The widespread use of topical antimicrobials enriches for resistance in Staphylococcus aureus isolated from patients with atopic dermatitis.

BACKGROUND: Carriage rates of Staphylococcus aureus on affected skin in atopic dermatitis (AD) are approximately 70%. Increasing disease severity during flares and overall disease severity correlate with increased burden of S. aureus. Treatment in AD therefore often targets S. aureus with topical and systemic antimicrobials. OBJECTIVES: To determine whether antimicrobial sensitivities and genetic determinants of resistance differed in S. aureus isolates from the skin of children with AD and healthy child nasal carriers. METHODS: In this case-control study, we compared S. aureus isolates from children with AD (n = 50) attending a hospital dermatology department against nasal carriage isolates from children without skin disease (n = 49) attending a hospital emergency department for noninfective conditions. Using whole genome sequencing we generated a phylogenetic framework for the isolates based on variation in the core genome, then compared antimicrobial resistance phenotypes and genotypes between disease groups. RESULTS: Staphylococcus aureus from cases and controls had on average similar numbers of phenotypic resistances per isolate. Case isolates differed in their resistance patterns, with fusidic acid resistance (FusR ) being significantly more frequent in AD (P = 0·009). The genetic basis of FusR also differentiated the populations, with chromosomal mutations in fusA predominating in AD (P = 0·049). Analysis revealed that FusR evolved multiple times and via multiple mechanism in the population. Carriage of plasmid-derived qac genes, which have been associated with reduced susceptibility to antiseptics, was eight times more frequent in AD (P = 0·016). CONCLUSIONS: The results suggest that strong selective pressure drives the emergence and maintenance of specific resistances in AD

miRNA analysis of childhood atopic dermatitis reveals a role for miR-451a

BACKGROUND: MicroRNAs (miRNAs), important regulators of gene expression, have been implicated in a variety of disorders. The expression pattern of miRNAs in pediatric atopic dermatitis (AD) has not been well studied. OBJECTIVE: We sought to investigate miRNA expression profiles in different blood compartments of infants with AD. METHODS: Small RNA and HTG-Edge sequencing were performed to identify differentially expressed miRNAs in PBMCs and plasma of AD infants versus age-matched healthy controls, with reverse transcription quantitative real-time PCR used for validation and measurement of miRNA targets. Logistic regression models with AUROC estimation was used to evaluate the diagnostic potential of chosen miRNAs for AD. RESULTS: RNA sequencing was performed to access miRNA expression profile in pediatric AD. We identified ten differentially expressed miRNAs in PBMCs and eight dysregulated miRNAs in plasma of AD infants compared to controls. Upregulated miRNAs in PBMCs included miRNAs known to be involved in inflammation: miR-223-3p, miR-126-5p and miR-143-3p. Differential expression of only one miRNA, miR-451a, was observed in both PBMCs and plasma of children with AD. Dysregulation of three miRNAs: miR-451a, miR-143-3p and miR-223-3p was validated in larger number of samples and miR-451a was identified as a predictive biomarker for the early diagnosis of the disease. Experimentally verified targets of miR-451a, IL6R and PSMB8, were increased in AD patients, negatively correlated with miR-451a levels and upregulated following inhibition of miR-451a in PBMCs. CONCLUSION: In infants with AD, a distinct peripheral blood miRNA signature is seen, highlighting the systemic effects of the disease. miR-451a is uniquely expressed in different blood compartments of AD patients and may serve as a promising novel biomarker for the early diagnosis of AD

Association of variation in the LAMA3\it {LAMA3} gene, encoding the alpha-chain of laminin 5, with atopic dermatitis in a German case-control cohort

$\bf Background:$ Atopic dermatitis (AD) is a chronic inflammatory skin disorder caused by complex interaction of genetic and environmental factors. Besides mutations in the filaggrin gene, leading to impaired skin barrier function, variation in genes encoding additional skin proteins has been suggested to contribute to disease risk. Laminin 5, playing an important role in skin integrity, is composed of three subunits encoded by the $\it {LAMA3}$, $\it {LAMB3}$ and $\it {LAMC2}$ genes in which biallelic mutations cause epidermolysis bullosa junctionalis. We aimed at evaluating the role of variation in the $\it {LAMA3}$, $\it {LAMB3}$ and $\it {LAMC2}$ genes for AD pathogenesis. $\bf Methods:$ 29 single nucleotide polymorphisms (SNPs) were genotyped in the three genes in a German AD case-control cohort comprising 470 unrelated AD patients and 320 non-atopic controls by means of restriction enzyme digestion. Allele, genotype and haplotype frequencies were compared between cases and controls using chi-square testing and the Haploview software. $\bf Results:$ Several SNPs in the $\it {LAMA3}$ gene showed significant association with AD in our cohort (p<0.01),while we did not detect association with variations in the $\it {LAMB3}$ and $\it {LAMC2}$ genes. Haplotype analysis additionally revealed several significantly associated haplotypes in the $\it {LAMA3}$ gene. Due to extensive linkage disequilibrium, though, we were not able to further differentiate the specific disease causing variation(s) in this region. $\bf Conclusions:$ We established the $\it {LAMA3}$ gene as novel potential susceptibility gene for AD. Additional studies in independent cohorts are needed to replicate these results