Reversal of atopic dermatitis with narrow-band UVB phototherapy and biomarkers for therapeutic response

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:128

Article

Tintle, Suzanne^1,2  Shemer, Avner^3,4  Suarez-Farinas, Mayte¹  Fujita, Hideki¹  Gilleaudeau, Patricia¹  Sullivan-Whalen, Mary¹  Johnson-Huang, Leanne¹  Chiricozzi, Andrea^1,5  Cardinale, Irma¹  Duan, Shenghui⁶  Bowcock, Anne⁶  Krueger, James G.¹  Guttman-Yassky, Emma^1,7 

[1] Rockefeller Univ, Lab Investigat Dermatol, New York, NY 10065 USA

[2] Columbia Univ, Coll Phys & Surg, New York, NY USA

[3] Tel Hashomer Hosp, Dept Dermatol, Tel Aviv, Israel

[4] Tel Aviv Univ, IL-69978 Tel Aviv, Israel

[5] Univ Roma Tor Vergata, Dept Dermatol, Rome, Italy

[6] Washington Univ, Sch Med, Dept Genet, St Louis, MO 63130 USA

[7] Cornell Univ, Weill Cornell Med Coll, Dept Dermatol, New York, NY 10021 USA

关键词: Atopic dermatitis;    phototherapy;    narrow-band UVB;    T(H)2;    T22;    biomarker;    skin;   

DOI  :  10.1016/j.jaci.2011.05.042

来源: Elsevier

【 摘 要 】

Background: Atopic dermatitis (AD) is a common inflammatory skin disease exhibiting a predominantly T(H)2/T22'' immune activation and a defective epidermal barrier. Narrow-band UVB (NB-UVB) is considered an efficient treatment for moderate-to-severe AD. In patients with psoriasis, NB-UVB has been found to suppress T(H)1/T(H)17 polarization, with subsequent reversal of epidermal hyperplasia. The immunomodulatory effects of this treatment are largely unknown in patients with AD. Objective: We sought to evaluate the effects of NB-UVB on immune and barrier abnormalities in patients with AD, aiming to establish reversibility of disease and biomarkers of therapeutic response. Methods: Twelve patients with moderate-to-severe chronic AD received NB-UVB phototherapy 3 times weekly for up to 12 weeks. Lesional and nonlesional skin biopsy specimens were obtained before and after treatment and evaluated by using gene expression and immunohistochemistry studies. Results: All patients had at least a 50% reduction in SCORAD index scores with NB-UVB phototherapy. The T(H)2, T22, and T(H)1 immune pathways were suppressed, and measures of epidermal hyperplasia and differentiation normalized. The reversal of disease activity was associated with elimination of inflammatory leukocytes and T(H)2/T22-associated cytokines and chemokines and normalized expression of barrier proteins. Conclusions: Our study shows that resolution of clinical disease in patients with chronic AD is accompanied by reversal of both the epidermal defects and the underlying immune activation. We have defined a set of biomarkers of disease response that associate resolved T(H)2 and T22 inflammation in patients with chronic AD with reversal of barrier pathology. By showing reversal of the AD epidermal phenotype with a broad immune-targeted therapy, our data argue against a fixed genetic phenotype. (J Allergy Clin Immunol 2011;128:583-93.)

【 授权许可】

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