Metabolomics as a tool to explore the staphylococcal biofilm

Orthopaedic infections can be polymicrobial existing as a microbiome. Infections often incorporate staphylococcal species, including Staphylococcus aureus. Such infections can lead to life threatening illness and implant failure. Furthermore, biofilm formation on the implant surface can occur, increasing pathogenicity, exacerbating antibiotic resistance and altering antimicrobial mechanism of action. Bacteria change dramatically during the transition to a biofilm growth state: phenotypically; transcriptionally; and metabolically, highlighting the need for research into molecular mechanisms involved in biofilm formation. Metabolomics can provide a tool to analyse metabolic changes which are directly related to the expressed phenotype. Here, we aimed to provide greater understanding of orthopaedic infection caused by S. aureus and biofilm formation on the implant surface. Through metagenome analysis by employing: implant material extraction; DNA extraction; microbial enrichment; and whole genome sequencing, we present a microbiome study of the infected prosthesis to resolve the causative species of orthopaedic hip infection. Results highlight the presence of S. aureus as a primary cause of orthopaedic infection along with Enterococcus faecium and the presence of secondary pathogen Clostridium difficile. Although results were hindered by the presence of host contaminating DNA even after microbial enrichment, conclusions could be made over the potential increased pathogenicity caused by the presence of a secondary pathogen and highlight method and sample preparation considerations when undertaking such a study. Following this finding, studies were focused on an orthopaedic clinical isolate of S. aureus and a metabolome extraction method for staphylococcal biofilms was developed using cell lysis through bead beating and solvent metabolome extraction. The method was found to be reproducible when coupled with liquid chromatography-mass spectrometry (LC-MS) and bioinformatics, allowing for the detection of significant changes in metabolism between planktonic and biofilm cultures to be identified and drug mechanism of actions (MOA) to be studied. Metabolomics results highlight significant changes in a number of metabolic pathways including arginine biosynthesis and purine metabolism between the two cell populations, evidence of S. aureus responding to their changing environment, including oxygen availability and a decrease in pH. Focused investigations on purine metabolism looking for biofilm modulation effects were carried out. Modulation of the S. aureus biofilm phenotype was observed through the addition of exogenous metabolites. Inosine increased biofilm biomass while formycin B, an inosine analogue, showed a dispersal effect and a potential synergistic effect in biofilm dispersal when coupled with gentamycin. Changes in metabolism between planktonic cells and biofilms highlight the requirement for antimicrobial testing to be carried out against planktonic cells and biofilms. Untargeted metabolomics was used to study the MOA of triclosan in S. aureus. The triclosan target and MOA in bacteria has already been characterised, however, questions remain over its effects in bacteria. Although the use of triclosan has come under increasing speculation, its full effects are still largely unknown. Results show that triclosan can induce a cascade of detrimental events in the cell metabolism including significant changes in amino acid metabolism, affecting planktonic cells and biofilms. Results and conclusions provide greater understanding of orthopaedic infections and specifically focus on the S. aureus biofilm, confirming S. aureus as a primary cause of orthopaedic infection and using metabolomic analysis to look at the changing state of metabolism between the different growth states. Metabolomics is a valuable tool for biofilm and drug MOA studies, helping understand orthopaedic infection and implant failure, providing crucial insight into the biochemistry of bacteria for the potential for inferences to be gained, such as the MOA of antimicrobials and the identification of novel metabolic drug targets.

Quantification of variable palmar ligaments around the triquetrum-hamate joint determined by lunate type

