Indiana University-Purdue University Indianapolis (IUPUI) / Periodontal disease is the leading cause of tooth loss in adults. Bacterial biofilm on tooth surfaces is the primary initiator of periodontal disease. Various factors contribute to the severity of periodontal disease including the different virulence factors of the bacteria within the biofilm. In the progression of periodontal disease, the microflora evolves from a predominantly Gram positive microbial population to a mainly Gram negative population. Specific gram negative bacteria with pronounced virulence factors have been implicated in the etiology and pathogenesis of periodontal disease, namely Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola which form the red complex of bacteria. The orange complex bacteria become more dominant in the maturation process of dental plaque and act to bridge the early colonizers of plaque with the later more dominant red complex bacterial and consists of such bacteria as Campylobacter showae, Campylobacter rectus, Fusobacterium nucleatum and Prevotella intermedia. Perhaps the most investigated contributing factor is the relationship between smoking and periodontal disease. When examining the association between cigarette smoking and interproximal bone loss, greater bone loss is associated with higher cigarette consumption, longer duration (i.e., pack year history) and higher lifetime exposure. The presence of various virulence factors such as the production of a capsular material, as well as the proteolytic activity of the various periopathodontic bacteria has been associated with the pathogenesis of periodontitis. Even though many different enzymes are produced in large quantities by these periodontal bacteria, trypsin-like enzymes, chymotrypsin-like enzymes and elastase-like enzymes, as well as dipeptidyl peptidase-like enzymes, have been thought to increase the destructive potential of the bacterium and mediate destruction of the periodontal apparatus. More specifically, it is hypothesized that the proteolytic activity of other clinically important periodontal pathogens, such as Fusobacterium nucleatum, Prevotella intermedia and Porphyromonas assacharolyticus, is increased in the presence of nicotine. The purpose of this study was to determine the effects of nicotine on F. nucleatum, P. intermedia and P. assacharolyticus proteolytic activity. Cultures were maintained on anaerobic blood agar plates containing 3% sheep blood. Bacterial cells were harvested from the plates and washed. Washed F. nucleatum, P. intermedia and P. assacharolyticus cells were incubated with 1 mg/ml of nicotine. Bacterial cells not incubated with nicotine were used as positive controls. Secreted enzymatic activity was measured using the synthetic chromogenic substrates glycyl-L-proline-p-nitroanilide (GPPNA), N-succinyl-L-alanyl-L-alanyl-L-alanyl-p-nitroanilide (SAAAPNA), N-succinyl-alanine-alanine-proline-phenylalanine-p-nitroanilide (SAAPPPNA) and N-α-benzoyl-L-arginine-p-nitroanilide (L-BAPNA) (Sigma-Aldrich Products, St. Louis, MO, USA). Appropriate means and standard deviations were determined for each of the enzymatic activities measured and analysis of variance (ANOVA) was used to compare the groups utilizing a 5% significance level for all comparisons. Results demonstrated that after 60 minutes of incubation of F. nucleatum, P. intermedia and P. assacharolyticus cells with 1 mg/ml of nicotine and the various synthetic substrates, had the following proteolytic activity for GPPNA: 0.83 ± 0.14, 0.72 ± 0.03 and 0.67 ± 0.10, respectively; SAAAPNA: 0.82 ± 0.06, 0.76 ± 0.05 and 0.68 ± 0.08, respectively; SAAPPPNA: 0.90 ± 0.13, 0.85 ± 0.17 and 0.72 ± 0.03, respectively; and BAPNA: 0.81 ± 0.15, 0.74 ± 0.13 and 0.74 ± 0.16, respectively. In conclusion, the results indicate that in the presence of 1 mg/ml of nicotine, the proteolytic activity of F. nucleatum and P. assacharolyticus was increased with all of the synthetic substrates (with statistical significance seen only in the increases with F. nucleatum and GPPNA, SAAAPNA and BAPNA). The proteolytic activity exhibited an increasing trend in activity for P. intermedia with SAAPPPNA and BAPNA but a decreasing trend in activity with GPPNA and SAAAPNA when incubated with 1 mg/ml of nicotine, once again demonstrating no statistical significance for any of the substrates. Therefore, it could be concluded that based on these results nicotine at a concentration of 1 mg/ml may increase the proteolytic activity of periodontal pathogens and thus may increase periodontal disease activity and subsequent periodontal breakdown. Further studies are needed to validate these results utilizing different concentrations of nicotine.

Opportunistic bacterial pathogens are present in the intestines of all mammals. These bacteria are symbionts to a certain extent, but under certain conditions these organisms can be deadly. Intestinal opportunistic pathogens encompass many genera and include organisms such as those in the Bacteroides fragilis group (i.e. B. fragilis and B. thetaiotaomicron), Escherichia coli, and Clostridium perfringens, resulting in an array of diseases and serious health risks. Typically these diseases affect individuals in poor or weakened health (elderly, immuno-compromised, neonates, etc.) but can affect healthy individuals as well. The intestinal tract is the main area of infection for these bacteria, however some of these organisms can be involved in wound infections, septicemia, urinary tract infections, and meningitis. This study focused on three areas: 1) Analysis of differences in gene expression between Bacteroides and Escherichia coli, in order to learn more about promoter structure, 2) Establishment of a diabetic mouse model for use in examining bacterial synergy during a polymicrobial infection, and 3) Characterization of Escherichia coli 360A and evaluation of the role of several virulence factors and environmental modulators in the pathogenesis of this strain. We used a newly developed lux gene reporter to evaluate gene expression in Bacteroides. We observed that there are barriers in both transcription and translation initiation that appear to limit the expression of foreign genes in Bacteroides. We were able to establish a mouse model for studying synergy during a polymicrobial infection and observed that E. coli 360A provided synergy towards B. fragilis NCTC 9343. These experiments also showed that the longer a mouse is afflicted with the complications of diabetes the more susceptible it is to polymicrobial infections. Systemic infections were used to evaluate the contribution of several virulence factors and environmental modulators in the pathogenesis of E. coli 360A. The results showed that a strain lacking both virulence factors CNF1 and HlyA, the terminal oxidase cytochrome o, or a double cyo/cyd mutant were, deficient in survival in the spleen, but not the liver of BALB/c mice. / Ph. D.

