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Raab JE, Hamilton DJ, Harju TB, Huynh TN, Russo BC. Pushing boundaries: mechanisms enabling bacterial pathogens to spread between cells. Infect Immun 2024; 92:e0052423. [PMID: 38661369 PMCID: PMC11385730 DOI: 10.1128/iai.00524-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
For multiple intracellular bacterial pathogens, the ability to spread directly into adjacent epithelial cells is an essential step for disease in humans. For pathogens such as Shigella, Listeria, Rickettsia, and Burkholderia, this intercellular movement frequently requires the pathogens to manipulate the host actin cytoskeleton and deform the plasma membrane into structures known as protrusions, which extend into neighboring cells. The protrusion is then typically resolved into a double-membrane vacuole (DMV) from which the pathogen quickly escapes into the cytosol, where additional rounds of intercellular spread occur. Significant progress over the last few years has begun to define the mechanisms by which intracellular bacterial pathogens spread. This review highlights the interactions of bacterial and host factors that drive mechanisms required for intercellular spread with a focus on how protrusion structures form and resolve.
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Affiliation(s)
- Julie E Raab
- Department of Immunology and Microbiology, School of Medicine, University of Colorado-Anschutz Medical Campus, Denver, Colorado, USA
| | - Desmond J Hamilton
- Department of Immunology and Microbiology, School of Medicine, University of Colorado-Anschutz Medical Campus, Denver, Colorado, USA
| | - Tucker B Harju
- Department of Immunology and Microbiology, School of Medicine, University of Colorado-Anschutz Medical Campus, Denver, Colorado, USA
| | - Thao N Huynh
- Department of Immunology and Microbiology, School of Medicine, University of Colorado-Anschutz Medical Campus, Denver, Colorado, USA
| | - Brian C Russo
- Department of Immunology and Microbiology, School of Medicine, University of Colorado-Anschutz Medical Campus, Denver, Colorado, USA
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Maitre A, Kratou M, Corona-Guerrero I, Abuin-Denis L, Mateos-Hernández L, Mosqueda J, Almazan C, Said MB, Piloto-Sardiñas E, Obregon D, Cabezas-Cruz A. Differential interactions of Rickettsia species with tick microbiota in Rh. sanguineus and Rh. turanicus. Sci Rep 2024; 14:20674. [PMID: 39237587 PMCID: PMC11377539 DOI: 10.1038/s41598-024-71539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024] Open
Abstract
Tick-borne rickettsioses, caused by Gram-negative bacteria of the Rickettsia genus, pose a growing global threat, with various arthropod vectors contributing to their transmission. Understanding the complex interactions within tick microbiota, including the role of Rickettsia species, is crucial for elucidating the dynamics of rickettsial diseases. Here, we investigate the taxonomic profiles and co-occurrence networks of Rickettsia in Rh. sanguineus sensus lato (s.l.) and Rh. turanicus ticks, revealing significant differences in community composition and local connectivity of Rickettsia species. While the microbiota of both tick species share common taxa, distinct differences in relative abundance and network topology suggest unique ecological niches. Moreover, robustness analysis demonstrates varying resilience to perturbations, indicating different strategies for network organization. Our findings also highlight metabolic differences between tick species, suggesting potential implications for Rickettsia interactions. Overall, this study provides insights into the intricate microbial landscape within ticks, shedding light on the functional redundancy and metabolic pathways associated with Rickettsia, thus advancing our understanding of tick-borne diseases.
