RT Journal Article SR Electronic T1 Therapeutic responses to Roseomonas mucosa in atopic dermatitis may involve lipid-mediated TNF-related epithelial repair JF Science Translational Medicine FD American Association for the Advancement of Science SP eaaz8631 DO 10.1126/scitranslmed.aaz8631 VO 12 IS 560 A1 Myles, Ian A. A1 Castillo, Carlo R. A1 Barbian, Kent D. A1 Kanakabandi, Kishore A1 Virtaneva, Kimmo A1 Fitzmeyer, Emily A1 Paneru, Monica A1 Otaizo-Carrasquero, Francisco A1 Myers, Timothy G. A1 Markowitz, Tovah E. A1 Moore, Ian N. A1 Liu, Xue A1 Ferrer, Marc A1 Sakamachi, Yosuke A1 Garantziotis, Stavros A1 Swamydas, Muthulekha A1 Lionakis, Michail S. A1 Anderson, Erik D. A1 Earland, Noah J. A1 Ganesan, Sundar A1 Sun, Ashleigh A. A1 Bergerson, Jenna R.E. A1 Silverman, Robert A. A1 Petersen, Maureen A1 Martens, Craig A. A1 Datta, Sandip K. YR 2020 UL http://stm.sciencemag.org/content/12/560/eaaz8631.abstract AB In a clinical trial, topical application of the healthy skin bacterium Roseomonas mucosa improved atopic dermatitis (AD) in children age 3 years or older. R. mucosa treatment was associated with improvements in disease symptoms, epithelial barrier function, the amount of Staphylococcus aureus growing on the skin, the need for topical steroids, and quality of life for children and their families. Clinical improvements and colonization of skin by R. mucosa persisted for up to 8 months after treatment cessation and were not associated with major adverse events. Cell culture analyses and studies in the MC903 mouse model of AD suggest that the therapeutic mechanism may involve lipid production by R. mucosa, cholinergic signaling, and flagellin expression leading to a TNFR2-mediated epithelial-to-mesenchymal transition.Dysbiosis of the skin microbiota is increasingly implicated as a contributor to the pathogenesis of atopic dermatitis (AD). We previously reported first-in-human safety and clinical activity results from topical application of the commensal skin bacterium Roseomonas mucosa for the treatment of AD in 10 adults and 5 children older than 9 years of age. Here, we examined the potential mechanism of action of R. mucosa treatment and its impact on children with AD less than 7 years of age, the most common age group for children with AD. In 15 children with AD, R. mucosa treatment was associated with amelioration of disease severity, improvement in epithelial barrier function, reduced Staphylococcus aureus burden on the skin, and a reduction in topical steroid requirements without severe adverse events. Our observed response rates to R. mucosa treatment were greater than those seen in historical placebo control groups in prior AD studies. Skin improvements and colonization by R. mucosa persisted for up to 8 months after cessation of treatment. Analyses of cellular scratch assays and the MC903 mouse model of AD suggested that production of sphingolipids by R. mucosa, cholinergic signaling, and flagellin expression may have contributed to therapeutic impact through induction of a TNFR2-mediated epithelial-to-mesenchymal transition. These results suggest that a randomized, placebo-controlled trial of R. mucosa treatment in individuals with AD is warranted and implicate commensals in the maintenance of the skin epithelial barrier.