Editors' ChoiceDERMATOLOGY

Defining targets to defeat hidradenitis suppurativa

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Science Translational Medicine  05 Jul 2017:
Vol. 9, Issue 397, eaan8200
DOI: 10.1126/scitranslmed.aan8200

Abstract

Immunological data implicates IL-17 pathway in the pathogenesis of hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is an idiopathic, chronic debilitating disease of apocrine skin that results in painful, draining skin nodules in the groin, axillae, and inframammary skin. Treatment includes prolonged multidrug antibiotic regimens and other agents that only provide partial and temporary relief. Recent success with anti–tumor necrosis factor (TNF) therapy is encouraging, yet ineffective, in a large subset of patients and highlights the need for detailed characterization of the immune response in HS in order to identify more specific therapeutic targets.

To that end, Moran et al. analyzed flow cytometry data obtained from the skin of anti-TNF treatment-naïve HS patients and compared it with that of anti-TNF–treated HS patients as well as healthy controls. Significantly, they found increased expression of interleukin-17 (IL-17)–producing cells in HS skin and identified those as T helper cell 17 (TH17) cells. Additionally, they describe dysregulation of the ratio of TH17:Treg cells in HS skin, which interestingly was corrected with anti-TNF treatment. This supports overall immune dysregulation as an etiological factor in HS and may suggest an explanation for the partial treatment success of anti-TNF agents in patients with HS. Next, they conducted cellular polyfunctionality analysis and demonstrated that overall treatment-naïve HS patients had more active T helper cells, confirming immune dysregulation in HS. They also found that in HS-skin, IL-17 and TNF expression predominated, and they were the most commonly coexpressed cytokines. Importantly, these trends were reversed with anti-TNF treatment.

Taken together these data expand the limited yet promising rationale for targeting the IL-17 pathway in treatment of HS. This is especially relevant as IL-17–specific agents are readily available on the market and may present a new horizon of hope for frustrated doctors and patients with this life-altering affliction. Notably the study is limited by lack of matched controls, small number of patients, and the heterogeneous severity of disease. Nonetheless, this study may help clinicians open the gate for new future therapies.

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