151
|
Nakahara T, Kido‐Nakahara M, Tsuji G, Furue M. Basics and recent advances in the pathophysiology of atopic dermatitis. J Dermatol 2020; 48:130-139. [DOI: 10.1111/1346-8138.15664] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Takeshi Nakahara
- Department of DermatologyGraduate School of Medical SciencesKyushu University FukuokaJapan
- Division of Skin Surface Sensing Graduate School of Medical Sciences Kyushu University FukuokaJapan
| | - Makiko Kido‐Nakahara
- Department of DermatologyGraduate School of Medical SciencesKyushu University FukuokaJapan
| | - Gaku Tsuji
- Department of DermatologyGraduate School of Medical SciencesKyushu University FukuokaJapan
- Research and Clinical Center for Yusho and Dioxin Kyushu University Hospital Fukuoka Japan
| | - Masutaka Furue
- Department of DermatologyGraduate School of Medical SciencesKyushu University FukuokaJapan
- Division of Skin Surface Sensing Graduate School of Medical Sciences Kyushu University FukuokaJapan
- Research and Clinical Center for Yusho and Dioxin Kyushu University Hospital Fukuoka Japan
| |
Collapse
|
152
|
Scheffold A, Bacher P, LeibundGut-Landmann S. T cell immunity to commensal fungi. Curr Opin Microbiol 2020; 58:116-123. [PMID: 33120172 DOI: 10.1016/j.mib.2020.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
Fungi are an important part of the microbiota in healthy barrier tissues. Fungal dysbiosis in turn is associated with local and distal inflammatory diseases. Recent advances have shed light on the antigen-specific IL-17-dependent mechanisms that regulate fungal commensalism and prevent fungal overgrowth during homeostasis. Progress in our understanding of species-specific differences in fungus-host interactions provides new hypotheses of why Candida albicans-targeting T cells exceed those directed against other fungal species in the human T cell repertoire. Importantly, C. albicans-specific Th17 cells can also contribute to immune pathology in distant organs such as the lung via cross-reaction with heterologous antigens.
Collapse
Affiliation(s)
- Alexander Scheffold
- Institute of Immunology, Christian-Albrechts Universität zu Kiel and Universitätsklinik Schleswig-Holstein, Kiel, Germany
| | - Petra Bacher
- Institute of Immunology, Christian-Albrechts Universität zu Kiel and Universitätsklinik Schleswig-Holstein, Kiel, Germany; Institute of Clinical Molecular Biology, Christian-Albrechts Universität zu Kiel, Kiel, Germany
| | - Salomé LeibundGut-Landmann
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Switzerland; Institute of Experimental Immunology, University of Zürich, Switzerland.
| |
Collapse
|
153
|
T-bet and STAT6 Coordinately Suppress the Development of IL-9-Mediated Atopic Dermatitis-Like Skin Inflammation in Mice. J Invest Dermatol 2020; 141:1274-1285.e5. [PMID: 33068596 DOI: 10.1016/j.jid.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022]
Abstract
T-bet and signal transducer and activator of transcription (STAT) 6 are critical factors for helper T-cell differentiation in humans and mice. Additionally, polymorphisms in TBX21 (T-bet) and STAT6 are associated with the susceptibility of allergic diseases. However, precise mechanisms of the reciprocal regulation between T-bet and STAT6 in allergy remain unclear. To determine the reciprocal regulation in vivo, we investigated the phenotype of T-bet/STAT6 double-deficient (T-bet-/- STAT6-/-) mice. Unexpectedly, T-bet-/- STAT6-/- mice but not T-bet-/- mice or STAT6-/- mice spontaneously developed severe dermatitis. Not only eosinophils and mast cells but also CD4+ T cells infiltrated into the skin of T-bet-/- STAT6-/- mice. Adoptive transfer of CD4+ T cells of T-bet-/- STAT6-/- mice into severe combined immunodeficient mice induced the accumulation of eosinophils and mast cells in the skin, whereas depletion of CD4+ T cells ameliorated the dermatitis in T-bet-/- STAT6-/- mice. Comprehensive transcriptome analyses revealed that IL-9 expression was enhanced in T-bet-/- STAT6-/- CD4+ T cells. Indeed, IL-9 neutralization ameliorated the dermatitis in T-bet-/- STAT6-/- mice. T-bet-/- STAT6-/- CD4+ T cells expressed functional thymic stromal lymphopoietin receptors and produced large amounts of IL-9 on thymic stromal lymphopoietin stimulation. These results indicate that T-bet and STAT6 coordinately suppress atopic dermatitis-like skin inflammation, possibly by inhibiting thymic stromal lymphopoietin-dependent IL-9 production in CD4+ T cells.
Collapse
|
154
|
Cork MJ, Thaçi D, Eichenfield LF, Arkwright PD, Sun X, Chen Z, Akinlade B, Boklage S, Guillemin I, Kosloski MP, Kamal MA, O'Malley JT, Patel N, Graham NMH, Bansal A. Dupilumab provides favourable long-term safety and efficacy in children aged ≥ 6 to < 12 years with uncontrolled severe atopic dermatitis: results from an open-label phase IIa study and subsequent phase III open-label extension study. Br J Dermatol 2020; 184:857-870. [PMID: 32969489 PMCID: PMC8247037 DOI: 10.1111/bjd.19460] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 02/06/2023]
Abstract
Background Children aged ≥ 6 to < 12 years with severe atopic dermatitis (AD) have limited treatment options. In a 16‐week, randomized, placebo‐controlled, phase III trial in children, dupilumab, a monoclonal antibody inhibiting interleukin (IL)‐4/IL‐13 signalling, significantly improved signs and symptoms with acceptable safety; longer‐term safety and efficacy data are lacking. Objectives To report the pharmacokinetic profile and long‐term safety and efficacy of dupilumab in children (aged ≥ 6 to < 12 years) with severe AD. Methods Children (aged ≥ 6 to < 12 years) with severe AD were enrolled in a global, multicentre, phase IIa, open‐label, ascending‐dose, sequential cohort study and subsequent open‐label extension (OLE) study. Patients received single‐dose dupilumab 2 or 4 mg kg−1 followed by 8‐week pharmacokinetic sampling, then 2 or 4 mg kg−1 weekly for 4 weeks (phase IIa), followed by the same weekly regimen (OLE). Primary endpoints were dupilumab concentration–time profile and treatment‐emergent adverse events (TEAEs); secondary assessments included Eczema Area and Severity Index (EASI) and Peak Pruritus Numeric Rating Scale (PP‐NRS) score. Results Of 38 children enrolled, 37 completed phase IIa and 33 continued to the OLE. Nonlinear, target‐mediated pharmacokinetics characterized dupilumab concentrations (week 24–48 mean serum concentrations: 2 mg kg−1, 61–77 mg L−1; 4 mg kg−1, 143–181 mg L−1). TEAEs were mostly mild to moderate and transient; none led to treatment discontinuation. The most commonly reported TEAEs were nasopharyngitis (2 mg kg−1, 47%; 4 mg kg−1, 56%) and AD exacerbation (29% and 13%, respectively). Single‐dose dupilumab rapidly improved AD with further improvements through week 52. Mean EASI and PP‐NRS improved by −37%/−33% and −17%/−20% at week 2 (phase IIa) and −92%/−84% and −70%/−58% at week 52 (OLE), respectively. Conclusions These safety and efficacy results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD. What is already known about this topic?Severe atopic dermatitis (AD) has a marked negative impact on patient quality of life and can cause financial burden owing to a lack of effective treatments. Dupilumab significantly improved signs and symptoms of AD with an acceptable safety profile in a 16‐week randomized, double‐blind, placebo‐controlled phase III study in children aged ≥ 6 to < 12 years with severe AD.
What does this study add?This study extends information on the safety, efficacy and pharmacokinetic profile of dupilumab treatment for up to 52 weeks in children aged ≥ 6 to < 12 years with severe AD. The results support the use of dupilumab as a continuous long‐term treatment for children aged ≥ 6 to < 12 years with severe AD.
Linked Comment: Sibbald. Br J Dermatol 2021; 184:792–793.
Collapse
Affiliation(s)
- M J Cork
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Children's Hospital Clinical Research Facility, Sheffield, UK
| | - D Thaçi
- Institute and Comprehensive Center of Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - L F Eichenfield
- Departments of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - P D Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - X Sun
- Regeneron Pharmaceuticals, Inc., Basking Ridge, NJ, USA
| | - Z Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - B Akinlade
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - S Boklage
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - M P Kosloski
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - M A Kamal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | - N M H Graham
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - A Bansal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| |
Collapse
|
155
|
Nakahara T, Izuhara K, Onozuka D, Nunomura S, Tamagawa-Mineoka R, Masuda K, Ichiyama S, Saeki H, Kabata Y, Abe R, Ohtsuki M, Kamiya K, Okano T, Miyagaki T, Ishiuji Y, Asahina A, Kawasaki H, Tanese K, Mitsui H, Kawamura T, Takeichi T, Akiyama M, Nishida E, Morita A, Tonomura K, Nakagawa Y, Sugawara K, Tateishi C, Kataoka Y, Fujimoto R, Kaneko S, Morita E, Tanaka A, Hide M, Aoki N, Sano S, Matsuda-Hirose H, Hatano Y, Takenaka M, Murota H, Katoh N, Furue M. Exploration of biomarkers to predict clinical improvement of atopic dermatitis in patients treated with dupilumab: A study protocol. Medicine (Baltimore) 2020; 99:e22043. [PMID: 32957324 PMCID: PMC7505282 DOI: 10.1097/md.0000000000022043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common eczematous skin disorder that profoundly reduces the quality of life due to intractable pruritus. Excellent therapeutic success of the anti-interleukin 4 receptor-α antibody dupilumab in clinical trials and a real-world clinical context indicates the crucial roles of interleukin (IL)-4 and IL-13 in the pathogenesis of AD. Along with the clinical improvement in skin scores and pruritus, dupilumab significantly and progressively reduces and normalizes the upregulated expression of T helper type 2 signatures such as Chemokine (C-C motif) ligand (CCL)17, CCL18, CCL22, and CCL26 in the lesional skin of AD. However, no blood/serum biomarkers are known to predict good or poor outcome in patients with AD treated with dupilumab. METHODS Patients are at least 18 years of age and have moderate-to-severe AD with Eczema Area and Severity Index (EASI) ≥16, Investigator's Global Assessment ≥3, and body surface area ≥10%. We are going to enroll more than 130 subjects from 18 medical facilities. Clinical objective findings will be evaluated by EASI. Subjective symptoms will be assessed by Patient-Oriented Eczema Measure, Numerical Rating Scale for Pruritus (Pruritus-NRS), Skin Comfort-NRS, and Treatment Satisfaction-NRS. We will measure 18 blood/serum biomarkers including % eosinophils in blood cell count, lactate dehydrogenase, total IgE, soluble interleukin 2 receptor, CCL17, CCL18, CCL22, CCL26, CCL27, IL-13, IL-22, IL-24, IL-25, IL-31, IL-33, thymic stromal lymphopoietin, periostin, and squamous cell carcinoma antigen-2. The clinical evaluation and biomarker sampling will be performed at 0, 2, 4, 8, and 16 weeks of dupilumab treatment. We will also perform proteomic analysis (of roughly 300 proteins) of the patients' sera obtained at 0 and 2 weeks of treatment. The primary endpoint is the association between "baseline levels of 18 biomarkers" and "% change from baseline of EASI at 16 weeks of dupilumab treatment." DISCUSSION This is the first clinical trial to explore the biomarkers, including potential proteomic markers, most strongly associated with improvement in EASI in patients with moderate-to-severe AD treated with dupilumab for 16 weeks (B-PAD study). A limitation is that we will only enroll Japanese patients.
