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Cutibacterium acnes is an intracellular and intra-articular commensal of the human shoulder joint.

TitleCutibacterium acnes is an intracellular and intra-articular commensal of the human shoulder joint.
Publication TypeJournal Article
Year of Publication2021
AuthorsHudek, R, Brobeil, A, Brüggemann, H, Sommer, F, Gattenlöhner, S, Gohlke, F
JournalJ Shoulder Elbow Surg
Date Published2021 Jan
KeywordsFemale, Gram-Positive Bacterial Infections, Humans, Male, Microbiota, Propionibacterium acnes, Shoulder, Shoulder Joint, Skin

BACKGROUND: Cutibacterium acnes (C acnes) is a mysterious member of the shoulder microbiome and is associated with chronic postoperative complications and low-grade infections. Nevertheless, it is unclear whether it represents a contaminant or whether it accounts for true infections. Because it can persist intracellularly in macrophages at several body sites, it might in fact be an intra-articular commensal of the shoulder joint.METHODS: In 23 consecutive, otherwise healthy patients (17 male, 6 female; 58 years) who had no previous injections, multiple specimens were taken from the intra-articular tissue during first-time arthroscopic and open shoulder surgery. The samples were investigated by cultivation, genetic phylotyping, and immunohistochemistry using C acnes-specific antibodies and confocal laser scanning microscopy.RESULTS: In 10 patients (43.5%), cultures were C acnes-positive. Phylotype IA1 dominated the subcutaneous samples (71%), whereas type II dominated the deep tissue samples (57%). Sixteen of 23 patients (69.6%) were C acnes-positive by immunohistochemistry; in total, 25 of 40 samples were positive (62.5%). Overall, 56.3% of glenohumeral immunohistochemical samples, 62.5% of subacromial samples, and 75% of acromioclavicular (AC) joint samples were positive. In 62.5% of the tested patients, C acnes was detected immunohistochemically to reside intracellularly within stromal cells and macrophages.DISCUSSION: These data indicate that C acnes is a commensal of the human shoulder joint, where it persists within macrophages and stromal cells. Compared with culture-based methods, immunohistochemical staining can increase C acnes detection. Phylotype II seems to be most prevalent in the deep shoulder tissue. The high detection rate of C acnes in osteoarthritic AC joints might link its intra-articular presence to the initiation of osteoarthritis.

Alternate JournalJ Shoulder Elbow Surg
PubMed ID32741563