Institut für Hygiene und Mikrobiologie
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Alveolar echinococcosis (AE) is a severe and life-threatening disease caused by the metacestode larva of the fox-tapeworm Echinococcus multilocularis. Parasite entry into the host evokes an early and potentially parasiticidal Th1 immune response that is gradually replaced by a permissive Th2 response. An immunoregulatory environment has also been reported in the host as the disease progresses. As a result of immunomodulation, E. multilocularis larvae persist in the host for decades without being expelled, and thus almost act like a perfect transplant. Very little is currently known on the molecular basis of the host immunomodulation by E. multilocularis. In this work, in vitro cultivation systems were used to assess the influence of metabolites released by the parasite larvae (E/S products) on host immune effector cells. E/S products of cultivated larvae that respresent the early (primary cells) and chronic (metacestode vesicles) phase of AE induced apoptosis and tolerogenic properties (poor responsiveness to LPS stimulation) in host dendritic cells (DC) whereas those of control larvae (protoscoleces) failed to do so. These findings show that the early infective stage of E. multilocularis induces tolerogenicity in host DC, which is most probably important for generating an immunosuppressive environment at an infection phase in which the parasite is highly vulnerable to host attacks. Interestingly, metacestode E/S products promoted the conversion of naïve CD4+ T-cells into Foxp3+ regulatory T-cells in vitro, whereas primary cell and protoscolex E/S products failed to do it. Since Foxp3+ regulatory T-cells are generally known to mediate immunosuppression, the present finding indicates that Foxp3+ regulatory T-cells, expanded by E/S products of the metacestode larva, could play a role in the parasite-driven immunomodulation of the host observed during AE. Furthermore, a substantial increase in number and frequency of suppressive Foxp3+ regulatory T-cells could be observed within peritoneal exudates of mice following intraperitoneal injection of E. multilocularis metacestodes, indicating that Foxp3+ regulatory T-cells could also play an important role in E. multilocularis-driven immunomodulation in vivo. Interestingly, a parasite activin ortholog, EmACT, secreted by metacestodes, was shown to expand host regulatory T-cells in a TGF-β-dependent manner, similarly to mammalian activin A. This observation indicated that E. multilocularis utilizes evolutionarily conserved TGF-β superfamily ligands, like EmACT, to expand host regulatory T-cells. Taken together, the present findings suggest EmACT, a parasite activin secreted by the metacestode and capable of expanding host regulatory T-cells, as an important player in the host immunomodulation by E. multilocularis larvae. Another parasite factor EmTIP, homologous to mammalian T-cell immunomodulatory protein (TIP) was characterized in this work. EmTIP could be detected in the secretions of the parasite primary cells and localized to the intercellular space within the parasite larvae. EmTIP blockade inhibited the proliferation of E. multilocularis primary cells and the formation of metacestode vesicles indicating a major role for parasite development. Furthermore, EmTIP evoked a strong release of IFN-γ by CD4+ T-cells hence suggesting that the secretion of this factor as a result of its role in parasite development could “secondarily” induce a potentially protective Th1 response. In conclusion, this work identified two molecules, EmACT and EmTIP, with high immunomodulatory potential that are released by E. multilocularis larvae. The data presented do provide insights into the mechanisms of parasite-driven host immunomodulation during AE that are highly relevant for the development of anti-parasitic immune therapies.
Background
The metacestode larva of Echinococcus multilocularis (Cestoda: Taeniidae) develops in the liver of intermediate hosts (typically rodents, or accidentally in humans) as a labyrinth of interconnected cysts that infiltrate the host tissue, causing the disease alveolar echinococcosis. Within the cysts, protoscoleces (the infective stage for the definitive canid host) arise by asexual multiplication. These consist of a scolex similar to that of the adult, invaginated within a small posterior body. Despite the importance of alveolar echinococcosis for human health, relatively little is known about the basic biology, anatomy and development of E. multilocularis larvae, particularly with regard to their nervous system.
Results
We describe the existence of a subtegumental nerve net in the metacestode cysts, which is immunoreactive for acetylated tubulin-α and contains small populations of nerve cells that are labeled by antibodies raised against several invertebrate neuropeptides. However, no evidence was found for the existence of cholinergic or serotoninergic elements in the cyst wall. Muscle fibers occur without any specific arrangement in the subtegumental layer, and accumulate during the invaginations of the cyst wall that form brood capsules, where protoscoleces develop. The nervous system of the protoscolex develops independently of that of the metacestode cyst, with an antero-posterior developmental gradient. The combination of antibodies against several nervous system markers resulted in a detailed description of the protoscolex nervous system, which is remarkably complex and already similar to that of the adult worm.
