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Park CO, Kim SM, Lee KH, Bieber T. Biomarkers for phenotype-endotype relationship in atopic dermatitis: a critical review. EBioMedicine 2024; 103:105121. [PMID: 38614010 PMCID: PMC11021839 DOI: 10.1016/j.ebiom.2024.105121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/15/2024] Open
Abstract
Atopic dermatitis (AD) is the most common form of chronic skin inflammation with diverse clinical variants. Historically, various AD phenotypes have been grouped together without considering their heterogeneity. This approach has resulted in a lack of phenotype- and endotype-adapted therapeutic strategies. Comprehensive insights into AD pathogenesis have enabled precise medicinal approach for AD. These efforts aimed to redefine the endophenotype of AD and develop various biomarkers for diverse purposes. Among these endeavours, efforts are underway to elucidate the mechanisms (and related biomarkers) that lead to the emergence and progression of atopic diseases originating from AD (e.g., atopic march). This review focuses on diverse AD phenotypes and calls for a definition of endophenotypes. While awaiting scientific validation, these biomarkers ensure predicting disease onset and trajectory and tailoring therapeutic strategies for the future.
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Affiliation(s)
- Chang Ook Park
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Su Min Kim
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang Hoon Lee
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Thomas Bieber
- Christine Kühne-Center of Allergy Research and Education, Medicine Campus, Davos, Switzerland
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2
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Weins AB, Kerzel S, Schnopp C. Schwere atopische Dermatitis im frühen Kindesalter: Besonderheiten, Herausforderungen und neue Perspektiven in der Versorgung. J Dtsch Dermatol Ges 2024; 22:350-356. [PMID: 38451004 DOI: 10.1111/ddg.15344_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 03/08/2024]
Abstract
ZusammenfassungDie atopische Dermatitis ist die häufigste chronische Hauterkrankung im Kindesalter mit einer Prävalenz von 10% bei Kleinkindern unter 2 Jahren, wovon etwa 15% einen hohen Schweregrad aufweisen. „Kinder sind keine kleinen Erwachsenen“, dies trifft für die schwere frühkindliche atopische Dermatitis in besonderem Maße zu. Innerhalb dieser sensiblen Lebensphase zeigen sich alterstypische Facetten der Erkrankung (psychosozial, neurokognitiv, klinisch‐morphologisch), die Unterschiede im Management mit sich bringen.Besondere Bedeutung hat die Identifikation von Säuglingen und Kleinkindern mit früh‐persistierendem, schwerem Verlauf mit Blick auf eine erstmals für diese Altersgruppe zugelassene Systemtherapie: sowohl für die unmittelbare Versorgung der Hauterkrankung als auch unter dem Aspekt einer möglichen Prävention von Begleiterkrankungen. Da der „atopische Phänotyp“ klinische Überlappungen zum Spektrum der Immundefekte aufweist, ist die korrekte Einordnung des Hautbefundes bei therapierefraktärem Ekzem essenziell. In dieser Arbeit beschreiben wir eine alltagstaugliche Strategie, um anhand anamnestischer Warnhinweise, dermatologischer Leitbefunde und Labordiagnostik eine Abgrenzung von ekzematösen Hauterscheinungen bei primären Immundefekten vorzunehmen. Dazu geben wir aktuelle Empfehlungen zum Management des schweren frühkindlichen atopischen Ekzems, auch in Bezug auf die Indikation zur Systemtherapie.