The quality of marine bathing water is currently assessed by monitoring the levels of faecal indicator bacteria. Among other drawbacks, results are retrospective using the traditional culture based methods. A rapid method is thus needed as an early warning to bathers for bacterial contamination in marine bathing waters. Total lipopolysaccharide (LPS) was chosen here as a potential general biomarker for bacterial contamination. Levels of total LPS, measured using a Kinetic QCL™ Limulus Amebocyte Lysate (LAL) assay, highly correlated with enumerated Escherichia coli and Bacteroides species. Levels of LPS in excess of 50 EU mL-1 were found to equate with water that was unsuitable for bathing under the current European Union regulations. Results showed that monitoring the levels of total LPS has a potential applicability as a rapid method for screening the quality of marine bathing water. More importantly, the LAL assay overcome the retrospective results when using culture based assessment since the LAL assay takes less than 30 minutes. Although false positive events were not detected, the occurrence of a false positive has been hypothesised, hence a more specific faecal biomarker was also investigated. LPS of five Bacteroides species (B. fragilis, B. caccae, B. ovatus, B. xylanisolvens and B. finegoldii) isolated from marine bathing waters samples were successfully profiled and showed high similarity between isolates in LPS gel electrophoresis banding pattern. Similar results were shown when investigating the endotoxic activity of Bacteroides species with the Kinetic QCL™ LAL assay. The potential biological relevance of Bacteroides LPS was also investigated in cell culture models indicating that Bacteroides showed similar induction of proinflammatory cytokines (TNF-α, IL-6 and IL-1α) and generally the biological activity was approximately 100 fold less than E. coli LPS. In addition, an ELISA assay was designed for the detection of Bacteroides LPS. Results showed that the Bacteroides LPS has a high potential to be used as a faecal biomarker, however, further work is required to develop a fully functional assay. The potential biological relevance of LPS present in contaminated bathing waters was also investigated in cell culture models. Results showed that there is a significant difference in the production of proinflammatory cytokines in comparison to “clean” bathing waters. Thus, results suggest that the European Directive regulations should be extended to cover the levels of total LPS in bathing waters to assure safety to the users of marine recreational water.

Em nosso estudo foi avaliada a presença das bactérias do grupo Bacteroides fragilis em 108 amostras fecais de bezerros com e sem diarréia, além de fatores de virulência e a similaridade genética entre as cepas de B. fragilis. Hemolisinas foram observadas em 36,3% e em 83,7% dos bezerros com e sem diarréia, respectivamente. Apenas 7,4% dos isolados foram hemaglutinantes. De todos os isolados, grande parte resistiu à ação do soro e 100% foram sensíveis ao imipenem e metronidazol. Houve resistência aos metais pesados utilizados. Plasmídios foram detectados em 7,4% dos isolados. Dentre 58,8% produtores de ß-lactamase, em 19,7% e em 26,0% de bezerros com e sem diarréia, respectivamente detectou-se o gene cepA, que foi observado também em plasmídios de 5,5 kb. O gene cfiA foi observado em 16,5% dos isolados diarréicos e em 12,6% de não diarréicos, mas não em plasmídios. O gene nanH foi detectado em 21,8% dos isolados e o gene bft somente em dois isolados diarréicos. A similaridadade genética entre os B. fragilis mostrou a heterogeneidade das bactérias. / In this study the bacteria of Bacteroides fragilis group was evaluated in 108 fecal samples of calves with and without diarrhea, besides virulence factors and the genetic similarity among the B. fragilis strains. Hemolysin was observed in 36.3% and in 83.7% of calves with and without diarrhea, respectively. Only 7.4% of the isolates showed hemagglutinability. Of all the isolates, the major part resisted to the action of the serum and 100% were sensitive to the imipenem and metronidazole. There was resistance to the used heavy metals. Plasmids were detected in 7.4% isolates. Among 58.8% ß- lactamase producing, 19.7% and 26.0% strains of calves with and without diarrhea, respectively the cepA gene was detected, that was also observed in 5.5 kb plasmids. The cfiA gene was observed in 16.5% of the diarrheic isolates and 12.6% of non-diarrheic, but not in plasmids. The nanH gene was detected in 21.8% of the isolates and the bft gene only in two diarrheic isolates. The genetic similarity among the B. fragilis showed the heterogeneity of the bacteria.

Atopic allergy is the most common chronic disease among children in the developed world. This high prevalence could be associated with low microbial exposure. The early gut microbiota appears to be important for immune maturation. Immunomodulatory components in human milk might differ between mothers and could therefore explain the contradictory results seen regarding breastfeeding and allergy development. The aim of this thesis was to investigate whether early colonization with certain gut microbiota species influences childhood immune responses and allergy development up to age five. Also, as human milk oligosaccharides (HMOs) might stimulate the growth of certain gut microbiota species, the consumption of neutral colostrum HMOs was investigated for their role in allergy development up to 18 months. The concentrations of neutral colostrum HMOs varied considerably between women; however this variation could not be explained by their allergic status. Neither was the consumption of neutral colostrum HMOs related to allergy development in their children up to 18 months. Infants who harboured lactobacilli group I and Bifidobacterium adolescentis one week after birth developed allergic disease less frequently during their first five years than infants who did not harbour these bacteria at the same time. Also, colonization with several Bifidobacterium species was associated with higher levels of house dust endotoxin and larger family size. The early Bifidobacterium flora influenced levels of salivary secretory IgA at six and 12 months but not during later childhood. Moreover, the intensity of early Bacteroides fragilis colonization was inversely associated with spontaneous Toll-like receptor 4 mRNA expression in peripheral blood cells collected 12 months after birth. In conclusion, these results indicate that the early infant gut microbiota influences systemic and mucosal immune maturation during infancy, and that it might be altered in infants developing allergic disease.

Em nosso estudo foi avaliada a presença das bactérias do grupo Bacteroides fragilis em 108 amostras fecais de bezerros com e sem diarréia, além de fatores de virulência e a similaridade genética entre as cepas de B. fragilis. Hemolisinas foram observadas em 36,3% e em 83,7% dos bezerros com e sem diarréia, respectivamente. Apenas 7,4% dos isolados foram hemaglutinantes. De todos os isolados, grande parte resistiu à ação do soro e 100% foram sensíveis ao imipenem e metronidazol. Houve resistência aos metais pesados utilizados. Plasmídios foram detectados em 7,4% dos isolados. Dentre 58,8% produtores de ß-lactamase, em 19,7% e em 26,0% de bezerros com e sem diarréia, respectivamente detectou-se o gene cepA, que foi observado também em plasmídios de 5,5 kb. O gene cfiA foi observado em 16,5% dos isolados diarréicos e em 12,6% de não diarréicos, mas não em plasmídios. O gene nanH foi detectado em 21,8% dos isolados e o gene bft somente em dois isolados diarréicos. A similaridadade genética entre os B. fragilis mostrou a heterogeneidade das bactérias. / In this study the bacteria of Bacteroides fragilis group was evaluated in 108 fecal samples of calves with and without diarrhea, besides virulence factors and the genetic similarity among the B. fragilis strains. Hemolysin was observed in 36.3% and in 83.7% of calves with and without diarrhea, respectively. Only 7.4% of the isolates showed hemagglutinability. Of all the isolates, the major part resisted to the action of the serum and 100% were sensitive to the imipenem and metronidazole. There was resistance to the used heavy metals. Plasmids were detected in 7.4% isolates. Among 58.8% ß- lactamase producing, 19.7% and 26.0% strains of calves with and without diarrhea, respectively the cepA gene was detected, that was also observed in 5.5 kb plasmids. The cfiA gene was observed in 16.5% of the diarrheic isolates and 12.6% of non-diarrheic, but not in plasmids. The nanH gene was detected in 21.8% of the isolates and the bft gene only in two diarrheic isolates. The genetic similarity among the B. fragilis showed the heterogeneity of the bacteria.

