A SERS-based multiple immuno-nanoprobe for ultrasensitive detection of neomycin and quinolone antibiotics via a lateral flow assay.

The authors describe an ultrasensitive method for simultaneous detection of neomycin (NEO) and quinolones antibiotics (QNS). It is based on the use of (a) two immuno-nanoprobes (a probe for NEO and a probe for QNS), (b) surface-enhanced Raman scattering (SERS) detection, and (c), a portable lateral flow assay (LFA). The two probes consist of gold nanoparticles (AuNPs) conjugated to the Raman active molecule 4-aminothiophenol (PATP), and to monoclonal antibody against NEO (NEO mAb) or against NOR (NOR mAb). Quantitative detection of NEO and QNS was realized via SERS of the PATP-coated AuNPs captured in the test line of a LFA. Under optimized condition, the visual limits of LFA are 10 ng·mL-1 for NEO and 200 ng·mL-1 for NOR, and with LODs down to 0.37 pg·mL-1 and 0.55 pg·mL-1 by using SERS. The NEO test line is not interfered by the NEO analogues gentamycin, streptomycin and tobramycin, but the NOR test line suffers from different degrees of cross-reactivity (CR) to 12 common other QNS, the CRs ranging from 1.5% to 136%. The recoveries of NEO and NOR from spiked milk samples ranged between 86% and 121%, with relative standard deviations (RSD) from 3% to 6%. The method is highly sensitive, accurate and effective. It may be applied to simultaneous detection of NEO and 8 QNS, including NOR, enoxacin, ciprofloxacin, ofloxacin, fleroxacin, marbofloxacin, enrofloxacin, and pefloxacin. Graphical abstract Schematic of a lateral flow assay (LFA) based on an indirect competitive model. By using two test lines, the LFA can detect the neomycin and quinolones antibiotics simultaneously. Based on the surface-enhanced Raman scattering (SERS), the LFA shows high sensitivity to antibiotics with low limit of detection.

Update on Quinolone Allergy.

PURPOSE OF REVIEW: Quinolones are a group of synthetic antibiotics widely use as first-line treatment for many infections. There has been an increase in the incidence of hypersensitivity reactions to quinolones in recent years, likely due to increased prescription. The purpose of this review is to summarize the clinical pictures, the methods used for diagnosing and the management of allergic reactions to quinolones. RECENT FINDINGS: Allergic reactions to quinolones can be immediate or delayed, being anaphylaxis and maculopapular exanthema respectively the most frequent clinical entities. A precise diagnosis is particularly difficult since clinical history is often unreliable, skin tests can induce false-positive results, and commercial in vitro test are not well validated. Therefore, drug provocation testing is considered the gold standard to establish diagnosis, which is not a risk-free procedure. Cross-reactivity between quinolones is difficult to predict due to the small number of patients included in the few published studies. Moreover, hypersensitivity to quinolones has also been associated with beta-lactam and neuromuscular blocking agent allergies, although further studies are needed to understand the underlying mechanisms. Avoidance of the culprit quinolone is indicated in patients with a diagnosis of hypersensitivity to these drugs. When quinolone treatment is the only therapeutic option available, desensitization is necessary. This review summarizes the complex diagnostic approach and management of allergic reactions to quinolones.

Four Specific Hapten Conformations Dominating Antibody Specificity: Quantitative Structure-Activity Relationship Analysis for Quinolone Immunoassay.

Antibody-based immunoassay methods have been important tools for monitoring drug residues in animal foods. However, because of limited knowledge about the quantitative structure-activity relationships between a hapten and its resultant antibody specificity, antibody production with the desired specificity is still a huge challenge. In this study, the three-dimensional quantitative structure-activity relationship (3D QSAR) was analyzed in accordance with the cross-reactivity of quinolone drugs reacting with the antibody raised by pipemidic acid as the immunizing hapten and compared with the reported cross-reactivity data and their hapten structures. It was found that the specificity of a quinolone antibody was strongly related to the conformation of the hapten used and that hapten conformations shaped like the letters "I", "P", and "Φ" were essential for the desired high specificity with low cross-reactivity, but that the hapten conformation shaped like the letter "Y" led to an antibody with broad specificity and high cross-reactivity. Almost all of the antibodies against quinolones could result from these four hapten conformations. It was first found that the concrete conformations dominated the specificity of the antibody to quinolone, which will be of significance for the accurate hapten design, predictable antibody specificity, and better understanding the recognition mechanism between haptens and the antibodies for immunoassays.

