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Digital archive of theses discussed at the University of Pisa


Thesis etd-04022018-193745

Thesis type
Tesi di dottorato di ricerca
Thesis title
Evaluation Of Predictive Value Of Serological And Cutaneous Markers For The Development Of Atopic Eczema
Academic discipline
Course of study
tutor Prof. Romanelli, Marco
  • Atopic Eczema
  • biomarkers
Graduation session start date
Release date
BACKGROUND/AIM: Atopic Eczema (AE) is not a life-threatening disease but has a dramatic effect on quality of life of patients and their relatives and thereby represents a significant socioeconomic burden. It is still considered a single disease, and in addition to severity, disease management currently does not consider its highly heterogeneous clinical phenotype.
As we are now entering the era of stratified medicine, the discovery of biomarkers as companion diagnostics is becoming a key element in the development of new prevention and therapeutic strategies, the identification of new biomarkers in the field of dermatology and allergy bears a high potential for many purposes. The research thus want to focus on preventive/screening markers, exploring cutaneous and serological markers.
To date, apart from family history, there is no way of accurately identifying which patients may be at greater risk of AE development and who might therefore benefit most from pharmacological and non-pharmacological intervention.
Recently, preliminary data highlighted the role of cutaneous markers, as trans-epidermal water loss (TEWL), as useful predictor of AE, and select those newborns who potentially have the best benefit from early intervention (i.e. daily use of emollient from the first day of life). Preliminary recent evidences highlighted cutaneous changes as predictive of AE, but systemic alterations (reflecting skin and immune mechanisms) may be present at birth and thus have a role as screening markers too. The chemokines CCL17, CCL18, CCL22,CCL27, IL-31, and TSLP (Thymus Stromal Lymphopoietin), are among the most studied systemic markers, as pointed out in our review published in 2017. A correlation between cutaneous and serological markers has not been studied yet.
AIM of the study is thus the evaluation of cutaneous (TEWL and hydration rate) and serological (CCL17, CCL18, CCL22,CCL27, IL-31, and TSLP) markers, their mutual correlation, even when atopic eczema has not appeared yet, in order to achieve new clinical and pathological data of the disease.
METHODS: To achieve these goals cutaneous data were evaluate at one, three and six months in order to predict the AE development. Serological biomarkers, as CCL chemokines CCL17, CCL18, CCL22,CCL27, IL-31, and TSLP (Thymus Stromal Lymphopoietin), were probed in cord blood of newborns.
RESULTS: The analysis of TEWL at antero-cubital fossa precedes and correlates with clinical AE signs, offering to physicians an objective way to evaluate newborns at risk and further preventive strategies.
The analysis of CCL17 and IL-31 cord blood serum levels, among the cytokine examined in this study, has offered new insights in highlighting newborns at risk. No association were found for TSLP, CCL18, CCL22, CCL27. These markers were rarely studied in the literature.
We believe that the novel findings in this study will facilitate and inform stratification of future intervention studies.