Gut metabolite L-lactate supports Campylobacter jejuni population expansion during acute infection.

How the microaerobic pathogen Campylobacter jejuni establishes its niche and expands in the gut lumen during infection is poorly understood. Using 6-wk-old ferrets as a natural disease model, we examined this aspect of C. jejuni pathogenicity. Unlike mice, which require significant genetic or physiological manipulation to become colonized with C. jejuni, ferrets are readily infected without the need to disarm the immune system or alter the gut microbiota. Disease after C. jejuni infection in ferrets reflects closely how human C. jejuni infection proceeds. Rapid growth of C. jejuni and associated intestinal inflammation was observed within 2 to 3 d of infection. We observed pathophysiological changes that were noted by cryptic hyperplasia through the induction of tissue repair systems, accumulation of undifferentiated amplifying cells on the colon surface, and instability of HIF-1α in colonocytes, which indicated increased epithelial oxygenation. Metabolomic analysis demonstrated that lactate levels in colon content were elevated in infected animals. A C. jejuni mutant lacking lctP, which encodes an L-lactate transporter, was significantly decreased for colonization during infection. Lactate also influences adhesion and invasion by C. jejuni to a colon carcinoma cell line (HCT116). The oxygenation required for expression of lactate transporter (lctP) led to identification of a putative thiol-based redox switch regulator (LctR) that may repress lctP transcription under anaerobic conditions. Our work provides better insights into the pathogenicity of C. jejuni.

4Dflow-VP-Net: A deep convolutional neural network for noninvasive estimation of relative pressures in stenotic flows from 4D flow MRI.

PURPOSE: To estimate relative transvalvular pressure gradient (TVPG) noninvasively from 4D flow MRI. METHODS: A novel deep learning-based approach is proposed to estimate pressure gradient across stenosis from four-dimensional flow MRI (4D flow MRI) velocities. A deep neural network 4D flow Velocity-to-Presure Network (4Dflow-VP-Net) was trained to learn the spatiotemporal relationship between velocities and pressure in stenotic vessels. Training data were simulated by computational fluid dynamics (CFD) for different pulsatile flow conditions under an aortic flow waveform. The network was tested to predict pressure from CFD-simulated velocity data, in vitro 4D flow MRI data, and in vivo 4D flow MRI data of patients with both moderate and severe aortic stenosis. TVPG derived from 4Dflow-VP-Net was compared to catheter-based pressure measurements for available flow rates, in vitro and Doppler echocardiography-based pressure measurement, in vivo. RESULTS: Relative pressures calculated by 4Dflow-VP-Net and in vitro pressure catheterization revealed strong correlation (r2 = 0.91). Correlations analysis of TVPG from reference CFD and 4Dflow-VP-Net for 450 simulated flow conditions showed strong correlation (r2 = 0.99). TVPG from in vitro MRI had a correlation coefficient of r2 = 0.98 with reference CFD. 4Dflow-VP-Net, applied to 4D flow MRI in 16 patients, showed comparable TVPG measurement with Doppler echocardiography (r2 = 0.85). Bland-Altman analysis of TVPG measurements showed mean bias and limits of agreement of -0.20 ± 2.07 mmHg and 0.19 ± 0.45 mmHg for CFD-simulated velocities and in vitro 4D flow velocities. In patients, overestimation of Doppler echocardiography relative to TVPG from 4Dflow-VP-Net (10.99 ± 6.77 mmHg) was observed. CONCLUSION: The proposed approach can predict relative pressure in both in vitro and in vivo 4D flow MRI of aortic stenotic patients with high fidelity.

Alveolar macrophages from EVALI patients and e-cigarette users: a story of shifting phenotype.

Exposure to e-cigarette vapors alters important biologic processes including phagocytosis, lipid metabolism, and cytokine activity in the airways and alveolar spaces. Little is known about the biologic mechanisms underpinning the conversion to e-cigarette, or vaping, product use-associated lung injury (EVALI) from normal e-cigarette use in otherwise healthy individuals. We compared cell populations and inflammatory immune populations from bronchoalveolar lavage fluid in individuals with EVALI to e-cigarette users without respiratory disease and healthy controls and found that e-cigarette users with EVALI demonstrate a neutrophilic inflammation with alveolar macrophages skewed towards inflammatory (M1) phenotype and cytokine profile. Comparatively, e-cigarette users without EVALI demonstrate lower inflammatory cytokine production and express features associated with a reparative (M2) phenotype. These data indicate macrophage-specific changes are occurring in e-cigarette users who develop EVALI.

