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Zhang L, Zhang X, Deng X, Wang P, Mo Y, Zhang Y, Tong X. Cytokines as drivers: Unraveling the mechanisms of epithelial-mesenchymal transition in COVID-19 lung fibrosis. Biochem Biophys Res Commun 2023; 686:149118. [PMID: 37931361 DOI: 10.1016/j.bbrc.2023.10.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 11/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), like other viruses, can induce proliferation of myofibroblasts and even lead to fibrosis in the lung. Epithelial-mesenchymal transition (EMT) is thought to play an essential role in the pathogenesis of Coronavirus disease 19 (COVID-19). EMT is originally a critical process that regulates the development of different tissues in the embryo, but in inflammatory situations, EMT tries to be activated again to control inflammation or even heal inflammatory damage. However, in pathological situations, such as chronic viral infections (e.g., COVID-19) or pulmonary fibrosis initiation, this benign healing transforms into sinister nature, pushing the lung into the fibrotic process. Notably, the cytokines released by inflammatory cells and the chronic inflammatory microenvironment shared by fibrotic cells promote each other as critical factors in the induction of pathological EMT. In the induction of SARS-CoV-2 virus, cytokines are an essential mediator of EMT transformation, and a summary of whether COVID-19 patients, during the infection phase, have many persistent inflammatory mediators (cytokines) that are a causative factor of EMT has not yet appeared. The following common signaling drivers, including Transforming growth factor beta (TGF-β), cytokines, Notch signaling pathway, Wnt and hypoxia signaling pathways, drive the regulation of EMT. In this review, we will focus on 3 key EMT signaling pathways: TGF-β, Leucine zipper transcription factor like 1 (LZTFL1) and the common interleukin family expressed in the lung. TGF-β-induced SNAIL and LZTFL1 were identified as regulatory EMT in COVID-19. For cytokines, the interleukin family is a common inducer of EMT and plays an essential role in the formation of the microenvironment of fibrosis. We sought to demonstrate that cytokines act as "communicators" and build the "microenvironment" of fibrosis together with EMT as a "bridge" to induce EMT in fibrosis. The mechanisms utilized by these two pathways could serve as templates for other mesenchymal transformations and provide new potential therapeutic targets.
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Affiliation(s)
- Lanlan Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China; State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu, China.
| | - Xin Zhang
- Department of Gastroenterology, West China (Airport) Hospital of Sichuan University, Chengdu, China; Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China.
| | - Xiaoqian Deng
- Department of Anesthesiology, West China Hospital, Sichuan university, Chengdu, China
| | - Pengbo Wang
- School of Professional Studies, Columbia University, USA
| | - Yan Mo
- Department of Neurology Medicine, The Aviation Industry Corporation of China (AVIC) 363 Hospital, Chengdu, China
| | - Yuansheng Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xia Tong
- Department of Gastroenterology, West China (Airport) Hospital of Sichuan University, Chengdu, China; Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
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2
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Li S, Duan X, Jiang N, Jeyarajan AJ, Warner CA, Li Y, Xu M, Li X, Tan L, Li M, Shao T, Li S, Chen L, Gao Y, Han M, Lin W. Vaccination increased host antiviral gene expression and reduced COVID-19 severity during the Omicron variant outbreak in Fuyang City, China. Int Immunopharmacol 2023; 120:110333. [PMID: 37201409 DOI: 10.1016/j.intimp.2023.110333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The differences in host antiviral gene expression and disease severity between vaccinated and non-vaccinated coronavirus disease 2019 (COVID-19) patients are not well characterized. We sought to compare the clinical characteristics and host antiviral gene expression patterns of vaccinated and non-vaccinated cohorts at the Second People's Hospital of Fuyang City. METHODS In this case-control study, we retrospectively analyzed 113 vaccinated patients with a COVID-19 Omicron variant infection, 46 non-vaccinated COVID-19 patients, and 24 healthy subjects (no history of COVID-19) recruited from the Second People's Hospital of Fuyang City. Blood samples were collected from each study participant for RNA extraction and PCR. We compared host antiviral gene expression profiles between healthy controls and COVID-19 patients who were either vaccinated or non-vaccinated at the time of infection. RESULTS In the vaccinated group, most patients were asymptomatic, with only 42.9 % of patients developing fever. Notably, no patients had extrapulmonary organ damage. In contrast, 21.4 % of patients in the non-vaccinated group developed severe/critical (SC) disease and 78.6 % had mild/moderate (MM) disease, with fever occurring in 74.2 % patients. We found that Omicron infection in COVID-19 vaccinated patients was associated with significantly increased expression of several important host antiviral genes including IL12B, IL13, CXCL11, CXCL9, IFNA2, IFNA1, IFNγ, and TNFα. CONCLUSION Vaccinated patients infected with the Omicron variant were mostly asymptomatic. In contrast, non-vaccinated patients frequently developed SC or MM disease. Older patients with SC COVID-19 also had a higher occurrence of mild liver dysfunction. Omicron infection in COVID-19 vaccinated patients was associated with the activation of key host antiviral genes and thus may play a role in reducing disease severity.
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Affiliation(s)
- Shasha Li
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang 236015, Anhui Province, PR China
| | - Xiaoqiong Duan
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, Sichuan Province, PR China
| | - Ning Jiang
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang 236015, Anhui Province, PR China; Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, PR China
| | - Andre J Jeyarajan
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Charlotte A Warner
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Yujia Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, Sichuan Province, PR China
| | - Min Xu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, Sichuan Province, PR China
| | - Xiuyong Li
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang 236015, Anhui Province, PR China
| | - Lin Tan
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang 236015, Anhui Province, PR China
| | - Ming Li
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang 236015, Anhui Province, PR China
| | - Tuo Shao
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Shilin Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, Sichuan Province, PR China
| | - Limin Chen
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, Sichuan Province, PR China
| | - Yufeng Gao
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, PR China.
| | - Mingfeng Han
- Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang 236015, Anhui Province, PR China.
| | - Wenyu Lin
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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3
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Jing W, Yang D, Liu X, Li L, Lu T, Li X. Dupilumab Therapy of Prurigo Nodularis: A Single-Center, Real-Life Observational Study. Dermatol Ther 2023. [DOI: 10.1155/2023/3835433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by severe itching accompanied by multiple nodules throughout the body. There is currently no effective drug-targeted treatment for PN. Dupilumab is a fully human monoclonal antibody which can suppress the Th2 inflammatory reaction. We aimed to assess the efficacy and safety of dupilumab in PN. There were 29 PN patients who received dupilumab treatment for four months. Serum total immunoglobulin E (Ig E), eosinophil counts, dermatology life quality index (DLQI), and numeric rating scale (NRS) were assessed on patients before and after treatment. We count the vaccination of novel coronavirus pneumonia (COVID-19) in patients and the impact on PN and treatment measures after vaccination. Plotting was performed using GraphPad Prism8, and the statistical analysis was performed using PASW Statistics18. The eosinophil counts in patients higher decreased to normal, and the Ig E levels gradually decreased and tended to normal levels after receiving dupilumab injection. The average DLQI score at the baseline was 23.93 ± 0.66 and decreased to 11.66 ± 0.55 (
) and 1.83 ± 0.22 (
) at 1-month and 6-monthfollow-up of treatment, respectively. The average NRS score at the baseline was 9.79 ± 0.08 and decreased to 3.52 ± 0.23 (
) and 0.31 ± 0.15 (
) at the 1-month and 6-monthfollow-up of treatment, respectively. Our study shows that dupilumab has achieved good efficacy in PN with few adverse reactions and high safety. We can recommend that patients follow the advice of specialists to be vaccinated and under the condition of stable disease, separated from dupilumab treatment for one week.
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4
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Abadeh A, Lee JK. Reduced COVID-19 vaccine response in patient treated with dupilumab for IgG4-related disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:118-119. [PMID: 36313899 PMCID: PMC9598042 DOI: 10.1016/j.jacig.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/13/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
Dupilumab is a novel anti-IL-4 receptor-α mAb that targets the signaling pathways of IL-4 and IL-13. Thus far, the data about adequate humoral immune response after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients who are taking dupilumab have been limited.
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Affiliation(s)
- Armin Abadeh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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5
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Borgia F, Li Pomi F, Vaccaro M, Alessandrello C, Papa V, Gangemi S. Oxidative Stress and Phototherapy in Atopic Dermatitis: Mechanisms, Role, and Future Perspectives. Biomolecules 2022; 12:1904. [PMID: 36551332 PMCID: PMC9775940 DOI: 10.3390/biom12121904] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Atopic dermatitis is a chronic inflammatory skin disease in which the overproduction of reactive oxygen species plays a pivotal role in the pathogenesis and persistence of inflammatory lesions. Phototherapy represents one of the most used therapeutic options, with benefits in the clinical picture. Studies have demonstrated the immunomodulatory effect of phototherapy and its role in reducing molecule hallmarks of oxidative stress. In this review, we report the data present in literature dealing with the main signaling molecular pathways involved in oxidative stress after phototherapy to target atopic dermatitis-affected cells. Since oxidative stress plays a pivotal role in the pathogenesis of atopic dermatitis and its flare-up, new research lines could be opened to study new drugs that act on this mechanism, perhaps in concert with phototherapy.