The ligaments of the wrist are highly variable and poorly described, which is more obvious on the ulnar side of the wrist. Previous studies highlighted the potential differences within the ligaments of the wrist but no consensus has been reached. Poor tissue description and inconsistent use of terminology hindered the reproducibility of the results. Improved understanding of the morphological variations between carpal bones may facilitate improved understanding of the ligamentous structure within the wrist. This study aims to identify the potential variations between carpal bones that could be used to separate palmar ligamentous patterns around the triquetrum-hamate joint into subgroups within the sample population. Investigations were performed following a detailed nomenclature and a clear definition of ligamentous structures to facilitate detailed description and reproducible results. Quantitative analyses were conducted using 3D modelling technique. Histological sections were then analysed to identify the structure of each ligamentous attachment. Variable patterns of ligamentous attachments were identified. Differences were not only obvious between samples but also between the right and left hands of the same person. These identifications suggested that the palmar ligamentous patterns around the triquetrum-hamate joint are best described as a spectrum with a higher affinity of the triquetrum-hamate-capitate ligament and the lunate-triquetrum ligament to be associated with type I lunate wrists on one extreme and type II lunate wrists with the palmar triquetrum-hamate ligament, triquetrum-hamate-capitate ligament and palmar radius-lunate-triquetrum ligament attachments at the other extreme. Histological analyses confirmed pervious established work regarding the mechanical role of ligaments in wrist joint biomechanics. Also, there were no significant differences between the quantitative data obtained from the Genelyn-embalmed and unembalmed specimens (p>0.05). The current study demonstrated variable ligamentous patterns that suggest different bone restraints and two different patterns of motion. These findings support previous suggestions regarding separating the midcarpal joint into two distinct functional types. Type I wrists were identified with ligamentous attachments that are suggestive of rotating/translating hamate whilst type II wrists identified with ligamentous attachments that are suggestive of flexing/extending hamate motion based upon the patterns of the ligamentous attachments in relation to the morphological features of the underlying lunate type of the wrist. This opens the horizon for particular consideration and/or modification of surgical procedures, which may enhance the clinical management of wrist dysfunction.

Ecology, physiology and performance in high-rate anaerobic digestion

The design demands on water and sanitation engineers are rapidly changing. The global population is set to rise from 7 billion to 10 billion by 2083. Urbanisation in developing regions is increasing at such a rate that a predicted 56% of the global population will live in an urban setting by 2025. Compounding these problems, the global water and energy crises are impacting the Global North and South alike. High-rate anaerobic digestion offers a low-cost, low-energy treatment alternative to the energy intensive aerobic technologies used today. Widespread implementation however is hindered by the lack of capacity to engineer high-rate anaerobic digestion for the treatment of complex wastes such as sewage. This thesis utilises the Expanded Granular Sludge Bed bioreactor (EGSB) as a model system in which to study the ecology, physiology and performance of high-rate anaerobic digestion of complex wastes. The impacts of a range of engineered parameters including reactor geometry, wastewater type, operating temperature and organic loading rate are systematically investigated using lab-scale EGSB bioreactors. Next generation sequencing of 16S amplicons is utilised as a means of monitoring microbial ecology. Microbial community physiology is monitored by means of specific methanogenic activity testing and a range of physical and chemical methods are applied to assess reactor performance. Finally, the limit state approach is trialled as a method for testing the EGSB and is proposed as a standard method for biotechnology testing enabling improved process control at full-scale. The arising data is assessed both qualitatively and quantitatively. Lab-scale reactor design is demonstrated to significantly influence the spatial distribution of the underlying ecology and community physiology in lab-scale reactors, a vital finding for both researchers and full-scale plant operators responsible for monitoring EGSB reactors. Recurrent trends in the data indicate that hydrogenotrophic methanogenesis dominates in high-rate anaerobic digestion at both full- and lab-scale when subject to engineered or operational stresses including low-temperature and variable feeding regimes. This is of relevance for those seeking to define new directions in fundamental understanding of syntrophic and competitive relations in methanogenic communities and also to design engineers in determining operating parameters for full-scale digesters. The adoption of the limit state approach enabled identification of biological indicators providing early warning of failure under high-solids loading, a vital insight for those currently working empirically towards the development of new biotechnologies at lab-scale.

