Weekly Eczema News Report 03/01/2023: Germ Warfare, Atopic Dermatitis In Lupus Patients, And The Case Of Mysterious Bacteria

Greetings! Meteorological spring begins this week, on March 1; this is a time for gardeners to start preparing their flowerbeds and vegetable patches, and for those of us who are not gardeners to enjoy the warmer, breezier days. This is a transitional period, as the cooler temperatures of winter begin to rise. In many places, this corresponds to an increase of thunderstorms and tornadoes; if this applies to you, take steps to ensure that you have an emergency plan with a safe place to shelter in the events of such weather. 

This also marks the beginning of allergy season for many of us. Eczema sufferers and others with conditions associated with atopy (asthma and rhinitis, for example) should make extra efforts to manage triggers during this time. 

Keeping a watch on pollen counts is key. Laundering clothes and washing hair after outdoor activities can reduce the transfer of pollen into living areas, as can the use of indoor air purifying systems and frequent vacuuming with a HEPA filter.

Good skin care is more important for you now if springtime pollen is a trigger for you, so be sure to wash with gentle cleansers, use a high-quality moisturizer, and remember that you have recourse to SmartLotionⓇ to help treat any outbreaks. Speak to your dermatologist and/or allergist if you need extra tools to manage eczema in the spring. 

Spring blows in with a lot of interesting news this week! In skin-related news, we find that viruses might soon be able to help us treat acne that resists antibiotic treatments–and a collagen abnormality common to atopic dermatitis, systemic lupus erythematosus (SLE), and other skin-related disorders has been identified. An association between microbiome abnormalities and two separate autoimmune disorders–SLE and multiple sclerosis (MS), respectively–has been discovered, which may help simplify the diagnosis of these complex diseases in the future. 

A Germ Warfare Approach for Acne Treatment?

Almost all English speakers have heard the phrase, “fighting fire with fire.” Recent research into the treatment of acne vulgaris shows a possible way to fight germs with more germs. 

Phages, or bacteriophages, are viruses that attack specific bacteria. They function by lysing bacteria, or causing lysis–a process by which cells are destroyed by ruptures of the cell membranes. Bacteriophages are found wherever bacteria exist, and they are abundant with an estimated 1031 species found on earth. 

Phages pose no direct threat to humans in and of themselves; they consist primarily of nucleic acids and proteins. So could we harness the lysing power of these phages to fight bacterial infection?

There has been evidence that phages could have some application in fighting skin disease since 1937. A phage corresponding to Cutibacterium acnes, the bacterium that most commonly causes acne vulgaris, was identified in 1964. Little research was done on applying this insight to treating acne, however, for years. 

Cue the discovery of multiple antibiotic-resistant C. acnes strains. Cutibacterium acnes colonizes the hair follicles and sebaceous glands. For many of us, it triggers an innate immune response which results in cytokine production, which leads to the redness and swelling we associate with acne. 

For several years, acne has been treated with both oral and topical antibiotics such as tetracycline, erythromycin, and clindamycin. Over the past two decades, however, an increase in antibiotic-resistant strains of C. acnes have been documented worldwide; antibiotic resistance ranges from 20-60%, which complicates the treatment of acne. 

The interest in phages for acne treatment has likewise increased. A promising Israeli study published in Nature Communications last week identified eight different phages that were useful in mice studies for topical treatment of lesions caused by several different C. acnes strains. The study authors note that while mice can be infected with C. acnes, acne itself is a condition unique to humans–so further studies must be conducted before any conclusions about treating humans can be reached. They also remark that while they found no strains that resisted both phage and antibiotic treatment, the possibility of “such a mutant” should not be discounted. 

They conclude by saying, “Taken together, our results support the notion that phage therapy has the potential to offer an additional, efficient, and safe treatment strategy for acne vulgaris and suggest that further clinical trials need to be undertaken to validate these findings, and determine the patient population that would benefit from phage therapy.” 

Collagen Abnormality Identified in Atopic Dermatitis, Lupus Patients

The extracellular matrix (ECM) of the dermis, the basement-layer of our skin, is a network of proteins and other molecules that help maintain the skin’s structure, and to a less-understood degree, its function. 

The ECM undergoes “remodeling” as a necessary part of maintaining homeostasis; the proteins in the ECM must adjust to maintain the skin’s integrity in the face of environmental stressors, and also when the skin is injured. 

Fibrous proteins called collagens play a primary role in the ECM of the dermis and its remodeling processes. Collagens are responsible for maintaining the integrity of the skin’s structure and for the regeneration of damaged tissues.

There are different types of collagen, each formed from different chains of amino acids, each of them playing a different role in ECM remodeling. When the remodeling process is dysregulated, as is seen in inflammatory diseases of the skin, the configuration of collagen chains is not normal. Some amino acids in these chains might be abnormally high, while others are deficient. 

