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Achten RE, Bakker DS, van Luijk CM, van der Wal M, de Graaf M, van Wijk F, Zuithoff NPA, van der Rijst LP, Boesjes CM, Thijs JL, de Boer JH, de Bruin-Weller MS. Ocular surface disease is common in moderate-to-severe atopic dermatitis patients. Clin Exp Allergy 2022; 52:801-805. [PMID: 35294787 PMCID: PMC9313815 DOI: 10.1111/cea.14127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Roselie E Achten
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daphne S Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chantal M van Luijk
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlot van der Wal
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa P van der Rijst
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Celeste M Boesjes
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith L Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein S de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
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Bakker DS, ter Linde JJM, Amini MM, Ariëns LFM, van Luijk CM, de Bruin‐Weller MS, Thijs JL, Vercoulen Y, van Wijk F. Conjunctival inflammation in dupilumab-treated atopic dermatitis comprises a multicellular infiltrate with elevated T1/T17 cytokines: A case series study. Allergy 2021; 76:3814-3817. [PMID: 34449906 PMCID: PMC9292644 DOI: 10.1111/all.15064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/21/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Daphne S. Bakker
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
- Center for Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - José J. M. ter Linde
- Center for Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Mojtaba M. Amini
- Center for Molecular Medicine University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Lieneke F. M. Ariëns
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Chantal M. van Luijk
- Department of Ophthalmology University Medical Center Utrecht Utrecht The Netherlands
| | - Marjolein S. de Bruin‐Weller
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Judith L. Thijs
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Yvonne Vercoulen
- Center for Molecular Medicine University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Femke van Wijk
- Center for Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
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Ariëns LFM, Bakker DS, Spekhorst LS, van der Schaft J, Thijs JL, Haeck I, Flinterman AE, Kamsteeg M, Schuttelaar MLA, Bruin-Weller MS. Rapid and Sustained Effect of Dupilumab on Work Productivity in Patients with Difficult-to-treat Atopic Dermatitis: Results from the Dutch BioDay Registry. Acta Derm Venereol 2021; 101:adv00573. [PMID: 34396421 PMCID: PMC9425610 DOI: 10.2340/00015555-3886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dupilumab treatment improves signs, symptoms, and quality of life in patients with moderate-to-severe atopic dermatitis. This study evaluated the impact of dupilumab treatment on absenteeism, presenteeism, and related costs in a large multi-centre cohort of adult patients with difficult-to-treat atopic dermatitis in daily practice. Patients treated with dupilumab participating in the Dutch BioDay Registry reporting employment were included. Absenteeism, presenteeism, and related costs at baseline and during follow-up were calculated using the Work Productivity and Activity Impairment questionnaire. A total of 218 adult patients with moderate-to-severe atopic dermatitis were included. Total work impairment reduced significantly from baseline (35.5%) to week 52 (11.5%), p < 0.001. Median weekly productivity losses reduced significantly from baseline (€379.8 (140.7–780.8)) to week 52 (€0.0 (0.0–211.0), p < 0.001). In this study, dupilumab treatment demonstrated a significant improvement in work productivity and reduction in associated costs in a large cohort of patients with difficult-to-treat atopic dermatitis in daily practice.
