Research reveals the crucial role of the skin microbiome in wound healing and antimicrobial resistance

Woman wearing a towel applying moisturiser

Our skin is truly remarkable, being the largest and most intricate organ in our body. It plays numerous vital roles in maintaining our overall wellbeing, but it is also susceptible to a wide range of issues, with over 3,000 potential skin disorders reported.(1)

What is not widely known is the skin also safeguards the body from harmful germs by using a sophisticated built-in defence system of microorganisms that live on the skin, known as the microbiota.

Now, researchers at Hull York Medical School are shedding light on the vital role of the skin microbiome in maintaining skin health, promoting wound healing, and combating antimicrobial resistance. Their findings have the potential to transform the way we approach skincare, wound management, and the fight against infectious diseases.

New research led by Dr Holly Wilkinson, a Lecturer in Wound Healing in the Biomedical Institute for Multimorbidity at the Medical School, is revealing the fascinating nature of the skin microbiome, with their findings marking a significant step forward in our understanding of skin health, wound healing, and antimicrobial resistance.

Understanding the skin microbiome

Unlike the widely studied gut microbiome, the skin microbiome remains a relatively unexplored territory.

Dr Wilkinson and her colleagues are working to gain a comprehensive understanding of the normal skin microbiome and its deviations from the healthy state.

By studying the intricacies of the normal microbiome and identifying what goes wrong in various conditions, such as antimicrobial resistance and chronic wounds, this could pave the way to developing effective therapies to address these issues.

Dr Wilkinson said, “Understanding our normal skin microbiome, what can go wrong, how we can prevent infections and how to intervene is crucial. By investigating how the microbiome changes in these situations, we can pinpoint the specific alterations that occur and determine how they lead to skin problems.”

This knowledge serves as a foundation for experiments to understand when the microbiome is in a different state, and how it can be restored. By developing treatments that modulate the microbiome and restore it to a healthier state, the researchers aim to combat antimicrobial resistance and promote better wound healing outcomes.

Dr Holly Wilkinson

Dr Holly Wilkinson

Dr Holly Wilkinson

The impact of the skin microbiome on chronic wounds, aging and skin health

Chronic wounds pose a significant burden to the NHS, and have a detrimental effect on the lives of millions of individuals. The annual cost of wound management is a staggering £8.3 billion, and 81% of this financial burden falls on community healthcare services. (2)

Wound care represents the third highest expense for the NHS, after cancer and diabetes

However, research on the skin microbiome offers promising avenues for targeted treatments and preventive measures. Dr Wilkinson, in collaboration with biotech pharmaceutical company Micreos Pharma, has identified the association between chronic wounds and the presence of Staphylococcus aureus bacteria in the skin microbiome.

By modulating the microbiome and specifically targeting this bacteria, Dr Wilkinson has found improved and accelerated wound healing, opening the door to potential therapeutic interventions.

Dr Wilkinson said, "Understanding the intricate relationship between aging, the skin microbiome, and skin health is crucial.

"By connecting these factors, we hope to gain insights into the mechanisms of skin aging and important insight into why older individuals are more prone to developing non-healing wounds and subsequent infections."

In the UK alone, 2.2 million people are living with chronic wounds, which negatively impact their quality of life through reduced mobility, pain and odour, limiting their daily activities (3)

Despite the best available care, current treatments for chronic wounds often prove ineffective, sometimes resulting in the drastic measure of lower-limb amputation. Unfortunately, lower-limb amputations carry a high risk of mortality. (4)

In addition to investigating chronic wounds, Dr Wilkinson's research delves into the effects of aging on the skin microbiome. Funded by the British Skin Foundation, the research reveals distinct differences in the microbiome between individuals under 30 and those over 65. Older individuals exhibit a reduction in beneficial microorganisms and an increase in bacteria linked to wound infections.

Dr Wilkinson will be presenting these new findings at the first conference of the Skin Microbiome in Healthy Ageing Network, a multi-disciplinary network of scientists, researchers, clinicians and industry, coming together to better understand the role of the skin microbiome in healthy ageing.

These studies prompt further exploration of how age-related changes in the microbiome contribute to infection susceptibility and poor wound healing. Moreover, the team seeks to understand the communication between skin bacteria and the body's cells.

