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Corren J, Szefler SJ, Sher E, Korenblat P, Soong W, Hanania NA, Berman G, Brusselle G, Zitnik R, Natalie CR, Sun L, Siu K, Wu WS, Lio P, Armstrong AW. Lebrikizumab in Uncontrolled Asthma: Reanalysis in a Well-Defined Type 2 Population. J Allergy Clin Immunol Pract 2024; 12:1215-1224.e3. [PMID: 38360213 DOI: 10.1016/j.jaip.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND LAVOLTA (L)I, LII, and ACOUSTICS were randomized, placebo-controlled, Phase 3 trials of lebrikizumab, a monoclonal antibody targeting IL-13 in patients with uncontrolled asthma. Failure to demonstrate efficacy may have been related to patient selection in those trials. OBJECTIVE To assess the efficacy in a well-defined subpopulation of patients with elevated blood eosinophil counts and a minimum number of prior asthma exacerbations. We performed an additional analysis in a subpopulation of patients with elevated FeNO and prior exacerbations. METHODS Adult (LI and LII) and adolescent patients (aged 12-17 years weighing ≥40 kg, ACOUSTICS) with uncontrolled asthma received lebrikizumab (125 mg, n = 832; or 37.5 mg, n = 829) or placebo (n = 833) subcutaneously every 4 weeks. Post hoc analysis of the annualized adjusted exacerbation rate (AER) was performed in a subpopulation of patients with baseline blood eosinophils of 300 cells/μL or greater and history of one or more exacerbations. In this subpopulation, there were 227 patients in the placebo group, 222 in the lebrikizumab 37.5-mg group, and 217 in the lebrikizumab 125-mg group. We summarized safety in patients who received at least one dose of lebrikizumab using adverse events. RESULTS Lebrikizumab significantly reduced AER compared with placebo in adults (AER reduction: 125 mg [38%]; and 37.5 mg [41%]) and adolescents (AER reduction:125 mg [59%]; 37.5 mg [64%]) with baseline blood eosinophils of 300 cells/μL or greater and one or more exacerbations. Most adverse events were mild or moderate in severity and did not lead to treatment discontinuation. CONCLUSION Lebrikizumab significantly reduced asthma exacerbations in a subpopulation of patients with elevated blood eosinophils, elevated FeNO, and a history of asthma exacerbation.
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Affiliation(s)
- Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, Calif.
| | - Stanley J Szefler
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | | | | | - Weily Soong
- Allervie Clinical Research-Alabama Allergy & Asthma Center, Birmingham, Ala
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas
| | - Gary Berman
- Clinical Research Institute and Allergy & Asthma Specialists, Minneapolis, Minn
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | | | - Luna Sun
- Eli Lilly and Company, Indianapolis, Ind
| | | | | | - Peter Lio
- Northwestern University Feinberg School of Medicine, Medical Dermatology Associates of Chicago, Chicago, Ill
| | - April W Armstrong
- Keck School of Medicine at University of Southern California and Clinical Research for the Southern California Clinical and Translational Research Institute (SC CTSI), Los Angeles, Calif
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Battesti G, Jachiet M, Lepelletier C, Petit A, Vignon-Pennamen MD, Cassius C, de Masson A, Battistella M, Bagot M, Bouaziz JD, Mahévas T. Two cases of dupilumab-responsive Kimura disease. Clin Exp Dermatol 2024; 49:502-506. [PMID: 38149974 DOI: 10.1093/ced/llad455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
Kimura disease (KD) is a rare, chronic angiolymphoproliferative inflammatory disease appearing to be mostly restricted to the skin and soft tissue. Cutaneous involvement of KD includes head and/or neck nodules showing suggestive histological features, frequently associated with an atopic dermatitis-like or prurigo-like presentation. KD is challenging to treat, with high rate of recurrence using current therapeutic strategies. Evidence for involvement of a T-helper type 2 (Th2) immune response in KD pathogenesis has been found in previous studies. Consequently, this study aimed to determine the efficacy and safety of dupilumab, a human monoclonal antibody that inhibits signalling of key Th2 cytokines, interleukin (IL)-4 and IL-13, within a single-centre cohort of patients with cutaneous KD. Two adults with a diagnosis of refractory (failure of at least one treatment line) cutaneous-restricted KD based on clinical, biological, histological, molecular and imaging findings received dupilumab for KD, and showed dramatic response with a good safety profile.
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Affiliation(s)
- Gilles Battesti
- Departments of Dermatology
- Université Paris Cité, Paris, France
| | | | | | | | | | - Charles Cassius
- Departments of Dermatology
- Université Paris Cité, Paris, France
| | - Adèle de Masson
- Departments of Dermatology
- Université Paris Cité, Paris, France
| | - Maxime Battistella
- Université Paris Cité, Paris, France
- Pathology, Saint-Louis Hospital, Paris, France
| | - Martine Bagot
- Departments of Dermatology
- Université Paris Cité, Paris, France
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Silverberg JI, Guttman-Yassky E, Thaçi D, Irvine AD, Stein Gold L, Blauvelt A, Simpson EL, Chu CY, Liu Z, Gontijo Lima R, Pillai SG, Seneschal J. Two Phase 3 Trials of Lebrikizumab for Moderate-to-Severe Atopic Dermatitis. N Engl J Med 2023; 388:1080-1091. [PMID: 36920778 DOI: 10.1056/nejmoa2206714] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Lebrikizumab, a high-affinity IgG4 monoclonal antibody targeting interleukin-13, prevents the formation of the interleukin-4Rα-interleukin-13Rα1 heterodimer receptor signaling complex. METHODS We conducted two identically designed, 52-week, randomized, double-blind, placebo-controlled, phase 3 trials; both trials included a 16-week induction period and a 36-week maintenance period. Eligible patients with moderate-to-severe atopic dermatitis (adults [≥18 years of age] and adolescents [12 to <18 years of age, weighing ≥40 kg]) were randomly assigned in a 2:1 ratio to receive either lebrikizumab at a dose of 250 mg (loading dose of 500 mg at baseline and week 2) or placebo, administered subcutaneously every 2 weeks. Outcomes for the induction period were assessed up to 16 weeks and are included in this report. The primary outcome was an Investigator's Global Assessment (IGA) score of 0 or 1 (indicating clear or almost clear skin; range, 0 to 4 [severe disease]) with a reduction (indicating improvement) of at least 2 points from baseline at week 16. Secondary outcomes included a 75% improvement in the Eczema Area and Severity Index score (EASI-75 response) and assessments of itch and of itch interference with sleep. Safety was also assessed. RESULTS In trial 1, the primary outcome was met in 43.1% of 283 patients in the lebrikizumab group and in 12.7% of 141 patients in the placebo group (P<0.001); an EASI-75 response occurred in 58.8% and 16.2%, respectively (P<0.001). In trial 2, the primary outcome was met in 33.2% of 281 patients in the lebrikizumab group and in 10.8% of 146 patients in the placebo group (P<0.001); an EASI-75 response occurred in 52.1% and 18.1%, respectively (P<0.001). Measures of itch and itch interference with sleep indicated improvement with lebrikizumab therapy. The incidence of conjunctivitis was higher among patients who received lebrikizumab than among those who received placebo. Most adverse events during the induction period were mild or moderate in severity and did not lead to trial discontinuation. CONCLUSIONS In the induction period of two phase 3 trials, 16 weeks of treatment with lebrikizumab was effective in adolescents and adults with moderate-to-severe atopic dermatitis. (Funded by Dermira; ADvocate1 and ADvocate2 ClinicalTrials.gov numbers, NCT04146363 and NCT04178967, respectively.).
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Affiliation(s)
- Jonathan I Silverberg
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Emma Guttman-Yassky
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Diamant Thaçi
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Alan D Irvine
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Linda Stein Gold
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Andrew Blauvelt
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Eric L Simpson
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Chia-Yu Chu
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Zhuqing Liu
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Renata Gontijo Lima
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Sreekumar G Pillai
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
| | - Julien Seneschal
- From the Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC (J.I.S.); the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.); the Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany (D.T.); the Department of Clinical Medicine, Trinity College Dublin, Dublin (A.D.I.); Dermatology Clinical Research, Henry Ford Health System, Detroit (L.S.G.); Oregon Medical Research Center (A.B.), and the Department of Dermatology, Oregon Health and Science University (E.L.S.) - both in Portland; the Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei (C.-Y.C.); Eli Lilly, Indianapolis (Z.L., R.G.L., S.G.P.); and the Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hospital Saint-André, Bordeaux University, Centre National de la Recherche Scientifique, ImmunoConcept, Unité Mixte de Recherche 5164, Bordeaux, France (J.S.)
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Jia F, Zhao Q, Shi P, Liu H, Zhang F. Dupilumab: Advances in the off-label usage of IL4/IL13 antagonist in dermatoses. Dermatol Ther 2022; 35:e15924. [PMID: 36219538 DOI: 10.1111/dth.15924] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/04/2022] [Indexed: 12/29/2022]
Abstract
Type 2 immune response refers to a complicated series of immune responses characterized by Th2 polarization and Th2 cytokines secretion. The IgE secretion, airway hypersensitivity, and effector cell recruitment (eosinophils, mast cells, basophils) in skin lesion and peripheral blood stream could be upregulated during the activation of type 2 immune response. Th1/Th2 ratio, also referred as Th1/Th2 balance, represent the T lymphocytes immune pattern to a certain degree: Th1-dominated responses are often involved in intracellular infections (e.g., mycobacterium tuberculosis) and autoimmune diseases (e.g., Graves' disease) while Th2-dominated responses are involved in allergic conditions (e.g., atopic dermatitis, eczema), IgE mediated diseases (e.g., urticaria), and fibrotic dermatoses (e.g., keloids). Dupilumab, as one of the most widely applied Th2 cytokine inhibitors, could block the bioactivity of IL-14/IL-13 via competitively binding to the common IL-4Rα subunit shared by IL-4 and IL-13 receptors. In addition to the direct inhibition of type 2 response, dupilumab is also effective in autoimmune and some infectious skin diseases through indirect regulation of type 1 immune response. The pathological mechanism of Th2 responses and advanced clinical application of dupilumab in skin diseases will be summarized and discussed in the review.
