Activation of myeloid dendritic cells by deoxynucleic acids from Cordyceps sinensis via a Toll-like receptor 9-dependent pathway.

The mechanism by which host cells recognize Cordyceps sinensis, a Chinese herbal medicine that is known to exhibit immunomodulating activity, remains poorly understood. In this study, we investigated whether the DNA of this fungus could activate mouse bone marrow-derived dendritic cells (BM-DCs). Upon stimulation with C. sinensis DNA, BM-DCs released IL-12p40 and TNF-alpha and expressed CD40. Cytokine production and CD40 expression were attenuated by chloroquin and bafilomycin A. Activation of BM-DCs by C. sinensis DNA was almost completely abrogated in TLR9KO mice. According to a luciferase reporter assay, C. sinensis DNA activated NF-kappaB in HEK293T cells transfected with the TLR9 gene. Finally, a confocal microscopic analysis showed that C. sinensis DNA was co-localized with CpG-ODN and partly with TLR9 and LAMP-1, a late endosomal marker, in BM-DCs. Our results demonstrated that C. sinensis DNA caused activation of BM-DCs in a TLR9-dependent manner.

[Adaptations to the incidental cases encountered at the division of clinical laboratory].

We analyzed 4 cases that were not determined as incidents and another 7 cases determined as incidents, found at the department of clinical laboratory of us from April 2009 to March 2010. The former cases were, excess values of LD, and Cl, and glucose leveled as 0 mg/dl incorrectly, and misdirected blood samples at the ER. Our routine equipment and sample flow did not detect these false values. Resetting for auto dilution system and secondary check by every worker were reconsidered for these measurements. Antiseptic drug usage was notified by clinicians, and actually affected to the excessive Cl value. Real incidents were, two unprocessed samples, leakage of a sample, missing processes that caused delay of clinical practice, mixed up sample labels, a lost narcotic patch during cardiac ultrasonography. A lack of checking, carelessness, and accidental mistakes were reevaluated and reminded for workers on the duties. Also inadequate pharmaceutical knowledge and responsibilities of this section might severely affect on these lessons. Efforts were taken so that all workers shared the accurate information. Code blue cases are defined here as those of life-threatening events and sudden vital changes occurred in highest emergency, involve all health care workers, patients, and families. It is very important here to keep regular trainings for workers to cope with such events as well as preemptive assessments on environment and underlying risks in our laboratory. In line with the continuous advances in clinical medicine, medical safety managements are growing issues. To achieve safer environment and minimize various type of risks in the hospital, these incidents are to be assessed and reported regularly.

Early production of tumor necrosis factor-alpha by Gr-1 cells and its role in the host defense to pneumococcal infection in lungs.

In this study, we elucidated the role of tumor necrosis factor (TNF)-alpha in the host defense to pulmonary infection with Streptococcus pneumoniae and defined the cellular source of this cytokine at an early stage of infection. Administration of anti-TNF-alpha monoclonal antibody (mAb) resulted in the reduced accumulation of neutrophils in bronchoalveolar lavage fluids (BALFs) and severe exacerbation of this infection. In a flow cytometric analysis, the intracellular expression of TNF-alpha was detected in Gr-1(bright+) and Gr-1(dull+) cells during the time intervals postinfection, and F4/80(+) cells expressed intracellular TNF-alpha before Gr-1(dull+) cells appeared. The Gr-1(bright+) and Gr-1(dull+) cells sorted from BALF cells at 24 h were identified as neutrophils and macrophage-like cells, respectively, and the Gr-1(dull+) cells expressing CD11c, partially CD11b and a marginal level of F4/80 secreted TNF-alpha in in vitro cultures. Finally, deletion of Gr-1(+) cells by administration of the specific mAb significantly reduced the concentrations of this cytokine in BALF at 6 and 12 h postinfection, but not the expression of TNF-alpha in F4/80(+) cells. Thus, these results demonstrated that neutrophils, F4/80(+) macrophages and Gr-1(dull+) CD11c(+) macrophage-like cells played an important role in the production of TNF-alpha in lungs at an early stage of infection with S. pneumoniae.

Toll-like receptor 9-dependent activation of myeloid dendritic cells by Deoxynucleic acids from Candida albicans.