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Affiliation(s)
- Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy
| | - Clara Alessandrello
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Vincenzo Papa
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
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6
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Zaazouee MS, Alwarraqi AG, Mohammed YA, Badheeb MA, Farhat AM, Eleyan M, Morad A, Zeid MAA, Mohamed AS, AbuEl-Enien H, Abdelalim A, Elsnhory AB, Hrizat YSM, Altahir NT, Atef D, Elshanbary AA, Alsharif KF, Alzahrani KJ, Algahtani M, Theyab A, Hawsawi YM, Aldarmahi AA, Abdel-Daim MM. Dupilumab efficacy and safety in patients with moderate to severe asthma: A systematic review and meta-analysis. Front Pharmacol 2022; 13:992731. [PMID: 36263132 PMCID: PMC9574251 DOI: 10.3389/fphar.2022.992731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Dupilumab is a human monoclonal antibody directed against the alpha subunit of the interleukin-4 receptor and inhibits the signaling of IL-4 and IL-13. It is approved for treating asthma and other type-2 inflammatory diseases. There is a conflict in the literature regarding the safety and efficacy of dupilumab. Thus, we aimed to assess the safety and efficacy of dupilumab in patients with moderate to severe asthma. Methods: Six databases (PubMed, Embase, Scopus, Web of Science, Cochrane library, and clinicaltrials.gov registry) were searched until January 2022. We included randomized controlled trials that compared dupilumab with the placebo in moderate to severe asthma patients. We extracted the data at 12 and 24 weeks and analyzed them using review manager 5.4. Findings: Thirteen trials were included. Dupilumab significantly improved the forced expiratory volume in 1 s, asthma control questionnaire score, the fraction of exhaled nitric oxide level, and immunoglobulin E level at 12 and 24 weeks (p < 0.05). However, it was associated with increased blood eosinophils at 12 and 24 weeks. Dupilumab was generally a safe agent for asthmatic patients. It showed no significant difference compared with the placebo regarding most adverse events. Conclusion: Dupilumab improves pulmonary function and reduces local and systemic inflammatory markers with minimal adverse events in patients with moderate to severe asthma.
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Affiliation(s)
| | | | | | | | | | - Mohammed Eleyan
- Department of Laboratory Medical Sciences, Alaqsa University, Gaza, Palestine
- Faculty of Medicine, Al-Azhar University, Gaza, Palestine
| | - Afnan Morad
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Marwa Abdel-Aziz Zeid
- Clinical Pharmacist, Pediatrics Department, Ministry of Health, Qalyubia, Egypt
- Faculty of Pharmacy, October 6 University, Giza, Egypt
| | - Aya Shaban Mohamed
- Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hazem AbuEl-Enien
- Faculty of Pharmacy and Drug Manufacturing, Pharos University, Alexandria, Egypt
| | | | | | | | | | - Doaa Atef
- Department of Emergency Medicine, Assiut University, Assiut, Egypt
| | | | - Khalaf F. Alsharif
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Khalid J. Alzahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Mohammad Algahtani
- Department of Laboratory and Blood Bank, Security Forces Hospital, Mecca, Saudi Arabia
| | - Abdulrahman Theyab
- Department of Laboratory and Blood Bank, Security Forces Hospital, Mecca, Saudi Arabia
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - Yousef M. Hawsawi
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
- Research Center, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A. Aldarmahi
- Basic Science Department, College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Mohamed M. Abdel-Daim
- Department of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, Jeddah, Saudi Arabia
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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7
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Munblit D, Greenhawt M, Brough HA, Pushkareva A, Karimova D, Demidova A, Warner JO, Kalayci O, Sediva A, Untersmayr E, Rodriguez Del Rio P, Vazquez-Ortiz M, Arasi S, Alvaro-Lozano M, Tsabouri S, Galli E, Beken B, Eigenmann PA. Allergic diseases and immunodeficiencies in children, lessons learnt from COVID-19 pandemic by 2022: A statement from the EAACI-section on pediatrics. Pediatr Allergy Immunol 2022; 33:e13851. [PMID: 36282136 PMCID: PMC9538373 DOI: 10.1111/pai.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
By the April 12, 2022, the COVID-19 pandemic had resulted in over half a billion people being infected worldwide. There have been 6.1 million deaths directly due to the infection, but the pandemic has had many more short- and long-term pervasive effects on the physical and mental health of the population. Allergic diseases are among the most prevalent noncommunicable chronic diseases in the pediatric population, and health-care professionals and researchers were seeking answers since the beginning of pandemic. Children are at lower risk of developing severe COVID-19 or dying from infection. Allergic diseases are not associated with a higher COVID-19 severity and mortality, apart from severe/poorly controlled asthma. The pandemic disrupted routine health care, but many mitigation strategies, including but not limited to telemedicine, were successfully implemented to continue delivery of high-standard care. Although children faced a multitude of pandemic-related issues, allergic conditions were effectively treated remotely while reduction in air pollution and lack of contact with outdoor allergens resulted in improvement, particularly respiratory allergies. There is no evidence to recommend substantial changes to usual management modalities of allergic conditions in children, including allergen immunotherapy and use of biologicals. Allergic children are not at greater risk of multisystem inflammatory syndrome development, but some associations with Long COVID were reported, although the data are limited, and further research is needed. This statement of the EAACI Section on Pediatrics provides recommendations based on the lessons learnt from the pandemic, as available evidence.
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Affiliation(s)
- Daniel Munblit
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Anna Pushkareva
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Diana Karimova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Anastasia Demidova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - John O Warner
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Omer Kalayci
- Pediatric Allergy and Asthma, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Anna Sediva
- Department of Immunology, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Marta Vazquez-Ortiz
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
| | - Montserrat Alvaro-Lozano
- Allergology and Clinical Immunology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Sophia Tsabouri
- Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elena Galli
- Pediatric Allergology Unit, Department of Pediatric Medicine, S.Pietro Hospital Fatebenefratelli, Rome, Italy
| | - Burcin Beken
- Department of Pediatric Allergy and Immunology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Philippe A Eigenmann
- Pediatric Allergy Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
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8
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Musters AH, Broderick C, Prieto‐Merino D, Chiricozzi A, Damiani G, Peris K, Dhar S, De A, Freeman E, Arents BWM, Burton T, Bosma AL, Chi C, Fletcher G, Drucker AM, Kabashima K, de Monchy EF, Panda M, Wall D, Vestergaard C, Mahé E, Bonzano L, Kattach L, Napolitano M, Ordoñez‐Rubiano MF, Haufe E, Patruno C, Irvine AD, Spuls PI, Flohr C. The effects of systemic immunomodulatory treatments on COVID-19 outcomes in patients with atopic dermatitis: Results from the global SECURE-AD registry. J Eur Acad Dermatol Venereol 2022; 37:365-381. [PMID: 36169355 PMCID: PMC9537876 DOI: 10.1111/jdv.18613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/17/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Limited data are available on the effects of systemic immunomodulatory treatments on COVID-19 outcomes in patients with atopic dermatitis (AD). OBJECTIVE To investigate COVID-19 outcomes in patients with AD treated with or without systemic immunomodulatory treatments, using a global registry platform. METHODS Clinicians were encouraged to report cases of COVID-19 in their patients with AD in the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Atopic Dermatitis (SECURE-AD) registry. Data entered from 1 April 2020 to 31 October 2021 were analysed using multivariable logistic regression. The primary outcome was hospitalization from COVID-19, according to AD treatment groups. RESULTS 442 AD patients (mean age 35.9 years, 51.8% male) from 27 countries with strongly suspected or confirmed COVID-19 were included in analyses. 428 (96.8%) patients were treated with a single systemic therapy (n = 297 [67.2%]) or topical therapy only (n = 131 [29.6%]). Most patients treated with systemic therapies received dupilumab (n = 216). Fourteen patients (3.2%) received a combination of systemic therapies. Twenty-six patients (5.9%) were hospitalized. No deaths were reported. Patients treated with topical treatments had significantly higher odds of hospitalization, compared with those treated with dupilumab monotherapy (odds ratio (OR) 4.65 [95%CI 1.71-14.78]), including after adjustment for confounding variables (adjusted OR (aOR) 4.99 [95%CI 1.4-20.84]). Combination systemic therapy which did not include systemic corticosteroids was associated with increased odds of hospitalization, compared with single agent non-steroidal immunosuppressive systemic treatment (OR 8.09 [95%CI 0.4-59.96], aOR 37.57 [95%CI 1.05-871.11]). Hospitalization was most likely in patients treated with combination systemic therapy which included systemic corticosteroids (OR 40.43 [95%CI 8.16-207.49], aOR 45.75 [95%CI 4.54-616.22]). CONCLUSIONS Overall, the risk of COVID-19 complications appears low in patients with AD, even when treated with systemic immunomodulatory agents. Dupilumab monotherapy was associated with lower hospitalization than other therapies. Combination systemic treatment, particularly combinations including systemic corticosteroids, was associated with the highest risk of severe COVID-19.