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Affiliation(s)
- Lieneke F M Ariëns
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands. E-mail:
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4
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Bakker DS, van der Wal MM, Heeb LE, Giovannone B, Asamoah M, Delemarre EM, Drylewicz J, Nierkens S, Boyman O, de Bruin-Weller MS, Thijs JL, van Wijk F. Early and Long-Term Effects of Dupilumab Treatment on Circulating T-Cell Functions in Patients with Moderate-to-Severe Atopic Dermatitis. J Invest Dermatol 2021; 141:1943-1953.e13. [DOI: 10.1016/j.jid.2021.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/21/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
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Bakker DS, Nierkens S, Knol EF, Giovannone B, Delemarre EM, van der Schaft J, van Wijk F, de Bruin-Weller MS, Drylewicz J, Thijs JL. Confirmation of multiple endotypes in atopic dermatitis based on serum biomarkers. J Allergy Clin Immunol 2021; 147:189-198. [DOI: 10.1016/j.jaci.2020.04.062] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/07/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
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Bakker DS, Ariens LFM, Giovannone B, Hijnen D, Delemarre EM, Knol E, Nierkens S, Bruin‐Weller MS, Thijs JL, Drylewicz J. EASI p-EASI: Predicting disease severity in atopic dermatitis patients treated with dupilumab using a combination of serum biomarkers. Allergy 2020; 75:3287-3289. [PMID: 33305359 PMCID: PMC7754122 DOI: 10.1111/all.14492] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/19/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Daphne S. Bakker
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Center for Translational Immunology Utrecht The Netherlands
| | - Lieneke F. M. Ariens
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
| | | | - DirkJan Hijnen
- Department of Dermatology Erasmus Medical Center Rotterdam The Netherlands
| | - Eveline M. Delemarre
- Center for Translational Immunology Utrecht The Netherlands
- Platform Immune Monitoring (PIM) University Medical Center Utrecht Utrecht The Netherlands
| | - Edward Knol
- Center for Translational Immunology Utrecht The Netherlands
| | - Stefan Nierkens
- Center for Translational Immunology Utrecht The Netherlands
- Platform Immune Monitoring (PIM) University Medical Center Utrecht Utrecht The Netherlands
| | | | - Judith L. Thijs
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Center for Translational Immunology Utrecht The Netherlands
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Spekhorst LS, Ariëns LF, Schaft J, Bakker DS, Kamsteeg M, Oosting AJ, Ridder I, Sloeserwij A, Romeijn GL, Graaf M, Haeck I, Thijs JL, Schuttelaar ML, de Bruin‐Weller MS. Two-year drug survival of dupilumab in a large cohort of difficult-to-treat adult atopic dermatitis patients compared to cyclosporine A and methotrexate: Results from the BioDay registry. Allergy 2020; 75:2376-2379. [PMID: 32302412 PMCID: PMC7540274 DOI: 10.1111/all.14324] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Lotte S. Spekhorst
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Lieneke F.M. Ariëns
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Jorien Schaft
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Daphne S Bakker
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Marijke Kamsteeg
- Department of Dermatology Radboud University Medical Center Nijmegen Nijmegen The Netherlands
| | | | - Ilona Ridder
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Annemiek Sloeserwij
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Geertruida L.E. Romeijn
- Department of Dermatology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Marlies Graaf
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Inge Haeck
- Department of Dermatology Reinier de GraafGasthuis Delft The Netherlands
| | - Judith L. Thijs
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Marie L.A. Schuttelaar
- Department of Dermatology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Marjolein S. de Bruin‐Weller
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
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Ariëns LFM, Schaft J, Bakker DS, Balak D, Romeijn MLE, Kouwenhoven T, Kamsteeg M, Giovannone B, Drylewicz J, Amerongen CCA, Delemarre EM, Knol EF, Wijk F, Nierkens S, Thijs JL, Schuttelaar MLA, Bruin‐Weller MS. Dupilumab is very effective in a large cohort of difficult-to-treat adult atopic dermatitis patients: First clinical and biomarker results from the BioDay registry. Allergy 2020; 75:116-126. [PMID: 31593343 DOI: 10.1111/all.14080] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [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: 05/25/2019] [Revised: 08/22/2019] [Accepted: 09/07/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Dupilumab has recently been approved for the treatment of moderate to severe atopic dermatitis (AD) in adults. Daily practice data on dupilumab treatment are scarce. OBJECTIVE To study the effect of 16-week treatment with dupilumab on clinical response and serum biomarkers in adult patients with moderate-severe AD in daily practice. METHODS Data were extracted from the BioDay registry, a prospective multicenter registry. Sixteen-week clinical effectiveness of dupilumab was expressed as number of patients achieving EASI-50 (Eczema Area and Severity Index) or EASI-75, as well as patient-reported outcomes measures (Patient-Oriented Eczema Measure, Dermatology Life Quality Index, Numeric Rating Scale pruritus). Twenty-one biomarkers were measured in patients treated with dupilumab without concomitant use of oral immunosuppressive drugs at five different time points (baseline, 4, 8, 12, and 16 weeks). RESULTS In total, 138 patients treated with dupilumab in daily practice were included. This cohort consisted of patients with very difficult-to-treat AD, including 84 (61%) patients who failed treatment on ≥2 immunosuppressive drugs. At week 16, the mean percent change in EASI score was 73%. The EASI-50 and EASI-75 were achieved by 114 (86%) and 82 (62%) patients after 16 weeks of treatment. The most reported side effect was conjunctivitis, occurring in 47 (34%) patients. During dupilumab treatment, disease severity-related serum biomarkers (TARC, PARC, periostin, and IL-22), eotaxin-1, and eotaxin-3 significantly decreased. CONCLUSION Treatment with dupilumab significantly improved disease severity and decreased severity-related serum biomarkers in patients with very difficult-to-treat AD in a daily practice setting.
