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Hreha TN, Collins CA, Cole EB, Jin RJ, Hunstad DA. Androgen exposure impairs neutrophil maturation and function within the infected kidney. mBio 2024; 15:e0317023. [PMID: 38206009 PMCID: PMC10865792 DOI: 10.1128/mbio.03170-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
Urinary tract infections (UTIs) in men are uncommon yet carry an increased risk for severe pyelonephritis and other complications. In models of Escherichia coli UTI, C3H/HeN mice develop high-titer pyelonephritis (most with renal abscesses) in a testosterone-dependent manner, but the mechanisms underlying this phenotype are unknown. Here, using female mouse models, we show that androgen exposure impairs neutrophil maturation in the upper and lower urinary tract, compounded by a reduction of neutrophil function within the infected kidney, enabling persistent high-titer infection and promoting abscess formation. Following intravesical inoculation with uropathogenic E. coli (UPEC), kidneys of androgen-exposed C3H mice showed delayed local pro-inflammatory cytokine responses while robustly recruiting neutrophils. These were enriched for an end-organ-specific population of aged but immature neutrophils (CD49d+, CD101-). Compared to their mature counterparts, these aged immature kidney neutrophils exhibited reduced function in vitro, including impaired degranulation and diminished phagocytic activity, while splenic, bone marrow, and bladder neutrophils did not display these alterations. Furthermore, aged immature neutrophils manifested little phagocytic activity within intratubular UPEC communities in vivo. Experiments with B6 conditional androgen receptor (AR)-deficient mice indicated rescue of the maturation defect when AR was deleted in myeloid cells. We conclude that the recognized enhancement of UTI severity by androgens is attributable, at least in part, to local impairment of neutrophil maturation in the urinary tract (largely via cell-intrinsic AR signaling) and a kidney-specific reduction in neutrophil antimicrobial capacity.IMPORTANCEAlthough urinary tract infections (UTIs) predominantly occur in women, male UTIs carry an increased risk of morbidity and mortality. Pyelonephritis in androgen-exposed mice features robust neutrophil recruitment and abscess formation, while bacterial load remains consistently high. Here, we demonstrate that during UTI, neutrophils infiltrating the urinary tract of androgen-exposed mice exhibit reduced maturation, and those that have infiltrated the kidney have reduced phagocytic and degranulation functions, limiting their ability to effectively control infection. This work helps to elucidate mechanisms by which androgens enhance UTI susceptibility and severity, illuminating why male patients may be predisposed to severe outcomes of pyelonephritis.
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Affiliation(s)
- Teri N. Hreha
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christina A. Collins
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Elisabeth B. Cole
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel J. Jin
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David A. Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
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2
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Abstract
Recent advances in preclinical modeling of urinary tract infections (UTIs) have enabled the identification of key facets of the host response that influence pathogen clearance and tissue damage. Here, we review new insights into the functions of neutrophils, macrophages, and antimicrobial peptides in innate control of uropathogens and in mammalian infection-related tissue injury and repair. We also discuss novel functions for renal epithelial cells in innate antimicrobial defense. In addition, epigenetic modifications during bacterial cystitis have been implicated in bladder remodeling, conveying susceptibility to recurrent UTI. In total, contemporary work in this arena has better defined host processes that shape UTI susceptibility and severity and might inform the development of novel preventive and therapeutic approaches for acute and recurrent UTI.
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Affiliation(s)
- Hunter W Kuhn
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Teri N Hreha
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA.
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3
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Potter RF, Zhang K, Reimler B, Marino J, Muenks CE, Alvarado K, Wallace MA, Westblade LF, McElvania E, Yarbrough ML, Hunstad DA, Dantas G, Burnham CAD. Uncharacterized and lineage-specific accessory genes within the Proteus mirabilis pan-genome landscape. mSystems 2023; 8:e0015923. [PMID: 37341494 PMCID: PMC10469602 DOI: 10.1128/msystems.00159-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/07/2023] [Indexed: 06/22/2023] Open
Abstract
Proteus mirabilis is a Gram-negative bacterium recognized for its unique swarming motility and urease activity. A previous proteomic report on four strains hypothesized that, unlike other Gram-negative bacteria, P. mirabilis may not exhibit significant intraspecies variation in gene content. However, there has not been a comprehensive analysis of large numbers of P. mirabilis genomes from various sources to support or refute this hypothesis. We performed comparative genomic analysis on 2,060 Proteus genomes. We sequenced the genomes of 893 isolates recovered from clinical specimens from three large US academic medical centers, combined with 1,006 genomes from NCBI Assembly and 161 genomes assembled from Illumina reads in the public domain. We used average nucleotide identity (ANI) to delineate species and subspecies, core genome phylogenetic analysis to identify clusters of highly related P. mirabilis genomes, and pan-genome annotation to identify genes of interest not present in the model P. mirabilis strain HI4320. Within our cohort, Proteus is composed of 10 named species and 5 uncharacterized genomospecies. P. mirabilis can be subdivided into three subspecies; subspecies 1 represented 96.7% (1,822/1,883) of all genomes. The P. mirabilis pan-genome includes 15,399 genes outside of HI4320, and 34.3% (5,282/15,399) of these genes have no putative assigned function. Subspecies 1 is composed of several highly related clonal groups. Prophages and gene clusters encoding putatively extracellular-facing proteins are associated with clonal groups. Uncharacterized genes not present in the model strain P. mirabilis HI4320 but with homology to known virulence-associated operons can be identified within the pan-genome. IMPORTANCE Gram-negative bacteria use a variety of extracellular facing factors to interact with eukaryotic hosts. Due to intraspecies genetic variability, these factors may not be present in the model strain for a given organism, potentially providing incomplete understanding of host-microbial interactions. In contrast to previous reports on P. mirabilis, but similar to other Gram-negative bacteria, P. mirabilis has a mosaic genome with a linkage between phylogenetic position and accessory genome content. P. mirabilis encodes a variety of genes that may impact host-microbe dynamics beyond what is represented in the model strain HI4320. The diverse, whole-genome characterized strain bank from this work can be used in conjunction with reverse genetic and infection models to better understand the impact of accessory genome content on bacterial physiology and pathogenesis of infection.
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Affiliation(s)
- Robert F. Potter
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kailun Zhang
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Ben Reimler
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jamie Marino
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Carol E. Muenks
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kelly Alvarado
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Meghan A. Wallace
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Lars F. Westblade
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Erin McElvania
- Department of Pathology and Laboratory Medicine, NorthShore University Health System, Evanston, Illinois, USA
| | - Melanie L. Yarbrough
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - David A. Hunstad
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Gautam Dantas
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Carey-Ann D. Burnham
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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4
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Perez MA, Hsiao HM, Chen X, Kunkel A, Baida N, Hussaini L, Lu AT, Kao CM, Laham FR, Hunstad DA, Beltran Y, Hammett TA, Godfred-Cato S, Chahroudi A, Anderson EJ, Belay E, Rostad CA. Serologic responses to COVID-19 vaccination in children with history of multisystem inflammatory syndrome (MIS-C). Vaccine 2023; 41:2743-2748. [PMID: 36964000 PMCID: PMC10015103 DOI: 10.1016/j.vaccine.2023.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/31/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
Understanding the serological responses to COVID-19 vaccination in children with history of MIS-C could inform vaccination recommendations. We prospectively enrolled seven children hospitalized with MIS-C and measured SARS-CoV-2 binding IgG antibodies to spike protein variants longitudinally pre- and post-Pfizer-BioNTech BNT162b2 primary series COVID-19 vaccination. We found that SARS-CoV-2 variant cross-reactive IgG antibodies variably waned following acute MIS-C, but were significantly boosted with vaccination and maintained for up to 3 months. We then compared post-vaccination binding, pseudovirus neutralizing, and functional antibody-dependent cell-mediated cytotoxicity (ADCC) titers to the reference strain (Wuhan-hu-1) and Omicron variant (B.1.1.529) among previously healthy children (n = 16) and children with history of MIS-C (n = 7) or COVID-19 (n = 8). Despite the breadth of binding antibodies elicited by vaccination in all three groups, pseudovirus neutralizing and ADCC titers were significantly reduced to the Omicron variant.
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Affiliation(s)
- Maria A Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Xuemin Chen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Amber Kunkel
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nadine Baida
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Austin T Lu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Carol M Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130 USA
| | | | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130 USA
| | - Yajira Beltran
- Arnold Palmer Hospital for Children, Orlando, FL 32806 USA
| | | | | | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA; Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ermias Belay
- Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA; Children's Healthcare of Atlanta, Atlanta, GA USA.
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5
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Yousaf AR, Kunkel A, Abrams JY, Shah AB, Hammett TA, Arnold KE, Beltran YL, Laham FR, Kao CM, Hunstad DA, Hussaini L, Baida N, Salazar L, Perez MA, Rostad CA, Godfred-Cato S, Campbell AP, Belay ED. COVID-19 Vaccine Reactogenicity and Vaccine Attitudes Among Children and Parents/Guardians After Multisystem Inflammatory Syndrome in Children or COVID-19 Hospitalization: September 2021-May 2022. Pediatr Infect Dis J 2023; 42:252-259. [PMID: 36729032 PMCID: PMC9935230 DOI: 10.1097/inf.0000000000003803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a multiorgan hyperinflammatory condition following SARS-CoV-2 infection. Data on COVID-19 vaccine adverse events and vaccine attitudes in children with prior MIS-C are limited. We described characteristics associated with COVID-19 vaccination, vaccine adverse events and vaccine attitudes in children with a history of MIS-C or COVID-19 and their parents/guardians. METHODS We enrolled children previously hospitalized for MIS-C or COVID-19 from 3 academic institutions. We abstracted charts and interviewed children and parents/guardians regarding vaccine adverse events and acceptability. RESULTS Of 163 vaccine-eligible children enrolled with a history of MIS-C and 70 with history of COVID-19, 51 (31%) and 34 (49%), respectively, received mRNA COVID-19 vaccine a median of 10 (Interquartile Range 6-13) months after hospital discharge. Among 20 children with MIS-C and parents/guardians who provided interviews, local injection site reaction of brief duration (mean 1.8 days) was most commonly reported; no children required medical care within 2 weeks postvaccination. Vaccine survey results of interviewed, vaccinated children and their parents/guardians: of 20 children with MIS-C and 15 children with COVID-19, 17 (85%) and 13 (87%), respectively, listed doctors in the top 3 most trusted sources for vaccine information; 13 (65%) and 9 (60%) discussed vaccination with their doctor. CONCLUSIONS COVID-19 vaccination was well tolerated in children with prior MIS-C or COVID-19 participating in our investigation. Parents/guardians regarded their children's doctors as a trusted source of information for COVID-19 vaccines, and most vaccinated children's parents/guardians had discussed COVID-19 vaccination for their child with their doctor.