[ES] La obesidad es uno de los principales problemas de salud pública debido a su elevada prevalencia y a las comorbilidades asociadas, lo que se traduce en una reducción considerable de la calidad y esperanza de vida, además de un enorme gasto económico. Su origen es multifactorial y el desarrollo de terapias efectivas para combatirla resulta complejo. La microbiota intestinal ejerce un papel relevante en el mantenimiento del balance energético y salud metabólica. Por ello, las estrategias basadas en la modificación de la microbiota intestinal son consideradas potenciales alternativas para el manejo clínico de la obesidad. No obstante, se requiere un mayor conocimiento sobre cuáles son las especies bacterianas clave en el mantenimiento de la homeostasis energética del hospedador y su modo de acción. El objetivo general de la tesis ha sido identificar nuevas estrategias basadas en la manipulación de la composición y funciones de la microbiota intestinal eficaces contra la obesidad, así como sus mecanismos de interacción con el hospedador. El capítulo primero de la tesis se centra en estudiar los mecanismos de acción por los que Bacteroides uniformis CECT 7771 ejerce efectos protectores frente al desarrollo de la obesidad, tal y como nuestro grupo ha descrito en trabajos previos. A través de un estudio en ratones con obesidad inducida por la dieta hemos demostrado que esta cepa reduce la disfunción metabólica a través de la modulación de la microbiota intestinal y las alteraciones inmunológicas en el intestino y el tejido adiposo asociados a la obesidad. Todos los efectos sobre el eje intestino-tejido adiposo parecen estar mediados por la activación de TLR5. Además, hemos desarrollado una estrategia similar a un simbiótico con el fin de incrementar la eficacia de esta bacteria administrándola a dosis menores. La formulación simbiótica se diseñó en base a la preferencia de B. uniformis CECT 7771 por el salvado de trigo (WBE) como fuente de carbono en cultivos in vitro. La administración conjunta de la bacteria y WBE mostró beneficios inmuno-metabólicos al reducir el aumento de peso corporal y la adiposidad, al tiempo que mejoraron las rutas del metabolismo energético moduladas por insulina y la homeostasis inmunológica intestinal. Además, reforzó la primera línea de defensa inmunológica al aumentar los niveles de butirato y restaurar los niveles de IEL inducidos y las ILC3. En el segundo capítulo hemos llevado a cabo dos estudios preclínicos que describen los efectos de dos nuevas bacterias autóctonas del tracto gastrointestinal humano como potenciales probióticos para el tratamiento de la obesidad identificadas por el grupo. El primer estudio, la administración de Holdemanella biformis CECT 9752 a ratones con obesidad inducida por la dieta redujo los niveles de glucosa en ayuno y mejoró la tolerancia oral a la glucosa de forma independiente a la insulina. A nivel del contenido luminal del intestino grueso, la bacteria incrementó los niveles de ácidos grasos insaturados, potenciales secretagogos lipídicos de GLP-1. A nivel del intestino delgado, incrementó la sensibilidad a GLP-1 de las neuronas vagales aferentes, mecanismo implicado en la producción endógena de glucosa. A nivel hepático, la suplementación con la bacteria redujo la gluconeogénesis y mejoró la sensibilidad a insulina. En el segundo estudio hemos evaluado los efectos inmuno-metabólicos de Phascolarctobacterium faecium DSM 32890, consumidora de succinato y productora de propionato en un modelo animal de obesidad. La administración redujo el aumento de peso corporal y la ingesta de alimentos y mejoró la tolerancia oral a la glucosa. Estos beneficios se asociaron a un aumento sostenido de la hormona intestinal anorexigénica PYY en plasma y una prevención de la hipersecreción de GIP inducida por la dieta rica en grasa. Además, la bacteria normalizó la inmunidad intestinal alterada en la obesidad, y mejoró / [CA] L'obesitat és un dels principals problemas de salut pública a causa de la seua elevada prevalença i a les comorbilitats associades, la qual cosa es tradueix en una reducció considerable de la qualitat i de l'esperança de vida, a més d'una enorme despesa econòmica. El seu origen es multifactorial i el desenvolupament de teràpies efectives per combatre-les resulta complex. La microbiota intestinal exerceix un paper rellevant en el manteniment del balanç energètic i salut metabòlica. Per això, les estrategias basades en la modificació de la microbiota intestinal son considerades hui en dia potencials alternatives per al maneig clínic de l'obesitat. No obstant això, es requereix d'un major coneixement sobre quines son les espècies bacterianes claus al manteniment de l'homeòstasi energètica de l'hoste i la seua manera d'acció. L'objectiu general de la tesi ha sigut identificar noves estratègies basades en la manipulació de la composició i funcions de la microbiota intestinal eficaces contra l'obesitat, així com els seus mecanismes d'interacció amb l'hoste. El capítol primer de la tesi es centra en estudiar els mecanismes d'acció pels quals Bacteroides uniformis CECT 7771 exerceix efectes protectors enfront del desenvolupament de l'obesitat, tal com el nostre grup ha descrit previament. A través d'un estudi en ratolins amb obesitat induïda per la dieta hem demostrat que aquesta soca redueix la disfunció metabòlica a través de la modulació de la microbiota intestinal i les alteracions immunològiques en l'intestí i al teixit adipos epididimal associats a l'obesitat. Tots els efectes sobre l'eix intestí-teixit adipós semblen estar mediades per l'activació de TLR5. A més, hem desenvolupat una estrategia similar a un simbiòtic amb la finalitat d'incrementar l'eficàcia d'aquest bacteri administrant-la a dosis menors. La fomulació simbiòtica es va dissenyar basant-se en la preferència de B. uniformis CECT 7771 pel segó del blat (WBE) com a font de carboni en cultius in vitro. L'administració conjunta de la bacteria i WBE va mostrar beneficis immuno-metabòlics al reduir l'augment de pes corporal i l'adipositat, al mateix temps que van millorar les rutes del metabolisme energètic modulades per insulina i la homeòstasi immunològica intestinal. A més, va reforçar la primera línia de defensa immunològica augmentant els nivells de butirat i restaurant els nivells de IEL induïts i de ILC3. Al segon capítol de la tesi hem dut a terme dos estudis preclínics que descriuen els efectes de dos nous bacteris autòctones del tracte gastrointestinal humà com a potencials probiòtics per al tractament de l'obesitat identificades amb posterioritat pel grup. El primer estudi, l'administració de Holdemanella biformis CECT 9752 a un model