dermatologists address conjunctivitis in patients with AD, especially during treatment with dupilumab.
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Affiliation(s)
- J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - M S de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Y A Leshem
- Department of Dermatology, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Vestergaard
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - R Foelster-Holst
- Department of Dermatology, Venereology and Allergy, University Clinics of Schleswig-Holstein, Kiel, Germany
| | - C Traidl-Hoffmann
- Institute of Environmental Medicine, UNIKA-T, Technical University of Munich, Augsburg, Germany.,Research Center for Environmental Health, Helmholtz Zentrum München, Augsburg, Germany.,Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - K Eyerich
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - A Taieb
- Department of Adult and Pediatric Dermatology, CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - J C Su
- Department of Dermatology, Eastern Health, Monash University, Parkville, Vic, Australia.,Department of Pediatrics, MCRI, University of Melbourne, Parkville, Vic, Australia
| | - T Bieber
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - M J Cork
- Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - L F Eichenfield
- Department of Dermatology, San Diego School of Medicine, University of California, San Diego, CA, USA.,Department of Pediatrics, San Diego School of Medicine, University of California, San Diego, CA, USA
| | | | - A Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Klinikum Thalkirchner Straße, München, Germany
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189
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Litman T. Personalized medicine-concepts, technologies, and applications in inflammatory skin diseases. APMIS 2019; 127:386-424. [PMID: 31124204 PMCID: PMC6851586 DOI: 10.1111/apm.12934] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/31/2019] [Indexed: 12/19/2022]
Abstract
The current state, tools, and applications of personalized medicine with special emphasis on inflammatory skin diseases like psoriasis and atopic dermatitis are discussed. Inflammatory pathways are outlined as well as potential targets for monoclonal antibodies and small-molecule inhibitors.
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Affiliation(s)
- Thomas Litman
- Department of Immunology and MicrobiologyUniversity of CopenhagenCopenhagenDenmark
- Explorative Biology, Skin ResearchLEO Pharma A/SBallerupDenmark
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190
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New and emerging therapies for paediatric atopic dermatitis. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:343-353. [DOI: 10.1016/s2352-4642(19)30030-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 01/02/2023]
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191
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Zak M, Hanan EJ, Lupardus P, Brown DG, Robinson C, Siu M, Lyssikatos JP, Romero FA, Zhao G, Kellar T, Mendonca R, Ray NC, Goodacre SC, Crackett PH, McLean N, Hurley CA, Yuen PW, Cheng YX, Liu X, Liimatta M, Kohli PB, Nonomiya J, Salmon G, Buckley G, Lloyd J, Gibbons P, Ghilardi N, Kenny JR, Johnson A. Discovery of a class of highly potent Janus Kinase 1/2 (JAK1/2) inhibitors demonstrating effective cell-based blockade of IL-13 signaling. Bioorg Med Chem Lett 2019; 29:1522-1531. [PMID: 30981576 DOI: 10.1016/j.bmcl.2019.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/27/2019] [Accepted: 04/03/2019] [Indexed: 01/22/2023]
Abstract
Disruption of interleukin-13 (IL-13) signaling with large molecule antibody therapies has shown promise in diseases of allergic inflammation. Given that IL-13 recruits several members of the Janus Kinase family (JAK1, JAK2, and TYK2) to its receptor complex, JAK inhibition may offer an alternate small molecule approach to disrupting IL-13 signaling. Herein we demonstrate that JAK1 is likely the isoform most important to IL-13 signaling. Structure-based design was then used to improve the JAK1 potency of a series of previously reported JAK2 inhibitors. The ability to impede IL-13 signaling was thereby significantly improved, with the best compounds exhibiting single digit nM IC50's in cell-based assays dependent upon IL-13 signaling. Appropriate substitution was further found to influence inhibition of a key off-target, LRRK2. Finally, the most potent compounds were found to be metabolically labile, which makes them ideal scaffolds for further development as topical agents for IL-13 mediated diseases of the lungs and skin (for example asthma and atopic dermatitis, respectively).
