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Katsipis G, Avgoulas DI, Geromichalos GD, Petala M, Pantazaki AA. In vitro and in silico evaluation of the serrapeptase effect on biofilm and amyloids of Pseudomonas aeruginosa. Appl Microbiol Biotechnol 2023; 107:7269-7285. [PMID: 37741938 PMCID: PMC10638192 DOI: 10.1007/s00253-023-12772-1] [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] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 09/25/2023]
Abstract
Pseudomonas aeruginosa is an emerging threat for hospitalized and cystic fibrosis patients. Biofilm, a microbial community embedded in extracellular polymeric substance, fortifies bacteria against the immune system. In biofilms, the expression of functional amyloids is linked with highly aggregative, multi-resistant strains, and chronic infections. Serrapeptase (SPT), a protease possessing similar or superior anti-microbial properties with many antibiotics, presents anti-amyloid potential. However, studies on the employment of SPT against Pseudomonas biofilms and Fap amyloid, or the possible mechanisms of action are scarce. Here, SPT inhibited biofilm formation of P. aeruginosa ATCC 27853 on both plastic and glass surfaces, with an IC50 of 11.26 µg/mL and 0.27 µg/mL, respectively. The inhibitory effect of SPT on biofilm was also verified with optical microscopy of crystal violet-stained biofilms and with confocal microscopy. Additionally, SPT caused a dose-dependent decrease of bacterial viability (IC50 of 3.07 µg/mL) as demonstrated by MTT assay. Reduction of bacterial functional amyloids was also demonstrated, employing both fluorescence microscopy with thioflavin T and photometrical determination of Congo-red-positive compounds. Both viability and functional amyloids correlated significantly with biofilm inhibition. Finally, in silico molecular docking studies provided a mechanistic insight into the interaction of SPT with FapC or FapD, proving that both peptides are possible targets of SPT. These results offer new insights into the biofilm formation of P. aeruginosa and potentiate the involvement of SPT in the prevention and eradication of Pseudomonas biofilms. KEY POINTS: • Serrapeptase inhibits biofilm formation of P. aeruginosa on plastic and glass. • Biofilm inhibition correlated with reduced viability and functional amyloid levels. • In silico studies indicated that serrapeptase may target FapC and FapD peptides.
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Affiliation(s)
- Georgios Katsipis
- Laboratory of Biochemistry, Department of Chemistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases (LND), Thermi, 57001, Thessaloniki, Greece
| | - Dimitrios I Avgoulas
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases (LND), Thermi, 57001, Thessaloniki, Greece
- Laboratory of Chemical and Environmental Technology, Deparment of Chemistry, Aristotle University of Thessaloniki, 54 124, 54124, Thessaloniki, Greece
| | - George D Geromichalos
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases (LND), Thermi, 57001, Thessaloniki, Greece
- Department of General and Inorganic Chemistry, Faculty of Chemistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Maria Petala
- Laboratory of Environmental Engineering & Planning, Department of Civil Engineering, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Anastasia A Pantazaki
- Laboratory of Biochemistry, Department of Chemistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases (LND), Thermi, 57001, Thessaloniki, Greece.
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Serrapeptase impairs biofilm, wall, and phospho-homeostasis of resistant and susceptible Staphylococcus aureus. Appl Microbiol Biotechnol 2023; 107:1373-1389. [PMID: 36635396 PMCID: PMC9898353 DOI: 10.1007/s00253-022-12356-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/25/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023]
Abstract
Staphylococcus aureus biofilms are implicated in hospital infections due to elevated antibiotic and host immune system resistance. Molecular components of cell wall including amyloid proteins, peptidoglycans (PGs), and lipoteichoic acid (LTA) are crucial for biofilm formation and tolerance of methicillin-resistant S. aureus (MRSA). Significance of alkaline phosphatases (ALPs) for biofilm formation has been recorded. Serrapeptase (SPT), a protease of Serratia marcescens, possesses antimicrobial properties similar or superior to those of many antibiotics. In the present study, SPT anti-biofilm activity was demonstrated against S. aureus (ATCC 25923, methicillin-susceptible strain, methicillin-susceptible S. aureus (MSSA)) and MRSA (ST80), with IC50 values of 0.67 μg/mL and 7.70 μg/mL, respectively. SPT affected bacterial viability, causing a maximum inhibition of - 46% and - 27%, respectively. Decreased PGs content at [SPT] ≥ 0.5 μg/mL and ≥ 8 μg/mL was verified for MSSA and MRSA, respectively. In MSSA, LTA levels decreased significantly (up to - 40%) at lower SPT doses but increased at the highest dose of 2 μg/mL, a counter to spectacularly increased cellular and secreted LTA levels in MRSA. SPT also reduced amyloids of both strains. Additionally, intracellular ALP activity decreased in both MSSA and MRSA (up to - 85% and - 89%, respectively), while extracellular activity increased up to + 482% in MSSA and + 267% in MRSA. Altered levels of DING proteins, which are involved in phosphate metabolism, in SPT-treated bacteria, were also demonstrated here, implying impaired phosphorus homeostasis. The differential alterations in the studied molecular aspects underline the differences between MSSA and MRSA and offer new insights in the treatment of resistant bacterial biofilms. KEY POINTS: • SPT inhibits biofilm formation in methicillin-resistant and methicillin-susceptible S. aureus. • SPT treatment decreases bacterial viability, ALP activity, and cell wall composition. • SPT-treated bacteria present altered levels of phosphate-related DING proteins.
