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Braunstein R, Hubanic G, Yerushalmy O, Oren-Alkalay S, Rimon A, Coppenhagen-Glazer S, Niv O, Marom H, Barsheshet A, Hazan R. Successful phage-antibiotic therapy of P. aeruginosa implant-associated infection in a Siamese cat. Vet Q 2024; 44:1-9. [PMID: 38726795 PMCID: PMC11089911 DOI: 10.1080/01652176.2024.2350661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 04/27/2024] [Indexed: 05/15/2024] Open
Abstract
Antibiotic-resistant pathogens are a growing global issue, leading to untreatable infectious diseases in both humans and animals. Personalized bacteriophage (phage) therapy, the use of specific anti-bacterial viruses, is currently a leading approach to combat antibiotic-resistant infections. The implementation of phage therapy has primarily been focused on humans, almost neglecting the impact of such infections on the health and welfare of companion animals. Pets also have the potential to spread resistant infections to their owners or the veterinary staff through zoonotic transmission. Here, we showcase personalized phage-antibiotic treatment of a cat with a multidrug-resistant Pseudomonas aeruginosa implant-associated infection post-arthrodesis surgery. The treatment encompassed a tailored combination of an anti-P. aeruginosa phage and ceftazidime, precisely matched to the pathogen. The phage was topically applied to the surgical wound while the antibiotic was administered intramuscularly. After two treatment courses spanning 7 and 3 weeks, the surgical wound, which had previously remained open for five months, fully closed. To the best of our knowledge, this is the first case of personalized phage therapy application in felines, which provides further evidence of the effectiveness of this approach. The successful outcome paves the way for personalized phage-antibiotic treatments against persistent infections therapy in veterinary practice.
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Affiliation(s)
- Ron Braunstein
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
| | - Goran Hubanic
- Vet-Holim, Animal Medical Center, Kiryat-Anavim, Israel
| | - Ortal Yerushalmy
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
| | - Sivan Oren-Alkalay
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
| | - Amit Rimon
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
- Tzameret, The Military Track of Medicine, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Shunit Coppenhagen-Glazer
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
| | - Ofir Niv
- Vet-Holim, Animal Medical Center, Kiryat-Anavim, Israel
| | - Hilik Marom
- Vet-Holim, Animal Medical Center, Kiryat-Anavim, Israel
| | | | - Ronen Hazan
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Israel
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2
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Onallah H, Yerushalmy O, Braunstein R, Alkalay-Oren S, Rimon A, Gelman D, Coppenhagen-Glazer S, Hazan R, Nir-Paz R. Protocol for phage matching, treatment, and monitoring for compassionate bacteriophage use in non-resolving infections. STAR Protoc 2024; 5:102949. [PMID: 38691464 PMCID: PMC11070627 DOI: 10.1016/j.xpro.2024.102949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/16/2024] [Accepted: 02/26/2024] [Indexed: 05/03/2024] Open
Abstract
Phage therapy has re-emerged as a promising treatment for non-resolving infections. Given the lack of approved phage treatments, there is a need to establish a compassionate use pipeline. Here, we present a protocol for phage matching, treatment, and monitoring for compassionate bacteriophage use in non-resolving infections. We describe steps for consultation and request implementation, evaluating and comparing different aspects of phage activity, and phage production. We then detail procedures for multidisciplinary meetings, ethics approvals, phage therapy, and follow-up. For complete details on the use and execution of this protocol, please refer to Onallah et al.1,2.
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Affiliation(s)
- Hadil Onallah
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel
| | - Ortal Yerushalmy
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Ron Braunstein
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Sivan Alkalay-Oren
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amit Rimon
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel; Tzameret, The Military Track of Medicine, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Daniel Gelman
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel; Tzameret, The Military Track of Medicine, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Shunit Coppenhagen-Glazer
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Ronen Hazan
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel.
| | - Ran Nir-Paz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel.
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3
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Onallah H, Hazan R, Nir-Paz R, Brownstein MJ, Fackler JR, Horne B, Hopkins R, Basu S, Yerushalmy O, Alkalay-Oren S, Braunstein R, Rimon A, Gelman D, Khalifa L, Adler K, Abdalrhman M, Gelman S, Katvan E, Coppenhagen-Glazer S, Moses A, Oster Y, Dekel M, Ben-Ami R, Khoury A, Kedar DJ, Meijer SE, Ashkenazi I, Bishouty N, Yahav D, Shostak E, Livni G, Paul M, Gross M, Ormianer M, Aslam S, Ritter M, Urish KL, La Hoz RM, Khatami A, Britton PN, Lin RCY, Iredell JR, Petrovic-Fabijan A, Lynch S, Tamma PD, Yamshchikov A, Lesho E, Morales M, Werzen A, Saharia K. Refractory Pseudomonas aeruginosa infections treated with phage PASA16: A compassionate use case series. Med 2023; 4:600-611.e4. [PMID: 37562400 DOI: 10.1016/j.medj.2023.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND A growing number of compassionate phage therapy cases were reported in the last decade, with a limited number of clinical trials conducted and few unsuccessful clinical trials reported. There is only a little evidence on the role of phages in refractory infections. Our objective here was to present the largest compassionate-use single-organism/phage case series in 16 patients with non-resolving Pseudomonas aeruginosa infections. METHODS We summarized clinical phage microbiology susceptibility data, administration protocol, clinical data, and outcomes of all cases treated with PASA16 phage. In all intravenous phage administrations, PASA16 phage was manufactured and provided pro bono by Adaptive Phage Therapeutics. PASA16 was administered intravenously, locally to infection site, or by topical use to 16 patients, with data available for 15 patients, mainly with osteoarticular and foreign-device-associated infections. FINDINGS A few minor side effects were noted, including elevated liver function enzymes and a transient reduction in white blood cell count. Good clinical outcome was documented in 13 out of 15 patients (86.6%). Two clinical failures were reported. The minimum therapy duration was 8 days with a once- to twice-daily regimen. CONCLUSIONS PASA16 with antibiotics was found to be relatively successful in patients for whom traditional treatment approaches have failed previously. Such pre-phase-1 cohorts can outline potential clinical protocols and facilitate the design of future trials. FUNDING The study was funded in part by The Israeli Science Foundation IPMP (ISF_1349/20), Rosetrees Trust (A2232), United States-Israel Binational Science Foundation (2017123), and the Milgrom Family Support Program.