The innate immune system of humans recognizes the human pathogenic fungus Candida albicans via sugar polymers present in the cell wall, such as mannan and beta-glucan. Here, we examined whether nucleic acids from C. albicans activate dendritic cells. C. albicans DNA induced interleukin-12p40 (IL-12p40) production and CD40 expression by murine bone marrow-derived myeloid dendritic cells (BM-DCs) in a dose-dependent manner. BM-DCs that lacked Toll-like receptor 4 (TLR4), TLR2, and dectin-1, which are pattern recognition receptors for fungal cell wall components, produced IL-12p40 at levels comparable to the levels produced by BM-DCs from wild-type mice, and DNA from a C. albicans pmr1Delta null mutant, which has a gross defect in mannosylation, retained the ability to activate BM-DCs. This stimulatory effect disappeared completely after DNase treatment. In contrast, RNase treatment increased production of the cytokine. A similar reduction in cytokine production was observed when BM-DCs from TLR9(-/-) and MyD88(-/-) mice were used. In a luciferase reporter assay, NF-kappaB activation was detected in TLR9-expressing HEK293T cells stimulated with C. albicans DNA. Confocal microscopic analysis showed similar localization of C. albicans DNA and CpG-oligodeoxynucleotide (CpG-ODN) in BM-DCs. Treatment of C. albicans DNA with methylase did not affect its ability to induce IL-12p40 synthesis, whereas the same treatment completely eliminated the ability of CpG-ODN to induce IL-12p40 synthesis. Finally, impaired clearance of this fungal pathogen was not found in the kidneys of TLR9(-/-) mice. These results suggested that C. albicans DNA activated BM-DCs through a TLR9-mediated signaling pathway using a mechanism independent of the unmethylated CpG motif.

Measurement of (1-3)-beta-D-glucan derived from different gauze types.

(1-3)-beta-D-glucan (BDG) is a cell-wall polysaccharide component found in most fungi. The measurement of BDG is a useful diagnostic marker for invasive fungal infections. However, it is well known that interfering substances can result in false positive reactions. We encountered a patient who underwent lung transplantation and presented with highly elevated BDG values, despite having no evidence of invasive fungal infection. We therefore hypothesized that elevated BDG values were originated from the gauze products used during surgery. While it is known that gauze products contain BDG, there have been no previous reports to quantitatively correlate amount of gauze usage and BDG levels. In this study, we extracted BDG from various gauze products and measured BDG to better understand the degree of which gauze contributes to elevated BDG values. Six types of commonly used surgical gauze products were selected for our study. Each of the surgical gauze was immersed in sterile, purified water for up to 120 minutes. At set intervals, BDG values in the water extracts were measured. Purified water samples without gauze were used as negative controls (< 4 pg/ml). After 120-minute extraction, BDG levels varied greatly depending on gauze products, ranging from 11.7 pg/ml to 6612 pg/ml. The gauze made of lyocell, which is a fiber produced from wood pulp cellulose, yielded the lowest levels of BDG, and probably would not cause false positive for fungal infections. There is a need for the development of a gauze product that does not contribute to elevated BDG values.

Toll-like receptor 4-dependent activation of myeloid dendritic cells by leukocidin of Staphylococcus aureus.

Leukocidin (Luk), an exotoxin of Staphylococcus aureus consisting of LukF and LukS, is a hetero-oligomeric pore-forming cytolytic toxin toward human and rabbit polymorphonuclear leukocytes. However, it is uncertain how Luk affects the host immune response. In the present study, we investigated whether Luk has the ability to stimulate mouse bone marrow-derived myeloid dendritic cells (BM-DCs). LukF activated BM-DCs to generate IL-12p40 mRNA, induce intracellular expression and extracellular secretion of this cytokine and express CD40 on their surface, whereas LukS showed a much lower or marginal ability in the activation of BM-DCs than its counterpart component. Similarly, TNF-alpha was secreted by BM-DCs upon stimulation with these components. Combined addition of these components did not lead to a further increase in IL-12p40 secretion. IL-12p40 production caused by LukF was completely abrogated in BM-DCs from TLR4-deficient mice similarly to the response to lipopolysaccharide (LPS). Polymixin B did not affect the LukF-induced IL-12p40 production, although the same treatment completely inhibited the LPS-induced response. Boiling significantly inhibited the response caused by LukF, but not by LPS. Finally, in a luciferase reporter assay, LukF induced the activation of NF-kappaB in HEK293T cells transfected with TLR4, MD2 and CD14, whereas LukS did not show such activity. These results demonstrate that LukF caused the activation of BM-DCs by triggering a TLR4-dependent signaling pathway and suggests that Luk may affect the host inflammatory response as well as show a cytolytic effect on leukocytes.

