Identification of atopic dermatitis phenotypes with good responses to probiotics (Lactobacillus plantarum CJLP133) in children
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Published on: September 26, 2019
11 Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnamgu, Seoul 06351, Republic of Korea.
Insights
Probiotic treatment with Lactobacillus plantarum CJLP133 may benefit atopic dermatitis (AD) patients with high IgE and Treg cells. This study identified specific immune markers predicting a positive response to probiotics in children with AD.
Area of Science:
- Immunology
- Microbiology
- Dermatology
Background:
- The efficacy of probiotics for atopic dermatitis (AD) is debated and patient-specific.
- Identifying responders to probiotic therapy is crucial for targeted treatment strategies.
Purpose of the Study:
- To identify a specific subgroup of atopic dermatitis patients who exhibit a significant clinical response to probiotic treatment.
- To investigate the immunological factors associated with a positive response to Lactobacillus plantarum CJLP133 in children with moderate to severe AD.
Main Methods:
- A 12-week randomized controlled trial involving 76 children with moderate to severe AD, treated with Lactobacillus plantarum CJLP133.
- Assessment of SCORing of AD (SCORAD) index, peripheral eosinophil counts, CD4+CD25+Foxp3+ regulatory T (Treg) cells, and serum IgE levels before and after treatment.
- Multivariable logistic regression analysis to identify predictors of a good clinical response (≥30% SCORAD reduction).
Main Results:
- 36 out of 76 patients (responders) showed a significant reduction in SCORAD (median reduction from 29.5 to 16.4).
- High baseline total IgE levels, increased transforming growth factor (TGF)-β expression, and a high proportion of Treg cells were significantly associated with a good clinical response.
- In responders, probiotic treatment led to a significant increase in Treg cells and a decrease in TGF-β mRNA expression.
Conclusions:
- A subgroup of atopic dermatitis patients with an immunologically active phenotype (high total IgE, elevated TGF-β, and numerous Treg cells) may benefit from Lactobacillus plantarum CJLP133.
- These findings suggest that specific immunological markers can predict probiotic responsiveness in AD, enabling personalized therapeutic approaches.
Abstract:
The therapeutic effect of probiotics in atopic dermatitis (AD) remains controversial and varies according to the individual patient. We aimed to identify a population of AD patients with a good clinical response to probiotic treatment. We recruited 76 children with a median age of 7.1 years who suffered from moderate to severe AD. After a 2-week washout period, all patients were given Lactobacillus plantarum CJLP133 at a dosage of 1×1010 colony-forming units once a day for 12 weeks. We measured eosinophil counts in the peripheral blood, the proportion of CD4+CD25+Foxp3+ regulatory T (Treg) cells in CD4+ T cells, serum total immunoglobulin E (IgE) levels, and specific IgE against common allergens before the start of the treatment (T1) and at discontinuation (T2). Responders were defined as patients with at least a 30% reduction in the SCORing of AD (SCORAD) index after treatment. There were 36 responders and 40 non-responders after probiotic treatment. The median SCORAD was reduced from 29.5 (range 20.6-46.3) at T1 to 16.4 (range 6.3-30.8) at T2 in the responder group (P<0.001). In multivariable logistic regression analysis, a good clinical response was significantly associated with high total IgE levels (aOR 5.1, 95% CI 1.1-23.6), increased expression of transforming growth factor (TGF)-β (aOR 4.6, 95% CI 1.3-15.9), and a high proportion of Treg cells in CD4+ T cells (aOR 3.7, 95% CI 1.1-12.7) at T1. In the responder group, the proportion of Treg cells was significantly increased after 12 weeks of treatment (P=0.004), while TGF-β mRNA expression was decreased (P=0.017). Our results suggest that a subgroup of patients with a specific AD phenotype showing an immunologically active state (high total IgE, increased expression of TGF-β, high numbers of Treg cells) may benefit from probiotic treatment with L. plantarum CJLP133.