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Quinones as an Efficient Molecular Scaffold in the Antibacterial/Antifungal or Antitumoral Arsenal. Int J Mol Sci 2022; 23:ijms232214108. [PMID: 36430585 PMCID: PMC9697455 DOI: 10.3390/ijms232214108] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
Quinone-based compounds constitute several general classes of antibiotics that have long shown unwavering efficiency against both Gram-positive and Gram-negative microbial infections. These quinone-based antibiotics are increasingly popular due to their natural origins and are used in natural beverages from herbs or plants in African, Chinese and Indian traditional medicines to treat and prevent various diseases. Quinone-based antibiotics display different bioactive profiles depending on their structures and exert specific biocidal and anti-biofilm properties, and based on recent literature, will be discussed herein.
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Xi J, An L, Wei G, Huang Y, Li D, Fan L, Gao L. Photolysis of methicillin-resistant Staphylococcus aureus using Cu-doped carbon spheres. Biomater Sci 2021; 8:6225-6234. [PMID: 33006334 DOI: 10.1039/d0bm01239d] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Developing alternative treatment strategies against methicillin-resistant Staphylococcus aureus (MRSA) infections is a challenge but could have many potential applications. In this paper, we developed a novel approach to eradicate MRSA through photolysis of the staphyloxanthin (STX) pigment found within the MRSA membranes and intracellular molecules (e.g. genomic DNA and proteins). Specifically, Cu-doped hollow carbon spheres (Cu-HCSs) were employed here for antibacterial treatment. Unlike blue-light treatment alone, which only "injured" MRSA, Cu-HCSs in combination with blue-light irradiation promoted photobleaching of STX to destroy membrane integrity, and further caused oxidative cleavage of DNA and proteins inside MRSA, working as a nuclease/protease mimicking nanozyme, resulting in efficient killing of MRSA. Mechanism analysis showed that the cleavage activity resulted from the elevated levels of singlet oxygen (1O2) generated from the photosensitized oxidation of Cu-HCSs. Further animal studies demonstrated that the photolysis activity of Cu-HCSs could be used to treat subcutaneous abscesses and bacteremia caused by MRSA. Thus, this photolysis-based antibacterial platform may help avoid bacterial resistance, with the potential to kill multidrug resistant bacteria.
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Affiliation(s)
- Juqun Xi
- Institute of Translational Medicine, Department of Pharmacology, School of Medicine, Yangzhou University, Yangzhou 225001, Jiangsu, China and Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou 225001, Jiangsu, China and Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, College of Veterinary Medicine, Yangzhou 225009, Jiangsu, China
| | - Lanfang An
- Institute of Translational Medicine, Department of Pharmacology, School of Medicine, Yangzhou University, Yangzhou 225001, Jiangsu, China
| | - Gen Wei
- Institute of Translational Medicine, Department of Pharmacology, School of Medicine, Yangzhou University, Yangzhou 225001, Jiangsu, China
| | - Yaling Huang
- Institute of Translational Medicine, Department of Pharmacology, School of Medicine, Yangzhou University, Yangzhou 225001, Jiangsu, China
| | - Dandan Li
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou 225001, Jiangsu, China
| | - Lei Fan
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou, Jiangsu 225002, China.
| | - Lizeng Gao
- CAS Engineering Laboratory for Nanozyme, Institute of Biophysis, Chinese Academy of Sciences, Beijing 100101, China.
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Devlin H, Fulaz S, Hiebner DW, O’Gara JP, Casey E. Enzyme-Functionalized Mesoporous Silica Nanoparticles to Target Staphylococcus aureus and Disperse Biofilms. Int J Nanomedicine 2021; 16:1929-1942. [PMID: 33727807 PMCID: PMC7954034 DOI: 10.2147/ijn.s293190] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/09/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Staphylococcus aureus biofilms pose a unique challenge in healthcare due to their tolerance to a wide range of antimicrobial agents. The high cost and lengthy timeline to develop novel therapeutic agents have pushed researchers to investigate the use of nanomaterials to deliver antibiofilm agents and target biofilm infections more efficiently. Previous studies have concentrated on improving the efficacy of antibiotics by deploying nanoparticles as nanocarriers. However, the dispersal of the extracellular polymeric substance (EPS) matrix in biofilm-associated infections is also critical to the development of novel nanoparticle-based therapies. METHODS This study evaluated the efficacy of enzyme-functionalized mesoporous silica nanoparticles (MSNs) against methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) biofilms. MSNs were functionalized with the enzyme lysostaphin, which causes cell lysis of S. aureus bacteria. This was combined with two other enzyme functionalized MSNs, serrapeptase and DNase I which will degrade protein and eDNA in the EPS matrix, to enhance eradication of the biofilm. Cell viability after treatment with enzyme-functionalized MSNs was assessed using a MTT assay and CLSM, while crystal violet staining was used to assess EPS removal. RESULTS The efficacy of all three enzymes against S. aureus cells and biofilms was significantly improved when they were immobilized onto MSNs. Treatment efficacy was further enhanced when the three enzymes were used in combination against both MRSA and MSSA. Regardless of biofilm maturity (24 or 48 h), near-complete dispersal and killing of MRSA biofilms were observed after treatment with the enzyme-functionalized MSNs. Disruption of mature MSSA biofilms with a polysaccharide EPS was less efficient, but cell viability was significantly reduced. CONCLUSION The combination of these three enzymes and their functionalization onto nanoparticles might extend the therapeutic options for the treatment of S. aureus infections, particularly those with a biofilm component.
