Elastase Production Research Articles

Molecular typing and biological characteristics of Pseudomonas aeruginosa isolated from cystic fibrosis patients in Brazil

The present study had as objective to evaluate the genotypic diversity and biological characteristics, such as hemolysin, protease, elastase of 56 clinical strains of Pseudomonas aeruginosa isolated from 13 cystic fibrosis (CF) patients attending at the School Hospital of Campinas State University (UNICAMP), Brazil. Genotypic diversity has been determined by Ribotyping (RT) and the pattern of the enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) of each strain. The production of elastase was significantly different only among mucoid and nonmucoid isolates. Joint results obtained by (RT) and ERIC-PCR methods were able to discriminate all strains isolated from both the same and different patients. Additionally, we observed four strain clusters with low diversity. The most infective strains were located in just two clusters. These results suggest that either there is a strong selection towards a specific genotype or that specific isolates could be responsible for the initial and subsequent colonization processes. More studies are necessary to know if these conclusions can be generalized for the general CF population.

Quorum sensing-dependent virulence during Pseudomonas aeruginosa colonisation and pneumonia in mechanically ventilated patients

BackgroundPseudomonas aeruginosa frequently colonises intubated patients and causes life-threatening ventilator-associated pneumonia (VAP). The role of quorum sensing (QS), regulating virulence in this pathogen, during colonisation and development of VAP is...

Heterogeneous virulence potential and high antibiotic resistance of Pseudomonas aeruginosa strains isolated from Korean pneumonia patients

Pseudomonas aeruginosa is an opportunistic human pathogen of clinical importance that causes airway infections in immunocompromised patients. Here, we report the virulence-associated characteristics of strains of P. aeruginosa, isolated from the sputa of 25 Korean pneumonia patients. A high degree of genomic plasticity was observed by random amplified polymorphic DNA genotype analysis, suggesting that the infections were caused by strains with diverse genomic backgrounds. Biofilm formation of each isolate was heterogeneous in terms of their relative motilities. In addition, 48% of isolates were defective in the production of 3-oxo-C(12)-HSL (PAI-1), a quorum sensing signal molecule. In these strains, PAI-1-dependent elastase production was correspondingly decreased, suggesting that a large number of strains were presumed to be quorum sensing deficient. Multidrug resistance (MDR) was seen in 56% of the isolates tested, and 44% of the MDR strains were resistant to five or more antibiotics. Taken together, our results provide additional insights into the virulence traits of P. aeruginosa clinical isolates, which will aid in treating P. aeruginosa infections in pneumonia patients.

Evaluation of Anti-Quorum-Sensing Activity of Edible Plants and Fruits through Inhibition of the N-Acyl-Homoserine Lactone System in Chromobacterium violaceum and Pseudomonas aeruginosa

Background: To find out an alternative strategy to antibiotic usage against bacterial infection. Materials and Methods: The purpose of this study is to describe the quorum-sensing (QS) inhibitory activity of edible plants and fruits against N-acyl-homoserine lactone (AHL)-mediated violacein production in Chromobacterium violaceum and virulence factor expression in Pseudomonas aeruginosa PAO1. Results: Aqueous extracts of Ananas comosus (Bromeliaceae), Musa paradiciaca (Musaceae), Manilkara zapota (Sapotaceae) and Ocimum sanctum (Lamiaceae) were prepared and anti-QS activity of each extract was tested against AHL-mediated phenotypic expressions of C. violaceum and PAO1. Most of these extracts showed significant reduction in AHL-mediated violacein production in C. violaceum as well as pyocyanin pigment, staphylolytic protease, elastase production and biofilm formation in PAO1. However, these extracts were not inhibitory to bacterial growth, revealing that the QS inhibition by the extracts is not related to static or killing effects on the bacteria. Conclusions: The present study identified the anti-QS activity of A. comosus, M. paradiciaca, M. zapota and O. sanctum. An AHL-inactivating compound from these plant sources can be used as an alternative to antibiotic compounds to prevent AHL-mediated bacterial infection in higher organisms.

