Dr Emma Guttman-Yassky Discusses the Role of the Immune Pathway in Atopic Dermatitis

For a long time, researchers were unsure if atopic dermatitis was primarily a barrier disease or an immune-drive disease, but dupilumab has provided a more clear-cut answer, said Emma Guttman-Yassky, MD, PhD, of the Icahn School of Medicine at Mount Sinai Medical Center in New York.

Transcript

How does the immune pathway play a role in atopic dermatitis?

Atopic dermatitis is an evolving field and for many years there was a debate whether it is primarily a barrier disease or primarily an immune-driven disease. There was not a clear-cut answer because the only way to prove it is actually to target specifics to the immune system and to show that you reversed the barrier. And that was not possible really until dupilumab.

There were some hints toward it. There were some immune-based treatments cyclosporine and methotrexate and itolizumab. And they all work, However, they do have some effects on keratinocyte and also they are very broad, so it is not really proving the immune hypothesis. To prove the immune hypthesis you need to take a single cytokine or 2 cytokines, like in this case, target them and then show that you reversed the barrier, and that's proving the immune hypothesis.

And that's exactly what happened here. Because with dupilumab we showed that not only the clinical disease activity was reversed, but by suppressing the cytokines, you also reversed major features of the barrier, such as the thickness, the epidermal hyperplasia. The S100 proteins are increased. You show the trend to improve filaggrin and loricrin.