Providing an in vitro depiction of microglial cells challenged with immunostimulatory extracellular vesicles of Naegleria fowleri.

Naegleria fowleri is the causative agent of primary amoebic meningoencephalitis, a rapid and acute infection of the central nervous system with a fatal outcome in >97% of cases. Due to the infrequent report of cases and diagnostic gaps that hinder the possibility of recovering clinic isolates, studies related to pathogenesis of the disease are scarce. However, the secretion of cytolytic molecules has been proposed as a factor involved in the progression of the infection. Several of these molecules could be included in extracellular vesicles (EVs), making them potential virulence factors and even modulators of the immune response in this infection. In this work, we evaluated the immunomodulatory effect of EVs secreted by two clinic isolates of Naegleria fowleri using in vitro models. For this purpose, characterization analyses between EVs produced by both isolates were first performed, for subsequent gene transcription analyses post incubation of these vesicles with primary cultures from mouse cell microglia and BV-2 cells. Analyses of morphological changes induced in primary culture microglia cells by the vesicles were also included, as well as the determination of the presence of nucleic acids of N. fowleri in the EV fractions. Results revealed increased expression of NOS, proinflammatory cytokines IL-6, TNF-α, and IL-23, and the regulatory cytokine IL-10 in primary cultures of microglia, as well as increased expression of NOS and IL-13 in BV-2 cells. Morphologic changes from homeostatic microglia, with small cellular body and long processes to a more amoeboid morphology were also observed after the incubation of these cells with EVs. Regarding the presence of nucleic acids, specific Naegleria fowleri DNA that could be amplified using both conventional and qPCR was confirmed in the EV fractions. Altogether, these results confirm the immunomodulatory effects of EVs of Naegleria fowleri over microglial cells and suggest a potential role of these vesicles as biomarkers of primary acute meningoencephalitis.

Futuro de la terapia y el diagnóstico con vesículas extracelulares / Future of therapeutics and diagnostics with extracellular vesicles

Resumen Las vesículas extracelulares son nanoparticulas secretadas por células procariotas y eucariotas, con funciones variadas que van desde la comunicación intercelular hasta la modulación de la respuesta inmune. La investigación en este tema se enfocó inicialmente en el aislamiento, identificación y caracterización, para luego abarcar los mecanismos fisiológicos en los que se ven involucradas. Más recientemente, la investigación, particularmente centrada en exosomas, ha permitido abrir campo a novedosas hipótesis sobre su utilidad en inmunoterapia y como marcadores biológicos. Esta revisión explora aspectos básicos sobre la biogénesis y la composición de los exosomas, así como su uso en diagnóstico y tratamiento, a partir del conocimiento generado sobre su aislamiento y purificación, distribución de cargos específicos y su relación con la respuesta inmune. Los hallazgos sobre su aplicabilidad en procesos cancerosos son promisorios; sin embargo, existe toda una ventana de posibilidades para investigar esta plataforma molecular como potenciales vacunas acelulares y marcadores de pronóstico, diagnóstico y alerta, tanto en cáncer como en patologías causadas por agentes infecciosos.

Abstract Extracellular vesicles are nanoparticles released by prokaryotic and eukaryotic cells, with a variety of functional roles in intercellular communication and even in modulation of the immune response. Research in this topic was initially focused on isolation, identification and characterization of the vesicles, with subsequent understanding of the physiological mechanisms in which they are involved. Furthermore, recent studies, particularly with exosomes, have opened the field to novel hypotheses about their usefulness in immunotherapy and as biological markers. This review explores general aspects about the biogenesis and composition of exosomes, as well as their potential use in diagnosis and treatment, based on the knowledge generated about their isolation, production, cargoes, delivery engineering and relationship with the immune response. The findings on its applicability in cancerous processes are promising, but there is still a variety of investigation possibilities of this molecular platforms as cell-free vaccines and as prognostic, diagnostic and/or warning markers, both in cancer but also in infectious diseases.

Characterization of Extracellular Vesicles Secreted by a Clinical Isolate of Naegleria fowleri and Identification of Immunogenic Components within Their Protein Cargo.

