Neutrophil Extracellular Traps are Involved in the Innate Immune Response to Infection with Leptospira

NETosis is a process by which neutrophils extrude their DNA together with bactericidal proteins that trap and/or kill pathogens. In the present study, we evaluated the ability of Leptospira spp. to induce NETosis using human ex vivo and murine in vivo models. Microscopy and fluorometric studies showed that incubation of human neutrophils with Leptospira interrogans serovar Copenhageni strain Fiocruz L1-130 (LIC) resulted in the release of DNA extracellular traps (NETs). The bacteria number, pathogenicity and viability were relevant factors for induction of NETs, but bacteria motility was not. Entrapment of LIC in the NETs resulted in LIC death; however, pathogenic but not saprophytic Leptospira sp. exerted nuclease activity and degraded DNA. Mice infected with LIC showed circulating NETs after 2 days post-infection (dpi). Depletion of neutrophils with mAb1A8 significantly reduced the amount of intravascular NETs in LIC-infected mice, increasing bacteremia at 3 dpi. Although there was a low bacterial burden, scarce neutrophils and an absence of inflammation in the early stages of infection in the kidney and liver, at the beginning of the leptospiruric phase, the bacterial burden was significantly higher in kidneys of neutrophil-depleted-mice compared to non-depleted and infected mice. Surprisingly, interstitial nephritis was of similar intensity in both groups of infected mice. Taken together, these data suggest that LIC triggers NETs, and that the intravascular formation of these DNA traps appears to be critical not only to prevent early leptospiral dissemination but also to preclude further bacterial burden.     

CXC chemokine receptor-2 ligands are required for neutrophil-mediated host defense in experimental brain abscesses

We have developed a mouse brain abscess model by using Staphylococcus aureus, one of the main etiologic agents of brain abscesses in humans. Direct damage to the blood-brain barrier was observed from 24 h to 7 days after S. aureus exposure as demonstrated by the accumulation of serum IgG in the brain parenchyma. Evaluation of brain abscesses by immunohistochemistry and flow cytometry revealed a prominent neutrophil infiltrate. To address the importance of neutrophils in the early containment of S. aureus infection in the brain, mice were transiently depleted of neutrophils before implantation of bacteria-laden beads. Neutrophil-depleted animals consistently demonstrated more severe brain abscesses and higher CNS bacterial burdens compared with control animals. S. aureus led to the induction of numerous chemokines in the brain, including macrophage-inflammatory protein (MIP)-1alpha/CCL3, MIP-1beta/CCL4, MIP-2/CXCL1, monocyte chemoattractant protein-1/CCL2, and TCA-3/CCL1, within 6 h after bacterial exposure. These chemokines also were expressed by both primary cultures of neonatal mouse microglia and astrocytes exposed to heat-inactivated S. aureus in vitro. Because neutrophils constitute the majority of the cellular infiltrate in early brain abscess development, subsequent analysis focused on MIP-2 and KC/CXCL1, two neutrophil-attracting CXC chemokines. Both MIP-2 and KC protein levels were significantly elevated in the brain after S. aureus exposure. Neutrophil extravasation into the brain parenchyma was impaired in CXCR2 knockout mice and was associated with increased bacterial burdens. These studies demonstrate the importance of the CXCR2 ligands MIP-2 and KC and neutrophils in the acute host response to S. aureus in the brain.     

Angiotensin-converting enzyme overexpression in mouse myelomonocytic cells augments resistance to Listeria and methicillin-resistant Staphylococcus aureus

Gene targeting in ES cells was used to substitute control of angiotensin converting enzyme (ACE) expression from the endogenous promoter to the mouse c-fms promoter. The result is an animal model called ACE 10/10 in which ACE is overexpressed by monocytes, macrophages, and other myelomonocytic lineage cells. To study the immune response of these mice to bacterial infection, we challenged them with Listeria monocytogenes or methicillin-resistant Staphylococcus aureus (MRSA). ACE 10/10 mice have a significantly enhanced immune response to both bacteria in vivo and in vitro. For example, 5 days after Listeria infection, the spleen and liver of ACE 10/10 mice had 8.0- and 5.2-fold less bacteria than wild type mice (WT). In a model of MRSA skin infection, ACE 10/10 mice had 50-fold less bacteria than WT mice. Histologic examination showed a prominent infiltrate of ACE-positive mononuclear cells in the skin lesions from ACE 10/10. Increased bacterial resistance in ACE 10/10 is directly due to overexpression of ACE, as it is eliminated by an ACE inhibitor. Critical to increased immunity in ACE 10/10 is the overexpression of iNOS and reactive nitrogen intermediates, as inhibition of iNOS by the inhibitor 1400W eliminated all in vitro and in vivo differences in innate bacterial resistance between ACE 10/10 and WT mice. Increased resistance to MRSA was transferable by bone marrow transplantation. The overexpression of ACE and iNOS by myelomonocytic cells substantially boosts innate immunity and may represent a new means to address serious bacterial infections.     

