POS0466 RESISTANT STARCH DIET IMPROVES DISTINCT GUT MICROBIOTA STRUCTURES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID SYNDROME

Background

Fiber-poor diets are linked to a reduction in gut microbiota diversity and gut barrier integrity, which is thought to promote the susceptibility to chronic inflammatory disorders1,2. We have previously shown that dietary resistant starch (RS) improves lupus-like disease in a murine model of SLE3 through the modulation of microbiota composition. If similar dysbiotic microbial community structures exist in subsets of SLE patients and if a RS intervention may be efficacious in those patients remains unclear.

Objectives

To test if the dietary RS content in SLE and SLE-related antiphospholipid syndrome (APS) affect gut microbial taxa associated with SLE in published cohorts to date.

Methods

We obtained stool and blood samples as well as diet history for up to 3 visits (0, 4 and 8 weeks) from 12 SLE (n=28) and 15 APS (n=44) patients as well as 20 controls (n=48) as previously published4-6. Microbiota composition was defined by 16S rRNA V4 region sequencing on the Illumina platform and correlated with dietary fiber content extracted from a diet questionnaire. We used the FDA reference list to determine dietary RS contents in patients` regular diets and defined RS quantities as being low if less than 2.5 g/day and as medium if 2.5 to 15 g/day. None of the patients achieved high RS greater than 15 g/day. Mann-Whitney or Kruskal-Wallis tests were performed to compare bacteria relative abundances among the different groups. Simple linear regression was performed to relate the bacterial abundance to RS content and other metadata.

Results

Medium intake of RS was associated with beneficial Bifidobacterium spp. in SLE patients (p=0.016) but not APS (p=0.509). Instead, APS patients who consumed medium quantities of RS in their diets had less gut bacterial taxa that are capable of producing cardiolipins (among them Collinsella; p=0.009) and Ruminococcus gnavus (p=0.0142), a species previously associated with lupus nephritis7. A recent Japanese metagenome-wide study8 associated Streptococcus spp. and related redox reaction genes with SLE, which may also affect oxidative processes in APS9. We therefore also explored Streptococcus levels in SLE and APS patients and found unexpectedly a significant reduction of streptococci in a subset of APS (p=0.004) but not SLE patients (p=0.451) in medium compared to low RS dietary content. Streptococcus abundance was correlated with both Collinsella (R2=0.3141; p=<0,0001) and Ruminococcus gnavus (R2=0.1687; p=<0,0056) in APS patients.

Conclusion

Medium compared to low RS quantities in the regular diets of SLE and APS patients were associated with unique alterations in gut microbial community structures. Bifidobacterium increased in SLE patients with diets containing medium RS whereas APS patients with medium RS carried less cardiolipin-synthesizing taxa and lupus-related pathobionts. In particular, Streptococcus species recently strongly associated with SLE and redox reactions in Japanese patients in a metagenome-wide study8, were significantly suppressed in APS patients on medium RS diets. This modulatory effect was not seen in SLE patients or control subjects consuming medium RS. Together, these findings support distinct dietary effects on autoimmune gut microbiomes depending on the disease state. They also suggest potential beneficial effects of increased RS content on gut microbiota in SLE and APS patients. Fully resolving gut microbial signatures and clinical characteristics in these patients may identify the ideal subset to benefit from an interventional pilot trial with RS.

References

[1] Thorburn et al., 2014, Immunity 19, 833-842

[2] Ruff et al, 2020, Nat Rev Microbiol 18, 521-538

[3] Zegarra-Ruiz et al., 2019, Cell Host Microbe 25, 113-127

[4] Greiling et al., 2018, Science Transl Med 10, 1–15

[5] Manfredo Vieira et al, 2018, Science 359, 1156-1161

[6] Ruff et al., 2019, Cell Host Microbe 26, 1–14

[7] Azzouz et al., 2019, Ann Rheum Dis 78, 947–956

[8] Tomofuji et al., 2021, Ann Rheum Dis 80, 1575–1583

[9] Giannakopoulos and Krilis, 2013, New Engl J Med 368, 1033-1044

Acknowledgements

The work was supported by grants from the National Institutes of Health (NIH) (R01AI118855, T32AI07019), Arthritis National Research Foundation, Arthritis Foundation, Lupus Research Alliance, and Maren Foundation.

Disclosure of Interests

Márcia Pereira: None declared, Iryna Kulyk: None declared, Sylvio Redanz: None declared, William E Ruff: None declared, Teri M. Greiling: None declared, Carina Dehner: None declared, Odelya Pagovich: None declared, Daniel Zegarra Ruiz: None declared, Cassyanne Aguiar: None declared, Doruk Erkan: None declared, Martin Kriegel Speakers bureau: Novartis, BMS, GSK, MSD, Grant/research support from: AbbVie, Employee of: Roche.

[The role of the microbiome in lupus and antiphospholipid syndrome]

Systemic lupus erythematosus (SLE) and antiphospholipid syndrome are related, systemic autoimmune diseases of unclear etiology. Genetically predisposing factors are known; however, these alone cannot be decisive for the onset and severity of these diseases. This article explains the role of the bacterial microbiome in the origin and progression of these rheumatic diseases. The most recent knowledge in the field of microbiome research based on animal experimental approaches, patient cohorts and human samples is summarized. Various commensal bacteria that promote autoimmunity, so-called pathobionts, which originate from the gut, the skin and the oral cavity, are described. Additionally, their different mechanisms of action are described: Enterococcus gallinarum and Limosilactobacillus reuteri induce adaptive autoimmunity and innate type I interferon pathways via translocation from the small intestine to the liver and spleen; Bacteroides thetaiotaomicron, Actinomyces massiliensis, Pseudopropionibacterium propionicum, Corynebacterium amycolatum, Ruminococcus gnavus and Roseburia intestinalis lead to the formation of pathogenic T‑cell and autoantibody responses via the cross-reactivity with autoantigens (Ro60, dsDNA and ß₂ glycoprotein I). Finally, potential future treatment approaches are also discussed, such as immunization against certain pathobionts or the targeted modulation of the microbiome via dietary approaches, which can successfully reduce autoimmune pathologies in animal models.

Malignant T Cell Activation by a Bacillus Species Isolated from Cutaneous T-Cell Lymphoma Lesions

Cutaneous T-cell lymphoma (CTCL) is a life-debilitating malignancy of lymphocytes homing to the skin. Although CTCL is thought to arise from a combination of genetic, epigenetic, and environmental factors, specific triggers are unclear. The skin is colonized by a unique microbiota and is heavily influenced by its interactions. We hypothesized that adaptive immune responses to skin commensals lead to clonal T-cell proliferation and transformation in the appropriate genetic background. We therefore collected lesional and nonlesional skin microbiota from patients with CTCL to study T cell interactions using skin T cell explants and peripheral, skin-homing CD4⁺ T cells. By various methods, we identified Bacillus safensis in CTCL lesions, a rare human commensal in healthy skin, and showed that it can induce malignant T cell activation and cytokine secretion. Taken together, our data suggest microbial triggers in the skin microbiota of patients with CTCL as potential instigators of tumorigenesis.

Skin Deep: The Role of the Microbiota in Cutaneous Autoimmunity

The skin microbiota is thought to possibly contribute to the pathogenesis of skin autoimmune diseases. The gut microbiota affects systemically the development and function of the immune system, thereby potentially influencing cutaneous autoimmunity as well. In this paper, we review the role of the gut and skin microbiota in cutaneous autoimmune diseases. Besides direct inflammatory effects at the skin barrier, microbiota may contribute to the pathogenesis of skin autoimmune diseases by metabolites, recall immune cell responses, and permeation of antigens to the subepidermal space. Skin and gut barrier dysfunction may represent a common pathophysiologic process allowing microbiota or its particles to promote autoimmune diseases at barrier surfaces.

Differential Response of Oral Mucosal and Gingival Cells to Corynebacterium durum, Streptococcus sanguinis, and Porphyromonas gingivalis Multispecies Biofilms

Polymicrobial interactions with oral mucosal surfaces determine the health status of the host. While a homeostatic balance provides protection from oral disease, a dysbiotic polymicrobial community promotes tissue destruction and chronic oral diseases. How polymicrobial communities transition from a homeostatic to a dysbiotic state is an understudied process. Thus, we were interested to investigate this ecological transition by focusing on biofilm communities containing high abundance commensal species and low abundance pathobionts to characterize the host-microbiome interactions occurring during oral health. To this end, a multispecies biofilm model was examined using the commensal species Corynebacterium durum and Streptococcus sanguinis and the pathobiont Porphyromonas gingivalis. We compared how both single and multispecies biofilms interact with different oral mucosal and gingival cell types, including the well-studied oral keratinocyte cell lines OKF4/TERT-1and hTERT TIGKs as well as human primary periodontal ligament cells. While single species biofilms of C. durum, S. sanguinis, and P. gingivalis are all characterized by unique cytokine responses for each species, multispecies biofilms elicited a response resembling S. sanguinis single species biofilms. One notable exception is the influence of P. gingivalis upon TNF-α and Gro-α production in hTERT TIGKs cells, which was not affected by the presence of other species. This study is also the first to examine the host response to C. durum. Interestingly, C. durum yielded no notable inflammatory responses from any of the tested host cells, suggesting it functions as a true commensal species. Conversely, S. sanguinis was able to induce expression and secretion of the proinflammatory cytokines IL-6 and IL-8, demonstrating a much greater inflammatory potential, despite being health associated. Our study also demonstrates the variability of host cell responses between different cell lines, highlighting the importance of developing relevant in vitro models to study oral microbiome-host interactions.

Targeted Swabbing of Implant-Associated Biofilm Formation-A Staining-Guided Sampling Approach for Optimizing Routine Microbiological Diagnostics

Background: Swabbing of implants removed from potentially infected sites represents a time saving and ubiquitously applicable alternative to sonication approaches. The latter bears an elevated risk of processing related contaminations due to the high number of handling steps. Since biofilms are usually invisible to the naked eye, adequate swabbing relies on the chance of hitting the colonized area on the implant. A targeted directed swabbing approach could overcome this detriment. Method: Three dyes were tested at different concentrations for their toxicity on biofilm-associated cells of S. epidermidis, the species most frequently identified as a causative agent of implant-associated infections. Results: Malachite green (0.2%) delivered the highest bacterial recovery rates combined with the best results in biofilm visualization. Its suitability for diagnostic approaches was demonstrated for smooth and rough implant surfaces. Biofilm-covered areas were successfully visualized. Conclusion: Subsequent targeted swab-sampling resulted in a significantly increased bacterial recovery rate compared to a dye-free “random swabbing” diagnostic approach.

Magnesium-Dependent Promotion of H2O2 Production Increases Ecological Competitiveness of Oral Commensal Streptococci

The pyruvate oxidase (SpxB)-dependent production of H₂O₂ is widely distributed among oral commensal streptococci. Several studies confirmed the ability of H₂O₂ to antagonize susceptible oral bacterial species, including caries-associated Streptococcus mutans as well as several periodontal pathobionts. Here we report a potential mechanism to bolster oral commensal streptococcal H₂O₂ production by magnesium (Mg²⁺) supplementation. Magnesium is a cofactor for SpxB catalytic activity, and supplementation increases the production of H₂O₂ in vitro. We demonstrate that Mg²⁺ affects spxB transcription and SpxB abundance in Streptococcus sanguinis and Streptococcus gordonii. The competitiveness of low-passage commensal streptococcal clinical isolates is positively influenced in antagonism assays against S. mutans. In growth conditions normally selective for S. mutans, Mg²⁺ supplementation is able to increase the abundance of S. sanguinis in dual-species biofilms. Using an in vivo biophotonic imaging platform, we further demonstrate that dietary Mg²⁺ supplementation significantly improves S. gordonii oral colonization in mice. In summary, our results support a role for Mg²⁺ supplementation as a potential prebiotic to promote establishment of oral health-associated commensal streptococci.

Synergism between Corynebacterium and Streptococcus sanguinis reveals new interactions between oral commensals

The oral microbiome engages in a diverse array of highly sophisticated ecological interactions that are crucial for maintaining symbiosis with the host. Streptococci and corynebacteria are among the most abundant oral commensals and their interactions are critical for normal biofilm development. In this study, we discovered that Streptococcus sanguinis specifically responds to the presence of Corynebacterium durum by dramatically altering its chain morphology and improving its overall fitness. By employing gas chromatography-mass spectrometry (GC-MS) analysis, specific fatty acids were identified in C. durum supernatants that are responsible for the observed effect. Membrane vesicles (MVs) containing these fatty acids were isolated from C. durum supernatants and were able to replicate the chain morphology phenotype in S. sanguinis, suggesting MV as a mediator of interspecies interactions. Furthermore, S. sanguinis responds to C. durum lipids by decreasing the expression of key FASII genes involved in fatty acid synthesis. Several of these genes are also essential for the chain elongation phenotype, which implicates a regulatory connection between lipid metabolism and chain elongation. In addition, C. durum was found to affect the growth, cell aggregation, and phagocytosis of S. sanguinis, revealing a complex association of these species that likely supports oral commensal colonization and survival.

Antibiotics release from cement spacers used for two-stage treatment of implant-associated infections after total joint arthroplasty

Two‐stage revision arthroplasty is the treatment of choice for periprosthetic infection, a serious complication after knee or hip arthroplasty. Our prospective clinical trial aimed to investigate the concentrations of gentamicin and vancomycin in wound exudate and tissue in two‐stage revision arthroplasty. Wound exudate and periprosthetic membrane samples were collected from 18 patients (10 hip and eight knee patients), who were due for two‐stage treatment after a periprosthetic joint infection. Samples were taken during insertion of antibiotic‐impregnated spacers and after their removal. The concentrations of gentamicin and vancomycin in wound exudates and adjacent tissue were analyzed using high‐performance liquid chromatography mass spectrometry. Average time period of spacer implantation was 13.6 weeks (9.3–22.6 weeks). The concentration of vancomycin in wound exudate decreased from a median of 43.28 μg/mL (0.28–261.22) after implantation to 0.46 μg/mL (0.13–37.47) after the removal of the spacer. In the adjacent tissue, vancomycin concentration was mainly undetectable prior to spacer implantation (0.003 μg/g [0.003–0.261]) and increased to 0.318 μg/g [0.024–484.16] at the time of spacer removal. This was also observed for gentamicin in the tissue of patients who previously had cement‐free implants (0.008 μg/g [0.008–0.087] vs. 0.164 μg/g [0.048–71.75]) while in the tissue of patients with previously cemented prosthesis, baseline concentration was already high (8.451 μg/g [0.152–42.926]). Despite the rapid decrease in antibiotics release from spacer cement observed in vitro, in vivo antibiotics are much longer detectable, especially in the adjacent soft tissue. © 2018 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published By Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2019. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1587–1597, 2019.

Influence of Probiotic Culture Supernatants on In Vitro Biofilm Formation of Staphylococci

Background

The effects of cell-free culture supernatants of probiotic Lactobacillus rhamnosus GG and Streptococcus salivarius K12 on replication and biofilm forming of Staphylococcus aureus and S. epidermidis were assessed in vitro.

Methods

S. aureus and S. epidermidis strains were exposed to cell-free culture supernatants of L. rhamnosus GG and S. salivarius K12 at different concentrations starting at 0, 4, and 24 h after the onset of incubation. Bacterial amplification was measured on microplate readers, as well as biofilm growth after safranine staining. Scanning electron microscopy was performed for visualization of biofilm status.

Results

The S. salivarius K12 culture supernatant not only reduced or prevented the formation and maturation of fresh biofilms but even caused a reduction of preformed S. epidermidis biofilms. The L. rhamnosus GG culture supernatant did not show clear inhibitory effects regardless of concentration or time of addition of supernatant, and even concentration-depending promotional effects on the planktonic and biofilm growth of S. aureus and S. epidermidis were observed.

Conclusion

In particular, the inhibitory effects of the S. salivarius K12 culture supernatant on the formation of staphylococcal biofilms are of potential relevance for biofilm-associated diseases and should be further assessed by in vivo infection models.

Live and let die: Hydrogen peroxide production by the commensal flora and its role in maintaining a symbiotic microbiome

The majority of commensal oral streptococci are able to generate hydrogen peroxide (H₂ O₂ ) during aerobic growth, which can diffuse through the cell membrane and inhibit competing species in close proximity. Competing H₂ O₂ production is mainly dependent upon the pyruvate oxidase SpxB, and to a lesser extent the lactate oxidase LctO, both of which are important for energy generation in aerobic environments. Several studies point to a broad impact of H₂ O₂ production in the oral environment, including a potential role in biofilm homeostasis, signaling, and interspecies interactions. Here, we summarize the current research regarding oral streptococcal H₂ O₂ generation, resistance mechanisms, and the ecological impact of H₂ O₂ production. We also discuss the potential therapeutic utility of H₂ O₂ for the prevention/treatment of dysbiotic diseases as well as its potential role as a biomarker of oral health.

Augmented recovery of microorganisms from swabs by homogenization: a novel standardizable high-throughput approach

A new approach introducing a quantitative and standardizable step into sample processing was evaluated by homogenizing in vitro inoculated swab tips with Precellys 24 high-throughput homogenizer. Recovery of microorganisms from homogenized swab tips was significantly higher as compared to conventional processing methods. Thus, swab homogenization is a promising approach introducing a new quality in microbial analysis.

Improved microbiological diagnostic due to utilization of a high-throughput homogenizer for routine tissue processing

Tissue specimens are valuable materials for microbiological diagnostics and require swift and accurate processing. Established processing methods are complex, labor intensive, hardly if at all standardizable, and prone to incorporate contaminants. To improve analyses from tissue samples in routine microbiological diagnostics, by facilitating, fastening, and standardizing processing as well as increasing the microbial yield, performance of Precellys 24 high-throughput tissue homogenizer was evaluated. Therefore, tissue samples were artificially inoculated with Staphylococcus aureus, Escherichia coli, and Candida albicans in 3 different ways on the surface and within the material. Microbial yield from homogenized samples was compared to direct plating method. Further, as proof of principle, routine tissue samples from knee and hip endoprosthesis infections were analyzed. The process of tissue homogenization with Precellys 24 homogenizer is easy and fast to perform and allows for a high degree of standardization. Microbial yield after homogenization was significantly higher as compared to conventional plating technique.

Heterologous expression of sahH reveals that biofilm formation is autoinducer-2-independent in Streptococcus sanguinis but is associated with an intact activated methionine cycle

Numerous studies have claimed deleterious effects of LuxS mutation on many bacterial phenotypes, including bacterial biofilm formation. Genetic complementation mostly restored the observed mutant phenotypes to WT levels, leading to the postulation that quorum sensing via a family of molecules generically termed autoinducer-2 (AI-2) is essential for many phenotypes. Because LuxS mutation has dual effects, this hypothesis needs to be investigated into the details for each bacterial species. In this study we used S. sanguinis SK36 as a model biofilm bacterium and employed physiological characterization and transcriptome approaches on WT and luxS-deficient strains, in combination with chemical, luxS, and sahH complementation experiments. SahH enables a direct conversion of SAH to homocysteine and thereby restores the activated methionine cycle in a luxS-negative background without formation of the AI-2 precursor 4,5-dihydroxy-2,3-pentanedione. With this strategy we were able to dissect the individual contribution of LuxS and AI-2 activity in detail. Our data revealed that S. sanguinis biofilm formation is independent from AI-2 substance pools and is rather supported by an intact activated methyl cycle. Of 216 differentially transcribed genes in the luxS mutant, 209 were restored by complementation with a gene encoding the S-adenosylhomocysteine hydrolase. Only nine genes, mainly involved in natural competence, were directly affected by the AI-2 quorum-sensing substance pool. Cumulatively, this suggested that biofilm formation in S. sanguinis is not under control of AI-2. Our study suggests that previously evaluated LuxS mutants in other species need to be revisited to resolve the precise contribution of AI-2 substance pools and the methionine pathways.

A five-species transcriptome array for oral mixed-biofilm studies

Background

Oral polymicrobial interactions and biofilm formation are associated with initiation and progression of caries, gingivitis, and periodontitis. Transcriptome studies of such interactions, allowing a first mechanistic insight, are hampered by current single-species array designs.

Methodology/Principal Findings

In this study we used 385 K NimbleGene™ technology for design and evaluation of an array covering the full genomes of 5 important physiological-, cariogenic-, and periodontitis-associated microorganisms (Streptococcus sanguinis, Streptococcus mutans, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, and Porphyromonas gingivalis). Array hybridization was done with cDNA from cultures grown for 24 h anaerobically. Single species experiments identified cross-species hybridizing array probes. These probes could be neglected in a mixed-species experimental setting without the need to exclude the whole genes from the analysis. Between 69% and almost 99% of the genomes were actively transcribed under the mono-species planktonic, monolayer, and biofilm conditions. The influence of Streptococcus mitis (not represented on the array) on S. mutans gene transcription was determined as a test for a dual-species mixed biofilm setup. Phenotypically, under the influence of S. mitis an increase in S. mutans biofilm mass and a decrease in media pH-value were noticed, thereby confirming previously published data. Employing a stringent cut-off (2-fold, p<0.05), 19 S. mutans transcripts were identified with increased abundance, and 11 with decreased abundance compared to a S. mutans mono-species biofilm. Several of these genes have previously been found differentially regulated under general and acid stress, thereby confirming the value of this array.

Conclusions/Significance

This new array allows transcriptome studies on multi-species oral biofilm interactions. It may become an important asset in future oral biofilm and inhibitor/therapy studies.

Setup of an in vitro test system for basic studies on biofilm behavior of mixed-species cultures with dental and periodontal pathogens

Background

Caries and periodontitis are important human diseases associated with formation of multi-species biofilms. The involved bacteria are intensively studied to understand the molecular basis of the interactions in such biofilms. This study established a basic in vitro single and mixed-species culture model for oral bacteria combining three complimentary methods. The setup allows a rapid screening for effects in the mutual species interaction. Furthermore, it is easy to handle, inexpensive, and reproducible.

Methods

Streptococcus mitis, S. salivarius and S. sanguinis, typical inhabitants of the healthy oral cavity, S. mutans as main carriogenic species, and Porphyromonas gingivalis, Fusobacterium nucleatum, Parvimonas micra, S. intermedius and Aggregatibacter actinomycetemcomitans as periodontitis-associated bacteria, were investigated for their biofilm forming ability. Different liquid growth media were evaluated. Safranin-staining allowed monitoring of biofilm formation under the chosen conditions. Viable counts and microscopy permitted investigation of biofilm behavior in mixed-species and transwell setups.

Findings

S. mitis, F. nucleatum, P. gingivalis and P. micra failed to form biofilm structures. S. mutans, S. sanguinis, S. intermedius and S. salivarius established abundant biofilm masses in CDM/sucrose. A. actinomycetemcomitans formed patchy monolayers. For in depth analysis S. mitis, S. mutans and A. actinomycetemcomitans were chosen, because i) they are representatives of the physiological-, cariogenic and periodontitis-associated bacterial flora, respectively and ii) their difference in their biofilm forming ability. Microscopic analysis confirmed the results of safranin staining. Investigation of two species combinations of S. mitis with either S. mutans or A. actinomycetemcomitans revealed bacterial interactions influencing biofilm mass, biofilm structure and cell viability.

Conclusions

This setup shows safranin staining, microscopic analysis and viable counts together are crucial for basic examination and evaluation of biofilms. Our experiment generated meaningful results, exemplified by the noted S. mitis influence, and allows a fast decision about the most important bacterial interactions which should be investigated in depth.