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Affiliation(s)
- Hadil Onallah
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel
| | - Ronen Hazan
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Ran Nir-Paz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel.
| | | | | | - Bri'Anna Horne
- Adaptive Phage Therapeutics, Gaithersburg, MD 20878, USA
| | - Robert Hopkins
- Adaptive Phage Therapeutics, Gaithersburg, MD 20878, USA
| | - Subhendu Basu
- Adaptive Phage Therapeutics, Gaithersburg, MD 20878, USA
| | - Ortal Yerushalmy
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Sivan Alkalay-Oren
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Ron Braunstein
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amit Rimon
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Daniel Gelman
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel; Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Leron Khalifa
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Karen Adler
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Mohanad Abdalrhman
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel
| | - Shira Gelman
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel; Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Eyal Katvan
- The Martin (Szusz) Department of Land of Israel Studies and Archaeology, Bar Ilan University, Ramat-Gan 52900, Israel; Peres Academic Center, Rehovot 7610202, Israel
| | - Shunit Coppenhagen-Glazer
- The Israeli Phage Therapy Center (IPTC) of Hadassah Medical Center and the Hebrew University, Jerusalem 9112102, Israel; Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Allon Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel
| | - Yonatan Oster
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center (HHUMC), Jerusalem 9112000, Israel
| | - Michal Dekel
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ronen Ben-Ami
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Amal Khoury
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Daniel J Kedar
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Suzy E Meijer
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Itay Ashkenazi
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Nancy Bishouty
- Pharmacy Department, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Dafna Yahav
- Infectious Disease Unit, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Eran Shostak
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center, Petah Tikva 4920235, Israel
| | - Gilat Livni
- Pediatric Infectious Diseases Unit, Schneider Children's Medical Center, Petah Tikva 4920235, Israel
| | - Mical Paul
- Rambam Health Care Campus and Faculty of Medicine, The Technion - Israel Institute of Technology, Haifa 3109601, Israel
| | - Menachem Gross
- Department of Otolaryngology-Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 9112000, Israel
| | - Matityahou Ormianer
- Department of Otolaryngology-Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem 9112000, Israel
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92093, USA; Center for Innovative Phage Applications and Therapeutics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Michele Ritter
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA 92093, USA
| | - Kenneth L Urish
- Bone and Joint Center, Magee Hospital, Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, USA
| | - Ricardo M La Hoz
- Division of Infectious Disease and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Ameneh Khatami
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ruby C Y Lin
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Jonathan R Iredell
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia; Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Aleksandra Petrovic-Fabijan
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Stephanie Lynch
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Pranita D Tamma
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Alexandra Yamshchikov
- Infectious Diseases Unit, Rochester Regional Health, Rochester, NY 14617, USA; Infectious Diseases Unit, University of Rochester Medical Center, Rochester, NY 14617, USA
| | - Emil Lesho
- Infectious Diseases Unit, Rochester Regional Health, Rochester, NY 14617, USA
| | - Megan Morales
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Alissa Werzen
- Division of Infectious Diseases, Jefferson Medicine, Philadelphia, PA 19107, USA
| | - Kapil Saharia
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Aslam S, Yerushalmy O, Courtwright A, Koval C, Luong M, Demir K, Pouch S, Onallah H, Browunshtine R, Rakov C, Gelman D, Coppenhagen-Glazer S, Pilewski J, Lipuma J, Nir-Paz R, Hazan R. Development of Burkholderia Cepacia Complex Targeted Clinical Registry and Phage Library. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Rimon A, Gelman D, Yerushalmy O, Coppenhagen-Glazer S, Katvan E, Nir-Paz R, Hazan R. Phage Therapy in Israel, Past, Present, and Future. Phage (New Rochelle) 2022; 3:85-94. [PMID: 36157284 PMCID: PMC9436258 DOI: 10.1089/phage.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The fascinating scientific history of phage therapy has been documented in numerous publications. In this study, however, we focus on an angle of the story that hitherto has remained relatively neglected, namely, phage therapy treatments, and the protagonists that conducted these in Mandatory-Palestine and subsequently the state of Israel, as part of a global trend. We complete the story by describing efforts in the new era of phage therapy in present-day Israel.
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Affiliation(s)
- Amit Rimon
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniel Gelman
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ortal Yerushalmy
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shunit Coppenhagen-Glazer
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Katvan
- Bar Ilan University, Ramat Gan, Israel
- Peres Academic Center, Rehovot, Israel
| | - Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, Jerusalem, and the Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronen Hazan
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Gelman D, Coppenhagen-Glazer S, Durst R, Nir-Paz R, Hazan R. 1061. Clinical Phage Microbiology: Evaluating Phages for Biofilm-associated Prosthetic Valve Endocarditis. Open Forum Infect Dis 2021. [PMCID: PMC8644819 DOI: 10.1093/ofid/ofab466.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prosthetic valve endocarditis (PVE) is a major treatment challenge associated with biofilm formation. It requires intensive infectious diseases consultations and prolonged therapy. Nevertheless, high mortality rates are reported even with timely diagnosis and optimal management. Bacteriophage (phage) therapy, the use of bacterial viruses as antimicrobial agents, has been suggested as a potential adjunctive treatment for PVE. This is due to the ability of lytic phages to synergize with antibiotics and to destroy biofilms. However, due to their high specificity, it is crucial to match the phages by in-vitro evaluations that simulate the clinical settings.
Methods
In this study we demonstrate this matching using an in-vitro PVE model of vancomycin-resistant Enterococcus faecalis (VRE). We have looked at the ability of the phage EFLK1, alone or in combination with antibiotics, to destroy mature biofilms from a commonly used bioprosthetic valve. In addition, we tried to predict these effects using several in-vitro phage susceptibility assays.
Results
We found that the phage EFLK1 presents a significant inhibitory effect against planktonic cultures of VRE, both alone or in combination with ampicillin or ceftriaxone. We then tested the effect of these combinations on mature biofilm grown on a standard 96-well plates. We found that the phage, or its combination with ceftriaxone, led to a two-log reduction in the bacterial viability. In contrast, the addition of ampicillin to the phage caused interference with this antibacterial effect. When tested against biofilm grown on a pericardial patch, the combination of EFLK1 and ceftriaxone was found most efficient. Finally, when tested on the whole bioprosthetic aortic valve, we found that the phage EFLK1 alone was even more efficient than its combination with ceftriaxone.
Biofilm Eradication from Bioprosthetic Aortic Valve
(A) Representation of E. faecalis biofilm formation on bioprosthetic valves. (B) Following 48-hours of growth, the valves were treated for five days by the phage EFLK1, ceftriaxone or their combination. The valves were then washed from any planktonic cells and the biofilm biomass was established by CFU enumeration.
Conclusion
This study demonstrates that a proper in-vitro matching is essential in the treatment of PVE with phages. As seen here, the phage-antibiotic combination intended for treatment should be drawn according to their efficacy on suitable models, simulating the clinical settings, with the specific pathogen, the valve material, and the used phages taken into consideration.
