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1.
mBio ; 12(2)2021 04 20.
Article in English | MEDLINE | ID: mdl-33879591

ABSTRACT

The opportunistic pathogen Pseudomonas aeruginosa produces an arsenal of virulence factors causing a wide range of diseases in multiple hosts and is difficult to eradicate due to its intrinsic resistance to antibiotics. With the antibacterial pipeline drying up, antivirulence therapy has become an attractive alternative strategy to the traditional use of antibiotics to treat P. aeruginosa infections. To identify P. aeruginosa genes required for virulence in multiple hosts, a random library of Tn5 mutants in strain PAO1-L was previously screened in vitro for those showing pleiotropic effects in the production of virulence phenotypes. Using this strategy, we identified a Tn5 mutant with an insertion in PA4130 showing reduced levels of a number of virulence traits in vitro Construction of an isogenic mutant in this gene presented results similar to those for the Tn5 mutant. Furthermore, the PA4130 isogenic mutant showed substantial attenuation in disease models of Drosophila melanogaster and Caenorhabditis elegans as well as reduced toxicity in human cell lines. Mice infected with this mutant demonstrated an 80% increased survival rate in acute and agar bead lung infection models. PA4130 codes for a protein with homology to nitrite and sulfite reductases. Overexpression of PA4130 in the presence of the siroheme synthase CysG enabled its purification as a soluble protein. Methyl viologen oxidation assays with purified PA4130 showed that this enzyme is a nitrite reductase operating in a ferredoxin-dependent manner. The preference for nitrite and production of ammonium revealed that PA4130 is an ammonia:ferredoxin nitrite reductase and hence was named NirA.IMPORTANCE The emergence of widespread antimicrobial resistance has led to the need for development of novel therapeutic interventions. Antivirulence strategies are an attractive alternative to classic antimicrobial therapy; however, they require identification of new specific targets which can be exploited in drug discovery programs. The host-specific nature of P. aeruginosa virulence adds complexity to the discovery of these types of targets. Using a sequence of in vitro assays and phylogenetically diverse in vivo disease models, we have identified a PA4130 mutant with reduced production in a number of virulence traits and severe attenuation across all infection models tested. Characterization of PA4130 revealed that it is a ferredoxin-nitrite reductase and hence was named NirA. These results, together with attenuation of nirA mutants in different clinical isolates, high level conservation of its gene product in P. aeruginosa genomes, and the lack of orthologues in human genomes, make NirA an attractive antivirulence target.


Subject(s)
Nitrite Reductases/genetics , Pseudomonas aeruginosa/enzymology , Pseudomonas aeruginosa/genetics , Virulence Factors/genetics , Ammonia/metabolism , Animals , Bacterial Proteins/metabolism , Caenorhabditis elegans , Cell Line , Disease Models, Animal , Drosophila melanogaster , Ferredoxins/metabolism , Gene Library , Humans , Male , Mice , Mice, Inbred C57BL , Mutation , Nitrite Reductases/metabolism , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/pathogenicity
2.
Environ Microbiol ; 18(10): 3390-3402, 2016 10.
Article in English | MEDLINE | ID: mdl-26743546

ABSTRACT

Pseudomonas aeruginosa produces increased levels of alginate in response to oxygen-deprived conditions. The regulatory pathway(s) that links oxygen limitation to increased synthesis of alginate has remained elusive. In the present study, using immunofluorescence microscopy, we show that anaerobiosis-induced alginate production by planktonic PAO1 requires the diguanylate cyclase (DGC) SadC, previously identified as a regulator of surface-associated lifestyles. Furthermore, we found that the gene products of PA4330 and PA4331, located in a predicted operon with sadC, have a major impact on alginate production: deletion of PA4330 (odaA, for oxygen-dependent alginate synthesis activator) caused an alginate production defect under anaerobic conditions, whereas a PA4331 (odaI, for oxygen-dependent alginate synthesis inhibitor) deletion mutant produced alginate also in the presence of oxygen, which would normally inhibit alginate synthesis. Based on their sequence, OdaA and OdaI have predicted hydratase and dioxygenase reductase activities, respectively. Enzymatic assays using purified protein showed that unlike OdaA, which did not significantly affect DGC activity of SadC, OdaI inhibited c-di-GMP production by SadC. Our data indicate that SadC, OdaA and OdaI are components of a novel response pathway of P. aeruginosa that regulates alginate synthesis in an oxygen-dependent manner.


