The role of regulatory T cells in atopic dermatitis

Regulatory T (T(reg)) cells play a pivotal role in immune suppression and are integral to the control of allergic responses. The chronic inflammatory skin condition atopic dermatitis (AD) is severest in patients who are sensitized to allergens from diverse sources including foods, pollens and animal danders, as well as skin-colonizing organisms. These individuals typically present with eczematous skin eruptions in early childhood, and evolution of the disease is thought to reflect an underlying dysregulated T-cell response to allergens that manifests as a Th2 response. Studying T(reg) cells in the context of AD from infancy into adulthood could yield insight into their role in disease pathogenesis and reveal new strategies for exploiting these cells for therapeutic purposes. Such studies are challenging in humans owing to the heterogeneous nature of T(reg) cells, lack of a reliable surface marker, and the paucity of knowledge surrounding the emergence of specialized T cells in early life. Moreover, the blurred distinction between activated effector T cells and T(reg) cells further complicates studies in the context of inflammatory disorders such as AD. There is emerging evidence to suggest that T(reg) cells can convert to Th2 cells and that this pathway is bidirectional. This phenomenon may be a double-edged sword with important implications not only for subverting T(reg) cells in disease, but also for potential treatments designed to amplify these cells in order to suppress the allergic inflammatory cascade in AD.