Change in Tissue Microbiome and Related Human Beta Defensin Levels Induced by Antibiotic Use in Bladder Carcinoma

It is now generally accepted that the success of antitumor therapy can be impaired by concurrent antibiotic therapy, the presence of certain bacteria, and elevated defensin levels around the tumor tissue. The aim of our current investigation was to identify the underlying changes in microbiome and defensin levels in the tumor tissue induced by different antibiotics, as well as the duration of this modification. The microbiome of the tumor tissues was significantly different from that of healthy volunteers. Comparing only the tumor samples, no significant difference was confirmed between the untreated group and the group treated with antibiotics more than 3 months earlier. However, antibiotic treatment within 3 months of analysis resulted in a significantly modified microbiome composition. Irrespective of whether Fosfomycin, Fluoroquinolone or Beta-lactam treatment was used, the abundance of Bacteroides decreased, and Staphylococcus abundance increased. Large amounts of the genus Acinetobacter were observed in the Fluoroquinolone-treated group. Regardless of the antibiotic treatment, hBD1 expression of the tumor cells consistently doubled. The increase in hBD2 and hBD3 expression was the highest in the Beta-lactam treated group. Apparently, antibiotic treatment within 3 months of sample analysis induced microbiome changes and defensin expression levels, depending on the identity of the applied antibiotic.

Bicarbonate Evokes Reciprocal Changes in Intracellular Cyclic di-GMP and Cyclic AMP Levels in Pseudomonas aeruginosa

The formation of Pseudomonas aeruginosa biofilms in cystic fibrosis (CF) is one of the most common causes of morbidity and mortality in CF patients. Cyclic di-GMP and cyclic AMP are second messengers regulating the bacterial lifestyle transition in response to environmental signals. We aimed to investigate the effects of extracellular pH and bicarbonate on intracellular c-di-GMP and cAMP levels, and on biofilm formation. P. aeruginosa was inoculated in a brain−heart infusion medium supplemented with 25 and 50 mM NaCl in ambient air (pH adjusted to 7.4 and 7.7 respectively), or with 25 and 50 mM NaHCO3 in 5% CO2 (pH 7.4 and 7.7). After 16 h incubation, c-di-GMP and cAMP were extracted and their concentrations determined. Biofilm formation was investigated using an xCelligence real-time cell analyzer and by crystal violet assay. Our results show that HCO3− exposure decreased c-di-GMP and increased cAMP levels in a dose-dependent manner. Biofilm formation was also reduced after 48 h exposure to HCO3−. The reciprocal changes in second messenger concentrations were not influenced by changes in medium pH or osmolality. These findings indicate that HCO3− per se modulates the levels of c-di-GMP and cAMP, thereby inhibiting biofilm formation and promoting the planktonic lifestyle of the bacteria.

The influence of antibiotics on transitory resistome during gut colonization with CTX-M-15 and OXA-162 producing Klebsiella pneumoniae ST15

Great efforts have been made to limit the transmission of carbapenemase-producing Enterobacteriaceae (CPE), however, the intestinal reservoir of these strains and its modulation by various antibiotics remain largely unexplored. Our aim was to assess the effects of antibiotic administration (ampicillin, ceftazidime, ciprofloxacin) on the establishment and elimination of intestinal colonization with a CTX-M-15 ESBL and OXA-162 carbapenemase producing Klebsiella pneumoniae ST15 (KP5825) in a murine (C57BL/6 male mice) model. Whole genome sequencing of KP5825 strain was performed on an Illumina MiSeq platform. Conjugation assays were carried out by broth mating method. In colonization experiments, 5 × 106 CFU of KP5825 was administered to the animals by orogastric gavage, and antibiotics were administered in their drinking water for two weeks and were changed every day. The gut colonization rates with KP5825 were assessed by cultivation and qPCR. In each of the stool samples, the gene copy number of blaOXA-162 and blaCTX-M-15 were determined by qPCR. Antibiotic concentrations in the stool were determined by high pressure liquid chromatography and a bioanalytical method. The KP5825 contained four different plasmid replicon types, namely IncFII(K), IncL, IncFIB and ColpVC. IncL (containing the blaOXA-162 resistance gene within a Tn1991.2 genetic element) and IncFII(K) (containing the blaCTX-M-15 resistance gene) plasmids were successfully conjugated. During ampicillin and ceftazidime treatments, colonization rate of KP5825 increased, while, ciprofloxacin treatments in both concentrations (0.1 g/L and 0.5 g/L) led to significantly decreased colonization rates. The gene copy number blaOXA-162 correlated with K. pneumoniae in vivo, while a major elevation was observed in the copy number of blaCTX-M-15 from the first day to the fifteenth day in the 0.5 g/L dose ceftazidime treatment group. Our results demonstrate that commonly used antibiotics may have diverse impacts on the colonization rates of intestinally-carried CPE, in addition to affecting the gene copy number of their resistance genes, thus facilitating their stable persistance and dissemination.