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Affiliation(s)
- Henry Devlin
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Stephanie Fulaz
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - Dishon Wayne Hiebner
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
| | - James P O’Gara
- Department of Microbiology, School of Natural Sciences, National University of Ireland, Galway, Ireland
| | - Eoin Casey
- UCD School of Chemical and Bioprocess Engineering, University College Dublin, Dublin, Ireland
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Kalaycı Yüksek F, Gümüş D, Gündoğan Gİ, Anğ Küçüker M. Cell-Free Lactobacillus sp Supernatants Modulate Staphylococcus aureus Growth, Adhesion and Invasion to Human Osteoblast (HOB) Cells. Curr Microbiol 2020; 78:125-132. [PMID: 33108492 DOI: 10.1007/s00284-020-02247-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022]
Abstract
The increase of antibiotic resistance has become a problem. Probiotic bacteria play an important role in preventive/supportive medicine. Therefore, we examined the inhibitory effects of four different Lactobacillus species' (L. acidophilus-La, L. plantarum-Lp, L. fermentum-Lf and L. rhamnosus-Lr) cell-free supernatants (CFSs) on growth, adhesion, invasion, and biofilm formation of Staphylococcus aureus and effects of S. aureus, CFSs, and S. aureus-CFSs co-existence on human osteoblast (HOB) cell viability. Growth alterations were measured spectrophotometrically. Adhesive/invasive bacterial counts were detected by colony counting. Biofilm was evaluated using microtiter plate assay. The MTT assay was used for detection of HOB cell viability. The growth of MSSA significantly (P < 0.01) decreased in the presence of two CFSs (Lf and Lr) (P < 0.01); the growth of MRSA significantly (P < 0.05) reduced in the presence of La CFSs. All tested CFSs were found to reduce adhesion and invasion of MSSA (P < 0.0001). The adhesion of MRSA was enhanced (P < 0.0001) in the presence of all CFSs except La and the invasion of MRSA was decreased (P < 0.01) in the presence of Lr and Lf CFSs. All tested CFSs were shown to inhibit biofilm formation significantly (P < 0.0001). The reduction of S. aureus infected HOB cell viability and exposed to all CFSs except Lr that was found to be significant (P < 0.0001). The viability of HOB cell during co-incubation with MSSA and CFSs was shown to be decreased significantly. However co-existence of MRSA and CFSs did not alter HOB cell viability. These results suggested that lactobacilli as probiotics have low protective effects on MRSA-infected host cells.
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Affiliation(s)
- Fatma Kalaycı Yüksek
- Department of Medical Microbiology, Medical Faculty, Istanbul Yeni Yüzyıl University, Istanbul, Turkey.
| | - Defne Gümüş
- Department of Medical Microbiology, Medical Faculty, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
| | - Gül İpek Gündoğan
- Department of Histology and Embryology, Medical Faculty, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
| | - Mine Anğ Küçüker
- Department of Medical Microbiology, Medical Faculty, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
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Aguayo-Ortiz R, Meza-Cervantez P, Castillo R, Hernández-Campos A, Dominguez L, Yépez-Mulia L. Insights into the Giardia intestinalis enolase and human plasminogen interaction. MOLECULAR BIOSYSTEMS 2018; 13:2015-2023. [PMID: 28770921 DOI: 10.1039/c7mb00252a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Giardia intestinalis is an intestinal parasite that causes diarrhea in humans and animals worldwide. The enolase of G. intestinalis (GiENO) participates in its glycolysis pathway and is abundantly expressed in the parasite cytosol; however, its localization on the surface of trophozoites and cysts has been demonstrated. Enolases from bacteria and parasites can have different functions and are considered moonlighting proteins, for example, as a cell surface plasminogen receptor. In relation to GiENO, no studies have been performed about its possible participation as a plasminogen receptor. In this work, we employed molecular docking and multiscale molecular dynamics (MD) simulations to explore the possible interactions of human plasminogen (HsPLG) with the open and closed GiENO conformations. Our proposed GiENO plasminogen binding site (PLGBs) was identified at Lys266 based on the sequence comparison with bacterial enolase known to act as a plasminogen receptor. Our docking results performed with multiple MD snapshots of the closed GiENO conformation showed that Lys266 preferentially binds to the K5 domain of HsPLG. On the other hand, open GiENO conformations from all-atom and coarse-grained simulations indicated a high preference of the HsPLG K4 domain for lysine residues 186 and 188. Furthermore, we identified a potential N-glycosylation site of GiENO which suggests a possible explanation for the parasite cell surface localization or host mucin oligosaccharide adhesion mechanism. Our study constitutes the first multiscale computational study to explore the plasminogen receptor function of GiENO for its further consideration as a potential therapeutic target for giardiasis treatment.
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Affiliation(s)
- R Aguayo-Ortiz
- Facultad de Química, Departamento de Fisicoquímica, Universidad Nacional Autónoma de México, CDMX, México 04510, Mexico.
