Pseudomonas aeruginosa strains with lipopolysaccharide defects exhibit reduced intracellular viability after invasion of corneal epithelial cells

Pseudomonas aeruginosa is a leading cause of infectious keratitis. Many ocular isolates of this bacterium invade corneal epithelial cells in vitro and in vivo. Antibiotic survival assays have shown that a complete core lipopolysaccharide is required for full epithelial invasion by P. aeruginosa. In this study, we show that P. aeruginosa mutants with defects in their lipopolysaccharide core and O antigen exhibited reduced viability after internalization by corneal epithelial cells. Restoration of lipopolysaccharide core and O antigen expression by complementation with the plasmid pLPS1 restored intracellular survival. P. aeruginosa strains with a complete lipopolysaccharide survived and replicated within the cells. The data suggest that lipopolysaccharide is involved in the intracellular survival and/or replication of P. aeruginosa, indicating an additional mechanism by which this important virulence factor may contribute to the pathogenesis of corneal infection.

Effects of daily and overnight wear of a novel hyper oxygen-transmissible soft contact lens on bacterial binding and corneal epithelium: a 13-month clinical trial

OBJECTIVE

To test prospectively a new biologic rationale for an advanced hyper oxygen-transmissible lens (HOTL) providing prospects for safer daily (DW) or extended (EW) contact lens wear.

DESIGN

Prospective, randomized, double-masked, single-center, 13-month clinical trial.

PARTICIPANTS

One hundred sixty-eight patients completed the DW study (1 month): control lens (n = 70); HOTL (n = 98). One hundred thirty-six patients finished 1 year of EW: controls (n = 56), HOTL (n = 25, 6 nights; n = 55, 30 nights).

TESTING

Irrigation chamber to collect corneal surface cells, confocal microscopy, tear collection at baseline, 2, and 4, weeks of DW, and 24 hours, 1, 3, 6, 9, and 12 months of EW.

MAIN OUTCOME MEASURES

(1) Pseudomonas aeruginosa (PA) binding to exfoliated corneal surface cells; (2) central epithelial thickness (CET); (3) superficial cell area (SCA); (4) epithelial surface cell exfoliation (DESQ); and (5) tear lactate dehydrogenase (LDH).

RESULTS

Daily wear with control lens increased PA binding from 5.90 +/- 2.60 to 7.81 +/- 3.04 bacteria per cell (P < 0.01); HOTL wear increased PA binding significantly less (5.31 +/- 1.87-5.98 +/- 2.26; P < 0.01). Daily wear produced no significant changes in CET or SCA. Significant decreases in DESQ were seen with both lenses with no significant intergroup differences. Tear LDH increased significantly in DW with HOTL wear versus control (P = 0.0017), but not after 1 month of subsequent EW (P = 0.533). One to 3 months of EW with control lens showed significantly higher PA binding than HOTL wear (P < 0.01); binding adaptively decreased thereafter, returning to baseline at 9 to 12 months. Lens EW produced significantly enlarged SCA, thinning of CET (except 6-night HOTL wear), and decreased DESQ (P < 0.01). Some adaptive recovery was seen with CET and DESQ, but not SCA; importantly, the data indicated no significant difference between 6- or 30-night EW for all outcomes.

CONCLUSIONS

Hyper oxygen-transmissible lens wear (DW or EW) produced significantly decreased PA binding compared with control lens wear, with no significant difference in wearing schedule (6 nights vs. 30 nights); additionally, there was a remarkable and unexpected adaptive recovery in the first 6 months of all soft lens wear, with a return to baseline PA binding levels and partial recovery for the other outcomes except SCA at 1 year. These results suggest that HOTL use should result in a decrease in the incidence of and risk(s) for lens-related microbial keratitis and that further epidemiologic studies should consider time in adapted EW in future risk and incidence analyses.

