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Cobra HADAB, Mozella AP, da Palma IM, Salim R, Leal AC. Cell-free Deoxyribonucleic Acid: A Potential Biomarker of Chronic Periprosthetic Knee Joint Infection. J Arthroplasty 2022; 37:2455-2459. [PMID: 35840076 DOI: 10.1016/j.arth.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The correct diagnosis of a chronic periprosthetic joint infection (PJI) is a major challenge in clinical practice, with the "gold standard" for diagnosis yet to be established. Synovial fluid analysis has been proven to be a useful tool for that purpose. Cell-free DNA (cf-DNA) levels have been shown to be increased in several conditions such as cancer, trauma, and sepsis. Therefore, this study was designed to evaluate the potential of synovial fluid cf-DNA quantification for the diagnosis of chronic periprosthetic infections following total knee arthroplasty. METHODS A prospective study with patients undergoing total knee arthroplasty revision surgery for any indication was performed. PJI diagnosis was defined according to the Second International Consensus Meeting on Musculoskeletal Infection (2018) criteria. The study cohort consisted of 26 patients classified as infected and 40 as noninfected. Synovial fluid cf-DNA direct quantification by fluorescent staining was made. Sensitivity, specificity, and receiver operating characteristic curve were calculated. RESULTS The cf-DNA levels were significantly higher in patients who had PJIs (122.5 ± 57.2 versus 4.6 ± 2.8 ng/μL, P < .0001). With a cutoff of 15 ng/μL, the area under the receiver operating characteristic, sensitivity, and specificity of cf-DNA were 0.978, 96.2%, and 100%, respectively. CONCLUSION The present study has shown that cf-DNA is increased in synovial fluid of patients who have chronic PJIs. It is a promising biomarker for knee PJI diagnosis and further studies are needed to confirm its utility.
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Affiliation(s)
- Hugo A de A B Cobra
- Center for Surgery of Knee, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - Alan P Mozella
- Center for Surgery of Knee, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - Idemar M da Palma
- Rios D'or Hospital, Rio de Janeiro, Brazil; Montese Medical Center, Rio de Janeiro, Brazil
| | - Rodrigo Salim
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ana C Leal
- Teaching and Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
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Campoccia D, Montanaro L, Arciola CR. Tracing the origins of extracellular DNA in bacterial biofilms: story of death and predation to community benefit. BIOFOULING 2021; 37:1022-1039. [PMID: 34823431 DOI: 10.1080/08927014.2021.2002987] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
Extracellular DNA (eDNA) is a macromolecule copiously found in various natural microenvironments, but its origin and significance still remain partly mysterious phenomena. Here, the multifaceted origins of eDNA in bacterial biofilms are explored. The release of eDNA can follow a suicidal programmed bacterial apoptosis or a fratricide-induced death, under the control of quorum sensing systems or triggered by specific stressors. eDNA can be released into the extracellular space or as a free macromolecule or enclosed within membrane vesicles or even through an explosion of bubbles. eDNA can also be derived from host tissue cells through bacterial cytolytic/proapoptotic toxins or stolen from neutrophil extracellular traps (NETs). eDNA can alternatively be produced by lysis-independent mechanisms. Sub-inhibitory doses of antibiotics, by killing a fraction of bacteria, result in stimulating the release of eDNA. Even phages appear to play a role in favoring eDNA release. Unveiling the origins of eDNA is critical to correctly address biofilm-associated infections.
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Affiliation(s)
- Davide Campoccia
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucio Montanaro
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carla Renata Arciola
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Yu J, Jiang F, Zhang F, Hamushan M, Du J, Mao Y, Wang Q, Han P, Tang J, Shen H. Thermonucleases Contribute to Staphylococcus aureus Biofilm Formation in Implant-Associated Infections-A Redundant and Complementary Story. Front Microbiol 2021; 12:687888. [PMID: 34248911 PMCID: PMC8266213 DOI: 10.3389/fmicb.2021.687888] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/27/2021] [Indexed: 12/26/2022] Open
Abstract
Biofilms formed by Staphylococcus aureus are one of the predominant causes of implant-associated infections (IAIs). Previous studies have found that S. aureus nucleases nuc1 and nuc2 modulate biofilm formation. In this study, we found low nuc1/nuc2 expression and high biofilm-forming ability among IAI isolates. Furthermore, in a mouse model of exogenous IAIs, Δnuc1/2 exhibited higher bacterial load on the surface of the implant than that exhibited by the other groups (WT, Δnuc1, and Δnuc2). Survival analysis of the hematogenous IAI mouse model indicated that nuc1 is a virulence factor related to mortality. We then detected the influence of nuc1 and nuc2 on biofilm formation and immune evasion in vitro. Observation of in vitro biofilm structures with scanning electron microscopy and evaluation of bacterial aggregation with flow cytometry revealed that both nuc1 and nuc2 are involved in biofilm structuring and bacterial aggregation. Unlike nuc1, which is reported to participate in immune evasion, nuc2 cannot degrade neutrophil extracellular traps. Moreover, we found that nuc1/nuc2 transcription is negatively correlated during S. aureus growth, and a possible complementary relationship has been proposed. In conclusion, nuc1/nuc2 are complementary genes involved in biofilm formation in exogenous IAIs. However, nuc2 contributes less to virulence and is not involved in immune evasion.
