Clostridium difficile toxins facilitate bacterial colonization by modulating the fence and gate function of colonic epithelium

The contribution of Clostridium difficile toxin A and B (TcdA and TcdB) to cellular intoxication has been extensively studied, but their impact on bacterial colonization remains unclear. By setting-up two- and three-dimensional in vitro models of polarized gut epithelium, we investigated how C. difficile infection is affected by host cell polarity and whether TcdA and TcdB contribute to such events. Indeed, we observed that C. difficile adhesion and penetration of the epithelial barrier is substantially enhanced in poorly polarized or EGTA-treated cells, indicating that bacteria bind preferentially to the basolateral cell surface. In this context, we demonstrated that sub-lethal concentrations of C. difficile TcdA are able to alter cell polarity by causing redistribution of plasma membrane components between distinct surface domains. Taken together, the data suggest that toxin-mediated modulation of host cell organization may account for the capacity of this opportunistic pathogen to gain access to basolateral receptors leading to a successful colonization of the colonic mucosa.

Multiple pathogen detection using nanoplasmonic sensing

Opportunistic diseases caused by Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) is an omnipresent global challenge. In order to manage these epidemics, we need to have low cost and easily deployable platforms at the point-of-care in high congestions regions like airports and public transit systems. In this dissertation we present our findings in using Localized Surface Plasmon Resonance (LSPR)-based detection of pathogens and other clinically relevant applications using microfluidic platforms at the point-of-care setting in resource constrained environment. The work presented here adopts the novel technique of LSPR to multiplex a lab-on-a-chip device capable of quantitatively detecting various types of intact viruses and its various subtypes, based on the principle of a change in wavelength occurring when metal nano-particle surface is modified with a specific surface chemistry allowing the binding of a desired pathogen to a specific antibody. We demonstrate the ability to detect and quantify subtype A, B, C, D, E, G and panel HIV with a specificity of down to 100 copies/mL using both whole blood sample and HIV-patient blood sample discarded from clinics. These results were compared against the gold standard Reverse Transcriptase Polymerase Chain Reaction (RT-qPCR). This microfluidic device has a total evaluation time for the assays of about 70 minutes, where 60 minutes is needed for the capture and 10 minutes for data acquisition and processing. This LOC platform eliminates the need for any sample preparation before processing. This platform is highly multiplexable as the same surface chemistry can be adapted to capture and detect several other pathogens like dengue virus, E. coli, M. Tuberculosis, etc.

Cooperative Cognitive Wireless Networks over TV White and Gray Spaces

Wireless networks rapidly became a fundamental pillar of everyday activities. Whether at work or elsewhere, people often benefits from always-on connections. This trend is likely to increase, and hence actual technologies struggle to cope with the increase in traffic demand. To this end, Cognitive Wireless Networks have been studied. These networks aim at a better utilization of the spectrum, by understanding the environment in which they operate, and adapt accordingly. In particular recently national regulators opened up consultations on the opportunistic use of the TV bands, which became partially free due to the digital TV switch over. In this work, we focus on the indoor use of of TVWS. Interesting use cases like smart metering and WiFI like connectivity arise, and are studied and compared against state of the art technology. New measurements for TVWS networks will be presented and evaluated, and fundamental characteristics of the signal derived. Then, building on that, a new model of spectrum sharing, which takes into account also the height from the terrain, is presented and evaluated in a real scenario. The principal limits and performance of TVWS operated networks will be studied for two main use cases, namely Machine to Machine communication and for wireless sensor networks, particularly for the smart grid scenario. The outcome is that TVWS are certainly interesting to be studied and deployed, in particular when used as an additional offload for other wireless technologies. Seeing TVWS as the only wireless technology on a device is harder to be seen: the uncertainity in channel availability is the major drawback of opportunistic networks, since depending on the primary network channel allocation might lead in having no channels available for communication. TVWS can be effectively exploited as offloading solutions, and most of the contributions presented in this work proceed in this direction.

