1
|
Ollech A, Lefferdink R, Sheth A, Blumstein A, Ramachandran D, Wagner A, Kenner-Bell B, Mancini AJ, Chamlin S, Kruse LL, Rangel SM, Paller AS. Systemic immunosuppressive therapies for children with refractory atopic dermatitis: a large real-life cohort study. Br J Dermatol 2023; 189:492-494. [PMID: 37405446 DOI: 10.1093/bjd/ljad222] [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: 05/10/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/06/2023]
Abstract
Systemic immunosuppressants are used off-label to treat paediatric patients with moderate-to severe atopic dermatitis (AD) for whom topical treatment has failed. A large real-life cohort of paediatric patients with AD treated with systemic immunosuppressive treatments is described in order to guide dermatologists’ prescribing practices when faced with a moderate to-severe AD paediatric patient who has failed or has a contraindication to topical treatment, phototherapy, biological agents or Janus kinase inhibitors.
Collapse
Affiliation(s)
- Ayelet Ollech
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Dermatology, Sheba Medical Center Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | - Anette Wagner
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Departments of Dermatology
- Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Brandi Kenner-Bell
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Departments of Dermatology
- Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Anthony J Mancini
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Departments of Dermatology
- Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah Chamlin
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Departments of Dermatology
- Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Lacey L Kruse
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Departments of Dermatology
- Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | - Amy S Paller
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Departments of Dermatology
- Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
2
|
Del Duca E, Renert-Yuval Y, Pavel AB, Mikhaylov D, Wu J, Lefferdink R, Fang M, Sheth A, Blumstein A, Facheris P, Estrada YD, Rangel SM, Krueger JG, Paller AS, Guttman-Yassky E. Proteomic characterization of atopic dermatitis blood from infancy to adulthood. J Am Acad Dermatol 2023; 88:1083-1093. [PMID: 36773824 PMCID: PMC10231669 DOI: 10.1016/j.jaad.2022.12.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 01/13/2022] [Revised: 10/10/2022] [Accepted: 12/11/2022] [Indexed: 02/12/2023]
Abstract
BACKGROUND Patients with atopic dermatitis (AD) have systemic biomarker dysregulation that differs by age group; however, the proteomic characteristics of these age-based changes are unknown. OBJECTIVE To profile blood proteins of patients with AD across different age groups versus age-appropriate controls. METHODS Using the Olink high-throughput proteomic platform, we profiled 375 serum proteins of 20 infants (age, 0-5 years), 39 children (age, 6-11 years), 21 adolescents (age, 12-17 years), and 20 adults (age, ≥18 years) with moderate-to-severe AD and 83 age-appropriate controls. RESULTS Each group presented a distinct systemic proteomic signature. Th2-related proteins were increased in infant AD and further intensified with age through adolescence and adulthood (interleukin 4/CCL13/CCL17). In contrast, Th1 axis down-regulation was detected in infants with AD and gradually reversed to increased Th1 products (interferon γ/CXCL9/CXCL10/CCL2) in patients with AD from childhood to adulthood. Despite their short disease duration, infants already had evidence of systemic inflammation, with significant upregulation of innate immunity (interleukin 17C/ interleukin-1RN), T-cell activation/migration (CCL19), Th2 (CCL13/CCL17), and Th17 (PI3) proteins. Adults with AD present unique upregulation of cardiovascular proteins related to coagulation and diabetes. LIMITATIONS Cross-sectional observational study with a single time point. CONCLUSION Systemic immune signatures of AD are age-specific beyond the shared Th2 immune activation. These data advocate for precision medicine approaches based on age-specific AD profiles.
