Increasing evidence shows that pediatric atopic dermatitis (AD) differs from adult AD on a biological level. Broad biomarker profiling across a wide range of ages of pediatric AD patients is however lacking. In the current study, we used luminex multiplex immunoassays to measure 145 biomarkers in serum from 240 children with AD (aged 0–17 years). Principal components analysis followed by unsupervised k-means cluster analysis were performed to identify patient clusters. Patients were stratified into age groups (0-4 years, 5-11 years, and 12-17 years) to assess association between age and cluster membership. Children aged 0-4 years had highest levels of Th1-skewing markers, and the lowest levels of Th17-related markers. Th2-related markers did not significantly differ between age groups. Similarly to adults, cluster analysis identified four distinct pediatric patient clusters (“Th2/retinol dominant”, “skin-homing dominant”, “Th1/Th2/Th17/IL-1 dominant”, and “Th1/IL-1/eosinophil inferior” cluster). Only the “Th1/Th2/Th17/IL-1 dominant” cluster resembled one of the previously identified adult clusters. Although no association with age or age of onset was found, disease severity was significantly associated with the "skin-homing dominant" cluster. In conclusion, four distinct patient clusters based on serum biomarker profiles could be identified in a large pediatric AD cohort, of which one was similar to previously identified adult clusters. The identification of endotypes driven by distinct underlying immunopathological pathways might be useful to define pediatric AD patients at risk of persistent disease and may necessitate different targeted treatment approaches.

ESDR234 - Unraveling heterogeneity in pediatric atopic dermatitis: identification of serum biomarker based patient clusters.

50th Annual Meeting of the European Society for Dermatological Research. VIRTUAL MEETING