title: Circulating LL-37 is a biomarker for eczema severity in children.
abstract: BACKGROUND
  Eczema lesions are characterized by impaired expression of antimicrobial peptides such as cathelicidin, which play crucial roles in the innate immune defence against cutaneous infections. LL-37 corresponds to amino acids 134-170 of human cathelicidin and is a multifunctional host defence molecule essential for normal immune responses to infection and tissue injury.
  
  
  OBJECTIVE
  The aim of this study was to investigate the relationship between childhood eczema and circulating LL-37 levels.
  
  
  METHODS
  One hundred and forty-four eczema children and 36 controls were recruited. Eczema severity was assessed by SCORing Atopic Dermatitis (SCORAD) and serum LL-37 concentration measured using enzyme immunoassay. Patients' skin hydration and transepidermal water loss at forearms were measured using Corneometer and Tewameter.
  
  
  RESULTS
  Patients' mean SCORAD was 49.2 and their disease was classified as mild (n=28; 12.8%), moderate (n=95; 43.6%) and severe (n=95; 43.6%). Serum LL-37 concentrations did not differ between eczema patients and controls (mean: 832 pg/mL vs. 952 pg/mL, P=0.471). However, serum LL-37 concentrations increased with increasing eczema severity among the patients (P=0.005 for trend). This biomarker shows weakly positive correlation with patients' objective SCORAD (r=0.207, P=0.013) and age (r=0.170, P=0.041), but not skin hydration or transepidermal water loss (P>0.09). Linear regression confirmed significant association between objective SCORAD and serum LL-37 when adjusted for age and gender as covariates (β=0.171, P=0.038). On the other hand, serum LL-37 did not differ between patients with and without heavy growth of staphylococci (P=0.151).
  
  
  CONCLUSIONS
  Circulating LL-37 may be a biomarker for severity of childhood eczema, which supports the importance of innate immunity in eczema pathogenesis.
authors.affiliation: Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. tfleung@cuhk.edu.hk
authors.forename: T F
authors.initials: TF
authors.lastname: Leung
authors.forename: K W
authors.initials: KW
authors.lastname: Ching
authors.forename: A P S
authors.initials: AP
authors.lastname: Kong
authors.forename: G W K
authors.initials: GW
authors.lastname: Wong
authors.forename: J C N
authors.initials: JC
authors.lastname: Chan
authors.forename: K L
authors.initials: KL
authors.lastname: Hon
mesh_terms: D023181:Antimicrobial Cationic Peptides / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D002648:Child; D004485:Eczema / Q000097:blood* / Q000473:pathology; D006801:Humans; D054804:Cathelicidins
chemical_list: D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; D054804:Cathelicidins