Collapse
Affiliation(s)
- Ester Del Duca
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York; Department of Dermatology, University of Magna Graecia, Catanzaro, Italy
| | - Yael Renert-Yuval
- Laboratory for Investigative Dermatology, the Rockefeller University, New York, New York
| | - Ana B Pavel
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York; Department of Biomedical Engineering, University of Mississippi, University, Mississippi
| | - Daniela Mikhaylov
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Jianni Wu
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Rachel Lefferdink
- Department of Dermatology and Paediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Milie Fang
- Department of Dermatology and Paediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anjani Sheth
- Department of Dermatology and Paediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alli Blumstein
- Department of Dermatology and Paediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paola Facheris
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York; Department of Biomedical Science, Humanitas University, Pieve Emanuele, Italy
| | - Yeriel D Estrada
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York
| | - Stephanie M Rangel
- Department of Dermatology and Paediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James G Krueger
- Laboratory for Investigative Dermatology, the Rockefeller University, New York, New York
| | - Amy S Paller
- Department of Dermatology and Paediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Emma Guttman-Yassky
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York; Laboratory for Investigative Dermatology, the Rockefeller University, New York, New York.
| |
Collapse
|
3
|
Lefferdink R, Rangel SM, Chima M, Ibler E, Pavel AB, Kim H, Wu B, Abu-Zayed H, Wu J, Jackson K, Singer G, Choate KA, Guttman-Yassky E, Paller AS. Secukinumab responses vary across the spectrum of congenital ichthyosis in adults. Arch Dermatol Res 2023; 315:305-315. [PMID: 35218370 PMCID: PMC10234080 DOI: 10.1007/s00403-022-02325-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/08/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 01/18/2023]
Abstract
IMPORTANCE Treatment of congenital ichthyoses primarily focuses on reversing skin scaling and is not pathogenesis based. Recent studies showed Th17 immune skewing, as in psoriasis, across the spectrum of ichthyosis, suggesting that targeting this pathway might broadly reduce disease severity. OBJECTIVE To determine whether secukinumab, an IL-17A inhibitor, can improve ichthyosis across several congenital ichthyosis subtypes. DESIGN Exploratory 16-week double-blind, randomized, placebo-controlled trial comparing secukinumab 300 mg every 4wks to placebo (1:1 randomization) in adults with the four major congenital ichthyosis subtypes (NCT03041038), followed by a 16-week open-label phase to evaluate response of the placebo-first group and a 20-week extension for safety. Significant differences in secukinumab- vs. placebo-treated subjects at Wk16 in the Ichthyosis Area Severity Index (IASI) score and lack of increased mucocutaneous bacterial and/or fungal infections were the co-primary efficacy and safety endpoints, respectively. SETTING Two tertiary referral centers: Northwestern University Feinberg School of Medicine, Chicago, and Mount Sinai Icahn School of Medicine, New York. PARTICIPANTS Twenty subjects ≥ 18 yo with genotype-confirmed epidermolytic ichthyosis, Netherton syndrome, lamellar ichthyosis, or congenital ichthyosiform erythroderma with at least moderate erythroderma. RESULTS IL-17A inhibition did not significantly reduce severity or increase mucocutaneous infections among the 18 who completed the 16-week double-blind phase. Five patients with 29-50% clinical improvement at Wk32 requested drug continuation. Th17-related biomarkers were not significantly reduced vs. baseline or placebo-treated levels. LIMITATIONS Small sample size; heterogeneous ichthyosis subsets. CONCLUSION IL-17 inhibition with secukinumab is safe, but not efficacious across the spectrum of adult ichthyoses. CLINICALTRIALS GOV REGISTRATION NUMBER NCT03041038; first posted on 02/02/2017.
Collapse
Affiliation(s)
- Rachel Lefferdink
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie M Rangel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Margot Chima
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Erin Ibler
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ana B Pavel
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
- Department of Biomedical Engineering, University of Mississippi, University, Oxford, MS, USA
| | - HeeJin Kim
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Benedict Wu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hajar Abu-Zayed
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jianni Wu
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Kathryn Jackson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Giselle Singer
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Keith A Choate
- Departments of Dermatology, Genetics, and Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, The Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA.