Subject(s)
Bacterial Proteins/metabolism , Cyclic GMP/analogs & derivatives , Escherichia coli Proteins/metabolism , Gene Expression Regulation, Bacterial , Oxygen/metabolism , Phosphorus-Oxygen Lyases/metabolism , Pseudomonas aeruginosa/metabolism , Alginates , Bacterial Proteins/genetics , Cyclic GMP/metabolism , Escherichia coli Proteins/genetics , Glucuronic Acid/biosynthesis , Hexuronic Acids , Operon , Phosphorus-Oxygen Lyases/genetics , Pseudomonas aeruginosa/genetics
3.
Mediators Inflamm ; 2015: 545417, 2015.
Article in English | MEDLINE | ID: mdl-26185363

ABSTRACT

PURPOSE: Neutrophil-dominated airway inflammation is a key feature of progressive lung damage in cystic fibrosis (CF). Thus, reducing airway inflammation is a major goal to prevent lung damage in CF. However, current anti-inflammatory drugs have shown several limits. PI3Kγ plays a pivotal role in leukocyte recruitment and activation; in the present study we determined the effects of genetic deletion and pharmacologic inhibition of PI3Kγ on airway inflammation and structural lung damage in a mouse model of CF lung disease. METHODS: ßENaC overexpressing mice (ßENaC-Tg) were backcrossed with PI3Kγ-deficient (PI3Kγ (KO)) mice. Tissue damage was assessed by histology and morphometry and inflammatory cell number was evaluated in bronchoalveolar lavage fluid (BALF). Furthermore, we assessed the effect of a specific PI3Kγ inhibitor (AS-605240) on inflammatory cell number in BALF. RESULTS: Genetic deletion of PI3Kγ decreased neutrophil numbers in BALF of PI3Kγ (KO)/ßENaC-Tg mice, and this was associated with reduced emphysematous changes. Treatment with the PI3Kγ inhibitor AS-605240 decreased the number of neutrophils in BALF of ßENaC-Tg mice, reproducing the effect observed with genetic deletion of the enzyme. CONCLUSIONS: These results demonstrate the biological efficacy of both genetic deletion and pharmacological inhibition of PI3Kγ in reducing chronic neutrophilic inflammation in CF-like lung disease in vivo.


Subject(s)
Class Ib Phosphatidylinositol 3-Kinase/physiology , Cystic Fibrosis/therapy , Inflammation/prevention & control , Lung/pathology , Neutrophil Infiltration , Animals , Class Ib Phosphatidylinositol 3-Kinase/genetics , Cystic Fibrosis/complications , Cystic Fibrosis/pathology , Epithelial Sodium Channels/physiology , Gene Deletion , Mice , Mice, Inbred C57BL , Mice, Transgenic , Phosphoinositide-3 Kinase Inhibitors
4.
Environ Microbiol ; 17(11): 4379-93, 2015 Nov.
Article in English | MEDLINE | ID: mdl-25845292

ABSTRACT

Pseudomonas aeruginosa is a multi-host opportunistic pathogen causing a wide range of diseases because of the armoury of virulence factors it produces, and it is difficult to eradicate because of its intrinsic resistance to antibiotics. Using an integrated whole-genome approach, we searched for P. aeruginosa virulence genes with multi-host relevance. We constructed a random library of 57 360 Tn5 mutants in P. aeruginosa PAO1-L and screened it in vitro for those showing pleiotropic effects in virulence phenotypes (reduced swarming, exo-protease and pyocyanin production). A set of these pleiotropic mutants were assayed for reduced toxicity in Drosophila melanogaster, Caenorhabditis elegans, human cell lines and mice. Surprisingly, the screening revealed that the virulence of the majority of P. aeruginosa mutants varied between disease models, suggesting that virulence is dependent on the disease model used and hence the host environment. Genomic analysis revealed that these virulence-related genes encoded proteins from almost all functional classes, which were conserved among P. aeruginosa strains. Thus, we provide strong evidence that although P. aeruginosa is capable of infecting a wide range of hosts, many of its virulence determinants are host specific. These findings have important implication when searching for novel anti-virulence targets to develop new treatments against P. aeruginosa.


Subject(s)
Caenorhabditis elegans/microbiology , Drosophila melanogaster/microbiology , Host Specificity/genetics , Pseudomonas aeruginosa/genetics , Pseudomonas aeruginosa/pathogenicity , Virulence Factors/genetics , Animals , Anti-Bacterial Agents/metabolism , Cell Line , Disease Models, Animal , Gene Library , Genomics , Humans , Male , Mice , Mice, Inbred C57BL , Pseudomonas Infections/microbiology , Pseudomonas Infections/pathology , Virulence/genetics
5.
J Cyst Fibros ; 13(5): 542-9, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25027419