Collapse
Affiliation(s)
- Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga
| | - Daisuke Onozuka
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka
| | - Satoshi Nunomura
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga
| | - Risa Tamagawa-Mineoka
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Koji Masuda
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Susumu Ichiyama
- Department of Dermatology, Nippon Medical School, Bunkyo-ku, Tokyo
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Bunkyo-ku, Tokyo
| | - Yudai Kabata
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Riichiro Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi
| | - Tatsuro Okano
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Kanagawa
| | - Tomomitsu Miyagaki
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Kanagawa
| | - Yozo Ishiuji
- Department of Dermatology, The Jikei University School of Medicine, Minato-ku
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Minato-ku
| | - Hiroshi Kawasaki
- Department of Dermatology, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - Keiji Tanese
- Department of Dermatology, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - Hiroshi Mitsui
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Shimokato, Chuo-shi, Yamanashi
| | - Tatsuyoshi Kawamura
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Shimokato, Chuo-shi, Yamanashi
| | - Takuya Takeichi
- Department of Dermatology, Nagoya University Graduate School of Medicine, Showa-ku
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Showa-ku
| | - Emi Nishida
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Kyoko Tonomura
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University
| | - Yukinobu Nakagawa
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University
| | - Koji Sugawara
- Department of Dermatology, Osaka City University Graduate School of Medicine, Abeno-ku
| | - Chiharu Tateishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Abeno-ku
| | - Yoko Kataoka
- Department of Dermatology, Osaka Habikino Medical Center, Habikino City, Osaka
| | - Rai Fujimoto
- Department of Dermatology, Osaka Habikino Medical Center, Habikino City, Osaka
| | - Sakae Kaneko
- Department of Dermatology, Shimane University Faculty of Medicine, Matsue, Shimane
| | - Eishin Morita
- Department of Dermatology, Shimane University Faculty of Medicine, Matsue, Shimane
| | - Akio Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima
| | - Natsuko Aoki
- Department of Dermatology, Kochi Medical School, Okatoyo-cho, Nankoku-shi, Kochi
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Okatoyo-cho, Nankoku-shi, Kochi
| | - Haruna Matsuda-Hirose
- Department of Dermatology, Faculty of Medicine, Oita University, Hasama-machi, Yufu, Oita
| | - Yutaka Hatano
- Department of Dermatology, Faculty of Medicine, Oita University, Hasama-machi, Yufu, Oita
| | - Motoi Takenaka
- Department of Dermatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Nagasaki, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki City, Nagasaki, Japan
| | - Norito Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka
| |
Collapse
|
156
|
Patrick GJ, Archer NK, Miller LS. Which Way Do We Go? Complex Interactions in Atopic Dermatitis Pathogenesis. J Invest Dermatol 2020; 141:274-284. [PMID: 32943210 DOI: 10.1016/j.jid.2020.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023]
Abstract
Atopic dermatitis (AD) is a common, chronic, inflammatory skin condition characterized by recurrent and pruritic skin eruptions. Multiple factors contribute to the pathogenesis of AD, including skin barrier dysfunction, microbial dysbiosis, and immune dysregulation. Interactions among these factors form a complex, multidirectional network that can reinforce atopic skin disease but can also be ameliorated by targeted therapies. This review summarizes the complex interactions among contributing factors in AD and the implications on disease development and therapeutic interventions.
Collapse
Affiliation(s)
- Garrett J Patrick
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nathan K Archer
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lloyd S Miller
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Janssen Research and Development, Spring House, Pennsylvania, USA.
| |
Collapse
|
157
|
Forward E, Lee G, Fischer G. Shades of grey: what is paediatric psoriasiform dermatitis and what does it have in common with childhood psoriasis? Clin Exp Dermatol 2020; 46:65-73. [PMID: 32735691 DOI: 10.1111/ced.14373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/16/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND While the majority of children with a chronic itchy rash suffer from atopic dermatitis (AD) and other forms of dermatitis, psoriasis is in the differential diagnosis. Certain patterns such as guttate and napkin psoriasis are accepted as classic paediatric psoriasis (PP); however, there are many patients who do not fit these classic forms of PP nor fulfil the accepted criteria for AD. 'Psoriasiform dermatitis' (PD) is a term that has been used for these patients; however, it has not been formally defined. Identification of this group of patients, who although not having the typical clinical features of psoriasis, respond well to psoriasis-specific treatment, may assist treatment decisions for these patients. AIM To describe PD and compare it with typical PP. METHODS Patients with classic PP (n = 109) were compared with a control group with AD (n = 449) and assessed for 21 clinical features associated with PP. Multivariate nonlinear regression analyses determined which features best separated the groups. Patients with dermatitis who demonstrated any of these 21 features (n = 43), which were used to diagnose PD, were then compared with the PP and AD groups. They were managed with psoriasis-specific treatment and Psoriasis Area and Severity Index (PASI) was recorded. RESULTS Of the 21 clinical features, 12 were found to clearly separate the classic PP and AD groups. Using the eight most significant (P < 0.0001) features, we found these two groups clearly separated at a score of 3 out of 8. Children with PD with ≥ 4 of these features responded well to treatment for psoriasis with a mean reduction of PASI by 85% at 6 weeks. CONCLUSIONS We found that patients with dermatitis who have ≥ 4 psoriasis-associated features may have a condition that has been previously alluded to but not defined in the literature, 'psoriasiform dermatitis'. Treatments usually reserved for patients with psoriasis appear to be effective in these patients.
Collapse
Affiliation(s)
- E Forward
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - G Lee
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - G Fischer
- Department of Dermatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| |
Collapse
|
158
|
Jee MH, Mraz V, Geisler C, Bonefeld CM. γδ T cells and inflammatory skin diseases. Immunol Rev 2020; 298:61-73. [DOI: 10.1111/imr.12913] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Mia Hamilton Jee
- The LEO Foundation Skin Immunology Research Center Department of Immunology and Microbiology Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Veronika Mraz
- The LEO Foundation Skin Immunology Research Center Department of Immunology and Microbiology Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Carsten Geisler
- The LEO Foundation Skin Immunology Research Center Department of Immunology and Microbiology Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Charlotte Menné Bonefeld
- The LEO Foundation Skin Immunology Research Center Department of Immunology and Microbiology Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| |
Collapse
|
159
|
Furue M. Regulation of Filaggrin, Loricrin, and Involucrin by IL-4, IL-13, IL-17A, IL-22, AHR, and NRF2: Pathogenic Implications in Atopic Dermatitis. Int J Mol Sci 2020; 21:E5382. [PMID: 32751111 PMCID: PMC7432778 DOI: 10.3390/ijms21155382] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
Atopic dermatitis (AD) is an eczematous, pruritic skin disorder with extensive barrier dysfunction and elevated interleukin (IL)-4 and IL-13 signatures. The barrier dysfunction correlates with the downregulation of barrier-related molecules such as filaggrin (FLG), loricrin (LOR), and involucrin (IVL). IL-4 and IL-13 potently inhibit the expression of these molecules by activating signal transducer and activator of transcription (STAT)6 and STAT3. In addition to IL-4 and IL-13, IL-22 and IL-17A are probably involved in the barrier dysfunction by inhibiting the expression of these barrier-related molecules. In contrast, natural or medicinal ligands for aryl hydrocarbon receptor (AHR) are potent upregulators of FLG, LOR, and IVL expression. As IL-4, IL-13, IL-22, and IL-17A are all capable of inducing oxidative stress, antioxidative AHR agonists such as coal tar, glyteer, and tapinarof exert particular therapeutic efficacy for AD. These antioxidative AHR ligands are known to activate an antioxidative transcription factor, nuclear factor E2-related factor 2 (NRF2). This article focuses on the mechanisms by which FLG, LOR, and IVL expression is regulated by IL-4, IL-13, IL-22, and IL-17A. The author also summarizes how AHR and NRF2 dual activators exert their beneficial effects in the treatment of AD.
