Eczema herpeticum (EH) is a disseminated, potentially life-threatening HSV infection in atopic dermatitis (AD) patients. Recently, we showed a type-2 skewed immune response to viruses in EH patients. Dupilumab is a monoclonal antibody targeting the IL-4Ra chain, and therefore acts directly against type-2 inflammation. Molecular investigations examining the impact of dupilumab on the immune defense against viruses are lacking so far. We aimed to analyze the effect of dupilumab on the antiviral response in AD patients with (ADEH+) and without (ADEH-) a history of EH. Blood from 56 AD patients of which 25 were treated with dupilumab as well as from 10 healthy controls was taken and IgE binding HSV-1 gD was measured. PBMCs were stimulated with HSV-1 protein and peptides, respectively, and antigen-reactive T cell enrichment via CD154 or CD137 was performed followed by flowcytometry to display the polarization. Cytokine profiles of HSV-reactive T cell lines (TCL) were examined by cytokine bead assay and MHC-I tetramer+ (HSV-UL25) CD8+ T cells were stained for IL-4 and IFN-gintracellularly. HSV-specific IgE was increased in ADEH+ and significantly reduced in dupilumab treatment patients. Frequencies of HSV-specific TC1 cells were elevated in ADEH- patients treated with dupilumab compared to untreated patients. HSV-specific TH cells showed stable frequencies under dupilumab therapy. Raised IFN-γ and reduced IL-4 production was shown in HSV-UL25-epitope-specific T cells of dupilumab treated AD patients compared to untreated ones. These results suggest that dupilumab strengthens the HSV-specific defense in AD increasing the specific type-1 immune response and attenuating type-2 related reactions including HSV-specific IgE production.

ESDR046 - Influence of dupilumab on HSV-specific immune response in atopic dermatitis

The scientific meeting of the European Society for Dermatological Research (ESDR) is held yearly, usually in September. With an international attendance of more than 1000 skin scientists from around the globe, the four-day event includes short oral presentations from peer-reviewed abstracts, keynote lectures from international experts, sponsored symposia, satellite programs, educational events as well as an important focus on posters, networking and building collaborations amongst scientists. For more information about this year’s meeting visit our website.