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8
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Oliveira W, Silva P, Silva R, Silva G, Machado G, Coelho L, Correia M. Staphylococcus aureus and Staphylococcus epidermidis infections on implants. J Hosp Infect 2018; 98:111-117. [DOI: 10.1016/j.jhin.2017.11.008] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/15/2017] [Indexed: 01/11/2023]
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9
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Hogan S, Zapotoczna M, Stevens N, Humphreys H, O'Gara J, O'Neill E. Potential use of targeted enzymatic agents in the treatment of Staphylococcus aureus biofilm-related infections. J Hosp Infect 2017; 96:177-182. [DOI: 10.1016/j.jhin.2017.02.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/08/2017] [Indexed: 01/15/2023]
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Maccauro G, Tetè S, Saggini A, Tripodi D, Castellani M, Conti F, Cianchetti E, Conti C, Rosati M, Toniato E, Fulcheri M, Salini V, Caraffa A, Antinolfi P, Frydas S, Torello M, Neri G, Pandolfi F, Conti P, Theoharides T. Induction of CCL2 (MCP-1) BY IL-33 in Human Umbelical Cord Blood Mast Cells. EUR J INFLAMM 2017. [DOI: 10.1177/1721727x1201000207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- G. Maccauro
- Orthopedics Division, Università Cattolica, Rome, Italy
| | - S. Tetè
- Dental School, University of Chieti-Pescara, Italy
| | - A. Saggini
- Orthopedics Division, University of Chieti-Pescara, Italy
| | - D. Tripodi
- Dental School, University of Chieti-Pescara, Italy
| | | | - F. Conti
- Gynecology Division, S. Spirito Hospital, Pescara, Italy
| | | | - C.M. Conti
- Psychology Faculty, University of Chieti, Italy
| | - M. Rosati
- Surgery Division, Ortona Hospital, Ortona, Italy
| | - E. Toniato
- Immunology Division, University of Chieti-Pescara, Italy
| | - M. Fulcheri
- Psychology Faculty, University of Chieti, Italy
| | - V. Salini
- Orthopedics Division, Chieti-Pescara University, Italy
| | - A. Caraffa
- Orthopedics Division, University of Perugia, Perugia, Italy
| | - P. Antinolfi
- Orthopedics Division, University of Perugia, Perugia, Italy
| | - S. Frydas
- Laboratory of Parasitology, Veterinary Faculty, Aristotelian University, Thessaloniki, Greece
| | - M. Torello
- Clinical Pathology, University of Chieti-Pescara, Italy
| | - G. Neri
- ENT Division, University of Chieti, Italy
| | - F. Pandolfi
- Department of Medicine, Catholic University of Rome, Rome, Italy
| | - P. Conti
- Immunology Division, University of Chieti-Pescara, Italy
| | - T.C. Theoharides
- Department of Physiology and Pharmacology, Tufts University School of Medicine, New England Medical Center, Boston, MA, USA
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Khan S, Cole N, Hume EB, Garthwaite LL, Nguyen-Khuong T, Walsh BJ, Willcox MD. Identification of pathogenic factors potentially involved in Staphylococcus aureus keratitis using proteomics. Exp Eye Res 2016; 151:171-8. [DOI: 10.1016/j.exer.2016.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 01/11/2023]
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Abstract
OBJECTIVES No sooner are contact lenses (CLs) inserted into the eyes than lipids, proteins, and glycoproteins rapidly accumulate on their surface, thus favoring the adhesion of commensal bacteria and biofilm formation. Infections may be caused by the proliferation of indigenous flora or other opportunistic pathogens. Our purpose was to evaluate the activity and the capacity of different CL solutions to interfere with the mechanisms of biofilm formation and stability and use of a system to study dynamically biofilm development. METHODS We evaluated the antibiofilm activity of three different multipurpose solutions (MPSs): Regard, Biotrue, and OPTI-FREE PureMoist on four bacterial species (Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Staphylococcus aureus). Static biofilm assay was first performed to analyze the effect of MPSs. Dynamic assays were performed with the BioFlux system to analyze the effect of the OxyChlorite solution Regard on the biofilm formation. RESULTS Our studies show that MPSs are able to completely inhibit biofilm formation of Staphylococcus species and of S. marcescens after only 4 hr of incubation. Moreover, a reduction of biofilm formation by Pseudomonas was noted. Best results on P. aeruginosa were obtained with Regard. Regard was also used for dynamic assay, revealing its ability to disaggregate the mature biofilm. Regard completely inhibited biofilm formation by S. epidermidis and slowed down biofilm development by P. aeruginosa. CONCLUSIONS Our findings indicate that the CL solutions tested were all able to reduce biofilm formation. Furthermore, the BioFlux system was proven to be useful for the evaluation of the effectiveness of CL solutions against microbial biofilm formation.
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Serratiopeptidase: a well-known metalloprotease with a new non-proteolytic activity against S. aureus biofilm. BMC Microbiol 2015; 15:207. [PMID: 26453184 PMCID: PMC4600273 DOI: 10.1186/s12866-015-0548-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/02/2015] [Indexed: 12/29/2022] Open
Abstract
Background The use of indwelling medical devices is associated with a significant risk of infections by Staphylococcus aureus (S. aureus) which possesses a variety of virulence factors including many toxins and the ability to invade eukaryotic cells or to form biofilm on biotic and abiotic surfaces. The virulence factors above described are often related to proteins exposed on the bacterial surface. Blocking S. aureus colonization may reduce the incidence of invasive infectious diseases. Previously reports evaluated the anti-infective properties of serratiopeptidase (Spep), an extracellular metalloprotease produced by Serratia marcescens ATCC 21074 (E-15), in impairing virulence-related staphylococcal properties, such as attachment to inert surfaces and adhesion/invasion on eukaryotic cells. However, to date its mechanism of action is unknown. Methods Spep gene was PCR amplified and cloned into expression vector pET28b(+). The mutant EspepA was constructed from plasmid pET28b-Spep applying the one-step overlap extension PCR strategy. There sulting plasmids were costransformed in EcBL21(DE3) cells with the plasmid pRuW4inh1 harboring the Erwinia chrysanthemi secretion system. Bacterial pellets and supernatants were collected and analyzed by SDS-PAGE and zymography. The unambiguous identification and a detailed structure characterization of both the wild type and the mutant Spep were obtained by mass spectrometric analyses. The resultant supernatants sterilized by filtration were separately used to condition biofilm formation of S. aureus. Quantification was based on crystal violet method. Results In this work we constructed Spep mutant by substituting the glutamic acid in the catalytic site with a residue of alanine. In this manner we were able to evaluate the anti-biofilm activity of Spep mutant in absence of proteolytic activity. As expected, this mutant did not display protease activity but it retained its anti-biofilm properties, suggesting that this action is independent by enzymatic activity. Conclusions New knowledge obtained from data reported in this paper calls attention to a novel mechanism of action of Spep. This protein could be developed as a potential “antipathogenic agent” capable to impair the ability of S. aureus to form biofilm on prostheses, catheters and medical devices, exploiting a mechanism different from the proteolytic activity.
