expert Q&A: Harpera Microbiopsy Punch enables study of atopic dermatitis

In my role as Trajan's Neoteryx microsampling product director for the Harpera™ Microbiopsy™ Punch, I explore the potential research benefits of the Harpera with many scientists who are investigating infectious skin diseases, dermatological conditions, or the pharmaceutical therapies being developed to treat those issues. I recently interviewed Drs. Yacine Amar and Martin Köberle, research scientists at the Technical University of Munich (TUM), on how they are using the Harpera device in their prospective birth cohort on atopic dermatitis (AD). 

As part of Prof. Biedermann’s team at the Clinic and Polyclinic for Dermatology and Allergology at TUM, Drs. Amar and Köberle investigate many skin diseases and conditions where the bacterial layer protecting the skin is damaged. They have a particular interest in understanding the role played by skin bacteria and other aspects of the cutaneous microbiome in atopic dermatitis, which can manifest in newborn infants.
 
 
Image: TUM Researchers from Left to Right: Yacine Amar and Martin Köberle  
Dr. Lapierre: Can you please explain the research you and the team at the Technical University of Munich are conducting? 

Dr. Amar: The Munich atopy prediction study (MAPS) is a prospective birth cohort we initiated in our dermatology hospital a couple of years ago to investigate the early life factors predicting or driving the development of atopic dermatitis (AD), with a particular focus on the role of skin microbial dysbiosis. 

Dr. Lapierre: Can you provide some background on the pathogenesis of atopic diseases and why your work is important? 

Dr. Köberle: Atopic dermatitis is the most frequent chronic inflammatory skin disorder affecting 20% of children and 5% of adults in industrialized countries. AD onset has been hypothesized to either involve a primary immune disbalance leading to Immunoglobulin E (IgE) sensitization and skin barrier impairment or rather, epithelial barrier defects leading to immune dysregulation.

Also, alterations of the cutaneous microbiome are thought to play an important role in the proposed mechanism. The large set of samples that we collected before, during and after recovery from AD offers a unique clinical setting to pinpoint the role of host-microbiota interactions in infant’s AD. 

Dr. Lapierre: To help our readers understand who is conducting this important work, can you tell us more about the people in the lab and the research teams? 

Dr. Amar: The experimental work of this project will be carried out at the dermatology hospital of the Technical University of Munich. Our research team is led by Prof. Tilo Biedermann, who designed and initiated this birth cohort. Experienced dermatologists at our clinic recruited 400 pregnant mothers and assessed different clinical parameters in newborns during this study. I supervised the microbiome sampling and analysis.  

Researcher Susanne Kublik, who conducts comparative microbiome analysis in Prof. Michael Schloter’s group at the Helmholtz Zentrum München, will sequence the generated 16S and metagenomics libraries. Prof. Tarl Prow, a co-inventor of the Harpera device who now directs the Skin Research Centre at the University of York, provided us with the Microbiopsy prototypes for skin sampling. Using the Microbiopsy, I collect the skin Microbiopsies that are then sequenced for transcriptomics as a service with the Qiagen GmbH company. I also analyze the generated microbiome and transcriptomes data and perform correlation analysis.  

Dr. Lapierre: Can you provide more information about the study participants? Why did you choose this population in particular? How does the skin condition affect their everyday life? 

Dr. Amar: AD is frequently observed in early infancy (during the first year of life), and although it is well understood, the factors triggering AD development in infancy remain unknown.

For this study cohort, we recruited infants from birth till the age of four years who have been followed-up at regular visits by experienced dermatologists. Infants with AD develop itchy lesions, particularly on the face, arms, and knees. They often scratch these lesions, leading to further skin barrier damage, considerably affecting their sleep and their overall wellbeing. AD causes a considerable burden to patients and their families and leads to increasing healthcare costs worldwide.   

Dr. Lapierre: Please explain why a Microbiopsy device is a good option for your work, and explain how are you applying the Microbiopsy technology in your Munich atopy prediction study? 

Dr. Amar: The Harpera device provides a real advantage for this study as they allow a non-invasive and painless sampling of infants.

Sampling infants with the available full-size biopsy sampling methods is very difficult, so the Harpera has provided us an easy and effective alternative. Samples are collected from lesional and non-lesional areas in addition to corresponding sites from healthy matched controls. 

Dr. Lapierre: What advantage does the Harpera device provide that was not available to you with other tools/methods? For example, does the Harpera allow you to collect multiple Microbiopsy specimens and at different time points with greater ease?  

Dr. Köberle: With this non-invasive approach using the Harpera device, the mothers easily gave us their consent to sample the babies. It was even possible to collect multiple samples over time for some study participants. This approach will allow us to gain greater insight into skin barrier and immune regulated genes in infant’s AD, which has thus far been unexplored using the classical sampling methods. 

Dr. Lapierre: What are your experiences so far with using the Harpera (In terms of the collection aspect and feedback from the participants and caregivers, as well as the analytical performance)? 

Dr. Amar: I optimized the sampling method and workflow from the point of sample collection up to data analysis. The Harpera sampling is safe and painless and it doesn’t leave marks on the babies’ skin. Most of the mothers were very cooperative and allowed us to use Harpera on the skin of their babies. For the few mothers who were initially hesitant to give their consent, we offered to test the Harpera devices on their arm as a first step to demonstrate the minimally invasive nature of the Harpera and to convince them of its safety.   

Dr. Lapierre: Are you publishing the results of your work soon and, if so, where can our readers learn more about your study? 

Dr. Amar: We are planning to publish the results of our microbiome/transcriptome analysis in the coming months. A summary presenting the general MAPS study design and objectives was recently published. (Preis et al, BMJ Open 2022; https://pubmed.ncbi.nlm.nih.gov/36691202/; DOI: 10.1136/bmjopen-2021-059256). 

Dr. Lapierre: What are the next steps for your research team & what is your ultimate goal with this work using Harpera skin sampling? 

Dr. Amar: Our ultimate aim is to define new biomarkers of AD and even to design effective therapies taking into consideration the multi-factorial aspect of this disease.  

Many thanks to Drs. Amar and Köberle, the research teams at the Technical University of Munich and the other centers involved in the MAPS study for sharing details of their work. The Harpera device is currently supplied for investigational use only (IUO) in clinical studies. Visit our Harpera product page for more information & resources.  

Image Credits: Trajan, iStock Photo (leadenpork, kajasja) 
The babies pictured in this article are models, and not actual patients involved in this study. 

Related Reading: 
Taking aim at skin bacteria - TUM