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Affiliation(s)
| | - Amber Kunkel
- From the CDC COVID-19 Response Team
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Yajira L. Beltran
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida
| | - Federico R. Laham
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida
| | - Carol M. Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - David A. Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Nadine Baida
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Luis Salazar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Maria A. Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Christina A. Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. AND Children’s Healthcare of Atlanta, Atlanta, Georgia
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6
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Sayed FAZ, Eissa NG, Shen Y, Hunstad DA, Wooley KL, Elsabahy M. Morphologic design of nanostructures for enhanced antimicrobial activity. J Nanobiotechnology 2022; 20:536. [PMID: 36539809 PMCID: PMC9768920 DOI: 10.1186/s12951-022-01733-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Despite significant progress in synthetic polymer chemistry and in control over tuning the structures and morphologies of nanoparticles, studies on morphologic design of nanomaterials for the purpose of optimizing antimicrobial activity have yielded mixed results. When designing antimicrobial materials, it is important to consider two distinctly different modes and mechanisms of activity-those that involve direct interactions with bacterial cells, and those that promote the entry of nanomaterials into infected host cells to gain access to intracellular pathogens. Antibacterial activity of nanoparticles may involve direct interactions with organisms and/or release of antibacterial cargo, and these activities depend on attractive interactions and contact areas between particles and bacterial or host cell surfaces, local curvature and dynamics of the particles, all of which are functions of nanoparticle shape. Bacteria may exist as spheres, rods, helices, or even in uncommon shapes (e.g., box- and star-shaped) and, furthermore, may transform into other morphologies along their lifespan. For bacteria that invade host cells, multivalent interactions are involved and are dependent upon bacterial size and shape. Therefore, mimicking bacterial shapes has been hypothesized to impact intracellular delivery of antimicrobial nanostructures. Indeed, designing complementarities between the shapes of microorganisms with nanoparticle platforms that are designed for antimicrobial delivery offers interesting new perspectives toward future nanomedicines. Some studies have reported improved antimicrobial activities with spherical shapes compared to non-spherical constructs, whereas other studies have reported higher activity for non-spherical structures (e.g., rod, discoid, cylinder, etc.). The shapes of nano- and microparticles have also been shown to impact their rates and extents of uptake by mammalian cells (macrophages, epithelial cells, and others). However, in most of these studies, nanoparticle morphology was not intentionally designed to mimic specific bacterial shape. Herein, the morphologic designs of nanoparticles that possess antimicrobial activities per se and those designed to deliver antimicrobial agent cargoes are reviewed. Furthermore, hypotheses beyond shape dependence and additional factors that help to explain apparent discrepancies among studies are highlighted.
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Affiliation(s)
- Fatma Al-Zahraa Sayed
- grid.507995.70000 0004 6073 8904School of Biotechnology, Science Academy, Badr University in Cairo, Badr City, Cairo, 11829 Egypt
| | - Noura G. Eissa
- grid.507995.70000 0004 6073 8904School of Biotechnology, Science Academy, Badr University in Cairo, Badr City, Cairo, 11829 Egypt ,grid.31451.320000 0001 2158 2757Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig, 44519 Egypt
| | - Yidan Shen
- grid.264756.40000 0004 4687 2082Departments of Chemistry, Materials Science and Engineering, and Chemical Engineering, Texas A&M University, College Station, TX 77842 USA
| | - David A. Hunstad
- grid.4367.60000 0001 2355 7002Departments of Pediatrics and Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Karen L. Wooley
- grid.264756.40000 0004 4687 2082Departments of Chemistry, Materials Science and Engineering, and Chemical Engineering, Texas A&M University, College Station, TX 77842 USA
| | - Mahmoud Elsabahy
- grid.507995.70000 0004 6073 8904School of Biotechnology, Science Academy, Badr University in Cairo, Badr City, Cairo, 11829 Egypt ,grid.264756.40000 0004 4687 2082Departments of Chemistry, Materials Science and Engineering, and Chemical Engineering, Texas A&M University, College Station, TX 77842 USA ,grid.440875.a0000 0004 1765 2064Misr University for Science and Technology, 6th of October City, Cairo, 12566 Egypt
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7
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Hreha T, Collins CA, Hunstad DA. Androgen exposure alters the neutrophil response to pyelonephritis. The Journal of Immunology 2022. [DOI: 10.4049/jimmunol.208.supp.58.05] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Urinary tract infections (UTIs) in men are uncommon but carry increased risk for severe upper-tract UTI (pyelonephritis) and complications including renal scarring. In preclinical models of Escherichia coli UTI, male C3H/HeN mice uniformly develop high-titer pyelonephritis (most with renal abscesses), while the majority of female C3H/HeN mice resolve renal infection within 7–14 days. We previously showed that this difference in outcomes is testosterone dependent. Here, we find that androgen exposure in female C3H/HeN mice alters the neutrophil response to UTI, increasing the propensity for severe renal inflammation and abscess formation as opposed to bacterial clearance and resolution of infection. Concordant with our prior published results, androgen exposure in C3H female mice given Escherichia coli UTI led to 3-log higher bacterial loads in the kidneys by 14 days post infection. We found that the kidneys of androgen-exposed mice harbored more neutrophils than standard females at baseline and throughout infection, correlated with higher levels of the neutrophil-recruiting chemokine CXCL1 (murine KC) in kidney tissue. In addition, the kidneys of androgen-exposed females were enriched for aged, immature neutrophils (Ly6G+, CD49d+, CD101−). Compared to their mature (CD101+) counterparts, these cells exhibited markers of increased degranulation, altered phagocytic activity, and diminished capacity for efflux from kidney tissue. These data support a model in which androgen-exposed mice, despite an apparently more robust neutrophil presence, fail to control renal bacterial infection due to altered neutrophil functions.
Supported by grants from NIH (R01 DK111541, R01 DK126697, R01 AI158418)
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Affiliation(s)
- Teri Hreha
- 1Pediatrics, Washington University in St Louis School of Medicine
| | | | - David A Hunstad
- 1Pediatrics, Washington University in St Louis School of Medicine
- 2Molecular Microbiology, Washington University in St Louis School of Medicine
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8
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Godfred-Cato S, Abrams JY, Balachandran N, Jaggi P, Jones K, Rostad CA, Lu AT, Fan L, Jabbar A, Anderson EJ, Kao CM, Hunstad DA, Rosenberg RB, Zafferani MJ, Ede KC, Ballan W, Laham FR, Beltran Y, Bryant B, Meng L, Hammett TA, Oster ME, Bamrah Morris S, Belay ED. Distinguishing Multisystem Inflammatory Syndrome in Children From COVID-19, Kawasaki Disease and Toxic Shock Syndrome. Pediatr Infect Dis J 2022; 41:315-323. [PMID: 35093995 PMCID: PMC8919949 DOI: 10.1097/inf.0000000000003449] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Distinguishing multisystem inflammatory syndrome in children (MIS-C) from coronavirus disease 2019 (COVID-19), Kawasaki disease (KD), and toxic shock syndrome (TSS) can be challenging. Because clinical management of these conditions can vary, timely and accurate diagnosis is essential. METHODS Data were collected from patients <21 years of age hospitalized with MIS-C, COVID-19, KD, and TSS in 4 major health care institutions. Patient demographics and clinical and laboratory data were compared among the 4 conditions, and a diagnostic scoring tool was developed to assist in clinical diagnosis. RESULTS A total of 233 patients with MIS-C, 102 with COVID-19, 101 with KD, and 76 with TSS were included in the analysis. Patients with MIS-C had the highest prevalence of decreased cardiac function (38.6%), myocarditis (34.3%), pericardial effusion (38.2%), mitral regurgitation (31.8%) and pleural effusion (34.8%) compared with patients with the other conditions. Patients with MIS-C had increased peak levels of C-reactive protein and decreased platelets and lymphocyte nadir counts compared with patients with COVID-19 and KD and elevated levels of troponin, brain natriuretic peptide and pro-brain natriuretic peptide compared with COVID-19. Diagnostic scores utilizing clinical findings effectively distinguished MIS-C from COVID-19, KD, and TSS, with internal validation showing area under the curve ranging from 0.87 to 0.97. CONCLUSIONS Compared with COVID-19, KD, and TSS, patients with MIS-C had significantly higher prevalence of cardiac complications, elevated markers of inflammation and cardiac damage, thrombocytopenia, and lymphopenia. Diagnostic scores can be a useful tool for distinguishing MIS-C from COVID-19, KD, and TSS.
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Affiliation(s)
| | | | | | - Preeti Jaggi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | | | - Christina A. Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Austin T. Lu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Lucie Fan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Carol M. Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - David A. Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Robert B. Rosenberg
- Division of Pediatric Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ
| | - Marc J. Zafferani
- Division of Pediatric Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ
| | - Kaleo C. Ede
- Department of Child Health, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ
- Division of Pediatric Rheumatology, Phoenix Children’s Hospital, Phoenix, AZ
| | - Wassim Ballan
- Department of Child Health, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ
- Pediatric Infectious Diseases, Phoenix Children’s Hospital, Phoenix, AZ
| | - Federico R. Laham
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL
| | - Yajira Beltran
- Division of Pediatric Infectious Diseases, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL
| | - Bobbi Bryant
- CDC COVID-19 Response Team, Atlanta, GA
- Oak Ridge Institute for Science and Education
| | - Lu Meng
- CDC COVID-19 Response Team, Atlanta, GA
- General Dynamics Information Technology, Falls Church, VA
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9
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Lapp SA, Abrams J, Lu AT, Hussaini L, Kao CM, Hunstad DA, Rosenberg RB, Zafferani MJ, Ede KC, Ballan W, Laham FR, Beltran Y, Hsiao HM, Sherry W, Jenkins E, Jones K, Horner A, Brooks A, Bryant B, Meng L, Hammett TA, Oster ME, Bamrah-Morris S, Godfred-Cato S, Belay E, Chahroudi A, Anderson EJ, Jaggi P, Rostad CA. Serologic and Cytokine Signatures in Children With Multisystem Inflammatory Syndrome and Coronavirus Disease 2019. Open Forum Infect Dis 2022; 9:ofac070. [PMID: 35237703 PMCID: PMC8883592 DOI: 10.1093/ofid/ofac070] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Received: 12/08/2021] [Accepted: 02/22/2022] [Indexed: 12/25/2022] Open
Abstract
Background The serologic and cytokine responses of children hospitalized with multisystem inflammatory syndrome (MIS-C) vs coronavirus disease 2019 (COVID-19) are poorly understood. Methods We performed a prospective, multicenter, cross-sectional study of hospitalized children who met the Centers for Disease Control and Prevention case definition for MIS-C (n = 118), acute COVID-19 (n = 88), or contemporaneous healthy controls (n = 24). We measured severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor-binding domain (RBD) immunoglobulin G (IgG) titers and cytokine concentrations in patients and performed multivariable analysis to determine cytokine signatures associated with MIS-C. We also measured nucleocapsid IgG and convalescent RBD IgG in subsets of patients. Results Children with MIS-C had significantly higher SARS-CoV-2 RBD IgG than children with acute COVID-19 (median, 2783 vs 146; P < .001), and titers correlated with nucleocapsid IgG. For patients with MIS-C, RBD IgG titers declined in convalescence (median, 2783 vs 1135; P = .010) in contrast to patients with COVID-19 (median, 146 vs 4795; P < .001). MIS-C was characterized by transient acute proinflammatory hypercytokinemia, including elevated levels of interleukin (IL) 6, IL-10, IL-17A, and interferon gamma (IFN-γ). Elevation of at least 3 of these cytokines was associated with significantly increased prevalence of prolonged hospitalization ≥8 days (prevalence ratio, 3.29 [95% CI, 1.17–9.23]). Conclusions MIS-C was associated with high titers of SARS-CoV-2 RBD IgG antibodies and acute hypercytokinemia with IL-6, IL-10, IL-17A, and IFN-γ.