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Affiliation(s)
- Fengming Jia
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Qing Zhao
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Peidian Shi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
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5
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Silverberg JI, Guttman-Yassky E, Gooderham M, Worm M, Rippon S, O'Quinn S, van der Merwe R, Kragh N, Kurbasic A, Wollenberg A. Health-related quality of life with tralokinumab in moderate-to-severe atopic dermatitis: A phase 2b randomized study. Ann Allergy Asthma Immunol 2020; 126:576-583.e4. [PMID: 33333295 DOI: 10.1016/j.anai.2020.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with a substantial burden on quality of life (QoL). OBJECTIVE To evaluate the effects of tralokinumab on health-related QoL in patients with moderate-to-severe AD using patient-reported outcomes. METHODS This was a phase 2b, randomized, double-blind, placebo-controlled, dose-ranging study in adults with moderate-to-severe AD. The patients received subcutaneous tralokinumab or placebo (1:1:1:1) every 2 weeks for 12 weeks and class 3 topical corticosteroid cream or ointment at least once daily from the run-in to end of follow-up. Patient-reported outcome end points were change from baseline to week 12 in the Dermatology Life Quality Index (dermatology life quality index (DLQI); prespecified secondary objective), the Short Form 36 Health Survey (SF-36) version 2, and sleep interference numeric rating scale score (prespecified exploratory objectives). RESULTS A total of 204 patients were randomized to placebo (n = 51) or tralokinumab (45 mg, n = 50; 150 mg, n = 51; 300 mg, n = 52). Tralokinumab 300 mg every 2 weeks improved total Dermatology Life Quality Index vs placebo at week 12 (placebo-adjusted mean change, -3.51 [95% confidence interval, -6.00 to -1.02]). At week 12, both the mental component summary (4.23 [0.98-7.47]) and the physical component summary (4.26 [1.83-6.69]) and all 8 domains of the Short Form 36 Health Survey were improved in patients treated with tralokinumab 300 mg vs placebo. Sleep interference was improved at week 12 with all tralokinumab doses vs placebo. CONCLUSION Tralokinumab improved health-related QoL in patients with moderate-to-severe atopic dermatitis, providing further evidence of the value of targeting interleukin-13 in such patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02347176; https://clinicaltrials.gov/ct2/show/NCT02347176.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melinda Gooderham
- School of Medicine, Queen's University, Kingston, Ontario, Canada; Centre for Dermatology and Probity Medical Research, Peterborough, Ontario, Canada
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Sean O'Quinn
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | | | - Nana Kragh
- Global Therapeutic and Value Strategy, LEO Pharma A/S, Ballerup, Denmark
| | - Azra Kurbasic
- Global Therapeutic and Value Strategy, LEO Pharma A/S, Ballerup, Denmark; Biostatistics and Pharmacoepidemiology, Medical Sciences, LEO Pharma A/S, Ballerup, Denmark
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
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6
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Austin CD, Gonzalez Edick M, Ferrando RE, Solon M, Baca M, Mesh K, Bradding P, Gauvreau GM, Sumino K, FitzGerald JM, Israel E, Bjermer L, Bourdin A, Arron JR, Choy DF, Olsson JK, Abreu F, Howard M, Wong K, Cai F, Peng K, Putnam WS, Holweg CT, Matthews JG, Kraft M, Woodruff PG. A randomized, placebo-controlled trial evaluating effects of lebrikizumab on airway eosinophilic inflammation and remodelling in uncontrolled asthma (CLAVIER). Clin Exp Allergy 2020; 50:1342-1351. [PMID: 32909660 PMCID: PMC7756263 DOI: 10.1111/cea.13731] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/16/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The anti-interleukin 13 (IL-13) monoclonal antibody lebrikizumab improves lung function in patients with moderate-to-severe uncontrolled asthma, but its effects on airway inflammation and remodelling are unknown. CLAVIER was designed to assess lebrikizumab's effect on eosinophilic inflammation and remodelling. OBJECTIVE To report safety and efficacy results from enrolled participants with available data from CLAVIER. METHODS We performed bronchoscopy on patients with uncontrolled asthma before and after 12 weeks of randomized double-blinded treatment with lebrikizumab (n = 31) or placebo (n = 33). The pre-specified primary end-point was relative change in airway subepithelial eosinophils per mm2 of basement membrane (cells/mm2 ). Pre-specified secondary and exploratory outcomes included change in IL-13-associated biomarkers and measures of airway remodelling. RESULTS There was a baseline imbalance in tissue eosinophils and high variability between treatment groups. There was no discernible change in adjusted mean subepithelial eosinophils/mm2 in response to lebrikizumab (95% CI, -82.5%, 97.5%). As previously observed, FEV1 increased after lebrikizumab treatment. Moreover, subepithelial collagen thickness decreased 21.5% after lebrikizumab treatment (95% CI, -32.9%, -10.2%), and fractional exhaled nitric oxide, CCL26 and SERPINB2 mRNA expression in bronchial tissues also reduced. Lebrikizumab was well tolerated, with a safety profile consistent with other lebrikizumab asthma studies. CONCLUSIONS & CLINICAL RELEVANCE We did not observe reduced tissue eosinophil numbers in association with lebrikizumab treatment. However, in pre-specified exploratory analyses, lebrikizumab treatment was associated with reduced degree of subepithelial fibrosis, a feature of airway remodelling, as well as improved lung function and reduced key pharmacodynamic biomarkers in bronchial tissues. These results reinforce the importance of IL-13 in airway pathobiology and suggest that neutralization of IL-13 may reduce asthmatic airway remodelling. CLINICAL TRIAL REGISTRATION NCT02099656.
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Affiliation(s)
| | | | - Ronald E. Ferrando
- Genentech, Inc.South San FranciscoCAUSA
- Present address:
Stemcentrx/AbbVie, Inc.South San FranciscoCAUSA
| | | | | | | | - Peter Bradding
- University of Leicester and Glenfield HospitalLeicesterUK
| | | | - Kaharu Sumino
- Washington University School of Medicine in St. LouisSt LouisMOUSA
| | | | | | | | | | | | | | | | | | | | - Kit Wong
- Genentech, Inc.South San FranciscoCAUSA
| | - Fang Cai
- Genentech, Inc.South San FranciscoCAUSA
| | - Kun Peng
- Genentech, Inc.South San FranciscoCAUSA
| | | | | | - John G. Matthews
- Genentech, Inc.South San FranciscoCAUSA
- Present address:
23andMeMountain ViewCAUSA
| | - Monica Kraft
- University of Arizona College of MedicineTucsonAZUSA
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7
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Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease that has become a global health problem. The pathophysiology of AD includes both skin barrier and immune abnormalities, with type 2 immune deviation central to several clinical phenotypes and underlying endotypes. Recognition of the persistent nature and systemic aspects of AD provides a rationale for treatment with a biologic. Dupilumab has been approved for patients 6 years of age and older with moderate to severe AD. Monoclonal antibodies are in phase 3 trials and may become part of a precision medicine approach to AD.
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MESH Headings
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Biological Products/pharmacology
- Biological Products/therapeutic use
- Clinical Trials as Topic
- Dermatitis, Atopic/diagnosis
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/immunology
- Dermatitis, Atopic/pathology
- Drug Approval
- Humans
- Immunoglobulin E/metabolism
- Interleukin-13/antagonists & inhibitors
- Interleukin-13/metabolism
- Interleukin-4/metabolism
- Interleukin-4 Receptor alpha Subunit/antagonists & inhibitors
- Interleukin-4 Receptor alpha Subunit/metabolism
- Off-Label Use
- Omalizumab/pharmacology
- Omalizumab/therapeutic use
- Receptors, Interleukin/antagonists & inhibitors
- Receptors, Interleukin/metabolism
- Severity of Illness Index
- Signal Transduction/drug effects
- Signal Transduction/immunology
- Skin/drug effects
- Skin/immunology
- Skin/pathology
- Treatment Outcome
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Affiliation(s)
- Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, 1400 Jackson Street, J310, Denver, CO 80206, USA.
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8
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Tsai M, Thauland TJ, Huang AY, Bun C, Fitzwater S, Krogstad P, Douine ED, Nelson SF, Lee H, Garcia-Lloret MI, Butte MJ. Disseminated Coccidioidomycosis Treated with Interferon-γ and Dupilumab. N Engl J Med 2020; 382:2337-2343. [PMID: 32521134 PMCID: PMC7333509 DOI: 10.1056/nejmoa2000024] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We describe a case of life-threatening disseminated coccidioidomycosis in a previously healthy child. Like most patients with disseminated coccidioidomycosis, this child had no genomic evidence of any known, rare immune disease. However, comprehensive immunologic testing showed exaggerated production of interleukin-4 and reduced production of interferon-γ. Supplementation of antifungal agents with interferon-γ treatment slowed disease progression, and the addition of interleukin-4 and interleukin-13 blockade with dupilumab resulted in rapid resolution of the patient's clinical symptoms. This report shows that blocking of type 2 immune responses can treat infection. This immunomodulatory approach could be used to enhance immune clearance of refractory fungal, mycobacterial, and viral infections. (Supported by the Jeffrey Modell Foundation and the National Institutes of Health.).
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Affiliation(s)
- Monica Tsai
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Timothy J Thauland
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Alden Y Huang
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Chantana Bun
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Sean Fitzwater
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Paul Krogstad
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Emilie D Douine
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Stanley F Nelson
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Hane Lee
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Maria I Garcia-Lloret
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
| | - Manish J Butte
- From the Divisions of Immunology, Allergy, and Rheumatology (M.T., T.J.T., C.B., M.I.G.-L., M.J.B.) and Infectious Diseases (S.F., P.K.), Department of Pediatrics, the Department of Human Genetics (E.D.D., S.F.N., H.L.), the Department of Pathology and Laboratory Medicine (H.L.), and the California Center for Rare Diseases, Institute for Precision Health (A.Y.H., S.F.N., M.J.B.), University of California, Los Angeles, Los Angeles
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9
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Foerster J, Molęda A. Virus-Like Particle-Mediated Vaccination against Interleukin-13 May Harbour General Anti-Allergic Potential beyond Atopic Dermatitis. Viruses 2020; 12:v12040438. [PMID: 32294982 PMCID: PMC7232523 DOI: 10.3390/v12040438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/31/2020] [Accepted: 04/09/2020] [Indexed: 12/23/2022] Open
Abstract
Virus-like particle (VLP)-based anti-infective prophylactic vaccination has been established in clinical use. Although validated in proof-of-concept clinical trials in humans, no VLP-based therapeutic vaccination against self-proteins to modulate chronic disease has yet been licensed. The present review summarises recent scientific advances, identifying interleukin-13 as an excellent candidate to validate the concept of anti-cytokine vaccination. Based on numerous clinical studies, long-term elimination of IL-13 is not expected to trigger target-related serious adverse effects and is likely to be safer than combined targeting of IL-4/IL-13. Furthermore, recently published results from large-scale trials confirm that elimination of IL-13 is highly effective in atopic dermatitis, an exceedingly common condition, as well as eosinophilic esophagitis. The distinctly different mode of action of a polyclonal vaccine response is discussed in detail, suggesting that anti-IL-13 vaccination has the potential of outperforming monoclonal antibody-based approaches. Finally, recent data have identified a subset of follicular T helper cells dependent on IL-13 which selectively trigger massive IgE accumulation in response to anaphylactoid allergens. Thus, prophylactic IL-13 vaccination may have broad application in a number of allergic conditions.
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MESH Headings
- Animals
- Anti-Allergic Agents/administration & dosage
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/immunology
- Antibodies, Neutralizing/immunology
- Cytokines/metabolism
- Dermatitis, Atopic/immunology
- Dermatitis, Atopic/metabolism
- Dermatitis, Atopic/prevention & control
- Humans
- Interleukin-13/antagonists & inhibitors
- Interleukin-13/immunology
- Ligands
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/metabolism
- Vaccination
- Vaccines, Virus-Like Particle/administration & dosage
- Vaccines, Virus-Like Particle/immunology
- Vaccines, Virus-Like Particle/therapeutic use
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10
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Abstract
Atopic dermatitis (AD) is a common cutaneous condition characterized by epidermal barrier disruption, severe skin inflammation, and pruritus. As a result of our growing understanding of disease pathogenesis, the therapeutic armamentarium to manage AD is rapidly expanding. Moving beyond broadly immunosuppressive agents, newer therapies for AD offer more targeted immunomodulation in the forms of phosphodiesterase 4 inhibitors, Janus kinase inhibitors, and anticytokine monoclonal antibodies. While such therapies are generally considered safer than traditional immunosuppressive agents that have been used off label for AD for decades, they are not without risk entirely. In some cases, potential side effects may be difficult to manage. This review summarizes current views on AD pathogenesis and discusses these novel and emerging therapies, including a discussion of the mechanisms of action, potential side effects, and limitations of current clinical trials for each drug. While the rapid and prolific expansion of therapies to treat AD is encouraging, additional studies are needed to adequately evaluate the long-term safety, efficacy, and generalizability among different age groups and disease subtypes.
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Affiliation(s)
| | - Sarina B Elmariah
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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11
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Liu Y, Zhang S, Chen R, Wei J, Guan G, Zhou M, Dong N, Cao Y. Meta-analysis of randomized controlled trials for the efficacy and safety of anti-interleukin-13 therapy with lebrikizumab in patients with uncontrolled asthma. Allergy Asthma Proc 2018; 39:332-337. [PMID: 30153886 DOI: 10.2500/aap.2018.39.4149] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several studies have evaluated the efficacy and safety of lebrikizumab treatment with uncontrolled asthma. However, most of these studies were small and conclusions were inconsistent. Furthermore, whether serum periostin can act as a good predictor of the response to lebrikizumab treatment is still not certain. METHOD We conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of lebrikizumab treatment with uncontrolled asthma. Trials were searched in PubMed, Embase, Web of Science and Cochrane. Outcome measures were the rate of asthma exacerbations, relative changes in the forced expiratory volume in the first second of expiration (FEV1) of predicted value (%) and incidence of adverse events. RESULT Five trials were finally included. Compared with placebo lebrikizumab treatment significantly decreased the rate of exacerbations(risk ratio [RR] 0.66 [95% confidence interval {CI}, 0.54-0.80]; p < 0.0001; n = 2039) and increased FEV1% of predicted value (weighted mean difference [WMD] 5.46 [95% CI, 2.48-8.43]; p < 0.0003; n = 351). Patients with high levels of serum periostin had greater exacerbation rate reductions (RR 0.59 [95%CI, 0.50-0.70]; p < 0.00001; n = 1157) and FEV1 of predicted value improvement (WMD 7.18 [95% CI, 2.93-11.42]; p < 0.0009; n = 177) than patients with low periostin levels in exacerbation rate reductions (RR 0.73 [95% CI, 0.47-1.14]; p < 0.17; n = 882) and FEV1 of predicted value improvement (WMD3.79 [95% CI, 0.39-7.97]; p < 0.08; n = 174). There was no significant difference in the incidence of adverse events in patients with lebrikizumab compared to placebo (RR 1.03 [95% CI, 0.99-1.06]; p < 0.11; n = 2056). CONCLUSION In patients with uncontrolled asthma, lebrikizumab treatment significantly decreased the rate of exacerbation and improved lung function, especially for patients with high periostin levels.
