No description available.

One of the major challenges facing clinicians is how to effectively manage excessive host immune response to pathogenic insults resulting in sepsis. This is demonstrated by the fact that despite over half-century research efforts, sepsis and its spectrum of diseases (severe sepsis and septic shock) are still associated with poor clinical outcome. Currently, sepsis is a leading cause of death in intensive care units. The immune system protects the host against pathogens and is therefore armed with an arsenal of deadly ammunitions (including chemicals, cells and proteins) necessary for the elimination of microbes. It is therefore paramount that the immune system must develop mechanisms necessary to prevent destruction of the host it is designed to protect. A good example of such a mechanism is found in the subset of lymphocytes known as regulatory T cells (Tregs). There is unequivocal experimental evidence of the role of Tregs in the maintenance of immune homeostasis and self tolerance and aberrant Treg function has been linked with several inflammatory diseases. Since sepsis is a disease marked by a hyper-inflammatory state, I investigated the possible role of Tregs in dampening sepsis-induced excessive inflammation. Using a murine model of lipopolysaccharide (LPS) infusion and bacterial infection, I show that Tregs are essential for survival during sepsis because their depletion leads to acute death to an otherwise non-lethal dose of LPS. This enhanced susceptibility to LPS following Treg depletion was also observed using live E. coli infection. Next, I probed the mechanism by which Tregs protect against LPS challenge. I found that defective Treg function leads to exaggerated activity of two immune cells – CD4+ effector T cells and neutrophils in response to LPS, leading to severe inflammatory response. Hence, this work successfully illustrates the critical role of Tregs in regulating other immune cells and the catastrophic consequences of defective Treg function during an immune response. Overall, this work highlights the significant role of Tregs in the regulation of bacteria associated inflammatory processes. The findings hold implications for the successful management of sepsis and have potential for use in development of adequate therapeutic intervention for sepsis. / October 2016

With the remarkable advancement in the nanoparticles (NPs)-based drug delivery systems (DDS) over the past several decades, the pharmacological properties associated with conventional free drugs delivery are improved. In this thesis, we report potential candidates for the next-generation NP-based DDS. While natural DDS are promising as they possess exceptional delivery mechanisms and selective targeting, synthetic DDS are more favorable for their low immunogenicity. Our developed natural DDS called magnetotactic bacterial cages (MBC), which is based on magnetotactic bacteria (MTB) as a guidable delivery vehicle for DNA functionalized gold nanoparticles (AuNPs). Loading DNA functionalized AuNPs in MTB aided in increasing the maximum-tolerated dose of DNA functionalized AuNPs and tackled issues related to DNA functionalized AuNPs stability and systemic delivery. Natural DDS hold great advantages; however, it is difficult to make complete prediction about their immunogenicity and toxicity on the basis of preclinical trials. Thus, we assessed the efficacy of synthetic NP-based DDS. Using inorganic platforms, we were able to develop the first visual monitoring system of bacteria-NPs interaction. The system offers simultaneous sensing and inhibition of bacteria in infected cells. The system is comprised of Au nanoclusters @lysozyme (AuNC@lys) colloids MSN loaded with antibacterial agents. The applicability of the inorganic DDS in the biomedical field has been limited by the high bioaccumulation risks. Hybrid materials combine the advantages of organic, inorganic and natural carriers, offering opportunities for enhanced stability, manipulating release behavior and combine two or more functions in a single platform. To further enhance the properties our inorganic DDS, we incorporated light-responsive organic ligands to silicabased NPs. Plasmid DNA was loaded on the light-responsive bridged silsesquioxane nanocomposites (BS NPs). Light irradiation was performed to reverse the surface charge of NPs via a photoreaction of the organic fragments (silsesquioxane) within the NPs, that resulted in the release of plasmid DNA in HeLa cancer cells. Finally, we assessed a new class of organic-inorganic DDS composed of inorganic metal ions and organic linkers, zeolite imidazolate frameworks-8 (ZIF-8). These NPs showed exceptional ability to entrap large cargo due to their tunable porosity and structural flexibility.

