Journal of Advanced Research

Journal of Advanced Research

Volume 44, February 2023, Pages 71-79
Journal of Advanced Research

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

https://doi.org/10.1016/j.jare.2022.03.019Get rights and content
Under a Creative Commons license
open access

Highlights

  • We conducted a large-scale investigation of skin microbiota composition and diversity in BP.

  • We reveal substantial differences in skin microbiota in patients with BP compared to that of control subjects.

  • We observe a transitional stage between normal- and diseased skin within patients with BP.

  • BP is characterized by a loss of protective microbiota and an increase in S. aureus, an inflammation-promoting species.

  • S. aureus ubiquitously associates with BP, suggesting a role in pathogenesis.

  • Our results may help inform clinical markers for assessing BP disease risk and prognosis.

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.

Keywords

Autoimmune blistering disease
Bullous pemphigoid
Skin microbiota
16s rRNA gene sequencing
Risk factor

Abbreviations

AI
autoimmune
BP
bullous pemphigoid
AIBD
Autoimmune blistering disease
BPDAI
Bullous Pemphigoid Disease Area Index
DF
degrees of freedom
IS
indicator species
ASV
amplicon sequence variant

Cited by (0)

Peer review under responsibility of Cairo University.

1

Authors contributed equally to this work.