Would hemodialysis patients benefit from a Staphylococcus aureus vaccine?

Staphylococcus aureus bloodstream infection can have potentially catastrophic consequences for patients on hemodialysis. Consequently, an effective vaccine to prevent S aureus infection would have a significant influence on morbidity and mortality in this group. To date, however, efforts to develop a vaccine have been unsuccessful. Previous antibody-inducing vaccine candidates did not prevent or attenuate S aureus infection in clinical trials. Recent advances have helped to elucidate the role of specific T-cell subsets, notably T-helper cell 1 and T-helper cell 17, in the immune response to S aureus. These cells are essential for coordinating an effective phagocytic response via cytokine production, indirectly leading to destruction of the organism. It is now widely accepted that next-generation S aureus vaccines must also induce effective T-cell-mediated immunity. However, there remains a gap in our knowledge: how will an S aureus vaccine drive these responses in those patients most at risk? Given that patients on hemodialysis are an immunocompromised population, in particular with specific T-cell defects, including defects in T-helper cell subsets, this is likely to affect their ability to respond to an S aureus vaccine. We urgently need a better understanding of T-cell-mediated immunity in this cohort if an efficacious vaccine is ever to be realized for these patients.

Bioinformatics and Functional Assessment of Toxin-Antitoxin Systems in Staphylococcus aureus.

Staphylococcus aureus is a nosocomial pathogen that can cause chronic to persistent infections. Among different mediators of pathogenesis, toxin-antitoxin (TA) systems are emerging as the most prominent. These systems are frequently studied in Escherichia coli and Mycobacterial species but rarely explored in S. aureus. In the present study, we thoroughly analyzed the S. aureus genome and screened all possible TA systems using the Rasta bacteria and toxin-antitoxin database. We further searched E. coli and Mycobacterial TA homologs and selected 67 TA loci as putative TA systems in S. aureus. The host inhibition of growth (HigBA) TA family was predominantly detected in S. aureus. In addition, we detected seven pathogenicity islands in the S. aureus genome that are enriched with virulence genes and contain 26 out of 67 TA systems. We ectopically expressed multiple TA genes in E. coli and S. aureus that exhibited bacteriostatic and bactericidal effects on cell growth. The type I Fst toxin created holes in the cell wall while the TxpA toxin reduced cell size and induced cell wall septation. Besides, we identified a new TA system whose antitoxin functions as a transcriptional autoregulator while the toxin functions as an inhibitor of autoregulation. Altogether, this study provides a plethora of new as well as previously known TA systems that will revitalize the research on S. aureus TA systems.

Assessment of Granulocyte Subset Activation: New Information from Image-Based Flow Cytometry.

Analysis of granulocyte function can provide important information about the state of the body's innate immune system. Existing flow cytometry methods that lack image-based analysis capabilities fail to fully evaluate granulocyte function. In the present method, we combine simultaneous detection of phagocytosis and oxidative burst in granulocytes to identify unique subsets of activated granulocytes. This analysis method provides novel information about granulocytes that allows our lab and others to evaluate the effectiveness of nutritional and lifestyle countermeasures, designed to improve immunity.

Preparation and characterization of a Staphylococcus aureus capsular polysaccharide-protein conjugate prepared by a low cost technique: a proof-of-concept study.