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Affiliation(s)
- Lieneke F. M. Ariëns
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Jorien Schaft
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Daphne S. Bakker
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Deepak Balak
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Margreet L. E. Romeijn
- Department of Dermatology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Tessa Kouwenhoven
- Department of Dermatology Radboud University Medical Center Nijmegen Nijmegen The Netherlands
| | - Marijke Kamsteeg
- Department of Dermatology Radboud University Medical Center Nijmegen Nijmegen The Netherlands
| | - Barbara Giovannone
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Julia Drylewicz
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | | | - Evelien M. Delemarre
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Edward F. Knol
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Femke Wijk
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Stefan Nierkens
- Laboratory of Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
| | - Judith L. Thijs
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
| | - Marie L. A. Schuttelaar
- Department of Dermatology Radboud University Medical Center Nijmegen Nijmegen The Netherlands
| | - Marjolein S. Bruin‐Weller
- Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht The Netherlands
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Thijs JL, Fiechter R, Giovannone B, de Bruin‐Weller MS, Knol EF, Bruijnzeel‐Koomen CAFM, Drylewicz J, Nierkens S, Hijnen D. Biomarkers detected in dried blood spots from atopic dermatitis patients strongly correlate with disease severity. Allergy 2019; 74:2240-2243. [PMID: 31016745 DOI: 10.1111/all.13839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Judith L. Thijs
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology Utrecht The Netherlands
| | - Renée Fiechter
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology Utrecht The Netherlands
| | - Barbara Giovannone
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology Utrecht The Netherlands
| | | | - Edward F. Knol
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology Utrecht The Netherlands
| | | | - Julia Drylewicz
- Laboratory of Translational Immunology Utrecht The Netherlands
| | - Stefan Nierkens
- Laboratory of Translational Immunology Utrecht The Netherlands
| | - DirkJan Hijnen
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology Utrecht The Netherlands
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Bakker DS, Drylewicz J, Nierkens S, Knol EF, Giovannone B, Delemarre EM, van der Schaft J, Balak DMW, de Bruin-Weller MS, Thijs JL. Early identification of atopic dermatitis patients in need of systemic immunosuppressive treatment. Clin Exp Allergy 2019; 49:1641-1644. [PMID: 31520450 PMCID: PMC6973172 DOI: 10.1111/cea.13495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Daphne S Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Julia Drylewicz
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan Nierkens
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edward F Knol
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Barbara Giovannone
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eveline M Delemarre
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jorien van der Schaft
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Deepak M W Balak
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolein S de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith L Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
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Thijs JL, Drylewicz J, Bruijnzeel‐Koomen CAFM, Giovannone B, Knol EF, de Bruin‐Weller MS, Nierkens S, Hijnen D. EASI p-EASI: Predicting disease severity in atopic dermatitis patients treated with cyclosporin A. Allergy 2019; 74:613-617. [PMID: 30368864 DOI: 10.1111/all.13651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Judith L. Thijs
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology Utrecht The Netherlands
| | - Julia Drylewicz
- Laboratory of Translational Immunology Utrecht The Netherlands
| | | | - Barbara Giovannone
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology Utrecht The Netherlands
| | - Edward F. Knol
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology Utrecht The Netherlands
| | | | - Stefan Nierkens
- Laboratory of Translational Immunology Utrecht The Netherlands
- U‐DAIR University Medical Center Utrecht Utrecht The Netherlands
| | - DirkJan Hijnen
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht The Netherlands
- Laboratory of Translational Immunology Utrecht The Netherlands
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Abstract
INTRODUCTION For many years, oral immunosuppressive drugs such as cyclosporine A, azathioprine, mycophenolic acid, and methotrexate were the only treatment options, in addition to topical treatment, in patients with severe atopic dermatitis (AD). Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha, is the first antibody-based treatment commercially available for the treatment of AD. In the near future, more antibody-based treatments and small molecules will become available in the treatment of severe AD. AREAS COVERED This review gives an overview of current and future therapies for severe AD, outlines options to optimize treatment with oral immunosuppressive drugs and gives an insight into the future of personalized treatment in AD. EXPERT OPINION Due to the heterogeneous character of AD, it is unlikely that all patients will respond equally to these newly tested drugs. We believe that biomarkers will lead to better identification of patients that will benefit from these highly specific, but expensive new treatments. In addition to a role for biomarkers in new treatments, the use of pharmacogenomic biomarkers can improve the efficacy of currently used oral immunosuppressive drugs in AD, which will still be needed for the treatment of moderate to severe AD in the coming years.