Collapse
Affiliation(s)
- Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashiku, Fukuoka 812-8582, Japan; ; Tel.: +81-92-642-5581; Fax: +81-92-642-5600
- Research and Clinical Center for Yusho and Dioxin, Kyushu University, Maidashi 3-1-1, Higashiku, Fukuoka 812-8582, Japan
- Division of Skin Surface Sensing, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashiku, Fukuoka 812-8582, Japan
| |
Collapse
|
160
|
Nousbeck J, McAleer M, Hurault G, Kenny E, Harte K, Kezic S, Tanaka R, Irvine A. MicroRNA analysis of childhood atopic dermatitis reveals a role for miR‐451a*. Br J Dermatol 2020; 184:514-523. [DOI: 10.1111/bjd.19254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
Affiliation(s)
- J. Nousbeck
- National Children’s Research Centre Crumlin, Dublin Ireland
- Clinical Medicine Trinity College Dublin Dublin Ireland
| | - M.A. McAleer
- National Children’s Research Centre Crumlin, Dublin Ireland
- Paediatric Dermatology Our Lady’s Children’s Hospital Crumlin, Dublin Ireland
| | - G. Hurault
- Department of Bioengineering Imperial College London London UK
| | - E. Kenny
- Department of Psychiatry Trinity Translational Medicine Institute St James’s Hospital Dublin Ireland
| | - K. Harte
- Department of Psychiatry Trinity Translational Medicine Institute St James’s Hospital Dublin Ireland
| | - S. Kezic
- Coronel Institute of Occupational Health Academic Medical Center Amsterdam the Netherlands
| | - R.J. Tanaka
- Department of Bioengineering Imperial College London London UK
| | - A.D. Irvine
- National Children’s Research Centre Crumlin, Dublin Ireland
- Clinical Medicine Trinity College Dublin Dublin Ireland
- Paediatric Dermatology Our Lady’s Children’s Hospital Crumlin, Dublin Ireland
| |
Collapse
|
161
|
Dal Bello G, Maurelli M, Schena D, Girolomoni G, Gisondi P. Drug survival of dupilumab compared to cyclosporin in moderate‐to‐severe atopic dermatitis patients. Dermatol Ther 2020; 33:e13979. [PMID: 32633446 DOI: 10.1111/dth.13979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/03/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Giacomo Dal Bello
- Section of Dermatology, Department of Medicine University of Verona Verona Italy
| | - Martina Maurelli
- Section of Dermatology, Department of Medicine University of Verona Verona Italy
| | - Donatella Schena
- Section of Dermatology, Department of Medicine University of Verona Verona Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine University of Verona Verona Italy
| | - Paolo Gisondi
- Section of Dermatology, Department of Medicine University of Verona Verona Italy
| |
Collapse
|
162
|
Chen J, Li C, Li H, Yu H, Zhang X, Yan M, Guo Y, Yao Z. Identification of a T H 2-high psoriasis cluster based on skin biomarker analysis in a Chinese psoriasis population. J Eur Acad Dermatol Venereol 2020; 35:150-158. [PMID: 32367566 DOI: 10.1111/jdv.16563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psoriasis is an immune-mediated, chronic inflammatory disease with diverse phenotypes. However, its biological diversity has not been well-characterized in Chinese psoriasis population. OBJECTIVES To characterize psoriasis biological heterogenicity using gene expression profiles of lesional skin biopsy specimens in a Chinese psoriasis population. METHODS Lesional tissues and blood samples from Chinese psoriasis patients (n = 40), atopic dermatitis (AD) patients (n = 25) and age-matched healthy controls (n = 19) were investigated by using real-time PCR array, histological evaluation and flow cytometry. Unsupervised hierarchical clustering was performed using gene expression profiles of patients with psoriasis. RESULTS Two distinct psoriasis clusters were identified. Both clusters indicated high TH 17 activation. One cluster (n = 6 of 40 consecutive psoriasis patients) indicated a strong TH 2 component in skin lesions, with early onset and low peripheral blood eosinophil level. Significantly higher IL-4, IL-13, IL-25, IL-31 and TSLP gene induction typified this cluster of psoriasis patients, even compared with AD patients. Both psoriasis clusters were characterized by neutrophilic microabscess formation. Histologically, the TH 2 high psoriasis cluster indicated a low percentage of perivascular eosinophils. CONCLUSIONS Two distinct psoriasis clusters were identified. One presented early onset and a low eosinophil level, indicating TH 17 polarization and a strong TH 2 component. These results laid the foundation for further demonstrating the pathogenesis of psoriasis in Chinese population.
Collapse
Affiliation(s)
- J Chen
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - C Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - H Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - H Yu
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - X Zhang
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - M Yan
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Guo
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Z Yao
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
163
|
Lee J, Kim B, Chu H, Zhang K, Kim H, Kim JH, Kim SH, Pan Y, Noh JY, Sun Z, Lee J, Jeong KY, Park KH, Park JW, Kupper TS, Park CO, Lee KH. FABP5 as a possible biomarker in atopic march: FABP5-induced Th17 polarization, both in mouse model and human samples. EBioMedicine 2020; 58:102879. [PMID: 32711257 PMCID: PMC7387782 DOI: 10.1016/j.ebiom.2020.102879] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 01/09/2023] Open
Abstract
Background While the incidence of patients with atopic dermatitis (AD) with atopic march (AM) showing respiratory allergy is steadily rising, the pathomechanism is still unknown. There are currently no biomarkers to predict progression of AM. Methods To explore the mechanism of AM, patients with AD and AM and healthy controls were recruited and RNA microarray, flow cytometry, quantitative real-time polymerase chain reaction, and immunofluorescence staining were performed. We also co-cultured dendritic cells and CD4+T cells with various Dermatophagoides farinae allergen fractions. Cytokine levels were evaluated using enzyme-linked immunosorbent assay. Findings Both fatty-acid-binding protein 5 (FABP5) and Th17-related genes were more highly expressed in AM. FABP5 knockdown significantly decreased Th17-inducing cytokines in keratinocytes and IL-17A in T cells from AM patients. Further confirmation was obtained using an AM mice model compared to mice without AM. Der f 1, a major D. farinae allergen, increased FABP5 and IL-17A expression in T cells from AM patients. Higher serum FABP5 levels from AM patients were positively correlated with serum IL-17A levels. Interpretation FABP5 expression, possibly enhanced by higher epicutaneous and respiratory sensitization to Der f 1, may directly promote Th17 responses in AD patients with AM. Thus, AM progression can be explained by Th17 reaction induced by FABP5. FABP5 was identified as a potential biomarker in AM. Funding This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT; No. NRF-2017R1A2B4009568), grants of the Korean Health Technology R&D Project, Ministry for Health, Welfare & Family Affairs, and the Republic of Korea (HI13C0010, HI14C1324, HI14C1799).
Collapse
Affiliation(s)
- Jungsoo Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea; Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea; Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea
| | - Bomi Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Howard Chu
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - KeLun Zhang
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeran Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Ji Hye Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Hyeong Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youdong Pan
- Department of Dermatology & Harvard Skin Disease Research Center, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, MA, USA
| | - Ji Yeon Noh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - ZhengWang Sun
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jongsun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Yong Jeong
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Thomas S Kupper
- Department of Dermatology & Harvard Skin Disease Research Center, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, MA, USA
| | - Chang Ook Park
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Kwang Hoon Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
164
|
Abstract
Atopic dermatitis (AD) is a common frequent chronic inflammatory skin disease which begins frequently in infancy. The clinical expression of AD is a recurrent eczema on a dry skin. AD is a multifactorial disease characterized by two linked abnormalities: a skin barrier defect and a cellular inflammation, with type-2 main components. However, the pathophysiology of AD is not as simple as this description looks like. In this review, we will present a synthesis of current knowledge on natural history of AD and the involved factors, in order to clarify AD care. The evolution of AD is associated with many atopic comorbidities, following the "atopic march" scheme: IgE-mediated food allergy, allergic asthma and rhinitis occurring classically after AD. In fact, this is rarely the case, but the atopic march seems to be associated with AD severity. AD has also many neuropsychological complications which are essential to be detected. Other factors could influence the natural history of AD: genetic mutations on different genes (proteins of skin barrier, innate and adaptive immunity pathways), skin dysbiosis with colonization by Staphylococcus aureus, sensitization against environmental proteins. AD treatment is based on the restauration of the skin barrier using emollients and on anti-inflammatory drugs (notably topical corticosteroids) during the inflammatory flares. It is not recommended to treat the skin colonization by S. aureus, excepted in case of skin infection. The probiotics have no efficiency as curative treatment of AD, but could have an interest for the primary prevention, especially in at-risk populations. © 2019 Elsevier Masson SAS. All rights reserved.
Collapse
Affiliation(s)
- C Braun
- Centre international de recherche en infectiologie (CIRI) (International Center for Infectiology Research), INSERM U1111, CNRS UMR 5308, 21 avenue Tony-Garnier, 69007 Lyon, France; Hospices civils de Lyon, service de pneumologie et allergologie pédiatriques, hôpital Femme-Mère-Enfant, Bron, France.
| | - A Nosbaum
- Centre international de recherche en infectiologie (CIRI) (International Center for Infectiology Research), INSERM U1111, CNRS UMR 5308, 21 avenue Tony-Garnier, 69007 Lyon, France; Hospices civils de Lyon, service d'allergologie et immunologie clinique, centre hospitalier Lyon-Sud, Pierre-Bénite, France
| |
Collapse
|
165
|
Lim JS, Kim JY, Lee S, Choi JK, Kim EN, Choi YA, Jang YH, Jeong GS, Kim SH. Bakuchicin attenuates atopic skin inflammation. Biomed Pharmacother 2020; 129:110466. [PMID: 32768955 DOI: 10.1016/j.biopha.2020.110466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022] Open
Abstract
Psoralea corylifolia is a medicinal herb that provides advantageous pharmacological effects against vitiligo and skin rash. Former studies have shown that bakuchicin, a furanocoumarin compound from the fruits of P. corylifolia, has therapeutic effects against inflammation, and infection. This study aimed to define the pharmacological effects of bakuchicin on inflammatory responses and lichenification, the major symptoms of atopic dermatitis (AD). To induce AD-like skin inflammation, we exposed the ears of female BALB/c mice to 2, 4-dinitrochlorobenzene (DNCB) and Dermatophagoides farinae (house dust mite) extract (DFE) for 4 weeks. Intragastric administration of bakuchicin attenuated the symptoms of AD-like skin inflammation, as evident by reductions in ear thickness, erythema, and keratosis. Bakuchicin also reversed increases in auricular epidermal and dermal layer thicknesses, and attenuated eosinophil and mast cell infiltration in AD-induced mice. It also suppressed Th2 gene expression as well as that of pro-inflammatory cytokines and chemokines, such as interleukin (IL)-4, IL-13, IL-31, IL-1β, IL-6, CXCL-1, and CCL-17 in the ear tissue. The levels of total and DFE-specific immunoglobulin (Ig)E, and IgG2a in the mice sera were reduced by the bakuchicin. To investigate the effect of bakuchicin on keratinocytes, experiments were performed using HaCaT cells, the representative cell type used in skin disease studies. Tumor necrosis factor-α and interferon-γ were used to activate keratinocytes. Bakuchicin suppressed Th2 gene expression and that of pro-inflammatory cytokines and chemokines; it also suppressed STAT-1 phosphorylation and the nuclear translocation of NF-κB in activated keratinocytes. These results suggest that bakuchicin attenuated AD symptoms, thus suggesting it as a potential therapeutic agent for the treatment of AD.
Collapse
Affiliation(s)
- Jae-Sung Lim
- Cell & Matrix Research Institute, Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jun Young Kim
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Soyoung Lee
- Immunoregulatory Materials Research Center, Korea Research Institute of Bioscience and Biotechnology, Jeongeup, Republic of Korea
| | - Jin Kyeong Choi
- Department of Immunology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Eun-Nam Kim
- College of Pharmacy, Keimyung University, Daegu, Republic of Korea
| | - Young-Ae Choi
- Cell & Matrix Research Institute, Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong Hyun Jang
- Department of Dermatology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Gil-Saeng Jeong
- College of Pharmacy, Keimyung University, Daegu, Republic of Korea.
| | - Sang-Hyun Kim
- Cell & Matrix Research Institute, Department of Pharmacology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| |
Collapse
|
166
|
Furue M, Ulzii D, Nakahara T, Tsuji G, Furue K, Hashimoto-Hachiya A, Kido-Nakahara M. Implications of IL-13Rα2 in atopic skin inflammation. Allergol Int 2020; 69:412-416. [PMID: 32037147 DOI: 10.1016/j.alit.2020.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/16/2022] Open
Abstract
Atopic dermatitis (AD) is a common eczematous skin disorder characterized by skin inflammation, barrier disruption, chronic pruritus and marked scratching. Th2 cytokines, especially IL-13, play a pathogenic role in AD. IL-13 signals via a heterodimeric receptor composed of IL-4Rα and IL-13 Rα1. A second receptor, IL-13 Rα2, binds to IL-13 with high affinity, but it works as a decoy receptor. IL-13 Rα2 is overexpressed in the lesional skin of AD. Notably, mechanical scratching, as well as IL-13 itself, also upregulates IL-13 Rα2 expression. The scratch-induced IL-13 Rα2 upregulation may attenuate the IL-13-mediated epidermal barrier dysfunction and dermal fibrosis. Recent studies stress an importance of another IL-13 Rα2 ligand, chitinase 3-like 1 or YKL-40 in Th2 differentiation. However, the implications of increased IL-13 Rα2 levels remain elusive in AD. In this review, we summarize the recent topics on IL-13 Rα2 in atopic skin inflammation.