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Affiliation(s)
- Andreas Benedikt Weins
- Klinik für Kinder- und Jugendmedizin, Universitätsklinik Augsburg
- KIDZ SKIN | Praxis für Kinder- und Jugenddermatologie, Ulm
| | - Sebastian Kerzel
- Krankenhaus Barmherzige Brüder, Klinik und Poliklinik für Kinder- und Jugendmedizin, Abteilung für Pädiatrische Pneumologie und Allergologie, Regensburg
| | - Christina Schnopp
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
- Praxis Burgstraße, München
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3
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Weins AB, Kerzel S, Schnopp C. Severe atopic dermatitis in early infancy: characteristics, challenges and new perspectives in clinical practice. J Dtsch Dermatol Ges 2024; 22:350-355. [PMID: 38450908 DOI: 10.1111/ddg.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 03/08/2024]
Abstract
Atopic dermatitis (AD) is the most common skin disease in infants and children with a prevalence of 10% in the first two years of life. In this age group up to 15% are severely affected. "Children are not little adults" - this applies in particular to infants with severe atopic dermatitis. Age-specific clinical aspects (psychosocial, neurocognitive, morphological) of the disease require an adjusted disease management. Considering recent approval of systemic treatment options, early identification of infants and children with severe and early persistent disease is of particular importance also in view of possible prevention of atopic comorbidity. As several inborn errors of immunity (IEI) share features of the atopic phenotype, it is essential for clinicians to distinguish signs of immunodeficiency from severe AD. Here, we describe a practical approach on the basis of clinical history and key dermatological and laboratory findings. Furthermore, this paper is aimed at providing an update on general management of severe AD in early infancy, including recommendations for systemic treatment.
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Affiliation(s)
- Andreas Benedikt Weins
- Department of Pediatrics, University Hospital Augsburg, Augsburg, Germany
- KIDZ SKIN | Practice for Pediatric Dermatology, Ulm, Germany
| | - Sebastian Kerzel
- Barmherzige Brüder Hospital, Department of Pediatrics, Section for Pediatric Pneumonology and Allergology, Regensburg, Germany
| | - Christina Schnopp
- Department of Dermatology and Allergology am Biederstein, Technical University Munich, Munich, Germany
- Practice Burgstraße, Munich, Germany
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4
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Technau-Hafsi K, Garzorz-Stark N, Eyerich K. [Molecular diagnosis of hand eczema]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05148-z. [PMID: 37272967 DOI: 10.1007/s00105-023-05148-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
- Kristin Technau-Hafsi
- Klinik für Dermatologie und Venerologie, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland.
- Universitäts-Hautklinik Freiburg, Hauptstr. 7, 79104, Freiburg, Deutschland.
| | - Natalie Garzorz-Stark
- Division of Dermatology, Department of Medicine, Karolinska Insitutet, Stockholm, Schweden
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München, Deutschland
- Dermagnostix GmbH, Hamburg, Deutschland
| | - Kilian Eyerich
- Klinik für Dermatologie und Venerologie, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
- Division of Dermatology, Department of Medicine, Karolinska Insitutet, Stockholm, Schweden
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5
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Schuler CF, Billi AC, Maverakis E, Tsoi LC, Gudjonsson JE. Novel insights into atopic dermatitis. J Allergy Clin Immunol 2023; 151:1145-1154. [PMID: 36428114 PMCID: PMC10164702 DOI: 10.1016/j.jaci.2022.10.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Abstract
Recent research into the pathophysiology and treatment of atopic dermatitis (AD) has shown notable progress. An increasing number of aspects of the immune system are being implicated in AD, including the epithelial barrier, TH2 cytokines, and mast cells. Major advances in therapeutics were made in biologic cytokine and receptor antagonists and among Janus kinase inhibitors. We focus on these areas and address new insights into AD epidemiology, biomarkers, endotypes, prevention, and comorbidities. Going forward, we expect future mechanistic insights and therapeutic advances to broaden physicians' ability to diagnose and manage AD patients, and perhaps to find a cure for this chronic condition.
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Affiliation(s)
- Charles F Schuler
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, Mich
| | - Allison C Billi
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Mich
| | - Emanual Maverakis
- Department of Dermatology, University of California-Davis, Sacramento, Calif
| | - Lam C Tsoi
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Mich
| | - Johann E Gudjonsson
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Mich.
