(WHS-P34) Novel anti-biofilm treatment for hidradenitis suppurativa tunneling wounds modulates host-pathogen response to promote scarless wound healing
Friday, May 17, 2024
7:30 AM – 5:00 PM East Coast USA Time
The function of the epidermis and response to wounding are significantly compromised during the development of the cutaneous inflammatory condition hidradenitis suppurativa (HS). Resident HS keratinocytes erroneously migrate into the surrounding area forming pathognomonic epithelial, intra-dermal tunneling wounds, which are primary drivers of chronic inflammation. In addition, HS tunneling wounds are colonized by anerobic bacteria that form treatment-resistant biofilms. Persistent biofilms are hypothesized to contribute to an aberrant inflammatory response and, subsequently, the relapsing nature of HS tunnels. Here we performed the first pilot longitudinal study to evaluate the effectiveness of antibiofilm therapy for HS tunneling wounds. HS Subjects (n=15) with confirmed tunnels were recruited to the study and pre-treatment lesional tissue was collected to evaluate the host response and microbiome composition. Subjects then instilled the antibiofilm surfactant gel daily into the tunneling wounds, and tissue was collected 28 days after the procedure for evaluation of the inflammatory response and bacterial load by 16s rDNA sequencing. RNA was isolated before and after treatment and host response was analyzed with Nanostring’s Ncounter technology. We observed 93% clinical, tunneling wound resolution and overall reduction of scarring at an average of 12 days after daily instillation of antibiofilm surfactant gel in HS tunneling wounds. Clinical findings correlated with the significant attenuation of the inflammatory response after anti-biofilm treatment, with marked reduction in INFg, IL-17, IL-6, IL-8, and TNFa signaling. Furthermore, the treatment resulted in reduction of bacterial load, and restoration of microbial dysbiosis reflected in lower abundance of anaerobic pathogens and restoration of commensal bacterial genera. Our study highlights the importance of therapeutic targeting of bacterial biofilms in HS tunneling wounds. We conclude that anti-biofilm therapeutics offer a novel treatment approach to suppress inflammation, restore healthy microbiome and alleviate clinical symptoms in affected patients.