ABSTRACT

RATIONALE: Pseudomonas aeruginosa (Pa) serology could potentially be a useful adjunct to respiratory culture methods for the detection of initial or early Pa infection in patients with cystic fibrosis (CF). OBJECTIVE: To evaluate the utility of Pa serology to predict Pa isolation from respiratory (generally oropharyngeal) cultures in the subsequent 6 or 12 months among young children with CF from whom Pa had never been previously cultured. Pa serology was also evaluated in a group of healthy controls. METHODS: Children ≤ 12 years of age without prior isolation of Pa from respiratory cultures participating in the Early Pseudomonal Infection Control EPIC Observational Study (EPIC OBS) had annual serum samples for measurement of antibodies against alkaline protease, elastase and exotoxin A using a commercial kit; controls had a single serum sample. Logistic regression with generalized estimating equations was used to characterize associations between log10 serum antibody titers and first isolation of Pa from a respiratory culture within the subsequent 6 or 12 months, with adjustment for sex and age. Receiver operating characteristic curves were used to optimize antibody titer cutpoints by age group. The diagnostic properties of each antibody were estimated using these optimized cutpoints. RESULTS: Pa serology was evaluated in 582 children with CF (2084 serum samples) and 94 healthy controls. There was substantial overlap between serum antibody titers among controls, CF patients who did not acquire Pa (N = 261) and CF patients who did acquire Pa (N = 321). The maximum positive predictive value for first Pa positive culture within the ensuing 6 months was 76.2% and maximum negative predictive value was 72.1% for any antigen or combination of antigens; values were similar for 12 months. CONCLUSIONS: Pa serology does not appear useful for predicting first Pa positive oropharyngeal culture among young CF patients.


Subject(s)
Antibodies, Bacterial/analysis , Cystic Fibrosis/complications , Pseudomonas Infections/diagnosis , Pseudomonas aeruginosa/immunology , Child , Female , Forecasting , Humans , Logistic Models , Male , Oropharynx/microbiology , Pseudomonas Infections/immunology , Pseudomonas aeruginosa/isolation & purification
6.
Cell Physiol Biochem ; 34(1): 56-70, 2014.
Article in English | MEDLINE | ID: mdl-24977481

ABSTRACT

BACKGROUND/AIMS: Inflammation is a major and critical component of the lung pathology in the hereditary disease cystic fibrosis. The molecular mechanisms of chronic inflammation in cystic fibrosis require definition. METHODS: We used several genetic mouse models to test a role of iNKT cells and ceramide in pulmonary inflammation of cystic fibrosis mice. Inflammation was determined by the pulmonary cytokine profil and the abundance of inflammatory cells in the lung. RESULTS: Here we provide a new concept how inflammation in the lung of individuals with cystic fibrosis is initiated. We show that in cystic fibrosis mice the mutation in the Cftr gene provokes a significant up-regulation of iNKT cells in the lung. Accumulation of iNKT cells serves to control autoimmune disease, which is triggered by a ceramide-mediated induction of cell death in CF organs. Autoimmunity becomes in particular overt in cystic fibrosis mice lacking iNKT cells and although suppression of the autoimmune response by iNKT cells is beneficial, IL-17(+) iNKT cells attract macrophages and neutrophils to CF lungs resulting in chronic inflammation. Genetic deletion of iNKT cells in cystic fibrosis mice prevents inflammation in CF lungs. CONCLUSION: Our data demonstrate an important function of iNKT cells in the chronic inflammation affecting cystic fibrosis lungs. iNKT cells suppress the auto-immune response induced by ceramide-mediated death of epithelial cells in CF lungs, but also induce a chronic pulmonary inflammation.


Subject(s)
Killer Cells, Natural/immunology , Animals , Autoantibodies/metabolism , Autoimmunity , B-Lymphocytes/immunology , B-Lymphocytes/metabolism , Cystic Fibrosis/metabolism , Cystic Fibrosis/pathology , Cystic Fibrosis Transmembrane Conductance Regulator/deficiency , Cystic Fibrosis Transmembrane Conductance Regulator/genetics , Cystic Fibrosis Transmembrane Conductance Regulator/metabolism , Disease Models, Animal , Interleukin-17/metabolism , Killer Cells, Natural/metabolism , Lung/immunology , Lung/metabolism , Mice , Mice, Inbred C57BL , Mice, Inbred CFTR , Pneumonia/metabolism , Pneumonia/pathology
7.
J Cyst Fibros ; 13(6): 623-31, 2014 Dec.
Article in English | MEDLINE | ID: mdl-24713593

ABSTRACT

BACKGROUND: How elevated temperature is generated during airway infections represents a hitherto unresolved physiological question. We hypothesized that innate immune defence mechanisms would increase luminal airway temperature during pulmonary infection. METHODS: We determined the temperature in the exhaled air of cystic fibrosis (CF) patients. To further test our hypothesis, a pouch inflammatory model using neutrophil elastase-deficient mice was employed. Next, the impact of temperature changes on the dominant CF pathogen Pseudomonas aeruginosa growth was tested by plating method and RNAseq. RESULTS: Here we show a temperature of ~38°C in neutrophil-dominated mucus plugs of chronically infected CF patients and implicate neutrophil elastase:α1-proteinase inhibitor complex formation as a relevant mechanism for the local temperature rise. Gene expression of the main pathogen in CF, P. aeruginosa, under anaerobic conditions at 38°C vs 30°C revealed increased virulence traits and characteristic cell wall changes. CONCLUSION: Neutrophil elastase mediates increase in airway temperature, which may contribute to P. aeruginosa selection during the course of chronic infection in CF.