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Affiliation(s)
- A. H. Musters
- Department of Dermatology, Amsterdam UMC, location Academic Medical CenterUniversity of Amsterdam, Amsterdam Public Health, Infection and ImmunityThe Netherlands
| | - C. Broderick
- Unit for Population‐Based Dermatology Research, Guy’s and St Thomas’ NHS Foundation Trust and King’s College LondonLondonUK
| | - D. Prieto‐Merino
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical MedicineLondonUK
| | - A. Chiricozzi
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly,Dermatologia, Università Cattolica del Sacro CuoreRomeItaly
| | - G. Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161MilanItaly,Department of Biomedical, Surgical and Dental SciencesUniversity of MilanMilanItaly,PhD Degree Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological SciencesUniversity of PaduaPaduaItaly
| | - K. Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro CuoreRomeItaly,UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli ‐ IRCCSRomeItaly
| | - S. Dhar
- Department of Pediatric DermatologyInstitute of Child HealthKolkataIndia
| | - A. De
- Department of DermatologyCalcutta National Medical CollegeKolkataIndia
| | - E. Freeman
- Department of Dermatology, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA,Medical Practice Evaluation CenterMongan Institute, Massachusetts General Hospital, Harvard Medical SchoolBostonMAUSA
| | - B. W. M. Arents
- Dutch Association for People with Atopic Dermatitis (VMCE), NijkerkThe Netherlands
| | - T. Burton
- Patient Representative (independent), NottinghamUnited Kingdom
| | - A. L. Bosma
- Department of Dermatology, Amsterdam UMC, location Academic Medical CenterUniversity of Amsterdam, Amsterdam Public Health, Infection and ImmunityThe Netherlands
| | - C.‐C. Chi
- Department of Dermatology, Chang Gung Memorial Hospital, LinkouTaoyuanTaiwan,College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - G. Fletcher
- National and International Skin Registry Solutions (NISR), Charles Institute of DermatologyUniversity College DublinDublinIreland
| | - A. M. Drucker
- Department of MedicineUniversity of Toronto, Toronto, Canada; Women's College Research Institute, Women's College HospitalTorontoCanada
| | - K. Kabashima
- Department of DermatologyKyoto University Graduate School of MedicineKyotoJapan,Singapore Immunology Network (SIgN) and Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), BiopolisSingapore
| | - E. F. de Monchy
- Department of Dermatology, Amsterdam UMC, location Academic Medical CenterUniversity of Amsterdam, Amsterdam Public Health, Infection and ImmunityThe Netherlands
| | - M. Panda
- Department of DVLInstitute of Medical Sciences and SUM HospitalBhubaneswarOdishaIndia
| | - D. Wall
- National and International Skin Registry Solutions (NISR), Charles Institute of DermatologyUniversity College DublinDublinIreland,Hair Restoration BlackrockDublinIreland
| | - C. Vestergaard
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - E. Mahé
- Service de Dermatologie et Médecine VasculaireCentre Hospitalier Victor Dupouy, 69 rue du Lieutenant‐Colonel Prud'honArgenteuilCedexFrance
| | - L. Bonzano
- Dermatology Unit, Azienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - L. Kattach
- Guy's & St. Thomas' Hospitals NHS Foundation Trust
| | - M. Napolitano
- Department of Medicine and Health Sciences Vincenzo TiberioUniversity of MoliseCampobassoItaly
| | | | - E. Haufe
- Center for Evidence‐based Health Care (ZEGV), Medical Faculty Carl Gustav Carus, TU DresdenDresdenGermany
| | - C. Patruno
- Dermatology and Venereology, Department of Health SciencesUniversity Magna Graecia of CatanzaroItaly
| | | | - P. I. Spuls
- Department of Dermatology, Amsterdam UMC, location Academic Medical CenterUniversity of Amsterdam, Amsterdam Public Health, Infection and ImmunityThe Netherlands
| | - C. Flohr
- Unit for Population‐Based Dermatology Research, Guy’s and St Thomas’ NHS Foundation Trust and King’s College LondonLondonUK
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9
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Li W, Man XY. Immunotherapy in atopic dermatitis. Immunotherapy 2022; 14:1149-1164. [PMID: 36046941 DOI: 10.2217/imt-2022-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the past decade, the emergence of biologics targeting human cytokine networks has advanced a new era in atopic dermatitis therapy. Dupilumab, in particular, the most widely studied and used IL-4/IL-13 inhibitor, has been considered a milestone in the treatment of patients with moderate-to-severe atopic dermatitis. In addition to the IL-4 and IL-13 pathways, many other cytokines and receptors have been newly targeted as therapeutic options. In this review, the authors provide an overview of the approved and tested biologics and JAK inhibitors for the treatment of atopic dermatitis, including their advantages and limitations.
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Affiliation(s)
- Wei Li
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Yong Man
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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10
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Patruno C, Potestio L, Scalvenzi M, Battista T, Raia F, Picone V, Fabbrocini G, Napolitano M. Dupilumab for the treatment of adult atopic dermatitis in special populations. J DERMATOL TREAT 2022; 33:3028-3033. [PMID: 35829641 DOI: 10.1080/09546634.2022.2102121] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Special populations (SPs) involve people who require additional consideration in clinical research. Effectiveness of treatment or occurrence of side effects may be different in SPs with respect to not-SPs. OBJECTIVES To retrospectively compare the effectiveness and safety of dupilumab in AD treatment of SPs versus not-SPs. METHODS A 52-weeks retrospective study was performed enrolling patients with a diagnosis of moderate-to-severe AD undergoing treatment with dupilumab at labelled dosage. Patients were divided in Group A (SPs patients) and Group B (not-SPs patients). Disease severity was assessed using Eczema Area Severity Index (EASI), Pruritus-Numerical Rating Scale (P-NRS), and Dermatology Life Quality Index (DLQI) score at baseline and after 4 weeks (W4), W16, W24, and W52. RESULTS A total of 263 patients were enrolled and divided in Group A (25) and Group B (238). SPs included history of cancer, severe kidney failure, viral hepatitis, neurological diseases, acquired immunodeficiency syndrome, and transplanted patients. A statistically significant reduction of EASI, DLQI, and P-NRS was assessed in both groups at each follow-up visit (p < 0.0001), without significant differences between the groups. No differences were recorded for safety. CONCLUSIONS There are not significant differences between SPs and not-SPs as regards effectiveness and safety of dupilumab in AD management.
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Affiliation(s)
- Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Massimiliano Scalvenzi
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Teresa Battista
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Flavia Raia
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Vincenzo Picone
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
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11
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Napolitano M, Potestio L, Di Vico F, Fabbrocini G, Patruno C. Letter to the editor submitted in response to 'Incidence and prognosis of COVID-19 in patients with atopic diseases on dupilumab: a multicentre retrospective cohort study'. J DERMATOL TREAT 2022; 33:3066-3067. [PMID: 35723534 DOI: 10.1080/09546634.2022.2089615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples, Federico II, Napoli, Italy
| | - Francesca Di Vico
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples, Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples, Federico II, Napoli, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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12
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Abstract
A principal purpose of type 2 immunity was thought to be defense against large parasites, but it also functions in the restoration of homeostasis, such as toxin clearance following snake bites. In other cases, like allergy, the type 2 T helper (Th2) cytokines and cells present in the environment are detrimental and cause diseases. In recent years, the recognition of cell heterogeneity within Th2-associated cell populations has revealed specific functions of cells with a particular phenotype or gene signature. In addition, here we discuss the recent data regarding heterogeneity of type 2 immunity-related cells, as well as their newly identified role in a variety of processes ranging from involvement in respiratory viral infections [especially in the context of the recent COVID-19 (coronavirus disease 2019) pandemic] to control of cancer development or of metabolic homeostasis.
