A computational model to predict severity of atopic eczema from 30 serum proteins

Full-body blue light irradiation as treatment for atopic dermatitis: a randomized sham-controlled clinical trial (AD-Blue)

BACKGROUND

Visible blue light (wavelength 400-495 nm) is a promising new treatment option for both psoriasis and atopic dermatitis (AD). Whilst previous clinical trials featured various devices and blue light at a variety of wavelengths, none of these interventions were challenged in objective clinical criteria.

PATIENTS AND METHODS

Eighty-seven patients diagnosed with AD were enrolled in AD-Blue, an international, prospective, double-blinded, three-armed (415 nm vs. 450 nm vs. sham control), randomized trial designed to investigate the safety and efficacy of prototype full-body blue light devices.

RESULTS

Full-body irradiation with 450 nm blue light but not 415 nm had a significant impact on itch (Itch-VAS, -1.6 ± 2.3; p  =  0.023 vs. sham irradiation). PO-SCORAD values also decreased significantly in response to irradiation at 415 nm (-11.5 ± 18.4; p = 0.028 vs. sham irradiation). None of the other outcome measures (EASI, SCORAD, IGA, DLQI) changed significantly. No safety signals were observed. Evaluation of skin transcriptomes, cytokine levels in serum, and ELISpots from peripheral blood mononuclear cells isolated from a subset of patients revealed moderate decreases in IL-31 in response to irradiation with blue light.

CONCLUSIONS

Despite its favorable safety profile and moderate reductions in itch and IL-31 levels, full-body blue light irradiation did not lead to an amelioration of any of the objective measures of AD.

Ganzkörper-Blaulichtbestrahlung zur Behandlung der atopischen Dermatitis: eine randomisierte, placebokontrollierte klinische Studie (AD-Blue)

Hintergrund

Sichtbares blaues Licht (Wellenlänge 400–495 nm) ist eine vielversprechende neue Behandlungsoption sowohl für Psoriasis als auch für atopische Dermatitis (AD). In früheren klinischen Studien wurden zwar verschiedene Geräte und blaues Licht mit unterschiedlichen Wellenlängen eingesetzt, aber keine dieser Prozeduren wurde anhand objektiver klinischer Kriterien geprüft.

Patienten und Methodik

87 Patienten mit AD wurden in die AD‐Blue‐Studie aufgenommen, eine internationale, prospektive, doppelblinde, dreiarmige (415 nm vs. 450 nm vs. Placebo), randomisierte Studie zur Untersuchung der Sicherheit und Wirksamkeit von Prototypen von Ganzkörper‐Blaulicht‐Bestrahlungsgeräten.

Ergebnisse

Die Ganzkörper‐Bestrahlung mit 450 nm blauem Licht, aber nicht mit 415 nm, hatte einen signifikant positiven Einfluss auf den Juckreiz (Pruritus‐VAS, –1,6 ± 2,3; p = 0,023 gegenüber der Placebobestrahlung). Die PO‐SCORAD‐Werte sanken ebenfalls signifikant als Reaktion auf die Bestrahlung bei 415 nm (–11,5 ± 18,4; p = 0,028 im Vergleich zur Placebobestrahlung). Keines der anderen Ergebnisse (EASI, SCORAD, IGA, DLQI) veränderte sich signifikant. Es wurden keine Sicherheitsprobleme beobachtet. Die Auswertung von Hauttranskriptomdaten, Zytokinspiegeln im Serum und ELISpots aus mononukleären Zellen des peripheren Blutes, die von einer Untergruppe von Patienten isoliert wurden, ergab eine moderate Abnahme von IL‐31 als Reaktion auf die Bestrahlung mit blauem Licht.

Schlussfolgerungen

Trotz des günstigen Sicherheitsprofils und der mäßigen Verringerung von Pruritus und IL‐31‐Spiegel führte die Ganzkörper‐Blaulichtbestrahlung bei AD zu keiner Verbesserung der objektiven Parameter zu Krankheitsschwere.

[Molecular diagnosis of hand eczema]

BACKGROUND

Because hand eczema is a diagnostic challenge even for experienced dermatologists, a correct diagnosis is essential to ensure success of specific therapies.

OBJECTIVES

Prerequisites for successful molecular diagnostics in general and in hand eczema in particular are discussed.