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6
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Bakker D, de Bruin-Weller M, Drylewicz J, van Wijk F, Thijs J. Biomarkers in atopic dermatitis. J Allergy Clin Immunol 2023; 151:1163-1168. [PMID: 36792449 DOI: 10.1016/j.jaci.2023.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/23/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
Atopic dermatitis (AD) is a complex and highly heterogeneous inflammatory skin disease. Given the highly heterogeneous character of AD, it is unlikely that every patient will respond equally to a particular treatment. The recent introduction of novel targeted therapies for AD has driven the need for patient stratification based on immunologic biomarkers. We have reviewed the use of different types of biomarkers as potential tools in the movement toward personalized medicine in AD, comprising different ways of endotyping patients with AD based on immunologic profiles and predictive biomarkers. The application of biomarkers will result in better characterization and stratification of patients and allow better comparison of current and new treatments. The ultimate goal will be to switch from the current generalized "one-drug-fits-all" management to more personalized "patient endotype-specific" management.
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Affiliation(s)
- Daphne Bakker
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Marjolein de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Julia Drylewicz
- Center for Translational Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Judith Thijs
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
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7
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Salava A, Salo V, Leppänen J, Lauerma A, Remitz A. Factors associated with severity of atopic dermatitis - a Finnish cross-sectional study. J Eur Acad Dermatol Venereol 2022; 36:2130-2139. [PMID: 35766133 PMCID: PMC9796899 DOI: 10.1111/jdv.18378] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/02/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Severity-associated factors in atopic dermatitis (AD) have focussed on early onset, concomitant atopic diseases, markers of Th2-shifted inflammation and filaggrin mutations. OBJECTIVES To investigate factors associated with severe AD in Finnish patients. METHODS We conducted a single-centre, cross-sectional observational study with 502 AD patients aged 4.79 to 79.90 years (mean 32.08 years). Disease severity was assessed with the Rajka-Langeland severity score and EASI and associated clinical signs were evaluated. Data regarding onset, relatives, atopic and other comorbidities was gathered retrospectively. We investigated total serum IgE-levels, a panel of filaggrin null mutations and functional variants of genes associated with skin barrier defects. RESULTS Factors more frequent in severe AD included early onset (P = 0.004, 95%CI 0.000-0.024), male sex (P = 0.002, 95%CI 0.000-0.11), history of smoking (P = 0.012, 95%CI 0.000-0.024), concomitant asthma (P = 0.001, 95%CI 0.000-0.011), palmar hyperlinearity (P = 0.013, 95%CI 0.014-0.059), hand dermatitis (P = 0.020, 95%CI 0.000-0.029) and history of contact allergy (P = 0.042, 95%CI 0.037-0.096). Body mass indices (P < 0.000, 95%CI 0.000-0.011) and total serum IgE-levels (P < 0.000, 95%CI 0.000-0.011) were higher in severe AD. No differences were observed for allergic rhinitis, allergic conjunctivitis, food allergy, peanut allergy, prick positivity, keratosis pilaris, history of herpes simplex infections, filaggrin null mutations and other gene variants. CONCLUSIONS Severity determinants in Finnish patients seem to be early-onset, male sex, smoking, overweight, concomitant asthma, palmar hyperlinearity, hand dermatitis and high IgE-levels. A sub-typing of patients in relation to confirmed severity determinants may be useful for course prediction, prognosis and targeted AD management.