Macrolide and quinolone-resistant Mycoplasma genitalium in a man with persistent urethritis: the tip of the British iceberg?

There is growing concern worldwide for macrolide resistance in M. genitalium following liberal use of 1 g azithromycin to treat non-gonococcal urethritis and confirmed C. trachomatis infection. Moxifloxacin is the second-line treatment for M. genitalium and still has excellent efficacy against it. However, recent reports indicating that quinolone resistance is more prevalent than previously thought are worrying. Routine testing of symptomatic men and women for M. genitalium is not currently recommended in BASHH guidelines, and attempts to implement such testing have been hampered by a lack of commercially available assays. We present a case of M. genitalium urethritis which failed to respond to four different antibiotic regimens, resulting in multiple visits to the clinic and anxiety for the patient.

Hypersensitivity reactions to non-betalactam antibiotics in children: an extensive review.

In contrast to hypersensitivity reactions (HSRs) to ß-lactam antibiotics in children, studies about HSR to non-ß-lactam antibiotics (NBLAs) such as sulfonamides, macrolides, quinolones, and antituberculosis agents are scarce, and information is generally limited to case reports. The aim of this extensive review was to summarize our present knowledge on clinical characteristics, evaluation, and management of HSR to NBLAs in children based on the literature published between 1980 and 2013. NBLAs have been reported to induce a wide spectrum of HSRs from mild eruptions to severe, and sometimes fatal, systemic drug reactions, especially in some high-risk groups. The diagnosis relied upon history and remained unconfirmed by allergological tests in most of the cases. Obtaining a detailed history is valuable in the diagnosis of suspected reactions to NBLAs. Diagnostic in vivo and in vitro tests for NBLAs lack validation, which makes the diagnosis challenging. The definitive diagnosis of NBLA hypersensitivity frequently depends upon drug provocation tests. Studies including children showed that only 7.8 to 36% of suspected immediate and delayed HSRs to NBLAs could be confirmed by skin and/or provocation tests. Therefore, a standardized diagnostic approach and management strategy should be developed and employed for pediatric patients in the evaluation of suspected HSRs to NBLAs, some of which may be critical and unreplaceable in certain clinical situations.

The Pseudomonas quinolone signal (PQS) stimulates chemotaxis of polymorphonuclear neutrophils.

Cross-talk between bacteria and mammalian cells is increasingly recognized as an important factor, especially during chronic infections. In particular, the interaction of extracellular bacterial signaling molecules with cells of the innate immune response is of special interest. In this context, we investigated whether the Pseudomonas quinolone signal (PQS) which is a quorum sensing molecule produced by bacteria and participates in biofilm formation and virulence has any influence on polymorphonuclear neutrophils (PMN), the cells of the "first line defense" against bacterial infections. We found that PQS did not enhance the bactericidal activity of PMN and did not induce apoptosis at concentrations up to 100 µM. However, PQS stimulated chemotaxis of PMN in doses of 10-100 µM. This PQS-dependent chemotaxis could be inhibited with SB203580 which blocks MAPkinase p38, suggesting a signaling pathway similar to AHL-12 induction. Using bacterial cell culture supernantants of Pseudomonas aeruginosa wild-type cells and a PQS-deficient mutant strain support the in vivo relevance of these findings. Since PQS is produced in the early phase of biofilm formation, PMN infiltration could be timely enough to eradicate bacteria before biofilm formation is completed, which confers the bacteria with a relative resistance to host defense mechanisms.

Rebamipide attenuates autoimmune arthritis severity in SKG mice via regulation of B cell and antibody production.

