噬菌体治疗肺炎克雷伯菌感染的研究进展

随着细菌的进化以及部分抗生素的滥用，耐药细菌的感染已成为21世纪主要的公共卫生挑战之一。其中，耐药肺炎克雷伯菌(Klebsiella pneumoniae)问题尤为突出。噬菌体在治疗耐药细菌感染引起的疾病方面展现出一定的潜力及独特优势，但目前噬菌体治疗尚缺乏统一的临床指导规范。虽然临床上有少数将噬菌体用于治疗肺炎克雷伯菌感染的成功案例，但多数情况下是采用噬菌体配合抗生素疗法，噬菌体在其中的作用仍不明确。本文综合评述国内外研究数据，回顾与噬菌体治疗肺炎克雷伯菌感染相关的数个重点问题，包括噬菌体的特性以及影响其疗效的因素，旨在为肺炎克雷伯菌和其他耐药细菌的噬菌体治疗提供参考。     

肺炎克雷伯菌噬菌体解聚酶的研究进展

肺炎克雷伯菌（Klebsiella pneumoniae）是在临床引起多种感染的常见条件致病菌之一。多重耐药肺炎克雷伯菌株的出现,给防控细菌感染带来了巨大阻力。肺炎克雷伯菌噬菌体编码的解聚酶是一种稳定性高、特异性强的生物酶,具有分解细菌胞外多糖、限制细菌生长等多种功能。解聚酶可为防控肺炎克雷伯菌感染提供新思路,在抗菌应用中具有广阔前景。本文就肺炎克雷伯菌噬菌体解聚酶的研究进展进行综述。     

一株肺炎克雷伯菌噬菌体的生物学特性及全基因组分析

【背景】随着抗生素的广泛使用甚至滥用,细菌耐药性问题日益显著,利用噬菌体治疗耐药致病菌的方法重新开始被人们关注。【目的】对一株烈性肺炎克雷伯菌噬菌体vB_KpnP_IME279进行生物学特性研究及生物信息学分析。【方法】以一株多重耐药的肺炎克雷伯菌为宿主菌,从医院污水中分离噬菌体,应用双层平板法检测噬菌体效价、最佳感染复数(Optimal MOI)、一步生长曲线以及裂解谱,纯化后通过透射电镜观察噬菌体形态;应用蛋白酶K/SDS法提取噬菌体全基因组,使用Illumina MiSeq测序平台进行噬菌体全基因组测序,测序后对噬菌体全基因组序列进行组装、注释、进化和比较基因组学分析。【结果】分离到一株新的肺炎克雷伯菌噬菌体,命名为vB_KpnP_IME279;其最佳感染复数为0.1,一步生长曲线显示潜伏期为20 min,平均裂解量140 PFU/cell,电镜观察显示该噬菌体属于短尾噬菌体科(Podoviridae)。基因组测序表明,噬菌体基因组全长为42 518 bp,(G+C)mol%含量为59.3%。BLASTn比对结果表明,该噬菌体与目前已知噬菌体的相似性较低,基因组仅70%区域与已知噬菌体有同源性。构建噬菌体主要衣壳蛋白的基因进化树,分析了噬菌体IME279与其他短尾科噬菌体的进化关系,结果表明该噬菌体是短尾科噬菌体的一名新成员。【结论】分离鉴定了一株新的肺炎克雷伯菌噬菌体,进行了生物学特性、全基因组测序和生物信息学分析,为研究肺炎克雷伯菌噬菌体与宿主之间的相互作用关系以及治疗多重耐药细菌感染奠定了基础。     

