1
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Harris E. Nerve Cell Growth Might Underlie Discomfort Tied to Recurrent UTIs. JAMA 2024; 331:1266. [PMID: 38517414 DOI: 10.1001/jama.2024.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
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2
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Steers NJ, Barasch J. Their last will and testament: dying immune cells protect the urinary system with extracellular DNA traps. Kidney Int 2023; 104:236-238. [PMID: 37479384 PMCID: PMC10950419 DOI: 10.1016/j.kint.2023.05.021] [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: 04/11/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 07/23/2023]
Abstract
Like most epithelial organs, the bladder and kidney can be directly accessed by bacteria evolved for invasion. Epithelia and immune cells attempt to stymie this infection with biophysical and chemical mechanisms. Goldspink et al. connected the Na+ gradient in the kidney medulla with an immune defense mounted by dead cells (namely, the explosive death of neutrophils and macrophages), resulting in extracellular DNA traps. The pathway from Na+ concentration to immune death is depicted.
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Affiliation(s)
- Nicholas J Steers
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA.
| | - Jonathan Barasch
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA.
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3
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Song CH, Kim YH, Naskar M, Hayes BW, Abraham MA, Noh JH, Suk G, Kim MJ, Cho KS, Shin M, Lee EJ, Abraham SN, Choi HW. Lactobacillus crispatus Limits Bladder Uropathogenic E. coli Infection by Triggering a Host Type I Interferon Response. Proc Natl Acad Sci U S A 2022; 119:e2117904119. [PMID: 35939684 PMCID: PMC9388105 DOI: 10.1073/pnas.2117904119] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Many urinary tract infections (UTIs) are recurrent because uropathogens persist within the bladder epithelial cells (BECs) for extended periods between bouts of infection. Because persistent uropathogens are intracellular, they are often refractive to antibiotic treatment. The recent discovery of endogenous Lactobacillus spp. in the bladders of healthy humans raised the question of whether these endogenous bacteria directly or indirectly impact intracellular bacterial burden in the bladder. Here, we report that in contrast to healthy women, female patients experiencing recurrent UTIs have a bladder population of Lactobacilli that is markedly reduced. Exposing infected human BECs to L. crispatus in vitro markedly reduced the intracellular uropathogenic Escherichia coli (UPEC) load. The adherence of Lactobacilli to BECs was found to result in increased type I interferon (IFN) production, which in turn enhanced the expression of cathepsin D within lysosomes harboring UPECs. This lysosomal cathepsin D-mediated UPEC killing was diminished in germ-free mice and type I IFN receptor-deficient mice. Secreted metabolites of L. crispatus seemed to be responsible for the increased expression of type I IFN in human BECs. Intravesicular administration of Lactobacilli into UPEC-infected murine bladders markedly reduced their intracellular bacterial load suggesting that components of the endogenous microflora can have therapeutic effects against UTIs.
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Affiliation(s)
- Chang Hyun Song
- Division of Life Sciences, Korea University, Seoul, 02841, South Korea
| | - Young Ho Kim
- Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon-si, 14584, South Korea
| | - Manisha Naskar
- Division of Life Sciences, Korea University, Seoul, 02841, South Korea
| | - Byron W Hayes
- Department of Pathology, Duke University Medical Center, Durham, NC 27710
| | - Mathew A Abraham
- Department of Pathology, Duke University Medical Center, Durham, NC 27710
| | - Joo Hwan Noh
- Division of Life Sciences, Korea University, Seoul, 02841, South Korea
| | - Gyeongseo Suk
- Division of Life Sciences, Korea University, Seoul, 02841, South Korea
| | - Min Jung Kim
- Division of Life Sciences, Korea University, Seoul, 02841, South Korea
| | - Kyu Sang Cho
- Division of Life Sciences, Korea University, Seoul, 02841, South Korea
| | - Minhye Shin
- Department of Microbiology, Inha University School of Medicine, Incheon, 22212, South Korea
| | - Eun-Jin Lee
- Division of Life Sciences, Korea University, Seoul, 02841, South Korea
| | - Soman N Abraham
- Department of Pathology, Duke University Medical Center, Durham, NC 27710
- Department of Immunology, Duke University Medical Center, Durham, NC 27710
- Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC 27710
| | - Hae Woong Choi
- Division of Life Sciences, Korea University, Seoul, 02841, South Korea
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4
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Huang J, Fu L, Huang J, Zhao J, Zhang X, Wang W, Liu Y, Sun B, Qiu J, Hu X, Liu Z, Guo X. Group 3 Innate Lymphoid Cells Protect the Host from the Uropathogenic Escherichia coli Infection in the Bladder. Adv Sci (Weinh) 2022; 9:e2103303. [PMID: 35018740 PMCID: PMC8867143 DOI: 10.1002/advs.202103303] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/01/2021] [Indexed: 05/09/2023]
Abstract
Innate lymphoid cells (ILCs) are crucial in orchestrating immunity and maintaining tissue homeostasis in various barrier tissues, but whether ILCs influence immune responses in the urinary tract remains poorly understood. Here, bladder-resident ILCs are comprehensively explored and identified their unique phenotypic and developmental characteristics. Notably, bladder-resident ILCs rapidly respond to uropathogenic Escherichia coli (UPEC) infection. It is found that ILC3 is necessary for early protection against UPEC infection in the bladder. Mechanistically, UPEC infection leads to interleukin (IL)-1β production in the bladder via a MyD88-dependent pathway, which promotes ILC3 activation. ILC3-expressed IL-17A further recruits neutrophils and controls UPEC infection in the bladder. Together, these results demonstrate a critical role for bladder ILCs in the host defense against UPEC infection.
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Affiliation(s)
- Jiaoyan Huang
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
| | - Liuhui Fu
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
| | - Jida Huang
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
| | - Jie Zhao
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
| | - Xin Zhang
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
| | - Wenyan Wang
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
| | - Yeyang Liu
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
| | - Bowen Sun
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
| | - Ju Qiu
- CAS Key Laboratory of Tissue Microenvironment and TumorShanghai Institute of Nutrition and HealthChinese Academy of SciencesShanghai200031China
| | - Xiaoyu Hu
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
| | - Zhihua Liu
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
| | - Xiaohuan Guo
- Institute for ImmunologyTsinghua UniversityBeijing100084China
- Department of Basic Medical SciencesSchool of MedicineTsinghua UniversityBeijing100084China
- Beijing Key Lab for Immunological Research on Chronic DiseasesTsinghua UniversityBeijing100084China
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5
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Olmos-Ortiz A, Olivares-Huerta A, García-Quiroz J, Avila E, Halhali A, Quesada-Reyna B, Larrea F, Zaga-Clavellina V, Díaz L. Cord Serum Calcitriol Inversely Correlates with Maternal Blood Pressure in Urinary Tract Infection-Affected Pregnancies: Sex-Dependent Immune Implications. Nutrients 2021; 13:nu13093114. [PMID: 34578991 PMCID: PMC8467737 DOI: 10.3390/nu13093114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Urinary tract infections (UTI) during pregnancy are frequently associated with hypertensive disorders, increasing the risk of perinatal morbidity. Calcitriol, vitamin D3’s most active metabolite, has been involved in blood pressure regulation and prevention of UTIs, partially through modulating vasoactive peptides and antimicrobial peptides, like cathelicidin. However, nothing is known regarding the interplay between placental calcitriol, cathelicidin, and maternal blood pressure in UTI-complicated pregnancies. Here, we analyzed the correlation between these parameters in pregnant women with UTI and with normal pregnancy (NP). Umbilical venous serum calcitriol and its precursor calcidiol were significantly elevated in UTI. Regardless of newborn’s sex, we found strong negative correlations between calcitriol and maternal systolic and diastolic blood pressure in the UTI cohort (p < 0.002). In NP, this relationship was observed only in female-carrying mothers. UTI-female placentas showed higher expression of cathelicidin and CYP27B1, the calcitriol activating-enzyme, compared to male and NP samples. Accordingly, cord-serum calcitriol from UTI-female neonates negatively correlated with maternal bacteriuria. Cathelicidin gene expression positively correlated with gestational age in UTI and with newborn anthropometric parameters. Our results suggest that vitamin D deficiency might predispose to maternal cardiovascular risk and perinatal infections especially in male-carrying pregnancies, probably due to lower placental CYP27B1 and cathelicidin expression.
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Affiliation(s)
- Andrea Olmos-Ortiz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas-Virreyes, Lomas de Chapultepec IV Sección, Miguel Hidalgo, Ciudad de Mexico 11000, Mexico
| | - Alberto Olivares-Huerta
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Janice García-Quiroz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Euclides Avila
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Ali Halhali
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Braulio Quesada-Reyna
- División de Obstetricia, UMAE Hospital de Gineco-Obstetricia No. 4 “Luis Castelazo Ayala”, IMSS, Rio de la Magdalena 289, Tizapán San Ángel, Progreso Tizapán, Álvaro Obregón, Ciudad de Mexico 01090, Mexico;
| | - Fernando Larrea
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Verónica Zaga-Clavellina
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas-Virreyes, Lomas de Chapultepec IV Sección, Miguel Hidalgo, Ciudad de Mexico 11000, Mexico
- Correspondence: (V.Z.-C.); (L.D.)
| | - Lorenza Díaz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
- Correspondence: (V.Z.-C.); (L.D.)
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6
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Habibi M, Azimi S, Khoobbakht D, Roghanian P, Asadi Karam MR. Immunization with recombinant protein Ag43::UpaH with alum and 1,25(OH)2D3 adjuvants significantly protects Balb/C mice against urinary tract infection caused by uropathogenic Escherichia coli. Int Immunopharmacol 2021; 96:107638. [PMID: 33848909 DOI: 10.1016/j.intimp.2021.107638] [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] [Received: 01/11/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
The majority of urinary tract infections (UTIs) are caused by uropathogenic Escherichia coli (UPEC). Designing a vaccine will certainly reduce the occurrence of infection and antibiotic resistance of the isolates. Antigen 43 (Ag43) and autotransporter H (UpaH) have been associated with the virulence of UPEC. In the present study, the efficacy of different formulations of a hybrid protein composed of Ag43 and UpaH with and without alum and 1,25(OH)2D3 (Vitamin D3) adjuvants were evaluated in mice model. A significant increase in IgG and cellular responses was developed against Ag43::UpaH as compared to the control mice. The addition of alum or a mixture of alum and Vitamin D3 to the protein significantly enhanced the serum IgG responses and tended to remain in a steady state until 6 months. In addition, the mentioned formulations produced significant amounts of IgG1, IL-4, and IL-17 as compared to the fusion protein alone. In addition to the mentioned formulations, the combination of protein with Vitamin D3 also resulted in significantly higher serum IgA and IFN-γ levels as compared to the fusion protein alone. Mice immunized with fusion plus alum and formulation protein admixed with both alum and Vitamin D3 significantly reduced the bacterial load in the bladders and kidneys of mice as compared to the control. In this study, for the first time, the ability of a novel hybrid protein in combination with adjuvants alum and Vitamin D3 was evaluated against UPEC. Our results indicated that fusion Ag43::UpaH admixed with alum and Vitamin D3 could be a promising candidate against UTIs.
