Sodium in the Skin and Atopic Dermatitis: The SIS-AD Study

摘要 自20世纪50年代以来，特应性皮炎（AD）的发病率增加了两倍，并且在城市和工业化地区最高， 可能是由于环境和饮食因素的变化。特应性皮炎现在是最负担的皮肤 全球范围内的疾病，病程和对新免疫调节治疗的反应仍然很高， 变量有一个关键的需要，以确定可修改的因素，可以改善病人的结果。中央 该建议的假设是过量的膳食钠（主要以作为盐消耗）集中在 皮肤作为对屏障功能差和水分损失以及皮肤钠的高水平的生理反应 加重特应性皮炎的临床表型。这个项目的基本原理是，皮肤作为一个 这是一个重要的调节器官，储存大量的钠;高浓度的钠会引发 炎症，包括特异性特应性皮炎的TH 2途径。我们的长期目标是了解 皮肤钠会影响炎症，并测试减少盐的摄入或储存是否会改善特应性 皮炎第一个具体目标将集中在皮肤中钠储存的原因上，并将评估 膳食钠摄入量和皮肤屏障功能对皮肤钠浓度影响第二特定 aim将关注皮肤钠的含义，并将检查皮肤钠与 特应性皮炎的严重性和持久性。它还将定义与以下疾病相关的功能性免疫概况： 皮肤和血液中的高钠。为了实现这些目标，我们将进行纵向队列研究， 对90名年龄> 50岁男性和女性进行了研究。入组将按钠摄入量和特应性分层 基线时的皮炎状态和严重程度。将使用食物频率问卷和尿液评估饮食 在每次研究访视之前，将使用一种新的非生物标志物测量皮肤钠浓度。 侵入性钠MRI技术。参与者将在入组后接受两年的随访。我们 多学科团队结合了临床和转化研究、营养和心血管方面的专业知识 流行病学、免疫学和高级成像。这一建议是创新的应用前沿 这些技术可以对皮肤中的钠进行成像，并确定皮肤和血液中的免疫细胞亚群。它还测试了一个 一种新的概念模型，将钠生理学和免疫学的发展联系起来， 特应性皮炎流行病学趋势的刺激。这一点很重要，因为其结果将用于 设计一项临床试验，代表一种全新的AD管理方法， 而不是仅仅关注免疫抑制。而且，它会增进我们对 钠生理学的方式，最终可能会影响高血压患者的管理， 心血管疾病

ABSTRACT Atopic dermatitis (AD) rates have tripled since the 1950s, and are highest in urban and industrialized areas, likely due to changing environmental and dietary factors. Atopic dermatitis is now the most burdensome skin disease globally, and disease course and response to new immunomodulatory treatments remain highly variable. There is a critical need to identify modifiable factors that could improve patient outcomes. The central hypothesis of this proposal is that excess dietary sodium (consumed primarily as salt) is concentrated in the skin as a physiologic response to poor barrier function and water loss, and that high levels of skin sodium exacerbate the clinical phenotype of atopic dermatitis. The rationale for this project is that the skin serves as an osmoregulatory organ, storing large amounts of sodium; and that high sodium concentrations trigger inflammation, including TH2 pathways specific to atopic dermatitis. Our long-term goals are to understand how skin sodium influences inflammation and to test whether reducing salt intake or storage improves atopic dermatitis. The first specific aim will focus on reasons for sodium storage in the skin and will evaluate the impact of dietary sodium intake and skin barrier function on skin sodium concentration. The second specific aim will focus on the implications of skin sodium and will examine the extent to which skin sodium is associated with atopic dermatitis severity and persistence. It will also define functional immune profiles associated with high skin sodium both in skin and in the blood. To achieve these aims, we will perform a longitudinal cohort study of 90 men and women age > 50 at enrollment. Enrollment will be stratified by sodium intake and atopic dermatitis status and severity at baseline. Diet will be evaluated using food frequency questionnaires and urine biomarkers prior to each study visit, and skin sodium concentration will be measured using a novel, non- invasive sodium MRI technique. Participants will be followed for two years after enrollment. Our multidisciplinary team combines expertise in clinical and translational research, nutritional and cardiovascular epidemiology, immunology, and advanced imaging. This proposal is innovative in its application of cutting-edge techniques to image sodium in the skin and to define immune cell subsets in the skin and blood. It also tests a new conceptual model that links developments in the understanding of sodium physiology and immune stimulation with epidemiologic trends in atopic dermatitis. It is significant because the results will be used to design a clinical trial that would represent a fundamentally new approach to AD management that addresses disease triggers rather than focusing only on immunosuppression. Moreover, it will improve our understanding of sodium physiology in ways that could ultimately impact the management of patients with hypertension and cardiovascular disease.