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Affiliation(s)
- Jinlong Yu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Feng Jiang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Feiyang Zhang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Musha Hamushan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiafei Du
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yanjie Mao
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiaojie Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Pei Han
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jin Tang
- Department of Clinical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hao Shen
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
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An Evaluation of the Antibacterial Properties of Tormentic Acid Congener and Extracts From Callistemon viminalis on Selected ESKAPE Pathogens and Effects on Biofilm Formation. Adv Pharmacol Pharm Sci 2020; 2020:8848606. [PMID: 33225299 PMCID: PMC7669338 DOI: 10.1155/2020/8848606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
ESKAPE pathogens, namely, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species, are responsible for a majority of all healthcare-acquired infections (HAI). The bacteria cause nosocomial infections in immunocompromised patients. Extracts from Callistemon viminalis have been shown to have antibacterial, antifungal, and anti-inflammatory activities. Tormentic acid congener, a pentacyclic triterpene saponin, was isolated from C. viminalis leaves. This study aimed to investigate the antibacterial effects of tormentic acid congener and leaf extracts on biofilm formation by A. baumannii, S. aureus, S. pyogenes, and P. aeruginosa. The antibacterial effects were determined by the microbroth dilution method, and ciprofloxacin was used as the standard antibacterial drug. Biofilm formation and detachment assays were performed using crystal violet staining. Production of extracellular polymeric DNA and polysaccharides from biofilms was also determined. Tormentic acid congener showed time-dependent antibacterial activity against P. aeruginosa with a MIC of 100 µg/ml and caused significant protein leakage. Antibacterial activity was found when tormentic acid congener was tested against both S. aureus and P. aeruginosa. The MICs were found to be 25 µg/ml and 12.5 µg/ml for P. aeruginosa and S. aureus cells, respectively. S. pyogenes was found to be susceptible to tormentic acid congener and the hydroethanolic extract with an MIC of 100 µg/ml and 25 µg/ml, respectively. A. baumannii was found not to be susceptible to the compound or the extracts. The compound and the extracts caused a significant decrease in the biofilm extracellular polysaccharide content of S. pyogenes. The extracts and tormentic acid congener caused detachment of biofilms and decreased the release of extracellular DNA and capsular polysaccharides from biofilms of P. aeruginosa and S. aureus. Tormentic acid congener and extracts, thus, have significant antibacterial and antibiofilm activities on these selected ESKAPE bacteria and can act as source lead compounds for the development of antibacterial triterpenoids.
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Assadian O, Zatorska B, Presterl E, Diab-El Schahawi M. A novel micellar formulation based on natural plant extracts enhances the efficacy of hydrogen peroxide against biofilms of Staphylococcus spp. and Pseudomonas aeruginosa. BIOFOULING 2020; 36:576-586. [PMID: 32586132 DOI: 10.1080/08927014.2020.1782388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
The antibacterial efficacy of hydrogen peroxide encapsulated in micelles (mH2O2) against biofilms was compared with that of hydrogen peroxide alone and of three commercially available aqueous biocides. The activity of mH2O2 on 24-h biofilms of reference strains of Staphylococcus spp. and Pseudomonas aeruginosa was tested in a static microtiter plate model. The biofilms were incubated with mH2O2 (17% v/v H2O2, 2% lactic acid, 0.3% phytoextract, H2O) and its individual ingredients and compared with three aqueous biocides at different concentrations and times of exposure. After 5-min exposure, 10% mH2O2 (corresponding to 1.7% v/v H2O2) achieved > 8 log10 reductions against all the test strains, while 1.7% H2O2 achieved a maximum of 1.5 log10 reduction. After 5-min exposure, none of the commercially available biocides tested showed themselves to be capable of completely eliminating the test strains embedded in biofilms. Hydrogen peroxide encapsulated in micelles demonstrated enhanced activity against planktonic cells and biofilms of Staphylococcus spp. and P. aeruginosa.
