Regulation by protein kinase of phagocytosis of Mycobacterium leprae by macrophages.

Mycobacterium leprae multiplies within host macrophages. The mechanism of internalisation of the bacteria by the phagocytic cells is unknown. In this study, M. leprae was purified from the foot pads of experimentally infected nu/nu mice. Peritoneal macrophages were harvested from BALB/c mice or C57 beige (bg/bg) mice. The effect of protein kinase inhibitors (erbstatin, genistein or staurosporine for BALB/c and bg/bg mice, plus herbimycin for bg/bg mice) on phagocytosis of the mycobacteria by the macrophage monolayers was tested. The untreated (control) macrophages phagocytosed M. leprae. Phagocytosis by BALB/c macrophages was inhibited by erbstatin and staurosporine but not by genistein; all the protein kinase inhibitors prevented uptake of M. leprae by bg/bg cells. The results demonstrate that protein kinase regulates phagocytosis of M. leprae by macrophages. The mechanism might prove to be a rational drug target for mycobacteria that multiply intracellularly.

Bactericidal action of ampicillin/sulbactam against intracellular mycobacteria.

The resistance of mycobacteria to beta-lactam antibiotics is attributed to their ability to synthesize beta-lactamase. In our previous studies, beta-lactam/beta-lactamase-inhibitor combinations suppressed the growth of several mycobacteria in axenic cultures and ampicillin/sulbactam was bactericidal to Mycobacterium tuberculosis H37Rv in vitro, and to Mycobacterium leprae multiplying in mouse foot-pads. Since both these organisms multiply in phagocytic cells in the host, it is important to know whether the drug combination is active against mycobacteria multiplying in macrophages. We tested the action of ampicillin/sulbactam against four potentially pathogenic (to humans or to animals) mycobacteria, M. simiae, M. haemophilum, M. avium, M. microti, when phagocytosed by mouse macrophages. Bacteria were exposed to monolayers of peritoneal macrophages harvested from BALB/c mice. Unphagocytosed bacilli were removed and three concentrations of ampicillin/sulbactam were tested. Optimum activity was observed at 100 mg/l which killed 58-97% of the mycobacteria within macrophages, as determined by the CFU. beta-Lactam/beta-lactamase-inhibitors, especially ampicillin/sulbactam, might provide an effective alternative therapy against infections caused by mycobacteria resistant to other drugs.

Postantibiotic effect of ampicillin/sulbactam against mycobacteria.

The postantibiotic effect (PAE) is an important pharmacodynamic property of antibiotics. Most drugs continue to exert a suppressive effect on the growth of bacteria, both in vitro and in vivo, even after the drug concentrations have fallen below detectable levels. Only limited information is available on the PAE of slow-growing organisms like mycobacteria. The PAE of ampicillin/sulbactam (Unasyn) was investigated against six species of mycobacteria, viz Mycobacterium avium, M. africanum, M. bovis BCG, M. simiae, M. scrofulaceum and M. tuberculosis H37Ra, by spectrophotometry. The cell counter method was also used in one set of experiments. The bacteria were exposed to ampicillin/sulbactam for 2 h, 24 h, 72 h or 7-10 days. Five concentrations, 5, 10, 50 or 100 micrograms/ml, of the drug were tested. Afterwards, the bacteria were washed free of Unasyn and allowed to multiply. Treatment of the mycobacteria for 2 h did not produce any PAE, although 100 micrograms/ml of the drug caused slower growth. Exposure to 50, 60, or 100 micrograms/ml, resulted in a prolonged PAE of approximately 3 days. The data on the PAE of Unasyn may be of clinical relevance in determining dosage regimens of the drug.

Development of a breastfeeding support program at Naval Hospital Sigonella, Italy.

