viernes, 21 de noviembre de 2014

2014 News Feature: The skin microbiome: More than skin deep

2014 News Feature: The skin microbiome: More than skin deep



Genome.gov National Human Genome Research Institute National Institutes of Health

The skin microbiome: More than skin deep

Skin metagenomics and defines relative abundance of viral, bacterial and fungal components of the microbial community. View the full illustration
View the full illustration
The billions of microbes that reside on human skin - probably more than 10 billion microbial cells on each of us - may be fellow travelers but they aren't free riders. Instead, the skin microbiota plays an intricate role in the human immune system, actually directing many immune functions and helping to defend its host against invading bacterial pathogens.
In a review article in the Nov. 21, 2014, issue of Science, Julie Segre, Ph.D., head of the Microbial Genomics Section of the National Human Genome Research Institute (NHGRI), and Yasmine Belkaid, Ph.D., head of the Mucosal Immunology Section of the National Institute of Allergy and Infectious Diseases (NIAID), sum up what researchers have learned so far about the advantages, and some of the downsides, of this intimate partnership.
The underlying advantage, of course, is that the microorganisms that live on human skin-called commensals - have evolved to defend their dwelling place - us.
For example, the skin bacterium Staphylococcus epidermidis produces a secretion that reduces inflammation and speeds wound healing by binding to an immune-system receptor. S. epidermidis also inhibits tissue colonization by the highly pathogenic S. aureus, the source of many hospital-acquired infections that in its methicillin-resistant form is known as the "superbug" MRSA.
Other skin microorganisms perform a wide variety of functions that help out their host. Among these functions are overall immune system screening, tissue repair, wound healing, inflammation control, production of defensive anti-microbial peptides (AMPs), acceleration of the complement arm of the immune system, regulation of interleukin-1 (IL-1), and modulation of T cells, key actors in directing immune system response. In fact, the richest concentrations of immune cells in the body are at sites populated by commensal cells, and the skin is "one of the largest reservoirs of memory T cells in the body," Drs. Belkaid and Segre report.
Most people don't realize the skin microbiota's contribution to their well-being. "Humans want to eat yogurt because they have the concept that the microbes in their gut are providing a benefit," said Dr. Segre. "Whereas on their hands, all people want to do is use hand sanitizer and sterilize themselves. They really do not perceive that there is a benefit to the microbes that reside on their skin."
A potential downside, of course, is that any disturbance of the fine balance of the skin microbes-called dysbiosis-can be costly. If the microbiota is sick, the human host will probably get sick, too.
Dysbiosis has long been associated with skin disorders such as atopic dermatitis (eczema), psoriasis and the teenage bugaboo, acne. Eczema prevalence has doubled in industrialized countries, possibly because of environmental pressures on the skin biota, such as increased usage of antibiotics, less exposure to environmental microbes in soil and water, and more conditioned environments. Moreover, Drs. Belkaid and Segre speculate that "profound changes" in the human skin microbiota may contribute to the increase in chronic inflammatory and autoimmune disorders seen in high-income countries."
If S. epidermidis fails to confine S. aureus to the nasal tissue that it often inhabits, the human host could be in for dangerous skin and soft tissue infections.
Researchers have not yet settled the question of how much human beings benefit from their microbial hangers-on. But Drs. Segre and Belkaid are convinced that humans do receive a net gain from their skin biota. After all, humans and their microbes evolved together. "I think we always gain more from them than we have lost," said Dr. Belkaid. "The presence of microbes is inherent to being alive. We cannot exist without them."
Several lines of research already point toward potential clinical advances from scientists' growing understanding of the skin microbiota.
For example, vaccine development and vaccination programs could be improved if ways are found to reduce inflammation at injection sites by modifying skin microorganisms. The vast cosmetics industry might be roiled by increased knowledge about the effect of makeup and moisturizing creams; an ointment that is makeup to a human might be nourishment-or poison - to a microbe.
More significantly, the human skin biota might help meet the growing challenge of pathogens that have grown resistant to antibiotic drugs. Microbes have ways of killing other microbes as they compete for living sites. Perhaps they can teach us new tricks.
"We envision a new therapeutic landscape leveraging unique mutagenic profiles with tailored clinical interventions, that reshape our microbial communities," Drs. Belkaid and Segre wrote in their Science paper. ". . . [S]ubtle alterations in defined nutrient availability may have a dramatic impact on the skin microbiota composition and when rationally designed could provide a powerful advantage for microbes endowed with regulatory or protective properties."

