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Mechanically ventilated patients are at risk of ventilator-associated pneumonia, a serious infection of the lungs. Not every ventilated patient develops pneumonia due to a combination of the protective layer of mucus in the airways, the immune system and prophylactic antibiotic therapy. To date, only little was known about the antimicrobial factors produced by humans that protect the lungs against infection. Research described in this thesis was therefore aimed at investigating to what extent the lungs of ventilated patients can inhibit the growth of bacteria, the major causative agent of pneumonia Streptococcus pneumoniae in particular. To this end, the accumulated mucus in the patients’ lungs, sputum, was investigated. The most important conclusion was that sputum can indeed possess antimicrobial activity, explained either by a combination of antibiotics and S. pneumoniae-specific antibodies, or by the innate immune defenses. Thus, sputum may serve as a valuable source of information to unravel the complex interactions between the human host, antimicrobial factors and the microbiome of the lower respiratory tract. A possible consequence of pneumonia is the dissemination of bacteria from the lungs to the bloodstream and the brain, which may lead to meningitis. This thesis describes how this process takes place, and how the so-called choline-binding protein CbpL contributes to invasive pneumococcal infections. In addition, possible future approaches to prevent meningitis caused by this bacterium are proposed.
Neue Antibiotika und Präventionsmaßnahmen gegen S. aureus sind aufgrund der starken Ausbreitung multiresistenter S. aureus-Stämme dringend erforderlich. Zur Entwicklung von Therapie- und Präventionsmaßnahmen werden geeignete Infektionsmodellen benötigt, die die klinische Situation möglichst exakt widerspiegeln. Da die Spezies S. aureus stark wirtsspezifisch ist, könnten wirtsadaptierte S. aureus-Stämme hierbei äußerst hilfreich sein. In der Infektionsforschung werden vor allem Mausmodelle verwendet. Da bisher jedoch angenommen wurde, dass Mäuse keine natürlichen Wirte von S. aureus sind, sind S. aureus-Forscher davon ausgegangen, dass Mäuse kein geeignetes Modell darstellen. Das wurde durch unsere und andere Arbeitsgruppen allerdings in den letzten Jahren widerlegt. Wir konnten zeigen, dass Labor- und Wildmäuse mit S. aureus besiedelt sind.
Im Rahmen dieser Arbeit sollte geklärt werden, ob murine Infektionsmodelle durch die Verwendung von mausadaptierten S. aureus-Stämmen optimiert werden können. Aus über 250 S. aureus-Stämmen, die aus Labor und Wildmäusen isoliert wurden, wurden vier mausadaptierte S. aureus-Isolate ausgewählt und mit dem humanen S. aureus-Isolat Newman in einem Pneumonie- und Bakteriämiemodell vergleichen. Diese Stämme wiesen einen repräsentativen spa-Typ sowie typischen Phagenmuster und Virulenzgene auf. Zudem waren sie in der Lage, murines Plasma zu koagulieren und in murinem Vollblut zu replizieren.
Es zeigte sich, dass das murine Isolat S. aureus DIP sowohl im Pneumonie- als auch im Bakteriämiemodell deutlich virulenter war als das humane Isolat Newman und die anderen getesteten mausadaptierten Stämme. Nach kürzester Zeit starben alle Tiere, die mit S. aureus DIP infiziert wurden. Wurde die Infektionsdosis im Vergleich zu Newman um 90 % reduziert, waren die bakterielle Last, der Belastungsscore, sowie die Zytokin- und Chemokinkonzentrationen nach Infektion mit S. aureus DIP bzw. S. aureus Newman vergleichbar. Im Besiedlungsmodell konnte gezeigt werden, dass die mausadaptierten Stämme S. aureus JSNZ sowie S. aureus DIP in der Lage sind, Mäuse über einen Zeitraum von 7 Tagen stabil zu besiedeln. Mäuse, die mit S. aureus Newman besiedelt waren, konnten den Stamm innerhalb dieses Zeitraums eliminieren. Die Genomsequenzierung der in vivo verwendeten S. aureus Stämme zeigte, dass lediglich S. aureus DIP für das Leukozidin LukMF‘ kodiert. Das lässt vermuten, dass die Präsenz des Virulenzfaktors für die gesteigerte Virulenz von S. aureus DIP verantwortlich sein könnte.