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Affiliation(s)
- Apolline Maitre
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700, Maisons-Alfort, France
- INRAE, UR 0045 Laboratoire de Recherches sur le Développement de l'Elevage (SELMET-LRDE), 20250, Corte, France
- EA 7310, Laboratoire de Virologie, Université de Corse, Corte, France
| | - Myriam Kratou
- Laboratory of Microbiology, National School of Veterinary Medicine of Sidi Thabet, University of Manouba, 2010, Manouba, Tunisia
| | - Ivan Corona-Guerrero
- Immunology and Vaccines Laboratory, C. A. Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Queretaro, Mexico
- C.A. Salud Animal y Microbiologia Ambiental. Facultad de Ciencias Naturales, Universidad Autonoma de Queretaro, Queretaro, Mexico
| | - Lianet Abuin-Denis
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700, Maisons-Alfort, France
- Animal Biotechnology Department, Center for Genetic Engineering and Biotechnology, Avenue 31 between 158 and 190, P.O. Box 6162, 10600, Havana, Cuba
| | - Lourdes Mateos-Hernández
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700, Maisons-Alfort, France
| | - Juan Mosqueda
- Immunology and Vaccines Laboratory, C. A. Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Queretaro, Mexico
- C.A. Salud Animal y Microbiologia Ambiental. Facultad de Ciencias Naturales, Universidad Autonoma de Queretaro, Queretaro, Mexico
| | - Consuelo Almazan
- Immunology and Vaccines Laboratory, C. A. Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Queretaro, Mexico
- C.A. Salud Animal y Microbiologia Ambiental. Facultad de Ciencias Naturales, Universidad Autonoma de Queretaro, Queretaro, Mexico
| | - Mourad Ben Said
- Laboratory of Microbiology, National School of Veterinary Medicine of Sidi Thabet, University of Manouba, 2010, Manouba, Tunisia
- Department of Basic Sciences, Higher Institute of Biotechnology of Sidi Thabet, University of Manouba, 2010, Manouba, Tunisia
| | - Elianne Piloto-Sardiñas
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700, Maisons-Alfort, France
- Direction of Animal Health, National Center for Animal and Plant Health, Carretera de Tapaste y Autopista Nacional, Apartado Postal 10, 32700, San José de Las Lajas, Mayabeque, Cuba
| | - Dasiel Obregon
- School of Environmental Sciences, University of Guelph, Guelph, ON, Canada.
| | - Alejandro Cabezas-Cruz
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700, Maisons-Alfort, France.
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Abroug N, Ksiaa I, Ben Aoun S, Nabi W, Mourali M, Jelliti B, Khairallah M. Sea-fan retinal neovascularization associated with rickettsial retinitis: a case report. BMC Ophthalmol 2024; 24:385. [PMID: 39218852 PMCID: PMC11367940 DOI: 10.1186/s12886-024-03654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Rickettsial disease has been commonly associated with retinitis, retinal vasculitis, and optic nerve involvement, but the development of retinal neovascularization has been very rarely reported. We herein describe a case of rickettsial retinitis complicated with the development of sea-fan retinal neovascularization documented with multimodal imaging, including fundus photography, SS-OCT, fluorescein angiography, and SS-OCT angiography. CASE PRESENTATION A 26-year-old female with a history of fever one week earlier presented with sudden decreased vision in the left eye. Best-corrected visual acuity (BCVA) was 20/2000 and the patient was diagnosed with rickettsial retinitis along the superotemporal retinal vascular arcade associated with serous retinal detachment and retinal hard exudates. The indirect immunofluorescence test was positive for Rickettsia conorii, and the patient was treated with oral doxycycline (200 mg/day) and oral prednisone (0.75 mg/kg/day, with gradual tapering). Four weeks after presentation, the retinal infiltrate and associated serous retinal detachment had resolved, but retinal hard exudates had increased. A large sea-fan preretinal fibrovascular neovascularization became apparent along the superotemporal retinal vascular arcade, but there was no associated retinal ischemia on fluorescein angiography. The patient received an adjunctive single intravitreal injection of 1.25 bevacizumab. Sequential follow-up examinations showed shrinking of sea-fan retinal neovascularization, a complete resolution of retinal hard exudates, and the development of a self-limited vitreous hemorrhage. On last follow-up, 30 months after intravitreal bevacizumab injection, BCVA was 20/25. CONCLUSION Patients with rickettsial retinitis may develop a sea-fan retinal neovascularization, with subsequent vitreous hemorrhage, putatively through inflammatory mechanisms. Multimodal imaging including OCT, fluorescein angiography, and OCT-angiography, is highly useful for accurate diagnosis and reliable monitoring of the evolution of retinitis, retinal neovascularization, and other retinal changes. The use of a combination therapy with oral doxycycline and corticosteroids and intravitreal anti-VEGF can improve outcomes.
