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Libon F, Caron J, Nikkels AF. Biomarkers in Atopic Dermatitis. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01193-1. [PMID: 38874894 DOI: 10.1007/s13555-024-01193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin condition. The pathogenesis involves genetic, environmental, and immunological factors as well as a barrier dysfunction of the epidermis. Biomarkers may play a significant role in diagnosis, severity assessment, and treatment monitoring of AD. They are categorizable into diagnostic and prognostic as well as severity and stratification biomarkers, offering the potential for a more personalized treatment approach. Although there have been tremendous therapeutic advancements with interleukin (IL) antagonists and Janus kinase (JAK) inhibitors, the domain of biomarkers still requires further research to clarify their place in the diagnosis and prognosis of AD to unravel a better scientific basis for personalized medical care for patients with AD. This article reviews the various biomarkers in relation to the different AD phenotypes and endotypes.
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Affiliation(s)
- Florence Libon
- Unit of Dermato-Allergology, Department of Dermatology and Venerology, University Hospital of Liège-Liège, CHU of Sart Tilman, University of Liège, 4000, Liège, Belgium
| | - Juliette Caron
- Allergology and Therapeutic Education Service, Saint Vincent-de-Paul Hospital, Lille Cedex, France
| | - Arjen F Nikkels
- Unit of Dermato-Allergology, Department of Dermatology and Venerology, University Hospital of Liège-Liège, CHU of Sart Tilman, University of Liège, 4000, Liège, Belgium.
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LaFon DC, Woo H, Fedarko N, Azar A, Hill H, Tebo AE, Martins TB, Han MK, Krishnan JA, Ortega VE, Barjaktarevic I, Kaner RJ, Hastie A, O'Neal WK, Couper D, Woodruff PG, Curtis JL, Hansel NN, Nahm MH, Dransfield MT, Putcha N. Reduced quantity and function of pneumococcal antibodies are associated with exacerbations of COPD in SPIROMICS. Clin Immunol 2023; 250:109324. [PMID: 37030524 PMCID: PMC10171244 DOI: 10.1016/j.clim.2023.109324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 04/10/2023]
Abstract
While hypogammaglobulinemia is associated with COPD exacerbations, it is unknown whether frequent exacerbators have specific defects in antibody production/function. We hypothesized that reduced quantity/function of serum pneumococcal antibodies correlate with exacerbation risk in the SPIROMICS cohort. We measured total pneumococcal IgG in n = 764 previously vaccinated participants with COPD. In a propensity-matched subset of n = 200 with vaccination within five years (n = 50 without exacerbations in the previous year; n = 75 with one, n = 75 with ≥2), we measured pneumococcal IgG for 23 individual serotypes, and pneumococcal antibody function for 4 serotypes. Higher total pneumococcal IgG, serotype-specific IgG (17/23 serotypes), and antibody function (3/4 serotypes) were independently associated with fewer prior exacerbations. Higher pneumococcal IgG (5/23 serotypes) predicted lower exacerbation risk in the following year. Pneumococcal antibodies are inversely associated with exacerbations, supporting the presence of immune defects in frequent exacerbators. With further study, pneumococcal antibodies may be useful biomarkers for immune dysfunction in COPD.
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Affiliation(s)
- David C LaFon
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States; UAB Lung Health Center, Birmingham, AL, United States.
