Lipid and Immune Biomarkers Can Potentially Predict Future Onset of Atopic Dermatitis in Infants
In this video, Evgeny Berdyshev, PhD, lead author of the study, "Stratum Corneum Lipid and Cytokine Biomarkers at Two Months of Age Predict the Future Onset of Atopic Dermatitis" discusses how lipid and immune biomarkers can potentially predict future onset of atopic dermatitis in infants, how his study fills a gap in our knowledge, and more.
- Berdyshev E, Kim J, Kim BE, et al. Stratum corneum lipid and cytokine biomarkers at two months of age predict the future onset of atopic dermatitis. J Allergy Clin Immunol. Published online February 23, 2023. doi: 10.1016/j.jaci.2023.02.013.
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Evgeny Berdyshev, PhD, is an Associate Professor in the Division of Pulmonary, Critical Care & Sleep Medicine at National Jewish Health (Denver, CO).
Dr Evgeny Berdyshev:
Hello, my name is Evgeny Berdyshev. I'm a professor at National Jewish Health in Denver, Colorado.
What was the impetus for your study on the potential for biomarkers predicting future onset of atopic dermatitis?
It's very good question. We have great drugs and biologics to try to cure atopic diseases. We can alleviate symptoms, but we are never able to completely cure the patient. So, now the focus of the research in the area of atopic diseases shifts towards the possibility to predict in order to prevent, to intervene before the onset of the disease. And until recently, it was not a major focus. Other studies focused on the treatments, but now it's the time to focus on the prediction. We published something like 7 years ago one of the first papers that addresses the question of possibility to predict future onset of atopic dermatitis. It was again our joint international collaborative study when infants were enrolled in Seoul, South Korea, and the top surface of the skin, which is called Stratum Corneum, was collected at the age of 2 months, and children were just monitored clinically until the age of 2 years. During that time, all the incidences of atopic dermatitis were recorded. Then, this skin tape strips with collected stratum corneum, that is a way to non-invasively collect material, even in newborns, were analyzed for the content of only one component - thymic stromal lymphopoietin (TSLP). TSLP is a cytokine that skin cells release in response to any kind of invasion, and they guide the immune system, immune cells to respond. So, at that moment, 7 years ago, we analyzed only the content of thymic stromal lymphopoietin. And it happened to be elevated at the age of 2 months, way before the onset of disease. We stated at that time that we need more parameters to predict future onset of atopic dermatitis with better precision. So, now, 7 years later, we came to the expansion of our original work. At the same time, currently, there are multiple studies around the world that are focusing at the early days, weeks, and months of human life to predict the onset of atopic disease.
How does your team’s study fill the current gap in our knowledge?
There is just a few publications in the area of prediction of future onset of atopic dermatitis. The field is technically open. We don't know what happens, what triggers its development. We even do not know how the property of the human skin changes over the first year of life, for example. And what we found is really, really exciting. We found multiple lipid and also cytokine biomarkers that tell us that the skin in children who will develop eczema is already changed at the age of 2 months. What we found is really important. We technically can say with very high precision which child is at risk to develop eczema in the future. We obtained the odds ratio of the onset of atopic dermatitis above 54. Technically, it's 99% of certitude that the child is at risk. But what is more important is the fact that at the age of 2 months, what we see is something that has already happened. This means that the original insult was either in between birth and 2 months of age or even in the mother’s utero, and we will turn our attention to that period in human life to understand the origins of the onset of atopic diseases.
Beyond dermatologists, what other specialists would be interested in your study results and why?
I believe our technology, our approach to look at the skin as the window towards inside of our body is really appealing and promising. We are planning to expand our look into asthma, for example, into a possibility to identify asthma endotypes through skin tape strips analytics. There are multiple endotypes of asthma as it is a very complex disease, even more complex than atopic dermatitis. We are currently able to identify, with good precision, which particular endotype of disease we have in atopic dermatitis. We can potentially do the same with asthma. But looking into the future, we actually see a roadmap to create a clinical assay for pediatricians that can answer, within a visit time of the mother with the baby, a question if the child is at risk of the future development of atopic diseases. Such an assay is not yet available, but there is a possibility to design a machinery and parameters to focus at that will allow almost immediate test in the clinic. And this will allow to introduce preemptive therapies. These might be specialized creams to enforce skin barrier, and some biologics. The whole problem is, how we see it, in the failure of the skin barrier function that allows allergens, bacteria, and viruses to get through our skin and to hyperactivate immune response. Food allergy is another atopic disease that can benefit from our technology. It's directly linked to the failure of the skin to hold the barrier. And I can tell you that the extension of our work that we just published in Journal of Allergy and Clinical Immunology will be into a food allergy. We are also working on the ability to identify children at risk of anaphylactic shock to food allergens without oral provocation, again using a skin tape striping approach. It's a very powerful technique as we see it, and we are working hard to push it forward.