Acne Vaccine: Everything You Need To Know.

What’s the best way to treat acne? If you suffer from acne, then it’s highly likely you’ve searched far and wide for the answer to this question. You’ve probably also tried many treatments, either prescribed by a doctor or bought over the counter, that may or may not have helped. Some of these acne treatments may have also had some nasty side-effects.

It often feels like a never-ending cycle when you’re trying to find a treatment that works. Couple that with the fact that you have to give each treatment a good few weeks or months to see results, you can be left frustrated, depressed, out-of-pocket, and no closer to finding a way to cure your acne.

But what if there was a treatment that could stop you from developing acne in the first place? That’s what one team of researchers is currently looking into! ^[1]

Yes, that’s right! A vaccine to prevent acne could be on the horizon. So, how can a vaccine prevent acne?

To answer this question, I should begin by briefly explaining what acne is and why you get it.

What Is Acne?

Acne is a common inflammatory skin condition characterised by blocked and inflamed hair follicles and sebaceous (oil) glands which result in lesions. It is caused by multiple overlapping factors. These factors are; excessive oil production, a build-up of dead skin cells, p-acnes bacteria, and inflammation ^[2][3][4][5].

Basically, your hormones affect the way your oil glands work. An excessive amount of oil can be produced when your hormones fluctuate (for example, during puberty or at certain points in the female menstrual cycle).

If you also have an abnormal build-up of dead skin cells on the surface of your skin, your hair follicles can become blocked and trap all of this oil inside.

A bacteria called p-acnes lives happily within your oil glands and feeds off of the oil for energy. When there is an abundance of trapped oil, the p-acnes bacteria have a bit of a feeding frenzy and can grow and multiply a lot quicker than usual.

This increase in bacteria causes inflammation in the hair follicle which, on the surface of the skin, appears as ‘red bumps’. Your body then goes into defence mode because of this increase in bacteria and sends in white blood cells to fight the bacteria. The result of this is a build up of dead white blood cells near the surface of the skin, otherwise known as pustules ^[2][3][4].

Now, how can a vaccine prevent this process?

How Does The Acne Vaccine Work?

Well, the vaccine is designed to reduce the p-acnes bacteria and the inflammation associated with it ^[6].

P-acnes Bacteria

P-acnes (full name – propionibacterium acnes) is a gram-positive bacteria that lives on human skin. Nearly everybody has p-acnes bacteria and it accounts for more than 60% of the bacteria present on human facial skin ^[7]. So, basically, it is entirely normal to have p-acnes bacteria present on your skin. However, it becomes an issue when the bacteria multiply to the point that there’s an overgrowth of p-acnes bacteria in the skin.

There are different strains of p-acnes bacteria, some of which are strongly associated with acne, and others that seem to be protective against acne ^[8].

P-acnes CAMP Factor

The vaccine targets what is known as Christie – Atkins – Munch-Peterson (CAMP) factor. CAMP factor is a protein that is produced by the p-acnes bacteria and acts as a pore-forming toxin ^[9]. P-acnes CAMP factor can kill oil producing cells in the oil glands and cause inflammation ^[10]. It has previously been demonstrated that a vaccination approach can prevent the inflammation caused by the p-acnes CAMP factor ^[9][10].

Scientific Evidence To Support The Acne Vaccine

Evidence In Mice

P-acnes CAMP Factor

In one study, when the ears of living mice were injected with p-acnes CAMP factor, it caused substantial inflammation. The same inflammation also occurred when human skin cells were treated with p-acnes CAMP factor. This led researchers to believe that the CAMP factor is involved in p-acnes-induced inflammation. Furthermore, when mice received an anti-CAMP factor vaccine prior to their ear injection, they experienced much less inflammation as a result of the p-acnes CAMP factor ^[9].

Can An Antidepressant Prevent Acne?

Additionally, an enzyme, known as acid sphingomyelinase (ASMase), was found to worsen the effects of the p-acnes bacteria through its interactions with the p-acnes CAMP factor. This was demonstrated when p-acnes bacteria caused less cell death when Desipramine (an antidepressant drug that also seems to prevent the action of ASMase) was added into the cell cultures. Furthermore, when the mice were given Desipramine 30 minutes prior to receiving the p-acnes CAMP factor injection, the injection caused much less ear inflammation.

This study highlighted how both an anti-CAMP factor vaccine and Desipramine can reduce the toxic effect of the p-acnes bacteria on skin cells ^[9].

An Anti-CAMP Factor Vaccine

More recently, anti-CAMP factor vaccinations have been researched even further. In this study, mice were vaccinated with either CAMP factor or a control substance. A booster dose was then given two weeks after the first vaccination. Five weeks after the first vaccination, antibodies to CAMP factor were detected in the mice ^[1].

As there is potential for human vaccination, a substance known to enhance the human bodies immune response to an antigen was added (aluminium). The addition of aluminium increased the number of CAMP factor antibodies by four times. Basically meaning, it increased the immunity provided by the vaccine.

Again, mice received an injection with the p-acnes bacteria. Mice who had received the vaccination with p-acnes CAMP factor experienced less redness and swelling from the p-acnes bacteria than the unvaccinated mice. Furthermore, even less redness and swelling were experienced by the mice who were given the vaccination that contained aluminium as well as CAMP factor.

Evidence In Human Skin Cells

Medications that perform well in mice don’t always perform well in humans. For this reason, the researchers also tested the vaccine on human skin samples.

They took small chunks of skin from the backs of patients with acne vulgaris, including skin where lesions were present and skin that was free of acne lesions.