| | - Han Woo
- Johns Hopkins University, Baltimore, MD, United States
| | - Neal Fedarko
- Johns Hopkins University, Baltimore, MD, United States
| | - Antoine Azar
- Johns Hopkins University, Baltimore, MD, United States
| | - Harry Hill
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, United States
| | - Anne E Tebo
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Thomas B Martins
- Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, UT, United States
| | - MeiLan K Han
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Igor Barjaktarevic
- Pulmonary and Critical Care, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Annette Hastie
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Wanda K O'Neal
- Marisco Lung Institute, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - David Couper
- University of North Carolina Department of Biostatistics, Chapel Hill, NC, United States
| | | | - Jeffrey L Curtis
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States; VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | | | - Moon H Nahm
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States; Department of Microbiology, University of Alabama at Birmingham, United States
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States; UAB Lung Health Center, Birmingham, AL, United States; Birmingham VA Medical Center, Birmingham, AL, United States
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Lawrence MG, Borish L. Specific antibody deficiency: Pearls and pitfalls for diagnosis. Ann Allergy Asthma Immunol 2022; 129:572-578. [PMID: 35671934 DOI: 10.1016/j.anai.2022.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Specific antibody deficiency is an immune deficiency defined by the presence of normal quantitative levels of immunoglobulins but impaired antibody responses to polysaccharide antigens in patients presenting with frequent otosinopulmonary infections with pyogenic bacteria. This review summarizes the pitfalls associated with defining exactly what constitutes an "impaired" antibody response to polysaccharide antigens and the importance of documenting actual pyogenic infections before making a diagnosis of an immune deficiency. DATA SOURCES PubMed review using the following words: specific antibody deficiency, pneumococcal vaccination, salmonella vaccination, infectious sinusitis Study Selection: This review focused on key studies that have been utilized to define what constitutes a "normal" humoral immune response to pneumococcal and salmonella vaccination in healthy subjects as well as published papers defining current expert opinion. RESULTS Published studies demonstrate wide variability in response to pneumococcal vaccination in healthy individuals making it daunting to define what constitutes an abnormal response. These challenges are exacerbated by striking laboratory variability in reporting results. CONCLUSION Clinical evaluations in individuals with self-reported recurrent acute sinusitis or lower respiratory infections need to document an infectious etiology with pyogenic bacteria and must rule out an underlying primary airway inflammatory disorder before consideration is made regarding the presence of an immune deficiency. In addition, decision making regarding diagnosis and treatment of patients being evaluated for humoral immunodeficiency should not hinge solely on the strict application of defined cutoffs for "normal" response to a single polysaccharide vaccine, but rather a global assessment of humoral immune function in the context of the clinical presentation.
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Affiliation(s)
- Monica G Lawrence
- Department of Medicine - University of Virginia, Charlottesville, Virginia; Department of Pediatrics - University of Virginia, Charlottesville, Virginia.
| | - Larry Borish
- Department of Medicine - University of Virginia, Charlottesville, Virginia; Department of Microbiology - University of Virginia, Charlottesville, Virginia
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Hansen AT, Söderström A, Jørgensen CS, Larsen CS, Petersen MS, Bernth Jensen JM. Diagnostic Vaccination in Clinical Practice. Front Immunol 2021; 12:717873. [PMID: 34659207 PMCID: PMC8514775 DOI: 10.3389/fimmu.2021.717873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/13/2021] [Indexed: 12/01/2022] Open
Abstract
Testing the antibody response to vaccination (diagnostic vaccination) is crucial in the clinical evaluation of primary immunodeficiency diseases. Guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI) provide detailed recommendations for diagnostic vaccination with pure pneumococcal polysaccharide vaccines (PPV). However, the degree of compliance with these guidelines and the utility of the guidelines in actual practice are undescribed. To address this, we systematically evaluated diagnostic vaccination in adult patients with suspected primary immunodeficiency diseases in a single tertiary center from 2011 to 2016 (n = 229). We found that full compliance with the AAAAI guidelines was achieved for only 39 patients (17%), suggesting that the guidelines are not easy to follow. Worse, interpretation according to the guidelines was heavily influenced by which serotype-specific antibodies that were used for the evaluation. We found that the arbitrary choices of serotype-specific antibodies could change the fraction of patients deemed to have ‘adequate immunity’ by a factor of four, exposing an inherent flaw in the guidelines. The flaw relates to dichotomous principles for data interpretation under the AAAAI guidelines. We therefore propose a revised protocol for diagnostic vaccination limited to PPV vaccination, subsequent antibody measurements, and data interpretation using Z-scores. The Z-score compiles multiple individual antibody levels, adjusted for different weighting, into one single continuous variable for each patient. In contrast to interpretation according to the AAAAI guidelines, the Z-scores were robust to variations in the choice of serotype-specific antibodies used for interpretation. Moreover, Z-scores revealed reduced immunity after vaccination in the patients with recurrent pneumonia (a typical symptom of antibody deficiency) compared with control patients. Assessment according to the AAAAI guidelines failed to detect this difference. We conclude that our simplified protocol and interpretation with Z-scores provides more robust clinical results and may enhance the value of diagnostic vaccination.