Conclusions
We provide evidence for the first time of the existence of a nervous system in the metacestode cyst wall, which is remarkable given the lack of motility of this larval stage, and the lack of serotoninergic and cholinergic elements. We propose that it could function as a neuroendocrine system, derived from the nervous system present in the bladder tissue of other taeniids. The detailed description of the development and anatomy of the protoscolex neuromuscular system is a necessary first step toward the understanding of the developmental mechanisms operating in these peculiar larval stages.
Background
Published models predicting nasal colonization with Methicillin-resistant Staphylococcus aureus among hospital admissions predominantly focus on separation of carriers from non-carriers and are frequently evaluated using measures of discrimination. In contrast, accurate estimation of carriage probability, which may inform decisions regarding treatment and infection control, is rarely assessed. Furthermore, no published models adjust for MRSA prevalence.
Methods
Using logistic regression, a scoring system (values from 0 to 200) predicting nasal carriage of MRSA was created using a derivation cohort of 3091 individuals admitted to a European tertiary referral center between July 2007 and March 2008. The expected positive predictive value of a rapid diagnostic test (GeneOhm, Becton & Dickinson Co.) was modeled using non-linear regression according to score. Models were validated on a second cohort from the same hospital consisting of 2043 patients admitted between August 2008 and January 2012. Our suggested correction score for prevalence was proportional to the log-transformed odds ratio between cohorts. Calibration before and after correction, i.e. accurate classification into arbitrary strata, was assessed with the Hosmer-Lemeshow-Test.
Results
Treating culture as reference, the rapid diagnostic test had positive predictive values of 64.8% and 54.0% in derivation and internal validation corhorts with prevalences of 2.3% and 1.7%, respectively. In addition to low prevalence, low positive predictive values were due to high proportion (> 66%) of mecA-negative Staphylococcus aureus among false positive results. Age, nursing home residence, admission through the medical emergency department, and ICD-10-GM admission diagnoses starting with “A” or “J” were associated with MRSA carriage and were thus included in the scoring system, which showed good calibration in predicting probability of carriage and the rapid diagnostic test’s expected positive predictive value. Calibration for both probability of carriage and expected positive predictive value in the internal validation cohort was improved by applying the correction score.
Conclusions
Given a set of patient parameters, the presented models accurately predict a) probability of nasal carriage of MRSA and b) a rapid diagnostic test’s expected positive predictive value. While the former can inform decisions regarding empiric antibiotic treatment and infection control, the latter can influence choice of screening method.
Background
Occupational exposure to live meningococci can potentially cause invasive meningococcal disease in laboratory staff. While, until recently, immunization with quadrivalent polysaccharide vaccine represented one cornerstone of protection, data on long-term persistence of antibodies in adults remain scarce.
Methods
We analyzed the relationship of antibody levels and time following quadrivalent polysaccharide vaccination (Mencevax® ACWY, GlaxoSmithKline) in a cross-sectional sample of 20 laboratory workers vaccinated at ages between 16.4 to 40.7 years from Germany. Sera were obtained 0.4 to 158.5 (median 35.3) months after vaccination. At the time of sampling, laboratory workers had been regularly exposed to meningococci for periods between 3.2 to 163.8 (median 41.2) months. Serum bactericidal assay (SBA) with rabbit complement and a microsphere-based flow analysis method were used to determine bactericidal titers and concentrations of IgG, respectively, against serogroups A, C, W135, and Y. Decay of antibodies was modeled using linear regression. Protective levels were defined as SBA titers ≥ 8.
