title: Ustekinumab treatment in severe atopic dermatitis: Down-regulation of T-helper 2/22 expression.
abstract: BACKGROUND
  It has recently been suggested that patients with moderate to severe atopic dermatitis (AD) may profit from anti-interleukin (IL)-12/-23 p40 therapy.
  
  
  OBJECTIVE
  We sought to assess the immunologic effects of ustekinumab treatment on AD skin and to correlate them with the clinical efficacy of this drug.
  
  
  METHODS
  We investigated the course of 3 patients with severe AD who were administered 45 mg of subcutaneous ustekinumab over a period of 16 weeks. Clinical scores and skin biopsy specimens, taken at baseline and at week 8, were used to assess changes in disease severity.
  
  
  RESULTS
  All patients showed a gradual improvement of the disease, achieving a 50% reduction in the Eczema Area and Severity Index score by week 16. Immunohistology of skin biopsy specimens revealed a significant decrease in the degree of epidermal hyperplasia/proliferation and the number of infiltrating dermal T cells, dendritic cells, and mast cells after treatment. Using quantitative real-time polymerase chain reaction of lesional skin, we found a clear reduction of T-helper 2-/22-associated molecules after therapy.
  
  
  CONCLUSIONS
  The small number of patients (n = 3) limits efficacy analysis and warrants prospective placebo-controlled studies in larger patient cohorts.
  
  
  CONCLUSIONS
  Blocking IL-12/-23 p40 could be beneficial for a subgroup of patients with severely infiltrated AD.
authors.affiliation: Department of Dermatology, Division of Immunology, Allergy, and Infectious Diseases, Medical University of Vienna, Vienna, Austria.
authors.forename: Doris
authors.initials: D
authors.lastname: Weiss
authors.affiliation: Department of Dermatology, Division of Immunology, Allergy, and Infectious Diseases, Medical University of Vienna, Vienna, Austria.
authors.forename: Michaela
authors.initials: M
authors.lastname: Schaschinger
authors.affiliation: Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
authors.forename: Robin
authors.initials: R
authors.lastname: Ristl
authors.affiliation: Department of Dermatology, Venereology, and Allergology, Medical University of Innsbruck, Innsbruck, Austria; Division of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Gruber
authors.affiliation: Juvenis Medical Center, Vienna, Austria.
authors.forename: Tamara
authors.initials: T
authors.lastname: Kopp
authors.affiliation: Department of Dermatology, Division of Immunology, Allergy, and Infectious Diseases, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Stingl
authors.affiliation: Department of Dermatology, Division of Immunology, Allergy, and Infectious Diseases, Medical University of Vienna, Vienna, Austria. Electronic address: christine.bangert@meduniwien.ac.at.
authors.forename: Christine
authors.initials: C
authors.lastname: Bangert
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D016207:Cytokines / Q000235:genetics / Q000378:metabolism; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000473:pathology*; D003879:Dermatologic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015536:Down-Regulation / Q000187:drug effects*; D005260:Female; D015870:Gene Expression / Q000187:drug effects; D006801:Humans; D007801:Langerhans Cells / Q000187:drug effects; D008297:Male; D008407:Mast Cells / Q000187:drug effects; D008875:Middle Aged; D012333:RNA, Messenger / Q000378:metabolism; D012720:Severity of Illness Index; D013602:T-Lymphocytes, Cytotoxic / Q000187:drug effects; D018417:Th1 Cells / Q000378:metabolism; D058504:Th17 Cells / Q000378:metabolism; D018418:Th2 Cells / Q000187:drug effects / Q000378:metabolism*; D000069549:Ustekinumab / Q000493:pharmacokinetics* / Q000627:therapeutic use
chemical_list: D016207:Cytokines; D003879:Dermatologic Agents; D012333:RNA, Messenger; D000069549:Ustekinumab
keywords: T helper 17; T helper 2; T helper 22; anti-interleukin-12/-23 p40; atopic dermatitis; cytokines; eczema; inflammatory; ustekinumab