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Affiliation(s)
- Hamida Hammad
- Laboratory of Mucosal Immunology and Immunoregulation, VIB-UGent Center for Inflammation Research, Ghent, Belgium; .,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Nincy Debeuf
- Laboratory of Mucosal Immunology and Immunoregulation, VIB-UGent Center for Inflammation Research, Ghent, Belgium; .,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Helena Aegerter
- Laboratory of Mucosal Immunology and Immunoregulation, VIB-UGent Center for Inflammation Research, Ghent, Belgium; .,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Andrew S Brown
- Laboratory of Mucosal Immunology and Immunoregulation, VIB-UGent Center for Inflammation Research, Ghent, Belgium; .,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Bart N Lambrecht
- Laboratory of Mucosal Immunology and Immunoregulation, VIB-UGent Center for Inflammation Research, Ghent, Belgium; .,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.,Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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13
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Stingeni L, Bianchi L, Antonelli E, Caroppo ES, Ferrucci SM, Ortoncelli M, Fabbrocini G, Nettis E, Schena D, Napolitano M, Gola M, Bonzano L, Rossi M, Belloni Fortina A, Balato A, Peris K, Foti C, Guarneri F, Romanelli M, Patruno C, Savoia P, Fargnoli MC, Russo F, Errichetti E, Bianchelli T, Bianchi L, Pellacani G, Feliciani C, Offidani A, Corazza M, Micali G, Milanesi N, Malara G, Chiricozzi A, Tramontana M, Hansel K, Bini V, Buligan C, Caroppo F, Bello GD, Dastoli S, De Brizi EV, Del Giudice MBDF, Diluvio L, Esposito M, Gelmetti A, Giacchetti A, Grieco T, Iannone M, Macchia L, Marietti R, Musumeci ML, Peccerillo F, Pluchino F, Radi G, Ribero S, Romita P, Tavecchio S, Tronconi G, Veronese F. Moderate to severe atopic dermatitis in adolescents treated with dupilumab: a multicenter Italian real-world experience. J Eur Acad Dermatol Venereol 2022; 36:1292-1299. [PMID: 35412683 PMCID: PMC9542087 DOI: 10.1111/jdv.18141] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/12/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
Background Moderate‐to‐severe atopic dermatitis (AD) in the adolescence is a high burden disease, and its treatment can be very challenging due to paucity of approved systemic drugs for this age and their side‐effects. Dupilumab was recently approved for treatment of adolescent AD. Objectives A multicentre, prospective, real‐world study on the effectiveness and safety of dupilumab in adolescents (aged from ≥12 to <18 years) with moderate‐to‐severe AD was conducted. The main AD clinical phenotypes were also examined. Methods Data of adolescents with moderate‐to‐severe AD treated with dupilumab at label dosage for 16 weeks were collected. Treatment outcome was assessed by EASI, NRS itch, NRS sleep loss and CDLQI scores at baseline and after 16 weeks of treatment. The clinical scores were also evaluated according to clinical phenotypes. Results One hundred and thirty‐nine adolescents were enrolled in the study. Flexural eczema and head and neck eczema were the most frequent clinical phenotypes, followed by hand eczema and portrait‐like dermatitis. Coexistence of more than 1 phenotype was documented in 126/139 (88.5%) adolescents. Three patients (2.1%) contracted asymptomatic SARS‐CoV‐2 infection and 1 of the discontinued dupilumab treatment before the target treatment period. A significant improvement in EASI, NRS itch, NRS sleep loss and CDLQI was observed after 16 weeks of treatment with dupilumab. This outcome was better than that observed in clinical trials. Dupilumab resulted effective in all AD phenotypes, especially in diffuse eczema. Twenty‐eight (20.1%) patients reported adverse events, conjunctivitis and flushing being the most frequent. None of patients discontinued dupilumab due to adverse event. Conclusions Dupilumab in adolescent AD showed excellent effectiveness at week 16 with consistent improvement of all clinical scores. Moreover, dupilumab showed a good safety profile also in this COVID‐19 pandemic era.
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Affiliation(s)
- L Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - L Bianchi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - E Antonelli
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - E S Caroppo
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - S M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Ortoncelli
- Division of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - E Nettis
- Department of Emergency and Organ Transplantation, Allergology and Clinical Immunology, University of Bari, Bari, Italy
| | - D Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - M Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - M Gola
- Unit of Allergological and Pediatric Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - L Bonzano
- Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - M Rossi
- Department of Dermatology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - A Belloni Fortina
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - A Balato
- Unit of Dermatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - K Peris
- Institute of Dermatology, Catholic University, Rome, Italy
| | - C Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - F Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M Romanelli
- Dermatology Unit, University of Pisa, Pisa, Italy
| | - C Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - P Savoia
- Dermatology Clinic, Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - M C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Russo
- Section of Dermatology, Department of Clinical, Surgical Medicine and Neuroscience, University of Siena, Siena, Italy
| | - E Errichetti
- Institute of Dermatology, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - T Bianchelli
- Dermatology Unit, Istituto Nazionale di Riposo e Cura per Anziani, INRCA-IRCCS Hospital, Ancona, Italy
| | - L Bianchi
- Dermatology Unit, System Medicine Department, University of Tor Vergata, Rome, Italy
| | - G Pellacani
- Department of Dermatology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - C Feliciani
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - A Offidani
- Dermatology Clinic, Clinical and Molecular Science Department, Polytechnic Marche University, Ancona, Italy
| | - M Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - N Milanesi
- Allergological and Occupational Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - G Malara
- Dermatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - A Chiricozzi
- Institute of Dermatology, Catholic University, Rome, Italy
| | - M Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - K Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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14
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Potestio L, Napolitano M, Bennardo L, Fabbrocini G, Patruno C. Atopic Dermatitis exacerbation after Covid‐19 vaccination in Dupilumab treated patients. J Eur Acad Dermatol Venereol 2022; 36:e409-e411. [DOI: 10.1111/jdv.17964] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/27/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- L. Potestio
- Section of Dermatology ‐ Department of Clinical Medicine and Surgery University of Naples Federico II
| | - M. Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio University of Molise Campobasso
| | - L. Bennardo
- Department of Health Sciences University Magna Graecia of Catanzaro Catanzaro
| | - G. Fabbrocini
- Section of Dermatology ‐ Department of Clinical Medicine and Surgery University of Naples Federico II
| | - C. Patruno
- Department of Health Sciences University Magna Graecia of Catanzaro Catanzaro
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15
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Su Küçük Ö, Güneş B, Taşlidere N, Işik BG, Akaslan TÇ, Özgen FP, Bahali AG. Evaluation of adult patients with atopic dermatitis treated with dupilumab: a single-center real-life experience. J Cosmet Dermatol 2022; 21:4781-4787. [PMID: 35038377 DOI: 10.1111/jocd.14785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
Adult atopic dermatitis (AD), especially adult-onset type appears to have different clinical manifestations. Dupilumab is an IL-4 receptor antagonist used in patients with moderate and severe atopic dermatitis, aged 12 years and older and it works by inhibiting the IL-4 and IL-13 signaling pathway. The purpose of our study is to retrospectively investigate the side effect profile and drug efficacy of thirteen adult patients who received dupilumab treatment and to evaluate the drug use status and the results during the COVID-19 pandemic. All of our patients responded to the treatment after one course of dupilumab injection and also CRP and LDH levels decreased. Conjunctivitis side effect was found at a slightly higher rate than in previous clinical studies. The treatment was continued during the COVID-19 pandemic in most patients. Meanwhile, four patients had COVID-19 infection, but one of them was not using dupixent at that time. We can conclude that dupilumab is an effective and safe therapy for patients with severe AD also in cases of severe infections.
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Affiliation(s)
- Özlem Su Küçük
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Begüm Güneş
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Nazan Taşlidere
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Bengisu Güçkan Işik
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Tahsin Çağdaş Akaslan
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatma Pelin Özgen
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Anıl Gülsel Bahali
- Department of Dermatology and Venereology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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16
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Ungar B, Glickman JW, Golant AK, Dubin C, Marushchak O, Gontzes A, Mikhaylov D, Singer GK, Baum D, Wei N, Sanin A, Gruenstein D, Lebwohl MG, Pavel AB, Guttman-Yassky E. COVID-19 Symptoms Are Attenuated in Moderate-to-Severe Atopic Dermatitis Patients Treated with Dupilumab. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:134-142. [PMID: 34737108 PMCID: PMC8558098 DOI: 10.1016/j.jaip.2021.10.050] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/09/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023]
Abstract
Background In the SARS-CoV-2/COVID-19 pandemic, we need to understand the impact of immunomodulatory medications on COVID-19 symptom severity in patients with inflammatory diseases, including the type 2/Th2 polarized skin disease, atopic dermatitis (AD). Objective Because it is believed that type 1/Th1 immunity controls viral infections and that there is a Th1/Th2 counter-regulation, we hypothesized that Th2 targeting with the IL-4Rα-antagonist, dupilumab, in patients with moderate-to-severe AD would rebalance the Th1/Th2 axis, potentially leading to attenuated COVID-19 symptoms. Methods A total of 1237 patients with moderate-to-severe AD in the Icahn School of Medicine at Mount Sinai Department of Dermatology were enrolled in a registry. Patients were screened for COVID-19-related symptoms and assigned a severity score (asymptomatic [0]-fatal [5]). Scores were compared among 3 treatment groups: dupilumab (n = 632), other systemic treatments (n = 107), and limited/no treatment (n = 498). Demographic and comorbid covariates were adjusted by multivariate generalized logistic regression models. Results The dupilumab-treated group showed reduced incidence and severity of COVID-19 symptoms versus other treatment groups. Dupilumab-treated patients were less likely to experience moderate-to-severe symptoms versus patients on other systemics (P = .01) and on limited/no treatment (P = .04), and less likely to experience any symptoms versus patients on other systemics (P = .01). This effect was seen in our entire cohort and in the subgroup of patients with verified COVID-19 or high-risk exposure. Conclusions Patients on dupilumab experienced less severe COVID-19 manifestations and lesser symptoms compared with patients on other systemics and on limited/no treatment. These results suggest that Th2 modulation with dupilumab may have a protective effect on anti-viral immune response in patients with AD.
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Affiliation(s)
- Benjamin Ungar
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob W Glickman
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandra K Golant
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Celina Dubin
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Olga Marushchak
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; Touro College of Osteopathic Medicine, New York, NY
| | - Alyssa Gontzes
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniela Mikhaylov
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Giselle K Singer
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Danielle Baum
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nancy Wei
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Antonio Sanin
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Diana Gruenstein
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mark G Lebwohl
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ana B Pavel
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biomedical Engineering, the University of Mississippi, University, Miss
| | - Emma Guttman-Yassky
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY.