耐甲氧西林金黄色葡萄球菌皮肤脓肿小鼠感染模型的建立与评估

目的建立耐甲氧西林金黄葡萄球菌（methicillin-resistant Staphylococcus aureus,MRSA）小鼠皮肤脓肿感染模型,观察脓肿形成动态变化及药物对脓肿愈合的影响。方法 45只SPF级裸鼠随机分为PBS对照组、感染组及给药组,用临床分离鉴定的ST-239型MRSA菌株皮下注射感染裸鼠,对脓肿的形成过程进行时相性观察,测定脓肿体积的变化,并通过H.E染色观察皮肤的组织病理学改变。结果 PBS处理组小鼠皮肤无脓肿形成,显微镜下皮肤各层结构清楚;感染组和给药组可见到典型的脓肿,临床症状的时相性过程明显,感染组小鼠皮肤真皮层的胶原纤维消失,可见大量炎性细胞浸润,给药组小鼠的脓肿体积在整个实验周期内低于感染组,且在第5天时与感染组相比有差异。结论成功建立MRSA小鼠皮肤脓肿感染模型,该模型的建立可为进一步研究来源于临床MRSA菌株的病原特性、发病机制、治疗方法等提供可靠的动物模型。     

Involvement of the platelet-activating factor receptor in host defense against Streptococcus pneumoniae during postinfluenza pneumonia

Although influenza infection alone may lead to pneumonia, secondary bacterial infections are a much more common cause of pneumonia. Streptococcus pneumoniae is the most frequently isolated causative pathogen during postinfluenza pneumonia. Considering that S. pneumoniae utilizes the platelet-activating factor receptor (PAFR) to invade the respiratory epithelium and that the PAFR is upregulated during viral infection, we here used PAFR gene-deficient (PAFR-/-) mice to determine the role of this receptor during postinfluenza pneumococcal pneumonia. Viral clearance was similar in wild-type and PAFR-/- mice, and influenza virus was completely removed from the lungs at the time mice were inoculated with S. pneumoniae (day 14 after influenza infection). PAFR-/- mice displayed a significantly reduced bacterial outgrowth in their lungs, a diminished dissemination of the infection, and a prolonged survival. Pulmonary levels of IL-10 and KC were significantly lower in PAFR-/- mice, whereas IL-6 and TNF-alpha were only trendwise lower. These data indicate that the pneumococcus uses the PAFR leading to severe pneumonia in a host previously exposed to influenza A.     

深圳市人民医院近五年临床分离金黄色葡萄球菌的分布及耐药性分析

目的 分析医院感染患者金黄色葡萄球菌的临床分布特征及耐药性变化,为临床治疗金黄色葡萄球菌感染提供依据。方法 回顾性分析2012年1月至2016年12月我院从临床各类标本中分离获得的1 141株金黄色葡萄球菌,统计其在各类标本和病区中的分布特点,并用Ｋ-Ｂ法测定该菌对常用抗菌药物的敏感性。结果 5年中共分离出1 141株金黄色葡萄球菌,标本来源构成比最多的是伤口分泌物（43.3%）、呼吸道标本（24.0%）和血液标本（10.2%）。耐甲氧西林金黄色葡萄球菌（MRSA）共有339株,占29.7%。各年MRSA的检出数依次为53株（31.9%）、51株（26.0%）、82株（35.2%）、81株（30.3%）和72株（26.0%）。MRSA主要分离自神经外科（13.8%）、呼吸监护室（10.6%）、重症监护室（8.8%）和骨科（7.7%）。MRSA对抗菌药物的耐药性普遍高于MSSA,二者比较差异有统计学意义（P＜0.05）。未发现对万古霉素、利奈唑胺、替考拉宁耐药的金黄色葡萄球菌。结论 MRSA感染多发生于长期使用抗菌药物,有皮肤软组织伤口及侵入性操作的科室及患者。MRSA具有多重耐药性,应严格掌握抗菌药物的使用适应证;同时临床治疗应根据药物敏感性报告针对性地合理用药,以便及时有效地控制感染并防止耐药菌株的扩散。     

Increasing the recruitment of neutrophils to the site of infection dramatically attenuates Borrelia burgdorferi infectivity

