<p>NK cells play a pivotal role in tumor rejection; however, once present in the tumor microenvironment, they are characterized by decreased cytotoxicity and reduced expression of activating receptors. The mechanisms governing the inactivation of NK cells within tumors remain poorly understood. Since tumor associated macrophages (TAMs) are a highly abundant and suppressive cell type within tumors, we hypothesized that they are capable of altering the function of NK cells. Following the co-culture of alternatively activated macrophages (M2) or TAMs with NK cells we observed that the expression of the cytotoxic marker CD27 on NK cells was down-regulated as well as the ability of these cells to kill YAC-1 cells in a killing assay. We have demonstrated that the mechanism by which M2 cells inhibit NK cells is TGF-β dependent. Notably, the developmental stage of NK cells after interaction with TAMs was altered and the NK cells became phenoytpically mature and potentially exhausted (CD27^lowCD11b^high). This prompted our interest in examining the developmental stage of NK cells from polyoma MT antigen (pyMT) transgenic mouse (MMTV-pMT) breast tumors. Interestingly, in contrast to the <em>in vitro</em> results, we have shown that NK cells isolated from pyMT tumors are developmentally immature; however maintain their maturity within the spleen. Their immature phenotype correlates well with their decreased expression of perforin, granzyme, and NKp46. Both our <em>in vitro</em> studies with TAMs and our <em>in vivo</em> developmental studies using the pyMT model demonstrate that NK cells are altered by their surroundings. A better understanding of how NK cells are modified by the tumor microenvironment will help to develop strategies aimed at bolstering immune responses against tumors.</p> / Master of Science (MSc)

<p>Influenza is a highly contagious respiratory disease. Yearly epidemics and pandemics account for high morbidity and mortality worldwide. Lung immunopathology is a major factor causing death following influenza. In addition, secondary bacterial superinfections that occur after influenza further complicate the lung immunopathology and contribute to higher morbidity and mortality. The research presented in this thesis addressed important, understudied questions in the complicated field of tissue immunopathogenesis and host defense to influenza and pneumococcal infections. Firstly, in a model of acute respiratory influenza infection, we found that the classically proinflammatory cytokine TNF plays a dual and biphasic role at different times post-infection. While it does have pro-immune roles in the beginning stages, TNF acts as a negative type 1 immune regulator at later points of infection. TNF controls the level of immune activation and has a key role in preventing lung immunopathology and aberrant tissue remodeling. Secondly, to further investigate mechanisms of lung pathology, we elucidated the role of bacterial replication and over activated host immune responses during bacterial superinfection following influenza. In our model of pulmonary <em>Streptococcus pneumoniae</em> infection after influenza, we found that dual infected animals experience rapid weight loss and succumb to infection. Bacterial outgrowth, dysregulated cytokine and chemokine expression, and severe lung neutrophilia and immunopathology are linked to the poor clinical outcome. Combined treatment with both an antibiotic azithromycin and corticosteroid dexamethasone best improves clinical outcome, bacterial clearance, cellular and cytokine responses, and immunopathology. Thirdly, in our continuing interest for improved therapies during pulmonary infections, we tested the transgenic expression of type I IFN as a treatment during <em>S. pneumoniae</em> infection. We found that IFN-a controls bacterial outgrowth and improves clinical outcome. Together, our findings provide novel insights into the mechanisms of lung immunopathology and treatment protocols for pulmonary influenza and pneumococcal infections.</p> / Doctor of Philosophy (Medical Science)

Case reports describe significant norovirus gastroenteritis morbidity in immunocompromised patients. We evaluated norovirus pathogenesis in prospectively enrolled solid organ (SOT) and hematopoietic stem cell transplant (HSCT) patients with diarrhea who presented to Texas Children's Hospital and submitted stool for enteric testing. Noroviruses were detected by real-time reverse transcription polymerase chain reaction. Clinical outcomes of norovirus diarrhea and non-norovirus diarrhea patients, matched by transplanted organ type, were compared. Norovirus infection was identified in 25 (22%) of 116 patients, more frequently than other enteropathogens. Fifty percent of norovirus patients experienced diarrhea lasting ≥14 days, with median duration of 12.5 days (range 1–324 days); 29% developed diarrhea recurrence. Fifty-five percent of norovirus patients were hospitalized for diarrhea, with 27% requiring intensive care unit (ICU) admission. One HSCT recipient developed pneumatosis intestinalis. Three HSCT patients expired ≤6 months of norovirus diarrhea onset. Compared to non-norovirus diarrhea patients, norovirus patients experienced significantly more frequent ICU admission (27% vs. 0%, p = 0.02), greater serum creatinine rise (median 0.3 vs. 0.2 mg/dL, p = 0.01), and more weight loss (median 1.6 vs. 0.6 kg, p < 0.01). Noroviruses are an important cause of diarrhea in pediatric transplant patients and are associated with significant clinical complications.