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17
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Gaspar-Marques J, van Zeller M, Carreiro-Martins P, Chaves Loureiro C. Severe asthma in the era of COVID-19: A narrative review. Pulmonology 2022; 28:34-43. [PMID: 34053902 PMCID: PMC8084617 DOI: 10.1016/j.pulmoe.2021.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Severe asthma management during the coronavirus disease 2019 (COVID-19) pandemic is a challenge and will continue to be, at least in the next few months, as herd immunity is still a mirage. A lot has to be learned about how COVID-19 affects underlying diseases, and severe asthma is no exception. METHODS Narrative review of papers available until February 2021 in PubMed and Google Scholar, relating severe asthma and COVID-19. Four main research topics were reviewed: SARS-CoV-2 infection: immunology and respiratory pathology; interrelationship of severe asthma endotypes and COVID-19 disease mechanisms; severe asthma epidemiology and COVID-19; and biologics for severe asthma in the context of COVID-19. RESULTS COVID-19 disease mechanisms start with upper respiratory cell infection, and afterwards several immunological facets are activated, contributing to disease severity, namely cell-mediated immunity and antibody production. Although infrequent in the COVID-19 course some patients develop a cytokine storm that causes organ damage and may lead to acute respiratory distress syndrome or multiorgan failure. Regarding severe asthma endotypes, type2-high might have a protective role both in infection risk and disease course. There is conflicting data regarding the epidemiological relationship between COVID-19 among severe asthma patients, with some studies reporting increased risk of infection and disease course, whereas others the other way round. Biologics for severe asthma do not seem to increase the risk of infection and severe COVID-19, although further evidence is needed. CONCLUSIONS Globally, in the era of COVID-19, major respiratory societies recommend continuing the biologic treatment, preferably in a self-home administration program.
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Affiliation(s)
- João Gaspar-Marques
- Immunoallergy Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, EPE, Lisbon, Portugal; NOVA Medical School/Comprehensive Health Research Center (CHRC) Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal.
| | - Mafalda van Zeller
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal,Faculty of Medicine of the University of Porto, Portugal
| | - Pedro Carreiro-Martins
- Immunoallergy Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, EPE, Lisbon, Portugal,NOVA Medical School/Comprehensive Health Research Center (CHRC) Campo dos Mártires da Pátria, 130, 1169-056 Lisbon, Portugal
| | - Cláudia Chaves Loureiro
- Pulmonology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal,Clinical Academic Center of Coimbra, Portugal
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18
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Simonetti O, Radi G, Molinelli E, Rizzetto G, Diotallevi F, Offidani A. Recommendations for dermatologists treating patients with atopic dermatitis during the Covid-19 pandemic: a look into the past for a conscious vaccination management. Hum Vaccin Immunother 2021; 17:3268-3275. [PMID: 34170791 PMCID: PMC8437527 DOI: 10.1080/21645515.2021.1925502] [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: 02/04/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects approximately 20% of children and 10% of adults. The implication of vaccines as a trigger for the de novo onset of AD in children or as a cause of exacerbation in individuals with a history of AD has long been debated. We present a brief review of the literature on AD and traditional vaccinations, proposing in addition the main recommendations for the management of patients with AD undergoing the vaccine against the SARS-COV-2 virus. Live attenuated vaccines seem to be associated with a relapse of AD and/or complications, such as eczema vaccinatum. For non-live vaccines, no adverse events are noted in atopic subjects. Since the Covid-19 vaccine is mRNA or viral vectored vaccine and there are no other currently used vaccines of this type, the same recommendations are applied as for all other non-live vaccines.
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Affiliation(s)
- Oriana Simonetti
- Dermatological Clinic Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Giulia Radi
- Dermatological Clinic Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Elisa Molinelli
- Dermatological Clinic Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Clinic Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Federico Diotallevi
- Dermatological Clinic Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Clinic Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
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19
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Jones ME, Kucharik AH, Pourali SP, Rajkumar JR, Gutierrez Y, Yim RM, Armstrong AW. The Use of Biologics During the COVID-19 Pandemic. Dermatol Clin 2021; 39:545-553. [PMID: 34556244 PMCID: PMC8166518 DOI: 10.1016/j.det.2021.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, there has been considerable discussion regarding the use of biologics in patients with inflammatory skin conditions, such as psoriasis, hidradenitis suppurativa, and atopic dermatitis. This article discusses clinical trial data, real-world evidence, and guidelines and recommendations for biologics that inhibit tumor necrosis factor, interleukin (IL)-12/23, IL-17, IL-23, and IL-4/13 during the COVID-19 pandemic. Across these inflammatory skin conditions, existing data generally suggest that biologics do not seem to increase the risk of COVID-19 infection or worsen COVID-19 outcomes. The impact of biologics on COVID-19 is an area of active exploration.
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Affiliation(s)
- Madison E Jones
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Alison H Kucharik
- Florida Atlantic University Charles E Schmidt College of Science, 777 Glades Road BC-71, Boca Raton, FL 33431, USA
| | - Sarah P Pourali
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, USA
| | - Jeffrey R Rajkumar
- Univeristy of Illinois College of Medicine at Chicago, 1853 W Polk St, Chicago, IL 60612, USA
| | - Yasmin Gutierrez
- University of California Riverside School of Medicine, 92521 Botanic Gardens Dr, Riverside, CA 92507, USA
| | - Rebecca M Yim
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - April W Armstrong
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
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20
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Ceryn J, Niedźwiedź M, Skibińska M, Ciążyńska M, Lesiak A, Narbutt J. COVID-19 in Patients with Atopic Dermatitis Treated with Dupilumab: Three Cases and a Literature Review. Clin Cosmet Investig Dermatol 2021; 14:1131-1138. [PMID: 34475772 PMCID: PMC8407774 DOI: 10.2147/ccid.s321003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022]
Abstract
There are limited clinical data on the impact of the SARS-CoV2 infection on patients with dermatological conditions treated with biologics. Dupilumab is a recombinant human IgG4 human monoclonal antibody that inhibits IL4 and IL13 signaling, and is used for moderate–severe atopic dermatitis treatment. We present three patients with atopic dermatitis (AD) treated with dupilumab who contracted COVID-19. In all patients, the infection had a mild course, and only in one, as documented by SCORAD, EASI, and DLQI scores, the condition of the skin deteriorated, and a prolonged positive PCR COVID-19 test was observed. The mechanism of dupilumab action and more evidence for IL13 importance in lung damage caused by SARS-CoV2 suggest a possible explanation for a mild–moderate course of the infection in treated AD patients. Based on current knowledge, there is evidence to continue dupilumab treatment in AD patients with mild–moderate COVID-19; however, careful assessment is needed for each patient.
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Affiliation(s)
- Justyna Ceryn
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, International Doctoral School of the Medical University of Lodz, Lodz, 91-347, Poland
| | - Michał Niedźwiedź
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, International Doctoral School of the Medical University of Lodz, Lodz, 91-347, Poland
| | - Małgorzata Skibińska
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, International Doctoral School of the Medical University of Lodz, Lodz, 91-347, Poland
| | - Magdalena Ciążyńska
- Department of Proliferative Diseases, Nicolaus Copernicus Multidisciplinary Centre for Oncology and Traumatology, Lodz, Poland
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, International Doctoral School of the Medical University of Lodz, Lodz, 91-347, Poland
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, International Doctoral School of the Medical University of Lodz, Lodz, 91-347, Poland
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21
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Passante M, Napolitano M, Dastoli S, Bennardo L, Fabbrocini G, Nisticò SP, Patruno C. Safety of omalizumab treatment in patients with chronic spontaneous urticaria and COVID-19. Dermatol Ther 2021; 34:e15111. [PMID: 34427028 PMCID: PMC8646731 DOI: 10.1111/dth.15111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Maria Passante
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maddalena Napolitano
- Department of Health Sciences V. Tiberio, University of Molise, Campobasso, Italy
| | - Stefano Dastoli
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luigi Bennardo
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Steven Paul Nisticò
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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22
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Hansel K, Patruno C, Antonelli E, Dal Bello G, Napolitano M, Fabbrocini G, Grieco T, Pellacani G, Fargnoli MC, Esposito M, Piras V, Zucca M, Girolomoni G, Stingeni L. Dupilumab in adolescents with moderate to severe atopic dermatitis: a 32-week real-world experience during the COVID-19 pandemic. Clin Exp Dermatol 2021; 47:165-167. [PMID: 34309892 PMCID: PMC8444687 DOI: 10.1111/ced.14862] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/28/2022]
Affiliation(s)
- K Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - C Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - E Antonelli
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - G Dal Bello
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - M Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - T Grieco
- Dermatology Unit, Sapienza University of Rome, Rome, Italy
| | - G Pellacani
- Dermatology Unit, Sapienza University of Rome, Rome, Italy
| | - M C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - M Esposito
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - V Piras
- Dermatological Clinic, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - M Zucca
- Dermatological Clinic, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - L Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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23
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Stingeni L, Bianchi L, Peris K, Fabbrocini G, Micali G, Calzavara-Pinton P, Tramontana M, Hansel K. SARS-CoV-2 vaccines and biological treatments: dermatological perspectives. Ital J Dermatol Venerol 2021; 156:118-120. [PMID: 33960748 DOI: 10.23736/s2784-8671.21.07055-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy -
| | - Ketty Peris
- Section of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | | | | | | | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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24
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Stingeni L, Hansel K, Antonelli E, Bello GD, Patruno C, Napolitano M, Fabbrocini G, Grieco T, Pellacani G, Fargnoli MC, Esposito M, Piras V, Zucca M, Girolomoni G. Atopic dermatitis in adolescents: Effectiveness and safety of dupilumab in a 16-week real-life experience during the COVID-19 pandemic in Italy. Dermatol Ther 2021; 34:e15035. [PMID: 34152670 DOI: 10.1111/dth.15035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022]
Abstract
Dupilumab showed significant improvement of adolescent atopic dermatitis (AD) signs and symptoms in clinical trials, with a good safety profile. Herein we report the real-word effectiveness and safety of dupilumab in adolescents with moderate to severe AD from January to October 2020, during the COVID-19 pandemic in Italy. All patients had a diagnosis of AD for a mean [SD] 12.8 [3.1] years. Baseline demographics, AD characteristics (EASI, cDLQI, NRS itch score, NRS sleep loss score) at baseline and week 16, and safety data were collected. Nineteen patients (52.6% men; mean [SD] age, 15.6 [1.4] years [range, 13-17 years]) were included in the analysis. All patients reached EASI-50 and 78.9% EASI-75, especially in those with EASI≥30 and BMI < 25 at baseline, with marked reduction for cDLQI (77.4%), NRS itch score (5.9 point), and NRS sleep loss score (87.5%). One patient contracted asymptomatic SARS-CoV-2 infection and 1 developed mild conjuntivitis, without stopping dupilumab. In this real-word experience the effectiveness of dupilumab was excellent and resulted higher than that observed in clinical trials, with a good safety profile during COVID-19 pandemic.