Staphylococcus aureus is a worldwide distributed pathogen that produces several diseases in many species and is the major cause of mastitis in dairy cows. S. aureus capsular polysaccharide 5 (CP5) has been widely proposed as a vaccine candidate since it is expressed in a high proportion of isolates from intramammary infections and is able to induce opsonophagocytic antibodies. However, to reach immunological properties, polysaccharides need to be coupled to carrier proteins. The aim of this study was to evaluate a conjugation method employing p-benzoquinone (PBQ), which was not previously reported for the development of vaccine components. Purified S. aureus CP5 was coupled to human serum albumin (HSA) with high efficiency, reaching a rate PS/protein of 0.5. Mice groups were immunized at days 0, 14, 28, and 42, with the conjugate (CP5-HSAPBQ), free CP5, or PBS, formulated with incomplete Freund adjuvant, and after 3 months, they were challenged with free CP5 to evaluate the memory response. IgG and IgM isotypes were measured on serum samples all along the experiment, and IgG subclasses were determined to analyze the humoral profile. In contrast to the response obtained with free CP5, CP5-HSAPBQ induced IgG titers of 1/238,900 after three doses and a memory response was observed after the challenge. Results indicate that immunization with CP5-HSAPBQ effectively induce a T-dependent immune response against CP5. Moreover, besides IgG2a was the main subtype obtained, the joint production of specific IgG1, IgG2b, and IgG3 types indicated a balanced humoral response. As p-benzoquinone conjugation of CPs to proteins is far less expensive and straightforward than other methods commonly used in vaccine preparations, the robust humoral response obtained using this method points out that this can be an interesting alternative to prepare S. aureus CP5 conjugate vaccines.

Assessment of in vivo antimicrobial activity of the carbene silver(I) acetate derivative SBC3 using Galleria mellonella larvae.

The antimicrobial drug candidate 1,3-dibenzyl-4,5-diphenyl-imidazol-2-ylidene silver(I) acetate (SBC3) was evaluated for its ability to function in vivo using larvae of Galleria mellonella. A SBC3 concentration of 25 µg/ml inhibited the growth of Staphylococcus aureus by 71.2% and Candida albicans by 86.2% in vitro. Larvae inoculated with 20 µl of SBC3 solution showed no ill effects up to a concentration of 250 µg/ml but administration of 500 µg/ml resulted in a 40% reduction in larval survival and administration of a dose of 1,000 µg/ml resulted in total larval death at 24 h. Larvae inoculated with S. aureus or C. albicans and subsequently administered SBC3 showed increased survival. Administration of SBC3 to larvae did not boost the insect immune response as indicated by lack of an increase in the density of circulating haemocytes (immune cells). The abundance of a number of proteins involved in the insect immune response was reduced in larvae that received 20 µl SBC3 solution of 100 µg/ml. This is the first demonstration of the in vivo activity of SBC3 against S. aureus and C. albicans and demonstrates that SBC3 does not stimulate a non-specific immune response in larvae.

The potential economic value of a Staphylococcus aureus vaccine among hemodialysis patients.

Staphylococcus aureus infections are a substantial problem for hemodialysis patients. Several vaccine candidates are currently under development, with hemodialysis patients being one possible target population. To determine the potential economic value of an S. aureus vaccine among hemodialysis patients, we developed a Markov decision analytic computer simulation model. When S. aureus colonization prevalence was 1%, the incremental cost-effectiveness ratio (ICER) of vaccination was ≤$25,217/quality-adjusted life year (QALY). Vaccination became more cost-effective as colonization prevalence, vaccine efficacy, or vaccine protection duration increased or vaccine cost decreased. Even at 10% colonization prevalence, a 25% efficacious vaccine costing $100 prevented 29 infections, 21 infection-related hospitalizations, and 9 inpatient deaths per 1000 vaccinated HD patients. Our results suggest that an S. aureus vaccine would be cost-effective (i.e., ICERs ≤ $50,000/QALY) among hemodialysis patients over a wide range of S. aureus prevalence, vaccine costs and efficacies, and vaccine protection durations and delineate potential target parameters for such a vaccine.

Functional assessment of Toll-like receptor 2 and its relevance in patients with Staphylococcus aureus infection of joint prosthesis.

Staphylococcus aureus induces inflammation in experimental models through Toll-like receptor 2 (TLR2). The clinical relevance of this observation is debated. We evaluated the relationship between TLR2 R753Q single nucleotide polymorphism (SNP) and S aureus infection of joint prosthesis. Human embryonic kidney 293 (HEK293) cells transfected with wild-type and mutant R753Q TLR2 gene were assessed for response to S aureus peptidoglycan. Real-time polymerase chain reaction and gene sequencing of DNA were performed to assess TLR2 R753Q SNP in 76 patients with S aureus prosthetic joint infection (PJI) and 208 noninfected controls. HEK293 cells expressing wild-type TLR2 gene responded robustly to S aureus peptidoglycan, while cells with mutant R753Q TLR2 gene did not. The prevalence of R753Q SNP was high in S aureus PJI patients (heterozygous in 8%, and homozygous in 22%), although not significantly different from controls (12% and 27%, respectively). The TLR2 variant allele was not significantly associated with the risk or survival free of recurrent PJI S aureus. In conclusion, TLR2 R753Q SNP disabled the cellular response to S aureus peptidoglycan in vitro. However, TLR2 R753Q SNP was not significantly associated with the risk or outcome of PJI due to S aureus in human patients.