1 alpha,25-Dihydroxyvitamin D3 inhibits pro-inflammatory cytokine and chemokine expression in human corneal epithelial cells colonized with Pseudomonas aeruginosa

The cytokines IL-1 beta, IL-6 and the chemokine IL-8 are key mediators of host inflammation. 1 alpha,25-Dihydroxyvitamin D3 (VD3) has been shown to regulate host immune responses in vivo and in vitro. The purpose of this study was to investigate whether the addition of VD3 to human corneal epithelial cells colonized with Pseudomonas aeruginosa altered the expression of IL-1 beta, IL-6 and IL-8. An immortalized human corneal epithelial (HCE) cell line was used in this study. After growth to confluency, HCE cells were challenged with P. aeruginosa strain 6294 in the presence or absence of 10-6 mol/L VD3 for 4 h, 8 h and 12 h. Gene expression of IL-1 beta, IL-6 and IL-8 was detected by reverse transcription-PCR (RT-PCR) from total RNA extracted from HCE cells. Protein concentrations of IL-1 beta, IL-6 and IL-8 in culture supernatants were measured by ELISA. Addition of VD3 to HCE cells colonized with P. aeruginosa significantly inhibited the expression of IL-1 beta and IL-8 mRNA and protein (P < 0.05). Although the expression of IL-6 mRNA was stimulated at 12 h post-challenge (P < 0.05), the expression of IL-6 protein was inhibited at all time points after the addition of VD3. In conclusion, this study demonstrated that VD3 inhibited the P. aeruginosa-induced expression of IL-1 beta, IL-6 and IL-8 in HCE cells, suggesting that this vitamin may have the potential to become a novel anti-inflammatory agent in ocular disease.

Internalization of Staphylococcus aureus by human corneal epithelial cells: role of bacterial fibronectin-binding protein and host cell factors

Wild-type Staphylococcus aureus was observed to be capable of invading human corneal epithelial cells (HCEC) in vitro. Internalization of S. aureus required expression of fibronectin-binding proteins (FnBPs); the capacity of an FnBP-deficient isogenic strain to invade HCEC was reduced by more than 99%. The binding of S. aureus to HCEC did not require viable bacteria, since UV-killed cells were observed to adhere efficiently. Invasion of HCEC by S. aureus involved active host cell mechanisms; uptake was nearly completely eliminated by cytochalasin D and genistein. These data suggest that FnBPs play a key role in host-parasite interactions and may serve as an important adhesin or invasin in ulcerative keratitis caused by S. aureus.

Pseudomonas aeruginosa internalization by corneal epithelial cells involves MEK and ERK signal transduction proteins

Invasion of epithelial cells represents a potential pathogenic mechanism for Pseudomonas aeruginosa. We explored the role of mitogen-activated protein kinase kinases (MEK 1/2) and the extracellular signal-regulated kinases (ERK 1/2) in P. aeruginosa invasion. Treatment of corneal epithelial cells with MEK inhibitors, PD98059 (20 microM) or UO126 (100 microM), reduced P. aeruginosa invasion by approximately 60% without affecting bacterial association with the cells (P=0.0001). UO124, a negative control for UO126, had no effect on bacterial internalization. Infection of cells with an internalization-defective flhA mutant of P. aeruginosa was associated with less ERK 1/2 tyrosine phosphorylation than infection with wild-type invasive P. aeruginosa. An ERK-2 inhibitor, 5-iodotubercidin (20 microM), reduced P. aeruginosa invasion by approximately 40% (P=0.035). Together, these data suggest that P. aeruginosa internalization by epithelial cells involves a pathway(s) that includes MEK and ERK signaling proteins.

Pseudomonas aeruginosa exotoxin A and keratitis in mice

PURPOSE

To determine the importance of Pseudomonas aeruginosa exotoxin A (ETA) as a virulence factor in corneal disease.

METHODS

Isogenic mutants deficient in ETA were constructed in P. aeruginosa strains PAO1 and ATCC 19660 by allelic exchange and then evaluated for virulence in a mouse model of bacterial keratitis. The effect of ETA on adherence to scarified corneal epithelium was assessed in an in vitro organ culture model.

RESULTS

Mutants of either P. aeruginosa PAO1 or 19660, deficient in ETA, adhered to wounded corneal tissue and initiated ocular disease similar to that in wild-type strains. However, in contrast to wild-type strains, ETA mutants were quickly cleared from the eye, inflammation diminished, and the cornea healed.

CONCLUSIONS

Although ETA has no effect on the ability of P. aeruginosa to adhere to corneal wounds or to initiate Pseudomonas keratitis, it is crucial for the organism to persist in the eye and ultimately cause disease.

Internal and external contamination of donor corneas before in situ excision: bacterial risk factors in 93 donors

BACKGROUND

Most studies of corneal donor contamination concentrate on postenucleation contamination of the eyeball. The purpose of the present study was to evaluate the relative contamination of in situ excised corneal tissue and relevance to final success or rejection by recipients of the corneal grafts.