Einfluss subviraler Partikel des humanen Cytomegalovirus auf die Induktion der antiviralen Immunantwort

Das humane Cytomegalovirus (HCMV) ist ein opportunistischer Krankheitserreger, der insbesondere bei Patienten mit unreifem oder geschwächtem Immunsystem schwere, teilweise lebensbedrohliche Erkrankungen verursacht. Aufgrund der klinischen Relevanz wird die Entwicklung einer Impfung gegen HCMV mit großem Nachdruck verfolgt. Subvirale Partikel des HCMV, sogenannte Dense Bodies (DB), stellen eine vielversprechende Impfstoff-Grundlage dar. Die innere Struktur der Partikel besteht aus viralen Proteinen, die als dominante Antigene der zellulären Immunantwort gegen HCMV identifiziert wurden. Die äußere Hülle der Partikel entspricht der Virushülle, sie enthält die viralen Oberflächenproteine als Zielantigene der neutralisierenden Antikörper (NTAk)-Antwort in ihrer natürlichen Konformation. Die für ein Totantigen außergewöhnlich hohe Immunogenität der Partikel wurde bereits in Vorarbeiten dokumentiert. Ein Ziel dieser Arbeit war es, den molekularen Hintergrund für die herausragenden, immunogenen Eigenschaften von DB aufzuklären. Im ersten Teil der Arbeit wurde daher die Hypothese geprüft, dass DB geeignet sind, die Ausreifung und Aktivierung von dendritischen Zellen (DC) zu vermitteln und damit deren Fähigkeit zur Antigenpräsentation zu stimulieren. Derart aktivierten DC kommt eine wichtige Rolle beim Priming der T-lymphozytären Immunantwort zu. In der Tat konnte gezeigt werden, dass die Behandlung von unreifen dendritischen Zellen (iDC) mit DB zu verstärkter Expression von solchen Molekülen auf der DC-Oberfläche führt, die mit Ausreifung der Zellen verknüpft sind. Der Nachweis der verstärkten Freisetzung proinflammatorischer Zytokine belegte die Aktivierung der Zellen im Sinne einer entzündlichen Reaktion. Die erfolgreiche Stimulation von CD4 und CD8 T-Lymphozyten durch DB-behandelte DC belegte schließlich die funktionelle Relevanz der Ergebnisse. Zusammengefasst konnten in diesem Abschnitt der Arbeit die molekularen Grundlagen der adjuvanten Wirkung von DB aufgeklärt werden. rnIn einem zweiten Abschnitt wurde die NTAk-Antwort nach DB-Immunisierung näher untersucht. Der humoralen Immunantwort kommt eine entscheidende Bedeutung bei der Prävention der HCMV-Übertragung zu. Hier galt es zu prüfen, welchen Einfluss stammspezifische Unterschiede in der Expression viraler Oberflächenproteine auf die Induktion der NTAk-Antwort nach DB-Immunisierung nehmen. Im Fokus stand dabei die variable Expression des pentameren Proteinkomplexes aus den viralen Proteinen gH/gL/pUL128-UL131A. Dieser Komplex wird nur von kliniknahen HCMV-Stämmen (HCMVKlin) exprimiert und ist für deren breiten Zelltropismus verantwortlich. Der pentamere Komplex fehlte in allen bisherigen Analysen der DB-Immunogenität, die auf der Grundlage von Laborstämmen des HCMV (HCMVLab) durchgeführt worden waren. Ein erster Versuchsansatz zeigte, dass die NTAk-Antwort, die durch DB von HCMVLab (DBLab) induziert wird, auch gegen die Infektion mit HCMVKlin einen gewissen Schutz vermittelt. Dies war ein überraschender Befund, da Antikörpern gegen den pentameren Komplex eine entscheidende Rolle bei der Neutralisation von HCMVKlin zugeschrieben wurde. Die Ergebnisse zeigten jedoch, dass Antikörper gegen andere Zielstrukturen zur Neutralisation von HCMVKlin beitragen. Hieraus resultierte unmittelbar die Frage, inwieweit eine Aufnahme des pentameren Komplexes in einen DB-basierten Impfstoff überhaupt notwendig war. Um dies zu beantworten war es notwendig, DB herzustellen, die den pentameren Komplex enthielten. Hierzu wurde ein HCMVLab durch Mutagenese des 235 kpb Genoms so modifiziert, dass von dem resultierenden Stamm der pentamere Komplex exprimiert wurde. In gereinigten DB dieses Stammes konnten die Komponenten des pentameren Komplexes nachgewiesen werden. Die Seren von Tieren, die mit DB dieses neuen Stammes immunisiert wurden, zeigten in der Tat eine deutlich gesteigerte Kapazität zur Neutralisation von HCMVKlin auf verschiedenen Zielzellen. Diese Ergebnisse unterstreichen schlussendlich, dass die Expression des pentameren Komplexes einen Vorteil bei der Induktion der antiviralen NTAk-Antwort erbringt. Zusammengefasst liefern die Erkenntnisse aus dieser Arbeit einen wichtigen Beitrag zum Verständnis der immunogenen Wirkung von DB. Auf dieser Grundlage war es nunmehr möglich, ein Projekt zur Austestung der DB-Vakzine in einer ersten klinischen Studie zu initiieren.

