The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization

Shinji Noda; Mayte Suárez-Fariñas; Benjamin Ungar; Soo Jung Kim; Cristina De Guzman Strong; Hui Xu; Xiangyu Peng; Yeriel D. Estrada; Saeko Nakajima; Tetsuya Honda; Jung U. Shin; Hemin Lee; James G. Krueger; Kwang Hoon Lee; Kenji Kabashima; Emma Guttman-Yassky

doi:10.1016/j.jaci.2015.08.015

The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased T_H17 polarization

Shinji Noda, Mayte Suárez-Fariñas, Benjamin Ungar, Soo Jung Kim, Cristina De Guzman Strong, Hui Xu, Xiangyu Peng, Yeriel D. Estrada, Saeko Nakajima, Tetsuya Honda, Jung U. Shin, Hemin Lee, James G. Krueger, Kwang Hoon Lee, Kenji Kabashima, Emma Guttman-Yassky

Department of Dermatology

Research output: Contribution to journal › Article › peer-review

425 Citations (Scopus)

Abstract

Background Atopic dermatitis (AD) shows very high prevalence in Asia, with a large unmet need for effective therapeutics. Direct comparisons between European American (EA) and Asian patients with AD are unavailable, but earlier blood studies detected increased IL-17⁺-producing cell counts in Asian patients with AD. Objective We sought to characterize the Asian AD skin phenotype and compare it with the EA AD skin phenotype. Methods We performed genomic profiling (real-time PCR) and immunohistochemistry on lesional and nonlesional biopsy specimens from 52 patients with AD (25 EAs and 27 Asians), 10 patients with psoriasis (all EAs), and 27 healthy subjects (12 EAs and 15 Asians). Results Although disease severity/SCORAD scores were similar between the AD groups (58.0 vs 56.7, P =.77), greater acanthosis, higher Ki67 counts, and frequent parakeratosis were characteristics of lesional epidermis from Asian patients with AD (P <.05). Most (24/27) Asian patients had high IgE levels. A principal component analysis using real-time PCR data clustered the Asian AD phenotype between the EA AD and psoriasis phenotypes. T_H2 skewing characterized both Asian and EA patients with AD but not patients with psoriasis. Significantly higher T_H17 and T_H22 (IL17A, IL19, and S100A12 in lesional and IL-22 in nonlesional skin; P <.05) and lower T_H1/interferon (CXCL9, CXCL10, MX1, and IFNG in nonlesional skin; P <.05) gene induction typified AD skin in Asian patients. Conclusion The Asian AD phenotype presents (even in the presence of increased IgE levels) a blended phenotype between that of EA patients with AD and those with psoriasis, including increased hyperplasia, parakeratosis, higher T_H17 activation, and a strong T_H2 component. The relative pathogenic contributions of the T_H17 and T_H2 axes in creating the Asian AD phenotype need to be tested in future clinical trials with appropriate targeted therapeutics.

Original language	English
Pages (from-to)	1254-1264
Number of pages	11
Journal	Journal of Allergy and Clinical Immunology
Volume	136
Issue number	5
DOIs	https://doi.org/10.1016/j.jaci.2015.08.015
Publication status	Published - 2015 Jul 9

Bibliographical note

Publisher Copyright:
© 2015 American Academy of Allergy, Asthma & Immunology.

All Science Journal Classification (ASJC) codes

Immunology and Allergy
Immunology

Access to Document

10.1016/j.jaci.2015.08.015

Cite this

Noda, S., Suárez-Fariñas, M., Ungar, B., Kim, S. J., De Guzman Strong, C., Xu, H., Peng, X., Estrada, Y. D., Nakajima, S., Honda, T., Shin, J. U., Lee, H., Krueger, J. G., Lee, K. H., Kabashima, K., & Guttman-Yassky, E. (2015). The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased T_H17 polarization. Journal of Allergy and Clinical Immunology, 136(5), 1254-1264. https://doi.org/10.1016/j.jaci.2015.08.015