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Affiliation(s)
- Mark Zak
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
| | - Emily J Hanan
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | | | - David G Brown
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Colin Robinson
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Michael Siu
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | | | | | - Guiling Zhao
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Terry Kellar
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Rohan Mendonca
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Nicholas C Ray
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Simon C Goodacre
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Peter H Crackett
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Neville McLean
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Christopher A Hurley
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Po-Wai Yuen
- Pharmaron Beijing Co. Ltd., 6 Taihe Road, BDA, Beijing 100176, PR China
| | - Yun-Xing Cheng
- Pharmaron Beijing Co. Ltd., 6 Taihe Road, BDA, Beijing 100176, PR China
| | - Xiongcai Liu
- Pharmaron Beijing Co. Ltd., 6 Taihe Road, BDA, Beijing 100176, PR China
| | - Marya Liimatta
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Pawan Bir Kohli
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Jim Nonomiya
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Gary Salmon
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Gerry Buckley
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Julia Lloyd
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow, Essex CM19 5TR, United Kingdom
| | - Paul Gibbons
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Nico Ghilardi
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Jane R Kenny
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Adam Johnson
- Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
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192
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193
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Abstract
Atopic dermatitis (AD) is one of the most common inflammatory skin diseases. AD is driven by barrier dysfunction and abnormal immune activation of T helper (Th) 2, Th22, and varying degrees of Th1 and Th17 among various subtypes. The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and spleen tyrosine kinase (SYK) pathways are involved in signaling of several AD-related cytokines, such as IFN-γ, IL-4, IL-13, IL-31, IL-33, IL-23, IL-22, and IL-17, mediating downstream inflammation and barrier alterations. While AD is primarily Th2-driven, the clinical and molecular heterogeneity of AD endotypes highlights the unmet need for effective therapeutic options that target more than one immune axis and are safe for long-term use. The JAK inhibitors, which target different combinations of kinases, have overlapping but distinct mechanisms of action and safety profiles. Several topical and oral JAK inhibitors have been shown to decrease AD severity and symptoms. A review of the JAK and SYK inhibitors that are currently undergoing evaluation for efficacy and safety in the treatment of AD summarizes available data on a promising area of therapeutics and further elucidates the complex molecular interactions that drive AD.
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Affiliation(s)
- Helen He
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, 5 E. 98th Street, New York, NY, 10029, USA.
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA.
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194
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Yao Y, Ravn Jørgensen AH, Thomsen SF. Biologics for chronic inflammatory skin diseases: an update for the clinician. J DERMATOL TREAT 2019; 31:108-130. [DOI: 10.1080/09546634.2019.1589643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Yiqiu Yao
- Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Simon Francis Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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195
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Johnson BB, Franco AI, Beck LA, Prezzano JC. Treatment-resistant atopic dermatitis: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12:181-192. [PMID: 30962700 PMCID: PMC6432884 DOI: 10.2147/ccid.s163814] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Atopic dermatitis (AD) is a common, chronic, relapsing-remitting inflammatory disease that can be challenging to treat. Patients with mild disease are usually managed well with good skin care practices including moisturization and appropriate bathing along with intermittent use of topical therapies such as topical corticosteroids and/or topical calcineurin inhibitors during flares. Patients with frequent flares may benefit from proactive application of topical therapies twice a week to the most troublesome areas. Patients with severe disease often present significant treatment challenges. Systemic therapies are usually required for severe AD but have varying degrees of success and can be associated with side-effect profiles that require counseling and close monitoring. Phototherapy has been shown to have success in treating moderate-to-severe AD, but several factors can limit its utility and efficacy including cost and access. New therapies are in development targeting specific pathways relevant for AD. Dupilumab was the first biologic treatment approved in North America, Europe, and Japan for adults with moderate-to-severe AD. Although this treatment can lead to rapid improvement in the majority of patients, there are inadequate responders. In this review, we discuss the clinical challenges and treatment options for moderate-to-severe refractory AD.