A newly developed immunoassay method based on optical measurement for Protein A detection.

We describe the development of an immunoassay using an antibody-silver nanoparticle (Ab-AgNP) conjugate as a catalyst for the silver enhancement reaction. The immuno-reaction signals that were magnified by silver metal precipitation were quantified using a commercial flatbed scanner. Protein A from Staphylococcus aureus (S. aureus), a common clinical pathogenic bacterium, was used in this research. The ease of infection of S. aureus necessitates the development of a fast detection method. The framework of the method described in this paper is based on the sandwich immunoassay and contains a 1st antibody (immunoglobulin G, IgG), an antigen (Protein A), and a 2nd antibody-colloidal silver conjugate (IgG-AgNPs). The silver enhancement reaction, a signal amplification method in which silver ions are reduced to metallic silver, is used to magnify the immuno-reaction signal. The change in signal, as visualized in grayscale, can be easily observed and analyzed by our optical scanning detection system. The relationship between antigen concentration and grayscale value is discussed. The detectable concentration limit for the antigen was found to be 1 ng/mL with 10 µg/mL of IgG and 300 µM of the IgG-AgNP conjugate. This immunoassay method provides the advantages of low cost, easy operation, and short detection time. Moreover, it has potential applications in clinical diagnoses.

Assessment of epithelial cells' immune and inflammatory response to Staphylococcus aureus when exposed to a macrolide.

Non-specific (innate) immune response plays a major role in defending the udder from bacterial invasion. Moreover, recent investigations suggest that mammary gland epithelial cells (MGEC) could have a large and important role as a source of soluble components of immune defences. Despite many attempts to find other ways to control/prevent mastitis (i.e. vaccine) antimicrobial therapy is still the most used and effective means of curing clinical and subclinical mastitis. However, drug concentrations and therapy durations are far from the optimal in order to reduce costs. Therefore, efficacy of antimicrobial therapy is dependent not only on the substance activity but also on the positive interactions with the host innate immune response. Surprisingly, information on these interactions is rather scarce in the mastitis field. A simple experimental model was developed based on BME-UV cell line, Staphylococcus aureus as a challenge and a macrolide as an antimicrobial to assess the interactions among epithelial cells, Staph. aureus and the potential effects of antimicrobials on the immune system. The results of this study confirmed that tylosin has good antimicrobial activity against both intracellular and extracellular Staph. aureus in bovine MGEC without affecting cell functions. In this study, a significant down-regulation of IL-1 and IL-6 was observed, while TNF and IL-8 expression rate numerically increased, but differences were not significant. To our knowledge, this is the first paper assessing the concentration of two lysosomal enzymes, lysozyme and N-acetyl-ß-d-glucosaminidase (NAGase), in Staph. aureus-stimulated MGEC. The results of this study confirmed that tylosin could have a significant effect on the release of these enzymes. Moreover, even if both enzymes have a similar substrate as a target, the results suggest different secretion mechanisms and an influence of antimicrobial treatment on these mechanisms. Successful mastitis cure is the result of achieving the optimal efficiency of both innate immune defences and therapeutical activities, by means of killing bacteria without eliciting an excessive inflammatory response. Therefore, antimicrobials for mastitis therapy should be selected not only on bacterial sensitivity, but also for their positive interactions with the innate immune response of the mammary gland. This study showed that an in-vitro model based on Staph. aureus challenge on MGEC could be helpful in assessing both the intracellular and extracellular activity of antimicrobials and their influence on epithelial cell immune and inflammatory response.