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12
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Wollenberg A, Howell MD, Guttman-Yassky E, Silverberg JI, Kell C, Ranade K, Moate R, van der Merwe R. Treatment of atopic dermatitis with tralokinumab, an anti-IL-13 mAb. J Allergy Clin Immunol 2018; 143:135-141. [PMID: 29906525 DOI: 10.1016/j.jaci.2018.05.029] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/23/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND IL-13 has an important role in atopic dermatitis (AD) pathogenesis. Tralokinumab is a fully human mAb that potently and specifically neutralizes IL-13. OBJECTIVE We sought to evaluate the efficacy and safety of tralokinumab in adults with moderate-to-severe AD. METHODS In this phase 2b study (NCT02347176), 204 adults were randomized 1:1:1:1 to receive 45, 150, or 300 mg of subcutaneous tralokinumab, or placebo, every 2 weeks for 12 weeks with concomitant topical glucocorticoids. Coprimary end points were change from baseline in Eczema Area Severity Index score and percentage of participants with an Investigator's Global Assessment response (0/1 score and reduction of ≥2 grades from baseline) at week 12. RESULTS At week 12, 300 mg of tralokinumab significantly improved change from baseline in Eczema Area Severity Index score versus placebo (adjusted mean difference, -4.94; 95% CI, -8.76 to -1.13; P = .01), and a greater percentage of participants achieved an Investigator's Global Assessment response (26.7% vs 11.8%). Greater responses were found in participants with greater concentrations of biomarkers of increased IL-13 activity. Participants treated with 300 mg of tralokinumab demonstrated improvements in SCORAD, Dermatology Life Quality Index, and pruritus numeric rating scale (7-day mean) scores versus placebo. Upper respiratory tract infection was the most frequent treatment-emergent adverse event reported as related to study drug in the placebo (3.9%) and pooled tralokinumab (3.9%) groups. CONCLUSIONS Tralokinumab treatment was associated with early and sustained improvements in AD symptoms and an acceptable safety and tolerability profile, thereby providing evidence for targeting IL-13 in patients with AD.
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Affiliation(s)
- Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig Maximillian University, Munich, Germany.
| | | | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at the Mount Sinai Medical Center Medicine, New York, NY
| | - Jonathan I Silverberg
- Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | | | - Rachel Moate
- Clinical Statistics and Data, MedImmune, Cambridge, United Kingdom
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13
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Maher P, Conti B. Deciphering the pathways that protect from IL-13-mediated potentiation of oxidative stress-induced dopaminergic nerve cell death. Cytokine 2018; 103:114-120. [PMID: 28969943 PMCID: PMC5808859 DOI: 10.1016/j.cyto.2017.09.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/31/2017] [Accepted: 09/18/2017] [Indexed: 01/27/2023]
Abstract
The majority of Parkinson's disease (PD) cases are sporadic with only about 10% of PD patients having a family history of the disease suggesting that this neurodegenerative disorder is the result of both environmental and genetic factors. Both oxidative stress and neuroinflammation are thought to contribute to PD. Previously, we showed that the activation of interleukin 13 receptor alpha 1 (IL-13Rα1) increases the sensitivity of dopaminergic neurons to oxidative damage both in cultured cells and in animals. In this study, we investigated the pathways involved in the IL-13-mediated potentiation of oxidative stress-induced dopaminergic cell death using a combination of cell survival assays and Western blotting with appropriate antibodies. In addition, siRNA was used to examine the role of 4E-BP1 in this cell toxicity paradigm. We show that activation of both the Jak-Stat and PI3 kinase-mTOR pathways play key roles in the promotion of cell death by IL-13 in the presence of mild oxidative stress. The Jak 1/2 inhibitor ruxolitinib, the mTOR inhibitor rapamycin and the PI3 kinase inhibitor LY294002 all prevented the potentiation of cell death by IL-13. Moreover, 4E-BP1, a target of mTOR, appeared to mediate the protective effects of rapamycin. Together, these results indicate that multiple signaling pathways downstream of IL-13Rα1 activation play a role in the toxic effects of IL-13 in dopaminergic neurons in the presence of mild oxidative stress and suggest that any of these pathways might provide potential targets for the treatment of PD.
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Affiliation(s)
- Pamela Maher
- The Salk Institute for Biological Studies, 10010 N. Torrey Pines Rd., La Jolla, CA 92037, United States.
| | - Bruno Conti
- The Scripps Research Institute, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, United States
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14
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Vangipuram R, Tyring SK. Dupilumab for Moderate-to-Severe Atopic Dermatitis. Skin Therapy Lett 2017; 22:1-4. [PMID: 29091379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory disease affecting 2-10% of adults and up to 15-30% of children. Despite a rising prevalence, effective and safe therapeutics for patients with moderate-to-severe AD are limited due to toxicity and side effects. Dupilumab, an interleukin (IL)-4 and IL-13 antagonist that limits type 2 T helper (Th2) driven inflammatory activity, is a promising therapeutic option. In clinical trials, it has demonstrated efficacy by reducing clinical activity and symptoms, and showed improvement in the AD genomic phenotype, including a significant reduction in Th2 chemokines and reversal of key epidermal markers of AD. It also has a favorable safety profile. This review discusses the role of dupilumab in treating Th2 related inflammation, and its efficacy and safety, as demonstrated in clinical trials. Dupilumab (Dupixent®) recently gained US FDA approval for patients with moderate-to-severe AD, and is poised to revolutionize the management of this chronic, relapsing condition.
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Affiliation(s)
- R Vangipuram
- School of Medicine, Department of Dermatology, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Dermatology, University of Texas Health Sciences Center, Houston, TX, USA
| | - S K Tyring
- School of Medicine, Department of Dermatology, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Dermatology, University of Texas Health Sciences Center, Houston, TX, USA
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15
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Devos FC, Pollaris L, Cremer J, Seys S, Hoshino T, Ceuppens J, Talavera K, Nemery B, Hoet PHM, Vanoirbeek JAJ. IL-13 is a central mediator of chemical-induced airway hyperreactivity in mice. PLoS One 2017; 12:e0180690. [PMID: 28704401 PMCID: PMC5509233 DOI: 10.1371/journal.pone.0180690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND While the importance of the Th2 cytokine IL-13 as a central mediator of airway hyperreactivity (AHR) has been described in allergic protein-induced asthma, this has never been investigated in chemical-induced asthma. OBJECTIVE We examined the importance of IL-13 in a mouse model of chemical-induced AHR, using toluene-2,4-diisocyanate (TDI). METHODS In a first set-up, wild type (WT) and IL-13 knockout (KO) C57Bl/6 mice were dermally treated on days 1 and 8 with 1% TDI or vehicle (acetone/olive oil) on both ears. On day 15, mice received an intranasal instillation with 0.1% TDI or vehicle. In a second set-up, WT mice sensitized with 1% TDI or vehicle, received i.v. either anti-IL-13 or control antibody prior to the intranasal challenge. RESULTS TDI-sensitized and TDI-challenged WT mice showed AHR to methacholine, in contrast to TDI-sensitized and TDI-challenged IL-13 KO mice, which also showed lower levels of total serum IgE. TDI-sensitized and TDI-challenged IL-13 KO mice had lower numbers of T-cells in the auricular lymph nodes. TDI-treated WT mice, receiving anti-IL-13, showed no AHR, in contrast to those receiving control antibody, despite increased levels of IgE. Anti-IL-13 treatment in TDI-treated WT mice resulted in lower levels of serum IL-13, but did not induce changes in T- and B-cell numbers, and in the cytokine production profile. CONCLUSION AND CLINICAL RELEVANCE We conclude that IL-13 plays a critical role in the effector phase of chemical-induced, immune-mediated AHR. This implicates that anti-IL-13 treatment could have a beneficial effect in patients with this asthma phenotype.
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Affiliation(s)
- Fien C. Devos
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Lore Pollaris
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Jonathan Cremer
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium
| | - Sven Seys
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium
| | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Medicine 1, Kurume University School of Medicine, Kurume, Japan
| | - Jan Ceuppens
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, University of Leuven, Leuven, Belgium
| | - Karel Talavera
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, University of Leuven, Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Peter H. M. Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Jeroen A. J. Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
- * E-mail:
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Tripp CS, Cuff C, Campbell AL, Hendrickson BA, Voss J, Melim T, Wu C, Cherniack AD, Kim K. RPC4046, A Novel Anti-interleukin-13 Antibody, Blocks IL-13 Binding to IL-13 α1 and α2 Receptors: A Randomized, Double-Blind, Placebo-Controlled, Dose-Escalation First-in-Human Study. Adv Ther 2017; 34:1364-1381. [PMID: 28455782 PMCID: PMC5487860 DOI: 10.1007/s12325-017-0525-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Indexed: 11/27/2022]
Abstract
Introduction A unique anti-interleukin (IL)-13 monoclonal antibody, RPC4046, was generated on the basis of differential IL-13 receptor (R) blockade as assessed in a murine asthma model; the safety, tolerability, pharmacokinetics, and pharmacodynamics of RPC4046 were evaluated in a first-in-human study. Methods Anti-IL-13 antibodies with varying receptor blocking specificity were evaluated in the ovalbumin-induced murine asthma model. A randomized, double-blind, placebo-controlled, dose-escalation first-in-human study (NCT00986037) was conducted with RPC4046 in healthy adults and patients with mild to moderate controlled asthma. Results In the ovalbumin model, blocking IL-13 binding to both IL-13Rs (IL-13Rα1 and IL-13Rα2) inhibited more asthma phenotypic features and more fully normalized the distinct IL-13 gene transcription associated with asthma compared with blocking IL-13Rα1 alone. In humans, RPC4046 exposure increased dose-dependently; pharmacokinetics were similar in healthy and asthmatic subjects, and blockade of both IL-13Rs uniquely affected IL-13 gene transcription. A minority of participants (28%) had antidrug antibodies, which were transient and appeared not to affect pharmacokinetics. Adverse event profiles were similar in healthy and asthmatic subjects, without dose-related or administration route differences, systemic infusion-related reactions, or asthma symptom worsening. Adverse events were mild to moderate, with none reported as probably related to RPC4046 or leading to discontinuations. Non-serious upper respiratory tract infections were more frequent with RPC4046 versus placebo. Conclusion RPC4046 is a novel anti-IL-13 antibody that blocks IL-13 binding to both receptors and more fully blocks the asthma phenotype. These results support further investigation of RPC4046 for IL-13-related allergic/inflammatory diseases (e.g., asthma and eosinophilic esophagitis). Funding AbbVie Inc. sponsored the studies and contributed to the design and conduct of the studies, data management, data analysis, interpretation of the data, and in the preparation and approval of the manuscript.
