Skip to main content
Advertisement
Browse Subject Areas
?

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here.

  • Loading metrics

Acid-treated Staphylococcus aureus induces acute silkworm hemolymph melanization

  • Yasuhiko Matsumoto ,

    Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Visualization, Writing – original draft, Writing – review & editing

    ymatsumoto@my-pharm.ac.jp

    Affiliation Department of Microbiology, Meiji Pharmaceutical University, Tokyo, Japan

  • Eri Sato,

    Roles Data curation, Formal analysis, Investigation, Methodology, Visualization

    Affiliation Department of Microbiology, Meiji Pharmaceutical University, Tokyo, Japan

  • Takashi Sugita

    Roles Project administration, Writing – review & editing

    Affiliation Department of Microbiology, Meiji Pharmaceutical University, Tokyo, Japan

Abstract

The skin microbiome maintains healthy human skin, and disruption of the microbiome balance leads to inflammatory skin diseases such as folliculitis and atopic dermatitis. Staphylococcus aureus and Cutibacterium acnes are pathogenic bacteria that simultaneously inhabit the skin and cause inflammatory diseases of the skin through the activation of innate immune responses. Silkworms are useful invertebrate animal models for evaluating innate immune responses. In silkworms, phenoloxidase generates melanin as an indicator of innate immune activation upon the recognition of bacterial or fungal components. We hypothesized that S. aureus and C. acnes interact to increase the innate immunity-activating properties of S. aureus. In the present study, we showed that acidification is involved in the activation of silkworm hemolymph melanization by S. aureus. Autoclaved-killed S. aureus (S. aureus [AC]) alone does not greatly activate silkworm hemolymph melanization. On the other hand, applying S. aureus [AC] treated with C. acnes culture supernatant increased the silkworm hemolymph melanization. Adding C. acnes culture supernatant to the medium decreased the pH. S. aureus [AC] treated with propionic acid, acetic acid, or lactic acid induced higher silkworm hemolymph melanization activity than untreated S. aureus [AC]. S. aureus [AC] treated with hydrochloric acid also induced silkworm hemolymph melanization. The silkworm hemolymph melanization activity of S. aureus [AC] treated with hydrochloric acid was inhibited by protease treatment of S. aureus [AC]. These results suggest that acid treatment of S. aureus induces innate immune activation in silkworms and that S. aureus proteins are involved in the induction of innate immunity in silkworms.

Introduction

The human skin microbiome maintains the skin environment to prevent the onset of inflammatory skin diseases such as folliculitis and atopic dermatitis [13]. Staphylococcus aureus, a gram-positive bacterium on human skin and in the nasal cavity, causes severe systemic infections such as sepsis and inflammatory skin infections such as folliculitis and atopic dermatitis [46]. S. aureus enters the hair follicles and proliferates, which induces immune responses and inflammation resulting in folliculitis [2, 5]. S. aureus peptidoglycan, a cell wall component, and proteins such as lipoproteins induce innate immune activation and inflammation [6, 7]. Understanding the mechanism underlying the induction of host immunity by S. aureus may contribute to the prevention and treatment of inflammatory skin diseases.

Cutibacterium acnes, a gram-positive bacterium on the human skin, is a causative agent of inflammatory skin diseases, such as acne vulgaris [1, 8, 9]. Acne vulgaris is an inflammatory skin disease that affects hair follicles and sebaceous glands [9]. C. acnes interacts with S. aureus in hair follicles [5]. Various factors such as lipase and propionic acid, which slightly acidify the skin surface, are produced by C. acnes, [10, 11]. Lipase released by C. acnes produces free fatty acids from sebum [12]. C. acnes also secretes short-chain fatty acids such as propionic acid to lower the pH of the skin environment [13]. The effects of these acidic substances associated with C. acnes on the induction of innate immunity by S. aureus, however, remain unknown.

Innate immune activation occurs in multiple immune cells through several pattern-recognition proteins [14, 15]. Therefore, the use of individual animals is desirable for evaluating the activation of immunity. Experiments using a large number of mammals such as mice trigger ethical issues from the perspective of animal welfare [16, 17]. The silkworm, an invertebrate, has benefits as a model animal to overcome these ethical issues [16, 18, 19]. Moreover, experimental systems using silkworms have been established to evaluate the innate immune activation by pathogenic microorganisms [2022]. The melanization response is an innate immune mechanism of insects, including silkworms [2325]. When pathogens enter the silkworm body, the silkworms produce melanin in the hemolymph to coagulate the pathogens and repair the wound [20, 25, 26]. Melanization and immune responses via the Toll pathway are mediated by the same signaling cascades [2325, 27]. Therefore, silkworm hemolymph melanization is a useful indicator for evaluating the induction of innate immunity by pathogens such as Cutibacterium acnes, Porphyromonas gingivalis, and Candida albicans [2022].