Extracellular vesicles (EVs) are small lipid vesicles released by both prokaryotic and eukaryotic cells, involved in intercellular communication, immunomodulation and pathogenesis. In this study, we performed a characterization of the EVs produced by trophozoites of a clinical isolate of the free-living amoeba Naegleria fowleri (N. fowleri). Size distribution, zeta potential, protein profile and protease activity were analyzed. Under our incubation conditions, EVs of different sizes were observed, with a predominant population ranging from 206 to 227 nm. SDS-PAGE revealed protein bands of 25 to 260 KDa. The presence of antigenic proteins was confirmed by Western blot, which evidenced strongest recognition by rat polyclonal antibodies raised against N. fowleri in the region close to 80 KDa and included peptidases, as revealed by zymography. Proteins in selected immunorecognized bands were further identified using nano-ESI-MS/MS. A preliminary proteomic profile of the EVs identified at least 184 proteins as part of the vesicles' cargo. Protease activity assays, in combination with the use of inhibitors, revealed the predominance of serine proteases. The present characterization uncovers the complexity of EVs produced by N. fowleri, suggesting their potential relevance in the release of virulence factors involved in pathogenicity. Owing to their cargo's diversity, further research on EVs could reveal new therapeutic targets or biomarkers for developing rapid and accurate diagnostic tools for lethal infections such as the one caused by this amoeba.

Primary Amebic Meningoencephalitis Related to Groundwater in Costa Rica: Diagnostic Confirmation of Three Cases and Environmental Investigation.

During the first trimester of 2020, the Ministry of Health of Costa Rica reported the first three cases of primary amebic meningoencephalitis (PAM). In two cases, laboratory personnel of the hospitals preliminarily identified amoeboid forms in cerebrospinal fluid (CSF) samples. For the molecular confirmation of species, CSF samples were sent to our laboratory. We carried out microscopic analyses and exflagellation assays. Besides, samples were cultured in 2% casein hydrolysate medium and in non-nutrient agar plates supplemented with Escherichia coli. Finally, PCR and sequencing were employed for the molecular diagnosis and species identification. In all cases, the presence of Naegleria fowleri was confirmed. An environmental investigation to identify the possible infection sources was also performed. Water samples from hot springs and groundwater from an artisan well were collected and after filtration and culture in non-nutrient agar plates supplemented with E. coli, thermotolerance and exflagellation assays were carried out. For the positive samples, PCR and sequencing were performed, confirming the presence of N. fowleri in several water samples. The report of these cases and the possible association with hot springs has had a significant impact on the population and health authorities of Costa Rica.

Isolation of Acanthamoeba T5 from Water: Characterization of Its Pathogenic Potential, Including the Production of Extracellular Vesicles.

Acanthamoeba is a genus of free-living amoebae widely distributed in nature, associated with the development of encephalitis and keratitis. Despite the fact that it is common to find genotype T5 in environmental samples, only a few cases have been associated with clinical cases in humans. The wide distribution of Acanthamoeba, the characteristic of being amphizoic and the severity of the disease motivate researchers to focus on the isolation of these organisms, but also in demonstrating direct and indirect factors that could indicate a possible pathogenic potential. Here, we performed the characterization of the pathogenic potential of an Acanthamoeba T5 isolate collected from a water source in a hospital. Osmo- and thermotolerance, the secretion of proteases and the effect of trophozoites over cell monolayers were analyzed by different methodologies. Additionally, we confirm the secretion of extracellular vesicles (EVs) of this isolate incubated at two different temperatures, and the presence of serine and cysteine proteases in these vesicles. Finally, using atomic force microscopy, we determined some nanomechanical properties of the secreted vesicles and found a higher value of adhesion in the EVs obtained at 37 °C, which could have implications in the parasite´s survival and damaging potential in two different biological environments.

In vitro effects of environmental isolates of Acanthamoeba T4 and T5 over human erythrocytes and platelets.

Free-living amoebae of the genus Acanthamoeba have been associated with keratitis and encephalitis. Some factors related to their pathogenic potential have been described, including the release of hydrolytic enzymes, and the adhesion and phagocytosis processes. However, other factors such as their effect over the hemodynamics and microcirculation elements have not been fully investigated. This work determines the in vitro activity of potentially pathogenic environmental isolates of Acanthamoeba genotype T4 and T5 over erythrocytes and platelets. The hemolytic activity (dependent and independent of contact), as well as the production of ADP of ten environmental isolates of Acanthamoeba obtained from dental units, combined emergency showers, dust, and hospital water, were measured. Tests were carried out over erythrocytes in suspension and blood agar plates, incubated at 4 °C, room temperature and 37 °C. Erythrophagocytosis and platelet aggregation assays were also performed. Live trophozoites of all of the isolates tested showed a hemolytic activity that was temperature-dependent. Over erythrocytes in suspension, variable hemolysis percentages were obtained: a maximum of 41% and a minimum of 15%. Regarding hemolysis over agar plates, two patterns of hemolysis were observed: double and simple halos. Conditioned medium and crude extracts of trophozoites did not show hemolytic activity. Erythrophagocytosis by Acanthamoeba was also observed; however, no production of ADP was determined by the employed methodology.