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
4
|
Rangu S, Collins J, García-Romero MT, Augsburger BD, Bruckner AL, Diaz LZ, Eichenfield LF, Faig W, Gorell ES, Lefferdink R, Lucky AW, Morel KD, Paller AS, Park H, Pastrana-Arellano E, Peoples K, Wiss K, Perman MJ, Castelo-Soccio L. Assessing pain catastrophizing and functional disability in pediatric epidermolysis bullosa patients. Pediatr Dermatol 2022; 40:422-427. [PMID: 36579717 DOI: 10.1111/pde.15220] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES The primary objective was to assess pain catastrophizing and functional disability in pediatric patients with epidermolysis bullosa (EB) and their parents/guardians. Secondary objectives included examining relationships between pain catastrophizing, functional disability, and correlations with other factors (e.g., age, disease severity, and percent of body surface area (BSA) involved). METHODS Patients with EB ages 8-16 and their parents/guardians who were English or Spanish speaking completed a one-time online survey. Parent measures included: demographics questionnaire, Pain Catastrophizing Scale-Parent (PCS), and Parent Functional Disability Inventory (FDI). Child measures included: PCS child and child FDI. Higher scores on both scales indicate higher levels of catastrophizing and functional disability. RESULTS Of 31 children, the mean age was 11.47 years and the majority (70.97%) had dystrophic EB. Mean scores were: 35.84 = PCS parent; 34.58 = PCS child; 30.87 = parent FDI; 29.77 = child FDI. Total scores for PCS parent, parent FDI, and child FDI increased significantly with disease severity and percentage of involved BSA (p < .01 for all). Total scores for PCS child increased significantly with percent of EB skin involvement (p = .04) but not disease severity. Older children reported more functional disability than their parents and younger children (p = .02). CONCLUSIONS Our results demonstrate significant positive correlations between negative thoughts related to pain and the experience of functional difficulties in patients with EB and their caregivers. Psychological, psychiatric, and/or behavioral interventions to help managing chronic pain may be effective for patients with EB.
Collapse
Affiliation(s)
- Sneha Rangu
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jessica Collins
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Bret D Augsburger
- Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anna L Bruckner
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lucia Z Diaz
- Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California San Diego, San Diego, California, USA.,Department Pediatrics, University of California San Diego, San Diego, California, USA.,Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Walter Faig
- Children's Hospital of Philadelphia, Research Institute, Philadelphia, Pennsylvania, USA
| | - Emily S Gorell
- Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Rachel Lefferdink
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anne W Lucky
- Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kimberly D Morel
- Department of Dermatology, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York, USA.,Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Amy S Paller
- Children's Hospital of Philadelphia, Research Institute, Philadelphia, Pennsylvania, USA
| | - Helen Park
- Department Pediatrics, University of California San Diego, San Diego, California, USA
| | | | - Kathleen Peoples
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marissa J Perman
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Leslie Castelo-Soccio
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
5
|
Tham KC, Lefferdink R, Duan K, Lim SS, Wong XFCC, Ibler E, Wu B, Abu-Zayed H, Rangel SM, Del Duca E, Chowdhury M, Chima M, Kim HJ, Lee B, Guttman-Yassky E, Paller AS, Common JEA. Distinct skin microbiome community structures in congenital ichthyosis. Br J Dermatol 2022; 187:557-570. [PMID: 35633118 PMCID: PMC10234690 DOI: 10.1111/bjd.21687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/28/2022] [Accepted: 05/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ichthyoses are rare genetic keratinizing disorders that share the characteristics of an impaired epidermal barrier and increased risk of microbial infections. Although ichthyotic diseases share a T helper (Th) 17 cell immune signature, including increased expression of antimicrobial peptides, the skin microbiota of ichthyoses is virtually unexplored. OBJECTIVES To analyse the metagenome profile of skin microbiome for major congenital ichthyosis subtypes. METHODS Body site-matched skin surface