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Affiliation(s)
- Jorien van der Schaft
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Judith L Thijs
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Floor M Garritsen
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - D Balak
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Marjolein S de Bruin-Weller
- a National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology , University Medical Center Utrecht , Utrecht , The Netherlands
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Bakker DS, Ariens LFM, van Luijk C, van der Schaft J, Thijs JL, Schuttelaar MLA, van Wijk F, Knol EF, Balak DMW, van Dijk MR, de Bruin-Weller MS. Goblet cell scarcity and conjunctival inflammation during treatment with dupilumab in patients with atopic dermatitis. Br J Dermatol 2019; 180:1248-1249. [PMID: 30597515 PMCID: PMC6850107 DOI: 10.1111/bjd.17538] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- D S Bakker
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L F M Ariens
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C van Luijk
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J van der Schaft
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J L Thijs
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - F van Wijk
- Laboratory of Translational Immunology , University Medical Center Utrecht, Utrecht, the Netherlands
| | - E F Knol
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.,Laboratory of Translational Immunology , University Medical Center Utrecht, Utrecht, the Netherlands
| | - D M W Balak
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M R van Dijk
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M S de Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
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Ariëns LFM, Bakker DS, van der Schaft J, Garritsen FM, Thijs JL, de Bruin-Weller MS. Dupilumab in atopic dermatitis: rationale, latest evidence and place in therapy. Ther Adv Chronic Dis 2018; 9:159-170. [PMID: 30181845 DOI: 10.1177/2040622318773686] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/23/2018] [Indexed: 01/26/2023] Open
Abstract
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. The prevalence of AD is increasing and is currently estimated at 10-20% in adults worldwide. In the majority of patients, AD can be adequately controlled with topical treatment or ultraviolet light therapy, but there is a high unmet need for effective and safe therapeutics in patients with more severe or difficult to treat AD. During the past decade, new advances in the understanding of the underlying immune pathogenesis of AD have led to the development of new, more targeted therapies. Dupilumab, a fully human monoclonal antibody targeting the interleukin (IL)-4 receptor α, thereby blocking the IL-4 and IL-13 pathway, is one of the first biologics that has been developed for AD. Dupilumab has shown promising results in phase III trials and has recently been approved by the US Food and Drug Administration and the European Commission for the treatment of moderate to severe AD. With the approval of dupilumab, we are entering a new era of biological therapeutics in AD management. The place of dupilumab should be established in the current treatment standards. Based on current treatment guidelines and experts' opinions in the management of AD, we have built a proposal for a treatment algorithm for systemic treatment of AD in European countries.
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Affiliation(s)
- Lieneke F M Ariëns
- Department of Dermatology and Allergology, University Medical Center Utrecht, Room G02.124, 3508 GA Utrecht, The Netherlands
| | - Daphne S Bakker
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | - Jorien van der Schaft
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | - Floor M Garritsen
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
| | - Judith L Thijs
- Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands
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Thijs JL, Strickland I, Bruijnzeel-Koomen CAFM, Nierkens S, Giovannone B, Knol EF, Csomor E, Sellman BR, Mustelin T, Sleeman MA, de Bruin-Weller MS, Herath A, Drylewicz J, May RD, Hijnen D. Serum biomarker profiles suggest that atopic dermatitis is a systemic disease. J Allergy Clin Immunol 2018; 141:1523-1526. [PMID: 29410314 DOI: 10.1016/j.jaci.2017.12.991] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/27/2017] [Accepted: 12/06/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Judith L Thijs
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Stefan Nierkens
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Barbara Giovannone
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edward F Knol
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | - Julia Drylewicz
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - DirkJan Hijnen
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Thijs JL, Drylewicz J, Fiechter R, Strickland I, Sleeman MA, Herath A, May RD, Bruijnzeel-Koomen CAFM, Knol EF, Giovannone B, de Bruin-Weller MS, Nierkens S, Hijnen DJ. EASI p-EASI: Utilizing a combination of serum biomarkers offers an objective measurement tool for disease severity in atopic dermatitis patients. J Allergy Clin Immunol 2017; 140:1703-1705. [PMID: 28823810 DOI: 10.1016/j.jaci.2017.06.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Judith L Thijs
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands; Laboratory of Translational Immunology, Utrecht, The Netherlands
| | - Julia Drylewicz
- Laboratory of Translational Immunology, Utrecht, The Netherlands
| | - Renée Fiechter
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands; Laboratory of Translational Immunology, Utrecht, The Netherlands
| | | | | | | | | | | | - Edward F Knol
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands; Laboratory of Translational Immunology, Utrecht, The Netherlands
| | - Barbara Giovannone
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands
| | | | - Stefan Nierkens
- Laboratory of Translational Immunology, Utrecht, The Netherlands; U-DAIR, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dirk Jan Hijnen
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands; Laboratory of Translational Immunology, Utrecht, The Netherlands.