Potentially pathogenic Acanthamoeba genotype T4 isolated from dental units and emergency combination showers.

BACKGROUND: Acanthamoeba is the genus of free-living amoebae that is most frequently isolated in nature. To date, 20 Acanthamoeba genotypes have been described. Genotype T4 is responsible for approximately 90% of encephalitis and keratitis cases. Due to the ubiquitous presence of amoebae, isolation from environmental sources is not uncommon; to determine the clinical importance of an isolation, it is necessary to have evidence of the pathogenic potential of amoebae. OBJECTIVE: The aim of this study was to physiologically characterise 8 Acanthamoeba T4 isolates obtained from dental units and emergency combination showers and to determine their pathogenic potential by employing different laboratory techniques. METHODS: Eight axenic cultures of Acanthamoeba genotype T4 were used in pathogenic potential assays. Osmotolerance, thermotolerance, determination and characterisation of extracellular proteases and evaluation of cytopathic effects in MDCK cells were performed. FINDINGS: All of the isolates were osmotolerant, thermotolerant and had serine proteases from 44-122 kDa. Two isolates had cytopathic effects on the MDCK cell monolayer. MAIN CONCLUSION: The presence of Acanthamoeba T4 with pathogenic potential in areas such as those tested in this study reaffirms the need for adequate cleaning and maintenance protocols to reduce the possibility of infection with free-living amoebae.

Potentially pathogenic Acanthamoeba genotype T4 isolated from dental units and emergency combination showers

BACKGROUND Acanthamoeba is the genus of free-living amoebae that is most frequently isolated in nature. To date, 20 Acanthamoeba genotypes have been described. Genotype T4 is responsible for approximately 90% of encephalitis and keratitis cases. Due to the ubiquitous presence of amoebae, isolation from environmental sources is not uncommon; to determine the clinical importance of an isolation, it is necessary to have evidence of the pathogenic potential of amoebae. OBJECTIVE The aim of this study was to physiologically characterise 8 Acanthamoeba T4 isolates obtained from dental units and emergency combination showers and to determine their pathogenic potential by employing different laboratory techniques. METHODS Eight axenic cultures of Acanthamoeba genotype T4 were used in pathogenic potential assays. Osmotolerance, thermotolerance, determination and characterisation of extracellular proteases and evaluation of cytopathic effects in MDCK cells were performed. FINDINGS All of the isolates were osmotolerant, thermotolerant and had serine proteases from 44-122 kDa. Two isolates had cytopathic effects on the MDCK cell monolayer. MAIN CONCLUSION The presence of Acanthamoeba T4 with pathogenic potential in areas such as those tested in this study reaffirms the need for adequate cleaning and maintenance protocols to reduce the possibility of infection with free-living amoebae.

Isolation and Molecular Characterization of Acanthamoeba Strains from Dental Units in Costa Rica.

Free-living amoebae are protozoa widely distributed in nature, which can be found in a variety of environments. Four genera are recognized as causal agents of infections in humans and animals: Acanthamoeba, Naegleria, Balamuthia, and Sappinia. In this study, the presence of Acanthamoeba in dental units was determined and the isolates obtained were molecularly characterized; osmotolerance and thermotolerance assays were also performed to evaluate multiplication under these conditions, frequently associated with pathogenicity. The morphological analysis and partial sequencing of the 18S rDNA gene revealed the presence of Acanthamoeba genotype T4 in 14% of the units sampled. Osmotolerance and thermotolerance tests were positive for more than 80% of the isolates. Up to date, this is the first study that reports the detection, identification, and genotyping of Acanthamoeba isolated from dental units in Costa Rica and even in Latin-America. Further assays to determine the potential pathogenicity of these Acanthamoeba isolates are underway.

Isolation and molecular characterization of Acanthamoeba and Balamuthia mandrillaris from combination shower units in Costa Rica.

Free living amoebae (FLA) are ubiquitous protozoa, which may behave as parasites under certain conditions. Four genera are recognized as causal agents of infections in humans and animals: Naegleria, Sappinia, Acanthamoeba and Balamuthia. This work determines the presence of FLA in combination shower units and employs molecular biology for the characterization of isolates. The morphological analysis and partial sequencing of the 18S rDNA gene revealed the presence of Acanthamoeba genotype T4 in 30% of the units sampled. In addition to Acanthamoeba cysts, trophozoites with morphological characteristics similar to Balamuthia were identified. PCR assay using the mitochondrial 16S rRNA gene as a target confirmed the identification of the amoeba as Balamuthia mandrillaris. Up to date, this is the first report of the isolation of B. mandrillaris in Central America and the fifth report worldwide.