Subject(s)
Body Temperature , Cystic Fibrosis/enzymology , Leukocyte Elastase/physiology , Respiratory Tract Infections/enzymology , Adolescent , Animals , Case-Control Studies , Child , Cystic Fibrosis/complications , Disease Models, Animal , Female , Hot Temperature , Humans , Male , Mice , Mice, Inbred C57BL , Pseudomonas Infections/enzymology , Pseudomonas Infections/microbiology , Pseudomonas Infections/pathology , Pseudomonas aeruginosa , Respiratory Tract Infections/microbiology , Respiratory Tract Infections/pathology
8.
J Cyst Fibros ; 13(2): 156-63, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24183915

ABSTRACT

BACKGROUND: A clinical study to investigate the leukotriene B(4) (LTB(4))-receptor antagonist BIIL 284 in cystic fibrosis (CF) patients was prematurely terminated due to a significantly increased risk of adverse pulmonary events. We aimed to establish the effect of BIIL284 in models of Pseudomonas aeruginosa lung infection, thereby contributing to a better understanding of what could have led to adverse pulmonary events in CF patients. METHODS: P. aeruginosa DNA in the blood of CF patients during and after acute pulmonary exacerbations and in stable patients with non-CF bronchiectasis (NCFB) and healthy individuals was assessed by PCR. The effect of BIIL 284 treatment was tested in an agar bead murine model of P. aeruginosa lung infection. Bacterial count and inflammation were evaluated in lung and other organs. RESULTS: Most CF patients (98%) and all patients with NCFB and healthy individuals had negative P. aeruginosa DNA in their blood. Similarly, the P. aeruginosa-infected mice showed bacterial counts in the lung but not in the blood or spleen. BIIL 284 treatment decreased pulmonary neutrophils and increased P. aeruginosa numbers in mouse lungs leading to significantly higher bacteremia rates and lung inflammation compared to placebo treated animals. CONCLUSIONS: Decreased airway neutrophils induced lung proliferation and severe bacteremia in a murine model of P. aeruginosa lung infection. These data suggest that caution should be taken when administering anti-inflammatory compounds to patients with bacterial infections.


Subject(s)
Amidines , Bacteremia/etiology , Carbamates , Cystic Fibrosis , Inflammation/drug therapy , Neutrophils , Pseudomonas aeruginosa , Adult , Amidines/administration & dosage , Amidines/adverse effects , Animals , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effects , Carbamates/administration & dosage , Carbamates/adverse effects , Cystic Fibrosis/blood , Cystic Fibrosis/complications , Cystic Fibrosis/physiopathology , Disease Models, Animal , Female , Humans , Inflammation/metabolism , Inflammation/physiopathology , Leukocyte Count , Lung/microbiology , Lung/pathology , Male , Mice , Neutrophils/drug effects , Neutrophils/metabolism , Pseudomonas Infections/blood , Pseudomonas Infections/complications , Pseudomonas Infections/physiopathology , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/isolation & purification , Receptors, Leukotriene B4/antagonists & inhibitors , Treatment Outcome
10.
Immunity ; 39(5): 874-84, 2013 Nov 14.
Article in English | MEDLINE | ID: mdl-24184056

ABSTRACT

Severe sepsis remains a poorly understood systemic inflammatory condition with high mortality rates and limited therapeutic options in addition to organ support measures. Here we show that the clinically approved group of anthracyclines acts therapeutically at a low dose regimen to confer robust protection against severe sepsis in mice. This salutary effect is strictly dependent on the activation of DNA damage response and autophagy pathways in the lung, as demonstrated by deletion of the ataxia telangiectasia mutated (Atm) or the autophagy-related protein 7 (Atg7) specifically in this organ. The protective effect of anthracyclines occurs irrespectively of pathogen burden, conferring disease tolerance to severe sepsis. These findings demonstrate that DNA damage responses, including the ATM and Fanconi Anemia pathways, are important modulators of immune responses and might be exploited to confer protection to inflammation-driven conditions, including severe sepsis.


