Introduction
Atopic dermatitis (AD) is a common inflammatory skin
disease1 that can significantly impact the quality of
life in affected patients2. Recent advances in
biomarker research have allowed for personalized
medicine3. In oncology, cancer survival rates
increased dramatically in patients presenting genetic traits known to
respond to certain therapies4. Similarly, the
discovery of biomarkers for inflammatory skin diseases could facilitate
their personalized care in the future5. AD is not a
homogeneous entity6, therefore, the identification of
biomarkers for disease endotypes may be of great value for proper
diagnosis7.
Dupilumab is a monoclonal antibody that targets the interleukin-4
receptor alpha (IL-4Rα) and is used to treat moderate-to-severe AD by
blocking the signaling pathways that are involved in inflammation and
allergic reactions8. In clinical trials, dupilumab was
effective in reducing the severity of AD symptoms including itch, and
improving the quality of life in many patients9.
However, not all patients respond well to the treatment, and some may
experience side effects. The clinical response to dupilumab in AD
patients can vary, and there are currently no reliable biomarkers that
can predict which patients will respond well to the treatment. Factors
that may affect the response to dupilumab include the severity and
duration of the disease, certain genetic mutations, and other medical
conditions9.
A thorough review by Renert-Yuval et al. summarized the body of
knowledge on the biomarkers in AD10. The authors
indicated that CCL17 and CCL22 are potential biomarkers that correlate
with clinical therapeutic response. One of the more recently suggested
biomarkers of AD severity is the skin microbiome11. It
has been shown that patients suffering from AD display a higher
colonization rate with Staphylococcus aureus (S. aureus )
which is further increased during exacerbation of the
disease12. We previously investigated the microbiome
of atopic dermatitis patients13 but did not evaluate
it upon systemic treatment with biologic therapeutics.
In this study, we aimed to identify biomarkers in AD patients and to
analyze their profile upon systemic therapy with dupilumab.