Desarrollo y evaluación de un método de obtención de larvas estériles de Lucilia eximia para su uso en terapia larval / Development and evaluation of a method to obtain sterile Lucilia eximia larvae for use in larval therapy

Objetivo: desarrollar un método de tratamiento de huevos de Lucilia eximia para la obtención de larvas estériles y evaluar la capacidad de supervivencia de dichas larvas en condiciones de refrigeración a 4°C. Métodos: se estableció un sistema de crianza para L. eximia. Los huevos fueron colectados en el sustrato de oviposición, se lavaron con solución salina estéril (0,85%), se trataron con hipoclorito de sodio (0,5%) y finalmente se esterilizaron con formalina, evaluando tres diferentes concentraciones (2,5%; 5,0% y 10,0%). Se verificó la esterilidad de los huevos empleando medios de cultivo bacteriológicos y la eclosión de los huevos esterilizados fue expresada mediante el cálculo de un índice de eclosión (IE). Además, se evaluó la supervivencia de las larvas de segundo y tercer estadio temprano (L2 y L3, respectivamente) en condiciones de refrigeración, durante las 4 primeras horas y luego a las 24 y 48 horas. Resultados: todas las concentraciones de formalina evaluadas fueron capaces de esterilizar los huevos. No se encontró una correlación entre el IE y las concentraciones de formalina utilizadas (R Spearman = -0,030, p = 0,848). Durante las primeras 4 horas a 4°C, un 100% de las L2 y las L3 sobrevivieron. Sin embargo, en ambos estadios larvales hubo un marcado descenso de la supervivencia a las 24 y 48 horas, siendo las L2 las más sensibles a las condiciones de refrigeración. Conclusiones: los resultados mostraron que la obtención de larvas estériles de L. eximia con el método utilizado es un proceso sencillo, pero la supervivencia de las larvas en condiciones de refrigeración es limitada.

Objective: develop a method to treat eggs of Lucilia eximia to obtain sterile larvae and evaluate the survival capacity of those larvae under refrigeration at 4°C. Methods: a rearing system was set up for L. eximia. The eggs were collected from the oviposition substrate, washed with sterile saline solution (0.85%), treated with sodium hypochlorite (0.5%), and sterilized with formalin. Three concentrations were evaluated: 2.5%; 5.0% and 10.0%. Egg sterility was verified by bacteriological culture. Eclosion of sterilized eggs was expressed by estimation of an eclosion rate (ER). An evaluation was conducted of the survival of larvae from the second and third early stages (L2 and L3, respectively) under refrigeration during the first 4 hours and then at 24 and 48 hours. Results: all the formalin concentrations evaluated were capable of sterilizing the eggs. No correlation was found between the ER and the formalin concentrations used (Spearman's Rho = -0.030, p = 0.848). During the first 4 hours at 4°C, 100% L2 and L3 survived. However, both larval stages showed a marked decrease in survival at 24 and 48 hours, L2 being the most sensitive to refrigeration. Conclusions: results show that obtaining sterile L. eximia larvae by this method is a simple process. However, larval survival under refrigeration is limited.

Rinoescleroma / Rhinoscleroma

Paciente masculino de 19 años de edad, proveniente de zona rural, con cuadro clínico de 3 años de oclusión nasal, episodios de inflamación facial, epistaxis, rinorrea fétida, hipoacusia derecha, adenopatías faciales múltiples y axiliares bilaterales; fue referido al Hospital México por una lesión granulomatosa obstructiva del tabique nasal. Una biopsia inicial reveló la presencia de tejido con infiltrado inflamatorio crónico, con predominio de macrófagos de aspectos espumoso. Una segunda biopsia fue positiva por Klebsiella pneumoniae subsp. rhinoscleromatis, y por anatomía patológica se describió una hiperplasia pseudoepiteliomatosa y en lámina propia denso infiltrado inflamatorio con base en linfocitos, células plasmáticas, cuerpos de Russell y macrófagos con citoplasma vacuolado, con presencia de microorganismos y detritos. El paciente recibió terapia con ciprofloxacina vía oral por siete meses, con lo cual resolvió desde el punto de vista etiológico...