Assessment of the hypothetical protein BB0616 in the murine infection of Borrelia burgdorferi.

bb0616 of Borrelia burgdorferi, the Lyme disease pathogen, encodes a hypothetical protein of unknown function. In this study, we showed that BB0616 was not surface-exposed or associated with the membrane through localization analyses using proteinase K digestion and cell partitioning assays. The expression of bb0616 was influenced by a reduced pH but not by growth phases, elevated temperatures, or carbon sources during in vitro cultivation. A transcriptional start site for bb0616 was identified by using 5' rapid amplification of cDNA ends, which led to the identification of a functional promoter in the 5' regulatory region upstream of bb0616. By analyzing a bb0616-deficient mutant and its isogenic complemented counterparts, we found that the infectivity potential of the mutant was significantly attenuated. The inactivation of bb0616 displayed no effect on borrelial growth in the medium or resistance to oxidative stress, but the mutant was significantly more susceptible to osmotic stress. In addition, the production of global virulence regulators such as BosR and RpoS as well as virulence-associated outer surface lipoproteins OspC and DbpA was reduced in the mutant. These phenotypes were fully restored when gene mutation was complemented with a wild-type copy of bb0616. Based on these findings, we concluded that the hypothetical protein BB0616 is required for the optimal infectivity of B. burgdorferi, potentially by impacting B. burgdorferi virulence gene expression as well as survival of the spirochete under stressful conditions.

Role of the Hypothetical Protein BB0563 during Borrelia burgdorferi Infection in Animals.

The alternative sigma factor RpoS in Borrelia burgdorferi, the etiological agent of Lyme disease, has long been postulated to regulate virulence-associated genes other than ospC and dbpA. Here, we demonstrate that bb0563, a gene encoding a hypothetical protein, is regulated by RpoS and contributes to the optimal infectivity of B. burgdorferi. When B. burgdorferi was exposed to environmental stimuli, bb0563 showed similar expression patterns as rpoS, ospC, and dbpA. Expression of bb0563 was significantly downregulated when rpoS was inactivated and was restored in the complemented strain. By using rapid amplification of cDNA ends (RACE) and luciferase reporter assays, a functional promoter was identified in the regulatory region upstream of bb0563. Gene expression from this promoter was drastically decreased in the rpoS mutant. We next investigated the role of bb0563 during animal infection. By using quantitative reverse transcription-PCR (RT-PCR), we found that bb0563 was highly expressed in mouse tissues during infection. We further created a bb0563-deficient mutant in a bioluminescent B. burgdorferi strain and examined infection dynamics using in vivo imaging. Relative to the parental and complemented strains, the mutant showed a delayed infection pattern and bacterial load was reduced. Another bb0563 deletion mutant was also created in the strain 297 background, and quantitative PCR (qPCR) analysis revealed a significantly lower spirochetal burden in tissue samples collected from animals infected with the mutant. In addition, localization studies indicate that BB0563 is not exposed on the cell surface but is associated with outer membrane. Taken together, these results suggest that bb0563 is required for optimal infectivity of B. burgdorferi during experimental infection.

BB0761, a MepM homolog, contributes to Borrelia burgdorferi cell division and mammalian infectivity.

M23 family endopeptidases play important roles in cell division and separation in a wide variety of bacteria. Recent studies have suggested that these proteins also contribute to bacterial virulence. However, the biological function of M23 peptidases in pathogenic spirochetes remains unexplored. Here, we describe Borrelia burgdorferi, the bacterial pathogen causing Lyme disease, requires a putative M23 family homolog, BB0761, for spirochete morphology and cell division. Indeed, the inactivation of bb0761 led to an aberrant filamentous phenotype as well as the impairment of B. burgdorferi growth in vitro. These phenotypes were complemented not only with B. burgdorferi bb0761, but also with the mepM gene from E. coli. Moreover, the bb0761 mutant showed a complete loss of infectivity in a murine model of Lyme borreliosis. Resistance of the mutant to osmotic and oxidative stresses was markedly reduced. Our combined results indicate that BB0761 contributes to B. burgdorferi cell division and virulence.

What Is in a Cat Scratch? Growth of Bartonella henselae in a Biofilm.