Electronic supplementary material The online version of this article (doi:10.1007/s12325-017-0525-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Carolyn Cuff
- AbbVie, Global Pharmaceutical R&D, Worcester, MA, USA.
| | | | | | - Jeff Voss
- AbbVie, Global Pharmaceutical R&D, Worcester, MA, USA
| | - Terry Melim
- AbbVie, Global Pharmaceutical R&D, Worcester, MA, USA
| | - Chengbin Wu
- AbbVie, Global Pharmaceutical R&D, Worcester, MA, USA
- EpimAb Biotherapeutics Inc., Shanghai, China
| | - Andrew D Cherniack
- AbbVie, Global Pharmaceutical R&D, Worcester, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
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Passalacqua G, Mincarini M, Colombo D, Troisi G, Ferrari M, Bagnasco D, Balbi F, Riccio A, Canonica GW. IL-13 and idiopathic pulmonary fibrosis: Possible links and new therapeutic strategies. Pulm Pharmacol Ther 2017; 45:95-100. [PMID: 28501346 DOI: 10.1016/j.pupt.2017.05.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 04/05/2017] [Accepted: 05/09/2017] [Indexed: 01/13/2023]
Abstract
The recent advances in the knowledge of immunological aspects of many pulmonary diseases, allowed to identify cells, biological functions, cytokines, and receptors that are preferentially involved in each disease. This is the case of asthma, where IL-13 (together with IL-4) is recognized as a central mediator. The role of IL-13 is strictly related, via complex signaling pathways, to eosinophil recruitment and activation, to mucus secretion, periostin generation and to fibrogenic processes (which are part of the remodeling process). These peculiar roles of IL-13 have suggested the hypothesis of its role in Idiopathic Pulmonary Fibrosis, and consequently of its antagonists in the treatment of such disease. We review herein the immunological roles of IL-13 in asthma and IPF, and the currently ongoing attempts to treat IPF by IL-13 antagonism strategies.
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Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Italy.
| | - Marcello Mincarini
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Italy
| | - Daniele Colombo
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Italy
| | - Giuseppe Troisi
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Italy
| | - Marta Ferrari
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Italy
| | - Francesco Balbi
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Italy
| | - Annamaria Riccio
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Italy
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18
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Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, Silverberg JI, Deleuran M, Kataoka Y, Lacour JP, Kingo K, Worm M, Poulin Y, Wollenberg A, Soo Y, Graham NMH, Pirozzi G, Akinlade B, Staudinger H, Mastey V, Eckert L, Gadkari A, Stahl N, Yancopoulos GD, Ardeleanu M. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med 2016; 375:2335-2348. [PMID: 27690741 DOI: 10.1056/nejmoa1610020] [Citation(s) in RCA: 1215] [Impact Index Per Article: 151.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dupilumab, a human monoclonal antibody against interleukin-4 receptor alpha, inhibits signaling of interleukin-4 and interleukin-13, type 2 cytokines that may be important drivers of atopic or allergic diseases such as atopic dermatitis. METHODS In two randomized, placebo-controlled, phase 3 trials of identical design (SOLO 1 and SOLO 2), we enrolled adults with moderate-to-severe atopic dermatitis whose disease was inadequately controlled by topical treatment. Patients were randomly assigned in a 1:1:1 ratio to receive, for 16 weeks, subcutaneous dupilumab (300 mg) or placebo weekly or the same dose of dupilumab every other week alternating with placebo. The primary outcome was the proportion of patients who had both a score of 0 or 1 (clear or almost clear) on the Investigator's Global Assessment and a reduction of 2 points or more in that score from baseline at week 16. RESULTS We enrolled 671 patients in SOLO 1 and 708 in SOLO 2. In SOLO 1, the primary outcome occurred in 85 patients (38%) who received dupilumab every other week and in 83 (37%) who received dupilumab weekly, as compared with 23 (10%) who received placebo (P<0.001 for both comparisons with placebo). The results were similar in SOLO 2, with the primary outcome occurring in 84 patients (36%) who received dupilumab every other week and in 87 (36%) who received dupilumab weekly, as compared with 20 (8%) who received placebo (P<0.001 for both comparisons). In addition, in the two trials, an improvement from baseline to week 16 of at least 75% on the Eczema Area and Severity Index was reported in significantly more patients who received each regimen of dupilumab than in patients who received placebo (P<0.001 for all comparisons). Dupilumab was also associated with improvement in other clinical end points, including reduction in pruritus and symptoms of anxiety or depression and improvement in quality of life. Injection-site reactions and conjunctivitis were more frequent in the dupilumab groups than in the placebo groups. CONCLUSIONS In two phase 3 trials of identical design involving patients with atopic dermatitis, dupilumab improved the signs and symptoms of atopic dermatitis, including pruritus, symptoms of anxiety and depression, and quality of life, as compared with placebo. Trials of longer duration are needed to assess the long-term effectiveness and safety of dupilumab. (Funded by Sanofi and Regeneron Pharmaceuticals; SOLO 1 ClinicalTrials.gov number, NCT02277743 ; SOLO 2 ClinicalTrials.gov number, NCT02277769 .).
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Affiliation(s)
- Eric L Simpson
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Thomas Bieber
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Emma Guttman-Yassky
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Lisa A Beck
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Andrew Blauvelt
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Michael J Cork
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Jonathan I Silverberg
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Mette Deleuran
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Yoko Kataoka
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Jean-Philippe Lacour
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Külli Kingo
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Margitta Worm
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Yves Poulin
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Andreas Wollenberg
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Yuhwen Soo
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Neil M H Graham
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Gianluca Pirozzi
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Bolanle Akinlade
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Heribert Staudinger
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Vera Mastey
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Laurent Eckert
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Abhijit Gadkari
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Neil Stahl
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - George D Yancopoulos
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
| | - Marius Ardeleanu
- From the Department of Dermatology, Oregon Health and Science University (E.L.S.), and Oregon Medical Research Center (A.B.) - both in Portland; the Department of Dermatology and Allergy, University of Bonn, Bonn (T.B.), the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M.W.), and the Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich (A.W.) - all in Germany; the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York (E.G.-Y.), the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), and Regeneron Pharmaceuticals, Tarrytown (Y.S., N.M.H.G., B.A., V.M., A.G., N.S., G.D.Y., M.A.) - all in New York; the Dermatology Research Unit, University of Sheffield Medical School, Sheffield, United Kingdom (M.J.C.); the Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (J.I.S.); the Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark (M.D.); the Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan (Y.K.); the Department of Dermatology, University Hospital of Nice, Nice (J.-P.L.), and Sanofi, Chilly-Mazarin (L.E.) - both in France; the Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia (K.K.); the Department of Medicine, Université Laval, Hôpital Hôtel-Dieu de Québec, Quebec, QC, Canada (Y.P.); and Sanofi, Bridgewater, NJ (G.P., H.S.)
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Matsunaga MC, Yamauchi PS. IL-4 and IL-13 Inhibition in Atopic Dermatitis. J Drugs Dermatol 2016; 15:925-929. [PMID: 27537991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Atopic dermatitis (AD) is a chronic, prevalent, multi-factorial condition that affects infants, children, and adults. Beyond topical therapy, a variety of systemic agents such as steroids, methotrexate, cyclosporine, azathioprine, mycophenoloic acid, and other agents are utilized to treat moderate to severe AD. However, these agents are associated with potential long term adverse events and organ toxicity. There is an unmet need for a safer, long-term systemic agent to adequately control moderate to severe AD. The role of the Th2 cytokines, IL-4 and IL-13, in AD has led to the development of biologic agents to treat AD. The aim of this article is to review the role of IL-4 and IL-13 in the pathogenesis of AD and discuss some of the clinical trial data that target and inhibit IL-4 and IL-13 in positively altering the course and outcome of AD.<BR /><BR /> <EM>J Drugs Dermatol</EM>. 2016;15(8):925-929.
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Shilovskii IP, Prozorova MS, Gaisina AR, Laskin AA, Smirnov VV, Babakhin AA, Khaitov MR. RNA INTERFERENCE: NEW APPROACH TO THE TREATMENT OF ALLERGIC ASTHMA (A REVIEW). Eksp Klin Farmakol 2016; 79:35-44. [PMID: 29949702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Asthma is among the most common chronic disorders of airways, which affects both children and adults. Asthma being a common disease among different segments of population, it has a high mortality rate and, in the absence of appropriate care, affects the quality of life and leads to economics losses. In a view of continuing growth in the incidence of asthma, it is important to find relevant biological targets for developing new approaches to astma therapy. Recent advances in molecular immunology, genetics, and bioinformatics allowed genes involved in the pathogenesis of asthma to be identified, which provided prerequisites for the development of new types of drugs that can regulate the activity of pathogenically significant genes. To date, a number of technologies for sequence-specific gene regulation (ASO, ribozymes, DNAzymes, EGS, DNA-decoys, U 1-adapters) are available, but RNA interference is the most promising approach in both terms of efficacy and financial cost. This review focuses on the generalization and analysis of experimental data regarding the use of RNA interference technology for the treatment of astma.
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MESH Headings
- Adult
- Aptamers, Nucleotide/genetics
- Aptamers, Nucleotide/metabolism
- Aptamers, Nucleotide/therapeutic use
- Asthma/genetics
- Asthma/immunology
- Asthma/pathology
- Asthma/therapy
- Child
- Chronic Disease
- DNA, Catalytic/genetics
- DNA, Catalytic/metabolism
- DNA, Catalytic/therapeutic use
- GATA3 Transcription Factor/antagonists & inhibitors
- GATA3 Transcription Factor/genetics
- GATA3 Transcription Factor/immunology
- Gene Expression
- Genetic Predisposition to Disease
- Genetic Therapy/methods
- Humans
- Interleukin-13/antagonists & inhibitors
- Interleukin-13/genetics
- Interleukin-13/immunology
- Interleukin-4/antagonists & inhibitors
- Interleukin-4/genetics
- Interleukin-4/immunology
- Oligonucleotides, Antisense/genetics
- Oligonucleotides, Antisense/metabolism
- Oligonucleotides, Antisense/therapeutic use
- Quality of Life
- RNA Interference
- RNA, Catalytic/genetics
- RNA, Catalytic/metabolism
- RNA, Catalytic/therapeutic use
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Cheng E, Zhang X, Wilson KS, Wang DH, Park JY, Huo X, Yu C, Zhang Q, Spechler SJ, Souza RF. JAK-STAT6 Pathway Inhibitors Block Eotaxin-3 Secretion by Epithelial Cells and Fibroblasts from Esophageal Eosinophilia Patients: Promising Agents to Improve Inflammation and Prevent Fibrosis in EoE. PLoS One 2016; 11:e0157376. [PMID: 27310888 PMCID: PMC4911010 DOI: 10.1371/journal.pone.0157376] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/28/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although most studies on treatments for eosinophilic esophagitis (EoE) have focused on effects in the epithelium, EoE is a transmural disease. Eosinophils that infiltrate the subepithelial layers of the esophagus lead to fibrosis and the serious complications of EoE, and current therapies have shown minimal effects on this fibrosis. We aimed to elucidate T helper (Th)2 cytokine effects on esophageal fibroblasts and to explore potential fibroblast-targeted therapies for EoE. METHODS We established telomerase-immortalized fibroblasts from human esophageal biopsies. We stimulated these esophageal fibroblasts with Th2 cytokines, and examined effects of omeprazole and inhibitors of the Janus kinase (JAK)-signal transducer and activator of transcription (STAT6) pathway (AS1517499, leflunomide, and ruxolitinib) on STAT6 phosphorylation, STAT6 nuclear translocation, and eotaxin-3 expression. We also measured the effects of these inhibitors in esophageal epithelial cells stimulated with Th2 cytokines. RESULTS As in esophageal epithelial cells, Th2 cytokines increased STAT6 phosphorylation, STAT6 nuclear translocation, eotaxin-3 transcription and protein secretion in esophageal fibroblasts. Unlike in epithelial cells, however, omeprazole did not inhibit cytokine-stimulated eotaxin-3 expression in fibroblasts. In contrast, JAK-STAT6 pathway inhibitors decreased cytokine-stimulated eotaxin-3 expression in both fibroblasts and epithelial cells. CONCLUSIONS Omeprazole does not inhibit Th2 cytokine-stimulated eotaxin-3 expression by esophageal fibroblasts, suggesting that PPIs will have limited impact on subepithelial EoE processes such as fibrosis. JAK-STAT6 pathway inhibitors block Th2 cytokine-stimulated eotaxin-3 expression both in fibroblasts and in epithelial cells, suggesting a potential role for JAK-STAT inhibitors in treating both epithelial inflammation and subepithelial fibrosis in EoE.