Borrelia burgdorferi infection causes an initial skin lesion called erythema migrans (EM) in human Lyme disease and in models of monkey and rabbit borreliosis. EM results from the inflammatory response triggered by spirochete replication and likely develops to contain the initial infection but allows bacterial dissemination to occur. The essential lack of neutrophil involvement in EM histopathology prompted us to examine the consequence of increasing their recruitment in the inflammatory response to the Lyme disease agent. B. burgdorferi was modified genetically to constitutively express and secrete the chemokine KC, a neutrophil chemoattractant. After inoculation into the dermis of the murine host, control spirochetes induced an infiltration of macrophages, neutrophils, and basophils within 6 h; however, the recruited neutrophils and basophils were quickly substituted by eosinophils, and the inflammatory response became macrophage dominant by 16 h. Such a response failed to contain the initial infection and allowed the spirochetes to disseminate. In contrast, B. burgdorferi with KC secretion induced an intensive neutrophil infiltration at the inoculation site, and as a result, the host's ability to control the initial infection was greatly enhanced. Taken together, this study suggests that the failure of sufficient neutrophil recruitment and activation during the initial inflammatory response may allow B. burgdorferi to effectively colonize the mammalian host.     

The antibacterial activity of plaunotol against Staphylococcus aureus isolated from the skin of patients with atopic dermatitis.

Plaunotol was tested for possible antibacterial activity against twenty strains of methicillin-resistant Staphylococcus aureus (MRSA) and fourteen strains of methicillin-sensitive S. aureus (MSSA) which had been isolated from the skin of patients with atopic dermatitis under growth-promoting conditions. Plaunotol was effective against all strains tested. The dose of plaunotol for 50% inhibition of growth (ID50) ranged from 2.5 to 16 micrograms/ml for strains of MRSA and from 2.5 to 7.0 micrograms/ml for those of MSSA. These results suggest that plaunotol may be useful in the prevention of infection by MRSA and in skin care for patients with atopic dermatitis.     

Host chemokines bind to Staphylococcus aureus and stimulate protein A release

There are few examples of host signals that are beneficial to bacteria during infection. Here we found that 31 out of 42 host immunoregulatory chemokines were able to induce release of the virulence factor protein A (SPA) from a strain of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Detailed study of chemokine CXCL9 revealed that SPA release occurred through a post-translational mechanism and was inversely proportional to bacterial density. CXCL9 bound specifically to the cell membrane of CA-MRSA, and the related SPA-releasing chemokine CXCL10 bound to both cell wall and cell membrane. Clinical samples from patients infected with S. aureus and samples from a mouse model of CA-MRSA skin abscess all contained extracellular SPA. Further, SPA-releasing chemokines were present in mouse skin lesions infected with CA-MRSA. Our data identify a potential new mode of immune evasion, in which the pathogen exploits a host defense factor to release a virulence factor; moreover, chemokine binding may serve a scavenging function in immune evasion by S. aureus.     

A CD-1 mouse model of infection with Staphylococcus aureus: influence of gender on infection with MRSA and MSSA isolates

Staphylococcus aureus is an important pathogen of humans and other animals, causing bacteremia, abscessation, toxemia, and other infectious diseases. An animal model using CD-1 mice was developed to study the pathogenesis of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). When inoculated into the CD-1 mouse model, it was shown that both MSSA isolates, (HR 78 and CSA-1) and MRSA isolates (MRSA 456 and MRSA 457) led to chronic infection of the kidney. Female CD-1 mice inoculated with MRSA 456 proved to be more susceptible to infection and mortality than their male counterparts. Castrated mice became more susceptible to infection than intact male mice, suggesting a hormonal involvement in the infection process.     

MRSA气溶胶诱导烫伤SKH-1无毛小鼠皮肤感染合并肺炎模型

目的探讨烫伤条件下,建立MRSA气溶胶致SKH-1无毛小鼠皮肤感染合并肺炎模型的方法及其评价指标。方法 48只SKH-1无毛小鼠,随机分成PBS对照组,单纯感染组和烫伤合并感染组。合并感染组小鼠皮肤烫伤后,MRSA（ST-239）气溶胶呼吸道感染,采用体重、血常规、菌血症率、皮肤和脏器荷菌量、病理组织学变化和分子生物学等指标对模型进行综合评价。结果与其他两组相比,合并感染组小鼠第3天体重下降明显;白细胞数显著增多;菌血症率达100%;皮肤和肺荷菌量较高,分别达108CFU/g和106CFU/g;镜下观察皮肤和肺炎症病变明显;免疫组化结果显示皮肤组织内CD138呈阳性表达;multi-PCR测定感染组织内nuc和mecA基因均为阳性。结论 SKH-1无毛小鼠烫伤再辅以MRSA气雾攻击的方式,可成功建立能够模拟临床上烧烫伤患者继发MRSA肺炎的动物模型,此模型对于抗MRSA药物药效评价研究具有重要临床应用价值。     