Disclosures
Ran Nir-Paz, MD, BiomX (Consultant)Technophage (Scientific Research Study Investigator, Advisor or Review Panel member)
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Affiliation(s)
- Daniel Gelman
- Hadassah-Hebrew University Medical Center, Jerusalem, Yerushalayim, Israel
| | | | - Ronen Durst
- Hadassah-Hebrew University Medical Center, Jerusalem, Yerushalayim, Israel
| | - Ran Nir-Paz
- Department of clinical Microbiology and Infectious Diseases, Hadassah-Hebrew university medical Center, Jerusalem 91120, Israel, Jerusalem, Yerushalayim, Israel
| | - Ronen Hazan
- Institute of Biomedical and Oral Research (IBOR), The Hebrew University, Jerusalem, Israel, Jerusalem, Yerushalayim, Israel
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7
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Gelman D, Yerushalmy O, Alkalay-Oren S, Rakov C, Ben-Porat S, Khalifa L, Adler K, Abdalrhman M, Coppenhagen-Glazer S, Aslam S, Schooley RT, Nir-Paz R, Hazan R. Clinical Phage Microbiology: a suggested framework and recommendations for the in-vitro matching steps of phage therapy. The Lancet Microbe 2021; 2:e555-e563. [DOI: 10.1016/s2666-5247(21)00127-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
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8
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Ben Porat S, Gelman D, Yerushalmy O, Alkalay-Oren S, Coppenhagen-Glazer S, Cohen-Cymberknoh M, Kerem E, Amirav I, Nir-Paz R, Hazan R. Expanding clinical phage microbiology: simulating phage inhalation for respiratory tract infections. ERJ Open Res 2021; 7:00367-2021. [PMID: 34760998 PMCID: PMC8573233 DOI: 10.1183/23120541.00367-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/05/2021] [Indexed: 11/12/2022] Open
Abstract
Phage therapy is a promising antibacterial strategy for resistant respiratory tract infections. Phage inhalation may serve this goal; however, it requires a careful assessment of their delivery by this approach. Here we present an in vitro model to evaluate phage inhalation. Eight phages, most of which target pathogens common in cystic fibrosis, were aerosolised by jet nebuliser and administered to a real-scale computed tomography-derived 3D airways model with a breathing simulator. Viable phage loads reaching the output of the nebuliser and the tracheal level of the model were determined and compared to the loaded amount. Phage inhalation resulted in a diverse range of titre reduction, primarily associated with the nebulisation process. No correlation was found between phage delivery to the phage physical or genomic dimensions. These findings highlight the need for tailored simulations of phage delivery, ideally by a patient-specific model in addition to proper phage matching, to increase the potential of phage therapy success.
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Affiliation(s)
- Shira Ben Porat
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Dept of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- These authors contributed equally
| | - Daniel Gelman
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Dept of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Dept of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- These authors contributed equally
| | - Ortal Yerushalmy
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sivan Alkalay-Oren
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shunit Coppenhagen-Glazer
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eitan Kerem
- Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Israel Amirav
- Pediatric Pulmonary Unit, Dana-Dwek Children's Hospital, Tel Aviv, Israel
| | - Ran Nir-Paz
- Dept of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- These authors contributed equally
| | - Ronen Hazan
- Institute of Biomedical and Oral Research, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- These authors contributed equally
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9
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Paul K, Merabishvili M, Hazan R, Christner M, Herden U, Gelman D, Khalifa L, Yerushalmy O, Coppenhagen-Glazer S, Harbauer T, Schulz-Jürgensen S, Rohde H, Fischer L, Aslam S, Rohde C, Nir-Paz R, Pirnay JP, Singer D, Muntau AC. Bacteriophage Rescue Therapy of a Vancomycin-Resistant Enterococcus faecium Infection in a One-Year-Old Child following a Third Liver Transplantation. Viruses 2021; 13:1785. [PMID: 34578366 PMCID: PMC8472888 DOI: 10.3390/v13091785] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/21/2021] [Accepted: 09/01/2021] [Indexed: 12/23/2022] Open
Abstract
Phage therapy is an experimental therapeutic approach used to target multidrug-resistant bacterial infections. A lack of reliable data with regard to its efficacy and regulatory hurdles hinders a broad application. Here we report, for the first time, a case of vancomycin-resistant Enterococcus faecium abdominal infection in a one-year-old, critically ill, and three times liver transplanted girl, which was successfully treated with intravenous injections (twice per day for 20 days) of a magistral preparation containing two Enterococcus phages. This correlated with a reduction in baseline C-reactive protein (CRP), successful weaning from mechanical ventilation and without associated clinical adverse events. Prior to clinical use, phage genome was sequenced to confirm the absence of genetic determinants conferring lysogeny, virulence or antibiotic resistance, and thus their safety. Using a phage neutralization assay, no neutralizing anti-phage antibodies in the patient's serum could be detected. Vancomycin-susceptible E. faecium isolates were identified in close relation to phage therapy and, by using whole-genome sequencing, it was demonstrated that vancomycin-susceptible E. faecium emerged from vancomycin-resistant progenitors. Covering a one year follow up, we provide further evidence for the feasibility of bacteriophage therapy that can serve as a basis for urgently needed controlled clinical trials.
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Affiliation(s)
- Kevin Paul
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.H.); (S.S.-J.); (D.S.); (A.C.M.)
| | - Maya Merabishvili
- Burn Centre, Laboratory for Molecular and Cellular Technology (LabMCT), Queen Astrid Military Hospital, B-1120 Brussels, Belgium;
| | - Ronen Hazan
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (D.G.); (L.K.); (O.Y.); (S.C.-G.)
| | - Martin Christner
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.C.); (H.R.)
| | - Uta Herden
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (U.H.); (L.F.)
| | - Daniel Gelman
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (D.G.); (L.K.); (O.Y.); (S.C.-G.)
| | - Leron Khalifa
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (D.G.); (L.K.); (O.Y.); (S.C.-G.)
| | - Ortal Yerushalmy
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (D.G.); (L.K.); (O.Y.); (S.C.-G.)
| | - Shunit Coppenhagen-Glazer
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (D.G.); (L.K.); (O.Y.); (S.C.-G.)
| | - Theresa Harbauer
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.H.); (S.S.-J.); (D.S.); (A.C.M.)
| | - Sebastian Schulz-Jürgensen
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.H.); (S.S.-J.); (D.S.); (A.C.M.)
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.C.); (H.R.)
| | - Lutz Fischer
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (U.H.); (L.F.)
| | - Saima Aslam
- Center for Innovative Phage Applications and Therapeutics, Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA 92093, USA;
| | - Christine Rohde
- Leibniz Institute DSMZ—German Collection of Microorganisms and Cell Cultures GmbH, 38124 Braunschweig, Germany;
| | - Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Disease, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel;
| | - Jean-Paul Pirnay
- Burn Centre, Laboratory for Molecular and Cellular Technology (LabMCT), Queen Astrid Military Hospital, B-1120 Brussels, Belgium;
| | - Dominique Singer
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.H.); (S.S.-J.); (D.S.); (A.C.M.)
| | - Ania Carolina Muntau
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.H.); (S.S.-J.); (D.S.); (A.C.M.)