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Affiliation(s)
- Edaire Cheng
- Esophageal Diseases Center, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Pediatrics, Children’s Health Children’s Medical Center, Dallas, Texas, United States of America
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Medical Services, Veterans Affairs North Texas Health Care System, Dallas, Texas, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- * E-mail:
| | - Xi Zhang
- Esophageal Diseases Center, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Medical Services, Veterans Affairs North Texas Health Care System, Dallas, Texas, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Kathleen S. Wilson
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - David H. Wang
- Esophageal Diseases Center, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Medical Services, Veterans Affairs North Texas Health Care System, Dallas, Texas, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Jason Y. Park
- Esophageal Diseases Center, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Pathology, Children’s Health Children’s Medical Center, Dallas, Texas, United States of America
| | - Xiaofang Huo
- Esophageal Diseases Center, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Medical Services, Veterans Affairs North Texas Health Care System, Dallas, Texas, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Chunhua Yu
- Esophageal Diseases Center, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Medical Services, Veterans Affairs North Texas Health Care System, Dallas, Texas, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Qiuyang Zhang
- Esophageal Diseases Center, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Medical Services, Veterans Affairs North Texas Health Care System, Dallas, Texas, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Stuart J. Spechler
- Esophageal Diseases Center, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Medical Services, Veterans Affairs North Texas Health Care System, Dallas, Texas, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Rhonda F. Souza
- Esophageal Diseases Center, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Medical Services, Veterans Affairs North Texas Health Care System, Dallas, Texas, United States of America
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
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Blakely K, Gooderham M, Papp K. Dupilumab, A Monoclonal Antibody for Atopic Dermatitis: A Review of Current Literature. Skin Therapy Lett 2016; 21:1-5. [PMID: 27223113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Atopic dermatitis results when aberrant barrier function and immune activation occur within the skin. Standard therapies for atopic dermatitis have fallen short, prompting efforts to discover novel therapeutics for this disease. Of these, dupilumab, a fully human monoclonal antibody that inhibits the actions of both IL-4 and IL-13, has shown the greatest promise. Clinical trials of systemic dupilumab in moderate-to-severe atopic dermatitis have demonstrated marked improvement in patient symptoms, including pruritus and clinically visible disease. Importantly, dupilumab treatment has been correlated with changes in the molecular signature of diseased skin, with reduction of both inflammatory and proliferative markers. Dupilumab recently received US FDA breakthrough therapy designation for atopic dermatitis, with ongoing trials in both adult and pediatric populations. Altogether, dupilumab has shed new light on the pathomechanisms driving atopic dermatitis and is making unprecedented advances towards highly effective control of this debilitating disease.
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Affiliation(s)
- K Blakely
- University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | - M Gooderham
- Skin Centre for Dermatology, Peterborough, ON, Canada; Probity Medical Research, Waterloo, ON Canada
| | - K Papp
- K. Papp Clinical Research, Waterloo, ON, Canada; Probity Medical Research, Waterloo, ON Canada
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Bachert C, Mannent L, Naclerio RM, Mullol J, Ferguson BJ, Gevaert P, Hellings P, Jiao L, Wang L, Evans RR, Pirozzi G, Graham NM, Swanson B, Hamilton JD, Radin A, Gandhi NA, Stahl N, Yancopoulos GD, Sutherland ER. Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. JAMA 2016; 315:469-79. [PMID: 26836729 DOI: 10.1001/jama.2015.19330] [Citation(s) in RCA: 531] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Dupilumab has demonstrated efficacy in patients with asthma and atopic dermatitis, which are both type 2 helper T-cell-mediated diseases. OBJECTIVE To assess inhibition of interleukins 4 and 13 with dupilumab in patients with chronic sinusitis and nasal polyposis. DESIGN, SETTING, AND PARTICIPANTS A randomized, double-blind, placebo-controlled parallel-group study conducted at 13 sites in the United States and Europe between August 2013 and August 2014 in 60 adults with chronic sinusitis and nasal polyposis refractory to intranasal corticosteroids with 16 weeks of follow-up. INTERVENTIONS Subcutaneous dupilumab (a 600 mg loading dose followed by 300 mg weekly; n = 30) or placebo (n = 30) plus mometasone furoate nasal spray for 16 weeks. MAIN OUTCOMES AND MEASURES Change in endoscopic nasal polyp score (range, 0-8; higher scores indicate worse status) at 16 weeks (primary end point). Secondary end points included Lund-Mackay computed tomography (CT) score (range, 0-24; higher scores indicate worse status), 22-item SinoNasal Outcome Test score (range, 0-110; higher scores indicating worse quality of life; minimal clinically important difference ≥8.90), sense of smell assessed using the University of Pennsylvania Smell Identification Test (UPSIT) score (range, 0-40; higher scores indicate better status), symptoms, and safety. RESULTS Among the 60 patients who were randomized (mean [SD] age, 48.4 years [9.4 years]; 34 men [56.7%]; 35 with comorbid asthma), 51 completed the study. The least squares (LS) mean change in nasal polyp score was -0.3 (95% CI, -1.0 to 0.4) with placebo and -1.9 (95% CI, -2.5 to -1.2) with dupilumab (LS mean difference, -1.6 [95% CI, -2.4 to -0.7]; P < .001). The LS mean difference between the 2 groups for the Lund-Mackay CT total score was -8.8 (95% CI, -11.1 to -6.6; P < .001). Significant improvements with dupilumab were also observed for the 22-item SinoNasal Outcome Test (LS mean difference between groups, -18.1 [95% CI, -25.6 to -10.6]; P < .001) and sense of smell assessed by UPSIT (LS mean difference, 14.8 [95% CI, 10.9 to 18.7]; P < .001). The most common adverse events were nasopharyngitis (33% in the placebo group vs 47% in the dupilumab group), injection site reactions (7% vs 40%, respectively), and headache (17% vs 20%). CONCLUSIONS AND RELEVANCE Among adults with symptomatic chronic sinusitis and nasal polyposis refractory to intranasal corticosteroids, the addition of subcutaneous dupilumab to mometasone furoate nasal spray compared with mometasone alone reduced endoscopic nasal polyp burden after 16 weeks. Further studies are needed to assess longer treatment duration, larger samples, and direct comparison with other medications. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01920893.
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Affiliation(s)
- Claus Bachert
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium2Clintec, Karolinska Institute, Stockholm, Sweden
| | - Leda Mannent
- Research and Development, Sanofi, Chilly Mazarin, France
| | | | - Joaquim Mullol
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Philippe Gevaert
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Peter Hellings
- Laboratory of Experimental Immunology, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lixia Jiao
- Research and Development, Sanofi, Bridgewater, New Jersey
| | - Lin Wang
- Research and Development, Sanofi, Bridgewater, New Jersey
| | | | | | | | - Brian Swanson
- Research and Development, Sanofi, Bridgewater, New Jersey
| | | | - Allen Radin
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Neil Stahl
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - E Rand Sutherland
- Immunology and Inflammation Development Franchise, Sanofi Research and Development, Cambridge, Massachusetts
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Buzney CD, Gottlieb AB, Rosmarin D. Asthma and Atopic Dermatitis: A Review of Targeted Inhibition of Interleukin-4 and Interleukin-13 As Therapy for Atopic Disease. J Drugs Dermatol 2016; 15:165-171. [PMID: 26885783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Type 2 helper T cell (Th2)-mediated inflammation plays a critical role in the pathogenesis of allergic asthma and atopic dermatitis (AD). Recent research focusing on the suppression of the Th2 axis with targeted inhibitors in atopic disease is showing promising early results. In particular, the simultaneous blockage of interleukin (IL)-4 and IL-13 has successfully mitigated symptoms of allergic asthma and AD in preliminary clinical trials. Given the current therapeutic challenges of treating these chronic and severe diseases, this review brings to light new data demonstrating that agents targeting IL-4 and IL-13 are relatively safe and effective medications in blocking the inflammatory cascade responsible for allergic asthma and atopic dermatitis.
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Abstract
In this review of articles published in the Journal in 2013, we report on the significant advances in environmental and occupational disorders. Research advances have led to the identification and defined the structure and function of several major allergens. A meta-analysis confirmed the importance of mold exposure in patients with allergic rhinitis, and a new immunologic classification of aspergillosis emerged. Insights into the role of diesel exhaust particles in patients with severe asthma were clarified. Improvements in stinging insect allergy diagnostics were reported. Genetic, immunologic, and biomarker studies advanced the understanding of adverse drug reactions. New practice parameters for cockroach allergen control were presented. The pathologic role of viruses and bacterial agents in patients with asthma and chronic obstructive pulmonary disease were further defined. An excellent review of allergen bronchoprovocation testing was reported. The roles of bronchoprovocation and bronchodilator responsiveness in asthma diagnosis were further clarified. A biomarker for neutrophilic asthma was identified. Therapeutic advances in asthma research include the inhibition of IL-13 by lebrikizumab, use of montelukast in asthmatic smokers, and a thorough review of bronchial thermoplasty in patients with severe asthma. Lastly, maternal asthma was linked to a number of adverse neonatal outcomes.
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Affiliation(s)
- David B Peden
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Robert K Bush
- Section of Allergy, Immunology, Pulmonary, Critical Care, and Sleep Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Beck LA, Thaçi D, Hamilton JD, Graham NM, Bieber T, Rocklin R, Ming JE, Ren H, Kao R, Simpson E, Ardeleanu M, Weinstein SP, Pirozzi G, Guttman-Yassky E, Suárez-Fariñas M, Hager MD, Stahl N, Yancopoulos GD, Radin AR. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. N Engl J Med 2014; 371:130-9. [PMID: 25006719 DOI: 10.1056/nejmoa1314768] [Citation(s) in RCA: 949] [Impact Index Per Article: 94.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13, has shown efficacy in patients with asthma and elevated eosinophil levels. The blockade by dupilumab of these key drivers of type 2 helper T-cell (Th2)-mediated inflammation could help in the treatment of related diseases, including atopic dermatitis. METHODS We performed randomized, double-blind, placebo-controlled trials involving adults who had moderate-to-severe atopic dermatitis despite treatment with topical glucocorticoids and calcineurin inhibitors. Dupilumab was evaluated as monotherapy in two 4-week trials and in one 12-week trial and in combination with topical glucocorticoids in another 4-week study. End points included the Eczema Area and Severity Index (EASI) score, the investigator's global assessment score, pruritus, safety assessments, serum biomarker levels, and disease transcriptome. RESULTS In the 4-week monotherapy studies, dupilumab resulted in rapid and dose-dependent improvements in clinical indexes, biomarker levels, and the transcriptome. The results of the 12-week study of dupilumab monotherapy reproduced and extended the 4-week findings: 85% of patients in the dupilumab group, as compared with 35% of those in the placebo group, had a 50% reduction in the EASI score (EASI-50, with higher scores in the EASI indicating greater severity of eczema) (P<0.001); 40% of patients in the dupilumab group, as compared with 7% in the placebo group, had a score of 0 to 1 (indicating clearing or near-clearing of skin lesions) on the investigator's global assessment (P<0.001); and pruritus scores decreased (indicating a reduction in itch) by 55.7% in the dupilumab group versus 15.1% in the placebo group (P<0.001). In the combination study, 100% of the patients in the dupilumab group, as compared with 50% of those who received topical glucocorticoids with placebo injection, met the criterion for EASI-50 (P=0.002), despite the fact that patients who received dupilumab plus glucocorticoids used less than half the amount of topical glucocorticoids used by those who received placebo plus the topical medication (P=0.16). Adverse events, such as skin infection, occurred more frequently with placebo; nasopharyngitis and headache were the most frequent adverse events with dupilumab. CONCLUSIONS Patients treated with dupilumab had marked and rapid improvement in all the evaluated measures of atopic dermatitis disease activity. Side-effect profiles were not dose-limiting. (Funded by Regeneron Pharmaceuticals and Sanofi; ClinicalTrials.gov numbers, NCT01259323, NCT01385657, NCT01639040, and NCT01548404.).
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MESH Headings
- Administration, Topical
- Adult
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Biomarkers/blood
- Chemokine CCL17/blood
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/genetics
- Dermatitis, Atopic/metabolism
- Dermatologic Agents/adverse effects
- Dermatologic Agents/therapeutic use
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Therapy, Combination
- Female
- Glucocorticoids/adverse effects
- Glucocorticoids/therapeutic use
- Humans
- Immunoglobulin E/blood
- Injections, Subcutaneous
- Interleukin-13/antagonists & inhibitors
- Interleukin-4/antagonists & inhibitors
- Male
- Severity of Illness Index
- Skin/metabolism
- Transcriptome/physiology
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Affiliation(s)
- Lisa A Beck
- From the Department of Dermatology, University of Rochester Medical Center, Rochester (L.A.B.), Regeneron Pharmaceuticals, Tarrytown (J.D.H., N.M.G., H.R., R.K., M.A., S.P.W., M.D.H., N.S., G.D.Y., A.R.R.), the Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai (E.G.-Y.), the Laboratory for Investigative Dermatology (E.G.-Y., M.S.-F.) and the Center for Clinical and Translational Science (M.S.-F.), Rockefeller University, New York - all in New York; the Department of Dermatology, Allergology, and Venereology, Universität zu Lübeck, Lübeck (D.T.), and the Department of Dermatology and Allergology, University of Bonn, Bonn (T.B.) - both in Germany; Sanofi, Bridgewater, NJ (R.R., J.E.M., G.P.); and the Department of Dermatology, Oregon Health and Science University, Portland (E.S.)