Des Weiteren sollten in dieser Arbeit ein Besiedlungsmodell mit murinen S. aureus-Isolaten etabliert und die beteiligten Immunzellen quantifiziert werden. Es zeigte sich, dass Mäuse mit murinen S. aureus-Isolaten bis zu 7 Tage besiedelt werden können wohingegen S. aureus Newman zu diesem Zeitpunkt nur noch in 20 % der Tiere nachweisbar war. Zudem konnte bei der intranasalen Besiedlung mit einer hohen Dosis S. aureus DIP [1 × 10^8 CFU] gezeigt werden, dass sowohl Th17-Zellen als auch γδ-T-Zellen nach 7 Tagen IL-17A, IL-17F und IL-22 produzieren. Jedoch konnte die Zytokinproduktion nur in Tieren nachgewiesen werden, die einen hohen Belastungsscore aufwiesen. Da nach 24 Stunden bei Tieren mit hohem Belastungsscore auch Bakterien in der Lunge detektiert wurde, ist anzunehmen, dass S. aureus diese Tiere nicht nur besiedelt, sondern bei ihnen auch eine Atemwegsinfektion verursacht hatte. Durch den geringen prozentualen Anteil an ILCs in den zervikalen Lymphknoten war es nicht möglich Rückschlüsse auf deren Zytokinproduktion zu ziehen. Somit gelang es zwar ein murines S. aureus-Besiedlungsmodell zu etablieren, jedoch kann keine Aussage zu den beteiligten Zellen des Immunsystems getroffen werden.
Zusammenfassend konnte gezeigt werden, dass Labormäuse mit mausadaptierten S. aureus-Stämmen länger besiedelt werden können als mit dem humanen Referenzstamm Newman. Zudem konnte mit Hilfe des mausadaptierten Stammes S. aureus DIP die Infektionsdosis im Pneumonie- und Bakteriämiemodell erheblich reduziert werden. Somit gelang es Mausmodelle durch die Verwendung von mausadaptierten S. aureus-Stämmen zu optimieren, auch wenn das nicht auf alle getesteten Isolate zutrifft. Durch die Anpassung an den murinen Wirt stellen mausadaptierte S. aureus-Stämme wie DIP und JSNZ ein physiologischeres Modell der Pathogen-Wirts-Interaktion dar. Die Verwendung eines solchen Stammes ermöglicht es ein besseres Verständnis für Infektionsprozesse und die Pathogen-Wirt-Interaktionen zu erlangen und dadurch eventuell neue Therapiemöglichkeiten zu entwickeln.
Es ist zu berücksichtigen, dass auch die Verwendung mausadaptierter S. aureus-Stämme in murinen Besiedlungs- und Infektionsmodellen lediglich ein Modell darstellt, welches Vor- und Nachteile hat. Daher ist es essenziell, dass Wissenschaftler die Grenzen jedes Modellsystems kennen und das richtige Infektionsmodell (oder eine Kombination davon) auswählen, um ihre Forschungsfragen zu beantworten.
Staphylococcus aureus is one of the commonly encountered bacteria of the human microbiome. Although mostly a seemingly harmless commensal microbe, S. aureus can act as an invasive pathogen with seriously devastating effects on its host’s health and wellbeing. A wide range of infections caused by this bacterium has been reported to affect diverse parts of the human body, including the skin, soft tissues and bones, as well as important organs like the heart, kidneys and lungs. Particularly, S. aureus is infamous for being a major causative agent of respiratory tract infections that may escalate up to necrotizing pneumonia. Due to its clinical relevance, this pathogen has been intensively studied for many years. Nonetheless, further research in this field is still needed, because of the high capacity of S. aureus to evolve drug resistance, its high genomic plasticity and adaptability and, not in the last place, the plethora of niches within the human body where it can thrive and survive. In this regard, there are still many uncertainties concerning the specific adaptations carried out by S. aureus during colonization and infection of the human body, the transition between both stages, and upon the invasion of different types of host cells. To shed more light on some of these adaptations, the research described in this thesis has employed in vitro models of infection that mimic particular conditions during the infectious process with special focus on the lung epithelium. The adaptations displayed by S. aureus were monitored using advanced proteomics. Furthermore, the analyses documented in this thesis included S. aureus strains with diverse backgrounds and epidemiology to take into account the genetic diversity encountered in this species.