Relative pressure estimation from 4D flow MRI using generalized Bernoulli equation in a phantom model of arterial stenosis.

OBJECTIVE: Arterial stenosis is a significant cardiovascular disease requiring accurate estimation of the pressure gradients for determining hemodynamic significance. In this paper, we propose Generalized Bernoulli Equation (GBE) utilizing interpolated-based method to estimate relative pressures using streamlines and pathlines from 4D Flow MRI. METHODS: 4D Flow MRI data in a stenotic phantom model and computational fluid dynamics simulated velocities generated under identical flow conditions were processed by Generalized Bernoulli Equation (GBE), Reduced Bernoulli Equations (RBE), as well as the Simple Bernoulli Equation (SBE) which is clinically prevalent. Pressures derived from 4D flow MRI and noise corrupted CFD velocities were compared with pressures generated directly with CFD as well as pressures obtained using Millar catheters under identical flow conditions. RESULTS: It was found that SBE and RBE methods underestimated the relative pressure for lower flow rates while overestimating the relative pressure at higher flow rates. Specifically, compared to the reference pressure, SBE underestimated the maximum relative pressure by 22[Formula: see text] for a pulsatile flow data with peak flow rate [Formula: see text] and overestimated by around 40[Formula: see text] when [Formula: see text]. In contrast, for GBE method the relative pressure values were overestimated by 15[Formula: see text] with [Formula: see text]and around 10[Formula: see text] with [Formula: see text]. CONCLUSION: GBE methods showed robust performance to additive image noise compared to other methods. Our findings indicate that GBE pressure estimation over pathlines attains the highest level of accuracy compared to GBE over streamlines, and the SBE and RBE methods.

Transcription of Cystathionine ß-Lyase (MetC) Is Repressed by HeuR in Campylobacter jejuni, and Methionine Biosynthesis Facilitates Colonocyte Invasion.

A previously identified transcriptional regulator in Campylobacter jejuni, termed HeuR, was found to positively regulate heme utilization. Additionally, transcriptomic work demonstrated that the putative operons CJJ81176_1390 to CJJ81176_1394 (CJJ81176_1390-1394) and CJJ81176_1214-1217 were upregulated in a HeuR mutant, suggesting that HeuR negatively regulates expression of these genes. Because genes within these clusters include a cystathionine ß-lyase (metC) and a methionine synthase (metE), it appeared HeuR negatively regulates C. jejuni methionine biosynthesis. To address this, we confirmed mutation of HeuR reproducibly results in metC overexpression under nutrient-replete conditions but did not affect expression of metE, while metC expression in the wild type increased to heuR mutant levels during iron limitation. We subsequently determined that both gene clusters are operonic and demonstrated the direct interaction of HeuR with the predicted promoter regions of these operons. Using DNase footprinting assays, we were able to show that HeuR specifically binds within the predicted -35 region of the CJJ81176_1390-1394 operon. As predicted based on transcriptional results, the HeuR mutant was able to grow and remain viable in a defined medium with and without methionine, but we identified significant impacts on growth and viability in metC and metE mutants. Additionally, we observed decreased adherence, invasion, and persistence of metC and metE mutants when incubated with human colonocytes, while the heuR mutant exhibited increased invasion. Taken together, these results suggest that HeuR regulates methionine biosynthesis in an iron-responsive manner and that the ability to produce methionine is an important factor for adhering to and invading the gastrointestinal tract of a susceptible host. IMPORTANCE As the leading cause of bacterium-derived gastroenteritis worldwide, Campylobacter jejuni has a significant impact on human health. Investigating colonization factors that allow C. jejuni to successfully infect a host furthers our understanding of genes and regulatory elements necessary for virulence. In this study, we have begun to characterize the role of the transcriptional regulatory protein, HeuR, on methionine biosynthesis in C. jejuni. When the ability to synthesize methionine is impaired, detrimental impacts on growth and viability are observed during growth in limited media lacking methionine and/or iron. Additionally, mutations in the methionine biosynthetic pathway result in decreased adhesion, invasion, and intracellular survival of C. jejuni when incubated with human colonocytes, indicating the importance of regulating methionine biosynthesis.

