Tailored vaccine could potentially treat paediatric atopic dermatitis

New research investigating the immune response in bacteria-driven eczema from Trinity College Dublin suggests a tailored vaccine could potentially treat the disorder in children. Eczema affects up to one-in-four children in Ireland and bacterial presentations can progress to severe infections, and in rare cases, to life- threatening systemic infections such as septicaemia.

“There is a real need for new options to treat and prevent infected flares of eczema in children,” said lead author of the study Dr Julianne Clowry, Consultant Dermatologist and Visiting Research Fellow at Trinity.

“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.

“In combination, these factors make a tailored vaccine a very attractive target as it could limit the severity of eczema, lead to better, longer-lasting 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 hayfever and asthma.”

The researchers, from Trinity’s Schools of Medicine, Computer Science and Statistics, Biochemistry, and Immunology, made significant progress in identifying new cellular targets for a vaccine by studying Staphylococcus aureus (S aureus)-related eczema, which is the most frequently associated pathogen with disease exacerbation.

The single-centre study recruited 93 children aged from 0-to-16 years over 10 months. Researchers then formed three groups for comparison of immune responses. The groups included those with: Eczema and a confirmed S aureus skin infection; eczema but no S aureus skin infection; and a healthy group of volunteers.

Prof Alan Irvine, Professor of Dermatology at Trinity, said: “While an interaction between the S 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. Our work outlines new discoveries about how children with eczema respond immunologically to infection with this common bacterium.”

The team used innovative combined Bayesian multinomial models to gain insight into important immune signatures associated with the S aureus bacterium in paediatric atopic dermatitis. The key discovery was that the proportions of T-cells and other biomarkers varied considerably in the different groups, and that the immune response was impacted in those with infected flares of eczema with the suppression of important T-cells that drive an effective immune response. These findings may provide novel targets to support a theoretical vaccine design.

Prof Rachel McLoughlin, Professor in Immunology at Trinity and senior author of the study, added: “This work has identified an overall pattern of immune suppression associated with infected flares of eczema, which results in the suppression of specific T-cells that are vital to help 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. This will help confirm if the patterns identified are consistent among different age groups, and in sub-groups with greater ethnic diversity.

“We believe that a more comprehensive understanding of the immune response to this bacteria S aureus in eczema has significant potential to revolutionise treatment approaches and make a major translational impact in the management of eczema.”