Interactions between bacteria and the human body are manifold and happen constantly. Most parts of the skin and gastrointestinal tract, the saliva, the oral mucosa, the conjunctiva and the vaginal mucosa are colonized with a multitude of bacterial species forming the human microbiota. Strikingly, the estimated amount of bacterial cells outnumbers the human body by 10 to 1. However, most of these bacteria colonize the human body without positive or negative effects and are regarded as commensals. Staphylococcus aureus a Gram positive bacterium is such a commensal bacterium of 25 % to 30 % of the world population. It is also an opportunistic pathogen and is able to cause infections in the lung, skin and heart and to induce sepsis. Its pathogenicity is mainly facilitated by the secretion of a broad spectrum of virulence factors which interact with the host. Some are distracting the immune system, others are targeting the host cell membrane or degrade macromolecular structures of the host in order to provide nutrients. Furthermore S. aureus is able to invade the host cell and to survive and replicate in the host cell cytosol or other compartments. The Gram negative proteobacterium Burkholderia pseudomallei is an environmental bacterium but still has the ability to enter the human body via body orifices or skin wounds. In a very efficient way it penetrates the host cell, replicates intracellular and the uses host structures to spread from cell to cell thereby causing the disease melioidosis often with fatal outcomes. Since the natural habitats of B. pseudomallei are wet soils, the change to the environment in the human body is drastic and requires a high degree of flexibility of the bacterium. Environmental stress conditions such as temperature, pH, nutrient limitation or presence of antibiotics induce a switch of colony morphology which is a special characteristic of this bacterium. Since it is assumed, that changes in colony morphology are connected to adaptive processes to the environmental changes, these morphology switches might also be important during infection. The host organism and the host cell on the other side try to kill and remove the bacterial threat by activating the immune system and cellular defence mechanisms. This includes generation of reactive oxygen and nitrogen species, production of antimicrobial peptides and cellular processes such as phagocytosis, autophagy, apoptosis and activation of the immune response. The actions and reactions on both, the pathogen side and the host side, are summarized as host-pathogen interactions. In the field of functional genomics, methods were developed to understand various levels of host-pathogen interactions. The holistic analysis of the mRNA (the transcriptome) or translated proteins (the proteome) were already very useful tools to describe important cellular processes on the host and the pathogen site. The level of metabolites with regard to host-pathogen interactions however, has been neglected so far. In this dissertation the metabolic composition in the intracellular and extracellular space of the host and the pathogen was analyzed. For this matter biochemical analytical tools were used such as 1H-nuclear magnetic resonance spectroscopy and chromatographic methods (GC and HPLC) coupled to mass spectrometry. The combination of these methods allows a broad coverage of physicochemical diverse metabolites. In accordance to the above mentioned biological levels like mRNA and proteins, the sum of all metabolites is referred as the metabolome. Consequently to transcriptomics and proteomics the analysis of the metabolome is referred as metabolomics. To gain insights into the infection relevant metabolome of the host-pathogen relationship between S. aureus and human lung cells several approaches were developed. First the distribution of the recently identified bacillithiol in different S. aureus strains was investigated with regard to its role during the infection. For that matter a HPLC-methodology was used with fluorescence based detection of labelled low molecular weight thiols (article I: Distribution and infection-related functions of bacillithiol in Staphylococcus aureus). After that the next aim was to reveal the effect of S. aureus on the host cell metabolism. To reduce the complexity of effects on the host cells an artificial model was chosen in a first approach. The lung cells were treated with the staphylococcal virulence factor alpha-hemolysin, a pore forming toxin and a holistic metabolomics approach was performed (article II: Staphylococcus aureus Alpha-Toxin Mediates General and Cell Type-Specific Changes in Metabolite Concentrations of Immortalized Human Airway Epithelial Cells). Using this approach, a protocol for cell culture metabolomics was established and first changes in the host cell metabolome that could be caused by S. aureus were described. However, this only describes specific changes caused by one single virulence factor and does not necessarily describes the reality during a S. aureus infection. Therefore in a next approach, an infection model using a human lung epithelial cell line and the S. aureus strain USA300 was established and used for metabolome analysis. Furthermore a combination of inhibitor treatment and metabolic labelling was used to clarify the metabolic activity in the host cell after exposure to S. aureus (article III: Metabolic features of a human airway epithelial