Would be interested in seeing where this go and looking ahead and subtypes of eosinophilic and non-eosinophilic endotypes and treatment implications

Key Points
• Source: The Journal of Allergy and Clinical Immunology
• Conclusion/Relevance: “Our observations indicate that AD [atopic dermatitis] can be stratified into eosinophilic and non-eosinophilic endotypes and might be an incentive for stratified trial designs and treatment strategies.”
• German researchers employed blood transcriptomic features of moderate to severe AD in 60 adults including 49 patients before and after dupilumab treatment, as well as from an independent sample of 31 patients and 43 controls.
• The eosinophil-high endotype demonstrated greater global dysregulation, a positive association between disease activity and signatures related to IL5 signaling, and pronounced correlations with several target proteins of antibodies or small molecules being explored for AD treatment.
• On the other hand, the eosinophil-low endotype demonstrated little transcriptomic dysregulation and no correlation with disease activity and gene expression.
• “Clinical improvement under dupilumab was accompanied by a decrease of innate immune responses and an increase of lymphocyte signatures including B cell activation and NK cell composition and/or function,” the authors wrote. “The proportion of super-responders was higher in the eosinophil-low endotype (32% vs. 11%). Continued downregulation of IL18RAP, interferon gamma, and granzyme A in the eosinophil-high endotype suggests a residual disturbance of NK cell function despite clinical improvement.”