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Rolo D, Assunção R, Ventura C, Alvito P, Gonçalves L, Martins C, Bettencourt A, Jordan P, Vital N, Pereira J, Pinto F, Matos P, Silva MJ, Louro H. Adverse Outcome Pathways Associated with the Ingestion of Titanium Dioxide Nanoparticles-A Systematic Review. Nanomaterials (Basel) 2022; 12:nano12193275. [PMID: 36234403 PMCID: PMC9565478 DOI: 10.3390/nano12193275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 05/15/2023]
Abstract
Titanium dioxide nanoparticles (TiO2-NPs) are widely used, and humans are exposed through food (E171), cosmetics (e.g., toothpaste), and pharmaceuticals. The oral and gastrointestinal (GIT) tract are the first contact sites, but it may be systemically distributed. However, a robust adverse outcome pathway (AOP) has not been developed upon GIT exposure to TiO2-NPs. The aim of this review was to provide an integrative analysis of the published data on cellular and molecular mechanisms triggered after the ingestion of TiO2-NPs, proposing plausible AOPs that may drive policy decisions. A systematic review according to Prisma Methodology was performed in three databases of peer-reviewed literature: Pubmed, Scopus, and Web of Science. A total of 787 records were identified, screened in title/abstract, being 185 used for data extraction. The main endpoints identified were oxidative stress, cytotoxicity/apoptosis/cell death, inflammation, cellular and systemic uptake, genotoxicity, and carcinogenicity. From the results, AOPs were proposed where colorectal cancer, liver injury, reproductive toxicity, cardiac and kidney damage, as well as hematological effects stand out as possible adverse outcomes. The recent transgenerational studies also point to concerns with regard to population effects. Overall, the findings further support a limitation of the use of TiO2-NPs in food, announced by the European Food Safety Authority (EFSA).
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Affiliation(s)
- Dora Rolo
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- ToxOmics—Centre for Toxicogenomics and Human Health, NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- Correspondence:
| | - Ricardo Assunção
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, 3810-193 Aveiro, Portugal
- IUEM, Instituto Universitário Egas Moniz, Egas Moniz-Cooperativa de Ensino Superior, CRL, 2829-511 Monte de Caparica, Portugal
| | - Célia Ventura
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- ToxOmics—Centre for Toxicogenomics and Human Health, NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Paula Alvito
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- CESAM, Centre for Environmental and Marine Studies, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Lídia Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, 1649-003 Lisbon, Portugal
| | - Carla Martins
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), 1169-056 Lisbon, Portugal
| | - Ana Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, 1649-003 Lisbon, Portugal
| | - Peter Jordan
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- BioISI—Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal
| | - Nádia Vital
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- ToxOmics—Centre for Toxicogenomics and Human Health, NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Joana Pereira
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- BioISI—Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal
| | - Fátima Pinto
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- ToxOmics—Centre for Toxicogenomics and Human Health, NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Paulo Matos
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- BioISI—Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal
| | - Maria João Silva
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- ToxOmics—Centre for Toxicogenomics and Human Health, NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Henriqueta Louro
- National Institute of Health Dr. Ricardo Jorge, 1649-016 Lisbon, Portugal
- ToxOmics—Centre for Toxicogenomics and Human Health, NOVA Medical School, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
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Vieira A, Vital N, Rolo D, Roque R, Gonçalves LM, Bettencourt A, Silva MJ, Louro H. Investigation of the genotoxicity of digested titanium dioxide nanomaterials in human intestinal cells. Food Chem Toxicol 2022; 161:112841. [PMID: 35093430 DOI: 10.1016/j.fct.2022.112841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022]
Abstract
The widespread use of titanium dioxide nanomaterials (TiO2 NMs) in food and consumer products such as toothpaste or food contact materials, suggests the relevance of human oral exposure to these nanomaterials (NMs) and raises the possibility of adverse effects in the gastrointestinal tract (GIT). We previously showed that the in vitro digestion of TiO2 NMs may increase their toxicity in intestinal cells. In this work, we analyzed the genotoxicity and the intracellular reactive oxygen species induction by physiologically relevant concentrations of three different TiO2 NMs (NM-102, NM-103 and NM-105) in Caco-2 and HT29-MTX-E12 intestinal cells, while considering the potential influence of the digestion process in the NMs' physiochemical characteristics. The results evidenced a DNA-damaging effect dependent on the NM, more relevant for the rutile/anatase NM-105, possibly due to its lower hydrodynamic size in the cells medium. In addition, the results of the micronucleus assay suggest effects on chromosomal integrity, an indicator of cancer risk, in the HT29-MTX-E12 cells, for all the tested TiO2 NMs, especially after the in vitro digestion. This work supports the evidence for concerns on the use of TiO2 NMs as a food additive, recently reported by EFSA, and for their use in applications in consumer products that may drive human exposure through ingestion.