Quorum Sensing and Virulence of Pseudomonas aeruginosa during Lung Infection of Cystic Fibrosis Patients

Pseudomonas aeruginosa is the predominant microorganism in chronic lung infection of cystic fibrosis patients. The chronic lung infection is preceded by intermittent colonization. When the chronic infection becomes established, it is well accepted that the isolated strains differ phenotypically from the intermittent strains. Dominating changes are the switch to mucoidity (alginate overproduction) and loss of epigenetic regulation of virulence such as the Quorum Sensing (QS). To elucidate the dynamics of P. aeruginosa QS systems during long term infection of the CF lung, we have investigated 238 isolates obtained from 152 CF patients at different stages of infection ranging from intermittent to late chronic. Isolates were characterized with regard to QS signal molecules, alginate, rhamnolipid and elastase production and mutant frequency. The genetic basis for change in QS regulation were investigated and identified by sequence analysis of lasR, rhlR, lasI and rhlI. The first QS system to be lost was the one encoded by las system 12 years (median value) after the onset of the lung infection with subsequent loss of the rhl encoded system after 17 years (median value) shown as deficiencies in production of the 3-oxo-C12-HSL and C4-HSL QS signal molecules respectively. The concomitant development of QS malfunction significantly correlated with the reduced production of rhamnolipids and elastase and with the occurrence of mutations in the regulatory genes lasR and rhlR. Accumulation of mutations in both lasR and rhlR correlated with development of hypermutability. Interestingly, a higher number of mucoid isolates were found to produce C4-HSL signal molecules and rhamnolipids compared to the non-mucoid isolates. As seen from the present data, we can conclude that P. aeruginosa and particularly the mucoid strains do not lose the QS regulation or the ability to produce rhamnolipids until the late stage of the chronic infection.

Direct Interaction between Quorum-sensing Regulator SmcR and RNA Polymerase Is Mediated by Integration Host Factor to Activate vvpE Encoding Elastase in Vibrio vulnificus

It has been suggested that quorum sensing is an important signal transduction system regulating the expression of numerous virulence genes in bacterial pathogens. We previously revealed that SmcR, a LuxR homologue of Vibrio vulnificus, activates promoter S, an RpoS-dependent promoter of vvpE encoding a potential virulence factor elastase and binds in vitro to a binding site centered at -196.5. In this study, chromatin immunoprecipitation assays and promoter deletion analyses demonstrated that SmcR binds to the vvpE regulatory region in vivo and directly interacts with RNAP for activation of the vvpE expression. A search for regulatory genes involved in the regulation of elastase production singled out ihfA, which encodes for a subunit of integration host factor (IHF). Levels of both elastase activity and vvpE transcript decreased significantly as a result of inactivation of ihfA, and primer extension analyses demonstrated that IHF regulates the vvpE transcription by activating PS. Direct binding of IHF to the two distinct binding sites centered at -174 and -131, respectively, was determined using an electrophoretic mobility shift assay and a DNase I protection assay. Chromatin immunoprecipitation assays revealed that the interaction of SmcR with RNAP in vivo was mediated by IHF. Collectively, the results proposed a model whereby IHF positions SmcR to contact RNAP by looping the vvpE regulatory DNA, thus allowing precise control of the expression level of VvpE during the pathogenesis of V. vulnificus.

Polyclonal Aspergillus fumigatus infection in captive penguins

Aspergillus fumigatus is a known opportunistic pathogen of penguins. Most reports of penguin aspergillosis have focused on clinical, histopathological and microbiological findings. The molecular characterization of A. fumigatus isolates involved in invasive infections in penguins has yet to be addressed. The aim of this work was to study the possible coexistence of different A. fumigatus genotypes in five clinical cases of invasive aspergillosis in captive penguins. Differences in other relevant characteristics of the isolates, including mating type and invasiveness, were also considered. Alkaline protease and elastase production by the A. fumigatus isolates was evaluated by plate assays. Random amplified polymorphic DNA, and microsatellite analysis techniques were used for molecular typing, and mating type ( MAT1-1 or MAT1-2) was determined by multiplex PCR. Although all isolates showed protease activity, differences in elastase activity were observed. The typing techniques indicated different genotypes in all the penguins, although one genotype was predominant in some cases. Fungal strains of different mating type were found in two different penguins, confirming infection polyclonality. In conclusion, captive penguins are susceptible to infection by multiple strains of A. fumigatus that differ not only in their genotype, but also in mating type and invasiveness. This finding has important consequences for the diagnosis and treatment of avian aspergillosis.