cell line infected with Staphylococcus aureus revealed by a metabolomics approach). Finally this thesis deals with the host-pathogen interaction of B. pseudomallei and its host with a focus on the role of the switch in colony morphology in basic metabolism. Various morphotypes of two strains were generated by nutrient limitation and their uptake of nutrients was monitored. Furthermore the morphotypes were used in in vitro and in vivo infections and subsequently isolated out of the cell line and mice respectively. After isolation, the colony morphology was determined and again the nutrient uptake profile was monitored (article IV: Burkholderia pseudomallei morphotypes show a synchronized metabolic pattern after acute infection). The information provided by this thesis adds a new complexity to the knowledge about the host-pathogen interactions of S. aureus and B. pseudomallei and their hosts. It furthermore lays the groundwork for future studies, which will deal with these and other bacterial host-pathogen interactions in order to understand the interdependencies of infection and metabolism.
Staphylococcus aureus is a commensal that colonizes the skin and mucosa of 20-30% of the human population without leading to symptoms of diseases. However, it is also the most important cause of nosocomial infections. Those range from minor skin infections to life-threatening diseases such as pneumonia, endocarditis or septicaemia. Development of strains with resistance against many antibiotics complicates the situation further. The variety of strains with their various properties is one reason why no successful vaccine has been introduced to the market, yet. Therefore, efficient strategies for prevention and therapy of these dangerous infections are urgently needed. To accomplish these goals, the understanding of molecular interactions between host and pathogen is indispensable. Within this dissertation, several internalization experiments were performed aiming to investigate the interaction of S. aureus HG001 and human cell lines upon infection on the protein level. In order to obtain sufficient amounts of proteins for comprehensive physiological interpretations, it is necessary to enrich bacteria, secreted bacterial proteins or infected host cells upon internalization. In the framework of this thesis, bacteria which continuously produce green fluorescent protein (GFP) were employed. With that it was possible to sort bacteria from lysed host cells by flow cytometry or to separate host cells carrying bacteria after contact from those which did not. Subsequently, the proteins were proteolytically digested and peptides were analyzed by mass spectrometry in a gel-free proteomics approach. To allow such analyses also for staphylococci which do not produce GFP, such as clinical isolates, an additional protocol was developed. Prior to the infection, bacteria were labeled with fluorescent or para-magnetic nanoparticles. Afterwards bacteria could be separated from host cell debris by fluorescence-based cell sorting or with the help of a strong magnet. In order to cover also important secreted virulence factors of S. aureus HG001, phagosomes and engulfed bacteria and secreted proteins were isolated from infected host cells. Further steps of protocol optimization included improved bacterial cell counting by fluorescence-based flow cytometry, enhanced data analysis by combination of different search algorithms, and comprehensive functional annotation of proteins of the applied strain by sequence comparison with other strains and organisms. First, the proteome adaptation of internalized S. aureus HG001 and the infected A549 host cells was investigated during the first hours of infection. It became clear, that the bacteria replicate inside the host during the first 6.5 h. After internalization the levels of bacterial enzymes involved in protein biosynthesis decreased. Furthermore, bacteria adapted their proteome to the harsh intracellular conditions such as oxygen limitation, cell wall stress, host defense in terms of oxidative stress, and nutrient limitation. After contact to S. aureus HG001, A549 cells produced increased amounts of cytokines (e.g. IL-8, IFN-γ) in comparison to non-treated A549 cells. In addition, activation of the immunoproteasome and hints of early apoptosis activity were observed. Afterwards, the response of S. aureus HG001 to internalization by A549, S9 or HEK 293 cells was compared on the proteome level. It was obvious, that the adaptation to stress and the reduced protein synthesis are conserved mechanisms. Host dependent differences were detected especially in the energy metabolism and the synthesis of some amino acids. Additionally, bacteria showed different intracellular replication patterns depending on the host cell line. A higher percentage of extracellular bacterial proteins was found in isolated phagosomes compared to the sorted samples. Selected low abundant virulence factors could be quantified at two points in time after infection with the help of the sensitive single reaction monitoring (SRM) method. Further, a heterogeneous mixture of several phagosomal maturation steps was present during the first 6.5 h after infection. Finally, the gel-free proteome analyses could be applied to investigate Bordetella pertussis, the cause of whooping cough, during iron limitation and after internalization, and the results were compared to the S. aureus HG001 data.