Resistência induzível à clindamicina entre isolados clínicos de Staphylococcus aureus / Resistencia inducible a clindamicina entre aislados clínicos de Staphylococcus aureus / Inducible clindamycin resistance in cinical isolates of Staphylococcus aureus

Falhas terapêuticas que ocorrem em tratamentos com clindamicina podem ser devido aos múltiplos mecanismos que conferem resistência aos antimicrobianos macrolídeos, lincosamidas e estreptogramina. Este estudo foi realizado para detectar a presença de resistência induzível à clindamicina em isolados clínicos de Staphylococcus aureus, por meio do D-teste, usando o disco de eritromicinae clindamicina segundo preconizado pelo CLSI, e sua relação com a resistência a oxacilina. A resistência MLSBc foi verificada em 79,06 por cento dos MRSA e a resistência MLSBi em 4,65 por cento. Para os MSSA, o fenótipo MLSBc foi de 2,88 por cento e o fenótipo MLSBi foi de 6,73 por cento. A resistência ao grupo MLS e a expressão constitutiva foi mais comum entre os isolados MRSA, e a frequência de MLSBi foi mais frequente em MSSA do que em MRSA. O fenótipo induzível pode comprometer a eficácia da clindamicina, portanto recomenda-se a realização do teste de indução e o monitoramento constante da susceptibilidade a droga dos isolados de S. aureus, considerando a necessidade de controle epidemiológico e terapêutico. (AU)

Fallas terapéuticas ocurridas en tratamientos con clindamicina pueden ser causadas por los múltiples mecanismos que confieren resistencia a los antimicrobianos macrólidos, lincosamidas y estreptograminas. Este estudio fue ejecutado para detectar la presencia de resistencia inducible a clindamicina en aislados clínicos de Staphylococcus aureus de promedio la prueba D, utilizando el disco de eritromicina y clindamicina que recomienda el CLSI, y su relación con la resistencia a oxacilina. La resistencia MLSBc fue verificada en el 79.06% por ciento de los MRSA y la resistencia MLSBi en el 4.65 por ciento. En cuanto a los MSSA, el fenotipo MLSBc alcanzó el 2.88 por ciento y el fenotipo MLSBi el 6.73 por ciento. La resistencia al grupo MLS y la expresión constitutiva fueran mas comunes entre el los aislados MRSA, y la frecuencia de MLSBi fue mas grande en MSSA que en MRSA. El fenotipo inducible puede comprometer la eficacia de la clindamicina, se recomendando por lo tanto la realización de pruebas de inducción y la monitoración constante de la susceptibilidad a drogas de los aislados de S. aureus, en vista de la necesidad del control epidemiólogo y terapéutico. (AU)

Clinical failure of clindamycin therapy has been reported due to multiple mechanisms that confer resistance to macrolide, lincosamide and streptogramin antibiotics. This study was undertaken to detect the presence of inducible clindamycin resistance amongclinical isolates of Staphylococcus aureus, by D-test, using erythromycin and clindamycin disks as per CLSI, and its relationship to oxacilin resistance. In this study, 79,06 percent of MRSA presented the phenotype MLSBc, and 4,65 percent the phenotype MLSBi, and 2,88 percent and 6,73 percent of MSSA, respectively. The resistance to MLS group and constitutive expression were more common among the MRSA isolates, and the MLSBi frequency was higher in MSSA than MRSA. The inducible phenotype can compromise the clindamycin efficacy, therefore both the inducible test and the constant monitoring of susceptibility to this drug in the S. aureus isolates are recommended, considering the necessity of epidemiology control and therapy. (AU)

[Neutrophil extracellular traps: method of detection and assessment of bacterial trapping efficacy].

AIM: To develop express method for detection of neutrophil extracellular traps represented by extracellular strands of neutrophils' DNA. MATERIALS AND METHODS: Acridine orange staining was used for visualization of neutrophil exracellular traps, which allows to quickly reveal the forming structures and to quantify this phenomenon. RESULTS: Performed studies showed that after 30-min of in vitro interaction of Escherichia coli, Staphylococcus aureus, lactobacteria, bifidobacteria and latex particles with neutrophils, the latter produces extracellular net-like structures, which were well visualized after staining of fixed preparations with acridine orange. Such structures are able to trap latex particles and bacteria more efficiently than live cell. Additionally, representatives of normal flora (bifidobacteria) actively stimulate production of traps. CONCLUSION: Production of neutrophil extracellular traps could be one of the main and effective mechanisms in antimicrobial defense of mucosal surfaces.