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Affiliation(s)
- Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 1st June Street, Monastir, 5000, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 1st June Street, Monastir, 5000, Tunisia.
| | - Safa Ben Aoun
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 1st June Street, Monastir, 5000, Tunisia
| | - Wijdene Nabi
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 1st June Street, Monastir, 5000, Tunisia
| | - Mootez Mourali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 1st June Street, Monastir, 5000, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 1st June Street, Monastir, 5000, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty of Medicine, University of Monastir, 1st June Street, Monastir, 5000, Tunisia
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Rymaszewska A, Piotrowski M. Rickettsia Species: Genetic Variability, Vectors, and Rickettsiosis-A Review. Pathogens 2024; 13:661. [PMID: 39204262 PMCID: PMC11357061 DOI: 10.3390/pathogens13080661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/02/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
Rickettsiae are an interesting group of bacteria comprising a large number of obligate intracellular species. The circulation of these bacteria in the environment depends on the presence of vectors (blood-sucking invertebrates) and their hosts. On the basis of phylogenetic analyses in 2022, a division into five groups of Rickettsia has been proposed: I belli group, II canadensis group, III typhus group, and IV and V spotted group fever (respectively II, phylogenetically older, and I). The genus Rickettsia includes species that are both pathogenic and nonpathogenic to humans and domestic and wild animals. Some Rickettsia species are invertebrate symbionts. Currently, rickettsiae, which are transmitted mainly by ticks, are spreading worldwide. This has been promoted by climate change, environmental changes caused by humans, and the synanthropisation of plants and animals. Therefore, it is extremely important to monitor the natural and urban environments. The study of potential vectors and reservoirs of bacteria in the genus Rickettsia should be a permanent part of the analysis of the modern human environment.
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Affiliation(s)
- Anna Rymaszewska
- Department of Genetics and Genomics, Institute of Biology, University of Szczecin, ul. Felczaka 3C, 71-412 Szczecin, Poland;
| | - Mariusz Piotrowski
- Department of Genetics and Genomics, Institute of Biology, University of Szczecin, ul. Felczaka 3C, 71-412 Szczecin, Poland;
- BIOSPACE Foundation, ul. Karpia 31, 61-619 Poznań, Poland
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Mertens-Scholz K, Hoffmann B, Gethmann JM, Brangsch H, Pletz MW, Klaus C. Prevalence of tick-borne bacterial pathogens in Germany-has the situation changed after a decade? Front Cell Infect Microbiol 2024; 14:1429667. [PMID: 39091677 PMCID: PMC11291221 DOI: 10.3389/fcimb.2024.1429667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Tick-borne pathogens, such as Borreliella spp., Rickettsia spp., and Anaplasma spp., are frequently detected in Germany. They circulate between animals and tick vectors and can cause mild to severe diseases in humans. Knowledge about distribution and prevalence of these pathogens over time is important for risk assessment of human and animal health. Methods Ixodes ricinus nymphs were collected at different locations in 2009/2010 and 2019 in Germany and analyzed for tick-borne pathogens by real-time PCR and sequencing. Results Borreliella spp. were detected with a prevalence of 11.96% in 2009/2010 and 13.10% in 2019 with B. afzelii and B. garinii as dominant species. Borrelia miyamotoi was detected in seven ticks and in coinfection with B. afzelii or B. garinii. Rickettsia spp. showed a prevalence of 8.82% in 2009/2010 and 1.68% in 2019 with the exclusive detection of R. helvetica. The prevalence of Anaplasma spp. was 1.00% in 2009/2010 and 7.01% in 2019. A. phagocytophilum was detected in seven tick samples. None of the nymphs were positive for C. burnetii. Discussion Here, observed changes in prevalence were not significant after a decade but require longitudinal observations including parameters like host species and density, climatic factors to improve our understanding of tick-borne diseases.
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Affiliation(s)
- Katja Mertens-Scholz
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Jena, Germany
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Bernd Hoffmann
- Institute of Diagnostic Virology, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Greifswald-Insel Riems, Germany
| | - Jörn M. Gethmann
- Institute of Epidemiology, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Greifswald-Insel Riems, Germany
| | - Hanka Brangsch
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Jena, Germany
| | - Mathias W. Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Christine Klaus
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut – Federal Research Institute for Animal Health (FLI), Jena, Germany
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Yang Z, Shi Z, Fang K, Ren D. Atypical Rickettsia japonica Infection Involving Critical Illness Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report. Infect Drug Resist 2024; 17:963-967. [PMID: 38495624 PMCID: PMC10944173 DOI: 10.2147/idr.s451404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
Background Rickettsia japonica infection is a rare disease, it is rare to report critical and severe case caused by this disease in Zhejiang Province, China. Patient Concerns We report a patient who initially sought medical attention due to fever and developed coma and convulsions during treatment. The patient did not develop typical eschar and rash. Eventually, the patient needed to be treated in the intensive care unit due to acute respiratory failure. Diagnoses The patient was diagnosed with Rickettsia japonica bloodstream infection by metagenomic next-generation sequencing (mNGS). Outcomes Due to the critical illness, the patient was transferred to the intensive care unit, received doxycycline and other treatments, and rapidly recovered and discharged. Conclusion The patient developed a critical illness after being infected with Rickettsia, when the medical history is unclear and clinical symptoms and signs are atypical, it is necessary to use mNGS examination for diagnosis.