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Ribeiro-Filho J, Calheiros AS, Vieira-de-Abreu A, de Carvalho KIM, da Silva Mendes D, Melo CB, Martins MA, da Silva Dias C, Piuvezam MR, Bozza PT. Curine inhibits eosinophil activation and airway hyper-responsiveness in a mouse model of allergic asthma. Toxicol Appl Pharmacol 2013; 273:19-26. [PMID: 23994558 DOI: 10.1016/j.taap.2013.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 01/16/2023]
Abstract
Allergic asthma is a chronic inflammatory airway disease with increasing prevalence around the world. Current asthma therapy includes drugs that usually cause significant side effects, justifying the search for new anti-asthmatic drugs. Curine is a bisbenzylisoquinoline alkaloid that modulates calcium influx in many cell types; however, its anti-allergic and putative toxic effects remain to be elucidated. Our aim was to investigate the effects of curine on eosinophil activation and airway hyper-responsiveness (AHR) and to characterize its potential toxic effects. We used a mouse model of allergic asthma induced by sensitization and challenge with ovalbumin (OVA) to evaluate the anti-allergic effects of oral treatment with curine. The oral administration of curine significantly inhibited eosinophilic inflammation, eosinophil lipid body formation and AHR in animals challenged with OVA compared with animals in the untreated group. The curine treatment also reduced eotaxin and IL-13 production triggered by OVA. Verapamil, a calcium channel antagonist, had similar anti-allergic properties, and curine pre-treatment inhibited the calcium-induced tracheal contractile response ex-vivo, suggesting that the mechanism by which curine exerts its effects is through the inhibition of a calcium-dependent response. A toxicological evaluation showed that orally administered curine did not significantly alter the biochemical, hematological, behavioral and physical parameters measured in the experimental animals compared with saline-treated animals. In conclusion, curine showed anti-allergic activity through mechanisms that involve inhibition of IL-13 and eotaxin and of Ca(++) influx, without inducing evident toxicity and as such, has the potential for the development of anti-asthmatic drugs.
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Affiliation(s)
- Jaime Ribeiro-Filho
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil; Laboratório de Imunofarmacologia, Departamento de Fisiologia e Patologia, UFPB, João Pessoa, Paraíba, Brazil
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Abstract
Over the past decade, there has been a cohesive effort from patients, physicians, clinical and basic scientists, and the pharmaceutical industry to find definitive treatments for idiopathic pulmonary fibrosis (IPF). As understanding of disease behavior and pathogenesis has improved, the aims of those treating IPF have shifted from reversing the disease to slowing or preventing progression of this chronic fibrotic illness. It is to be hoped that by slowing disease progression, survival will be improved from the current dismal median of 3.5 years following diagnosis. In Europe and Asia, a milestone has recently been reached with the licensing of the first IPF-specific drug, pirfenidone. This review assesses the current treatment modalities available for IPF, including pirfenidone. It also turns an eye to the future and discusses the growing number of promising compounds currently in development that it is hoped, in time, will make their way into the clinic as treatments for IPF.
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Affiliation(s)
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
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Corren J, Lemanske RF, Hanania NA, Korenblat PE, Parsey MV, Arron JR, Harris JM, Scheerens H, Wu LC, Su Z, Mosesova S, Eisner MD, Bohen SP, Matthews JG. Lebrikizumab treatment in adults with asthma. N Engl J Med 2011; 365:1088-98. [PMID: 21812663 DOI: 10.1056/nejmoa1106469] [Citation(s) in RCA: 1157] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Many patients with asthma have uncontrolled disease despite treatment with inhaled glucocorticoids. One potential cause of the variability in response to treatment is heterogeneity in the role of interleukin-13 expression in the clinical asthma phenotype. We hypothesized that anti-interleukin-13 therapy would benefit patients with asthma who had a pretreatment profile consistent with interleukin-13 activity. METHODS We conducted a randomized, double-blind, placebo-controlled study of lebrikizumab, a monoclonal antibody to interleukin-13, in 219 adults who had asthma that was inadequately controlled despite inhaled glucocorticoid therapy. The primary efficacy outcome was the relative change in prebronchodilator forced expiratory volume in 1 second (FEV(1)) from baseline to week 12. Among the secondary outcomes was the rate of asthma exacerbations through 24 weeks. Patient subgroups were prespecified according to baseline type 2 helper T-cell (Th2) status (assessed on the basis of total IgE level and blood eosinophil count) and serum periostin level. RESULTS At baseline, patients had a mean FEV(1) that was 65% of the predicted value and were taking a mean dose of inhaled glucocorticoids of 580 μg per day; 80% were also taking a long-acting beta-agonist. At week 12, the mean increase in FEV(1) was 5.5 percentage points higher in the lebrikizumab group than in the placebo group (P = 0.02). Among patients in the high-periostin subgroup, the increase from baseline FEV(1) was 8.2 percentage points higher in the lebrikizumab group than in the placebo group (P = 0.03). Among patients in the low-periostin subgroup, the increase from baseline FEV(1) was 1.6 percentage points higher in the lebrikizumab group than in the placebo group (P = 0.61). Musculoskeletal side effects were more common with lebrikizumab than with placebo (13.2% vs. 5.4%, P = 0.045). CONCLUSIONS Lebrikizumab treatment was associated with improved lung function. Patients with high pretreatment levels of serum periostin had greater improvement in lung function with lebrikizumab than did patients with low periostin levels. (Funded by Genentech; ClinicalTrials.gov number, NCT00930163 .).
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Slager RE, Hawkins GA, Ampleford EJ, Bowden A, Stevens LE, Morton MT, Tomkinson A, Wenzel SE, Longphre M, Bleecker ER, Meyers DA. IL-4 receptor α polymorphisms are predictors of a pharmacogenetic response to a novel IL-4/IL-13 antagonist. J Allergy Clin Immunol 2010; 126:875-8. [PMID: 20920778 DOI: 10.1016/j.jaci.2010.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 07/26/2010] [Accepted: 08/02/2010] [Indexed: 02/03/2023]
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Borish L. IL-4 and IL-13 dual antagonism: a promising approach to the dilemma of generating effective asthma biotherapeutics. Am J Respir Crit Care Med 2010; 181:769-70. [PMID: 20382798 DOI: 10.1164/rccm.201002-0147ed] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mitchell J, Dimov V, Townley RG. IL-13 and the IL-13 receptor as therapeutic targets for asthma and allergic disease. Curr Opin Investig Drugs 2010; 11:527-534. [PMID: 20419598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
It is widely accepted that T-helper 2 cell (Th2) cytokines play an important role in the maintenance of asthma and allergy. Emerging evidence has highlighted the role of IL-13 in the pathogenesis of these diseases. In particular, IL-13 is involved in the regulation of IgE synthesis, mucus hypersecretion, subepithelial fibrosis and eosinophil infiltration, and has been associated with the regulation of certain chemokine receptors, notably CCR5. Thus, targeting IL-13 and its associated receptors may be a therapeutic approach to the treatment of asthma and/or allergy. Pharmaceutical and biotechnology companies are researching various strategies, based on this approach, aimed at binding IL-13, increasing the level of the IL-13 decoy receptor, IL-13Ralpha2, or blocking the effect of the chemokine receptor CCR5. This review focuses on the therapeutic potential of anti-IL-13 agents and their role in the treatment of asthma and allergy.
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Affiliation(s)
- Jesse Mitchell
- Creighton University, Department of Medical Microbiology and Immunology, 601 North 30th Street, Suite 3M100, Omaha, NE 68131, USA
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Tomkinson A, Tepper J, Morton M, Bowden A, Stevens L, Harris P, Lindell D, Fitch N, Gundel R, Getz EB. Inhaled vs subcutaneous effects of a dual IL-4/IL-13 antagonist in a monkey model of asthma. Allergy 2010; 65:69-77. [PMID: 19796211 DOI: 10.1111/j.1398-9995.2009.02156.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pitrakinra is a recombinant protein derived from human interleukin-4 (IL-4) that binds to IL-4Ralpha and acts as a competitive antagonist of IL-4 and IL-13. The studies reported here compare the dose-ranging effects of pitrakinra on allergen-induced airway hyperresponsiveness (AHR) and airway eosinophilia when administered subcutaneously (s.c.) or by inhalation to the Ascaris suum-sensitive cynomolgus monkey for the purpose of elucidating the primary site of pitrakinra's anti-asthmatic action. METHODS Airway responsiveness to inhaled methacholine and bronchoalveolar lavage cell composition was determined before and after three allergen exposures with a 1-week course of twice-daily (b.i.d.) s.c. or inhaled pitrakinra or placebo treatment. RESULTS Treatment with s.c. pitrakinra significantly reduced allergen-induced AHR, with a maximum effect of a 2.8- to 3.8-fold increase in methacholine PC(100) relative to control (P < 0.05) observed at b.i.d. s.c. doses of 0.05-0.5 mg/kg. Inhaled pitrakinra also significantly reduced AHR with a similar maximum effect of a 2.8- to 3.2-fold increase in methacholine PC(100) relative to control (P < 0.05) at nominal b.i.d. doses of 3-100 mg. The maximal effect on AHR following inhalation was observed at a plasma concentration which exhibited no efficacy via the subcutaneous route. The effect of pitrakinra on lung eosinophilia was not statistically significant following either route of administration, although lung eosinophil count was reduced in all studies relative to control. CONCLUSION Local administration of pitrakinra to the lung is sufficient to inhibit AHR, one of the cardinal features of asthma, indicating the therapeutic potential of inhaled pitrakinra in the treatment of atopic asthma.
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Reenaers C, Louis E, Belaiche J. [Biologic therapies in chronic inflammatory bowel diseases]. Rev Med Liege 2009; 64:301-304. [PMID: 19642463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases which can be difficult to control with conventional therapies. Thanks to a better knowledge of their physiopathology, new therapies aimed at specific targets of the inflammatory cascade were developed. Three monoclonal anti-TNF antibodies were produced. Infliximab and adalimumab, currently widely used, can induce sustained remission in Crohn's disease. Infliximab is also efficacious in UC. Certolizumab pegol provides good short term results; its long term efficacy, however, remains to be assessed by further clinical trials. Therapies targeting leucocyte trafficking (anti-integrine) have also been provided and are associated with good clinical responses in Crohn's disease. Natalizumab (anti-alpha4) is responsible for significant side effects and is no longer in use in gasrtoenterology in Europe whereas MLN02 (anti-alpha417) has a good profile in terms of efficacy and safety. Monoclonal anti bodies targeting other cytokines are under development, mainly ustekinumab which inhibits IL12 and IL23. Ustekinumab generates favourable clinical responses in Crohn's disease. The development of biologic therapies in inflammatory bowel disease has dramatically altered the course and management of these disorders.
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Affiliation(s)
- C Reenaers
- Université de Liège, CHU de Liège, Belgique
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Blease K. Therapeutics targeting IL-13 for the treatment of pulmonary inflammation and airway remodeling. Curr Opin Investig Drugs 2008; 9:1180-1184. [PMID: 18951297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Targeting the IL-13 pathway appears to be a viable approach to ameliorate pulmonary inflammation and remodeling. Support for this hypothesis comes from preclinical and preliminary clinical data. Diverse approaches have been used to target the IL-13 pathway, including neutralizing antibodies specific for IL-13, targeting IL-13 receptors using antibodies or chimeric proteins, and therapeutics that target the downstream signaling molecules that are activated upon binding of the IL-13 receptor to its ligand. This review summarizes the progress made in the development of therapeutics targeting the IL-13 pathway for treating diseases associated with inflammation and remodeling of the lung.