animal d'obesitat va reduir els nivells de glucosa en dejú i va millorar la tolerància oral a la glucosa de manera independent a la insulina. A nivell del contingut luminal de l'intestí gros, el bacteri va incrementar els nivells d'àcids grassos insaturats, potencials secretagogos lipídics de GLP-1. A nivell de l'intestí prim, va incrementar la sensibilitat a GLP-1 de les neurones vagals aferents, mecanisme implicat en la producció endògena de glucosa. A nivell hepàtic, la suplementació amb el bacteri va reduir la gluconeogènesi i va millorar la sensibilitat a insulina. En el segon estudi hem avaluat els efectes immuno-metabòlics de Phascolarctobacterium faecium DSM 32890, consumidora de succinat i productora de propionat a un model animal d'obesitat. L'administració va reduir l'augment de pes corporal i l'ingesta d'aliments i va millorar la tolerància oral a la glucosa. Aquests beneficis es van associar a un augment sostingut de l'hormona intestinal anorexigénica PYY en plasma i la prevenció de la hipersecreció de GIP induïda per la dieta rica en greix. A més, el bacteri va normalitzar la immunitat intestinal alterada en l'obesitat i va millorar / [EN] Obesity is one of the main public health problems due to its high prevalence and associated comorbidities, which results in a considerable reduction of the health-related quality of life and life expectancy, as well as in an overwhelming cost to global health economies. It has a multifactorial origin and the development of effective therapies is complex and has become one of the main challenges for society. The gut microbiota plays an important role in the maintenance of energy balance and metabolic health. Therefore, strategies based on gut microbiota modification to beneficially modulate energy metabolism are nowadays considered potential alternatives for the clinical management of obesity. However, the effective implementation of these strategies requires the identification of key bacterial species for the maintenance of host energy homeostasis as well as the better understanding of which mechanisms are behind of their effects. The general objective of this doctoral thesis has been to identify new and effective strategies against obesity based on the manipulation of the gut microbiota composition and function, as well as their mechanisms of interaction with the host. The first chapter of the thesis focuses on studying the mechanisms of action by which Bacteroides uniformis CECT 7771 induces protective effects against the onset of obesity, based on previous studies of our group. An intervention conducted in diet-induced obese mice, we have demonstrated that this strain reduces metabolic dysfunction through the modulation of the intestinal microbiota and immune players obesity associated in both intestine and epididymal white adipose tissue. All the effects on the gut-adipose tissue axis appear to be mediated by TLR5 activation. Moreover, we have developed a symbiotic strategy with the aim of increasing the B. uniformis anti-obesity efficacy at lower doses. The symbiotic formulation was designed based on the preference of B. uniformis CECT 7771 for wheat bran (WBE) as a carbon source in in vitro cultures. The co-administration of the bacteria and WBE showed immuno-metabolic benefits reducing body weight gain and adiposity, along with improving insulin-modulated energy metabolism pathways and intestinal immune homeostasis. In addition, It strengthened the first line of immune defence by increasing butyrate levels and restoring levels of induced IEL and ILC3. In the second chapter of the thesis we have carried out two pre-clinical studies describing the effects of two new autochthonous bacteria of the human gastrointestinal tract as potential probiotics for the treatment of obesity identified later by the group. The first study, the administration of Holdemanella biformis CECT 9752 in an animal model obesity reduced fasting glucose levels and improved oral glucose tolerance in an insulin-independent manner. In the luminal content of the large intestine, the bacteria increased the abundance of unsaturated fatty acids, potential GLP-1 secretagogues. In the small intestine, it could directly increase the GLP-1 sensitivity of vagal afferent neurons, a mechanism involved in hepatic endogenous glucose production. At the hepatic level, the supplementation with the bacteria reduced gluconeogenesis and improved insulin sensitivity. In the second study we have evaluated the immuno-metabolic effects of Phascolarctobacterium faecium DSM 32890 succinate consumer and propionate producer in an animal model of diet-induced obesity. The bacteria reduced body weight gain and food intake and improved oral glucose tolerance. These benefits were associated with a sustained increase in plasma of the anorexigenic gut hormone PYY and a prevention of high-fat diet-induced GIP hypersecretion. In addition, the bacteria normalized the impaired intestinal immunity in obesity and improved intestinal barrier integrity. / This study received funding from the European Union Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No. 797297 (M.R-P) and from the European Union 7th Framework program under the grant agreement no 613979 (MyNewGut) and grant AGL2017-88801-P from the Spanish Ministry of Economy and Competitiveness (MCIU, Spain). The Santiago Grisolía scholarship (GRISOLIAP/2014/110) to E.F from Generalitat Valenciana and the FPI scholarship (BES-2015-073930) of I López-Almela and the PTA contract (PTA2013-8836-I) of I. Campillo from MCIU are fully acknowledged. / López Almela, I. (2021). Descifrando las funciones de la microbiota intestinal en la obesidad [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/174897