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Affiliation(s)
- Mehri Habibi
- Department of Molecular Biology, Pasteur Institute of Iran, Pasteur Ave, Tehran 13164, Iran
| | - Saba Azimi
- Department of Molecular Biology, Pasteur Institute of Iran, Pasteur Ave, Tehran 13164, Iran
| | - Dorna Khoobbakht
- Department of Molecular Biology, Pasteur Institute of Iran, Pasteur Ave, Tehran 13164, Iran
| | - Pooneh Roghanian
- Department of Molecular Biology, Pasteur Institute of Iran, Pasteur Ave, Tehran 13164, Iran
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7
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Lu Y, Liu M, Tursi NJ, Yan B, Cao X, Che Q, Yang N, Dong X. Uropathogenic Escherichia coli Infection Compromises the Blood-Testis Barrier by Disturbing mTORC1-mTORC2 Balance. Front Immunol 2021; 12:582858. [PMID: 33679734 PMCID: PMC7933507 DOI: 10.3389/fimmu.2021.582858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/19/2021] [Indexed: 01/05/2023] Open
Abstract
The structural and functional destruction of the blood-testis barrier (BTB) following uropathogenic E. coli (UPEC) infection may be a critical component of the pathologic progress of orchitis. Recent findings indicate that the mammalian target of the rapamycin (mTOR)-signaling pathway is implicated in the regulation of BTB assembly and restructuring. To explore the mechanisms underlying BTB damage induced by UPEC infection, we analyzed BTB integrity and the involvement of the mTOR-signaling pathway using in vivo and in vitro UPEC-infection models. We initially confirmed that soluble virulent factors secreted from UPEC trigger a stress response in Sertoli cells and disturb adjacent cell junctions via down-regulation of junctional proteins, including occludin, zonula occludens-1 (ZO-1), F-actin, connexin-43 (CX-43), β-catenin, and N-cadherin. The BTB was ultimately disrupted in UPEC-infected rat testes, and blood samples from UPEC-induced orchitis in these animals were positive for anti-sperm antibodies. Furthermore, we herein also demonstrated that mTOR complex 1 (mTORC1) over-activation and mTORC2 suppression contributed to the disturbance in the balance between BTB "opening" and "closing." More importantly, rapamycin (a specific mTORC1 inhibitor) significantly restored the expression of cell-junction proteins and exerted a protective effect on the BTB during UPEC infection. We further confirmed that short-term treatment with rapamycin did not aggravate spermatogenic degeneration in infected rats. Collectively, this study showed an association between abnormal activation of the mTOR-signaling pathway and BTB impairment during UPEC-induced orchitis, which may provide new insights into a potential treatment strategy for testicular infection.
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Affiliation(s)
- Yongning Lu
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Miao Liu
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nicholas J. Tursi
- Department of Biology, University of Pennsylvania, Philadelphia, PA, United States
| | - Bin Yan
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiang Cao
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Che
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nianqin Yang
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xi Dong
- Reproductive Medicine Centre, Zhongshan Hospital, Fudan University, Shanghai, China
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8
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Abstract
ABSTRACT A 55-year-old woman with multiple medical problems, including anuric, dialysis-dependent, end-stage renal disease, presented with persistent fever of unknown origin. Despite extensive workup with cross-sectional imaging and panculture, the etiology was not found. Eventually, an 111In-labeled WBC scan was performed to evaluate for occult infection, which revealed intense heterogeneous uptake in the urinary bladder. Subsequent bladder catheterization showed pus and blood, which grew Klebsiella pneumoniae. The fevers resolved with adjustment of the therapy. Although urinary analysis and culture are standard practice in the workup of fever of unknown origin, anuria may obscure this common source of infection.
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Affiliation(s)
- Henrik Ullman
- From the Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles
| | | | | | - Chiayi Ni
- Department of Radiology-Nuclear Medicine Division, Olive View-UCLA Medical Center, Sylmar, CA
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Martin-Cruz L, Sevilla-Ortega C, Benito-Villalvilla C, Diez‐Rivero CM, Sanchez-Ramón S, Subiza JL, Palomares O. A Combination of Polybacterial MV140 and Candida albicans V132 as a Potential Novel Trained Immunity-Based Vaccine for Genitourinary Tract Infections. Front Immunol 2021; 11:612269. [PMID: 33552074 PMCID: PMC7858650 DOI: 10.3389/fimmu.2020.612269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022] Open
Abstract
Recurrent urinary tract infections (RUTIs) and recurrent vulvovaginal candidiasis (RVVCs) represent major healthcare problems with high socio-economic impact worldwide. Antibiotic and antifungal prophylaxis remain the gold standard treatments for RUTIs and RVVCs, contributing to the massive rise of antimicrobial resistance, microbiota alterations and co-infections. Therefore, the development of novel vaccine strategies for these infections are sorely needed. The sublingual heat-inactivated polyvalent bacterial vaccine MV140 shows clinical efficacy for the prevention of RUTIs and promotes Th1/Th17 and IL-10 immune responses. V132 is a sublingual preparation of heat-inactivated Candida albicans developed against RVVCs. A vaccine formulation combining both MV140 and V132 might well represent a suitable approach for concomitant genitourinary tract infections (GUTIs), but detailed mechanistic preclinical studies are still needed. Herein, we showed that the combination of MV140 and V132 imprints human dendritic cells (DCs) with the capacity to polarize potent IFN-γ- and IL-17A-producing T cells and FOXP3+ regulatory T (Treg) cells. MV140/V132 activates mitogen-activated protein kinases (MAPK)-, nuclear factor-κB (NF-κB)- and mammalian target of rapamycin (mTOR)-mediated signaling pathways in human DCs. MV140/V132 also promotes metabolic and epigenetic reprogramming in human DCs, which are key molecular mechanisms involved in the induction of innate trained immunity. Splenocytes from mice sublingually immunized with MV140/V132 display enhanced proliferative responses of CD4+ T cells not only upon in vitro stimulation with the related antigens contained in the vaccine formulation but also upon stimulation with phytohaemagglutinin. Additionally, in vivo sublingual immunization with MV140/V132 induces the generation of IgG and IgA antibodies against all the components contained in the vaccine formulation. We uncover immunological mechanisms underlying the potential mode of action of a combination of MV140 and V132 as a novel promising trained immunity-based vaccine (TIbV) for GUTIs.
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MESH Headings
- Animals
- Antigens, Bacterial/administration & dosage
- Antigens, Bacterial/immunology
- Antigens, Fungal/administration & dosage
- Antigens, Fungal/immunology
- Bacterial Infections/immunology
- Bacterial Infections/metabolism
- Bacterial Infections/microbiology
- Bacterial Infections/prevention & control
- Bacterial Vaccines/administration & dosage
- Bacterial Vaccines/immunology
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- Candidiasis, Vulvovaginal/immunology
- Candidiasis, Vulvovaginal/metabolism
- Candidiasis, Vulvovaginal/microbiology
- Candidiasis, Vulvovaginal/therapy
- Cells, Cultured
- Coculture Techniques
- Cytokines/metabolism
- Dendritic Cells/drug effects
- Dendritic Cells/immunology
- Female
- Fungal Vaccines/administration & dosage
- Fungal Vaccines/immunology
- Humans
- Lymphocyte Activation/drug effects
- Mice, Inbred BALB C
- Phenotype
- Urinary Tract Infections/immunology
- Urinary Tract Infections/metabolism
- Urinary Tract Infections/microbiology
- Urinary Tract Infections/prevention & control
- Vaccination
- Vaccines, Combined/administration & dosage
- Vaccines, Combined/immunology
- Mice
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Affiliation(s)
- Leticia Martin-Cruz
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | - Carmen Sevilla-Ortega
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | - Cristina Benito-Villalvilla
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | | | - Silvia Sanchez-Ramón
- Department of Clinical Immunology and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Immunology, ENT and Ophthalmology, School of Medicine, Complutense University, Madrid, Spain
| | | | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
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10
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Mbanefo EC, Le L, Pennington LF, Hsieh YJ, Odegaard JI, Lapira K, Jardetzky TS, Falcone FH, Hsieh MH. IPSE, a urogenital parasite-derived immunomodulatory molecule, suppresses bladder pathogenesis and anti-microbial peptide gene expression in bacterial urinary tract infection. Parasit Vectors 2020; 13:615. [PMID: 33298153 PMCID: PMC7724859 DOI: 10.1186/s13071-020-04490-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/04/2020] [Accepted: 11/19/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Parasitic infections can increase susceptibility to bacterial co-infections. This may be true for urogenital schistosomiasis and bacterial urinary tract co-infections (UTI). We previously reported that this co-infection is facilitated by S. haematobium eggs triggering interleukin-4 (IL-4) production and sought to dissect the underlying mechanisms. The interleukin-4-inducing principle from Schistosoma mansoni eggs (IPSE) is one of the most abundant schistosome egg-secreted proteins and binds to IgE on the surface of basophils and mast cells to trigger IL-4 release. IPSE can also translocate into host nuclei using a nuclear localization sequence (NLS) to modulate host transcription. We hypothesized that IPSE is the factor responsible for the ability of S. haematobium eggs to worsen UTI pathogenesis. METHODS Mice were intravenously administered a single 25 μg dose of recombinant S. haematobium-derived IPSE, an NLS mutant of IPSE or PBS. Following IPSE exposure, mice were serially weighed and organs analyzed by histology to assess for toxicity. Twenty-four hours after IPSE administration, mice were challenged with the uropathogenic E. coli strain UTI89 by urethral catheterization. Bacterial CFU were measured using urine. Bladders were examined histologically for UTI-triggered pathogenesis and by PCR for antimicrobial peptide and pattern recognition receptor expression. RESULTS Unexpectedly, IPSE administration did not result in significant differences in urine bacterial CFU. However, IPSE administration did lead to a significant reduction in UTI-induced bladder pathogenesis and the expression of anti-microbial peptides in the bladder. Despite the profound effect of IPSE on UTI-triggered bladder pathogenesis and anti-microbial peptide production, mice did not demonstrate systemic ill effects from IPSE exposure. CONCLUSIONS Our data show that IPSE may play a major role in S. haematobium-associated urinary tract co-infection, albeit in an unexpected fashion. These findings also indicate that IPSE either works in concert with other IL-4-inducing factors to increase susceptibility of S. haematobium-infected hosts to bacterial co-infection or does not contribute to enhancing vulnerability to this co-infection.
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Affiliation(s)
- Evaristus C. Mbanefo
- Division of Urology, Department of Surgery, Children’s National Hospital, West Wing, 4th Floor, 111 Michigan Avenue NW, Washington, DC 20010 USA
- Present Address: National Institutes of Health, Bethesda, MD USA
| | - Loc Le
- Biomedical Research Institute, Rockville, MD USA
- Present Address: A-TEK, Baltimore, MD USA
| | | | - Yi- Ju Hsieh
- Biomedical Research Institute, Rockville, MD USA
- Present Address: Fountain Biopharma, Taipei, Taiwan
| | | | | | | | - Franco H. Falcone
- Institute of Parasitology, Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Michael H. Hsieh
- Division of Urology, Department of Surgery, Children’s National Hospital, West Wing, 4th Floor, 111 Michigan Avenue NW, Washington, DC 20010 USA
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11
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Abstract
BACKGROUND AND AIMS The link between diabetes and increased risk of infectious disease has long been recognized, but has re-entered sharp focus following the COVID-19 pandemic. METHODS A literature search was conducted in PubMed for articles in English on diabetes and infection. RESULTS Diabetes predisposes to infections through alterations in innate and acquired immune defenses. Outcomes of infection are worse in people with uncontrolled diabetes, and infection can worsen hyperglycemia in hitherto well controlled diabetes (bidirectional relationship). Diabetes does not increase the risk of infection with COVID-19 per se, but predisposes to severe disease and poor outcomes. COVID-19 has also been linked to deterioration of glycemic control as well as new-onset diabetes. CONCLUSIONS Clinicians caring for people with diabetes should be aware of the increased risk of infections in this population, as well as the possibility of worsening hyperglycemia. A holistic approach with frequent monitoring of blood glucose levels and appropriate titration of medications, along with close attention to nutritional status, is essential to ensure the best possible outcomes.
