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Obed O, Chong AC, Su M, Ong PY. Emerging drugs for the treatment of atopic dermatitis: a focus on phase 2 and phase 3 trials. Expert Opin Emerg Drugs 2024:1-17. [PMID: 38662529 DOI: 10.1080/14728214.2024.2345643] [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: 02/16/2024] [Accepted: 04/12/2024] [Indexed: 04/30/2024]
Abstract
INTRODUCTION Atopic dermatitis (AD) is an inflammatory skin condition that affects millions of pediatric and adult patients with well-studied impact on morbidity and quality of life. Management occurs in a stepwise fashion beginning with preventative measures before immunomodulators are introduced. However, challenges remain in treatment of moderate-to-severe atopic dermatitis that is refractory to first- and second-line treatments and there are only few topical anti-inflammatory options, especially for pediatric patients. AREAS COVERED New medications are required to address these gaps as lesions may persist despite treatment or patients may discontinue treatment due to actual or anticipated adverse effects of mainstay medications. Emerging research into the pathophysiology of AD and the immune system at large has provided opportunities for novel interventions aimed at stopping AD mechanisms at new checkpoints. Clinical trials for 36 agents currently in phase 2 or phase 3 are evaluated with particular focus on the studies for, B244, CBP-201, tapinarof, lebrikizumab, nemolizumab, amlitelimab, and rocatinlimab as they explore novel pathways and have some of the most promising results. EXPERT OPINION These clinical trials contribute to the evolution of AD treatment toward greater precision based on salient pathways with a particular focus on moderate-to-severe AD to enhance efficacy and minimize adverse effects.
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Affiliation(s)
- Ogechi Obed
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Albert C Chong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Malcolm Su
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peck Y Ong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles; Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
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Shobnam N, Saksena S, Ratley G, Yadav M, Chaudhary PP, Sun AA, Howe KN, Gadkari M, Franco LM, Ganesan S, McCann KJ, Hsu AP, Kanakabandi K, Ricklefs S, Lack J, Yu W, Similuk M, Walkiewicz MA, Gardner DD, Barta K, Tullos K, Myles IA. Topical Steroid Withdrawal is a Targetable Excess of Mitochondrial NAD. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.17.24305846. [PMID: 38712043 PMCID: PMC11071640 DOI: 10.1101/2024.04.17.24305846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Topical corticosteroids (TCS) are first-line therapies for numerous skin conditions. Topical Steroid Withdrawal (TSW) is a controversial diagnosis advocated by patients with prolonged TCS exposure who report severe systemic reactions upon treatment cessation. However, to date there have been no systematic clinical or mechanistic studies to distinguish TSW from other eczematous disorders. Methods A re-analysis of a previous survey with eczematous skin disease was performed to evaluate potential TSW distinguishing symptoms. We subsequently conducted a pilot study of 16 patients fitting the proposed diagnostic criteria. We then performed: tissue metabolomics, transcriptomics, and immunostaining on skin biopsies; serum metabolomics and cytokine assessments; shotgun metagenomics on microbiome skin swabs; genome sequencing; followed by functional, mechanistic studies using human skin cell lines and mice. Results Clinically distinct TSW symptoms included burning, flushing, and thermodysregulation. Metabolomics and transcriptomics both implicated elevated NAD+ oxidation stemming from increased expression of mitochondrial complex I and conversion of tryptophan into kynurenine metabolites. These abnormalities were induced by glucocorticoid exposure both in vitro and in a cohort of healthy controls (N=19) exposed to TCS. Targeting complex I via either metformin or the herbal compound berberine improved outcomes in both cell culture and in an open-label case series for patients with TSW. Conclusion Taken together, our results suggest that TSW has a distinct dermatopathology. While future studies are needed to validate these results in larger cohorts, this work provides the first mechanistic evaluation into TSW pathology, and offers insights into clinical identification, pharmacogenomic candidates, and directed therapeutic strategies.
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Ratley G, Zeldin J, Sun AA, Yadav M, Chaudhary PP, Myles IA. Spatial modeling connecting childhood atopic dermatitis prevalence with household exposure to pollutants. COMMUNICATIONS MEDICINE 2024; 4:74. [PMID: 38637696 PMCID: PMC11026442 DOI: 10.1038/s43856-024-00500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic, inflammatory disease characterized by dry, pruritic skin. In the U.S., the prevalence of AD has increased over three-fold since the 1970s. We previously reported a geographic association between isocyanate-containing air pollution and AD as well as mechanistic data demonstrating that isocyanates induce skin dysbiosis and activate the host itch receptor TRPA1. However, non-spatial models are susceptible to spatial confounding and may overlook other meaningful associations. METHODS We added spatial analysis to our prior model, contrasting pollution data with clinical visits. In addition, we conducted a retrospective case-control survey of childhood exposure to BTEX-related products. Finally, we assessed implicated compounds, in pure form and as part of synthetic fabric, for their effect on the growth and metabolism of skin commensal bacteria. RESULTS Spatial analysis implicate benzene, toluene, ethylbenzene, and, most significantly, xylene (BTEX) compounds. Survey odds ratios for AD were significant for xylene-derived polyester bed sheets (OR = 9.5; CI 2.2-40.1) and diisocyanate-containing wallpaper adhesive (OR = 6.5; CI 1.5-27.8). Staphylococcus aureus lives longer on synthetic textiles compared to natural textiles. Meanwhile, synthetic fabric exposure shifts the lipid metabolism of health-associated commensals (Roseomonas mucosa and S. epidermidis) away from therapeutic pathways. CONCLUSIONS We propose that BTEX chemicals in their raw forms and in synthetic products represent a unifying hypothesis for environmentally induced AD flares through their ability to create dysbiosis in the skin microbiota and directly activate TRPA1. Unequal distribution of these pollutants may also influence racial disparities in AD rates.