一株新型裂解K63荚膜型肺炎克雷伯菌的噬菌体分离鉴定和生物学特性研究及全基因组分析

[背景]噬菌体具有特定的杀菌能力,对生态和细菌的进化具有重要影响。近年来由于多重耐药细菌的全球出现,噬菌体疗法逐渐引起了人们的关注。[目的]对一株新型裂解K63荚膜型肺炎克雷伯菌的噬菌体vB_KpnP_IME308进行生物学特性研究、测序和比较基因组学的分析。[方法]以一株从临床分离到的肺炎克雷伯菌为宿主菌分离噬菌体,应用双层平板法进行噬菌体最佳感染复数(optimal multiplicity of infection)、一步生长曲线(one-step growth curve)、温度以及pH敏感性实验测定,纯化噬菌体并通过透射电镜观察噬菌体形态;应用标准的苯酚-氯仿提取方案提取噬菌体全基因组,使用Illumina MiSeq测序平台进行噬菌体全基因组测序,测序后对噬菌体全基因组序列进行组装、注释、进化和比较基因组学分析。[结果]分离到一株新型的肺炎克雷伯菌噬菌体,命名为vB_KpnP_IME308;其最佳感染复数为0.001,一步生长曲线结果显示,其感染宿主菌的潜伏期约为20 min,裂解期约为80 min,平均裂解量330PFU/cell;噬菌体vB_KpnP_IME308在4-50℃和pH 5.0-10.0范围内稳定;电镜观察该噬菌体属于短尾噬菌体科(Podoviridae)。基因组测序结果表明,噬菌体基因组全长为43 091bp,(G+C)mol%含量为53.9%,(A+T)mol%含量为46.1%。BLASTn比对结果表明,该噬菌体与目前已知噬菌体基因组仅84%区域有相似性。噬菌体进化树结果表明该噬菌体属于Autographivirinae亚科的Drulisvirus属的成员。[结论]从医院污水中分离鉴定了一株新型的肺炎克雷伯菌噬菌体,表征并分析了噬菌体全基因组序列,这些结果均表明该噬菌体具有开发为抗肺炎克雷伯菌制剂的潜力,为噬菌体治疗多重耐药细菌感染奠定了基础。     

多重耐药肺炎克雷伯菌噬菌体KP002的生物学特性及基因组学研究

以上海某些医院临床分离到的多重耐药肺炎克雷伯菌为宿主菌,从不同环境的污水中分离获得1株肺炎克雷伯菌噬菌体KP002。电子显微镜显示其为有尾噬菌体,头部直径约70nm,尾长约80nm,尾宽约20nm。对其生物学特性进行研究,结果显示此株噬菌体在pH 3~9及4~50℃的环境中具有较高活性;6min吸附率达95%以上;潜伏期为10min,爆发期为50min;裂解量为172pfu/cell。结果表明,该噬菌体对pH值和温度适应范围较宽。对其全基因组进行测序分析,结果显示其基因组为环状双链DNA,全长47 173bp,GC含量为48%。本研究筛选获得1株对pH值和温度适应范围较宽的耐药肺炎克雷伯菌烈性噬菌体KP002,为建立耐药肺炎克雷伯菌的噬菌体库以用于治疗临床多重耐药菌感染提供了新的思路。     

基于基因组学的肺炎克雷伯菌噬菌体安全性评估

泛耐药肺炎克雷伯菌的流行,使得临床面临无药可用,越来越多的肺炎克雷伯菌噬菌体近年来被报道,并在动物模型中证明了它们用于防控细菌感染的有效性。然而,噬菌体作为病毒的一类,不同于传统的抗菌药物,在临床应用之前需要进行更为全面的评估,本研究将基于基因组学对已报道的肺炎克雷伯菌噬菌体安全性进行评估。通过生物信息学分析噬菌体基因组上是否含有肺炎克雷伯菌限制性内切酶识别位点来评估其基因组稳定性,并就其是否携带有害基因和是否属于溶原性噬菌体等方面进行分析研究。目前已报道22株肺炎克雷伯菌噬菌体的全基因组,7株属于肌尾科,12株属于短尾科,3株属于长尾科;而本研究基于噬菌体全基因组同源性分析结果将短尾科、长尾科和肌尾科中的JD001归为一类,定义为Kp_PhageⅠ;肌尾科分为Kp_phageⅡa和Kp_PhageⅡb两类。噬菌体基因组上含有数目不等的肺炎克雷伯菌限制性内切酶识别位点,不携带有毒力基因和耐药基因。5株属于温和噬菌体,17株属于烈性噬菌体。研究显示肺炎克雷伯菌噬菌体在基因组水平具有良好的安全性,但是基因组上较多的肺炎克雷伯菌限制性内切酶识别位点,使其抗菌谱可能较窄。在使用噬菌体用于防控细菌感染时部分温和噬菌体需要谨慎排除。     

肺炎克雷伯菌基因组可移动遗传元件的研究进展

肺炎克雷伯菌是目前临床上最主要的耐药致病菌之一,对人类健康造成了很大威胁。近年来,细菌耐药成为治疗肺炎克雷伯菌感染的主要难题,尤其是高毒力、高耐药性肺炎克雷伯菌的出现对临床工作造成了巨大挑战,而研究表明其耐药基因和毒力基因主要由可移动遗传元件携带而传播。因此,为了更好地认识及防控肺炎克雷伯菌感染,本文对肺炎克雷伯菌基因组中几种常见可移动元件(包括质粒、前噬菌体、插入序列等)及其与肺炎克雷伯菌耐药性和致病性之间的关系进行了综述,并阐述了其在耐药基因和毒力基因传播过程中的作用机制。     