Collapse
|
167
|
Abstract
Atopic dermatitis (AD) is generally considered a T helper type 2-dominated disease. Pediatric AD is usually less severe than adult AD, but it may present as moderate to severe lesions that are inadequately managed by current modalities including emollients/moisturizers, topical corticosteroids (TCSs), topical calcineurin inhibitors (TCIs), and even systemic immunosuppressants (such as cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil). In addition, systemic immunosuppressants are often not recommended for childhood AD by the current guidelines due to their toxicities. Therefore, there is still an unmet need for a safe and effective long-term therapy for pediatric AD patients whose disease is inadequately controlled or who are intolerant to current treatments. The emerging therapeutics for AD focuses on intervening in the inflammatory pathway by targeting specific cytokines/chemokines or their receptors. Monoclonal antibodies against immunoglobulin E (IgE), interleukin (IL)-4 receptor subunit α, IL-5, IL-13, IL-31 receptor subunit α, IL-33, and thymic stromal lymphopoietin (TSLP) have been evaluated clinically for AD. Encouraging results have been reported for many of the biologics, of which the most exciting is dupilumab. Other emerging systemic therapies include small molecules such as baricitinib, abrocitinib, upadacitinib, and tradipitant. Several novel topical agents are under clinical investigation for the treatment of AD, including topical phosphodiesterase 4 (PDE4) inhibitors, Janus kinase (JAK) inhibitors, aryl hydrocarbon receptor (AhR) modulating agents, and transient receptor potential vanilloid subfamily member 1 (TRPV1) antagonists. Accompanied by thorough characterization of different phenotype and endotype subsets, the application of precision medicine could provide new prospects for the optimal treatment of AD.
Collapse
Affiliation(s)
- Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
| |
Collapse
|
168
|
Möbus L, Rodriguez E, Harder I, Stölzl D, Boraczynski N, Gerdes S, Kleinheinz A, Abraham S, Heratizadeh A, Handrick C, Haufe E, Werfel T, Schmitt J, Weidinger S. Atopic dermatitis displays stable and dynamic skin transcriptome signatures. J Allergy Clin Immunol 2020; 147:213-223. [PMID: 32615169 DOI: 10.1016/j.jaci.2020.06.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Skin transcriptome studies in atopic dermatitis (AD) showed broad dysregulation as well as "improvement" under therapy. These observations were mainly made in trials and based on microarray data. OBJECTIVES Our aim was to explore the skin transcriptome and the impact of systemic treatment in patients of the TREATgermany registry. METHODS Biopsy specimens from 59 patients with moderate-to-severe AD before and 30 patients 12 weeks after start of systemic treatment (dupilumab [n = 22] or cyclosporine [n = 8]) and from 31 healthy controls were subjected to mRNA sequencing. Differential expression, pathway enrichment, correlation, and coexpression network analysis were conducted. RESULTS Both lesional and nonlesional skin showed a stable "core" signature characterized by disturbed epidermal differentiation and activation of IL-31/IL-1 signaling. A second dynamic signature showed progressive enrichment for type 2 inflammation, TH17 signaling, and natural killer cell function. Markers correlated with disease activity have functions in epidermal barrier properties and immune modulation. IL4RA was among the top 3 central dysregulated genes. Cyclosporine led to a more pronounced global transcriptome reversion and normalized TH17 cell/IL23 signaling, whereas dupilumab led to a stronger increase in level of epidermal differentiation markers. Both treatments strongly decreased levels of type 2 markers, but overall the residual profile was still profoundly different from that of healthy skin. Lower levels of IL4RA and IL13 and high IL36A expression were related to a stronger clinical response to dupilumab. CONCLUSION The AD core signature is characterized by dysregulation of genes related to keratinocyte differentiation and itch signaling. A dynamic signature reflects progressive immune responses dominated by type 2 cytokines with an additional role of TH17 and natural killer cell signaling.
Collapse
Affiliation(s)
- Lena Möbus
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Elke Rodriguez
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Inken Harder
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Dora Stölzl
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nicole Boraczynski
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sascha Gerdes
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Susanne Abraham
- University Allergy Centre, Carl Gustav Carus University Medical Centre, TU Dresden, Dresden, Germany
| | - Annice Heratizadeh
- Division of Immunodermatology and Allergy Research, Department of Dermatology, Allergy, and Venereology, Hannover Medical School, Hannover, Germany
| | - Christiane Handrick
- Practice for Dermatology and Venereology, Christiane Handrick, MD, Berlin, Germany
| | - Eva Haufe
- Center for Evidence-Based Health Care, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology, Allergy, and Venereology, Hannover Medical School, Hannover, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Health Care, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| |
Collapse
|
169
|
Williams MR, Costa SK, Zaramela LS, Khalil S, Todd DA, Winter HL, Sanford JA, O'Neill AM, Liggins MC, Nakatsuji T, Cech NB, Cheung AL, Zengler K, Horswill AR, Gallo RL. Quorum sensing between bacterial species on the skin protects against epidermal injury in atopic dermatitis. Sci Transl Med 2020; 11:11/490/eaat8329. [PMID: 31043573 DOI: 10.1126/scitranslmed.aat8329] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 11/12/2018] [Accepted: 04/11/2019] [Indexed: 12/15/2022]
Abstract
Colonization of the skin by Staphylococcus aureus is associated with exacerbation of atopic dermatitis (AD), but any direct mechanism through which dysbiosis of the skin microbiome may influence the development of AD is unknown. Here, we show that proteases and phenol-soluble modulin α (PSMα) secreted by S. aureus lead to endogenous epidermal proteolysis and skin barrier damage that promoted inflammation in mice. We further show that clinical isolates of different coagulase-negative staphylococci (CoNS) species residing on normal skin produced autoinducing peptides that inhibited the S. aureus agr system, in turn decreasing PSMα expression. These autoinducing peptides from skin microbiome CoNS species potently suppressed PSMα expression in S. aureus isolates from subjects with AD without inhibiting S. aureus growth. Metagenomic analysis of the AD skin microbiome revealed that the increase in the relative abundance of S. aureus in patients with active AD correlated with a lower CoNS autoinducing peptides to S. aureus ratio, thus overcoming the peptides' capacity to inhibit the S. aureus agr system. Characterization of a S. hominis clinical isolate identified an autoinducing peptide (SYNVCGGYF) as a highly potent inhibitor of S. aureus agr activity, capable of preventing S. aureus-mediated epithelial damage and inflammation on murine skin. Together, these findings show how members of the normal human skin microbiome can contribute to epithelial barrier homeostasis by using quorum sensing to inhibit S. aureus toxin production.
Collapse
Affiliation(s)
- Michael R Williams
- Department of Dermatology, University of California, San Diego, San Diego, CA 92093, USA
| | - Stephen K Costa
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Livia S Zaramela
- Department of Pediatrics, University of California, San Diego, San Diego, CA 92093, USA
| | - Shadi Khalil
- Department of Dermatology, University of California, San Diego, San Diego, CA 92093, USA
| | - Daniel A Todd
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA
| | - Heather L Winter
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA
| | - James A Sanford
- Department of Dermatology, University of California, San Diego, San Diego, CA 92093, USA
| | - Alan M O'Neill
- Department of Dermatology, University of California, San Diego, San Diego, CA 92093, USA
| | - Marc C Liggins
- Department of Dermatology, University of California, San Diego, San Diego, CA 92093, USA
| | - Teruaki Nakatsuji
- Department of Dermatology, University of California, San Diego, San Diego, CA 92093, USA
| | - Nadja B Cech
- Department of Chemistry and Biochemistry, University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA
| | - Ambrose L Cheung
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Karsten Zengler
- Department of Pediatrics, University of California, San Diego, San Diego, CA 92093, USA.,Center for Microbiome Innovation, University of California, San Diego, San Diego, CA 92093, USA.,Department of Bioengineering, University of California, San Diego, San Diego, CA 92093, USA
| | - Alexander R Horswill
- Department of Veterans Affairs Denver Health Care System, Denver, CO 80045, USA.,Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Richard L Gallo
- Department of Dermatology, University of California, San Diego, San Diego, CA 92093, USA. .,Center for Microbiome Innovation, University of California, San Diego, San Diego, CA 92093, USA
| |
Collapse
|
170
|
Toncic RJ, Kezic S, Hadzavdic SL, Marinovic B, Jakasa I. Stratum Corneum Biomarkers in Atopic Dermatitis: Biological and Spatial Variability. ACTA ACUST UNITED AC 2020. [DOI: 10.2174/1875318302010010047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:
Atopic dermatitis is a highly heterogeneous skin disease, mainly affecting children. Introduction of biological therapies has urged the development of biomarkers to facilitate personalized therapy. Stratum corneum biomarkers emerged as a promising non-invasive alternative to skin biopsy, yet validation of spatial and biological variability is essential for their application in clinical research.
Objective:
To assess spatial and biological variability of stratum corneum biomarkers for atopic dermatitis.
Methods:
Stratum corneum was collected from 17 atopic dermatitis patients by consecutive application of eight adhesive tapes to a lesional skin site and 2 cm and 4 cm from the lesion. Two non-lesional sites at a 2 cm distance from the same lesion were collected to determine biological variability. Filaggrin degradation products (NMF) were determined by liquid chromatography and thirteen cytokines (IL-4, IL-13, IL-18, IL-31, IL-33, CCL17, CCL22, CCL27, CXCL8, IL-1α, IL-RA, IL-18, IL-22) by multiplex immunoassay.
Results:
Biomarker levels showed gradual changes from lesional to non-lesional skin sites at 2 cm and 4 cm; magnitude and direction of change were biomarker-specific. Intra-subject variability ranged from 17.3% (NMF) to 85.1% (CXCL8). Biomarker levels from two stratum corneum depths were highly correlated; several biomarkers showed significant depth dependence.
Conclusion:
Stratum corneum enables non-invasive collection of relevant immune and epidermal biomarkers, but biomarker-specific spatial and biological variability emphasizes the importance of standardized procedures for stratum corneum collection.
