Here are the ‘spy’ cells that can guide personalised treatment

“No one size fits all”. The same dress does not suit everyone. In medicine, specialists are increasingly taking on the role of a tailor, tailoring treatments to the individual patient based on the characteristics of their condition. This approach can also be applied to the treatment of chronic spontaneous urticaria, a condition that causes hives, skin swelling and severe itching – not to be confused with a classic allergy.

This conclusion is based on research published in Allergy, conducted by experts at Trinity College Dublin led by Niall Conlon (lead author Katia Ridge). The research sought to identify potential markers capable of guiding treatment on a case-by-case basis, by pinpointing specific ‘spy’ cells that characterise the response to treatment. These are known as myeloid progenitors and are a particular type of mast cell, i.e. cells belonging to the white blood cell family.

The study investigated a rare type of mast cell, known as myeloid progenitor cells, in the blood of patients with chronic spontaneous urticaria, comparing these cells in people with chronic spontaneous urticaria and in healthy control subjects. The response to treatment with a specific anti-IgE therapy was also assessed. The research shows that subjects who responded rapidly to this treatment had a higher number of myeloid progenitors in their blood compared with those who responded more slowly to the therapy. Practical implications? This simple laboratory test could be used to predict who is likely to respond best to anti-IgE therapy. There is, moreover, a strong rationale for using mast cells as an assessment parameter. These are, in fact, cells which, once activated by IgE antibodies, release a series of inflammatory factors that trigger the skin response and are ultimately responsible for itching and urticaria.

Essentially, according to the experts, the future routine use (we are still talking about working hypotheses) of these sensor cells could prove extremely useful in personalising treatment, helping to understand how different patients respond differently to the same therapy. However, there are still issues to be clarified, particularly regarding the practical application of tests of this kind. Katia Ridge herself points this out in a note from the Irish university. “Mast cells are difficult to study. Mature mast cells are not found in the blood,” comments the researcher. “For this reason, we used a method to study an extremely rare immature form of mast cell in the blood, known as a mast cell progenitor. Our findings point to potential inflammatory markers in this condition and highlight that chronic urticaria is more than just a skin manifestation.” What’s more, the research findings could have significant implications not only for people with urticaria, but potentially also for other allergic conditions, enabling the prediction of treatment response by exploring the characteristics of these specific cells.