METHODS

Ninety-three donors underwent anterior chamber puncture (ACP) and corneal epithelium scarification (CS) before and after disinfection with 5% povidone-iodine. Following in situ excision, corneas were preserved in culture medium at +35 degrees C. Morphological and bacteriological assessment was carried out after culture, and recipients were followed up over a 2-year period.

RESULTS

Samples taken by ACP, CS before disinfection, CS after disinfection and a culture medium sample were contaminated by bacteria in, respectively, 8 (8.6%), 23 (24.7%) 4 (4.3%) and 5 (5.4%) donors. Contamination of aqueous humor was significantly associated with age, death-to-sample time and premortem systemic infection. Contamination of epithelium significantly increased culture medium contamination.

CONCLUSION

External bacteria on donor cornea are mainly skin bacteria (especially Staphylococcus) and can be partially eliminated by a povidone-iodine wash. Internal bacteria are mainly gut bacteria and may be due to perimortem bacteriemia. However, bacterial infection at the time of death appears to have no effect on the incidence of endophthalmitis in recipients and should no longer prevent use of such corneal tissue in grafts.

Adaptive effects of 30-night wear of hyper-O(2) transmissible contact lenses on bacterial binding and corneal epithelium: a 1-year clinical trial

OBJECTIVE

To determine effects of lens type and oxygen transmissibility on human corneal epithelium during extended wear (EW).

DESIGN

Prospective, randomized, double-masked, single-center, parallel treatment groups, 1-year clinical trial.

PARTICIPANTS

One hundred seventy-eight patients completed the study: (1) high-O(2) soft lens (6-night [N] EW) (n = 27); (2) hyper-O(2) soft lens (6N-EW, n = 33) or (30N-EW, n = 66); and (3) hyper-O(2) rigid gas-permeable lens (RGP) (30N-EW, n = 52).

INTERVENTION

Irrigation chamber to collect exfoliated corneal surface cells, confocal microscopy, and tear collection at baseline, 1, 3, 6, 9, 12 months of EW.

MAIN OUTCOME MEASURES

(1) Pseudomonas aeruginosa (PA) binding to exfoliated corneal surface cells; (2) central epithelial thickness; (3) superficial epithelial cell area; (4) epithelial surface cell exfoliation; and (5) tear lactate dehydrogenase.

RESULTS

Quantitative evidence demonstrated increased binding of PA to human exfoliated corneal epithelial cells during the first 3 months of soft lens EW; the control high-O(2) test lens showed significantly higher bacterial binding (P < 0.05). Binding activity gradually decreased thereafter and returned to baseline after 9 and 12 months. The corneal epithelium demonstrated enlargement of surface cell size, thinning of central epithelium, and a significant decrease in surface cell shedding (P < 0.05). Remarkably, there was subsequent partial adaptive recovery in cell shedding and epithelial thickness but not surface cell size. There was no significant difference between 6N and 30N continuous wear of the hyper-O(2) soft lens for all outcome measures. Importantly, hyper-O(2) RGP lens wear did not show significantly increased PA binding during 1 year.

CONCLUSIONS

This study establishes three important new findings: (1) hyper-O(2) soft lens EW produces significantly less PA binding than the lower O(2) soft lens with no significant difference in PA binding with 6N versus 30N EW of the hyper-O(2) soft lens; (2) there is a remarkable adaptive recovery after 6 months with all soft lens wear with gradual return to prelens PA binding levels and partial recovery of other outcome measures for all test lenses EW except surface cell size; (3) 30N EW of the hyper-O(2) RGP lens produced no significant increases in PA binding over 1 year. Taken together, these results suggest that introduction of new hyper-O(2) transmissible lens materials into clinical use may offer safer EW, and future epidemiologic studies of ulcerative infectious keratitis should consider both lens type and time in lens EW in any incidence/risk analysis.

The role of IL-1beta in the regulation of IL-8 and IL-6 in human corneal epithelial cells during Pseudomonas aeruginosa colonization

PURPOSE

Recent studies have shown that the levels of interleukin (IL)-1beta, IL-6 and IL-8 are associated with the severity of infectious diseases. The purpose of this study was to investigate whether IL-1beta regulates the expression of IL-6 and IL-8 in human corneal epithelial cells during Pseudomonas aeruginosa colonization.

METHODS

Confluent immortalized human corneal epithelial cells were challenged with P. aeruginosa 6294 in the presence of anti-human IL-1beta antibody or matched control antibody. The cells were also challenged with recombinant IL-1beta protein without bacterial colonization. Expression of IL-1beta, IL-6 and IL-8 mRNA and protein was detected by reverse transcription (RT)-PCR and by enzyme-linked immunosorbent assay (ELISA), respectively. IL-1beta localization was determined by immunohistochemistry.

