Effect of anaerobic bacteria on killing of Proteus mirabilis by human polymorphonuclear leukocytes

Pressure ulcers microbiota dynamics and wound evolution

Bacterial species and their role in delaying the healing of pressure ulcers (PU) in spinal cord injury (SCI) patients have not been well described. This pilot study aimed to characterise the evolution of the cutaneous microbiota of PU in SCI cohort. Twenty-four patients with SCI from a French neurological rehabilitation centre were prospectively included. PU tissue biopsies were performed at baseline (D0) and 28 days (D28) and analysed using 16S rRNA gene-based sequencing analysis of the V3–V4 region. At D0, if the overall relative abundance of genus highlighted a large proportion of Staphylococcus, Anaerococcus and Finegoldia had a significantly higher relative abundance in wounds that stagnated or worsened in comparison with those improved at D28 (3.74% vs 0.05%; p = 0.015 and 11.02% versus 0.16%; p = 0.023, respectively). At D28, Proteus and Morganella genera were only present in stagnated or worsened wounds with respectively 0.02% (p = 0.003) and 0.01% (p = 0.02). Moreover, Proteus, Morganella, Anaerococcus and Peptoniphilus were associated within the same cluster, co-isolated from biopsies that had a poor evolution. This pathogroup could be a marker of wound degradation and Proteus could represent a promising target in PU management.

Metabolic Feedback Inhibition Influences Metabolite Secretion by the Human Gut Symbiont Bacteroides thetaiotaomicron

Bacteroides is a highly abundant taxon in the human gut, and Bacteroides thetaiotaomicron (B. theta) is a ubiquitous human symbiont that colonizes the host early in development and persists throughout its life span. The phenotypic plasticity of keystone organisms such as B. theta is important to understand in order to predict phenotype(s) and metabolic interactions under changing nutrient conditions such as those that occur in complex gut communities. Our study shows B. theta prioritizes energy conservation and suppresses secretion of “overflow metabolites” such as organic acids and amino acids when concentrations of acetate are high. Secreted metabolites, especially amino acids, can be a source of nutrients or signals for the host or other microbes in the community. Our study suggests that when metabolically stressed by acetate, B. theta stops sharing with its ecological partners.

Microbial metabolism and trophic interactions between microbes give rise to complex multispecies communities in microbe-host systems. Bacteroides thetaiotaomicron (B. theta) is a human gut symbiont thought to play an important role in maintaining host health. Untargeted nuclear magnetic resonance metabolomics revealed B. theta secretes specific organic acids and amino acids in defined minimal medium. Physiological concentrations of acetate and formate found in the human intestinal tract were shown to cause dose-dependent changes in secretion of metabolites known to play roles in host nutrition and pathogenesis. While secretion fluxes varied, biomass yield was unchanged, suggesting feedback inhibition does not affect metabolic bioenergetics but instead redirects carbon and energy to CO₂ and H₂. Flux balance analysis modeling showed increased flux through CO₂-producing reactions under glucose-limiting growth conditions. The metabolic dynamics observed for B. theta, a keystone symbiont organism, underscores the need for metabolic modeling to complement genomic predictions of microbial metabolism to infer mechanisms of microbe-microbe and microbe-host interactions.

IMPORTANCEBacteroides is a highly abundant taxon in the human gut, and Bacteroides thetaiotaomicron (B. theta) is a ubiquitous human symbiont that colonizes the host early in development and persists throughout its life span. The phenotypic plasticity of keystone organisms such as B. theta is important to understand in order to predict phenotype(s) and metabolic interactions under changing nutrient conditions such as those that occur in complex gut communities. Our study shows B. theta prioritizes energy conservation and suppresses secretion of “overflow metabolites” such as organic acids and amino acids when concentrations of acetate are high. Secreted metabolites, especially amino acids, can be a source of nutrients or signals for the host or other microbes in the community. Our study suggests that when metabolically stressed by acetate, B. theta stops sharing with its ecological partners.

Effects of Eimeria tenella infection on chicken caecal microbiome diversity, exploring variation associated with severity of pathology

Eimeria species cause the intestinal disease coccidiosis, most notably in poultry. While the direct impact of coccidiosis on animal health and welfare is clear, its influence on the enteric microbiota and by-stander effects on chicken health and production remains largely unknown, with the possible exception of Clostridium perfringens (necrotic enteritis). This study evaluated the composition and structure of the caecal microbiome in the presence or absence of a defined Eimeria tenella challenge infection in Cobb500 broiler chickens using 16S rRNA amplicon sequencing. The severity of clinical coccidiosis in individual chickens was quantified by caecal lesion scoring and microbial changes associated with different lesion scores identified. Following E. tenella infection the diversity of taxa within the caecal microbiome remained largely stable. However, infection induced significant changes in the abundance of some microbial taxa. The greatest changes were detected in birds displaying severe caecal pathology; taxa belonging to the order Enterobacteriaceae were increased, while taxa from Bacillales and Lactobacillales were decreased with the changes correlated with lesion severity. Significantly different profiles were also detected in infected birds which remained asymptomatic (lesion score 0), with taxa belonging to the genera Bacteroides decreased and Lactobacillus increased. Many differential taxa from the order Clostridiales were identified, with some increasing and others decreasing in abundance in Eimeria-infected animals. The results support the view that caecal microbiome dysbiosis associated with Eimeria infection contributes to disease pathology, and could be a target for intervention to mitigate the impact of coccidiosis on poultry productivity and welfare. This work highlights that E. tenella infection has a significant impact on the abundance of some caecal bacteria with notable differences detected between lesion score categories emphasising the importance of accounting for differences in caecal lesions when investigating the relationship between E. tenella and the poultry intestinal microbiome.