samples were collected from the scalp, upper arm and upper buttocks of 16 healthy control participants and 22 adult patients with congenital forms of ichthyosis for whole metagenomics sequencing analysis. RESULTS Taxonomic profiling showed significant shifts in bacteria and fungi abundance and sporadic viral increases across ichthyosis subtypes. Cutibacterium acnes and Malassezia were significantly reduced across body sites, consistent with skin barrier disruption and depletion of lipids. Microbial richness was reduced, with specific increases in Staphylococcus and Corynebacterium genera, as well as shifts in fungal species, including Malassezia. Malassezia globosa was reduced at all body sites, whereas M. sympodialis was reduced in the ichthyotic upper arm and upper buttocks. Malassezia slooffiae, by contrast, was strikingly increased at all body sites in participants with congenital ichthyosiform erythroderma (CIE) and lamellar ichthyosis (LI). A previously undescribed Trichophyton species was also detected as sporadically colonizing the skin of patients with CIE, LI and epidermolytic ichthyosis subtypes. CONCLUSIONS The ichthyosis skin microbiome is significantly altered from healthy skin with specific changes predominating among ichthyosis subtypes. Skewing towards the Th17 pathway may represent a response to the altered microbial colonization in ichthyosis. What is already known about this topic? The skin microbiome of congenital ichthyoses is largely unexplored. Microbes play an important role in pathogenesis, as infections are common. The relative abundances of staphylococci and corynebacteria is increased in the cutaneous microbiome of patients with Netherton syndrome, but extension of these abundances to all congenital ichthyoses is unexplored. What does this study add? A common skin microbiome signature was observed across congenital ichthyoses. Distinct microbiome features were associated with ichthyosis subtypes. Changes in microbiome may contribute to T helper 17 cell immune polarization. What is the translational message? These data provide the basis for comparison of the microbiome with lipidomic and transcriptomic alterations in these forms of ichthyosis and consideration of correcting the dysbiosis as a therapeutic intervention.
Collapse
Affiliation(s)
- Khek-Chian Tham
- A*STAR Skin Research Labs, Agency for Science, Technology and Research, 8A Biomedical Grove, #06-10 Immunos, Singapore, 138648, Singapore
| | - Rachel Lefferdink
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kaibo Duan
- Singapore Immunology Network, Agency for Science, Technology and Research, 8A Biomedical Grove, #03 Immunos, Singapore, 138648, Singapore
| | - Seong Soo Lim
- A*STAR Skin Research Labs, Agency for Science, Technology and Research, 8A Biomedical Grove, #06-10 Immunos, Singapore, 138648, Singapore
| | - X F Colin C Wong
- A*STAR Skin Research Labs, Agency for Science, Technology and Research, 8A Biomedical Grove, #06-10 Immunos, Singapore, 138648, Singapore
| | - Erin Ibler
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Benedict Wu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hajar Abu-Zayed
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Mashkura Chowdhury
- Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Margot Chima
- Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Hee Jee Kim
- Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology and Research, 8A Biomedical Grove, #03 Immunos, Singapore, 138648, Singapore
| | | | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John E A Common
- A*STAR Skin Research Labs, Agency for Science, Technology and Research, 8A Biomedical Grove, #06-10 Immunos, Singapore, 138648, Singapore
| |
Collapse
|
6
|
Guttman-Yassky E, Diaz A, Pavel AB, Fernandes M, Lefferdink R, Erickson T, Canter T, Rangel S, Peng X, Li R, Estrada Y, Xu H, Krueger JG, Paller AS. Use of Tape Strips to Detect Immune and Barrier Abnormalities in the Skin of Children With Early-Onset Atopic Dermatitis. JAMA Dermatol 2021; 155:1358-1370. [PMID: 31596431 DOI: 10.1001/jamadermatol.2019.2983] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Molecular profiling of skin biopsies is the criterion standard for evaluating the cutaneous atopic dermatitis (AD) phenotype. However, skin biopsies are not always feasible in children. A reproducible minimally invasive approach that can track cutaneous disease in pediatric longitudinal studies or clinical trials is lacking. Objective To assess a minimally invasive approach using tape strips to identify skin biomarkers that may serve as a surrogate to biomarkers identified using whole-tissue biopsies. Design, Setting, and