RESULTS

Human corneal epithelial cells expressed low levels of IL-1beta and high levels of IL-6 and IL-8 during P. aeruginosa colonization. Addition of IL-1beta Ab resulted in a significant decrease (P < 0.05) in IL-8 protein expression at 4 h, 8 h and 12 h. Addition of IL-1beta Ab reduced IL-6 protein expression at 8 h and increased IL-6 protein expression at 12 h. Addition of recombinant IL-1beta protein alone strongly stimulated the expression of IL-8 and IL-6. Immunohistochemical staining showed that IL-1beta protein was present both intracellularly and extracellularly in P. aeruginosa colonized cells.

CONCLUSIONS

IL-1beta is able to modulate expression of both IL-6 and IL-8 at transcriptional and post-transcriptional levels in human corneal epithelial cells.

Resistance of Pseudomonas aeruginosa isolates to hydrogel contact lens disinfection correlates with cytotoxic activity

One of the most common pathogens in infection of hydrogel contact lens wearers is Pseudomonas aeruginosa, which can gain access to the eye via contamination of the lens, lens case, and lens care solutions. Only one strain per species is used in current regulatory testing for the marketing of chemical contact lens disinfectants. The aim of this study was to determine whether P. aeruginosa strains vary in their susceptibility to hydrogel contact lens disinfectants. A method for rapidly screening bacterial susceptibility to contact lens disinfectants was developed, based on measurement of the MIC. The susceptibility of 35 P. aeruginosa isolates to two chemical disinfectants was found to vary among strains. MICs ranged from 6.25 to 100% for both disinfectants at 37 degrees C, and a number of strains were not inhibited by a 100% disinfectant concentration in the lens case environment at room temperature (22 degrees C). Resistance to disinfection appeared to be an inherent rather than acquired trait, since some resistant strains had been isolated prior to the introduction of the disinfectants and some susceptible P. aeruginosa strains could not be made more resistant by repeated disinfectant exposure. A number of P. aeruginosa strains which were comparatively more resistant to short-term disinfectant exposure also demonstrated the ability to grow to levels above the initial inoculum in one chemical disinfectant after long-term (24 to 48 h) disinfectant exposure. Resistance was correlated with acute cytotoxic activity toward corneal epithelial cells and with exsA, which encodes a protein that regulates cytotoxicity via a complex type III secretion system. These results suggest that chemical disinfection solutions may select for contamination with cytotoxic strains. Further investigation of the mechanisms and factors responsible for resistance may also lead to strategies for reducing adverse responses to contact lens wear.

Epithelial infectious crystalline keratopathy

PURPOSE

To report 2 cases of epithelial infectious crystalline keratopathy.

METHODS

Two patients (2 eyes) with significant meibomitis presented with minimal inflammation and plaque-like lesions on the corneal surface made of fine crystalline structures. Corneal scrapings of these lesions were performed for microbiological evaluation. The patients were treated with topical ciprofloxacin and artificial tears.

RESULTS

Smear examination of the corneal scrapings revealed numerous bacteria and keratinized epithelial cells with no inflammatory cells. Culture showed a significant growth of Staphylococcus epidermidis and Corynebacterium species in the first case and Pseudomonas aeroginosa in the second case. The response to treatment was poor, with recurrence of the crystalline lesion.

CONCLUSION

Infectious crystalline keratopathy lesions may involve the epithelium and occur on the corneal surface.

Human corneal epithelial extracellular matrix perlecan serves as a site for Pseudomonas aeruginosa binding

PURPOSE

Previous data has shown that basement membrane associated perlecan serves as a binding site for Pseudomonas aeruginosa in the wounded mouse cornea. The current study determined whether it also provides a binding site for Pseudomonas aeruginosa in transformed human corneal epithelium.

METHODS

Bacterial adherence to transformed human corneal epithelial cells grown in normal or in media containing various inhibitors of glycosaminoglycan synthesis was tested. Bacterial binding was similarly tested in wild-type and in mutant Chinese hamster ovary cell lines naturally deficient in glycosaminoglycan synthesis. Transformed human corneal epithelial extracellular matrix also was tested before and after treatment with anti-proteoglycan monoclonal antibodies or heparinase III before bacterial inoculation. Scanning electron microscopy was used to quantitate adherent bacteria. Intact transformed human corneal epithelial cells or extracellular matrix, the latter either treated or not treated with heparinase III or chondroitin ABC lyase were stained to localize perlecan.