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Affiliation(s)
- Ranjit Unnikrishnan
- Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India.
| | - Anoop Misra
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India), New Delhi, India; Fortis C-DOC Center for Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
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12
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Mao X, Guo H, Yao R, Bao L, Sun J, Bao Y, Guo B, Gao Y, Shi Y, Zhang H, Cui X. Crude polysaccharides from the seeds of Vaccaria segetalis prevent the urinary tract infection through the stimulation of kidney innate immunity. J Ethnopharmacol 2020; 260:112578. [PMID: 31962152 DOI: 10.1016/j.jep.2020.112578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/13/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The seeds of Vaccaria segetalis (Neck.) Garcke is used for the treatment of urinary diseases in Traditional Chinese Medicine according to the Chinese Pharmacopoeia. Crude polysaccharides and the aqueous extract from the seeds of V. segetalis (SVCP) were proved to be effective on treating benign prostatic hyperplasia. AIM OF THE STUDY The aim of this study was to test the effects of SVCP on urinary tract infection (UTI) induced by uropathogenic Escherichia coli (UPEC) strain CFT073 in the rat model and to investigate the underlying mechanisms. MATERIALS AND METHODS A rat UTI model was established with the infection of UPEC strain CFT073. After oral administration of SVCP, the urinalysis and histological examination were evaluated. The levels of pro-inflammatory cytokines, procalcitonin (PCT) and polymeric Ig receptor (PIGR) were used to test the effects of SVCP on host immunity. The mRNA level of PapG in CFT073 was used to test the influence of SVCP on virulence factor. The effects of SVCP on the inhibition of bacterial adhesion were evaluated with mice UTI model. RESULTS In the rat UTI model, the levels of bacterial load, white blood cells (WBC) and red blood cells (RBC) in urine and the pathological injury in the bladder were significantly up-regulated, the expression of PIGR in kidney was down-regulated, no significant change was observed on the pro-inflammatory cytokines in urine. After oral administration of SVCP for 3 days, the levels of bacterial load, WBC and RBC in urine were significantly decreased, the pathological injury in the bladder were remarkably inhibited. The expression of IL-6, IL-8 in urine and PIGR in kidney were significantly up-regulated by SVCP (200 mg/kg). SVCP showed no effect on the concentration of PCT in serum. SVCP failed to down-regulate the mRNA level of PapG in CFT073. In the mice UTI model, pre-treatment of SVCP failed to inhibit the intracellular bacterial load in the bladder. CONCLUSIONS The therapeutic effects of SVCP on treating UTIs might result from the up-regulation of innate immunity in the kidney. SVCP can be used as an alternative therapeutic agent for UTIs.
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Affiliation(s)
- Xin Mao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Hongling Guo
- Institute of Mental Health, Peking University Sixth Hospital and National Clinical Research Center for Mental Disorders, Peking University, Beijing, 100191, China
| | - Rongmei Yao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China; College of Traditional Chinese Medicine, North China University of Sciences and Technology, Hebei, 063210, China
| | - Lei Bao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jing Sun
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yanyan Bao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Bo Guo
- Department of Hematology and Endocrinology, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, China
| | - Yingjie Gao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yujing Shi
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Haijiang Zhang
- Jiangsu Key Laboratory of Regional Resource Exploitation and Medicinal Research, Huaiyin Institute of Technology, Huai'an, 223003, China; Huai'an Socal Technologies Co Ltd., Huai'an, 223003, China.
| | - Xiaolan Cui
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
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13
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Patras KA, Coady A, Babu P, Shing SR, Ha AD, Rooholfada E, Brandt SL, Geriak M, Gallo RL, Nizet V. Host Cathelicidin Exacerbates Group B Streptococcus Urinary Tract Infection. mSphere 2020; 5:e00932-19. [PMID: 32321824 PMCID: PMC7178553 DOI: 10.1128/msphere.00932-19] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/06/2020] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS) causes frequent urinary tract infection (UTI) in susceptible populations, including individuals with type 2 diabetes and pregnant women; however, specific host factors responsible for increased GBS susceptibility in these populations are not well characterized. Here, we investigate cathelicidin, a cationic antimicrobial peptide, known to be critical for defense during UTI with uropathogenic Escherichia coli (UPEC). We observed a loss of antimicrobial activity of human and mouse cathelicidins against GBS and UPEC in synthetic urine and no evidence for increased cathelicidin resistance in GBS urinary isolates. Furthermore, we found that GBS degrades cathelicidin in a protease-dependent manner. Surprisingly, in a UTI model, cathelicidin-deficient (Camp-/-) mice showed decreased GBS burdens and mast cell recruitment in the bladder compared to levels in wild-type (WT) mice. Pharmacologic inhibition of mast cells reduced GBS burdens and histamine release in WT but not Camp-/- mice. Streptozotocin-induced diabetic mice had increased bladder cathelicidin production and mast cell recruitment at 24 h postinfection with GBS compared to levels in nondiabetic controls. We propose that cathelicidin is an important immune regulator but ineffective antimicrobial peptide against GBS in urine. Combined, our findings may in part explain the increased frequency of GBS UTI in diabetic and pregnant individuals.IMPORTANCE Certain populations such as diabetic individuals are at increased risk for developing urinary tract infections (UTI), although the underlying reasons for this susceptibility are not fully known. Additionally, diabetics are more likely to become infected with certain types of bacteria, such as group B Streptococcus (GBS). In this study, we find that an antimicrobial peptide called cathelicidin, which is thought to protect the bladder from infection, is ineffective in controlling GBS and alters the type of immune cells that migrate to the bladder during infection. Using a mouse model of diabetes, we observe that diabetic mice are more susceptible to GBS infection even though they also have more infiltrating immune cells and increased production of cathelicidin. Taken together, our findings identify this antimicrobial peptide as a potential contributor to increased susceptibility of diabetic individuals to GBS UTI.
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Affiliation(s)
- Kathryn A Patras
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Alison Coady
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Priyanka Babu
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Samuel R Shing
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Albert D Ha
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Emma Rooholfada
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Stephanie L Brandt
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | | | - Richard L Gallo
- Department of Dermatology, University of California, San Diego, La Jolla, California, USA
| | - Victor Nizet
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
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14
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Peng H, Purkerson JM, Freeman RS, Schwaderer AL, Schwartz GJ. Acidosis induces antimicrobial peptide expression and resistance to uropathogenic E. coli infection in kidney collecting duct cells via HIF-1α. Am J Physiol Renal Physiol 2020; 318:F468-F474. [PMID: 31841391 PMCID: PMC7052658 DOI: 10.1152/ajprenal.00228.2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/07/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/23/2022] Open
Abstract
Acute pyelonephritis is frequently associated with metabolic acidosis. We previously reported that metabolic acidosis stimulates expression of hypoxia-inducible factor (HIF)-1α-induced target genes such as stromal derived factor-1 and cathelicidin, an antimicrobial peptide. Since the collecting duct (CD) plays a pivotal role in regulating acid-base homeostasis and is the first nephron segment encountered by an ascending microbial infection, we examined the contribution of HIF-1α to innate immune responses elicited by acid loading of an M-1 immortalized mouse CD cell line. Acid loading of confluent M-1 cells was achieved by culture in pH 6.8 medium supplemented with 5-(N-ethyl-N-isopropyl)-amiloride to block Na+/H+ exchange activity for 24 h. Acid loading induced antimicrobial peptide [cathelicidin and β-defensin (Defb2 and Defb26)] mRNA expression and M-1 cell resistance to uropathogenic Escherichia coli infection to an extent similar to that obtained by inhibition of HIF prolyl hydroxylases, which promote HIF-1α protein degradation. The effect of acid loading on M-1 cell resistance to uropathogenic E. coli infection was reduced by inhibition of HIF-1α (PX-478), and, in combination with prolyl hydroxylase inhibitors, acidosis did not confer additional resistance. Thus, metabolic stress of acidosis triggers HIF-1α-dependent innate immune responses in CD (M-1) cells. Whether pharmacological stabilization of HIF prevents or ameliorates pyelonephritis in vivo warrants further investigation.
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Affiliation(s)
- Hu Peng
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey M Purkerson
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Robert S Freeman
- Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, New York
| | - Andrew L Schwaderer
- Department of Pediatrics, Riley Hospital, University of Indiana School of Medicine, Indianapolis, Indiana
| | - George J Schwartz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
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15
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Mushi MF, Alex VG, Seugendo M, Silago V, Mshana SE. C - reactive protein and urinary tract infection due to Gram-negative bacteria in a pediatric population at a tertiary hospital, Mwanza, Tanzania. Afr Health Sci 2019; 19:3217-3224. [PMID: 32127899 PMCID: PMC7040338 DOI: 10.4314/ahs.v19i4.45] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Gram-negative bacteria are the major cause of urinary tract infections (UTI) in children. There is limited data on UTI systemic response as measured using C-reactive protein (CRP). Here, we report the association of CRP and UTI among children attending the Bugando Medical Centre, Mwanza, Tanzania. Methods A cross-sectional study was conducted between May and July 2017. Urine and blood were collected and processed within an hour of collection. Data were analyzed using STATA version 13. Results Of 250 enrolled children, 76(30.4%) had significant bacteriuria with 56(22.4%, 95%CI; 11.5–33.3) having gram-negative bacteria infection. There was dual growth of gram-negative bacteria in 3 patients. Escherichia coli (32.2%, 19/59) was the most frequently pathogen detected. A total of 88/250(35.2%) children had positive CRP on qualitative assay. By multinomial logistic regression, positive CRP (RRR=4.02, 95%CI: 2.1–7.7, P<0.001) and age ≤ 2years (RRR=2.4, 95%CI: 1.23–4.73, P<0.01) significantly predicted the presence of significant bacteriuria due to gram-negative enteric bacteria. Conclusion C-reactive protein was significantly positive among children with UTI due to gram-negative bacteria and those with fever. In children with age ≤ 2 years, positive CRP indicates UTI due to gram-negative enteric bacteria.
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Affiliation(s)
- Martha F Mushi
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Science
| | - Vaileth G Alex
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Science
| | - Mwanaisha Seugendo
- Department of Pediatric and Child Health, Weill Bugando School of Medicine, Catholic University of Health and child health
| | - Vitus Silago
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Science
| | - Stephen E Mshana
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Science
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16
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Pradeep I, Anupama SH, Koshy P, Kurien A, Rohit A, Mathew M, Parthasarathy R, Abraham G. A rare association of Mycobacterium tuberculosis infection of kidney and urinary tract with immunoglobulin A nephropathy. Indian J Med Microbiol 2019; 37:587-589. [PMID: 32436885 DOI: 10.4103/ijmm.ijmm_19_482] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mycobacterium tuberculosis(MTB)-related secondary immunoglobulin A (IgA) nephropathy is reported in a 72-year-old male patient. The patient was diagnosed to have MTB infection of the kidney and genitourinary tract which was diagnosed by the demonstration of the organism by GeneXpert Ultra and culture. Concurrent kidney biopsy showed IgA nephropathy. The patient responded to urethral double-J stenting and four-drug antituberculous therapy with improvement of kidney function and resolution of MTB. IgA nephropathy can present as primary glomerulonephritis or secondary to MTB infection.