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Affiliation(s)
- A. Salava
- Skin and Allergy HospitalHelsinki University HospitalHelsinkiFinland
| | - V. Salo
- Skin and Allergy HospitalHelsinki University HospitalHelsinkiFinland
| | - J. Leppänen
- Skin and Allergy HospitalHelsinki University HospitalHelsinkiFinland
| | - A. Lauerma
- Skin and Allergy HospitalHelsinki University HospitalHelsinkiFinland
| | - A. Remitz
- Skin and Allergy HospitalHelsinki University HospitalHelsinkiFinland
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8
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Mastraftsi S, Vrioni G, Bakakis M, Nicolaidou E, Rigopoulos D, Stratigos AJ, Gregoriou S. Atopic Dermatitis: Striving for Reliable Biomarkers. J Clin Med 2022; 11:jcm11164639. [PMID: 36012878 PMCID: PMC9410433 DOI: 10.3390/jcm11164639] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/02/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
Atopic dermatitis (AD) is a highly heterogeneous inflammatory disease regarding both its pathophysiology and clinical manifestations. However, it is treated according to the “one-size-fits-all” approach, which may restrict response to treatment. Thus, there is an unmet need for the stratification of patients with AD into distinct endotypes and clinical phenotypes based on biomarkers that will contribute to the development of precision medicine in AD. The development of reliable biomarkers that may distinguish which patients with AD are most likely to benefit from specific targeted therapies is a complex procedure and to date none of the identified candidate biomarkers for AD has been validated for use in routine clinical practice. Reliable biomarkers in AD are expected to improve diagnosis, evaluate disease severity, predict the course of disease, the development of comorbidities, or the therapeutic response, resulting in effective and personalized treatment of AD. Among the studied AD potential biomarkers, thymus and activation-regulated chemokine/C-C motif ligand 17 (TARC/CCL17) has the greatest evidence-based support for becoming a reliable biomarker in AD correlated with disease severity in both children and adults. In this review, we present the most prominent candidate biomarkers in AD and their suggested use.
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Affiliation(s)
- Styliani Mastraftsi
- 1st Department of Dermatology and Venereology, Andreas Sygros Hospital for Skin and Venereal Diseases, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece
- Correspondence: ; Tel.: +30-6974819341
| | - Georgia Vrioni
- 1st Department of Dermatology and Venereology, Andreas Sygros Hospital for Skin and Venereal Diseases, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Michail Bakakis
- 1st Department of Dermatology and Venereology, Andreas Sygros Hospital for Skin and Venereal Diseases, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Electra Nicolaidou
- 1st Department of Dermatology and Venereology, Andreas Sygros Hospital for Skin and Venereal Diseases, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology and Venereology, Andreas Sygros Hospital for Skin and Venereal Diseases, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Alexander J. Stratigos
- 1st Department of Dermatology and Venereology, Andreas Sygros Hospital for Skin and Venereal Diseases, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Stamatios Gregoriou
- 1st Department of Dermatology and Venereology, Andreas Sygros Hospital for Skin and Venereal Diseases, Medical School, National and Kapodistrian University of Athens, 16121 Athens, Greece
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Ziehfreund S, Tizek L, Hangel N, Fritzsche MC, Weidinger S, Smith C, Bryce PJ, Greco D, van den Bogaard EH, Flohr C, Rastrick J, Eyerich S, Buyx A, Conrad C, Eyerich K, Zink A. Requirements and expectations of high-quality biomarkers for atopic dermatitis and psoriasis in 2021 - a two-round Delphi survey among international experts. J Eur Acad Dermatol Venereol 2022; 36:1467-1476. [PMID: 35470457 DOI: 10.1111/jdv.18178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic inflammatory skin diseases such as atopic dermatitis (AD) and psoriasis (PSO) present major challenges in health care. Thus, biomarkers to identify disease trajectories and response to treatments to improve the lives of affected individuals warrant great research consideration. The requirements that these biomarkers must fulfill for use as practical clinical tools have not yet been adequately investigated. AIM To identify the core elements of high-quality AD and PSO biomarkers to prepare recommendations for current biomarker research. METHOD A cross-sectional two-round Delphi survey was conducted from August to October 2019 and October to November 2020. All participants were members of the BIOMAP project, an EU-funded consortium of clinicians, researchers, patient organizations and pharmaceutical industry partners. The first round consisted of three open-ended questions. Responses were qualitatively analyzed, and 26 closed statements were developed. For the second round, 'agreement' was assumed when the responses of ≥70% of the participants were ≥5 points on a 7-point Likert scale for each statement. Priority classification was based on mean scores (<20th-percentile=low, 20th-60th-percentile=medium, >60th-percentile=high). RESULTS Twenty-one and twenty-six individuals participated in round one and two, respectively. From 26 statements that were included in round 2, 18 achieved agreement (8 concerning the performance, 8 for the purpose, and 2 on current obstacles). Seven statements were classified as high priority, e.g., those concerning reliability, clinical validity, a high positive predictive value, prediction of the therapeutic response, and disease progression. Another seven statements were assigned medium priority, e.g., those about analytical validity, prediction of comorbidities, and therapeutic algorithm. Low priority included four statements, like those concerning cost-effectiveness and prediction of disease flares. CONCLUSION The core requirements that experts agreed on being essential for high-quality AD and PSO biomarkers, require rapid validation. Biomarkers can therefore be assessed based on these prioritized requirements.
