1
|
Shaw TD, Krasnodembskaya AD, Schroeder GN, Doherty DF, Silva JD, Tandel SM, Su Y, Butler D, Ingram RJ, O'Kane CM. Human mesenchymal stromal cells inhibit Mycobacterium avium replication in clinically relevant models of lung infection. Thorax 2024:thorax-2023-220819. [PMID: 38508718 DOI: 10.1136/thorax-2023-220819] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Novel therapeutic strategies are urgently needed for Mycobacterium avium complex pulmonary disease (MAC-PD). Human mesenchymal stromal cells (MSCs) can directly inhibit MAC growth, but their effect on intracellular bacilli is unknown. We investigated the ability of human MSCs to reduce bacterial replication and inflammation in MAC-infected macrophages and in a murine model of MAC-PD. METHODS Human monocyte-derived macrophages (MDMs) were infected with M. avium Chester strain and treated with human bone marrow-derived MSCs. Intracellular and extracellular colony-forming units (CFUs) were counted at 72 hours. Six-week-old female balb/c mice were infected by nebulisation of M. avium Chester. Mice were treated with 1×106 intravenous human MSCs or saline control at 21 and 28 days post-infection. Lungs, liver and spleen were harvested 42 days post-infection for bacterial counts. Cytokines were quantified by ELISA. RESULTS MSCs reduced intracellular bacteria in MDMs over 72 hours (median 35% reduction, p=0.027). MSC treatment increased extracellular concentrations of prostaglandin E2 (PGE2) (median 10.1-fold rise, p=0.002) and reduced tumour necrosis factor-α (median 28% reduction, p=0.025). Blocking MSC PGE2 production by cyclo-oxygenase-2 (COX-2) inhibition with celecoxib abrogated the antimicrobial effect, while this was restored by adding exogenous PGE2. MSC-treated mice had lower pulmonary CFUs (median 18% reduction, p=0.012), but no significant change in spleen or liver CFUs compared with controls. CONCLUSION MSCs can modulate inflammation and reduce intracellular M. avium growth in human macrophages via COX-2/PGE2 signalling and inhibit pulmonary bacterial replication in a murine model of chronic MAC-PD.
Collapse
Affiliation(s)
- Timothy D Shaw
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | | | - Gunnar N Schroeder
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Declan F Doherty
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Johnatas Dutra Silva
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Shikha M Tandel
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Yue Su
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - David Butler
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Rebecca J Ingram
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Cecilia M O'Kane
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| |
Collapse
|
2
|
Patterson CM, Shaw TD, Gerovasili V, Khatana U, Jose RJ. Emerging therapies and respiratory infections: Focus on the impact of immunosuppressants and immunotherapies. Clin Med (Lond) 2024; 24:100015. [PMID: 38387208 PMCID: PMC11024833 DOI: 10.1016/j.clinme.2024.100015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Host defences to infection are based upon an integrated system of physical and biochemical barriers, innate and adaptive immunity. Weakness in any of these defensive elements leads to increased susceptibility to specific pathogens. Understanding how medical therapies disrupt host defences is key to the successful prevention, diagnosis and management of respiratory infection in the immunocompromised host.