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17
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Thijs JL, Strickland I, Bruijnzeel-Koomen CAFM, Nierkens S, Giovannone B, Csomor E, Sellman BR, Mustelin T, Sleeman MA, de Bruin-Weller MS, Herath A, Drylewicz J, May RD, Hijnen D. Moving toward endotypes in atopic dermatitis: Identification of patient clusters based on serum biomarker analysis. J Allergy Clin Immunol 2017; 140:730-737. [PMID: 28412391 DOI: 10.1016/j.jaci.2017.03.023] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/08/2017] [Accepted: 03/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a complex, chronic, inflammatory skin disease with a diverse clinical presentation. However, it is unclear whether this diversity exists at a biological level. OBJECTIVE We sought to test the hypothesis that AD is heterogeneous at the biological level of individual inflammatory mediators. METHODS Sera from 193 adult patients with moderate-to-severe AD (six area, six sign atopic dermatitis [SASSAD] score: geometric mean, 22.3 [95% CI, 21.3-23.3] and 39.1 [95% CI, 37.5-40.9], respectively) and 30 healthy control subjects without AD were analyzed for 147 serum mediators, total IgE levels, and 130 allergen-specific IgE levels. Population heterogeneity was assessed by using principal component analysis, followed by unsupervised k-means cluster analysis of the principal components. RESULTS Patients with AD showed pronounced evidence of inflammation compared with healthy control subjects. Principal component analysis of data on sera from patients with AD revealed the presence of 4 potential clusters. Fifty-seven principal components described approximately 90% of the variance. Unsupervised k-means cluster analysis of the 57 largest principal components delivered 4 distinct clusters of patients with AD. Cluster 1 had high SASSAD scores and body surface areas with the highest levels of pulmonary and activation-regulated chemokine, tissue inhibitor of metalloproteinases 1, and soluble CD14. Cluster 2 had low SASSAD scores with the lowest levels of IFN-α, tissue inhibitor of metalloproteinases 1, and vascular endothelial growth factor. Cluster 3 had high SASSAD scores with the lowest levels of IFN-β, IL-1, and epithelial cytokines. Cluster 4 had low SASSAD scores but the highest levels of the inflammatory markers IL-1, IL-4, IL-13, and thymic stromal lymphopoietin. CONCLUSION AD is a heterogeneous disease both clinically and biologically. Four distinct clusters of patients with AD have been identified that could represent endotypes with unique biological mechanisms. Elucidation of these endotypes warrants further investigation and will require future intervention trials with specific agents, such as biologics.