Cryptococcus neoformans inhibits nitric oxide synthesis caused by CpG-oligodeoxynucleotide-stimulated macrophages in a fashion independent of capsular polysaccharides.

Cryptococcus neoformans is eradicated by macrophages via production of NO. Unmethylated CpG-ODN protect mice from infection with this fungal pathogen by inducing IFN-gamma. The present study was designed to elucidate the effect of C. neoformans on the synthesis of NO by alveolar macrophages. For this purpose, MH-S, an alveolar macrophage cell line, was stimulated with CpG-ODN in the presence of IFN-gamma. A highly virulent strain of C. neoformans with thick capsule suppressed the production of NO. Capsular polysaccharides were not essential for this suppression, because there was no difference between acapsular mutant (Cap67) and its parent strain. Physical or close interaction of Cap67 with MH-S was necessary, as shown by the loss of such effect when direct contact was interfered by nitrocellulose membrane. Similar effects were observed by disrupted as well as intact Cap67. Whereas the inhibitory effect of intact Cap67 was completely abrogated by heat treatment, disrupted Cap67 did not receive such influence. Finally, disrupted Cap67 did not show any inhibitory effect on the TLR9-mediated activation of NF-kappaB in a luciferase reporter assay with HEK293T cells, although the TLR4-mediated activation was suppressed. These results revealed that C. neoformans suppressed the synthesis of NO by CpG-ODN and IFN-gamma-stimulated macrophages in a fashion independent of capsular polysaccharides, although the precise mechanism remains to be elucidated.

Deoxynucleic acids from Cryptococcus neoformans activate myeloid dendritic cells via a TLR9-dependent pathway.

The mechanism of host cell recognition of Cryptococcus neoformans, an opportunistic fungal pathogen in immunocompromised patients, remains poorly understood. In the present study, we asked whether the DNA of this yeast activates mouse bone marrow-derived myeloid dendritic cells (BM-DCs). BM-DCs released IL-12p40 and expressed CD40 upon stimulation with cryptococcal DNA, and the response was abolished by treatment with DNase, but not with RNase. IL-12p40 production and CD40 expression were attenuated by chloroquine, bafilomycin A, and inhibitory oligodeoxynucleotides (ODN) that suppressed the responses caused by CpG-ODN. Activation of BM-DCs by cryptococcal DNA was almost completely abrogated in TLR9 gene-disrupted (TLR9(-/-)) mice and MyD88(-/-) mice, similar to that by CpG-ODN. In addition, upon stimulation with whole yeast cells of acapsular C. neoformans, TLR9(-/-) BM-DCs produced a lower amount of IL-12p40 than those from wild-type mice, and TLR9(-/-) mice were more susceptible to pulmonary infection with this fungal pathogen than wild-type mice, as shown by increased number of live colonies in lungs. Treatment of cryptococcal DNA with methylase resulted in reduced IL-12p40 synthesis by BM-DCs. Furthermore, using a luciferase reporter assay, cryptococcal DNA activated NF-kappaB in HEK293 cells transfected with the TLR9 gene. Finally, confocal microscopy showed colocalization of fluorescence-labeled cryptococcal DNA with CpG-ODN and the findings merged in part with the distribution of TLR9 in BM-DCs. Our results demonstrate that cryptococcal DNA causes activation of BM-DCs in a TLR9-dependent manner and suggest that the CpG motif-containing DNA may contribute to the development of inflammatory responses after infection with C. neoformans.

Validation of low-temperature steam with formaldehyde sterilization for endoscopes, using validation device.

BACKGROUND: Validation of sterilization is an important step before clinical use of medical equipment. Adequate validation of sterilization of the endoscope has not been reported. One reason for this is the lack of suitable devices for validation. METHODS: The VDES (validation device for endoscope sterilization; Olympus prototype model, Olympus, Tokyo, Japan) was designed in two types (type A and type B) and resembles gastroscopes and duodenoscopes, respectively. Each type consists of inner and outer tubing and a central capsule containing a biological indicator. The device was designed to examine the effectiveness of low-temperature sterilizers, such as ethylene oxide gas, hydrogen peroxide gas plasma, and low-temperature steam with formaldehyde (LTSF) sterilizer. The aim of this study was to validate the sterilization of GI endoscopes by the LTSF sterilizer. Sterilization was assessed using both types of VDES after a 60-min application of LTSF. RESULTS: Culture of the biological indicator confirmed the complete eradication of the bacteria in a total of 10 experiments with each type of VDES after LTSF sterilization. CONCLUSIONS: Our results confirm that the LTSF sterilizer may sterilize endoscopes currently distributed by Olympus. Commercialization of VDES will make it possible to evaluate the reliability of sterilization when it is set in the sterilization device with endoscopes.