Subject(s)
Anthracyclines/pharmacology , Anti-Bacterial Agents/pharmacology , DNA Repair/drug effects , Lung/drug effects , Peritonitis/drug therapy , Sepsis/prevention & control , Adenoviridae Infections/immunology , Animals , Anthracyclines/therapeutic use , Anti-Bacterial Agents/therapeutic use , Ataxia Telangiectasia Mutated Proteins/deficiency , Ataxia Telangiectasia Mutated Proteins/physiology , Autophagy-Related Protein 7 , Cecum/injuries , DNA Damage , Epirubicin/administration & dosage , Epirubicin/pharmacology , Epirubicin/therapeutic use , Fanconi Anemia Complementation Group D2 Protein/physiology , Inflammation , Inflammation Mediators/analysis , Injections, Intraperitoneal , Lung/metabolism , Meropenem , Mice , Mice, Inbred C57BL , Microtubule-Associated Proteins/deficiency , Microtubule-Associated Proteins/physiology , Organ Specificity , Peritonitis/etiology , Peritonitis/genetics , Peritonitis/immunology , Peritonitis/physiopathology , Respiratory Tract Infections/immunology , Shock, Septic/prevention & control , Thienamycins/therapeutic use , Whole-Body Irradiation
12.
Cell Physiol Biochem ; 31(4-5): 505-12, 2013.
Article in English | MEDLINE | ID: mdl-23572075

ABSTRACT

BACKGROUND/AIMS: Several recent studies revealed an accumulation of ceramide in bronchial, tracheal and intestinal epithelial cells of mice and patients with cystic fibrosis (CF). Normalization of ceramide concentrations in lungs of CF mice employing the functional acid sphingomyelinase inhibitor amitriptyline also normalized mucociliary clearance, chronic inflammation and infection susceptibility to pulmonary P. aeruginosa in these mice. METHODS: To test for a beneficial effect of amitriptyline in vivo, we performed a phase IIb randomised, double-blind, placebo-controlled study. Twenty-one CF patients were treated with 25 mg/d amitriptyline twice daily for 28 days. The placebo consisted of 19 patients and was also treated twice per day. The primary endpoint was the change in lung function in the intention-to-treat (ITT) population. Secondary endpoints were ceramide levels in epithelial cells and safety. RESULTS: After treatment, forced expiratory volume in 1 sec predicted (FEV1) increased 6.3 ± 11.5% (p=0.08) in the ITT population (36 of 40 CF patients) and 8.5 ± 10% (p=0.013) in the per protocol (PP) population (29 of 40 patients). Ceramide levels decreased in nasal epithelial cells after amitriptyline treatment. Amitriptyline had no severe and only mild and mostly transient adverse effects, i.e. xerostomia and tiredness. CONCLUSION: Amitriptyline is safe in CF-patients, increases FEV1 and reduces ceramide in lung cells of CF patients.


Subject(s)
Adrenergic Uptake Inhibitors/therapeutic use , Amitriptyline/therapeutic use , Cystic Fibrosis/drug therapy , Adolescent , Adult , Ceramides/analysis , Cohort Studies , Double-Blind Method , Female , Forced Expiratory Volume , Humans , Male , Placebo Effect , Treatment Outcome , Young Adult
13.
J Cyst Fibros ; 12(6): 817-20, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23481089

ABSTRACT

Gaseous nitric oxide (NO) is bactericidal in vitro. However whether and how it can be used for the treatment of bacterial lung infections in patients with cystic fibrosis is unclear. Here we assessed the bactericidal effect of intermittently inhaled 160 ppm NO for 30 min every 4 h in a Pseudomonas aeruginosa pneumonia model in rats. NO significantly reduced P. aeruginosa colony count in rat lungs but did not affect neutrophil myeloperoxidase function methemoglobin percentage nor plasma nitrite/nitrate levels. This regimen warrants exploration in infected patients with cystic fibrosis.


Subject(s)
Bacterial Load/drug effects , Nitric Oxide/pharmacology , Pneumonia, Bacterial/microbiology , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa , Administration, Inhalation , Animals , Disease Models, Animal , Male , Nitric Oxide/administration & dosage , Rats , Rats, Sprague-Dawley
14.
J Immunol ; 190(3): 1276-84, 2013 Feb 01.
Article in English | MEDLINE | ID: mdl-23277486