Intra-abdominal infections: considerations for the use of the carbapenems

Intra-abdominal infection remains a common and frequently severe medical condition, carrying with it significant morbidity and mortality. These infections are almost always polymicrobial in nature as they are caused by mixed aerobic/anaerobic intestinal flora. Despite substantial improvements in both the medical and surgical management of these infections over the last several decades, there remains an opportunity to further enhance the utilization of adjunctive antibiotic therapy. As a result of the epidemiology and the current resistance profile of the infecting pathogens, the carbapenems represent a class of antibiotics that are considered appropriate for the treatment of severe intra-abdominal infections. This review will discuss the classification and microbiology of these infections and emerging resistance in the pathogens of interest. The review also and focuses on the role of the carbapenems in the management of the constellation of diseases known as intra-abdominal infection.

Abscess forming ability of streptococcus milleri group: synergistic effect with Fusobacterium nucleatum

The abscess forming abilities of "Streptococcus milleri" strains (Streptococcus constellatus, Streptococcus anginiosus, and Streptococcus intermedius) isolated from dentoalveolar abscesses and the synergistic effect of Fusobacterium nucleatum co-inoculated with the isolates were examined on a mouse subcutaneous abscess model. Five days after inoculation, all S. milleri strains formed abscesses, which showed less pathological spread to surrounding connective tissues than those formed by Staphylococcus aureus 209P strain and were similar to those by F. nucleatum ATCC25586. When each S. milleri strain and F. nucleatum were co-inoculated, abscess sizes and each bacterial number recovered from abscesses increased in comparison to those treated by bacterial mono-inoculation of each S. milleri strain or F. nucleatum alone. The strongest synergistic effect was observed in the combination of S. constellatus and F. nucleatum. In a time course experiment with this combination, the recovery of S. constellatus subsequently decreased after the decrement of F. nucleatum, and it appeared that the association with F. nucleatum maintained the bacterial number of S. constellatus in the abscess. The cell-free supernatant of F. nucleatum had a tendency to increase the abscess size caused by S. constellatus in this model. When S. constellatus was cultured with F. nucleatum culture supernatant in vitro, growth enhancement in the early phase was observed. Furthermore, the phagocytic killing of S. constellatus by human polymorphonuclear leukocytes (PMNs) was significantly suppressed and the PMN membranes appeared to be injured by addition of the F. nucleatum culture supernatant. These results suggest that the pathogenicity of S. milleri strains in odontogenic infections may be enhanced by the co-existence of F. nucleatum.

The effect of the bacterial product, succinic acid, on neutrophil bactericidal activity

We investigated the effect of succinic acid on neutrophil bactericidal activity in a model of intra-abdominal abscess induced in mice by the peritoneal inoculation of 5 x 10(6) cfu ml-1 E. coli and 5 x 10(8) cfu ml-1 B. fragilis plus 1 mg of bran as faecal fibre analogue. The mean pH of the induced abscesses at week 1 was 6.7, higher than the pH associated with succinic acid inhibitory activity. We therefore determined the effect of succinic acid (0-100 mM) at pH 6.7 on the bactericidal activity of mouse bone marrow-derived neutrophils. Phagocytic killing of Proteus mirabilis by neutrophils was significantly inhibited by 30-100 mM succinic acid at pH 6.7 but there was no significant effect of succinic acid on engulfment of bacteria at this pH. However, significant inhibition of intracellular killing (assayed by adding succinic acid to suspensions of neutrophils which had engulfed bacteria in low serum concentrations but in the absence of succinic acid) was noted at 70 and 100 mM. These results indicate that succinic acid inhibits neutrophil bactericidal activity at a physiological pH, principally through inhibition of intracellular killing mechanisms and therefore contributing to bacterial persistence in this model of abscess formation.

Molecular characterization of a heme-binding protein of Bacteroides fragilis BE1

An iron-repressible 44-kDa outer membrane protein plays a crucial role in the acquisition of heme by the anaerobic bacterium Bacteroides fragilis. The DNA sequence of the gene encoding the 44-kDa protein (hupA) was determined. The hupA gene encodes a protein of 431 amino acid residues with a calculated molecular mass of 48,189 Da. The hupA gene is preceded by an open reading frame of 480 bp that probably encodes a protein with a calculated molecular mass of 18,073 Da. hupA and this open reading frame are likely organized in an operon, and a sequence homologous to the Escherichia coli consensus Fur box was present in the putative promoter region of the operon. Heme-binding studies showed that HupA binds heme. Analysis of the deduced amino acid sequence revealed signature heme-binding consensus motifs, characteristic of heme lyases. Subcellular localization studies in E. coli revealed that HupA was mainly found in the cytoplasmic membrane but not in the outer membrane of E. coli. This suggested that B. fragilis uses another strategy for the translocation of this outer membrane protein across its cell envelope than E. coli does. HupA did not have significant homology with other putative bacterial heme receptors.