In this study, using silkworm hemolymph melanization as an indicator of innate immune activation, we found that treatment with C. acnes culture supernatant enhanced the immune-inducing activity of S. aureus. Moreover, treatment with acidic substances such as propionic acid, acetic acid, lactic acid, and hydrochloric acid enhanced the immune-inducing activity of S. aureus. These findings suggest that acidification is involved in immune induction by S. aureus.

Materials & methods

Reagents

Gifu anaerobic medium agar was purchased from Nissui Pharmaceutical Co., Ltd. (Tokyo, Japan). Tryptic soy broth was purchased from Becton Dickinson (Franklin Lakes, NJ, USA). Protease K was purchased from QIAGEN (Hilden, Germany). Propionic acid, acetic acid, lactic acid, and hydrochloric acid were purchased from FUJIFILM Wako Pure Chemical Corporation (Osaka, Japan).

Culture of bacteria

C. acnes ATCC6919 and S. aureus Newman strains were used in this study. The C. acnes ATCC6919 strain was spread on Gifu anaerobic medium agar and incubated under anaerobic conditions at 37°C for 3 days [22]. The S. aureus Newman strain was spread on tryptic soy broth agar and incubated under aerobic conditions at 37°C for 1 day [22]. To prepare the C. acnes culture supernatant (CS), C. acnes ATCC6919 strain (8 x 109 cells) was added to 10 mL of tryptic soy broth + 2% glucose medium and incubated at 37°C for 6 days under anaerobic conditions.

Silkworm rearing

The silkworm rearing procedures were previously described [28]. Silkworm eggs (Hu Yo × Tukuba Ne) were purchased from Ehime-Sanshu Co. Ltd. (Ehime, Japan), disinfected, and hatched at 25°C –27°C. Silkworms were fed an artificial diet, Silkmate 2S, containing antibiotics purchased from Ehime-Sanshu Co., Ltd. Fifth-instar larvae were used for the infection experiments.

In vivo melanization assay

An in vivo melanization assay was performed as previously described [22], with slight modifications. The silkworm injection experiments were performed as previously described [29]. Fifth instar silkworm larvae were fed an artificial diet (1.5 g Silkmate 2S; Ehime-Sanshu Co., Ltd) overnight. A 50-μL suspension of bacterial samples was injected into the silkworm hemolymph with a 1-ml tuberculin syringe (Terumo Medical Corporation, Tokyo, Japan). The silkworms were maintained at 37°C for 3 h. Hemolymph was collected from the larvae through a cut on the first proleg as described previously [30]. The silkworm hemolymph (50 μL) was mixed with 50 μL of physiologic saline solution (0.9% NaCl: PSS). Absorbance at 490 nm was measured using a microplate reader (iMark™ microplate reader; Bio-Rad Laboratories Inc., Hercules, CA, USA). Each experiment was performed at least twice to check reproducibility.

Protease treatment

Autoclaved S. aureus cells [AC] were diluted with phosphate-buffered saline (PBS) to an absorbance at 600 nm (A600) = 3 in 1 mL, and 50 μL protease K (0.75 AU/ml) was added. After incubation for 1 h at 50°C, the samples were centrifuged at 15,000 rpm for 10 min at room temperature. The precipitate was suspended in PSS (1 mL), and the remaining enzymes were inactivated by incubation at 80°C for 30 min. The samples were centrifuged at 15,000 rpm for 10 min at room temperature and the precipitate was diluted with PSS to A600 = 1 to obtain the precipitate sample.

Statistical analysis

Statistical differences between groups were analyzed using the Student’s t-test, the Tukey’s test or the Tukey-Kramer test. The Student’s t-test was used to assess whether the two groups were statistically significantly different. The Tukey’s test and the Tukey-Kramer test were used to assess whether the multiple groups were statistically significantly different. Each experiment was performed at least twice. A P value of less than 0.05 was considered statistically significant.