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Affiliation(s)
- Immanuel Pradeep
- Department of Pathology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | | | - Priyanka Koshy
- Department of Pathology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Abraham Kurien
- Department of Urology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Anusha Rohit
- Department of Microbiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Milly Mathew
- Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | | | - Georgi Abraham
- Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
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17
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Stewart BJ, Ferdinand JR, Young MD, Mitchell TJ, Loudon KW, Riding AM, Richoz N, Frazer GL, Staniforth JUL, Braga FAV, Botting RA, Popescu DM, Vento-Tormo R, Stephenson E, Cagan A, Farndon SJ, Polanski K, Efremova M, Green K, Velasco-Herrera MDC, Guzzo C, Collord G, Mamanova L, Aho T, Armitage JN, Riddick ACP, Mushtaq I, Farrell S, Rampling D, Nicholson J, Filby A, Burge J, Lisgo S, Lindsay S, Bajenoff M, Warren AY, Stewart GD, Sebire N, Coleman N, Haniffa M, Teichmann SA, Behjati S, Clatworthy MR. Spatiotemporal immune zonation of the human kidney. Science 2019; 365:1461-1466. [PMID: 31604275 PMCID: PMC7343525 DOI: 10.1126/science.aat5031] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [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: 03/05/2018] [Revised: 01/31/2019] [Accepted: 09/04/2019] [Indexed: 11/02/2022]
Abstract
Tissue-resident immune cells are important for organ homeostasis and defense. The epithelium may contribute to these functions directly or by cross-talk with immune cells. We used single-cell RNA sequencing to resolve the spatiotemporal immune topology of the human kidney. We reveal anatomically defined expression patterns of immune genes within the epithelial compartment, with antimicrobial peptide transcripts evident in pelvic epithelium in the mature, but not fetal, kidney. A network of tissue-resident myeloid and lymphoid immune cells was evident in both fetal and mature kidney, with postnatal acquisition of transcriptional programs that promote infection-defense capabilities. Epithelial-immune cross-talk orchestrated localization of antibacterial macrophages and neutrophils to the regions of the kidney most susceptible to infection. Overall, our study provides a global overview of how the immune landscape of the human kidney is zonated to counter the dominant immunological challenge.
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Affiliation(s)
- Benjamin J Stewart
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, CB2 0QQ, UK
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - John R Ferdinand
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, CB2 0QQ, UK
| | - Matthew D Young
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Thomas J Mitchell
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Department of Surgery, University of Cambridge, CB2 0QQ, UK
| | - Kevin W Loudon
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, CB2 0QQ, UK
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
| | - Alexandra M Riding
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, CB2 0QQ, UK
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
| | - Nathan Richoz
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, CB2 0QQ, UK
| | - Gordon L Frazer
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, CB2 0QQ, UK
| | - Joy UL Staniforth
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, CB2 0QQ, UK
| | | | - Rachel A Botting
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Dorin-Mirel Popescu
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Roser Vento-Tormo
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Emily Stephenson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Alex Cagan
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Sarah J Farndon
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
- UCL Great Ormond Street Hospital Institute of Child Health, London WC1N 1E, UK
| | - Krzysztof Polanski
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Mirjana Efremova
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Kile Green
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | | | - Charlotte Guzzo
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Grace Collord
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Department of Paediatrics, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Lira Mamanova
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
| | - Tevita Aho
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
| | - James N Armitage
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
| | - Antony CP Riddick
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
| | - Imran Mushtaq
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Stephen Farrell
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
| | - Dyanne Rampling
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - James Nicholson
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
- Department of Paediatrics, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Andrew Filby
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Johanna Burge
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
| | - Steven Lisgo
- Human Developmental Biology Resource, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Susan Lindsay
- Human Developmental Biology Resource, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Marc Bajenoff
- Centre d’Immunologie de Marseille-Luminy, Marseille, France
| | - Anne Y Warren
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
| | - Grant D Stewart
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
- Department of Surgery, University of Cambridge, CB2 0QQ, UK
| | - Neil Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
- UCL Great Ormond Street Hospital Institute of Child Health, London WC1N 1E, UK
| | - Nicholas Coleman
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | - Muzlifah Haniffa
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Department of Dermatology and NIHR Newcastle Biomedical research Centre, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne NE2 4LP, UK
| | - Sarah A Teichmann
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Theory of Condensed Matter Group, Cavendish Laboratory/Department of Physics, University of Cambridge, Cambridge CB3 0HE, UK
| | - Sam Behjati
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
- Department of Paediatrics, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Menna R Clatworthy
- Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, CB2 0QQ, UK
- Cambridge University Hospitals NHS Foundation Trust, and NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, CB10 1SA, UK
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18
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Giannakopoulos X, Sakkas H, Ragos V, Tsiambas E, Bozidis P, M Evangelou A, Papadopoulou C, Petrogiannopoulos L, Sofikitis N. Impact of enterococcal urinary tract infections in immunocompromised - neoplastic patients. J BUON 2019; 24:1768-1775. [PMID: 31786836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Infections in immunocompromised-neoplastic patients represent a severe complication. Among bacteria, Enterococcus species constitute a common causative pathogen of urinary tract infections (UTIs), especially among hospitalized patients with or without urinary tract carcinoma, related commonly to urinary tract abnormalities, urinary catheters or prolonged antibiotic treatment. Although enterococci have been considered more commonly as colonization bacteria in the intestine than virulent agents, they are frequently implicated in UTIs. The high incidence of enterococcal UTIs is associated with several risk factors including age, female gender, previous UTI, diabetes, pregnancy, immunosuppression due to cancer development and progression, renal transplantation and spinal cord injury. Clinical manifestations are usually absent or mild in enterococcal UTIs, which may also become an important source for both bacteremia and endocarditis. Over the last years, the prevalence of multidrug resistant enterococci, particularly vancomycin-resistant E. faecium and E. faecalis has significantly risen worldwide, associated with increased morbidity, limited treatment options and increased health-care costs. In this review, the current knowledge on enterococcal UTIs epidemiology and influence in the corresponding immunocompromised patients is highlighted.
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Affiliation(s)
- Xenofon Giannakopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Wu KY, Zhang T, Zhao GX, Ma N, Zhao SJ, Wang N, Wang JX, Li ZF, Zhou W, Li K. The C3a/C3aR axis mediates anti-inflammatory activity and protects against uropathogenic E coli-induced kidney injury in mice. Kidney Int 2019; 96:612-627. [PMID: 31133456 DOI: 10.1016/j.kint.2019.03.005] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 11/18/2022]
Abstract
Both the C3a/C3aR and C5a/C5aR1 axes are regarded as important pathways for inducing and regulating inflammatory responses. It is well documented that the C5a/C5aR1 axis is a potent inflammatory mediator in the pathogenesis of many clinic disorders. However, our understanding of the role of the C3a/C3aR axis in renal disorders remains limited. Contrary to the C5a/C5aR axis, we now show that the C3a/C3aR axis has a protective role in uropathogenic Escherichia coli (UPEC)-induced renal injury. C3aR-/- mice were found to develop severe renal pathology compared to wild type mice, a pathology characterized by intense tissue damage and an increased bacterial load within the kidney. This was associated with an overwhelming production of pro-inflammatory mediators and increased neutrophil infiltration in the kidney. Bone marrow chimera experiments found that tissue damage and bacterial load were significantly reduced in C3aR-/- mice that received bone marrow from wild type mice, compared with that in mice re-populated with bone marrow from C3aR-/- mice. This supports a critical role for C3aR on myeloid cells in the pathological process. Pharmacological treatment of mice with a C3aR agonist reduced both the extent of tissue injury and bacterial load. Mechanistic analyses indicated that the C3a/C3aR axis downregulates the lipopolysaccharide-induced pro-inflammatory responses in macrophages and facilitates the phagocytosis of UPEC by phagocytes. Thus, our findings clearly demonstrate a protective role of the C3a/C3aR axis in UPEC-induced renal injury, conferred by the suppression of pro-inflammatory responses and enhanced phagocytosis by macrophages.
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Affiliation(s)
- Kun-Yi Wu
- Core Research Laboratory, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ting Zhang
- Core Research Laboratory, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Guo-Xiu Zhao
- Core Research Laboratory, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ning Ma
- Core Research Laboratory, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Shu-Juan Zhao
- Core Research Laboratory, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Na Wang
- Core Research Laboratory, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jia-Xing Wang
- Core Research Laboratory, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zong-Fang Li
- National Local Joint Engineering Research Centre of Biodiagnostics and Biotherapy, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Wuding Zhou
- Medical Research Council (MRC) Centre for Transplantation, King's College London, Guy's Hospital, UK.
| | - Ke Li
- Core Research Laboratory, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Centre of Biodiagnostics and Biotherapy, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
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20
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De Kleermaeker FGCM, Uitdehaag BMJ, van Oosten BW, van Munster CEP. [Paroxysmal hypothermia in multiple sclerosis]. Ned Tijdschr Geneeskd 2019; 163:D3116. [PMID: 30676705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) can be accompanied by paroxysmal symptoms. These are diverse in nature and often not well known. CASE DESCRIPTION In the emergency department, we repeatedly saw a 49-year-old man with secondary progressive MS with recurrent episodes of hypothermia, loss of consciousness, thrombocytopenia and worsening of pre-existing neurological deficits. In some of these episodes we identified an underlying urinary tract infection, which we treated. After normalization of the body temperature, we observed complete recovery of the clinical signs and platelet count. CONCLUSION Paroxysmal hypothermia can be a symptom of MS and is accompanied by a change in level of consciousness, increase of neurological deficits and haematological disturbances. Usually, there is full recovery after normalization of the body temperature and treatment of any underlying infections. Early recognition of these recurrent symptoms is important to prevent unnecessary diagnostics and overtreatment.
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Affiliation(s)
- F G C M De Kleermaeker
- Canisius-Wilhelmina Ziekenhuis, afd. Neurologie, Nijmegen
- Contact: F.G.C.M. de Kleermaeker
| | | | - Bob W van Oosten
- MS Centrum Amsterdam, Amsterdam UMC, locatie VUmc, afd. Neurologie
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Emal D, Rampanelli E, Claessen N, Bemelman FJ, Leemans JC, Florquin S, Dessing MC. Calcineurin inhibitor Tacrolimus impairs host immune response against urinary tract infection. Sci Rep 2019; 9:106. [PMID: 30643171 PMCID: PMC6331640 DOI: 10.1038/s41598-018-37482-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 10/09/2017] [Accepted: 10/18/2018] [Indexed: 01/14/2023] Open
Abstract
Calcineurin inhibitor Tacrolimus, is a potent immunosuppressive drug widely used in order to prevent acute graft rejection. Urinary tract infection (UTI) is the most frequent infectious complication in renal transplant patients and long-term use of Tacrolimus might be involved in higher susceptibility to bacterial infections. It remains largely unknown how Tacrolimus affects the host innate immune response against lower and upper UTI. To address this issue, we used experimental UTI model by intravesical inoculation of uropathogenic E.coli in female wild-type mice pre-treated with Tacrolimus or solvent (CTR). We found that Tacrolimus pre-treated mice displayed higher bacterial loads (cystitis, pyelonephritis and bacteremia) than CTR mice. Granulocytes from Tacrolimus pre-treated mice phagocytized less E. coli, released less MPO and expressed decreased levels of CXCR2 receptor upon infection. Moreover, Tacrolimus reduced TLR5 expression in bladder macrophages during UTI. This immunosuppressive state can be explained by the upregulation of TLR-signaling negative regulators (A20, ATF3, IRAK-M and SOCS1) and parallel downregulation of TLR5 as observed in Tacrolimus treated granulocytes and macrophages. We conclude that Tacrolimus impairs host innate immune responses against UTI.
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Affiliation(s)
- Diba Emal
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Elena Rampanelli
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nike Claessen
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaklien C Leemans
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sandrine Florquin
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark C Dessing
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Tanaka A, Leung PSC, Gershwin ME. Pathogen infections and primary biliary cholangitis. Clin Exp Immunol 2019; 195:25-34. [PMID: 30099750 PMCID: PMC6300644 DOI: 10.1111/cei.13198] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 12/14/2022] Open
Abstract
Primary biliary cholangitis (PBC) is a multi-factorial disease caused by the interaction of both genetic predisposition and environmental triggers. Bacterial infection has been investigated most intensively, both epidemiologically and experimentally, as a prime environmental aetiology in PBC. The association of recurrent history of urinary tract infection (UTI) with PBC has been frequently confirmed by several large-scale, case-control studies, despite variation in geographic area or case-finding methods. Escherichia coli is a predominant pathogen in most cases with UTI. Animal studies and molecular mimicry analysis between the human and E. coli E2 subunit of the 2-oxo-acid dehydrogenase complexes demonstrated that E. coli infection is a key factor in breaking immunological tolerance against the mitochondria, resulting in the production of anti-mitochondrial autoantibodies (AMA), the disease-specific autoantibodies of PBC. Novosphingobium aromaticivorans, a ubiquitous xenobiotic-metabolizing bacterium, is another candidate which may be involved in the aetiology of PBC. Meanwhile, improved environmental hygiene and increased prevalence of PBC, especially in males, may argue against the aetiological role of bacterial infection in PBC. Multiple mechanisms can result in the loss of tolerance to mitochondrial autoantigens in PBC; nonetheless, bacterial infection is probably one of the dominant pathways, especially in female patients. Notably, there is a rising prevalence of male patients with PBC. With increasing exposure to environmental xenobiotics in both genders, studies directed towards identifying the environmental culprit with systematically designed case-control studies are much needed to further determine the environmental factors and role of bacterial infections in PBC.