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Artini M, Cellini A, Papa R, Tilotta M, Scoarughi GL, Gazzola S, Fontana C, Tempera G, Cocconcelli PS, Selan L. Adhesive behaviour and virulence of coagulase negative staphylococci isolated from Italian cheeses. Int J Immunopathol Pharmacol 2015; 28:341-50. [PMID: 26238537 DOI: 10.1177/0394632015593236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 06/03/2015] [Indexed: 11/15/2022] Open
Abstract
Coagulase-negative staphylococci (CoNS) belong to saprophytic microbiota on the skin and mucous membranes of warm-blooded animals and humans, but are also isolated from foodstuffs such as meat, cheese, and milk. In other circumstances, some CoNS can act as pathogens. Thus the presence of CoNS may not be an immediate danger to public health, but can become a risk factor. In particular antibiotic-resistant genes could be transferred to other potentially pathogenic microorganisms. Furthermore, CoNS are known to be strong biofilm producers and this is also a risk factor for public health. The aim of the present work was to determine the genotypic and phenotypic profiles of 106 CoNS belonging to four different species isolated from five different Italian cheeses for the presence of some adhesion and virulence features. In order to verify a possible correlation between the formation of biofilm and staphylococcal virulence factors, we checked the presence of adhesin genes by PCR and we investigated the ability of these strains to make biofilm at different temperatures. Furthermore, in some conditions, we analyzed surface proteins and autolytic pattern of selected strains. In conclusion, we checked the presence of norA and mecA genes responsible for fluoroquinolones and methicillin resistance, respectively. We found resistant genes in a proportion of the food isolates in amounts of 9.4% (mecA) and 5.7% (norA). These data support the importance to continuously examine the microbiota not only for the creation of a database but also to safeguard public health.
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Affiliation(s)
- Marco Artini
- Department of Public Health & Infectious Diseases, University of Rome "Sapienza", Italy
| | - Andrea Cellini
- Department of Public Health & Infectious Diseases, University of Rome "Sapienza", Italy
| | - Rosanna Papa
- Department of Public Health & Infectious Diseases, University of Rome "Sapienza", Italy
| | - Marco Tilotta
- Department of Public Health & Infectious Diseases, University of Rome "Sapienza", Italy
| | - Gian Luca Scoarughi
- Department of Public Health & Infectious Diseases, University of Rome "Sapienza", Italy
| | - Simona Gazzola
- Istituto di Microbiologia-CRB, Università Cattolica del Sacro Cuore, Piacenza Cremona, Italy
| | - Cecilia Fontana
- Istituto di Microbiologia-CRB, Università Cattolica del Sacro Cuore, Piacenza Cremona, Italy
| | - Gianna Tempera
- Department of Microbiological and Gynecological Sciences, University of Catania, Italy
| | - Pier Sandro Cocconcelli
- Istituto di Microbiologia-CRB, Università Cattolica del Sacro Cuore, Piacenza Cremona, Italy
| | - Laura Selan
- Department of Public Health & Infectious Diseases, University of Rome "Sapienza", Italy
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Nonprofessional phagocytic cell receptors involved in Staphylococcus aureus internalization. BIOMED RESEARCH INTERNATIONAL 2014; 2014:538546. [PMID: 24826382 PMCID: PMC4009297 DOI: 10.1155/2014/538546] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/21/2014] [Indexed: 12/22/2022]
Abstract
Staphylococcus aureus is a successful human and animal pathogen. The majority of infections caused by this pathogen are life threatening, primarily because S. aureus has developed multiple evasion strategies, possesses intracellular persistence for long periods, and targets the skin and soft tissues. Therefore, it is very important to understand the mechanisms employed by S. aureus to colonize and proliferate in these cells. The aim of this review is to describe the recent discoveries concerning the host receptors of nonprofessional phagocytes involved in S. aureus internalization. Most of the knowledge related to the interaction of S. aureus with its host cells has been described in professional phagocytic cells such as macrophages. Here, we showed that in nonprofessional phagocytes the α 5 β 1 integrin host receptor, chaperons, and the scavenger receptor CD36 are the main receptors employed during S. aureus internalization. The characterization and identification of new bacterial effectors and the host cell receptors involved will undoubtedly lead to new discoveries with beneficial purposes.