The role of encapsulated anaerobic bacteria in synergistic infections

The effect of encapsulation on the virulence, survival, and protection of anaerobic bacteria from phagocytosis is reviewed. Support for the importance of encapsulated Gram-negative anaerobic rods (Bacteroides sp., Prevotella sp. and Porphyromonas sp.), anaerobic and facultative Gram-positive cocci (AFGPC) was provided by their higher recovery rate in oropharyngeal infections, abscesses and blood, compared to their number in the normal flora. The pathogenicity of Bacteroides, Fusobacterium, Clostridium, and AFGPC was studied by inoculating them into mice and observing their ability to induce subcutaneous abscesses. Encapsulated Bacteroides, Fusobacteria, and AFGPC generally induced abscesses, whereas non-encapsulated organisms did not. However, many of the strains that had only a minimal number of encapsulated organisms (< 1%) survived in the abscesses, and they became heavily encapsulated when inoculated with other viable or non-viable encapsulated bacteria. Thereafter, these strains were able to induce abscesses when injected alone. Encapsulated Gram-negative anaerobic rods and AFGPC-induced bacteraemia and translocation, and increased the mortality of the infected animals more often than did the non-encapsulated form of the same strains. As determined by using selective antimicrobial therapy and quantitative cultures of abscesses induced in mice, possession of a capsule generally made Gram-negative anaerobic rods more important than their aerobic counterparts. Synergistic potentials were seen between encapsulated Gram-negative anaerobic rods and all tested aerobic bacteria and most AFGPC, and also between most AFGPC and Pseudomonas aeruginosa or Staphylococcus aureus. These studies demonstrated the importance of encapsulated anaerobes in mixed infections.

Epidemiological aspects of infections caused by Bacteroides fragilis and Clostridium difficile

Bacteroides fragilis and Clostridium difficile are two of the most common anaerobes associated with human disease. Studies on the epidemiology of Bacteroides fragilis are limited and are based predominantly on serogrouping, which suggests intraspecies differences. Further studies using newer techniques for typing are required to elucidate the epidemiological characteristics of this important pathogen. By contrast, numerous phenotypic, immunological and molecular methods have been developed for typing and fingerprinting of Clostridium difficile and applied in epidemiological studies to show conclusively that Clostridium difficile is nosocomially acquired and that there is transmission and cross-infection between hospital patients.

Depolarization of polymorphonuclear leukocytes by Porphyromonas (Bacteroides) gingivalis 381 in the absence of respiratory burst activation

Bacteroides spp. may contribute to the chronicity of mixed infections by affecting the normal functions of polymorphonuclear leukocytes (PMN). This study evaluated the physiologic and biochemical responses of human peripheral blood PMN to a variety of strains of the oral periodontal pathogen Porphyromonas (Bacteroides) gingivalis. Strain 381 and ATCC type strain 33277 caused rapid and lasting depolarization of the electrochemical potential that exists across the PMN membrane by a mechanism that was independent of activation of the pertussis toxin-sensitive G protein or protein kinase C. Membrane depolarization did not initiate increases in intracellular calcium or respiratory burst activation, and activity was not inhibited by surface proteolysis or sugars. However, membrane depolarization was associated with inhibition of PMN responses to the chemotactic peptide N-formylmethionyl leucyl phenylalanine. Membrane-depolarizing activity was isolated with the outer membrane of strain 381 by surface extraction of the bacteria by using Zwittergent 3,14, followed by Sephacryl S-200 gel filtration chromatography. The partially purified outer membrane components were heat stable, were not inhibited by tosyl-lysine chloromethyl ketone, and inhibited N-formylmethionyl leucyl phenylalanine-stimulated superoxide production. The results suggest that outer membrane components of P. gingivalis 381 and 33277 have porinlike activity that can depolarize PMN membranes and immobilize PMN responses to chemotactic peptides. This may prove to be an important virulence characteristic of these strains.

Effect of intraperitoneal administration of oxygen on the course of experimentally induced peritonitis

Over the first 3 days of experimentally induced peritonitis, 40 rabbits were given oxygen intraperitoneally (IP) up to a pressure of 3 to 5 mm Hg in the peritoneal cavity at 12-hour intervals. Compared with a control group, significant differences were recorded in the mortality rate within the studied 7-day period of peritonitis (p less than 0.05). In 29 rabbits with intraperitoneal administration of oxygen, the size of the area that formed the inner wall of the abscess cavity was significantly smaller (p less than 0.01) on day 7 of peritonitis than in the control group. The number of samples obtained from the abscesses positive for Clostridium perfringens (p less than 0.05) and for Staphylococcus aureus (p less than 0.001) was significantly lower in rabbits that had received intraperitoneal oxygen than in the control group. The number of samples from the abscesses positive for Escherichia coli and Streptococcus faecalis was significantly lower in the control group than in the group with intraperitoneal administration of oxygen (p less than 0.05). These results indicate that intraperitoneal administration of oxygen has an effect on the mortality rate associated with peritonitis, the size of the intraperitoneal abscess, and the bacterial composition of these abscesses.