Results

Comparison of melanization-inducing activity between heat-killed C. acnes and S. aureus

The injection of heat-killed C. acnes cells obtained by autoclaving causes silkworm hemolymph melanization [22]. We examined whether heat-killed C. acnes and S. aureus cells differed in their ability to induce silkworm hemolymph melanization. The experimental scheme for silkworm hemolymph melanization is shown in Fig 1. Melanization was induced by injection of autoclave-treated C. acnes, but not by that of autoclave-treated S. aureus (Fig 2A and 2B). The result suggests that the silkworm hemolymph melanization activity induced by heat-killed S. aureus is lower than that by heat-killed C. acnes.

thumbnail
Fig 1. Evaluation system for inducing silkworm hemolymph melanization using bacterial samples.

Illustration of an experimental method to determine silkworm hemolymph melanization. Sample solution was injected into the silkworm hemolymph. The silkworms were maintained at 37°C for 3 h. The hemolymph was collected from the larvae through a cut on the first proleg. Absorbance was measured at 490 nm.

https://doi.org/10.1371/journal.pone.0298502.g001

thumbnail
Fig 2. Comparison of silkworm hemolymph melanization induced by heat-killed C. acnes and S. aureus.

(A, B) Sample solution was injected to silkworms and hemolymph was collected at 3 hours after injection. Samples were saline (Saline), heat-killed C. acnes cell suspension (C. acnes; 1 x 108 cells/larva), or heat-killed S. aureus cell suspension (S. aureus; 1 x 108 cells/larva). (A) Photograph. (B) Absorbance at 490 nm (A490). n = 8/group. Statistically significant differences between groups were evaluated using the Tukey’s test. *P < 0.05.

https://doi.org/10.1371/journal.pone.0298502.g002

Increased melanization-inducing activity of S. aureus after treatment with C. acnes culture supernatant

Silkworm hemolymph melanization was increased by injecting silkworms with S. aureus [AC] treated with C. acnes CS (Fig 3). We confirmed that C. acnes CS alone did not induce silkworm hemolymph melanization (Fig 3). These results suggest that the substances produced by C. acnes induced the silkworm hemolymph melanization activity of S. aureus.

thumbnail
Fig 3. Silkworm hemolymph melanization was induced by injecting heat-killed S. aureus treated with C. acnes culture supernatant.

(A) Preparation of C. acnes culture supernatant (CS)-treated S. aureus [AC]. The S. aureus [AC] fraction was treated with C. acnes CS at 37°C for 24 h. (B, C) Sample solution was injected to silkworms and hemolymph was collected at 3 hours after injection. Samples were saline (Saline), C. acnes CS, S. aureus [AC], C. acnes CS-treated S. aureus [AC] supernatant (Sup), or precipitate (Ppt). (B) Photograph. (C) Absorbance at 490 nm (A490). n = 11-12/group. Statistically significant differences between groups were evaluated using the Tukey-Kramer test. *P < 0.05.

https://doi.org/10.1371/journal.pone.0298502.g003

Silkworm hemolymph melanization by acid-treated S. aureus cells

C. acnes produces short-chain fatty acids such as propionic acid [13], which affect the pH in the environment [3, 31]. The pH of the C. acnes CS used in this study was lower than that of the preculture medium (Table 1). Therefore, we tested whether silkworm hemolymph melanization by S. aureus [AC] was induced by pretreatment with propionic acid. Propionic acid-treated S. aureus [AC] induced silkworm hemolymph melanization (Fig 4). Next, we examined whether acids other than propionic acid increased the silkworm hemolymph melanization activity of S. aureus [AC]. Compared with untreated S. aureus [AC], S. aureus [AC] treated with acetic acid, lactic acid, or hydrochloric acid also exhibited higher silkworm hemolymph melanization activity (Fig 5). On the other hand, administration of these short-chain fatty acid solutions did not affect melanization of the silkworm hemolymph (S1 Fig in S1 File). Furthermore, injections of S. aureus [AC] treated with low-pH solutions adjusted by hydrochloric acid at 37°C for 24 h also enhanced silkworm hemolymph melanization in a pH-dependent manner, with more melanization occurring at a lower pH (Fig 6). These results suggest that acid treatment induces silkworm hemolymph melanization activity by S. aureus.

thumbnail
Fig 4. Silkworm hemolymph melanization induced by the injection of heat-killed S. aureus treated with propionic acid.