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Affiliation(s)
- Brian B Johnson
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA,
| | - Abigail I Franco
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA,
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA,
| | - James C Prezzano
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA,
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196
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Leshem YA, Bissonnette R, Paul C, Silverberg JI, Irvine AD, Paller AS, Cork MJ, Guttman-Yassky E. Optimization of placebo use in clinical trials with systemic treatments for atopic dermatitis: an International Eczema Council survey-based position statement. J Eur Acad Dermatol Venereol 2019; 33:807-815. [PMID: 30859656 PMCID: PMC6594032 DOI: 10.1111/jdv.15480] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND As novel systemic therapeutics for patients with atopic dermatitis (AD) are developed, ethical and methodological concerns regarding placebo-controlled-trials (PCT) have surfaced. OBJECTIVE To guide the design and implementation of PCT in AD, focusing on trials with systemic medications. METHODS A subgroup of the International Eczema Council (IEC) developed a consensus e-survey, which was disseminated to IEC members. RESULTS The response rate was 43/82 (52%). Consensus was reached on 24/27 statements and on 3/11 options from multiple-selection statements, including: performing monotherapy studies in proof-of-concept phases; avoiding concomitant topical corticosteroids or calcineurin inhibitors until a predefined timepoint as rescue (borderline consensus); selection of sites and assessors with recognized expertise in AD clinical trials; clear definition and identification of baseline disease severity; minimizing time and proportion of patients on placebo; using daily emollients with several options provided; instigating open-label extension studies for enrolment after a predefined timepoint; and including outcomes which set a higher bar for disease clearance. CONCLUSION Conducting PCT in AD requires balancing several, sometimes opposing principles, including ethics, methodology, regulatory requirements and real-world needs. This paper can provide a framework for conducting PCT with systemic medications for patients with AD.
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Affiliation(s)
- Y A Leshem
- Department of Dermatology, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - C Paul
- Paul Sabatier University, Toulouse, France
| | - J I Silverberg
- Department of Dermatology, Department of Preventive Medicine, and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A D Irvine
- Pediatric Dermatology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.,National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.,Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine and Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - M J Cork
- Sheffield Dermatology Research Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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197
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Al-Afif KAM, Buraik MA, Buddenkotte J, Mounir M, Gerber R, Ahmed HM, Tallman AM, Steinhoff M. Understanding the Burden of Atopic Dermatitis in Africa and the Middle East. Dermatol Ther (Heidelb) 2019; 9:223-241. [PMID: 30850961 PMCID: PMC6522619 DOI: 10.1007/s13555-019-0285-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Indexed: 12/13/2022] Open
Abstract
Atopic dermatitis (AD) is a common inflammatory skin disease characterized by intensely pruritic lesions. The prevalence of atopic dermatitis is increasing in developing regions, including Africa and the Middle East. However, these regions are underrepresented in the dermatology literature, and a better understanding of the growing burden of atopic dermatitis in Africa and the Middle East is necessary. Herein, we summarize current knowledge on atopic dermatitis epidemiology, disease burden, and treatment options in Africa and the Middle East, highlighting the unmet needs of patients in these regions. With these needs in mind, we provide clinical recommendations for appropriate management of atopic dermatitis in Africa and the Middle East. FUNDING: Pfizer Inc. Plain language summary available for this article.
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Affiliation(s)
| | - Mohamad Ali Buraik
- Department of Dermatology, King Fahd Central Hospital, Jizan, Saudi Arabia
| | - Joerg Buddenkotte
- Department of Dermatology and HMC Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Mounir
- Departments of Inflammation and Immunology and Emerging Markets, Pfizer Inc, Dubai, United Arab Emirates
| | - Robert Gerber
- Departments of Outcomes and Evidence and Statistics, Pfizer Inc, Groton, CT, USA
| | - Haytham Mohamed Ahmed
- Departments of Inflammation and Immunology and Emerging Markets, Pfizer Inc, Jeddah, Saudi Arabia
| | | | - Martin Steinhoff
- Department of Dermatology and HMC Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Qatar University, Doha, Qatar.,Department Of Dermatology, Weill Cornell University, New York, NY, USA
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198
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Sánchez-Borges M, Capriles-Hulett A, Ortega-Martell JA, Zubeldia IA. New and Potential Treatments for Atopic Dermatitis: Biologicals and Small Molecules. Curr Allergy Asthma Rep 2019; 19:18. [PMID: 30815760 DOI: 10.1007/s11882-019-0849-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW An update on new therapies currently approved or potentially useful in the future for the management of patients suffering moderate-to-severe atopic dermatitis. RECENT FINDINGS New pathogenic mechanisms involved in atopic dermatitis have permitted to propose novel therapeutic approaches devised to control the inflammatory process observed in involved cutaneous tissues by neutralizing mediators, cytokines, and their receptors. Recent research findings have disclosed important and previously unrecognized pathogenic mechanisms that have resulted in innovative targeted therapies, such as dupilumab, and potentially other biologicals and small molecules. Further studies should permit the sub-classification of patients according to the relevance of different mediators and inflammatory cells. It can be concluded that the treatment of atopic dermatitis has entered into the era of personalized/precision medicine.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.