超广谱β-内酰胺酶肺炎克雷伯菌噬菌体F20的分离鉴定及其对小鼠败血症治疗效果

【背景】肺炎克雷伯菌是引起临床感染的重要条件致病菌之一,肺炎克雷伯菌中产超广谱β-内酰胺酶(Extended-spectrum beta-lactamases,ESBLs)的耐药菌株增多迫切需要找到一种新的治疗方法。【目的】自污水中分离超广谱β-内酰胺酶肺炎克雷伯菌噬菌体,并明确其生物学特性、观察其治疗小鼠产ESBLs肺炎克雷伯菌感染的疗效。【方法】电镜观察F20形态,调查其噬菌谱、生长曲线等生物学特性。建立小鼠败血症感染模型观察F20治疗小鼠肺炎克雷伯菌感染的疗效。【结果】F20在其宿主菌的菌苔上形成裂解性噬菌体所具有的完全透明的噬菌斑,电镜观察F20具典型的有尾噬菌体目长尾病毒科病毒的形态特征。一步生长曲线显示F20的潜伏期为18 min,裂解量为89 PFU/细胞。稳定性试验显示F20在pH 5.0-9.0及50°C环境均具良好稳定性。使用噬菌体F20对败血症小鼠治疗后,治疗组小鼠各外周血和各脏器(肺脏、肝脏、脾脏和肾脏)中的细菌数也显著小于对照组细菌数(P0.001),与对照组相比下降大约1–3数量级。F20治疗败血症小鼠存活率达到87.5%,无毒副作用,而对照组小鼠在1 d内全部死亡,可显著提高小鼠的存活率(P0.001)。【结论】新分离的裂解性噬菌体F20在小鼠体内能安全有效地治疗超广谱β-内酰胺酶肺炎克雷伯菌引起的败血症,可作为生物抗菌剂的有效成分。     

噬菌体治疗研究进展

噬菌体发现之初, 便被前苏联和东欧医学界用来治疗细菌感染。但是, 随着抗生素时代的到来, 人们慢慢忽略了对噬菌体的深入研究。近来, 由于全球耐药菌感染率不断攀升, 用抗生素治疗细菌感染面临了前所未有的挑战, 一些科学家和临床工作者开始重新把注意力集中到噬菌体研究上来, 并在这个领域取得了极大的进展, 尤其是通过大量的实验证明: 噬菌体可以有效地提高细菌感染的实验动物的存活率。本文就近几年国内外的科研工作者在噬菌体治疗领域所取得的进展做一综述。     

噬菌体治疗细菌性感染的进展

噬菌体是自然界中广泛存在的细菌病毒,作为细菌的天然杀手,在细菌性感染尤其是多重耐药菌感染的治疗方面具有抗生素无法比拟的优势。综述了利用活噬菌体治疗细菌性感染的早期研究及近几年的初步临床试验结果、利用噬菌体裂解酶治疗细菌性感染的最新进展,指出了噬菌体治疗真正得以应用所面临的主要障碍并综述分析了一些具有一定可行性的解决方案,以期为噬菌体治疗的研究和应用提供参考,并推动噬菌体治疗研究的进一步发展。     

Structural changes induced by a lytic bacteriophage make ciprofloxacin effective against older biofilm of Klebsiella pneumoniae

Bacteria have evolved multiple mechanisms, such as biofilm formation, to thwart antibiotic action. Yet antibiotics remain the drug of choice against clinical infections. It has been documented that young biofilm of Klebsiella pneumoniae could be eradicated significantly by ciprofloxacin treatment alone. Since age of biofilm is a decisive factor in determining the outcome of antibiotic treatment, in the present study biofilm of K. pneumoniae, grown for extended periods was treated with ciprofloxacin and/or depolymerase producing lytic bacteriophage (KPO1K2). The reduction in bacterial numbers of older biofilm was greater after application of the two agents in combination as ciprofloxacin alone could not reduce bacterial biomass significantly in older biofilms (P > 0.05). Confocal microscopy suggested the induction of structural changes in the biofilm matrix and a decrease in micro-colony size after KPO1K2 treatment. The role of phage associated depolymerase was emphasized by the insignificant eradication of biofilm by a non-depolymerase producing bacteriophage that, however, eradicated the biofilm when applied concomitantly with purified depolymerase. These findings demonstrate that a lytic bacteriophage alone can eradicate older biofilms significantly and its action is primarily depolymerase mediated. However, application of phage and antibiotic in combination resulted in slightly increased biofilm eradication confirming the speculation that antibiotic efficacy can be augmented by bacteriophage.     

