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特应性皮炎(Atopic Dermatitis, AD) 是一种慢性、复发性、炎症性皮肤疾病,常伴有强烈瘙痒、皮肤干燥和屏障功能受损。它通常发生于儿童期,但可持续或首次发病于成人。AD 的发病机制复杂,涉及遗传易感性、免疫系统失衡(尤其是Th2介导的炎症反应)、皮肤微生物群失调以及环境因素等。该病不仅影响皮肤健康,还严重损害患者的睡眠、心理状态和生活质量。
最新研究进展
免疫通路研究与靶向治疗的突破:对Th2相关细胞因子(如IL-4、IL-13、IL-31)的深入研究推动了生物制剂的发展。代表药物**dupilumab(度普利尤单抗)**通过阻断IL-4Rα信号通路显著改善中重度AD症状,成为里程碑式疗法。新一代靶向药物(如IL-13单抗lebrikizumab、IL-31受体拮抗剂nemolizumab)正在临床试验中显示良好疗效。
小分子口服药物的崛起:Janus激酶(JAK)抑制剂(如upadacitinib、abrocitinib、baricitinib)通过调控多条细胞因子通路,快速缓解瘙痒和皮疹,已成为生物制剂之外的重要治疗选择。
皮肤屏障修复与微生物组研究:研究证实皮肤屏障蛋白(如filaggrin)突变及金黄色葡萄球菌(S. aureus)定植与AD严重程度密切相关。针对皮肤菌群重塑和屏障修复的外用新策略(益生菌霜、脂质调节制剂)正逐步进入临床。
系统性管理理念形成:从单纯皮肤病管理转向全身性炎症疾病干预,强调与哮喘、过敏性鼻炎等共病的综合管理。
亟需解决的临床痛点
早期诊断与分层不足:不同人群(儿童、成人、慢性复发型)病理特征差异显著,缺乏精准的分型与预测标志物。
治疗长期依从性差:外用药治疗需长期坚持,患者依从性与安全性监测不足。
难治性与复发性管理挑战:部分患者对生物制剂或JAK抑制剂反应有限,停药后易复发。
安全性与成本问题:长期系统性免疫调节治疗的安全性(尤其是JAK抑制剂的感染与血栓风险)及经济负担亟待优化。
心理与社会影响被低估:AD常伴焦虑、抑郁等心理共病,但心理支持体系尚未完善。
特应性皮炎的治疗正从传统的对症管理转向以免疫通路精准干预为核心的个体化治疗。未来的研究重点应聚焦于早期分型诊断、生物标志物发现、长期疗效与安全性评估,以及皮肤—免疫—微生态互作机制的深入解析,以实现更持久、更安全的疾病控制与生活质量提升。
我们仅对美国国立卫生研究院(NIH)资助的在研特应性皮炎相关项目进行梳理,希望给同仁们的选题思路提供一点启发。
2025年,以 "Atopic Dermatitis"为检索词、在题目中进行检索,美国NIH针对特应性皮炎的在研有30项。
一,谁获得了这些研究?
1. 在研基金最多的PI:
LEUNG, DONALD YM,国家犹太人健康(NATIONAL JEWISH HEALTH)
NADEAU, KARI C.,哈佛大学(HARVARD UNIVERSITY)
GEHA, RAIF SALIM,波士顿儿童医院(BOSTON CHILDREN'S HOSPITAL )
2,基金最多的研究机构
NATIONAL JEWISH HEALTH 美国国家犹太健康中心
HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH 哈佛大学公共卫生学院
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO 加利福尼亚大学旧金山分校
BOSTON CHILDREN'S HOSPITAL 波士顿儿童医院
WASHINGTON UNIVERSITY 华盛顿大学(圣路易斯)
二,研究热点
研究领域总览(根据关键词)
研究大的方向也包括儿童特应性皮炎(Pediatric Atopic Dermatitis)、免疫反应(Immune Responses)、金黄色葡萄球菌(S. Aureus)等。
三,借鉴与突破
我们也分享在该领域的几项课题摘要,希望对同仁们有所启发。
A,ATOPIC DERMATITIS RESEARCH NETWORK LEADERSHIP CENTER
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in the general population. AD is associated with defective skin barrier function, microbial dysbiosis, as well as various cutaneous immune abnormalities including type 2 inflammation and decreased cutaneous host defense. These abnormalities translate into multiple phenotypes and endotypes that are not fully defined and therefore, effective targeted therapies, beyond type 2 immune blockade, to reverse these various subsets of AD are lacking. Beyond its effects on cutaneous defense, AD is associated with systemic inflammation and appears to be the first step in the development of other atopic conditions including food allergy and asthma. This grant application is being submitted in response to RFA-AI-19-014, Atopic Dermatitis Research Network-Leadership Center (ADRN-LC). The goal of this proposal is to create an ADRN-LC which will provide the overall scientific strategy and organizational structure to the ADRN and will interact closely with the ADRN Clinical Research Centers (ADRN-CRCs), to support the conduct of multi-site clinical studies and trials that will elucidate mechanisms of skin barrier dysfunction and cutaneous immune responses in atopic dermatitis (AD). The central hypothesis in this application is that different phenotypes and endotypes of AD are associated with distinct defects in their skin barrier, microbiome, and skin immune responses which can be characterized by novel approaches to skin sampling and open up avenues for paradigm shifting therapeutic interventions to benefit patients with severe persistent AD. We will achieve our objectives with the following Aims: · Specific Aim 1: To establish an Administrative and Clinical Research Operations Leadership Center that will be responsible for implementation, coordination, and funding of clinical trials and studies for the ADRN-LC in research areas evaluating mechanism and treatment of AD. · Specific Aim 2: To develop a Network-wide multi-center ADRN clinical trial to evaluate the long- term effects of targeted