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Romanò CL, Toscano M, Romanò D, Drago L. Antibiofilm agents and implant-related infections in orthopaedics: where are we? J Chemother 2013; 25:67-80. [PMID: 23684354 DOI: 10.1179/1973947812y.0000000045] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Orthopaedics is currently the largest market of biomaterials worldwide and implant-related infections, although relatively rare, remain among the first reasons for joint arthroplasty and osteosynthesis failure. Bacteria start implant infection by adhering to biomaterials and producing biofilms, which represent a major reason for bacterial persistence, in spite of antibiotic treatment and host's defence. In the last two decades, a number of different antibiofilm agents have been studied and both in vitro and in vivo results appear now promising, even if their effective role in orthopaedics remains to be assessed. In this review, we introduce an original classification of antibiofilm agents, based on their mechanism of action and examine the available data concerning their possible application to orthopaedic implant-related infections. Molecules that interfere with biofilm production (biofilm prevention agents) include anti-adhesion compounds, quorum sensing inhibitors, non-steroideal anti-inflammatory drugs, and antimicrobial peptides; N-acetylcysteine and specific enzymes promise the greatest therapeutic possibilities by disrupting established biofilms (biofilm disrupting agents). The identification of antimicrobials able to bypass the biofilm barrier (biofilm bypassing agents), and antibiofilm vaccines are further strategies aimed to reduce the impact of biofilm-related infections, opening new pathways in controlling implant-related infections. However, this review shows that still insufficient knowledge is currently available as to regard the efficacy and safety of the investigated antibiofilm strategies to treat infection that involve bone tissue and biomaterials commonly implanted in orthopaedics, pointing out the need for further research in this promising field.
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Affiliation(s)
- Carlo L Romanò
- CRIO Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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Papa R, Artini M, Cellini A, Tilotta M, Galano E, Pucci P, Amoresano A, Selan L. A new anti-infective strategy to reduce the spreading of antibiotic resistance by the action on adhesion-mediated virulence factors in Staphylococcus aureus. Microb Pathog 2013; 63:44-53. [PMID: 23811076 DOI: 10.1016/j.micpath.2013.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 04/29/2013] [Accepted: 05/06/2013] [Indexed: 11/19/2022]
Abstract
Staphylococcus aureus is a flexible microbial pathogen frequently isolated from community-acquired and nosocomial infections. S. aureus expresses a wide array of secreted and cell surface-associated virulence factors, including proteins that promote adhesion to damaged tissue and to the surface of host cells, and that bind proteins in blood to help evade immune responses. Furthermore, surface proteins have a fundamental role in virulence related properties of S. aureus, including biofilm formation. The present study evaluates the anti-infective capabilities of a secreted protein of Serratia marcescens (serratiopeptidase, SPEP), in impairing some staphylococcal virulence-related properties, such as attachment to inert surfaces and adhesion/invasion on eukaryotic cells. SPEP seems to exert its action by modulating specific proteins. It is not assessed if this action is due to the proteolytic activity of SPEP or to a specific mechanism which triggers an out/inside signal. Proteomic studies performed on surface proteins extracted from SPEP treated S. aureus cultures revealed that a number of proteins are affected by the treatment. Among these we found the adhesin/autolysin Atl, SdrD, Sbi, EF-Tu and EF-G. EF-Tu and EF-G are known to perform a variety of function, depending on their cytoplasmic or surface localization. All these factors can facilitate bacterial colonization, persistence and invasion of host tissues. Our results suggest that SPEP could be developed as a potential "anti-infective agent" capable to hinder the entry of S. aureus into human tissues, and also impairs the ability of this pathogen to adhere to prostheses, catheters and medical devices.
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Affiliation(s)
- Rosanna Papa
- Department of Public Health and Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
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18
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Anti-biofilm activity of the Antarctic marine bacterium Pseudoalteromonas haloplanktis TAC125. Res Microbiol 2013; 164:450-6. [DOI: 10.1016/j.resmic.2013.01.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/24/2013] [Indexed: 01/05/2023]
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19
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Leejae S, Hasap L, Voravuthikunchai SP. Inhibition of staphyloxanthin biosynthesis in Staphylococcus aureus by rhodomyrtone, a novel antibiotic candidate. J Med Microbiol 2012; 62:421-428. [PMID: 23242641 DOI: 10.1099/jmm.0.047316-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Staphyloxanthin is the eponymous feature of the human pathogen Staphylococcus aureus, and the pigment promotes resistance to reactive oxygen species and host neutrophil-based killing. To probe the possible use of rhodomyrtone isolated from Rhodomyrtus tomentosa (Aiton) Hassk. leaves to inhibit pigment production in S. aureus, experiments were carried out to compare pigment production and the susceptibility of rhodomyrtone-treated S. aureus and untreated cells to oxidants in vitro. In addition, we observed the innate immune clearance of S. aureus after incubation with rhodomyrtone using an ex vivo assay system - human whole-blood survival. The results indicated that rhodomyrtone-treated S. aureus exhibited reduced pigmentation, and that rhodomyrtone treatment led to a dose-dependent increase in the susceptibility of the pathogen to H(2)O(2) and singlet oxygen killing. Consequently, the survival ability of the treated organisms decreased in freshly isolated human whole blood due to less carotenoid pigment to act as an antioxidant scavenger. Rhodomyrtone may be acting via effects on DnaK and/or σ(B), resulting in many additional effects on bacterial virulence.