Total hip and knee replacement surgery results in changes in leukocyte and endothelial markers.

BackgroundIt is estimated that over 8 million people in the United Kingdom suffer from osteoarthritis. These patients may require orthopaedic surgical intervention to help alleviate their clinical condition. Investigations presented here was to test the hypothesis that total hip replacement (THR) and total knee replacement (TKR) orthopaedic surgery result in changes to leukocyte and endothelial markers thus increasing inflammatory reactions postoperatively.MethodsDuring this 'pilot study', ten test subjects were all scheduled for THR or TKR elective surgery due to osteoarthritis. Leukocyte concentrations were measured using an automated full blood count analyser. Leukocyte CD11b (Mac-1) and CD62L cell surface expression, intracellular production of H2O2 and elastase were measured as markers of leukocyte function. Von Willebrand factor (vWF) and soluble intercellular adhesion molecule-1 (sICAM-1) were measured as markers of endothelial activation.ResultsThe results obtained during this study demonstrate that THR and TKR orthopaedic surgery result in similar changes of leukocyte and endothelial markers, suggestive of increased inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in a leukocytosis, this being demonstrated by an increase in the total leukocyte concentration following surgery. Evidence of leukocyte activation was demonstrated by a decrease in CD62L expression and an increase in CD11b expression by neutrophils and monocytes respectively. An increase in the intracellular H2O2 production by neutrophils and monocytes and in the leukocyte elastase concentrations was also evident of leukocyte activation following orthopaedic surgery. With respect to endothelial activation, increases in vWF and sICAM-1 concentrations were demonstrated following surgery.ConclusionIn general it appeared that most of the leukocyte and endothelial markers measured during these studies peaked between days 1-3 postoperatively. It is proposed that by allowing orthopaedic surgeons access to alternative laboratory markers such as CD11b, H2O2 and elastase, CD62L, vWF and sICAM-1, an accurate assessment of the extent of inflammation due to surgery per se could be made. Ultimately, the leukocyte and endothelial markers assessed during this investigation may have a role in monitoring potential infectious complications that can occur during the postoperative period.

Systemic Inflammatory Response Syndrome Score at Admission Predicts Injury Severity, Organ Damage and Serum Neutrophil Elastase Production in Trauma Patients

Systemic inflammatory response syndrome (SIRS) is a clinical condition representing the culmination of the activation of a complex network of acute endogenous mediators. We investigated both the relationship between the results of SIRS assessments in 212 trauma patients at the time of hospital arrival and measures of trauma severity determined using the Injury Severity Score (ISS) and the Revised Trauma Score (RTS). We then considered the possibility of whether this assessment could be used to predict the development of organ dysfunction as a complication in trauma patients after admission. The serum neutrophil elastase (SNE) level was also measured in 47 cases. The cases with SIRS had a significantly higher ISS and a lower RTS. Organ dysfunction occurred in 22 cases, and a significant correlation was noted between the development of organ dysfunction and the presence of SIRS (86.4%; 19 cases/22 cases, p=0.0007) at the time of arrival. The SNE level was significantly higher among the patients who fulfilled the four SIRS criteria than among the other patients (p=0.0301). We concluded that the greater the SIRS score at the time of hospital arrival, the greater the anatomical and physiological severity of the trauma patient's condition.