(A) Preparation of propionic acid (PA)-treated S. aureus [AC]. The S. aureus [AC] fraction was treated with propionic acid (1%: 130 mM) at 37°C for 24 h. (B, C) Sample solution was injected to silkworms and hemolymph was collected at 3 hours after injection. Samples were S. aureus [AC] or propionic acid (130 mM)-treated S. aureus [AC] precipitates (Ppt). (B) Photograph. (C) Absorbance at 490 nm (A490). n = 6/group. Statistically significant differences between groups were evaluated using the Tukey-Kramer test. *P < 0.05.

https://doi.org/10.1371/journal.pone.0298502.g004

thumbnail
Fig 5. Effects of acid treatment of heat-killed S. aureus on silkworm hemolymph melanization.

(A) Preparation of the acid-treated S. aureus [AC]. The S. aureus [AC] fraction was treated with acetic acid (AA) (130 mM), lactic acid (LA) (130 mM), or hydrochloric acid (HA) (130 mM) at 37°C for 24 h. (B, C) Sample solution was injected to silkworms and hemolymph was collected at 3 hours after injection. Samples were S. aureus [AC], AA, LA, or HA-treated S. aureus [AC] precipitates (Ppt). (B) Photograph. (C) Absorbance at 490 nm (A490). n = 5-7/group. Statistically significant differences between groups were evaluated using the Student’s t-test. *P < 0.05.

https://doi.org/10.1371/journal.pone.0298502.g005

thumbnail
Fig 6. Effects of low-pH treatments of heat-killed S. aureus on silkworm hemolymph melanization.

(A) Preparation of the acid-treated S. aureus [AC]. The S. aureus [AC] fraction was treated with saline or hydrochloric acid solution adjusted to pH 2–7 at 37°C for 24 h. (B, C) Sample solution was injected to silkworms and hemolymph was collected at 3 hours after injection. Samples were S. aureus [AC] or low pH-treated S. aureus [AC] precipitate (Ppt). (B) Photograph. (C) Absorbance at 490 nm (A490). n = 5-6/group. Statistically significant differences between groups were evaluated using the Tukey-Kramer test. *P < 0.05.

https://doi.org/10.1371/journal.pone.0298502.g006

thumbnail
Table 1. Decrease in the pH of medium by the addition of C. acnes culture.

https://doi.org/10.1371/journal.pone.0298502.t001

Effect of protease treatment on the induction of silkworm hemolymph melanization by S. aureus

S. aureus lipoproteins bind to mammalian TLR2 and activate innate immunity [6, 7]. Therefore, we hypothesized that a protein in S. aureus [AC] was responsible for this activity. Melanization of the silkworm hemolymph by S. aureus [AC] treated with low pH was decreased by pretreating the S. aureus [AC] with a protease (Fig 7). On the other hand, administration of protease solution did not affect melanization of the silkworm hemolymph (S1 Fig in S1 File). These results suggest that S. aureus proteins are involved in the induction of silkworm hemolymph melanization by acid-treated S. aureus.

thumbnail
Fig 7. Effect of protease treatment of heat-killed S. aureus on silkworm hemolymph melanization.

(A) Preparation of the acid-treated S. aureus [AC] with protease treatment. S. aureus [AC] was treated with protease K. Protease K-treated S. aureus [AC] was further treated with hydrochloric acid solution adjusted to pH 3 at 37°C for 7 days. (B, C) Sample solution was injected to silkworms and hemolymph was collected at 3 hours after injection. Samples were saline (Saline), acid-treated S. aureus [AC] precipitate ([AC] Ppt), or acid-treated protease K-treated S. aureus [AC] precipitate ([ProK] Ppt). (B) Photograph. (C) Absorbance at 490 nm (A490). n = 5-6/group. Statistically significant differences between groups were evaluated using the Tukey-Kramer test. *P < 0.05.

https://doi.org/10.1371/journal.pone.0298502.g007

Discussion

Acid treatment of S. aureus stimulates innate immune activity in silkworms, and the innate immune activating substances of S. aureus may be proteins. Our findings suggest that acid-treated S. aureus induces excess host immunity, which may cause immune-active diseases, such as folliculitis.

S. aureus and C. acnes are gram-positive bacteria present in the human skin that cause inflammatory diseases such as folliculitis [2]. We hypothesized that an interaction between S. aureus and C. acnes within the hair follicle may influence the induction of innate immune responses by S. aureus. In the present study, we found that acidic substances released by C. acnes affected the immune-inducing activity of S. aureus. Further studies should be conducted in mammalian models to confirm and develop these findings.