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10
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Ben-Zaken H, Kraitman R, Coppenhagen-Glazer S, Khalifa L, Alkalay-Oren S, Gelman D, Ben-Gal G, Beyth N, Hazan R. Isolation and Characterization of Streptococcus mutans Phage as a Possible Treatment Agent for Caries. Viruses 2021; 13:825. [PMID: 34063251 PMCID: PMC8147482 DOI: 10.3390/v13050825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022] Open
Abstract
Streptococcus mutans is a key bacterium in dental caries, one of the most prevalent chronic infectious diseases. Conventional treatment fails to specifically target the pathogenic bacteria, while tending to eradicate commensal bacteria. Thus, caries remains one of the most common and challenging diseases. Phage therapy, which involves the use of bacterial viruses as anti-bacterial agents, has been gaining interest worldwide. Nevertheless, to date, only a few phages have been isolated against S. mutans. In this study, we describe the isolation and characterization of a new S. mutans phage, termed SMHBZ8, from hundreds of human saliva samples that were collected, filtered, and screened. The SMHBZ8 genome was sequenced and analyzed, visualized by TEM, and its antibacterial properties were evaluated in various states. In addition, we tested the lytic efficacy of SMHBZ8 against S. mutans in a human cariogenic dentin model. The isolation and characterization of SMHBZ8 may be the first step towards developing a potential phage therapy for dental caries.
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Affiliation(s)
- Hadar Ben-Zaken
- Department of Prosthodontics, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel; (H.B.-Z.); (R.K.); (G.B.-G.); (N.B.)
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Sciences, School of Dental Medicine, The Hebrew University, Jerusalem 91120, Israel; (S.C.-G.); (L.K.); (S.A.-O.); (D.G.)
| | - Reut Kraitman
- Department of Prosthodontics, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel; (H.B.-Z.); (R.K.); (G.B.-G.); (N.B.)
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Sciences, School of Dental Medicine, The Hebrew University, Jerusalem 91120, Israel; (S.C.-G.); (L.K.); (S.A.-O.); (D.G.)
| | - Shunit Coppenhagen-Glazer
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Sciences, School of Dental Medicine, The Hebrew University, Jerusalem 91120, Israel; (S.C.-G.); (L.K.); (S.A.-O.); (D.G.)
| | - Leron Khalifa
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Sciences, School of Dental Medicine, The Hebrew University, Jerusalem 91120, Israel; (S.C.-G.); (L.K.); (S.A.-O.); (D.G.)
| | - Sivan Alkalay-Oren
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Sciences, School of Dental Medicine, The Hebrew University, Jerusalem 91120, Israel; (S.C.-G.); (L.K.); (S.A.-O.); (D.G.)
| | - Daniel Gelman
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Sciences, School of Dental Medicine, The Hebrew University, Jerusalem 91120, Israel; (S.C.-G.); (L.K.); (S.A.-O.); (D.G.)
| | - Gilad Ben-Gal
- Department of Prosthodontics, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel; (H.B.-Z.); (R.K.); (G.B.-G.); (N.B.)
| | - Nurit Beyth
- Department of Prosthodontics, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel; (H.B.-Z.); (R.K.); (G.B.-G.); (N.B.)
| | - Ronen Hazan
- Institute of Biomedical and Oral Research (IBOR), Faculty of Dental Sciences, School of Dental Medicine, The Hebrew University, Jerusalem 91120, Israel; (S.C.-G.); (L.K.); (S.A.-O.); (D.G.)
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11
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Rakov C, Ben Porat S, Alkalay-Oren S, Yerushalmy O, Abdalrhman M, Gronovich N, Huang L, Pride D, Coppenhagen-Glazer S, Nir-Paz R, Hazan R. Targeting Biofilm of MDR Providencia stuartii by Phages Using a Catheter Model. Antibiotics (Basel) 2021; 10:antibiotics10040375. [PMID: 33918377 PMCID: PMC8065852 DOI: 10.3390/antibiotics10040375] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 01/29/2023] Open
Abstract
Providencia spp. are emerging pathogens mainly in nosocomial infections. Providencia stuartii in particular is involved in urinary tract infections and contributes significantly to the high incidence of biofilm-formation in catheterized patients. Furthermore, recent reports suggested a role for multiple drug resistant (MDR) P. stuartii in hospital-associated outbreaks which leads to excessive complications resulting in challenging treatments. Phage therapy is currently one of the most promising solutions to combat antibiotic-resistant infections. However, the number of available phages targeting Providencia spp. is extremely limited, restricting the use of phage therapy in such cases. In the present study, we describe the isolation and characterization of 17 lytic and temperate bacteriophages targeting clinical isolates of Providencia spp. as part of the Israeli Phage Bank (IPB). These phages, isolated from sewage samples, were evaluated for host range activity and effectively eradicated 95% of the tested bacterial strains isolated from different geographic locations and displaying a wide range of antibiotic resistance. Their lytic activity is demonstrated on agar plates, planktonic cultures, and biofilm formed in a catheter model. The results suggest that these bacteriophages can potentially be used for treatment of antibiotic-resistant Providencia spp. infections in general and of urinary tract infections in particular.
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Affiliation(s)
- Chani Rakov
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (C.R.); (S.B.P.); (S.A.-O.); (O.Y.); (N.G.); (S.C.-G.)
| | - Shira Ben Porat
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (C.R.); (S.B.P.); (S.A.-O.); (O.Y.); (N.G.); (S.C.-G.)
| | - Sivan Alkalay-Oren
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (C.R.); (S.B.P.); (S.A.-O.); (O.Y.); (N.G.); (S.C.-G.)
| | - Ortal Yerushalmy
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (C.R.); (S.B.P.); (S.A.-O.); (O.Y.); (N.G.); (S.C.-G.)
| | - Mohanad Abdalrhman
- Hadassah-Hebrew University Medical Center, Department of Clinical Microbiology and Infectious Diseases, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (M.A.); (R.N.-P.)
| | - Niv Gronovich
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (C.R.); (S.B.P.); (S.A.-O.); (O.Y.); (N.G.); (S.C.-G.)
| | - Lina Huang
- Department of Pathology, University of California, San Diego, CA 92093, USA; (L.H.); (D.P.)
| | - David Pride
- Department of Pathology, University of California, San Diego, CA 92093, USA; (L.H.); (D.P.)
| | - Shunit Coppenhagen-Glazer
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (C.R.); (S.B.P.); (S.A.-O.); (O.Y.); (N.G.); (S.C.-G.)
| | - Ran Nir-Paz
- Hadassah-Hebrew University Medical Center, Department of Clinical Microbiology and Infectious Diseases, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (M.A.); (R.N.-P.)
| | - Ronen Hazan
- Institute of Dental Sciences, School of Dentistry, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (C.R.); (S.B.P.); (S.A.-O.); (O.Y.); (N.G.); (S.C.-G.)