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Affiliation(s)
- A. Tanaka
- Department of MedicineTeikyo University School of MedicineTokyoJapan
| | - P. S. C. Leung
- Division of Rheumatology Allergy and Clinical ImmunologyUniversity of California School of MedicineDavisCAUSA
| | - M. E. Gershwin
- Division of Rheumatology Allergy and Clinical ImmunologyUniversity of California School of MedicineDavisCAUSA
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Lorenzin G, Piccinelli G, Carlassara L, Scolari F, Caccuri F, Caruso A, De Francesco MA. Myroides odoratimimus urinary tract infection in an immunocompromised patient: an emerging multidrug-resistant micro-organism. Antimicrob Resist Infect Control 2018; 7:96. [PMID: 30094005 PMCID: PMC6080552 DOI: 10.1186/s13756-018-0391-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 06/09/2018] [Accepted: 07/31/2018] [Indexed: 01/07/2023] Open
Abstract
Background Myroides spp. are common environmental organisms and they can be isolated predominantly in water, soil, food and in sewage treatment plants. In the last two decades, an increasing number of infections such as urinary tract infections and skin and soft tissue infections, caused by these microorganisms has been reported. Selection of appropriate antibiotic therapy to treat the infections caused by Myroides spp. is difficult due to the production of a biofilm and the organism's intrinsic resistance to many antibiotic classes. Case presentation We report the case of a 69-year-old immunocompromised patient who presented with repeated episodes of macroscopic haematuria, from Northern Italy.A midstream urine sample cultured a Gram negative rod in significant amounts (> 105 colony-forming units (cfu)/mL), which was identified as Myroides odoratimimus. The patient was successfully treated with trimethoprim/sulfamethoxazole after antibiotic susceptibility testing confirmed its activity. Conclusion This case underlines the emergence of multidrug resistant Myroides spp. which are ubiquitous in the environment and it demands that clinicians should be more mindful about the role played by atypical pathogens, which may harbour or express multidrug resistant characteristics, in immunocompromised patients or where there is a failure of empiric antimicrobial therapy.
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Affiliation(s)
- Giovanni Lorenzin
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-Spedali Civili, P. le Spedali Civili 1, 25123 Brescia, Italy
- Institute of Microbiology and Virology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giorgio Piccinelli
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-Spedali Civili, P. le Spedali Civili 1, 25123 Brescia, Italy
| | - Lucrezia Carlassara
- Department of Nephrology, University of Brescia, Hospital of Montichiari, Brescia, Italy
| | - Francesco Scolari
- Department of Nephrology, University of Brescia, Hospital of Montichiari, Brescia, Italy
| | - Francesca Caccuri
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-Spedali Civili, P. le Spedali Civili 1, 25123 Brescia, Italy
| | - Arnaldo Caruso
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-Spedali Civili, P. le Spedali Civili 1, 25123 Brescia, Italy
| | - Maria Antonia De Francesco
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-Spedali Civili, P. le Spedali Civili 1, 25123 Brescia, Italy
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Glaser K, Silwedel C, Fehrholz M, Henrich B, Waaga-Gasser AM, Claus H, Speer CP. Ureaplasma isolates stimulate pro-inflammatory CC chemokines and matrix metalloproteinase-9 in neonatal and adult monocytes. PLoS One 2018; 13:e0194514. [PMID: 29558521 PMCID: PMC5860755 DOI: 10.1371/journal.pone.0194514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/17/2018] [Accepted: 03/05/2018] [Indexed: 11/25/2022] Open
Abstract
Being generally regarded as commensal bacteria, the pro-inflammatory capacity of Ureaplasma species has long been debated. Recently, we confirmed Ureaplasma–driven pro-inflammatory cytokine responses and a disturbance of cytokine equilibrium in primary human monocytes in vitro. The present study addressed the expression of CC chemokines and matrix metalloproteinase-9 (MMP-9) in purified term neonatal and adult monocytes stimulated with serovar 8 of Ureaplasma urealyticum (Uu) and serovar 3 of U. parvum (Up). Using qRT-PCR and multi-analyte immunoassay, we assessed mRNA and protein expression of the monocyte chemotactic proteins 1 and 3 (MCP-1/3), the macrophage inflammatory proteins 1α and 1β (MIP-1α/β) as well as MMP-9. For the most part, both isolates stimulated mRNA expression of all given chemokines and MMP-9 in cord blood and adult monocytes (p<0.05 and p<0.01). These results were paralleled by Uu and Up-induced secretion of MCP-1 protein in both cells (neonatal: p<0.01, adult: p<0.05 and p<0.01). Release of MCP-3, MIP-1α, MIP-1β and MMP-9 was enhanced upon exposure to Up (neonatal: p<0.05, p<0.01 and p<0.001, respectively; adult: p<0.05). Co-stimulation of LPS-primed monocytes with Up increased LPS-induced MCP-1 release in neonatal cells (p<0.05) and aggravated LPS-induced MMP-9 mRNA in both cell subsets (neonatal: p<0.05, adult: p<0.01). Our results document considerable expression of pro-inflammatory CC chemokines and MMP-9 in human monocytes in response to Ureaplasma isolates in vitro, adding to our previous data. Findings from co-stimulated cells indicate that Ureaplasma may modulate monocyte immune responses to a second stimulus.
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Affiliation(s)
- Kirsten Glaser
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
- * E-mail:
| | - Christine Silwedel
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
| | - Markus Fehrholz
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
| | - Birgit Henrich
- Institute of Medical Microbiology and Hospital Hygiene, University Clinic of Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Ana Maria Waaga-Gasser
- Department of Surgery I, Molecular Oncology & Immunology, University of Würzburg, Würzburg, Germany
| | - Heike Claus
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Christian P. Speer
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
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25
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Bakthavatchalu V, Wert KJ, Feng Y, Mannion A, Ge Z, Garcia A, Scott KE, Caron TJ, Madden CM, Jacobsen JT, Victora G, Jaenisch R, Fox JG. Cytotoxic Escherichia coli strains encoding colibactin isolated from immunocompromised mice with urosepsis and meningitis. PLoS One 2018; 13:e0194443. [PMID: 29554148 PMCID: PMC5858775 DOI: 10.1371/journal.pone.0194443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/17/2017] [Accepted: 03/02/2018] [Indexed: 01/19/2023] Open
Abstract
Immune-compromised mouse models allow for testing the preclinical efficacy of human cell transplantations and gene therapy strategies before moving forward to clinical trials. However, CRISPR/Cas9 gene editing of the Wsh/Wsh mouse strain to create an immune-compromised model lacking function of Rag2 and Il2rγ led to unexpected morbidity and mortality. This warranted an investigation to ascertain the cause and predisposing factors associated with the outbreak. Postmortem examination was performed on 15 moribund mice. The main lesions observed in these mice consisted of ascending urogenital tract infections, suppurative otitis media, pneumonia, myocarditis, and meningoencephalomyelitis. As Escherichia coli strains harboring polyketide synthase (pks) genomic island were recently isolated from laboratory mice, the tissue sections from the urogenital tract, heart, and middle ear were subjected to E. coli specific PNA-FISH assay that revealed discrete colonies of E. coli associated with the lesions. Microbiological examination and 16S rRNA sequencing confirmed E. coli-induced infection and septicemia in the affected mice. Further characterization by clb gene analysis and colibactin toxicity assays of the pks+ E. coli revealed colibactin-associated cytotoxicity. Rederivation of the transgenic mice using embryo transfer produced mice with an intestinal flora devoid of pks+ E. coli. Importantly, these barrier-maintained rederived mice have produced multiple litters without adverse health effects. This report is the first to describe acute morbidity and mortality associated with pks+ E. coli urosepsis and meningitis in immunocompromised mice, and highlights the importance of monitoring and exclusion of colibactin-producing pks+ E. coli.
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Affiliation(s)
- Vasudevan Bakthavatchalu
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Katherine J. Wert
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts, United States of America
| | - Yan Feng
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Anthony Mannion
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Zhongming Ge
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Alexis Garcia
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Kathleen E. Scott
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Tyler J. Caron
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Carolyn M. Madden
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Johanne T. Jacobsen
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts, United States of America
| | - Gabriel Victora
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts, United States of America
| | - Rudolf Jaenisch
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts, United States of America
| | - James G. Fox
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- * E-mail:
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Yu Y, Kwon K, Tsitrin T, Bekele S, Sikorski P, Nelson KE, Pieper R. Characterization of Early-Phase Neutrophil Extracellular Traps in Urinary Tract Infections. PLoS Pathog 2017; 13:e1006151. [PMID: 28129394 PMCID: PMC5298345 DOI: 10.1371/journal.ppat.1006151] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 04/05/2016] [Revised: 02/08/2017] [Accepted: 12/24/2016] [Indexed: 12/15/2022] Open
Abstract
Neutrophils have an important role in the antimicrobial defense and resolution of urinary tract infections (UTIs). Our research suggests that a mechanism known as neutrophil extracellular trap (NET) formation is a defense strategy to combat pathogens that have invaded the urinary tract. A set of human urine specimens with very high neutrophil counts had microscopic evidence of cellular aggregation and lysis. Deoxyribonuclease I (DNase) treatment resulted in disaggregation of such structures, release of DNA fragments and a proteome enriched in histones and azurophilic granule effectors whose quantitative composition was similar to that of previously described in vitro-formed NETs. The effector proteins were further enriched in DNA-protein complexes isolated in native PAGE gels. Immunofluorescence microscopy revealed a flattened morphology of neutrophils associated with decondensed chromatin, remnants of granules in the cell periphery, and myeloperoxidase co-localized with extracellular DNA, features consistent with early-phase NETs. Nuclear staining revealed that a considerable fraction of bacterial cells in these structures were dead. The proteomes of two pathogens, Staphylococcus aureus and Escherichia coli, were indicative of adaptive responses to early-phase NETs, specifically the release of virulence factors and arrest of ribosomal protein synthesis. Finally, we discovered patterns of proteolysis consistent with widespread cleavage of proteins by neutrophil elastase, proteinase 3 and cathepsin G and evidence of citrullination in many nuclear proteins. Urinary tract infections (UTIs) are one of the world’s most widespread infectious diseases, with an estimated number of 150 million cases per year. Neutrophils play an important role in the defense of human patients against microbes causing UTIs. Molecules produced by neutrophils that migrate into the urinary tract can kill the invading microbes and resolve an infection, often without a need to treat patients with an antibiotic. Our work shows strong support for a mechanism called the formation of neutrophil extracellular traps (NETs), previously described for other infections and autoimmune conditions, which are involved in killing pathogens that have invaded the urinary tract. We show evidence of extracellular chromatin-containing structures using immunofluorescence microscopy and identified proteins that bind to the chromatin DNA and have functions to damage and kill bacterial cells or stop their growth.
