Abstract

One of the major causes of prosthetic joint failure is infection. Recently, coagulase negative Staphylococcus epidermidis has been identified as an emergent, nosocomial pathogen involved in subclinical prosthetic joint infections (PJIs). The diagnosis of PJIs mediated by S. epidermidis is usually complex and difficult due to the absence of acute clinical signs derived from the host immune system response. Therefore, analysis of protein patterns in biofilm-producing S. epidermidis allows for the examination of the molecular basis of biofilm formation. Thus, in the present study, the proteome of a clinical isolate S. epidermidis was analyzed when cultured in its planktonic or sessile form to examine protein expression changes depending on culture conditions. After 24 h of culture, sessile bacteria exhibited increased gene expression for ribosomal activity and for production of proteins related to the initial attachment phase, involved in the capsular polysaccharide/adhesin, surface associated proteins and peptidoglycan biosynthesis. Likewise, planktonic S. epidermidis was able to aggregate after 24 h, synthesizing the accumulation associate protein and cell-wall molecules through the activation of the YycFG and ArlRS, two component regulatory pathways. Prolonged culture under vigorous agitation generated a stressful growing environment triggering aggregation in a biofilm-like matrix as a mechanism to survive harsh conditions. Further studies will be essential to support these findings in order to further delineate the complex mechanisms of biofilm formation of S. epidermidis and they could provide the groundwork for the development of new drugs against biofilm-related infections, as well as the identification of novel biomarkers of subclinical or chronic infections mediated by these emerging, low virulence pathogens.

Highlights

  • Prosthetic joint infections (PJIs) are one of the main causes of joint prosthetic failure with an incidence of 2.5% of total joint arthroplasty associated with an increase of risk following revision surgery (10%) (Romano et al, 2016)

  • S. epidermidis ATCC 35984 is known to have a faster growth rate compared to the clinical isolate strain (Bottagisio et al, 2019); this is characterized by a different proteomic profile even after 24 h of either sessile or planktonic culture

  • Since the aforementioned culture conditions did not make it possible to determine which proteins are crucial for the initial steps of biofilm formation process, attention was focused

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Summary

Introduction

Prosthetic joint infections (PJIs) are one of the main causes of joint prosthetic failure with an incidence of 2.5% of total joint arthroplasty associated with an increase of risk following revision surgery (10%) (Romano et al, 2016) These numbers reflect the economic impact on the U.S Health Care System (>$50,000 per revision) and a noticeable risk of mortality – up to 7% for 80-year-old patients (Lentino, 2003). S. epidermidis, a Gram-positive, coagulase-negative bacterial species, has recently emerged as a common cause of numerous nosocomial infections associated with medical devices, in immunocompromised adults and infants (Ziebuhr et al, 2006). This is mainly due to the presence of S. epidermidis on healthy human skin where it lives as a commensal bacterium. The skin of healthy people is colonized by 10–24 different strains of S. epidermidis at any time and the host-bacteria bond is mutually beneficial since it impairs the attachment of more virulent bacteria (i.e., S. aureus) through microbial competition while conferring the optimal habitat for bacterial growth (Fey and Olson, 2010)

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