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Affiliation(s)
- Stacey A Lapp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Joseph Abrams
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Austin T Lu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Carol M Kao
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Robert B Rosenberg
- Division of Pediatric Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona, College of Medicine–Phoenix, Phoenix, Arizona, USA
| | - Marc J Zafferani
- Division of Pediatric Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona, College of Medicine–Phoenix, Phoenix, Arizona, USA
| | - Kaleo C Ede
- Department of Child Health, University of Arizona, College of Medicine–Phoenix, Phoenix, Arizona, USA
- Division of Pediatric Rheumatology, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Wassim Ballan
- Department of Child Health, University of Arizona, College of Medicine–Phoenix, Phoenix, Arizona, USA
- Pediatric Infectious Diseases, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | | | - Yajira Beltran
- Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Whitney Sherry
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Elan Jenkins
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kaitlin Jones
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Anna Horner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Alyssa Brooks
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Bobbi Bryant
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Lu Meng
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Apex Systems affiliated with General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Teresa A Hammett
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew E Oster
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sapna Bamrah-Morris
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shana Godfred-Cato
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ermias Belay
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Preeti Jaggi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
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10
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Abman SH, Armstrong S, Baker S, Bogue CW, Carlo W, Chalak L, Daniels SR, Davis S, Debaun MR, Fike C, Frazer L, Gibson K, Gill M, Glass H, Gordon CM, Goyal M, Hirschhorn J, Holtz L, Hunstad DA, Leonard MB, Maitre N, Markham L, McAllister-Lucas L, Orange J, Shah P, Simon T, Steinhorn RH, Tarini B, Walker-Harding LR. The american pediatric society and society for pediatric research joint statement against racism and social injustice. Pediatr Res 2022; 91:72. [PMID: 32882704 PMCID: PMC7492687 DOI: 10.1038/s41390-020-01107-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/29/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022]
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11
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Song Y, Elsabahy M, Collins CA, Khan S, Li R, Hreha TN, Shen Y, Lin YN, Letteri RA, Su L, Dong M, Zhang F, Hunstad DA, Wooley KL. Morphologic Design of Silver-Bearing Sugar-Based Polymer Nanoparticles for Uroepithelial Cell Binding and Antimicrobial Delivery. Nano Lett 2021; 21:4990-4998. [PMID: 34115938 PMCID: PMC8545462 DOI: 10.1021/acs.nanolett.1c00776] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Platelet-like and cylindrical nanostructures from sugar-based polymers are designed to mimic the aspect ratio of bacteria and achieve uroepithelial cell binding and internalization, thereby improving their potential for local treatment of recurrent urinary tract infections. Polymer nanostructures, derived from amphiphilic block polymers composed of zwitterionic poly(d-glucose carbonate) and semicrystalline poly(l-lactide) segments, were constructed with morphologies that could be tuned to enhance uroepithelial cell binding. These nanoparticles exhibited negligible cytotoxicity, immunotoxicity, and cytokine adsorption, while also offering substantial silver cation loading capacity, extended release, and in vitro antimicrobial activity (as effective as free silver cations) against uropathogenic Escherichia coli. In comparison to spherical analogues, cylindrical and platelet-like nanostructures engaged in significantly higher association with uroepithelial cells, as measured by flow cytometry; despite their larger size, platelet-like nanostructures maintained the capacity for cell internalization. This work establishes initial evidence of degradable platelet-shaped nanostructures as versatile therapeutic carriers for treatment of epithelial infections.
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Affiliation(s)
- Yue Song
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
| | - Mahmoud Elsabahy
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
- Science Academy, Badr University in Cairo, Badr City, Cairo 11829, Egypt
| | - Christina A. Collins
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Sarosh Khan
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
| | - Richen Li
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
| | - Teri N. Hreha
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Yidan Shen
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
| | - Yen-Nan Lin
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
- College of Medicine, Texas A&M University, Bryan, Texas 77807, USA
| | - Rachel A. Letteri
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
| | - Lu Su
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
| | - Mei Dong
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
| | - Fuwu Zhang
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
| | - David A. Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Karen L. Wooley
- Departments of Chemistry, Chemical Engineering, and Materials Science & Engineering, Texas A&M University, College Station, Texas 77842, USA
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12
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Abstract
Urinary tract infections (UTIs) are generally considered a disease of women. However, UTIs affect females throughout the lifespan, and certain male populations (including infants and elderly men) are also susceptible. Epidemiologically, pyelonephritis is more common in women but carries increased morbidity when it does occur in men. Among children, high-grade vesicoureteral reflux is a primary risk factor for upper-tract UTI in both sexes. However, among young infants with UTI, girls are outnumbered by boys; risk factors include posterior urethral valves and lack of circumcision. Recent advances in mouse models of UTI reveal sex differences in innate responses to UTI, which vary somewhat depending on the system used. Moreover, male mice and androgenized female mice suffer worse outcomes in experimental pyelonephritis; evidence suggests that androgen exposure may suppress innate control of infection in the urinary tract, but additional androgen effects, as well as non-hormonal sex effects, may yet be specified. Among other intriguing directions, recent experiments raise the hypothesis that the postnatal testosterone surge that occurs in male infants may represent an additional factor driving the higher incidence of UTI in males under 6 months of age. Ongoing work in contemporary models will further illuminate sex- and sex-hormone-specific effects on UTI pathogenesis and immune responses.
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Affiliation(s)
- Clayton D Albracht
- Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8208, St. Louis, MO, 63110, USA
| | - Teri N Hreha
- Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8208, St. Louis, MO, 63110, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8208, St. Louis, MO, 63110, USA.
- Department of Molecular Microbiology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8230, St. Louis, MO, 63110, USA.
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13
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Fortuny LR, Cabler SS, Hunstad DA, Yarbrough ML. Blueberry Muffin Rash, Bilateral Cataracts, and Thrombocytopenia in a Neonate. Clin Chem 2021; 67:472-475. [PMID: 33674845 DOI: 10.1093/clinchem/hvaa310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Lisandro R Fortuny
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Stephanie S Cabler
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - David A Hunstad
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Melanie L Yarbrough
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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14
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McLellan LK, McAllaster MR, Kim AS, Tóthová Ľ, Olson PD, Pinkner JS, Daugherty AL, Hreha TN, Janetka JW, Fremont DH, Hultgren SJ, Virgin HW, Hunstad DA. A host receptor enables type 1 pilus-mediated pathogenesis of Escherichia coli pyelonephritis. PLoS Pathog 2021; 17:e1009314. [PMID: 33513212 PMCID: PMC7875428 DOI: 10.1371/journal.ppat.1009314] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/10/2021] [Accepted: 01/13/2021] [Indexed: 12/26/2022] Open
Abstract
Type 1 pili have long been considered the major virulence factor enabling colonization of the urinary bladder by uropathogenic Escherichia coli (UPEC). The molecular pathogenesis of pyelonephritis is less well characterized, due to previous limitations in preclinical modeling of kidney infection. Here, we demonstrate in a recently developed mouse model that beyond bladder infection, type 1 pili also are critical for establishment of ascending pyelonephritis. Bacterial mutants lacking the type 1 pilus adhesin (FimH) were unable to establish kidney infection in male C3H/HeN mice. We developed an in vitro model of FimH-dependent UPEC binding to renal collecting duct cells, and performed a CRISPR screen in these cells, identifying desmoglein-2 as a primary renal epithelial receptor for FimH. The mannosylated extracellular domain of human DSG2 bound directly to the lectin domain of FimH in vitro, and introduction of a mutation in the FimH mannose-binding pocket abolished binding to DSG2. In infected C3H/HeN mice, type 1-piliated UPEC and Dsg2 were co-localized within collecting ducts, and administration of mannoside FIM1033, a potent small-molecule inhibitor of FimH, significantly attenuated bacterial loads in pyelonephritis. Our results broaden the biological importance of FimH, specify the first renal FimH receptor, and indicate that FimH-targeted therapeutics will also have application in pyelonephritis. Urinary tract infections (UTIs) are among the most common bacterial infections in humans. While much has been discovered about how E. coli cause bladder infections, less is known about the host-pathogen interactions that underlie kidney infection (pyelonephritis). We employed recently developed mouse models to show that bacterial surface fibers called type 1 pili, which bear the adhesive protein FimH and are known to mediate E. coli binding to bladder epithelium, are also required for ascending kidney infection. We developed a cell-culture model of bacterial binding to renal collecting duct, then performed a screen using the gene-editing tool CRISPR to identify the first known FimH receptor in the kidney. This epithelial cell-surface protein, desmoglein-2, was shown to directly bind FimH, and we localized this binding to specific extracellular domains of DSG2. Further, we showed that mannosides, small-molecule FimH inhibitors currently in development to treat bladder infection, are also effective in experimental kidney infection. Our study reveals a novel host-pathogen interaction during pyelonephritis and demonstrates how this interaction may be therapeutically targeted.
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Affiliation(s)
- Lisa K. McLellan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Michael R. McAllaster
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Arthur S. Kim
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Ľubomíra Tóthová
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Patrick D. Olson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jerome S. Pinkner
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Allyssa L. Daugherty
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Teri N. Hreha
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - James W. Janetka
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Daved H. Fremont
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Scott J. Hultgren
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Herbert W. Virgin
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - David A. Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
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15
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Cabler SS, Hogan PG, Fritz SA, Bednarski JJ, Hunstad DA. Incidence and treatment of hemophagocytic lymphohistiocytosis in hospitalized children with Ehrlichia infection. Pediatr Blood Cancer 2020; 67:e28436. [PMID: 32706439 DOI: 10.1002/pbc.28436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/23/2022]
Abstract
We report a large cohort of pediatric patients with human monocytic ehrlichiosis (HME), enabling an estimated incidence of secondary hemophagocytic lymphohistiocytosis (HLH) in hospitalized children with HME. Among 49 children with PCR-confirmed Ehrlichia infection, 8 (16%) met current criteria for HLH. Those with HLH had more significant hematologic abnormalities and longer durations from symptom onset to admission and definitive anti-infective therapy. Among these eight, three received chemotherapy plus doxycycline, one of whom died; the other five were treated with doxycycline without chemotherapy, and all survived without HLH recurrence. Our findings demonstrate that antimicrobial therapy alone can successfully resolve Ehrlichia-associated HLH.
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Affiliation(s)
- Stephanie S Cabler
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey J Bednarski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
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16
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Hreha TN, Collins CA, Daugherty AL, Griffith JM, Hruska KA, Hunstad DA. Androgen-Influenced Polarization of Activin A-Producing Macrophages Accompanies Post-pyelonephritic Renal Scarring. Front Immunol 2020; 11:1641. [PMID: 32849562 PMCID: PMC7399094 DOI: 10.3389/fimmu.2020.01641] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 01/31/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022] Open
Abstract
Ascending bacterial pyelonephritis, a form of urinary tract infection (UTI) that can result in hospitalization, sepsis, and other complications, occurs in ~250,000 US patients annually; uropathogenic Escherichia coli (UPEC) cause a large majority of these infections. Although UTIs are primarily a disease of women, acute pyelonephritis in males is associated with increased mortality and morbidity, including renal scarring, and end-stage renal disease. Preclinical models of UTI have only recently allowed investigation of sex and sex-hormone effects on pathogenesis. We previously demonstrated that renal scarring after experimental UPEC pyelonephritis is augmented by androgen exposure; testosterone exposure increases both the severity of pyelonephritis and the degree of renal scarring in both male and female mice. Activin A is an important driver of scarring in non-infectious renal injury, as well as a mediator of macrophage polarization. In this work, we investigated how androgen exposure influences immune cell recruitment to the UPEC-infected kidney and how cell-specific activin A production affects post-pyelonephritic scar formation. Compared with vehicle-treated females, androgenized mice exhibited reduced bacterial clearance from the kidney, despite robust myeloid cell recruitment that continued to increase as infection progressed. Infected kidneys from androgenized mice harbored more alternatively activated (M2) macrophages than vehicle-treated mice, reflecting an earlier shift from a pro-inflammatory (M1) phenotype. Androgen exposure also led to a sharp increase in activin A-producing myeloid cells in the infected kidney, as well as decreased levels of follistatin (which normally antagonizes activin action). As a result, infection in androgenized mice featured prolonged polarization of macrophages toward a pro-fibrotic M2a phenotype, accompanied by an increase in M2a-associated cytokines. These data indicate that androgen enhancement of UTI severity and resulting scar formation is related to augmented local activin A production and corresponding promotion of M2a macrophage polarization.
