Investigating microbiome associations with clinical manifestations of systemic sclerosis

About the Project

Systemic sclerosis (SSc), or scleroderma, is a rare rheumatological disease characterised by immune dysregulation, vascular dysfunction, and progressive tissue fibrosis affecting the skin and internal organs. SSc has among the highest mortality rates of the rheumatic diseases, has no known cure, and is associated with substantial chronic morbidity and impaired quality of life. Increasing evidence suggests that disturbances of local microbial communities may contribute to inflammation, immune activation, infection susceptibility, impaired healing, and disease expression in SSc, although these relationships remain poorly understood.

Key clinical manifestations provide clear opportunities to investigate host–microbiome interactions. Approximately half of patients develop painful digital ulcers, which are often slow to heal and prone to recurrent colonisation or infection by organisms such as Staphylococcus aureus and enteric bacteria. Gastrointestinal involvement affects more than 90% of patients and may involve the entire gastrointestinal tract; dysmotility can predispose to small intestinal bacterial overgrowth, malabsorption, nutritional compromise, and reduced quality of life. Orofacial involvement is also common, affecting the lips, oral mucosa, salivary glands, and perioral tissues. Xerostomia, frequently associated with overlapping Sjögren’s syndrome, may contribute to dental disease, accelerated caries, mucosal abnormalities, and altered oral microbial ecology.

This project will use molecular microbiology, microbiome profiling, culture-based analysis, and bioinformatics to investigate relationships between microbial communities, infection, inflammation, and disease expression in SSc. Patients will be recruited through Salford Royal Hospital, typically alongside routine outpatient appointments within the established SSc clinical service. Relevant demographic, clinical, imaging, and disease-related data will be collected alongside microbiological sampling from relevant anatomical sites, potentially including digital ulcers, skin, oral sites, saliva, and gastrointestinal-associated samples. The work will build on supervisory expertise in applied microbiology, wound infection, biofilms, antimicrobial technologies, microbiome science, clinical rheumatology, and host–microbiome interactions.