By correlating changes in the skin microbiome with various age-associated changes in skin properties, such as reduced elasticity and loss of hydration, the researchers aim to provide functional evidence of the relationship between the microbiome and cellular aging processes.

Dr Wilkinson emphasises the importance of understanding the connection between aging, the skin microbiome, and skin health.

topless man in black shirt

Photo by Nsey Benajah on Unsplash

Photo by Nsey Benajah on Unsplash

Collaborative success between science, clinicians and industry

Collaboration with clinicians is a key aspect of the research conducted by Dr Wilkinson and her colleagues in the Centre for Biomedicine at Hull York Medical School. Their research laboratories are situated at Castle Hill Hospital, part of the Hull University Teaching Hospitals NHS Trust.

This proximity to clinical settings has facilitated strong partnerships between researchers and healthcare professionals, enabling collaborations in the field of wound healing.

For example, the laboratory team includes several clinicians conducting postgraduate research, such as a plastic surgeon and an infection specialist.

The culture at Hull University Teaching Hospitals NHS Trust fosters a mutual interest in research, with partnerships forged with plastic surgeons, infection specialists, and vascular surgeons.

This ethos has recently led to Professor Gavin Barlow, a Senior Clinical Lecturer in Infection and Honorary Consultant, and Professor Mat Hardman, Wound Group lead, securing funding from the Medical Research Council for a state-of-the-art microbiome profiling device, called a PromethION. This technology has substantially enhanced the research capabilities of the team, to delve deeper into microbiome sequencing and beyond.

A researcher using the PromethION

The integration of the PromethION 24 into skin research is noteworthy, as Hull University Teaching Hospitals NHS Trust is one of the few NHS trusts in possession of this cutting-edge technology

The integration of the PromethION 24 into skin research is noteworthy, as Hull University Teaching Hospitals NHS Trust is one of the few NHS trusts in possession of this cutting-edge technology

This merging of clinical expertise and scientific inquiry has been instrumental in advancing translational research.

Dr Wilkinson said of the culture, "Unlike my previous experiences in other institutions, Hull York Medical School is set up in a way that facilitates clinicians to actively participate in biomedical research.”

"At Hull York Medical School, one of the real beauties is the seamless collaboration between researchers and clinicians"
Dr Holly Wilkinson

She continued, “As a basic scientist involved in translational research, having that ongoing dialogue and access to patient samples from clinicians is crucial. Developing these collaborations has been surprisingly easy at Hull York Medical School, where even non-research active clinicians show a keen interest in research."

The potential applications of microbiome research are huge. Here Dr Wilkinson emphasised the importance of linking the various threads of the team’s work in order to understand the bigger picture.

Their research, and collaborations with clinicians and industry, is providing a broader understanding of the translational relevance of new discoveries, and how it can be applied in a practical setting. This is important to maximise the potential impact of the work.

Dr Wilkinson said, “Your skin microbiome is crucial for maintaining your skin health, so any kind of deviation away from a healthy skin microbiome are going to increase your chance of skin disease or infections.

"It is imperative to understand our normal skin microbiome and determine what happens when it goes wrong. It is a really exciting field to be involved in.”

For more information about this research, contact Dr Holly Wilkinson, Lecturer in Wound Healing in the Biomedical Institute for Multimorbidity.

References

(1) Lim HW, Collins SAB, Resneck JS Jr, Bolognia JL, Hodge JA, Rohrer TA, Van Beek MJ, Margolis DJ, Sober AJ, Weinstock MA, Nerenz DR, Smith Begolka W, Moyano JV. The burden of skin disease in the United States. J Am Acad Dermatol. 2017 May;76(5):958-972.e2. DOI: 10.1016/j.jaad.2016.12.043. Epub 2017 Mar 1. PMID: 28259441.

(2) Guest JF, Fuller GW, Vowden PCohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013BMJ Open 2020;10:e045253. doi: 10.1136/bmjopen-2020-045253

(3) Advanced wound care: develop new treatments in the UK - Gov.uk

(4) A Meta-analysis of Long-term Mortality and Associated Risk Factors following Lower Extremity Amputation. Annals of Vascular Surgery, April 2017. DOI:https://doi.org/10.1016/j.avsg.2016.12.015

TopBuilt with Shorthand