Published April 9, 2023 | Version v1
Journal article Open

Dupilumab but not cyclosporine treatment shifts the microbiome toward a healthy skin flora in patients with moderate-to-severe atopic dermatitis

Creators

  • 1. Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-­Holstein, Campus Kiel, Kiel, Germany
  • 2. Center of Evidence-­Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
  • 3. Clinics for Dermatology, Elbe Klinikum Buxtehude, Buxtehude, Germany
  • 4. Department of Dermatology, Medical Faculty Carl Gustav Carus, University Allergy Center, TU Dresden, Dresden, Germany
  • 5. Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
  • 6. Division of Occupational Dermatology, Department of Dermatology, Ruprecht-­Karls University Heidelberg, Heidelberg, Germany
  • 7. Department of Dermatology, Ruprecht-­Karls University Heidelberg, Heidelberg, Germany
  • 8. Practice Dr. med. Christiane Handrick, Berlin, Germany
  • 9. Institute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
  • 10. Clinics and Outpatient Clinics for Dermatology and Allergy, LMU Munich, Munich, Germany
  • 11. Department of Dermatology and Allergy, University Medical Center Mainz, Mainz, Germany
  • 12. Practice Dr. med. Konstantin Ertner, Nuremberg, Germany
  • 13. Department of Dermatology, University Hospital, Friedrich Alexander University Erlangen-­Nuernberg, Erlangen, Germany
  • 14. Practice Dr. med. Beate Schwarz, Langenau, Germany
  • 15. Dermatology Clinic, Helix Medical Excellence Center Mainz, Mainz, Germany
  • 16. Practice Dr. med. Franca Wiemers, Leipzig, Germany
  • 17. Dermatology Center, Hannover, Germany
  • 18. Practice Dr. med. Julia Wildberger, Hautmedizin Bad Soden, Bad Soden, Germany
  • 19. Biobank PopGen and Institute of Epidemiology, Kiel University, Kiel, Germany
  • 20. Institute of Epidemiology, Kiel University, Kiel, Germany

Description

Abstract
Background: Atopic dermatitis (AD) patients display an altered skin microbiome which
may not only be an indicator but also a driver of inflammation. We aimed to investi-
gate associations among AD patients' skin microbiome, clinical data, and response to
systemic therapy in patients of the TREATgermany registry.
Methods: Skin swabs of 157 patients were profiled with 16S rRNA gene amplicon
sequencing before and after 3 months of treatment with dupilumab or cyclosporine.
For comparison, 16s microbiome data from 258 population-­based healthy controls
were used. Disease severity was assessed using established instruments such as the
Eczema Area and Severity Index (EASI).
Results: We confirmed the previously shown correlation of Staphylococcus aureus
abundance and bacterial alpha diversity with AD severity as measured by EASI.
Therapy with Dupilumab shifted the bacterial community toward the pattern seen in
healthy controls. The relative abundance of Staphylococci and in particular S. aureus
significantly decreased on both lesional and non-­lesional skin, whereas the abundance
of Staphylococcus hominis increased. These changes were largely independent from
the degree of clinical improvement and were not observed for cyclosporine.
Conclusions: Systemic treatment with dupilumab but not cyclosporine tends to re-
store a healthy skin microbiome largely independent of the clinical response indicat-
ing potential effects of IL-­4RA blockade on the microbiome.

Files

Allergy - 2023 - Hartmann - Dupilumab but not cyclosporine treatment shifts the microbiome toward a healthy skin flora in.pdf

Files (3.3 MB)

Additional details

Funding

BIOMAP – Biomarkers in Atopic Dermatitis and Psoriasis 821511
European Commission