The Host Cellular Immune Response to Infection by Campylobacter Spp. and Its Role in Disease.

Campylobacter spp. are the leading cause of bacterium-derived gastroenteritis worldwide, impacting 96 million individuals annually. Unlike other bacterial pathogens of the gastrointestinal tract, Campylobacter spp. lack many of the classical virulence factors that are often associated with the ability to induce disease in humans, including an array of canonical secretion systems and toxins. Consequently, the clinical manifestations of human campylobacteriosis and its resulting gastrointestinal pathology are believed to be primarily due to the host immune response toward the bacterium. Further, while gastrointestinal infection is usually self-limiting, numerous postinfectious disorders can occur, including the development of Guillain-Barré syndrome, reactive arthritis, and irritable bowel syndrome. Because gastrointestinal disease likely results from the host immune response, the development of these postinfectious disorders may be due to dysregulation or misdirection of the same inflammatory response. As a result, it is becoming increasingly important to the Campylobacter field, and human health, that the cellular immune responses toward Campylobacter be better understood, including which immunological events are critical to the development of disease and the postinfectious disorders mentioned above. In this review, we collectively cover the cellular immune responses across susceptible hosts to Campylobacter jejuni infection, along with the tissue pathology and postinfectious disorders which may develop.

Induction of neutrophil extracellular traps by Campylobacter jejuni.

Campylobacter jejuni is the leading cause of bacterial-derived gastroenteritis worldwide and can lead to several post-infectious inflammatory disorders. Despite the prevalence and health impacts of the bacterium, interactions between the host innate immune system and C. jejuni remain poorly understood. To expand on earlier work demonstrating that neutrophils traffic to the site of infection in an animal model of campylobacteriosis, we identified significant increases in several predominantly neutrophil-derived proteins in the faeces of C. jejuni-infected patients, including lipocalin-2, myeloperoxidase and neutrophil elastase. In addition to demonstrating that these proteins significantly inhibited C. jejuni growth, we determined they are released during formation of C. jejuni-induced neutrophil extracellular traps (NETs). Using quantitative and qualitative methods, we found that purified human neutrophils are activated by C. jejuni and exhibit signatures of NET generation, including presence of protein arginine deiminase-4, histone citrullination, myeloperoxidase, neutrophil elastase release and DNA extrusion. Production of NETs correlated with C. jejuni phagocytosis/endocytosis and invasion of neutrophils suggesting that host- and bacterial-mediated activities are responsible for NET induction. Further, NET-like structures were observed within intestinal tissue of C. jejuni-infected ferrets. Finally, induction of NETs significantly increased human colonocyte cytotoxicity, indicating that NET formation during C. jejuni infection may contribute to observed tissue pathology. These findings provide further understanding of C. jejuni-neutrophil interactions and inflammatory responses during campylobacteriosis.

E-Cigarette or Vaping Product Use-associated Lung Injury: Developing a Research Agenda. An NIH Workshop Report.

The NHLBI convened a working group on October 23, 2019, to identify the most relevant and urgent research priorities and prevailing challenges in e-cigarette or vaping product use-associated lung injury (EVALI). Experts across multiple disciplines discussed the complexities of the EVALI outbreak, identified research priorities, and recommended strategies to address most effectively its causal factors and improve diagnosis, treatment, and prevention of this disease. Many research priorities were identified, including the need to create national and international registries of patients with EVALI, to track accurately those affected and assess outcomes. The group concluded that biospecimens from subjects with EVALI are urgently needed to help define EVALI pathogenesis and that vaping has disease risks that are disparate from smoking, with the occurrence of EVALI highlighting the importance of broadening e-cigarette research beyond comparators to smoking-related diseases.

Dual-Venc acquisition for 4D flow MRI in aortic stenosis with spiral readouts.