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Affiliation(s)
- Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elettra Antonelli
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giacomo Dal Bello
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Cataldo Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Teresa Grieco
- Dermatology Unit, Sapienza University of Rome, Rome, Italy
| | | | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Esposito
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Viviana Piras
- Dermatological Clinic, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Myriam Zucca
- Dermatological Clinic, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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25
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Nguyen C, Yale K, Casale F, Ghigi A, Zheng K, Silverberg JI, Mesinkovska NA. SARS-CoV-2 infection in patients with atopic dermatitis: a cross-sectional study. Br J Dermatol 2021; 185:640-641. [PMID: 33955543 PMCID: PMC8239933 DOI: 10.1111/bjd.20435] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/21/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- C Nguyen
- Department of Dermatology, University of California Irvine School of Medicine, Irvine, CA, USA
| | - K Yale
- Department of Dermatology, University of California Irvine School of Medicine, Irvine, CA, USA
| | - F Casale
- Department of Dermatology, University of California Irvine School of Medicine, Irvine, CA, USA
| | - A Ghigi
- Department of Informatics, University of California Irvine Donald Bren School of Information and Computer Science, Irvine, CA, USA
| | - K Zheng
- Department of Informatics, University of California Irvine Donald Bren School of Information and Computer Science, Irvine, CA, USA
| | - J I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - N A Mesinkovska
- Department of Dermatology, University of California Irvine School of Medicine, Irvine, CA, USA
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26
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Marko M, Pawliczak R. Can we safely use systemic treatment in atopic dermatitis during the COVID-19 pandemic? Overview of selected conventional and biologic systemic therapies. Expert Rev Clin Immunol 2021; 17:619-627. [PMID: 33866905 DOI: 10.1080/1744666x.2021.1919511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the medical community has faced major challenges that affect disease management in all areas. Dermatologists and immunologists have to choose appropriate treatment strategy taking into consideration the risk of infection and possible exacerbation of the course of the disease in patients with confirmed infection. Management of atopic dermatitis (AD) in moderate to severe cases is based on systemic therapy such as cyclosporine, azathioprine, methotrexate and dupilumab.Areas covered: A literature search in PubMed database was performed until 6 March 2021. In this review, the authors discuss non-biologic and biologic systemic medications for AD and provide an overview of therapeutic recommendations during COVID-19 pandemic.Expert opinion: In case of an active COVID-19 infection, conventional systemic treatment and biological treatment needs to be stopped until clinical recovery. Noninfected patients with systemic treatment of AD should continue their therapy via self-application. The authors can conclude that understanding of dupilumab therapy is better recognized in context AD treatment during COVID-19 pandemic in comparison to cyclosporine, azathioprine and methotrexate. However, this systemic immunosuppressants still require further investigation and literature complementation.
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Affiliation(s)
- Monika Marko
- Department of Immunopathology, Faculty of Medicine, Division of Biomedical Science, Medical University of Lodz, Lodz, Poland
| | - Rafał Pawliczak
- Department of Immunopathology, Faculty of Medicine, Division of Biomedical Science, Medical University of Lodz, Lodz, Poland
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27
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Beecker J, Papp K, Dutz J, Vender R, Gniadecki R, Cooper C, Gisondi P, Gooderham M, Hong C, Kirchhof M, Lynde C, Maari C, Poulin Y, Puig L. Position statement for a pragmatic approach to immunotherapeutics in patients with inflammatory skin diseases during the coronavirus disease 2019 pandemic and beyond. J Eur Acad Dermatol Venereol 2021; 35:797-806. [PMID: 33533553 PMCID: PMC8014810 DOI: 10.1111/jdv.17075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 12/14/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, a novel RNA virus that was declared a global pandemic on 11 March 2020. The efficiency of infection with SARS-CoV-2 is reflected by its rapid global spread. The SARS-CoV-2 pandemic has implications for patients with inflammatory skin diseases on systemic immunotherapy who may be at increased risk of infection or more severe infection. This position paper is a focused examination of current evidence considering the mechanisms of action of immunotherapeutic drugs in relation to immune response to SARS-CoV-2. We aim to provide practical guidance for dermatologists managing patients with inflammatory skin conditions on systemic therapies during the current pandemic and beyond. Considering the limited and rapidly evolving evidence, mechanisms of action of therapies, and current knowledge of SARS-CoV-2 infection, we propose that systemic immunotherapy can be continued, with special considerations for at risk patients or those presenting with symptoms.
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Affiliation(s)
- J. Beecker
- University of OttawaOttawaONCanada
- Division of DermatologyThe Ottawa HospitalOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
- Probity Medical Research Inc.WaterlooONCanada
| | - K.A. Papp
- Probity Medical Research Inc.WaterlooONCanada
- K Papp Clinical ResearchWaterlooONCanada
| | - J. Dutz
- Skin Care CenterVancouverBCCanada
- Department of Dermatology and Skin ScienceUniversity of British ColumbiaVancouverBCCanada
- Skin ScienceBC Children's Hospital Research InstituteVancouverBCCanada
| | - R.B. Vender
- Dermatrials Research Inc.HamiltonONCanada
- Department of MedicineMcMaster UniversityHamiltonONCanada
| | - R. Gniadecki
- Probity Medical Research Inc.WaterlooONCanada
- Division of DermatologyDepartment of MedicineFaculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - C. Cooper
- University of OttawaOttawaONCanada
- Ottawa Hospital Research InstituteOttawaONCanada
- The Ottawa Hospital and Regional Hepatitis ProgramOttawaONCanada
| | - P. Gisondi
- Department of MedicineSection of Dermatology and VenereologyUniversity of VeronaVeronaItaly
| | - M. Gooderham
- Probity Medical Research Inc.WaterlooONCanada
- SKiN Centre for DermatologyPeterboroughONCanada
| | - C.H. Hong
- Probity Medical Research Inc.WaterlooONCanada
- Department of Dermatology and Skin ScienceUniversity of British ColumbiaVancouverBCCanada
- Dr. Chih‐ho Hong Medical Inc.SurreyBCCanada
| | - M.G. Kirchhof
- University of OttawaOttawaONCanada
- Division of DermatologyThe Ottawa HospitalOttawaONCanada
| | - C.W. Lynde
- Probity Medical Research Inc.WaterlooONCanada
- Lynde Institute for DermatologyMarkhamONCanada
| | - C. Maari
- Innovaderm Research IncMontrealQCCanada
| | - Y. Poulin
- Centre de Recherche Dermatologique du Québec MétropolitainQuébecQCCanada
- Department of MedicineUniversité LavalHôpital Hôtel‐Dieu de QuébecQuebécQCCanada
| | - L. Puig
- Department of DermatologyHospital de la Santa Creu i Sant PauBarcelonaSpain
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28
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Azevedo MLV, Zanchettin AC, Vaz de Paula CB, Motta Júnior JDS, Malaquias MAS, Raboni SM, Neto PC, Zeni RC, Prokopenko A, Borges NH, Godoy TM, Benevides APK, de Souza DG, Baena CP, Machado-Souza C, de Noronha L. Lung Neutrophilic Recruitment and IL-8/IL-17A Tissue Expression in COVID-19. Front Immunol 2021; 12:656350. [PMID: 33868301 PMCID: PMC8044579 DOI: 10.3389/fimmu.2021.656350] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
The new SARS-CoV-2 virus differs from the pandemic Influenza A virus H1N1 subtype (H1N1pmd09) how it induces a pro-inflammatory response in infected patients. This study aims to evaluate the involvement of SNPs and tissue expression of IL-17A and the neutrophils recruitment in post-mortem lung samples from patients who died of severe forms of COVID-19 comparing to those who died by H1N1pdm09. Twenty lung samples from patients SARS-CoV-2 infected (COVID-19 group) and 10 lung samples from adults who died from a severe respiratory H1N1pdm09 infection (H1N1 group) were tested. The tissue expression of IL-8/IL-17A was identified by immunohistochemistry, and hematoxylin and eosin (H&E) stain slides were used for neutrophil scoring. DNA was extracted from paraffin blocks, and genotyping was done in real time-PCR for two IL17A target polymorphisms. Tissue expression increasing of IL-8/IL-17A and a higher number of neutrophils were identified in samples from the H1N1 group compared to the COVID-19 group. The distribution of genotype frequencies in the IL17A gene was not statistically significant between groups. However, the G allele (GG and GA) of rs3819025 was correlated with higher tissue expression of IL-17A in the COVID-19 group. SARS-CoV-2 virus evokes an exacerbated response of the host’s immune system but differs from that observed in the H1N1pdm09 infection since the IL-8/IL-17A tissue expression, and lung neutrophilic recruitment may be decreased. In SNP rs3819025 (G/A), the G allele may be considered a risk allele in the patients who died for COVID-19.
