The nonlesional skin surface distinguishes atopic dermatitis with food allergy as a unique endotype
Donald Y M Leung, Agustin Calatroni, Livia S Zaramela, Petra K LeBeau, Nathan Dyjack, Kanwaljit Brar, Gloria David, Keli Johnson, Susan Leung, Marco Ramirez-Gama, Bo Liang, Cydney Rios, Michael T Montgomery, Brittany N Richers, Clifton F Hall, Kathryn A Norquest, John Jung, Irina Bronova, Simion Kreimer, C Conover Talbot Jr, Debra Crumrine, Robert N Cole, Peter Elias, Karsten Zengler, Max A Seibold, Evgeny Berdyshev, Elena Goleva, Donald Y M Leung, Agustin Calatroni, Livia S Zaramela, Petra K LeBeau, Nathan Dyjack, Kanwaljit Brar, Gloria David, Keli Johnson, Susan Leung, Marco Ramirez-Gama, Bo Liang, Cydney Rios, Michael T Montgomery, Brittany N Richers, Clifton F Hall, Kathryn A Norquest, John Jung, Irina Bronova, Simion Kreimer, C Conover Talbot Jr, Debra Crumrine, Robert N Cole, Peter Elias, Karsten Zengler, Max A Seibold, Evgeny Berdyshev, Elena Goleva
Abstract
Skin barrier dysfunction has been reported in both atopic dermatitis (AD) and food allergy (FA). However, only one-third of patients with AD have FA. The purpose of this study was to use a minimally invasive skin tape strip sampling method and a multiomics approach to determine whether children with AD and FA (AD FA+) have stratum corneum (SC) abnormalities that distinguish them from AD without FA (AD FA-) and nonatopic (NA) controls. Transepidermal water loss was found to be increased in AD FA+. Filaggrin and the proportion of ω-hydroxy fatty acid sphingosine ceramide content in nonlesional skin of children with AD FA+ were substantially lower than in AD FA- and NA skin. These abnormalities correlated with morphologic changes in epidermal lamellar bilayer architecture responsible for barrier homeostasis. Shotgun metagenomic studies revealed that the nonlesional skin of AD FA+ had increased abundance of Staphylococcus aureus compared to NA. Increased expression of keratins 5, 14, and 16 indicative of hyperproliferative keratinocytes was observed in the SC of AD FA+. The skin transcriptome of AD FA+ had increased gene expression for dendritic cells and type 2 immune pathways. A network analysis revealed keratins 5, 14, and 16 were positively correlated with AD FA+, whereas filaggrin breakdown products were negatively correlated with AD FA+. These data suggest that the most superficial compartment of nonlesional skin in AD FA+ has unique properties associated with an immature skin barrier and type 2 immune activation.
Conflict of interest statement
Competing interests: The authors declare that they have no competing interests. D.Y.M.L., E.G., and E.B. are inventors on patent application serial no 62/746,313 submitted by National Jewish Health that covers methods of identifying AD with FA as a unique endotype.
Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.
Figures
Source: PubMed