Unexpected persistence of extended-spectrum ß-lactamase-producing Enterobacteriaceae in the faecal microbiota of hospitalised patients treated with imipenem.

Imipenem is active against extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) but favours the intestinal emergence of resistance. The effects of imipenem on intestinal microbiota have been studied using culture-based techniques. In this study, the effects were investigated in patients using culture and metagenomic techniques. Seventeen hospitalised adults receiving imipenem were included in a multicentre study (NCT01703299, http://www.clinicaltrials.gov). Most patients had a history of antibiotic use and/or hospitalisation. Stools were collected before, during and after imipenem treatment. Bacterial and fungal colonisation was assessed by culture, and microbiota changes were assessed using metagenomics. Unexpectedly, high colonisation rates by imipenem-susceptible ESBL-E before treatment (70.6%) remained stable over time, suggesting that imipenem intestinal concentrations were very low. Carriage rates of carbapenem-resistant Gram-negative bacilli (0-25.0%) were also stable over time, whereas those of yeasts (64.7% before treatment) peaked at 76.5% during treatment and decreased thereafter. However, these trends were not statistically significant. Yeasts included highly diverse colonising Candida spp. Metagenomics showed no global effect of imipenem on the bacterial taxonomic profiles at the sequencing depth used but demonstrated specific changes in the microbiota not detected with culture, attributed to factors other than imipenem, including sampling site or treatment with other antibiotics. In conclusion, culture and metagenomics were highly complementary in characterising the faecal microbiota of patients. The changes observed during imipenem treatment were unexpectedly limited, possibly because the microbiota was already disturbed by previous antibiotic exposure or hospitalisation.

Human immunodeficiency virus type 1 entry into murine cell lines and lymphocytes from transgenic mice expressing a glycoprotein 120-binding mutant mouse CD4.

Human CD4, the receptor for the gp120 envelope glycoprotein of HIV-1, is the route for viral entry into CD4+ cells; other cellular factors may cooperate with CD4 to facilitate HIV-1 entry into human cells. Human CD4 expressed on murine cells does not readily mediate HIV-1 entry, which may reflect a functional incompatibility of human CD4 with murine cellular components. We postulated that a HIV-1 gp120-binding mutant murine CD4 (L3T4) possessing a minimal number of human amino acid residues could facilitate HIV-1 entry into rodent cells, unlike human CD4. This hypothesis led us to develop a series of murine L3T4 mutants that bear human CD4 gp120-binding region amino acid residues while retaining most L3T4 epitopes. HeLa cell transfectants expressing gp120-binding mutant L3T4 proteins could be infected with HIV-1. Three mouse cell lines expressing these L3T4 mutant proteins could also be infected with HIV-1 as determined by PCR techniques that detect viral DNA and spliced RNAs. Lectin-stimulated polymorphonuclear leukocytes from transgenic mice (SBL mouse) expressing a gp120-binding L3T4 mutant protein were infected with HIV-1 at the same frequency as lectin-stimulated human peripheral blood lymphocytes as determined by in situ PCR analyses. Supernatant p24gag and reverse transcriptase levels in HIV-infected mouse cell cultures, however, were routinely at background levels, unlike HIV-infected human cell cultures. Thus, gp120-binding mutant L3T4 proteins mediate viral entry in all mouse cells that were tested, but high-level viral replication is absent in these cells.

Rapamycin treatment depresses intragraft expression of KC/MIP-2, granzyme B, and IFN-gamma in rat recipients of cardiac allografts.

Rapamycin (RPM) treatment prevents accelerated rejection of cardiac allografts in sensitized rats. The prominent feature of this brisk 24-h rejection, which includes a panoply of both cellular and humoral host immune responses, is a massive infiltration of rejecting grafts with neutrophils. In this study we tested the hypothesis that RPM-mediated therapeutic effects on accelerated rejection may be linked to decreased expression of protein encoded by gro/melanoma-growth stimulatory activity gene (KC) and macrophage inflammatory protein-2 (MIP-2) genes, the operational rat homologues of the human intercrine-alpha cytokines with proinflammatory IL-8-like neutrophil activation/chemotactic properties. The induction of these genes was then correlated with mRNA profiles encoding for Th1-selective IFN-gamma and CTL-specific granzyme B proteins. Northern blot analysis of RNA from cardiac allografts of sensitized untreated recipients, revealed maximal levels of KC and MIP-2 mRNA at 3 to 6 h after transplantation. In contrast, IFN-gamma mRNA, which was at most very weakly expressed at 3 h, peaked between 6 to 12 h. As with IFN-gamma, granzyme B transcripts were undetectable at 3 h, but peaked around the time of actual graft rejection at 24 h. RPM therapy abrogated accelerated rejection and prolonged cardiac allograft survival to ca. 46 days. This effect was associated with markedly reduced expression of KC and MIP-2 mRNA in the first 24 h as well as at 7 and 34 days after transplantation. Moreover, RPM completely blocked intragraft appearance of granzyme B and IFN-gamma mRNA in long term cardiac allografts. Immunohistologic analysis has revealed that accelerated rejection was associated with extensive neutrophil infiltration, which peaked at 18 to 24 h. At this time, leukocytes and endothelium were intensely stained for IL-8 and IFN-gamma antibodies. In contrast, the allografts from RPM-treated hosts showed essentially no neutrophil infiltration and minor, focal staining for IL-8 and IFN-gamma. This study demonstrates an association between the early expression of genes for proinflammatory IL-8-dependent neutrophil chemotactic activity, and later expression of genes associated with activation/effector activity of CTL and NK cells. It also documents a novel effect of RPM in vivo, which results in the suppression of intragraft IL-8-like and CTL-dependent mRNA/protein production and diminished neutrophil infiltration; these may contribute to the striking efficacy of RPM therapy in sensitized graft recipients.

Chemical identification of a prostaglandin-induced T suppressor (PITS).

Prostaglandin E1 is known to block the activation and function of immunocompetent cells. Previous studies from this laboratory have established that one pathway where prostaglandin E1 acts involves the stimulation of a glass-wool adherent T-suppressor cell. Prostaglandin stimulates this suppressor cell to release a suppressor lymphokine(s), termed the prostaglandin-induced T cell-derived suppressor (PITS). We report here the further characterization of this factor using high-pressure liquid chromatographic analyses, precursor labeling studies, and bioanalysis, all of which indicate that this factor contains a leukotriene.