- Correspondence: ; Tel.: +972-26758588
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12
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Sheffer-Levi S, Rimon A, Lerer V, Shlomov T, Coppenhagen-Glazer S, Rakov C, Zeiter T, Nir-Paz R, Hazan R, Molho-Pessach V. Antibiotic Susceptibility of Cutibacterium acnes Strains Isolated from Israeli Acne Patients. Acta Derm Venereol 2020; 100:adv00295. [PMID: 33021324 PMCID: PMC9274907 DOI: 10.2340/00015555-3654] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Antibiotic-resistant Cutibacterium acnes has been reported worldwide, but data from Israeli patients with acne is currently lacking. This study evaluated the antibiotic susceptibility of C. acnes, isolated from 50 Israeli patients with acne to commonly prescribed antibiotics, using the Epsilometer test (E-test). Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis, 16S rRNA sequencing and single locus sequence typing (SLST) molecular typing were used to identify and characterize C. acnes. Among 36 strains isolated, phylotype IA1 was most common. Resistance to at least one antibiotic was found in 30.6% of tested strains. Resistance rates were highest for erythromycin (25.0%), followed by doxycycline (19.4%), clindamycin (16.7%), minocycline (11.1%) and tetracycline (8.3%). Significant correlation was found between resistance to multiple antibiotics, with 5.6% of isolates resistant to all antibiotics tested. When reviewing resistances rate worldwide antibiotic resistance was found to be prevalent in Israel. Measures to limit the emergence of antibiotic-resistant strains of Cutibacterium acnes should be taken and alternative treatments should be sought.
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Affiliation(s)
- Sivan Sheffer-Levi
- Department of Dermatology, Hadassah Hebrew University Medical Center, 91120 Jerusalem, Israel. E-mail:
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13
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Nir-Paz R, Gelman D, Khouri A, Sisson BM, Fackler J, Alkalay-Oren S, Khalifa L, Rimon A, Yerushalmy O, Bader R, Amit S, Coppenhagen-Glazer S, Henry M, Quinones J, Malagon F, Biswas B, Moses AE, Merril G, Schooley RT, Brownstein MJ, Weil YA, Hazan R. Successful Treatment of Antibiotic-resistant, Poly-microbial Bone Infection With Bacteriophages and Antibiotics Combination. Clin Infect Dis 2020; 69:2015-2018. [PMID: 30869755 DOI: 10.1093/cid/ciz222] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/13/2019] [Indexed: 12/26/2022] Open
Abstract
A patient with a trauma-related left tibial infection associated with extensively drug-resistant Acinetobacter baumannii and multidrug-resistant Klebsiella pneumoniae was treated with bacteriophages and antibiotics. There was rapid tissue healing and positive culture eradication. As a result, the patient's leg did not have to be amputated and he is undergoing rehabilitation.
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Affiliation(s)
- Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Daniel Gelman
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University, Jerusalem, Israel.,Tzameret, The Military Track of Medicine, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ayman Khouri
- Orthopedic Surgery Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Sivan Alkalay-Oren
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University, Jerusalem, Israel
| | - Leron Khalifa
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University, Jerusalem, Israel
| | - Amit Rimon
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University, Jerusalem, Israel.,Tzameret, The Military Track of Medicine, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ortal Yerushalmy
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University, Jerusalem, Israel
| | - Reem Bader
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sharon Amit
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Matthew Henry
- The Geneva Foundation and Biological Defense Research Directorate Naval Medical Research Center, Frederick, Maryland
| | - Javier Quinones
- The Geneva Foundation and Biological Defense Research Directorate Naval Medical Research Center, Frederick, Maryland
| | - Francisco Malagon
- The Geneva Foundation and Biological Defense Research Directorate Naval Medical Research Center, Frederick, Maryland
| | - Biswajit Biswas
- The Geneva Foundation and Biological Defense Research Directorate Naval Medical Research Center, Frederick, Maryland
| | - Allon E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Robert T Schooley
- Department of Medicine, Division of Infectious Diseases, University of California San Diego, La Jolla, California
| | | | - Yoram A Weil
- Orthopedic Surgery Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen Hazan
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University, Jerusalem, Israel
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14
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Aouizerat T, Maeir AM, Paz Y, Gadot Y, Szitenberg A, Alkalay-Oren S, Coppenhagen-Glazer S, Klutstein M, Hazan R. Isolation and Characterization of Live Yeast Cells from Ancient Clay Vessels. Bio Protoc 2020; 10:e3473. [PMID: 33654708 DOI: 10.21769/bioprotoc.3473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 11/02/2022] Open
Abstract
Ancient fermented food has been studied mainly based on residue analysis and recipes and reconstruction attempts were performed using modern domesticated yeast. Furthermore, microorganisms which participated in fermentation were studied using ancient-DNA techniques. In a recent paper, we presented a novel approach based on the hypothesis that enriched yeast populations in fermented beverages could have become the dominant species in storage vessels and their descendants could be isolated and studied today. Here we present a pipeline for isolation of yeast from clay vessels uncovered in archeological sites and transferred to the microbiology lab where they can be isolated and characterized. This method opens new avenues for experimental archeology and enables attempts to recreate ancient food and beverages using the original microorganisms.
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Affiliation(s)
- Tzemach Aouizerat
- Institute of Dental Sciences, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aren M Maeir
- Tell es-Safi/Gath Archaeological Project, The Martin (Szusz) Department of Land of Israel and Archaeology, Bar-Ilan University, Ramat-Gan, Israel
| | - Yitzhak Paz
- Israel Antiquities Authority, Jerusalem, Israel
| | | | - Amir Szitenberg
- Microbial Metagenomics Division, Dead Sea and Arava Science Center, Masada, Israel
| | - Sivan Alkalay-Oren
- Institute of Dental Sciences, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shunit Coppenhagen-Glazer
- Institute of Dental Sciences, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Klutstein
- Institute of Dental Sciences, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronen Hazan
- Institute of Dental Sciences, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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15
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Shlezinger M, Coppenhagen-Glazer S, Gelman D, Beyth N, Hazan R. Eradication of Vancomycin-Resistant Enterococci by Combining Phage and Vancomycin. Viruses 2019; 11:v11100954. [PMID: 31623253 PMCID: PMC6833023 DOI: 10.3390/v11100954] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022] Open
Abstract
Currently, effective options are needed to fight vancomycin-resistant Enterococcus faecalis (VRE). The present study shows that combinations of phage and vancomycin are highly efficient against VRE, despite being resistant to the antibiotic. Vancomycin-phage EFLK1 (anti-E. faecalis phage) synergy was assessed against VRE planktonic and biofilm cultures. The effect of the combined treatment on VRE biofilms was determined by evaluating the viable counts and biomass and then visualized using scanning electron microscopy (SEM). The cell wall peptidoglycan was stained after phage treatment, visualized by confocal microscopy and quantified by fluorescence activated cell sorting (FACS) analysis. The combined treatment was synergistically effective compared to treatment with phage or antibiotic alone, both in planktonic and biofilm cultures. Confocal microscopy and FACS analysis showed that fluorescence intensity of phage-treated bacteria increased eight-fold, suggesting a change in the peptidoglycan of the cell wall. Our results indicate that with combined treatment, VRE strains are not more problematic than sensitive strains and thus give hope in the continuous struggle against the current emergence of multidrug resistant pathogens.
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Affiliation(s)
- Mor Shlezinger
- Department of Prosthodontics, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel.
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel.
| | - Shunit Coppenhagen-Glazer
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel.
| | - Daniel Gelman
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel.
| | - Nurit Beyth
- Department of Prosthodontics, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel.
| | - Ronen Hazan
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University, Jerusalem 91120, Israel.