Oxidative stress is involved in the pathophysiology of rheumatoid arthritis (RA). We investigated the therapeutic potential of rebamipide, a gastroprotective agent with a property of reactive oxygen species scavenger, on the development of inflammatory polyarthritis and the pathophysiological mechanisms by which rebamipide might confer anti-arthritic effects in SKG mice, an animal model of RA. Intraperitoneal (i.p.) injection of rebamipide attenuated the severity of clinical and histological arthritis. Rebampide treatment reduced the number of T helper type 1 (Th1), Th2, Th17, inducible T cell co-stimulator (ICOS)(+) follicular helper T (Tfh) transitional type (T2) and mature B cells in the spleen, but increased the number of regulatory T (Treg ), CD19(+) CD1d(high) CD5(high) , CD19(+) CD25(high) forkhead box protein 3 (FoxP3)(+) regulatory B (Breg ) cells, memory B cells, and transitional type 1 (T1) B cells. In addition, flow cytometric analysis revealed significantly decreased populations of FAS(+) GL-7(+) germinal centre B cells and B220(-) CD138(+) plasma cells in the spleens of rebamipide-treated SKG mice compared to controls. Rebamipide decreased germinal centre B cells and reciprocally induced Breg cells in a dose-dependent manner in vitro. Rebamipide-induced Breg cells had more suppressive capacity in relation to T cell proliferation and also inhibited Th17 differentiation from murine CD4(+) T cells. Together, these data show that i.p. administration of rebamipide suppresses arthritis severity by inducing Breg and Treg cells and suppressing Tfh and Th17 cells in a murine model of RA.

Immediate allergic hypersensitivity to quinolones associates with neuromuscular blocking agent sensitization.

BACKGROUND: We identified a case of quinolone allergic hypersensitivity associated with quaternary ammonium (QA) sensitization, the allergic determinant of neuromuscular blocking agents (NMBAs). Concomitant sensitization to several chemically different drugs is rarely reported and raises the question of a nonfortuitous association. OBJECTIVE: We evaluated a potential association between quinolone immediate allergic hypersensitivity and NMBA sensitization. METHODS: QA-specific IgE detection was prospectively performed in 26 patients who presented an immediate hypersensitivity reaction to quinolones: 17 with a confirmed allergic hypersensitivity and 9 with allergic hypersensitivity not confirmed. We also included a control population of 88 outpatients without a history of quinolone or NMBA hypersensitivity. Patients with positive QA-specific IgE benefited from a NMBA allergologic workup. RESULTS: The prevalence of positive QA-specific IgE was significantly higher in patients with quinolone allergic hypersensitivity (9/17, 53%) compared with patients with allergic hypersensitivity not confirmed (1/9, 11%) than in controls (3/88, 3.4%). In the quinolone allergic population, ofloxacin elicited inhibition of the 4 positive QA-specific IgE sera tested, in a dose-response manner. Among the 9 patients with positive QA-specific IgE, the QA sensitization (positivity of specific IgE) was confirmed by positive skin tests and/or basophil activation tests to at least 1 NMBA in 5 of the 7 tested patients. CONCLUSION: We report here the first documentation of a high prevalence of QA sensitization in patients with quinolone allergic hypersensitivity. These results suggest a new way for NMBA sensitization. It thus seems appropriate to investigate NMBA sensitization when quinolone allergic hypersensitivity is diagnosed.

Laquinimod in multiple sclerosis.

Laquinimod is a novel, orally administered immune-modulatory molecule in advanced phase clinical trials in relapsing-remitting multiple sclerosis. Experimental evidence to date, derived mostly from animal models of multiple sclerosis, suggests that laquinimod may mediate its effects via modulating pro-inflammatory immune responses and interfering with cell trafficking, as well as potentially acting directly in the central nervous system to limit demyelination and axonal injury. The clinical trial results to date have established efficacy on imaging markers of disease activity and have shown a favorable safety and tolerability profile. If phase III studies confirm clinical efficacy and safety, laquinimod would represent a welcome new option in the treatment of multiple sclerosis.

Hypersensitivity reactions to quinolones.

PURPOSE OF REVIEW: The purpose of this review is to examine in detail the new advances in the pathomechanisms and diagnosis of immediate and nonimmediate hypersensitivity reactions to quinolones, as well as analyze cross-reactivity among different quinolones. RECENT FINDINGS: Hypersensitivity reactions to quinolones, especially anaphylactic reactions, have become more common in the past decade. This phenomenon could be related to their increased consumption. Although attempts have been made to standardize skin testing, the diagnosis of immediate hypersensitivity reactions to quinolones is mainly based on drug provocation. Some in-vitro, radioimmunoassay and basophil activation tests have also been used for diagnostic purposes, with results indicating that they could be complementary to in-vivo tests. Cross-reactivity seems to exist between first and second-generation quinolones, with lower levels with the third and fourth generations. However, no general rules exist for predicting cross-reactivity and it needs to be analyzed patient by patient. Nonimmediate hypersensitivity reactions also exist, especially maculopapular exanthema and fixed drug eruptions, and a T-cell mechanism has been demonstrated. SUMMARY: Over the past decade the number of hypersensitivity reactions to quinolones has increased. These reactions can be severe and diagnosis difficult to confirm. Although new in-vitro tests hold promise, drug provocation testing remains the most frequently used and reliable diagnostic method.