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Affiliation(s)
- Adriana Vieira
- Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisboa, Portugal.
| | - Nádia Vital
- Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisboa, Portugal.
| | - Dora Rolo
- Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisboa, Portugal.
| | - Rossana Roque
- Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisboa, Portugal.
| | - Lídia M Gonçalves
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003, Lisbon, Portugal.
| | - Ana Bettencourt
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003, Lisbon, Portugal
| | - Maria João Silva
- Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisboa, Portugal; ToxOmics-Centre for Toxicogenomics and Human Health, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.
| | - Henriqueta Louro
- Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisboa, Portugal; ToxOmics-Centre for Toxicogenomics and Human Health, NOVA Medical School, Universidade NOVA de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisboa, Portugal.
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Vieira A, Gramacho A, Rolo D, Vital N, Silva MJ, Louro H. Cellular and Molecular Mechanisms of Toxicity of Ingested Titanium Dioxide Nanomaterials. Advances in Experimental Medicine and Biology 2022; 1357:225-257. [DOI: 10.1007/978-3-030-88071-2_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractAn exponential increase in products containing titanium dioxide nanomaterials (TiO2), in agriculture, food and feed industry, lead to increased oral exposure to these nanomaterials (NMs). Thus, the gastrointestinal tract (GIT) emerges as a possible route of exposure that may drive systemic exposure, if the intestinal barrier is surpassed. NMs have been suggested to produce adverse outcomes, such as genotoxic effects, that are associated with increased risk of cancer, leading to a concern for public health. However, to date, the differences in the physicochemical characteristics of the NMs studied and other variables in the test systems have generated contradictory results in the literature. Processes like human digestion may change the NMs characteristics, inducing unexpected toxic effects in the intestine. Using TiO2 as case-study, this chapter provides a review of the works addressing the interactions of NMs with biological systems in the context of intestinal tract and digestion processes, at cellular and molecular level. The knowledge gaps identified suggest that the incorporation of a simulated digestion process for in vitro studies has the potential to improve the model for elucidating key events elicited by these NMs, advancing the nanosafety studies towards the development of an adverse outcome pathway for intestinal effects.
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Espinal P, Pantel A, Rolo D, Marti S, López-Rojas R, Smani Y, Pachón J, Vila J, Lavigne JP. Relationship Between Different Resistance Mechanisms and Virulence in Acinetobacter baumannii. Microb Drug Resist 2019; 25:752-760. [PMID: 30632884 DOI: 10.1089/mdr.2018.0182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: This study analyzed the virulence of several Acinetobacter baumannii strains expressing different resistance mechanisms using the Caenorhabditis elegans infection model. Results: Strains susceptible/resistant to carbapenems (presenting class D (OXA-23, OXA-24), class B metallo-β-lactamase (MBL) (NDM-1), penicillin binding protein (PBP) altered and decreased expression of Omp 33-36 kDa) and isogenic A. baumannii strains susceptible/resistant to colistin (presenting loss of lipopolysaccharide (LPS) and pmrA mutations) were included to evaluate the virulence using the C. elegans infection model. The nematode killing assay, bacterial ingestion in worms, and bacterial lawn avoidance assay were performed with the Fer-15 mutant line. A. baumannii strains generally presented low virulence, showing no difference between carbapenem-resistant strains (expressing class D, MBLs, or altered PBP) and their isogenic susceptible strains. In contrast, the absence of the Omp 33-36 kDa protein in the knockout was associated with a decrease of virulence, and a significant difference was observed between colistin-resistant mutants and their susceptible counterpart when the mechanism of resistance was associated with the loss of LPS but not with its modification. Conclusions: Resistance to carbapenems in A. baumannii associated with the production of OXA-type or NDM-type enzymes does not seem to affect their virulence in the C. elegans infection model. In contrast, the presence of Omp 33-36 kDa, and high level resistance to colistin related with the loss of LPS, might contribute with the virulence profile in A. baumannii.
