Interplay of Staphylococcal and Host Proteases Promotes Skin Barrier Disruption in Netherton Syndrome

Cell Rep. 2020 Mar 3;30(9):2923-2933.e7. doi: 10.1016/j.celrep.2020.02.021.


Netherton syndrome (NS) is a monogenic skin disease resulting from loss of function of lymphoepithelial Kazal-type-related protease inhibitor (LEKTI-1). In this study we examine if bacteria residing on the skin are influenced by the loss of LEKTI-1 and if interaction between this human gene and resident bacteria contributes to skin disease. Shotgun sequencing of the skin microbiome demonstrates that lesional skin of NS subjects is dominated by Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis). Isolates of either species from NS subjects are able to induce skin inflammation and barrier damage on mice. These microbes promote skin inflammation in the setting of LEKTI-1 deficiency due to excess proteolytic activity promoted by S. aureus phenol-soluble modulin α as well as increased bacterial proteases staphopain A and B from S. aureus or EcpA from S. epidermidis. These findings demonstrate the critical need for maintaining homeostasis of host and microbial proteases to prevent a human skin disease.

Keywords: Netherton syndrome; S. aureus; S. epidermidis; epidermal barrier; proteases; skin inflammation; skin microbiome.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Animals
  • Bacterial Toxins / metabolism
  • Child
  • Colony Count, Microbial
  • Epidermis
  • Female
  • Humans
  • Male
  • Mice, Inbred C57BL
  • Microbiota
  • Middle Aged
  • Netherton Syndrome / enzymology
  • Netherton Syndrome / microbiology*
  • Netherton Syndrome / pathology*
  • Peptide Hydrolases / metabolism*
  • Phenols
  • Skin / microbiology*
  • Skin / pathology*
  • Solubility
  • Staphylococcus aureus / enzymology*
  • Staphylococcus epidermidis / enzymology*


  • Bacterial Toxins
  • Phenols
  • staphylococcal delta toxin
  • Peptide Hydrolases