一株新型牛源肺炎克雷伯菌噬菌体的分离鉴定

【背景】肺炎克雷伯菌(Klebsiella pneumoniae)是一种广泛分布于环境中的重要致病菌,该菌较高的耐药性致其在养殖业中治疗较为困难。【目的】分离一株裂解性肺炎克雷伯菌噬菌体,对分离株进行生物学特性鉴定和基因组学分析。【方法】使用双层平板法从四川省某奶牛场中分离、纯化出一株裂解性噬菌体,测定其裂解谱、热稳定性、酸碱耐受度、最佳感染复数及一步生长曲线等生物学特性,并进行全基因组的测序及注释分析。【结果】得到一株裂解性肺炎克雷伯菌噬菌体vB_Kpn_B01,该噬菌体拥有透明且无晕环的噬菌斑,热稳定性较高,在极酸或极碱环境下不进行裂解活动,特异性较强,属长尾噬菌体科(Siphoviridae)。vB_Kpn_B01全基因组大小为113 227 bp,GC含量为47.97%。注释结果显示噬菌体拥有149个编码序列和25个tRNAs,不含耐药基因及毒力基因。通过噬菌体的进化树分析发现,该噬菌体为Sugarlandvirus。【结论】vB_Kpn_B01拥有高效的生长特性和对不利环境的低耐受性,拥有裂解宿主菌的必备基因,并不含耐药基因及毒力基因,具有应用于畜牧业中防治多重耐药细菌的潜力。     

A scaled-down model for the translation of bacteriophage culture to manufacturing scale

Therapeutic bacteriophages are emerging as a potential alternative to antibiotics and synergistic treatment of antimicrobial-resistant infections. This is reflected by their use in an increasing number of recent clinical trials. Many more therapeutic bacteriophage is being investigated in preclinical research and due to the bespoke nature of these products with respect to their limited infection spectrum, translation to the clinic requires combined understanding of the biology underpinning the bioprocess and how this can be optimized and streamlined for efficient methods of scalable manufacture. Bacteriophage research is currently limited to laboratory scale studies ranging from 1–20 ml, emerging therapies include bacteriophage cocktails to increase the spectrum of infectivity and require multiple large-scale bioreactors (up to 50 L) containing different bacteriophage–bacterial host reactions. Scaling bioprocesses from the milliliter scale to multi-liter large-scale bioreactors is challenging in itself, but performing this for individual phage-host bioprocesses to facilitate reliable and robust manufacture of phage cocktails increases the complexity. This study used a full factorial design of experiments approach to explore key process input variables (temperature, time of infection, multiplicity of infection, agitation) for their influence on key process outputs (bacteriophage yield, infection kinetics) for two bacteriophage–bacterial host bioprocesses (T4 – Escherichia coli; Phage K – Staphylococcus aureus). The research aimed to determine common input variables that positively influence output yield and found that the temperature at the point of infection had the greatest influence on bacteriophage yield for both bioprocesses. The study also aimed to develop a scaled down shake-flask model to enable rapid optimization of bacteriophage batch bioprocessing and translate the bioprocess into a scale-up model with a 3 L working volume in stirred tank bioreactors. The optimization performed in the shake flask model achieved a 550-fold increase in bacteriophage yield and these improvements successfully translated to the large-scale cultures.     

细菌与噬菌体相互抵抗机制研究进展

噬菌体作为一种侵染细菌的病毒,能够特异性识别宿主细菌。近年来,抗生素的过度使用导致耐药细菌的出现,噬菌体有望成为对抗耐药细菌的新武器。在细菌与噬菌体长期共进化过程中,二者都演化出一系列抵御策略。本文从抑制噬菌体吸附、阻止噬菌体DNA进入、切割噬菌体基因组、流产感染以及群体感应对噬菌体的调控等方面,对细菌抵抗噬菌体的机制以及噬菌体应对细菌的策略进行了综述,同时还列举了细菌和噬菌体相互抵抗机制的检测方法,以期为噬菌体在细菌控制中的应用以及探究细菌抵抗噬菌体的机制提供理论依据。     

Analysis of Structure and Function of Putative Surface-Exposed Proteins Encoded in the Streptococcus pneumoniae Genome: A Bioinformatics-Based Approach to Vaccine and Drug Design

Streptococcus pneumoniae is the most common cause of fatal community-acquired pneumonia, middle ear infection, and meningitis. The prevention and treatment of this infection have become a top priority for the medical-scientific community. The present polysaccharide-based vaccine used to immunize susceptible hosts is only ～60% effective and is ineffective in children younger than 2 years of age. The new conjugate vaccine, based on the engineered diphtheria toxin coupled to polysaccharide antigens, is approved only for use in children under 2 years of age to treat invasive disease. While penicillin is the drug of choice to treat infections secondary to S. pneumoniae, increasing numbers of bacterial strains are resistant to penicillin as well as to broad spectrum antibiotics such as vancomycin. Thus, there is a need to identify new strategies to prevent and treat diseases caused by to S. pneumoniae.