Collapse
Affiliation(s)
- Caroline M Patterson
- Consultant in Respiratory Transplant Medicine, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
| | - Timothy D Shaw
- Academic Clinical Lecturer in Infectious Diseases and Medical Microbiology, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Vicky Gerovasili
- Consultant in Respiratory Transplant Medicine, Royal Brompton and Harefield hospital, part of Guys and St Thomas NHS Foundation trust, London, UK
| | - Usman Khatana
- Specialty Trainee in Respiratory Medicine, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Ricardo J Jose
- Consultant in Host Defence, Royal Brompton and Harefield hospital, part of Guys and St Thomas NHS Foundation trust, London, UK
| |
Collapse
|
3
|
Shaw TD, Curran T, Cooke S, McMullan R, Hunter M. The utility of 16S rRNA gene sequencing on intraoperative specimens from intracranial infections: an 8-year study in a regional UK neurosurgical unit. Br J Neurosurg 2021:1-6. [PMID: 34927521 DOI: 10.1080/02688697.2021.2016620] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/01/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
Background: Optimal management of intracranial infections relies on microbiological diagnosis and antimicrobial choice, but conventional culture-based testing is limited by pathogen viability and pre-sampling antimicrobial exposure. Broad-range 16S rRNA gene sequencing has been reported in the management of culture-negative infections but its utility in intracranial infection is not well-described. We studied the efficacy of 16S rRNA gene sequencing to inform microbiological diagnosis and antimicrobial choice in intracranial infections.Methods: This was a retrospective study of all intraoperative neurosurgical specimens sent for 16S rRNA gene sequencing over an 8-year period at a regional neurosurgical centre in the UK. Specimen selection was performed using multidisciplinary approach, combining neurosurgical and infection specialist discussion.Results: Twenty-five intraoperative specimens taken during neurosurgery from 24 patients were included in the study period. The most common reason for referral was pre-sampling antimicrobial exposure (68%). Bacterial rDNA was detected in 60% of specimens. 16S rRNA gene sequencing contributed to microbiological diagnosis in 15 patients and informed antimicrobial management in 10 of 24 patients with intracranial infection. These included targeted antibiotics after detection of a clinically-significant pathogen that had not been identified through other microbiological testing (3 cases), detection of commensal organisms in neurosurgical infection which justified continued broad cover (2 cases) and negative results from intracranial lesions with low clinical suspicion of bacterial infection which justified avoidance or cessation of antibiotics (5 cases).Conclusion: Overall, 16S rRNA gene sequencing represented an incremental improvement in diagnostic testing and was most appropriately used to complement, rather than replace, conventional culture-based testing for intracranial infection.
Collapse
Affiliation(s)
- Timothy D Shaw
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
- Department of Medical Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Tanya Curran
- Department of Medical Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Stephen Cooke
- Regional Neurosciences Unit, Belfast Health and Social Care Trust, Belfast, UK
| | - Ronan McMullan
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
- Department of Medical Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Michael Hunter
- Infectious Diseases Unit, Belfast Health and Social Care Trust, Belfast, UK
| |
Collapse
|
4
|
Affiliation(s)
- Timothy D. Shaw
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, UK
| | - Daniel F. McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, UK
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK
| | - Cecilia M. O’Kane
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, UK
| |
Collapse
|
5
|
Shaw TD, Fairley DJ, Schneiders T, Pathiraja M, Hill RLR, Werner G, Elborn JS, McMullan R. The use of high-throughput sequencing to investigate an outbreak of glycopeptide-resistant Enterococcus faecium with a novel quinupristin-dalfopristin resistance mechanism. Eur J Clin Microbiol Infect Dis 2018; 37:959-967. [PMID: 29478197 PMCID: PMC5916979 DOI: 10.1007/s10096-018-3214-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/10/2018] [Accepted: 02/13/2018] [Indexed: 12/01/2022]
Abstract
High-throughput sequencing (HTS) has successfully identified novel resistance genes in enterococci and determined clonal relatedness in outbreak analysis. We report the use of HTS to investigate two concurrent outbreaks of glycopeptide-resistant Enterococcus faecium (GRE) with an uncharacterised resistance mechanism to quinupristin-dalfopristin (QD). Seven QD-resistant and five QD-susceptible GRE isolates from a two-centre outbreak were studied. HTS was performed to identify genes or predicted proteins that were associated with the QD-resistant phenotype. MLST and SNP typing on HTS data was used to determine clonal relatedness. Comparative genomic analysis confirmed this GRE outbreak involved two distinct clones (ST80 and ST192). HTS confirmed the absence of known QD resistance genes, suggesting a novel mechanism was conferring resistance. Genomic analysis identified two significant genetic determinants with explanatory power for the high level of QD resistance in the ST80 QD-resistant clone: an additional 56aa leader sequence at the N-terminus of the lsaE gene and a transposon containing seven genes encoding proteins with possible drug or drug-target modification activities. However, HTS was unable to conclusively determine the QD resistance mechanism and did not reveal any genetic basis for QD resistance in the ST192 clone. This study highlights the usefulness of HTS in deciphering the degree of relatedness in two concurrent GRE outbreaks. Although HTS was able to reveal some genetic candidates for uncharacterised QD resistance, this study demonstrates the limitations of HTS as a tool for identifying putative determinants of resistance to QD.