BACKGROUND: Single Venc 4D flow MRI with Cartesian readout is hampered by poor velocity resolution and noise when imaging during diastole. Dual Venc acquisitions typically require the acquisition of two distinct datasets, which leads to longer scan times. PURPOSE/HYPOTHESIS: To design and develop a 4D Spiral Dual Venc sequence. The sequence allows for separate systolic and diastolic Venc s as part of a single acquisition with a prescribed switch time. The implemented sequence was hypothesized to be comparable to Cartesian 4D flow, but with increased velocity resolution in the diastolic phase and with better scan efficiency and reduced noise. STUDY TYPE: Prospective. POPULATION: The studied populations were two phantoms-a straight pipe with a stenotic narrowing and a phantom of the aortic arch which included a calcific polymeric valve-under both steady and pulsatile flows, six healthy volunteers, and eight patients with severe aortic stenosis (AS). FIELD STRENGTH/SEQUENCE: 1.5T, Dual Venc 4D flow with spiral readouts. ASSESSMENT: Data from the proposed sequence were compared with data from 4D Cartesian Dual Venc and Single Venc acquisitions. Noise was assessed from the acquired velocity data with the pump turned off and by varying Venc . Steady acquisitions were compared to the proximal slice of the lowest Single Venc acquisition. STATISTICAL TESTS: Steady flows were compared using relative-root-mean-squared-error (RRMSE). For in vivo flows and pulsatile in vitro flows, net flow for corresponding timepoints were compared with the Pearson correlation test (P < 0.01). RESULTS: For steady flows, RRMSEs for Single Venc s ranged from 17.6% to 19.4%, and 9.6% to 16.5% for Dual Venc s. The net flow correlation coefficient for the aortic arch phantom was 0.975, and 0.995 for the stenotic phantom. Normal volunteer and patient comparisons yielded a correlation of 0.970 and 0.952, respectively. in vitro and in vivo pulsatile flow waveforms closely matched. DATA CONCLUSION: The Dual Venc offers improved noise properties and velocity resolution, while the spiral trajectory offers a scan efficient acquisition with short echo time yielding reduced flow artifacts. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2020;52:117-128.

E-cigarette Use, or Vaping, Practices and Characteristics Among Persons with Associated Lung Injury - Utah, April-October 2019.

In August 2019, the Utah Department of Health (UDOH) received reports from health care providers of several cases of lung injury in persons who reported use of electronic cigarette (e-cigarette), or vaping, products (1,2). To describe the characteristics of medical care, potentially related conditions, and exposures among 83 patients in Utah, detailed medical abstractions were completed for 79 (95%) patients. Among patients receiving chart abstractions, 70 (89%) were hospitalized, 39 (49%) required breathing assistance, and many reported preexisting respiratory and mental health conditions. Interviews were conducted by telephone or in person with 53 (64%) patients or their proxies, and product samples from eight (15%) of the interviewed patients or proxies were tested. Among 53 interviewed patients, all of whom reported using e-cigarette, or vaping, products within 3 months of acute lung injury, 49 (92%) reported using any products containing tetrohydrocannabinol (THC), the principal psychoactive component of cannabis; 35 (66%) reported using any nicotine-containing products, and 32 (60%) reported using both. As reported in Wisconsin and Illinois (1), most THC-containing products were acquired from informal sources such as friends or illicit in-person and online dealers. THC-containing products were most commonly used one to five times per day, whereas nicotine-containing products were most commonly used >25 times per day. Product sample testing at the Utah Public Health Laboratory (UPHL) showed evidence of vitamin E acetate in 17 of 20 (89%) THC-containing cartridges, which were provided by six of 53 interviewed patients. The cause or causes of this outbreak is currently unknown (2); however, the predominant use among patients of e-cigarette, or vaping, products with prefilled THC-containing cartridges suggests that the substances in these products or the way in which they are heated and aerosolized play an important role in the outbreak. At present, persons should not use e-cigarette, or vaping, products that contain THC. In addition, because the specific cause or causes of lung injury are not yet known and while the investigation continues, persons should consider refraining from use of all e-cigarette, or vaping, products.

Dynamics of acute Montipora white syndrome: bacterial communities of healthy and diseased M. capitata colonies during and after a disease outbreak.