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Affiliation(s)
- Zheng Yang
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Zhanli Shi
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Kun Fang
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Danhong Ren
- Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People's Republic of China
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Sit B, Lamason RL. Pathogenic Rickettsia spp. as emerging models for bacterial biology. J Bacteriol 2024; 206:e0040423. [PMID: 38315013 PMCID: PMC10883807 DOI: 10.1128/jb.00404-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Our understanding of free-living bacterial models like Escherichia coli far outpaces that of obligate intracellular bacteria, which cannot be cultured axenically. All obligate intracellular bacteria are host-associated, and many cause serious human diseases. Their constant exposure to the distinct biochemical niche of the host has driven the evolution of numerous specialized bacteriological and genetic adaptations, as well as innovative molecular mechanisms of infection. Here, we review the history and use of pathogenic Rickettsia species, which cause an array of vector-borne vascular illnesses, as model systems to probe microbial biology. Although many challenges remain in our studies of these organisms, the rich pathogenic and biological diversity of Rickettsia spp. constitutes a unique backdrop to investigate how microbes survive and thrive in host and vector cells. We take a bacterial-focused perspective and highlight emerging insights that relate to new host-pathogen interactions, bacterial physiology, and evolution. The transformation of Rickettsia spp. from pathogens to models demonstrates how recalcitrant microbes may be leveraged in the lab to tap unmined bacterial diversity for new discoveries. Rickettsia spp. hold great promise as model systems not only to understand other obligate intracellular pathogens but also to discover new biology across and beyond bacteria.
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Affiliation(s)
- Brandon Sit
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Rebecca L. Lamason
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Kumpitsch C, Fischmeister FPS, Lackner S, Holasek S, Madl T, Habisch H, Wolf A, Schöpf V, Moissl-Eichinger C. Reduced olfactory performance is associated with changed microbial diversity, oralization, and accumulation of dead biomaterial in the nasal olfactory area. Microbiol Spectr 2024; 12:e0154923. [PMID: 38193689 PMCID: PMC10846256 DOI: 10.1128/spectrum.01549-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
The partial or complete loss of the sense of smell, which affects about 20% of the population, impairs the quality of life in many ways. Dysosmia and anosmia are mainly caused by aging, trauma, infections, or even neurodegenerative disease. Recently, the olfactory area-a site containing the olfactory receptor cells responsible for odor perception-was shown to harbor a complex microbiome that reflects the state of olfactory function. This initially observed correlation between microbiome composition and olfactory performance needed to be confirmed using a larger study cohort and additional analyses. A total of 120 participants (middle-aged, no neurodegenerative disease) were enrolled in the study to further analyze the microbial role in human olfactory function. Olfactory performance was assessed using the Sniffin' Stick battery, and participants were grouped accordingly (normosmia: n = 93, dysosmia: n = 27). The olfactory microbiome was analyzed by 16S rRNA gene amplicon sequencing and supplemented by metatranscriptomics in a subset (Nose 2.0). Propidium monoazide (PMA) treatment was performed to distinguish between intact and non-intact microbiome components. The gastrointestinal microbiome of these participants was also characterized by amplicon sequencing and metabolomics and then correlated with food intake. Our results confirm that normosmics and dysosmics indeed possess a distinguishable olfactory microbiome. Alpha diversity (i.e., richness) was significantly increased in dysosmics, reflected by an increase in the number of specific taxa (e.g., Rickettsia, Spiroplasma, and Brachybacterium). Lower olfactory performance was associated with microbial signatures from the oral cavity and periodontitis (Fusobacterium, Porphyromonas, and Selenomonas). However, PMA treatment revealed a higher accumulation of dead microbial material in dysosmic subjects. The gastrointestinal microbiome partially overlapped with the nasal microbiome but did not show substantial variation with respect to olfactory performance, although the diet of dysosmic individuals was shifted toward a higher meat intake. Dysosmia is associated with a higher burden of dead microbial material in the olfactory area, indicating an impaired clearance mechanism. As the microbial community of dysosmics (hyposmics and anosmics) appears to be influenced by the oral microbiome, further studies should investigate the microbial oral-nasal interplay in individuals with partial or complete olfactory loss.IMPORTANCEThe loss of the sense of smell is an incisive event that is becoming increasingly common in today's world due to infections such as COVID-19. Although this loss usually recovers a few weeks after infection, in some cases, it becomes permanent-why is yet to be answered. Since this condition often represents a psychological burden in the long term, there is a need for therapeutic approaches. However, treatment options are limited or even not existing. Understanding the role of the microbiome in the impairment of olfaction may enable the prediction of olfactory disorders and/or could serve as a possible target for therapeutic interventions.