QuickStats: Death Rates* for Three Selected Causes of Injury†— National Vital Statistics System, United States, 1979–2012

QuickStats: Death Rates* for Three Selected Causes of Injury†— National Vital Statistics System, United States, 1979–2012

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Vol. 63, No. 46
November 21, 2014
 
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QuickStats: Death Rates* for Three Selected Causes of Injury— National Vital Statistics System, United States, 1979–2012

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November 21, 2014 / 63(46);1095

The figure is a line chart showing that in 2012, a total of 41,502 drug poisoning deaths, 34,935 motor vehicle traffic deaths, and 33,563 firearm deaths occurred. The age-adjusted death rate for drug poisoning more than quadrupled from 3.0 per 100,000 in 1979 to 13.1 in 2012. In contrast, the age-adjusted rate dropped from 22.1 to 10.9 for motor vehicle traffic deaths and from 14.7 to 10.5 for firearm deaths during this period. The age-adjusted drug poisoning death rate exceeded the motor vehicle traffic death rate beginning in 2009.
* Per 100,000, age-adjusted to the 2000 U.S. standard population.
Selected because they are the most frequently occurring causes of injury deaths. Injuries are from all manners, including unintentional, suicide, homicide, undetermined intent, and legal intervention. Drug poisoning deaths include those resulting from drug overdose and other misuse of drugs. Drugs include legal and illegal drugs.
§ In 1999, International Classification of Diseases, 10th Revision (ICD-10) replaced the previous revision of the ICD (ICD-9). This resulted in approximately 5% fewer deaths being classified as motor vehicle traffic–related deaths and 2% more deaths being classified as poisoning-related deaths. Therefore, death rates for 1998 and earlier are not directly comparable with those computed after 1998. Little change was observed in the classification of firearm-related deaths from ICD-9 to ICD-10.
In 2012, a total of 41,502 drug poisoning deaths, 34,935 motor vehicle traffic deaths, and 33,563 firearm deaths occurred. The age-adjusted death rate for drug poisoning more than quadrupled from 3.0 per 100,000 in 1979 to 13.1 in 2012. In contrast, the age-adjusted rate dropped from 22.1 to 10.9 for motor vehicle traffic deaths and from 14.7 to 10.5 for firearm deaths during this period. The age-adjusted drug poisoning death rate exceeded the motor vehicle traffic death rate beginning in 2009.
Source: CDC WONDER, compressed mortality file, underlying cause-of-death, available at http://wonder.cdc.gov/mortsql.html.
Reported by: Li-Hui Chen, PhD, lchen3@cdc.gov, 301-458-4446; Andrew Fenelon.
Alternate Text: The figure above is a line chart showing that in 2012, a total of 41,502 drug poisoning deaths, 34,935 motor vehicle traffic deaths, and 33,563 firearm deaths occurred. The age-adjusted death rate for drug poisoning more than quadrupled from 3.0 per 100,000 in 1979 to 13.1 in 2012. In contrast, the age-adjusted rate dropped from 22.1 to 10.9 for motor vehicle traffic deaths and from 14.7 to 10.5 for firearm deaths during this period. The age-adjusted drug poisoning death rate exceeded the motor vehicle traffic death rate beginning in 2009.

Errata: Vol. 63, No. 44

Errata: Vol. 63, No. 44

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Vol. 63, No. 46
November 21, 2014
 
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Errata: Vol. 63, No. 44

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November 21, 2014 / 63(46);1094


In the report, "Declines in Pneumonia Hospitalizations of Children Aged <2 Years Associated with the Use of Pneumococcal Conjugate Vaccines — Tennessee, 1998–2012," in Table 2, under the heading and subheading PCV13 years compared with pre-PCV7 years, % change in rates, the value should read, -72.

Errata: Vol. 63, No. 45

Errata: Vol. 63, No. 45



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Vol. 63, No. 46
November 21, 2014
 
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Errata: Vol. 63, No. 45

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November 21, 2014 / 63(46);1094

In this issue, the date in the title of an announcement was incorrect. The title should read, "World Day of Remembrance for Road Traffic Victims — November 16,2014."

Errata: Vol. 63, No. 46

Errata: Vol. 63, No. 46

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November 21, 2014
 
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Errata: Vol. 63, No. 46

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November 21, 2014 / 63(46);1094