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Affiliation(s)
- Grace Ratley
- Laboratory of Clinical Immunology and Microbiology, Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Jordan Zeldin
- Laboratory of Clinical Immunology and Microbiology, Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Ashleigh A Sun
- Laboratory of Clinical Immunology and Microbiology, Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Manoj Yadav
- Laboratory of Clinical Immunology and Microbiology, Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Prem Prashant Chaudhary
- Laboratory of Clinical Immunology and Microbiology, Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA
| | - Ian A Myles
- Laboratory of Clinical Immunology and Microbiology, Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA.
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Achanta S, Chintagari NR, Balakrishna S, Liu B, Jordt SE. Pharmacologic Inhibition of Transient Receptor Potential Ion Channel Ankyrin 1 Counteracts 2-Chlorobenzalmalononitrile Tear Gas Agent-Induced Cutaneous Injuries. J Pharmacol Exp Ther 2024; 388:613-623. [PMID: 38050077 PMCID: PMC10801748 DOI: 10.1124/jpet.123.001666] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Abstract
Deployment of the tear gas agent 2-chlorobenzalmalononitrile (CS) for riot control has significantly increased in recent years. The effects of CS have been believed to be transient and benign. However, CS induces severe pain, blepharospasm, lachrymation, airway obstruction, and skin blisters. Frequent injuries and hospitalizations have been reported after exposure. We have identified the sensory neuronal ion channel, transient receptor potential ankyrin 1 (TRPA1), as a key CS target resulting in acute irritation and pain and also as a mediator of neurogenic inflammation. Here, we examined the effects of pharmacologic TRPA1 inhibition on CS-induced cutaneous injury. We modeled CS-induced cutaneous injury by applying 10 μl CS agent [200 mM in dimethyl sulfoxide (DMSO)] to each side of the right ears of 8- to 9-week-old C57BL/6 male mice, whereas left ears were applied with solvent only (DMSO). The TRPA1 inhibitor HC-030031 or A-967079 was administered after CS exposure. CS exposure induced strong tissue swelling, plasma extravasation, and a dramatic increase in inflammatory cytokine levels in the mouse ear skin. We also showed that the effects of CS were not transient but caused persistent skin injuries. These injury parameters were reduced with TRPA1 inhibitor treatment. Further, we tested the pharmacologic activity of advanced TRPA1 antagonists in vitro. Our findings showed that TRPA1 is a crucial mediator of CS-induced nociception and tissue injury and that TRPA1 inhibitors are effective countermeasures that reduce key injury parameters when administered after exposure. Additional therapeutic efficacy studies with advanced TRPA1 antagonists and decontamination strategies are warranted. SIGNIFICANCE STATEMENT: 2-Chlorobenzalmalononitrile (CS) tear gas agent has been deployed as a crowd dispersion chemical agent in recent times. Exposure to CS tear gas agents has been believed to cause transient acute toxic effects that are minimal at most. Here we found that CS tear gas exposure causes both acute and persistent skin injuries and that treatment with transient receptor potential ion channel ankyrin 1 (TRPA1) antagonists ameliorated skin injuries.
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Affiliation(s)
- Satyanarayana Achanta
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
| | - Narendranath Reddy Chintagari
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
| | - Shrilatha Balakrishna
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
| | - Boyi Liu
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
| | - Sven-Eric Jordt
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
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Zeldin J, Tran TT, Yadav M, Chaudhary PP, D'Souza BN, Ratley G, Ganesan S, Myles IA. Antimony Compounds Associate with Atopic Dermatitis and Influence Models of Itch and Dysbiosis. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2023; 10:452-457. [PMID: 37692200 PMCID: PMC10485844 DOI: 10.1021/acs.estlett.3c00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Compared to the myriad of known triggers for rhinitis and asthma, environmental exposure research for atopic dermatitis (AD) is not well established. We recently reported that an untargeted search of U.S. Environmental Protection Agency (EPA) databases versus AD rates by United States (U.S.) postal codes revealed that isocyanates, such as toluene diisocyanate (TDI), are the pollutant class with the strongest spatiotemporal and epidemiologic association with AD. We further demonstrated that (di)isocyanates disrupt ceramide-family lipid production in commensal bacteria and activate the thermo-itch host receptor TRPA1. In this report, we reanalyzed regions of the U.S. with low levels of diisocyanate pollution to assess if a different chemical class may contribute. We identified antimony compounds as the top associated pollutant in such regions. Exposure to antimony compounds would be expected from brake dust in high-traffic areas, smelting plants, bottled water, and dust from aerosolized soil. Like TDI, antimony inhibited ceramide-family lipid production in Roseomonas mucosa and activated TRPA1 in human neurons. While further epidemiologic research will be needed to directly evaluate antimony exposure with surrounding AD prevalence and severity, these data suggest that compounds which are epidemiologically associated with AD, inhibit commensal lipid production, and activate TRPA1 may be causally related to AD pathogenesis.
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Affiliation(s)
- Jordan Zeldin
- Epithelial Therapeutics Unit, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Tan T Tran
- Epithelial Therapeutics Unit, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Manoj Yadav
- Epithelial Therapeutics Unit, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Prem Prashant Chaudhary
- Epithelial Therapeutics Unit, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Brandon N D'Souza
- Epithelial Therapeutics Unit, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Grace Ratley
- Epithelial Therapeutics Unit, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Sundar Ganesan
- National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Ian A Myles
- Epithelial Therapeutics Unit, National Institutes of Health, Bethesda, Maryland 20892, United States
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