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Affiliation(s)
- Anette Tarp Hansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Söderström
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
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Sterrett S, Peng BJ, Burton RL, LaFon DC, Westfall AO, Singh S, Pride M, Anderson AS, Ippolito GC, Schroeder HW, Nahm MH, Krishna Prasad A, Goepfert P, Bansal A. Peripheral CD4 T follicular cells induced by a conjugated pneumococcal vaccine correlate with enhanced opsonophagocytic antibody responses in younger individuals. Vaccine 2020; 38:1778-1786. [PMID: 31911030 DOI: 10.1016/j.vaccine.2019.12.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/06/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND PCV13 (conjugated polysaccharide) and PPSV23 (polysaccharide only) are two licensed vaccines targeting S. pneumoniae. The role of CD4 T-cell responses in pneumococcal vaccines among healthy participants and their impact on antibodies is not yet known. METHODS Ten adults (5 old and 5 young) received PCV13 (prime) and a year later PPSV23 (boost). Blood samples were collected prior to and multiple time points after vaccination. CD4 T cells responding to CRM197, polysaccharide (PS), CRM197 conjugated polysaccharide (CPS), PCV13 and PPSV23 vaccines were measured by flow cytometry. Serum antibodies were analyzed via multiplex opsonophagocytosis (MOPA) and pneumococcal IgG assays. RESULTS Vaccine-specific CD4 T cells were induced in all ten vaccinees post PCV13. Older vaccinees mounted higher peak responses and those specific for PCV13 and conjugated PS-1 were more polyfunctional compared to the younger group. Vaccine-elicited peripheral T follicular helper (Tfh) cells were only detected in the younger group who also exhibited a higher fold change in OPA titers post both vaccines. Importantly, Tfh cells following PCV13 correlated only with PCV13 serotype specific OPA titers after PPSV23 vaccination. CONCLUSIONS These findings demonstrate age related differences in immune response and the potential importance of Tfh in modulating functional antibody responses following pneumococcal vaccination.
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Affiliation(s)
- Sarah Sterrett
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States
| | - Binghao J Peng
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States
| | - Robert L Burton
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States
| | - David C LaFon
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States
| | - Andrew O Westfall
- University of Alabama at Birmingham, Department of Biostatistics Birmingham, Birmingham, AL, United States
| | - Suddham Singh
- Pfizer Vaccine Research & Development, Pearl River, New York, United States
| | - Michael Pride
- Pfizer Vaccine Research & Development, Pearl River, New York, United States
| | | | | | - Harry W Schroeder
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States; University of Alabama at Birmingham, Department of Microbiology Birmingham, Birmingham, AL, United States
| | - Moon H Nahm
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States; University of Alabama at Birmingham, Department of Microbiology Birmingham, Birmingham, AL, United States
| | - A Krishna Prasad
- Pfizer Vaccine Research & Development, Pearl River, New York, United States
| | - Paul Goepfert
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States; University of Alabama at Birmingham, Department of Microbiology Birmingham, Birmingham, AL, United States.
| | - Anju Bansal
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States.
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Marsh RA, Orange JS. Antibody deficiency testing for primary immunodeficiency: A practical review for the clinician. Ann Allergy Asthma Immunol 2019; 123:444-453. [PMID: 31446132 DOI: 10.1016/j.anai.2019.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/14/2019] [Accepted: 08/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review selected published studies related to the diagnostic evaluation of antibody deficiency. DATA SOURCES Published literature. STUDY SELECTIONS Studies related to the diagnostic evaluation of antibody deficiency and existing recommendations were selected. RESULTS Many primary immunodeficiency diseases include humoral deficiency. Practical tests used in the clinical evaluation of patients for possible antibody deficiency include immunoglobulin measurement, specific antibody titers, and B-cell enumeration and phenotyping. CONCLUSION Clinically available tests can be used to readily evaluate patients for antibody deficiencies.
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Affiliation(s)
- Rebecca A Marsh
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jordan S Orange
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
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Schroeder HW. The Many Gaps in Our Knowledge of the Etiology, Pathogenesis, Complications, and Prognosis of Hypogammaglobulinemia and Common Variable Immune Deficiency. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:1285-1286. [PMID: 30961841 DOI: 10.1016/j.jaip.2019.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Harry W Schroeder
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Ala.
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