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Affiliation(s)
- Christina Kumpitsch
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Florian Ph. S. Fischmeister
- Department of Psychology, University of Graz, Graz, Austria
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- BioTechMed, Graz, Austria
| | - Sonja Lackner
- Otto Loewi Research Center, Division of Immunology, Medical University of Graz, Graz, Austria
| | - Sandra Holasek
- Otto Loewi Research Center, Division of Immunology, Medical University of Graz, Graz, Austria
| | - Tobias Madl
- BioTechMed, Graz, Austria
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Ageing, Molecular Biology and Biochemistry, Research Unit Integrative Structural Biology, Medical University of Graz, Graz, Austria
| | - Hansjörg Habisch
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Ageing, Molecular Biology and Biochemistry, Research Unit Integrative Structural Biology, Medical University of Graz, Graz, Austria
| | - Axel Wolf
- Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - Veronika Schöpf
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christine Moissl-Eichinger
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
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Dzul-Rosado K, Panti-Balam C, Lavín-Sánchez D, Palma-Chan A, Caamal-Poot M, Achach-Medina K, Quiñones-Vega C, Lugo-Caballero C, Noh-Pech H, Tello-Martín R, López-Ávila K, Arias-León J, González-Reynoso A, Puerto-Manzano F. Clinical and laboratory features of rickettsioses in Yucatan, Mexico. Acta Trop 2024; 249:107048. [PMID: 37931342 DOI: 10.1016/j.actatropica.2023.107048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/05/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
Rickettsia species are obligate intracellular bacteria that can cause mild to severe human disease. Based on phylogeny, clinical symptoms, and antigenic properties, rickettsiae are classified into four groups. Infections by these agents are characterized by clinical symptoms ranging from self-limited to severe and even fatal febrile illnesses, depending on the Rickettsia spp. involved, the patient's predisposition, and timely medical care. The present study aimed to characterize rickettsial diseases in Yucatan according to clinical and laboratory features appearing in medical records corresponding to 427 samples taken between 2015 and 2018. A study was conducted over the period 2015-2018 on 427 samples. Clinical and laboratory features were documented from the patients' medical records. For molecular diagnosis, blood was collected in 3.8 % sodium citrate as anticoagulant, and DNA was extracted. Single-step and nested PCR amplification was performed using genus-specific primers for the rickettsial 17kDa and ompB genes. The amplicons obtained were purified and sequenced. A total of 22.7 % (97/427) positive cases of Rickettsia spp. were identified by PCR from 14.15 % (15/106) of the municipalities in Yucatan. 75.2 % (73/97) of the cases were from the city of Merida during the autumn (September-December). The age groups with the highest frequency of confirmed cases were pediatric (5-14 years) (57.7 %) and adults (25-49 years) (42.2 %). There were six fatal cases in children, one associated with R. typhi and five with R. rickettsii. In non-fatal cases, 32.9 % (32/97) corresponded to the spotted fever group (SFG), and 60.8 % (59/97) to the typhus group (TG). Significant differences in signs, and laboratory data, were observed between the pediatric and adult populations. For the treatment of patients, oral and intravenous doxycycline was used in severe hospitalized cases. Typhus group and spotted fever group Rickettsiae are endemic pathological agents found in urban and rural areas of our region. Molecular identification allows for greater diagnostic accuracy and timely treatment and consequently a better prognosis. It is necessary to implement or reinforce measures focused on the dissemination of knowledge regarding rickettsial diseases and their prevention.