Adenovirus Isolated From a Cat Is Related to Human Adenovirus 1

An adenovirus (AdV) has been isolated from the rectal swab of a domestic cat (Felis catus) and named feline adenovirus (FeAdV) isolate. It replicates and causes cytopathological effects in many human, feline, other mammalian cell lines that have both Coxsackie-adenovirus-receptor and integrins. Its antigens cross-react with anti-human adenovirus antibodies in immunofluorescence and immunocytochemistry assays. Electron microscopy revealed typical extracellular icosahedral particles and pseudo arrays inside cells. Sequence analysis of hexon and fiber genes indicates that this virus might belong to human adenovirus (HAdV) C species and might be a variant of type 1. In the fiber protein, three altered amino acids occur in the shaft; four altered residues are found in the knob region as compared to a European HAdV might be type 1 isolate (strain 1038, D11). One alteration affects amino acid 442 forming an RGS motif in an alanine rich region that might be an alternative way to bind integrins with subsequent internalization. Substitutions in the hexon sequence are silent. As compared to published HAdV sequences, the fiber is related to the original American prototype and recently described Taiwanese HAdV 1 isolates, but the hexon sequences are related to adenovirus isolates from France, Germany, Japan, and Taiwan. Serology carried out on FeAdV infected M426 cells indicates a prevalence of IgG in 80% of domestic cats in Delaware, United States. FeAdV isolate seems to be a recently recognized virus with possible pathogenic effects and, simultaneous human and feline infections are possible. Further molecular and biological characterization of this feline adenovirus isolate, as well as studies on both human and feline epidemiology and pathomechanisms, especially in endangered big cats, are warranted. FeAdV might have further practical advantages. Namely, it could be utilized in both human and feline AIDS research, developed into diagnostic tools, and gene therapy vectors in the near future.

Bicarbonate Inhibits Bacterial Growth and Biofilm Formation of Prevalent Cystic Fibrosis Pathogens

We investigated the effects of bicarbonate on the growth of several different bacteria as well as its effects on biofilm formation and intracellular cAMP concentration in Pseudomonas aeruginosa. Biofilm formation was examined in 96-well plates, with or without bicarbonate. The cAMP production of bacteria was measured by a commercial assay kit. We found that NaHCO₃ (100 mmol l^-1) significantly inhibited, whereas NaCl (100 mmol l^-1) did not influence the growth of planktonic bacteria. MIC and MBC measurements indicated that the effect of HCO3− is bacteriostatic rather than bactericidal. Moreover, NaHCO₃ prevented biofilm formation as a function of concentration. Bicarbonate and alkalinization of external pH induced a significant increase in intracellular cAMP levels. In conclusion, HCO3− impedes the planktonic growth of different bacteria and impedes biofilm formation by P. aeruginosa that is associated with increased intracellular cAMP production. These findings suggest that aerosol inhalation therapy with HCO3− solutions may help improve respiratory hygiene in patients with cystic fibrosis and possibly other chronically infected lung diseases.

Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals

The roseoloviruses, human herpesvirus (HHV)-6A, HHV-6B, and HHV-7, can cause severe encephalitis or encephalopathy. In immunocompetent children, primary HHV-6B infection is occasionally accompanied by diverse clinical forms of encephalitis. Roseolovirus coinfections with heterologous viruses and delayed primary HHV-7 infection in immunocompetent adults result in very severe neurological and generalized symptoms. Recovery from neurological sequelae is slow and sometimes incomplete. In immunocompromised patients with underlying hematological malignancies and transplantation, frequent single or simultaneous reactivation of roseoloviruses elicit severe, lethal organ dysfunctions, including damages in the limbic system, brain stem, and hippocampus. Most cases have been due to HHV-6B with HHV-6A accounting for 2-3%. The most severe manifestation of HHV-6B reactivation is post-transplantation limbic encephalitis. Seizures, cognitive problems, and abnormal EEG are common. Major risk factors for HHV-6B-associated encephalitis include unrelated cord blood cell transplantation and repeated hematopoietic stem cell transplantation. Rare genetic disorders, male gender, certain HLA constellation, and immune tolerance to replicating HHV-6 in persons carrying chromosomally integrated HHV-6 might also predispose an individual to roseolovirus-associated brain damage. At this time, little is known about the risk factors for HHV-7-associated encephalitis. Intrathecal glial cell destruction due to virus replication, overexpression of proinflammatory cytokines, and viral mimicry of chemokines all contribute to brain dysfunction. High virus load in the cerebrospinal fluid, hippocampal astrogliosis, and viral protein expression in HHV-6B-associated cases and multiple microscopic neuronal degeneration in HHV-7-associated cases are typical laboratory findings. Early empirical therapy with ganciclovir or foscarnet might save the life of a patient with roseolovirus-associated encephalitis.

Kurthia gibsonii as a sexually transmitted zoonosis: From a neglected condition during World War II to a recent warning for sexually transmitted disease units

CONTEXT

Zoonotic sexual transmission.

AIMS

Identification of unknown microorganisms causing sexually transmitted zoonotic infection was a common effort of clinicians and the laboratory.

SETTINGS AND DESIGN

A male patient had recurring urethritis and balanitis after having repeated unprotected penetrative sexual intercourse with female piglets. He claimed allergy to metals and plastics. Routine microbiological tests were carried out.

MATERIALS AND METHODS

Specimens from the urethra, glans, rectum, throat, urine, and blood were cultured. Subsequently, isolates were tested for their biochemical activity and antibiotic susceptibility.

RESULTS

Kurthia gibsonii was isolated from both urethra and glans. No other concomitant infection was detected. The patient was cured with oral cefuroxime for 15 days and topical gentamicin cream for 2 months.

CONCLUSION

This is the first reported zoophilic infection by Kurthia spp. Fecal contamination of animals' genital tract was the possible source of infection. Immune disturbance of the patient might predispose to opportunistic Kurthia infection.

Kurthia gibsonii as a sexually transmitted zoonosis: From a neglected condition during World War II to a recent warning for sexually transmitted disease units

CONTEXT

Zoonotic sexual transmission.

AIMS

Identification of unknown microorganisms causing sexually transmitted zoonotic infection was a common effort of clinicians and the laboratory.

SETTINGS AND DESIGN

A male patient had recurring urethritis and balanitis after having repeated unprotected penetrative sexual intercourse with female piglets. He claimed allergy to metals and plastics. Routine microbiological tests were carried out.

MATERIALS AND METHODS

Specimens from the urethra, glans, rectum, throat, urine, and blood were cultured. Subsequently, isolates were tested for their biochemical activity and antibiotic susceptibility.

RESULTS

Kurthia gibsonii was isolated from both urethra and glans. No other concomitant infection was detected. The patient was cured with oral cefuroxime for 15 days and topical gentamicin cream for 2 months.

CONCLUSION

This is the first reported zoophilic infection by Kurthia spp. Fecal contamination of animals' genital tract was the possible source of infection. Immune disturbance of the patient might predispose to opportunistic Kurthia infection.

[Integrated optical sensor for rapid analysis of biological samples]

INTRODUCTION

In the medical diagnostics of bacteria, the rapid detection of pathogenic microorganisms from body fluids is one of the most important tasks. The majority of the modern measuring techniques are based on specific labels bound to the bacteria. However, this strategy usually assumes a rather time-consuming procedure involving several steps (e.g., the widely used enzyme-linked immunosorbent assay normally consists of 5 consecutive steps). Hence, there is an urgent need for the elaboration of rapid, "label-free" techniques, that are often based on Lab-on-a-chip devices.