Effect of daptomycin, metronidazole and mezlocillin combinations on mixed bacterial cultures involving facultative and anaerobic bacteria

The in vitro activities of different daptomycin concentrations in combination with metronidazole (4 mg/l) or/and mezlocillin (8 mg/l) were investigated on mixed bacterial cultures involving gram-positive facultative cocci. Bacteroides fragilis group strains and Escherichia coli. When Streptococcus faecalis alone or together with E. coli was cultured with B. thetaiotaomicron the colony counts of the latter were 4 log units higher after incubation in the presence of daptomycin and metronidazole than when it was cultured alone. After the addition of mezlocillin, this effect disappeared and all 3 strains were killed. When the same antibiotic combinations were used in the presence of beta-lactamase producing Staphylococcus aureus, the activity of mezlocillin was decreased significantly. The colony counts of the co-cultured B. thetaiotaomicron and E. coli proved to be 2 log and 6 log higher, respectively, than those observed after they were cultured alone. The antimicrobial susceptibilities of the clinical isolates tested here in mixed cultures of up to 3 strains were modified significantly by interactions between the strains and the antibiotics used.

Bacteria, toxins, and the peritoneum

Intraperitoneal infections are caused by members of the gastrointestinal flora, mainly Escherichia coli, enterococci, Klebsiella, Enterobacter, Proteus, Bacteroides, anaerobic cocci, Clostridia, and Fusobacteria. The Gram-negative aerobic bacteria exert their pathogenic potential mainly through endotoxin which acts by way of mediators, causing systemic septic response and, initially, the local response of the peritoneal cavity. The main virulence factors of anaerobic bacteria are exoenzymes and capsular polysaccharides. Peritoneal infections are truly synergistic infections. The most important synergistic mechanisms are protection against host defense and creation of a suitable environment by one member of the flora for another. Aside from bacteria, certain adjuvant substances, i.e., bile, gastric juice, blood, and necrotic tissue, play a role in the pathogenesis of peritonitis. The peritoneum deals with an infection in 3 ways: first, the direct absorption of bacteria into the lymphatics via the stoma of the diaphragmatic peritoneum; second, the local destruction of bacteria through phagocytosis by either resident macrophages or polymorphonuclear granulocytes attracted to the peritoneal cavity; and third, the localization of the infection in the form of an abscess.

Suppression of bactericidal activity of human polymorphonuclear leukocytes by Bacteroides gingivalis

The direct effects of the culture supernatant of oral microorganisms on the bactericidal activity of human polymorphonuclear leukocytes (PMNs) were investigated. The bactericidal activity of PMNs, which were preincubated with the supernatant of Bacteroides gingivalis, Bacteroides intermedius, Bacteroides melaninogenicus or phosphate-buffered saline, was examined by counting the surviving bacteria. B. gingivalis-treated PMNs were found to have a diminished ability for killing bacteria in the presence or absence of serum. The chemiluminescence response of PMNs, which were preincubated with the culture supernatant of B. gingivalis, was strikingly reduced compared with that of PMNs preincubated with phosphate-buffered saline or other bacterial culture supernatants. The production of superoxide anion (O2-) by PMNs stimulated with either formyl-methionyl-leucyl-phenylalanine or phorbol myristate acetate was reduced in both cases after the PMNs were preincubated with the culture supernatant of B. gingivalis. However, it was observed that there was more reduction in superoxide anion (O2-) production stimulated with formyl-methionyl-leucyl-phenylalanine compared with that stimulated with phorbol myristate acetate. These results suggest that B. gingivalis releases a factor which interferes with the bactericidal activity of PMNs by modulating the generation of reactive oxygen species. These suppressive effects on bactericidal activity may be important in the pathogenesis of this microorganism.

Tissue plasminogen activator reverses the deleterious effect of infection on colonic wound healing

Fibrin deposition in response to bacterial peritonitis appears to predispose to residual infection in the peritoneal cavity. Our previous studies have demonstrated that intraperitoneal fibrinolysis using human recombinant tissue plasminogen activator (t-PA) prevented abscess formation in a rat intra-abdominal sepsis model. To investigate the potential adverse side effects of its use in the peritoneal cavity, the effect of t-PA on colonic anastomotic wound healing and on systemic coagulation parameters was examined in the rat. T-PA did not adversely affect colonic healing five and ten days after anastomosis. In animals infected intraperitoneally at the time of the anastomosis, t-PA reversed the inhibition of healing induced by perianastomotic abscesses at five days. This effect was mediated by the ability of t-PA to prevent perianastomotic abscess formation. After intraperitoneal administration, t-PA had no effect on prothrombin and partial thromboplastin times in either uninfected or infected animals and there was no evidence of clinical bleeding related to its use. These studies suggest that intraperitoneal fibrinolysis using t-PA may provide a safe, effective form of adjuvant therapy in the management of fibrinopurulent peritonitis.