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Affiliation(s)
- Karla Dzul-Rosado
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico.
| | - Candi Panti-Balam
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Dayana Lavín-Sánchez
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | | | | | | | | | - Cesar Lugo-Caballero
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Henry Noh-Pech
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Raúl Tello-Martín
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Karina López-Ávila
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
| | - Juan Arias-León
- Inter-Institutional Unit of Epidemiologic and Clinical Research, Medicine Faculty, Autonomous University of Yucatan, Yucatan, Mexico
| | | | - Fernando Puerto-Manzano
- Dr. Hideyo Noguchi Regional Research Center, Emerging and Re-emerging Disease Laboratory, Avenida Itzáes, No 490 x Calle 59, Col. Centro, CP 97000, Autonomous University of Yucatan, Merida, Yucatan 97000, Mexico
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10
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Enright AL, Banta AB, Ward RD, Rivera Vazquez J, Felczak MM, Wolfe MB, TerAvest MA, Amador-Noguez D, Peters JM. The genetics of aerotolerant growth in an alphaproteobacterium with a naturally reduced genome. mBio 2023; 14:e0148723. [PMID: 37905909 PMCID: PMC10746277 DOI: 10.1128/mbio.01487-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
IMPORTANCE The inherent complexity of biological systems is a major barrier to our understanding of cellular physiology. Bacteria with markedly fewer genes than their close relatives, or reduced genome bacteria, are promising biological models with less complexity. Reduced genome bacteria can also have superior properties for industrial use, provided the reduction does not overly restrict strain robustness. Naturally reduced genome bacteria, such as the alphaproteobacterium Zymomonas mobilis, have fewer genes but remain environmentally robust. In this study, we show that Z. mobilis is a simplified genetic model for Alphaproteobacteria, a class with important impacts on the environment, human health, and industry. We also identify genes that are only required in the absence of atmospheric oxygen, uncovering players that maintain and utilize the cellular energy state. Our findings have broad implications for the genetics of Alphaproteobacteria and industrial use of Z. mobilis to create biofuels and bioproducts.
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Affiliation(s)
- Amy L. Enright
- DOE Great Lakes Bioenergy Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Amy B. Banta
- DOE Great Lakes Bioenergy Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ryan D. Ward
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Laboratory of Genetics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Julio Rivera Vazquez
- DOE Great Lakes Bioenergy Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Magdalena M. Felczak
- DOE Great Lakes Bioenergy Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, Michigan, USA
| | - Michael B. Wolfe
- DOE Great Lakes Bioenergy Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biochemistry, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michaela A. TerAvest
- DOE Great Lakes Bioenergy Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, Michigan, USA
| | - Daniel Amador-Noguez
- DOE Great Lakes Bioenergy Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jason M. Peters
- DOE Great Lakes Bioenergy Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Center for Genomic Science Innovation, University of Wisconsin-Madison, Madison, Wisconsin, USA
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11
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Dahmani M, Zhu JC, Cook JH, Riley SP. Anaphylatoxin signaling activates macrophages to control intracellular Rickettsia proliferation. Microbiol Spectr 2023; 11:e0253823. [PMID: 37855623 PMCID: PMC10714731 DOI: 10.1128/spectrum.02538-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
IMPORTANCE Pathogenic Rickettsia species are extremely dangerous bacteria that grow within the cytoplasm of host mammalian cells. In most cases, these bacteria are able to overpower the host cell and grow within the protected environment of the cytoplasm. However, a dramatic conflict occurs when Rickettsia encounter innate immune cells; the bacteria can "win" by taking over the host, or the bacteria can "lose" if the host cell efficiently fights the infection. This manuscript examines how the immune complement system is able to detect the presence of Rickettsia and alert nearby cells. Byproducts of complement activation called anaphylatoxins are signals that "activate" innate immune cells to mount an aggressive defensive strategy. This study enhances our collective understanding of the innate immune reaction to intracellular bacteria and will contribute to future efforts at controlling these dangerous infections.