The Naval Hospital (NH) Sigonella, which contains a level one nursery, cares for prenatal patients in an isolated military community. Many of the traditional support systems available to breastfeeding mothers in the United States, such as Le Leche League, are unavailable in this setting. Some prenatal patients in this setting who have had the desire to breastfeed have failed to do so because they were not offered a structured educational support system that encouraged and monitored their breastfeeding efforts. This prompted the pediatric nurse, functioning as breastfeeding counselor nurse at NH Sigonella, to develop a breastfeeding support program. The goal of the program is to educate new mothers about breastfeeding and to encourage them to initiate and continue breastfeeding for at least 5 to 6 months. These goals are in line with the Healthy People 2000 (1990) objectives, which are to increase to at least 75% the proportion of mothers who breastfeed their babies in the early postpartum period and to at least 50% the proportion of those who continue breastfeeding until their babies are 5 to 6 months old. At delivery, the breastfeeding counselor meets individually with each new mother who expresses the desire to breastfeed. During this visit, she observes and evaluates each mother's breastfeeding technique. Discharge follow-up via telephone is conducted weekly for 4 weeks and at 3 and 6 months postpartum. Data collection after 6 months revealed that 86.7% of all new mothers initiated breastfeeding and 51.4% of those mothers continued breastfeeding for 5 to 6 months. The Breastfeeding Counseling Support Program will enhance NH Sigonella's efforts in continuing to meeting the objectives of Healthy People 2000 and the Breast Feeding Hospital Initiative while providing the benefits of breastfeeding to mother and infant.

Bactericidal action of oral ampicillin/sulbactam against Mycobacterium leprae.

We reported previously that an injectable form of ampicillin/sulbactam, Unasyn, was bactericidal to Mycobacterium leprae multiplying in mouse foot pads. In this study, we examined the effect of an orally active form of ampicillin/sulbactam, Sultamicillin, on the growth of M. leprae in mice. Three concentrations of the drug, mixed with the feed, were administered from the start until the mice were killed at 6 months; 0.01% of the drug inhibited bacterial growth by 54%, 0.10% by 74% and 0.20% by 93%. To test whether oral ampicillin/sulbactam was bactericidal, 0.50% of the drug, mixed with the feed, was administered to experimentally infected mice for 3 months during the logarithmic phase of bacterial growth, and then discontinued; multiplication of the bacilli was monitored monthly for the next 8 months. The results showed that orally active ampicillin/sulbactam is bactericidal to M. leprae.

Suppression of the growth of six potentially-pathogenic mycobacteria by beta-lactam/beta-lactamase-inhibitors.

Drug-resistant tuberculosis and opportunistic infections by mycobacteria in immunocompromised subjects are not readily controlled with the antimycobacterial drugs now available. beta-Lactam antibiotics, the most widely used antibacterial agents, are ineffective against mycobacteria since they synthesize beta-lactamases. The beta-lactam/beta-lactamase-inhibitor combinations are used at present to treat infections caused by other beta-lactamase-positive organisms. Six potentially-pathogenic mycobacteria: Mycobacterium avium, M. chelonei, M. haemophilum, M. microti, M. scrofulaceum and M. simiae, were cultured in 7H9 medium (containing Tween 80 and albumin, dextrose, catalase) at 37 degrees C for 10-14 days, with or without various concentrations (2-100 micrograms/ml) of ampicillin/sulbactam, amoxicillin/clavulanate and piperacillin/tazobactam. More than 50-80% inhibition of the mycobacterial growth was observed at drug levels of 40-100 micrograms/ml in the medium; the drugs were active even when the detergent (Tween 80) was omitted. Against four of the mycobacteria, ampicillin/sulbactam proved to be the most active. The beta-lactam/beta-lactamase-inhibitor combinations may be of use as rational therapeutic agents against mycobacterial infections.

Properties of lysophospholipase in Mycobacterium leprae.