ABSTRACT

Pseudomonas aeruginosa persists in patients with cystic fibrosis (CF) and drives CF lung disease progression. P. aeruginosa potently activates the innate immune system, mainly mediated through pathogen-associated molecular patterns, such as flagellin. However, the host is unable to eradicate this flagellated bacterium efficiently. The underlying immunological mechanisms are incompletely understood. Myeloid-derived suppressor cells (MDSCs) are innate immune cells generated in cancer and proinflammatory microenvironments and are capable of suppressing T cell responses. We hypothesized that P. aeruginosa induces MDSCs to escape T cell immunity. In this article, we demonstrate that granulocytic MDSCs accumulate in CF patients chronically infected with P. aeruginosa and correlate with CF lung disease activity. Flagellated P. aeruginosa culture supernatants induced the generation of MDSCs, an effect that was 1) dose-dependently mimicked by purified flagellin protein, 2) significantly reduced using flagellin-deficient P. aeruginosa bacteria, and 3) corresponded to TLR5 expression on MDSCs in vitro and in vivo. Both purified flagellin and flagellated P. aeruginosa induced an MDSC phenotype distinct from that of the previously described MDSC-inducing cytokine GM-CSF, characterized by an upregulation of the chemokine receptor CXCR4 on the surface of MDSCs. Functionally, P. aeruginosa-infected CF patient ex vivo-isolated as well as flagellin or P. aeruginosa in vitro-generated MDSCs efficiently suppressed polyclonal T cell proliferation in a dose-dependent manner and modulated Th17 responses. These studies demonstrate that flagellin induces the generation of MDSCs and suggest that P. aeruginosa uses this mechanism to undermine T cell-mediated host defense in CF and other P. aeruginosa-associated chronic lung diseases.


Subject(s)
Cystic Fibrosis/complications , Flagellin/immunology , Immune Evasion/immunology , Immune Tolerance/immunology , Myeloid Cells/immunology , Pneumonia, Bacterial/immunology , Pseudomonas Infections/immunology , Pseudomonas aeruginosa/pathogenicity , Adolescent , Adult , Bacterial Proteins/genetics , Cells, Cultured/immunology , Culture Media, Conditioned/pharmacology , Cystic Fibrosis/microbiology , Disease Susceptibility , Female , Flagella/immunology , Flagella/physiology , Flagellin/genetics , Flagellin/pharmacology , Gene Expression Regulation/immunology , Humans , Immunity, Innate , Lung/microbiology , Male , Myeloid Cells/drug effects , Myelopoiesis/immunology , Pneumonia, Bacterial/etiology , Pneumonia, Bacterial/microbiology , Pseudomonas Infections/etiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/genetics , Pseudomonas aeruginosa/immunology , Pseudomonas aeruginosa/isolation & purification , Receptors, CXCR4/biosynthesis , Receptors, CXCR4/genetics , Receptors, CXCR4/immunology , T-Lymphocyte Subsets/immunology , Th17 Cells/immunology , Toll-Like Receptor 5/immunology , Up-Regulation/immunology , Young Adult
15.
Am J Respir Crit Care Med ; 187(6): 621-9, 2013 Mar 15.
Article in English | MEDLINE | ID: mdl-23306544

ABSTRACT

RATIONALE: Cystic fibrosis (CF) is characterized by progressive pulmonary inflammation that is infection-triggered. Pseudomonas aeruginosa represents a risk factor for deterioration of lung function and reduced life expectancy. OBJECTIVES: To assess T-cell cytokine/chemokine production in clinically stable children with CF and evaluate the association between T-cell subtypes and susceptibility for infection with P. aeruginosa. METHODS: T-cell cytokine/chemokine profiles were measured in bronchoalveolar lavage fluid (BALF) from children with CF (n = 57; 6.1 ± 5.9 yr) and non-CF control subjects (n = 18; 5.9 ± 4.3 yr). Memory responses to Aspergillus fumigatus and P. aeruginosa were monitored. High-resolution computed tomography-based Helbich score was assessed. In a prospective observational trial the association between BALF cytokine/chemokine profiles and subsequent infection with P. aeruginosa was studied. MEASUREMENTS AND MAIN RESULTS: Th1- (INF-γ), Th2- (IL-5, IL-13), Th17- (IL-17A), and Th17-related cytokines (IL-1ß, IL-6) were significantly up-regulated in airways of patients with CF. IL-17A, IL-13, and IL-5 were significantly higher in BALF of symptomatic as compared with clinically asymptomatic patients with CF. IL-17A and IL-5 correlated with the percentage of neutrophils in BALF (r = 0.41, P < 0.05 and r = 0.46, P < 0.05, respectively). Th17- (IL-17A, IL-6, IL-1ß, IL-8) and Th2-associated cytokines and chemokines (IL-5, IL-13, TARC/CCL17), but not IFN-γ levels, significantly correlated with high-resolution computed tomography changes (Helbich score; P < 0.05). P. aeruginosa- and A. fumigatus-specific T cells from patients with CF displayed significantly higher IL-5 and IL-17A mRNA expression. IL-17A and TARC/CCL17 were significantly augmented in patients that developed P. aeruginosa infection within 24 months. CONCLUSIONS: We propose a role for Th17 and Th2 T cells in chronic inflammation in lungs of patients with CF. High concentrations of these cytokines/chemokines in CF airways precede infection with P. aeruginosa.