CAMP Factor in Acne Vs Non-Acne Skin

First, it was identified that there was a higher expression of p-acnes CAMP factor in the acne lesions than in the acne-free skin. Furthermore, in the acne-free skin, the CAMP factor was only detected in hair follicles and oil glands, whereas, in the lesions, it was detected everywhere.

P-acnes CAMP Factor Antibodies

Finally, skin samples were incubated with the antibodies to the p-acnes CAMP factor. Here, the antibodies successfully reduced the number of inflammatory skin markers in the acne lesions ^[1]. This research has demonstrated that antibodies to CAMP factor decrease the inflammatory response to p-acnes in mice as well as in human tissue ^[6].

What’s Next For The Acne Vaccine?

So that’s basically the research behind the acne vaccine. Of course, the vaccine still has quite a way to go. It will have to pass clinical trials before it can be used in the general population. However, so far, it looks promising.

However, it is important to note that acne suffers have no more p-acnes bacteria present on their skin than people who do not suffer from acne ^[6]. In fact, the p-acnes bacteria has some protective effects. Specifically, it helps prevent infection from other bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) ^[11]. So it will be important to ensure normal skin flora stays balanced ^[6].

Furthermore, the research has only demonstrated that the vaccine can reduce the inflammation associated with acne. While this will certainly improve the appearance of acne, it is unlikely to cure it completely. The acne symptoms caused by hormones and dead skin build-up are unlikely to be affected or improved by the vaccine.

Nevertheless, it is a step in the right direction and an acne vaccine could replace the use of antibiotics in the treatment of acne.

Why Is An Acne Vaccine Important?

This is particularly of interest as antibiotic use comes with side-effects and can contribute to antibiotic resistance.

As acne isn’t a life-threatening disease, it may seem slightly over the top to vaccinate against it. However, recent research has highlighted just how psychologically damaging living with acne can be. It negatively impacts the quality of life in 90% of people suffering from the condition. Furthermore, more than half of those with acne experience anxiety, depression, and emotional distress that can be accompanied by suicidal thoughts ^[12].

Therefore, a treatment that could prevent this psychological damage is long overdue.

In a press release, the lead investigator, Chun-Ming Huang, PhD explained: “Once validated by a large-scale clinical trial, the potential impact of our findings is huge for the hundreds of millions of individuals suffering from acne vulgaris”.

So what do you think? Do you suffer from acne? Would you be willing to vaccinate yourself against acne? Let us know what you think in the comment section!

References

1. Wang, Y., Hata, T., Tong, Y., Kao, M., Zouboulis, C., Gallo, R. & Huang, M. (2018). ‘The Anti-Inflammatory Activities of Propionibacterium acnes CAMP Factor-Targeted Acne Vaccines’. Journal of Investigative Dermatology, In Press, Available at: https://www.jidonline.org/article/S0022-202X(18)32228-0/fulltext
2. Dawson, A. & Dellavalle, R. (2013). ‘Acne Vulgaris’. British Medical Journal (BMJ), 346, 30-33.
3. Hywel, C., Williams, C., Dellavalle, R. & Garner, S. (2012). ‘Acne vulgaris’. The Lancet, 379 (9813), 361-372.
4. National Institute of Care and Excellence (NICE; 2018). ‘Acne Vulgaris’. NICE Clinical Guidelines. Available from: https://cks.nice.org.uk/acne-vulgaris#!topicsummary
5. Kraft, J. & Freiman, A. (2011). ‘Management of acne’. Canadian Medical Association Journal, 183(7), 430-435.
6. Contassot, E. (2018). ‘Vaccinating against Acne: Benefits and Potential Pitfalls’. Journal of Investigative Dermatology, In Press, Available at: https://www.jidonline.org/article/S0022-202X(18)32295-4/fulltext?rss=yes
7. Grice, E., Kong, H., Conlan, S., Deming, C., Davis, J., Young, A. et al. (2009). ‘Topographical and temporal diversity of the human skin microbiome’. Science, 324, 1190-1192.
8. Gibbon, S., Tomida, S., Chiu, B., Nguyen, L., Du, C., Liu, M., Elashoff, D., Erfe, M., Loncaric, A., Kim, J., Modlin, R., Miller, J., Sodergren, E., Craft, N., Weinstock, M. & Li, H. (2013). ‘Propionibacterium acnes Strain Populations in the Human Skin Microbiome Associated with Acne’. Journal of Investigative Dermatology, 133(9), 2152-2160.
9. Nakatsuji, T., Tang, D., Zhang, L., Gallo, R. & Huang, C. (2011). ‘Propionibacterium acnes CAMP Factor and Host Acid Sphingomyelinase Contribute to Bacterial Virulence: Potential Targets for Inflammatory Acne Treatment’. PLoS One, 6(4), Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075254/
10. Liu, P., Nakatsuji, T., Zhu, W., Gallo, R. & Huang, C. (2011). ‘Passive immunoprotection targeting a secreted CAMP factor of propionibacterium acnes as a novel immunotherapeutic for acne vulgaris’. Vaccine, 29, 3230-3238.
11. Shu, M., Wang, Y., Yu, J., Kuo, S., Coda, A., Jiang, Y., Gallo, R. & Huang, C. (2013). ‘Fermentation of Propionibacterium acnes, a Commensal Bacterium in the Human Skin Microbiome, as Skin Probiotics against Methicillin-Resistant Staphylococcus aureus’. PLoS One, 8(2), Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055380
12. Lukaviciute, L., Navickas, P., Navickas, A., Grigaitiene, J., Ganceviciene, R. & Zouboulis, C. (2017). ‘Quality of life, anxiety prevalence, depression symptomatology and suicidal ideation among acne patients in Lithuania’. J Eur Acad Dermatol Venereol, 31, 1900-1906.