[Experimental, clinical and immunologic assessment of acellular staphylococcal vaccine "Staphylovac"].

Results of experimental, clinical and immunological effects of acellular dry staphylococcal vaccine "Staphylovac" developed in Mechnikov Research Institute of Vaccines and Sera are presented. Original mildly virulent strains of Staphylococcus aureus having high immunogenicity, and intra- and interspecies protective activity against different representatives of opportunistic microflora were used for construction of the preparation. Low-toxicity and weak anapylactogenicity of the vaccine were established. In experiments on mice, guinea pigs and rabbits significant protective, antigenic and immunomodulate activity of the preparation was revealed with low sensitization of animals. Clinical trials performed in different centers showed that inclusion of vaccinotherapy in complex treatment of chronic staphylococcal infections (chronic pyodermia, lung abscess etc.) resulted in prolonged pathologic locus, decrease of number and severity of exacerbations, prolongation of remission, and complete recovery in significant number of patients. Activation of innate and adaptive immunity was revealed in the same patients. It was shown on the large group of athletes that administration of the vaccine by aerosol route prevents disruption of immunologic adaptation occurring due to excess physical activity and stress situations during competitions.

[Assessment of bactericidal and growth-inhibiting activity of blood serum using flow cytometry and photometry].

Method of measurement of biological fluids bactericidal activity against Staphylococcus aureus using laser flow cytometry has been developed and proposed for clinical use. Overall bactericidal activity of sera of healthy donors has been assessed by this method. Strong positive correlation between bactericidal activity measured by flow cytometry and ability of the sera of healthy donors to inhibit bacterial growth assessed by photometric method was determined. High degree of positive correlation between results of cytometry and classical microbiological method of measurement of mentioned parameters has been shown.

The business of developing antibacterials.

Although some dazzling technical approaches have fallen short, dozens of small companies and a few major pharmas seek new products for this medically crucial, modest-growth market.

Assessment of the opsonic activity of purified bovine sIgA following intramammary immunization of cows with Staphylococcus aureus.

The phagocytosis of Staphylococcus aureus by bovine polymorphonuclear neutrophils (PMN) requires the presence of antibodies. Among the major isotypes of bovine antibodies, IgG2 and IgM are considered opsonic for bovine PMN. However, the role of purified bovine secretory IgA (sIgA) as an opsonin has not been assessed. In the present study, IgG2 were obtained from serum and sIgA, IgG1, and IgM were purified from the colostrums of three cows intramammarily immunized with heat-killed Staphylococcus aureus. The Ig preparations were assayed for specific antibodies, and the opsonic capacity of every isotype was investigated. Despite the presence of antibodies, we observed no distinct chemiluminescence response of PMN stimulated with sIgA- or IgG1-opsonized S. aureus, whereas IgM or IgG2 bound to bacteria induced a marked chemiluminescence response. Moreover, the counting of internalized bacteria per PMN after phagocytosis revealed a low uptake of S. aureus opsonized with sIgA or IgG1, in contrast to IgM or IgG2, which triggered efficient ingestion of bacteria. Priming of neutrophils by TNF-alpha, IFN-gamma, or C5adesArg did not promote an oxidative burst or uptake of sIgA-opsonized S. aureus to a greater extent than with IgG1-opsonized bacteria. Furthermore, analysis of uningested bacteria by flow cytometry after incubation with PMN showed a preferential uptake of IgM-opsonized S. aureus by PMN and only few sIgA-positive stained bacteria were PMN-associated. These experiments indicate that sIgA, like IgG1 and unlike IgM or IgG2, could not be considered as a major opsonin for phagocytosis of S. aureus by bovine blood PMN.