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Affiliation(s)
- Stefanie Ziehfreund
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany
| | - Linda Tizek
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany
| | - Nora Hangel
- Institute for History and Ethics of Medicine, Technical University of Munich, Munich, Germany
| | | | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Catherine Smith
- St John's Institute of Dermatology, Kings College London, and Guys and St Thomas' NHS Foundation Trust, 9th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Paul J Bryce
- Type 2 Inflammation & Fibrosis Cluster, Immunology & Inflammation Therapeutic Area, Sanofi US, Cambridge, MA, United States of America
| | - Dario Greco
- Faculty of Medicine and Health Technology, BioMediTech Institute, Tampere University, Tampere, Finland.,Institute of Biotechnology, Helsinki Institute for Life Science (HiLife), University of Helsinki, Helsinki, Finland
| | - Ellen H van den Bogaard
- Department of Dermatology, Radboud university medical center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Joe Rastrick
- Immunology Research, New Medicines UCB Pharma, Slough, UK
| | - Stefanie Eyerich
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802, Munich, Germany
| | - Alena Buyx
- Institute for History and Ethics of Medicine, Technical University of Munich, Munich, Germany
| | - Curdin Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Kilian Eyerich
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany.,Division of Dermatology and Venerology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology and Venereology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Alexander Zink
- Technical University of Munich, School of Medicine, Department of Dermatology and Allergy, Munich, Germany.,Division of Dermatology and Venerology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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10
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Fania L, Moretta G, Antonelli F, Scala E, Abeni D, Albanesi C, Madonna S. Multiple Roles for Cytokines in Atopic Dermatitis: From Pathogenic Mediators to Endotype-Specific Biomarkers to Therapeutic Targets. Int J Mol Sci 2022; 23:ijms23052684. [PMID: 35269828 PMCID: PMC8910412 DOI: 10.3390/ijms23052684] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 12/20/2022] Open
Abstract
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases, which generally presents with intense itching and recurrent eczematous lesions. AD affects up to 20% of children and 10% of adults in high-income countries. The prevalence and incidence of AD have increased in recent years. The onset of AD mostly occurs in childhood, although in some cases AD may persist in adult life or even manifest in middle age (adult-onset AD). AD pathophysiology is made of a complex net, in which genetic background, skin barrier dysfunction, innate and adaptive immune responses, as well as itch contribute to disease development, progression, and chronicization. One of the most important features of AD is skin dehydration, which is mainly caused by filaggrin mutations that determine trans-epidermal water loss, pH alterations, and antigen penetration. In accordance with the “outside-inside” theory of AD pathogenesis, in a context of an altered epidermal barrier, antigens encounter epidermal antigen presentation cells (APCs), such as epidermal Langerhans cells and inflammatory epidermal dendritic cells, leading to their maturation and Th-2 cell-mediated inflammation. APCs also bear trimeric high-affinity receptors for immunoglobulin E (IgE), which induce IgE-mediated sensitizations as part of pathogenic mechanisms leading to AD. In this review, we discuss the role of cytokines in the pathogenesis of AD, considering patients with various clinical AD phenotypes. Moreover, we describe the cytokine patterns in patients with AD at different phases of the disease evolution, as well as in relation to different phenotypes/endotypes, including age, race, and intrinsic/extrinsic subtypes. We also discuss the outcomes of current biologics for AD, which corroborate the presence of multiple cytokine axes involved in the background of AD. A deep insight into the correlation between cytokine patterns and the related clinical forms of AD is a crucial step towards increasingly personalized, and therefore more efficient therapy.