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Affiliation(s)
- Yanbao Yu
- The J. Craig Venter Institute, Rockville, MD, United States of America
| | - Keehwan Kwon
- The J. Craig Venter Institute, Rockville, MD, United States of America
| | - Tamara Tsitrin
- The J. Craig Venter Institute, Rockville, MD, United States of America
| | - Shiferaw Bekele
- The J. Craig Venter Institute, Rockville, MD, United States of America
| | - Patricia Sikorski
- The J. Craig Venter Institute, Rockville, MD, United States of America
| | - Karen E. Nelson
- The J. Craig Venter Institute, Rockville, MD, United States of America
| | - Rembert Pieper
- The J. Craig Venter Institute, Rockville, MD, United States of America
- * E-mail:
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27
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Sullivan MJ, Carey AJ, Leclercq SY, Tan CK, Ulett GC. Increased Age, but Not Parity Predisposes to Higher Bacteriuria Burdens Due to Streptococcus Urinary Tract Infection and Influences Bladder Cytokine Responses, Which Develop Independent of Tissue Bacterial Loads. PLoS One 2016; 11:e0167732. [PMID: 27936166 PMCID: PMC5147962 DOI: 10.1371/journal.pone.0167732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/16/2016] [Accepted: 11/18/2016] [Indexed: 12/18/2022] Open
Abstract
Streptococcus agalactiae causes urinary tract infection (UTI) in pregnant adults, non-pregnant adults, immune-compromised individuals and the elderly. The pathogenesis of S. agalactiae UTI in distinct patient populations is poorly understood. In this study, we used murine models of UTI incorporating young mice, aged and dam mice to show that uropathogenic S. agalactiae causes bacteriuria at significantly higher levels in aged mice compared to young mice and this occurs coincident with equivalent levels of bladder tissue colonisation at 24 h post-infection (p.i.). In addition, aged mice exhibited significantly higher bacteriuria burdens at 48 h compared to young mice, confirming a divergent pattern of bacterial colonization in the urinary tract of aged and young mice. Multiparous mice, in contrast, exhibited significantly lower urinary titres of S. agalactiae compared to age-matched nulliparous mice suggesting that parity enhances the ability of the host to control S. agalactiae bacteriuria. Additionally, we show that both age and parity alter the expression levels of several key regulatory and pro-inflammatory cytokines, which are known to be important the immune response to UTI, including Interleukin (IL)-1β, IL-12(p40), and Monocyte Chemoattractant Protein-1 (MCP-1). Finally, we demonstrate that other cytokines, including IL-17 are induced significantly in the S. agalactiae-infected bladder regardless of age and parity status. Collectively, these findings show that the host environment plays an important role in influencing the severity of S. agalactiae UTI; infection dynamics, particularly in the context of bacteriuria, depend on age and parity, which also affect the nature of innate immune responses to infection.
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Affiliation(s)
- Matthew J. Sullivan
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Alison J. Carey
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sophie Y. Leclercq
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Research and Development Center, Ezequiel Dias Foundation (Funed), Belo Horizonte, MG, Brazil
| | - Chee K. Tan
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Glen C. Ulett
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- * E-mail:
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Choi HW, Bowen SE, Miao Y, Chan CY, Miao EA, Abrink M, Moeser AJ, Abraham SN. Loss of Bladder Epithelium Induced by Cytolytic Mast Cell Granules. Immunity 2016; 45:1258-1269. [PMID: 27939674 DOI: 10.1016/j.immuni.2016.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [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: 02/11/2016] [Revised: 08/20/2016] [Accepted: 09/13/2016] [Indexed: 01/09/2023]
Abstract
Programmed death and shedding of epithelial cells is a powerful defense mechanism to reduce bacterial burden during infection but this activity cannot be indiscriminate because of the critical barrier function of the epithelium. We report that during cystitis, shedding of infected bladder epithelial cells (BECs) was preceded by the recruitment of mast cells (MCs) directly underneath the superficial epithelium where they docked and extruded their granules. MCs were responding to interleukin-1β (IL-1β) secreted by BECs after inflammasome and caspase-1 signaling. Upon uptake of granule-associated chymase (mouse MC protease 4 [mMCPT4]), BECs underwent caspase-1-associated cytolysis and exfoliation. Thus, infected epithelial cells require a specific cue for cytolysis from recruited sentinel inflammatory cells before shedding.
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Affiliation(s)
- Hae Woong Choi
- Department of Pathology, Duke University, Durham, NC 27710, USA.
| | - Samantha E Bowen
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27710, USA
| | - Yuxuan Miao
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27710, USA
| | - Cheryl Y Chan
- Program in Emerging Infectious Diseases, Duke-National University of Singapore, Singapore 169857, Singapore
| | - Edward A Miao
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Magnus Abrink
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, 75007 Uppsala, Sweden
| | - Adam J Moeser
- Departments of Large Animal Clinical Sciences and Physiology, Michigan State University, East Lansing, MI 48824, USA
| | - Soman N Abraham
- Department of Pathology, Duke University, Durham, NC 27710, USA; Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27710, USA; Department of Immunology, Duke University, Durham, NC 27710, USA; Program in Emerging Infectious Diseases, Duke-National University of Singapore, Singapore 169857, Singapore
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Mike LA, Smith SN, Sumner CA, Eaton KA, Mobley HLT. Siderophore vaccine conjugates protect against uropathogenic Escherichia coli urinary tract infection. Proc Natl Acad Sci U S A 2016; 113:13468-13473. [PMID: 27821778 PMCID: PMC5127358 DOI: 10.1073/pnas.1606324113] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [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] [Indexed: 12/12/2022] Open
Abstract
Uropathogenic Escherichia coli (UPEC) is the primary cause of uncomplicated urinary tract infections (UTIs). Whereas most infections are isolated cases, 1 in 40 women experience recurrent UTIs. The rise in antibiotic resistance has complicated the management of chronic UTIs and necessitates new preventative strategies. Currently, no UTI vaccines are approved for use in the United States, and the development of a highly effective vaccine remains elusive. Here, we have pursued a strategy for eliciting protective immunity by vaccinating with small molecules required for pathogenesis, rather than proteins or peptides. Small iron-chelating molecules called siderophores were selected as antigens to vaccinate against UTI for this vaccine strategy. These pathogen-associated stealth siderophores evade host immune defenses and enhance bacterial virulence. Previous animal studies revealed that vaccination with siderophore receptor proteins protects against UTI. The poor solubility of these integral outer-membrane proteins in aqueous solutions limits their practical utility. Because their cognate siderophores are water soluble, we hypothesized that these bacterial-derived small molecules are prime vaccine candidates. To test this hypothesis, we immunized mice with siderophores conjugated to an immunogenic carrier protein. The siderophore-protein conjugates elicited an adaptive immune response that targeted bacterial stealth siderophores and protected against UTI. Our study has identified additional antigens suitable for a multicomponent UTI vaccine and highlights the potential use of bacterial-derived small molecules as antigens in vaccine therapies.
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Affiliation(s)
- Laura A Mike
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Sara N Smith
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Christopher A Sumner
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Kathryn A Eaton
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Harry L T Mobley
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109
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Marinova S, Nenkov P, Markova R, Nikolaeva S, Kostadinova R, Mitov I, Vretenarska M. Cellular and Humoral Systemic and Mucosal Immune Responses Stimulated by an Oral Polybacterial Immunomodulator in Patients with Chronic Urinary Tract Infections. Int J Immunopathol Pharmacol 2016; 18:457-473. [PMID: 16164822 DOI: 10.1177/039463200501800306] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 11/15/2022] Open
Abstract
An oral polybacterial immunomodulator Urostim (U), composed of killed cells and their lysates from E. coli expressing type 1 and P-pili, E. coli Re mutant, P. mirabilis, K. pneumoniae and E. faecalis was created for immunoprophylaxis and immunotherapy of urinary tract infections (UTIs). In experimental animal models, the stimulating effect of U on lymphocyte functional activity, macrophage phagocytosis and antibody producing cells, was established. In this study the immuno-modulating effects of U on the proliferating capacity and ultrastructural morphologic changes of lymphocytes, cytokine production and specific systemic humoral and mucosal immune responses in patients with UTIs have been evaluated. Patients enrolled in the study, received orally 50 mg U daily for a period of three months. On days 0,30 and 90 a quantitative analysis was performed on lymphoproliferative responses to polyclonal mitogens, IL-2 and the specific antigen U, the production of specific serum and saliva IgA, IgM and IgG antibodies to all components of U and the concentration of pro-inflammatory cytokines. There was significant improvement of non-specific and specific lymphoproliferative responses on days 30 and 90 after the onset of treatment with U, confirmed by electron-microscopic studies. The highest concentrations of serum proinflammatory cytokines TNF-α, IL-1β, and IL-6 were registered at baseline followed by a decrease until the end of the observation period. This finding correlates with the gradual decrease of immune activation as measured by the spontaneous lymphocyte proliferation. Data from the production of specific antibacterial antibodies in serum and saliva show two types of reactions. The first type was registered in patients with low pre-treatment levels in whom the concentration of specific antibodies increased on days 30 and 90. The second type of reaction was observed in patients with high pre-treatment levels, which dropped on day 30 and were usually followed by an increase at the end of the study. These results provide evidence for the immuno-modulating effect of U. Our data show that the oral administration of the polybacterial immunomodulator Urostim stimulates adequate cellular and humoral systemic and mucosal immune responses in patients with chronic UTIs.
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Affiliation(s)
- S Marinova
- National Center of Infectious and Parasitic Diseases (NCIPD), Sofia, Bulgaria
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Kaneko K. [Up-to-date concept on urinary tract infections with a focus on innate immunity]. Nihon Jinzo Gakkai Shi 2016; 58:17-25. [PMID: 26950977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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32
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Cui Y, Franciszkiewicz K, Mburu YK, Mondot S, Le Bourhis L, Premel V, Martin E, Kachaner A, Duban L, Ingersoll MA, Rabot S, Jaubert J, De Villartay JP, Soudais C, Lantz O. Mucosal-associated invariant T cell-rich congenic mouse strain allows functional evaluation. J Clin Invest 2015; 125:4171-85. [PMID: 26524590 DOI: 10.1172/jci82424] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/03/2015] [Indexed: 01/11/2023] Open
Abstract
Mucosal-associated invariant T cells (MAITs) have potent antimicrobial activity and are abundant in humans (5%-10% in blood). Despite strong evolutionary conservation of the invariant TCR-α chain and restricting molecule MR1, this population is rare in laboratory mouse strains (≈0.1% in lymphoid organs), and lack of an appropriate mouse model has hampered the study of MAIT biology. Herein, we show that MAITs are 20 times more frequent in clean wild-derived inbred CAST/EiJ mice than in C57BL/6J mice. Increased MAIT frequency was linked to one CAST genetic trait that mapped to the TCR-α locus and led to higher usage of the distal Vα segments, including Vα19. We generated a MAIThi congenic strain that was then crossed to a transgenic Rorcgt-GFP reporter strain. Using this tool, we characterized polyclonal mouse MAITs as memory (CD44+) CD4-CD8lo/neg T cells with tissue-homing properties (CCR6+CCR7-). Similar to human MAITs, mouse MAITs expressed the cytokine receptors IL-7R, IL-18Rα, and IL-12Rβ and the transcription factors promyelocytic leukemia zinc finger (PLZF) and RAR-related orphan receptor γ (RORγt). Mouse MAITs produced Th1/2/17 cytokines upon TCR stimulation and recognized a bacterial compound in an MR1-dependent manner. During experimental urinary tract infection, MAITs migrated to the bladder and decreased bacterial load. Our study demonstrates that the MAIThi congenic strain allows phenotypic and functional characterization of naturally occurring mouse MAITs in health and disease.