Participants This cross-sectional study of 51 children younger than 5 years recruited children with moderate to severe AD and children without AD from the dermatology outpatient clinics at a children's hospital. Sixteen tape strips were serially collected from the nonlesional and lesional skin of 21 children who had AD and were less than 6 months from disease initiation and from the normal skin of 30 children who did not have AD between January 22, 2016, and April 20, 2018. Main Outcomes and Measures Gene and protein expression were evaluated using quantitative real-time polymerase chain reaction and immunohistochemistry. Results A total of 51 children younger than 5 years were included in the study; 21 children had moderate to severe AD with less than 6 months of disease duration, and 30 children did not have AD. Of the 21 children with AD, the mean (SD) age was 1.7 (1.7) years, and most were male (15 [71.4%] and white (15 [71.4%]). Of the 30 children without AD, the mean (SD) age was 1.8 (2.0) years, and most were female (20 [66.7%]) and white (22 [73.3%]). Seventy-seven of 79 evaluated immune and barrier gene products were detected (gene detection rate, 97%) in 70 of 71 tape strips (sample detection rate, 99%), with 53 of 79 markers differentiating between children with lesional and/or nonlesional AD from children without AD. Many cellular markers of T cells (CD3), AD-related dendritic cells (Fc ε RI and OX40 ligand receptors), and key inflammatory (matrix metallopeptidase 12), innate (interleukin 8 [IL-8] and IL-6), helper T cell 2 (TH2; IL-4, IL-13, and chemokines CCL17 and CCL26), and TH17/TH22 (IL-19, IL-36G, and S100A proteins) genes were significantly increased in lesional and nonlesional AD compared with tape strips from normal skin. For example, IL-4 mean (SE) for lesional was -15.2 (0.91) and normal was -19.5 (0.48); P < .001. Parallel decreases occurred in epidermal barrier gene products (FLG, CLDN23, and FA2H) and negative immune regulators (IL-34 and IL-37). For example, the decrease for FLG lesional was mean (SE) -2.9 (0.42) and for normal was 2.2 (0.45); P < .001. Associations were found between disease severity or transepidermal water loss and TH2 (IL-33 and IL-4R) and TH17/TH22 (IL-36G and S100As) products in lesional and nonlesional AD skin (evaluated using the SCORing Atopic Dermatitis, Eczema Area and Severity Index, and Pruritus Atopic Dermatitis Quickscore tools). Conclusions and Relevance In this study, tape strips provide a minimally invasive alternative for serially evaluating AD-associated cutaneous biomarkers and may prove useful for tracking pediatric AD therapeutic response and predicting future course and comorbidities.
Collapse
Affiliation(s)
- Emma Guttman-Yassky
- Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Aisleen Diaz
- Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York.,School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Ana B Pavel
- Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Marie Fernandes
- Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Rachel Lefferdink
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Taylor Erickson
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Talia Canter
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephanie Rangel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Xiangyu Peng
- Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Randall Li
- Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Yeriel Estrada
- Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - Hui Xu
- Department of Dermatology and Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
7
|
Renert-Yuval Y, Del Duca E, Pavel AB, Fang M, Lefferdink R, Wu J, Diaz A, Estrada YD, Canter T, Zhang N, Wagner A, Chamlin S, Krueger JG, Guttman-Yassky E, Paller AS. The molecular features of normal and atopic dermatitis skin in infants, children, adolescents, and adults. J Allergy Clin Immunol 2021; 148:148-163. [PMID: 33453290 DOI: 10.1016/j.jaci.2021.01.