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Affiliation(s)
- Paula Espinal
- 1 Barcelona Institute for Global Health (ISGlobal) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,2 National Institute of Health and Medical Research, U1047, Montpellier University, Nîmes, France
| | - Alix Pantel
- 2 National Institute of Health and Medical Research, U1047, Montpellier University, Nîmes, France.,3 Department of Microbiology, University Hospital Nîmes, Nîmes, France
| | - Dora Rolo
- 1 Barcelona Institute for Global Health (ISGlobal) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sara Marti
- 4 Microbiology Department, Hospital Universitari Bellvitge, Barcelona, Spain.,5 Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Rafael López-Rojas
- 6 Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | - Younes Smani
- 6 Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | - Jerónimo Pachón
- 6 Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | - Jordi Vila
- 1 Barcelona Institute for Global Health (ISGlobal) Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jean-Philippe Lavigne
- 2 National Institute of Health and Medical Research, U1047, Montpellier University, Nîmes, France.,3 Department of Microbiology, University Hospital Nîmes, Nîmes, France
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Cepas V, López Y, Muñoz E, Rolo D, Ardanuy C, Martí S, Xercavins M, Horcajada JP, Bosch J, Soto SM. Relationship Between Biofilm Formation and Antimicrobial Resistance in Gram-Negative Bacteria. Microb Drug Resist 2018; 25:72-79. [PMID: 30142035 DOI: 10.1089/mdr.2018.0027] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Gram-negative microorganisms are a significant cause of infection in both community and nosocomial settings. The increase, emergence, and spread of antimicrobial resistance among bacteria are the most important health problems worldwide. One of the mechanisms of resistance used by bacteria is biofilm formation, which is also a mechanism of virulence. This study analyzed the possible relationship between antimicrobial resistance and biofilm formation among isolates of three Gram-negative bacteria species. Several relationships were found between the ability to form biofilm and antimicrobial resistance, being different for each species. Indeed, gentamicin and ceftazidime resistance was related to biofilm formation in Escherichia coli, piperacillin/tazobactam, and colistin in Klebsiella pneumoniae, and ciprofloxacin in Pseudomonas aeruginosa. However, no relationship was observed between global resistance or multidrug-resistance and biofilm formation. In addition, compared with other reported data, the isolates in the present study showed higher rates of antimicrobial resistance. In conclusion, the acquisition of specific antimicrobial resistance can compromise or enhance biofilm formation in several species of Gram-negative bacteria. However, multidrug-resistant isolates do not show a trend to being greater biofilm producers than non-multiresistant isolates.
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Affiliation(s)
- Virginio Cepas
- 1 ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona , Barcelona, Spain
| | - Yuly López
- 1 ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona , Barcelona, Spain
| | - Estela Muñoz
- 1 ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona , Barcelona, Spain
| | - Dora Rolo
- 1 ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona , Barcelona, Spain
| | - Carmen Ardanuy
- 2 Department of Microbiology, Hospital Universitari de Bellvitge , IDIBELL, Universitat de Barcelona, Barcelona, Spain .,3 CIBERes (CIBER de Enfermedades Respiratorias) , ISCIII, Madrid, Spain
| | - Sara Martí
- 2 Department of Microbiology, Hospital Universitari de Bellvitge , IDIBELL, Universitat de Barcelona, Barcelona, Spain .,3 CIBERes (CIBER de Enfermedades Respiratorias) , ISCIII, Madrid, Spain
| | - Mariona Xercavins
- 4 Department of Microbiology, Hospital Mutua de Terrassa , Terrassa, Spain
| | | | - Jordi Bosch
- 1 ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona , Barcelona, Spain .,6 Department of Microbiology, Hospital Clínic-Universitat de Barcelona , Barcelona, Spain
| | - Sara M Soto
- 1 ISGlobal, Barcelona Center for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona , Barcelona, Spain .,6 Department of Microbiology, Hospital Clínic-Universitat de Barcelona , Barcelona, Spain
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Simões AS, Tavares DA, Rolo D, Ardanuy C, Goossens H, Henriques-Normark B, Linares J, de Lencastre H, Sá-Leão R. lytA-based identification methods can misidentify Streptococcus pneumoniae. Diagn Microbiol Infect Dis 2016; 85:141-8. [PMID: 27107535 DOI: 10.1016/j.diagmicrobio.2016.03.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/19/2016] [Accepted: 03/20/2016] [Indexed: 02/01/2023]
Abstract
During surveillance studies we detected, among over 1500 presumptive pneumococci, 11 isolates displaying conflicting or novel results when characterized by widely accepted phenotypic (optochin susceptibility and bile solubility) and genotypic (lytA-BsaAI-RFLP and MLST) identification methods. We aimed to determine the genetic basis for the unexpected results given by lytA-BsaAI-RFLP and investigate the accuracy of the WHO recommended lytA real-time PCR assay to classify these 11 isolates. Three novel lytA-BsaAI-RFLP signatures were found (one in pneumococcus and two in S. mitis). In addition, one pneumococcus displayed the atypical lytA-BsaAI-RFLP signature characteristic of non-pneumococci and two S. pseudopneumoniae displayed the typical lytA-BsaAI-RFLP pattern characteristic of pneumococci. lytA real-time PCR misidentified these three isolates. In conclusion, identification of pneumococci by lytA real-time PCR, and other lytA-based methodologies, may lead to false results. This is of particular relevance in the increasingly frequent colonization studies relying solely on culture-independent methods.