Coral diseases contribute to the decline of coral reefs globally and threaten the health and future of coral reef communities. Acute Montipora white syndrome (aMWS) is a tissue loss disease that has led to the mortality of hundreds of Montipora capitata colonies in Kane'ohe Bay, Hawai'i in recent years. This study describes the analysis of coral-associated bacterial communities using high-throughput sequencing generated by the PacBio RSII platform. Samples from three health states of M. capitata (healthy, healthy-diseased and diseased) were collected during an ongoing aMWS outbreak and a non-outbreak period and the bacterial communities were identified to determine whether a shift in community structure had occurred between the two periods. The bacterial communities associated with outbreak and non-outbreak samples were significantly different, and one major driver was a high abundance of operational taxonomic units (OTUs) identified as Escherichia spp. in the outbreak sequences. In silico bacterial source tracking suggested this OTU was likely from sewage contamination of livestock, rather than human, origin. The most abundant coliform OTU was a culturable E. fergusonii isolate, strain OCN300, however, it did not induce disease signs on healthy M. capitata colonies when used in laboratory infection trials. In addition, screening of the sequencing output found that the most abundant OTUs corresponded to previously described M. capitata pathogens. The synergistic combination of known coral pathogens, sewage contaminants and other stressors, such as fluctuating seawater temperatures and bacterial pathogens, have the potential to escalate the deterioration of coral reef ecosystems.

Pseudoalteromonas piratica sp. nov., a budding, prosthecate bacterium from diseased Montipora capitata, and emended description of the genus Pseudoalteromonas.

A Gram-stain-negative, motile, rod-shaped bacterium designated OCN003T was cultivated from mucus taken from a diseased colony of the coral Montipora capitata in Kane'ohe Bay, O'ahu, Hawai'i. Colonies of OCN003T were pale yellow, 1-3 mm in diameter, convex, smooth and entire. The strain was heterotrophic, strictly aerobic and strictly halophilic. Cells of OCN003T produced buds on peritrichous prosthecae. Growth occurred within the pH range of 5.5 to 10, and the temperature range of 14 to 39 °C. Major fatty acids were 16 : 1ω7c, 16 : 0, 18 : 1ω7c, 17 : 1ω8c, 12 : 0 3-OH and 17 : 0. Phylogenetic analysis of 1399 nucleotides of the 16S rRNA gene nucleotide sequence and a multi-locus sequence analysis of three genes placed OCN003T in the genus Pseudoalteromonas and indicated that the nearest relatives described are Pseudoalteromonas spongiae, P. luteoviolacea, P. ruthenica and P. phenolica(97-99 % sequence identity). The DNA G+C content of the strain's genome was 40.0 mol%. Based on in silico DNA-DNA hybridization and phenotypic differences from related type strains, we propose that OCN003T represents the type strain of a novel species in the genus Pseudoalteromonas, proposed as Pseudoalteromonas piratica sp. nov. OCN003T (=CCOS1042T=CIP 111189T). An emended description of the genus Pseudoalteromonas is presented.

Assessment of disease lesion removal as a method to control chronic Montipora white syndrome.

Coral colonies in Kane'ohe Bay, Hawai'i (USA), are afflicted with the tissue loss disease chronic Montipora white syndrome (cMWS). Here we show that removal of chronic disease lesions is a potential method to slow the progression of cMWS in M. capitata. Over the 24 wk observation period, treatment colonies lost almost half the amount of tissue that was lost by control colonies. The percentage of tissue loss at each sampling interval (mean ± SEM; treatment: 1.17 ± 0.47%, control: 2.25 ± 0.63%) and the rate of tissue loss per day (treatment: 0.13 ± 0.04%, control: 0.27 ± 0.08%) were both significantly lower on treated colonies than control colonies. While lesion removal stopped tissue loss at the initial infection site, which allowed colony healing, it did not prevent re-infection; in all but one of the treated colonies, new cMWS lesions appeared in other areas of the colony but not around the treatment margins. Additionally, the rate of new infections was similar between treatment and control colonies, indicating that physical injury from lesion removal did not appear to increase cMWS susceptibility. These results indicate that lesion removal reduced morbidity in M. capitata exhibiting cMWS but did not stop the disease.