Lysophospholipids are key intermediates in the metabolism of phospholipids. Cytoplasmic membranes of both eukaryotes and prokaryotes are made of phospholipid bilayers. Phospholipases are activated during phagocytosis. Lysophospholipids generated by phospholipase A2 or A1 degrade cell membranes and can cause cell lysis. An active lysophospholipase, that hydrolyzes lysophospholipids, was detected by the radioisotope technique in Mycobacterium leprae. About two-thirds of the enzyme was particulate and one-third cytoplasmic. Optimum activity was at 37 degrees C, and at pH 6.0. Temperatures above 70 degrees C completely inactivated the enzyme. The compound AACOCF3, a trifluromethylketone analog of arachiodonic acid, inhibited the activity; the inhibition appeared to be of the uncompetetive type. The K(m) of the enzyme was 2.5 x 10(-4)M, suggesting a fairly strong affinity for the substrate. Lysophospholipids have been shown to be microbicidal to invading organisms. Possession of lysophospholipase by M. leprae is apparently one of the methods by which the bacilli overcome the defense mechanisms of the host.

beta-Lactamase activity in mycobacteria including Mycobacterium avium and suppression of their growth by a beta-lactamase-stable antibiotic.

beta-Lactamase has been reported from only a few mycobacteria. It is widely assumed that Mycobacterium avium strains do not contain the enzyme, but earlier assays were done using insensitive methods. Thus the beta-lactamase activity in cell-free extracts of ten selected strains of mycobacteria, including four strains of M. avium, was determined using a highly sensitive spectrophotometric method. The results showed that all the mycobacteria tested possess the enzyme, which explains their resistance to beta-lactam antibiotics. However, some of the bacteria differed from others in the action of the inhibitors, clavulanate, sulbactam and tazobactam against their beta-lactamases. Growth of the mycobacteria was suppressed by novel combinations of the beta-lactam/beta-lactamase-inhibitors, and by a new beta-lactamase-stable cephalosporin, Cefepime (aminothiazolyl methoxyimino cephalosporin). The results presented, as well as reports of previous studies in vivo, suggest that the intracellular growth of the bacilli or the high partition coefficient of a beta-lactamase inhibitor such as sulbactam does not impede the antimycobacterial action of these compounds.

Use of beta-lactam/beta-lactamase-inhibitor combinations as antimycobacterial agents.

Mycobacterium tuberculosis and Mycobacterium leprae develop resistance against the drugs used to treat tuberculosis and leprosy, respectively. Now multidrug-resistant tuberculosis is spreading in many countries, especially with the emergence of AIDS. Multidrug treatment is being promoted at present to eradicate leprosy. Since M. leprae may also become multidrug-resistant, new approaches have to be adopted for controlling mycobacterial diseases. Mycobacteria usually synthesize beta-lactamase and are insensitive to beta-lactam antibiotics. M. tuberculosis contains a constitutive beta-lactamase; de-repression of beta-lactamase has been reported in M. leprae. Three different beta-lactam/beta-lactamase-inhibitor combinations (ampicillin/sulbactam, amoxicillin/clavulanate and piperacillin/tazobactam) were used to suppress the growth of several strains of mycobacteria (including M. tuberculosis H37Rv) in vitro. Ampicillin/sulbactam is a potent bactericidal agent against M. leprae multiplying in mouse foot pads. In the present work, ampicillin/sulbactam showed higher activity than the other drug combinations. The beta-lactam/beta-lactamase inhibitors are likely to be effective as rational therapeutic agents against mycobacterial infections.

Competency of human-derived Mycobacterium leprae to use palmitic acid in the synthesis of phenolic glycolipid-I and phthiocerol dimycocerosate and to release CO2 in axenic culture.

Insufficient numbers of viable Mycobacterium leprae have hampered metabolic studies using human-derived M. leprae. In this study, sufficient numbers of M. leprae were obtained from an untreated lepromatous patient to titrate the effects of pH on the metabolism of 14C-palmitic acid by M. leprae. Catabolic metabolism (oxidation of 14C-palmitic acid and release of 14CO2) was maximal when M. leprae were incubated at 33 degrees C and suspended in Middlebrook 7H9, ADC supplemented medium that had been buffered to maintain a pH of 4.8. Anabolic metabolism (synthesis of 14C-phenolic glycolipid-I and its precursor, 14C-phthiocerol dimycocerosate) was maximal when the pH was maintained at 6.8.

