Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.
Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, 119074, Singapore.
Biotechnol J. 2020 Oct;15(10):e1900322. doi: 10.1002/biot.201900322. Epub 2020 Apr 6.
The skin microbiome plays a central role in inflammatory skin disorders such as atopic dermatitis (AD). In AD patients, an imbalance between pathogenic Staphylococcus aureus (S. aureus) and resident skin symbionts creates a state of dysbiosis which induces immune dysregulation and impairs skin barrier function. There are now exciting new prospects for microbiome-based interventions for AD prevention. In the hopes of achieving sustained control and management of disease in AD patients, current emerging biotherapeutic strategies aim to harness the skin microbiome associated with health by restoring a more diverse symbiotic skin microbiome, while selectively removing pathogenic S. aureus. Examples of such strategies are demonstrated in skin microbiome transplants, phage-derived anti-S. aureus endolysins, monoclonal antibodies, and quorum sensing (QS) inhibitors. However, further understanding of the skin microbiome and its role in AD pathogenesis is still needed to understand how these biotherapeutics alter the dynamics of the microbiome community; to optimize patient selection, drug delivery, and treatment duration; overcome rapid recolonization upon treatment cessation; and improve efficacy to allow these therapeutic options to eventually reach routine clinical practice.
皮肤微生物组在炎症性皮肤疾病（如特应性皮炎）中起着核心作用。在 AD 患者中，致病性金黄色葡萄球菌（S. aureus）和常驻皮肤共生体之间的失衡会导致微生态失调，从而诱导免疫失调和破坏皮肤屏障功能。目前，基于微生物组的 AD 预防干预措施具有令人兴奋的新前景。为了实现对 AD 患者疾病的持续控制和管理，当前新兴的生物治疗策略旨在通过恢复更具多样性的共生皮肤微生物组，同时选择性地去除致病性 S. aureus，利用与健康相关的皮肤微生物组。此类策略的示例包括皮肤微生物组移植、噬菌体衍生的抗 S. aureus 内溶素、单克隆抗体和群体感应（QS）抑制剂。然而，为了了解这些生物疗法如何改变微生物组群落的动态，仍需要进一步了解皮肤微生物组及其在 AD 发病机制中的作用；优化患者选择、药物输送和治疗持续时间；克服治疗停止后的快速再定植；并提高疗效，以使这些治疗选择最终能够常规应用于临床实践。