Händedesinfektionsmittel können durch bestimmte Agenzien wie z. B. Hautcremes beeinflusst werden. Fragestellung der Arbeit war, ob die Interaktion von einem alkoholischen Händedesinfektionsmittel mit zwei verschiedenen Massagemitteln die Wirksamkeit der Händedesinfektion beeinflusst. Der Hauptversuch war eine Desinfektionsstudie, angelehnt an die EN 1500, mit 21 Probanden. Nach Kontamination mit E. coli wurden Vorwerte ermittelt, dann fand eine 20-minütige Massage statt, anschließend wurde das Massagemittel mit Papierhandtüchern abgerieben, die Händedesinfektion durchgeführt und Nachwerte ermittelt. Darauf aufbauende Untersuchungen beinhalteten zum einen Experimente über die Bedeutung des Abreibens mit Papierhandtüchern und über die Überlebensrate der Bakterien nach der Massage. Zum anderen sollten die Untersuchungen zeigen, ob von Massagemittel eingeschlossene Erreger im Gegensatz zu Erregern an der Oberfläche der Mittel erschwert an die Probesammelflüssigkeit abgegeben werden und wie die Desinfektionseffizienz von auf dem Massagemittel liegenden, nicht einmassierten Bakterien ist. Beim Hauptversuch sowie beim Versuch ohne Papierhandtücher waren die Reduktionsfaktoren der Massagegruppen signifikant höher als die der Referenzgruppe. Die folgenden Experimente ergaben, dass möglicherweise ein Teil der E. coli Bakterien während der Massage abstirbt. Des Weiteren ergaben unsere Resultate, dass von Massagemittel eingeschlossene Bakterien kaum an das Probesammelmedium abgegeben werden, wohingegen oberflächlich auf dem Massagemittel befindliche Bakterien ohne Probleme in die Sammelflüssigkeit gelangen. Findet die Desinfektion von oberflächlich auf den Massagemittel liegenden nicht massierten Bakterien statt, so gibt es keine signifikanten Unterschiede zwischen den Reduktionsfaktoren. Es gibt zwar im Hauptexperiment signifikante Unterschiede zwischen den verschiedenen Reduktionsfaktoren. Jedoch ist das darauf zurückzuführen, dass die Bakterien möglicherweise während der Massage teilweise absterben bzw. die Abgabe an das Sammelmedium durch die Massagemittel behindert wird. Als Schlussfolgerung kann abgeleitet werden, dass Physiotherapeuten wahrscheinlich ihre Hände nach der Massage desinfizieren können, ohne dass die Desinfektionsleistung des alkoholischen Präparates dadurch herabgesetzt wird. 72 Um das Ergebnis zu verifizieren, sollten in Zukunft Versuchsabläufe geplant werden, bei denen die Massagezeit kürzer gewählt wird, um den Fehlerfaktor des Bakterienabsterbens zu minimieren.