Effect of IFN-gamma on the killing of S. aureus in human whole blood. Assessment of bacterial viability by CFU determination and by a new method using alamarBlue.

Given the increasing incidence of methicillin resistant Staphylococcus aureus (MRSA) and the recent emergence of MRSA with a reduced susceptibility to vancomycin, alternative approaches to the treatment of infection are of increasing relevance. The purpose of these studies was to evaluate the effect of IFN-gamma on the ability of white blood cells to kill S. aureus and to develop a simpler, higher throughput bacterial killing assay. Using a methicillin sensitive clinical isolate of S. aureus, a clinical isolate of MRSA, and a commercially available strain of MRSA, studies were conducted using a killing assay in which the bacteria were added directly into whole blood. The viability of the bacteria in samples harvested at various time points was then evaluated both by the classic CFU assay and by a new assay using alamarBlue. In the latter method, serially diluted samples and a standard curve containing known concentrations of bacteria were placed on 96-well plates, and alamarBlue was added. Fluorescence readings were taken, and the viability of the bacteria in the samples was calculated using the standard curve. The results of these studies demonstrated that the CFU and alamarBlue methods yielded equivalent detection of bacteria diluted in buffer. For samples incubated in whole blood, however, the alamarBlue method tended to yield lower viabilities than the CFU method due to the emergence of a slower growing subpopulation of S. aureus upon incubation in the blood matrix. A significant increase in bacterial killing was observed upon pretreatment of whole blood for 24 h with 5 or 25 ng/ml IFN-gamma. This increase in killing was detected equivalently by the CFU and alamarBlue methods. In summary, these studies describe a method that allows for the higher throughput analysis of the effects of immunomodulators on bacterial killing.

Development of coagglutination reagents for serological grouping of streptococci.

Coagglutination reagents for the rapid serological grouping of groups A, B, C, F and G Streptococcus have been developed. Antisera to groups A, B, C, F and G Streptococcus were raised in rabbits. After absorption with cross-reacting antigens, the specific antibodies were coated on Staphylococcus protein-A and used as group-specific coagglutination reagents. The sensitivity of the reagents for groups A, C and G Streptococcus was 100 per cent and the specificity was 100, 100, and 98.77 per cent, respectively. The sensitivity and specificity of these reagents were consistent up to 12 months, although specificity declined with longer storage. The in-house coagglutination reagents for groups A, C and G streptococcus were also tested in comparison with the commercially available Streptococcus Phadebact test and yielded almost identical results. Sensitivity of the in-house of group B Streptococcus reagent was low, while the group F reagent gave a high incidence of false positive reaction.

Low cost production and purification of polyclonal antibodies to staphylococcal enterotoxin A

An immunization scheme for production of antiserum to staphylococcal enterotoxin A (SEA) is proposed. The reference method of Robbins and Bergdoll was modified to reduce the number of doses and the amount of toxin used per animal. The best immunization scheme used injections in days 0,8,24,59,62 and 67. The amount of toxin at each injection was 5,6,20,50,100 and 200ug, respectively. The total amount of toxin was 381ug, which corresponded to a reduction of 107ug in the amount of toxin for each animal when compared to the reference method. The average antiserum titer using the Optimum Sensitivity Plate - OSP was 1:60 and using ELISA the titer was 1:100.000. The lack of cross-reactivity with other staphylococcal enterotoxins indicated high specificity of the antibody to SEA. The proposed immunization scheme was adequate to produce specific SEA antisera, with high titers and the aditional advantage of reducing the amount of purified SEA required for immunization.

Functional assessment of bovine monocytes isolated from peripheral blood.

Bovine monocytes were isolated from the peripheral blood of cattle by adherence of peripheral blood mononuclear cells to plastic. Three in vitro methods were modified to evaluate bovine monocyte function. These methods were: (1) ingestion of 125I-iododeoxyuridine labeled Staphylococcus aureus; (2) antibody-dependent cell-mediated cytotoxicity; (3) luminol-dependent and native chemiluminescence. Description of monocyte isolation and assay development is discussed in the text. Assays to evaluate monocyte function are useful for assessing immune status of the animal.