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Affiliation(s)
- Marina Luise Viola Azevedo
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Aline Cristina Zanchettin
- Postgraduate Program in Biotechnology Applied to Child and Adolescent Health, Faculdades Pequeno Príncipe, Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Caroline Busatta Vaz de Paula
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Jarbas da Silva Motta Júnior
- Hospital Marcelino Champagnat, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Mineia Alessandra Scaranello Malaquias
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Sonia Mara Raboni
- Virology Laboratory, Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, Brazil
| | - Plínio Cezar Neto
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Rafaela Chiuco Zeni
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Amanda Prokopenko
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Nícolas Henrique Borges
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Thiago Mateus Godoy
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ana Paula Kubaski Benevides
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Daiane Gavlik de Souza
- Virology Laboratory, Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, Brazil
| | - Cristina Pellegrino Baena
- Hospital Marcelino Champagnat, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Cleber Machado-Souza
- Postgraduate Program in Biotechnology Applied to Child and Adolescent Health, Faculdades Pequeno Príncipe, Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Lucia de Noronha
- Laboratory of Experimental Pathology, Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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29
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Tan Y, Tang F. SARS-CoV-2-mediated immune system activation and potential application in immunotherapy. Med Res Rev 2021; 41:1167-1194. [PMID: 33185926 DOI: 10.1002/med.21756] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Although novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-mediated pulmonary inflammation has recently attracted great attention, its pathology and pathogenesis are not clear. Notably, due to both its high infective and pathogenicity, SARS-CoV-2 infection may cause a severe sometimes fatal respiratory disease. A specific vaccine, which relies on the analysis of SARS-CoV-2 structural protein-derived antigenic peptides, is indispensable for restraining the spread and reducing the mortality of SARS-CoV-2. SARS-CoV-2 infections activate cytototxic, myeloid-derived suppressor cells, dendritic cells, macrophages, as well as natural killer, B, helper T, and regulatory T cells, thus further stimulating innate and antigen-specific immune responses. Nevertheless, many immune effector cells cause hyperinflammation and pulmonary immunopathology by releasing proinflammatory cytokines and chemokines, including interferon (IFN)-α, IFN-β, IFN-γ, monocyte chemoattractant protein-1, macrophage inflammatory protein (MIP)-1A, MIP1B, interleukin (IL)-1, IL-2, IL-4, IL-6, IL-7, IL-8, IL-9, IL-12, IL-17, and IL-18, platelet-derived growth factor, fibroblast growth factor, tumor necrosis factor-α, and induced protein 10. Interestingly, related products derived from SARS-CoV-2 are likely to trigger immune evasion. Therefore, investigating SARS-CoV-2-specific vaccines, blocking immunopathology, and prohibiting immune evasion are urgently required for treating SARS-CoV-2 infection. In this review, we emphatically illuminated the development of a SARS-CoV-2-specific vaccine based on the analysis of epitopes, also expounding the molecular mechanisms of SARS-CoV-2-mediated cytokine release syndrome. Furthermore, we comprehensively discussed SARS-CoV-2-associated immune evasion and lung immunopathology. Lastly, potential therapeutic strategies against SARS-CoV-2 were explored.
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Affiliation(s)
- Yuan Tan
- Department of Clinical Laboratory, Hunan Key Laboratory of Oncotarget Gene, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Faqin Tang
- Department of Clinical Laboratory, Hunan Key Laboratory of Oncotarget Gene, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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30
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Interleukin-13 as a target to alleviate severe coronavirus disease 2019 and restore lung homeostasis. J Clin Transl Res 2021; 7:116-120. [PMID: 34027204 PMCID: PMC8132187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/09/2022] Open
Abstract
The ongoing coronavirus disease (COVID-19) pandemic urgently requires the availability of interventions that improve outcomes for those with severe disease. Since severe acute respiratory syndrome coronavirus 2 infection is characterized by dysregulated lung mucosae, and that mucosal homeostasis is heavily influenced by interleukin (IL)-13 activity, we explore recent findings indicating that IL-13 production is proportional to disease severity. We propose that excessive IL-13 contributes to the progression of severe/fatal COVID-19 by (1) promoting the recruitment of immune cells that express inflammatory cytokines, causing a cytokine storm that results in widespread destruction of lung tissue, (2) directly facilitating tissue-remodeling that causes airway hyperinflammation and obstruction, and (3) diverting the immune system away from developing high-quality cytotoxic T cells that confer effective anti-viral immunity. These factors may cumulatively result in significant lung distress, multi-organ failure, and death. Here, we suggest repurposing existing IL-13-inhibiting interventions, including antibody therapies routinely used for allergic lung hyperinflammation, as well as viral vector-based approaches, to alleviate disease. Since many of these strategies have previously been shown to be both safe and effective, this could prove to be a highly cost-effective solution. Relevance for Patients There remains a desperate need to establish medical interventions that reliably improves outcomes for patients suffering from COVID-19. We explore the role of IL-13 in maintaining homeostasis at the lung mucosae and propose that its dysregulation during viral infection may propagate the hallmarks of severe disease - further exploration may provide a platform for invaluable therapeutics.
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31
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Patrucco F, Benfante A, Villa E, Principe S, Scichilone N, Solidoro P. Severe asthma and COVID-19: lessons from the first wave. J Asthma 2020; 59:239-242. [PMID: 33297799 DOI: 10.1080/02770903.2020.1861622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Severe asthma is considered a risk factor for SARS-Coronavirus 2 (SARS-CoV-2) infection but scientific evidences are lacking. METHODS we performed a literature search and review based on PubMed database national, international recommendations as well as papers on severe asthmatic patients and their management during SARS-CoV-2 pandemic. RESULTS the majority of international recommendations, expert panels and editorials provide indications about management of severe asthmatic patients. No published studies evaluated the effects of biologic agents on severe asthmatic patients during SARS-CoV-2 pandemic. CONCLUSIONS the relationship between SARS-CoV-2 and asthma is variable worldwide and severe asthmatic patients were seldom reported in published cohorts. International recommendations suggest maintaining asthma under control to limit exacerbations occurrence, by using all available treatment. The minimum steroid dosage effective to control symptoms should be maintained to avoid exacerbations; biologic agents administration should be regularly scheduled encouraging patient support programmes.