A soluble Bacteroides by-product impairs phagocytic killing of Escherichia coli by neutrophils

The effect of Bacteroides culture filtrate on killing of Escherichia coli by neutrophils was examined as a potential mechanism for E. coli-Bacteroides microbial synergy. A low-molecular-weight heat-stable factor present in the 22-h culture filtrate of Bacteroides fragilis 9032 impaired neutrophil killing function. To determine whether short-chain fatty acids present in the filtrate could account for the inhibition, the fatty acid content of the culture filtrate was determined and sterile medium supplemented with measured concentrations of fatty acids was tested for its effect on neutrophil function. Succinic and acetic acids were measured in high concentrations, while lactic, formic, and fumaric acids were present in lower concentrations. Reconstituted media mimicked the inhibitory effect of B. fragilis filtrate on neutrophil killing capacity. In further support of the hypothesis that short-chain fatty acids were responsible for the inhibition, the filtrates of other Bacteroides strains were found to be inhibitory only after bacterial growth had entered the stationary phase, a period during which fatty acid production is maximized. Further studies investigating the mechanism of impaired neutrophil killing showed that B. fragilis 9032 culture filtrate inhibited both phagocytosis of [3H]thymidine-labeled E. coli by neutrophils and the intrinsic microbicidal functions of the neutrophil. Impairment of neutrophil superoxide production was mediated via the ability of short-chain fatty acids present in B. fragilis filtrate to reduce neutrophil cytoplasmic pH. These studies suggest that Bacteroides strains capable of reaching stationary phase in vivo may contribute to the pathogenesis of mixed infections by direct inhibition of neutrophil function.

Induction of macrophage procoagulant activity by Bacteroides fragilis

Fibrin deposition in the peritoneal cavity during acute peritonitis appears to predispose the host to abscess formation by providing an environment for bacterial proliferation protected from host defenses. The purpose of the present study was to determine whether the potent abscess-inducing anaerobe Bacteroides fragilis could promote fibrin deposition by inducing mononuclear cells to express procoagulant activity (PCA). B. fragilis stimulated PCA in a dose-dependent fashion, achieving a maximum at 10(7) CFU/ml. Heat-killed B. fragilis induced comparable levels of PCA, while a nonspecific phagocytic stimulus, latex beads, was not stimulatory. B. fragilis was capable of inducing PCA even when phagocytosis was blocked by preexposure of cells to latex beads. The results suggested that phagocytosis was neither necessary nor sufficient for the generation of PCA. Cell separation studies showed that PCA was solely produced by macrophages and that lymphocytes did not augment its production. These studies suggest one potential mechanism by which B. fragilis might initiate abscess formation.

Outer membrane proteins of Bacteroides fragilis and Bacteroides vulgatus in relation to iron uptake and virulence

A virulent strain B. fragilis BE1 and an avirulent strain B. vulgatus BE20 were grown in a culture medium with and without the addition of a synthetic chelator (Bipyridyl) to induce iron limitation. Cells grew more slowly under iron stress, although the growth rate of the B. vulgatus strain was more affected under these conditions than the strain of B. fragilis. The outer membrane protein profile of these strains was studied in relation to the iron concentration in the growth medium by means of SDS-polyacrylamide gel electrophoresis. Four proteins, with the apparent molecular weights of 89, 49, 44 and 23.5 kDa, were consistently present in the outer membrane of B. fragilis BE1 grown under iron restricted conditions. In B. vulgatus BE20 cells a 44 and a 23.5 kDa protein were absent and only the expression of an 89 kDa protein was clearly seen under these conditions. The iron regulated proteins, particularly the 44 kDa protein, could be involved to an iron uptake mechanism in B. fragilis. So the presence of these proteins might play an important role in the virulence of this anaerobic bacterium.

The role of black-pigmented Bacteroides in human oral infections

Today, 10 black-pigmented Bacteroides (BPB) species are recognized. The majority of these species can be isolated from the oral cavity. BPB species are involved in anaerobic infections of oral and non-oral sites. In the oral cavity, BPB species are associated with gingivitis, periodontitis, endodontal infections and odontogenic abscesses. Cultural studies suggest a specific role of the various BPB species in the different types of infection. Bacteroides gingivalis is closely correlated with destructive periodontitis in adults as well as in juveniles. Bacteroides intermedius seems to be less specific since it is found in gingivitis, periodontitis, endodontal infections and odontogenic abscesses. The recently described Bacteroides endodontalis is closely associated with endodontal infections and odontogenic abscesses of endodontal origin. There are indications that these periodontopathic BPB species are only present in the oral cavity of subjects suffering from periodontal breakdown, being absent on the mucosal surfaces of subjects without periodontal breakdown. BPB species associated with healthy oral conditions are Bacteroides melaninogenicus, Bacteroides denticola and Bacteroides loescheii. There are indications that these BPB species are part of the normal indigenous oral microflora. Many studies in the past have documented the pathogenic potential and virulence of BPB species. This virulence can be explained by the large numbers of virulence factors demonstrated in this group of micro-organisms. Among others, the proteolytic activity seems to be one of the most important features. Several artificial substrates as well as numerous biological proteins are degraded. These include anti-inflammatory proteins such as alpha-2-macroglobulin, alpha-1-antitrypsin, C3 and C5 complement factors and immunoglobulins. B. gingivalis is by far the most proteolytic species, followed by B. endodontalis. Like other bacteria, the lipopolysaccharide of B. gingivalis has shown to be active in bone resorption in vitro and is capable in stimulating interleukin-1 production in human peripheral monocytes. Based on the well documented association with periodontal disease and the possession of relevant virulence factors, BPB species must be considered as important micro-organisms in the etiology of oral infections. B. gingivalis seems to be the most pathogenic and virulent species.