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Affiliation(s)
- Judith L Thijs
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Stefan Nierkens
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Barbara Giovannone
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | - Julia Drylewicz
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - DirkJan Hijnen
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Thijs JL, Herath A, de Bruin-Weller MS, Hijnen D. Multiplex platform technology and bioinformatics are essential for development of biomarkers in atopic dermatitis. J Allergy Clin Immunol 2017; 139:1065. [DOI: 10.1016/j.jaci.2016.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
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Thijs JL, Knipping K, Bruijnzeel-Koomen CAF, Garssen J, de Bruin-Weller MS, Hijnen DJ. Immunoglobulin free light chains in adult atopic dermatitis patients do not correlate with disease severity. Clin Transl Allergy 2016; 6:44. [PMID: 27980722 PMCID: PMC5139123 DOI: 10.1186/s13601-016-0132-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/14/2016] [Indexed: 12/02/2022] Open
Abstract
Background Although total IgE levels have been proposed as a biomarker for disease severity in atopic dermatitis (AD) and are increased in the majority of AD patients, they do not correlate with disease severity during short-term follow-up. During the synthesis of immunoglobulins, free light chains (Ig-FLCs) are produced in excess over heavy chains. In comparison with IgE molecules, Ig-FLCs have a very short serum half-life. Therefore, Ig-FLCs might be more suitable as a biomarker for disease severity during follow-up. Recent studies showed increased serum levels of kappa Ig-FLCs in infants with AD, correlating with disease severity. The aim of this study was to investigate serum kappa Ig-FLC levels in adults with AD, and their correlation to disease severity. Methods Serum kappa If-FLC and total IgE levels were measured in 82 moderate to severe AD patients and 49 non-atopic controls. Blood was collected from patients before start of treatment with potent topical steroids (European classification: III–IV). 32 patients were treated during a clinical admission, and in this subpopulation a second blood sample was taken after 2 weeks of treatment. Clinical severity was determined by the Six Area Six Sign Atopic Dermatitis (SASSAD) severity score and a panel of serum biomarkers, including thymus and activation-regulated chemokine (TARC). Results Serum kappa Ig-FLCs levels in adult AD patients were not increased compared to non-atopic controls. Moreover, we observed no correlation between kappa Ig-FLC serum levels and disease severity determined by SASSAD and a panel of serum biomarkers, including TARC. Serum kappa Ig-FLC levels did also not decrease during treatment. Conclusion There are no differences in serum kappa Ig-FLC levels between adult patients suffering from moderate to severe AD compared to non-atopic controls. Moreover, serum levels of kappa Ig-FLCs cannot be used as a biomarker for disease severity in adult AD.
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Affiliation(s)
- J L Thijs
- Department of Dermatology and Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - K Knipping
- Nutricia Research, Utrecht, The Netherlands ; Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - C A F Bruijnzeel-Koomen
- Department of Dermatology and Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - J Garssen
- Nutricia Research, Utrecht, The Netherlands ; Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - M S de Bruin-Weller
- Department of Dermatology and Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - D J Hijnen
- Department of Dermatology and Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Thijs JL, Van Der Geest BAM, Van Der Schaft J, Van Den Broek MP, Van Seggelen WO, Bruijnzeel-Koomen CAF, Hijnen DJ, Van Schaik RH, De Bruin-Weller MS. Predicting therapy response to mycophenolic acid using UGT1A9 genotyping: towards personalized medicine in atopic dermatitis. J DERMATOL TREAT 2016; 28:242-245. [PMID: 27549213 DOI: 10.1080/09546634.2016.1227420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Atopic dermatitis (AD) is a very common chronic inflammatory skin disease requiring long-term treatment. Mycophenolic acid (MPA) is used off-label in treatment of patients with severe AD failing Cyclosporin A (CsA) treatment, however clinical efficacy is observed in only half of the AD patients. In blood, MPA levels are known to have a large interindividual variability. Low MPA exposure and increased enzyme activity correlates with the presence of UGT1A9 polymorphisms. In this retrospective study, 65 adult AD patients treated with MPA were classified as responder or non-responder to MPA treatment. UGT1A9 polymorphisms were determined using PCR. A significantly higher number of UGT1A9 polymorphisms was found in the group that did not respond to MPA treatment. Of the patients that carried a UGT1A9 polymorphism, 85.7% were non-responsive to MPA treatment. This implies that non-responsiveness in AD patients is more likely to occur in carriers of a UGT1A9 polymorphism. In a binary logistic regression analysis the odds ratio (OR) was 8.65 (95% confidence interval: 0.93-80.17). Our results show that UGT1A9 polymorphisms can be used to identify patients with non-responsiveness to MPA. Patients with UGT1A9 polymorphisms might benefit from higher MPA dosage.