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/01/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although atopic dermatitis (AD) often presents in infancy and persists into adulthood, comparative characterization of AD skin among different pediatric age groups is lacking. OBJECTIVE We sought to define skin biopsy profiles of lesional and nonlesional AD across different age groups (0-5-year-old infants with disease duration <6 months, 6-11-year-old children, 12-17-year-old adolescents, ≥18-year-old adults) versus age-appropriate controls. METHODS We performed gene expression analyses by RNA-sequencing and real-time PCR (RT-PCR) and protein expression analysis using immunohistochemistry. RESULTS TH2/TH22 skewing, including IL-13, CCL17/thymus and activation-regulated chemokine, IL-22, and S100As, characterized the common AD signature, with a global pathway-level enrichment across all ages. Nevertheless, specific cytokines varied widely. For example, IL-33, IL-1RL1/IL-33R, and IL-9, often associated with early atopic sensitization, showed greatest upregulations in infants. TH17 inflammation presented a 2-peak curve, with highest increases in infants (including IL-17A and IL-17F), followed by adults. TH1 polarization was uniquely detected in adults, even when compared with adolescents, with significant upregulation in adults of IFN-γ and CXCL9/CXCL10/CXCL11. Although all AD age groups had barrier abnormalities, only adults had significant decreases in filaggrin expression. Despite the short duration of the disease, infant AD presented robust downregulations of multiple barrier-related genes in both lesional and nonlesional skin. Clinical severity scores significantly correlated with TH2/TH22-related markers in all pediatric age groups. CONCLUSIONS The shared signature of AD across ages is TH2/TH22-skewed, yet differential expression of specific TH2/TH22-related genes, other TH pathways, and barrier-related genes portray heterogenetic, age-specific molecular fingerprints.
Collapse
Affiliation(s)
- Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY; Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ester Del Duca
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | - Ana B Pavel
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biomedical Engineering, University of Mississippi, Oxford, Miss
| | - Milie Fang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Rachel Lefferdink
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jianni Wu
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aisleen Diaz
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeriel D Estrada
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Talia Canter
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ning Zhang
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annette Wagner
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Sarah Chamlin
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Emma Guttman-Yassky
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY; Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| |
Collapse
|
8
|
Pavel AB, Renert‐Yuval Y, Wu J, Del Duca E, Diaz A, Lefferdink R, Fang MM, Canter T, Rangel SM, Zhang N, Krueger JG, Paller AS, Guttman‐Yassky E. Tape strips from early-onset pediatric atopic dermatitis highlight disease abnormalities in nonlesional skin. Allergy 2021; 76:314-325. [PMID: 32639640 DOI: 10.1111/all.14490] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Skin biopsies promote our understanding of atopic dermatitis/AD pathomechanisms in infants/toddlers with early-onset AD, but are not feasible in pediatric populations. Tape strips are an emerging, minimally invasive alternative, but global transcriptomic profiling in early pediatric AD is lacking. We aimed to provide global lesional and nonlesional skin profiles of infants/toddlers with recent-onset, moderate-to-severe AD using tape strips. METHODS Sixteen tape strips were collected for RNA-seq profiling from 19 infants/toddlers (<5 years old; lesional and nonlesional) with early-onset moderate-to-severe AD (≤6 months) and 17 healthy controls. RESULTS We identified 1829 differentially expressed genes/DEGs in lesional AD and 662 DEGs in nonlesional AD, vs healthy skin (fold-change ≥2, FDR <0.05), with 100% sample recovery. Both lesional and nonlesional skin showed significant dysregulations of Th2 (CCL17 and IL4R) and Th22/Th17 (IL36G, CCL20, and S100As)-related genes, largely lacking significant Th1-skewing. Significant down-regulation of terminal differentiation (FLG and FLG2), lipid synthesis/metabolism (ELOVL3 and FA2H), and tight junction (CLDN8) genes were primarily seen in lesional AD. Significant negative correlations were identified between Th2 measures and epidermal barrier gene-subsets and individual genes (FLG with IL-4R and CCL17; r < -0.4, P < .05). Significant correlations were also identified between clinical measures (body surface area/BSA, pruritus ADQ, and transepidermal water loss/TEWL) with immune and barrier mRNAs in lesional and/or nonlesional AD (FLG/FLG2 with TEWL; r < -0.4, P < .05). CONCLUSION RNA-seq profiling using tape strips in early-onset pediatric AD captures immune and barrier alterations in both lesional and nonlesional skin. Tape strips provide insight into disease pathomechanisms and cutaneous disease activity.