Biology of asaccharolytic black-pigmented Bacteroides species

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The role of Bacteroides encapsulation in the lethal synergy between Escherichia coli and Bacteroides species studied in a rat fibrin clot peritonitis model

Encapsulation in Bacteroides species has been thoroughly studied in vivo as a virulence factor in abscess formation. Its pathogenic role in lethal infections caused by a mixture of pathogens has been less well investigated. Our previous studies using the rat fibrin clot peritonitis model have demonstrated lethal synergy between Bacteroides fragilis and Escherichia coli. In order to determine the synergistic role of the encapsulation of the Bacteroides component in this model, inoculations of E. coli plus one of seven Bacteroides strains of differing degrees of encapsulation were assessed for their effect on mortality. Both unencapsulated Bacteroides strains tested (B. distasonis 1244, B. vulgatus 4300) produced an early lethal synergistic effect with E. coli while the heavily encapsulated strain, B. thetaiotaomicron 1603 did not do so. The four other Bacteroides strains tested were encapsulated and their synergy with E. coli was demonstrated. Control Gram-positive strains, Streptococcus faecalis and Staphylococcus aureus, did not alter mortality when mixed with E. coli in this model. These studies support the concept that virulence factors other than encapsulation are important in the outcome of polymicrobial infections in which Bacteroides species play a part.

The Bacteroides by-product succinic acid inhibits neutrophil respiratory burst by reducing intracellular pH

Short-chain fatty acids, particularly succinic acid, are major metabolic by-products of Bacteroides species. To determine their role as potential virulence factors in infections containing Bacteroides species, short-chain fatty acids were examined for their effect on the neutrophil respiratory burst. Succinate (30 to 50 mM) irreversibly impaired superoxide and hydrogen peroxide production in response to opsonized zymosan and phorbol myristate acetate when neutrophils were treated at pH 5.5 but not pH 6.0 or greater. Several other short-chain fatty acids tested produced similar inhibition. Reversible inhibition of oxygen consumption was found when neutrophils were incubated in succinate-containing medium (pH 6.0) as well as control medium (pH 6.0 and 5.5). Neutrophil cytoplasmic pH was measured by fluorimetric techniques to determine whether the inhibition was mediated via a reduction in intracellular pH. The intracellular pH of cells in control medium (pH 6.5 or less) was significantly reduced compared with pH 7.4. The addition of succinate (30 mM) to these media caused a further significant reduction in cytoplasmic pH at each pH level. The reduction in intracellular pH was sufficient to account for both the irreversible and reversible impairment of the neutrophil respiratory burst. Thus, short-chain fatty acids appear to exert their inhibition, at least in part, by reducing intracellular pH. These data also demonstrate the potential for interactions between Bacteroides species and their microenvironment to increase the virulence of an infection.

Role of encapsulated anaerobic bacteria in synergistic infections

The effect of encapsulation on the virulence, survival, and protection of anaerobic bacteria from phagocytosis is reviewed. Support for the importance of encapsulated Bacteroides sp. and anaerobic and facultative Gram-positive cocci (AFGPC) was provided by their higher recovery rate in oropharyngeal infections, compared to their number in the normal oral flora. Studies of the pathogenicity of anaerobic bacteria of the Bacteroides, Fusobacterium, and Clostridium genera and AFGPC are also presented. The organisms were inoculated into mice and their ability to induce subcutaneous abscesses was determined. Encapsulated Bacteroides, Fusobacteria, and AFGPC generally induced abscesses, whereas unencapsulated organisms did not. However, many of the strains that had only a minimal number of encapsulated organisms (less than 1%) survived in the abscess, and became heavily encapsulated when inoculated with other viable or nonviable encapsulated bacteria. These strains were thereafter able to induce abscesses when injected alone. Encapsulated Bacteroides sp. and anaerobic cocci induced bacteremia and translocation, and increased the mortality of the infected animals more often than did the unencapsulated form of the same strains. The relative importance of encapsulated anaerobes in relation to their aerobic and facultative counterparts in mixed infection was studied, using selective antimicrobial therapy and quantitative cultures of abscesses induced in mice. With few exceptions, possession of a capsule made Bacteroides sp. more important than their aerobic counterparts. Synergistic potentials were seen between encapsulated Bacteroides sp. and all tested aerobic bacteria and most AFGPC, and between most AFGPC and Pseudomonas aeruginosa or Staphylococcus aureus. These studies demonstrated the importance of encapsulated anaerobes in mixed infections.

Effect of Bacteroides fragilis grown in the presence of clindamycin, metronidazole and fusidic acid on opsonization and killing of Escherichia coli

Bactericidal action of human polymorphonuclear leucocytes on Escherichia coli in the presence of Bacteroides fragilis grown in subinhibitory concentrations of clindamycin, metronidazole and fusidic acid was studied. Bacteroides fragilis grown in the absence of drugs significantly inhibited the killing of Escherichia coli. Bacteroides fragilis grown in the presence of the drugs had a reduced inhibitory effect on the killing of Escherichia coli but this reduction was only significant for Bacteroides fragilis grown in 1/2 MIC of clindamycin. The phagocytosis of Bacteroides fragilis grown with and without clindamycin, as measured by killing, was the same. Complement consumption of Bacteroides fragilis grown with and without clindamycin did not differ. Clindamycin-treated Bacteroides fragilis fixed C3 to a significantly lower degree than did untreated bacteria. The chemiluminescence of Escherichia coli opsonized with serum preincubated with clindamycin-treated Bacteroides fragilis was significantly higher than with serum preincubated with untreated bacteria. These results suggested that in killing experiments of mixed Escherichia coli and Bacteroides fragilis, the mechanism underlying the reduced inhibitory capacity of clindamycin-exposed Bacteroides fragilis is related to greater availability of C3 in serum for opsonization of Escherichia coli.

