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Mayo Clinic Grand Rounds

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Title: Mayo Clinic Grand Rounds Author: Yoon Cohen Last modified by: Office 2004 Test Drive User Created Date: 9/17/2012 4:41:22 AM Document presentation format – PowerPoint PPT presentation

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Title: Mayo Clinic Grand Rounds


1
The Skin Microbiome Yoon K. Cohen, D.O. Hot
Spots in Dermatology August 18, 2013
2
Objectives
  • Human Microbiome Project
  • Introduction of Skin Microbiome
  • Factors Contributing to Variation in the Skin
    Microbiome
  • Topographical Distribution of Microbes
  • Microbes Commonly Found on Skin
  • The Skin Microbiome and Diseases

3
Human Microbiome Project
  • 250 Healthy Volunteers
  • 5 Sites
  • Nasal passage
  • Oral cavities
  • GI
  • Urogenital tract
  • Skin
  • 16S ribosomal RNA genomic sequening on 11,174
    samples
  • Conserved regions ? a binding site for PCR primer
  • Hypervariable regions ? taxonomic classification

4
Chen YE, et al. The skin microbiome Current
perspectives and futures challenges. J Am Acad
Dematol. 2013 69143-155
5
Skin Microbiome
  • Microbiology and dermatology have been intimately
    related
  • The cutaneous surface is inhabited by myriad
    bacteria, fungi, and viruses. Now we begin to
    understand how these microbial communities impact
    human health and disease
  • The skin microbiota plays a vital role in
    educating the immune system as the cutaneous
    innate and adaptive immune reponses can modulate
    the skin microbiota

Grice EA, Segre JA. The skin microbiome. Nat Rev
Microbiol. 2011 9 244-53
6
Microbiome and skin immunology
Chen YE, et al. The skin microbiome Current
perspectives and futures challenges. J Am Acad
Dematol. 2013 69143-155
7
Skin Microbiome
  • Three major questions
  • What microbes are present on the skin surface?
  • How does microbial diversity contribute to health
    and disease states?
  • How do dermatologic practices alter microbial
    diversity?

Kong HH, Segre JA. Skin Microbiome Looking
Back to Move Forward. J Invest Dermatol.
2011132933-39
8
Factors Contributing to Variation in the Skin
Microbiome
Grice EA, Segre JA. The skin microbiome. Nat Rev
Microbiol. 2011 9 244-53
9
Topographical Distribution of Bacteria on Skin
Sites
Grice EA, Segre JA. The skin microbiome. Nat Rev
Microbiol. 2011 9 244-53
10
Composition of a Single Metagenome
Chen YE, et al. The skin microbiome Current
perspectives and futures challenges. J Am Acad
Dematol. 2013 69143-155
11
Interpersonal Variation of the Skin Microbiome
This chart demonstrates that skin microbial
variation is more dependent on the site than on
the individual. Bars represents the relative
abundance of bacterial taxa as determined by 16S
ribosomal RNA sequencing
Grice EA, Segre JA. The skin microbiome. Nat Rev
Microbiol. 2011 9 244-53
12
Temporal diversity of the microbiome
Oh et al, Shifts in human skin and nares
microbiota of healthy children and adults. Genome
Medicine. 2012
13
Bacteria Commonly Found on Skin
  • Staphylococcus epidermidis
  • Staphylococcus aureus
  • Corynebacterium spp.
  • Propionibacterium acnes

14
S. Epidermidis
  • Pathogen
  • Frequent cause of nosocomial infections
  • Immunocomprised patients
  • Indwelling devices
  • Commensal
  • Major skin inhabitant
  • Produce antibacterial products
  • Bacteriocins (epidermin, epilancin K7, Pep5,
    staphlococcin 1580)

