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Serum leptin and adiponectin levels in atopic dermatitis (AD) and their relation to disease severity

2016; Elsevier BV; Volume: 75; Issue: 3 Linguagem: Inglês

10.1016/j.jaad.2016.04.036

1097-6787

Byeol Han, Wen Hao Wu, Jung Min Bae, Sook‐Ja Son, June Hyunkyung Lee, Tae Young Han,

Adipokines, Inflammation, and Metabolic Diseases

To the Editor: There has been accumulating clinical evidence for an association between obesity and the prevalence of atopic dermatitis (AD).1Zhang A. Silverberg J.I. Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis.J Am Acad Dermatol. 2015; 72: 606-616.e4Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar One hypothesis explaining this association is disruption of immune tolerance induced by obesity-associated adipokines including leptin and adiponectin.2Hersoug L.G. Linneberg A. The link between the epidemics of obesity and allergic diseases: does obesity induce decreased immune tolerance?.Allergy. 2007; 62: 1205-1213Crossref PubMed Scopus (194) Google Scholar The aim of this study was to identify the relationship between body mass index (BMI) and AD severity and to investigate whether adipokine levels are associated with AD severity. This study included patients with AD who visited the Department of Dermatology at Eulji Medical Center in Seoul, Korea, between January 2015 and August 2015. This study was approved by the Ethics Committee of Eulji Medical Center, and informed consent was obtained from each patient. The diagnosis of AD was based on the criteria of Hanifin and Rajka as described by Zhang and Silverberg.1Zhang A. Silverberg J.I. Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis.J Am Acad Dermatol. 2015; 72: 606-616.e4Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar Intrinsic AD was defined by low total serum IgE levels (≤200 kU/L), and extrinsic AD was defined by high total serum IgE levels (>200 kU/L). Severity of AD was evaluated by means of the Severity Scoring of AD (SCORAD) index. In this study, we examined the serum leptin and adipokine levels of patients with AD using multiplex assay. BMI, serum total IgE, total eosinophil count, and proinflammatory and anti-inflammatory cytokines were measured. Pearson correlation test was performed to determine the correlations among these measurements. An independent t test and analysis of covariance were used to examine the difference in serum adiponectin level between extrinsic AD and intrinsic AD. All analyses were performed using software (R 3.0.1; R Foundation for Statistical Computing, Vienna, Austria). There were 64 Korean patients with AD (27 male and 37 female) with an average age of 17.3 (range 1-46) years. Of them, 41 cases of extrinsic AD and 23 of intrinsic AD were included. The mean SCORAD was 35.1 and mean BMI was 20.3 kg/m2. In the Pearson correlation analyses, there was a significant association between BMI and SCORAD (r = .246, P = .05), which is consistent with previous reports.1Zhang A. Silverberg J.I. Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis.J Am Acad Dermatol. 2015; 72: 606-616.e4Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar, 3Koutroulis I. Magnelli L. Gaughan J. Weiner E. Kratimenos P. Atopic dermatitis is more severe in children over the age of two who have an increased body mass index.Acta Paediatr. 2015; 104: 713-717Crossref PubMed Scopus (15) Google Scholar Furthermore, positive correlation between BMI and total IgE level (r = 0.374, P = .002) and negative correlation between total IgE and adiponectin (r = –0.254, P = .043) were observed. BMI and leptin had a significant correlation (r = 0.48, P < .001) and an inverse correlation was observed between BMI and adiponectin (r = –0.463, P < .001). There were no significant differences in the analysis of leptin and adiponectin levels according to SCORAD index (Fig 1). The mean adiponectin levels in extrinsic AD (18232 ng/mL) were lower than in intrinsic AD (13,403 ng/mL) using an independent t test (P = .05). This difference was also significant when using analysis of covariance, with covariance for BMI (P = .05) (Fig 2). Between 2 categories of AD, extrinsic and intrinsic type, important differences in T-cell polarity have been demonstrated. Our data suggested that adiponectin may play a more significant role in extrinsic AD than intrinsic AD.Fig 2Mean serum adiponectin levels in intrinsic and extrinsic atopic dermatitis (AD). Extrinsic AD has lower adiponectin levels than intrinsic AD (P = .05).View Large Image Figure ViewerDownload Hi-res image Download (PPT) The adipose tissue in obese individuals leads to a systemic inflammatory state producing changes in the serum levels of cytokines, chemokines, and adipokines. Among adipokines, serum leptin is a proinflammatory that affects both innate and adpative immune responses and serum adiponectin has important anti-inflammatory effects in obesity.2Hersoug L.G. Linneberg A. The link between the epidemics of obesity and allergic diseases: does obesity induce decreased immune tolerance?.Allergy. 2007; 62: 1205-1213Crossref PubMed Scopus (194) Google Scholar, 4Yuksel H. Sogut A. Yilmaz O. Onur E. Dinc G. Role of adipokines and hormones of obesity in childhood asthma.Allergy Asthma Immunol Res. 2012; 4: 98-103Crossref PubMed Scopus (56) Google Scholar Adipokines have been reported to be associated with allergic diseases such as asthma, AD, and allergic rhinitis.2Hersoug L.G. Linneberg A. The link between the epidemics of obesity and allergic diseases: does obesity induce decreased immune tolerance?.Allergy. 2007; 62: 1205-1213Crossref PubMed Scopus (194) Google Scholar, 4Yuksel H. Sogut A. Yilmaz O. Onur E. Dinc G. Role of adipokines and hormones of obesity in childhood asthma.Allergy Asthma Immunol Res. 2012; 4: 98-103Crossref PubMed Scopus (56) Google Scholar In asthma, increased airway hyperresponsiveness induced by high leptin levels and low adiponectin levels is considered one of the mechanisms of association between obesity and asthma.5Shore S.A. Terry R.D. Flynt L. Xu A. Hug C. Adiponectin attenuates allergen-induced airway inflammation and hyperresponsiveness in mice.J Allergy Clin Immunol. 2006; 118: 389-395Abstract Full Text Full Text PDF PubMed Scopus (251) Google Scholar Although adipokines are considered one of the factors in the puzzle of obesity and AD, their exact pathogenic role and influences should be further investigated.