Results
Half-lives of SBA titers against serogroups A, C, W135, and Y were estimated at 27.4, 21.9, 18.8, and 28.0 months, respectively. Average durations of protection were estimated at 183.9, 182.0, 114.6, and 216.4 months, respectively. Inter-individual variation was high; using lower margins of 95% prediction intervals, minimal durations of protection against serogroups A, C, W135 and Y were estimated at 33.5, 24.6, 0.0, and 55.1 months, respectively. The proportion of staff with protective SBA titers against W135 (65.0%) was significantly lower than proportions protected against A (95.0%), C (94.7%), and Y (95.0%). Consistently, geometric mean titer (97.0) and geometric mean concentration of IgG (2.1 μg/ml) was lowest against serogroup W135. SBA titers in a subset of individuals with incomplete protection rose to ≥ 128 (≥ 8 fold) after reimmunization with a quadrivalent glycoconjugate vaccine.
Conclusions
The average duration of protection following immunization with a quadrivalent polysaccharide vaccine in adults was ≥ 115 months regardless of serogroup. A substantial proportion (approximately 23% according to our decay model) of adult vaccinees may not retain protection against serogroup W135 for five years, the time suggested for reimmunization.
Neisseria meningitidis ist ein wichtiger Erreger von Meningitis und Sepsis insbesondere bei jungen Menschen, gleichzeitig sind hohe Raten asymptomatischen Trägertums bekannt. Als die Virulenz begünstigende Faktoren wurden unter anderem die Kapsel, Pili, äußere Membranvesikel (OMV) und Lipopolysaccharid (LPS) identifiziert, die es dem Erreger erleichtern, das menschliche Immunsystem zu überwinden.
Dabei war bisher die Rolle von Neutrophil Extracellular Traps (NETs) als neu beschriebene Komponente der angeborenen Immunantwort nicht untersucht worden. NETs stellen spinnennetzartige DNA-Strukturen mit globulären Proteindomänen dar, die aus neutrophilen Granulozyten entstehen und als antimikrobiell gelten. Ziel dieser Arbeit war es, die Wirkung von NETs auf Meningokokken zu charakterisieren und mögliche Resistenzmechanismen der Bakterien zu identifizieren.
In den vorliegenden Versuchen konnte gezeigt werden, dass Meningokokken an NETs binden und durch diese in ihrer Proliferation gehemmt werden. Eine Lokalisation der Bakterien an die NETs konnte dargestellt werden, LPS und Pili wurden als wichtige Strukturen für die Vermittlung der NET-Bindung identifiziert. OMVs zeigten sich als protektiv gegenüber dem Einfluss der NETs, indem sie die Bindung der Erreger an die NETs blockierten.
Wenig empfindlich zeigten sich die Bakterien gegenüber Histonen als den quantitativ bedeutsamsten NET-Proteinen. Meningokokken schützen sich gegenüber dem Einfluss der NETs durch Ausbildung von Kapsel und LPS mit intakter Phosphoethanolamin-Modifikation. Ebenso vermitteln zwei Cathelicidin-Resistenzgene den Bakterien einen Überlebensvorteil. Keine Rolle bei der NET-Resistenz spielten die untersuchten Effluxmechanismen.
Neuere Untersuchungen von Lappann et al. indentifizierten Meningokokken und OMVs als potente NET-Induktoren. Damit könnten durch die relativ NET-resistenten Mikroorganismen andere Abwehrmechanismen der Neutrophilen konterkariert werden und eine Immunevasion begünstigt werden. Genauere Untersuchungen diesbezüglich stehen noch aus.
Neisseria meningitidis is a facultative human pathogen that occasionally shows strong resistance against serum complement exposure. Previously described factors that mediate meningococcal serum resistance are for example the capsule, LPS sialylation, and expression of the factor H binding protein. I aimed for identification of novel serum resistance factors, thereby following two approaches, i) the analysis of the impact of global regulators of gene expression on serum resistance; and ii) a comparative analysis of closely related strains differing in serum resistance. (i) Of six meningococcal global regulators of gene expression studied, only mutation of the zinc uptake regulator Zur reduced complement deposition on meningococci. Little was known about meningococcal Zur and regulatory processes in response to zinc. I therefore elucidated the yet unidentified meningococcal Zur regulon comparing the transcriptional response of the N. meningitidis strain MC58 under zinc-rich and zinc-deficient conditions using a common reference design of microarray analysis. The meningococcal Zur regulon comprises 17 genes, of which 15 genes were repressed and two genes were activated at high zinc condition. Amongst the Zur-repressed genes were genes involved in zinc uptake, tRNA modification, and ribosomal assembly. A 23 bp meningococcal consensus Zur binding motif (Zur box) with a conserved central palindrome was established (TGTTATDNHATAACA) and detected in the promoter region of all regulated transcriptional units (genes/operons). In vitro binding of meningococcal Zur to the Zur box of three selected genes was shown for the first time using EMSAs. Binding of meningococcal Zur to DNA depended specifically on zinc, and mutations in the palindromic sequence constrained Zur binding to the DNA motif. ii) Three closely related strains of ST-41/44 cc from invasive disease and carriage which differed in their resistance to serum complement exposure were analysed to identify novel mediators of serum resistance. I compared the strains’ gene content by microarray analysis which revealed six genes being present in both carrier isolates, but absent in the invasive isolate. Four of them are part of two Islands of horizontally transferred DNA, i.e. IHT-B and –C. The working group furthermore applied a comprehensive screening assay, a transcriptome and a proteome analysis leading to identification of three target proteins. I contributed to establish the role of these three proteins in serum resistance: The adhesin Opc mediates serum resistance by binding of vitronectin, a negative regulator of the complement system; the hypothetical protein NMB0865 slightly contributes to serum resistance by a yet unknown mechanism; and NspA, recently identified to bind the negative complement regulator factor H, led to considerable reduced complement-mediated killing.