AIM

In this paper, the authors report on the development of a biosensor based on a miniature, integrated optical Mach-Zehnder interferometer.

METHOD

Functionalization of the measuring arm of the sensor by antibodies, made the rapid and specific label-free detection of pathogens feasible.

RESULTS

Using the combination of the interferometer with a microfluidic system, the device was able to detect Escherichia coli bacteria at concentrations as low as 10(6) colony forming unit/ml within minutes.

CONCLUSIONS

This makes the newly developed biosensor a promising device for a wide range of applications, not only in medical microbiology, but microbial forensics, criminal investigations, bio-terrorism threats and in environmental studies as well.

Integrated optical biosensor for rapid detection of bacteria

In medical diagnostics, rapid detection of pathogenic bacteria from body fluids is one of the basic issues. Most state-of-the-art methods require optical labeling, increasing the complexity, duration and cost of the analysis. Therefore, there is a strong need for developing selective sensory devices based on label-free techniques, in order to increase the speed, and reduce the cost of detection. In a recent paper, we have shown that an integrated optical Mach-Zehnder interferometer, a highly sensitive all-optical device made of a cheap photopolymer, can be used as a powerful lab-on-a-chip tool for specific, labelfree detection of proteins. By proper modifications of this technique, our interferometric biosensor was combined with a microfluidic system allowing the rapid and specific detection of bacteria from solutions, having the surface of the sensor functionalized by bacterium-specific antibodies. The experiments proved that the biosensor was able to detect Escherichia coli bacteria at concentrations of 106 cfu/ml within a few minutes, that makes our device an appropriate tool for fast, label-free detection of bacteria from body fluids such as urine or sputum. On the other hand, possible applications of the device may not be restricted to medical microbiology, since bacterial identification is an important task in microbial forensics, criminal investigations, bio-terrorism threats and in environmental studies, as well.

Isolation of Kurthia gibsonii from non-gonorrheal urethritis: implications for the pathomechanism upon surveying the literature

The incidence and number of species involved in the spectrum of sexually transmitted infections continue to increase. Laboratories have to be prepared for identification of unusual microbes. In our practice, a male patient had recurring urethritis and balanitis after having repeated unprotected insertive sexual intercourse with female piglets. He also had allergy to scents and some metals, otherwise he showed no general symptoms. Specimens were swabbed from the urethra, inflamed glans, rectum, mouth onto several culture media, subsequently isolates were tested for their morphology, biochemical activity. Kurthia gibsonii was isolated from urethra and glans. No concomitant infection with other microbes was detected, haemoculture was negative. Relying upon antibiotic sensitivity test, he was cured with 2 × 500 mg oral cefuroxime for 15 days, and topical gentamycin cream for 2 months. This is the first reported sexually transmitted, zoonotic infection without generalization by Kurthia spp. We report first the antibiogram of K. gibsonii. Slight differences in the antibiotic sensitivity suggest independent infection and sensitivity of urethral and mucous membrane tissues to distinct K. gibsonii strains. Allergy of the patient might predispose to opportunistic infection. Such aspects ought to be tested in details in further cases.

Immunochemistry of adenoviruses: limitations and new horizons of gene therapy

Adenoviruses have increasingly been recognized as significant viral pathogens causing high morbidity and mortality especially among immunocompromised individuals such as transplant recipients and AIDS patients. Through the infection process, after the adenovirus fiber and penton are bonded to cell surface receptors through special amino acid moieties, secondary messengers activate protein kinases, pro-inflammatory cytokines and chemokines. Serotype and species specific antibodies also are induced. Recombinant human adenoviruses have been pivotal in the development of gene therapy strategies and have shown a great promise for the treatment of genetic disorders and malignancies. Recent studies have enlightened their harmful immunological effects dependent on fiber and hexon polypeptide structure and receptor binding. Pre-existing antibodies or those elicited by vectors neutralize input recombinant adenovirus particles rendering them ineffective. Mediators induce serious even lethal side effects and cytotoxic reactions which extinguish transgene expression. To overcome these difficulties new strategies are required in the application of recombinant adenoviruses to redirect vector entry from the natural receptors to alternative binding sites or using rare human or animal adenovirus fiber molecules to modify the native fiber structure by altering amino acid structure and creating chimeric fibers. This requires searching for, isolating and characterizing new serotypes, mutants or variants for new generation vectors. Human adenovirus 1 feline isolate (feline adenovirus) might fulfil these criteria.

