A drug strategy aimed at revving up the immune system and boosting a type of immune cell known as natural killer cells appears to effectively treat eczema in mice. Eczema is most commonly treated by suppressing the immune system, but not all patients get relief. The approach, from researchers at Washington University School of Medicine in St. Louis, may point to a potential treatment for the skin condition, as well as other health problems linked to it, including asthma. At least 10 percent of the U.S. population has eczema - an itchy, splotchy rash that leaves many patients discouraged due to a lack of many effective treatments. Therapies for eczema include topical steroids, drugs called calcineurin inhibitors, and the monoclonal antibody drug dupilumab (Dupixent), all of which treat the rash by blocking part of the body’s immune response.
Natural killer (NK) cells, a type of immune cell, are also being evaluated as a cancer therapy. These cells play a particular role in attacking cells the immune system recognizes as foreign, including some tumor cells. In the new study - published in the journal Science Translational Medicine - the researchers were surprised to learn that natural killer cells also effectively treated eczema in mice. “If you look at the skin of the mice we studied, their eczema resolves in a way we haven’t seen before with other therapies,” says principal investigator Brian S. Kim, MD, a dermatologist and an associate professor of medicine and co-director of Washington University’s Center for the Study of Itch & Sensory Disorders. “And so far, our mouse model of eczema has accurately predicted what we will see in patients. Eczema is a chronic disease, and using steroids day in and day out is not advisable because it can contribute to thinning of the skin, which can contribute to other side effects. Long-term use can lead to easy bruising and even stretch marks on the skin. We need more reliable treatments to bring relief, and we think boosting natural killer cells may be one way to do that.”
The researcher noticed over time that his patients tend to have very low levels of NK cells in their blood. “We were perplexed as to why that might be, but the numbers were low enough, consistently enough, that eventually we started using them almost like a diagnostic tool. If we had any doubt about whether a person had eczema, we’d take a blood sample and look at their NK cell levels.”
Helping Eczema Patients
Using a mouse model of the skin disease and removing the animals’ ability to make NK cells, he noticed that markers of inflammation in the animals worsened. Later, when they used an investigational drug prototype to increase the number of NK cells in the animals, inflammation lessened, and the mice got better. In addition to improving skin rash associated with eczema, boosting the numbers of NK cells could help restore immunity to viruses in eczema patients. People who have very low numbers of NK cells turn out to be more susceptible to the herpes virus, pox viruses and HPV viruses, among others.
Rather than revving up part of the immune system, the drug dupilumab, on the other hand, blocks part of the body’s immune response. The drug was approved for clinical use in 2017, and is safe, very effective and has helped many eczema patients improve. Patients typically receive injections of the drug twice a month. However, about 60 percent of those treated with the drug in clinical trials did not respond as well as their doctors would have liked. In addition, some patients see improvement on most of the body but experience flare-ups on the face. There also are side effects in some patients, such as conjunctivitis.
Researchers are eager to see if the strategy of revving up part of the immune system might help eczema patients. Investigational drugs that increase NK cell populations are being tested as treatments for some types of cancer in clinical trials at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. Those studies suggest the drugs selectively boost NK cells, so the researchers now working with researchers from Siteman to test them in a clinical trial targeting eczema. “We have a patent pending for this strategy, and we’re planning to move toward trials,” Kim said. “And we won’t limit our studies to eczema. This strategy could help patients who have asthma or food allergies, conditions that often appear along with eczema.”
Could Treating Eczema Alleviate Asthma?
Scientists from VIB-UGent have discovered insights for a possible new therapy for eczema that also reduces the severity of asthma. The findings are an important next step in understanding the relationship between the two inflammatory diseases and to developing effective therapies. The results of the study are published in the Journal of Investigative Dermatology. Children with atopic dermatitis (AD), a type of eczema of the skin, show an increased risk of developing asthma later in life. This phenomenon, also known as atopic march, raises questions on whether therapies can be developed that not only tackle AD, but also prevent the onset of other allergic diseases. Intrigued by this possibility, a team of VIB scientists took to the lab.
House dust mites are known culprits in the development of both AD and asthma, as exposure to the mites induces inflammation. Dr. Julie Deckers, Prof. Karolien De Bosscher and Prof. Hamida Hammad – all with VIB-UGent Center for Inflammation Research - created a mouse model to look further into the relationship between the two diseases. "As predicted, our test showed that house dust mite-induced skin inflammation leads to aggravated levels of allergic airway inflammation,” Deckers said. “Yet, to our surprise, this response significantly differs from the reaction to direct exposure of house dust mites in the lungs without prior skin inflammation. These results have given us a deeper understanding of the complexity of the atopic march."
The real challenge, however, was to investigate whether the relief of skin inflammation might influence the subsequent development of asthma. The team therefore combined two anti-inflammatory compounds - corticosteroids and PPARƴ agonists - into one potential treatment in mice. "The combined therapy effectively alleviated AD, but was insufficient at preventing allergic asthmatic response in the lungs,” she added. “However, the treatment did significantly reduce the severity of the asthma by counteracting one aspect of the specific immune response in the lungs. In this way, the therapy represents a potent remedy against allergic skin inflammation and the aggravation of atopic march."
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With over 30 years of writing and editing experience for newspapers, magazines and corporate communications, Kevin Kerfoot writes about natural health, nutrition, skincare and oral hygiene for Trusted Health Products’ natural health blog and newsletters.
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