University of Oulu

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 Patsatsi, Claudia Pföhler, Miklós Sárdy, Laura Huilaja, Snejina Vassileva, Detlef Zillikens, Saleh Ibrahim, Christian D. Sadik, Enno Schmidt, John F. Baines, Characterization of the skin microbiota in bullous pemphigoid patients and controls reveals novel microbial indicators of disease, Journal of Advanced Research, Volume 44, 2023, Pages 71-79, ISSN 2090-1232,

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

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Author: Belheouane, Meriem1,2,3; Hermes, Britt M.1,2; Van Beek, Nina4;
Organizations: 1Max Planck Institute for Evolutionary Biology, August-Thienemann-Str. 2, 24306 Plön, Germany
2Section of Evolutionary Medicine, Institute for Experimental Medicine, Kiel University, Arnold-Heller-Str. 3, 24105 Kiel, Germany
3Research Center Borstel, Evolution of the Resistome, Leibniz Lung Center, Parkallee 1-40, 23845 Borstel, Germany
4Department of Dermatology, Allergy, and Venereology, University of Lübeck, 23538 Lübeck, Germany
5Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
6Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
7Department of Dermatology and Venereology, Medical University - Sofia, 1, St. G. Sofiiski str, 1431 Sofia, Bulgaria
8Department of Dermatology, Venereology and Allergology, University of Kiel, 24105 Kiel, Germany
9Department of Dermatology, University Hospital, TU Dresden, 01307 Dresden, Germany
10Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
11Department of Dermatology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
12Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
13Department of Dermatology, Rouen University Hospital, INSERM U1234, Normandie University, Rouen, France
14Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
15Autoimmune Bullous Diseases Unit, 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, 56403 Thessaloniki, Greece
16Department of Dermatology, University of Saarland, Homburg/ Saar, Germany
17PEDEGO Research Unit, University of Oulu; Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
18Center for Research on Inflammation of the Skin (CRIS), University of Lübeck, 23538 Lübeck, Germany
19College of Medicine and Sharjah Institute for Medical Research, University of Sharjah, 27272 Sharjah, UAE
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.4 MB)
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Language: English
Published: Elsevier, 2023
Publish Date: 2023-07-13


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.

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Series: Journal of advanced research
ISSN: 2090-1232
ISSN-E: 2090-1224
ISSN-L: 2090-1232
Volume: 44
Pages: 77 - 79
DOI: 10.1016/j.jare.2022.03.019
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by the German Research Foundation (DFG), through Clinical Research Unit 303, project number 269234613, subproject P2, jointly awarded to Prof. Dr. John F. Baines and Prof. Dr. Dr. Enno Schmidt, and the DFG Cluster of Excellence 2167 ‘Precision Medicine in Chronic Inflammation (PMI)’ (grant no. EXC2167).
Copyright information: © 2022 The Authors. Published by Elsevier B.V. on behalf of Cairo University. This is an open access article under the CC BY-NC-ND license (