Dissemination of a Highly Virulent Pathogen: Tracking The Early Events That Define Infection

The series of events that occurs immediately after pathogen entrance into the body is largely speculative. Key aspects of these events are pathogen dissemination and pathogen interactions with the immune response as the invader moves into deeper tissues. We sought to define major events that occur early during infection of a highly virulent pathogen. To this end, we tracked early dissemination of Yersinia pestis, a highly pathogenic bacterium that causes bubonic plague in mammals. Specifically, we addressed two fundamental questions: (1) do the bacteria encounter barriers in disseminating to draining lymph nodes (LN), and (2) what mechanism does this nonmotile bacterium use to reach the LN compartment, as the prevailing model predicts trafficking in association with host cells. Infection was followed through microscopy imaging in addition to assessing bacterial population dynamics during dissemination from the skin. We found and characterized an unexpected bottleneck that severely restricts bacterial dissemination to LNs. The bacteria that do not pass through this bottleneck are confined to the skin, where large numbers of neutrophils arrive and efficiently control bacterial proliferation. Notably, bottleneck formation is route dependent, as it is abrogated after subcutaneous inoculation. Using a combination of approaches, including microscopy imaging, we tested the prevailing model of bacterial dissemination from the skin into LNs and found no evidence of involvement of migrating phagocytes in dissemination. Thus, early stages of infection are defined by a bottleneck that restricts bacterial dissemination and by neutrophil-dependent control of bacterial proliferation in the skin. Furthermore, and as opposed to current models, our data indicate an intracellular stage is not required by Y. pestis to disseminate from the skin to draining LNs. Because our findings address events that occur during early encounters of pathogen with the immune response, this work can inform efforts to prevent or control infection.     

Extracellular Adenosine Protects against Streptococcus pneumoniae Lung Infection by Regulating Pulmonary Neutrophil Recruitment

An important determinant of disease following Streptococcus pneumoniae (pneumococcus) lung infection is pulmonary inflammation mediated by polymorphonuclear leukocytes (PMNs). We found that upon intratracheal challenge of mice, recruitment of PMNs into the lungs within the first 3 hours coincided with decreased pulmonary pneumococci, whereas large numbers of pulmonary PMNs beyond 12 hours correlated with a greater bacterial burden. Indeed, mice that survived infection largely resolved inflammation by 72 hours, and PMN depletion at peak infiltration, i.e. 18 hours post-infection, lowered bacterial numbers and enhanced survival. We investigated host signaling pathways that influence both pneumococcus clearance and pulmonary inflammation. Pharmacologic inhibition and/or genetic ablation of enzymes that generate extracellular adenosine (EAD) (e.g. the ectoenzyme CD73) or degrade EAD (e.g. adenosine deaminase) revealed that EAD dramatically increases murine resistance to S. pneumoniae lung infection. Moreover, adenosine diminished PMN movement across endothelial monolayers in vitro, and although inhibition or deficiency of CD73 had no discernible impact on PMN recruitment within the first 6 hours after intratracheal inoculation of mice, these measures enhanced PMN numbers in the pulmonary interstitium after 18 hours of infection, culminating in dramatically elevated numbers of pulmonary PMNs at three days post-infection. When assessed at this time point, CD73 ^-/- mice displayed increased levels of cellular factors that promote leukocyte migration, such as CXCL2 chemokine in the murine lung, as well as CXCR2 and β-2 integrin on the surface of pulmonary PMNs. The enhanced pneumococcal susceptibility of CD73 ^-/- mice was significantly reversed by PMN depletion following infection, suggesting that EAD-mediated resistance is largely mediated by its effects on PMNs. Finally, CD73-inhibition diminished the ability of PMNs to kill pneumococci in vitro, suggesting that EAD alters both the recruitment and bacteriocidal function of PMNs. The EAD-pathway may provide a therapeutic target for regulating potentially harmful inflammatory host responses during Gram-positive bacterial pneumonia.     

