Loss of microbial diversity and body site heterogeneity in individuals with Hidradenitis Suppurativa

Abstract

Hidradenitis Suppurativa (HS) is a chronic, scarring, inflammatory skin disease affecting hair follicles in axillae, inguinal, and anogenital regions. Dysbiosis in HS patients compared to healthy subjects is documented. However, whether dysbiosis is specific to particular body sites or skin niches is unknown. We investigated the follicular and skin surface microbiome of the axilla and groin of HS patients (n=11) and healthy individuals (n=10) using 16S rRNA gene sequencing (V3-V4). We sampled non-lesional (HSN) and lesional skin (HSL) of HS patients. β-diversity was significantly decreased (p<0.05) in HSN and HSL skin compared to normal skin with loss of body site and skin niche heterogeneity in HS samples. The relative bacterial abundance of specific microbes was also significantly different between normal and HSN (15 genera) or HSL (21 genera) skin. Smoking and alcohol use influenced the β-diversity (p<0.08) in HS skin. We investigated metabolic profiles of bacterial communities in HS and normal skin using a computational approach.Metabolism, Genetic Information Processing, andEnvironmental Information Processingwere significantly different between normal and HS samples. Altered metabolic pathways associated with dysbiosis of HS skin suggest mechanisms underlying the disease pathology and information about treatment with drugs targeting those pathways.

Skin Microbiota Perturbations Are Distinct and Disease Severity–Dependent in Hidradenitis Suppurativa

“…Building upon prior reports of increased relative abundances of anaerobes in HS, we further define a positive association between relative abundances of anaerobes and disease severity in a diverse North American HS population. Our findings support previous reports of Porphyromonadaceae and Prevotellaceae in HS inguinal creases and extend the spectrum of obligate anaerobes described in HS to include Fusobacteria and Clostridiales (Ring et al, 2019(Ring et al, , 2017Schneider et al, 2019). Colonization of the inguinal crease with these gut and vaginal commensal anaerobes and common wound colonizers is plausible, given the proximity to these anatomic sites and the chronic nature of HS lesions.…”

“…Recent studies have used a genomic approach to examine skin microbiota shifts in HS lesional skin and demonstrated relative abundances of Corynebacterium, Firmicutes, and anaerobes at HS lesional sites (Guet-Revillet et al, 2014;Ring et al, 2019Ring et al, , 2017Schneider et al, 2019). How these skin microbiota perturbations relate to overall disease severity, however, is not understood.…”

A systematic review and critical appraisal of metagenomic and culture studies in hidradenitis suppurativa

“…Skin swab with buffer, punch or cyanoacrylate biopsy [15] This systematic review was prospectively registered with…”

“…Since Cutibacterium is decreased in HS lesions, it is possible that an increase in pH allows a cutaneous dysbiosis to develop and other pathogenic organisms to establish themselves in lesions. [15,45]…”

“…[14] Specifically, they found statistically significant differences between swabs and biopsies in the abundance of Bacteroidetes and Clostridiales as well as differences in α-and β-diversity. In addition, Schneider et al [15] found α-diversity differences in HS samples between cyanoacrylate biopsy and swabs. This contrasts with an earlier and more limited study in 2008 that showed similar compositions between swabs, scrapes and biopsies in healthy controls.…”