INTRODUÇÃO: As infecções por bactérias anaeróbias são geralmente de origem endógena, polimicrobianas e mistas. Devido a sua natureza fastidiosa, essas bactérias necessitam de uma prévia incubação em meios líquidos enriquecidos, como o caldo Thioglicolato (CT) para serem recuperadas, o isolamento desses microrganismos é trabalhoso e o tempo de resposta - TAT (turn around time) estendido desse exame pode estar associado a falhas terapêuticas e ao aumento da resistência bacteriana. A cultura de anaeróbios (CANA) ainda é um desafio para os laboratórios clínicos de rotina e novas estratégias para diminuir o TAT são fundamentais para que esse exame forneça um impacto clínico significativo. OBJETIVO: Otimizar o processo de triagem da CANA pela modificação do CT; comparar a identificação dos anaeróbios pelas metodologias fenotípicas ANC (Vitek 2- bioMérieux, France) e MALDI-TOF (Vitek MS - bioMérieux, France) e verificar o impacto econômico das ações propostas MÉTODOS: O caldo de triagem CT foi modificado eluindo individualmente discos comerciais de antibióticos (em concentrações fixas) selecionados por apresentarem baixa ou nenhuma ação contra microrganismos anaeróbios e com um bom espectro de ação para os principais aeróbios associados em culturas mistas e foram escolhidos aqueles que após uma bateria de testes frente a 15 cepas dos principais anaeróbios envolvidos em infecções humanas mantiveram a viabilidade inicial. O caldo Thioglicolato modificado (CTM) foi composto pela adição dos antibióticos que apresentaram a melhor \"performance\" acima descrita. A sensibilidade e especificidade do CTM foram avaliadas paralelamente com CT na rotina de CANA do HCFMUSP. Para a avaliar a identificação fenotípica, 421 anaeróbios isolados no período de seis meses foram submetidos a identificação pelo ANC (Vitek 2) e MALDI-TOF (Vitek MS). Os resultados discordantes ou com baixa discriminação da espécie foram avaliados pelo sequenciamento 16S rRNA. O impacto econômico da introdução do CTM bem como os custos diretos da identificação pelo MALDI-TOF foram avaliados. RESULTADOS: O CTM foi composto por amicacina, gentamicina e aztreonam. Das 159 amostras clínicas triadas pelo CT e CTM, 11 (7%) foram positivas para CANA com as mesmas espécies isoladas em ambos os meios. Utilizando o CTM, foi obtida uma redução dos falsos positivos de 97 (61%) para 69 (43%) quando comparado ao CT (p < 0,05). O TAT do resultado negativo da CANA com o CTM foi reduzido de 14 para sete dias em 28 (18%) amostras; o CTM permitiu a liberação do resultado positivo da CANA 48 horas à frente do CT. A sensibilidade do CTM foi igual ao CT, porém a especificidade foi superior em 19%. Das 421 cepas avaliadas, 35 foram identificadas somente pelo MALDI-TOF (Vitek MS) sendo que uma (Clostridium innocum) foi identificada somente pelo sequenciamento 16S rRNA. Das 386 avaliadas por ambas as metodologias, houve uma concordância de 97% e os resultados das 13 (3%) cepas submetidas ao sequenciamento foram concordantes em 92% com o MALDI-TOF (Vitek MS) que promoveu a redução do TAT do resultado positivo em cinco dias. A implementação do CTM possibilitou uma redução de custos nessa amostragem, de R$ 2.240,00 e a identificação pelo MALDI-TOF proporcionou uma economia de R$ 7.786,00. Considerando os valores econômicos encontrados nesse estudo e projetando-os nas estatísticas de CANA do HCFMUSP em 2017, o CTM poderia proporcionar uma economia de R$ 132.560,00 /ano e o MALDI-TOF uma redução nos gastos de R$ 13.579,00/ ano CONCLUSÕES: A padronização e implementação do CTM permitiu uma um aumento significativo de especificidade da cultura anaeróbia com redução do TAT e dos custos. A utilização do MALDI-TOF diminuiu o TAT das identificações aliado a uma melhor performance de forma custo efetiva / INTRODUCTION: Anaerobic bacterial infections are usually of endogenous origin, polymicrobial and mixed. Because of their fastidious nature, these bacteria require prior incubation in enriched liquid media, such as Thioglycolate broth (TB) to be recovered, the isolation of these microorganisms is laborious, and the TAT (turn around time) extended time of this examination may be associated with therapeutic failures and increased bacterial resistance. Anaerobic culture (AC) is still a challenge for routine clinical laboratories, and new strategies for lowering TAT are critical to provide a significant clinical impact. OBJECTIVE: To optimize the AC screening process by modifying the TB; Compare anaerobical identification between (Vitek 2- bioMérieux, France) and MALDI-TOF (Vitek MS - bioMérieux, France) and to verify the economic impact of the proposed actions. METHODS: TB broth was modified by eluting individually antibiotic commercial discs (at fixed concentrations) selected for low or no action against anaerobic microorganisms and with a good action spectrum for the main associated aerobes in mixed cultures. Those who maintained the initial viability after a battery of tests against 15 strains of the major anaerobes involved in human infections were selected. Modified Thioglycolate Broth (MTB) was composed of the antibiotics that presented the best performance described above. The sensitivity and specificity of MTB were evaluated in parallel with TB in the HCFMUSP AC routine. To evaluate the phenotypic identification, 421 anaerobes isolated in the six-month period were submitted to identification by ANC (Vitek 2) and MALDI-TOF (Vitek MS). Discordant results or those with low discrimination of the species were submitted to 16S rRNA sequencing. The economic impact of the introduction of MTB as well as the direct costs of MALDI-TOF identification were assessed. RESULTS: MTB was composed of amikacin, gentamicin and aztreonam. Of the 159 clinical samples screened by TB and MTB, 11 (7%) were positive for AC with the same species isolated in both media. Using MTB, a reduction of false positives was obtained from 97 (61%) to 69 (43%) when compared to TB (p < 0.05). The TAT of the negative result of the AC with the MTB was reduced from 14 to 7 days in 28 (18%) samples; the MTB allowed the release of the AC positive result 48 hours ahead of the TB. The sensitivity of MTB was equal to TB, but the specificity was higher in 19%. Of the 421 strains evaluated, 35 were identified only by MALDI-TOF (Vitek MS) and one (Clostridium innocum) was identified only by 16S rRNA sequencing. Of the 386 evaluated by both methodologies, there was a concordance of 97% and the results of the 13 (3%) strains submitted to the sequencing were concordant in 92% with the MALDI-TOF (Vitek MS) that promoted TAT of the positive result reduction in five days. The implementation of the MTB made possible a reduction of costs in this sampling, of US $ 677,00 and the identification by MALDI-TOF provided a saving of US $ 2354,00. Considering the economic values found in this study and projecting them in the HCFMUSP AC statistics in 2017, the MTB could provide savings of US $40,070.00 / year and MALDI-TOF a reduction in expenses of US $ 4,100.00 / year. CONCLUSIONS: Standardization and implementation of MTB allowed a significant increase of anaerobic culture specificity with TAT and costs reduction. The use of MALDI-TOF reduced the TAT of the identifications and also resulted in a better performance in a cost effective way