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Affiliation(s)
- Teri N Hreha
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Christina A Collins
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Allyssa L Daugherty
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Jessie M Griffith
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Keith A Hruska
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.,Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, United States
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, United States
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17
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Hogan PG, Parrish KL, Mork RL, Boyle MG, Muenks CE, Thompson RM, Morelli JJ, Sullivan ML, Hunstad DA, Wardenburg JB, Rzhetsky A, Gehlert SJ, Burnham CAD, Fritz SA. HOME2: Household vs. Personalized Decolonization in Households of Children with Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infection - A Randomized Clinical Trial. Clin Infect Dis 2020; 73:e4568-e4577. [PMID: 32521007 DOI: 10.1093/cid/ciaa752] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 03/05/2020] [Accepted: 06/05/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A household approach to decolonization decreases skin and soft tissue infection (SSTI) incidence, though this is burdensome and costly. As prior SSTI increases risk for SSTI, we hypothesized the effectiveness of decolonization measures to prevent SSTI when targeted to household members with prior year SSTI would be non-inferior to decolonizing all household members. METHODS Upon completion of our 12-month observational HOME study, 102 households were enrolled in HOME2, a 12-month, randomized non-inferiority trial. Pediatric index patients with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) SSTI, their household contacts, and pets were enrolled. Households were randomized 1:1 to the Personalized (decolonization performed only by household members who experienced SSTI during the HOME study) or Household (decolonization performed by all household members) approaches. The 5-day regimen included hygiene education, twice-daily intranasal mupirocin, and daily bleach-water baths. At 5 follow-up visits in participants' homes, swabs to detect S. aureus were collected from participants, environmental surfaces, and pets; incident SSTI were ascertained. RESULTS Non-inferiority of the Personalized Approach was established for the primary outcome 3-month cumulative SSTI: 23 of 212 (10.8%) participants reported SSTI in Household Approach households, while 23 of 236 (9.7%) participants reported SSTI in Personalized Approach households; difference in proportions -1.1% (95% CI -6.7%, 4.5%). In multivariable analyses, prior year SSTI and baseline MRSA colonization were associated with cumulative SSTI. CONCLUSIONS The Personalized Approach was non-inferior to the Household Approach in preventing SSTI. Future studies should interrogate longer durations of decolonization and/or decontamination of the household environment to reduce household MRSA burden.
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Affiliation(s)
- Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katelyn L Parrish
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan L Mork
- Graduate Program in the Biophysical Sciences, University of Chicago, Chicago, Illinois, USA.,Committee of Microbiology, University of Chicago, Chicago, Illinois, USA.,Institute for Genomics and Systems Biology, and University of Chicago, Chicago, Illinois, USA
| | - Mary G Boyle
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carol E Muenks
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryley M Thompson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John J Morelli
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Melanie L Sullivan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Andrey Rzhetsky
- Department of Human Genetics, University of Chicago, Chicago, Illinois, USA
| | - Sarah J Gehlert
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carey-Ann D Burnham
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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18
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Hogan PG, Mork RL, Thompson RM, Muenks CE, Boyle MG, Sullivan ML, Morelli JJ, Williams CV, Sanchez N, Hunstad DA, Wardenburg JB, Gehlert SJ, Burnham CAD, Rzhetsky A, Fritz SA. Environmental Methicillin-resistant Staphylococcus aureus Contamination, Persistent Colonization, and Subsequent Skin and Soft Tissue Infection. JAMA Pediatr 2020; 174:552-562. [PMID: 32227144 PMCID: PMC7105954 DOI: 10.1001/jamapediatrics.2020.0132] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE The longitudinal association among persistent Staphylococcus aureus colonization, household environmental contamination, and recurrent skin and soft tissue infection (SSTI) is largely unexplored to date. OBJECTIVES To identify factors associated with persistent S aureus colonization and recurrent SSTI in households with children with community-associated methicillin-resistant S aureus (MRSA) SSTI. DESIGN, SETTING, AND PARTICIPANTS This 12-month prospective cohort study included 150 children with community-associated MRSA SSTI, 542 household contacts, and 154 pets enrolled from January 3, 2012, through October 20, 2015. A total of 5 quarterly home visits were made to 150 households in the St Louis, Missouri, region. Statistical analysis was performed from September 18, 2018, to January 7, 2020. EXPOSURES Covariates used in S aureus strain persistence and interval SSTI models included S aureus colonization and contamination measures, personal hygiene and sharing habits, health history, activities external to the home, and household characteristics (eg, cleanliness, crowding, home ownership, and pets). Serial samples to detect S aureus were collected from household members at 3 anatomic sites, from pets at 2 anatomic sites, and from environmental surfaces at 21 sites. MAIN OUTCOMES AND MEASURES Molecular epidemiologic findings of S aureus isolates were assessed via repetitive-sequence polymerase chain reaction. Individual persistent colonization was defined as colonization by an identical strain for 2 consecutive samplings. Longitudinal, multivariable generalized mixed-effects logistic regression models were used to assess factors associated with persistent S aureus personal colonization, environmental contamination, and interval SSTI. RESULTS Among 692 household members in 150 households, 326 (47%) were male and 366 (53%) were female, with a median age of 14.82 years (range, 0.05-82.25 years). Of 540 participants completing all 5 samplings, 213 (39%) were persistently colonized with S aureus, most often in the nares and with the strain infecting the index patient at enrollment. Nine pets (8%) were persistently colonized with S aureus. Participants reporting interval intranasal mupirocin application were less likely to experience persistent colonization (odds ratio [OR], 0.44; 95% credible interval [CrI], 0.30-0.66), whereas increasing strain-specific environmental contamination pressure was associated with increased individual persistent colonization (OR, 1.17; 95% CrI, 1.06-1.30). Strains with higher colonization pressure (OR, 1.47; 95% CrI, 1.25-1.71) and MRSA strains (OR, 1.57; 95% CrI, 1.16-2.19) were more likely to persist. Seventy-six index patients (53%) and 101 household contacts (19%) reported interval SSTIs. Individuals persistently colonized with MRSA (OR, 1.56; 95% CrI, 1.17-2.11), those with a history of SSTI (OR, 2.55; 95% CrI, 1.88-3.47), and index patients (OR, 1.54; 95% CrI, 1.07-2.23) were more likely to report an interval SSTI. CONCLUSIONS AND RELEVANCE The study findings suggest that recurrent SSTI is associated with persistent MRSA colonization of household members and contamination of environmental surfaces. Future studies may elucidate the effectiveness of specific combinations of personal decolonization and environmental decontamination efforts in eradicating persistent strains and mitigating recurrent SSTIs.
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Affiliation(s)
- Patrick G. Hogan
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ryan L. Mork
- Graduate Program in the Biophysical Sciences, University of Chicago, Chicago, Illinois,Committee of Microbiology, University of Chicago, Chicago, Illinois,Institute for Genomics and Systems Biology, University of Chicago, Chicago, Illinois
| | - Ryley M. Thompson
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Carol E. Muenks
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Mary G. Boyle
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Melanie L. Sullivan
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John J. Morelli
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Caroline V. Williams
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nataly Sanchez
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - David A. Hunstad
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri,Department of Molecular Microbiology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | - Sarah J. Gehlert
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Carey-Ann D. Burnham
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri,Department of Molecular Microbiology, Washington University School of Medicine in St Louis, St Louis, Missouri,Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri,Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Andrey Rzhetsky
- Department of Human Genetics, University of Chicago, Chicago, Illinois
| | - Stephanie A. Fritz
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
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19
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Hurley E, Peeples ES, Bates CM, Hunstad DA, Barkin SL. Perspective commentary from the Society for Pediatric Research: supporting early-stage pediatric physician-scientist success. Pediatr Res 2020; 87:834-838. [PMID: 31896124 DOI: 10.1038/s41390-019-0745-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Edward Hurley
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Carlton M Bates
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David A Hunstad
- Departments of Pediatrics and Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Shari L Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
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20
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Hreha TN, Collins CA, Daugherty AL, Twentyman J, Paluri N, Hunstad DA. TGFβ1 orchestrates renal fibrosis following Escherichia coli pyelonephritis. Physiol Rep 2020; 8:e14401. [PMID: 32227630 PMCID: PMC7104652 DOI: 10.14814/phy2.14401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 01/08/2023] Open
Abstract
Renal scarring after pyelonephritis is linked to long-term health risks for hypertension and chronic kidney disease. Androgen exposure increases susceptibility to, and severity of, uropathogenic Escherichia coli (UPEC) pyelonephritis and resultant scarring in both male and female mice, while anti-androgen therapy is protective against severe urinary tract infection (UTI) in these models. This work employed androgenized female C57BL/6 mice to elucidate the molecular mechanisms of post-infectious renal fibrosis and to determine how these pathways are altered by the presence of androgens. We found that elevated circulating testosterone levels primed the kidney for fibrosis by increasing local production of TGFβ1 before the initiation of UTI, altering the ratio of transcription factors Smad2 and Smad3 and increasing the presence of mesenchymal stem cell (MSC)-like cells and Gli1 + activated myofibroblasts, the cells primarily responsible for deposition of scar components. Increased production of TGFβ1 and aberrations in Smad2:Smad3 were maintained throughout the course of infection in the presence of androgen, correlating with renal scarring that was not observed in non-androgenized female mice. Pharmacologic inhibition of TGFβ1 signaling blunted myofibroblast activation. We conclude that renal fibrosis after pyelonephritis is exacerbated by the presence of androgens and involves activation of the TGFβ1 signaling cascade, leading to increases in cortical populations of MSC-like cells and the Gli1 + activated myofibroblasts that are responsible for scarring.
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Affiliation(s)
- Teri N. Hreha
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
| | | | | | - Joy Twentyman
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
- Present address:
Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Nitin Paluri
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
| | - David A. Hunstad
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
- Department of Molecular MicrobiologyWashington University School of MedicineSt. LouisMOUSA
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21
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Flores-Mireles A, Hreha TN, Hunstad DA. Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection. Top Spinal Cord Inj Rehabil 2020; 25:228-240. [PMID: 31548790 DOI: 10.1310/sci2503-228] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Urinary tract infections (UTIs) are among the most common microbial infections in humans and represent a substantial burden on the health care system. UTIs can be uncomplicated, as when affecting healthy individuals, or complicated, when affecting individuals with compromised urodynamics and/or host defenses, such as those with a urinary catheter. There are clear differences between uncomplicated UTI and catheter-associated UTI (CAUTI) in clinical manifestations, causative organisms, and pathophysiology. Therefore, uncomplicated UTI and CAUTI cannot be approached similarly, or the risk of complications and treatment failure may increase. It is imperative to understand the key aspects of each condition to develop successful treatment options and improve patient outcomes. Here, we will review the epidemiology, pathogen prevalence, differential mechanisms used by uropathogens, and treatment and prevention of uncomplicated UTI and CAUTI.
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Affiliation(s)
| | - Teri N Hreha
- Washington University School of Medicine, Saint Louis, Missouri
| | - David A Hunstad
- Washington University School of Medicine, Saint Louis, Missouri
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22
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Parrish KL, Wylie KM, Reich PJ, Hogan PG, Wylie TN, Kennedy CR, Lainhart W, Hunstad DA, Burnham CAD, Fritz SA. Carriage of the Toxic Shock Syndrome Toxin Gene by Contemporary Community-Associated Staphylococcus aureus Isolates. J Pediatric Infect Dis Soc 2019; 8:470-473. [PMID: 30285124 PMCID: PMC6831934 DOI: 10.1093/jpids/piy098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/13/2018] [Indexed: 01/02/2023]
Abstract
We report here the prevalence of the tst-1 gene among 252 methicillin-susceptible Staphylococcus aureus (MSSA) isolates and 458 methicillin-resistant S aureus (MRSA) isolates collected from 531 subjects between 2008 and 2017, one of which was recovered from a child with MRSA toxic shock syndrome. tst-1 was encoded by 43 (6%) S aureus isolates overall: 42 (16.7%) MSSA isolates and 1 (0.2%) MRSA isolate (P < .001).