Collapse
|
171
|
Nomura T, Wu J, Kabashima K, Guttman-Yassky E. Endophenotypic Variations of Atopic Dermatitis by Age, Race, and Ethnicity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1840-1852. [DOI: 10.1016/j.jaip.2020.02.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 12/21/2022]
|
172
|
Abstract
Host-microbiota interactions are fundamental for the development of the immune system. Drastic changes in modern environments and lifestyles have led to an imbalance of this evolutionarily ancient process, coinciding with a steep rise in immune-mediated diseases such as autoimmune, allergic and chronic inflammatory disorders. There is an urgent need to better understand these diseases in the context of mucosal and skin microbiota. This Review discusses the mechanisms of how the microbiota contributes to the predisposition, initiation and perpetuation of immune-mediated diseases in the context of a genetically prone host. It is timely owing to the wealth of new studies that recently contributed to this field, ranging from metagenomic studies in humans and mechanistic studies of host-microorganism interactions in gnotobiotic models and in vitro systems, to molecular mechanisms with broader implications across immune-mediated diseases. We focus on the general principles, such as breaches in immune tolerance and barriers, leading to the promotion of immune-mediated diseases by gut, oral and skin microbiota. Lastly, the therapeutic avenues that either target the microbiota, the barrier surfaces or the host immune system to restore tolerance and homeostasis will be explored.
Collapse
|
173
|
Calzavara-Pinton P, Belloni Fortina A, Bonamonte D, Marseglia GL, Miraglia Del Giudice M, Musarra A, Nettis E, Neri I, Patruno C, Stingeni L, Peris K. Diagnosis and management of moderate to severe atopic dermatitis in adolescents. A Consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Italian Association of Hospital Dermatologists and Public Health (ADOI), the Italian Association of Hospital and Territorial Allergists and Immunologists (AAIITO), the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC), the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA), and the Italian Society of Pediatric Dermatology (SIDerP). Ital J Dermatol Venerol 2020; 156:184-197. [PMID: 32438781 DOI: 10.23736/s2784-8671.20.06654-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease with increasing global incidence, which has a multifactorial pathogenesis and a variable expressivity. Clinical features of AD are different in adults compared to children, but it is well recognized the substantial impact of the disease on patients' quality of life at any age. Indeed, little is known about AD in adolescence, a period of life generally associated with high psychological burden and vulnerability to depression. Guidelines for the management of AD are available for both children and adults but specific guidelines for the diagnosis and treatment of AD in adolescents are lacking. Seven Italian scientific societies of dermatologists, allergists, and pediatric allergists joined in a specific meeting to provide practical guidance for the diagnosis and management of moderate-to-severe adolescent AD suitable for the Italian clinical practice. Through a modified Delphi procedure, consensus was reached by 59 Italian experts in the management of AD on 20 statements covering five areas of interest about adolescent AD, including disease complexity, burden and social impact, diagnosis and definition of severity, current treatments, and new biologic therapies. This paper reports recommendations for the diagnosis and management of AD specifically in adolescents, pointing out some peculiar clinical features and focusing on the choice of medications. Dupilumab, the first biologic approved for the treatment of adolescents with AD, represents a useful treatment option due to its efficacy and reassuring safety profile.
Collapse
Affiliation(s)
| | | | - Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Gian L Marseglia
- Department of Pediatrics, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antonino Musarra
- Unit of Allergy, National Healthcare System, Reggio Calabria, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Iria Neri
- Unit of Dermatology, Department of Specialistic, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Cataldo Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Stingeni
- Section of Clinical Allergological Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Ketty Peris
- Unit of Dermatology, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | |
Collapse
|
174
|
Sparber F, Ruchti F, LeibundGut-Landmann S. Host Immunity to Malassezia in Health and Disease. Front Cell Infect Microbiol 2020; 10:198. [PMID: 32477963 PMCID: PMC7232612 DOI: 10.3389/fcimb.2020.00198] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/15/2020] [Indexed: 12/23/2022] Open
Abstract
The microbiota plays an integral role in shaping physical and functional aspects of the skin. While a healthy microbiota contributes to the maintenance of immune homeostasis, dysbiosis can result in the development of diverse skin pathologies. This dichotomous feature of the skin microbiota holds true not only for bacteria, but also for fungi that colonize the skin. As such, the yeast Malassezia, which is by far the most abundant component of the skin mycobiota, is associated with a variety of skin disorders, of which some can be chronic and severe and have a significant impact on the quality of life of those affected. Understanding the causative relationship between Malassezia and the development of such skin disorders requires in-depth knowledge of the mechanism by which the immune system interacts with and responds to the fungus. In this review, we will discuss recent advances in our understanding of the immune response to Malassezia and how the implicated cells and cytokine pathways prevent uncontrolled fungal growth to maintain commensalism in the mammalian skin. We also review how the antifungal response is currently thought to affect the development and severity of inflammatory disorders of the skin and at distant sites.
Collapse
Affiliation(s)
- Florian Sparber
- Section of Immunology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Fiorella Ruchti
- Section of Immunology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Salomé LeibundGut-Landmann
- Section of Immunology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
175
|
Wu J, Guttman-Yassky E. Efficacy of biologics in atopic dermatitis. Expert Opin Biol Ther 2020; 20:525-538. [PMID: 32003247 DOI: 10.1080/14712598.2020.1722998] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/25/2020] [Indexed: 12/22/2022]
Abstract
Introduction: Atopic dermatitis (AD) is a heterogeneous disease. Recent advancements in understanding AD pathogenesis resulted in the exponential expansion of its therapeutic pipeline, particularly following the success and FDA-approval of dupilumab. Different phenotypes of AD by age and ethnicity have also recently been described and clinical studies of emerging treatments will further clarify the role of each cytokine pathway in AD.Areas covered: We review the impressive repertoire of biologics for treatment of moderate-to-severe AD, including those targeting Th2, Th22, Th17/IL-23 and IgE. We highlight the scientific rationale behind each approach and provide a discussion of the most recent clinical efficacy and safety data.Expert opinion: AD is a complex disease and recent research has identified numerous endotypes, reinforcing the rationale for developing targeted therapeutics to antagonize these factors. Dupilumab has revolutionized AD treatment and its mechanistic studies also offer crucial insight into AD pathogenesis. Nevertheless, this biologic does not work for everyone, highlighting the need for a more precise approach to address the unique immune fingerprints of each AD subset. Ultimately targeted therapeutics will complement our understanding of the AD molecular map and help push AD management into an era of personalized medicine.
Collapse
Affiliation(s)
- Jianni Wu
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| |
Collapse
|
176
|
Facheris P, Valenti M, Pavia G, Guanziroli E, Narcisi A, Borroni RG, Costanzo A. Brodalumab: A new way to inhibit
IL
‐17 in psoriasis. Dermatol Ther 2020; 33:e13403. [DOI: 10.1111/dth.13403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Paola Facheris
- Dermatology, Humanitas Clinical and Research Center ‐ IRCCS Rozzano, Milan Italy
- Department of Biomedical Sciences Humanitas University Pieve Emanuele, Milan Italy
| | - Mario Valenti
- Dermatology, Humanitas Clinical and Research Center ‐ IRCCS Rozzano, Milan Italy
- Department of Biomedical Sciences Humanitas University Pieve Emanuele, Milan Italy
| | - Giulia Pavia
- Dermatology, Humanitas Clinical and Research Center ‐ IRCCS Rozzano, Milan Italy
- Department of Biomedical Sciences Humanitas University Pieve Emanuele, Milan Italy
| | - Elena Guanziroli
- Dermatology, Humanitas Clinical and Research Center ‐ IRCCS Rozzano, Milan Italy
| | - Alessandra Narcisi
- Dermatology, Humanitas Clinical and Research Center ‐ IRCCS Rozzano, Milan Italy
| | - Riccardo G. Borroni
- Dermatology, Humanitas Clinical and Research Center ‐ IRCCS Rozzano, Milan Italy
- Department of Biomedical Sciences Humanitas University Pieve Emanuele, Milan Italy
| | - Antonio Costanzo
- Dermatology, Humanitas Clinical and Research Center ‐ IRCCS Rozzano, Milan Italy
- Department of Biomedical Sciences Humanitas University Pieve Emanuele, Milan Italy
| |
Collapse
|
177
|
|
178
|
Pavel AB, Zhou L, Diaz A, Ungar B, Dan J, He H, Estrada YD, Xu H, Fernandes M, Renert-Yuval Y, Krueger JG, Guttman-Yassky E. The proteomic skin profile of moderate-to-severe atopic dermatitis patients shows an inflammatory signature. J Am Acad Dermatol 2020; 82:690-699. [DOI: 10.1016/j.jaad.2019.10.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023]
|
179
|
Perälä M, Ahola M, Mikkola T, Pelkonen AS, Remitz A, Mäkelä MJ. Young children with moderate-to-severe atopic dermatitis can be treated safely and effectively with either topical tacrolimus or mild corticosteroids. Acta Paediatr 2020; 109:550-556. [PMID: 31483891 DOI: 10.1111/apa.15001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/02/2019] [Accepted: 09/03/2019] [Indexed: 01/10/2023]
Abstract
AIM We collected evidence and safety data for topical tacrolimus in small children with atopic dermatitis (AD) and compared the usage with topical corticosteroid. METHODS This was an interim analysis of 75 patients (55% female) at 1 year of an ongoing 3-year randomised open-label comparative follow-up study of topical tacrolimus vs corticosteroid treatment. One- to three-year-old children with moderate-to-severe eczema referred to the Skin and Allergy Hospital in Helsinki, Finland, were enrolled. RESULTS Efficacy parameters, the Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), transepidermal water loss (TEWL), eczema area, serum total immunoglobulin E (IgE) and the blood eosinophil count, showed improvement in both groups during the study. However, patients with signs of early sensitisation at baseline (elevated serum total IgE, elevated eosinophil count, positive prick tests or specific IgEs to aero or food allergens) had statistically significantly lower TEWL at the eczema site and a smaller eczema area at 12 months in the tacrolimus group. No severe adverse effects were seen during the treatment. CONCLUSION Children with AD and signs of early sensitisation appeared to benefit more from early tacrolimus than corticosteroid treatment. Small children may need stronger but nevertheless safe ointment options when treating moderate-to-severe AD.