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16
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Gelman D, Beyth S, Lerer V, Adler K, Poradosu-Cohen R, Coppenhagen-Glazer S, Hazan R. Combined bacteriophages and antibiotics as an efficient therapy against VRE Enterococcus faecalis in a mouse model. Res Microbiol 2018; 169:531-539. [PMID: 29777835 DOI: 10.1016/j.resmic.2018.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/06/2018] [Accepted: 04/17/2018] [Indexed: 10/16/2022]
Abstract
Clinical applications of bacteriophage therapy have been recently gathering significant attention worldwide, used mostly as rescue therapy in cases of near-fatal antibiotic failure. Thus, clinically relevant in-vivo models presenting both short- and long-term implications of phage therapy given as rescue treatment for fulminant infections are of highest importance. In this study, a cocktail consisting of two lytic bacteriophages was used to evaluate the therapeutic efficacy of phage therapy as a rescue treatment for severe septic peritonitis in a mouse model. We established that a single injection of the bacteriophage cocktail was sufficient to completely reverse a 100% mortality trend caused by Vancomycin-Resistant Enterococcus faecalis, with significant improvement in both the clinical state and laboratory test results, and without harmful effects on the microbiome. The combination of bacteriophages with a suboptimal antibiotic regimen imparts an additional beneficial effect on the treatment success.
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Affiliation(s)
- Daniel Gelman
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Hadassah Campus, P.O.B 12272, Jerusalem, 91120, Israel; The Military Track of Medicine, Faculty of Medicine, The Hebrew University - Hadassah School of Medicine, Hadassah Campus, P.O.B 12272, Jerusalem, 91120, Israel.
| | - Shaul Beyth
- Orthopedic Surgery Department, Hadassah Medical Center, Hadassah University Hospital, P.O.B 12000, Jerusalem, 91120, Israel.
| | - Vanda Lerer
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Hadassah Campus, P.O.B 12272, Jerusalem, 91120, Israel.
| | - Karen Adler
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Hadassah Campus, P.O.B 12272, Jerusalem, 91120, Israel.
| | - Ronit Poradosu-Cohen
- Department of Infectious Diseases of Sourasky Medical Center and Tel-Aviv University, Tel-Aviv, Israel.
| | - Shunit Coppenhagen-Glazer
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Hadassah Campus, P.O.B 12272, Jerusalem, 91120, Israel.
| | - Ronen Hazan
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Hadassah Campus, P.O.B 12272, Jerusalem, 91120, Israel.
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17
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Khalifa L, Gelman D, Shlezinger M, Dessal AL, Coppenhagen-Glazer S, Beyth N, Hazan R. Defeating Antibiotic- and Phage-Resistant Enterococcus faecalis Using a Phage Cocktail in Vitro and in a Clot Model. Front Microbiol 2018. [PMID: 29541067 PMCID: PMC5835721 DOI: 10.3389/fmicb.2018.00326] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The deteriorating effectiveness of antibiotics is propelling researchers worldwide towards alternative techniques such as phage therapy: curing infectious diseases using viruses of bacteria called bacteriophages. In a previous paper, we isolated phage EFDG1, highly effective against both planktonic and biofilm cultures of one of the most challenging pathogenic species, the vancomycin-resistant Enterococcus (VRE). Thus, it is a promising phage to be used in phage therapy. Further experimentation revealed the emergence of a mutant resistant to EFDG1 phage: EFDG1r. This kind of spontaneous resistance to antibiotics would be disastrous occurrence, however for phage-therapy it is only a minor hindrance. We quickly and successfully isolated a new phage, EFLK1, which proved effective against both the resistant mutant EFDG1r and its parental VRE, Enterococcus faecalis V583. Furthermore, combining both phages in a cocktail produced an additive effect against E. faecalis V583 strains regardless of their antibiotic or phage-resistance profile. An analysis of the differences in genome sequence, genes, mutations, and tRNA content of both phages is presented. This work is a proof-of-concept of one of the most significant advantages of phage therapy, namely the ability to easily overcome emerging resistant bacteria.
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Affiliation(s)
- Leron Khalifa
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniel Gelman
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mor Shlezinger
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Prosthodontics, Hadassah School of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Axel Lionel Dessal
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shunit Coppenhagen-Glazer
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nurit Beyth
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Prosthodontics, Hadassah School of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronen Hazan
- Faculty of Dental Sciences, Hadassah School of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Shlezinger M, Khalifa L, Houri-Haddad Y, Coppenhagen-Glazer S, Resch G, Que YA, Beyth S, Dorfman E, Hazan R, Beyth N. Phage Therapy: A New Horizon in the Antibacterial Treatment of Oral Pathogens. Curr Top Med Chem 2017; 17:1199-1211. [PMID: 27770768 DOI: 10.2174/1568026616666160930145649] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/08/2016] [Accepted: 06/11/2016] [Indexed: 11/22/2022]
Abstract
Dental diseases are perhaps the most prevalent infection-related diseases in humans. Biofilm is involved in almost every infectious disease compromising oral health, notably caries, periodontal disease, gingivitis, endodontic infections and peri-implantitis. Current therapies of biofilm-derived oral infections lack sensitivity; they are not species-specific and kill pathogenic species as well as commensal species, which are protective against the formation of pathogenic biofilms. Moreover, antibiotics have a limited effect on biofilm and are almost unused in oral diseases. A promising alternative approach is bacteriophage (phage) therapy. Phages play a key role in the natural balance in a predator-prey relationship with bacteria and thus have the potential to be efficient anti-bacterial agents. Phages are highly efficient against biofilm, strain specific and easy to isolate and manipulate. Thus, like in many other medicinal fields, phage therapy offers new horizons to dentistry, both therapeutics and research. The present review presents the etiology of common oral diseases, characterization of the infection and the treatment challenges of phage therapy in dentistry. Recent findings and development in the use of phages for prevention, control, and treatment of oral infections as well as possibilities of engineering the oral microbiome are discussed.
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Affiliation(s)
- Mor Shlezinger
- Department of Prosthodontics, Faculty of Dental Sciences Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Leron Khalifa
- Faculty of Dental Sciences Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yael Houri-Haddad
- Department of Prosthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | | | - Grégory Resch
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Shaul Beyth
- Orthopedic Surgery Complex, Hadassah University Hospital, Jerusalem, Israel
| | - Elisheva Dorfman
- Faculty of Dental Sciences Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Ronen Hazan
- Faculty of Dental Sciences Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Nurit Beyth
- Department of Prosthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
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Khalifa L, Shlezinger M, Beyth S, Houri-Haddad Y, Coppenhagen-Glazer S, Beyth N, Hazan R. Phage therapy against Enterococcus faecalis in dental root canals. J Oral Microbiol 2016; 8:32157. [PMID: 27640530 PMCID: PMC5027333 DOI: 10.3402/jom.v8.32157] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/13/2016] [Accepted: 07/27/2016] [Indexed: 12/16/2022] Open
Abstract
Antibiotic resistance is an ever-growing problem faced by all major sectors of health care, including dentistry. Recurrent infections related to multidrug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, and vancomycin-resistant enterococci (VRE) in hospitals are untreatable and question the effectiveness of notable drugs. Two major reasons for these recurrent infections are acquired antibiotic resistance genes and biofilm formation. None of the traditionally known effective techniques have been able to efficiently resolve these issues. Hence, development of a highly effective antibacterial practice has become inevitable. One example of a hard-to-eradicate pathogen in dentistry is Enterococcus faecalis, which is one of the most common threats observed in recurrent root canal treatment failures, of which the most problematic to treat are its biofilm-forming VRE strains. An effective response against such infections could be the use of bacteriophages (phages). Phage therapy was found to be highly effective against biofilm and multidrug-resistant bacteria and has other advantages like ease of isolation and possibilities for genetic manipulations. The potential of phage therapy in dentistry, in particular against E. faecalis biofilms in root canals, is almost unexplored. Here we review the efforts to develop phage therapy against biofilms. We also focus on the phages isolated against E. faecalis and discuss the possibility of using phages against E. faecalis biofilm in root canals.