Collapse
Affiliation(s)
- Ana B. Pavel
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Biomedical Engineering University of Mississippi MS USA
| | - Yael Renert‐Yuval
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
| | - Jianni Wu
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
- College of Medicine State University of New York Downstate Medical Center Brooklyn NY USA
| | - Ester Del Duca
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
- Department of Dermatology University of Rome Tor Vergata Rome Italy
| | - Aisleen Diaz
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
- Ponce Health Sciences University School of Medicine Ponce PR USA
| | - Rachel Lefferdink
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Milie M. Fang
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Talia Canter
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | | | - Ning Zhang
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - James G. Krueger
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
| | - Amy S. Paller
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Emma Guttman‐Yassky
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
| |
Collapse
|
9
|
Diaz A, He H, Pavel A, Lefferdink R, Fang M, Canter T, Rangel S, Krueger J, Paller A, Guttman-Yassky E. 253 RNA-seq profiling of tape strips from infants with atopic dermatitis show profound barrier and immune abnormalities. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
10
|
Czarnowicki T, He H, Canter T, Han J, Lefferdink R, Erickson T, Rangel S, Kameyama N, Kim HJ, Pavel AB, Estrada Y, Krueger JG, Paller AS, Guttman-Yassky E. Evolution of pathologic T-cell subsets in patients with atopic dermatitis from infancy to adulthood. J Allergy Clin Immunol 2019; 145:215-228. [PMID: 31626841 DOI: 10.1016/j.jaci.2019.09.031] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/23/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The circulating immune phenotype was defined in adults and young children with early atopic dermatitis (AD), but chronologic changes in the blood of infants and children with AD through adolescence have not been explored. OBJECTIVE We sought to compare immune activation and cytokine polarization in the blood of 0- to 5-year-old (n = 39), 6- to 11-year-old (n = 26), 12- to 17-year-old (n = 21) and 18-year-old or older (n = 43) patients with AD versus age-matched control subjects. METHODS Flow cytometry was used to measure IFN-γ, IL-9, IL-13, IL-17, and IL-22 cytokine levels in CD4+/CD8+ T cells, with inducible costimulator molecule and HLA-DR defining midterm and long-term T-cell activation, respectively, within skin-homing/cutaneous lymphocyte antigen (CLA)+ versus systemic/CLA- T cells. Unsupervised clustering differentiated patients based on their blood biomarker frequencies. RESULTS Although CLA+ TH1 frequencies were significantly lower in infants with AD versus all older patients (P < .01), frequencies of CLA+ TH2 T cells were similarly expanded across all AD age groups compared with control subjects (P < .05). After infancy, CLA- TH2 frequencies were increased in patients with AD in all age groups, suggesting systemic immune activation with disease chronicity. IL-22 frequencies serially increased from normal levels in infants to highly significant levels in adolescents and adults compared with levels in respective control subjects (P < .01). Unsupervised clustering aligned the AD profiles along an age-related spectrum from infancy to adulthood (eg, inducible costimulator molecule and IL-22). CONCLUSIONS The adult AD phenotype is achieved only in adulthood. Unique cytokine signatures characterizing individual pediatric endotypes might require age-specific therapies. Future longitudinal studies, comparing the profile of patients with cleared versus persistent pediatric AD, might define age-specific changes that predict AD clearance.
Collapse
Affiliation(s)
- Tali Czarnowicki
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Helen He
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Talia Canter
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Joseph Han
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rachel Lefferdink
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Taylor Erickson
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Stephanie Rangel
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Naoya Kameyama
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hyun Je Kim
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ana B Pavel
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeriel Estrada
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
11
|
Gwillim E, Jimenez J, Ali Y, Figueiredo A, Lefferdink R, Puar N, Laumann A, Colavincenzo M, West D, Nardone B. 205 Risk of ischemic heart disease in patients with alopecia areata: A large, urban, retrospective Midwestern US patient population study. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|