RESULTS

Examination of the binding of bacteria to transformed human corneal epithelial cells (normal media vs with inhibitors) and Chinese hamster ovary cell lines suggested that bacterial binding was not associated with the surface of either cell type. In contrast, anti-perlecan antibody, as well as heparinase III decreased the binding of bacteria to corneal extracellular matrix. Fluorescence staining localized perlecan to the extracellular matrix beneath the corneal epithelial cells.

CONCLUSIONS

Perlecan localized to the extracellular matrix but not the apical surface of transformed human corneal epithelial cells, provides a binding site for Pseudomonas aeruginosa.

C57BL/6 mice lacking Muc1 show no ocular surface phenotype

PURPOSE

To test the hypothesis that a membrane-spanning mucin, Muc1, facilitates the spread of tear film and protects against bacterial adherence.

METHODS

Age-matched, Muc1 null mice and wild-type mice of C57BL/6 genetic background were used for comparison. Eyes were examined by slit lamp biomicroscopy with fluorescein solution to assess epithelial damage and tear film stability. Structure of the ocular surface epithelia was examined by light microscopy, scanning and transmission electron microscopy, and wholemount confocal microscopy. Bacterial adherence assay was performed on in vivo corneas with Pseudomonas aeruginosa containing a plasmid encoding green fluorescent protein, followed by wholemount confocal microscopy. Real-time reverse transcription-polymerase chain reaction was performed using Muc4-specific primers to quantitate Muc4 mRNA expression in ocular surface tissues.

RESULTS

No differences were found between Muc1 null and control mice in any parameter tested. Ocular surface epithelia of Muc1 null mice of the C57BL/6 strain had a normal appearance of surface microplicae, a well-developed glycocalyx on the apical cell membrane, and a normal appearance of goblet cell mucin packets. There was no convincing evidence that bacterial adherence on the cornea was increased in Muc1 null mice. Muc4 mRNA expression was not upregulated in Muc1 null mice compared with control. No ocular surface infections were observed in Muc1 null mice of the C57BL/6 strain (n = 204), which were housed in the animal facility over a period of 26 months.

CONCLUSIONS

Muc1 null mice of C57BL/6 background appeared normal in all respects tested. These data differ from the reported phenotype in the mice of the C57BL/6 x SVJ129 background, which show development of blepharitis and conjunctivitis.

Membrane-type matrix metalloproteinases in mice intracorneally infected with Pseudomonas aeruginosa

PURPOSE

To establish the presence of membrane-type matrix metalloproteinases (MT-MMPs) in the cornea and their expression in naive and immunized mice intracorneally infected with Pseudomonas aeruginosa.

METHODS

Naive (unimmunized) and immunized C57BL/6J mice were infected with P. aeruginosa, and gene expression of MT-MMPs were detected by RT-PCR. Immunoblot analysis and immunostaining were also used to characterize the MT-MMP response in both sets of animals.

RESULTS

Expression of MT1-MMP, MT2-MMP, and MT3-MMP (MMP 14, 15, and 16) was detected by RT-PCR and immunoblot analysis. Of the three MT-MMPs detected, MT1-MMP exhibited the greatest expression at protein levels. In general, a bell-shaped curve was obtained for each of the MT-MMPs in naive mice, but all of them showed much less expression in the immunized mice. MT1-MMP was localized in the epithelial tissue of the cornea, whereas MT2-MMP and MT3-MMP were mainly found in the interface between the epithelium and substantia propria.

CONCLUSIONS

MT1-MMP was detected and expressed to a greater extent in naive mice than MT2-MMP and MT3-MMP. Peak expression of all three MT-MMPs showed a good correlation with the overall inflammatory response.

Pathogenesis and treatment of "sterile" midperipheral corneal infiltrates associated with soft contact lens use

PURPOSE

To demonstrate the sterile nature of presumed sterile midperipheral corneal infiltrates associated with soft contact lens (SCL) use and to show that withholding antibiotics or the occasional use of a topical corticosteroid alone may, with strict guidelines, have a role in the treatment of this entity.

METHODS

Nine consecutive patients presenting with typical midperipheral corneal infiltrates after SCL wear were seen in the office (O.H.D.) during a 2-year period, 1996-1998. All patients were initially placed on topical fluorometholone as the only treatment.

