Serum levels of C‐C motif chemokine ligand 2 and interleukin‐8 as possible biomarkers in patients with toxic epidermal necrolysis accompanied by acute respiratory distress syndrome

• Published in: Journal of dermatology 2023-04, Vol.50 (4), p.500-510
• Main Authors: Watanabe, Tomoya, Watanabe, Yuko, Ikeda, Noriko, Aihara, Michiko, Yamaguchi, Yukie
• Format: Article
• Language: English
• Subjects: acute respiratory distress syndrome; biomarker; Biomarkers; Chemokines; Cytokines; Cytokines - metabolism; C‐C motif chemokine ligand 2; Humans; Immunohistochemistry; Interleukin 6; Interleukin-8; Ligands; Monocyte chemoattractant protein 1; Respiratory distress syndrome; Respiratory Distress Syndrome - diagnosis; Respiratory Distress Syndrome - metabolism; Retrospective Studies; Serum levels; Stevens-Johnson Syndrome - complications; Stevens-Johnson Syndrome - diagnosis; Toxic epidermal necrolysis
• ISSN: 0385-2407; 1346-8138
• DOI: 10.1111/1346-8138.16647

Toxic epidermal necrolysis (TEN) is a fatal cutaneous adverse reaction that occasionally affects multiple organs. Acute respiratory distress syndrome (ARDS) is a rare complication that can cause rapid and potentially fatal pulmonary dysfunction. However, the mechanisms underlying TEN‐induced ARDS remain unknown. This retrospective single‐center study aimed to identify potential biomarkers for predicting ARDS onset in TEN patients. Pre‐treatment serum samples were collected from 16 TEN patients and 16 healthy controls (HCs). The serum levels of cytokines/chemokines were determined using the Luminex Assay Human Premixed Multi‐analyte kit. The expression levels of cytokines and chemokines in the skin were examined via immunohistochemistry. The serum levels of C‐C motif chemokine ligand 2 (CCL2), interleukin (IL)‐6, and IL‐8 were significantly higher in TEN patients with ARDS than in those without ARDS and in HCs, whereas those of CCL2 and IL‐8 were not significantly different between TEN patients without ARDS and HCs. There was no significant difference in CCL2 and IL‐8 expression in the skin between TEN patients with and without ARDS. Interestingly, there were no significant differences in the cytokine/chemokine levels between TEN and other organ damage, other than ARDS and TEN without any organ damage. We further analyzed the changes in cytokine/chemokine levels before and after treatment in two TEN patients with ARDS. CCL2, IL‐6, and IL‐8 levels decreased after systemic treatment compared to their baseline levels before treatment at an early stage. These results suggest that IL‐8 and CCL2 may be involved in the pathogenesis of TEN‐induced ARDS and have potential application as predictive markers for ARDS onset.