The last decade has been witness to a number of seminal discoveries in the field of innate immunity. The discovery that microbial molecules and endogenous danger signals can be detected by germ-line encoded receptors has changed the way we study the immune system. Indeed, the characterization of Toll in Drosophila as a sensor of microbial products in 1997 then led to the discovery of a family of Toll Like Receptors (TLRs) in mammals. TLRs are critical for the induction of inflammatory responses and the generation of a successful adaptive immune response. The array of ligands that these transmembrane proteins recognized mediates defense against bacteria, viruses, fungus and parasites, as well as, possibly, cancerous cells. In addition to this membrane-bound family of recognition proteins, two families of pattern recognition receptors have been recently shown to respond to microbial and chemical ligands within the cytosol. These represent the Nod Like Receptors (NLRs) and RIGI-like helicase receptor (RLH) families. Nod1 and Nod2 are members of the NLR family of proteins, which are responsible for the recognition of components derived from the bacterial cell wall, more precisely, moieties of peptidoglycan. As such, Nod1 and Nod2 are implicated in the recognition and the defense against bacterial pathogens. Importantly, the genes encoding these two proteins have also been linked to the etiology of several inflammatory disorders such as Crohn’s disease and asthma. In this thesis, we show that recognition of Nod1 and Nod2 ligands generates a rapid and transient inflammatory response in vivo. When co-injected with a model protein, Nod1 and Nod2 ligands exhibit adjuvant properties that lead to the generation of an antigen-specific Th2 type adaptive immune response. Surprisingly, recognition of the Nod1 ligand in non-hematopoietic cells is critical for the generation of this immune response. In contrast, TLRs classically tip the balance towards a Th1 response and interestingly, co-injection of TLR and Nod ligands synergize to generate a more potent immune response characterized by the generation of Th1, Th2 and Th17 T cell respones. To study the role of Nod1 and Nod2 in the context of a bacterial infection in vivo, we used an intestinal mouse pathogen, Salmonella enterica serovar Typhimurium. We were able to show that Nod1-deficient mice, but not Nod2-deficient mice, are more susceptible to the strain of this bacterium, which enters the host through the active pickup in the intestinal lumen by underlying myeloid cells. This sampling mechanism is mediated by a subset of dendritic cells that populate the intestinal lamina propria. Accordingly, the defect seen in Nod1-deficient mice localizes to the mucosal barrier where these dendritic cells appear to have an impaired response towards the bacteria. Taken together, these results increase our knowledge on the general role of Nod1 and Nod2 in immunity and might generate new avenues of research and potential therapeutic targets.

The last decade has been witness to a number of seminal discoveries in the field of innate immunity. The discovery that microbial molecules and endogenous danger signals can be detected by germ-line encoded receptors has changed the way we study the immune system. Indeed, the characterization of Toll in Drosophila as a sensor of microbial products in 1997 then led to the discovery of a family of Toll Like Receptors (TLRs) in mammals. TLRs are critical for the induction of inflammatory responses and the generation of a successful adaptive immune response. The array of ligands that these transmembrane proteins recognized mediates defense against bacteria, viruses, fungus and parasites, as well as, possibly, cancerous cells. In addition to this membrane-bound family of recognition proteins, two families of pattern recognition receptors have been recently shown to respond to microbial and chemical ligands within the cytosol. These represent the Nod Like Receptors (NLRs) and RIGI-like helicase receptor (RLH) families. Nod1 and Nod2 are members of the NLR family of proteins, which are responsible for the recognition of components derived from the bacterial cell wall, more precisely, moieties of peptidoglycan. As such, Nod1 and Nod2 are implicated in the recognition and the defense against bacterial pathogens. Importantly, the genes encoding these two proteins have also been linked to the etiology of several inflammatory disorders such as Crohn’s disease and asthma. In this thesis, we show that recognition of Nod1 and Nod2 ligands generates a rapid and transient inflammatory response in vivo. When co-injected with a model protein, Nod1 and Nod2 ligands exhibit adjuvant properties that lead to the generation of an antigen-specific Th2 type adaptive immune response. Surprisingly, recognition of the Nod1 ligand in non-hematopoietic cells is critical for the generation of this immune response. In contrast, TLRs classically tip the balance towards a Th1 response and interestingly, co-injection of TLR and Nod ligands synergize to generate a more potent immune response characterized by the generation of Th1, Th2 and Th17 T cell respones. To study the role of Nod1 and Nod2 in the context of a bacterial infection in vivo, we used an intestinal mouse pathogen, Salmonella enterica serovar Typhimurium. We were able to show that Nod1-deficient mice, but not Nod2-deficient mice, are more susceptible to the strain of this bacterium, which enters the host through the active pickup in the intestinal lumen by underlying myeloid cells. This sampling mechanism is mediated by a subset of dendritic cells that populate the intestinal lamina propria. Accordingly, the defect seen in Nod1-deficient mice localizes to the mucosal barrier where these dendritic cells appear to have an impaired response towards the bacteria. Taken together, these results increase our knowledge on the general role of Nod1 and Nod2 in immunity and might generate new avenues of research and potential therapeutic targets.

