BACKGROUND: The C-159T polymorphism of the CD14 receptor gene can be associated with the development of atopic dermatitis. Probiotics can modulate chronic inflammation through activation of the CD14 receptor. So, the efficacy of probiotic therapy can be dependent on this genetic polymorphism. AIM: The purpose of the study was to investigate the efficacy of adding probiotic (Lactobacillus acidophilus, LA-5 and Bifidobacterium animalis subsp. lactis, ВВ-12) to standard treatment (ointment of fluticasone propionate 0.005% and emollient) of atopic dermatitis in adults during 28 days, depending on the stratification of patients on CC or TT genotypes of the CD14 receptor gene. MATERIAL AND METHODS: The study included 37 adult patients with AD. There were identified 19 patients with exogenous (IgE-dependent) and 18 with endogenous (IgE-dependent) AD. To evaluate the efficacy of the probiotics all patients were divided into three groups for both exogenous and endogenous AD. The first group was selected from patients with CC genotype (C-159T) who received standard therapy (ointment of fluticasone propionate 0.005% – 2 times a day, emollients – 2 times a day) and probiotic (Lactobacillus acidophilus, LA-5 and Bifidobacterium animalis subsp. lactis, ВВ-12 - 1 capsule 2 times per day) The second group included patients with CC genotype, who received only standard therapy. The third group was presented by patients with TT genotype (C-159T) who received standard therapy and probiotic. The SCORAD and DLQI parameters were evaluated on Day 0, 14 and 28. The level of IL-4, IL-5, IL-10, TGF-β cytokines was determined on Day 0 and Day 28. RESULTS: The results of our study found that the addition of probiotics (Lactobacillus acidophilus, LA-5 and Bifidobacterium animalis subsp. lactis, ВВ-12) to standard treatment (ointment of fluticasone propionate 0.005%, emollient) significantly increased the effectiveness of treatment of atopic dermatitis in adults with exogenous form and CC genotype (C-159T), confirmed by clinical (a significant decrease of SCORAD and DLQI indices) and immunological criteria (a significant decrease of IL-4 and an increase of TGF-β). CONCLUSION: Simultaneous determination of the exogenous or endogenous form, identification of the C-159T genotypes, evaluation of the serum level of IL-4 and TGF-β can serve as an algorithm for the personalised treatment of patients with atopic dermatitis.

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Актуальность. Атопическим дерматитом (АД) страдает 10-20% педиатрического и 1-3% взрослого населения. Распространенность АД в течение последних 30 лет выросла во всем мире, включая около пятой части населения развитых стран. Атопический дерматит или атопическая экзема является хроническим воспалительным заболеванием кожи, представляет серьезную проблему общественного здоровья во всем мире. Эта болезнь имеет существенный социально-экономическое бремя частично из-за отсутствия эффективного лечения, способного контролировать болезнь в долгосрочной перспективе. Целью исследования стал анализ современных представлений патогенеза и особенностей течения атопического дерматита. Материалы и методы. В процессе исследования были использованы методы семантического оценивания научных документов, а также методы структурного и логического анализа. В исследовании использованы материалы планирования и выполнения диссертационной работы по специальности 14.01.20 - кожные и венерические болезни и 14.03.08 - иммунология и аллергология. Результаты. В статье представлены результаты анализа обзора современных научных исследований патогенеза и особенностей течения атопического дерматита. Проанализированы последние направления научного поиска, научная новизна, теоретическое и практическое значение достижений научных исследований в практическом здравоохранении. Освещены подходы к современной профилактики и лечения атопического дерматита. Выводы. Наше настоящее понимание о АД резко изменилось на протяжении последних годов, главным образом, из-за значительного прогресса в эпидемиологии и генетике, огромный прорыв в понимании концепции атопического марша, а также раскрытия новых аспектов анамнеза болезни и изучения форм АД, которые персистируют в течение всей жизни. Четкое определение различных клинических фенотипов, с одной стороны, и потенциальных биомаркеров с другой являются ключевыми элементами для успешного развития новых и персонализированных терапевтических подходов у больных АД.

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Litus O. I., Derkach N. V., Litus V. I. Abstract. The aim of the study was to research polymorphism of the C-159T gene of the CD14 receptor gene and the levels of serum cytokines in exogenous and endogenous atopic dermatitis in adults.Materials and methods. The study included 96 adult patients with atopic dermatitis. The control group consisted of 90 healthy volunteers. The polymerase chain reaction with electrophoretic detection was used to analyze the polymorphism of the gene. The content of total IgE and cytokines of TNF-α, IL-2, γ-IF, IL-4, IL-5, IL-10, TFR-β in serum was determined by ELISA.Results and Discussion. It was found that the prevalence of the CC genotype leads to an increased risk of developing exogenous atopic dermatitis, which is associated with a high level of total IgE, IL-5 and low IL-10, TGF-β at a given genotype. At the same time, the reduction in the risk of development of both endogenous and exogenous atopic dermatitis is associated with prevalence in the population of genotypes CT and TT. Reducing the risk of atopic dermatitis in the presence of the T allele can be explained by the low concentration of IL-5 and high IL-10, TGF-β in comparison with the homozygous genotype of the CC.Conclusions. The risk of development of atopic dermatitis is authentically increased (Р = 0,033) at a prevalence allele with polymorphic site CD14 of a receptor. In the presence of a genotype of CC in patients with exogenous atopic dermatitis high levels of the general IgE, IL-5 and low IL-10, TFR-β in comparison with other genotypes are characteristic.Decreasing the risk of developing exogenous atopic dermatitis endogenous is associated with a prevalence in population of genotypes of СT and TT. The risk of developing atopic dermatitis in the presence allele is reduced. The T is characterized by low concentration of IL-5 and high IL-10, TFR-β in comparison with a homozygous genotype of CC.The risk of atopic dermatitis development is increased with the prevalence of allele C and decreased with allele T of the polymorphic region C-159T of the CD14 receptor.