RESULTS

Eight of the nine patients experienced a rapid relief of symptoms and the infiltrates were noted to be smaller and less dense in 34 days. Therapy was discontinued after 7 days, by which time the lesions had cleared. The ninth patient developed a microbial keratitis from which Pseudomonas aeruginosa was cultured. With appropriate therapy, visual acuity returned to 20/25. Two different algorithms are offered for the treatment of a putative sterile infiltrate associated with SCL use.

CONCLUSION

The use of a topical corticosteroid alone may have a role in the treatment of presumed sterile midperipheral corneal infiltrates associated with SCLs when strict guidelines are followed. Such therapy suggests that the infiltrates are not the result of infection.

Role of Pseudomonas aeruginosa culture filtrates in the association, invasion, and cytotoxicity against cloned cells from murine corneal epithelium and KB cells

PURPOSE

To clarify the effect of Pseudomonas aeruginosa culture filtrates on the association with, invasion into, and cytotoxicity against cloned cells from murine corneal epithelial cells and KB cells.

METHODS

Simian virus 40-transformed murine corneal epithelial (MCE) cells were established. Murine corneal epithelial cells and KB cells were infected with a protease-positive strain, IID1117 (Pa IID1117), and a protease-negative strain, IID1130 (Pa IID1130) of P. aeruginosa, and then tested for association and invasion of Pa IID1117. The cytotoxicity test was performed by incubating the cells with culture filtrate.

RESULTS

Association of Pa IID1117 with KB cells pretreated with Pa IID1130 was significantly promoted. After pretreatment with culture filtrate, invasion was more effective into MCE cells than into KB cells. When infecting bacteria (Pa IID1117) were pretreated with protease inhibitor, invasion of the bacteria into MCE cells and KB cells clearly decreased. The cellular damage induced by the culture filtrate of Pa IID1130 was greater than the damage by that of Pa IID1117.

CONCLUSION

These results suggest that association of P. aeruginosa with MCE cells and KB cells was influenced by the culture filtrates other than proteases, and that invasion of P. aeruginosa into MCE cells and KB cells was promoted by protease.

Pro-inflammatory cytokine/chemokine gene expression in human corneal epithelial cells colonized by Pseudomonas aeruginosa

Pro-inflammatory cytokines interleukin-6 (IL-6), interleukin-1beta (IL- 1beta), tumour necrosis factor-alpha (TNF-alpha) and chemokine interleukin-8 (IL-8) may play a significant role in the regulation of bacterial corneal infection. The aim of this study was to investigate the gene expression of these four mediators in a human corneal epithelial cell line challenged with Pseudomonas aeruginosa within 12 h. Human corneal epithelial monolayers were colonized with P. aeruginosa strains Paerl, 6206 and 6294. Expression of IL-6, IL-8, IL-1beta and TNF-alpha was analysed using semi-quantitative reverse transcription-polymerase chain reaction. Results showed that both IL-6 and IL-8 mRNA were expressed very early (4 h) during bacterial colonization and remained at high levels until the end of the experiment. Expression of IL-1beta and TNF-alpha mRNA appeared at 8 h after bacterial stimulation. No expression of IL-8, IL-1beta and TNF-alpha mRNA was observed in unstimulated cells. Interleukin-6 mRNA was expressed at low levels in unstimulated cells. In conclusion, bacterial colonization of human corneal epithelial cells induced expression of IL-6 and IL-8 mRNA earlier and at higher levels than IL-1beta and TNF-alpha mRNA.

Invasive strains of Pseudomonas aeruginosa are able to cause epithelial cell cytotoxicity that is dependent on bacterial cell density

The purpose of this study was to investigate the hypothesis that quorum-sensing systems are involved in the ability of invasive Pseudomonas aeruginosa strains to cause corneal epithelial cell death. Two invasive strains, 6294 and PAOI, were co-cultured with human corneal epithelial cells at different bacterial concentrations (10(5), 10(7) and 10(9) CFU/mL). Cytotoxicity was measured using a cytotoxicity assay kit. The levels of autoinducer in the supernatant were examined using a reporter strain of Agrobacterium tumefaciens (A136). Protease production was also monitored. Cytotoxicity of both strains was dependent on bacterial density; a moderate to high concentration of bacterial cells (10(7) and 10(9) CFU/mL) caused 70% to 94% loss of cell variability. Cytotoxicity was significantly correlated with enhanced autoinducer and protease production (r>0.95, P<0.05). These results indicate that the invasive strains regulate the production of virulence factors and, in turn, induce chronic dose-related cytotoxicity.