Abstract The purpose of the present study was to compare the procalcitonin (PCT), neopterin, interleukin-8 (IL-8), interleukin-10 (IL-10) and interleukin-12 (IL-12) levels with those of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in cancer patients with (56) and without infection (36) and to evaluate their ability to differentiate infections from neoplastic fever (n = 10). The infection group had statistically higher levels of CRP (91 vs. 19 mg/l, p < 0.001), PCT (0.28 vs.0.12 ng/ml, p < 0.001), neopterin (12.8 pg/mL vs. 4.0 pg/mL, p < 0.001), IL-8 (27.7 vs. 16.9 pg/ml, p = 0.032), IL-10 (3.8 pg/mL vs. 1.8 pg/mL, p = 0.005) and ratios of neopterin to IL-12 (1.74 vs. 0.11, p < 0.001), and IL-10 to IL-12 (0.4 vs. 0.05, p < 0.001) than the non-infection group. After a subdivision of the study population into patients with local or advanced disease, the differences between the study groups remained statistically significant for CRP and neopterin both in local (p < 0.05 and p < 0.001) and advanced diasease (p < 0.01 and p < 0.001) and in advanced disease for PCT (p < 0.001), IL-10 (p < 0.05), IL-12 (p < 0.05), neopterin to IL-12 ratio (p < 0.01) and IL-10 to IL-12 ratio (p < 0.01). The ESR levels did not differ between the study group (50 vs. 42 p = 0.16), while the IL-12 values were lower in the infection group (10.6 pg/mL vs. 71.6 pg/mL, p = 0.007). The tumor load did not influence any of the studied infection markers within the study groups. For identifying bacteremia by area under the operating characteristics curves (AUC), the highest values were obtained for PCT (0.92) and neopterin (0.90), and slightly lower values were recorded for the ratios neopterin to IL-12 (0.79) and IL-10 to IL-12 (0.75). None of the markers or ratios were good for differentiating non-bacteremic infections from neoplastic fever, the AUC values rangin from 0.27 for ESR to 0.61 for IL-10 to IL-12 ratio. The simultaneous use of the ratio of neopterin to IL-12 with its high sensitivity (82%) and that of IL-10 to IL-12 with its high specificity (90%) should be further studied.

No description available.

Infections in patients with acute liver failure (ALF) and acute liver injury (ALI) are a frequent occurrence. Because ALF and ALI patients share many of the same clinical features as patients with severe sepsis and septic shock, identifying an infection based upon clinical manifestations is extremely difficult. Bacterial culture and sensitivity reports require 24 to 72 hours to be finalized after the need for a culture is suspected and obtained. During this time period, ALF and ALI patients are either not receiving required antibiotic therapy, receiving antibiotic therapy that is not required or not appropriate for the infecting bacterial pathogen, or receiving the correct antibiotic prophylaxis. Receiving an antibiotic that is not needed or inappropriate adds another level of complexity to the ALF and ALI patients because antibiotics may exacerbate liver dysfunction. The purpose of this study was to determine the utility of serum procalcitonin concentrations (SPCTC) as a biomarker of bacterial infections in patients with acute liver failure (ALF) and acute liver injury (ALI). This three part study measured SPCTC retrospectively on samples from ALF and ALI patients who were prospectively enrolled in the United States Acute Liver Failure Study Group (USALFSG) ALF and ALI studies. In the first part of the study, subjects were categorized according to how many SIRS continuum components they had and whether there was a documented infection. In the second part, serial samples on subjects who developed infections were identified. And, in the third part, serial samples on subjects diagnosed with infection on day one of the study and categorized based upon transplant free survival (TFS) or death and/or liver transplant (DoT) were identified. Procalcitonin was not found to be useful in identifying infection in the ALF and ALI patient populations. A cut-off for indication of infection was calculated to be 1.62 ng/mL using receiver operator curve (ROC) analysis. Despite the fact that there was an overall increase in SPCTC as the severity of illness increased in patients with a documented infection, there were confounding variables including antibiotic use, missing data, and small sample size that may have contributed to the poor sensitivity and specificity (0.643 and 0.620 respectively) calculated as part of the ROC analysis. SPCTC values appeared to be increased in subject with acetaminophen (APAP) toxicity and may have affected the cut-off, sensitivity, and specificity results. Increased SPCTC values were seen in APAP subjects who did not have a documented infection. It is unknown at this time if the SPCTC were increase due to liver damage, an undiagnosed infection, or as a result of increase cytokine production due to the APAP toxicity. Serial PCT concentrations in patients who achieved TFS showed a greater decrease over time than those of patients who died or received a liver transplant, however, the TFS group contained a large portion of APAP subjects. Further prospective studies are needed to determine the extent of interference with SPCTC in patients with APAP toxicity and to better define the PCT concentration cut-off between infection and no infection in the ALF and ALI populations.

