The systemic immune phenotype of AD has been defined in adults and recently in young children with early disease, but chronologic changes in pediatric AD blood through adolescence have not been explored. Defining the chronological sequence of the AD phenotype is critical for leveraging new age-specific targeted treatments and prophylactic approaches. We studied immune activation and cytokine polarization in the blood of 0-5y/o, 6-11y/o, 12-17y/o and >18y/o with AD vs. age-matched controls. Using flow cytometry we measured the frequencies of activated polar CD4+/CD8+ T-cell subsets within skin-homing/CLA+vs. systemic/CLA-T-cells. Intracellular staining defined Th1/Tc1, Th2/Tc2, Th9/Tc9, Th17/Tc17, and Th22/Tc22 populations. Unsupervised clustering was used to differentiate patients based on their blood biomarker frequencies, and sharply distinguished groups aligned along a chronological spectrum. While CLA+Th1 frequencies were significantly lower in infants with AD vs. all older patients (P<0.01), CLA+Th2 T-cells were expanded similarly across all AD age groups compared with controls (P<0.05). After infancy, the CLA-Th2 frequencies were significantly increased in AD in all age groups, suggesting systemic immune activation with chronicity. While IL-22 frequencies were not increased in AD infants, they serially increased to highly significant in adolescents and adults compared to respective controls (P<0.01). Th1 frequencies nearly doubled between 0-5 and 5-12y/o in both AD (7.7% vs. 14%; P=0.03) and controls (11.9% vs. 19.5%; P=0.04), but the Th1/Th2 ratio remained significantly decreased in AD across all age groups vs. controls. Unique cytokine signatures in different patient age-groups advocate for specific rather than uniform therapeutic approaches. Comparing the profile of cleared vs persistent pediatric AD, ideally through longitudinal studies, will better define age-specific changes that predict AD clearance.
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