The Scots in Ireland: culture, colonialism and memory, 1315-1826

This thesis examines three key moments in the intersecting histories of Scotland, Ireland and England, and their impact on literature. Chapter one Robert Bruce and the Last King of Ireland: Writing the Irish Invasion, 1315- 1826‘, is split into two parts. Part one, Barbour‘s (other) Bruce‘ focuses on John Barbour‘s The Bruce (1375) and its depiction of the Bruce‘s Irish campaign (1315-1318). It first examines the invasion material from the perspective of the existing Irish and Scottish relationship and their opposition to English authority. It highlights possible political and ideological motivations behind Barbour‘s negative portrait of Edward Bruce - whom Barbour presents as the catalyst for the invasion and the source of its carnage and ultimate failure - and his partisan comparison between Edward and his brother Robert I. It also probes the socio-polticial and ideological background to the Bruce and its depiction of the Irish campaign, in addition to Edward and Robert. It peers behind some of the Bruce‘s most lauded themes such as chivalry, heroism, loyalty, and patriotism, and exposes its militaristic feudal ideology, its propaganda rich rhetoric, and its illusions of freedom‘. Part one concludes with an examination of two of the Irish section‘s most marginalised figures, the Irish and a laundry woman. Part two, Cultural Memories of the Bruce Invasion of Ireland, 1375-1826‘, examines the cultural memory of the Bruce invasion in three literary works from the Medieval, Early Modern and Romantic periods. The first, and by far the most significant memorialisation of the invasion is Barbour‘s Bruce, which is positioned for the first time within the tradition of ars memoriae (art of memory) and present-day cultural memory theories. The Bruce is evaluated as a site of memory and Barbour‘s methods are compared with Icelandic literature of the same period. The recall of the invasion in late sixteenth century Anglo-Irish literature is then considered, specifically Edmund Spenser‘s A View of the State of Ireland, which is viewed in the context of contemporary Ulster politics. The final text to be considered is William Hamilton Drummond‘s Bruce’s Invasion of Ireland (1826). It is argued that Drummond‘s poem offers an alternative Irish version of the invasion; a counter-memory that responds to nineteenth-century British politics, in addition to the controversy surrounding the publication of the Ossian fragments. Chapter two, The Scots in Ulster: Policies, Proposals and Projects, 1551-1575‘, examines the struggle between Irish and Scottish Gaels and the English for dominance in north Ulster, and its impact on England‘s wider colonial ideology, strategy, literature and life writing. Part one entitled Noisy neighbours, 1551-1567‘ covers the deputyships of Sir James Croft, Sir Thomas Radcliffe, and Sir Henry Sidney, and examines English colonial writing during a crucial period when the Scots provoked an increase in militarisation in the region. Part two Devices, Advices, and Descriptions, 1567-1575‘, deals with the relationship between the Scots and Turlough O‘Neill, the influence of the 5th Earl of Argyll, and the rise of Sorley Boy MacDonnell. It proposes that a renewed Gaelic alliance hindered England‘s conquest of Ireland and generated numerous plantation proposals and projects for Ulster. Many of which exhibit a blurring‘ between the documentary and the literary; while all attest to the considerable impact of the Gaelic Scots in both motivating and frustrating various projects for that province, the most prominent of which were undertaken by Sir Thomas Smith in 1571 and Walter Devereux, 1st Earl of Essex in 1573.