On the human skin, various bacteria, including C. acnes and S. aureus, produce short-chain fatty acids such as lactic acid [32]. Moreover, S. aureus and C. acnes produce lipases that produce free fatty acids from sebum [13], which can decrease the pH of the skin. On the other hand, bacteria such as Delftia acidovorans, a gram-negative bacterium on human skin, produce ammonia that increases the pH [33]. Therefore, the balance of the skin microbiome may affect changes in skin pH. Weak acidity caused by alterations in the skin microbiome may induce an innate immune response by S. aureus. Proteins of S. aureus may be involved in the immune activity induced by acid-treated S. aureus in the silkworm evaluation system. The conformational changes of proteins responsible for inducing innate immunity by acid treatment, however, remain unknown. We assumed that S. aureus lipoproteins treated with acids lead to conformational changes, and that acid-treated lipoproteins are easily recognized by Toll receptors, which are involved in innate immunity in silkworms. Preventing the acid-enhanced induction of innate immune activation by S. aureus may contribute to inhibiting the onset of inflammatory skin diseases such as folliculitis.

As a limitation of this study, the effects of acid-treated S. aureus on inflammation in individual mammals were not evaluated. It is also unclear whether the effects of an acidic pH on the skin microbiome are related to immune induction. Furthermore, the responsible proteins of S. aureus have not yet been identified. The effects of acid treatment and the identification of the responsible proteins are important issues for future research.

Conclusion

Acid-treated S. aureus induces innate immunity in silkworms, and S. aureus proteins may be the responsible factors.

Acknowledgments

We thank Yu Sugiyama, Sachi Koganesawa, and Hiromi Kanai (Meiji Pharmaceutical University) for technical assistance rearing the silkworms. We also thank the editors of SciTechEdit International LLC (Highlands Ranch, CO, USA) for providing editorial support during the production of this manuscript.