Collapse
Affiliation(s)
- Timothy D Shaw
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK. .,Department of Medical Microbiology, Kelvin Laboratory, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
| | - D J Fairley
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.,Department of Medical Microbiology, Kelvin Laboratory, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - T Schneiders
- Division of Infection and Pathway Medicine, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - M Pathiraja
- Department of Medical Microbiology, Kelvin Laboratory, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - R L R Hill
- Antimicrobial Resistance & Healthcare-Associated Infection, Public Health England, London, UK
| | - G Werner
- National Reference Centre for Staphylococci and Enterococci, Robert Koch-Institute, Wernigerode Branch, Berlin, Germany
| | - J S Elborn
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - R McMullan
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, UK.,Department of Medical Microbiology, Kelvin Laboratory, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| |
Collapse
|
6
|
Kenny SL, Shaw TD, Downey DG, Moore JE, Rendall JC, Elborn JS. Eradication of Pseudomonas aeruginosa in adults with cystic fibrosis. BMJ Open Respir Res 2014; 1:e000021. [PMID: 25478173 PMCID: PMC4212722 DOI: 10.1136/bmjresp-2014-000021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 01/12/2014] [Revised: 03/24/2014] [Accepted: 03/26/2014] [Indexed: 11/15/2022] Open
Abstract
Background Eradication of new infection of Pseudomonas aeruginosa is an important intervention in managing cystic fibrosis (CF). Previous trials, studying predominantly under 18-year-olds, indicate that antibiotic eradication therapy (AET) has success rates of 62.8–93.0%. In this retrospective cohort study, we report the outcomes of AET in an adult population. Methods Adults with a confirmed diagnosis of CF and a first isolation of P aeruginosa were studied between 1999 and 2012. Choice of therapy, time to eradication and reinfection, and lung function (forced expiratory volume in 1 s (FEV1)) were determined. Results 20 patients (median age 27 years) isolated P aeruginosa during the study period. 10 patients were treated with oral ciprofloxacin (median duration 6 weeks) and nebulised colomycin (median duration 3 months). 7 patients were treated with intravenous antipseudomonal antibiotics (median duration 14 days). 2 patients received other combinations of oral and inhaled antipseudomonal therapy and one patient received no therapy. AET was successful in 15 cases who received antipseudomonal therapy (79%). The median time to eradication was 1 month. The median time to reinfection with P aeruginosa was 43 months. There was no significant change in FEV1 after 12 months. Conclusions Aggressive AET of new infection of P aeruginosa in adults is successful in the majority of patients and has similar efficacy to the reported efficacy in paediatric populations.
Collapse
Affiliation(s)
- S L Kenny
- Centre for Infection and Immunity, Queen's University Belfast , Belfast , UK ; Adult CF Centre, BHSCT , Belfast , UK
| | - T D Shaw
- Centre for Infection and Immunity, Queen's University Belfast , Belfast , UK ; Adult CF Centre, BHSCT , Belfast , UK
| | | | - J E Moore
- Department of Bacteriology , Belfast City Hospital , Belfast , UK
| | | | - J S Elborn
- Centre for Infection and Immunity, Queen's University Belfast , Belfast , UK
| |
Collapse
|