Mutation of the toxR or mshA genes from Vibrio coralliilyticus strain OCN014 reduces infection of the coral Acropora cytherea.

Thermal stress increases the incidence of coral disease, which is predicted to become more common with climate change, even on pristine reefs such as those surrounding Palmyra Atoll in the Northern Line Islands that experience minimal anthropogenic stress. Here we describe a strain of Vibrio coralliilyticus, OCN014, which was isolated from Acropora cytherea during an outbreak of Acropora white syndrome (AWS), a tissue loss disease that infected 25% of the A. cytherea population at Palmyra Atoll in 2009. OCN014 recreated signs of disease in experimentally infected corals in a temperature-dependent manner. Genes in OCN014 with expression levels positively correlated with temperature were identified using a transposon-mediated genetic screen. Mutant strains harbouring transposon insertions in two such genes, toxR (a toxin regulator) and mshA (the 11th gene of the 16-gene mannose-sensitive hemagglutinin (MSHA) type IV pilus operon), had reduced infectivity of A. cytherea. Deletion of toxR and the MSHA operon in a second strain of V. coralliilyticus, OCN008, that induces acute Montipora white syndrome in a temperature-independent manner had similarly reduced virulence. This work provides a link between temperature-dependent expression of virulence factors in a pathogen and infection of its coral host.

Emerging coral diseases in Kane'ohe Bay, O'ahu, Hawai'i (USA): two major disease outbreaks of acute Montipora white syndrome.

In March 2010 and January 2012, we documented 2 widespread and severe coral disease outbreaks on reefs throughout Kane'ohe Bay, Hawai'i (USA). The disease, acute Montipora white syndrome (aMWS), manifested as acute and progressive tissue loss on the common reef coral M. capitata. Rapid visual surveys in 2010 revealed 338 aMWS-affected M. capitata colonies with a disease abundance of (mean ± SE) 0.02 ± 0.01 affected colonies per m of reef surveyed. In 2012, disease abundance was significantly higher (1232 aMWS-affected colonies) with 0.06 ± 0.02 affected colonies m(-1). Prior surveys found few acute tissue loss lesions in M. capitata in Ka¯ne'ohe Bay; thus, the high number of infected colonies found during these outbreaks would classify this as an emerging disease. Disease abundance was highest in the semi-enclosed region of south Kane'ohe Bay, which has a history of nutrient and sediment impacts from terrestrial runoff and stream discharge. In 2010, tagged colonies showed an average tissue loss of 24% after 1 mo, and 92% of the colonies continued to lose tissue in the subsequent month but at a slower rate (chronic tissue loss). The host-specific nature of this disease (affecting only M. capitata) and the apparent spread of lesions between M. capitata colonies in the field suggest a potential transmissible agent. The synchronous appearance of affected colonies on multiple reefs across Kane'ohe Bay suggests a common underlying factor. Both outbreaks occurred during the colder, rainy winter months, and thus it is likely that some parameter(s) associated with winter environmental conditions are linked to the emergence of disease outbreaks on these reefs.

Structures of complexes comprised of Fischerella transcription factor HetR with Anabaena DNA targets.

HetR is an essential regulator of heterocyst development in cyanobacteria. Many mutations in HetR render Anabaena incapable of nitrogen fixation. The protein binds to a DNA palindrome upstream of hetP and other genes. We have determined the crystal structures of HetR complexed with palindromic DNA targets, 21, 23, and 29 bp at 2.50-, 3.00-, and 3.25-Å resolution, respectively. The highest-resolution structure shows fine details of specific protein-DNA interactions. The lower-resolution structures with longer DNA duplexes have similar interaction patterns and show how the flap domains interact with DNA in a sequence nonspecific fashion. Fifteen of 15 protein-DNA contacts predicted on the basis of the structure were confirmed by single amino acid mutations that abolished binding in vitro and complementation in vivo. A striking feature of the structure is the association of glutamate 71 from each subunit of the HetR dimer with three successive cytosines in each arm of the palindromic target, a feature that is conserved among all known heterocyst-forming cyanobacteria sequenced to date.