耐甲氧西林金黄色葡萄球菌诱导SKH-1无毛小鼠菌血症模型

目的建立SKH-1无毛小鼠感染MRSA致菌血症模型的方法及其评价体系。方法 62只SPF级SKH-1无毛小鼠随机分成PBS对照组、低剂量模型组、高剂量模型组及给药组,尾静脉注射无菌PBS至对照组小鼠体内,其余各组小鼠尾静脉注射相应剂量MRSA(ST-239)菌悬液,从体重、死亡率、血常规、血液细菌浓度、主要器官荷菌量及病理改变等方面对模型进行评价,并用抗生素替考拉宁对模型进行检验。结果各组感染小鼠体重均下降明显,血常规指标改变明显;高剂量组死亡率高,血液中细菌浓度较高,肝、肾等多组织器官播散严重,皮肤可见多发性脓肿灶;使用替考拉宁能显著降低小鼠死亡率,减轻主要器官的损伤程度。结论应用MRSA菌株可成功诱导建立SKH-1无毛小鼠菌血症模型,模型具有病理特征明显及观察简便的优点,为相关药物评价研究提供了一个理想的动物模型。     

2009—2012年金黄色葡萄球菌血液分离株的临床分布和耐药性研究

目的调查和分析金黄色葡萄球菌败血症患者的临床特点和菌株的耐药情况,为临床诊断和合理用药提供参考。方法收集并分析2009年至2012年血培养确诊为金黄色葡萄球菌败血症患者的临床及菌株资料。结果2009年至2012年金黄色葡萄球菌血液分离株共80株,其中甲氧西林耐药金黄色葡萄球菌（methieillin resistant Staphylococcus,MRSA）占50％。2009年至2011年对甲氧西林的耐药率逐年提高,2012年呈下降趋势。其中MRSA血流感染患者多为合并基础疾病的老年人,留置静脉导管及体腔引流管、气管插管、联合使用抗生素、住院时间长为易感因素。结论金黄色葡萄球菌血液分离株中,MRSA检出率高,占50％,临床表现大多较重,合并多种基础疾病。加强抗生素的管理及重视和预防院内感染后能明显降低MRSA的检出率。     

Recruited macrophages control dissemination of group A Streptococcus from infected soft tissues

Group A Streptococcus (GAS) causes diverse infections in humans, ranging from mild to life-threatening invasive diseases, such as necrotizing fasciitis (NF), a rapidly progressing deep tissue infection. Despite prompt treatments, NF remains a significant cause of morbidity and mortality, even in previously healthy individuals. The early recruitment of leukocytes is crucial to the outcome of NF; however, although the role of polymorphonuclear neutrophils (PMNs) in host defense against NF is well established, the role of recruited macrophages remains poorly defined. Using a cutaneous murine model mimicking human NF, we found that mice deficient in TNF-α were highly susceptible to s.c. infections with GAS, and a paucity of macrophages, but not PMNs, was demonstrated. To test whether the effects of TNF-α on the outcome of infection are mediated by macrophages/monocytes, we systemically depleted C57BL/6 mice of monocytes by pharmacological and genetic approaches. Systemic monocyte depletion substantially increased bacterial dissemination from soft tissues without affecting the number of recruited PMNs or altering the bacterial loads in soft tissues. Enhanced GAS dissemination could be reverted by either i.v. injection of monocytes or s.c. administration of peritoneal macrophages. These experiments demonstrated that recruited macrophages play a key role in defense against the extracellular pathogen GAS by limiting its spread from soft tissues.     

Cytokines Induced Neutrophil Extracellular Traps Formation: Implication for the Inflammatory Disease Condition

Neutrophils (PMNs) and cytokines have a critical role to play in host defense and systemic inflammatory response syndrome (SIRS). Neutrophil extracellular traps (NETs) have been shown to extracellularly kill pathogens, and inflammatory potential of NETs has been shown. Microbial killing inside the phagosomes or by NETs is mediated by reactive oxygen and nitrogen species (ROS/RNS). The present study was undertaken to assess circulating NETs contents and frequency of NETs generation by isolated PMNs from SIRS patients. These patients displayed significant augmentation in the circulating myeloperoxidase (MPO) activity and DNA content, while PMA stimulated PMNs from these patients, generated more free radicals and NETs. Plasma obtained from SIRS patients, if added to the PMNs isolated from healthy subjects, enhanced NETs release and free radical formation. Expressions of inflammatory cytokines (IL-1β, TNFα and IL-8) in the PMNs as well as their circulating levels were significantly augmented in SIRS subjects. Treatment of neutrophils from healthy subjects with TNFα, IL-1β, or IL-8 enhanced free radicals generation and NETs formation, which was mediated through the activation of NADPH oxidase and MPO. Pre-incubation of plasma from SIRS with TNFα, IL-1β, or IL-8 antibodies reduced the NETs release. Role of IL-1β, TNFα and IL-8 thus seems to be involved in the enhanced release of NETs in SIRS subjects.