Escherichia coli isoladas de infecções do trato urinário (ITU) são conhecidas como E. coli uropatogênicas (UPEC). Dentre as E. coli diarreiogênicas, o patótipo denominado E. coli enteroagregativa (EAEC) é definido pela produção do padrão de adesão agregativa em células epiteliais cultivadas. Estudos recentes mostraram que algumas cepas de UPEC albergam propriedades de virulência de EAEC, indicando que cepas de EAEC podem causar ITU. Assim sendo, o objetivo deste estudo foi analisar as relações filogenéticas entre cepas de EAEC que apresentam marcadores genéticos de E. coli extraintestinais (ExPEC) e cepas de UPEC com e sem marcadores genéticos de EAEC. Para tal, foram selecionadas 92 EAEC, 8 UPEC com e 10 sem marcadores de EAEC. As 92 EAEC foram analisadas quanto à presença dos genes considerados como marcadores de cepas de ExPEC (papA/papC, sfa/foc, afa/dra, iutA, kpsMT II), detectando 30 (32,6%) cepas com esse perfil. Estas 30 cepas foram selecionadas para análises de filogrupos e multilocus sequence type (MLST) junto às cepas de UPEC. Foi observado que 17 (54,4%) cepas de EAEC e 3 (16,6%) de UPEC pertenceram ao filogrupo A, 2 (6,45%) EAEC e 1 (5,5%) UPEC ao filogrupo B1, 3 (9,68%) EAEC e 8 (44,4%) UPEC ao filogrupo B2, 6 (19,35%) EAEC e 2 (11,1%) UPEC ao filogrupo D, 1 (3,2%) EAEC e 4 (22,2%) UPEC ao filogrupo E, 1 (3,2%) EAEC ao filogrupo F e 1 EAEC (3,2%) não pôde ser classificada de acordo com esta metodologia. Comparando os dois grupos de UPEC notou-se que dentre as cepas com marcadores de EAEC 3 (37,5%) pertenceram ao filogrupo E, 2 (25%) aos filogrupos A e D e 1 (12,5%) ao filogrupo B1. Dentre as cepas sem marcadores de EAEC 1 (10%) pertenceu ao filogrupo A, 1 (10%) ao filogrupo E e 8 (80%) ao filogrupo B2. As análises de MLST através do sequenciamento dos genes recA, fumC, icd, mdh, purA, adk e gyrB permitiram determinar 42 sequence types (ST) distintos, dos quais 22 foram descritos neste estudo. Os mais comuns foram o ST 10 (5 cepas) e ST 95 e ST 746 (ambos com 2 cepas cada). A árvore filogenética gerada confirmou esses dados, mostrando o grupamento das cepas de EAEC com marcadores de ExPEC com as cepas de UPEC com marcadores de EAEC. Em resumo, o presente estudo mostrou que um subgrupo de cepas de EAEC está inserido nos mesmos grupos filogenéticos de cepas de UPEC com marcadores de EAEC apresentando, portanto, correlação filogenética. Houve diferenças de distribuição filogenética entre cepas de UPEC com e sem marcador de EAEC. Concui-se que cepas de EAEC podem apresentar potencial uropatogênico, tanto no curso de uma infecção diarreica, quanto em carreadores assintomáticos. / Escherichia coli isolated from urinary tract infections (UTI) are known as uropathogenic E. coli (UPEC). Among the diarrheagenic E. coli, the enteroaggregative E. coli (EAEC) pathotype is defined by the production of the aggregative adherence on cultured epithelial cells. Recent studies have shown that some UPEC strains harbor virulence properties of EAEC, indicating that EAEC strains can cause UTI. Therefore, the aim of this study was to analyze the phylogenetic relationships among EAEC strains that have genetic markers of extraintestinal E. coli (ExPEC) and UPEC strains, with and without genetic markers of EAEC. For that reason, we selected 92 EAEC, 8 UPEC with and 10 without EAEC markers. The 92 EAEC were analyzed for the presence of genes considered as markers for ExPEC strains (papA/papC, sfa/foc, afa/dra, iutA, kpsMT II), detecting 30 (32.6%) strains with that profile. These 30 strains were selected for phylogroup and multilocus sequence type (MLST) analysis with the UPEC strains. It was observed that 17 (54.4%) EAEC and 3 (16.6%) UPEC belonged to the phylogroup A, 2 (6.45%) EAEC and 1 (5.5%) UPEC to the phylogroup B1, 3 (9.68%) EAEC and 8 (44.4%) UPEC to the phylogroup B2, 6 (19.35%) EAEC and 2 (11.1%) UPEC to the phylogroup D, 1 (3.2%) EAEC and 4 (22.2%) UPEC to the phylogroup E, 1 (3.2%) EAEC to the phylogroup F and 1 (3.2%) EAEC could not be classified according to this methodology. Comparing the two groups of UPEC it was observed that among the UPEC strains with EAEC markers, 3 (37.5%) belonged to the phylogroup E, 2 (25%) to the phylogroups A and D and 1 (12.5%) to the phylogroup B1. Among the UPEC strains without EAEC markers, 1 (10%) belonged to the phylogroup A, 1 (10%) to the phylogroup E and 8 (80%) to the phylogroup B2. The MLST analysis by sequencing of recA, fumC, icd, mdh, purA, adk and gyrB genes allowed to determine 42 distinct sequence types (ST), of whom, 22 were described in this study. The most common were ST 10 (5 strains), and ST 95 and ST 746 (both with two strains each). The phylogenetic tree generated confirmed that data, showing the clustering of EAEC strains (harboring ExPEC markers) with the UPEC strains (harboring EAEC markers). In summary, the current study showed that a subgroup of EAEC strains are clustered in the same phylogenetic groups of UPEC strains with EAEC markers and, thus, present phylogenetic correlation. Also, there were differences in phylogenetic distribution among UPEC strains with and without EAEC markers. In conclusion, EAEC strains may have uropathogenic potential, either in the course of a diarrheal infection or in asymptomatic carriers.