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Affiliation(s)
- Alexandra S Simões
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier (ITQB), Universidade Nova de Lisboa (UNL), Oeiras, Portugal
| | - Débora A Tavares
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier (ITQB), Universidade Nova de Lisboa (UNL), Oeiras, Portugal
| | - Dora Rolo
- Microbiology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBERES (Ciber de Enfermedades Respiratorias), ISCIII, Madrid, Spain
| | - Carmen Ardanuy
- Microbiology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBERES (Ciber de Enfermedades Respiratorias), ISCIII, Madrid, Spain
| | - Herman Goossens
- Department of Medical Microbiology, University of Antwerp, Antwerp, Belgium; Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Birgitta Henriques-Normark
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Josefina Linares
- Microbiology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBERES (Ciber de Enfermedades Respiratorias), ISCIII, Madrid, Spain
| | - Hermínia de Lencastre
- Laboratory of Molecular Genetics, ITQB, UNL, Oeiras, Portugal; Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, NY, USA
| | - Raquel Sá-Leão
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier (ITQB), Universidade Nova de Lisboa (UNL), Oeiras, Portugal.
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Rolo D, S. Simões A, Domenech A, Fenoll A, Liñares J, de Lencastre H, Ardanuy C, Sá-Leão R. Disease isolates of Streptococcus pseudopneumoniae and non-typeable S. pneumoniae presumptively identified as atypical S. pneumoniae in Spain. PLoS One 2013; 8:e57047. [PMID: 23437306 PMCID: PMC3578818 DOI: 10.1371/journal.pone.0057047] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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: 12/05/2012] [Accepted: 01/16/2013] [Indexed: 11/27/2022] Open
Abstract
We aimed to obtain insights on the nature of a collection of isolates presumptively identified as atypical Streptococcus pneumoniae recovered from invasive and non-invasive infections in Spain. One-hundred and thirty-two isolates were characterized by: optochin susceptibility in ambient and CO2-enriched atmosphere; bile solubility; PCR-based assays targeting pneumococcal genes lytA, ply, pspA, cpsA, Spn9802, aliB-like ORF2, and a specific 16S rRNA region; multilocus sequence analysis; and antimicrobial susceptibility. By multilocus sequence analysis, 61 isolates were S. pseudopneumoniae, 34 were pneumococci, 13 were S. mitis, and 24 remained unclassified as non-pneumococci. Among S. pseudopneumoniae isolates, 51 (83.6%) were collected from respiratory tract samples; eight isolates were obtained from sterile sources. High frequency of non-susceptibility to penicillin (60.7%) and erythromycin (42.6%) was found. Only 50.8% of the S. pseudopneumoniae isolates displayed the typical optochin phenotype originally described for this species. None harbored the cpsA gene or the pneumococcal typical lytA restriction fragment length polymorphism. The Spn9802 and the specific 16S rRNA regions were detected among the majority of the S. pseudopneumoniae isolates (n = 59 and n = 49, respectively). The ply and pspA genes were rarely found. A high genetic diversity was found and 59 profiles were identified. Among the S. pneumoniae, 23 were capsulated and 11 were non-typeable. Three non-typeable isolates, associated to international non-capsulated lineages, were recovered from invasive disease sources. In conclusion, half of the atypical pneumococcal clinical isolates were, in fact, S. pseudopneumoniae and one-fourth were other streptococci. We identified S. pseudopneumoniae and non-typeable pneumococci as cause of disease in Spain including invasive disease.