[Adenovirus infections in immunocompromised patients]

Human adenoviruses function as genetic models and vectors for gene therapy. Upper respiratory, gastrointestinal or ocular infections usually have mild course without any major complication in immunocompetent individuals. However, reactivation from latency in immunocompromised patients may lead to death. Depending on the underlying diseases, different adenovirus serotypes damage different organs. In children with severe combined immunodeficiency syndrome, serotypes of species A and C induce lung, liver or bladder inflammation. Paediatric hematopoietic stem cell transplantation is frequently followed by serotype 31-induced pneumonia, enteritis, cystitis. B serotypes can destroy transplanted organs. In AIDS patients, D and novel F serotypes cause enteritis. Recombinants of B serotypes induce urinary tract infections. Progression of lymphomas, tumours, and systemic lupus erythematosus might be facilitated by immunosuppressive effects of adenoviruses. As far as the diagnostic work-up of adenoviruses, detection of viral DNA and virus copy number is predictive, while serology testing is quite unreliable. For treatment, cidofovir derivates, ribavirin, ganciclovir, vidarabine and microRNA have been used.

Immunosenescence and vaccination of the elderly II. New strategies to restore age-related immune impairment

One of the greatest health-care challenges in the elderly is to ensure that vaccination against infections are optimally effective, but vaccination can only be effective if cells that are capable of responding are still present in the repertoire. The reversing of immunosenescence could be achieved by improving immune responses or altering vaccine formulation. Recent vaccination strategies in the elderly exert low effectiveness. Nutritional interventions and moderate exercise delay T cell senescence. Telomerase activity and expression of toll-like receptors can be improved by chemotherapy. Reversion of thymic atrophy could be achieved by thymus transplantation, depletion of accumulated dysfunctional naive T cells and herpesvirus-specific exhausted memory cells. Administration of immunostimulatory and anti-inflammatory cytokines show the best practical approach. Reduced dendritic cell activity and co-receptor expression might be increased by interleukin (IL)-2 administration. IL-7 protects both B and T lymphocytes, but IL-2, IL-10, keratinocyte growth factor, thymic stromal lymphopoietin, as well as leptin and growth hormone also have a stimulatory effect on thymopoiesis. In animals, several strategies have been explored to produce more efficacious vaccines including high dose vaccines, DNA vaccines with immunostimulatory patch, virosomal vaccines and vaccines containing new adjuvants. Hopefully, one of these approaches will be translated into human therapy in a short time.

Immunosenescence and vaccination of the elderly, I. Age-related immune impairment

The sharp increase of life expectancy and the increasing ratio of ageing population pose new challenges for the public health system. The elderly suffer from more frequent and severe infections than young people. Theoretically, vaccination could protect the elderly against several infectious diseases, but due to their age-related immune impairment, vaccination might fail in many cases. Instead of ineffective vaccination campaigns, exploration and restoration of age-dependent dysregulation of their immune functions have to be placed into the focus of recent research. Frequent comorbidities in these people augment immune defects. Immunosenescence affects both the innate and adaptive immunity. Disturbances in macrophage-derived cytokine release and reduction of the natural killer cell mediated cytotoxicity lead to increased frequency of respiratory, gastrointestinal and skin infections. Although the humoral immunity retains most of its original activity through life span, ageing dampens the ability of B cells to produce antibodies against novel antigens. Age-related declination of the cellular immunity is the consequence of thymic atrophy, reduced output of new T lymphocytes, accumulation of anergic memory cells, deficiencies in the cytokine production and uncertain antigen presentation. Persistent infection by different herpesviruses and other parasites contribute to the loss of immunosurveillance and premature exhaustion of T cells.