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Affiliation(s)
- Katelyn L Parrish
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kristine M Wylie
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Patrick J Reich
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Todd N Wylie
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Colleen R Kennedy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - William Lainhart
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
| | - Carey-Ann D Burnham
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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23
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Olson PD, McLellan LK, Liu A, Briden KE, Tiemann KM, Daugherty AL, Hruska KA, Hunstad DA. Correction: Renal scar formation and kidney function following antibiotic-treated murine pyelonephritis (doi: 10.1242/dmm.030130). Dis Model Mech 2018; 11:11/9/dmm036798. [PMID: 30213794 PMCID: PMC6177002 DOI: 10.1242/dmm.036798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Olson PD, McLellan LK, Hreha TN, Liu A, Briden KE, Hruska KA, Hunstad DA. Androgen exposure potentiates formation of intratubular communities and renal abscesses by Escherichia coli. Kidney Int 2018; 94:502-513. [PMID: 30041870 DOI: 10.1016/j.kint.2018.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 02/01/2018] [Revised: 04/02/2018] [Accepted: 04/19/2018] [Indexed: 11/18/2022]
Abstract
Females across their lifespan and certain male populations are susceptible to urinary tract infections (UTI). The influence of female vs. male sex on UTI is incompletely understood, in part because preclinical modeling has been performed almost exclusively in female mice. Here, we employed established and new mouse models of UTI with uropathogenic Escherichia coli (UPEC) to investigate androgen influence on UTI pathogenesis. Susceptibility to UPEC UTI in both male and female hosts was potentiated with 5α-dihydrotestosterone, while males with androgen receptor deficiency and androgenized females treated with the androgen receptor antagonist enzalutamide were protected from severe pyelonephritis. In androgenized females and in males, UPEC formed dense intratubular, biofilm-like communities, some of which were sheltered from infiltrating leukocytes by the tubular epithelium and by peritubular fibrosis. Abscesses were nucleated by small intratubular collections of UPEC first visualized at five days postinfection and briskly expanded over the subsequent 24 hours. Male mice deficient in Toll-like receptor 4, which fail to contain UPEC within abscesses, were susceptible to lethal dissemination. Thus, androgen receptor activation imparts susceptibility to severe upper-tract UTI in both female and male murine hosts. Visualization of intratubular UPEC communities illuminates early renal abscess pathogenesis and the role of abscess formation in preventing dissemination of infection. Additionally, our study suggests that androgen modulation may represent a novel therapeutic route to combat recalcitrant or recurrent UTI in a range of patient populations.
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Affiliation(s)
- Patrick D Olson
- Medical Scientist Training Program, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lisa K McLellan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Teri N Hreha
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alice Liu
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kelleigh E Briden
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keith A Hruska
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA.
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25
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Kulkarni DH, McDonald KG, Knoop KA, Gustafsson JK, Kozlowski KM, Hunstad DA, Miller MJ, Newberry RD. Goblet cell associated antigen passages are inhibited during Salmonella typhimurium infection to prevent pathogen dissemination and limit responses to dietary antigens. Mucosal Immunol 2018; 11:1103-1113. [PMID: 29445136 PMCID: PMC6037413 DOI: 10.1038/s41385-018-0007-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/19/2017] [Accepted: 12/26/2017] [Indexed: 02/04/2023]
Abstract
Dietary antigen acquisition by lamina propria (LP) dendritic cells (DCs) is crucial to induce oral tolerance and maintain homeostasis. However, encountering innocuous antigens during infection can lead to inflammatory responses, suggesting processes may limit steady-state luminal antigen capture during infection. We observed that goblet cell (GC) associated antigen passages (GAPs), a steady-state pathway delivering luminal antigens to LP-DCs, are inhibited during Salmonella infection. GAP inhibition was mediated by IL-1β. Infection abrogated luminal antigen delivery and antigen-specific T cell proliferation in the mesenteric lymph node (MLN). Antigen-specific T cell proliferation to dietary antigen was restored by overriding GAP suppression; however, this did not restore regulatory T cell induction, but induced inflammatory T cell responses. Salmonella translocation to the MLN required GCs and correlated with GAPs. Genetic manipulations overriding GAP suppression, or antibiotics inducing colonic GAPs, but not antibiotics that do not, increased dissemination and worsened outcomes independent of luminal pathogen burden. Thus, steady-state sampling pathways are suppressed during infection to prevent responses to dietary antigens, limit pathogen entry, and lessen the disease. Moreover, antibiotics may worsen Salmonella infection by means beyond blunting gut microbiota colonization resistance, providing new insight into how precedent antibiotic use aggravates enteric infection.
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Affiliation(s)
- Devesha H Kulkarni
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Keely G McDonald
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Kathryn A Knoop
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Jenny K Gustafsson
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Konrad M Kozlowski
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, 63110, USA
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Mark J Miller
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Rodney D Newberry
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, 63110, USA.
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26
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Cho S, Heo GS, Khan S, Huang J, Hunstad DA, Elsabahy M, Wooley KL. A Vinyl Ether-Functional Polycarbonate as a Template for Multiple Postpolymerization Modifications. Macromolecules 2018; 51:3233-3242. [PMID: 29915431 PMCID: PMC6002957 DOI: 10.1021/acs.macromol.8b00047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A highly-reactive vinyl ether-functionalized aliphatic polycarbonate and its block copolymer were developed as templates for multiple post-polymerization conjugation chemistries. The vinyl ether-functional six-membered cyclic carbonate monomer was synthesized by a well-established two-step procedure starting from 2,2-bis(hydroxymethyl)propionic acid. An organobase-catalyzed ring-opening polymerization of the synthesized monomer afforded polycarbonates with pendant vinyl ether functionalities (PMVEC). The vinyl ether moieties on the resulting polymers were readily conjugated with hydroxyl- or thiol-containing compounds via three different post-polymerization modification chemistries - acetalization, thio-acetalization, and thiol-ene reaction. Acetal-functionalized polycarbonates were studied in depth to exploit their acid-labile acetal functionalities. Acetalization of the amphiphilic diblock copolymer of poly(ethylene glycol) methyl ether (mPEG) and PMVEC, mPEG113-b-PMVEC13, with the model hydroxyl compound 4- methylbenzyl alcohol resulted in a maximum of 42% acetal and 58% hydroxyl side chain groups. Nonetheless, the amphiphilicity of the block polymer allowed for its self-assembly in water to afford nanostructures, as characterized via dynamic light scattering and transmission electron microscopy. The kinetics of acetal cleavage within the block polymer micelles were examined in acidic buffered solutions (pH 4 and 5). In addition, mPEG-b-PMVEC and its hydrolyzed polymer mPEG-b-PMHEC (i.e., after full cleavage of acetals) exhibited minimal cytotoxicity to RAW 264.7 mouse macrophages, indicating that this polymer system represents a biologically non-hazardous material with pH-responsive activity.
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Affiliation(s)
- Sangho Cho
- Department of Chemistry, Department of Chemical Engineering,
Department of Materials Science & Engineering, and Laboratory for
Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255
TAMU, College Station, Texas 77842-3012, United States
- Materials Architecturing Research Center, Korea Institute of
Science and Technology, Seoul 02792, Republic of Korea
- Division of Nano & Information Technology, KIST
School, Korea University of Science and Technology, Seoul 02792, Republic of
Korea
| | - Gyu Seong Heo
- Department of Chemistry, Department of Chemical Engineering,
Department of Materials Science & Engineering, and Laboratory for
Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255
TAMU, College Station, Texas 77842-3012, United States
- Mallinckrodt Institute of Radiology
| | - Sarosh Khan
- Department of Chemistry, Department of Chemical Engineering,
Department of Materials Science & Engineering, and Laboratory for
Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255
TAMU, College Station, Texas 77842-3012, United States
| | - Jessica Huang
- Department of Chemistry, Department of Chemical Engineering,
Department of Materials Science & Engineering, and Laboratory for
Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255
TAMU, College Station, Texas 77842-3012, United States
| | - David A. Hunstad
- Departments of Pediatrics and Molecular Microbiology,
Washington University, St. Louis, Missouri 63110, United States
| | - Mahmoud Elsabahy
- Department of Chemistry, Department of Chemical Engineering,
Department of Materials Science & Engineering, and Laboratory for
Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255
TAMU, College Station, Texas 77842-3012, United States
- Department of Pharmaceutics, Faculty of Pharmacy and Assiut
International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University,
71515 Assiut, Egypt
| | - Karen L. Wooley
- Department of Chemistry, Department of Chemical Engineering,
Department of Materials Science & Engineering, and Laboratory for
Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255
TAMU, College Station, Texas 77842-3012, United States
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27
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Yarbrough ML, Briden KE, Mitsios JV, Weindel AL, Terrill CM, Hunstad DA, Dietzen DJ. Mass spectrometric measurement of urinary kynurenine-to-tryptophan ratio in children with and without urinary tract infection. Clin Biochem 2018; 56:83-88. [PMID: 29679555 DOI: 10.1016/j.clinbiochem.2018.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 02/02/2018] [Revised: 03/26/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Indoleamine-2,3-dioxygenase (IDO) catalyzes the first step of tryptophan (Trp) catabolism, yielding kynurenine (Kyn) metabolites. The kynurenine-to-tryptophan (K/T) ratio is used as a surrogate for biological IDO enzyme activity. IDO expression is increased during Escherichia coli urinary tract infection (UTI). Thus, our objective was to develop a method for measurement of Kyn/Trp ratio in human blood and urine and evaluate its use as a biomarker of UTI. METHODS A mass spectrometric method was developed to measure Trp and Kyn in serum and urine specimens. The method was applied to clinical urine specimens from symptomatic pediatric patients with laboratory-confirmed UTI or other acute conditions and from healthy controls. RESULTS The liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was linear to 500 μmol/L for both Trp and Kyn. Imprecision ranged from 5 to 15% for Trp and 6-20% for Kyn. Analytical recoveries of Trp and Kyn ranged from 96 to 119% in serum and 90-97% in urine. No correlation was found between the K/T ratio and circulating IDO mass (r = 0.110) in serum. Urinary Kyn and Trp in the pediatric test cohort demonstrated elevations in the K/T ratio in symptomatic patients with UTI (median 13.08) and without UTI (median 14.38) compared to healthy controls (median 4.93; p < 0.001 for both comparisons). No significant difference in K/T ratio was noted between symptomatic patients with and without UTI (p = 0.84). CONCLUSIONS Measurement of Trp and Kyn by LC-MS/MS is accurate and precise in serum and urine specimens. While urinary K/T ratio is not a specific biomarker for UTI, it may represent a general indicator of a systemic inflammatory process.
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Affiliation(s)
- Melanie L Yarbrough
- Departments of Pathology and Immunology, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Kelleigh E Briden
- Departments of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - John V Mitsios
- Departments of Pathology and Immunology, School of Medicine, Washington University, St. Louis, Missouri, USA
| | | | - Cindy M Terrill
- Departments of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - David A Hunstad
- Departments of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri, USA; Departments of Molecular Microbiology, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Dennis J Dietzen
- Departments of Pathology and Immunology, School of Medicine, Washington University, St. Louis, Missouri, USA; Departments of Pediatrics, School of Medicine, Washington University, St. Louis, Missouri, USA.