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Affiliation(s)
- Dora Rolo
- Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Microbiology Department, Universistat de Barcelona, Barcelona, Spain
- Centro de investigación en red de enfermedades respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Alexandra S. Simões
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Arnau Domenech
- Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Microbiology Department, Universistat de Barcelona, Barcelona, Spain
- Centro de investigación en red de enfermedades respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Asunción Fenoll
- National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Josefina Liñares
- Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Microbiology Department, Universistat de Barcelona, Barcelona, Spain
- Centro de investigación en red de enfermedades respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Hermínia de Lencastre
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal
- Laboratory of Microbiology, The Rockefeller University, New York, New York, United States of America
| | - Carmen Ardanuy
- Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Microbiology Department, Universistat de Barcelona, Barcelona, Spain
- Centro de investigación en red de enfermedades respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Sá-Leão
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal
- Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal
- * E-mail:
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Grau I, Ardanuy C, Calatayud L, Rolo D, Domenech A, Liñares J, Pallares R. Invasive pneumococcal disease in healthy adults: increase of empyema associated with the clonal-type Sweden(1)-ST306. PLoS One 2012; 7:e42595. [PMID: 22912711 PMCID: PMC3418254 DOI: 10.1371/journal.pone.0042595] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 07/10/2012] [Indexed: 11/18/2022] Open
Abstract
Background Adult invasive pneumococcal disease (IPD) occurs mainly in the elderly and patients with co-morbidities. Little is known about the clinical characteristics, serotypes and genotypes causing IPD in healthy adults. Methods We studied 745 culture-proven cases of IPD in adult patients aged 18–64 years (1996–2010). Patients were included in two groups: 1.) adults with co-morbidities, and 2.) healthy adults, who had no prior or coincident diagnosis of a chronic or immunosuppressive underlying disease. Microbiological studies included pneumococcal serotyping and genotyping. Results Of 745 IPD episodes, 525 (70%) occurred in patients with co-morbidities and 220 (30%) in healthy adults. The healthy adults with IPD were often smokers (56%) or alcohol abusers (18%). As compared to patients with co-morbidities, the healthy adults had (P<0.05): younger age (43.5+/−13.1 vs. 48.7+/−11.3 years); higher proportions of women (45% vs. 24%), pneumonia with empyema (15% vs. 7%) and infection with non-PCV7 serotypes including serotypes 1 (25% vs. 5%), 7F (13% vs. 4%), and 5 (7% vs. 2%); and lower mortality (5% vs. 20%). Empyema was more frequently caused by serotype 1. No death occurred among 79 patients with serotype 1 IPD. There was an emergence of virulent clonal-types Sweden1-ST306 and Netherlands7F-ST191. The vaccine serotype coverage with the PCV13 was higher in healthy adults than in patients with co-morbidities: 82% and 56%, respectively, P<0.001. Conclusion In this clinical study, one-third of adults with IPD had no underlying chronic or immunosuppressive diseases (healthy adults). They were often smokers and alcohol abusers, and frequently presents with pneumonia and empyema caused by virulent clones of non-PCV7 serotypes such as the Sweden1-ST306. Thus, implementing tobacco and alcohol abuse-cessation measures and a proper pneumococcal vaccination, such as PCV13 policy, in active smokers and alcohol abusers may diminish the burden of IPD in adults.