Entry of Neisseria meningitidis (the meningococcus) into human brain microvascular endothelial cells (HBMEC) is mediated by fibronectin or vitronectin bound to the surface protein Opc forming a bridge to the respective integrins. This interaction leads to cytoskeletal rearrangement and uptake of meningococci. In this study, we determined that the focal adhesion kinase (FAK), which directly associates with integrins, is involved in integrin-mediated internalization of N. meningitidis in HBMEC. Inhibition of FAK activity by the specific FAK inhibitor PF 573882 reduced Opc-mediated invasion of HBMEC more than 90%. Moreover, overexpression of FAK mutants that were either impaired in the kinase activity or were not capable of autophosphorylation or overexpression of the dominant-negative version of FAK (FRNK) blocked integrin-mediated internalization of N. meningitidis. Importantly, FAK-deficient fibroblasts were significantly less invaded by N. meningitidis. Furthermore, N. meningitidis induced tyrosine phosphorylation of several host proteins including the FAK/Src complex substrate cortactin. Inhibition of cortactin expression by siRNA silencing and mutation of critical amino acid residues within cortactin, that encompass Arp2/3 association and dynamin binding, significantly reduced meningococcal invasion into eukaryotic cells suggesting that both domains are critical for efficient uptake of N. meningitidis into eukaryotic cells. Together, these results indicate that N. meningitidis exploits the integrin signal pathway for its entry and that FAK mediates the transfer of signals from activated integrins to the cytoskeleton. A cooperative interplay between FAK, Src and cortactin then enables endocytosis of N. meningitidis into host cells.
Alveolar echinococcosis (AE), a severe and life-threatening disease is caused by the small fox tapeworm Echinococcus multilocularis. Currently, the options of chemotherapeutic treatment are very limited and are based on benzimidazole compounds, which act merely parasitostatic in vivo and often display strong side effects. Therefore, new therapeutic drugs and targets are urgently needed. In the present work the role of two evolutionarily conserved signalling pathways in E. multilocularis, namely the insulin signalling cascade and Abl kinases, has been studied in regard to host-parasite interaction and the possible use in anti-AE chemotherapy.