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MESH Headings
- Animals
- Chemotaxis, Leukocyte
- Crosses, Genetic
- Disease Models, Animal
- Female
- Gene Rearrangement, alpha-Chain T-Cell Antigen Receptor
- Germ-Free Life
- Histocompatibility Antigens Class I/immunology
- Humans
- Immunologic Memory
- Kruppel-Like Transcription Factors/analysis
- Lymphocyte Activation
- Lymphocyte Count
- Lymphoid Tissue/cytology
- Lymphokines/metabolism
- Mice
- Mice, Congenic/genetics
- Mice, Congenic/immunology
- Mice, Congenic/microbiology
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Transgenic
- Microbiota
- Minor Histocompatibility Antigens
- Natural Killer T-Cells/immunology
- Natural Killer T-Cells/metabolism
- Nuclear Receptor Subfamily 1, Group F, Member 3/analysis
- Phenotype
- Polymorphism, Single Nucleotide
- Promyelocytic Leukemia Zinc Finger Protein
- Radiation Chimera
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Cytokine/analysis
- Urinary Tract Infections/immunology
- Urinary Tract Infections/microbiology
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Abstract
The mononuclear phagocytes (dendritic cells and macrophages) are closely related immune cells with central roles in anti-infectious defense and maintenance of organ integrity. The canonical function of dendritic cells is the activation of T cells, whereas macrophages remove apoptotic cells and microbes by phagocytosis. In the kidney, these cell types form an intricate system of mononuclear phagocytes that surveys against injury and infection and contributes to organ homeostasis and tissue repair but may also promote progression of CKD. This review summarizes the general functions and classification of dendritic cells and macrophages in the immune system and recapitulates why overlapping definitions and historically separate research have created controversy about their tasks. Their roles in acute kidney disease, CKD, and renal transplantation are described, and therapeutic strategy to modify these cells for therapeutic purposes is discussed.
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Affiliation(s)
- Christina K Weisheit
- Institute of Experimental Immunology, University Clinic, Rheinische Friedrich-Wilhelms University, Bonn, Germany and Clinic for Anesthesiology and Intensive Care, University Clinic, Rheinische Friedrich-Wilhelms University, Bonn, Germany; and
| | - Daniel R Engel
- Institute of Experimental Immunology, University Clinic, Rheinische Friedrich-Wilhelms University, Bonn, Germany and Institute for Experimental Immunology and Imaging, University Duisburg-Essen and University Hospital Essen, Essen, Germany
| | - Christian Kurts
- Institute of Experimental Immunology, University Clinic, Rheinische Friedrich-Wilhelms University, Bonn, Germany and
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Miao Y, Li G, Zhang X, Xu H, Abraham SN. A TRP Channel Senses Lysosome Neutralization by Pathogens to Trigger Their Expulsion. Cell 2015; 161:1306-19. [PMID: 26027738 PMCID: PMC4458218 DOI: 10.1016/j.cell.2015.05.009] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [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: 09/18/2014] [Revised: 01/28/2015] [Accepted: 03/27/2015] [Indexed: 02/01/2023]
Abstract
Vertebrate cells have evolved elaborate cell-autonomous defense programs to monitor subcellular compartments for infection and to evoke counter-responses. These programs are activated by pathogen-associated pattern molecules and by various strategies intracellular pathogens employ to alter cellular microenvironments. Here, we show that, when uropathogenic E. coli (UPEC) infect bladder epithelial cells (BECs), they are targeted by autophagy but avoid degradation because of their capacity to neutralize lysosomal pH. This change is detected by mucolipin TRP channel 3 (TRPML3), a transient receptor potential cation channel localized to lysosomes. TRPML3 activation then spontaneously initiates lysosome exocytosis, resulting in expulsion of exosome-encased bacteria. These studies reveal a cellular default system for lysosome homeostasis that has been co-opted by the autonomous defense program to clear recalcitrant pathogens.
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Affiliation(s)
- Yuxuan Miao
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Guojie Li
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Xiaoli Zhang
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Haoxing Xu
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Soman N Abraham
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC 27710, USA; Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA; Department of Immunology, Duke University Medical Center, Durham, NC 27710, USA; Program in Emerging Infectious Diseases, Duke-National University of Singapore, Singapore 169857, Singapore.
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35
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Lin AE, Beasley FC, Olson J, Keller N, Shalwitz RA, Hannan TJ, Hultgren SJ, Nizet V. Role of Hypoxia Inducible Factor-1α (HIF-1α) in Innate Defense against Uropathogenic Escherichia coli Infection. PLoS Pathog 2015; 11:e1004818. [PMID: 25927232 PMCID: PMC4415805 DOI: 10.1371/journal.ppat.1004818] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 11/28/2014] [Accepted: 03/18/2015] [Indexed: 02/04/2023] Open
Abstract
Uropathogenic E. coli (UPEC) is the primary cause of urinary tract infections (UTI) affecting approximately 150 million people worldwide. Here, we revealed the importance of transcriptional regulator hypoxia-inducible factor-1 α subunit (HIF-1α) in innate defense against UPEC-mediated UTI. The effects of AKB-4924, a HIF-1α stabilizing agent, were studied using human uroepithelial cells (5637) and a murine UTI model. UPEC adherence and invasion were significantly reduced in 5637 cells when HIF-1α protein was allowed to accumulate. Uroepithelial cells treated with AKB-4924 also experienced reduced cell death and exfoliation upon UPEC challenge. In vivo, fewer UPEC were recovered from the urine, bladders and kidneys of mice treated transurethrally with AKB-4924, whereas increased bacteria were recovered from bladders of mice with a HIF-1α deletion. Bladders and kidneys of AKB-4924 treated mice developed less inflammation as evidenced by decreased pro-inflammatory cytokine release and neutrophil activity. AKB-4924 impairs infection in uroepithelial cells and bladders, and could be correlated with enhanced production of nitric oxide and antimicrobial peptides cathelicidin and β-defensin-2. We conclude that HIF-1α transcriptional regulation plays a key role in defense of the urinary tract against UPEC infection, and that pharmacological HIF-1α boosting could be explored further as an adjunctive therapy strategy for serious or recurrent UTI. Urinary tract infection (UTI), commonly caused by uropathogenic E.coli (UPEC), affects more than 150 million people worldwide, resulting in 14 million hospital visits per year and an estimated total cost of 6 billion dollars in direct health care. Due to the high prevalence of UTI and rapid emergence of antibiotic-resistant bacteria, new effective strategies to prevent and treat UTI are urgently needed. Here, we describe a global regulatory role of transcription factor hypoxia-inducible factor-1 (HIF-1) in innate antimicrobial defense against UPEC. HIF-1 stabilization reduces UPEC attachment to and invasion of uroepithelial cells, and protects bladders from UPEC-mediated cytotoxicity in vivo. In the murine UTI model, we found normal bladder HIF-1 expression is required for efficient UPEC clearance, since HIF-1-deficient mice suffer more severe infection than normal mice. Further studies showed that key elements of host protection provided by HIF-1 regulation are uroepithelial cell nitric oxide and antimicrobial peptide production. This study provides valuable insight into the importance of HIF-1 in supporting host immunity during UTI and its potential as a therapeutic target.
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Affiliation(s)
- Ann E. Lin
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
| | - Federico C. Beasley
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
| | - Joshua Olson
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
| | - Nadia Keller
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
| | | | - Thomas J. Hannan
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Center for Women’s Infectious Disease Research, 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
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Victor Nizet
- Division of Pediatric Pharmacology & Drug Discovery, University of California, San Diego, La Jolla, California, United States of America
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, United States of America
- Rady Children’s Hospital, San Diego, California, United States of America
- * E-mail:
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Svenson SB, Källenius G, Korhonen TK, Möllby R, Roberts JA, Tullus K, Winberg J. Initiation of clinical pyelonephritis--the role of P-fimbriae-mediated bacterial adhesion. Contrib Nephrol 2015; 39:252-72. [PMID: 6146493 DOI: 10.1159/000409254] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Fasth A, Bjure J, Hjälmås K, Jacobsson B, Jodal U. Serum autoantibodies to Tamm-Horsfall protein and their relation to renal damage and glomerular filtration rate in children with urinary tract malformations. Contrib Nephrol 2015; 39:285-95. [PMID: 6744875 DOI: 10.1159/000409257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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38
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Lynn KL, Bailey RR, Groufsky A, Hunt JS, Bean AR, McGiven AR. Antibodies to Tamm-Horsfall urinary glycoprotein in patients with urinary tract infection, reflux nephropathy, urinary obstruction and paraplegia. Contrib Nephrol 2015; 39:296-304. [PMID: 6744876 DOI: 10.1159/000409258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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39
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Mustafina LR, Logvinov SV, Yuriyev SY. [DYNAMICS OF CHANGES IN THE NUMERICAL DENSITY OF PLACENTAL MACROPHAGES DURING UROGENITAL INFECTION IN EARLY PREGNANCY]. Morfologiia 2015; 147:54-58. [PMID: 26234041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The changes in the numerical density of macrophages of maternal (basal decidua) and fetal (Kashchenko-Hofbauer cells) origin were studied in the placenta of women with opportunistic (Ureaplasma urealyticum and Mycoplasma hominis) and pathogenic (Chlamydia trachomatis) urogenital microflora. Histological study of placenta was performed and CD68-immunoreactive cells were detected immunohistochemically in the basal decidua and in the chorionic villi obtained during artificial abortions for non-medical reasons in the 6-8th week of pregnancy (n=136). The results showed no changes in the numerical density of macrophages of maternal origin and a significant decrease in the numerical density of macrophages in the stroma of the chorionic villi, which was associated in Chlamydial infection with a delayed, and in Ureaplasma and Mycoplasma infection - with an accelerated development of the villous tree.
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40
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Rushworth RL, Torpy DJ. A descriptive study of adrenal crises in adults with adrenal insufficiency: increased risk with age and in those with bacterial infections. BMC Endocr Disord 2014; 14:79. [PMID: 25273066 PMCID: PMC4200115 DOI: 10.1186/1472-6823-14-79] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/03/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An adrenal crisis (AC) is a major cause of morbidity in hypoadrenal patients. However, there is little information available on the incidence and underlying causes of AC. METHODS The aim of the present study was to describe the incidence of AC in New South Wales (NSW), Australia. Using a health department database, we selected de-identified data on all adults aged 20 years and over who were treated in any hospital in NSW between July1, 2000-June 30, 2011, with either a principal or secondary diagnosis of an AC. AC admission rates were calculated overall and within age categories. Frequencies of co-morbid diagnoses were analysed by age and sex groups. Poisson regression was used to assess the significance of the observed change in AC related admissions with age, while controlling for any secular trends by including year in the model. Chi sq tests were used to assess the differences in frequencies of categorical variables between groups. RESULTS 824 patients received treatment for an AC in hospital, corresponding to 74.9 admissions/year. The majority (62.5%) of the patients were women and 52.8% were aged 60 years and over. Admission rates were significantly associated with increasing age (p < 0.0001). Patients in the 60-69, 70-79 and 80+ age groups had the highest average admission rates (24.3, 35.2 and 45.8 per million/year). A principal or secondary diagnosis of an infection was reported in 317 (38.5%) patients and infection was significantly associated with age (p < 0.0001) with older patients having the highest proportion of cases. The most frequent infections were pneumonia/lower respiratory tract infection in 85 (10.3%) cases and urinary tract infection (UTI) in 82 (10.0%) patients. Women experienced 78.0% of the reported UTIs. There were 125 patients (15.2%) with an AC and a record of gastroenteritis. Twenty-six (3.2%) patients died in hospital but, of these, only 4 deaths (0.9%) were recorded among the 467 patients with a principal diagnosis of an AC. CONCLUSIONS The incidence of AC increases with age. Infections, especially bacterial infections, are associated with the incidence of ACs and this increases with age.