A clump of Staphylococcus epidermidis bacteria
15
S. Aureus
  • Pathogen
  • Frequent cause of infections (self-limited to
    invasive)
  • Methicillin-resistance is a healthcare problem
  • Phenol-soluble modulins (PSMs) produced in high
    levels by CA-MRSA
  • Streptococcus pyogenes is sensitive to S. aureus
    PSMs, which may partically explain CA-MRSA
    dominance
  • Commensal
  • Asymptomatic nasal colonizers
  • 20 permanently colonized
  • 30-50 transiently colonized
  • S. aureus preferentially hemolyzes human
  • blood to utilizes iron from heme to promote
    proliferation
  • Can produce bacteriocin (staphylococcin 462)

16
Corynebacterium spp.
  • Pathogen
  • Diphtheroids
  • /- C. dephtheriae
  • Part of normal skin flora
  • C. minutissimum (erytherasma) and C. tenuis
    (trichomycosis)
  • Risk factors for infections
  • Immunocompromised patients
  • Skin barrier defects
  • Commensal
  • Prevents oxidative damage by producing superoxide
    dismutase
  • Produce bacteriocin-like compounds

17
Propionibacterium acnes
  • Pathogen
  • Associated with folliculitis, systemic infections
    and acnes
  • Commensal
  • Produce bacteriocin-like compounds with activity
    against bacteria, yeast and molds

18
Other Microbes Commonly Found on Skin
  • Malassezia spp.
  • Demodex mites
  • Human papillomavirus (HPV)

19
Identifying Fungi and Viruses
  • Fungi
  • Similar strategy can be used to classify the 18S
    rRNA or the intervening sequence (ITS) of fungi
  • Viruses
  • De-novo sequencing
  • Challenging what to use for control for DNA or
    RNA viruses
  • Currently resequencing the human genome to
    identify viral associated disease
  • Once you find them, finding them again is
    PCR-based

Grice EA, Segre JA. The skin microbiome. Nat Rev
Microbiol. 2011 9 244-53
20
  • Relative abundance of fungal genera and
    Malassezia species at different human skin sites.
  • Fungal diversity of individual body sites of
    healthy volunteers (110) was taxonomically
    classified at the genus level, with further
    resolution of Malassezia species.

Findley et al. Topographic diversity of fungal
and bacterial communities in human skin. Nature.
June 2013
21
Skin Diseases Associated with Dysbiosis
Gallo RL, Nakatsuji T. Microbial Symbiosis with
the innate immune Defense System of the Skin. J
invest Dermatol. 2011
22
Conclusions
  • Skin Microbiome ? How molecular approaches allow
    us to better understand the relationship between
    skin microbiome and human health disease states
  • Currently active ongoing research for skin
    microbiome under NIH Human Microbiome Project
  • Future Therapeutic Options
  • The impact of repeated use of topical/systemic
    antimicrobial therapies
  • Mainstay of dermatologic practice
  • Associated risks are not fully understood
  • Alternative therapies
  • Probiotic microbial organisms
  • Antimicrobial chemicals derived from
    microorganisms or humans

23
References
  1. Grice EA, Segre JA. The skin microbiome. Nat Rev
    Microbiol. 2011 9 244-53
  2. Kong HH, Segre JA. Skin Microbiome Looking Back
    to Move Forward. J Invest Dermatol. 2012 132
    933-39
  3. Capone KA. Dowd SE, Stamatas GN, et al. Diversity
    of the Human Skin Microbiome Early in Life. J
    invest Dermatol. 2011 131 2026-32
  4. Gallo RL, Nakatsuji T. Microbial Symbiosis with
    the innate immune Defense System of the Skin. J
    invest Dermatol. 2011 131 1974-80
  5. Gaspari AA, et al. Chapter 9. Antimicrobial
    Peptides. Clinical and Basic Immunodermatology.
    Springer. London. 2009
  6. Zimmer C. Tending the Bodys Microbial Garden.
    The New York Times. June 18, 2012
  7. Specter M. Germs Are Us. The New Yorker. October
    22, 2012
  8. Gorman C. Explore the Human Microbiome.
    Scientific American. May 15, 2012

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The Sebago Lake in Maine, May 27th, 2012
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