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The following is a summary of “Dupilumab-associated ocular surface disease is characterized by a shift from Th2/Th17 toward Th1/Th17 inflammation,” published in the February 2024 issue of Allergy & Immunology by Thormann, et al.

Dupilumab is commonly used to treat atopic dermatitis (AD), but approximately one-third of patients with AD develop dupilumab-associated ocular surface disease (DAOSD), the pathomechanism of which remains poorly understood. For a study, researchers sought to investigate inflammatory markers in tear fluids of patients undergoing dupilumab therapy.

Tear fluids were collected from AD patients with DAOSD (ADwDAOSD), AD patients without DAOSD (ADw/oDAOSD), and non-AD patients before and during dupilumab therapy. A specialized proteomic approach quantified inflammatory markers, while next-generation sequencing technology determined the ocular surface microbiome.

During dupilumab therapy, an upregulation of 31 inflammatory markers was observed in DAOSD tear fluids compared to baseline in patients with AD. Although IL-12B was upregulated in both ADwDAOSD and ADw/oDAOSD groups, inflammatory markers’ patterns significantly differed over time. In the ADwDAOSD group, there was a shift from a mixed Th2/Th17 pattern at baseline toward a Th1/Th17 profile under dupilumab. Additionally, remodeling and fibrosis markers were upregulated in DAOSD. Semantic map and hierarchical cluster analyses of baseline marker expression revealed four clusters distinguishing between AD and non-AD, as well as ADwDAOSD and ADw/oDAOSD patient groups. In a pilot study, dupilumab therapy was associated with a decrease in the richness of the ocular surface microbiome.

DAOSD is characterized by a Th1/Th17 cytokine profile and an upregulation of markers that promote remodeling and fibrosis. The expression pattern of inflammatory markers in tear fluids at baseline may be a prognostic factor for DAOSD.

Reference: onlinelibrary.wiley.com/doi/10.1111/all.16045