In vitro evaluation of IgE-mediated hypersensitivity reactions to quinolones.

BACKGROUND: Hypersensitivity IgE-mediated reactions to quinolones are not easy to diagnose, with skin testing inducing false positive results. The aim of the study was to evaluate the in vitro-specific IgE response in patients with immediate allergic reactions to quinolones. METHODS: We evaluated 38 patients with confirmed immediate allergic reactions to quinolones. Those with anaphylaxis were considered allergic by clinical history, once other possible causes were ruled out, and those with urticaria by drug provocation. Sepharose-radioimmunoassay (RIA) and basophil activation test (BAT) with ciprofloxacin, moxifloxacin and levofloxacin were performed. RESULTS: The quinolones involved were moxifloxacin (N = 24), ciprofloxacin (N = 11) and levofloxacin (N = 3). Sepharose-RIA was positive in 12 cases (31.57%) and BAT in 27 (71.05%). With Sepharose-RIA, 8 (21%) were positive to ciprofloxacin, 7 (18.4%) to moxifloxacin and 7 (18.4%) to levofloxacin. With BAT, 23 (60.5%) were positive to ciprofloxacin, 12 (31.6%) to moxifloxacin and 8 (21%) to levofloxacin. The specificity of the Sepharose-RIA was demonstrated by inhibition tests. To confirm that the BAT results observed were IgE mediated, the PI3K inhibitor wortmannin was used, with this compound inhibiting the BAT when stimulated with anti-IgE and the different quinolones, but not when fMLP was used as the basophil stimulator. Sepharose-RIA and BAT were repeated in positive cases 1 year later, detecting a decrease in all cases, with four becoming negative. CONCLUSION: Immediate hypersensitivity reactions to quinolones do occur, with moxifloxacin being the drug most frequently involved. The BAT is a useful method for diagnosing patients. Specific IgE was demonstrated by Sepharose-RIA and inhibition assay.

Broad-specific antibodies for a generic immunoassay of quinolone: development of a molecular model for selection of haptens based on molecular field-overlapping.

A new molecular model for quinolone haptens was developed based on molecular field-overlapping. The quanlitive modeling of 3-D conformations showed that the conformation difference among quinolones is caused mainly by the different substitutes at the 1 and 7 positions. The 8-substitute also showed some effect by its inter-reaction with the 1-substitute. The conformational similarity of 27 quinolones to each other was for the first time calculated and exploited for a selection of haptens according to desired broad specificity of corresponding antibodies. The developed model was preliminarily validated with antibodies against different quinolones. A significant positive correlation (R = 0.7793) was observed between calculated overlapping coefficients of haptens and the cross-reactivity of corresponding polyclonal antibodies (Pabs), which confirmed the overall accuracy of the developed model and its application in quantitative structure-activity relationship analysis. On the basis of molecular modeling results, the strategy for the production of broad specific antibodies against quinolones was suggested and the potentiality of several candidates was predicted.

Pseudomonas aeruginosa quorum-sensing signal molecules interfere with dendritic cell-induced T-cell proliferation.

Pseudomonas aeruginosa releases a wide array of toxins and tissue-degrading enzymes. Production of these malicious virulence factors is controlled by interbacterial communication in a process known as quorum sensing. An increasing body of evidence reveals that the bacterial signal molecule N-(3-oxododecanoyl)-L-homoserine lactone (OdDHL) exhibits both quorum-sensing signalling and immune-modulating properties. Recently, yet another quorum-sensing signal molecule, the Pseudomonas quinolone signal (PQS), has been shown to affect cytokine release by mitogen-stimulated human T cells. In the present article we demonstrate that both OdDHL and PQS decrease the production of interleukin-12 (IL-12) by Escherichia coli lipopolysaccharide-stimulated bone marrow-derived dendritic cells (BM-DCs) without altering their IL-10 release. Moreover, BM-DCs exposed to PQS and OdDHL during antigen stimulation exhibit a decreased ability to induce T-cell proliferation in vitro. Collectively, this suggests that OdDHL and PQS change the maturation pattern of stimulated DCs away from a proinflammatory T-helper type I directing response, thereby decreasing the antibacterial activity of the adaptive immune defence. OdDHL and PQS thus seem to possess dual activities in the infection process: as inducers of virulence factors as well as immune-modulators facilitating the infective properties of this pathogen.