- Clínica El Avila, 6a transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060, Venezuela.
| | - Arnaldo Capriles-Hulett
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
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199
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Yu S, Li Y, Zhou Y, Follansbee T, Hwang ST. Immune mediators and therapies for pruritus in atopic dermatitis and psoriasis. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2019. [DOI: 10.1002/cia2.12049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sebastian Yu
- Department of Dermatology; University of California Davis School of Medicine; Sacramento California
- Department of Dermatology; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Dermatology; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Yanxi Li
- Department of Dermatology; University of California Davis School of Medicine; Sacramento California
| | - Yan Zhou
- Department of Dermatology; University of California Davis School of Medicine; Sacramento California
| | - Taylor Follansbee
- Department of Neurobiology, Physiology and Behavior; University of California Davis; Davis California
| | - Samuel T. Hwang
- Department of Dermatology; University of California Davis School of Medicine; Sacramento California
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200
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Feasibility Analysis of Interleukin-13 as a Target for a Therapeutic Vaccine. Vaccines (Basel) 2019; 7:vaccines7010020. [PMID: 30759882 PMCID: PMC6466196 DOI: 10.3390/vaccines7010020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The development of therapeutic vaccines requires thorough knowledge of potential hazards associated with long-term inactivation of self-proteins. Among potential targets, interleukin 13 (IL-13) merits consideration, as monoclonal antibodies disrupting IL-13 signaling are proving to be exceedingly effective in common conditions such as atopic dermatitis. OBJECTIVE Given the mass publication of scientific data, an appraisal of safety aspects is challenging. METHODS We here provide a three-fold approach to survey clinically relevant information on off-target effects, both adverse and beneficial, that may potentially be encountered in patients undergoing long-term IL-13 inactivation. First, we review non-clinical data in vivo and in vitro. Second, we summarize safety data accumulating from patients dosed with anti-IL-13 drugs. Third, we exploit human mutation data as well as emerging large-scale genetic datasets (global exome data from 60,000 patients) to obtain information on any association of IL-13-inactivating genetic variants with disease states. In addition, we: (1) dissect the precise efficacy signals obtained with various drugs targeting IL-13 and/or IL-4, and (2) summarize unintended, but potentially beneficial effects of prolonged IL-13 inactivation on several functional systems. RESULTS Prolonged repression of IL-13 in several thousand patients so far has not uncovered any non-redundant functions of IL-13 in immune defense. Furthermore, missense mutations in the key genes IL-13, IL-13Rα1, IL-13Rα2, IL-4, IL-4Rα are common, while no case reports have been published on any immune deficiency or increased risk of neoplastic disease associated with such mutations, suggesting that these genes do not harbor non-redundant roles in adult outbred humans. In terms of efficacy, data from clinically used drugs strongly suggest that targeting IL-13 only, as opposed to IL-13 and IL-4, may be effective in eczema while being more selective. Importantly, several lines of evidence suggest that inhibition of IL-13 may in fact harbor potentially beneficial effects on non-targeted systems, including glucose metabolism, hepatic fibrosis, and atherosclerosis, suggesting that respective outcomes should be systematically captured in patients dosed with IL-13 interfering drugs. Collectively, available evidence suggests that IL-13 may fulfill safety requirements required for the target of a therapeutic vaccine.
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