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Affiliation(s)
- Luca Fania
- Integrated Center for Research in Atopic Dermatitis (CRI-DA), IDI-IRCCS, Via Monti di Creta, 104, 00167 Rome, Italy; (L.F.); (G.M.); (F.A.); (E.S.)
| | - Gaia Moretta
- Integrated Center for Research in Atopic Dermatitis (CRI-DA), IDI-IRCCS, Via Monti di Creta, 104, 00167 Rome, Italy; (L.F.); (G.M.); (F.A.); (E.S.)
| | - Flaminia Antonelli
- Integrated Center for Research in Atopic Dermatitis (CRI-DA), IDI-IRCCS, Via Monti di Creta, 104, 00167 Rome, Italy; (L.F.); (G.M.); (F.A.); (E.S.)
| | - Enrico Scala
- Integrated Center for Research in Atopic Dermatitis (CRI-DA), IDI-IRCCS, Via Monti di Creta, 104, 00167 Rome, Italy; (L.F.); (G.M.); (F.A.); (E.S.)
| | - Damiano Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, 00167 Rome, Italy;
| | - Cristina Albanesi
- Laboratory of Experimental Immunology, IDI-IRCCS, Via Monti di Creta, 104, 00167 Rome, Italy;
- Correspondence:
| | - Stefania Madonna
- Laboratory of Experimental Immunology, IDI-IRCCS, Via Monti di Creta, 104, 00167 Rome, Italy;
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11
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Ogulur I, Pat Y, Ardicli O, Barletta E, Cevhertas L, Fernandez‐Santamaria R, Huang M, Bel Imam M, Koch J, Ma S, Maurer DJ, Mitamura Y, Peng Y, Radzikowska U, Rinaldi AO, Rodriguez‐Coira J, Satitsuksanoa P, Schneider SR, Wallimann A, Zhakparov D, Ziadlou R, Brüggen M, Veen W, Sokolowska M, Baerenfaller K, Zhang L, Akdis M, Akdis CA. Advances and highlights in biomarkers of allergic diseases. Allergy 2021; 76:3659-3686. [PMID: 34519063 PMCID: PMC9292545 DOI: 10.1111/all.15089] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/19/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
During the past years, there has been a global outbreak of allergic diseases, presenting a considerable medical and socioeconomical burden. A large fraction of allergic diseases is characterized by a type 2 immune response involving Th2 cells, type 2 innate lymphoid cells, eosinophils, mast cells, and M2 macrophages. Biomarkers are valuable parameters for precision medicine as they provide information on the disease endotypes, clusters, precision diagnoses, identification of therapeutic targets, and monitoring of treatment efficacies. The availability of powerful omics technologies, together with integrated data analysis and network‐based approaches can help the identification of clinically useful biomarkers. These biomarkers need to be accurately quantified using robust and reproducible methods, such as reliable and point‐of‐care systems. Ideally, samples should be collected using quick, cost‐efficient and noninvasive methods. In recent years, a plethora of research has been directed toward finding novel biomarkers of allergic diseases. Promising biomarkers of type 2 allergic diseases include sputum eosinophils, serum periostin and exhaled nitric oxide. Several other biomarkers, such as pro‐inflammatory mediators, miRNAs, eicosanoid molecules, epithelial barrier integrity, and microbiota changes are useful for diagnosis and monitoring of allergic diseases and can be quantified in serum, body fluids and exhaled air. Herein, we review recent studies on biomarkers for the diagnosis and treatment of asthma, chronic urticaria, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, food allergies, anaphylaxis, drug hypersensitivity and allergen immunotherapy. In addition, we discuss COVID‐19 and allergic diseases within the perspective of biomarkers and recommendations on the management of allergic and asthmatic patients during the COVID‐19 pandemic.