Bartonella henselae (B. henselae) is a gram-negative bacterium that causes cat scratch disease, bacteremia, and endocarditis, as well as other clinical presentations. B. henselae has been shown to form a biofilm in vitro that likely plays a role in the establishment and persistence of the bacterium in the host. Biofilms are also known to form in the cat flea vector; hence, the ability of this bacterium to form a biofilm has broad biological significance. The release of B. henselae from a biofilm niche appears to be important in disease persistence and relapse in the vertebrate host but also in transmission by the cat flea vector. It has been shown that the BadA adhesin of B. henselae is critical for adherence and biofilm formation. Thus, the upregulation of badA is important in initiating biofilm formation, and down-regulation is important in the release of the bacterium from the biofilm. We summarize the current knowledge of biofilm formation in Bartonella species and the role of BadA in biofilm formation. We discuss the evidence that defines possible mechanisms for the regulation of the genes required for biofilm formation. We further describe the regulation of those genes in the conditions that mimic both the arthropod vector and the mammalian host for B. henselae. The treatment for persistent B. henselae infection remains a challenge; hence, a better understanding of the mechanisms by which this bacterium persists in its host is critical to inform future efforts to develop drugs to treat such infections.

A non-coding RNA controls transcription of a gene encoding a DNA binding protein that modulates biofilm development in Bartonella henselae.

Bartonella henselae (Bh) is a Gram-negative zoonotic bacterium that can grow as large aggregates and form biofilms in vitro dependent upon the adhesin BadA. Previously, we reported that the Houston-1 strain of Bh has a family of nine small, highly-expressed intergenic transcripts called Bartonellaregulatory transcripts, Brt1-9. Each of the Brts bears a stem and loop structure on the 3' end followed by a gene encoding a DNA binding protein called the Transcriptional regulatory proteins, Trp1-9. RNA-seq analysis of laboratory-grown bacteria revealed the trps were poorly transcribed suggesting that the 3' stem and loop on the Brts results in transcript termination upstream of the trp genes under these conditions. Here we demonstrate that transcription of brt1 continues into trp1 when Bh is grown in a biofilm. Deletion of brt1, or just the 3' terminus of brt1 (containing the stem and loop structure), resulted in increased transcription of both trp1 and badA and increased biofilm formation. Trp1 was shown to directly bind the putative badA promoter region as demonstrated by an electrophoretic mobility shift assay (EMSA). Our data suggest that the 3' end of brt1 responds to a stimulus generated by growth of Bh in an in vitro biofilm to allow increased trp1 transcription. We further show that transcription of trp1 increases under conditions consistent with the mammalian host but is not highly expressed in the cat flea vector until the bacterium is excreted into the flea feces. Based on these data, we hypothesize that the 3' end of Brt1 functions to control trp1 transcription and Trp1 in turn results in increased badA expression and enhanced biofilm formation.

Sustainability in medicine.

Given the current state of the U.S. healthcare system, with increasingly complicated regulations and paperwork and decreasing reimbursements, the question arises: Is it possible to provide safe, high-quality healthcare and reduce costs? Furthermore, is it possible to care for the health of your patients while simultaneously caring for the financial health of your practice and promoting improvement in the overall health of the planet? This article will review some steps currently being taken by various companies and hopefully stimulate ideas for changes you may want to consider for your own practice, hospital, or institution.

Value-based purchasing and the doctor-patient relationship.

The Value-Based Purchasing (VBP) program was established by the Secretary of Health and Human Services, in accordance with mandates under the Patient Protection and Affordable Care Act of 2010. Under the VBP program, the Centers for Medicare & Medicaid Services will decrease payments for certain Diagnosis Related Group (DRG) payments. Of the approximately 3100 acute care hospitals affected by the reductions, which hospitals will be able to recoup some of the losses and which ones will be forfeiting the total amount will be decided by predetermined performance measures. Seventy percent of the VBP Total Performance Score (TPS) will involve the Process of Core Measures, which include quality measures of treatment of acute myocardial infarction, heart failure, pneumonia, healthcare-associated infections, and surgical care improvement. The remaining 30% of the TPS will be determined by patient satisfaction. Hospitals will be graded according to points awarded for quality achievement, improvement from baseline, and consistency.