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28
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Olson PD, McLellan LK, Liu A, Briden KE, Tiemann KM, Daugherty AL, Hruska KA, Hunstad DA. Renal scar formation and kidney function following antibiotic-treated murine pyelonephritis. Dis Model Mech 2017; 10:1371-1379. [PMID: 28882930 PMCID: PMC5719254 DOI: 10.1242/dmm.030130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/04/2017] [Indexed: 12/19/2022] Open
Abstract
We present a new preclinical model to study treatment, resolution and sequelae of severe ascending pyelonephritis. Urinary tract infection (UTI), primarily caused by uropathogenic Escherichia coli (UPEC), is a common disease in children. Severe pyelonephritis is the primary cause of acquired renal scarring in childhood, which may eventually lead to hypertension and chronic kidney disease in a small but important fraction of patients. Preclinical modeling of UTI utilizes almost exclusively females, which (in most mouse strains) exhibit inherent resistance to severe ascending kidney infection; consequently, no existing preclinical model has assessed the consequences of recovery from pyelonephritis following antibiotic treatment. We recently published a novel mini-surgical bladder inoculation technique, with which male C3H/HeN mice develop robust ascending pyelonephritis, highly prevalent renal abscesses and evidence of fibrosis. Here, we devised and optimized an antibiotic treatment strategy within this male model to more closely reflect the clinical course of pyelonephritis. A 5-day ceftriaxone regimen initiated at the onset of abscess development achieved resolution of bladder and kidney infection. A minority of treated mice displayed persistent histological abscess at the end of treatment, despite microbiological cure of pyelonephritis; a matching fraction of mice 1 month later exhibited renal scars featuring fibrosis and ongoing inflammatory infiltrates. Successful antibiotic treatment preserved renal function in almost all infected mice, as assessed by biochemical markers 1 and 5 months post-treatment; hydronephrosis was observed as a late effect of treated pyelonephritis. An occasional mouse developed chronic kidney disease, generally reflecting the incidence of this late sequela in humans. In total, this model offers a platform to study the molecular pathogenesis of pyelonephritis, response to antibiotic therapy and emergence of sequelae, including fibrosis and renal scarring. Future studies in this system may inform adjunctive therapies that may reduce the long-term complications of this very common bacterial infection. Summary: A new model of antibiotic-treated severe pyelonephritis offers a novel platform to study the molecular pathogenesis of pyelonephritis, response to antibiotic therapy, and sequelae, including fibrosis and renal scarring.
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Affiliation(s)
- Patrick D Olson
- Medical Scientist Training Program, Washington University School of Medicine, St Louis, MO 63110, USA.,Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Lisa K McLellan
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Alice Liu
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Kelleigh E Briden
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Kristin M Tiemann
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Allyssa L Daugherty
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Keith A Hruska
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA.,Department of Cell Biology and Physiology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA .,Department of Molecular Microbiology, Washington University School of Medicine, St Louis, MO 63110, USA
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DeBord MA, Southerland MR, Wagers PO, Tiemann KM, Robishaw NK, Whiddon KT, Konopka MC, Tessier CA, Shriver LP, Paruchuri S, Hunstad DA, Panzner MJ, Youngs WJ. Synthesis, characterization, in vitro SAR and in vivo evaluation of N,N'bisnaphthylmethyl 2-alkyl substituted imidazolium salts against NSCLC. Bioorg Med Chem Lett 2017; 27:764-775. [PMID: 28126518 PMCID: PMC5575737 DOI: 10.1016/j.bmcl.2017.01.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/14/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Alkyl- and N,N'-bisnaphthyl-substituted imidazolium salts were tested in vitro for their anti-cancer activity against four non-small cell lung cancer cell lines (NCI-H460, NCI-H1975, HCC827, A549). All compounds had potent anticancer activity with 2 having IC50 values in the nanomolar range for three of the four cell lines, a 17-fold increase in activity against NCI-H1975 cells when compared to cisplatin. Compounds 1-4 also showed high anti-cancer activity against nine NSCLC cell lines in the NCI-60 human tumor cell line screen. In vitro studies performed using the Annexin V and JC-1 assays suggested that NCI-H460 cells treated with 2 undergo an apoptotic cell death pathway and that mitochondria could be the cellular target of 2 with the mechanism of action possibly related to a disruption of the mitochondrial membrane potential. The water solubilities of 1-4 was over 4.4mg/mL using 2-hydroxypropyl-β-cyclodextrin as a chemical excipient, thereby providing sufficient solubility for systemic administration.
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Affiliation(s)
- Michael A. DeBord
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
| | - Marie R. Southerland
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
| | - Patrick O. Wagers
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
| | - Kristin M. Tiemann
- Departments of Pediatrics and Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Nikki K. Robishaw
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
| | - Kyle T. Whiddon
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
| | - Michael C. Konopka
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
| | - Claire A. Tessier
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
| | - Leah P. Shriver
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
- Department of Biology, University of Akron, Akron, Ohio 44325, United States
| | - Sailaja Paruchuri
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
| | - David A. Hunstad
- Departments of Pediatrics and Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Matthew J. Panzner
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
| | - Wiley J. Youngs
- Department of Chemistry, University of Akron, Akron, Ohio 44325, United States, USA. Tel: 330-972-5362, Fax: 330-972-6085
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30
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Lim YH, Tiemann KM, Hunstad DA, Elsabahy M, Wooley KL. Polymeric nanoparticles in development for treatment of pulmonary infectious diseases. Wiley Interdiscip Rev Nanomed Nanobiotechnol 2016; 8:842-871. [PMID: 27016134 PMCID: PMC5035710 DOI: 10.1002/wnan.1401] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 02/08/2016] [Accepted: 02/15/2016] [Indexed: 12/17/2022]
Abstract
Serious lung infections, such as pneumonia, tuberculosis, and chronic obstructive cystic fibrosis-related bacterial diseases, are increasingly difficult to treat and can be life-threatening. Over the last decades, an array of therapeutics and/or diagnostics have been exploited for management of pulmonary infections, but the advent of drug-resistant bacteria and the adverse conditions experienced upon reaching the lung environment urge the development of more effective delivery vehicles. Nanotechnology is revolutionizing the approach to circumventing these barriers, enabling better management of pulmonary infectious diseases. In particular, polymeric nanoparticle-based therapeutics have emerged as promising candidates, allowing for programmed design of multi-functional nanodevices and, subsequently, improved pharmacokinetics and therapeutic efficiency, as compared to conventional routes of delivery. Direct delivery to the lungs of such nanoparticles, loaded with appropriate antimicrobials and equipped with 'smart' features to overcome various mucosal and cellular barriers, is a promising approach to localize and concentrate therapeutics at the site of infection while minimizing systemic exposure to the therapeutic agents. The present review focuses on recent progress (2005-2015) important for the rational design of nanostructures, particularly polymeric nanoparticles, for the treatment of pulmonary infections with highlights on the influences of size, shape, composition, and surface characteristics of antimicrobial-bearing polymeric nanoparticles on their biodistribution, therapeutic efficacy, and toxicity. WIREs Nanomed Nanobiotechnol 2016, 8:842-871. doi: 10.1002/wnan.1401 For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Young H Lim
- Department of Chemistry, Department of Chemical Engineering, Department of Materials Science & Engineering, Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, TX, USA
| | - Kristin M Tiemann
- Department of Pediatrics, Washington University of School of Medicine, St. Louis, MO, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University of School of Medicine, St. Louis, MO, USA
- Department of Molecular Microbiology, Washington University of School of Medicine, St. Louis, MO, USA
| | - Mahmoud Elsabahy
- Department of Chemistry, Department of Chemical Engineering, Department of Materials Science & Engineering, Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, TX, USA.
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut International Center of Nanomedicine, Al-Rajhy Liver Hospital, Assiut University, Assiut, Egypt.
- Misr University for Science and Technology, 6th of October City, Egypt.
| | - Karen L Wooley
- Department of Chemistry, Department of Chemical Engineering, Department of Materials Science & Engineering, Laboratory for Synthetic-Biologic Interactions, Texas A&M University, College Station, TX, USA.
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Abstract
The clinical syndromes comprising urinary tract infection (UTI) continue to exert significant impact on millions of patients worldwide, most of whom are otherwise healthy women. Antibiotic therapy for acute cystitis does not prevent recurrences, which plague up to one fourth of women after an initial UTI. Rising antimicrobial resistance among uropathogenic bacteria further complicates therapeutic decisions, necessitating new approaches based on fundamental biological investigation. In this review, we highlight contemporary advances in the field of UTI pathogenesis and how these might inform both our clinical perspective and future scientific priorities.
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Affiliation(s)
- Lisa K McLellan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA.
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Olson PD, Hunstad DA. Subversion of Host Innate Immunity by Uropathogenic Escherichia coli. Pathogens 2016; 5:pathogens5010002. [PMID: 26742078 PMCID: PMC4810123 DOI: 10.3390/pathogens5010002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/03/2015] [Accepted: 12/29/2015] [Indexed: 01/09/2023] Open
Abstract
Uropathogenic Escherichia coli (UPEC) cause the majority of community-onset urinary tract infections (UTI) and represent a major etiologic agent of healthcare-associated UTI. Introduction of UPEC into the mammalian urinary tract evokes a well-described inflammatory response, comprising pro-inflammatory cytokines and chemokines as well as cellular elements (neutrophils and macrophages). In human UTI, this inflammatory response contributes to symptomatology and provides means for diagnosis by standard clinical testing. Early in acute cystitis, as demonstrated in murine models, UPEC gains access to an intracellular niche that protects a population of replicating bacteria from arriving phagocytes. To ensure the establishment of this protected niche, UPEC employ multiple strategies to attenuate and delay the initiation of host inflammatory components, including epithelial secretion of chemoattractants. Recent work has also revealed novel mechanisms by which UPEC blunts neutrophil migration across infected uroepithelium. Taken together, these attributes distinguish UPEC from commensal and nonpathogenic E.coli strains. This review highlights the unique immune evasion and suppression strategies of this bacterial pathogen and offers directions for further study; molecular understanding of these mechanisms will inform the development of adjunctive, anti-virulence therapeutics for UTI.
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Affiliation(s)
- Patrick D Olson
- Medical Scientist Training Program, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8208, St. Louis, MO 63110, USA.
| | - David A Hunstad
- Departments of Pediatrics and Molecular Microbiology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8208, St. Louis, MO 63110, USA.
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Abstract
Urinary tract infections (UTI) are among the most common bacterial infections of humans. The mouse provides an excellent and tractable model system for cystitis and pyelonephritis caused by Escherichia coli and other uropathogens. Using a well-established model of experimental cystitis in which the bladders of female mice are infected via transurethral catheterization, the molecular details of the pathogenesis of bacterial cystitis have been substantially illuminated in the last decade. Uropathogenic E. coli attach to bladder epithelium (both in human and mouse) via adhesive type 1 pili, establish a replicative niche within epithelial cell cytoplasm, and form intracellular bacterial communities that are protected from antibiotic effects and immune clearance. The use of different inbred and mutant mouse strains offers the opportunity to study outcomes of infection, including resolution, formation of quiescent intracellular bacterial reservoirs, chronic bacterial cystitis, and recurrent infections. Urine, bladder, and kidney tissues can be analyzed by bacterial culture, histology, immunohistochemistry, immunofluorescent and confocal microscopy, electron microscopy, and flow cytometry, while a broad array of soluble markers (e.g., cytokines) can also be profiled in serum, urine, and tissue homogenates by ELISA, Western blotting, multiplex bead array, and other approaches. This model promises to afford continued opportunity for discovery of pathogenic mechanisms and evaluation of therapeutic and preventive strategies for acute, chronic, and recurrent UTI.
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Affiliation(s)
- Thomas J Hannan
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Avenue, Campus, 8208, St. Louis, MO, 63110, USA. .,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA.