INTRODUÇÃO: As infecções por bactérias anaeróbias são geralmente de origem endógena, polimicrobianas e mistas. Devido a sua natureza fastidiosa, essas bactérias necessitam de uma prévia incubação em meios líquidos enriquecidos, como o caldo Thioglicolato (CT) para serem recuperadas, o isolamento desses microrganismos é trabalhoso e o tempo de resposta - TAT (turn around time) estendido desse exame pode estar associado a falhas terapêuticas e ao aumento da resistência bacteriana. A cultura de anaeróbios (CANA) ainda é um desafio para os laboratórios clínicos de rotina e novas estratégias para diminuir o TAT são fundamentais para que esse exame forneça um impacto clínico significativo. OBJETIVO: Otimizar o processo de triagem da CANA pela modificação do CT; comparar a identificação dos anaeróbios pelas metodologias fenotípicas ANC (Vitek 2- bioMérieux, France) e MALDI-TOF (Vitek MS - bioMérieux, France) e verificar o impacto econômico das ações propostas MÉTODOS: O caldo de triagem CT foi modificado eluindo individualmente discos comerciais de antibióticos (em concentrações fixas) selecionados por apresentarem baixa ou nenhuma ação contra microrganismos anaeróbios e com um bom espectro de ação para os principais aeróbios associados em culturas mistas e foram escolhidos aqueles que após uma bateria de testes frente a 15 cepas dos principais anaeróbios envolvidos em infecções humanas mantiveram a viabilidade inicial. O caldo Thioglicolato modificado (CTM) foi composto pela adição dos antibióticos que apresentaram a melhor \"performance\" acima descrita. A sensibilidade e especificidade do CTM foram avaliadas paralelamente com CT na rotina de CANA do HCFMUSP. Para a avaliar a identificação fenotípica, 421 anaeróbios isolados no período de seis meses foram submetidos a identificação pelo ANC (Vitek 2) e MALDI-TOF (Vitek MS). Os resultados discordantes ou com baixa discriminação da espécie foram avaliados pelo sequenciamento 16S rRNA. O impacto econômico da introdução do CTM bem como os custos diretos da identificação pelo MALDI-TOF foram avaliados. RESULTADOS: O CTM foi composto por amicacina, gentamicina e aztreonam. Das 159 amostras clínicas triadas pelo CT e CTM, 11 (7%) foram positivas para CANA com as mesmas espécies isoladas em ambos os meios. Utilizando o CTM, foi obtida uma redução dos falsos positivos de 97 (61%) para 69 (43%) quando comparado ao CT (p < 0,05). O TAT do resultado negativo da CANA com o CTM foi reduzido de 14 para sete dias em 28 (18%) amostras; o CTM permitiu a liberação do resultado positivo da CANA 48 horas à frente do CT. A sensibilidade do CTM foi igual ao CT, porém a especificidade foi superior em 19%. Das 421 cepas avaliadas, 35 foram identificadas somente pelo MALDI-TOF (Vitek MS) sendo que uma (Clostridium innocum) foi identificada somente pelo sequenciamento 16S rRNA. Das 386 avaliadas por ambas as metodologias, houve uma concordância de 97% e os resultados das 13 (3%) cepas submetidas ao sequenciamento foram concordantes em 92% com o MALDI-TOF (Vitek MS) que promoveu a redução do TAT do resultado positivo em cinco dias. A implementação do CTM possibilitou uma redução de custos nessa amostragem, de R$ 2.240,00 e a identificação pelo MALDI-TOF proporcionou uma economia de R$ 7.786,00. Considerando os valores econômicos encontrados nesse estudo e projetando-os nas estatísticas de CANA do HCFMUSP em 2017, o CTM poderia proporcionar uma economia de R$ 132.560,00 /ano e o MALDI-TOF uma redução nos gastos de R$ 13.579,00/ ano CONCLUSÕES: A padronização e implementação do CTM permitiu uma um aumento significativo de especificidade da cultura anaeróbia com redução do TAT e dos custos. A utilização do MALDI-TOF diminuiu o TAT das identificações aliado a uma melhor performance de forma custo efetiva / INTRODUCTION: Anaerobic bacterial infections are usually of endogenous origin, polymicrobial and mixed. Because of their fastidious nature, these bacteria require prior incubation in enriched liquid media, such as Thioglycolate broth (TB) to be recovered, the isolation of these microorganisms is laborious, and the TAT (turn around time) extended time of this examination may be associated with therapeutic failures and increased bacterial resistance. Anaerobic culture (AC) is still a challenge for routine clinical laboratories, and new strategies for lowering TAT are critical to provide a significant clinical impact. OBJECTIVE: To optimize the AC screening process by modifying the TB; Compare anaerobical identification between (Vitek 2- bioMérieux, France) and MALDI-TOF (Vitek MS - bioMérieux, France) and to verify the economic impact of the proposed actions. METHODS: TB broth was modified by eluting individually antibiotic commercial discs (at fixed concentrations) selected for low or no action against anaerobic microorganisms and with a good action spectrum for the main associated aerobes in mixed cultures. Those who maintained the initial viability after a battery of tests against 15 strains of the major anaerobes involved in human infections were selected. Modified Thioglycolate Broth (MTB) was composed of the antibiotics that presented the best performance described above. The sensitivity and specificity of MTB were evaluated in parallel with TB in the HCFMUSP AC routine. To evaluate the phenotypic identification, 421 anaerobes isolated in the six-month period were submitted to identification by ANC (Vitek 2) and MALDI-TOF (Vitek MS). Discordant results or those with low discrimination of the species were submitted to 16S rRNA sequencing. The economic impact of the introduction of MTB as well as the direct costs of MALDI-TOF identification were assessed. RESULTS: MTB was composed of amikacin, gentamicin and aztreonam. Of the 159 clinical samples screened by TB and MTB, 11 (7%) were positive for AC with the same species isolated in both media. Using MTB, a reduction of false positives was obtained from 97 (61%) to 69 (43%) when compared to TB (p < 0.05). The TAT of the negative result of the AC with the MTB was reduced from 14 to 7 days in 28 (18%) samples; the MTB allowed the release of the AC positive result 48 hours ahead of the TB. The sensitivity of MTB was equal to TB, but the specificity was higher in 19%. Of the 421 strains evaluated, 35 were identified only by MALDI-TOF (Vitek MS) and one (Clostridium innocum) was identified only by 16S rRNA sequencing. Of the 386 evaluated by both methodologies, there was a concordance of 97% and the results of the 13 (3%) strains submitted to the sequencing were concordant in 92% with the MALDI-TOF (Vitek MS) that promoted TAT of the positive result reduction in five days. The implementation of the MTB made possible a reduction of costs in this sampling, of US $ 677,00 and the identification by MALDI-TOF provided a saving of US $ 2354,00. Considering the economic values found in this study and projecting them in the HCFMUSP AC statistics in 2017, the MTB could provide savings of US $40,070.00 / year and MALDI-TOF a reduction in expenses of US $ 4,100.00 / year. CONCLUSIONS: Standardization and implementation of MTB allowed a significant increase of anaerobic culture specificity with TAT and costs reduction. The use of MALDI-TOF reduced the TAT of the identifications and also resulted in a better performance in a cost effective way