@article{62741180bd4b4ee7860bc22cb30b206b,

title = "The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization",

abstract = "Background Atopic dermatitis (AD) shows very high prevalence in Asia, with a large unmet need for effective therapeutics. Direct comparisons between European American (EA) and Asian patients with AD are unavailable, but earlier blood studies detected increased IL-17+-producing cell counts in Asian patients with AD. Objective We sought to characterize the Asian AD skin phenotype and compare it with the EA AD skin phenotype. Methods We performed genomic profiling (real-time PCR) and immunohistochemistry on lesional and nonlesional biopsy specimens from 52 patients with AD (25 EAs and 27 Asians), 10 patients with psoriasis (all EAs), and 27 healthy subjects (12 EAs and 15 Asians). Results Although disease severity/SCORAD scores were similar between the AD groups (58.0 vs 56.7, P =.77), greater acanthosis, higher Ki67 counts, and frequent parakeratosis were characteristics of lesional epidermis from Asian patients with AD (P <.05). Most (24/27) Asian patients had high IgE levels. A principal component analysis using real-time PCR data clustered the Asian AD phenotype between the EA AD and psoriasis phenotypes. TH2 skewing characterized both Asian and EA patients with AD but not patients with psoriasis. Significantly higher TH17 and TH22 (IL17A, IL19, and S100A12 in lesional and IL-22 in nonlesional skin; P <.05) and lower TH1/interferon (CXCL9, CXCL10, MX1, and IFNG in nonlesional skin; P <.05) gene induction typified AD skin in Asian patients. Conclusion The Asian AD phenotype presents (even in the presence of increased IgE levels) a blended phenotype between that of EA patients with AD and those with psoriasis, including increased hyperplasia, parakeratosis, higher TH17 activation, and a strong TH2 component. The relative pathogenic contributions of the TH17 and TH2 axes in creating the Asian AD phenotype need to be tested in future clinical trials with appropriate targeted therapeutics.",

author = "Shinji Noda and Mayte Su{\'a}rez-Fari{\~n}as and Benjamin Ungar and Kim, {Soo Jung} and {De Guzman Strong}, Cristina and Hui Xu and Xiangyu Peng and Estrada, {Yeriel D.} and Saeko Nakajima and Tetsuya Honda and Shin, {Jung U.} and Hemin Lee and Krueger, {James G.} and Lee, {Kwang Hoon} and Kenji Kabashima and Emma Guttman-Yassky",

note = "Publisher Copyright: {\textcopyright} 2015 American Academy of Allergy, Asthma & Immunology.",

year = "2015",

month = jul,

day = "9",

doi = "10.1016/j.jaci.2015.08.015",

language = "English",

volume = "136",

pages = "1254--1264",

journal = "Journal of Allergy and Clinical Immunology",

issn = "0091-6749",

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number = "5",

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Noda, S, Suárez-Fariñas, M, Ungar, B, Kim, SJ, De Guzman Strong, C, Xu, H, Peng, X, Estrada, YD, Nakajima, S, Honda, T, Shin, JU, Lee, H, Krueger, JG, Lee, KH, Kabashima, K & Guttman-Yassky, E 2015, 'The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased T_H17 polarization', Journal of Allergy and Clinical Immunology, vol. 136, no. 5, pp. 1254-1264. https://doi.org/10.1016/j.jaci.2015.08.015

TY - JOUR

T1 - The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization

AU - Noda, Shinji

AU - Suárez-Fariñas, Mayte

AU - Ungar, Benjamin

AU - Kim, Soo Jung

AU - De Guzman Strong, Cristina

AU - Xu, Hui

AU - Peng, Xiangyu

AU - Estrada, Yeriel D.

AU - Nakajima, Saeko

AU - Honda, Tetsuya

AU - Shin, Jung U.

AU - Lee, Hemin

AU - Krueger, James G.