Oxidative stress and its haemodynamic consequences in chronic kidney disease

Chronic kidney disease (CKD) is associated with increased cardiovascular risk in comparison with the general population. This can be observed even in the early stages of CKD, and rises in proportion to the degree of renal impairment. Not only is cardiovascular disease (CVD) more prevalent in CKD, but its nature differs too, with an excess of morbidity and mortality associated with congestive cardiac failure, arrhythmia and sudden death, as well as the accelerated atherosclerosis which is also observed. Conventional cardiovascular risk factors such as hypertension, dyslipidaemia, obesity, glycaemia and smoking, are highly prevalent amongst patients with CKD, although in many of these examples the interaction between risk factor and disease differs from that which exists in normal renal function. Nevertheless, the extent of CVD cannot be fully explained by these conventional risk factors, and non-conventional factors specific to CKD are now recognised to contribute to the burden of CVD. Oxidative stress is a state characterised by excessive production of reactive oxygen species (ROS) and other radical species, a reduction in the capacity of antioxidant systems, and disturbance in normal redox homeostasis with depletion of protective vascular signalling molecules such as nitric oxide (NO). This results in oxidative damage to macromolecules such as lipids, proteins and DNA which can alter their functionality. Moreover, many enzymes are sensitive to redox regulation such that oxidative modification to cysteine thiol groups results in activation of signalling cascades which result in adverse cardiovascular effects such as vascular and endothelial dysfunction. Endothelial dysfunction and oxidative stress are present in association with many conventional cardiovascular risk factors, and can be observed even prior to the development of overt, clinical, vascular pathology, suggesting that these phenomena represent the earliest stages of CVD. In the presence of CKD, there is increased ROS production due to upregulated NADPH oxidase (NOX), increase in a circulating asymmetric dimethylarginine (ADMA), uncoupling of endothelial nitric oxide synthase (eNOS) as well as other mechanisms. There is also depletion in exogenous antioxidants such as ascorbic acid and tocopherol, and a reduction in activity of endogenous antioxidant systems regulated by the master gene regulator Nrf-2. In previous studies, circulating markers of oxidative stress have been shown to be increased in CKD, together with a reduction in endothelial function in a stepwise fashion relating to the severity of renal impairment. Not only is CVD linked to oxidative stress, but the progression of CKD itself is also in part dependent on redox sensitive mechanisms. For example, administration of the ROS scavenger tempol attenuates renal injury and reduces renal fibrosis seen on biopsy in a mouse model of CKD, whilst conversely, supplementation with the NOS inhibitor L-NAME causes proteinuria and renal impairment. Previous human studies examining the effect of antioxidant administration on vascular and renal function have been conflicting however. The work contained in this thesis therefore examines the effect of antioxidant administration on vascular and endothelial function in CKD. Firstly, 30 patients with CKD stages 3 – 5, and 20 matched hypertensive controls were recruited. Participants with CKD had lower ascorbic acid, higher TAP and ADMA, together with higher augmentation index and pulse wave velocity. There was no difference in baseline flow mediated dilatation (FMD) between groups. Intravenous ascorbic acid increased TAP and O2-, and reduced central BP and augmentation index in both groups, and lowered ADMA in the CKD group only. No effect on FMD was observed. The effects of ascorbic acid on kidney function was then investigated, however this was hindered by the inherent drawbacks of existing methods of non-invasively measuring kidney function. Arterial spin labelling MRI is an emerging imaging technique which allows measurement of renal perfusion without administration of an exogenous contrast agent. The technique relies upon application of an inversion pulse to blood within the vasculature proximal to the kidneys, which magnetically labels protons allowing measurement upon transit to the kidney. At the outset of this project local experience using ASL MRI was limited and there ensued a prolonged pre-clinical phase of testing with the aim of optimising imaging strategy. A study was then designed to investigate the repeatability of ASL MRI in a group of 12 healthy volunteers with normal renal function. The measured T1 longitudinal relaxation times and ASL MRI perfusion values were in keeping with those found in the literature; T1 time was 1376 ms in the cortex and 1491 ms in the whole kidney ROI, whilst perfusion was 321 mL/min/100g in the cortex, and 228 mL/min/100g in the whole kidney ROI. There was good reproducibility demonstrated on Bland Altman analysis, with a CVws was 9.2% for cortical perfusion and 7.1% for whole kidney perfusion. Subsequently, in a study of 17 patients with CKD and 24 healthy volunteers, the effects of ascorbic acid on renal perfusion was investigated. Although no change in renal perfusion was found following ascorbic acid, it was found that ASL MRI demonstrated significant differences between those with normal renal function and participants with CKD stages 3 – 5, with increased cortical and whole kidney T1, and reduced cortical and whole kidney perfusion. Interestingly, absolute perfusion showed a weak but significant correlation with progression of kidney disease over the preceding year. Ascorbic acid was therefore shown to have a significant effect on vascular biology both in CKD and in those with normal renal function, and to reduce ADMA only in patients with CKD. ASL MRI has shown promise as a non-invasive investigation of renal function and as a biomarker to identify individuals at high risk of progressive renal impairment.