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Affiliation(s)
- R Louise Rushworth
- />School of Medicine, Sydney, The University of Notre Dame, Australia, 60 Oxford St, Darlinghurst, NSW 2010 Australia
| | - David J Torpy
- />Endocrine and Metabolic Unit, Royal Adelaide Hospital and Discipline of Medicine, University of Adelaide, Adelaide, SA Australia
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Spencer JD, Schwaderer AL, Becknell B, Watson J, Hains DS. The innate immune response during urinary tract infection and pyelonephritis. Pediatr Nephrol 2014; 29:1139-49. [PMID: 23732397 PMCID: PMC3800267 DOI: 10.1007/s00467-013-2513-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [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: 03/26/2013] [Revised: 04/16/2013] [Accepted: 05/08/2013] [Indexed: 11/27/2022]
Abstract
Despite its proximity to the fecal flora, the urinary tract is considered sterile. The precise mechanisms by which the urinary tract maintains sterility are not well understood. Host immune responses are critically important in the antimicrobial defense of the urinary tract. During recent years, considerable advances have been made in our understanding of the mechanisms underlying immune homeostasis of the kidney and urinary tract. Dysfunctions in these immune mechanisms may result in acute disease, tissue destruction and overwhelming infection. The objective of this review is to provide an overview of the innate immune response in the urinary tract in response to microbial assault. In doing so, we focus on the role of antimicrobial peptides-a ubiquitous component of the innate immune response.
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Affiliation(s)
- John David Spencer
- Department of Pediatrics, Division of Nephrology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA,
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42
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Junuzovic D, Zunic L, Dervisefendic M, Skopljak A, Pasagic A, Masic I. The toxic effect on leukocyte lineage of antimicrobial therapy in urinary and respiratory infections. Med Arch 2014; 68:167-9. [PMID: 25568526 PMCID: PMC4240340 DOI: 10.5455/medarh.2014.68.167-169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 05/28/2014] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Antimicrobials are widely used in infectious diseases. Only the timely intervention will contribute to the positive outcome of the disease. Unjustified use of antimicrobial prophylaxis may have adverse effects, i.e., result in bacterial resistance to existing antimicrobials, as well as toxic effects on leukocyte lineage and other parameters of the blood. GOAL The goal of this study was to confirm that the antimicrobial therapy of urinary, gynecological and respiratory infections has a toxic effect on leukocyte lineage. Followed by lowered immunity and the emergence of risk for health complications especially in oncology and other immunodeficient patients for whom to apply pharmacotherapy it is necessary to have adequate immunity, or white blood cell count that is greater than 4.0x10(9)/L. MATERIAL AND METHODS A prospective-retrospective study was conducted on a sample of 30 patients in a Primary Health Care Center in Gracanica during the period from March 01, 2013 until April 01, 2014. Testing of this sample was conducted by survey on health status and treatment, or on taking of antimicrobial therapy and other treatment regimens, with the referral diagnosis and determination of leukocytes count in by hematology counter SYSMEX. Results of leukocytes below and close to the lower reference values were statistically analyzed by Students t-test. RESULTS Mean WBC count in the group treated with antimicrobial therapy was 3.687±0.83 x10(9)/L, in the group which during repeated infection did not use the antimicrobial therapy 5.09±1.04 x10(9)/L, and in the control group of healthy subjects 7.178±1.038 x10(9)/L. Statistical analysis with Student's t test indicate highly significant differences between group of patients that used antimicrobial therapy with the group of patient that did not used antimicrobial during repeated infection (t=6.091; p=0.0001), as well as significant differences in mean WBC count of both of these groups and the controls (t=4.984; p=0.0001, and t=8.402, p=0.0001). CONCLUSION Use of antimicrobial drugs leads to serious toxic reactions, or leukopenia. Indications for the use of antimicrobial therapy must be strictly followed, because banal, frequent infections are not indication for antimicrobial therapy. It is necessary to know the types of infection causes. Important is the proper and timely selection of antimicrobial therapy. When selecting the drug we should bear in mind its antimicrobial activity, pharmacokinetic and toxic properties, as well as patient health status. Possible is also the application of preventive medicine as well as other manner of solving infection.
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Affiliation(s)
- Dzelaludin Junuzovic
- Department of Urology, Clinical center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Lejla Zunic
- Health center Gracanica, Gracanica, Bosnia and Herzegovina
- Faculty of Health sciences, University of Zenica, Zenica, Bosnia and Herzegovina
| | | | - Amira Skopljak
- Department of Family medicine, University of Sarajevo, Bosnia and Herzegovina
| | - Almir Pasagic
- Department of Family medicine, University of Sarajevo, Bosnia and Herzegovina
| | - Izet Masic
- Faculty of Health sciences, University of Zenica, Zenica, Bosnia and Herzegovina
- Department of Family medicine, University of Sarajevo, Bosnia and Herzegovina
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Kawalec P, Mikrut A, Łopuch S. The safety of dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose cotransporter 2 (SGLT-2) inhibitors added to metformin background therapy in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Res Rev 2014; 30:269-83. [PMID: 24829965 DOI: 10.1002/dmrr.2494] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of the present meta-analysis was to assess the safety profile of dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose cotransporter 2 (SGLT-2) inhibitors in comparison with placebo as add-on to metformin therapy in patients with type 2 diabetes. Randomized controlled trials and controlled clinical trials were identified by searching Pubmed, Embase and the Cochrane Central Register of Controlled Trials database until 15 July 2013. All included studies were critically appraised and analysed with the use of Review Manager 5.1.0 software according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement protocol. Twenty randomized and double-blinded studies published in 22 articles fulfilled the inclusion criteria for meta-analysis. The overall results demonstrated that the use of oral antidiabetic agents (analysed separately and together) was not associated with any significantly increased risk of any serious adverse events including hypoglycaemia and gastrointestinal disorders. Moreover, the use of DPP-4 or SGLT-2 inhibitors significantly decreased risk of diarrhoea compared with placebo, when given concomitantly with metformin. However, we found that the SGLT-2 inhibitors were more likely to cause a genital infection. Despite some limitations, the findings of this meta-analysis indicate that DPP-4 or SGLT-2 inhibitors have favourable safety profile, and such therapy, when combined with metformin is well tolerated.
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Koliscak LP, Johnson JW, Beardsley JR, Miller DP, Williamson JC, Luther VP, Ohl CA. Optimizing empiric antibiotic therapy in patients with severe β-lactam allergy. Antimicrob Agents Chemother 2013; 57:5918-23. [PMID: 24041892 PMCID: PMC3837866 DOI: 10.1128/aac.01202-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 06/12/2013] [Accepted: 09/06/2013] [Indexed: 11/20/2022] Open
Abstract
Antibiotic selection is challenging in patients with severe β-lactam allergy due to declining reliability of alternate antibiotics. Organisms isolated from these patients may exhibit unique resistance phenotypes. The objective of this study was to determine which alternate antibiotics or combinations provide adequate empirical therapy for patients with β-lactam allergy who develop Gram-negative infections at our institution. We further sought to determine the effects of risk factors for drug resistance on empirical adequacy. A retrospective analysis was conducted for adult patients hospitalized from September 2009 to May 2010 who had a severe β-lactam allergy and a urine, blood, or respiratory culture positive for a Gram-negative organism and who met predefined criteria for infection. Patient characteristics, culture and susceptibility data, and predefined risk factors for antibiotic resistance were collected. Adequacies of β-lactam and alternate antibiotics were compared for all infections and selected subsets. The primary outcome was adequacy of each alternate antibiotic or combination for all infections. One hundred sixteen infections (40 pneumonias, 67 urinary tract infections, and 9 bacteremias) were identified. Single alternate agents were adequate less frequently than β-lactams and combination regimens. Only in cases without risk factors for resistance did single-agent regimens demonstrate acceptable adequacy rates; each factor conferred a doubling of risk for resistance. Resistance risk factors should be considered in selecting empirical antibiotics for Gram-negative pathogens in patients unable to take β-lactams due to severe allergy.
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Affiliation(s)
- Lindsey P. Koliscak
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
- Wingate University, School of Pharmacy, Wingate, North Carolina, USA
| | - James W. Johnson
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - James R. Beardsley
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
| | - David P. Miller
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - John C. Williamson
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vera P. Luther
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christopher A. Ohl
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Townes CL, Ali A, Gross N, Pal D, Williamson S, Heer R, Robson CN, Pickard RS, Hall J. Prostate specific antigen enhances the innate defence of prostatic epithelium against Escherichia coli infection. Prostate 2013; 73:1529-37. [PMID: 23818154 DOI: 10.1002/pros.22700] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/25/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study investigated whether the increase in serum prostate specific antigen (PSA) typically seen during male urinary tract infection (UTI) is incidental or reflects an innate defence mechanism of the prostate. The protective roles of the whey-acid-motif-4-disulphide core (WFDC) proteins, secretory leukoproteinase inhibitor (SLPI) and WFDC2, in the prostate were also examined. METHODS UTI recurrence was assessed retrospectively in men following initial UTI by patient interview. PSA, SLPI, and WFDC2 gene expression were assessed using biopsy samples. LNCaP and DU145 in vitro prostate cell models were utilized to assess the effects of an Escherichia coli challenge on PSA and WFDC gene expression, and bacterial invasion of the prostate epithelium. The effects of PSA on WFDC antimicrobial properties were studied using recombinant peptides and time-kill assays. RESULTS Men presenting with PSA >4 ng/ml at initial UTI were less likely to have recurrent (r) UTI than those with PSA <4 ng/ml [2/15 (13%) vs. 7/10 (70%), P < 0.01]. Genes encoding PSA, SLPI and WFDC2, were expressed in prostatic epithelium, and the PSA and SLPI proteins co-localized in vivo. Challenging LNCaP (PSA-positive) cells with E. coli increased PSA, SLPI, and WFDC2 gene expression (P < 0.05), and PSA synthesis (P < 0.05), and reduced bacterial invasion. Pre-incubation of DU145 (PSA-negative) cells with PSA also decreased bacterial invasion. In vitro incubation of recombinant SLPI and WFDC2 with PSA resulted in peptide proteolysis and increased E. coli killing. CONCLUSIONS Increased PSA during UTI appears protective against rUTI and in vitro is linked to proteolysis of WFDC proteins supporting enhanced prostate innate defences.
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Affiliation(s)
- Claire L Townes
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, UK
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Tsiporenko SI. [Studying the dynamics of the levels CD4+CD25+, CD4+ HLA-DR4 + and CD4+CD95+ cells in the semen of men with oligosymptomatic forms of chronic urogenital infection complicated infertility under the influence of fortege]. Lik Sprava 2013:79-83. [PMID: 25510094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The markers of activating of lymphocytes in sperm of men with the oligosymptomatic forms of chronic urogenital infection depending on fertility. It is set that the increasing of correlation of CD25/CD95 brings to growth of pathological forms of spermatozoa and, consequently, to the decline of impregnating ability of men. Fortege application leads to the normalization of this correlation and a reduction of pathological forms of sperm and thus to the increasing of the fertilizing potential.
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Dasiuk TI. [Complex personalized therapy of patients with chlamydiosis taking into consideration abnormalities of pro-oxidant-antioxidant and immune systems]. Lik Sprava 2013:109-118. [PMID: 25095696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A new original, pathogenetically relevant method of complex differentiated treatment of chlamydial urogenital disorders was developed with the consideration of prooxidant-antioxidant and immune systems statuses. That provides a personalized usage in the treatment plan modern azalide antibiotic azithromycin and immunomodulator herbal drug manax taking into the account clinical course of the disease.
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Duitman J, Teske GJD, Butter LM, Leemans JC, Florquin S, Spek CA. CCAAT/enhancer-binding protein delta (C/EBPδ) plays a minor role in renal host defense against uropathogenic Escherichia coli. Transpl Infect Dis 2013; 15:E119-21. [PMID: 23582055 DOI: 10.1111/tid.12081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/24/2012] [Accepted: 12/23/2012] [Indexed: 11/29/2022]
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Sheviakov MA. [Immunotherapy of infectious and inflammatory diseases of the urinary tract and its effectiveness]. Urologiia 2013:98-102. [PMID: 23789373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Affiliation(s)
- Ine Jorgensen
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Patrick C. Seed
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Microbiology and Molecular Genetics, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
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