Chasing the human skin microbiome: developing an efficient and versatile device to collect microbial samples from a broad range of skin sites Brice Le François, Anne Bouevitch, Jean Macklaim and Evgueni Doukhanine DNA Genotek Inc., 3000 - 500 Palladium Drive, Ottawa, Ontario, K2V 1C2, Canada

Abstract 16S and ITS sequencing reveals differences across P-189 sampled skin sites The human skin is a vast and diverse environment that harbours a rich microbiota composed of hundreds of bacterial as well consistent with literature data as fungal and viral taxa in lower relative abundance. The discrete regions of the human skin can be grouped into three main groups based on their physico-chemical properties: sebaceous, wet and dry. Previous studies have indicated that each of these sites tend to support different microbial species; for instance acnes is primarily found on lipid-rich sebaceous sites. The skin surface A Main genera identi ed by 16S sequencing is generally poor in nutrients and therefore it is only able to sustain a much lower microbial biomass than the gut or the oral cavity. 100 Very low microbial abundance combined with a wide variety of collection sites makes skin microbiome sampling notoriously difficult, Other and no standardized reliable collection methods are available. To this end, we developed a swab-based skin microbiome collection ; ; Clostridia; Clostridiales; Family_XI; Anaerococcus and stabilization device (P-189), and demonstrated that this prototype can consistently collect microbiome samples from sebaceous, Bacteria; ; Actinobacteria; wet and dry skin sites. Given the critical importance of DNA yields in skin microbiome studies, we developed an optimized processing 75 ; ; Dermacoccus pipeline for P-189 collected samples, and show that our collection device is able to reliably yield DNA in sufficient quantities for Bacteria; ; Gammaproteobacteria; downstream analysis, including from traditionally very low yield dry skin sites. Taxonomic analysis of P-189 collected skin microbiome Betaproteobacteriales; Neisseriaceae; Bacteria; Proteobacteria; Gammaproteobacteria; samples using 16S/ITS and shotgun sequencing revealed microbial profiles consistent with published data, indicating efficient capture Pseudomonadales; Moraxellaceae; Acinetobacter of site-specific microbial taxa, with minimum background contamination. Lastly, we also tested the quantitative performance of 50 Bacteria; Firmicutes; Bacilli; Lactobacillales; our device, and determined that the P-189 prototype can successfully collect as little as 104 bacterial cells spiked on artificial skin. Streptococcaceae; Streptococcus

Taken together, our data indicates that the P-189 is a versatile collection device optimized for skin microbiome studies. % Abundance Bacteria; Actinobacteria; Actinobacteria; Corynebacteriales; Corynebacteriaceae; Lawsonella 25 Bacteria; Actinobacteria; Actinobacteria; Corynebacteriales; P-189: an optimized method for skin microbiome collections Corynebacteriaceae; Bacteria; Firmicutes; Bacilli; Bacillales; Staphylococcaceae; Staphylococcus Bacteria; Actinobacteria; Actinobacteria; ; 0 ; Cutibacterium