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Affiliation(s)
- J L Thijs
- a Department of Dermatology and Allergology
| | | | | | | | | | | | - D J Hijnen
- a Department of Dermatology and Allergology
| | - R H Van Schaik
- c Department of Clinical Chemistry and Hematology , University Medical Center Utrecht , Utrecht , the Netherlands.,d Department of Clinical Chemistry , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
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Urbach C, Gordon NC, Strickland I, Lowne D, Joberty-Candotti C, May R, Herath A, Hijnen D, Thijs JL, Bruijnzeel-Koomen CA, Minter RR, Hollfelder F, Jermutus L. Combinatorial Screening Identifies Novel Promiscuous Matrix Metalloproteinase Activities that Lead to Inhibition of the Therapeutic Target IL-13. ACTA ACUST UNITED AC 2015; 22:1442-1452. [PMID: 26548614 DOI: 10.1016/j.chembiol.2015.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/10/2015] [Accepted: 09/28/2015] [Indexed: 12/20/2022]
Abstract
The practical realization of disease modulation by catalytic degradation of a therapeutic target protein suffers from the difficulty to identify candidate proteases, or to engineer their specificity. We identified 23 measurable, specific, and new protease activities using combinatorial screening of 27 human proteases against 24 therapeutic protein targets. We investigate the cleavage of monocyte chemoattractant protein 1, interleukin-6 (IL-6), and IL-13 by matrix metalloproteinases (MMPs) and serine proteases, and demonstrate that cleavage of IL-13 leads to potent inhibition of its biological activity in vitro. MMP-8 degraded human IL-13 most efficiently in vitro and ex vivo in human IL-13 transgenic mouse bronchoalveolar lavage. Hence, MMP-8 is a therapeutic protease lead against IL-13 for inflammatory conditions whereby reported genetic and genomics data suggest an involvement of MMP-8. This work describes the first exploitation of human enzyme promiscuity for therapeutic applications, and reveals both starting points for protease-based therapies and potential new regulatory networks in inflammatory disease.
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Affiliation(s)
- Carole Urbach
- Department of Antibody Discovery and Protein Engineering, MedImmune, Granta Park, Cambridge CB21 6GH, UK.
| | - Nathaniel C Gordon
- Department of Antibody Discovery and Protein Engineering, MedImmune, Granta Park, Cambridge CB21 6GH, UK; Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
| | - Ian Strickland
- Department of Respiratory, Inflammation and Autoimmunity, MedImmune, Granta Park, Cambridge CB21 6GH, UK
| | - David Lowne
- Department of Antibody Discovery and Protein Engineering, MedImmune, Granta Park, Cambridge CB21 6GH, UK
| | | | - Richard May
- Department of Respiratory, Inflammation and Autoimmunity, MedImmune, Granta Park, Cambridge CB21 6GH, UK
| | - Athula Herath
- Non Clinical Biostatistics, MedImmune, Granta Park, Cambridge CB21 6GH, UK
| | - DirkJan Hijnen
- Department of Dermatology, University Medical Center, 3508 GA Utrecht, the Netherlands
| | - Judith L Thijs
- Department of Dermatology, University Medical Center, 3508 GA Utrecht, the Netherlands
| | | | - Ralph R Minter
- Department of Antibody Discovery and Protein Engineering, MedImmune, Granta Park, Cambridge CB21 6GH, UK
| | - Florian Hollfelder
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
| | - Lutz Jermutus
- Department of Antibody Discovery and Protein Engineering, MedImmune, Granta Park, Cambridge CB21 6GH, UK
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Thijs JL, Damoiseaux RAMJ, Lucassen P, Pasmans SGMA, de Bruin-Weller MS, Bruijnzeel-Koomen CAFM. [Allergy testing in atopic dermatitis: often unnecessary]. Ned Tijdschr Geneeskd 2013; 157:A5652. [PMID: 23515037] [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: 06/01/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease from which many children and adults suffer. In the Netherlands, the majority of patients with AD are treated in the primary health care setting. There is no clear consensus about whether or not to conduct allergy testing in patients with AD. Determining sensitization to inhalant allergens in children with AD has no consequences for its treatment and course and is therefore not necessary. Allergy testing is useful if the child is suspected of having allergic asthma or allergic rhinoconjunctivitis. Determining sensitization to food allergens in children with AD without a positive history of acute allergic reactions to food has no therapeutic consequences and could result in the unnecessary prescription or following of elimination diets.- Similarly, determining sensitization to inhalant and food allergens has no influence on the treatment regimen for adults with AD. This type of testing is therefore not useful, unless the medical history reveals indications for the occurrence of acute allergic reactions to certain allergens.
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Affiliation(s)
- Judith L Thijs
- Afd. Dermatologie en Allergologie, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands
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