Elevated levels of Type VI collagen, specifically, have been associated with atopic dermatitis in several studies over the years.  A recent study in Cophenhagen, published in Scientific Reports in late February, resulted in the creation of an immunoassay that can identify a fragment of a Type VI collagen chain (called C6A6) in the blood; the study also found an association between higher Type VI collagen serum levels and atopic dermatitis, psoriasis, hidradenitis suppurativa, systemic lupus erythematosus, systemic sclerosis, urticaria, vitiligo, and cutaneous malignant melanoma. 

The study’s authors found that C6A6 was detectable in human serum, as well as mouse and rat serum, and that C6A6 is found in higher levels in patients with the aforementioned conditions. They also found that higher serum levels of C6A6 corresponded with increased severity of eczema symptoms. 

This points to an effective blood test for diagnosing inflammatory skin disorders in the future; in the case of diseases like lupus, which can be difficult and time-consuming to diagnose, this is definitely a boon. The study’s authors also found that topical calcineurin inhibitors were associated with lower levels of C6A6, supporting their use in the treatment of these diseases.

The researchers say that, as far as they are aware, this is the first time that a blood test to detect C6A6 has been designed–a definite win in our quest to understand inflammatory skin conditions. 

The Case of the Mysterious Bacteria X

Multiple Sclerosis (MS) is a devastating disease that affects millions. It is caused by an abnormal immune response (often associated with viral infection) in which antibodies attack the myelin sheath of the neurons in the central nervous system (CNS). This can result in abnormal sensations, ranging from mild pins and needles to severe pain, loss of sensation, gait and balance issues, and damage to the optic nerve, to name but a few of the problems MS patients endure. 

For several years, we have known that the gut microbiome of MS patients differs dramatically from that of healthy individuals. Researchers presented evidence at the recent 2023 Conference for  Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) of a correlation between a specific bacterium and inflammation associated with Secondary Progressive MS (SPMS). 

Researchers report that a certain bacterial species is overabundant in the guts of people with SPMS, and that these bacteria could possibly promote neuroinflammation and play a role in the progression of disability for these patients. 

The researchers did not name the bacterial strain, citing subject confidentiality concerns, calling them “bacteria X.” They isolated the bacteria from the guts of SPMS patients and transferred them to mouse subjects, observing that this led to more pronounced disability and increased amounts of the TH-17 cells, pro-inflammatory immune cells associated with MS-related inflammation. 

They hypothesize that the activity of this bacterium’s flagella–hairlike appendages that help the bacterium move and also to invade cells–promotes inflammation. 

Daiki Takewaki, one of the researchers involved in the study, told conference attendees, “We confirmed that bacteria X has the capacity of inducing Th17 cells in the gut and subsequently exacerbate neuronal inflammation.”

Takewaki added that the bacteria is “possibly associated with disease progression from RRMS to SPMS.”

Takewaki says that there is a possibility that targeting the bacteria might prove beneficial in slowing the progression of SPMS. 

“The selective elimination of pathogenic bacteria, including this bacteria X, might lead to innovate therapies for SPMS patients,” he said. 

Secondary Progressive MS is a particularly demoralizing form of the disease. With relapsing/remitting MS (RRMS), patients experience flares of inflammation, during which they experience worsening symptoms, followed by a “remission” when the symptoms typically lessen and the damaged myelin sheath can repair itself to a degree. Patients with RRMS generally respond well to disease-modifying therapies. 

If a patient advances to SPMS, the disease progresses without remissions. Secondary progressive MS does not respond well to treatment, and SPMS is associated with greater levels of disability than RRMS. Advances in the research of SPMS, such as the discovery of Bacteria X, are hard-won first steps in developing more effective treatments of this disease. 

Oral Microbiome Peculiarities of Lupus

Like MS, systemic lupus erythematous (SLE), commonly known simply as lupus, is an autoimmune disorder. Unlike MS, in which the immune cells target neurons, lupus is characterized by immune system attacks on multiple systems. This includes the skin, joints, blood, and internal organs.

While the gut microbiome’s relation to the disease has been extensively studied, the oral microbiome has received less attention. Researchers in China decided to remedy that. They published the findings of their study recently in The Journal of Translational Medicine. 

The study authors found that SLE patients have markedly different oral microbiota than healthy subjects. In addition, the oral microbiome of SLE patients changed as the disease progressed, with certain strains of bacteria associated with greater severity of the disease. 

Prevotella and Veillonella were higher in SLE patients, they say, while Streptococcus and Porphyromonas was lowered. During flares, Abiotrophia and Lactobacillales populations increased, while populations of Phyllobacterium and Micrococcusaceae decreased. 

The samples were taken from simple, non-invasive scrapings of tongue coatings; this, say the researchers, could one day become the basis of a less-invasive diagnostics tool for SLE. 

The news this week has been pretty good, I’d say, perfect for the beginning of brighter, warmer days. Take care of yourselves and your microbiomes, and have a wonderful spring!