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Affiliation(s)
- Mustapha Dahmani
- Department of Veterinary Medicine, University of Maryland-College Park, College Park, Maryland, USA
| | - Jinyi C. Zhu
- Department of Veterinary Medicine, University of Maryland-College Park, College Park, Maryland, USA
| | - Jack H. Cook
- Department of Veterinary Medicine, University of Maryland-College Park, College Park, Maryland, USA
| | - Sean P. Riley
- Department of Veterinary Medicine, University of Maryland-College Park, College Park, Maryland, USA
- Virginia-Maryland College of Veterinary Medicine, College Park, Maryland, USA
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12
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Lionello FCP, Rotundo S, Bruno G, Marino G, Morrone HL, Fusco P, Costa C, Russo A, Trecarichi EM, Beltrame A, Torti C. Touching Base with Some Mediterranean Diseases of Interest from Paradigmatic Cases at the "Magna Graecia" University Unit of Infectious Diseases: A Didascalic Review. Diagnostics (Basel) 2023; 13:2832. [PMID: 37685370 PMCID: PMC10486464 DOI: 10.3390/diagnostics13172832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Among infectious diseases, zoonoses are increasing in importance worldwide, especially in the Mediterranean region. We report herein some clinical cases from a third-level hospital in Calabria region (Southern Italy) and provide a narrative review of the most relevant features of these diseases from epidemiological and clinical perspectives. Further, the pathogenic mechanisms involved in zoonotic diseases are reviewed, focusing on the mechanisms used by pathogens to elude the immune system of the host. These topics are of particular concern for individuals with primary or acquired immunodeficiency (e.g., people living with HIV, transplant recipients, patients taking immunosuppressive drugs). From the present review, it appears that diagnostic innovations and the availability of more accurate methods, together with better monitoring of the incidence and prevalence of these infections, are urgently needed to improve interventions for better preparedness and response.
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Affiliation(s)
- Ferdinando Carmelo Pio Lionello
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Salvatore Rotundo
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Gabriele Bruno
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Gabriella Marino
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Helen Linda Morrone
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
| | - Paolo Fusco
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Chiara Costa
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Alessandro Russo
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Anna Beltrame
- College of Public Health, University of South Florida, Gainesville, FL 33620, USA;
| | - Carlo Torti
- Department of Medical and Surgical Sciences, University “Magna Graecia”, 88100 Catanzaro, Italy; (F.C.P.L.); (S.R.); (G.B.); (G.M.); (H.L.M.); (A.R.); (E.M.T.); (C.T.)
- Unit of Infectious and Tropical Diseases, “Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
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13
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Zhou Y, Hua S, Song L. The versatile defender: exploring the multifaceted role of p62 in intracellular bacterial infection. Front Cell Infect Microbiol 2023; 13:1180708. [PMID: 37216179 PMCID: PMC10196109 DOI: 10.3389/fcimb.2023.1180708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
As a highly conserved, multifunctional protein with multiple domains, p62/SQSTM1 plays a crucial role in several essential cellular activities, particularly selective autophagy. Recent research has shown that p62 is crucial in eradicating intracellular bacteria by xenophagy, a selective autophagic process that identifies and eliminates such microorganisms. This review highlights the various roles of p62 in intracellular bacterial infections, including both direct and indirect, antibacterial and infection-promoting aspects, and xenophagy-dependent and independent functions, as documented in published literature. Additionally, the potential applications of synthetic drugs targeting the p62-mediated xenophagy mechanism and unresolved questions about p62's roles in bacterial infections are also discussed.