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34
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Olson PD, Hruska KA, Hunstad DA. Androgens Enhance Male Urinary Tract Infection Severity in a New Model. J Am Soc Nephrol 2015; 27:1625-34. [PMID: 26449605 DOI: 10.1681/asn.2015030327] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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: 03/27/2015] [Accepted: 08/15/2015] [Indexed: 12/17/2022] Open
Abstract
Urinary tract infections (UTIs) occur predominantly in females but also affect substantial male patient populations; indeed, morbidity in complicated UTI is higher in males. Because of technical obstacles, preclinical modeling of UTI in male mice has been limited. We devised a minimally invasive surgical bladder inoculation technique that yields reproducible upper and lower UTI in both male and female mice, enabling studies of sex differences in these infections. Acute uropathogenic Escherichia coli (UPEC) cystitis in C57BL/6 and C3H/HeN males recapitulated the intracellular bacterial community pathway previously shown in females. However, surgically infected females of these strains exhibited more robust bladder cytokine responses and more efficient UPEC control than males. Compared with females, C3H/HeN males displayed a striking predilection for chronic cystitis, manifesting as persistent bacteriuria, high-titer bladder bacterial burdens, and chronic inflammation. Furthermore, males developed more severe pyelonephritis and 100% penetrant renal abscess (a complication that is rare in female mice). These phenotypes were sharply abrogated after castration but restored with exogenous testosterone, suggesting that male susceptibility to UTI is strongly influenced by androgen exposure. These data substantiate the long-standing presumption that anatomic differences in urogenital anatomy confer protection from UTI in males; however, as clinically observed, male sex associated with more severe UTI once these traditional anatomic barriers were bypassed. This study introduces a highly tractable preclinical model for interrogating sex differences in UTI susceptibility and pathogenesis, and illuminates an interplay between host sex and UTI that is more complex than previously appreciated.
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Affiliation(s)
- Patrick D Olson
- Department of Pediatrics, Medical Scientist Training Program
| | - Keith A Hruska
- Department of Pediatrics, Department of Cell Biology and Physiology, and
| | - David A Hunstad
- Department of Pediatrics, Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
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35
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Rosen DA, Hilliard JK, Tiemann KM, Todd EM, Morley SC, Hunstad DA. Klebsiella pneumoniae FimK Promotes Virulence in Murine Pneumonia. J Infect Dis 2015; 213:649-58. [PMID: 26347570 DOI: 10.1093/infdis/jiv440] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 05/22/2015] [Accepted: 08/10/2015] [Indexed: 11/15/2022] Open
Abstract
Klebsiella pneumoniae, a chief cause of nosocomial pneumonia, is a versatile and commonly multidrug-resistant human pathogen for which further insight into pathogenesis is needed. We show that the pilus regulatory gene fimK promotes the virulence of K. pneumoniae strain TOP52 in murine pneumonia. This contrasts with the attenuating effect of fimK on urinary tract virulence, illustrating that a single factor may exert opposing effects on pathogenesis in distinct host niches. Loss of fimK in TOP52 pneumonia was associated with diminished lung bacterial burden, limited innate responses within the lung, and improved host survival. FimK expression was shown to promote serum resistance, capsule production, and protection from phagocytosis by host immune cells. Finally, while the widely used K. pneumoniae model strain 43816 produces rapid dissemination and death in mice, TOP52 caused largely localized pneumonia with limited lethality, thereby providing an alternative tool for studying K. pneumoniae pathogenesis and control within the lung.
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Affiliation(s)
- David A Rosen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Julia K Hilliard
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kristin M Tiemann
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Elizabeth M Todd
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - S Celeste Morley
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - David A Hunstad
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
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36
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Lim YH, Tiemann KM, Heo GS, Wagers PO, Rezenom YH, Zhang S, Zhang F, Youngs WJ, Hunstad DA, Wooley KL. Preparation and in vitro antimicrobial activity of silver-bearing degradable polymeric nanoparticles of polyphosphoester-block-poly(L-lactide). ACS Nano 2015; 9:1995-2008. [PMID: 25621868 PMCID: PMC4455953 DOI: 10.1021/nn507046h] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The development of well-defined polymeric nanoparticles (NPs) as delivery carriers for antimicrobials targeting human infectious diseases requires rational design of the polymer template, an efficient synthetic approach, and fundamental understanding of the developed NPs, e.g., drug loading/release, particle stability, and other characteristics. Herein, we developed and evaluated the in vitro antimicrobial activity of silver-bearing, fully biodegradable and functional polymeric NPs. A series of degradable polymeric nanoparticles (dNPs), composed of phosphoester and L-lactide and designed specifically for silver loading into the hydrophilic shell and/or the hydrophobic core, were prepared as potential delivery carriers for three different types of silver-based antimicrobials-silver acetate or one of two silver carbene complexes (SCCs). Silver-loading capacities of the dNPs were not influenced by the hydrophilic block chain length, loading site (i.e., core or shell), or type of silver compound, but optimization of the silver feed ratio was crucial to maximize the silver loading capacity of dNPs, up to ca. 12% (w/w). The release kinetics of silver-bearing dNPs revealed 50% release at ca. 2.5-5.5 h depending on the type of silver compound. In addition, we undertook a comprehensive evaluation of the rates of hydrolytic or enzymatic degradability and performed structural characterization of the degradation products. Interestingly, packaging of the SCCs in the dNP-based delivery system improved minimum inhibitory concentrations up to 70%, compared with the SCCs alone, as measured in vitro against 10 contemporary epidemic strains of Staphylococcus aureus and eight uropathogenic strains of Escherichia coli. We conclude that these dNP-based delivery systems may be beneficial for direct epithelial treatment and/or prevention of ubiquitous bacterial infections, including those of the skin and urinary tract.
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Affiliation(s)
- Young H. Lim
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering, and Laboratory for Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255 TAMU, College Station, Texas 77842, United States
| | - Kristin M. Tiemann
- Department of Pediatrics, Washington University of School of Medicine, St. Louis, MO 63110, United States
| | - Gyu Seong Heo
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering, and Laboratory for Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255 TAMU, College Station, Texas 77842, United States
| | - Patrick O. Wagers
- Department of Chemistry and Center for Silver Therapeutics Research, University of Akron, Akron, OH 44325, United States
| | - Yohannes H. Rezenom
- Laboratory for Biological Mass Spectrometry, Department of Chemistry, Texas A&M University, College Station, Texas 77843, United States
| | - Shiyi Zhang
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering, and Laboratory for Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255 TAMU, College Station, Texas 77842, United States
| | - Fuwu Zhang
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering, and Laboratory for Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255 TAMU, College Station, Texas 77842, United States
| | - Wiley J. Youngs
- Department of Chemistry and Center for Silver Therapeutics Research, University of Akron, Akron, OH 44325, United States
| | - David A. Hunstad
- Department of Pediatrics, Washington University of School of Medicine, St. Louis, MO 63110, United States
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Karen L. Wooley
- Departments of Chemistry, Chemical Engineering, and Materials Science and Engineering, and Laboratory for Synthetic-Biologic Interactions, Texas A&M University, P.O. Box 30012, 3255 TAMU, College Station, Texas 77842, United States
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Abstract
BACKGROUND Cathelicidin is a proposed defender against infection of the urinary tract via its antimicrobial properties, but its activity has not been delineated in a dedicated cystitis model. METHODS Female C57Bl/6 mice, wild type or deficient in cathelin-related antimicrobial peptide (CRAMP; an ortholog of the sole human cathelicidin, LL-37), were infected transurethrally with the cystitis-derived uropathogenic Escherichia coli (UPEC) strain UTI89. Infection course was evaluated by bladder titers, intracellular bacterial community quantification, and histological analysis. Immune responses and resolution were characterized through cytokine profiling, microscopy, and quantitation of epithelial recovery from exfoliation. RESULTS CRAMP-deficient mice exhibited significantly lower bladder bacterial loads and fewer intracellular bacterial communities during acute cystitis. Although differences in bacterial titers were evident as early as 1 hour after infection, CRAMP-deficient mice showed no baseline alterations in immune activation, uroepithelial structure, apical expression of uroplakins (which serve as bacterial receptors), or intracellular bacterial growth rate. CRAMP-deficient hosts demonstrated less intense cytokine responses, diminished neutrophil infiltration, and accelerated uroepithelial recovery. CONCLUSIONS Mice lacking the antimicrobial peptide cathelicidin experienced less severe infection than wild-type mice in a well-established model of cystitis. Although CRAMP exhibits in vitro antibacterial activity against UPEC, it may enhance UPEC infection in the bladder by promoting epithelial receptivity and local inflammation.
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Affiliation(s)
- Elizabeth S Danka
- Department of Pediatrics Division of Biology and Biomedical Sciences
| | - David A Hunstad
- Department of Pediatrics Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
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38
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Al-Zubeidi D, Burnham CAD, Hogan PG, Collins R, Hunstad DA, Fritz SA. Molecular Epidemiology of Recurrent Cutaneous Methicillin-Resistant Staphylococcus aureus Infections in Children. J Pediatric Infect Dis Soc 2014; 3:261-4. [PMID: 25844165 PMCID: PMC4381745 DOI: 10.1093/jpids/pit046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/19/2013] [Indexed: 11/14/2022]
Abstract
We assessed the relatedness by repetitive-sequence polymerase chain reaction of isolates obtained from children with recurrent methicillin-resistant Staphylococcus aureus cutaneous infections over 6 years. Ninety percent of the cases could be attributed to recurrence of the same strain type, suggesting that optimized decolonization methods in children might effectively prevent recurrent infection.
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Affiliation(s)
| | | | | | | | - David A. Hunstad
- Department of Pediatrics,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
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39
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El Feghaly RE, Hunstad DA. A Newborn With Hydrops, Hydrocephalus, and Ophthalmologic Abnormalities. J Pediatric Infect Dis Soc 2013; 2:391-3. [PMID: 26619503 DOI: 10.1093/jpids/pit047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 07/09/2013] [Indexed: 01/05/2023]
Affiliation(s)
| | - David A Hunstad
- Departments of Pediatrics Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
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40
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Abstract
The recruitment of immune cells from the periphery to the site of inflammation is an essential step in the innate immune response at any mucosal surface. During infection of the urinary bladder, polymorphonuclear leukocytes (PMN; neutrophils) migrate from the bloodstream and traverse the bladder epithelium. Failure to resolve infection in the absence of a neutrophilic response demonstrates the importance of PMN in bladder defense. To facilitate colonization of the bladder epithelium, uropathogenic Escherichia coli (UPEC), the causative agent of the majority of urinary tract infections (UTIs), dampen the acute inflammatory response using a variety of partially defined mechanisms. To further investigate the interplay between host and bacterial pathogen, we developed an in vitro model of this aspect of the innate immune response to UPEC. In the transuroepithelial neutrophil migration assay, a variation on the Boyden chamber, cultured bladder epithelial cells are grown to confluence on the underside of a permeable support. PMN are isolated from human venous blood and are applied to the basolateral side of the bladder epithelial cell layers. PMN migration representing the physiologically relevant basolateral-to-apical direction in response to bacterial infection or chemoattractant molecules is enumerated using a hemocytometer. This model can be used to investigate interactions between UPEC and eukaryotic cells as well as to interrogate the molecular requirements for the traversal of bladder epithelia by PMN. The transuroepithelial neutrophil migration model will further our understanding of the initial inflammatory response to UPEC in the bladder.
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Affiliation(s)
- Megan E Lau
- Department of Pediatrics, Washington University School of Medicine
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41
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Abstract
STUDY OBJECTIVES To compare vancomycin trough concentrations in overweight or obese pediatric patients to those with normal body habitus, after initial dosing based on total body weight (TBW). DESIGN Retrospective observational case-control study. SETTING Free-standing academic pediatric hospital. PATIENTS Forty-two overweight or obese pediatric patients were matched to 84 children of normal body habitus (NBH). MEASUREMENTS AND MAIN RESULTS Empiric vancomycin dosing was based on TBW and guided by an age-stratified dosing algorithm previously developed at our center. Initial steady-state vancomycin trough concentrations were retrieved from the electronic medical record. Overweight and obese children had significantly higher initial vancomycin trough concentrations compared with children who had an NBH (median 14.4 μg/ml vs 10.5 μg/ml, p<0.001). Initial vancomycin trough concentrations above 20 μg/ml occurred more often in overweight and obese children (p=0.016). Our dosing algorithm suggested that initial vancomycin trough concentrations below 10 μg/ml occurred significantly more often in children with NBH (p<0.001). CONCLUSIONS Overweight and obese pediatric patients may have elevated initial vancomycin trough concentrations when empiric dosing is based on TBW. Special attention to therapeutic drug monitoring is warranted in all children.