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Affiliation(s)
- Sukanlaya Leejae
- Department of Microbiology and Natural Products Research Center, Faculty of Science, Prince of Songkla University, Songkhla 90112, Thailand
| | - Laila Hasap
- Department of Microbiology and Natural Products Research Center, Faculty of Science, Prince of Songkla University, Songkhla 90112, Thailand
| | - Supayang Piyawan Voravuthikunchai
- Department of Microbiology and Natural Products Research Center, Faculty of Science, Prince of Songkla University, Songkhla 90112, Thailand
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20
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Artini M, Papa R, Scoarughi GL, Galano E, Barbato G, Pucci P, Selan L. Comparison of the action of different proteases on virulence properties related to the staphylococcal surface. J Appl Microbiol 2012; 114:266-77. [PMID: 23057709 DOI: 10.1111/jam.12038] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/19/2012] [Accepted: 10/04/2012] [Indexed: 01/03/2023]
Abstract
AIMS The purpose of this study was to evaluate the antimicrobial efficacy of five different proteases belonging to two different families on Staphylococcus aureus and Staphylococcus epidermidis strains. METHODS AND RESULTS We used three serine proteases and two metalloproteases in single species biofilm formation assays and in human cell invasion processes. Following each protease incubation with bacterial cells, surface protein patterns were analysed by SDS-PAGE and zymography. Some differently expressed proteins were identified by mass spectrometry. CONCLUSIONS The effect of tested proteases on biofilm formation was not related to the protease category but was strain-dependent and was related to the biofilm formation capacity of each staphylococcal strain. Some proteases showed a nonspecific and indiscriminate effect on surface proteins, while others induced a discrete and reproducible action on protein profiles. SIGNIFICANCE AND IMPACT OF THE STUDY The inhibition of the surface-related virulence factors is a promising avenue to overcome persistent infections caused by bacterial biofilms. To this end, we show here that proteases, in particular the metalloprotease serratiopeptidase, can interfere with adhesion and invasion of eukaryotic cells and biofilm formation in staphylococci and their use could represent a viable treatment for the development of novel combination therapies.
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Affiliation(s)
- M Artini
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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21
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Abstract
Skin and soft tissue infections are among the most common diseases requiring surgical treatment. The presentation of patients varies from folliculitis to severe necrotizing infections with a fatal outcome. The diagnosis of a necrotizing infection is often difficult. The correct diagnosis is often made after deterioration of the patient's condition in the rapid course of the disease. The early and correct diagnosis and immediate surgery are decisive for the prognosis. Treatment at a specialized intensive care unit and the administration of a broad spectrum antibiotic are pivotal for the survival of individual patients.
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Zielinska AK, Beenken KE, Mrak LN, Spencer HJ, Post GR, Skinner RA, Tackett AJ, Horswill AR, Smeltzer MS. sarA-mediated repression of protease production plays a key role in the pathogenesis of Staphylococcus aureus USA300 isolates. Mol Microbiol 2012; 86:1183-96. [PMID: 23075270 DOI: 10.1111/mmi.12048] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2012] [Indexed: 01/31/2023]
Abstract
Mutation of staphylococcal accessory regulator (sarA) results in increased production of extracellular proteases in Staphylococcus aureus, which has been correlated with decreased biofilm formation and decreased accumulation of extracellular toxins. We used murine models of implant-associated biofilm infection and S. aureus bacteraemia (SAB) to compare virulence of USA300 strain LAC, its isogenic sarA mutant, and derivatives of each of these strains with mutations in all 10 of the genes encoding recognized extracellular proteases. The sarA mutant was attenuated in both models, and this was reversed by eliminating production of extracellular proteases. To examine the mechanistic basis, we identified proteins impacted by sarA in a protease-dependent manner. We identified 253 proteins where accumulation was reduced in the sarA mutant compared with the parent strain, and was restored in the sarA/protease mutant. Additionally, in SAB, the LAC protease mutant exhibited a hypervirulent phenotype by comparison with the isogenic parent strain, demonstrating that sarA also positively regulates production of virulence factors, some of which are subject to protease-mediated degradation. We propose a model in which attenuation of sarA mutants is defined by their inability to produce critical factors and simultaneously repress production of extracellular proteases that would otherwise limit accumulation of virulence factors.
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Affiliation(s)
- Agnieszka K Zielinska
- Department of Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Nicoletti M, Maccauro G, Tripodi D, Saggini A, Potalivo G, Castellani M, Conti F, Rosati M, Tomato E, Caraffa A, Antinolfi P, Conti P, Theoharides T. Impact of IL-33 on PGD2 Generation by Activated Human Cord Blood-Derived Mast Cell: Lack of Effect on Tryptase Release. EUR J INFLAMM 2012. [DOI: 10.1177/1721727x1201000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Mast cells are important not only in allergic reactions, but also in inflammation and are involved in a variety of responses including the immediate release of potent inflammatory mediators after activation by cross-linking of FcεRI molecules. Prostaglandin D2 (PGD2) is a major cyclooxygenase metabolite of arachidonic acid produced by mast cells and it is released following allergen challenge in allergic diseases. IL-33 is an iflammatory cytokine which is critically involved in the regulation of in vitro and in vivo cyclooxygenase production, providing a potential therapeutic target for inflammatory disorders. In this study, using human derived umbelical cord blood mast cells, we show that IL-33 (50 ng/ml), and calcium ionophore A 23187 (0.5 μg/ml), compound 48/80 (10−5 M) or anti-IgE (10 μg/ml), enhaced the production of PGD2 and this effect was inhibited by indomethacin. However, IL-33 was unable to induce tryptase release in these cells. These effects confirm the inflammatory property of IL-33 by stimulating PGD2 but not tryptase in human mast cells. The inhibitory effect of this new cytokine may have a potential therapeutic response in allergic and inflammatory diseases.