Collapse
Affiliation(s)
- Miia Perälä
- University of Helsinki and Helsinki University Hospital, Skin and Allergy Hospital Helsinki Finland
| | - Maria Ahola
- University of Helsinki and Helsinki University Hospital, Skin and Allergy Hospital Helsinki Finland
| | - Tytti Mikkola
- University of Helsinki and Helsinki University Hospital, Skin and Allergy Hospital Helsinki Finland
| | - Anna S. Pelkonen
- University of Helsinki and Helsinki University Hospital, Skin and Allergy Hospital Helsinki Finland
| | - Anita Remitz
- University of Helsinki and Helsinki University Hospital, Skin and Allergy Hospital Helsinki Finland
| | - Mika J. Mäkelä
- University of Helsinki and Helsinki University Hospital, Skin and Allergy Hospital Helsinki Finland
| |
Collapse
|
180
|
Abstract
Only few diseases have been studied as extensively and on as many different levels in recent years as atopic dermatitis (AD). One of the reasons why AD is the focus of interest is that it is one of the most common chronic inflammatory skin diseases, affecting up to 30 % of children and 1-10 % of adults. Numerous complex alterations both on the genetic level as well as on the level of innate and adaptive immunity have been identified and form the basis for the characterization of different patient groups and the development of novel diagnostic and therapeutic approaches. Despite the complex pathophysiological and immunological differences, which are closely related to disease stage and severity, as well as the heterogeneity of individual trigger factors, treatment of AD - in particular that of moderate-to-severe AD - was long limited to merely symptomatic and relatively nonspecific immunosuppressive approaches. Since the approval of the first biologic for the treatment of moderate-to-severe adult AD (commercially available in Germany since late 2017), there has been some movement in the field of AD management. The present review highlights recent pathophysiologic insights. Advances in research allow for better characterization of certain patient subgroups and different disease manifestations. In addition, they form the basis of current and future developments in the field of precision medicine in AD.
Collapse
Affiliation(s)
- William Grobe
- Department of Dermatology and Allergology, Christine Kühne Center for Allergy Research and Education, Universität of Bonn, Bonn, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergology, Christine Kühne Center for Allergy Research and Education, Universität of Bonn, Bonn, Germany
| | - Natalija Novak
- Department of Dermatology and Allergology, Christine Kühne Center for Allergy Research and Education, Universität of Bonn, Bonn, Germany
| |
Collapse
|
181
|
Ravnborg N, Ambikaibalan D, Agnihotri G, Price S, Rastogi S, Patel KR, Singam V, Andersen Y, Halling AS, Silverberg JI, Egeberg A, Thyssen JP. Prevalence of asthma in patients with atopic dermatitis: A systematic review and meta-analysis. J Am Acad Dermatol 2020; 84:471-478. [PMID: 32112994 DOI: 10.1016/j.jaad.2020.02.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND It is well established that asthma is common in patients with atopic dermatitis (AD). OBJECTIVES We performed a systematic review and meta-analysis to determine the prevalence of asthma and respiratory symptoms in individuals with AD as well as the association between AD and asthma. METHODS At least 2 authors independently searched the medical databases PubMed, EMBASE, LILACS, and SCOPUS for all English-language studies with data on asthma prevalence among patients with AD or the association between AD and asthma. Pooled odds ratios with 95% confidence intervals (CIs) and pooled proportions were estimated with random-effects models. The Newcastle-Ottawa scale was used to assess study quality. RESULTS The search yielded 39,503 articles. Of these, 213 studies were included in a quantitative analysis. The overall pooled prevalence of asthma was 25.7% (95% CI, 23.7-27.7) in patients with AD and 8.1% (95% CI, 7.0-9.4) among reference individuals. There was a significant association between AD and asthma when compared with reference individuals (odds ratio, 3.03; 95% CI, 2.64-3.47). LIMITATIONS The definitions of AD and asthma differed across the included studies and varied from self-report to physician diagnosed. CONCLUSIONS Asthma is a common comorbidity of AD. Physicians should be cognizant of this relationship and address asthma symptoms in their patients.
Collapse
Affiliation(s)
- Nanna Ravnborg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Danni Ambikaibalan
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | | | - Shmuel Price
- Midwestern University Chicago College of Osteopathic Medicine, Illinois
| | - Supriya Rastogi
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin R Patel
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Vivek Singam
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Yuki Andersen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Anne-Sofie Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Jonathan I Silverberg
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
182
|
Sugaya M. The Role of Th17-Related Cytokines in Atopic Dermatitis. Int J Mol Sci 2020; 21:E1314. [PMID: 32075269 PMCID: PMC7072946 DOI: 10.3390/ijms21041314] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
T helper-17 (Th17) cells, which mainly produce IL-17, are associated with development of various autoimmune diseases such as rheumatoid arthritis, inflammatory bowel diseases, multiple sclerosis, and psoriasis. IL-17 and related cytokines are therapeutic targets of these diseases. In atopic dermatitis (AD), Th2 cytokines such as IL-4 and IL-13 are regarded to be the main player of the disease; however, Th17 cytokines are also expressed in AD skin lesions. Expression of IL-22 rather than IL-17 is predominant in AD skin, which is contrary to cytokine expression in psoriasis skin. Relatively low IL-17 expression in AD skin can induce relatively low antimicrobial peptide expression, which may be a reason why bacterial infection is frequently seen in AD patients. Failure of clinical trials for investigating the efficacy of anti-IL-12/23 p40 in AD has suggested that IL-17 expressed in skin lesions should not be the main player but a bystander responding to barrier dysfunction.
Collapse
Affiliation(s)
- Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Ichikawa Hospital, 6-1-14, Kounodai, Ichikawa, Chiba 272-0827, Japan
| |
Collapse
|
183
|
Kim M, Kim J. Phenotypes and endotypes of atopic dermatitis: Clinical implications. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.1.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Minji Kim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Dongtan, Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea
| |
Collapse
|
184
|
Abstract
Atopic dermatitis (AD) was once thought to be a benign childhood disease that remitted with increasing age. However, recent studies have transformed the understanding of AD, particularly in adult patients. AD is common in adults and can lead to substantial disability by negatively affecting sleep, mental health, and quality of life. There seem to be different genetic, immunologic, and epidemiologic risk factors for AD in adults than in children. This article examines the pathophysiology, epidemiology, heterogeneous clinical presentation, burden, diagnosis, and treatment of adult AD.
Collapse
Affiliation(s)
- Jonathan I Silverberg
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, USA.
| |
Collapse
|
185
|
Abstract
Recent epidemiological studies found the US prevalence of atopic dermatitis in adults to be approximately 7%. In particular, one in four adults with atopic dermatitis report adult onset of their disease. Adult-onset compared to child-onset atopic dermatitis is associated with distinct risk factors, lesional distribution and morphology, associated signs, genetics, and comorbidities. Adult-onset atopic dermatitis is a clinical diagnosis, and must be distinguished from other entities in the differential diagnosis, e.g., allergic contact dermatitis and cutaneous T-cell lymphoma. Further research is necessary to better understand the pathogenesis and optimal treatment approaches in adult-onset/recurrent atopic dermatitis.
Collapse
|
186
|
Sparber F, De Gregorio C, Steckholzer S, Ferreira FM, Dolowschiak T, Ruchti F, Kirchner FR, Mertens S, Prinz I, Joller N, Buch T, Glatz M, Sallusto F, LeibundGut-Landmann S. The Skin Commensal Yeast Malassezia Triggers a Type 17 Response that Coordinates Anti-fungal Immunity and Exacerbates Skin Inflammation. Cell Host Microbe 2019; 25:389-403.e6. [PMID: 30870621 DOI: 10.1016/j.chom.2019.02.002] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/28/2018] [Accepted: 02/05/2019] [Indexed: 12/12/2022]
Abstract
Commensal fungi of the mammalian skin, such as those of the genus Malassezia, are associated with atopic dermatitis and other common inflammatory skin disorders. Understanding of the causative relationship between fungal commensalism and disease manifestation remains incomplete. By developing a murine epicutaneous infection model, we found Malassezia spp. selectively induce IL-17 and related cytokines. This response is key in preventing fungal overgrowth on the skin, as disruption of the IL-23-IL-17 axis compromises Malassezia-specific cutaneous immunity. Under conditions of impaired skin integrity, mimicking a hallmark of atopic dermatitis, the presence of Malassezia dramatically aggravates cutaneous inflammation, which again was IL-23 and IL-17 dependent. Consistently, we found a CCR6+ Th17 subset of memory T cells to be Malassezia specific in both healthy individuals and atopic dermatitis patients, whereby the latter showed enhanced frequency of these cells. Thus, the Malassezia-induced type 17 response is pivotal in orchestrating antifungal immunity and in actively promoting skin inflammation.
Collapse
Affiliation(s)
- Florian Sparber
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Zürich 8057, Switzerland
| | - Corinne De Gregorio
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona 6500, Switzerland
| | - Simone Steckholzer
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Zürich 8057, Switzerland
| | - Filipa M Ferreira
- Institute of Laboratory Animal Science, University of Zürich, Schlieren 8952, Switzerland
| | - Tamas Dolowschiak
- Institute of Experimental Immunology, University of Zürich, Zürich 8057, Switzerland
| | - Fiorella Ruchti
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Zürich 8057, Switzerland
| | - Florian R Kirchner
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Zürich 8057, Switzerland
| | - Sarah Mertens
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Zürich 8057, Switzerland
| | - Immo Prinz
- Institute of Immunology, Hannover Medical School, Hannover 30625, Germany
| | - Nicole Joller
- Institute of Experimental Immunology, University of Zürich, Zürich 8057, Switzerland
| | - Thorsten Buch
- Institute of Laboratory Animal Science, University of Zürich, Schlieren 8952, Switzerland
| | - Martin Glatz
- Department of Dermatology, University and University Hospital of Zürich, Zürich 8091, Switzerland
| | - Federica Sallusto
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona 6500, Switzerland; Institute of Microbiology, ETH Zürich, Zürich 8093, Switzerland
| | | |
Collapse
|
187
|
Crisaborole and atopic dermatitis skin biomarkers: An intrapatient randomized trial. J Allergy Clin Immunol 2019; 144:1274-1289. [DOI: 10.1016/j.jaci.2019.06.047] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/15/2019] [Accepted: 06/27/2019] [Indexed: 12/22/2022]
|
188
|
Kim MH, Jin SP, Jang S, Choi JY, Chung DH, Lee DH, Kim KH, Kim HY. IL-17A-Producing Innate Lymphoid Cells Promote Skin Inflammation by Inducing IL-33-Driven Type 2 Immune Responses. J Invest Dermatol 2019; 140:827-837.e9. [PMID: 31628929 DOI: 10.1016/j.jid.2019.08.447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/06/2019] [Accepted: 08/16/2019] [Indexed: 01/09/2023]
Abstract
Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease characterized by type 2 cytokines secreted by T helper type 2 cells and group 2 innate lymphoid cells. Despite a high degree of heterogeneity, AD is still explained by type 2 immunity, and the role of IL-17A, which is increased in acute, pediatric, or Asian patients with AD, remains poorly understood. Here, we aimed to investigate the role of IL-17A-producing group 3 innate lymphoid cells (ILC3s), which are unexplored immune cells, in the pathogenesis of AD. We found that the numbers of ILC3s in the skin of AD-induced mice were increased, and that neutralizing IL-17A delayed development of AD. Moreover, adoptive transfer of ILC3s accelerated the symptoms of AD. Mechanically, ILC3s induced IL-33 production by nonimmune skin cells, keratinocytes, and fibroblasts, which promoted type 2 immune responses. Because AD has a complex pathophysiology and a broad spectrum of clinical phenotypes, the presence of ILC3s in the skin and their interaction with nonimmune skin cells could explain the pathogenesis of cutaneous AD.