Dental caries is a multifactorial, bacterial, chronic infection that affects millions of people in the world and has become a public health problem. Also referred to as tooth decay, this disease is one of the most common disorders throughout the world, second only to the common cold. Dental caries is the most common chronic childhood disease in the United States and is 5 to 7 times more common than asthma. According to the World Oral Health Report in 2003, dental caries affect 60-80% of school children and a vast majority of adults. Dental caries is a chronic bacterial infection of the hard tissue of the tooth that is characterized by alternating phases of demineralization and remineralization. Dental decay can lead to significant pain and dysfunction that can interfere with basic functions such as eating, sleeping, and speaking. If left untreated, dental caries can result in cavities forming and eventually tooth loss. Although the prevalence and severity of dental caries has decreased over the years, this disease can be better controlled with proper fluoride exposure. Fluoride therapy has become the cornerstone strategy in the prevention of dental caries development and progression. With fluoride being available in various forms, fluoride exposure and/or treatment has greatly increased and has led to decreased incidences of dental caries. Fluoride has the ability to control the initiation and progression of carious lesions, mainly through the promotion of remineralization and the reduction in tooth enamel demineralization. Whether administered systemically or topically, the use of fluoride has proven to be effective in reducing the prevalence of dental caries. The aim of this review is to compare the topical methods of fluoride therapy with systemic applications. The goal is to evaluate the various forms of fluoride treatments based on cost effectiveness, safety, concentration and dosage of fluoride, ease of application, and accessibility to the community. This review will also identify the populations that are most susceptible to dental caries. The purpose of this review is to examine the benefits and risks of the various options of fluoride treatments in order to determine which would be the most the effective, safe, and efficient means of preventing dental caries in high risk populations. Based on the literature review, it was determined that the populations with the greatest risk for dental caries comprised of young children who were from lower socioeconomic backgrounds and elderly adults over the age of 65. After comparing the various forms of fluoride therapies, it was found that systemic fluoride treatments, mainly water fluoridation, would be the most effective in preventing dental caries in high caries risk populations.