Subject(s)
Cystic Fibrosis/metabolism , Cytokines/metabolism , Pseudomonas Infections/metabolism , Pseudomonas aeruginosa , Th17 Cells/metabolism , Th2 Cells/metabolism , Adolescent , Bronchoalveolar Lavage Fluid , Child , Child, Preschool , Female , Humans , Interferon-gamma/metabolism , Male , Prognosis , Prospective Studies
16.
J Cyst Fibros ; 12(2): 147-53, 2013 Mar.
Article in English | MEDLINE | ID: mdl-22944725

ABSTRACT

BACKGROUND: The prognostic value of Pseudomonas aeruginosa serology for antibiotic therapy in cystic fibrosis patients is not well understood. METHODS: Using five antigens from two ELISAs, we assessed whether positive serology in CF patients participating in the multi-center Early Pseudomonas Infection in Children (EPIC) trial would predict treatment failure, time to pulmonary exacerbation and risk for recurrent P. aeruginosa isolation post eradication. RESULTS: Baseline positive P. aeruginosa serology was not significantly associated with failure of initial P. aeruginosa eradication measured at week 10 (adjusted for baseline culture) but seropositivity to the antigens alkaline protease and exotoxin A was significantly associated with increased risk for recurrent P. aeruginosa isolation during the 60 week post eradication follow-up period (p=0.003 and p=0.001 respectively). There was no association between baseline seropositivity and time to pulmonary exacerbation. CONCLUSION: P. aeruginosa serology may complement culture results in clinicians' efforts to successfully monitor recurrence of early P. aeruginosa in CF patients.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Cystic Fibrosis/microbiology , Pseudomonas Infections/blood , Pseudomonas Infections/drug therapy , Bacteriological Techniques , Child , Cystic Fibrosis/complications , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Prognosis , Pseudomonas Infections/complications , Pseudomonas aeruginosa/isolation & purification , Recurrence , Risk Factors , Serologic Tests
17.
Am J Respir Cell Mol Biol ; 48(1): 71-7, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23043087

ABSTRACT

A genome-wide association study identified interferon-related development regulator-1 (IFRD1), a protein expressed by neutrophils, as a key modifier gene in cystic fibrosis (CF) lung disease. Here, we investigated the expression and regulation of IFRD1 in CF neutrophils. IFRD1 expression was quantified in peripheral blood and airway neutrophils from patients with CF, patients with non-CF lung disease, and healthy control subjects. The regulation of IFRD1 expression was analyzed using isolated neutrophils and ex vivo stimulation assays with CF airway fluids. IFRD1 single-nucleotide polymorphisms (SNPs) were analyzed in a CF cohort (n = 572) and correlated with longitudinal lung function and IFRD1 expression. Patients with CF expressed higher protein levels of IFRD1 in peripheral blood neutrophils compared with healthy or non-CF disease control subjects. Within patients with CF, IFRD1 protein expression levels in neutrophils were lower in airway fluids compared with peripheral blood. High IFRD1 expression was positively associated with the production of reactive oxygen species (ROS) in CF neutrophils. In vitro regulation studies showed that CF airway fluid and the CF-characteristic chemokines CXCL8 and CXCL2 down-regulated IFRD1 expression in neutrophils, an effect that was mediated through CXCR2. Genetic analyses showed that three IFRD1 SNPs were associated with longitudinal declines in lung function, and modulated IFRD1 expression. These studies demonstrate that IFRD1 expression is systemically up-regulated in human CF neutrophils, is linked to the production of ROS, and is modulated by chemokines in CF airway fluids, depending on the IFRD1 genotype. Understanding the regulation of IFRD1 may pave the way for novel therapeutic approaches to target neutrophilic inflammation in CF.


Subject(s)
Cystic Fibrosis/genetics , Cystic Fibrosis/physiopathology , Immediate-Early Proteins/genetics , Immediate-Early Proteins/metabolism , Case-Control Studies , Chemokine CXCL2/metabolism , Cohort Studies , Cystic Fibrosis/immunology , Humans , Immunity, Innate , Interleukin-8/metabolism , Lung/immunology , Lung/physiopathology , Neutrophils/immunology , Neutrophils/metabolism , Polymorphism, Single Nucleotide , Reactive Oxygen Species/metabolism
18.
Thorax ; 68(4): 344-50, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23135343