In this article, we summarize the utilization of the recently available S. pneumoniae genomic information in order to identify and characterize novel proteins likely located on the surface of this Gram-positive pathogenic bacterium. Because only a limited number of surface proteins of S. pneumoniae have been characterized to date, this information provides new insights into the pathogenesis of this organism as well as highlights possible avenues for its treatment and/or prevention in the future. The review is divided into two sections.

First, we briefly summarize current information about known surface-exposed proteins of S. pneumoniae. This is followed by the illustration of procedures for the identification of new putative surface-exposed proteins. These have signal peptides required for their extra-cytoplasmic transport and/or additional signature sequences. Some of these will be S. pneumoniae virulence factors. The signature sequences we have chosen are those leading to protein binding to choline present on the bacterial surface, attachment to peptidoglycan of the cell wall, or anchoring to lipids of the cytoplasmic membrane. All these signatures are indicative of binding of proteins to the surface of this organism.

Secondly, we illustrate the application of bioinformatics and modeling tools to these selected proteins in order to provide information about their likely functions and preliminary three-dimensional structure models. The focal point of the analysis of these proteins, their sequences, and structures is the evaluation of their antigenic properties and possible roles in pathogenicity. The information obtained from the genome analysis will be instrumental in the development of a more effective prophylactic and/or therapeutic agents to prevent and to treat infections due to S. pneumoniae.     

Bacteriophages and bacteriophage‐derived endolysins as potential therapeutics to combat Gram‐positive spore forming bacteria

Since their discovery in 1915, bacteriophages have been routinely used within Eastern Europe to treat a variety of bacterial infections. Although initially ignored by the West due to the success of antibiotics, increasing levels and diversity of antibiotic resistance is driving a renaissance for bacteriophage‐derived therapy, which is in part due to the highly specific nature of bacteriophages as well as their relative abundance. This review focuses on the bacteriophages and derived lysins of relevant Gram‐positive spore formers within the Bacillus cereus group and Clostridium genus that could have applications within the medical, food and environmental sectors.     

一株金黄色葡萄球菌噬菌体的裂解谱特异性和分子分类研究

[目的] 从医院污水中分离金黄色葡萄球菌噬菌体,观察其形态,确证裂解谱特征并研究生物学和基因学特性,为噬菌体的临床应用奠定实验基础。[方法] 将金黄色葡萄球菌ATCC25923作为宿主菌,采用双层琼脂平板法从医院污水中分离纯化噬菌体,电镜下观察形态并测定其最佳感染复数、一步生长曲线及裂解谱;全基因组测序并进行基因结构分析和功能注释。[结果] 从4份医院污水中共分离到1株金黄色葡萄球菌噬菌体（命名为vB_SauH_SAP1）,仅裂解10株临床分离的葡萄球菌属受试菌（共计37株）,其余74株其他种属菌株不能被裂解;透射电镜观察具有正20面体头部和收缩性尾部,属于肌尾噬菌体;其最佳感染复数为0.1,潜伏期10 min,裂解期为20 min。vB_SauH_SAP1基因组全长143375 bp,G+C含量为30.2%,编码226个开放阅读框（ORF）,未发现已知的毒力相关基因和抗生素抗性基因,基因组与Kayvirus属葡萄球菌噬菌体有较高的同源性。[结论] 分离到1株新的Kayvirus属金黄色葡萄球菌噬菌体,根据生物学特性和基因组研究,具有一定的潜在应用价值。     

M13 Virus based detection of bacterial infections in living hosts

We report a first method for using M13 bacteriophage as a multifunctional scaffold for optically imaging bacterial infections in vivo. We demonstrate that M13 virus conjugated with hundreds of dye molecules (M13‐Dye) can target and distinguish pathogenic infections of F‐ pili expressing and F ‐negative strains of E. coli. Further, in order to tune this M13‐Dye complex suitable for targeting other strains of bacteria, we have used a 1‐step reaction for creating an anti‐bacterial antibody ‐M13‐Dye probe. As an example, we show anti‐S. aureus ‐M13‐Dye able to target and image infections of S. aureus in living hosts, with a 3.7× increase in fluorescence over background. (© 2014 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)