MATERIALS AND METHODS

Basic research and opinion statement on new developments in molecular diagnostics are considered with a special focus on hand eczema.

RESULTS

The first molecular classifier to distinguish psoriasis from (hand) eczema signature has been introduced as CE-marked in vitro diagnostics (CE-IVD); many more biomarkers associated with diagnostics, theranostics, or natural course of the disease are currently being investigated.

CONCLUSIONS

Diagnosis of hand eczema will be supported by molecular diagnostics in the near future; we are at the beginning of the molecular era in dermatology.

Can serum biomarkers predict the outcome of systemic immunosuppressive therapy in adult atopic dermatitis patients?

Background

Atopic dermatitis (AD or eczema) is a most common chronic skin disease. Designing personalised treatment strategies for AD based on patient stratification is of high clinical relevance, given a considerable variation in the clinical phenotype and responses to treatments among patients. It has been hypothesised that the measurement of biomarkers could help predict therapeutic responses for individual patients.

Objective

We aim to assess whether serum biomarkers can predict the outcome of systemic immunosuppressive therapy in adult AD patients.

Methods

We developed a statistical machine learning model using the data of an already published longitudinal study of 42 patients who received azathioprine or methotrexate for over 24 weeks. The data contained 26 serum cytokines and chemokines measured before the therapy. The model described the dynamic evolution of the latent disease severity and measurement errors to predict AD severity scores (Eczema Area and Severity Index, (o)SCORing of AD and Patient Oriented Eczema Measure) two-weeks ahead. We conducted feature selection to identify the most important biomarkers for the prediction of AD severity scores.

Results

We validated our model in a forward chaining setting and confirmed that it outperformed standard time-series forecasting models. Adding biomarkers did not improve predictive performance.

Conclusions

In this study, biomarkers had a negligible and non-significant effect for predicting the future AD severity scores and the outcome of the systemic therapy.

Human and computational models of atopic dermatitis: A review and perspectives by an expert panel of the International Eczema Council

Atopic dermatitis (AD) is a prevalent disease worldwide and is associated with systemic comorbidities representing a significant burden on patients, their families, and society. Therapeutic options for AD remain limited, in part because of a lack of well-characterized animal models. There has been increasing interest in developing experimental approaches to study the pathogenesis of human AD in vivo, in vitro, and in silico to better define pathophysiologic mechanisms and identify novel therapeutic targets and biomarkers that predict therapeutic response. This review critically appraises a range of models, including genetic mutations relevant to AD, experimental challenge of human skin in vivo, tissue culture models, integration of “omics” data sets, and development of predictive computational models. Although no one individual model recapitulates the complex AD pathophysiology, our review highlights insights gained into key elements of cutaneous biology, molecular pathways, and therapeutic target identification through each approach. Recent developments in computational analysis, including application of machine learning and a systems approach to data integration and predictive modeling, highlight the applicability of these methods to AD subclassification (endotyping), therapy development, and precision medicine. Such predictive modeling will highlight knowledge gaps, further inform refinement of biological models, and support new experimental and systems approaches to AD. (J Allergy Clin Immunol 2019;143:36–45.)

Biologic Therapy for Atopic Dermatitis: Moving Beyond the Practice Parameter and Guidelines

Atopic dermatitis (AD), a common chronic pruritic inflammatory skin disease, impacts the quality of life of patients and caregivers and has become a global health problem. It is increasingly recognized as a disease not only of children but also of adults who may have a persistent or relapsing course from childhood or who develop new-onset adult disease. Besides well-established atopic comorbidities, associations with a number of nonatopic comorbidities have been reported. AD is characterized by both immune dysregulation and epidermal barrier dysfunction. The findings that nonlesional skin in AD has both terminal keratinocyte differentiation defects and immune abnormalities as well as multiple markers of immune and inflammatory activation in the circulation point to the systemic nature of the disease and have important translational implications. Although AD is predominantly associated with type 2 immune responses, activation of other cytokine pathways including T_H1, T_H22, and T_H17/IL-23 has been reported, suggesting potential therapeutic targets and provide a rationale for treatment with novel biologics. Dupilumab, a fully human mAb targeting the IL-4 Rα subunit, blocks signaling of both IL-4 and IL-13 and is the first biologic to be approved for the treatment of moderate-to-severe AD in adult patients. Other biologics in current trials for AD are targeting the IL-31 receptor, IL-13, and the common p40 subunit of IL-12/IL-23.

