Antibodies against a synthetic peptidoglycan-precursor pentapeptide cross-react with at least two distinct populations of uncross-linked soluble peptidoglycan secreted by Micrococcus luteus cells

Vancomycin covalently bonded to titanium beads kills Staphylococcus aureus

Periprosthetic infections are life-threatening complications that occur in about 6% of medical device insertions. Stringent sterile techniques have reduced the incidence of infections, but many implant patients are at high risk for infection, especially the elderly, diabetic, and immune compromised. Moreover, because of low vascularity at the site of the new implant, antibiotic prophylaxis is often not effective. To address this problem, we designed a covalent modification to titanium implant surfaces to render them bactericidal. Specifically, we aminopropylated titanium, a widely used implant material and extended a tether by solid phase coupling of ethylene glycol linkers, followed by solid phase coupling of vancomycin. Vancomycin covalently attached to titanium still bound soluble bacterial peptidoglycan, reduced Staphylococcus aureus colony-forming units by 88% +/- 16% over 2 hr, and retained antibacterial activity upon a repeated challenge.

Changes in mu opioid receptors and rheological properties of erythrocytes among opioid abusers

Opioids, reported originally to bind to specific receptors in the brain, now also appear to bind to receptors on blood cells. The high prevalence of anemia among chronic opioid users leads us to propose that chronic opiate use results in elevated mu opioid receptor levels on human erythrocytes and that these receptor changes may affect erythrocyte membrane properties. Blood samples from 17 opioid-dependent subjects (based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition or DSM-IV) and 15 drug-free controls were assayed for mu opioid receptors on erythrocytes using a flow cytometry immunoassay. Deformability and the hydration status of erythrocytes were studied by ektacytometry. Data were analyzed by independent t-tests, tests of correlation, chi square and cluster analyses. As expected, the percentage of erythrocytes from opioid-dependent subjects with opioid receptors (opioid receptor levels) was significantly higher (47.4 +/- 38.3%) than controls (22.8 +/- 30.1%) (t = 2.01, df = 30, p < 0.05). Also, the opioid-dependent patients showed a wide variation in the percentage of erythrocytes bearing opioid receptors and data analyses of these patients showed two strongly defined clusters. One subgroup consisted of nine individuals with very high receptor levels (mean = 81.5%) while the other had eight patients with low receptor levels (mean = 9.1%) that were not significantly different than the receptor levels of controls. Ektacytometry of opioid dependent patients with high opioid receptor levels showed changes in rheological parameters of erythrocytes, such as deformability index and cellular hydration. For example, a positive correlation was observed between opioid receptor levels and deformability indices among opioid-dependent patients (r = 0.74, p < 0.005). Our findings indicate that the mu opioid receptor is present on human erythrocytes, although with considerable variation in receptor levels, and that the levels of this receptor are significantly elevated with chronic opioid exposure. Moreover, erythrocytes with high opioid receptor levels from chronic opiate users seem to have high deformability. This study may offer clues to the biological properties of peripheral blood cells that may be mediated by mu opioid receptors and lead to a better understanding of some of the clinical effects of opioid use.

Detection of soluble peptidoglycan in urine after penicillin administration

A unique enzyme-linked immunosorbent assay was developed to detect soluble peptidoglycans in biological fluids. It makes use of the similar affinities of vancomycin and purified rabbit antibodies to peptidoglycan precursor sequences found in soluble peptidoglycans. This assay has been used to detect as little as 500 pg of soluble peptidoglycan per ml of serum and 5 pg/ml of urine. Studies of normal individuals and Staphylococcus aureus-infected patients revealed only a few sera with detectable levels of soluble peptidoglycans. Studies of normal volunteers who were given a single oral dose of 250 mg of penicillin VK showed that about half had detectable levels of soluble peptidoglycans in their urine up to 6 h after ingestion. This suggests that soluble peptidoglycans can be released by indigenous bacteria in detectable amounts. In one volunteer, a detectable level of soluble peptidoglycan in the urine at 6 h decreased to an undetectable level at 12 h. Such an ephemeral appearance of soluble peptidoglycan in the urine could account for the small number of human sera that had detectable levels of soluble peptidoglycan.

Soluble peptidoglycan from Staphylococcus aureus is a murine B-lymphocyte mitogen

Soluble peptidoglycan from Staphylococcus aureus has been shown to be capable of causing murine B lymphocytes from the spleen to proliferate and to secrete immunoglobulins in both an in vitro and an in vivo assay. The optimal concentration in vitro was between 33 and 100 micrograms/ml. A 3-day incubation with soluble peptidoglycan was more stimulatory than was a 1- or 2-day incubation. Removal of most of the T lymphocytes with anti-theta serum did not result in any significant change in the mitogenic activity of soluble peptidoglycan on the remaining B cells.

Evidence for the secretion of soluble peptidoglycans by clinical isolates of Staphylococcus aureus

Four isolates of Staphylococcus aureus from patients with endocarditis and bacteremia were capable of secreting high-molecular-weight soluble peptidoglycans when grown in a minimal cell wall medium containing penicillin G. Vancomycin was not able to substitute for penicillin G in triggering this secretion. Secretion reflected de novo synthesis of soluble peptidoglycan and was strongly dependent on time of incubation (30 to 60 min), and number of bacteria (2 X 10(8) to 5 X 10(8) colony-forming units per ml), but not on penicillin G concentration (10 to 250 micrograms/ml). The incorporation of alanine into the peptidoglycans secreted in vitro by these isolates incubated in the presence of penicillin G under optimal conditions was variable. The least incorporation of alanine into peptidoglycan occurred with an isolate from a patient treated with nafcillin who had no detectable antipeptidoglycan titer.

Antibody levels to bacterial peptidoglycan in human sera during the time course of endocarditis and bacteremic infections caused by Staphylococcus aureus

Sera from patients with endocarditis and bacteremia due to Staphylococcus aureus were compared for peptidoglycan-binding capacity with those from normal blood donors. Those patients treated with beta-lactam antibiotics had higher antigen-binding levels than normal donors and patients treated exclusively with vancomycin (P less than 0.01). The factor responsible for this activity was purified by affinity chromatography from a normal donor and shown to be an immunoglobulin. Specificity studies indicated that the immunodominant determinant was a peptide sequence found in peptidoglycan precursors. Since soluble peptidoglycan molecules having the precursor peptide sequence are known to be secreted by some gram-positive bacteria like Micrococcus luteus when grown in the presence of beta-lactam antibiotics, these soluble molecules may constitute the "natural" immunogen. Such a hypothesis is consistent with the study of the peptidoglycan-binding capacities in the sera of these patients during the course of treatment. For most of the responding patients studied (four of four with bacteremia and seven of nine with endocarditis), a significant increase in peptidoglycan-binding capacity was observed in sera taken 1 to 5 weeks after the initiation of beta-lactam antibiotic therapy (compared with the initial serum studied). No such increase in the peptidoglycan-binding capacity over a similar time span was noted in the sera of people not receiving beta-lactam antibiotics (none of seven).