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Complementary Analysis of Local and Systemic Effects of Dupilumab in Paediatric AD Using Tape Strips and Serum
Lisa P van der Rijst1,2, Edward F Knol2,3, Nicolaas P A Zuithoff4
1Department of Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Insights
Dupilumab treatment rapidly reduced immune mediators like PARC/CCL18 and TARC/CCL17 in children with atopic dermatitis. Minimally invasive tape strips effectively monitored these local and systemic skin changes alongside clinical improvement.
Area of Science:
- Immunology
- Dermatology
- Proteomics
Background:
- Atopic dermatitis (AD) is a chronic inflammatory skin disease.
- Understanding local and systemic immune responses is crucial for effective treatment monitoring.
Purpose of the Study:
- To investigate immune-related proteins in tape strips and serum of pediatric AD patients treated with dupilumab.
- To correlate these protein changes with clinical severity.
Main Methods:
- Twenty pediatric AD patients received dupilumab.
- Serum and tape strip samples were collected at baseline, 4, and 16 weeks.
- Fifteen proteins were measured using Luminex, alongside Eczema Area and Severity Index (EASI) and Numeric Rating Scale (NRS) itch scores.
Main Results:
- Dupilumab treatment significantly reduced PARC/CCL18 and TARC/CCL17 in skin and serum.
- Tape strips showed reductions in IL-8, IL-18, CTACK/CCL27, CXCL10, periostin, and MMP-1.
- PARC/CCL18 strongly correlated with AD severity (EASI and NRS itch).
Conclusions:
- Dupilumab treatment induces distinct local and systemic proteomic changes in pediatric AD.
- Tape strips and serum complement each other in profiling immune and epidermal proteins.
- Minimally invasive tape stripping is useful for monitoring treatment responses in pediatric AD.
Objective:
This study investigates local and systemic immune-related proteins in tape strips and serum of paediatric atopic dermatitis (AD) patients treated with dupilumab, and explores their correlation with clinical severity.
Methods:
Twenty paediatric AD patients (< 18 years) starting dupilumab treatment were included. Serum samples and tape strips from lesional and non-lesional skin were collected at baseline, 4 and 16 weeks of treatment. Fifteen pre-specified proteins were measured at each visit by Luminex multiplex immunoassay. Clinical severity outcome measures included the Eczema Area and Severity Index (EASI) and Numeric Rating Scale (NRS) itch. Statistical analyses included Wilcoxon signed-rank tests and Spearman correlations.
Results:
Along with clinical improvement, 16 weeks of dupilumab treatment resulted in a rapid and significant reduction in the disease-associated mediators PARC/CCL18 and TARC/CCL17 in both tape-stripped skin and serum. While the cytokine and chemokine profiles differed between the sampling methods, both effectively captured immunological changes associated with dupilumab treatment. Tape strips demonstrated significant reductions in innate pro-inflammatory cytokines (IL-8/CXCL8, IL-18), the T cell-recruiting chemokine CTACK/CCL27, the Type 1 immune mediator CXCL10, and tissue repair and remodelling proteins (periostin, MMP-1) in response to treatment, but were less sensitive in detecting T cell-derived cytokines (IL-4, IL-13). In both skin and serum, several proteins were significantly correlated with AD severity, as measured by EASI and NRS itch, with PARC/CCL18 emerging as the strongest correlated protein.
Conclusion:
Our findings provide insight into the distinct local and systemic proteomic changes in response to dupilumab treatment in paediatric AD patients. These findings underscore the complementary roles of tape strips and serum in profiling immune and epidermal barrier proteins, highlighting the utility of minimally invasive tape stripping for monitoring proteomic responses to targeted therapies in paediatric AD.