In der vorliegenden Arbeit sollten die in der veterinärmedizinischen Literatur bisher diskutierten Ursachen für LJD bei Makropoden hinsichtlich ihrer tatsächlichen Bedeutung abgeklärt und die Eignung einer formalininaktivierten, bestandsspezifischen Adsorbatvakzine zur Prophylaxe von LJD getestet werden. Da LJD eine parodontale Erkrankung darstellt, wurden auch die für Entstehung einer humanen Parodontitis prädisponierenden Faktoren mit in die Untersuchung einbezogen. Es wurden Tupferproben zur bakteriologischen Untersuchung von insgesamt 15 gesunden und 11 an LJD erkrankten Kängurus entnommen. Dabei konnten gramnegative Anaerobier bei allen Tieren isoliert werden. Fusobacterium nucleatum wurde in 82% der von an LJD erkrankten und nur in 33% der von gesunden Tieren entnommenen Tupferproben nachgewiesen, womit sich ein signifikanter Zusammenhang (P < 0,05) zwischen diesem Erreger und LJD ergab. Weitere überwiegend bei erkrankten Makropoden nachgewiesene Anaerobier stellten Prevotella oris/oralis (bei 73% der LJD-Fälle und bei 40% der gesunden Tiere) sowie Capnocytophaga spp. (45% vs. 13%) dar. Bacteroides spp. und Porphyromonas gingivalis wurden – wenn auch nur mit 3 bzw. 2 Nachweisen – ausschließlich bei kranken Tieren isoliert. Fusobacterium necrophorum wurde jeweils in 27% der Kängurus gefunden und spielte damit in dieser Studie keine Rolle für die Entstehung von LJD. In Übereinstimmung mit der Literatur konnten Moraxella spp. ausschließlich bei gesunden Makropoden isoliert werden. Vertreter dieser Gattung gehören damit offensichtlich zur normalen Maulflora der Kängurus. Für die Zoos in Halle und Leipzig wurde eine formalininaktivierte, bestandsspezifische Adsorbatvakzine gegen die bei einem an LJD erkrankten Känguru des jeweiligen Bestandes isolierten gramnegativen Anaerobier hergestellt. 7 Tiere (2 Rote Riesenkängurus, 5 Bennettwallabies) des Leipziger Zoos und 6 Bennettkängurus des Zoos in Halle wurden geimpft, wobei Auffrischungsimpfungen nach 4 bzw. 8 Wochen und nach 6 bzw. 12 Monaten erfolgten. Die spezifischen AK gegen das Prüfantigen Fusobacterium necrophorum wurden im SLA bestimmt. Es konnte keine Erhöhung der AK-Titer induziert werden und auch die Todesrate infolge von LJD senkte sich während des Untersuchungszeitraumes von 42 Monaten in den beiden Zoos nicht. Die höchsten AK-Level (1:512 bis 1:2048) ließen sich im Serum von natürlich infizierten und letztendlich tödlich erkrankten Bennettwallabies des Zoos in Hoyerswerda feststellen. Der Nachweis von AK-Titern im Serum von nicht geimpften Jungtieren lässt vermuten, dass AK via Kolostrum oder Dottersackplazenta auf die Jungtiere übertragen werden. Die Untersuchungen hinsichtlich der Fütterung zeigten, dass im Zoo Leipzig eine azidotische Stoffwechsellage induziert wurde, was sich bei den Leipziger Bennettkängurus in einem mit 7,53 signifikant niedrigeren Vormagen-pH-Wert im Vergleich zu den Hallenser und Auer Tieren (8,25 und 8,38) offenbarte. Dies schlug sich auch in erhöhten K-, Cholesterol- und &#61537;-Amylasewerten im Serum der Leipziger Wallabies nieder, womit gezeigt werden konnte, dass sich diese Parameter offenbar auch bei Makropoden zur Diagnostik einer chronischen Azidose eignen. Die Versorgung der Bennettkängurus in Magdeburg und Halle mit Ca und P war zwar nicht ausreichend, spiegelte sich aber nicht in veränderten Blutwerten dieser Mengenelemente wider. Die Aktivität der AP nimmt mit zunehmenden Alter ähnlich wie bei anderen Tierarten ab. Ihre negative Korrelation mit dem Alter der Tiere war dabei hochsignifikant (P < 0,001, r = 0,77 bzw. 0,62). Beim direkten Vergleich gesunder mit an LJD erkrankten Tieren konnte weder eine Störung im Ca/P-Stoffwechsel noch eine Azidose in Verbindung zu LJD gebracht werden. In allen Zoos erfolgte eine Überversorgung mit Vitamin A, wobei die Bedarfswerte für Schaflämmer um das 3,5fache bis 41fache übertroffen wurden. Den Bedarfswerten am nächsten lagen die Versorgungswerte der Bennettkängurus vom TP Aue und der Östlichen Grauen Riesenkängurus vom Zoo Magdeburg, beides Bestände ohne LJD. Die ermittelten Retinolplasmakonzentrationen standen in keiner Beziehung zu den Vitamin-A-Gehalten im Futter, was darauf hindeutet, dass sich Retinolbestimmungen im Blutplasma ebenso wie bei anderen Tierarten nur in extremsten defizitären Situationen zur Einschätzung des Vitamin-A-Status eignen. Ob eine Hypervitaminose A für die Entstehung von LJD tatsächlich eine Rolle spielt, muss in zukünftigen Arbeiten unter Einbeziehung von Retinolesterbestimmungen in der Leber abgeklärt werden. Die Glukosewerte lagen mit 8,57 mmol/l (M. rufus) bzw. 6,51 mmol/l (M. rufogriseus) über den bisher bekannten Werten aus der Literatur. Da die Werte bei an LJD erkrankten Kängurus niedriger waren als bei gesunden Tieren, kann ein Diabetes mellitus als Ursache für LJD ausgeschlossen werden. Weder die Durchsicht von 144 Sektionsprotokollen noch die Bestimmung der Kreatinin- und Harnstoffkonzentration im Serum von an LJD erkrankten Tieren ließen einen Zusammenhang zwischen Erkrankungen der Nieren und LJD erkennen. 30 Tiere verendeten an LJD, wovon 20% auch an den Nieren erkrankt waren. Allerdings wiesen auch 16,7% der anderweitig gestorbenen Kängurus eine Nierenerkrankung auf. Die Serumkonzentrationen von Harnstoff bzw. Kreatinin der an LJD erkrankten Makropoden unterschieden sich nicht von den für die gesunden Roten Riesenkängurus (7,40 mmol bzw. 114 mmol/l) und Bennettwallabies (7,81 mmol/l bzw. 86 mmol/l) ermittelten Werten. Insgesamt 184 Sera von 107 Kängurus wurden auf AK gegen MaHV-1 und MaHV-2 mittels Neutralisationtest geprüft. Während 94,4% bzw. 97,2% der Roten Riesenkängurus serologisch positiv für MaHV-1 bzw. MaHV-2 waren, reagierten von den 71 überprüften Bennettkängurus nur 4 bzw. 3 Tiere positiv. Unter den Wallabies befanden sich auch 21 an LJD erkrankte Tiere, wovon lediglich 2 Tiere gegen MaHV-1 und 1 Tier gegen MaHV-2 eine Serokonversion zeigten. Die AK-Titer der Roten Riesenkängurus ließen keine Unterschiede zwischen gesunden und an LJD leidenden Tieren zu und die entnommenen Serumpaarproben von 5 zum Zeitpunkt der Blutentnahme an LJD leidenden Riesenkängurus zeigten kein einheitliches Verhalten im Sinne einer Serokonversion. Somit ließ sich der Verdacht, dass die Reaktivierung latenter Herpesinfektionen die Ursache für LJD sein könnte, nicht bestätigen. Im Ergebnis der vorliegenden