Interactions between polymorphonuclear leucocytes, Bacteroides sp, and Escherichia coli: their role in the pathogenesis of mixed infection

Five Bacteroides fragilis strains and five Bacteroides vulgatus strains were compared with regard to their ability to consume complement and to fix C3, their killing by polymorphonuclear leucocytes, and their ability to inhibit the bactericidal effect of serum and polymorphs on Escherichia coli strains. Complement consumption was positively related to C3 fixation, but no relation was observed between these variables and the killing of the anaerobes. Greatest inhibition of the killing of E coli by serum and polymorphs was achieved with the bacteroides strains that fixed most complement. The greater virulence of B fragilis in mixed infections with E coli was not reflected either by a greater ability to inhibit the killing of E coli or a greater resistance of the anaerobes themselves to the bactericidal effect of serum and polymorphs.

Neutrophil activity in abscess-bearing mice: comparative studies with neutrophils isolated from peripheral blood, elicited peritoneal exudates, and abscesses

Intraabdominal abscesses were induced in mice by intraperitoneal inoculation of Bacteroides fragilis and Escherichia coli plus bran as the abscess-potentiating agent. Six- or seven-day-old abscesses were mechanically disaggregated in buffer, and the cells obtained were fractionated on discontinuous Percoll density gradients. Neutrophil populations of different density, each approximately 90% pure, were isolated. When the abscess-derived neutrophils were subsequently incubated with normal serum in vitro under aerobic conditions, the viability of the gram-negative bacteria that had been phagocytosed within the abscess did not change significantly. This anergy to intracellular bacteria (on subsequent incubation in vitro under optimal conditions for phagocytic killing) was also found for neutrophils that had been obtained from abscesses induced by a mixture that included Proteus mirabilis plus B. fragilis and from those induced by E. coli plus P. mirabilis. While unable to significantly kill intracellular organisms that had been phagocytosed in vivo, the abscess-derived neutrophils could engulf and kill organisms to which they were exposed in vitro. Neutrophils from abscesses induced by P. mirabilis only plus bran killed that organism introduced in vitro significantly more effectively than the organisms that had been engulfed in vivo. In contrast, neutrophils from abscesses induced by the gram-positive organism Staphylococcus aureus plus bran were able to kill their intracellular organisms on subsequent incubation in vitro as effectively as they could kill added S. aureus. Neutrophils isolated from the peripheral blood and from induced peritoneal exudates of abscess-bearing mice were able to phagocytose and kill organisms in vitro with greater efficiency than abscess-derived neutrophils. The mechanism whereby neutrophils from abscesses induced by the gram-positive organism S. aureus can kill the organisms phagocytosed in vivo on subsequent in vitro incubation, in contrast to the relative anergy to their intracellular organisms displayed by neutrophils derived from abscesses induced by combinations of gram-negative bacteria, is not known.

Effect of bacterial competition on the opsonization, phagocytosis, and intracellular killing of microorganisms by granulocytes

The ingestion of Escherichia coli by human granulocytes in vitro was reduced in the presence of Bacteroides fragilis or Staphylococcus aureus. This reduction of ingestion proved to be mainly attributable to the absence of opsonization of E. coli, which was due to complement consumption by B. fragilis and S. aureus. The intracellular killing of E. coli was decreased in the presence of B. fragilis and S. aureus because of consumption of complement components required for extracellular stimulation of granulocytes to kill intracellular bacteria. Decreased intracellular killing of E. coli by granulocytes containing either B. fragilis or S. aureus is due to the limited killing capacity of granulocytes. These interactions between E. coli and B. fragilis or S. aureus found for phagocytosis and intracellular killing were also observed in in vivo studies: in an experimental thigh lesion infection in mice, E. coli showed stronger proliferation after coinoculation with B. fragilis or with S. aureus than after injection of E. coli alone. These in vitro and in vivo findings indicate that bacterial interactions, not only between aerobic and anaerobic bacteria but also between two species of aerobic microorganisms, compete for host defense mechanisms (i.e., opsonization, phagocytosis, and intracellular killing).

Effect of the presence of black pigmented Bacteroides of differing pathogenicity on the phagocytosis of Escherichia coli by rat polymorphonuclear leucocytes

An investigation was made of the ability of rat polymorphonuclear leucocytes (PMNLs) to phagocytose Escherichia coli in the presence of two species of black pigmented Bacteroides (B. melaninogenicus and B. intermedius). When both the bacteria were opsonized together in the presence of normal rat serum, B. melaninogenicus and B. intermedius impaired the phagocytosis of E. coli significantly. However, the phagocytosis of these black pigmented Bacteroides remained unaffected in the presence of E. coli. The inhibition of phagocytosis was seen only after the initial first hour of incubation. The inhibition of phagocytosis of E. coli in the presence of B. intermedius was more than in the presence of B. melaninogenicus. The above observation confirms the important role played by black pigmented Bacteroides in experimental mixed infections with E. coli as observed by us earlier.

