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Butyric acid as a solution to gut microbiota dysfunction in patients with Psoriasis

CRISTINA GARFELLA SANCHO
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Science, Nutritionism

‘Scientific review article’

Butyric acid as a solution to gut microbiota dysfunctionality in patients with Psoriasis.

Context

The exact root cause of the skin disease psoriasis is unknown, a number of genetic factors are involved in its onset and development, as well as environmental factors responsible for triggering outbreaks: trauma; infections; drugs; increased emotional stress and metabolic factors are suggested as substantial reasons.
Published evidence supports that patients with autoimmune diseases suffer from an altered gut microbiota.

 

Objetives

We aimed to examine whether:

  1. The gut microbiota of patients with psoriasis was altered, in its balance and functional potential, compared to healthy patients.
  2. Is there a difference when compared with healthy cohabiting couples.
  3. There are relationships with disease severity and seasonal impact on gut microbiota.

 

Debate

The gut and skin barrier share many characteristics. The gut and skin are very analogous to each other in purpose and functionality. Both organs are highly innervated and vascularised, as both are essential for immune and neuroendocrine function [6].
This similarity gives rise to the existence of the gut-skin axis [6].
The epidermis of the skin provides a total skin surface area of approximately 25m2 and is one of the largest epithelial surfaces for interaction with microorganisms. The gastrointestinal tract is one of the largest interfaces (30m2) between the host and its environment. It is estimated that about 60 tonnes of food passes through the gut in a lifetime, all of which has a major impact on human health. Both the gut and the skin are immensely immersed in microbiota, as the skin is estimated to have around1012 microbial cells, while the gut has1014 microbial cells.
The inner surface of the gut and the outer surface of the skin are covered by epithelial cells (ECs) that have direct contact with the exogenous environment. ECs maintain an important link between the internal body and the external environment. They act as a first line of defence, preventing the entry of micro-organisms [7]. Keratin, which is present in the stratified squamous epithelium of the skin, presents a formidable physical barrier to most micro-organisms [9]. In addition, this compound makes the skin resistant to weak acids and bases, bacterial enzymes and toxins [9]. Mucous membranes provide similar mechanical barriers, comprising a glycoprotein layer on top of the epithelium in which commensal bacteria reside. The acidity of the skin (pH 5.4-5.9) creates an inhospitable environment for potential pathogens and inhibits bacterial growth. The sebum produced by the sebaceous glands acts as a seal for the hair follicles and contains various antimicrobial molecules as well as nutritional lipids specific for beneficial micro-organisms. Meanwhile, in the digestive system, saliva and tear fluid contain lysozyme, followed by the mucous membranes of the stomach which secrete strong acids and protein-digesting enzymes. In addition, mucus traps micro-organisms that enter the digestive and respiratory tract. All this brings their parallelism even closer.
Numerous studies have provided evidence of a profound bidirectional link between gastrointestinal health and skin homeostasis through modification of the immune system
[11-13]. Modulation of the immune system occurs primarily through the gut microbiota. However, the commensal skin microbiota is equally essential for the maintenance of skin immune homeostasis. [14]. Both gut and skin harbour diverse bacterial, fungal and viral species that maintain symbiosis with the human habitat; this balance could lead to impaired barrier function. Restoration of skin homeostasis after disruption or stress via the gut microbiota affects both innate and adaptive immunity.

The control of immune processes within mucosal tissues depends on the interaction between ECs and dendritic cells (DCs), as both cell types are involved in antigen detection and presentation. Other similarities between gut and skin tissues is the high rate of cell turnover, which inhibits adherence and infection by the colonising microbiome. Skin and gut are the two main niches harbouring symbiotic prokaryotic and eukaryotic microorganisms. Both tissues actively respond to stress and anxiety, as they face similar challenges. Surprisingly, diseases such as inflammatory bowel disease and psoriasis involve epithelial barrier dysfunction and an increased rate of epithelial cell turnover. The increased permeability of the epidermal skin and intestinal barrier is due to the increased interaction of allergens and pathogens with inflammatory receptors on immune cells. Both diseases have an analogous immune response and involve phagocytic, dendritic and natural killer cells together with a variety of cytokines and antimicrobial peptides that induce a T-cell response. In addition, both diseases are characterised by dysbiosis in the composition of the microbiome lining the respective interface linings.
The microbiome of the skin and gut are similarly affected. The skin is the body’s largest barrier to the external environment. It is richly perfused with immune cells and heavily colonised by microbial cells, which in turn train immune cells and determine the host’s well-being. The intestinal tract harbours a diverse collection of bacteria, fungi and protozoa. Many of these microorganisms are essential for metabolic and immune function, as they metabolise complex non-digestible polysaccharides into essential nutrients such as vitamin K and B12, butyrate
[15,16,17], propionate and acetate. The latter have a positive effect on the integrity of the epithelial barrier. The integrity of the intestinal barrier plays a crucial role in protecting the microbiota from entering the systemic circulation and preventing inflammation in the gut. Diet may play a vital role in the maintenance of certain skin pathologies. Lifestyle, such as diet and hygiene, has a determining impact on the tolerance of the immune system to the commensal microbiota, which, in combination with genetic susceptibility, leads to microbial dysbiosis and diseases, which have been associated with the development of numerous immune-mediated inflammatory diseases, such as rheumatoid arthritis, psoriasis and atopic dermatitis.

Trial

126 faecal samples were collected from 53 patients with systemically untreated plaque psoriasis; 52 healthy controls matched for age, sex and body mass index; and 21 domestic partners. A subpopulation of 18 patients with psoriasis and 19 healthy controls continued in a longitudinal study, where four to six faecal samples were collected for 9 to 12 months. The gut microbiota was characterised by metagenomic sequencing (shotgun) analysis.

Results

Significantly lower variability (P = 0.007) and difference in community composition (P = 0.01) of metagenomic species was observed in patients with psoriasis compared to healthy controls, and patients with psoriasis had lower microbial diversity than their partners (P = 0-04). In addition, functional richness decreased in patients with psoriasis compared to healthy controls (P = 0.01) and partners (P = 0.05). Increased disease severity correlated with alterations in taxonomy and function, with a slight trend towards less metagenomic species variability, although not significant (P = 0.08). Seasonal analysis showed no changes in community composition in healthy controls or in patients with psoriasis.

Trial conclusions

The findings of a different gut microbiota in composition and functional potential between patients with psoriasis and healthy controls support a link between gut microbiota and psoriasis. These findings need to be validated in larger studies and a possible causal relationship between gut microbiota and psoriasis remains to be demonstrated.

Final conclusions

The direct relationship between the two largest organs of the human organism, the skin and the gut, and how disorders of their resident microbiota affect the health and function of the different organs of the body, bring us to a conclusion with a firm foundation: By caring for the microbiota and microbiome of our gut, for example by taking butyric acid in the form of natural triglyceride, we contribute to the health of both organs, skin and gut, whereby the associated pathologies will be improved and compensated for by the proper functioning of the two axis variables. Skin diseases, such as psoriasis, are attenuated and controlled through the care of the intestinal and skin bacterial flora.
Author’s note: we are indeed missing the other axis of coordinates, the brain, which we will be able to discuss on future occasions.

Juan Fernández

Biologist and Founder of KeyBiological

Member no.: 20846-X

www.KeyBiological.com

 

 

Bibliographical references

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