Profiling of epidermal lipids in a mouse model of dermatitis: Identification of potential biomarkers

Lipids are important structural and functional components of the skin. Alterations in the lipid composition of the epidermis are associated with inflammation and can affect the barrier function of the skin. SHARPIN-deficient cpdm mice develop a chronic dermatitis with similarities to atopic dermatitis in humans. Here, we used a recently-developed approach named multiple reaction monitoring (MRM)-profiling and single ion monitoring to rapidly identify discriminative lipid ions. Shorter fatty acyl residues and increased relative amounts of sphingosine ceramides were observed in cpdm epidermis compared to wild type mice. These changes were accompanied by downregulation of the Fasn gene which encodes fatty acid synthase. A profile of diverse lipids was generated by fast screening of over 300 transitions (ion pairs). Tentative attribution of the most significant transitions was confirmed by product ion scan (MS/MS), and the MRM-profiling linear intensity response was validated with a C17-ceramide lipid standard. Relative quantification of sphingosine ceramides CerAS(d18:1/24:0)2OH, CerAS(d18:1/16:0)2OH and CerNS(d18:1/16:0) discriminated between the two groups with 100% accuracy, while the free fatty acids cerotic acid, 16-hydroxy palmitic acid, and docosahexaenoic acid (DHA) had 96.4% of accuracy. Validation by liquid chromatography tandem mass spectrometry (LC-MS/MS) of the above-mentioned ceramides was in agreement with MRM-profiling results. Identification and rapid monitoring of these lipids represent a tool to assess therapeutic outcomes in SHARPIN-deficient mice and other mouse models of dermatitis and may have diagnostic utility in atopic dermatitis.

Advances in atopic dermatitis and urticarial in 2016

This review highlights recent key advances in the pathology and therapies of inflammatory skin diseases, focusing on atopic dermatitis (AD) and chronic spontaneous urticaria (CSU). Regarding AD, transcriptomic analysis with human samples revealed different immune profiles between childhood and adult AD. Phase III clinical trials of dupilumab, an anti-IL-4 receptor α antibody, in the treatment of AD have successfully finished, and dupilumab will appear in clinical practice as the first biologic for AD in 2017. In addition, a novel biologic that targets IL-31 shows promising results in a phase II trial. As for the skin microbiome study, novel insights into the mechanisms of microbial dysbiosis, such as colonization of Staphylococcus aureus, a common feature of AD, were proposed. Regarding CSU, autoreactive CD4⁺ T cells that react to FcεRI were discovered, which might contribute to the development of CSU. These findings provide new insights into the pathogenesis of AD and CSU and will lead to more specific and personalized treatments.

An Integrated Model of Atopic Dermatitis Biomarkers Highlights the Systemic Nature of the Disease

Current atopic dermatitis (AD) models link epidermal abnormalities in lesional skin to cytokine activation. However, there is evolving evidence of systemic immune activation and detectable abnormalities in nonlesional skin. Because some of the best single correlations with severity (Scoring of AD, or SCORAD) are detected not only in lesional but also nonlesional skin and blood, more complex biomarker models of AD are needed. We thus performed extensive biomarker measures in these compartments using univariate and multivariate approaches to correlate disease biomarkers with SCORAD and with a combined hyperplasia score [thickness and keratin 16 (K16) mRNA] at baseline and after cyclosporine A treatment in 25 moderate to severe AD patients. Increases in serum cytokines and chemokines (IL-13, IL-22, CCL17) were found in AD versus healthy individuals and were reduced with treatment. SCORAD correlated with immune (IL-13, IL-22) and epidermal (thickness, K16) measures in lesional and, even more strongly, in nonlesional AD. Serum cytokines also had higher correlations with nonlesional markers at baseline and with treatment. Multivariate U statistics improved baseline and treatment-response SCORAD correlations. Nonlesional models showed the strongest correlations, with further improvement upon integration of serum markers. Even better correlations were obtained between biomarkers and the hyperplasia score. Larger cohorts are needed to confirm these preliminary data.