Collapse
Affiliation(s)
- Min Ho Kim
- Laboratory of Mucosal Immunology, Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Seon-Pil Jin
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Cutaneous Aging Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sunhyae Jang
- Laboratory of Cutaneous Aging and Hair Research, Seoul National University Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji-Yeob Choi
- Laboratory of Behavioral Systems Epidemiology, Department of Biomedical Sciences, Seoul National University Graduate School, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hyun Chung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Immune Regulation in Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hun Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Cutaneous Aging Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University, Seoul, Korea
| | - Kyu Han Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Cutaneous Aging Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University, Seoul, Korea.
| | - Hye Young Kim
- Laboratory of Mucosal Immunology, Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.
| |
Collapse
|
189
|
Czarnowicki T, He H, Canter T, Han J, Lefferdink R, Erickson T, Rangel S, Kameyama N, Kim HJ, Pavel AB, Estrada Y, Krueger JG, Paller AS, Guttman-Yassky E. Evolution of pathologic T-cell subsets in patients with atopic dermatitis from infancy to adulthood. J Allergy Clin Immunol 2019; 145:215-228. [PMID: 31626841 DOI: 10.1016/j.jaci.2019.09.031] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/23/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The circulating immune phenotype was defined in adults and young children with early atopic dermatitis (AD), but chronologic changes in the blood of infants and children with AD through adolescence have not been explored. OBJECTIVE We sought to compare immune activation and cytokine polarization in the blood of 0- to 5-year-old (n = 39), 6- to 11-year-old (n = 26), 12- to 17-year-old (n = 21) and 18-year-old or older (n = 43) patients with AD versus age-matched control subjects. METHODS Flow cytometry was used to measure IFN-γ, IL-9, IL-13, IL-17, and IL-22 cytokine levels in CD4+/CD8+ T cells, with inducible costimulator molecule and HLA-DR defining midterm and long-term T-cell activation, respectively, within skin-homing/cutaneous lymphocyte antigen (CLA)+ versus systemic/CLA- T cells. Unsupervised clustering differentiated patients based on their blood biomarker frequencies. RESULTS Although CLA+ TH1 frequencies were significantly lower in infants with AD versus all older patients (P < .01), frequencies of CLA+ TH2 T cells were similarly expanded across all AD age groups compared with control subjects (P < .05). After infancy, CLA- TH2 frequencies were increased in patients with AD in all age groups, suggesting systemic immune activation with disease chronicity. IL-22 frequencies serially increased from normal levels in infants to highly significant levels in adolescents and adults compared with levels in respective control subjects (P < .01). Unsupervised clustering aligned the AD profiles along an age-related spectrum from infancy to adulthood (eg, inducible costimulator molecule and IL-22). CONCLUSIONS The adult AD phenotype is achieved only in adulthood. Unique cytokine signatures characterizing individual pediatric endotypes might require age-specific therapies. Future longitudinal studies, comparing the profile of patients with cleared versus persistent pediatric AD, might define age-specific changes that predict AD clearance.
Collapse
Affiliation(s)
- Tali Czarnowicki
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Helen He
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Talia Canter
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Joseph Han
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rachel Lefferdink
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Taylor Erickson
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Stephanie Rangel
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Naoya Kameyama
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hyun Je Kim
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ana B Pavel
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeriel Estrada
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
190
|
He H, Li R, Choi S, Zhou L, Pavel A, Estrada YD, Krueger JG, Guttman-Yassky E. Increased cardiovascular and atherosclerosis markers in blood of older patients with atopic dermatitis. Ann Allergy Asthma Immunol 2019; 124:70-78. [PMID: 31622668 DOI: 10.1016/j.anai.2019.10.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with increased systemic inflammation and cardiovascular risk. Although previous studies have found increased inflammatory proteins in the blood of patients with AD, detailed comparison among patients with AD of different ages is unavailable. OBJECTIVE To characterize the blood proteomic signature of patients with AD as a function of age. METHODS We used the OLINK high-throughput proteomic assay to measure serum inflammatory and cardiovascular risk proteins in 71 patients with moderate to severe AD from 3 age groups (18-40 years old [n = 26], 41-60 years old [n = 24], and >60 years old [n = 21]) compared with 37 age-matched controls. Total and allergen-specific serum IgEs were also measured. RESULTS When we compared patients with AD from 3 different age groups with their respective controls, we identified a total of 172 differentially expressed proteins. TH2 chemokines (CCL13, CCL17) were consistently elevated in patients with AD across all ages (P < .05), whereas TH1 (CXCL10) and TH17 (KYNU, CCL20) markers incrementally increased with age in both patients with AD and healthy subjects. Elderly patients with AD (>60 years old) exhibited striking upregulation of key proinflammatory proteins, including markers of atherosclerosis (CCL4, CCL7, SORT1), cardiovascular risk (GDF15, MPO, ST2), cell adhesion (CDH3), and apoptosis (FAS; all P < .05) compared with younger patients with AD and age-matched controls. We also found that total and allergen-specific serum IgEs decreased significantly with age in patients with AD (P < .05). CONCLUSION Elderly patients with AD had increased levels of systemic inflammatory markers, including those associated with cardiovascular and atherosclerosis risk, which may explain their increased incidence of cardiovascular disease. This finding suggests that older patients with AD may benefit from cardiovascular disease screening and prevention.
Collapse
Affiliation(s)
- Helen He
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Randall Li
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Seulah Choi
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lisa Zhou
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ana Pavel
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yeriel D Estrada
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Emma Guttman-Yassky
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
191
|
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.
Collapse
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.
| |
Collapse
|
192
|
Chiang CC, Cheng WJ, Korinek M, Lin CY, Hwang TL. Neutrophils in Psoriasis. Front Immunol 2019; 10:2376. [PMID: 31649677 PMCID: PMC6794444 DOI: 10.3389/fimmu.2019.02376] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/23/2019] [Indexed: 12/22/2022] Open
Abstract
Neutrophils are the most abundant innate immune cells. The pathogenic roles of neutrophils are related to chronic inflammation and autoimmune diseases. Psoriasis is a chronic systemic inflammatory disease affecting ~2–3% of the world population. The abundant presence of neutrophils in the psoriatic skin lesions serves as a typical histopathologic hallmark of psoriasis. Recent reports indicated that oxidative stress, granular components, and neutrophil extracellular traps from psoriatic neutrophils are related to the initial and maintenance phases of psoriasis. This review provides an overview on the recent (up to 2019) advances in understanding the role of neutrophils in the pathophysiology of psoriasis, including the effects of respiratory burst, degranulation, and neutrophil extracellular trap formation on psoriatic immunity and the clinical relationships.
Collapse
Affiliation(s)
- Chih-Chao Chiang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Supervisor Board, Taoyuan Chinese Medicine Association, Taoyuan, Taiwan.,Puxin Fengze Chinese Medicine Clinic, Taoyuan, Taiwan
| | - Wei-Jen Cheng
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.,Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Michal Korinek
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, and Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Yu Lin
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Long Hwang
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, and Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Chinese Herbal Medicine Research Team, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Chemical Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
| |
Collapse
|
193
|
Schwartz C, Moran T, Saunders SP, Kaszlikowska A, Floudas A, Bom J, Nunez G, Iwakura Y, O’Neill L, Irvine AD, McKenzie ANJ, Ogg G, Walsh PT, Demengeot J, Fallon PG. Spontaneous atopic dermatitis in mice with a defective skin barrier is independent of ILC2 and mediated by IL-1β. Allergy 2019; 74:1920-1933. [PMID: 30937919 PMCID: PMC6850072 DOI: 10.1111/all.13801] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common skin diseases with a multifactorial etiology. Mutations leading to loss of skin barrier function are associated with the development of AD with group 2 innate lymphoid cells (ILC2) promoting acute skin inflammation. Filaggrin-mutant (Flgft/ft ) mice develop spontaneous skin inflammation accompanied by an increase in skin ILC2 numbers, IL-1β production, and other cytokines recapitulating human AD. Here, we investigated the role of ILC2, effector cytokines, inflammasome activation, and mast cell function on the development of chronic AD-like inflammation in mice. METHODS Mice with a frameshift mutation in the filaggrin gene develop spontaneous dermatitis. Flgft/ft mice were crossed to cell- or cytokine-deficient mouse strains, or bred under germ-free conditions. Skin inflammation was scored, and microbiome composition was analyzed. Skin protein expression was measured by multiplex immunoassay. Infiltrating cells were analyzed by flow cytometry. RESULTS Wild-type and Flgft/ft mice significantly differ in their microbiome composition. Furthermore, mutant mice do not develop skin inflammation under germ-free conditions. ILC2 deficiency did not ameliorate chronic dermatitis in Flgft/ft mice, which was also independent of IL-4, IL-5, IL-9, IL-13, IL-17A, and IL-22. Inflammation was independent of NLRP3 inflammasome activation but required IL-1β and IL-1R1-signaling. Mechanistically, IL-1β promoted hyperactivation of IL-1R1-expressing mast cells. Treatment with anti-IL-1β-antibody alleviated dermatitis exacerbation, while antibiotic intervention ameliorated dermatitis in neonatal mice but not in adults with established inflammation. CONCLUSIONS In summary, we identified a critical role for the microbiome and IL-1β mediating chronic inflammation in mice with an impaired skin barrier.