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Affiliation(s)
- M. Nicoletti
- Department of Neurosciences and Imaging, University of Chieti, Italy
| | - G. Maccauro
- Orthopedics Division, Catholic University of Rome, Rome, Italy
| | - D. Tripodi
- Dental School, University of Chieti-Pescara, Chieti, Italy
| | - A. Saggini
- Dermatology Department, University Tor Vergata, Rome, Italy
| | - G. Potalivo
- Orthopedics Division, University of Perugia, Perugia, Italy
| | - M.L. Castellani
- Immunology Division, University of Chieti-Pescara, Chieti, Italy
| | - F. Conti
- Gynecology Division, “Santo Spirito” Hospital, Pescara, Italy
| | - M. Rosati
- Gynecology Division, “Santo Spirito” Hospital, Pescara, Italy
| | - E. Tomato
- Immunology Division, University of Chieti-Pescara, Chieti, Italy
| | - A. Caraffa
- Orthopedics Division, University of Perugia, Perugia, Italy
| | - P. Antinolfi
- Orthopedics Division, University of Perugia, Perugia, Italy
| | - P. Conti
- Immunology Division, University of Chieti-Pescara, Chieti, Italy
| | - T.C. Theoharides
- Department of Physiology and Pharmacology, Tufts University School of Medicine, New England Medical Center, Boston, MA, USA
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Tetè S, Tripodi D, Rosati M, Conti F, Maccauro G, Saggini A, Salini V, Cianchetti E, Caraffa A, Antinolfi P, Toniato E, Castellani ML, Pandolfi F, Frydas S, Conti P, Theoharides TC. Endothelial cells, cholesterol, cytokines, and aging. Int J Immunopathol Pharmacol 2012; 25:355-63. [PMID: 22697067 DOI: 10.1177/039463201202500205] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
It has been reported that high levels of cholesterol and triglycerides are associated with increased risk of developing atherosclerosis and shorter life. In fact, vascular endothelial dysfunction occurs during the human aging process. Accumulation of lipids in vascular endothelium activates leukocytes to produce cytokines and chemokines which recruit macrophages. On the other hand, macrophages augment inflammatory response and secrete vascular endothelial growth factor, a key cytokine that mediates angiogenesis and inflammatory response. In addition, hyperlipidaemia is one of the main risk factors for aging, hypertension and diabetes. Here, we review the interrelationship between endothelial cells, high level of cholesterol, and aging.
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25
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Maccauro G, Tripodi D, Saggini A, Conti F, Cianchetti E, Angelucci D, Rosati M, Toniato E, Fulcheri M, Tetè S, Salini V, Caraffa A, Antinolfi P, Frydas S, Conti P, Theoharides T. Calcium Ionophore A23187 and Compound 48/80 Induce PGD2 and Tryptase in Human Cord Blood-Derived Mast Cells: Lack of Effect of IL-18. EUR J INFLAMM 2012. [DOI: 10.1177/1721727x1201000104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Immunological and biochemical reactions associated with inflammation are elicited in response to a physical or immunological challenge. Early in inflammation there is mobilization and infiltration of neutrophils, mast cells and macrophages to the site of inflammation. These cells release pro-inflammatory compounds icluding cytokines, vasoactive peptides (eg., histamine), and eicosanoids. The release of prostaglandin D2 (PGD2) and tryptase induced by anti-IgE, A23187 and compound 48/80 were studied using in vitro a good and valid model of human cord blood-derived mast cells (HCBDMC). Tryptase is a mast cell product and enhances vasopermeability with anticoagulant activities. In this study we measure the release of PGD2 and tryptase on mast cells activate by anti-IgE, calcium ionophore A23187, polybasic compound 48/80 (an agent containing a cationic region adjacent to a hydrophobic moiety, which works by activating G proteins) and IL-18. The generation of PGD2 was measured by radioimmunoassay. Release of PGD2 was detectable (after 12 h) following challenge with anti-IgE, A23187 and compound 48/80. Our data show that mature HCBDMC produce proinflammatory PGD2 following triggering with anti-IgE and with IgE-independent agonists, such as calcium ionophore A23187 and polybasic compound 48/80, while IL-18 was unable to stimulate the release of PGD2 or tryptase on HCBDMC. Although a great deal has been learned about the mediators produced by mast cells, the ultimate biologic function(s) of mast cells remains a mystery.
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Affiliation(s)
- G. Maccauro
- Orthopedics Division, Università Cattolica, Rome, Italy
| | - D. Tripodi
- Dental School, University of Chieti-Pescara, Italy
| | - A. Saggini
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - F. Conti
- Gynecology Division, Pescara Hospital, Pescara, Italy
| | - E. Cianchetti
- Ortona Hospital, University of Chieti-Pescara, Italy
| | - D. Angelucci
- Pathological Anatomy, Chieti Hospital, Chieti, Italy
| | - M. Rosati
- Gynecology Division, Pescara Hospital, Pescara, Italy
| | - E. Toniato
- Immunology Division, University of Chieti-Pescara, Italy
| | | | - S. Tetè
- Dental School, University of Chieti-Pescara, Italy
| | - V. Salini
- Orthopedics Division, University of Chieti-Pescara, Italy
| | - A. Caraffa
- Orthopedics Division, University of Perugia, Perugia, Italy
| | - P. Antinolfi
- Orthopedics Division, University of Perugia, Perugia, Italy
| | - S. Frydas
- Laboratory of Parasitology, Veterinary Faculty, Aristotelian University, Thessaloniki, Greece
| | - P. Conti
- Immunology Division, University of Chieti-Pescara, Italy
| | - T.C. Theoharides
- Department of Physiology and Pharmacology, Tufts University School of Medicine, New England Medical Center, Boston, MA, USA
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