New vaccine may help treat children with skin condition

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Skin lotions are one of the current treatments for eczema. Catherine Falls Commercial/Getty Images
  • Researchers in Ireland say a new vaccine may help treat eczema flares in children.
  • They say the vaccines would be tailored to children’s individual “immune signatures.”
  • Current treatments include keeping skin from getting too dry and moisturizing using lotions.

A multi-disciplinary team from Ireland’s Trinity College Dublin published a study today in the journal JCI Insight suggesting a “tailored vaccine” could affectively tame bacteria-driven eczema in children.

The researchers have identified new cellular targets for a vaccine after they furthered their understanding of how the immune response works in cases of eczema caused by the common staphylococcus aureusbacterium.

Eczema, also known as atopic dermatitis, affects up to one in four children in Ireland, the researchers said in a statement.

Characterized by dry, itchy skin and “weeping” wounds when bacteria is involved, the wounds can become more serious infections and impact someone’s quality of life.

Though rare, eczema can lead to life-threatening systemic infections such as septicaemia (when bacteria enters the bloodstream and cause blood poisoning).

“There is a real need for new options to treat and prevent infected flares of eczema in children,” said Dr. Julianne Clowry, a consultant dermatologist, visiting research fellow at Trinity, and lead author of the study, in a statement. “Current strategies are limited in their success and even when they do provide relief, the effects may be short-term as symptoms often return.”

“Although antibiotics are needed in some cases, scientists are trying hard to deliver alternative options due to the growing problems posed by antimicrobial resistance,” she added.

Clowry said when combined, the detrimental factors make a tailored vaccine an attractive target to possibly limit the severity of eczema, produce longer lasting and better outcomes, and reduce the need for antibiotics “all while also reducing the risk of complications and potentially the development of other atopic diseases, such as hay fever and asthma.”

The research team came together from different departments at the college, including the schools of medicine, statistics, and computer science.

Together, the researchers said, they uncovered important “immune signatures” in children with infected flares of eczema. Focusing on those signatures provided them new specific targets, which they said was helpful in designing a theoretical vaccine.

The team worked with 93 children, some as old as 16 years. Researchers examined immune responses between three groups: those with eczema and a confirmed S. aureus skin infection, those with eczema but no S. aureusskin infection, and a group of participants without eczema.

Researchers said they found that proportions of “T cells” (white blood cells that fight infection) and other biomarkers varied considerably between the groups. Human bodies contain many different types of T cells, but all play unique roles in regulating how the body responds to infections.

The immune response was impacted in those with infected flares of eczema, with the suppression of some of the important T cells that drive an effective immune response.

The researchers said the findings provide an early map to developing therapies that could give effective, targeted relief from recurrent eczema flares.

“While an interaction between the staphylococcus aureus bug and eczema has been known for many decades, novel scientific approaches are continuing to make key discoveries about the complex relationship between these bacteria and human responses to it,’ said Alan Irvine, a professor of dermatology at Trinity, in a statement. “Our work outlines new discoveries about how children with eczema respond immunologically to infection with this common bacterium.”

Rachel McLoughlin, an immunology professor at Trinity and senior author on the study, said the group identified an overall pattern of immune suppression associated with infected flares of eczema, resulting in the suppression of specific T cells that are vital to initiate an effective immune response.

“Further work is now required to broaden the scope of these results by expanding to a larger number of people,” McLoughlin said in a statement. “This will help confirm if the patterns identified are consistent among different age groups and in sub-groups with greater ethnic diversity.”

Dr. Leslie Young, a pediatrician and primary care physician at MemorialCare Medical Group – Lakewood in California, told Medical News Today the two most important current approaches to controlling eczema are to keep the skin from getting too dry and to reduce skin irritation that is triggered by the dryness.

“Since eczema is a chronic condition and the tendency for the skin to react to dryness is determined by genetics and the immune response, these strategies are only temporary measures that calm episodic flare-ups,” said Young, who was not involved in the study.

“The irritation is usually controlled with topical steroid medications or immune inhibitors, both of which can cause significant side effects when utilized chronically,” Young said. “When infection is involved in eczema exacerbation, oral antibiotics are often used to stop the infection. All these treatments are only effective on a short-term basis.”

Young said the vaccine could help people whose eczema is triggered by infection.

“I am hesitant to recommend this vaccine to people who have never experienced eczema because staphylococcal bacteria often colonize the skin of many healthy individuals and causes no harm to them,” Young said. “The natural presence of this bacteria on healthy skin can prevent the overgrowth of harmful bacteria. I am concerned about the unforeseen consequences of modifying the natural population of bacteria on healthy skin.”

Dr. J. Wes Ulm, a medical researcher and bioinformatics expert who works as an analyst for the National Institutes of Health, told Medical News Today the study is an intriguing and potentially promising approach to disease management that, while still in its early stages, “may nonetheless help to open up a wider range of customized interventions for eczema and diseases like it.”

“Moisturizers or corticosteroid ointments are mainstays of basic treatment, though other topical creams containing substances like PDE-4 [inhibitors] or calcineurin inhibitors – which help to temper the immune and inflammatory responses contributing to eczema – have become more common,” said Ulm, who was not involved in the study. “In general, skin hydration to reduce dryness is the go-to first therapy, particularly for pediatric eczema. In more severe cases, however, treatments like phototherapy, JAK inhibitors – which impede an enzyme – the janus kinase, exacerbating the errant immune response – or subcutaneous (below the skin) biologics are also options.”

Ulm added it’s not likely vaccination would be used as a preventative measure because eczema has a diverse source and onset of illness in different individuals.

‘With that said, it’s possible that further studies will reveal subpopulations – perhaps patient cohorts with genetic variations rendering them particularly susceptible to more severe eczema cases – who might benefit from such a vaccine-based approach to ward off disease onset in the first place,” he said.

Read the full article here

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