microbiome transplantation on clinical outcomes in AD as well as epithelial barrier function, microbial dysbiosis, and cutaneous immunity. · Specific Aim 3: To design a Network-wide ADRN one-year observational study to assess the stability of AD phenotypes/endotypes using a Network correlation analysis of transcriptomics (conventional and single cell RNA sequencing), skin tape proteomics, lipidomics, and microbiome over time in subjects with persistent mild vs. persistent severe AD and assessment of therapeutic responses to topical corticosteroids and Dupilumab. · Specific Aim 4: To carry out a Network-wide multi-center ADRN clinical trial to examine the effects of targeted IL-1 blockade on the clinical outcome, skin microbiome, epithelial skin barrier, and cutaneous immune response in AD patients who have an inadequate response to IL-4/IL-13 blockade using Dupilumab therapy. Accomplishment of these Specific Aims will contribute to novel and important advances in our understanding of mechanisms of host skin defense and paradigm-shifting treatments of AD. The establishment of this ADRN-LC will also provide budgetary and scientific resources for the Systems Biology of Early Atopy Birth Cohort study that is under development by the Consortium for Food Allergy Research (CoFAR).
B, SEAL (Stopping Atopic dermatitis and ALlergy) Study: Prevent allergy by enhancing the skin barrier
SEAL (Stopping Eczema and ALlergy) Study Food allergy (FA) is an epidemic among children in the U.S., U.K., and other countries. There is increasing evidence that epicutaneous allergen sensitization through a dysfunctional skin barrier results in allergic responses whereas early consumption of food allergens induces oral tolerance, as described by the dual allergen exposure hypothesis. In the Learning Early About Peanut LEAP and Enquiring About Tolerance (EAT) studies, dry skin and the severity and the duration of eczema or atopic dermatitis (AD) in the 1st year of life were predictors of peanut allergy (PA) and sensitization. In the SEAL study, we aim to intervene very early in a high-risk infant group, as soon they have the earliest onset of dry skin or eczema in the 1st 10 weeks of life, but before they have developed allergies. By reducing the duration and severity of eczema and preventing eczema exacerbations, we aim to prevent epicutaneous allergen sensitization and significantly reduce the incidence of FA. Our primary objective is to test if the combination of trilipid skin emollient use early in life with proactive topical steroids decreases the prevalence of FA compared to controls. We propose a randomized (1:1), controlled trial design for infants with dry skin or eczema (n=750 total) to compare the effect of proactive treatment against a reactive treatment group for the prevention of FA, by reducing dry skin, and the severity and duration of eczema in early infancy. We will test our hypothesis with the following specific aims using world-class clinical research units known for excellent recruitment and retention of patient cohorts, mechanistic testing, and state of the art research. Specific Aim 1: To determine if proactive versus reactive treatment will reduce the occurrence of FA in a prospective, randomized, and controlled intervention trial of infants with eczema. Specific Aim 2: To test whether the skin of children in the proactive treatment will show improved epithelial barrier markers with increased commensal bacteria colonization. Specific Aim 3: To determine whether proactive treatment will be associated with protective immune responses. If the aims are achieved, our proposal will make a clinical impact by providing a new, clinical strategy to prevent the occurrence of FA in young infants that present with the earliest signs of dry skin or eczema.
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