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Affiliation(s)
- Leron Khalifa
- Institute of Dental Science, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Mor Shlezinger
- Department of Prosthodontics, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Shaul Beyth
- Orthopedic Surgery Complex, Hadassah University Hospital, Jerusalem, Israel
| | - Yael Houri-Haddad
- Department of Prosthodontics, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Shunit Coppenhagen-Glazer
- Institute of Dental Science, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Nurit Beyth
- Department of Prosthodontics, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Ronen Hazan
- Institute of Dental Science, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel;
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Gur C, Ibrahim Y, Isaacson B, Yamin R, Abed J, Gamliel M, Enk J, Bar-On Y, Stanietsky-Kaynan N, Coppenhagen-Glazer S, Shussman N, Almogy G, Cuapio A, Hofer E, Mevorach D, Tabib A, Ortenberg R, Markel G, Miklić K, Jonjic S, Brennan CA, Garrett WS, Bachrach G, Mandelboim O. Binding of the Fap2 protein of Fusobacterium nucleatum to human inhibitory receptor TIGIT protects tumors from immune cell attack. Immunity 2015; 42:344-355. [PMID: 25680274 DOI: 10.1016/j.immuni.2015.01.010] [Citation(s) in RCA: 781] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/19/2014] [Accepted: 01/23/2015] [Indexed: 12/17/2022]
Abstract
Bacteria, such as Fusobacterium nucleatum, are present in the tumor microenvironment. However, the immunological consequences of intra-tumoral bacteria remain unclear. Here, we have shown that natural killer (NK) cell killing of various tumors is inhibited in the presence of various F. nucleatum strains. Our data support that this F. nucleatum-mediated inhibition is mediated by human, but not by mouse TIGIT, an inhibitory receptor present on all human NK cells and on various T cells. Using a library of F. nucleatum mutants, we found that the Fap2 protein of F. nucleatum directly interacted with TIGIT, leading to the inhibition of NK cell cytotoxicity. We have further demonstrated that tumor-infiltrating lymphocytes expressed TIGIT and that T cell activities were also inhibited by F. nucleatum via Fap2. Our results identify a bacterium-dependent, tumor-immune evasion mechanism in which tumors exploit the Fap2 protein of F. nucleatum to inhibit immune cell activity via TIGIT.
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Affiliation(s)
- Chamutal Gur
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC Jerusalem, 91120, Israel; The Rheumatology Research Center, Hadassah-Hebrew University, Jerusalem, 91120, Israel
| | - Yara Ibrahim
- The Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, 91120, Israel
| | - Batya Isaacson
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC Jerusalem, 91120, Israel
| | - Rachel Yamin
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC Jerusalem, 91120, Israel
| | - Jawad Abed
- The Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, 91120, Israel
| | - Moriya Gamliel
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC Jerusalem, 91120, Israel
| | - Jonatan Enk
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC Jerusalem, 91120, Israel
| | - Yotam Bar-On
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC Jerusalem, 91120, Israel
| | - Noah Stanietsky-Kaynan
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC Jerusalem, 91120, Israel
| | - Shunit Coppenhagen-Glazer
- The Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, 91120, Israel
| | - Noam Shussman
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, 91120, Israel
| | - Gideon Almogy
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, 91120, Israel
| | - Angelica Cuapio
- Department of Vascular Biology and Thrombosis Research Medical University of Vienna, 1090, Austria
| | - Erhard Hofer
- Department of Vascular Biology and Thrombosis Research Medical University of Vienna, 1090, Austria
| | - Dror Mevorach
- The Rheumatology Research Center, Hadassah-Hebrew University, Jerusalem, 91120, Israel
| | - Adi Tabib
- The Rheumatology Research Center, Hadassah-Hebrew University, Jerusalem, 91120, Israel
| | - Rona Ortenberg
- Ella Institute of Melanoma, Sheba Medical Center, Ramat-Gan, 526260, Israel
| | - Gal Markel
- Ella Institute of Melanoma, Sheba Medical Center, Ramat-Gan, 526260, Israel
| | - Karmela Miklić
- Department of Histology and Embryology Center for Proteomics, Faculty of Medicine, University of Rijeka, 51000, Croatia
| | - Stipan Jonjic
- Department of Histology and Embryology Center for Proteomics, Faculty of Medicine, University of Rijeka, 51000, Croatia
| | | | - Wendy S Garrett
- Harvard School of Public Health, Boston, MA, 02115, USA; Dana-Farber Cancer Institute, Boston, MA, 02115, USA
| | - Gilad Bachrach
- The Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, 91120, Israel.
| | - Ofer Mandelboim
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC Jerusalem, 91120, Israel.
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Doron L, Coppenhagen-Glazer S, Ibrahim Y, Eini A, Naor R, Rosen G, Bachrach G. Identification and characterization of fusolisin, the Fusobacterium nucleatum autotransporter serine protease. PLoS One 2014; 9:e111329. [PMID: 25357190 PMCID: PMC4214739 DOI: 10.1371/journal.pone.0111329] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/11/2014] [Indexed: 12/30/2022] Open
Abstract
Fusobacterium nucleatum is an oral anaerobe associated with periodontal disease, adverse pregnancy outcomes and colorectal carcinoma. A serine endopeptidase of 61–65 kDa capable of damaging host tissue and of inactivating immune effectors was detected previously in F. nucleatum. Here we describe the identification of this serine protease, named fusolisin, in three oral F. nucleatum sub-species. Gel zymogram revealed fusobacterial proteolytic activity with molecular masses ranging from 55–101 kDa. All of the detected proteases were inhibited by the serine protease inhibitor PMSF. analysis revealed that all of the detected proteases are encoded by genes encoding an open reading frame (ORF) with a calculated mass of approximately 115 kDa. Bioinformatics analysis of the identified ORFs demonstrated that they consist of three domains characteristic of autotransporters of the type Va secretion system. Our results suggest that the F. nucleatum fusolisins are derived from a precursor of approximately 115 kDa. After crossing the cytoplasmic membrane and cleavage of the leader sequence, the C-terminal autotransporter domain of the remaining 96–113 kDa protein is embedded in the outer membrane and delivers the N-terminal S8 serine protease passenger domain to the outer cell surface. In most strains the N-terminal catalytic 55–65 kDa domain self cleaves and liberates itself from the autotransporter domain after its transfer across the outer cell membrane. In F. nucleatum ATCC 25586 this autocatalytic activity is less efficient resulting in a full length membrane-anchored serine protease. The mature serine protease was found to cleave after Thr, Gly, Ala and Leu residues at the P1 position. Growth of F. nucleatum in complex medium was inhibited when serine protease inhibitors were used. Additional experiments are needed to determine whether fusolisin might be used as a target for controlling fusobacterial infections.
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Affiliation(s)
- Lior Doron
- Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Shunit Coppenhagen-Glazer
- Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yara Ibrahim
- Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Amir Eini
- Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Ronit Naor
- Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Graciela Rosen
- Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Gilad Bachrach
- Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
- * E-mail:
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Gur C, Coppenhagen-Glazer S, Rosenberg S, Yamin R, Enk J, Glasner A, Bar-On Y, Fleissig O, Naor R, Abed J, Mevorach D, Granot Z, Bachrach G, Mandelboim O. Natural killer cell-mediated host defense against uropathogenic E. coli is counteracted by bacterial hemolysinA-dependent killing of NK cells. Cell Host Microbe 2014; 14:664-74. [PMID: 24331464 DOI: 10.1016/j.chom.2013.11.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/08/2013] [Accepted: 10/25/2013] [Indexed: 12/30/2022]
Abstract
Uropathogenic Escherichia coli (UPEC) are a common cause of urinary tract infections (UTIs) in humans. While the importance of natural killer (NK) cells in innate immune protection against tumors and viral infections is well documented, their role in defense against bacterial infections is still emerging, and their involvement in UPEC-mediated UTI is practically unknown. Using a systematic mutagenesis approach, we found that UPEC adheres to NK cells primarily via its type I fimbriae and employs its hemolysinA toxin to kill NK cells. In the absence of hemolysinA, NK cells directly respond to the bacteria and secrete the cytokine TNF-α, which results in decreased bacterial numbers in vitro and reduction of bacterial burden in the infected bladders. Thus, NK cells control UPEC via TNF-α production, which UPEC counteracts by hemolysinA-mediated killing of NK cells, representing a previously unrecognized host defense and microbial counterattack mechanism in the context of UTI.
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Affiliation(s)
- Chamutal Gur
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC, Jerusalem 91120, Israel; Internal Medicine Department, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Shunit Coppenhagen-Glazer
- The Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel
| | - Shilo Rosenberg
- Urology Department, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Rachel Yamin
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC, Jerusalem 91120, Israel
| | - Jonatan Enk
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC, Jerusalem 91120, Israel
| | - Ariella Glasner
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC, Jerusalem 91120, Israel
| | - Yotam Bar-On
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC, Jerusalem 91120, Israel
| | - Omer Fleissig
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC, Jerusalem 91120, Israel; The Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel
| | - Ronit Naor
- The Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel
| | - Jawad Abed
- The Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel
| | - Dror Mevorach
- Internal Medicine Department, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Zvi Granot
- Department of Developmental Biology and Cancer Research, The Hebrew University Hadassah Medical School, IMRIC, Jerusalem 91120, Israel
| | - Gilad Bachrach
- The Institute of Dental Sciences, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel.
| | - Ofer Mandelboim
- The Lautenberg Center of General and Tumor Immunology, The Hebrew University Hadassah Medical School, IMRIC, Jerusalem 91120, Israel.
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Rosenberg S, Horowitz R, Coppenhagen-Glazer S, Pizov G, Elia A, Gofrit ON, Ginsburg I, Pode D. Intravesical administration of green tea extract attenuates the inflammatory response of bacterial cystitis - a rat model. BJU Int 2014; 114:601-7. [DOI: 10.1111/bju.12544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Shilo Rosenberg
- Department of Urology; Hadassah Medical Center; Hebrew University; Jerusalem Israel
| | - Ray Horowitz
- Department of Clinical Microbiology and Infectious Diseases; Hadassah Medical Center; Hebrew University; Jerusalem Israel
| | - Shunit Coppenhagen-Glazer
- Institute for Dental Sciences Hebrew University; Hadassah School of Dental Medicine; Jerusalem Israel
| | - Galina Pizov
- Department of Pathology; Hadassah Medical Center; Hebrew University; Jerusalem Israel
| | - Anna Elia
- Department of Urology; Hadassah Medical Center; Hebrew University; Jerusalem Israel
| | - Ofer N. Gofrit
- Department of Urology; Hadassah Medical Center; Hebrew University; Jerusalem Israel
| | - Isaac Ginsburg
- Institute for Dental Sciences Hebrew University; Hadassah School of Dental Medicine; Jerusalem Israel
| | - Dov Pode
- Department of Urology; Hadassah Medical Center; Hebrew University; Jerusalem Israel
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Sol A, Ginesin O, Chaushu S, Karra L, Coppenhagen-Glazer S, Ginsburg I, Bachrach G. LL-37 opsonizes and inhibits biofilm formation of Aggregatibacter actinomycetemcomitans at subbactericidal concentrations. Infect Immun 2013; 81:3577-85. [PMID: 23836819 PMCID: PMC3811755 DOI: 10.1128/iai.01288-12] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 07/02/2013] [Indexed: 12/26/2022] Open
Abstract
Host defense peptides are immediate responders of the innate immunity that express antimicrobial, immunoregulatory, and wound-healing activities. Neutrophils are a major source for oral host defense peptides, and phagocytosis by neutrophils is a major mechanism for bacterial clearance in the gingival tissue. Dysfunction of or reduction in the numbers of neutrophils or deficiency in the LL-37 host defense peptide was each previously linked with proliferation of oral Aggregatibacter actinomycetemcomitans which resulted in an aggressive periodontal disease. Surprisingly, A. actinomycetemcomitans shows resistance to high concentrations of LL-37. In this study, we demonstrated that submicrocidal concentrations of LL-37 inhibit biofilm formation by A. actinomycetemcomitans and act as opsonins and agglutinins that greatly enhance its clearance by neutrophils and macrophages. Improved uptake of A. actinomycetemcomitans by neutrophils was mediated by their opsonization with LL-37. Enhanced phagocytosis and killing of A. actinomycetemcomitans by murine macrophage-like RAW 264.7 cells were dependent on their preagglutination by LL-37. Although A. actinomycetemcomitans is resistant to the bactericidal effect of LL-37, our results offer a rationale for the epidemiological association between LL-37 deficiency and the expansion of oral A. actinomycetemcomitans and indicate a possible therapeutic use of cationic peptides for host defense.
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Affiliation(s)
| | | | - Stella Chaushu
- Department of Orthodontics, The Hebrew University—Hadassah School of Dental Medicine
| | - Laila Karra
- Department of Pharmacology and Experimental Therapeutics, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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