ExoT of cytotoxic Pseudomonas aeruginosa prevents uptake by corneal epithelial cells

The presence of invasion-inhibitory activity that is regulated by the transcriptional activator ExsA of cytotoxic Pseudomonas aeruginosa has previously been proposed. The results of this study show that both ExoT and ExoS, known type III secreted effector proteins of P. aeruginosa that are regulated by ExsA, possess this activity. Invasion was reduced 94.4% by ExoT and 96.0% by ExoS. Invasion-inhibitory activity is not linked to ADP-ribosylation activity, at least for ExoS, since a noncatalytic mutant also inhibits uptake by an epithelial cell line (invasion was reduced 96. 0% by ExoSE381A).

Short-term hypoxia downregulates epithelial cell desquamation in vivo, but does not increase Pseudomonas aeruginosa adherence to exfoliated human corneal epithelial cells

PURPOSE

This study evaluates the effect of hypoxic and hypercapnic stress on bacterial adherence to surface corneal epithelial cells, as well as tear LDH levels, surface cell desquamation, and corneal swelling in normal human subjects.

METHODS

Sixteen eyes of eight human volunteers were successively exposed to three gas mixtures (air, 100% N2, 95% N2-5% CO2) through tightly fitted goggles for six hours at two-week intervals. Exfoliated epithelial cells were collected and counted using a modified corneal irrigation chamber. Bacterial binding was determined by measuring Pseudomonas aeruginosa (PA) adherence to exfoliated corneal epithelial cells. The effects of hypoxic or hypercapnic stress on the corneal surface were also assessed by tear LDH measurement, and quantification of surface epithelial cell size and epithelial and stromal thickness were determined by in vivo confocal microscopy.

RESULTS

Short-term precorneal hypoxia significantly decreased corneal epithelial cell desquamation. Both short-term hypoxia alone and combined with hypercapnia induced significant corneal stromal swelling (7 to 8%) but did not significantly enhance PA adherence to exfoliated human corneal epithelial cells.

CONCLUSIONS

This study demonstrates, for the first time, that short-term precorneal hypoxia downregulates corneal epithelial cell desquamation in humans. These results also demonstrate that short-term hypoxia alone or combined with hypercapnia does not significantly increase PA adherence to exfoliated epithelial cells from the human cornea. The results reveal that either longer hypoxic exposure or other interactive factor(s), including but not limited to the mechanical effect of the contact lens itself, may be required for promotion of increased epithelial cell-PA binding following lens wear in humans.

The relationship between contact lens oxygen permeability and binding of Pseudomonas aeruginosa to human corneal epithelial cells after overnight and extended wear

PURPOSE

We designed a 3-year, prospective, randomized, masked clinical trial to evaluate the relationship of contact lens oxygen transmissibility and bacterial adherence to exfoliated surface epithelial cells in human overnight and extended lens wearers in a single center; corneal cell desquamation rate, surface epithelial cell size, and tear lactate dehydrogenase (LDH) levels were also determined concurrently.

METHODS

One hundred nine human volunteers were successfully fit with test lenses prospectively and completed this study. Seven soft and three rigid gas permeable (RGP) lenses with stratified oxygen transmissibility were evaluated. After one week adaptation to daily wear, patients continually wore test lenses bilaterally for three months on a six nights wear, one night off basis. Before and after 24 hour, 1 month, and three months extended contact lens wear, exfoliated surface epithelial cells were collected using a modified corneal irrigation chamber. Bacterial binding was determined by measuring Pseudomonas aeruginosa (PA) adherence to exfoliated corneal epithelial cells. The number of exfoliated cells with adherent bacteria were counted using fluorescence microscopy. The effects of contact lens wear on the corneal surface were further assessed by alterations in tear LDH, and by surface epithelial cell size and epithelial thickness using in vivo tandem scanning confocal microscopy (TSCM). Baseline values of outcome measures served as controls for individual patients; a concurrent group of controls were also followed to monitor seasonal or possible individual fluctuations.

RESULTS

Quantitative evidence demonstrated that lens physical oxygen transmissibility properties and not lens type significantly correlated inversely with binding of PA to human exfoliated corneal epithelial cells after overnight and extended wear (R=0.258, P=0.0084); there was a significant decrease in surface epithelial cell desquamation and a significant increase in surface cell size following wear for all test lenses (P<0.05). Epithelial thinning was also observed following lens wear (P<0.05).