Development of an immunoaffinity column method using broad-specificity monoclonal antibodies for simultaneous extraction and cleanup of quinolone and sulfonamide antibiotics in animal muscle tissues.

This paper describes a novel mixed-bed immunoaffinity column (IAC) method. The IAC was produced by coupling anti-quinolone and anti-sulfonamide broad-specificity monoclonal antibodies to Sepharose 4B for simultaneously isolating 13 quinolones (QNs) and 6 sulfonamides (SAs) from swine and chicken muscle tissues, followed by antibiotic determination using liquid chromatography-tandem mass spectrometry (LC-MS/MS). A new broad-specificity Mab (B1A4E8) toward sulfonamides was produced using sulfamethoxazole as hapten that demonstrated cross-reactivities to 6 SAs in the range of 31-112%. IAC optimized conditions were found that allowed the IAC to be reused for selective binding of both SAs and QNs. Recoveries of all 19 antibiotics from animal muscle ranged from 72.6 to 107.6%, with RSDs below 11.3% and 15.4% for intra-day and inter-day experiments, respectively. The limit of quantification ranged from 0.5 to 3.0ng/g. The strategy used here for a mixed-bed IAC may be used to study other compounds and more than two classes of analytes simultaneously.

Reduced frequency of atopic dermatitis in quinoline-allergic patients: the 'hapten-atopy hypothesis'.

BACKGROUND: While allergy to food proteins is almost exclusively found in association with atopy, it has been our experience that contact allergy to some contact allergens/haptens with both cutaneous and gastrointestinal exposures is reduced in atopic dermatitis (AD) patients as a group. OBJECTIVE: To assess the contact allergy rates of two classes of antimicrobial haptens, one with both cutaneous and gastrointestinal exposures (quinolines) and one with only significant cutaneous exposure (aminoglycosides), with respect to the presence or absence of AD. METHODS: Contact allergy rates to neomycin (aminoglycoside) and quinoline mix/clioquinol in patients attending the St John's Institute of Dermatology for diagnostic patch testing were retrospectively analysed; current AD and history of AD were noted. RESULTS: In comparison to neomycin-allergic subjects, there was a highly significant negative association between quinoline contact allergy and current presence of AD (P = 0.0028); negative association between quinoline contact allergy and a history of AD did not reach significance (P = 0.07). CONCLUSIONS: In comparison to an antimicrobial with no significant gastrointestinal exposure (neomycin), contact allergy to quinolines is negatively associated with the presence of AD. This is in contrast to food protein allergy, which is strongly associated with atopy. Possible explanations could include (i) confounding factors or (ii) AD patients are efficient at orally tolerizing haptens and inefficient at orally tolerizing proteins, secondary to their atopic status or (iii) oral tolerance of haptens antagonizes tolerance of food proteins and also leads to an immunological shift towards atopy (hapten-atopy hypothesis).

Detection of specific IgE to quinolones.

BACKGROUND: In the last years, immediate reactions to quinolone antibiotics have been observed with increasing frequency, mainly urticaria, angioedema, and shock. No test was available because of the high incidence of false-positive results on skin tests. Thus the pathogenesis, value of diagnostic procedures, and cross-reactivity have not been evaluated in a systematic way. OBJECTIVE: We sought to assess whether these reactions are IgE mediated and whether an in vitro test for quinolone-specific IgE is useful in the diagnosis and understanding of cross-reactivity. METHODS: We assayed specific serum IgE to quinolones using epoxy-activated sepharose 6B as the solid phase in 55 patients with immediate adverse reactions; specificity of IgE binding was demonstrated by inhibition tests. RESULTS: The test yielded positive results in 30 (54.5%) patients who were tested 1 to 48 months after the reaction had occurred. The quinolone-specific IgE seems to disappear more slowly in atopic patients. The cross-reactivity between various quinolones allowed us to identify a common structural motif within quinolones that might be responsible for clinical and serologic cross-reactivity. CONCLUSION: A substantial portion of immediate reactions to quinolones appear to be IgE mediated. Cross-reactivity of IgE among different quinolones is frequent and suggests that a common avoidance of quinolones should be attempted in all patients with respective symptoms.