Receptors and aging: Dedicated to the memory of Paul Ehrlich for the 100th anniversary of his Nobel Prize

The initiation and evolution of the receptor concept and its application in pharmacology can be traced back to Paul Ehrlich's original experiments. Since several decades the receptor concept is in the foreground of cell biology and pharmacology. We present here a short reminder of Ehrlich's concepts on receptor action, its evolution and modifications as a result of increasing life expectancy of human societies. Results obtained by several teams on the age-dependent modifications of receptor function are reviewed with special emphasis on the age-dependent loss of receptors and of uncoupling of receptors from their intracellular transmission pathway. As a special example we summarize our results on the elastin receptor and its age-dependent modifications. These modifications result in the loss of the physiologically helpful functions mediated by this receptor, such as vasodilation by coupling with the inducible nitric oxide synthase (iNOS)-inhibition of cellular cholesterol synthesis and modulation of free radical production by inhibition of the guanine nucleotide binding protein (Gi protein)-mediated transmission pathway. Only the harmful effects such as free radical release and up-regulation of elastase production remain in “old” cells. The age-dependent modifications of receptor function play an important role in the increasing frequency and severity of age-related diseases such as athero-arteriosclerosis and emphysema as well as the loss of hormone- and drug actions. These processes and their inhibition or correction represent a new challenge for cellular pharmacology.

Production of elastase by pathogenic and non-pathogenic fungi.

Many yeasts, dermatophytes as well as moulds liberate hydrolytic enzymes into the growth medium. The enzymes may serve the fungus by different ways, e. g., they cause chemical and physical changes in the immediate surrounding of the fungus thus enhancing the living possibilities. The production of enzymes capable of digesting mammalian proteins would aid pathogenic fungi to penetrate the human epidermis and to spread in the dermis. Many of the dermatophytes are, in fact, capable of digesting keratin by the aid of keratinase, collagen by the aid of collagenase (RIPPON and LORINCZ, 1964) and even elastin by the aid of elastase (RIPPON and VARADI, 1968). Elastase and collagenase could serve the organism also by breaking the intercellular connection of the epidermal cells or by dissolving the basal membrane (KOTRAJARAS, 1965). The production of elastase, one of the most specific proteases by fungi has been the subject of only one report in which relatively few species were tested (RIPPON and VARADI, 1968). Further studies on the elastase producing ability of the pathogenic as well as non-pathogenic fungi might clarify the role of this enzyme in the pathogenicity of the fungi. They could also disclose whether tests on the elastase production could be of value in the routinly identification of fungi. Material and methods The production of elastase by growing colonies of yeasts, dermatophytes and moulds was tested by using two kinds of test agar plates. The basic growth medium was the same in both types of plates containing glucose 10.0 g, pepton aus casein (Merdc) 5.0 g, glycerol 5.0 g, sodium chloride 5.0 g, Standard I1 Nahrbouillon Merdc 15.0 g, agar 30.0 g, yeast extract 3.0 g and aqua destillata 1000 ml. One gram of elasdn powder (Sigma Chem. Comp.) was added to 100 ml sterilized agar which was poured on test plates thus following essentially the method of R~PPON and VARADI (1968). In these plates the grains of elastin appear gray against the yellowish badrground. Elastase activity was manifested as dissolution of the grains and thus as the appearance of a clear ring around the colony. In the second type of growth plates the elastin was replaced by elastin which was coupled with Remazolbrilliant Blue B according to RINDERKNECHT (1970). In these plates (incubated at 23' C) the grains are dark blue and after dissolution of the grains a clear ring is seen. The zones of cleraing around the fungi were recorded after 4, 7, and 14 days respectively. The species of fungi tested were from the collection of our laboratory (most of them are originally from Centraalbureau voor Schimmelcultures, Holland).

Opposing effects of carbon monoxide (CO) releasing molecule (CORM3) on activation of polymorphonuclear leukocytes (PMN) and endothelial cells (HUVEC) in sepsis.