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Affiliation(s)
- Imma Grau
- Infectious Disease Department, Hospital Bellvitge, Idibell, Ciberes, University of Barcelona, Barcelona, Spain
| | - Carmen Ardanuy
- Microbiology Department, Hospital Bellvitge, Idibell, Ciberes, University of Barcelona, Barcelona, Spain
| | - Laura Calatayud
- Microbiology Department, Hospital Bellvitge, Idibell, Ciberes, University of Barcelona, Barcelona, Spain
| | - Dora Rolo
- Microbiology Department, Hospital Bellvitge, Idibell, Ciberes, University of Barcelona, Barcelona, Spain
| | - Arnau Domenech
- Microbiology Department, Hospital Bellvitge, Idibell, Ciberes, University of Barcelona, Barcelona, Spain
| | - Josefina Liñares
- Microbiology Department, Hospital Bellvitge, Idibell, Ciberes, University of Barcelona, Barcelona, Spain
| | - Roman Pallares
- Infectious Disease Department, Hospital Bellvitge, Idibell, Ciberes, University of Barcelona, Barcelona, Spain
- * E-mail:
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Pires R, Rolo D, Morais A, Brito-Avô A, Johansson C, Henriques-Normark B, Gonçalo-Marques J, Santos-Sanches I. Description of macrolide-resistant and potential virulent clones of Streptococcus pyogenes causing asymptomatic colonization during 2000-2006 in the Lisbon area. Eur J Clin Microbiol Infect Dis 2011; 31:849-57. [PMID: 22012657 DOI: 10.1007/s10096-011-1384-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 08/08/2011] [Indexed: 11/26/2022]
Abstract
The asymptomatic oropharyngeal colonization rate by Streptococcus pyogenes was 10.7% in children (901 among 8,405 children 0-16 years old) and 3.3% in adults (37 among 1,126 households of children) in the Lisbon area during 2000-2006. Macrolide-resistant S. pyogenes from children (n = 149) was variable with time: 9.8-10.7% in 2000-2002, 28.1% in 2003, 19.6-2.7% in 2004-2005 and 14.6% in 2006. Eight lineages (97.3% of isolates) were identified based on at least 80% similarity of PFGE patterns, T types, emm types and multilocus sequence types (ST). The elevated frequency of macrolide resistance was associated with M phenotype lineages I (emm12/ST36) and V (emm4, emm75/ST39 and a novel emmstMrp6 type) and with one cMLS(B) lineage IV (emm28/ST52) known to be associated with upper respiratory tract and invasive infections. Significant associations (p < 0.05) between emm type/virulence genotype were found, such as emm1/speA (+) ssa (-), emm4/ssa (+) prtF1 (+), emm12/speA (-) ssa (-). The high prevalence (>20%) of speC, prtF1 or ssa was probably caused either by clonal dissemination (speC), or to horizontal gene transfer events (prtF1 and ssa). This report contributes to a better understanding of the molecular epidemiology and evolution of macrolide-resistant S. pyogenes causing symptom-free oropharyngeal colonization. These colonizing strains carry macrolide resistance and virulence genes capable of being transferred to other bacterial species sharing the same niche.
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Affiliation(s)
- R Pires
- Centro de Recursos Microbiológicos, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Campus de Caparica, 2829-516, Caparica, Portugal
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Rolo D, Fenoll A, Ardanuy C, Calatayud L, Cubero M, de la Campa AG, Linares J. Trends of invasive serotype 6C pneumococci in Spain: emergence of a new lineage. J Antimicrob Chemother 2011; 66:1712-8. [DOI: 10.1093/jac/dkr193] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ardanuy C, Domenech A, Rolo D, Calatayud L, Tubau F, Ayats J, Martin R, Linares J. Molecular characterization of macrolide- and multidrug-resistant Streptococcus pyogenes isolated from adult patients in Barcelona, Spain (1993-2008). J Antimicrob Chemother 2010; 65:634-43. [DOI: 10.1093/jac/dkq006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ardanuy C, Rolo D, Fenoll A, Tarrago D, Calatayud L, Liñares J. Emergence of a multidrug-resistant clone (ST320) among invasive serotype 19A pneumococci in Spain. J Antimicrob Chemother 2009; 64:507-10. [PMID: 19535383 DOI: 10.1093/jac/dkp210] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Multidrug-resistant Streptococcus pneumoniae isolates of serotype 19A have emerged all over the world in recent years. The aim of this study was to characterize highly penicillin-resistant pneumococcal strains of the 19A serotype, collected in Spain from 1997 to 2007 from patients with invasive disease. METHODS Antibiotic susceptibility was studied by microdilution. All penicillin-resistant pneumococci were typed by PFGE and selected strains were studied by multilocus sequence typing (MLST). The presence of genes related to the Tn916 family of transposons was investigated by PCR. RESULTS From a total of 1197 invasive pneumococcal isolates of serotype 19A received at the Spanish Reference Laboratory between 1997 and 2007, 51 (4.3%) strains showed high-level resistance to penicillin (MICs of 2-4 mg/L). These 51 isolates belonged to three multiresistant clones related to sequence type (ST)81 (n = 21), ST320 (n = 19) and ST276 (n = 11). All 51 serotype 19A pneumococci were tetracycline-resistant and had the tet(M) gene, and 41 strains were macrolide-resistant, harbouring the erm(B) gene. The presence of int and xis genes was detected in all strains associated with other genes of the Tn916 family. CONCLUSIONS The rise in penicillin-resistant serotype 19A invasive pneumococci in Spain was associated with the emergence and clonal spread of two worldwide-disseminated multiresistant clones (ST276 and ST320). The Spain(23F)-1-19A (ST81) clone remained stable throughout the study period. Multidrug resistance was associated with transposons of the Tn916 family.