In the report, "Ebola Epidemic — Liberia, March–October 2014," which was first published as an MMWR Early Release on November 14, 2004, multiple errors occurred.
The list of authors and their affiliations should read as follows: Tolbert Nyenswah1, Miatta Fahnbulleh1, Francis Ketah1, Moses Massaquoi1, Thomas Nagbe1, Luke Bawo1, James Dorbor Falla1, Henry Kohar1, Alex Gasasira2, Pierre Nabeth2, Heather Popowitz3, Sheldon Yett3, Lindis Hurum4, Laurence Sailly4, Sean Casey5, Benjamin Espinosa6, Andrea McCoy6, Heinz Feldman7, Lisa Hensley7, Mark Baily8, Justin Pendarvis9, Barry Fields10, Terrence Lo10, Jin Quin10, John Aberle-Grasse10, Kim Lindblade10, Josh Mott10, Lucy Boulanger10, Athalia Christie10, Susan Wang10, Joel Montgomery10, Frank Mahoney10 (Author affiliations at end of text).
1Ministry of Health and Social Welfare, Liberia; 2World Health Organization; 3United Nations Children's Fund; 4Médecins Sans Frontières; 5International Medical Corps; 6U.S. Navy; 7National Institutes of Health; 8U.S. Army Medical Research Institute of Infectious Diseases; 9U.S. Agency for International Development;10CDC
In the fifth paragraph, the third sentence should read as follows: "After aggressive response in Lofa, the county experienced multiple outbreak waves, with a peak in case counts between late July and late September (Figure 1)."
In the sixth paragraph, the fourth sentence should read as follows: "As of November 8, MoHSW reported 329 health care workers infected with Ebola, including 157 who died."
In the seventh paragraph, the third sentence should read as follows: "The Firestone company established a 10-bed unit in April in Margibi county (4)."
In the Discussion, the fifth sentence should read, "However, progress of control efforts is tenuous as situation reports in the past 2 weeks suggest a leveling off of case counts and outbreaks in new areas."

Announcement: National Chronic Obstructive Pulmonary Disease (COPD) Awareness Month — November 2014

Announcement: National Chronic Obstructive Pulmonary Disease (COPD) Awareness Month — November 2014

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Vol. 63, No. 46
November 21, 2014
 
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Announcement: National Chronic Obstructive Pulmonary Disease (COPD) Awareness Month — November 2014

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November 21, 2014 / 63(46);1093


Chronic obstructive pulmonary disease (COPD) is a respiratory condition that makes it hard to breathe by limiting airflow in and out of the lungs. COPD includes emphysema and chronic bronchitis. Each year, more persons in the United States die from COPD than from stroke, injuries, or diabetes (1). The symptoms of COPD include frequent coughing (sometimes called "smoker's cough" if the patient is a current or former smoker), excess phlegm or sputum production, shortness of breath while doing activities the patient used to be able to do, wheezing, and not being able to take a deep breath. The primary cause of COPD in the United States is smoking, but one fourth of patients with COPD have never smoked (2). The risk for COPD increases with age and is higher among women than men and among American Indians/Alaska Natives than other ethnic groups (3).
November is National COPD Awareness Month. The observance is supported by the National Heart, Lung, and Blood Institute's COPD: Learn More, Breathe Better campaign. This year, the campaign encourages persons who are experiencing COPD symptoms to "Take the First Step" and discuss their symptoms with their physician. Lung function can be evaluated through a simple breathing test called spirometry. Although COPD currently has no cure, it can be treated, making it possible for patients to improve their quality of life.
More information about COPD is available from CDC at http://www.cdc.gov/copd and from the National Heart, Lung, and Blood Institute athttp://www.nhlbi.nih.gov/health/educational/copdExternal Web Site Icon.

References

  1. Heron M. Deaths: leading causes for 2010. Natl Vital Stat Rep 2013;62(6).
  2. CDC. Chronic obstructive pulmonary disease among adults—United States, 2011. MMWR Morb Mortal Wkly Rep 2012;61:938–43.
  3. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH. COPD surveillance—United States, 1999–2011. Chest 2013;144:284–305.

Announcement: Diabetes State Atlas Now Available Online

Announcement: Diabetes State Atlas Now Available Online

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Vol. 63, No. 46
November 21, 2014
 
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Announcement: Diabetes State Atlas Now Available Online

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November 21, 2014 / 63(46);1092


CDC's Division of Diabetes Translation announces the launch of the Diabetes State Atlas (available at http://www.cdc.gov/diabetes/data), an interactive Internet tool for the public to view maps and charts of diabetes data and trends at the U.S. state level. Some of the features of the atlas include 1) customizable maps and graphics of diabetes surveillance data, 2) an interactive application to view state-specific trends by age and sex, and 3) downloadable maps, charts, and data tables that can be used in grant applications, reports, articles, and publications.
The Diabetes State Atlas can help state public health officials document the burden of diabetes in their states, monitor trends, identify high-risk groups and assess disparities between groups, and track progress in achieving Healthy People 2020 diabetes objectives (1).
In the United States, about 29 million persons have diabetes (2). An additional 86 million adults have prediabetes, putting them at increased risk for developing type 2 diabetes, heart disease, and stroke (2). However, persons with diabetes can take steps to control the disease and prevent complications, and those with prediabetes can prevent or delay the onset of type 2 diabetes through weight loss and physical activity (3). Information about diabetes prevention and control is available online from CDC's Division of Diabetes Translation at http://www.cdc.gov/diabetes/home/index.html.

References

  1. US Department of Health and Human Services. Healthy people 2020. Washington, DC: US Department of Health and Human Services; 2014. Available athttps://www.healthypeople.govExternal Web Site Icon.
  2. CDC. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/diabetes/pubs/statsreport14.htm.
  3. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403.