Recently, it has been shown that CORM‐released CO can modulate inflammatory response. In this study we assessed the effects and potential mechanisms of water‐soluble CO‐releasing molecule, CORM3, in experimental model of sepsis.Sepsis in mice was induced by cecal ligation/puncture (CLP). CORM3 (3mg/kg; iv) was administered 15 min after CLP induction. PMN accumulation (MPO assay) in the lung was assessed 6 hr later. In in vitro experiments human PMN were primed with LPS (10ng/ml) and stimulated with fMLP (100nM). PMN production of ROS (oxidation of L‐012/DHR123 over 30 min period of time) and release of elastase (AAPV‐pNA; 1hr) were assessed. In parallel, HUVEC were stimulated with LPS (1µg/ml) and assessed for ROS production, E‐selectin/ICAM‐1 expression (RT‐PCR) and 51Cr‐PMN adhesion/migration. Some experiments were performed in the presence of CORM‐3 (1‐100 µM).The obtained results indicate that CORM3 significantly reduced PMN accumulation in the lung of septic mice. In parallel, LPS‐induced increase in HUVEC ROS production, E‐selectin/ICAM‐1 expression and PMN adhesion/migration were attenuated by CORM‐3. On the contrary, CORM3 markedly increased ROS production and potentiated release of elastase by LPS‐primed PMN.These data indicate that CORM3 reduces inflammation in the septic lung by differentially modulating PMN and endothelial cell activation (HSFO‐ NA6171 and MOP‐68848)

Cortisol-binding globulin cleavage at sites of inflammation in critically ill patients

In vitro studies have shown that cortisol-binding globulin (CBG) can be cleaved by neutrophil elastase with a resulting reduction in affinity for cortisol [1]. Local elastase production by activated neutrophils may trigger cortisol release by CBG cleavage, providing a potential mechanism for targeted delivery of corticosteroids to inflamed tissues. We looked for evidence of this process at sites of inflammation in critically ill patients.

Local and Systemic Responses in Matrix Metalloproteinase 8-Deficient Mice duringPorphyromonas gingivalis-Induced Periodontitis

Periodontitis is a bacterium-induced chronic inflammation that destroys tissues that attach teeth to jaw bone. Pathologically excessive matrix metalloproteinase 8 (MMP-8) is among the key players in periodontal destruction by initiating type I collagen degradation. We studied MMP-8 in Porphyromonas gingivalis-induced periodontitis by using MMP-8-deficient (MMP8(-/-)) and wild-type (WT) mice. Alveolar bone loss, inflammatory mediator expression, serum immunoglobulin, and lipoprotein responses were investigated to clarify the role of MMP-8 in periodontitis and systemic inflammatory responses. P. gingivalis infection induced accelerated site-specific alveolar bone loss in both MMP8(-/-) and WT mice relative to uninfected mice. The most extensive bone degradation took place in the P. gingivalis-infected MMP8(-/-) group. Surprisingly, MMP-8 significantly attenuated (P < 0.05) P. gingivalis-induced site-specific alveolar bone loss. Increased alveolar bone loss in P. gingivalis-infected MMP8(-/-) and WT mice was associated with increase in gingival neutrophil elastase production. Serum lipoprotein analysis demonstrated changes in the distribution of high-density lipoprotein (HDL) and very-low-density lipoprotein (VLDL) particles; unlike the WT mice, the MMP8(-/-) mice underwent a shift toward a smaller HDL/VLDL particle sizes. P. gingivalis infection increased the HDL/VLDL particle size in the MMP8(-/-) mice, which is an indicator of lipoprotein responses during systemic inflammation. Serum total lipopolysaccharide activity and the immunoglobulin G-class antibody level in response to P. gingivalis were significantly elevated in both infected mice groups. Thus, MMP-8 appears to act in a protective manner inhibiting the development of bacterium-induced periodontal tissue destruction, possibly through the processing anti-inflammatory cytokines and chemokines. Bacterium-induced periodontitis, especially in MMP8(-/-) mice, is associated with systemic inflammatory and lipoprotein changes that are likely involved in early atherosclerosis.