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Affiliation(s)
- Carmen Ardanuy
- Microbiology Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
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Rolo D, Ardanuy C, Fleites A, Martín R, Liñares J. Diversity of pneumococcal surface protein A (PspA) among prevalent clones in Spain. BMC Microbiol 2009; 9:80. [PMID: 19419534 PMCID: PMC2684541 DOI: 10.1186/1471-2180-9-80] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 05/06/2009] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND PspA is recognized as a major pneumococcal virulence factor and a possible vaccine candidate. The aim of this study was to analyze the PspA family and clade distribution among 112 Spanish pneumococci representatives of dominant clones among patients with invasive disease (n = 66) and nasopharyngeal healthy carriage in children (n = 46). RESULTS PspA family 2 was predominant among invasive (63.6%) and carriage (54.3%) pneumococcal isolates. No PspA family 3 isolates were detected and only one strain was PspA negative. Although four clonal complexes contained strains of different clades, a clear association between clade and multi locus sequence typing results was found. Clades 1, 3 and 4 were associated with a wide variety of sequence types (ST) related to multiresistant and antibiotic-susceptible worldwide-disseminated clones. Clade 1 was associated with Spain 6B-ST90, Spain 14-ST18, Colombia 5-ST289, Sweden 1-ST306, Denmark 14-ST230 and Sweden 1-ST304 clones. Clade 3 was associated with Spain 23F-ST81, Spain 9V-ST156, Tennessee 14-ST67, Netherlands 3-ST180 and Netherlands 7F-ST191 clones. Clade 4 was related to Sweden 15A-ST63, Netherlands 18C-ST113 and Greece 21-ST193 clones. In contrast, PspA clade was not related to serotype, age or clinical origin of the isolates. CONCLUSION PspA clades were associated with genotypes. PspA family 2 and family 1 were dominant among major Spanish pneumococcal clones isolated from patients with invasive disease and nasopharyngeal carriage in children.
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Affiliation(s)
- Dora Rolo
- Microbiology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona, IDIBELL, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- CIBERES (CIBER de Enfermedades Respiratorias), ISCIII, Madrid, Spain
| | - Carmen Ardanuy
- Microbiology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona, IDIBELL, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- CIBERES (CIBER de Enfermedades Respiratorias), ISCIII, Madrid, Spain
| | - Ana Fleites
- Microbiology Department, Hospital Central de Asturias, Oviedo, Spain
| | - Rogelio Martín
- Microbiology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona, IDIBELL, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josefina Liñares
- Microbiology Department, Hospital Universitari de Bellvitge, Universitat de Barcelona, IDIBELL, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- CIBERES (CIBER de Enfermedades Respiratorias), ISCIII, Madrid, Spain
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Pires R, Rolo D, Mato R, Feio de Almeida J, Johansson C, Henriques-Normark B, Morais A, Brito-Avô A, Gonçalo-Marques J, Santos-Sanches I. Resistance to bacitracin in Streptococcus pyogenes from oropharyngeal colonization and noninvasive infections in Portugal was caused by two clones of distinct virulence genotypes. FEMS Microbiol Lett 2009; 296:235-40. [PMID: 19486163 DOI: 10.1111/j.1574-6968.2009.01642.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
During 2000-2007 in Lisbon, we identified 45 bacitracin-resistant Streptococcus pyogenes isolates among 1629 isolates: 24 from oropharyngeal healthy carriers (out of 1026), 21 from patients with noninvasive infections (out of 559) and zero from invasive infections (out of 44). Forty-four of those isolates, mainly of colonization, are low-level bacitracin-resistant members of the cMLS(B)-macrolide-resistant and tetracycline-susceptible emm28/ST52 clone previously detected in Europe, but only among clinical samples. One high-level bacitracin-resistant isolate, associated with a tonsillitis/pharyngitis episode, is cMLS(B)-macrolide-resistant and tetracycline-resistant member of the emm74/ST120 lineage, which was not previously known to include bacitracin-resistant isolates. The bcrABDR operon encoding an ATP-binding cassette transporter in Enterococcus faecalis was not detected among these bacitracin-resistant S. pyogenes strains. Virulence profiling indicated that genes coding for exotoxins and superantigens seem to be clone specific. This study provides an increased knowledge about specific bacitracin-resistant S. pyogenes strains, which may be useful in future investigations aiming to understand the mechanism(s) leading to bacitracin resistance and the cause(s) for differences in colonization and/or dissemination potential.