ABSTRACT

PURPOSE: To assess efficacy and safety of a new dry powder formulation of inhaled colistimethate sodium in patients with cystic fibrosis (CF) aged ≥6 years with chronic Pseudomonas aeruginosa lung infection. STUDY DESIGN AND METHODS: A prospective, centrally randomised, phase III, open-label study in patients with stable CF aged ≥6 years with chronic P aeruginosa lung infection. Patients were randomised to Colobreathe dry powder for inhalation (CDPI, one capsule containing colistimethate sodium 1 662 500 IU, twice daily) or three 28-day cycles with twice-daily 300 mg/5 ml tobramycin inhaler solution (TIS). Study duration was 24 weeks. RESULTS: 380 patients were randomised. After logarithmic transformation of data due to a non-normal distribution, adjusted mean difference between treatment groups (CDPI vs TIS) in change in forced expiratory volume in 1 s (FEV1% predicted) at week 24 was -0.98% (95% CI -2.74% to 0.86%) in the intention-to-treat population (n=373) and -0.56% (95% CI -2.71% to 1.70%) in the per protocol population (n=261). The proportion of colistin-resistant isolates in both groups was ≤1.1%. The number of adverse events was similar in both groups. Significantly more patients receiving CDPI rated their device as 'very easy or easy to use' (90.7% vs 53.9% respectively; p<0.001). CONCLUSION: CDPI demonstrated efficacy by virtue of non-inferiority to TIS in lung function after 24 weeks of treatment. There was no emergence of resistance of P aeruginosa to colistin. Overall, CDPI was well tolerated. TRIAL REG NO: EudraCT 2004-003675-36.


Subject(s)
Colistin/analogs & derivatives , Cystic Fibrosis/drug therapy , Administration, Inhalation , Adult , Anti-Bacterial Agents , Clinical Trials, Phase III as Topic , Colistin/administration & dosage , Female , Forced Expiratory Volume , Humans , Male , Powders , Prospective Studies , Pseudomonas Infections/complications , Pseudomonas aeruginosa , Tobramycin/administration & dosage , Treatment Outcome , Young Adult
19.
J Cyst Fibros ; 11(6): 461-79, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23137712

ABSTRACT

In patients with cystic fibrosis (CF) lung damage secondary to chronic infection is the main cause of death. Treatment of lung disease to reduce the impact of infection, inflammation and subsequent lung injury is therefore of major importance. Here we discuss the present status of antibiotic therapy for the major pathogens in CF airways, including prophylaxis against infection, eradication of early infection, suppression of chronic infection, and the treatment of infective exacerbations. We outline measures to optimize maintenance treatment for infection in the light of novel antibiotic drug formulations. We discuss new developments in culture-independent microbiological diagnostic techniques and the use of tools for monitoring the success of antibiotic treatment courses. Finally, cost-effectiveness analyses for antibiotic treatment in CF patients are discussed.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Cystic Fibrosis/microbiology , Pneumonia, Bacterial/drug therapy , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa , Humans , Pneumonia, Bacterial/microbiology
20.
PLoS One ; 7(10): e47896, 2012.
Article in English | MEDLINE | ID: mdl-23082228

ABSTRACT

Small non-coding regulatory RNAs (sRNAs) post-transcriptionally affect multiple phenotypes in prokaryotes and eukaryotes, yet most of the underlying regulatory mechanisms and the nature of the target mRNAs remain unclear. Here we report the identification and functional analysis of the novel cis-encoded sRNA h2cR, from the human opportunistic pathogen Burkholderia cenocepacia J2315. The sRNA was found to negatively regulate the hfq2 mRNA, through binding to part of the 5'-UTR region of the hfq2 mRNA, resulting in accelerated hfq2 mRNA decay and reduced protein levels in exponentially growing cells. Both the h2cR transcript and the hfq2 mRNA are stabilized by the other B. cenocepacia RNA chaperone, Hfq. Infection experiments using the nematode Caenorhabditis elegans revealed that down-regulation of Hfq2 by h2cR decreases the B. cenocepacia ability to colonize and persist within the nematode, suggesting a role for h2cR on bacterial persistence in the host.


Subject(s)
Bacterial Proteins/metabolism , Burkholderia cenocepacia/genetics , RNA, Bacterial/metabolism , 5' Untranslated Regions/genetics , Animals , Bacterial Proteins/genetics , Base Sequence , Burkholderia cenocepacia/growth & development , Burkholderia cenocepacia/pathogenicity , Caenorhabditis elegans/microbiology , Cloning, Molecular , Colony Count, Microbial , Gene Expression Regulation, Bacterial , Gene Silencing , Genome, Bacterial/genetics , Humans , Molecular Sequence Data , Protein Binding/genetics , RNA, Bacterial/genetics , RNA, Messenger/genetics , RNA, Messenger/metabolism , Transcription, Genetic , Virulence/genetics
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