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Affiliation(s)
- Ojan Assadian
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Vienna, Austria
| | - Beata Zatorska
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Vienna, Austria
| | - Magda Diab-El Schahawi
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Vienna, Austria
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Patel H, Patel F, Jani V, Jha N, Ansari A, Paliwal B, Rathod B, Patel D, Patel P, Kothari V. Anti-pathogenic potential of a classical ayurvedic Triphala formulation. F1000Res 2019; 8:1126. [PMID: 33093941 PMCID: PMC7549186 DOI: 10.12688/f1000research.19787.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
A classical
ayurvedic polyherbal formulation namely
Triphala was assessed for its anti-pathogenic potential against five different pathogenic bacteria. Virulence of four of them towards the model host
Caenorhabditis elegans was attenuated (by 18-45%) owing to pre-treatment with
Triphala Formulation (TF) (≤20 µg/ml). TF
could also exert significant therapeutic effect on worms already infected with
Chromobacterium violaceum (MTCC 2656),
Serratia marcescens (MTCC 97) or
Staphylococcus aureus (MTCC 737). Prophylactic use of TF
allowed worms to score 14-41% better survival in face of subsequent pathogen challenge. Repeated exposure to this formulation induced resistance in
S. marcescens, but not in
P. aeruginosa. It also exerted a post-extract effect (PEE) on three of the test pathogens. TF was able to modulate production of quorum sensing (QS)-regulated pigments in three of the multidrug-resistant gram-negative test bacteria. Haemolytic activity of
S. aureus was heavily inhibited under the influence of this formulation.
P. aeruginosa's lysozyme-susceptibility was found to increase by ~25-43% upon TF-pretreatment. These results validate therapeutic potential of one of the most widely used polyherbal
ayurvedic formulations called
Triphala.
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Affiliation(s)
- Hinal Patel
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Foram Patel
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Vinit Jani
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Neha Jha
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Afsa Ansari
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Bhumika Paliwal
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Bharatsingh Rathod
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Dhruvi Patel
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Pooja Patel
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Vijay Kothari
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
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Patel H, Patel F, Jani V, Jha N, Ansari A, Paliwal B, Rathod B, Patel D, Patel P, Kothari V. Anti-pathogenic potential of a classical ayurvedic Triphala formulation. F1000Res 2019; 8:1126. [PMID: 33093941 PMCID: PMC7549186 DOI: 10.12688/f1000research.19787.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 08/27/2023] Open
Abstract
A classical ayurvedic polyherbal formulation namely Triphala was assessed for its anti-pathogenic potential against five different pathogenic bacteria. Virulence of four of them towards the model host Caenorhabditis elegans was attenuated (by 18-45%) owing to pre-treatment with Triphala Formulation (TF) (≤20 µg/ml). TF could also exert significant therapeutic effect on worms already infected with Chromobacterium violaceum (MTCC 2656), Serratia marcescens (MTCC 97) or Staphylococcus aureus (MTCC 737). Prophylactic use of TF allowed worms to score 14-41% better survival in face of subsequent pathogen challenge. Repeated exposure to this formulation induced resistance in S. marcescens, but not in P. aeruginosa. It also exerted a post-extract effect (PEE) on three of the test pathogens. TF was able to modulate production of quorum sensing (QS)-regulated pigments in three of the multidrug-resistant gram-negative test bacteria. Haemolytic activity of S. aureus was heavily inhibited under the influence of this formulation. P. aeruginosa's lysozyme-susceptibility was found to increase by ~25-43% upon TF-pretreatment. These results validate therapeutic potential of one of the most widely used polyherbal ayurvedic formulations called Triphala.
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Affiliation(s)
- Hinal Patel
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Foram Patel
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Vinit Jani
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Neha Jha
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Afsa Ansari
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Bhumika Paliwal
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Bharatsingh Rathod
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Dhruvi Patel
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Pooja Patel
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
| | - Vijay Kothari
- Institute of Science, Nirma University, Ahmedabad, Gujarat, 382481, India
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