Characterization of the skin microbiota in bullous pemphigoid patients and controls reveals novel microbial indicators of disease: Characterization of the skin microbiota in bullous pemphigoid patients

Meriem Belheouane, Britt M. Hermes, Nina Van Beek, Sandrine Benoit, Philippe Bernard, Kossara Drenovska, Sascha Gerdes, Regine Gläser, Matthias Goebeler, Claudia Günther, Anabelle von Georg, Christoph M. Hammers, Maike M. Holtsche, Bernhard Homey, Orsolya N. Horváth, Franziska Hübner, Beke Linnemann, Pascal Joly, Dalma Márton, Aikaterini PatsatsiClaudia Pföhler, Miklós Sárdy, Laura Huilaja, Snejina Vassileva, Detlef Zillikens, Saleh Ibrahim, Christian D. Sadik, Enno Schmidt, John F. Baines*

*Corresponding author for this work
3 Citations (Scopus)

Abstract

Introduction: Bullous pemphigoid (BP) is the most common autoimmune blistering disease. It predominately afflicts the elderly and is significantly associated with increased mortality. The observation of age-dependent changes in the skin microbiota as well as its involvement in other inflammatory skin disorders suggests that skin microbiota may play a role in the emergence of BP blistering. We hypothesize that changes in microbial diversity associated with BP might occur before the emergence of disease lesions, and thus could represent an early indicator of blistering risk. Objectives: The present study aims to investigate potential relationships between skin microbiota and BP and elaborate on important changes in microbial diversity associated with blistering in BP. Methods: The study consisted of an extensive sampling effort of the skin microbiota in patients with BP and age- and sex-matched controls to analyze whether intra-individual, body site, and/or geographical variation correlate with changes in skin microbial composition in BP and/or blistering status. Results: We find significant differences in the skin microbiota of patients with BP compared to that of controls, and moreover that disease status rather than skin biogeography (body site) governs skin microbiota composition in patients with BP. Our data reveal a discernible transition between normal skin and the skin surrounding BP lesions, which is characterized by a loss of protective microbiota and an increase in sequences matching Staphylococcus aureus, a known inflammation-promoting species. Notably, Staphylococcus aureus is ubiquitously associated with BP disease status, regardless of the presence of blisters. Conclusion: The present study suggests Staphylococcus aureus may be a key taxon associated with BP disease status. Importantly, we however find contrasting patterns in the relative abundances of Staphylococcus hominis and Staphylococcus aureus reliably discriminate between patients with BP and matched controls. This may serve as valuable information for assessing blistering risk and treatment outcomes in a clinical setting.

Original languageEnglish
JournalJournal of Advanced Research
Volume44
Pages (from-to)71-79
Number of pages9
ISSN2090-1232
DOIs
Publication statusPublished - 02.2023

Research Areas and Centers

  • Academic Focus: Center for Infection and Inflammation Research (ZIEL)
  • Centers: Center for Research on Inflammation of the Skin (CRIS)

DFG Research Classification Scheme

  • 204-05 Immunology

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