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Affiliation(s)
- Yuhao Zhou
- Department of Respiratory Medicine, Center for Pathogen Biology and Infectious Diseases, Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, The First Hospital of Jilin University, Changchun, China
- State Key Laboratory for Zoonotic Diseases, The First Hospital of Jilin University, Changchun, China
| | - Shucheng Hua
- Department of Respiratory Medicine, Center for Pathogen Biology and Infectious Diseases, Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, The First Hospital of Jilin University, Changchun, China
- State Key Laboratory for Zoonotic Diseases, The First Hospital of Jilin University, Changchun, China
| | - Lei Song
- Department of Respiratory Medicine, Center for Pathogen Biology and Infectious Diseases, Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, The First Hospital of Jilin University, Changchun, China
- State Key Laboratory for Zoonotic Diseases, The First Hospital of Jilin University, Changchun, China
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14
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Otsuki H, Kondo Y, Tademoto S, Ito D. Phylogenetic Analysis of Spotted Fever Group Rickettsia Gene from Ticks and Human Patients in Tottori Prefecture, Japan. Yonago Acta Med 2023; 66:246-256. [PMID: 37229380 PMCID: PMC10203642 DOI: 10.33160/yam.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/27/2023]
Abstract
Background Japanese spotted fever (JSF) is a tick-borne bacterial febrile disease caused by Rickettsia japonica characterized by fever, rash, and occasional death. The number of patients in Japan and the Tottori Prefecture has been increasing over the past 20 years. Most cases were found in Eastern Tottori; however, the distribution of patients has expanded to the Central and Western regions. Ticks carried by wild animals may be the cause, but the prevalence of R. japonica in ticks has not yet been analyzed. Methods Ticks were collected by flagging-dragging from 16 sites in Tottori, Japan. The ticks were morphologically classified and DNA was extracted. The 17-kDa antigen gene was amplified using nested PCR. PCR amplicons from ticks and JSF patients were sequenced and phylogenetically compared. Results In total, 177 ticks were collected and identified as Haemahysalis, Ixodes, Amblyomma, and Dermcentor. The Spotted Fever Group Rickettsia (SFGR) was detected in Haemahysalis and Amblyomma spp. using PCR, with positivity rates of 36.8% and 33.3%, respectively. DNA sequencing and phylogenetic analysis revealed that positive ticks harbored R. japonica, P. raoultii, and other Rickettsiae species; however, the patient's samples were restricted to R. japonica. Similar to the incidence of JSF, the rate of R. japonica-positive ticks was higher in the Eastern region; however, R. japonica-positive ticks were also detected in the Western region. Conclusion R. japonica sequences had been found in ticks collected in Tottori Prefecture. Ticks harboring R. japonica were found in the Eastern and Western parts of Tottori Prefecture and the sequences were identical to the human cases. Only the R. japonica sequence has been detected in patients with spotted fever symptoms, even though ticks were harboring various SFGRs.
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Affiliation(s)
- Hitoshi Otsuki
- Division of Medical Zoology, Department of Microbiology and Immunology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Yoko Kondo
- Division of Medical Zoology, Department of Microbiology and Immunology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Sayuri Tademoto
- Technical Department, Tottori University, Yonago 683-8503, Japan
| | - Daisuke Ito
- Division of Medical Zoology, Department of Microbiology and Immunology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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15
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Narra HP, Alsing J, Sahni A, Montini M, Zafar Y, Sahni SK. A Small Non-Coding RNA Mediates Transcript Stability and Expression of Cytochrome bd Ubiquinol Oxidase Subunit I in Rickettsia conorii. Int J Mol Sci 2023; 24:4008. [PMID: 36835430 PMCID: PMC9960880 DOI: 10.3390/ijms24044008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
Small regulatory RNAs (sRNAs) are now widely recognized for their role in the post-transcriptional regulation of bacterial virulence and growth. We have previously demonstrated the biogenesis and differential expression of several sRNAs in Rickettsia conorii during interactions with the human host and arthropod vector, as well as the in vitro binding of Rickettsia conorii sRNA Rc_sR42 to bicistronic cytochrome bd ubiquinol oxidase subunits I and II (cydAB) mRNA. However, the mechanism of regulation and the effect of sRNA binding on the stability of the cydAB bicistronic transcript and the expression of the cydA and cydB genes are still unknown. In this study, we determined the expression dynamics of Rc_sR42 and its cognate target genes, cydA and cydB, in mouse lung and brain tissues during R. conorii infection in vivo and employed fluorescent and reporter assays to decode the role of sRNA in regulating cognate gene transcripts. Quantitative RT-PCR revealed significant changes in the expression of sRNA and its cognate target gene transcripts during R. conorii infection in vivo, and a greater abundance of these transcripts was observed in the lungs compared to brain tissue. Interestingly, while Rc_sR42 and cydA exhibited similar patterns of change in their expression, indicating the influence of sRNA on the mRNA target, the expression of cydB was independent of sRNA expression. Further, we constructed reporter plasmids of sRNA and cydAB bicistronic mRNA to decipher the role of sRNA on CydA and CydB expression. We observed increased expression of CydA in the presence of sRNA but detected no change in CydB expression in the presence or absence of sRNA. In sum, our results demonstrate that the binding of Rc_sR42 is required for the regulation of cydA but not cydB. Further studies on understanding the influence of this interaction on the mammalian host and tick vector during R. conorii infection are in progress.
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Affiliation(s)
- Hema P. Narra
- Department of Pathology, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555, USA
| | | | | | | | | | - Sanjeev K. Sahni
- Department of Pathology, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555, USA
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