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Hülpüsch C, Weins AB, Traidl‐Hoffmann C, Reiger M. A new era of atopic eczema research: Advances and highlights. Allergy 2021; 76:3408-3421. [PMID: 34407212 DOI: 10.1111/all.15058] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/03/2021] [Accepted: 08/12/2021] [Indexed: 01/09/2023]
Abstract
Atopic eczema (AE) is an inflammatory skin disease with involvement of genetic, immunological and environmental factors. One hallmark of AE is a skin barrier disruption on multiple, highly interconnected levels: filaggrin mutations, increased skin pH and a microbiome dysbiosis towards Staphylococcus aureus overgrowth are observed in addition to an abnormal type 2 immune response. Extrinsic factors seem to play a major role in the development of AE. As AE is a first step in the atopic march, its prevention and appropriate treatment are essential. Although standard therapy remains topical treatment, powerful systemic treatment options emerged in the last years. However, thorough endotyping of the individual patients is still required for ideal precision medicine approaches in future. Therefore, novel microbial and immunological biomarkers were described recently for the prediction of disease development and treatment response. This review summarizes the current state of the art in AE research.
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Affiliation(s)
- Claudia Hülpüsch
- Department of Environmental Medicine Faculty of Medicine University of Augsburg Augsburg Germany
- Institute of Environmental Medicine Helmholtz Zentrum München Augsburg Germany
- CK CARE – Christine Kühne Center for Allergy research and Education Davos Switzerland
| | - Andreas B. Weins
- Department of Dermatology Faculty of Medicine University of Augsburg Augsburg Germany
| | - Claudia Traidl‐Hoffmann
- Department of Environmental Medicine Faculty of Medicine University of Augsburg Augsburg Germany
- Institute of Environmental Medicine Helmholtz Zentrum München Augsburg Germany
- CK CARE – Christine Kühne Center for Allergy research and Education Davos Switzerland
- ZIEL Technical University of Munich Freising Germany
| | - Matthias Reiger
- Department of Environmental Medicine Faculty of Medicine University of Augsburg Augsburg Germany
- Institute of Environmental Medicine Helmholtz Zentrum München Augsburg Germany
- CK CARE – Christine Kühne Center for Allergy research and Education Davos Switzerland
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Hou T, Tsang MS, Chu IM, Kan LL, Hon K, Leung T, Lam CW, Wong C. Skewed inflammation is associated with aberrant interleukin-37 signaling pathway in atopic dermatitis. Allergy 2021; 76:2102-2114. [PMID: 33569791 DOI: 10.1111/all.14769] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a severe global burden on physical, physiological, and mental health. The role of IL-37, a fundamental inhibitor of immunity, in AD was herein explored. METHOD Serum levels of IL-37 and T helper (Th) 2-related inflammatory mediators were quantified in subjects with or without AD. The expression of IL-37 receptors was determined by flow cytometry. Proteomics was employed to explore the serum protein profile and novel biomarkers. In vitro cell model, 3D-keratinocytes mimicking skin model, and the serum of subjects with or without AD were investigated to verify the proteomic results. RESULTS AD patients were found to present with higher levels of total and specific IgE as well as Th2 inflammatory mediators compared with healthy controls (HC). IL-37 level and its receptor IL18Rɑ expression in AD patients were significantly decreased, together with increased population of eosinophils, indicating that the signaling of IL37/IL18Rɑ was dampened. In addition, proteomic analysis revealed a significantly differential protein profile of AD patients compared with HC. IL-37 showed the strongest negative correlation with involucrin, a keratinizing epithelia protein. IL-37 was verified to suppress induced involucrin expression in in vitro skin cell models. AD patients show a significantly higher serum concentration of involucrin compared with HC. Together, our results demonstrated that IL-37 plays a regulatory role in AD. Its deficiency may lead to the aberrant involucrin expression in AD. CONCLUSIONS The dysregulation of serum protein and skin disruption in AD is related to the insufficiency of IL-37 and its attenuated anti-inflammatory signaling.