References

  1. 1. Byrd AL, Belkaid Y, Segre JA. The human skin microbiome. Nat Rev Microbiol. 2018;16: 143–155. pmid:29332945
  2. 2. Lousada MB, Lachnit T, Edelkamp J, Rouillé T, Ajdic D, Uchida Y, et al. Exploring the human hair follicle microbiome. Br J Dermatol. 2021;184: 802–815. pmid:32762039
  3. 3. Smythe P, Wilkinson HN. The Skin Microbiome: Current Landscape and Future Opportunities. Int J Mol Sci. 2023;24: 3950. pmid:36835363
  4. 4. Leung DYM. Atopic dermatitis: New insights and opportunities for therapeutic intervention. J Allergy Clin Immunol. 2000;105: 860–876. pmid:10808164
  5. 5. Nowicka D, Grywalska E. Staphylococcus aureus and Host Immunity in Recurrent Furunculosis. Dermatology. 2019;235: 295–305. pmid:30995649
  6. 6. Hulme J. Staphylococcus Infection: Relapsing Atopic Dermatitis and Microbial Restoration. Antibiotics. 2023;12: 222. pmid:36830133
  7. 7. Iwamoto K, Moriwaki M, Miyake R, Hide M. Staphylococcus aureus in atopic dermatitis: Strain-specific cell wall proteins and skin immunity. Allergol Int. 2019;68: 309–315. pmid:30878567
  8. 8. Stirling A, Worthington T, Rafiq M, Lambert PA, Elliott TS. Association between sciatica and Propionibacterium acnes. Lancet. 2001;357: 2024–2025. pmid:11438138
  9. 9. Rozas M, Ruijter AH de, Fabrega MJ, Zorgani A, Guell M, Paetzold B, et al. From Dysbiosis to Healthy Skin: Major Contributions of Cutibacterium acnes to Skin Homeostasis. Microorganisms. 2021;9: 628. pmid:33803499
  10. 10. Elias PM. The skin barrier as an innate immune element. Semin Immunopathol. 2007;29: 3. pmid:17621950
  11. 11. Christensen GJM, Brüggemann H. Bacterial skin commensals and their role as host guardians. Benef Microbes. 2014;5: 201–215. pmid:24322878
  12. 12. Mayslich C, Grange PA, Dupin N. Cutibacterium acnes as an Opportunistic Pathogen: An Update of Its Virulence-Associated Factors. Microorganisms. 2021;9: 303. pmid:33540667
  13. 13. Sanford JA, Zhang L-J, Williams MR, Gangoiti JA, Huang C-M, Gallo RL. Inhibition of HDAC8 and HDAC9 by microbial short-chain fatty acids breaks immune tolerance of the epidermis to TLR ligands. Sci Immunol. 2016;1. pmid:28783689
  14. 14. Zhang W, Tettamanti G, Bassal T, Heryanto C, Eleftherianos I, Mohamed A. Regulators and signalling in insect antimicrobial innate immunity: Functional molecules and cellular pathways. Cell Signal. 2021;83: 110003. pmid:33836260
  15. 15. Geng T, Lu F, Zhu F, Wang S. Lineage-specific gene evolution of innate immunity in Bombyx mori to adapt to challenge by pathogens, especially entomopathogenic fungi. Dev Comp Immunol. 2021;123: 104171. pmid:34118279
  16. 16. Matsumoto Y, Sekimizu K. Silkworm as an experimental animal for research on fungal infections. Microbiol Immunol. 2019;63: 41–50. pmid:30666711
  17. 17. Replacement Flecknell P., reduction and refinement. ALTEX. 2002;19: 73–78.
  18. 18. Matsumoto Y. Facilitating Drug Discovery in Human Disease Models Using Insects. Biol Pharm Bull. 2020;43: 216–220. pmid:32009109
  19. 19. Kaito C, Murakami K, Imai L, Furuta K. Animal infection models using non-mammals. Microbiol Immunol. 2020;64: 585–592. pmid:32757288
  20. 20. Ishii K, Hamamoto H, Imamura K, Adachi T, Shoji M, Nakayama K, et al. Porphyromonas gingivalis peptidoglycans induce excessive activation of the innate immune system in silkworm larvae. J Biol Chem. 2010;285: 33338–33347. pmid:20702417
  21. 21. Yasu T, Matsumoto Y, Sugita T. Pharmacokinetics of voriconazole and its alteration by Candida albicans infection in silkworms. J Antibiot. 2021;74: 443–449. pmid:34045695
  22. 22. Matsumoto Y, Sato E, Sugita T. Acute melanization of silkworm hemolymph by peptidoglycans of the human commensal bacterium Cutibacterium acnes. PLoS ONE. 2022;17: e0271420. pmid:36155485
  23. 23. Lemaitre B, Hoffmann J. The host defense of Drosophila melanogaster. Annu Rev Immunol. 2007;25: 697–743. pmid:17201680
  24. 24. Lu A, Zhang Q, Zhang J, Yang B, Wu K, Xie W, et al. Insect prophenoloxidase: the view beyond immunity. Front Physiol. 2014;5: 252. pmid:25071597
  25. 25. Marieshwari BN, Bhuvaragavan S, Sruthi K, Mullainadhan P, Janarthanan S. Insect phenoloxidase and its diverse roles: melanogenesis and beyond. J Comp Physiol B. 2023;193: 1–23. pmid:36472653
  26. 26. Ishii K, Hamamoto H, Sekimizu K. Studies of host-pathogen interactions and immune-related drug development using the silkworm: interdisciplinary immunology, microbiology, and pharmacology studies. Drug Discov Ther. 2015;9: 238–246. pmid:25865526
  27. 27. Lindsay SA, Wasserman SA. Conventional and non-conventional Drosophila Toll signaling. Dev Comp Immunol. 2014;42: 16–24. pmid:23632253
  28. 28. Kaito C, Akimitsu N, Watanabe H, Sekimizu K. Silkworm larvae as an animal model of bacterial infection pathogenic to humans. Microb Pathog. 2002;32: 183–190. pmid:12079408
  29. 29. Matsumoto Y, Tateyama Y, Sugita T. Evaluation of Antibacterial Drugs Using Silkworms Infected by Cutibacterium acnes. Insects. 2021;12: 619. pmid:34357279
  30. 30. Matsumoto Y, Sumiya E, Sugita T, Sekimizu K. An invertebrate hyperglycemic model for the identification of anti-diabetic drugs. PLoS ONE. 2011;6: e18292. pmid:21479175
  31. 31. Sanford JA, O’Neill AM, Zouboulis CC, Gallo RL. Short-Chain Fatty Acids from Cutibacterium acnes Activate Both a Canonical and Epigenetic Inflammatory Response in Human Sebocytes. J Immunol. 2019;202: 1767–1776. pmid:30737272
  32. 32. Pessôa R, Clissa PB, Sanabani SS. The Interaction between the Host Genome, Epigenome, and the Gut–Skin Axis Microbiome in Atopic Dermatitis. Int J Mol Sci. 2023;24: 14322. pmid:37762624
  33. 33. Ohkubo T, Matsumoto Y, Ogasawara Y, Sugita T. Alkaline stress inhibits the growth of Staphylococcus epidermidis by inducing TCA cycle-triggered ROS production. Biochem Biophys Res Commun. 2022;588: 104–110. pmid:34953206