Call number: LD2668 .T4 1978 L443 / Master of Science

Call number: LD2668 .T4 1984 G57 / Master of Science

This thesis is about analyzing genetic differences among isolates of Francisella tularensis – the tularemia-causing bacterium. To elucidate how these bacterial isolates are related, and their geographical and genetic origins, I have developed typing assays for Francisella and used them to study the epidemiology of tularemia. Tularemia is an infectious disease of humans and other mammals found throughout the Northern Hemisphere. The severity of the disease depends on the type of F. tularensis causing the infection. In Sweden, as in other countries of Europe and Eurasia, tularemia is caused by F. tularensis subsp. holarctica, while other varieties of the bacterium occur in Middle Asia and North America. It is important to identify a tularemia infection promptly in order to initiate the correct antibiotic treatment. A rapid identification of the causative F. tularensis variety gives additional clinical information. In recent years, several genomes of various Francisella strains have been sequenced, and in this thesis, I have utilized these genomes to identify genetic markers. In studies reported in the first paper (I) appended to the thesis, we identified and analyzed insertion/deletion mutations (INDELs) inferred to have resulted from a sequence repeat-mediated excision mechanism. We found eight new Regions of Difference (RDs) among Francisella strains. Using RDs together with single nucleotide polymorphisms (SNPs), we were able to predict an evolutionary scenario for F. tularensis in which Francisella novicida was the oldest variety while F. tularensis subsp. holarctica was the youngest. We also found that all virulence-attenuated isolates analyzed had deletions at two specific genetic regions - denoted RD18 and RD19 – suggesting that repeat-mediated excision is a mechanism of attenuation in F. tularensis. In subsequent studies (presented in paper II), we developed a combined analysis of INDELs lacking flanking repeats and variable number of tandem repeats (VNTRs). Both markers could be assayed using the same analytical equipment. The inclusion of INDELs provided increased phylogenetic robustness compared with the use of VNTRs alone, while still maintaining a high level of genetic resolution. In analyses described in the next paper (III), we selected INDELs from paper (II) and discovered novel SNPs by DNA comparisons of multiple Francisella strains. Thirty-four phylogenetically informative genetic markers were included in a hierarchical real-time PCR array for rapid and robust characterization of Francisella. We successfully used the assay to genotype 14 F. tularensis isolates from tularemia patients and DNA in six clinical ulcer specimens. Finally, in paper (IV) we demonstrated a strategy to enhance epidemiological investigations of tularemia by combining GIS-mapping of disease-transmission place collected from patient interviews, with high-resolution genotyping of F. tularensis subsp. holarctica isolates recovered from tularemia patients. We found the geographic distributions of specific F. tularensis subsp. holarctica sub-populations to be highly localized during outbreaks (infections by some genotypes being restricted to areas as small as 2 km2), indicative of a landscape epidemiology of tularemia with distinct point sources of infection. In conclusion, the results acquired during the studies underlying this thesis contribute to our understanding of the genetic genealogy of tularemia at both global and local outbreak scales.

UA Open Access Publishing Fund / Background: Current understanding of tuberculosis (TB) genotype clustering in the US is based on individual risk factors. This study sought to identify whether area-based socioeconomic status (SES) was associated with genotypic clustering among culture-confirmed TB cases. Methods: A retrospective cohort analysis was performed on data collected on persons with incident TB in King County, Washington, 2004–2008. Multilevel models were used to identify the relationship between area-level SES at the block group level and clustering utilizing a socioeconomic position index (SEP). Results: Of 519 patients with a known genotyping result and block group, 212 (41%) of isolates clustered genotypically. Analyses suggested an association between lower area-based SES and increased recent TB transmission, particularly among US-born populations. Models in which community characteristics were measured at the block group level demonstrated that lower area-based SEP was positively associated with genotypic clustering after controlling for individual covariates. However, the trend in higher clustering odds with lower SEP index quartile diminished when additional block-group covariates. Conclusions: Results stress the need for TB control interventions that take area-based measures into account, with particular focus on poor neighborhoods. Interventions based on area-based characteristics, such as improving case finding strategies, utilizing location-based screening and addressing social inequalities, could reduce recent rates of transmission.