Studie und im Zusammenhang mit den Angaben aus der Literatur stellt sich LJD primär als eine Infektion mit gramnegativen Anaerobiern dar, wovon Fusobacterium nucleatum, Bacteroides spp., Prophyromonas gingivalis und Fusobacterium necrophorum, Biovar A die größte Bedeutung haben dürften. Den Abschluss der Arbeit bilden Empfehlungen für die Haltung von Kängurus in zoologischen Einrichtungen und für die Therapie von LJD. Im Anhang finden sich Röntgenaufnahmen und Photographien von erkrankten und gesunden Makropoden. / The aim of this thesis was the investigation of the aetiology of Lumpy Jaw Disease (LJD) in macropods concentrating specifically on the causes of the diseases in current veterinary medicine literature and to evaluate the use of a group-specific Al(OH)3-adjuvanted, formalin-inactivated whole-cell vaccine for the control of LJD in kangaroos kept in zoos. LJD is regarded as periodontal disease, therefore the risk factors for the development of human periodontitis were also included in this study. The oral flora from 15 healthy macropods and 11 animals suffering from LJD was isolated. At least one anaerobic gram-negative bacterial species was found in swabs of each macropod. The occurrence of Fusobacterium nucleatum was associated with LJD (P < 0.05) by detecting this bacterium in 82% of the kangaroos suffering from LJD compared to only in 33% of the healthy animals. Prevotella oris/oralis and Capnocytophaga spp. were also predominantly found in diseased animals in comparison with healthy macropods (73% vs. 40% and 45% vs. 13% respectively). Bacteroides spp. and Porphyromonas gingivalis were isolated in only 3 and 2 kangaroos suffering from LJD, respectively. Contrary to previously published studies about LJD Fusobacterium necrophorum was not associated with LJD, as this anaerobe was detected in only 27% of the diseased as well as healthy macropods. Moraxella spp. seem to be a part of the normal oral flora of macropods and was found exclusively in healthy animals. 11 Red-necked Wallabies (Macropus rufogriseus) and 2 Red Kangaroos (Macropus rufus) were immunized with a group-specific Al(OH)3-adjuvanted, formalin-inactivated whole-cell vaccine containing previously in a kangaroo suffering from LJD isolated gramnegative anaerobs. The kangaroos were re-vaccinated after 1, 2, 6 and 12 months. Blood was collected from each animal at the same time. Antibodies were titrated against Fusobacterium necrophorum in an agglutination assay. The vaccine failed to induce increased levels of antibodies as well as to protect wallabies and kangaroos against LJD. As the highest antibody titres were detected in most severely diseased wallabies kept in the Hoyerswerda zoo, the protective role of the humoral immune response in LJD seems to be doubtful. The finding of detectable levels of antibodies in unvaccinated joeys supports the theory, that there is a transmission of antibodies from the mother to the offspring via colostrum or yolk-sac placenta. The diet of the Red-necked Wallabies in one zoo has induced an acidosis: The pH of the forestomach fluid collected by probang was lower in the animals of this zoo (pH = 7.53) than in the wallabies of two other zoos (pH = 8.25 and 8.38, respectively). Potassium, cholesterol and &#61537;-amylase were also higher in the blood of the animals of this zoo in comparison to the wallabies of the two other ones, hence these blood values seem to be helpful for the diagnosis of chronic acidosis in macropods. There was a calcium and phosphor deficiency in the nutrition of the wallabies in two zoos, but the blood concentration of both of these minerals was not changed. The activity of the ALP correlated negative with the age of the Bennett`s Wallabies (P < 0.001, r = -.77 and r = -.62 respectively, depending on the instruments). All of the above mentioned blood values showed no differences between healthy and diseased animals and could so far not support the assumption, that an imbalance in Ca and P metabolism or an acidosis are important factors for LJD. The macropods of all investigated zoos were fed on a diet rich in vitamin A ranging from the 3.5 to the 41fold requirement for lambs. The vitamin A content of the diets for the 2 collections without a history of LJD was the lowest in this study. These results raised the point, that a hypervitaminosis A could be a more predisposing factor for LJD than a vitamin A deficiency. Due to the fact the plasma retinol concentration was independent from the vitamin A content of the diet and so not helpful in diagnosis of a vitamin A deficiency or toxicity, further investigations regarding the role of vitamin A in the aetiopathogenesis of LJD should include measurements of the liver tissue content of retinol esters. The glucose plasma concentration of the healthy Red Kangaroos (8.57 mmol/l) as well as the Red-necked Wallabies (6.51 mmol/l) was higher than previously published values for macropods, but also higher than the results of the diseased animals in this study. Therefore diabetes mellitus can be ruled out as an underlying factor for LJD. The analysis of 144 pathological records showed, that 30 animals died because of LJD, 20% of them and 16.7% of the other 114 macropods had a concurrent kidney disease. The urea and creatinin concentration in serum samples of healthy animals was not higher than the values of diseased animals. In conclusion, these results suggest kidney diseases are not important for the development of LJD. Altogether 184 sera collected from 107 kangaroos were tested for antibodies against MaHV-1 and MaHV-2 using a neutralisation assay. The prevalence of the MaHV-1- as well as MaHV-2-antibodies was high among the Red Kangaroos (94.4% and 97.2% respectively), but low among the Red-necked Wallabies (5.6% and 4.2% respectively). Seroconversion for MaHV-1 was seen in 2 out of 21 wallabies suffering from LJD, only 1 of these animals also had antibodies against MaHV-2. The antibody-titres against both of the macropodid herpes viruses also did not differ between Red Kangaroos with and without LJD, therefore a reactivation of a latent herpesvirus infection does not appear to be causative for LJD. In summary, considering the results of this study and previously published literature LJD is an infectious disease caused by gramnegative anaerobic bacteria with Fusobacterium nucleatum, Bacteroides spp., Porphyromonas gingivalis and Fusobacterium necrophorum subsp. necrophorum being of most significance. Recommendations concerning the keeping of kangaroos in captivity and the management of LJD are listed in the conclusion of this thesis. Some radiographs and photos of diseased and healthy kangaroos are attached.