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Affiliation(s)
- Daniel E Heble
- Department of Pharmacy, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
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42
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Fritz SA, Tiemann KM, Hogan PG, Epplin EK, Rodriguez M, Al-Zubeidi DN, Bubeck Wardenburg J, Hunstad DA. A serologic correlate of protective immunity against community-onset Staphylococcus aureus infection. Clin Infect Dis 2013; 56:1554-61. [PMID: 23446627 DOI: 10.1093/cid/cit123] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Staphylococcus aureus is among the leading causes of human infection. Widespread drug resistance, emergence of highly virulent strains, and the ability of S. aureus to colonize >30% of the human population contribute to this organism's pathogenic success. Human serologic responses to S. aureus and their relationship to protective immunity remain incompletely defined, challenging the strategic development of efficacious vaccines. METHODS We measured humoral responses to 2 staphylococcal exotoxins, α-hemolysin (Hla) and Panton-Valentine leukocidin (PVL; LukF-PV/LukS-PV subunits), both premier targets of current vaccine and immunotherapy development. We correlated acute and convalescent serum antibody levels with incidence of recurrent infection over 12 months follow-up in 235 children with S. aureus colonization, primary or recurrent skin and soft tissue infection, or invasive disease. RESULTS Cutaneous infection elicited transient increases in anti-Hla and anti-PVL antibodies; however, subsequent infection risk was similar between primary and recurrent cutaneous infection cohorts. Patients with invasive infections had the lowest preexisting titers against Hla and LukF but displayed the highest convalescent titers. Across cohorts, convalescent anti-Hla titers correlated with protection against subsequent S. aureus infection. CONCLUSIONS Cutaneous S. aureus infection does not reliably provoke durable, protective immune responses. This study provides the first link between protection from disease recurrence and the humoral response to Hla, a virulence factor already implicated in disease pathogenesis. These observations can be utilized to refine ongoing vaccine and immunotherapy efforts and inform the design of clinical trials.
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Affiliation(s)
- Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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43
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Abstract
We conducted a 2-sample pharmacokinetic study of oseltamivir in 12 premature infants. Oseltamivir 1 mg/kg/dose twice daily in infants <38 weeks postmenstrual age (n=8) resulted in oseltamivir carboxylate exposure comparable to previously published pediatric data, which helps prospectively validate this regimen. Oseltamivir 3 mg/kg/dose once daily in premature infants >38 weeks postmenstrual age (born prematurely but chronologically past term, n=4) resulted in similar oseltamivir and oseltamivir carboxylate exposure. Although these results suggest persistence of immature renal function in this subgroup, further pharmacokinetic/pharmacodynamic description is required to confirm the appropriateness of this regimen.
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44
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Abstract
During acute cystitis, uropathogenic Escherichia coli (UPEC) induce bladder epithelial cell exfoliation, which eliminates infected cells and promotes UPEC dissemination. Dhakal and Mulvey (2012) uncover the mechanism that induces this exfoliation and reintroduce the pore-forming toxin, hemolysin, as an effector that surprisingly targets multiple host pathways to facilitate infection.
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Affiliation(s)
- Sheryl S Justice
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
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45
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Loughman JA, Hunstad DA. Induction of indoleamine 2,3-dioxygenase by uropathogenic bacteria attenuates innate responses to epithelial infection. J Infect Dis 2012; 205:1830-9. [PMID: 22474038 DOI: 10.1093/infdis/jis280] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Uropathogenic Escherichia coli (UPEC) are the chief cause of urinary tract infections. Although neutrophilic inflammation is a hallmark of disease, previous data indicate that UPEC promotes local dampening of host innate immune responses. Here, we show that UPEC attenuates innate responses to epithelial infection by inducing expression of indoleamine 2,3-dioxygenase (IDO), a host enzyme with previously defined roles in adaptive immune regulation. UPEC induced IDO expression in human uroepithelial cells and polymorphonuclear leukocytes (PMN) in vitro and in bladder tissue during murine cystitis via a noncanonical, interferon-independent pathway. In the bladders of UPEC-infected IDO-deficient mice, we observed augmented expression of proinflammatory cytokines and local inflammation, correlated with reduced survival of extracellular bacteria. Pharmacologic inhibition of IDO also increased human PMN transepithelial migration. Stimulation of IDO expression therefore represents a pathogen strategy to create local immune privilege at epithelial surfaces, attenuating innate responses to promote colonization and the establishment of infection.
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Affiliation(s)
- Jennifer A Loughman
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
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46
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Lin LY, Tiemann KM, Li Y, Pinkner JS, Walker JN, Hultgren SJ, Hunstad DA, Wooley KL. Synthetic polymer nanoparticles conjugated with FimH(A) from E. coli pili to emulate the bacterial mode of epithelial internalization. J Am Chem Soc 2012; 134:3938-41. [PMID: 22360307 DOI: 10.1021/ja2091917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Amphiphilic block copolymer nanoparticles are conjugated with uropathogenic Escherichia coli type 1 pilus adhesin FimH(A) through amidation chemistry to enable bladder epithelial cell binding and internalization of the nanoparticles in vitro.
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Affiliation(s)
- Lily Yun Lin
- Department of Chemistry and Chemical Engineering, Texas A&M University, P.O. Box 30012, College Station, Texas 77842, USA
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47
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Zhang B, Watts KM, Hodge D, Kemp LM, Hunstad DA, Hicks LM, Odom AR. A second target of the antimalarial and antibacterial agent fosmidomycin revealed by cellular metabolic profiling. Biochemistry 2011; 50:3570-7. [PMID: 21438569 DOI: 10.1021/bi200113y] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Antimicrobial drug resistance is an urgent problem in the control and treatment of many of the world's most serious infections, including Plasmodium falciparum malaria, tuberculosis, and healthcare-associated infections with Gram-negative bacteria. Because the non-mevalonate pathway of isoprenoid biosynthesis is essential in eubacteria and P. falciparum and this pathway is not present in humans, there is great interest in targeting the enzymes of non-mevalonate metabolism for antibacterial and antiparasitic drug development. Fosmidomycin is a broad-spectrum antimicrobial agent currently in clinical trials of combination therapies for the treatment of malaria. In vitro, fosmidomycin is known to inhibit the deoxyxylulose phosphate reductoisomerase (DXR) enzyme of isoprenoid biosynthesis from multiple pathogenic organisms. To define the in vivo metabolic response to fosmidomycin, we developed a novel mass spectrometry method to quantitate six metabolites of non-mevalonate isoprenoid metabolism from complex biological samples. Using this technique, we validate that the biological effects of fosmidomycin are mediated through blockade of de novo isoprenoid biosynthesis in both P. falciparum malaria parasites and Escherichia coli bacteria: in both organisms, metabolic profiling demonstrated a block of isoprenoid metabolism following fosmidomycin treatment, and growth inhibition due to fosmidomycin was rescued by media supplemented with isoprenoid metabolites. Isoprenoid metabolism proceeded through DXR even in the presence of fosmidomycin but was inhibited at the level of the downstream enzyme, methylerythritol phosphate cytidyltransferase (IspD). Overexpression of IspD in E. coli conferred fosmidomycin resistance, and fosmidomycin was found to inhibit IspD in vitro. This work has validated fosmidomycin as a biological reagent for blocking non-mevalonate isoprenoid metabolism and suggests a second in vivo target for fosmidomycin within isoprenoid biosynthesis, in two evolutionarily diverse pathogens.
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Affiliation(s)
- Baichen Zhang
- Proteomics and Mass Spectrometry Facility, Donald Danforth Plant Science Center, St. Louis, Missouri 63132, United States
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48
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Fritz SA, Krauss MJ, Epplin EK, Burnham CA, Garbutt J, Dunne WM, Hunstad DA, Storch GA. The natural history of contemporary Staphylococcus aureus nasal colonization in community children. Pediatr Infect Dis J 2011; 30:349-51. [PMID: 21412205 PMCID: PMC3077955 DOI: 10.1097/inf.0b013e3181fe075e] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The natural history of contemporary Staphylococcus aureus nasal colonization was evaluated in community children during a 1-year period. Methicillin-susceptible S. aureus nasal carriage was more persistent than methicillin-resistant S. aureus nasal carriage, which was usually self-limited. Children with persistent staphylococcal colonization often carried identical strains. Identification of persistent methicillin-resistant S. aureus carriers might inform strategies for decolonization and reduction of staphylococcal transmission.
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Affiliation(s)
- Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
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49
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Loughman JA, Hunstad DA. Attenuation of human neutrophil migration and function by uropathogenic bacteria. Microbes Infect 2011; 13:555-65. [PMID: 21315174 DOI: 10.1016/j.micinf.2011.01.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/06/2010] [Accepted: 01/27/2011] [Indexed: 12/27/2022]
Abstract
The establishment of bacterial infections at mucosal epithelial surfaces is determined by the balance of virulence attributes of the pathogen with the activity of innate host defenses. Polymorphonuclear leukocytes (PMN) are key responders in many bacterial infections, but the mechanisms by which pathogens subvert these early responses to establish infection are largely undefined. Here, we model early interactions between human PMN and the primary cause of urinary tract infections, namely uropathogenic Escherichia coli (UPEC). Our objective was to define virulence phenotypes of uropathogens that permit evasion of PMN activity. We show that UPEC strains, as compared with laboratory and commensal E. coli, resist phagocytic killing and dampen the production of antimicrobial reactive oxygen species by PMN. Analysis of the transcriptional responses of PMN to E. coli strains revealed that UPEC exposure downregulates the expression of PMN genes that direct pro-inflammatory signaling and PMN chemotaxis, adhesion, and migration. Consistent with these data, UPEC attenuated transepithelial neutrophil recruitment in an in vitro model of acute infection and in a murine model of bacterial cystitis. We propose that these UPEC strategies are important in the establishment of epithelial infection, and that the findings are germane to bacterial infections at other epithelial surfaces.
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Affiliation(s)
- Jennifer A Loughman
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO 63110-1093, USA
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50
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Horvath DJ, Li B, Casper T, Partida-Sanchez S, Hunstad DA, Hultgren SJ, Justice SS. Morphological plasticity promotes resistance to phagocyte killing of uropathogenic Escherichia coli. Microbes Infect 2010; 13:426-37. [PMID: 21182979 DOI: 10.1016/j.micinf.2010.12.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/17/2010] [Accepted: 12/11/2010] [Indexed: 12/23/2022]
Abstract
Uropathogenic Escherichia coli proceed through a complex intracellular developmental pathway that includes multiple morphological changes. During intracellular growth within Toll-like receptor 4-activated superficial bladder epithelial cells, a subpopulation of uropathogenic E. coli initiates SulA-mediated filamentation. In this study, we directly investigated the role of bacterial morphology in the survival of uropathogenic E. coli from killing by phagocytes. We initially determined that both polymorphonuclear neutrophils and macrophages are recruited to murine bladder epithelium at times coincident with extracellular bacillary and filamentous uropathogenic E. coli. We further determined that bacillary uropathogenic E. coli were preferentially destroyed when mixed uropathogenic E. coli populations were challenged with cultured murine macrophages in vitro. Consistent with studies using elliptical-shaped polymers, the initial point of contact between the phagocyte and filamentous uropathogenic E. coli influenced the efficacy of internalization. These findings demonstrate that filamentous morphology provides a selective advantage for uropathogenic E. coli evasion of killing by phagocytes and defines a mechanism for the essential role for SulA during bacterial cystitis. Thus, morphological plasticity can be viewed as a distinct class of mechanism used by bacterial pathogens to subvert host immunity.
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Affiliation(s)
- Dennis J Horvath
- Center for Microbial Pathogenesis, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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