The British cattle population hosts a diverse community of endemic pathogens that impact the sustainability of beef and dairy production. As such, there has been a tremendous amount of ongoing research to develop more cost-effective strategies for controlling disease at the industry level. Cattle movements have come under particular scrutiny over the past decade both because of their role in spreading many economically important diseases and because the movements of individual cattle in Great Britain have been explicitly recorded in a centralized electronic database since 1998. Numerous studies have shown that these cattle movements organize into complex networks with key structural and temporal features that influence transmission dynamics. Building on previous work, this thesis used a variety of epidemiological and statistical models to highlight limitations in the current approaches to controlling disease as well as opportunities for reducing endemic disease prevalence through targeted interventions. Empirical disease data from the national bovine tuberculosis (bTB) control programme and from two seroprevalence studies of bovine viral diarrhoea virus (BVDV) in Scottish cattle herds were used in conjunction with movement data from the Cattle Tracing System (CTS) database. Endemic diseases are often challenging to control due to lack of affordable and accurate diagnostic tests as well as the presence of subclinically infected carriers that can easily escape detection. There was evidence that combined issues with the sensitivity and specificity of routine surveillance methods for bTB were contributing to a low level of disease transmission within and between Scottish cattle herds from 2002 to 2009. For BVDV, herds that purchased pregnant beef dams, beef dams with a calf at foot, and open dairy heifers were significantly more likely to be seropositive even though these movements were responsible for only a small number of network contacts. In both cases, targeting the subset of high risk movements with disease specific biosecurity measures may be a more cost-effective use of limited national disease control resources. Other researchers have suggested that control strategies should target multiple diseases simultaneously to reduce trade-offs in resource allocation. Using key indicators of herd reproductive performance derived from the CTS database, it was shown that improving the reproductive management of herds operating below industry standards could reduce endemic disease prevalence by reducing the movements of replacement breeding cattle. A series of network generation algorithms were also developed to study the effects of restricting contact formation based on key demographic and network characteristics of actively trading cattle farms. Strategies that increased network fragmentation either by forcing highly connected farms to form contacts with other highly connected farms or preventing the formation of movements with a high predicted betweenness centrality were found to be particularly effective in limiting disease transmission. For these models to be useful in guiding future policy decisions, it is important to incorporate financial and behavioural drivers of dynamic network change. Following the introduction of pre- and post-movement testing requirements for cattle imported into Scotland from endemic bTB regions, there was a significant decline in cross-border movements, which has likely contributed to the decreasing risk of bTB outbreaks as much as testing itself. Many endemic cattle diseases such as BVDV also spread through local transmission mechanisms, which may undermine the success of disease control programmes that exclusively target cattle movements. There was also evidence that in the absence of national animal legislation, few farmers were likely to adopt biosecurity measures against BVDV. This may be related to the perceived inefficacy of recommendations as well as general unawareness of farm disease status due to the non-specific clinical signs of BVDV outbreaks. Although the CTS database was originally intended for use in slaughter traceback investigations, results from this thesis show how the basic records of births, deaths, and movements can be used to generate valuable insights into the epidemiology of endemic cattle diseases. The findings also emphasize that the management decisions of individual herds can have a substantial impact on industry level transmission dynamics, which offers unique opportunities to develop novel and more cost-effective disease control programmes.

No description available.

The hypotheses of this study are that reduction and rational usage of antibiotics reduces development of antibiotic resistance. In Sweden, the trends do not follow this pattern. Despite a decrease in prescriptions of antibiotics, there is an increase in the number of patients infected with Methicillin-resistant Staphylococcus Aureus (MRSA), Extended Spectrum Beta-Lactamases (ESBL) and ESBL selecting for carbapenem-resistance (ESBLCARBA). This study aims to study factors affecting antibiotic resistance management. An additional aim is to use a multidisciplinary approach for a subject that has mostly been studied with quantitative methods. First, linear regressions investigated any possible significant changes of prescription rates in outpatient care, hospital usage of antibiotic groups and antibiotic resistance. After this, nine interviews were conducted with physicians in outpatient care, hospital care and with representatives from the Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (Strama), a network working for Swedish prevention against antibiotics resistance. There was a significant decrease in the number of prescriptions of antibiotics in outpatient care among all Swedish counties and a small, but significant increase of antibiotics used in hospitals. The number of patients infected with multidrug resistant bacteria also show a significant increase. The interviews revealed that health care workers in all counties follow the same guidelines and try to be as specific as possible in choosing antibiotics to hit specific bacteria. The respondents suggested migration and extended travelling as explanations to the growing number of cases of multidrug resistant bacteria. Further, two major factors emerged as important for an efficient antibiotic resistance management; Education/knowledge and Discussion. The results indicate a need for further research on rational usage of antibiotics and the use of broad-spectrum antibiotics in hospital care, rather than the reduction through prescriptions. The results indicate that rational usage has a bigger impact than reduction. Using a multidisciplinary approach gave a broader perspective on the issue and future studies should see the possibilities of mixing quantitative and qualitative studies.