A longitudinal study of the diabetic skin and wound microbiome

Melissa Gardiner,Catherine M Burke,Mauro Vicaretti,Stephen Bush,Elizabeth Harry,Jill Sparks,Michael Liu,Aaron Darling,Sunaina Bansal

doi:10.7717/peerj.3543

Melissa Gardiner, Catherine M Burke + Show 7 more

Open Access

https://doi.org/10.7717/peerj.3543

Copy DOI

Abstract

BackgroundType II diabetes is a chronic health condition which is associated with skin conditions including chronic foot ulcers and an increased incidence of skin infections. The skin microbiome is thought to play important roles in skin defence and immune functioning. Diabetes affects the skin environment, and this may perturb skin microbiome with possible implications for skin infections and wound healing. This study examines the skin and wound microbiome in type II diabetes.MethodsEight type II diabetic subjects with chronic foot ulcers were followed over a time course of 10 weeks, sampling from both foot skin (swabs) and wounds (swabs and debrided tissue) every two weeks. A control group of eight control subjects was also followed over 10 weeks, and skin swabs collected from the foot skin every two weeks. Samples were processed for DNA and subject to 16S rRNA gene PCR and sequencing of the V4 region.ResultsThe diabetic skin microbiome was significantly less diverse than control skin. Community composition was also significantly different between diabetic and control skin, however the most abundant taxa were similar between groups, with differences driven by very low abundant members of the skin communities. Chronic wounds tended to be dominated by the most abundant skin Staphylococcus, while other abundant wound taxa differed by patient. No significant correlations were found between wound duration or healing status and the abundance of any particular taxa.DiscussionThe major difference observed in this study of the skin microbiome associated with diabetes was a significant reduction in diversity. The long-term effects of reduced diversity are not yet well understood, but are often associated with disease conditions.

Highlights

Type II diabetes is one the fastest growing chronic diseases in the world today, predicted to rise from 382 million people in 2013 to 592 million in 2035 (Guariguata et al, 2014)
One limitation of this study is that, commonly used in microbiome studies (Cope et al, 2017; David et al, 2014; Halfvarson et al, 2017; Smith et al, 2016), the V4 region of the 16S rRNA gene does not allow differentiation between Staphylococcus aureus and other Staphylococcus species found on skin, such as Staphylococcus epidermidis (Conlan, Kong & Segre, 2012)
The major effect associated with diabetes observed here was a significant reduction in the diversity of the skin microbiome

Summary

Introduction

Type II diabetes is one the fastest growing chronic diseases in the world today, predicted to rise from 382 million people in 2013 to 592 million in 2035 (Guariguata et al, 2014). This leads to many serious complications affecting the heart, kidneys, eyes, blood vessels and nerves (World Health Organisation, 2016). The development of foot ulcers is the culmination of several of these complications, estimated to affect 15 % of diabetes sufferers (Reiber, Boyko & Smith, 1995) These wounds are often slow to heal, difficult to treat, and prone to infection. Type II diabetes is a chronic health condition which is associated with skin conditions including chronic foot ulcers and an increased incidence of skin infections. Eight type II diabetic subjects with chronic foot ulcers were followed over a time course of 10 weeks, sampling from both foot skin (swabs) and wounds (swabs and debrided tissue) every two weeks. The long-term effects of reduced diversity are not yet well understood, but are often associated with disease conditions

Objectives

Results

Discussion

Conclusion