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Published on: September 26, 2019
Stratum corneum and microbial biomarkers precede and characterize childhood atopic dermatitis
Melina Fonfara1, Jan Hartmann1, Dora Stölzl1
1Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany.
Insights
Elevated skin biomarkers and altered microbiomes appear before infant atopic dermatitis (AD) onset. These molecular changes characterize early AD, offering potential predictive insights for this common inflammatory skin condition.
Area of Science:
- Dermatology
- Immunology
- Microbiology
Background:
- Atopic dermatitis (AD) is the most common pediatric inflammatory skin disease.
- Current biomarkers for predicting AD onset are lacking.
- Molecular mechanisms of pediatric AD are less understood than adult AD.
Purpose of the Study:
- To identify epidermal proteome and microbiome changes preceding AD onset in neonates.
- To characterize early-stage AD at a molecular level.
- To build upon previous research in AD development.
Main Methods:
- Longitudinal analysis of epidermal biomarkers and microbial profiles.
- Study cohort: 50 high-risk neonates from a randomized controlled trial on early emollient use.
- Data collection up to 24 months of age.
Main Results:
- 26% of infants developed AD by 24 months, with onset around 10 months.
- Increased levels of specific biomarkers (e.g., IL-1Ra, TNFβ, TSLP) were observed before AD onset.
- Delayed skin microbiome maturation and altered composition were noted prior to AD onset.
- At AD manifestation, elevated Th2, Th17/22, Th1, and innate immunity markers were found, with reduced Streptococcus and increased Staphylococcus epidermidis.
Conclusions:
- Pro-inflammatory biomarkers in the stratum corneum increase before pediatric AD.
- Alterations in the skin microbiome precede and characterize the onset of pediatric AD.
Background:
Atopic dermatitis (AD) is the most common paediatric inflammatory skin disease. There are currently no robust biomarkers that could reliably predict its manifestation, and on the molecular level, it is less well characterized than adult AD.
Objectives:
This study aimed to extend previous findings and provide evidence for distinct changes of the epidermal proteome and microbiome preceding the onset of AD as well as characterizing early AD.
Methods:
We longitudinally analysed epidermal biomarker levels and microbial profiles in a cohort of 50 neonates at high risk for AD, who had participated in a randomized controlled trial on early emollient use for AD prevention.
Results:
About 26% of the infants developed AD until month 24 with an average age of 10 month at disease onset. In children with later AD, IL-1Ra, TNFβ, IL-8, IL-18, IL-22, CCL2, TARC, TSLP and VEGFa showed increased levels prior to disease manifestation with levels of IL-1Ra, TNFβ and VEGFa already increased shortly after birth. Further, children with later AD displayed a delayed maturation and differentially composed skin microbiome prior to AD onset. At manifestation, levels of multiple Th2, Th17/22 and Th1-associated biomarkers as well as innate immunity markers were elevated, and abundances of commensal Streptococcus species were reduced in favour of Staphylococcus epidermidis.
Conclusions:
Our results indicate that elevations of proinflammatory stratum corneum biomarkers and alterations of the skin microbiome precede paediatric AD and characterize the disease at onset.
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