Early skin inflammatory biomarker is predictive of development and persistence of atopic dermatitis in infants

Georgios N Stamatas; Takahiro Sato; Carol Ní Chaoimh; Thierry Oddos; Richard Insel; Jonathan O'B Hourihane; Alan D Irvine

doi:10.1016/j.jaci.2024.02.018

Early skin inflammatory biomarker is predictive of development and persistence of atopic dermatitis in infants

J Allergy Clin Immunol. 2024 Mar 7:S0091-6749(24)00234-3. doi: 10.1016/j.jaci.2024.02.018. Online ahead of print.

Authors

Georgios N Stamatas¹, Takahiro Sato², Carol Ní Chaoimh³, Thierry Oddos⁴, Richard Insel², Jonathan O'B Hourihane⁵, Alan D Irvine⁶

Affiliations

¹ Translational Science Essential Health, Johnson & Johnson Santé Beauté, Santé Beauté, France. Electronic address: georgios.stamatas@outlook.com.
² World Without Disease Accelerator, Janssen R&D, Titusville, NJ.
³ Paediatrics and Child Health, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland.
⁴ Translational Science Essential Health, Johnson & Johnson Santé Beauté, Santé Beauté, France.
⁵ INFANT Research Centre, University College Cork, Cork, Ireland; Paediatrics and Child Health, Royal College of Surgeons, Dublin, Ireland.
⁶ Clinical Medicine, Trinity College Dublin, Dublin, Ireland.

PMID: 38460678
DOI: 10.1016/j.jaci.2024.02.018

Abstract

Background: The Short-Term Topical Application for Prevention of Atopic Dermatitis (STOP AD) study, a randomized, open-label trial evaluating the effect of short-term (from the first 4 postnatal days to age 8 weeks) skin barrier protection using Aveeno Dermexa Fast & Long-Lasting Balm (Johnson & Johnson, New Brunswick, NJ) in infants with a parent with allergic disease, demonstrated decreased cumulative incidence and decreased prevalence of atopic dermatitis (AD) at age 12 months.

Objective: In the STOP AD study, we aimed to identify skin biomarkers that are associated with risk of development of AD.

Methods: Skin swabs were collected from the cheek and antecubital fossa (AF) at baseline, age 8 weeks, and age 12 months from subsets of study participants from the intervention arm (n = 43 of 119) and control arm (n = 43 of 138) and were analyzed for specific cytokines (CCL27, CXCL2, human β-defensin-1 [hBD-1], IL-18, IL-8, IL-1α, IL-1 receptor antagonist [IL-1RA], IL-1β, S100A8/9, and IL-36γ) by ELISA.

Results: Higher titers of S100A8/9 at the AF at age 8 weeks in infants with the filaggrin wild-type genotype (FLGwt), but not in those with filaggrin loss-of-function mutation (FLGmut), predicted (1) development of AD in the first year of life (P = .033), (2) presence of AD at ages 6 or 12 months (P = .009 and .035, respectively), (3) persistence of AD between ages 6 and 12 months (P < .001), and (4) development of AD with the emollient intervention.

Conclusion: Increased titers of S100A8/9 from skin swabs of the AF in high-risk infants at age 8 weeks with FLGwt were predictive of AD development in the first year of life and other AD features. These findings suggest that there are different molecular pathways leading to AD in individuals with FLGmut and in individuals with FLGwt. Early identification of infants who are likely to develop AD will allow more targeted interventions.

Keywords: Atopic dermatitis; biomarker; emollient; prediction; skin barrier.