November 2019

Dr Andrew McDowell is a Lecturer in Personalised Medicine within the Northern Ireland Centre for Stratified Medicine, Ulster University. He was awarded a British Skin Foundation Studentship Grant entitled ‘Metagenomic and culture-based characterisation of Propionibacterium acnes communities in patients with severe recalcitrant papulopustular and nodular acne’, which commenced in October 2017 and currently supports a PhD student, Joseph McLaughlin, in his laboratory. 

Here Andrew and Joe explain in more detail about their research and what they hope to achieve. 

What is acne?

Acne is a very common chronic inflammatory skin condition that normally occurs in teenagers and young adults, and results in oily skin and the development of blackheads, whiteheads and pus-filled spots on the face, back and chest. Although not life-threatening, acne can have profound social and psychological effects, which are frequently more significant when the symptoms are severe and scarring of the skin occurs.

Acne is believed to occur when the sebaceous glands of the skin produce too much oil (sebum) which, along with dead skin cells, blocks the pores in the skin resulting in blackheads or whiteheads. Pus-filled spots can then occur when particular strains of a bacterium normally found on the skin called Propionibacterium acnes becomes enriched in the oily environment triggering inflammation.

How do we treat acne?

While a number of different treatment options exist for acne, topical (e.g., creams) and oral antibiotics targeting P. acnes, such as tetracycline and erythromycin, have been used for decades to manage patients, especially those with moderate-to-severe symptoms. For patients prescribed an oral antibiotic, treatments may last from three-to-six months until no further improvement is seen.

Emergence of multi-drug resistant acne

The widespread and prolonged use of oral and topical antibiotics to treat acne has led to the emergence and circulation of P. acnes ‘super-bug’ strains that are multi-drug resistant. Even more alarming has been the observation that some patients who cannot be effectively managed with antibiotics are also non-responsive to powerful oral retinoid drugs prescribed when other treatment measures don’t work. Despite these serious problems, our knowledge of the underlying causes of these more treatment resistant forms of acne, described in the media as ‘super-acne’ is poor. Characterisation of the P. acnes strain population associated with severe, initially non-responsive acne is therefore vital so we can identify new, multi-drug resistant forms that may be driving the development of these particular types of the condition. Such a study may also provide valuable information for the development of a new generation of diagnostic tests that can be used for personalised approaches to treatment and management of acne patients.

What this project is doing?

This project, which is being conducted in close collaboration with Dr Alison Layton and colleagues at Harrogate and District NHS Trust, is using cutting edge molecular biology techniques, including DNA sequencing, alongside traditional culture methods, to map the P. acnes strain community colonising the skin of patients with the most severe forms of acne that are not responding to initial treatments, especially oral retinoid drugs.

We are also examining how sensitive P. acnes strains isolated from patients are to common antibiotics used to treat acne, as well as determining the underlying mechanisms the bacterium has used to develop resistance. Furthermore, we are investigating new, non-antibiotic-based, approaches for the treatment of these patients.

Strain Biobank

A key deliverable of this project has also been to create a biobank and database of highly characterised, multi-drug resistant strains of P. acnes and other resistant propionibacteria isolated from patients, that is accessible to researchers worldwide. This biobank, known as the PORES (PropiOnibacteria REsistant to antibioticS) Biobank, will be made available to researchers worldwide and create an important legacy from the study, as well as added value for the funding made available from the British Skin Foundation (BSF).

Thanks to the BSF and its supporters

This research has only been possible thanks to support from the BSF and its supporters for which we are extremely grateful. As a result of this studentship, Joe has been able to continue his studies and develop new skills and knowledge that he can carry forward in his future career in medical research. This will also be an important legacy to the funding provided.

Dr Andrew McDowell, Ulster University

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