Forearm Face Scalp Toe web

B Main genera identi ed by ITS sequencing

100 Other

Fungi; Basidiomycota; Agaricomycetes; Agaricales; Agaricaceae; Agaricus Fungi; Basidiomycota; Tremellomycetes; Trichosporonales; Trchosporonaceae; Apiotrichum 75 Fungi; Ascomycota; Dothideomycetes; Capnodiales; Cladosporiaceae; Cladosporium Fungi; Basidiomremellomycetes; Cysto lobasidiales; Mrakiaceae; Mrakia Fungi; Ascomycota; Saccharomycetes; 50 Saccharomycetales; Debaryomycetaceae; Debaryomyces Figure 1: P-189 kit contents. The kit is optimized for self-collection of skin microbiome samples using a flocked swab and a wetting reagent. % Abundance Fungi; Ascomycota; Saccharomycetes; Collected sample on the swab is shipped while stored in DNA Genotek’s stabilizing solution. Saccharomycetales; Saccharomycetaceae; Saccharomyces Fungi; Ascomycota Materials and methods 25 Fungi; Ascomycota; Saccharomycetes; Saccharomycetales; Saccharomycetales; Candida Fungi; Ascomycota; Saccharomycetes; Samples Saccharomycetales; Phaomycetaceae; Cyberlindnera Skin microbial samples were collected by 8 donors using the P-189 prototype from dry (forearm), sebaceous (face and scalp) as well as Fungi; Basidiomycota; Malasseziomycetes; 0 Malasseziales; Malasseziaceae; Malassezia wet (toe web) skin sites. Collected samples were processed with our optimized pipelines and extracted using PowerFecal® Pro (PF-Pro) or bead beating, an in-house protocol specifically developed for low biomass samples. DNA was quantified using PicoGreen® and used Forearm Face Scalp Toe web as a template for 16S and ITS sequencing. Skin intact cell mock community (MSA-2005) was purchased from ATCC and either spiked Figure 4: Bacterial and fungal taxonomic profiles of skin microbial samples collected from the forearm (dry), face and scalp (sebaceous) and toe directly in the extraction tubes or collected using the P-189 swab. webs (wet) using the P-189 prototype. Samples were collected form a total of 8 donors and extracted using bead beating. (A) 16S rRNA gene was amplified using primers targeting V3-V4. Relative abundance plot was generated from the filtered ASV data classified using the Silva database. Sequencing and analysis (B) For fungal analysis the ITS2 region was amplified by PCR and the relative abundance plot was generated from the filtered ASV data classified Library preparation, sequencing and bioinformatics were conducted using 16S V3-V4 hypervariable regions (bacterial) and ITS 2 using the UNITE database. (fungal) paired-end amplicon sequencing, with PE-300 V3 kit on an Illumina® MiSeq platform. Raw sequence data were processed using the Dada2 (v 1.10.1) pipeline. Briefly, primers were removed (cutadapt 2.1), and reads were quality filtered and trimmed. Using Dada2’s error estimation model, reads were dereplicated, merged into full-length amplicons, and chimeras were removed before The P-189 prototype demonstrates efficient capture/release generating the amplicon sequence variants (ASVs) used for downstream analyses. ASVs were assigned via Dada2 using the of skin-associated bacterial cells Silva v132 database (16S amplicons) or the UNITE (10.10.2017) database (for ITS2 amplicons). Only ASVs having at least 1% abundance in any one sample were retained for downstream analyses. For metagenomics sequencing, samples were processed using CoreBiome’s A Spread increasing amounts of B Theoretical proprietary BoosterShot™ on a NovaSeq platform. F. philomiragia on artificial skin: 104 to 109 CFUs 100

Improved processing pipeline for P-189 for optimal DNA yields P-189 75 from the three major types of skin sites Collect using P-189 prototype and extract using optimized 50 A P-189 B bead beating protocol Add 25 proteinase K CFUs recovered (%) Quantify amounts of Sample Incubate Transfer and concentrate 1 hour at 50°C to 250 µL (Speedvac) F. philomiragia collected 0 preparation and extracted by qPCR 109 108 107 106 105 104 (1-2 hours) 800 Bead beating 600 PF-Pro 2.5” x 2.5” area Spiked F. philomiragia (CFUs) Bead beating PowerFecal-Pro 400 (DNAG) 200 Figure 5: Quantitative performance of the P-189 prototype using an artificial skin model. (A) Increasing amounts of F. philomiragia were spread Transfer to bead beating on approximately a 6 square inches piece of artificial skin (SynDaver) and allowed to dry. The spiked bacteria were collected using P-189 devices tube - homogenize DNA following our standard IFUs and processed using bead beating. (B) Recovery of F. philomiragia was assessed using a qPCR assay targeting the extraction 20 iglC3 gene. Recovery efficiency was calculated as a percentage of the total CFUs spiked on the artificial skin surface prior to collection and (1.5 hours) DNA yields (ng/kit) 10 Inhibitor removal averaged 38% across the range of spiked amounts. 0 Face Scalp Forearm Toe web Bioburden DNA binding and washes Controls Sebaceous Dry Wet The P-189 prototype yields high quality DNA in high enough concentrations for shotgun sequencing using BoosterShot Elute A B samples + – Figure 2: Processing strategies for P-189 samples for optimal DNA recovery. (A) Schematic of the optimized pipelines used to process entire 36.0 4e+08 P-189 samples in a single extraction. Performance of a commercially available extraction kit (Qiagen’s PowerFecal-Pro) or an in-house developed extraction (bead beating) were tested and compared. (B) Total DNA yields extracted from samples collected from the three major types of skin 35.5 sites (sebaceous, dry and wet) using P-189 prototype. Duplicate samples collected by 8 donors were extracted using either PowerFecal-Pro or 3e+08 bead beating and quantified using the Picogreen assay. 35.0 Type Post qc 2e+08 34.0 Raw