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Affiliation(s)
- Filippo Patrucco
- Medical and Specialistic Department, Division of Respiratory Diseases, AOU Maggiore della Carità, Novara, Italy.,Translational Medicine Department, University of Piemonte Orientale, Novara, Italy
| | - Alida Benfante
- PROMISE Department, University of Palermo, Palermo, Italy
| | - Elisa Villa
- Pneumology Unit, ASL Genova 3, Villa Scassi Hospital, Genova, Italy
| | | | | | - Paolo Solidoro
- Medical Sciences Department, University of Turin, Torino, Italy.,Cardiovascular and Thoracic Department, Pneumology Unit U, AOU Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
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32
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In silico immune infiltration profiling combined with functional enrichment analysis reveals a potential role for naïve B cells as a trigger for severe immune responses in the lungs of COVID-19 patients. PLoS One 2020; 15:e0242900. [PMID: 33264345 PMCID: PMC7710067 DOI: 10.1371/journal.pone.0242900] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
COVID-19, caused by SARS-CoV-2, has rapidly spread to more than 160 countries worldwide since 2020. Despite tremendous efforts and resources spent worldwide trying to explore antiviral drugs, there is still no effective clinical treatment for COVID-19 to date. Approximately 15% of COVID-19 cases progress to pneumonia, and patients with severe pneumonia may die from acute respiratory distress syndrome (ARDS). It is believed that pulmonary fibrosis from SARS-CoV-2 infection further leads to ARDS, often resulting in irreversible impairment of lung function. If the mechanisms by which SARS-CoV-2 infection primarily causes an immune response or immune cell infiltration can be identified, it may be possible to mitigate excessive immune responses by modulating the infiltration and activation of specific targets, thereby reducing or preventing severe lung damage. However, the extent to which immune cell subsets are significantly altered in the lung tissues of COVID-19 patients remains to be elucidated. This study applied the CIBERSORT-X method to comprehensively evaluate the transcriptional estimated immune infiltration landscape in the lung tissues of COVID-19 patients and further compare it with the lung tissues of patients with idiopathic pulmonary fibrosis (IPF). We found a variety of immune cell subtypes in the COVID-19 group, especially naïve B cells were highly infiltrated. Comparison of functional transcriptomic analyses revealed that non-differentiated naïve B cells may be the main cause of the over-active humoral immune response. Using several publicly available single-cell RNA sequencing data to validate the genetic differences in B-cell populations, it was found that the B-cells collected from COVID-19 patients were inclined towards naïve B-cells, whereas those collected from IPF patients were inclined towards memory B-cells. Further differentiation of B cells between COVID-19 mild and severe patients showed that B cells from severe patients tended to be antibody-secreting cells, and gene expression showed that B cells from severe patients were similar to DN2 B cells that trigger extrafollicular response. Moreover, a higher percentage of B-cell infiltration seems associated with poorer clinical outcome. Finally, a comparison of several specific COVID-19 cases treated with targeted B-cell therapy suggests that appropriate suppression of naïve B cells might potentially be a novel strategy to alleviate the severe symptoms of COVID-19.
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Vaz de Paula CB, de Azevedo MLV, Nagashima S, Martins APC, Malaquias MAS, Miggiolaro AFRDS, da Silva Motta Júnior J, Avelino G, do Carmo LAP, Carstens LB, de Noronha L. IL-4/IL-13 remodeling pathway of COVID-19 lung injury. Sci Rep 2020; 10:18689. [PMID: 33122784 PMCID: PMC7596721 DOI: 10.1038/s41598-020-75659-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Abstract
The COVID-19 fatality rate is high when compared to the H1N1pdm09 (pandemic Influenza A virus H1N1 subtype) rate, and although both cause an aggravated inflammatory response, the differences in the mechanisms of both pandemic pneumonias need clarification. Thus, our goal was to analyze tissue expression of interleukins 4, 13, (IL-4, IL-13), transforming growth factor-beta (TGF-β), and the number of M2 macrophages (Sphingosine-1) in patients who died by COVID-19, comparing with cases of severe pneumopathy caused by H1N1pdm09, and a control group without lung injury. Six lung biopsy samples of patients who died of SARS-CoV-2 (COVID-19 group) were used and compared with ten lung samples of adults who died from a severe infection of H1N1pdm09 (H1N1 group) and eleven samples of patients who died from different causes without lung injury (CONTROL group). The expression of IL-4, IL-13, TGF-β, and M2 macrophages score (Sphingosine-1) were identified through immunohistochemistry (IHC). Significantly higher IL-4 tissue expression and Sphingosine-1 in M2 macrophages were observed in the COVID-19 group compared to both the H1N1 and the CONTROL groups. A different mechanism of diffuse alveolar damage (DAD) in SARS-CoV-2 compared to H1N1pdm09 infections were observed. IL-4 expression and lung remodeling are phenomena observed in both SARS-CoV-2 and H1N1pdm09. However, SARS-CoV-2 seems to promote lung damage through different mechanisms, such as the scarce participation Th1/Th17 response and the higher participation of the Th2. Understanding and managing the aggravated and ineffective immune response elicited by SARS-CoV-2 merits further clarification to improve treatments propose.
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Affiliation(s)
- Caroline Busatta Vaz de Paula
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil.
| | - Marina Luise Viola de Azevedo
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Seigo Nagashima
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Ana Paula Camargo Martins
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Mineia Alessandra Scaranello Malaquias
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Anna Flavia Ribeiro Dos Santos Miggiolaro
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Jarbas da Silva Motta Júnior
- School of Medicine, Postgraduate Program of Health Sciences, Pontifícia Universidade Católica do Paraná-PUCPR, Rua Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Gibran Avelino
- Hospital Marcelino Champagnat, School of Medicine, Pontifical Catholic University of Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Leticia Arianne Panini do Carmo
- School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Lucas Baena Carstens
- School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
| | - Lucia de Noronha
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná-PUCPR, R. Imaculada Conceição, 1155 - Prado Velho, Curitiba, PR, Brazil
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Thangaraju P, Venkatesan N, Sudha TYS, Venkatesan S, Thangaraju E. Role of Dupilumab in Approved Indications of COVID-19 Patient: an Efficacy-Based Nonsystematic Critical Analysis. ACTA ACUST UNITED AC 2020; 2:2126-2130. [PMID: 32935079 PMCID: PMC7483051 DOI: 10.1007/s42399-020-00510-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/30/2022]
Abstract
With many drugs being tried in the management and treatment of COVID-19, dupilumab is one such monoclonal antibody that has come under the limelight for its possible role as an adjunct therapy in COVID-19 position. There are isolated case reports and series that document a milder course of COVID-19 infection in patients who have already been on dupilumab therapy for treatment of conditions such as atopic dermatitis and chronic rhino-sinusitis with nasal polyp. There is also an ongoing debate regarding the continuation of biologicals in the COVID patient. In this article, a non-systematic critical analysis of dupilumab was performed to delve into this hypothesis further.
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Affiliation(s)
- Pugazhenthan Thangaraju
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS) Raipur, Raipur, Chhatisgarh India
| | - Nanditha Venkatesan
- All India Institute of Medical Sciences (AIIMS) Raipur, Raipur, Chhatisgarh India
| | - T Y Sree Sudha
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS) Raipur, Raipur, Chhatisgarh India
| | - Sajitha Venkatesan
- Department Of Microbiology, All India Institute of Medical Sciences (AIIMS) Raipur, Raipur, Chhatisgarh India
| | - Eswaran Thangaraju
- AKT memorial college of engineering and technology, Kallakurichi, Tamil Nadu India
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35
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Ordóñez-Rubiano MF, Campo I, Casas M. Dupilumab in atopic dermatitis, a protocol for SARS-COV-2-infected patients. Dermatol Ther 2020; 33:e14172. [PMID: 32779378 PMCID: PMC7435550 DOI: 10.1111/dth.14172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/26/2020] [Accepted: 07/31/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Maria Fernanda Ordóñez-Rubiano
- Atopic Dermatitis Clinic, Department of Dermatology, Cayre Clinical Center, Bogotá, Colombia.,Division of Dermatology, Department of Internal Medicine, Military Central Hospital, Bogotá, Colombia
| | - Isabela Campo
- Division of Dermatology, Department of Internal Medicine, Military Central Hospital, Bogotá, Colombia
| | - Mirian Casas
- Atopic Dermatitis Clinic, Department of Dermatology, Cayre Clinical Center, Bogotá, Colombia
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36
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Rossi M, Rovati C, Arisi M, Soglia S, Calzavara-Pinton P. Management of adult patients with severe atopic dermatitis treated with dupilumab during COVID-19 pandemic: A single-center real-life experience. Dermatol Ther 2020; 33:e13765. [PMID: 32500660 PMCID: PMC7300580 DOI: 10.1111/dth.13765] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Mariateresa Rossi
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Chiara Rovati
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Mariachiara Arisi
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Simone Soglia
- Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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Patruno C, Stingeni L, Fabbrocini G, Hansel K, Napolitano M. Dupilumab and COVID-19: What should we expect? Dermatol Ther 2020; 33:e13502. [PMID: 32362061 PMCID: PMC7267436 DOI: 10.1111/dth.13502] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/16/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID‐19) is a pandemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) with high morbidity and mortality. There are very limited data on the interference of immunomodulating drugs on the risk of infection and on the course of the disease. In particular, there are no current clinical data about the interference exerted by dupilumab, a biologic drugs blocking IL‐4 and IL‐13, used for adult atopic dermatitis. The pathogenesis of COVID‐19 is complex, characterized by an immune response mainly Th1/Th17. The hyper‐activation of these cells may cause the release of pro‐inflammatory cytokines that may result in lung impairment. IL‐4 and IL‐13 are Th2 cytokines, thus being part of a pathway not considered implicated in host defense mechanism against viral infections. Indeed, viral infections, including respiratory infections, have not been reported as a significant adverse event in clinical trials. Furthermore, dupilumab has been proved to be efficacious also in exacerbations of asthma, and it is known that viral infections can worsen asthma. Therefore, the current data seem to suggest that treatment with dupilumab should not be stopped during COVID‐19 pandemic. Obviously, a careful assessment is mandatory for each individual patient and further studies are necessary to characterize the immunologic responses in COVID‐19.
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Affiliation(s)
- Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Maddalena Napolitano
- Department of Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
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