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Affiliation(s)
- Tianheng Hou
- Department of Chemical Pathology Prince of Wales HospitalThe Chinese University of Hong Kong Hong Kong China
| | - Miranda Sin‐Man Tsang
- Department of Chemical Pathology Prince of Wales HospitalThe Chinese University of Hong Kong Hong Kong China
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants The Chinese University of Hong Kong Hong Kong China
| | - Ida Miu‐Ting Chu
- Department of Chemical Pathology Prince of Wales HospitalThe Chinese University of Hong Kong Hong Kong China
| | - Lea Ling‐Yu Kan
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants The Chinese University of Hong Kong Hong Kong China
| | - Kam‐Lun Hon
- Department of Paediatrics The Chinese University of Hong KongPrince of Wales Hospital Hong Kong China
| | - Ting‐Fan Leung
- Department of Paediatrics The Chinese University of Hong KongPrince of Wales Hospital Hong Kong China
| | - Christopher Wai‐Kei Lam
- Faculty of Medicine and State Key Laboratory of Quality Research in Chinese Medicines Macau University of Science and Technology Macau China
| | - Chun‐Kwok Wong
- Department of Chemical Pathology Prince of Wales HospitalThe Chinese University of Hong Kong Hong Kong China
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants The Chinese University of Hong Kong Hong Kong China
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Renert-Yuval Y, Thyssen JP, Bissonnette R, Bieber T, Kabashima K, Hijnen D, Guttman-Yassky E. Biomarkers in atopic dermatitis-a review on behalf of the International Eczema Council. J Allergy Clin Immunol 2021; 147:1174-1190.e1. [PMID: 33516871 PMCID: PMC11304440 DOI: 10.1016/j.jaci.2021.01.013] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/22/2020] [Accepted: 01/15/2021] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis (AD) is a common yet complex skin disease, posing a therapeutic challenge with increasingly recognized different phenotypes among variable patient populations. Because therapeutic response may vary on the basis of heterogeneous clinical and molecular phenotypes, a shift toward precision medicine approaches may improve AD management. Herein, we will consider biomarkers as potential instruments in the toolbox of precision medicine in AD and will review the process of biomarker development and validation, the opinion of AD experts on the use of biomarkers, types of biomarkers, encompassing biomarkers that may improve AD diagnosis, biomarkers reflecting disease severity, and those potentially predicting AD development, concomitant atopic diseases, or therapeutic response, and current practice of biomarkers in AD. We found that chemokine C-C motif ligand 17/thymus and activation-regulated chemokine, a chemoattractant of TH2 cells, has currently the greatest evidence for robust correlation with AD clinical severity, at both baseline and during therapy, by using the recommendations, assessment, development, and evaluation approach. Although the potential of biomarkers in AD is yet to be fully elucidated, due to the complexity of the disease, a comprehensive approach taking into account both clinical and reliable, AD-specific biomarker evaluations would further facilitate AD research and improve patient management.
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Affiliation(s)
- Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Robert Bissonnette
- Department of Dermatology, Innovaderm Research, Montreal, Quebec, Canada
| | - Thomas Bieber
- Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, University of Bonn, Bonn, Germany
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University School of Medicine, Kyoto, Japan
| | - DirkJan Hijnen
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emma Guttman-Yassky
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.
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