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Abstract
BACKGROUND Interleukin-13 (IL-13) receptors are overexpressed in glioblastoma multiforme (GBM). The presence of IL-13 binding sites in GBM and their absence in normal brain tissue validates IL-13 receptor as an important target in human GBM. OBJECTIVE This review discusses the bench-to-bedside experience with a recombinant cytotoxin composed of human IL-13 and a truncated form of Pseudomonas exotoxin A (PE38QQR), delivered via convection-enhanced delivery (CED), in GBM treatment. METHODS The authors review publications regarding the laboratory research and clinical development of IL-13-directed therapies and summarize the future of IL-13-targeted cytotoxin. CONCLUSION The IL-13 receptor remains an important potential target in GBM, and preliminary experience with the IL-13-PE38QQR cytotoxin (also called cintredekin besudotox) has helped to pave the way for study of CED as an important means of drug delivery to malignant gliomas. Ongoing analysis of recently completed clinical trials will determine the future of this agent and its potential therapeutic targets.
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Affiliation(s)
- Melike Mut
- Hacettepe Hastanesi Beyin Cerrahisi, Bolum 71 Sihhiye, Ankara 06100, Turkey.
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Deepak P, Sanjay K, Acharya A. IL-13 Ralpha2-mediated interleukin-13 neutralization represses in vivo progressive growth of a T-cell lymphoma. J Exp Clin Cancer Res 2007; 26:347-352. [PMID: 17987794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Dalton's lymphoma (DL) is a T-cell lymphoma of spontaneous origin, characterized by highly invasive and malignant nature, killing the host in a very short period of life span. DL-bearing host is reflected by very high titer of IL-13 in serum. Therefore, we hypothesized that over expression of IL-13 may greatly affect the growth of DL-cells in a tumor-bearing host. In this study, to assess the involvement of IL-13 in DL-cell progression, we have blocked the IL-13 activity/signalling by the systemic delivery of non-signaling decoy receptor IL-13 Ralpha2, and IL-13 level vs DL-cell proliferation were measured. We observed that systemic delivery of IL-13 Ralpha2 inhibits the DL-cell progression in much extent and enhances the survival and longevity of DL-bearing mice. Further, this study re-inforce the therapeutic advantage of IL-13 Ralpha2 in a T-cell lymphoma tumor system.
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Affiliation(s)
- P Deepak
- Centre of Advance Study in Zoology, Banaras Hindu University, Varanasi, India
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Lundell AC, Andersson K, Josefsson E, Steinkasserer A, Rudin A. Soluble CD14 and CD83 from human neonatal antigen-presenting cells are inducible by commensal bacteria and suppress allergen-induced human neonatal Th2 differentiation. Infect Immun 2007; 75:4097-104. [PMID: 17526743 PMCID: PMC1952007 DOI: 10.1128/iai.01744-06] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 12/08/2006] [Accepted: 05/21/2007] [Indexed: 01/03/2023] Open
Abstract
CD14 is expressed on the cell surface of various antigen-presenting cells, and CD83 is a maturation marker for dendritic cells (DC). CD14 and CD83 are also present as soluble proteins, and both have immunoregulatory functions. We examined whether neonatal cord blood monocytes or DC released soluble CD14 (sCD14) or sCD83 when exposed to the commensal intestinal bacteria Clostridium perfringens, Staphylococcus aureus, Lactobacillus rhamnosus, Escherichia coli, and Bacteroides fragilis. We found that the gram-positive bacteria C. perfringens and S. aureus, but not gram-negative bacteria, induced the release of sCD14 from monocytes. DC, on the other hand, released sCD14 in response to both gram-positive and gram-negative bacteria. Moreover, the expression of the virulence factor staphylococcal protein A seemed to be important for S. aureus-induced sCD14 production from both monocytes and DC. Soluble CD83 was released from DC, but not from monocytes, when exposed to both gram-positive and gram-negative bacteria. Finally, to investigate whether sCD14 or sCD83 could modulate neonatal allergen-induced T-cell differentiation, DC were exposed to birch allergen alone or in the presence of sCD14 or sCD83 and then cocultured with autologous T cells. We demonstrate that sCD14 and sCD83 inhibited the birch allergen-induced Th2 differentiation by suppressing interleukin 13 production. Together, these results suggest that the commensal intestinal flora may be an important stimulus for the developing immune system by inducing the immunoregulatory proteins sCD14 and sCD83, which may be involved in preventing T-cell sensitization to allergens in infants.
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Affiliation(s)
- Anna-Carin Lundell
- Department of Rheumatology and Inflammation Research, Göteborg University, Guldhedsgatan 10, 413 46 Göteborg, Sweden.
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Paveglio SA, Allard J, Mayette J, Whittaker LA, Juncadella I, Anguita J, Poynter ME. The tick salivary protein, Salp15, inhibits the development of experimental asthma. J Immunol 2007; 178:7064-71. [PMID: 17513755 PMCID: PMC4140411 DOI: 10.4049/jimmunol.178.11.7064] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Activation of Th2 CD4(+) T cells is necessary and sufficient to elicit allergic airway disease, a mouse model with many features of human allergic asthma. Effectively controlling the activities of these cells could be a panacea for asthma therapy. Blood-feeding parasites have devised remarkable strategies to effectively evade the immune response. For example, ticks such as Ixodes scapularis, which must remain on the host for up to 7 days to feed to repletion, secrete immunosuppressive proteins. Included among these proteins is the 15-kDa salivary protein Salp15, which inhibits T cell activation and IL-2 production. Our objective for these studies was to evaluate the T cell inhibitory properties of Salp15 in a mouse model of allergic asthma. BALB/cJ mice were Ag sensitized by i.p. injection of OVA in aluminum hydroxide, with or without 50 mug of Salp15, on days 0 and 7. All mice were challenged with aerosolized OVA on days 14-16 and were studied on day 18. Compared with control mice sensitized with Ag, mice sensitized with Ag and Salp15 displayed significantly reduced airway hyperresponsiveness, eosinophilia, Ag-specific IgG1 and IgE, mucus cell metaplasia, and Th2 cytokine secretion in vivo and by CD4(+) T cells restimulated with Ag in vitro. Our results demonstrate that Salp15 can effectively prevent the generation of a Th2 immune response and the development of experimental asthma. These studies, and those of others, support the notion that a lack of ectoparasitism may contribute to the increasing prevalence of allergic asthma.
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Affiliation(s)
- Sara A. Paveglio
- Department of Medicine, Vermont Lung Center and University of Vermont, Burlington, VT 05405
| | - Jenna Allard
- Department of Medicine, Vermont Lung Center and University of Vermont, Burlington, VT 05405
| | - Jana Mayette
- Department of Medicine, Vermont Lung Center and University of Vermont, Burlington, VT 05405
| | - Laurie A. Whittaker
- Department of Medicine, Vermont Lung Center and University of Vermont, Burlington, VT 05405
| | - Ignacio Juncadella
- Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA 01003
| | - Juan Anguita
- Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, MA 01003
| | - Matthew E. Poynter
- Department of Medicine, Vermont Lung Center and University of Vermont, Burlington, VT 05405
- Address correspondence and reprint requests to Dr. Matthew E. Poynter, Department of Medicine, Division of Pulmonary Disease and Critical Care, University of Vermont, 149 Beaumont Avenue, HSRF 220, Burlington, VT 05405.
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Ma Y, HayGlass KT, Becker AB, Fan Y, Yang X, Basu S, Srinivasan G, Simons FER, Halayko AJ, Peng Z. Novel recombinant interleukin-13 peptide-based vaccine reduces airway allergic inflammatory responses in mice. Am J Respir Crit Care Med 2007; 176:439-45. [PMID: 17556715 DOI: 10.1164/rccm.200610-1405oc] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Interleukin (IL)-13 plays a pivotal role in the pathogenesis of allergic asthma. Passive administration of its monoclonal antibody or soluble receptor to block overproduced IL-13 has been proven to be effective in controlling airway allergic responses in animal models, but these approaches have disadvantages of short half-lives, high costs, and possible adverse effects. OBJECTIVES We sought to develop a novel therapeutic strategy through constructing an IL-13 peptide-based vaccine for blocking IL-13 on a persistent effect basis and to evaluate its in vivo effects using a murine model. METHODS To break self-tolerance, truncated hepatitis B core antigen was used as a carrier. Vaccine was prepared by inserting a peptide derived from the receptor binding site of mouse IL-13 into the immunodominant epitope region of the carrier using gene recombination methods. Mice received vaccine subcutaneously three times, and then subjected to intraperitoneal sensitization and intranasal challenge with ovalbumin. Control animals received carrier or saline in place of vaccine. MEASUREMENTS AND MAIN RESULTS The vaccine presented as virus-like particles and induced sustained and high titered IL-13-specific IgG without the use of conventional adjuvant. Vaccination significantly suppressed ovalbumin-induced inflammatory cell number, and IL-13 and IL-5 levels in bronchoalveolar lavage fluids. Serum total and ovalbumin-specific IgE were also significantly inhibited. Moreover, allergen-induced goblet cell hyperplasia, lung tissue inflammatory cell infiltration, and pulmonary hyperresponsiveness to inhaled methacholine were significantly suppressed in vaccinated mice. CONCLUSIONS Our data indicate that IL-13 peptide-based vaccines could be an effective therapeutic approach in the treatment of asthma.
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Affiliation(s)
- Yanbing Ma
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Johansson S, Wennergren G, Aberg N, Rudin A. Clara cell 16-kd protein downregulates T(H)2 differentiation of human naive neonatal T cells. J Allergy Clin Immunol 2007; 120:308-14. [PMID: 17481711 DOI: 10.1016/j.jaci.2007.03.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 03/20/2007] [Accepted: 03/22/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Levels of the Clara cell 16-kd protein (CC16) are lower in plasma and bronchoalveolar lavage fluid from adults with asthma relative to those seen in healthy control subjects, and CC16 inhibits the T(H)2 cytokine production from murine T cells. OBJECTIVE We sought to determine the plasma levels of CC16 in infants and to investigate whether CC16 might inhibit the T(H)2 cytokine production from neonatal T cells. METHODS Cord blood and blood samples at 4, 18, and 36 months of age were taken from 64 children prospectively, and CC16 levels were analyzed in plasma. Cord monocyte-derived dendritic cells (DCs) were pulsed with birch allergen extract alone or together with CC16 or prostaglandin D(2) receptor inhibitors, after which autologous naive CD4(+) T cells were added to the DCs. The production of IL-5, IL-13, and IFN-gamma was measured by means of ELISA and flow cytometry. RESULTS The plasma levels of CC16 in children peaked at 4 months. CC16 did not directly affect the cytokine production from human T(H)2 cells. However, CC16 inhibited birch pollen extract-stimulated T(H)2 differentiation of naive T cells through the DC. Inhibition of the prostaglandin D(2) receptors did not consistently result in suppressed T(H)2 differentiation. CONCLUSION The production of CC16 seems to peak early in life, and CC16 has an inhibitory effect on T(H)2 cell differentiation from human infants by affecting DCs. CLINICAL IMPLICATIONS CC16 is an immunoregulatory protein, and its inhibitory effect on T(H)2 cell differentiation might be of importance in the pathogenesis of allergy in infants.
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Affiliation(s)
- Sofi Johansson
- Department of Pediatrics, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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Knackmuss S, Krause S, Engel K, Reusch U, Virchow JC, Mueller T, Kraich M, Little M, Luttmann W, Friedrich K. Specific inhibition of interleukin-13 activity by a recombinant human single-chain immunoglobulin domain directed against the IL-13 receptor alpha1 chain. Biol Chem 2007; 388:325-30. [PMID: 17338640 DOI: 10.1515/bc.2007.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Interleukin-13 (IL-13) is a T-cell-derived pleiotropic cytokine of particular medical importance because of its critical role in the development of allergic asthma. The effects of IL-13 on its target cells are mediated through a dimeric transmembrane receptor (IL-13R), which shares the IL-4Ralpha subunit with the IL-4R system, but contains as a specific component the IL-13Ralpha1 chain. We have generated a set of single-chain Fv fragments with specific binding capacity to the extracellular domain of the human IL-13Ralpha1 receptor. Bacteriophage clones displaying receptor-binding antibody domains were selected from both naive and synthetic libraries by repetitive panning on recombinant and cell surface-expressed recombinant IL-13Ralpha1. Their specific reactivity with native human IL-13Ralpha1 expressed on the surface of transfected cells was demonstrated by flow cytometry. One binder that specifically interfered with cell activation by IL-13 was extensively characterized. This scFv inhibited IL-13-driven gene transcription and cell proliferation in test cell lines, as well as IL-13-induced activation of primary human monocytes in a dose-dependent manner, with an IC(50) below 300 nM. This novel reagent thus constitutes a valuable tool for the further elucidation of IL-13 function in disease and offers potential therapeutic perspectives.
