Understanding the role that T cells play in the chronic allergic inflammatory skin disorder, atopic dermatitis (AD), is highly relevant to the development of specific treatments for this debilitating disease. Regulatory T cells (Tregs) normally suppress pro-inflammatory T cells in healthy subjects. The proposed studies will investigate whether Tregs from AD patients can actually contribute to inflammatory responses in the skin. The primary objectives are as follows: (1) To examine the capacity for Tregs to convert to pathogenic T cells which secrete Th2 cytokines upon exposure to factors expressed at the site of allergic inflammation;(2) To determine whether treatments which diminish Th2 pathways can enhance the induction of protective Tregs in vitro. Low expression of CD127 (IL-7R 1 chain) will be used to isolate natural (CD25+CD127lo) and adaptive (CD25negCD127lo) Tregs from AD patients. Data suggests that natural Tregs from these patients can acquire Th2 effector properties, while IL-10-producing adaptive Tregs are protective.
In Aim 1, studies will elucidate the properties of distinct CD127lo Treg types, compare their susceptibility to T cell-activating factors expressed in AD skin, and determine their pathogenic versus protective potential. Multi-color flow cytometry and standard in vitro T cell assays will be used to analyze the phenotype and suppressive function of distinct CD127lo Treg types. Responsiveness of CD127lo T cells to Th2-promoting factors expressed in AD skin (thymic stromal lymphopoietin (TSLP), allergen, or bacterial superantigen) will be examined using flow cytometry imaging to identify IL-4+ T cells undergoing mitosis at the single-cell level. The role of transcription factors involved in Th2 polarization and IL-4 receptor signaling (STAT5 and STAT6) will be assessed in Treg activation mediated by TSLP and in amplification of this response by allergen. Small interfering RNAs will be used to test whether inhibiting Th2 signaling molecules in CD25+CD127lo Tregs can block effector function and restore suppressor activity.
In Aim 2, the presence of distinct types of CD127lo Tregs at the site of allergic inflammation will first be confirmed in skin biopsies from atopy patch test (APT) sites. The capacity for Tregs to convert to Th2 effectors at these sites will be tested in a novel skin explant assay by analyzing the Th2 effector properties of CD25+CD127lo Tregs cultured with keratinocytes from APT sites.
In Aim 3, the goal is to identify treatment strategies which could be used to enhance induction of protective Tregs. The relationship of IL-10-secreting Tregs to other CD127lo Treg types will be analyzed using an allergen variant (H22-Fel d 1) which induces IL-10-expressing T cells. Allergen-specific IL-10-secreting Tregs will be expanded in vitro in order to determine their protective properties and to compare IL-10-secreting Tregs derived from distinct CD127lo precursors. The role of Th2 cytokines in inhibiting induction of IL-10-producing Tregs in vitro will be examined. Changes in induction of this Treg type will be monitored ex vivo during treatments which are known to improve skin condition and to diminish Th2 pathways.

Public Health Relevance

It is widely recognized that T cells play an important role in the inflammation that is a cardinal feature of the chronic allergic skin disease, atopic dermatitis (AD). Although considerable progress has been made in defining the role of regulatory T cells (Tregs) in allergic disease, there are still major gaps in our knowledge. The proposed studies, which investigate how Tregs function in AD skin, are highly relevant to the development of T cell-based treatments for this debilitating disease.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project (R01)
Project #
Application #
Study Section
Hypersensitivity, Autoimmune, and Immune-mediated Diseases Study Section (HAI)
Program Officer
Davidson, Wendy F
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Virginia
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Wisniewski, Julia A; Muehling, Lyndsey M; Eccles, Jacob D et al. (2018) TH1 signatures are present in the lower airways of children with severe asthma, regardless of allergic status. J Allergy Clin Immunol 141:2048-2060.e13
Wisniewski, J A; Commins, S P; Agrawal, R et al. (2015) Analysis of cytokine production by peanut-reactive T cells identifies residual Th2 effectors in highly allergic children who received peanut oral immunotherapy. Clin Exp Allergy 45:1201-13
Romeo, Martin J; Agrawal, Rachana; Pomés, Anna et al. (2014) Reply: To PMID 24084078. J Allergy Clin Immunol 134:762-3
Agrawal, R; Wisniewski, J; Yu, M D et al. (2014) Infection with human rhinovirus 16 promotes enhanced IgE responsiveness in basophils of atopic asthmatics. Clin Exp Allergy 44:1266-73
Agrawal, Rachana; Woodfolk, Judith A (2014) Skin barrier defects in atopic dermatitis. Curr Allergy Asthma Rep 14:433
Romeo, Martin J; Agrawal, Rachana; Pomés, Anna et al. (2014) A molecular perspective on TH2-promoting cytokine receptors in patients with allergic disease. J Allergy Clin Immunol 133:952-60
Wisniewski, J A; Agrawal, R; Minnicozzi, S et al. (2013) Sensitization to food and inhalant allergens in relation to age and wheeze among children with atopic dermatitis. Clin Exp Allergy 43:1160-70
Wisniewski, J; Agrawal, R; Woodfolk, J A (2013) Mechanisms of tolerance induction in allergic disease: integrating current and emerging concepts. Clin Exp Allergy 43:164-76
Agrawal, Rachana; Wisniewski, Julia A; Woodfolk, Judith A (2011) The role of regulatory T cells in atopic dermatitis. Curr Probl Dermatol 41:112-24
Reefer, Amanda J; Hulse, Kathryn E; Lannigan, Josephine A et al. (2010) Flow cytometry imaging identifies rare T(H)2 cells expressing thymic stromal lymphopoietin receptor in a ""proallergic"" milieu. J Allergy Clin Immunol 126:1049-58, 1058.e1-10

Showing the most recent 10 out of 15 publications