Effects of Escherichia coli and Bacteroides fragilis on peritoneal host defenses

Escherichia coli and Bacteroides fragilis are common copathogens in clinical intra-abdominal sepsis, yet it is unclear how they interact synergistically in vivo. We sought to determine whether E. coli and B. fragilis, in combination but not alone, could exert a detrimental effect on the peritoneal host defenses of translymphatic absorption and bacterial phagocytosis. Our data indicated that nonviable E. coli (O18ab:K56/K7:- and O111:B4), Klebsiella pneumoniae, B. fragilis, and Bacteroides thetaiotaomicron were handled in a similar fashion by both host defenses of the peritoneal cavity. The use of 2 X 10(8) nonviable radiolabeled E. coli as a tracer and either 2 X 10(9) B. fragilis or 2 X 10(9) E. coli (either viable or nonviable) as a competing agent to inhibit host defenses demonstrated that although clearance and phagocytosis could be inhibited, the inhibition occurred to a similar degree with either E. coli or B. fragilis. Thus, B. fragilis did not compete to any greater extent than E. coli did for peritoneal clearance or opsonization and phagocytosis in vivo. These data indicate that bacterial synergy probably does not occur on the basis of reduced peritoneal clearance or by a reduction in the opsonization and phagocytosis of either organism by the copathogen. These results provide indirect support for the hypothesis that in bacterial synergy, one organism directly stimulates the growth of the other, perhaps by providing a growth factor.

Succinic acid, a metabolic by-product of Bacteroides species, inhibits polymorphonuclear leukocyte function

Anaerobes, in particular Bacteroides spp., are the predominant bacteria present in mixed intra-abdominal infections, yet their critical importance in the pathogenicity of these infections is not clearly defined. Succinic acid, a major fatty acid by-product of Bacteroides metabolism, was tested for its effect on neutrophil function to determine whether it might play a role in enhancing the virulence of Bacteroides-containing infections. At pH 5.5 but not pH 7.0, succinic acid at concentrations commonly found in clinical abscesses profoundly inhibits in vitro neutrophil function. It virtually obliterates phagocytic killing of Escherichia coli and reduces neutrophil random migration and chemotactic response to formyl-methionyl-leucyl-phenylalanine and C5a. These effects occur in conjunction with a reduced chemiluminescent peak and delayed time to the peak. The effect on neutrophils is only partially reversible by multiple washings. These findings suggest that succinic acid may be an important Bacteroides virulence factor when present in the microenvironment of a mixed intra-abdominal infection in which concentrations are high and the pH of the medium is reduced.

Killing of Escherichia coli by human polymorphonuclear leucocytes in the presence of Bacteroides fragilis

The inhibitory effect of Bacteroides fragilis on the in vitro killing of Escherichia coli by polymorphonuclear leucocytes was studied with two pairs of E coli and B fragilis isolated from human wound infections. Both B fragilis strains behaved similarly: they inhibited the killing of one E coli strain, while the killing of the other E coli strain was not affected. The different behaviour of the two E coli strains depended on their need for fresh serum in the killing by the polymorphonuclear leucocytes. The inhibitory effect of the B fragilis strains could be completely accounted for by their effect on complement.

Pathogenic synergy: mixed intra-abdominal infections

In this article we review our researches into the pathogenesis of mixed infections. These may conveniently be divided into in vitro and in vivo studies. In vitro we confirmed that interference with the killing of aerobes by polymorphonuclear leucocytes (PMN's) is a property of the Bacteroides strains tested and appears to depend on competition for opsonins i.e. complement factors. Further studies are in progress to define which complement factors and which bacterial structures are involved. The influence of B. fragilis on chemotaxis has also been studied. Our preliminary data suggest that B. fragilis is itself poorly chemotactic and reduces the chemoattractivity of Proteus mirabilis. This observation is surprising when we consider that abscess formation is the hall-mark of B. fragilis infections and needs clarification. In vivo we have developed a skin infection model in mice which is economical and gives reproducible and quantitative results. In this model we have demonstrated pathogenic synergy between Escherichia coli and B. fragilis. Further studies are planned to assess the role of complement and bacterial factors in this in vivo synergy.

Pathogenic synergy: mixed infections in the oral cavity

In almost all infections in the oral cavity, mixed populations of bacteria are present. However, recent evidence points to a certain specificity in these infections: Streptococcus mutans is related to caries and black-pigmented Bacteroides species are suspected pathogens in periodontal disease. Periodontal diseases, endodontic infections and submucous abscesses in the oral cavity are probably mixed infections in which anaerobic bacteria together with facultatives or other anaerobes are present. In experimental mixed anaerobic infections black-pigmented Bacteroides strains have been shown to play a key role. Little is known about the pathogenic synergy between the bacteria involved in mixed infections. Important mechanisms could be nutritional interrelationships and interactions with the host defense. Within the group of black-pigmented Bacteroides B. gingivalis seems to be the most virulent species. These bacteria possess a great number of virulence factors, which might be important in the pathogenesis of oral infections.