DTN discovery and routing: from space applications to terrestrial networks.

L'argomento di questa tesi è l'architettura di rete Delay-/Disruption-Tolerant Networking (DTN), progettata per operare nelle reti “challenged”, dove la suite di protocolli TCP/IP risulta inefficace a causa di lunghi ritardi di propagazione del segnale, interruzioni e disturbi di canale, ecc. Esempi di reti “challenged” variano dalle reti interplanetarie alle Mobile Ad-Hoc Networks (MANETs). Le principali implementazioni dell'architettura DTN sono DTN2, implementazione di riferimento, e ION, sviluppata da NASA JPL per applicazioni spaziali. Una grande differenza tra reti spaziali e terrestri è che nello spazio i movimenti dei nodi sono deterministici, mentre non lo sono per i nodi mobili terrestri, i quali generalmente non conoscono la topologia della rete. Questo ha portato allo sviluppo di diversi algoritmi di routing: deterministici per le reti spaziali e opportunistici per quelle terrestri. NASA JPL ha recentemente deciso di estendere l'ambito di applicazione di ION per supportare anche scenari non deterministici. Durante la tesi, svolta presso NASA JPL, mi sono occupato di argomenti diversi, tutti finalizzati a questo obiettivo. Inizialmente ho testato la nuova implementazione dell'algoritmo IP Neighbor Discovery (IPND) di ION, corretti i bug e prodotta la documentazione ufficiale. Quindi ho contribuito ad integrare il Contact Graph Routing (CGR) di ION nel simulatore DTN “ONE” utilizzando la Java Native Interface (JNI) come ponte tra il codice Java di ONE e il codice C di ION. In particolare ho adattato tutte le librerie di ION necessarie per far funzionare CGR all'interno dell'ambiente di ONE. Infine, dopo aver analizzato un dataset di tracce reali di nodi mobili, ho contribuito a progettare e a sviluppare OCGR, estensione opportunistica del CGR, quindi ne ho curato l'integrazione in ONE. I risultati preliminari sembrano confermare la validità di OCGR che, una volta messo a punto, può diventare un valido concorrente ai più rinomati algoritmi opportunistici.

Alveolar inflammation in cystic fibrosis

In infected lungs of the cystic fibrosis (CF) patients, opportunistic pathogens and mutated cystic fibrosis transmembrane conductance regulator protein (CFTR) contribute to chronic airway inflammation that is characterized by neutrophil/macrophage infiltration, cytokine release and ceramide accumulation. We sought to investigate CF lung inflammation in the alveoli.

Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis

In patients with HIV-1 infection who are starting combination antiretroviral therapy (ART), the incidence of immune reconstitution inflammatory syndrome (IRIS) is not well defined. We did a meta-analysis to establish the incidence and lethality of the syndrome in patients with a range of previously diagnosed opportunistic infections, and examined the relation between occurrence and the degree of immunodeficiency. Systematic review identified 54 cohort studies of 13 103 patients starting ART, of whom 1699 developed IRIS. We calculated pooled cumulative incidences with 95% credibility intervals (CrI) by Bayesian methods and did a random-effects metaregression to analyse the relation between CD4 cell count and incidence of IRIS. In patients with previously diagnosed AIDS-defining illnesses, IRIS developed in 37.7% (95% CrI 26.6-49.4) of those with cytomegalovirus retinitis, 19.5% (6.7-44.8) of those with cryptococcal meningitis, 15.7% (9.7-24.5) of those with tuberculosis, 16.7% (2.3-50.7) of those with progressive multifocal leukoencephalopathy, and 6.4% (1.2-24.7) of those with Kaposi's sarcoma, and 12.2% (6.8-19.6) of those with herpes zoster. 16.1% (11.1-22.9) of unselected patients starting ART developed any type of IRIS. 4.5% (2.1-8.6) of patients with any type of IRIS died, 3.2% (0.7-9.2) of those with tuberculosis-associated IRIS died, and 20.8% (5.0-52.7) of those with cryptococcal meningitis died. Metaregression analyses showed that the risk of IRIS is associated with CD4 cell count at the start of ART, with a high risk in patients with fewer than 50 cells per microL. Occurrence of IRIS might therefore be reduced by initiation of ART before immunodeficiency becomes advanced.

Survey of aspergillosis in non-neutropenic patients in Swiss teaching hospitals

Clin Microbiol Infect ABSTRACT: Invasive aspergillosis (IA) is a live-threatening opportunistic infection that is best described in haematological patients with prolonged neutropenia or graft-versus-host disease. Data on IA in non-neutropenic patients are limited. The aim of this study was to establish the incidence, disease manifestations and outcome of IA in non-neutropenic patients diagnosed in five Swiss university hospitals during a 2-year period. Case identification was based on a comprehensive screening of hospital records. All cases of proven and probable IA were retrospectively analysed. Sixty-seven patients were analysed (median age 60 years; 76% male). Sixty-three per cent of cases were invasive pulmonary aspergillosis (IPA), and 17% of these were disseminated aspergillosis. The incidence of IPA was 1.2/10?000 admissions. Six of ten cases of extrapulmonary IA affected the brain. There were six cases of invasive rhinosinusitis, six cases of chronic pulmonary aspergillosis, and cases three of subacute pulmonary aspergillosis. The most frequent underlying condition of IA was corticosteroid treatment (57%), followed by chronic lung disease (48%), and intensive-care unit stays (43%). In 38% of patients with IPA, the diagnosis was established at autopsy. Old age was the only risk factor for post-mortem diagnosis, whereas previous solid organ transplantation and chronic lung disease were associated with lower odds of post-mortem diagnosis. The mortality rate was 57%.

Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count <200 cells/microL?

Current guidelines suggest that primary prophylaxis for Pneumocystis jiroveci pneumonia (PcP) can be safely stopped in human immunodeficiency virus (HIV)-infected patients who are receiving combined antiretroviral therapy (cART) and who have a CD4 cell count >200 cells/microL. There are few data regarding the incidence of PcP or safety of stopping prophylaxis in virologically suppressed patients with CD4 cell counts of 101-200 cells/microL.

Helper response to experimentally manipulated predation risk in the cooperatively breeding cichlid Neolamprologus pulcher

Background We manipulated predation risk in a field experiment with the cooperatively breeding cichlid Neolamprologus pulcher by releasing no predator, a medium- or a large-sized fish predator inside underwater cages enclosing two to three natural groups. We assessed whether helpers changed their helping behaviour, and whether within-group conflict changed, depending on these treatments, testing three hypotheses: ