Genome-wide association study of hemolytic uremic syndrome causing Shiga toxin-producing Escherichia coli from Sweden, 1994-2018

Shiga toxin-producing Escherichia coli (STEC) infection can cause clinical manifestations ranging from diarrhea to potentially fatal hemolytic uremic syndrome (HUS). This study is aimed at identifying STEC genetic factors associated with the development of HUS in Sweden. A total of 238 STEC genomes from STEC-infected patients with and without HUS between 1994 and 2018 in Sweden were included in this study. Serotypes, Shiga toxin gene (stx) subtypes, and virulence genes were characterized in correlation to clinical symptoms (HUS and non-HUS), and pan-genome wide association study was performed. Sixty-five strains belonged to O157:H7, and 173 belonged to non-O157 serotypes. Our study revealed that strains of O157:H7 serotype especially clade 8 were most commonly found in patients with HUS in Sweden. stx2a and stx2a + stx2c subtypes were significantly associated with HUS. Other virulence factors associated with HUS mainly included intimin (eae) and its receptor (tir), adhesion factors, toxins, and secretion system proteins. Pangenome wide-association study identified numbers of accessory genes significantly overrepresented in HUS-STEC strains, including genes encoding outer membrane proteins, transcriptional regulators, phage-related proteins, and numerous genes related to hypothetical proteins. Whole-genome phylogeny and multiple correspondence analysis of pangenomes could not differentiate HUS-STEC from non-HUS-STEC strains. In O157:H7 cluster, strains from HUS patients clustered closely; however, no significant difference in virulence genes was found in O157 strains from patients with and without HUS. These results suggest that STEC strains from different phylogenetic backgrounds may independently acquire genes determining their pathogenicity and confirm that other non-bacterial factors and/or bacteria-host interaction may affect STEC pathogenesis.

Anti-Salmonella activity of lactobacilli from different habitats

Lactic acid bacteria (LAB) may contribute to the food safety. In the present study, the antagonistic activity of 45 Bulgarian Lactobacillus homo- and heterofermentative strains of human and dairy origin, and 4 multibacterial formulas against Salmonella enterica subsp. enterica serovar Typhimurium (S. Typhimurium) was assessed. In vitro tests were performed in different model systems - milk, soymilk, De Man Rogose Sharp (MRS) medium, to simulate real conditions in the food chain. The highest antagonistic activity was observed with cell-free supernatants of exponential MRS broth cultures of the strains isolated from breast milk, followed by lactobacilli from white brined and green cheese. The detected antimicrobial activity against the pathogen was strain-specific and depended on the culture conditions. Lactobacillus (reclassified as Lactoplantibacillus) plantarum strains, cultivated in skimmed milk and whey protein medium, were able to inhibit S. Typhimurium growth, while a limited inhibitory activity was detected for fermented soymilks. A bacteriocinogenic Ligilactobacillus (the previous Lactobacillus) salivarius strain reduced the number of living pathogenic cells during co-cultivation in whole milk. The inhibition was significant only when L. salivarius was inoculated in predominance. In case of underrepresented LAB number, S. Typhimurium over-growth was observed. Eight lactobacilli in combination as a multibacterial co-culture expressed synergic antagonistic effect against Salmonella and were pre-selected as promising. Further characterisation of their active metabolites, however, is needed before their classification as bio-protective agents.

P–049 The presence of double heads is associated with increased frequency of the other sperm abnormalities

Study question

Is there an association between the presence of spermatozoa with double heads and the other sperm abnormalities in human semen?

Summary answer

Patients with double-headed spermatozoa had a significantly increased percentage of morphological abnormalities (head, midpiece and tail defects).

What is known already

The morphological evaluation of spermatozoa has a prognostic value for successful IVF procedure. It has been proven that certain morphological defects have a negative impact on fertilization, embryo quality, and pregnancy outcome in in-vitro fertilization cycles. Sperm abnormalities, such as double head, double tail and thin midpiece are rarely observed. However, their effect on the other sperm defects has not been well studied yet. The aim of this study was to examine the effect of the presence of double-headed spermatozoa on the frequency of occurrence of the other sperm defects.

Study design, size, duration

This retrospective study includes 2140 men aged between 18 and 73 years, with a mean of 36 years. It was conducted at Nadezhda Women’s Health Hospital, Bulgaria between October 2015 and August 2020. A comparative analysis was performed between semen samples with and without double-headed spermatozoa and the other sperm abnormalities, as well as the percentage of morphologically normal forms.

Participants/materials, setting, methods

Morphological analysis was performed according to the Kruger’s strict criteria. Totally 23 types of abnormalities were determined: head defects (small, large, amorphous, elongated, round, pear-shaped, double, acephalic, detached head, small and large acrosomal areas and spermatozoa without acrosome), midpiece defects (thick, bent, asymmetric, thin midpiece and cytoplasmic droplets), tail defects (stumped, coiled and double tail), acrosomal vacuoles, nuclear vacuoles and multiple defects. Statistics: Mann-Whitney U-test and T-test; P ≤ 0.05.

Main results and the role of chance

Presence of double-headed spermatozoa was observed in 12.62% (270/2140) of the studied samples. In these patients the frequency of occurrence of double-headed spermatozoa ranged between 1% and 29% with a mean of 0.41%±1.71%. Men with double-headed spermatozoa had significantly higher percentage of spermatozoa with small heads (24.51%±22.65%, P = 0.04), round heads (11.69%±10.13%, P < 0.01), nuclear vacuoles (10.64%±5.25%, P < 0.01), sperm without acrosome (9.76%±8.61%, P = 0.05), asymmetric midpiece (4.73%±3.96%, P < 0.05), bent midpiece (8.9%±7.22%, P < 0.01), thin midpiece (2.13%±4.44%, P < 0.01), double tail (1.78%±0.8%, P < 0.01), detached head (1.98%±1.42%, P < 0.01), stumped tail (6.03%±5.19%, P = 0.02), and cytoplasmic droplets (8.86%±5.02%, P < 0.01) compared to the patients without double-headed spermatozoa. Moreover, the percentage of sperm with multiple defects in the double-headed group was significantly higher (35.53%±29.91%, P < 0.01), while the percentage of normal forms was significantly lower (2.93%±3.64%, P < 0.01) compared to the patients without double heads.

Limitations, reasons for caution

In this study unequal sample sized groups were compared. We also need to investigate whether the obtained results will be confirmed in patients with certain pathological states, such as oligozoospermia, teratozoospermia, and asthenozoospermia.

Wider implications of the findings: The present study revealed that the presence of double-headed spermatozoa in the ejaculate is related to an increased frequency of the other semen abnormalities. The double-headed spermatozoa could be used as an indicator for the total morphological quality of human spermatozoa

Trial registration number

Not applicable

Whole-genome characterization of hemolytic uremic syndrome-causing Shiga toxin-producing Escherichia coli in Sweden

Shiga toxin-producing Escherichia coli, a foodborne bacterial pathogen, has been linked to a broad spectrum of clinical outcomes ranging from asymptomatic carriage to fatal hemolytic uremic syndrome (HUS). Here, we collected clinical data and STEC strains from HUS patients from 1994 through 2018, whole-genome sequencing was performed to molecularly characterize HUS-associated STEC strains, statistical analysis was conducted to identify bacterial genetic factors associated with severe outcomes in HUS patients. O157:H7 was the most predominant serotype (57%) among 54 HUS-associated STEC strains, followed by O121:H19 (19%) and O26:H11 (7%). Notably, some non-predominant serotypes such as O59:H17 (2%) and O109:H21 (2%) also caused HUS. All O157:H7 strains with one exception belonged to clade 8. During follow-up at a median of 4 years, 41% of the patients had renal sequelae. Fifty-nine virulence genes were found to be statistically associated with severe renal sequelae, these genes encoded type II and type III secretion system effectors, chaperones, and other factors. Notably, virulence genes associated with severe clinical outcomes were significantly more prevalent in O157:H7 strains. In contrast, genes related to mild symptoms were evenly distributed across all serotypes. The whole-genome phylogeny indicated high genomic diversity among HUS-STEC strains. No distinct cluster was found between HUS and non-HUS STEC strains. The current study showed that O157:H7 remains the main cause of STEC-associated HUS, despite the rising importance of other non-O157 serotypes. Besides, O157:H7 is associated with severe renal sequelae in the follow-up, which could be a risk factor for long-term prognosis in HUS patients.

Association between vitamin D, antimicrobial peptides and urinary tract infection in infants and young children

AIM

Vitamin D stimulates production of the endogenous antimicrobial peptides cathelicidin and β-defensin-2, which are expressed in the urinary tract. We investigated vitamin D status and levels of cathelicidin and β-defensin-2 and their association with urinary tract infection (UTI).

METHODS

The study included 120 children under three years of age: 76 children with UTIs and 44 otherwise healthy children with congenital hydronephrosis. Serum 25-hydroxycholecalciferol levels were measured by direct competitive electro-chemiluminescence immunoassay, and plasma cathelicidin and β-defensin-2 concentrations were analysed by enzyme-linked immunosorbent assay.

RESULTS

We found that vitamin D insufficiency and deficiency are prevalent in young children (21%). Serum vitamin D levels negatively correlated with age and were significantly lower in girls. Levels of vitamin D positively correlated with levels of cathelicidin but not with β-defensin-2. Low concentrations of vitamin D were associated with UTIs in girls, but we did not see any correlation with the recurrence of infection at one-year follow-up.

CONCLUSION

Vitamin D deficiency is common and may prove to be a risk factor for UTIs especially in girls. We hypothesise that adequate supplementation with vitamin D may become a way to prevent first-time UTIs.

[SEX HORMONE INFLUENCE ON PERIPHERAL NATURAL KILLER CELLS COUNT]

Proper evaluation of immunological factors connected with pregnancy establishment increased the possibility for exact treatment in high risk gestation cases. Hormonal changes during an ovarian cycle may affect immune response, which is crucial for the embryonic implantation. Peripheral Natural killer (pNK) cells are key components of immune systems and their activities could be regulated by sex hormones. In the present study we investigated the effects of estrogen fluctuation on the number of NK cells in vivo during the early follicular and middle luteal phase of menstrual cycle. In 63 healthy women with at least one full term pregnancy and regular menstrual cycle with duration between 24 and 32 days, blood samples have been collected twice for investigation of CD3/CD16/CD56 positive lymphocytes. The mean pNK count in follicular phase was 11.6% with 4.7% variation. The median was 10.6%. The mean pNK count in luteal phase was 12.1% with 5.1% variation, respectively median for cell number 11.8%. The two-tailed t-test comparison did not find any statistical difference despite the slight elevation of pNK cells count in luteal phase. The insignificant variation in pNK cells count objected the suggestion to evaluate immunological status in women with adverse pregnancy outcome in specific phase of menstrual cycle.

Spastin gene mutations in Bulgarian patients with hereditary spastic paraplegia

Hereditary spastic paraplegia (HSP) is an extremely heterogeneous group of neurodegenerative disorders affecting the longest axons in the central nervous system. The most common genetic form accounting for about 40% of the autosomal-dominant HSP (ADHSP) cases is spastin gene, SPG4. We performed mutation screening of the spastin gene on 36 unrelated HSP patients from three different ethnic groups (Bulgarian, Turks and Gypsies) and found four new mutations and one already reported. The phenotype-genotype correlations in Bulgarian SPG4 patients showed a great difference in the age at disease onset between patients with missense mutations and those harboring deletions and splice-site mutations. Our study is the first to present corroborative clinical data in favor of the general hypothesis that the clinical course of the disease is related to the type of the spastin mutation. The clinical and genealogical findings in Bulgarian SPG4 patients suggest that a positive family history for inheritance as an autosomal-dominant trait is a strong indication for spastin mutation screening.

Negative ion behavior in single- and dual-frequency plasma etching reactors: particle-in-cell/Monte Carlo collision study

Particle-in-cell/Monte Carlo simulations are used to simulate the trajectories and energies of randomly sampled F- and CF-(3) ions in capacitively coupled radio-frequency discharges, in order to clarify the movement of the negative ions in the sheaths and plasma in both single- and dual-frequency regimes, as well as in symmetric and asymmetric discharges. In the single-frequency reactor both types of negative ions are confined in the plasma and the main loss mechanism is recombination with positive ions. In the dual-frequency reactor under certain operating conditions when the sheaths are wide and the bulk plasma is narrow the light F- ions move across from one sheath to the other, and they can even be lost at the electrodes. The main loss mechanisms are then electron detachment and absorption at the electrodes. The much heavier CF-(3) ions are still confined in the bulk and represent the major negative charge. In an asymmetric discharge the electric field in the sheath to the smaller (powered) electrode is much stronger than that in the sheath to the grounded electrode. Consequently, the F- ions reach mainly the grounded electrode.

Numerical investigation of ion-energy-distribution functions in single and dual frequency capacitively coupled plasma reactors

Ion-energy-distribution functions (IEDFs) are numerically investigated in capacitively coupled (cc) radio frequency (rf) Ar/CF(4)/N(2) discharges by a one-dimensional particle-in-cell/Monte Carlo model. The simulation considers electron-neutral collisions, various kinds of collisions of ions (Ar+, CF+3, N+2, F-, and CF-3) with neutral, positive-negative ion, and electron-ion recombination. The influence of pressure, applied voltage amplitude, and applied frequency on the Ar+, CF+3, and N+2 IEDFs is presented. The dependence on the frequency regime is investigated by simulations of the Ar/CF(4)/N(2) mixture in single (13.56 MHz) and dual frequency (2+27 MHz or 1+27 MHz) cc reactors. A comparison of the simulation results with analytical calculations in a collisionless rf sheath is discussed. The results show that the IEDFs shift toward the low energies with increasing pressure or decreasing applied voltage amplitude. The Ar+ and N+2 IEDFs exhibit secondary maxima due to the charge transfer collisions. The CF+3 IEDF has a peak at high energies in consistency with the average sheath potential drop. The IEDFs in the dual frequency regime are broad and bimodal.

[Lansinoh in the treatment of sore nipples in breastfeeding women]

The aim of the study was to assess the efficacy and side effects of purified lanolin (Lansinoh) in the prophylactics and treatment of sore nipples. Fifty-seven women aged 20-35 years have been treated - 41 (72%) with phototype III-IV and 16 (28%) with phototype I-II. Thirty-seven (65%) of them were primiparous and 20 (35%) were multiparous. Pre-delivery preparation of the breast has been performed in 16 (28%) of the women. Two groups of patients were formed: I gr. - 10 women (17,5%) with no complaints applying the preparation with preventive aim and II gr. - 47 (82,5%) women with sore nipples of different severity. Therapeutic efficacy was assessed according to the nipple attribute score. In the first group of patients due to the application of Lansinoh the skin remained smooth and elastic and breast-feeding was not disturbed. In the II group Lansinoh lead to a statistically significant difference in the nipple attribute score before and after treatment. The improvement was most pronounced in patients with light and moderate forms of inflammation, in women with phototype III-IV, in multipara and in patients with pre-delivery preparation of the breast.

CONCLUSION

Lansinoh is purified lanolin suitable for prophylactics and treatment of sore nipples.

[The transfer of genes for Brown Rust resistance from Aegilops umbellulata Eig. to wheat (Triticum aestivum L.) genome]

The potential of a genome-substituted form Avrolata (AABBUU) as a genetic system in genomic and chromosome manipulations for gene transfer from the wild species Aegilops umbellulata Eig. (UU) to cultivated wheat was studied. It was shown that plants combining resistance to leaf brown rust with high productivity may be produced from this form by classical hybridization procedures. The resistance gene introduced to line R-12 is dominant and probably identical to the Lr9 gene. By N-banding, chromosome staining technique and gliadin electrophoresis, the structural changes in chromosomes 1A, 2A, 4B, 6B, 7B, 1D, and 2D of the resistant line R-12 were revealed.

Gene mapping in Gypsies identifies a novel demyelinating neuropathy on chromosome 8q24

Founder effect and linkage disequilibrium have been successfully exploited to map single gene disorders, and the study of isolated populations is emerging as a major approach to the investigation of genetically complex diseases. In the search for genetic isolates ranging from Pacific islands to Middle East deserts, the 10 million Gypsies resident in Europe have largely escaped the attention of geneticists. Because of their geographical ubiquity, lack of written history and the presumed social and cultural nature of their isolation, Gypsies are construed as not meeting the criteria for a well defined founder population. Gypsy society has a complex structure with subdivisions and stratifications that are incomprehensible to the surrounding populations. Marginalization by the health care systems in most countries results in a lack of information on causes of morbidity and mortality and little is known about hereditary disorders or the population genetic characteristics of Gypsies. This study is the first example of mapping a disease gene in endogamous Gypsy groups. Using lod score analysis and linkage disequilibrium, we have located a novel demyelinating neuropathy to a narrow interval on chromosome 8q24. We show that the disease, occurring in Gypsy groups of different identity and history of migrations, is caused by a single mutation whose origin predates the divergence of these groups.

Comparative analysis of sister-chromatid exchanges in plant and human chromosomes

Species specificity concerning the two main SCE characteristics, namely frequency and localization, of "spontaneous" SCEs in plant cells (root tips of Crepis capillaris) and in human lymphocytes was investigated under comparable conditions. The FPG technique was used for detection of SCEs after bifilar incorporation of BrdU into DNA (TB-BB). Data of parallel experiments showed that the frequency of SCEs in plant cells was considerably higher than that observed in human lymphocytes--13.2 and 7.3 SCEs per cell respectively. The difference was even more pronounced when the SCE frequency was estimated on the basis of DNA content/cell (pg). Analysis of SCE distribution was limited to SCEs localized in the centromere, since contradictory results most frequently concerned this chromosome region. The data of the present experiments showed that the frequency of SCEs localized in the centromere regions of plant chromosomes was considerably lower than that observed in human chromosomes. Compared with the relative sizes of the centromere regions in the two genomes, however, these frequencies proved to be quite similar. In both systems the centromeres were involved in SCE, as could be expected for random distribution, along the length of the chromosomes.

On the genotoxicity of the pesticides Endodan and Kilacar in 6 different test systems

Two pesticides, the fungicide Endodan (ethylene thiuram monosulphide) and the insecticide-acaricide Kilacar (bis(parachlorophenyl)cyclopropyl methanol), produced or used in the neighbouring countries of Bulgaria and Greece were investigated in a coordinated research programme for their genotoxic effects in a variety of test systems. This included the Ames test, Aspergillus nidulans for mitotic segregation, in vitro human lymphocyte cell cultures for SCE and chromosomal aberrations, in vivo bone marrow cells in hamsters and rats and the dominant lethal test in rats. The genotoxicity of Endodan was found to range from negative to slightly positive in different test systems. At concentrations of 7.5 and 12.0 micrograms/plate together with S9 mix it induced base-pair substitutions in the TA100 strain of Salmonella typhimurium at a rather low level. At a dose of 93 mg/kg b.w. it also caused chromosomal aberrations in acutely treated hamster bone marrow cells. A significant increase of SCE was also found in human lymphocyte cultures at a concentration of 20.0 micrograms/ml. Endodan was found to be negative in A. nidulans for somatic segregation, lymphocyte cultures for chromosomal aberrations and mitotic activity and in rats for dominant lethals and chromosomal aberrations. Kilacar was found to be a weak mutagen in the TA97 strain of S. typhimurium at concentrations of 2.5 and 5.0 micrograms/plate together with S9 mix. At concentrations of 1.0, 1.5 and 2 micrograms/ml Kilacar increased the number of mitotic segregants in A. nidulans by 160%, 220% and 156% respectively over the control. In Syrian hamster bone marrow cells after acute administration at concentrations of 0, 40, 80 and 160 mg/kg, the MI was 5.50, 4.30, 3.10 and 1.30 respectively, and an increase in chromosomal aberrations of about 300% over the control was observed with a concentration of 80 mg/kg. In human lymphocytes no significant changes were observed in either MI or SCE. In the dominant lethal test after chronic treatment of male rats at doses of 5.1, 10.2 and 102.0 mg/kg b.w. no significant mutagenic effect was found although a decrease was shown in the percentage of females with implants mated with treated males in the first week.