Investigation of extracellular elastase, acid proteinase and phospholipase activities as putative virulence factors in clinical isolates of Aspergillus species

We investigated the production of extracellular elastase, acid proteinase and phospholipase enzyme activities in clinical isolates of Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger and any possible correlation between the existence of these enzymes and development of invasive aspergillosis. A total of 73 strains (45 A. fumigatus, 23 A. flavus, 5 A. niger) isolated from patients with invasive aspergillosis (n = 55), superficial aspergillosis (n = 5), allergic bronchopulmonary aspergillosis (n = 1), and from those colonized with Aspergillus (n = 12) were included in the study. The enzymatic activities were tested on solid media supplemented with the corresponding substrates. Elastase activity was detected in 95.6, 82.6, and 0% of A. fumigatus, A. flavus, and A. niger isolates, respectively. Acid proteinase activity was detected only for A. fumigatus and in 20 of 45 isolates belonging to this species. Phospholipase activity was present in all strains of A. fumigatus and A. niger but in none of the isolates of A. flavus. No statistical correlation could be established between the existence of elastase or acid proteinase activity and development of invasive disease (p > 0.05). While high phospholipase production was found to be associated with development of invasive aspergillosis (p < 0.01), not all isolates that caused invasive diseases showed high phospholipase activities.

Heparin coating of poly(ethylene terephthalate) decreases hydrophobicity, monocyte/leukocyte interaction and tissue interaction

Woven poly(ethylene terephthalate) (PET) is widely used in implantable medical devices. Upon implantation, fibrinogen interacts with the PET and changes conformation, such that the fibrinogen P2 epitope may become exposed. This allows inflammatory cells to interact with the material. In this study we have coated PET with heparin and show that this decreases PET hydrophobicity and the presence of the fibrinogen P2 epitope on the material surface. In addition, we show that heparin-induced reduction of PET hydrophobicity correlates with decreased exposure of the fibrinogen P2 epitope and reduced adhesion of monocytes. Reduction of PET hydrophobicity was furthermore associated with reduced PMN elastase production and decreased interaction between PET and embryonic chicken tissue. We conclude that the heparin coating-induced decrease in PET hydrophobicity is associated with decreased interaction between PET and inflammatory cells. Independent of this interaction, the hydrophobic nature of the heparin coating is related to tissue interaction as demonstrated by a reduction in adhesion, growth and spreading of tissue on PET. The combination of these properties makes heparin coating a candidate for improving biocompatibility of PET.

Enzymatic characterization of Vibrio alginolyticus strains isolated from bivalves harvested at Venice Lagoon (Italy) and Guanabara Bay (Brazil)

The aquatic ecosystem is the natural habitat of microorganisms including Vibrio and Aeromonas genus which are pathogenic to human and animals. In the present investigation the frequency of these bacteria and the enzymatic characteristics of 34 Vibrio alginolyticus strains isolated from bivalves harvested in Venice Lagoon (Italy) and Guanabara Bay (Brazil) were carried out from November 2003 to February 2004. The mussels' samples were submitted to enrichment in Alkaline Peptone Water (APW) added with 1% of sodium chloride (NaCl) and APW plus 3% NaCl incubated at 37 degrees C for 18-24 h. Following the samples were streaked onto TCBS Agar (Thiossulfate Citrate Bile Sucrose Agar) and the suspected colonies were submitted to biochemical characterization. Also, the Vibrio alginolyticus strains were evaluated to collagenase, elastase and chondroitinase production. The results showed the isolation of 127 microorganisms distributed as follows: 105 Vibrio strains such as V. alginolyticus (32.4%), V. harveyi (19%) and V. parahaemolyticus (7.6%), 20 Aeromonas strains and two Plesiomonas shigelloides were the main pathogens isolated. We observed the production of the three enzymes from V. alginolyticus strains considered as the main virulence factors of the bacteria, especially in cases of human dermatological infection.

