Haemophilus influenzae in acute exacerbations of chronic obstructive pulmonary disease

Respiratory syncytial virus persistence in macrophages downregulates intercellular adhesion molecule-1 expression and reduces adhesion of non-typeable Haemophilus influenzae

BACKGROUND

Persistence of respiratory syncytial virus (RSV) has been associated with episodes of chronic obstructive pulmonary disease (COPD); furthermore, co-infection of RSV with non-typeable Haemophilus influenzae (NTHi) is increasingly recognized as a cause of exacerbations of COPD.

OBJECTIVE

To study whether RSV persistence in a macrophage (Mφ)-like cell line alters NTHi uptake (adhesion and ingestion).

METHODS

A murine Mφ-like cell line persistently infected with RSV (MφP) was used. The effects of RSV persistence on NTHi uptake by MφP and mock-infected Mφ (MφN) were determined by flow-cytometric assays with NTHi labelled with either ethidium bromide or FITC. Expression of intercellular adhesion molecule-1 (ICAM-1), a ligand for NTHi, was determined by measuring mRNA through real-time PCR and protein by Western blot assays.

RESULTS

RSV persistence reduced both the capacity of Mφ to take up bacteria and the expression of ICAM-1 mRNA and protein. Furthermore, when ICAM-1 was blocked with anti-ICAM-1 antibody, the adhesion capacity of NTHi was significantly reduced for MφN, whereas for MφP the effect was less evident, implying that ICAM-1 participates in NTHi adhesion to Mφ.

CONCLUSION

RSV persistence in murine Mφ diminishes their capacity to adhere and ingest NTHi through downregulation of ICAM-1 expression at the transcriptional level.

Managing acute lower respiratory tract infections in an era of antibacterial resistance

Respiratory tract infections account for more than 116 million office visits and an estimated 3 million visits to hospital EDs annually. Patients presenting at EDs with symptoms suggestive of lower respiratory tract infections of suspected bacterial etiology are often severely ill, thus requiring a rapid presumptive diagnosis and empiric antimicrobial treatment. Traditionally, clinicians have relied on beta-lactam or macrolide antibiotics to manage community-acquired lower respiratory tract infections. However, the emerging resistance of Streptococcus pneumoniae to beta-lactams and/or macrolides may affect the clinical efficacy of these agents. Inappropriate use of antibiotics and use of agents with an overly broad spectrum of antimicrobial activity have contributed to the emergence of antibiotic resistance. When treating respiratory infections, clinicians need to prescribe antimicrobial agents only for those individuals with infections of suspected bacterial etiology; to select agents with a targeted spectrum of activity that ensures coverage against typical S pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis strains, including antibiotic-resistant strains and atypical pathogens; and to consider agents with specific chemical properties that limit the development of antimicrobial resistance and that achieve concentrations at sites of infection that exceed those required for bactericidal activity. Newer classes of antimicrobial agents, such as the oxazolidinones and ketolides, will likely play a significant role in this era of antimicrobial resistance.

Human eosinophils selectively recognize and become activated by bacteria belonging to different taxonomic groups

Eosinophils are predominantly found in tissues that have an interface with the external environment and its bacterial flora, such as the gastrointestinal and respiratory tracts. Although it is not the primary function of eosinophils to phagocytose and kill bacteria, we hypothesized that they might be able to recognize and become activated by microorganisms that enter the normally sterile tissues where they reside. The aim of this study was to evaluate whether human eosinophils get universally activated by bacteria or if they discriminate between bacteria derived from different phylogenetic groups. Eleven bacterial species representative of different taxonomic groups were examined. A hierarchy was seen among the bacterial species regarding their capacity to activate eosinophils. Furthermore, several eosinophilic activation patterns were evoked by the different bacterial species. The strongest eosinophil activator, Escherichia coli, elicited chemotaxis, degranulation and respiratory burst. Low numbers of bacteria caused the release of the granule proteins major basic protein and eosinophil peroxidase, whereas high numbers were required for the release of eosinophil cationic protein (ECP). Eosinophils did not seem to discriminate between gram-positive and gram-negative bacteria, unlike monocytes. However, the release of ECP was mainly seen after stimulation with gram-negative species. Blockade of the formyl peptide receptor partially inhibited bacterial activation of eosinophils, implicating its involvement in this activity. We propose that the presence of defined bacterial species in the normally sterile tissues inhabited by eosinophils may constitute danger signals to eosinophils. This may be of importance in the perpetuation of allergic inflammation.

Nontypeable Haemophilus influenzae activates human eosinophils through beta-glucan receptors

Eosinophils are a characteristic component of the inflammatory response seen in several diseases, including allergic asthma and chronic obstructive pulmonary disease. After activation, eosinophil-derived products may exert proinflammatory effects and cause considerable tissue damage. In the present study, we investigated innate interactions between the respiratory tract pathogen nontypeable Haemophilus influenzae (NTHi) and human eosinophils. Bacterial binding to eosinophils was dependent on (1-3)-beta-D-glucan receptors, as deduced from blocking experiments using the soluble glucan derivatives laminarin and scleroglucan. In addition, expression of the beta-glucan receptor dectin-1 was shown in eosinophils by reverse transcriptase-polymerase chain reaction. Activation of the beta-glucan receptors by bacteria elicited a time- and dose-dependent respiratory burst in eosinophils. NTHi caused increased expression of the proinflammatory chemokine interleukin-8 as measured by reverse transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assay. Incubation of eosinophils in the presence of NTHi for 4.5 h revealed upregulation of 245 different genes as detected by microarray. Signal transduction-related transcripts were most strongly upregulated, followed by cytokine mRNAs. Our findings suggest that NTHi can induce an innate inflammatory response in eosinophils that is mainly mediated via beta-glucan receptors. This points to possible pathophysiologic mechanisms involving innate recognition of NTHi by eosinophils during infection of the airways, thus promoting inflammation in chronic pulmonary disease.