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Affiliation(s)
- Renato Pires
- Centro de Recursos Microbiológicos, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Caparica, Portugal
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Ardanuy C, Tubau F, Pallares R, Calatayud L, Domínguez M, Rolo D, Grau I, Martín R, Liñares J. Epidemiology of Invasive Pneumococcal Disease among Adult Patients in Barcelona Before and After Pediatric 7‐Valent Pneumococcal Conjugate Vaccine Introduction, 1997–2007. Clin Infect Dis 2009; 48:57-64. [DOI: 10.1086/594125] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Rato M, Rolo D, Bexiga R, Nunes S, Cavaco L, Vilela C, Santos-Sanches I. P998 Antimicrobial resistance patterns and genotypes of Streptococcus agalactiae and Streptococcus dysgalactiae ssp. dysgalactiae from bovine mastitis in Portuguese dairy farms. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70839-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rolo D, Custòdio S, Nunes A, Cabral R, Rato M, Oliveira V, Tavares D, Pires R, Morais A, Faria M, Barros R, Peres I, Trigueiro G, Cardoso C, Marques J, Santos-Sanches I. P755 Rapid variations in the macrolide resistance frequency, phenotypes and clones of group A streptococci from pharyngeal colonisation and infections, 2000 to 2006. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pires R, Rolo D, Gama-Norton L, Morais A, Lito L, Salgado MJ, Johansson C, Möllerberg G, Henriques-Normark B, Gonçalo-Marques J, Santos-Sanches I. Group A Streptococci from carriage and disease in Portugal: evolution of antimicrobial resistance and T antigenic types during 2000-2002. Microb Drug Resist 2006; 11:360-70. [PMID: 16359196 DOI: 10.1089/mdr.2005.11.360] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this study, we analyzed the antimicrobial resistance properties and T antigenic types of 511 isolates collected in Lisbon district, Portugal, from throat swabs of healthy subjects (n=341), during 2000-2002 and from diverse infection sites (n=170) of outpatients and inpatients, during 1999-2002. Erythromycin resistance was higher in tonsillitis/pharyngitis (27.4%) and skin infection isolates (21.1%), than in carriage and invasive isolates (<or=10%). Differences in erythromycin resistance among children and adults were noticed only for carriage isolates (9.3% in children and 21.1% in adults). Most erythromycin-resistant isolates from carriage (82.4%) and tonsillitis/pharyngitis (71.9%) showed the M phenotype. All M phenotype isolates (n=53) carried mef(A), whereas all MLS(B) phenotype isolates (n=19) carried erm(B) and not erm(A). Resistance to tetracycline [mediated by tet(M) in most isolates] was <or=6% in tonsillitis/pharyngitis and carriage isolates, 36.8% in skin infection isolates, and 44.1% in invasive isolates. The M phenotype increased since 2000, linked to a decrease of tetracycline resistance, and was predominantly associated with T1 in 2000-2001 and T12 in 2002 among carriage isolates, and with T8/25/Imp19 through 2000-2002 among tonsillitis/pharyngitis isolates. The majority (53%) of the tetracycline-resistant invasive isolates were nontypable. All isolates were susceptible to penicillin and chloramphenicol. This study showed that tetracycline and macrolide resistance frequency and phenotypes differ among GAS from various origins and changed over time. Moreover, T typing suggested that most drug-resistant isolates causing oropharyngeal carriage are distinct from the majority of isolates causing noninvasive and invasive infection.
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Affiliation(s)
- R Pires
- Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Monte de Caparica, Portugal
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