Background: Staphylococcus aureus (S. aureus) is frequently detected in the skin of patients with atopic dermatitis (AD), and involved in the flare of AD. There are some evidence-specific strains of S. aureus affect the severity of AD. However, the mechanism of predominant colonization and the aggravation of dermatitis by certain strains of S. aureus in the patients with AD are still unknown.Objective: To reveal the characteristics of S. aureus from patients with AD (S. aureus-AD), we analyzed the interaction of S. aureus-AD and keratinocytes in comparison with those of S. aureus laboratory strains (S. aureus-stand.).
Methods:We stimulated HaCaT cells, keratinocyte cell line, and human epidermal keratinocytes by heat-killed S. aureus strains, then evaluated immune response of keratinocytes by ELISA, immunofluorescence staining, and flow cytometry.Results: Upon incubation with keratinocytes, three out of four strains of heat-killed S. aureus-AD were strongly agglutinated inside the cytoplasm. In the cells, they are located in lysosomes and promoted the secretion of interleukin-1α (IL-1α). These reactions were not observed by any of four strains of S. aureus-stand. and S. epidermidis and were abolished by the treatment of S. aureus with proteinase K. Moreover, the IL-1α secretion was diminished by the inhibition of Toll-like receptor 9 (TLR9). Conclusion: S. aureus-AD accumulates in lysosome of keratinocytes by means of bacterial cell wall proteins and induces IL-1α via TLR9. K E Y W O R D S atopic dermatitis, dermatology, innate immunity, microbiome, staphylococcus aureus 1 | INTRODUCTION Atopic dermatitis (AD) is a common chronic skin disease characterized by pruritus and recurrent eczematous lesions. 1 There is a strong correlation between filaggrin (FLG) mutations and AD, but not all carriers of FLG mutation develop AD, 2 suggesting the involvement of other causative or aggravating factors in the pathogenesis of AD. Many patients with AD frequently suffer from cutaneous infections by Staphylococcus aureus (S. aureus). Moreover, S. aureus is commonly isolated from patients with AD, even from apparently non-lesion skin. 3 Furthermore, S. aureus colonization has been shown to be associated with AD severity and observed even before the onset of AD in infants. 4 A previous study of the skin microbiome of patients with AD revealed reduced diversity and high Staphylococcus proportions in flares of untreated AD, 5 whereas Staphylococcus epidermidis (S. epidermidis) predominates on the skin surface of healthy individuals. In murine models, S. aureus colonization and low diversity of the microbiome drive AD-like lesions in the skin. 6Compared to standard S. aureus strains, S. aureus isolated from AD skin are able to induce different innate immune responses. S. aureus from AD skin are internalized into keratinocytes and accumulate in lysosomes with inducing IL-1α secretion via TLR9. Specific surface proteins of S. aureus from AD skin are responsible for their internalization.