Reversal of drug resistance in Mycobacterium leprae by ampicillin/sulbactam.

The multiplication of Mycobacterium leprae in foot pads of experimentally-infected mice was suppressed by intramuscular administration of ampicillin combined with sulbactam or YTR-830H, two potent inhibitors of beta-lactamase in the bacteria. The antibiotic or the inhibitors by themselves were inactive. Ampicillin/sulbactam also inhibited the growth of drug-resistant M. leprae which grew in the presence of rifampin or dapsone. The finding provides a new approach to treat leprosy and to overcome drug resistance of the mycobacteria.

A unique type of GABA binding by Mycobacterium leprae.

Neurotropism is one of the unusual properties of Mycobacterium leprae. The organism contains glutamic acid decarboxylase that generates gamma-amino-butyric acid (GABA) which is an inhibitory neurotransmitter. The binding of GABA by M. leprae in vitro was studied by using 3H-GABA as substrate. The bacteria had high-affinity binding sites for the amino acid. The uptake was a specific saturable process with a Km of 66.7 pM, pH optimum of 7.3 and a temperature optimum of 37 degrees C. The binding did not seem to be time-dependent, being complete in about 5 min. None of the known antagonists and agonists of GABA uptake by neurons, showed any significant effect on M. leprae; the receptors in the bacteria are apparently of a non-neuronal type, and different from those reported in spermatozoa and Pseudomonas.

Fusidic acid is highly active against extracellular and intracellular Mycobacterium leprae.

The activity of fusidic acid against Mycobacterium leprae was studied in axenic medium and in bacilli residing within mouse peritoneal macrophages. Activity was assessed by subsequent quantitation of bacillary radiorespirometric activity. Significant inhibition in both systems was observed at 0.156 micrograms/ml, and an approximately 50% reduction in activity occurred after exposure to 1.25 to 2.5 micrograms/ml. The excellent human pharmacokinetics and in vitro activity of fusidic acid against the leprosy bacillus warrant a clinical trial of this drug for leprosy.

Active transport of ATP and presence of a vanadate-sensitive membrane-bound ATPase in Mycobacterium leprae.

It is not known how Mycobacterium leprae obtains energy for survival and growth in the host tissues; the organism does not grow in vitro. In the studies reported here, M. leprae incorporated labelled ATP, which was blocked by cyanide, unlabelled ATP or ADP, but not by adenosine or Pi. It seems that the organism takes up unhydrolysed ATP by an active transport process. The bacterium contained a membrane-bound, vanadate-sensitive E1 E2-ATPase (which creates a transmembrane potential driving transport of solutes into cells). The enzyme was not inhibited by N-ethylmaleimide, suggesting that it is not an F0F1-ATPase which catalyses ATP synthesis. Apparently, M. leprae derives energy-rich compounds from the host cell.

Isolation and characterization of an environmental acid-fast organism producing diphenoloxidase activity in vivo.

Water and soil samples were collected from natural habitats of the nine-banded armadillo and tested for the presence of acid-fast organisms by injection into the foot pads of experimental mice. Sixteen months post inoculation an acid-fast organism was isolated from the foot pad and spleen of one of the mice. The isolate exhibited diphenoloxidase activity as determined by its ability to convert D-3,4-dihydroxyphenylalanine to the corresponding quinone. The same organisms grown in vitro lacked detectable diphenoloxidase activity. However, diphenoloxidase activity was observed in acid-fast organisms harvested from spleen tissue of mice experimentally inoculated with a pure culture of the isolate. The environmental isolate was tentatively classed with the Mycobacterium avium-intracellulare complex.