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Affiliation(s)
- Stefan Knackmuss
- Affimed Therapeutics AG, Im Neuenheimer Feld 582, D-69120 Heidelberg, Germany
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Bree A, Schlerman FJ, Wadanoli M, Tchistiakova L, Marquette K, Tan XY, Jacobson BA, Widom A, Cook TA, Wood N, Vunnum S, Krykbaev R, Xu X, Donaldson DD, Goldman SJ, Sypek J, Kasaian MT. IL-13 blockade reduces lung inflammation after Ascaris suum challenge in cynomolgus monkeys. J Allergy Clin Immunol 2007; 119:1251-7. [PMID: 17379289 DOI: 10.1016/j.jaci.2007.02.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 02/07/2007] [Accepted: 02/08/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Airway inflammation is a hallmark feature of asthma and a driver of airway hyperresponsiveness. IL-13 is a key inducer of airway inflammation in rodent models of respiratory disease, but a role for IL-13 has not been demonstrated in primates. OBJECTIVE We sought to test the efficacy of a neutralizing antibody to human IL-13 in a cynomolgus monkey model of lung inflammation. METHODS Using cynomolgus monkeys (Macaca fascicularis) that are sensitized to Ascaris suum through natural exposure, we developed a reproducible model of acute airway inflammation after segmental A suum antigen challenge. This model was used to test the in vivo efficacy of mAb13.2, a mouse mAb directed against human IL-13, and IMA-638, the humanized counterpart of mAb13.2. Bronchoalveolar lavage (BAL) cells and BAL fluid were collected before and after antigen challenge and assayed for cellular content by means of differential count. RESULTS Total BAL cell count, eosinophil number, and neutrophil number were all reduced in animals treated with mAb13.2 or IMA-638 compared with values in control animals that were untreated, given saline, or treated with human IgG of irrelevant specificity. In addition, levels of eotaxin and RANTES in BAL fluid were reduced in anti-IL-13-treated animals compared with levels seen in control animals. CONCLUSION These findings support a role for IL-13 in maintaining lung inflammation in response to allergen challenge in nonhuman primates. CLINICAL IMPLICATIONS IL-13 neutralization with a specific antibody could be a useful therapeutic strategy for asthma.
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Keane MP, Gomperts BN, Weigt S, Xue YY, Burdick MD, Nakamura H, Zisman DA, Ardehali A, Saggar R, Lynch JP, Hogaboam C, Kunkel SL, Lukacs NW, Ross DJ, Grusby MJ, Strieter RM, Belperio JA. IL-13 is pivotal in the fibro-obliterative process of bronchiolitis obliterans syndrome. J Immunol 2007; 178:511-9. [PMID: 17182591 DOI: 10.4049/jimmunol.178.1.511] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute allograft rejection is considered to be a predominately type 1 immune mediated response to the donor alloantigen. However, the type 2 immune mediated response has been implicated in multiple fibroproliferative diseases. Based on the fibro-obliterative lesion found during bronchiolitis obliterans syndrome (BOS), we hypothesized that the type 2 immune mediated response is involved in chronic lung allograft rejection. Specifically, whereas acute rejection is, in part, a type 1 immune response, chronic rejection is, in part, a type 2 immune response. We found the type 2 cytokine, IL-13, to be elevated and biologically active in human bronchoalveolar lavage fluid during BOS. Translational studies using a murine model of BOS demonstrated increased expression of IL-13 and its receptors that paralleled fibro-obliteration. In addition, in vivo neutralization of IL-13 reduced airway allograft matrix deposition and murine BOS, by a mechanism that was independent of IL-4. Furthermore, using IL-13Ralpha2(-/-) mice, we found increased fibro-obliteration. Moreover, anti-IL-13 therapy in combination with cyclosporin A had profound effects on reducing murine BOS. This supports the notion that IL-13 biological axis plays an important role during the pathogenesis of BOS independent of the IL-4 biological axis.
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Affiliation(s)
- Michael P Keane
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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Klein M, Klein-Hessling S, Palmetshofer A, Serfling E, Tertilt C, Bopp T, Heib V, Becker M, Taube C, Schild H, Schmitt E, Stassen M. Specific and redundant roles for NFAT transcription factors in the expression of mast cell-derived cytokines. J Immunol 2007; 177:6667-74. [PMID: 17082579 DOI: 10.4049/jimmunol.177.10.6667] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
By virtue of their ability to express a plethora of biologically highly active mediators, mast cells (MC) are involved in both adaptive and innate immune responses. MC-derived Th2-type cytokines are thought to act as local amplifiers of Th2 reactions, including chronic inflammatory disorders such as allergic asthma, whereas MC-derived TNF-alpha is a critical initiator of antimicrobial defense. In this study, we demonstrate that the transcription factors NFATc1 and NFATc2 are part of a MC-specific signaling network that regulates the expression of TNF-alpha and IL-13, whereas NFATc3 is dispensable. Primary murine bone marrow-derived MC from NFATc2(-/-) mice, activated by either ionomycin or IgE/Ag cross-link, display a strong reduction in the production of these cytokines, compared with bone marrow-derived MC from wild-type mice. Detailed analyses of TNF-alpha and IL-13 expression using small interfering RNA-mediated knockdown reveals that both NFATc2 and NFATc1 are able to drive the expression of these cytokines, whereas neither degranulation nor the expression of IL-6 depends on NFAT activity. These results support the view that high NFAT activity is necessary for TNF-alpha and IL-13 promoter induction in MC, irrespective of whether NFATc2 or NFATc1 or a combination of both is present.
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Gogishvili T, Hahn C, Meinhard J, Hohaus A, Erb K, Sebald W, Bröcker EB, Grunewald SM. Inhibition of IL-4/IL-13 does not enhance the efficacy of allergen immunotherapy in murine allergic airway inflammation. Int Arch Allergy Immunol 2006; 142:165-74. [PMID: 17077644 DOI: 10.1159/000096610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 06/27/2006] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Successful allergen-specific immunotherapy (SIT) is associated with reduced Th2 cytokine production and the induction of IL-10-producing regulatory T cells. To improve treatment efficacy, we investigated the impact of an IL-4/IL-13 inhibitor during SIT. METHODS BALB/c mice were sensitized intranasally with ovalbumin (OVA) for 4 weeks. Subsequently, they were subjected to intranasal SIT, with OVA being administered at doses increasing from 1 mug to 1 mg over 3 weeks with or without an IL-4/IL-13 inhibitor. Serum OVA-specific antibodies were measured and bronchoalveolar lavage (BAL) fluids were checked for airway eosinophilia. Subsequently, lung tissue was examined histologically for inflammatory infiltrates. Cytokines were detected in BAL fluids and spleen cell cultures. Furthermore, CD4 CD25 double-positive spleen T cells were checked for intracellular IL-10 production by flow cytometry. RESULTS OVA sensitization resulted in persistent IgE synthesis and an eosinophil-rich allergic airway inflammation combined with increased IL-4 and IL-5 levels. Therefore, intranasal SIT could efficiently reverse the allergic phenotype. This was associated with decreased IL-4 and IL-5 levels, and increased IL-10 levels in BAL fluids as well as increased amounts of IL-10-producing CD25+ regulatory T cells. However, mice treated with the IL-4/IL-13 inhibitor during SIT did not produce significantly different results . CONCLUSION The use of an IL-4/IL-13 inhibitor as an adjuvant for SIT did not enhance anti-allergic effects. Thus, the observed reversal of Th2 responses during SIT may not be the keystone for successful therapy, but rather other factors, e.g. IL-10-producing regulatory T cells, may be crucial.
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Affiliation(s)
- Tea Gogishvili
- Department of Dermatology, University of Wurzburg, Wurzburg, Germany
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Kasaian MT, Donaldson DD, Tchistiakova L, Marquette K, Tan XY, Ahmed A, Jacobson BA, Widom A, Cook TA, Xu X, Barry AB, Goldman SJ, Abraham WM. Efficacy of IL-13 neutralization in a sheep model of experimental asthma. Am J Respir Cell Mol Biol 2006; 36:368-76. [PMID: 17023688 DOI: 10.1165/rcmb.2006-0244oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IL-13 contributes to airway hyperresponsiveness, mucus secretion, inflammation, and fibrosis, suggesting that it plays a central role in asthma pathogenesis. Neutralization of IL-13 with sIL-13Ralpha2-Fc (sIL-13R) reduces allergen-induced airway responses in rodent models of respiratory disease, but its efficacy in a large animal model has not been previously reported. In this study, we determined whether two different strategies for IL-13 neutralization modified experimental asthma in sheep. Sheep with natural airway hypersensitivity to Ascaris suum antigen were treated intravenously either with sIL-13R, a strong antagonist of sheep IL-13 bioactivity in vitro, or with IMA-638 (IgG1, kappa), a humanized antibody to human IL-13. Higher doses of IMA-638 were used because, although it is a potent antagonist of human IL-13, this antibody has 20 to 30 times lower binding and neutralization activity against sheep IL-13. Control animals received human IgG of irrelevant specificity. Sheep were treated 24 h before inhalation challenge with nebulized A. suum. The effects on antigen-induced early and late bronchial responses, and antigen-induced hyperresponsiveness, were assessed. Both sIL-13R and IMA-638 provided dose-dependent inhibition of the antigen-induced late responses and airway hyperresponsiveness. The highest dose of IMA-638 also reduced the early phase response. These findings suggest that IL-13 contributes to allergen-induced airway responses in this sheep model of asthma, and that neutralization of IL-13 is an effective strategy for blocking these A. suum-induced effects.
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Affiliation(s)
- Marion T Kasaian
- Department of Inflammation, Wyeth Research, 200 CambridgePark Drive, Cambridge, MA 02140, USA.
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Perkins C, Wills-Karp M, Finkelman FD. IL-4 induces IL-13-independent allergic airway inflammation. J Allergy Clin Immunol 2006; 118:410-9. [PMID: 16890766 DOI: 10.1016/j.jaci.2006.06.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 05/31/2006] [Accepted: 06/06/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The related T(H)2 cytokines IL-4 and IL-13 are produced during allergic responses, signal through receptors that contain IL-4 receptor (IL-4R) alpha, and promote allergic inflammation by activating signal transducer and activator of transcription 6. IL-4 promotes T(H)2 response induction, and IL-13 is necessary and sufficient to induce airways hyperresponsiveness (AHR) and goblet cell hyperplasia in some mouse models of asthma. The nonredundant role of IL-13 could reflect unique IL-13 activation of a signaling pathway, inhibitory effects induced by IL-4 but not IL-13, or greater production-potency of IL-13 than IL-4. OBJECTIVES We sought to distinguish among these possibilities by determining whether IL-4 inhalation can induce acute allergic airways disease in the absence of IL-13. METHODS Mice were inoculated intratracheally with IL-13 or a long-acting formulation of IL-4. Responses of IL-13-deficient and IL-13-sufficient mice were compared, as were responses in mice treated with a potent IL-13 antagonist, anti-IL-4Ralpha antibody, or control reagents. RESULTS IL-4 inhalation stimulated bronchoalveolar lavage fluid eosinophilia, AHR, and goblet cell hyperplasia. These responses were similar in IL-13-deficient and IL-13-sufficient mice and were not inhibited by an IL-13 antagonist but were blocked by anti-IL-4Ralpha antibody. CONCLUSION IL-4 can induce IL-13-independent AHR and goblet cell hyperplasia. Thus the greater role for IL-13 than IL-4 in the induction of these acute allergy-related changes reflects increased production, potency, or both of IL-13 relative to IL-4 rather than a unique IL-13-signaling pathway or a suppressive effect of IL-4. CLINICAL IMPLICATIONS Dual IL-4/IL-13 inhibition might be more effective than selective IL-13 inhibition at suppressing allergic inflammation in some circumstances.
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Affiliation(s)
- Charles Perkins
- Division of Immunology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA
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