Collapse
Affiliation(s)
- Christian Schwartz
- School of MedicineTrinity Biomedical Sciences Institute, Trinity College DublinDublinIreland
- Mikrobiologisches Institut ‐ Klinische Mikrobiologie, Immunologie und HygieneUniversitätsklinikum Erlangen and Friedrich‐Alexander Universität (FAU) Erlangen‐NürnbergErlangenGermany
| | - Tara Moran
- School of MedicineTrinity Biomedical Sciences Institute, Trinity College DublinDublinIreland
- National Children’s Research Centre, Our Lady’s Children’s HospitalDublinIreland
| | - Sean P. Saunders
- School of MedicineTrinity Biomedical Sciences Institute, Trinity College DublinDublinIreland
- National Children’s Research Centre, Our Lady’s Children’s HospitalDublinIreland
| | - Agnieszka Kaszlikowska
- School of MedicineTrinity Biomedical Sciences Institute, Trinity College DublinDublinIreland
- National Children’s Research Centre, Our Lady’s Children’s HospitalDublinIreland
| | - Achilleas Floudas
- School of MedicineTrinity Biomedical Sciences Institute, Trinity College DublinDublinIreland
- National Children’s Research Centre, Our Lady’s Children’s HospitalDublinIreland
| | - Joana Bom
- Instituto Gulbenkian de CiênciaOeirasPortugal
| | - Gabriel Nunez
- Department of Pathology and Comprehensive Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichigan
| | - Yoichiro Iwakura
- Research Institute for Biomedical SciencesTokyo University of ScienceChibaJapan
| | - Luke O’Neill
- School of Biochemistry and ImmunologyTrinity Biomedical Sciences Institute, Trinity College DublinDublinIreland
| | - Alan D. Irvine
- National Children’s Research Centre, Our Lady’s Children’s HospitalDublinIreland
- Department of Paediatric DermatologyOur Lady’s Children’s HospitalDublinIreland
| | | | - Graham Ogg
- MRC Human Immunology Unit, Weatherall Institute of Molecular MedicineJohn Radcliffe HospitalUniversity of OxfordOxfordUK
| | - Patrick T. Walsh
- National Children’s Research Centre, Our Lady’s Children’s HospitalDublinIreland
- Trinity Translational Medicine Institute, St James’s Hospital, Trinity College DublinDublinIreland
| | | | - Padraic G. Fallon
- School of MedicineTrinity Biomedical Sciences Institute, Trinity College DublinDublinIreland
- National Children’s Research Centre, Our Lady’s Children’s HospitalDublinIreland
- Trinity Translational Medicine Institute, St James’s Hospital, Trinity College DublinDublinIreland
| |
Collapse
|
194
|
Abstract
Atopic dermatitis is a complex, chronic inflammatory skin disorder with significant morbidity. It is often a frustrating condition for both children and parents due to chronic and relapsing course. There is now an increasing understanding of the disease pathogenesis resulting in discovery of much wanted newer therapeutics and targeted therapies after a long time. Whether these interventions will result in sustained benefits or long term cure remains to be seen.
Collapse
Affiliation(s)
- Shweta Saini
- Division of Allergy and Immunology, Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Pediatric Specialty Center, Suite # 4018, 3950 Beaubien Boulevard, Detroit, MI 48201, USA
| | - Milind Pansare
- Division of Allergy and Immunology, Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Pediatric Specialty Center, Suite # 4018, 3950 Beaubien Boulevard, Detroit, MI 48201, USA.
| |
Collapse
|
195
|
Furue K, Ito T, Tsuji G, Ulzii D, Vu YH, Kido-Nakahara M, Nakahara T, Furue M. The IL-13-OVOL1-FLG axis in atopic dermatitis. Immunology 2019; 158:281-286. [PMID: 31509236 DOI: 10.1111/imm.13120] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Despite sharing interleukin-4 receptor α (IL-4Rα) in their signaling cascades, IL-4 and IL-13 have different functions in atopic inflammation. IL-13 preferentially participates in the peripheral tissues because tissue-resident group 2 innate lymphoid cells produce IL-13 but not IL-4. In contrast, lymph node T follicular helper cells express IL-4 but not IL-13 to regulate B-cell immunity. The dominant microenvironment of IL-13 is evident in the lesional skin of atopic dermatitis (AD). The IL-13-rich local milieu causes barrier dysfunction by down-regulating the OVOL1-filaggrin (FLG) axis and up-regulating the periostin-IL-24 axis. Genome-wide association studies also point to the crucial involvement of the IL-13, OVOL1 and FLG genes in the pathogenesis of AD. Biologics targeting IL-13, such as the anti-IL-4Rα antibody dupilumab and the anti-IL-13 antibody tralokinumab, successfully improve AD lesions and further highlight the importance of IL-13 in the pathogenesis of AD.
Collapse
Affiliation(s)
- Kazuhisa Furue
- Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Takamichi Ito
- Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Gaku Tsuji
- Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Dugarmaa Ulzii
- Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yen Hai Vu
- Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Makiko Kido-Nakahara
- Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.,Division of Skin Surface Sensing, Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.,Division of Skin Surface Sensing, Department of Dermatology, Faculty of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.,Research and Clinical Center for Yusho and Dioxin, Kyushu University Hospital, Higashi-ku, Fukuoka, Japan
| |
Collapse
|
196
|
Oral Janus kinase/SYK inhibition (ASN002) suppresses inflammation and improves epidermal barrier markers in patients with atopic dermatitis. J Allergy Clin Immunol 2019; 144:1011-1024. [DOI: 10.1016/j.jaci.2019.07.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 12/26/2022]
|
197
|
Bissonnette R, Maari C, Forman S, Bhatia N, Lee M, Fowler J, Tyring S, Pariser D, Sofen H, Dhawan S, Zook M, Zammit D, Usansky H, Denis L, Rao N, Song T, Pavel A, Guttman‐Yassky E. The oral Janus kinase/spleen tyrosine kinase inhibitor ASN002 demonstrates efficacy and improves associated systemic inflammation in patients with moderate-to-severe atopic dermatitis: results from a randomized double-blind placebo-controlled study. Br J Dermatol 2019; 181:733-742. [PMID: 30919407 PMCID: PMC6850605 DOI: 10.1111/bjd.17932] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND ASN002 is an oral dual inhibitor of Janus kinase and spleen tyrosine kinase, which are involved in the pathogenesis of atopic dermatitis (AD) through their regulatory role on T helper (Th)1, Th2 and Th17/Th22 pathways. OBJECTIVES The objectives of this study were to evaluate the efficacy, safety, pharmacokinetics and effects on systemic biomarkers of ASN002 in patients with moderate-to-severe AD. Methods A total of 36 patients with moderate-to-severe AD were randomized (3 : 1) to ASN002 or placebo in the phase Ib study. Three dosage cohorts were studied over a 28-day period (20 mg, 40 mg and 80 mg once daily). RESULTS ASN002 was superior to placebo for the proportion of patients achieving Eczema Area and Severity Index (EASI) 50 (20 mg 20%, P = 0·93; 40 mg 100%, P = 0·003; 80 mg 83%, P = 0·03; placebo 22%), EASI 75 (20 mg 0%, P = 0·27; 40 mg 71%, P = 0·06; 80 mg 33%, P = 0·65; placebo 22%) and in change from baseline in pruritus (20 mg -1·3 ± 2·1, P = 0·81; 40 mg -3·1 ± 2·7, P = 0·27; 80 mg -4·7 ± 2·1, P = 0·01; placebo -1·6 ± 1·8). Adverse events were generally mild and similar across all groups. ASN002 showed dose-dependent plasma exposure with low interpatient variability, significantly downregulated several serum biomarkers involved in Th1, Th2 and Th17/Th22 immunity, and decreased the atherosclerosis-associated biomarker E selectin/SELE. CONCLUSIONS In patients with moderate-to-severe AD, ASN002 showed strong efficacy with rapid onset of action and associated improvements in systemic inflammation.
Collapse
Affiliation(s)
- R. Bissonnette
- Innovaderm Research Inc.1851 Sherbrooke Street East, Suite 502MontrealH2K 4L5QuebecCanada
| | - C. Maari
- Innovaderm Research Inc.1851 Sherbrooke Street East, Suite 502MontrealH2K 4L5QuebecCanada
| | - S. Forman
- Forward Clinical Trials, Inc.4915 Ehrlich RoadTampa33624FLU.S.A
| | - N. Bhatia
- Therapeutics Clinical Research9025 Balboa Avenue, Suite 105San Diego92123CAU.S.A
| | - M. Lee
- Progressive Clinical ResearchP.A., LLC1973 North West Loop 410, Suite 106San Antonio78213TXU.S.A
| | - J. Fowler
- Dermatology Specialists Research3810 Springhurst Boulevard, Suite 130Louisville40241KYU.S.A
| | - S. Tyring
- Center for Clinical StudiesUniversity of Texas Health Science Center451 North Texas AvenueHouston77598TXU.S.A
| | - D. Pariser
- Department of DermatologyEastern Virginia Medical School and Virginia Clinical Research Inc.6160 Kempsville Circle, Suite 200ANorfolk23502VAU.S.A
| | - H. Sofen
- Dermatology Research Associates8930 South Sepulveda BoulevardLos Angeles90045CAU.S.A
| | - S. Dhawan
- Center for Dermatology Clinical Research Inc.2557 Mowry Avenue, Suite 21 and 25Fremont94538CAU.S.A
| | - M. Zook
- Olympian Clinical Research1201 South Myrtle AvenueClearwater33756FLU.S.A
| | - D.J. Zammit
- Asana BioSciences, LLC997 Lenox Drive, Suite 220, Princeton Pike Corporate CenterLawrenceville08648NJU.S.A
| | - H. Usansky
- Asana BioSciences, LLC997 Lenox Drive, Suite 220, Princeton Pike Corporate CenterLawrenceville08648NJU.S.A
| | - L. Denis
- Asana BioSciences, LLC997 Lenox Drive, Suite 220, Princeton Pike Corporate CenterLawrenceville08648NJU.S.A
| | - N. Rao
- Asana BioSciences, LLC997 Lenox Drive, Suite 220, Princeton Pike Corporate CenterLawrenceville08648NJU.S.A
| | - T. Song
- Icahn School of Medicine at Mount Sinai1425 Madison Avenue, Icahn Building 13‐76New York10029NYU.S.A
| | - A.B. Pavel
- Icahn School of Medicine at Mount Sinai1425 Madison Avenue, Icahn Building 13‐76New York10029NYU.S.A
| | - E. Guttman‐Yassky
- Icahn School of Medicine at Mount Sinai1425 Madison Avenue, Icahn Building 13‐76New York10029NYU.S.A
| |
Collapse
|
198
|
Gür Çetinkaya P, Şahiner ÜM. Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turk J Med Sci 2019; 49:963-984. [PMID: 31408293 PMCID: PMC7018348 DOI: 10.3906/sag-1810-105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder of childhood. Underlying factors that contribute to AD are impaired epithelial barrier, alterations in the lipid composition of the skin, immunological imbalance including increased Th2/Th1 ratio, proinflammatory cytokines, decreased T regulatory cells, genetic mutations, and epigenetic alterations. Atopic dermatitis is a multifactorial disease with a particularly complicated pathophysiology. Discoveries to date may be considered the tip of the iceberg, and the increasing number of studies in this field indicate that there are many points to be elucidated in AD pathophysiology. In this review, we aimed to illustrate the current understanding of the underlying pathogenic mechanisms in AD, to evaluate available treatment options with a focus on recently discovered therapeutic agents, and to determine the personal, familial, and economic burdens of the disease, which are frequently neglected issues in AD. Currently available therapies only provide transient solutions and cannot fully cure the disease. However, advances in the understanding of the pathogenic mechanisms of the disease have led to the production of new treatment options, while ongoing drug trials also have had promising results.
Collapse
Affiliation(s)
- Pınar Gür Çetinkaya
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
199
|
The blood proteomic signature of early-onset pediatric atopic dermatitis shows systemic inflammation and is distinct from adult long-standing disease. J Am Acad Dermatol 2019; 81:510-519. [DOI: 10.1016/j.jaad.2019.04.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 12/20/2022]
|
200
|
Atopic Dermatitis and Type 2 Immune Deviation. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|