AU - Lee, Kwang Hoon

AU - Kabashima, Kenji

AU - Guttman-Yassky, Emma

PY - 2015/7/9

Y1 - 2015/7/9

N2 - Background Atopic dermatitis (AD) shows very high prevalence in Asia, with a large unmet need for effective therapeutics. Direct comparisons between European American (EA) and Asian patients with AD are unavailable, but earlier blood studies detected increased IL-17+-producing cell counts in Asian patients with AD. Objective We sought to characterize the Asian AD skin phenotype and compare it with the EA AD skin phenotype. Methods We performed genomic profiling (real-time PCR) and immunohistochemistry on lesional and nonlesional biopsy specimens from 52 patients with AD (25 EAs and 27 Asians), 10 patients with psoriasis (all EAs), and 27 healthy subjects (12 EAs and 15 Asians). Results Although disease severity/SCORAD scores were similar between the AD groups (58.0 vs 56.7, P =.77), greater acanthosis, higher Ki67 counts, and frequent parakeratosis were characteristics of lesional epidermis from Asian patients with AD (P <.05). Most (24/27) Asian patients had high IgE levels. A principal component analysis using real-time PCR data clustered the Asian AD phenotype between the EA AD and psoriasis phenotypes. TH2 skewing characterized both Asian and EA patients with AD but not patients with psoriasis. Significantly higher TH17 and TH22 (IL17A, IL19, and S100A12 in lesional and IL-22 in nonlesional skin; P <.05) and lower TH1/interferon (CXCL9, CXCL10, MX1, and IFNG in nonlesional skin; P <.05) gene induction typified AD skin in Asian patients. Conclusion The Asian AD phenotype presents (even in the presence of increased IgE levels) a blended phenotype between that of EA patients with AD and those with psoriasis, including increased hyperplasia, parakeratosis, higher TH17 activation, and a strong TH2 component. The relative pathogenic contributions of the TH17 and TH2 axes in creating the Asian AD phenotype need to be tested in future clinical trials with appropriate targeted therapeutics.

AB - Background Atopic dermatitis (AD) shows very high prevalence in Asia, with a large unmet need for effective therapeutics. Direct comparisons between European American (EA) and Asian patients with AD are unavailable, but earlier blood studies detected increased IL-17+-producing cell counts in Asian patients with AD. Objective We sought to characterize the Asian AD skin phenotype and compare it with the EA AD skin phenotype. Methods We performed genomic profiling (real-time PCR) and immunohistochemistry on lesional and nonlesional biopsy specimens from 52 patients with AD (25 EAs and 27 Asians), 10 patients with psoriasis (all EAs), and 27 healthy subjects (12 EAs and 15 Asians). Results Although disease severity/SCORAD scores were similar between the AD groups (58.0 vs 56.7, P =.77), greater acanthosis, higher Ki67 counts, and frequent parakeratosis were characteristics of lesional epidermis from Asian patients with AD (P <.05). Most (24/27) Asian patients had high IgE levels. A principal component analysis using real-time PCR data clustered the Asian AD phenotype between the EA AD and psoriasis phenotypes. TH2 skewing characterized both Asian and EA patients with AD but not patients with psoriasis. Significantly higher TH17 and TH22 (IL17A, IL19, and S100A12 in lesional and IL-22 in nonlesional skin; P <.05) and lower TH1/interferon (CXCL9, CXCL10, MX1, and IFNG in nonlesional skin; P <.05) gene induction typified AD skin in Asian patients. Conclusion The Asian AD phenotype presents (even in the presence of increased IgE levels) a blended phenotype between that of EA patients with AD and those with psoriasis, including increased hyperplasia, parakeratosis, higher TH17 activation, and a strong TH2 component. The relative pathogenic contributions of the TH17 and TH2 axes in creating the Asian AD phenotype need to be tested in future clinical trials with appropriate targeted therapeutics.

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JO - Journal of Allergy and Clinical Immunology

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