Understanding the bacterial imbalance in Hidradenitis Suppurativa patients: Insights into microbial community shifts and colonization by opportunistic pathogens

Abstract

Patients suffering from hidradenitis suppurativa (HS) develop painful skin lesions, significantly decreasing their quality of life. This chronic disease is triggered by plugged hair follicles resulting in an aberrant immune response, skin microbiome imbalance and secondary bacterial colonization. As a result, a diversity of treatment options are currently applied, including antibiotics, biologicals like adalimumab and surgery, which often provide only short-term relief. Alternative strategies, like phage therapy, have been proposed but identification of the target bacterium is key. Therefore, a spatial and longitudinal analysis was performed on skin swabs of lesions from 39 HS patients and 18 healthy controls, leading to a total collection of 108 lesional samples and 35 control samples at different time points and locations throughout the body. Samples were subjected to 16S rRNA community analysis, as well as bacterial isolation using aerobic and anaerobic culturing in combination with MALDI-TOF. Our data demonstrate that the bacterial community present in lesions of patients with HS is out of balance compared to healthy individuals, in which the niche ofStaphylococcusandCorynebacteriumis taken over byEscherichia-Shigella. Overall, three bacterial community profiles of HS lesions and one of healthy individuals could be distinguished. Although the overall bacterial composition was not associated with the disease severity defined by the Hurley classification system, lesions often become colonized with opportunistic pathogens includingStaphylococcus aureusandPseudomonas aeruginosaat increasing disease severities. Furthermore, patients with a concurrent IBD diagnosis did not reveal a significantly different bacterial skin community.

Hidradenitis Suppurativa Patients Exhibit a Distinctive and Highly Individualized Skin Virome

“…The findings indicated that cFLVC1 phages primarily target Corynebacterium species, while cFLVC3 phages predominantly infect Staphylococcus species (Figure 4A; Supplementary Table 12). Furthermore, 16S bacterial data obtained from a parallel study was used to confirm the association between the healthy core phages and their respective bacterial host (Figure 4B; Supplementary Table 17) [36]. A notable positive correlation 18 was found between the RA of cFLVC1 and the RA of Corynebacterium (n=51, r=0.29, AdjP=0.039; Figure 4B; Supplementary Table 17), providing further evidence of a connection between these phages and their bacterial hosts.…”

“…A total of 144 samples were collected, consisting of 108 patient samples and 36 healthy control samples. A more detailed overview of the study design and sample collection was previously described by Bens and colleagues [36].…”