CONCLUSIONS

These results establish for the first time a significant correlation between contact lens-induced increases in epithelial PA binding and lens oxygen transmissibility in humans. New ultra-oxygen permeable test lenses did not appear to increase bacterial binding over individual control levels; all test lenses suppressed surface epithelial cell shedding. Taken together, these findings suggest that a new generation of contact lenses constructed from ultra-transmissible oxygen materials may offer a significant potential advance in safety for extended wear.

Nonulcerating bacterial keratitis associated with soft and rigid contact lens wear

OBJECTIVE

An unusual presentation of contact lens-related bacterial keratitis is that of epithelial nodular infiltrates and stromal inflammation without epithelial ulceration. The authors study the initial diagnosis, clinical features, causative organisms, and outcomes of corneal infections presenting in this manner.

DESIGN

The study design was a 20-month retrospective chart review.

PARTICIPANTS

Five patients with culture-proven bacterial keratitis who had predominantly nodular epithelial lesions were studied.

RESULTS

Four infections were associated with soft contact lens wear and one with rigid lens wear. All patients had largely intact epithelium; typical gray-colored epithelial nodules, some with underlying anterior stromal haze; and diffuse, fine, cellular stromal inflammation. Two patients were referred with the tentative diagnosis of Acanthamoeba infection and two as contact lens-related sterile keratitis. Epithelial cultures from three cases yielded Serratia sp., one yielded Corynebacterium, and one Streptococcus pneumoniae. All responded to antibacterial medication; final corrected visual acuity in all cases was 20/30 or better.

CONCLUSIONS

Bacterial infection associated with contact lens wear can be established within the corneal epithelium without initially producing an ulcer. A wide range of both gram-positive and gram-negative organisms can be involved. Early recognition and treatment appear to result in a favorable outcome.

Cytotoxic strains of Pseudomonas aeruginosa can damage the intact corneal surface in vitro

PURPOSE

Although the corneal epithelial cell layer is believed to serve as a barrier against most types of bacteria, certain strains of P. aeruginosa have been shown to kill corneal epithelial cells in primary cultures. The aim of this study was to test whether these strains could damage epithelia on uninjured whole corneas.

METHODS

Five-week-old Sprague-Dawley rats were sacrificed and their eyes were placed in organ culture. The corneal surface of each eye was incubated with 8 microL of media alone or a bacterial suspension containing 8 x 10(6) cfu of one of 12 cytotoxic and noncytotoxic strains of P. aeruginosa for 3 hours at 35 degrees C. Trypan blue was then added to visualize surface epithelial cell injury. A masked observer examined each cornea under a dissecting microscope and assigned a score of between 1 and 3 to describe the extent of injury.

RESULTS

Cytotoxic P. aeruginosa injured the surface epithelium. The extent of injury induced by the various strains correlated with previously published in vitro measures of cytotoxic capacity toward cultured corneal epithelial cells. Cytotoxicity required at least 2 hours of bacterial contact and was dependent upon ExsA, a transcriptional activator of several genes in P. aeruginosa, including the gene encoding exoenzyme S.

CONCLUSIONS

Cytotoxic P. aeruginosa strains can damage epithelia on an uninjured corneal surface providing there is prolonged bacterial contact. Stagnation of cytotoxic bacteria against the corneal surface may contribute to the pathogenesis of infection associated with the use of soft contact lenses.

Binding of Staphylococcus aureus to fibronectin and glycolipids on corneal surfaces

Staphylococcus aureus is one of the most common pathogens of bacterial corneal ulcers. It is generally believed that the first step necessary in the development of an infection involves adherence of bacteria to host tissue. The mechanisms by which staphylococci adhere to ocular epithelium have not yet been defined. An in vitro assay was used to measure binding of S. aureus and Streptococcus pyogenes to a cornea epithelial cell line. Reduction of the amount of cell-surface fibronectin by proteinase treatment decreased the adherence of S. pyogenes to a greater degree than that of S. aureus. The significantly higher number of staphylococci adhering to the cells as compared with S. pyogenes (P < 0.001) suggests the presence of additional binding sites for S. aureus. Using a thin-layer chromatogram overlay assay, we showed binding of S. aureus to various glycolipids extracted from corneal epithelial cells and corneal tissue. S. aureus was found to bind to gangliosides and asialo-GM1, whereas S. pyogenes did not bind to any of these complex lipids. The increased adherence potential of S. aureus due to the ability to bind to glycolipids may provide a selective advantage for S. aureus and explain the prevalence of this organism in bacterial corneal ulcers.