Optimized processing of P-189 samples efficiently captures microbial Mean Q-score profiles from mock communities and donor skin sites 1e+08 34.0 Number of sequences

A Main genera identi ed by 16S sequencing B Exploratory PCoA of Bray Curtis Dissimilarities 33.5 0e+00

Toe Scalp Face 50 60 70 80 90 100 100 Other web Sequence length 80 Cutibacterium Micrococcus 0.50 Skin site 60 Staphylococcus Figure 6: Quality metrics of skin samples library prepped and sequenced using CoreBiome’s BoosterShot. (A) Mean Q-scores of skin samples Forearm 40 Streptococcus collected from the toe web, scalp and face using the P-189 devices. Post-QC: post filtering reads such as read length filtering and chimera removal. Face Acinetobacter 0.25 (B) Sequence length distribution of the post-qc sequencing reads from P-189 skin samples. 20 Corynebacterium Scalp

Relative abundance Toe web 0 Theoretical PF-PRo Bead P-189 0.00 Conclusions beating (Swab • P-189 skin collection prototypes can be used to collect human skin microbial samples from a wide variety of sites. Our device

Extraction only collection) PCo2: 15% variation explained is compatible with the three major types of skin sites (sebaceous, dry and wet). -0.50 -0.25 0.00 0.25 • Using our optimized pipelines, we are able to process the entire collected sample in a single extraction, maximizing DNA yields from a wide range of skin sites, including forearm (a particularly low biomass dry site). PCo1: 40.8% variation explained • Taxonomic analysis of bacterial and fungal profiles using 16S and ITS2 demonstrate that the P-189 device can accurately capture the unique microbial features from each sampled site. Figure 3: P-189 offers efficient capture and recovery of microbial profiles from mock community and major types of skin sites. (A) Taxonomic profiles of • The quantitative performance testing of our swab-based kit shows that capture and recovery of bacterial cells from skin is ATCC intact cell skin mock community (MSA-2005) extracted with PowerFecal-Pro, bead beating or collected using the P-189 prototype and extracted efficient (38% recovery on average). As little as 104 CFUs can be recovered/detected when using our collection kit, confirming using bead beating. (B) Principal coordinate analysis (PCoA) plot of samples collected from the three major types of skin sites (sebaceous, dry and wet) the performance observed with dry skin sampling. using P-189 prototype. Samples were collected by 8 donors and extracted using bead beating. For taxonomic profiling, the V3-V4 region of the 16S gene • P-189 collected samples processed using our pipelines yields high quality DNA in high enough concentrations for shotgun was amplified. Plots were generated from the filtered ASV data, rarefied to 5000 reads, and generating Bray-Curtis dissimilarities between samples. metagenomics sequencing allowing for greater insights into the human skin microbiome.

© 2019 DNA Genotek Inc., a subsidiary of OraSure Technologies, Inc., all rights reserved. All brands and names contained herein are the property of their respective owners. Superior samples Patent (www.dnagenotek.com/legalnotices) MK-01336 Issue 1/2019-10 Proven performance www.dnagenotek.com • [email protected]