Evaluation of the BD Phoenix SMIC/ID, a new streptococci identification and antimicrobial susceptibility panel, for potential routine use in a university-based clinical microbiology laboratory.

We evaluated the new BD Phoenix automated microbiology system (Becton Dickinson Diagnostic Systems, Sparks, MD) SMIC/ID-4 panel for routine identification (ID) and antimicrobial susceptibility testing (AST) of streptococci in a university-based laboratory. Clinical isolates of Streptococcus pneumoniae (n = 92), Streptococcus pyogenes (n = 24), and Streptococcus agalactiae (n = 10) were collected, and comparisons were made with the routine manual methods used in our microbiology laboratory for ID and susceptibility testing. ID concordance with manual methods was 85.9%, 95.8%, and 90.0% for S. pneumoniae, S. pyogenes, and S. agalactiae, respectively. With respect to AST concordance for S. pneumoniae and beta-hemolytic streptococci (S. pyogenes and S. agalactiae) using Phoenix and standard broth microdilution panels, overall essential agreement was 93.0% and 97.5%, respectively, whereas overall category agreement was 92.4% and 98.9%, respectively. Major and minor error rates for S. pneumoniae and beta-hemolytic streptococci were 0.5% and 0.3%, and 7.1% and 0.8%, respectively. Very major errors were not observed in this study. Mean time for ID and AST test completion was 13.6 +/- 1.6, 10.7 +/- 2.4, and 11.2 +/- 2.3 h for S. pneumoniae, S. pyogenes, and S. agalactiae, respectively. We have demonstrated that Phoenix ID results show high agreement with manual ID and that AST performance was equivalent to standard broth microdilution in less time.

Assessment of RAISUS, a novel system for identification and antimicrobial susceptibility testing for enterococci.

RAISUS, a system developed by Nissui Pharmaceutical (Tokyo, Japan), is a novel fully automated system for rapid identification and antimicrobial susceptibility testing. The aim of this study was to compare RAISUS with VITEK systems and microdilution tests based on the National Committee for Clinical Laboratory Standards, with regard to the identification and susceptibility of 64 enterococci. The agreement rate between RAISUS and VITEK was 98.4% (63/64) for bacterial identification. One strain was identified as E. faecalis by RAISUS, but as E. faecium by VITEK. Regarding susceptibility tests, the range of essential agreement and agreement in clinical categories for RAISUS and VITEK ranged from 70.3% to 95.3% and from 68.8% to 96.9%, respectively. Results of antimicrobial susceptibility testing for vancomycin (VAN) showed very major, major, and minor errors in 0%, 3.1% (2/64), and 0%, respectively. RAISUS could provide reports of detection of VAN-resistant enterococci (VRE) within 5 h by using fluorogenic substances and redox. In conclusion, RAISUS could be useful in a clinical setting because it allows rapid identification of enterococci and the potential ability to detect VRE more promptly than the VITEK system.

[Roles of Department of Clinical Laboratory in infection control].

The Department of Clinical Laboratory plays an important role in the hospital and has much information about patients and pathogens. Laboratory data are essential to support clinical physicians who diagnose and treat patients. For nosocomial infections, laboratory-based surveillance is recognized as essential to confirm outbreaks. Therefore, the role of the Department of Clinical Laboratory is very important in infection control. In Tohoku University Hospital, we have an Infection Control Unit located in the Department of Clinical Laboratory. The core role of the Infection Control Unit is diagnosis, treatment and preventative healthcare associated with infections. The Infection Control Team (ICT) performs rounds in the hospital (The ICT members are ICN, ICD, a microbiological technologist and a dietician), consultations about clinical cases, infection control, and organize the regional infection control network, "Miyagi Infection Control Network". The ICT rounds are performed once a week in two wards, and two times a year for one ward. The consultations are an important role of the ICD, and concern clinical infection cases and infection control in our hospital and the other regional hospitals, and produce advice on appropriate clinical information. The regional network is important for the collection of information about the pathogens and the susceptibility of antimicrobial agents in the region. "Miyagi Infection Control Network" has held a forum 5 times a year from 1999, and 300-400 healthcare workers join the forum and discuss infection control.