Neisseria meningitidis, Auslöser der Meningokokken-Meningitis und Sepsis, trägt auch heute noch zur hohen Kindersterblichkeit in Entwicklungsländern bei und sorgt, vor allem im afrikanischen Meningitis-Gürtel, immer wieder für Epidemien mit gravierenden Folgen für die Betroffenen. Im Rahmen dieser Arbeit wurden zwei an der Pathogenität von N. meningitidis beteiligte Proteine, der Transkriptionsregulator FarR und der Transportkanal HrpB, näher charakterisiert, um weitere Einblicke in die immer noch nicht vollständig entschlüsselte Pathogenese der Meningokokken-Meningitis zu erhalten. Das Neisseria adhesin A NadA ist Bestandteil der sich aktuell in der Entwicklung befindenden Impfung gegen Meningokokken der Serogruppe B. Im dem bekapselten B-Stamm MC58 wurde gezeigt, dass nadA unter der negativen Kontrolle des Transkriptionsregulators FarR steht (Schielke et al., 2009). In den ebenfalls zur Gattung Neisseria gehörenden Neisseria gonorrhoeae (Ng) wurde bereits 2001 ein FarR-Homolog beschrieben (Shafer et al., 2001). NgFarR ist an der Resistenz gegenüber antimikrobiellen, langkettigen Fettsäuren beteiligt, indem es die Expression des FarABEffluxpumpen-Systems reguliert, welches eingedrungene Fettsäuren wieder nach extrazellulär befördert. Dagegen zeigten Palmitinsäure-Resistenztests, dass FarR nicht an der intrinsischen Fettsäure-Resistenz der Meningokokken beteiligt ist. Die Deletion und die Komplementierung von farR hatten weder in bekapselten noch in unbekapselten Meningokokken Einfluss auf das normale Wachstumsverhalten. Ein Western Blot- Nachweis des FarR-Proteins in der frühen, mittleren und späten exponentiellen Wachstumsphase von Wildtyp, Kapsel-Deletionsmutante und farR-Komplementante zeigte, dass die Menge an FarR im zeitlichen Verlauf kontinuierlich zunimmt und FarR damit Wachstumsphasen-abhängig exprimiert wird. Dabei scheint es einer posttranskriptionalen oder posttranslationalen Regulation zu unterliegen, da auch in dem farRkomplementierten Stamm unabhängig vom farR-Promotor eine entsprechende Hochregulation stattfindet. In Infektionsversuchen wurde die Interaktion zwischen Meningokokken und humanen polymorphkernigen Granulozyten untersucht. In den Infektionsassays wurde die farRDeletionsmutante innerhalb des dreistündigen Versuchsrahmens deutlich stärker durch die Granulozyten abgetötet als der Serogruppe B-Wildtyp. Als Mitglied der in Bakterien und Archaeen weit verbreiteten Familie der MarR-Transkriptionsregulatoren (Multiple antibiotic resistance Regulator, MarR) bindet FarR mit hoher Wahrscheinlichkeit auch als Homodimer an seine Bindesequenz auf der DNA. FarR erkennt eine 16 bp lange, palindromische Sequenz in der Promotorregion von nadA (NMB1994), wodurch die nadA-Expression verhindert wird. Außerdem erkennt FarR eine ähnliche Bindesequenz im Promotorbereich von farAB (NMB0318/0319), wobei es aber keinen regulatorischen Einfluss ausübt. Mit einer aus diesen beiden Bindestellen berechneten minimalen Bindesequenz wurde im Genom von MC58 weitere mögliche Bindepartner detektiert. Eine Auswahl dieser möglichen Bindestellen wurde in Electrophoretic Mobility Shift Assays auf eine direkte Interaktion mit dem FarR-Protein hin untersucht, wobei sich allerdings keine direkte Bindung nachweisen ließ. Diese Ergebnisse darauf hin, dass der Transkriptionsregulator FarR hoch spezifisch bestimmte DNA-Bindesequenzen erkennt und die entsprechenden Gene reguliert. In der Promotorregion des TpsB-Proteins HrpB wurde in den sequenzierten Referenzstämmen Z2491, MC58, FAM18 und α14 eine mit der minimalen FarR-Bindesequenz kompatible Sequenz gefunden. In Electrophoretic Mobility Shift Assays konnte allerdings gezeigt werden, dass FarR nicht direkt daran bindet. Um das Transport-Protein HrpB näher zu charakterisieren, wurde das entsprechende Gen in 22 N. meningitidis-Isolaten sequenziert. Dabei zeigte sich, dass das Transportprotein hrpB in allen untersuchten invasiven und nicht-invasiven Stämmen vorhanden ist. Dieses äußerst konservierte Protein weist nur im seinem C-terminalen Bereich eine relativ variable Region auf, was vermutlich auf Rekombinationsereignisse zurückzuführen ist. Ein Alignment der Aminosäure-Sequenz des Serogruppe C-Stamms FAM18 mit der des homologen Bordetella pertussis TpsB-Proteins FhaC zeigte, dass die dreidimensionale Struktur des HrpB ebenfalls eine α-Helix, eine transmembranöse Domäne und variable extrazelluläre Loops enthält. Zusammengenommen erfüllt HrpB somit wichtige Bedingungen, um als Vakzine-Bestandteil in Betracht gezogen zu werden.