Secretory Immunoglobulin A Blunts Gut-Mediated Priming of Neutrophils In Vitro

Gut ischemia may prime neutrophils to produce an exaggerated inflammatory response when challenged with bacterial pathogens. Secretory immunoglobulin A (sIgA) is the first line of defense against potential pathogens, but may also exert its anti-inflammatory effects on potentially destructive neutrophil functions. We hypothesized that sIgA would blunt the gut-mediated priming events that lead to neutrophil hypersensitivity to bacterial challenge. Confluent Caco2 cell monolayers were grown in a two-chamber culture system under normoxic or hypoxic conditions for 90 minutes followed by a 90-minute reoxygenation period. sIgA was placed in apical chamber media in experimental groups before reoxygenation period. Supernatants were then collected and incubated with neutrophils. Lipopolysaccharide was then used to activate neutrophils. Measurements of CD11b expression, elastase and superoxide anion production, and chemotaxis were undertaken. Polymorphonuclear neutrophils (PMNs) treated with Caco2 cells undergoing hypox-reoxygenation followed by activation with lipopolysaccharide show a dramatic increase in inflammatory potential when compared with naïve neutrophils (n = 4, *p < 0.001). The addition of sIgA in this same group before the activation step showed a blunting of the inflammatory response, but never to the level of naïve PMN. sIgA is the principal defense against potential pathogens at mucosal surfaces. Additional protective activity may be found in its ability to downregulate gut-mediated neutrophil priming. Although more work needs to be performed examining the role of sIgA in the pathogenesis of sepsis, this study shows that sIgA downregulates the measured determinants of neutrophil inflammatory potential.

Resistance and Virulence of Pseudomonas aeruginosa Clinical Strains Overproducing the MexCD-OprJ Efflux Pump

Since their initial description 2 decades ago, MexCD-OprJ-overproducing efflux mutants of Pseudomonas aeruginosa (also called nfxB mutants) have rarely been described in the clinical setting. Screening of 110 nonreplicate clinical isolates showing moderate resistance to ciprofloxacin (MIC from 0.5 microg/ml to 4 microg/ml) yielded only four mutants (3.6%) of that type harboring various alterations in the repressor gene nfxB. MexCD-OprJ upregulation correlated with an increased resistance to ciprofloxacin, cefepime, and chloramphenicol in most of the clinical strains, concomitant with a higher susceptibility to ticarcillin, aztreonam, imipenem, and aminoglycosides. Evidence was obtained that this increased susceptibility to aminoglycosides results from the impaired activity of efflux pump MexXY-OprM. Furthermore, MexCD-OprJ upregulation was found to impair bacterial growth and to have a strain-specific, variable impact on rhamnolipid, elastase, phospholipase C, and pyocyanin production. Review of patient files indicated that the four nfxB mutants were responsible for confirmed cases of infection and emerged during long-term therapy with ciprofloxacin. Taken together, these data show that, while rather infrequent among P. aeruginosa strains with low-level resistance to ciprofloxacin, MexCD-OprJ-overproducing mutants may be isolated after single therapy with fluoroquinolones and may be pathogenic.

Quorum-sensing activity and related virulence factor expression in clinically pathogenic isolates of Pseudomonas aeruginosa

Respiratory isolates of Pseudomonas aeruginosa were collected from 58 critically-ill patients with ventilator-associated pneumonia. Expression of elastase and pyocyanin was assessed semi-quantitatively, while quorum-sensing activity was assessed by quantifying the levels of the autoinducers N-3-oxododecanoyl-L-homoserine lactone (C12-HSL) and N-butanoyl-L-homoserine lactone (C4-HSL). Correlations were sought between quorum-sensing activity and the expression of these two virulence factors, and all results were compared to those obtained with the laboratory reference strains PA103, a strain defective in quorum-sensing, and PAO1, a functional quorum-sensing strain. More than two-thirds of clinically pathogenic isolates had increased levels of elastase and/or pyocyanin, and high quorum-sensing activity, as assessed by autoinducer levels. However, a strong correlation between quorum-sensing activity and virulence factor production was revealed only for elastase and not for pyocyanin (C12-HSL/elastase, r = 0.7, p 2 × 10−9; C4-HSL/elastase, r = 0.7, p 2 × 10−9). These data suggest that the pathogenicity of P. aeruginosa isolates from critically-ill patients with ventilator-associated pneumonia is caused, at least in part, by an increase in elastase production regulated by quorum-sensing, while increased pyocyanin production in these isolates may be regulated predominantly by mechanisms other than quorum-sensing.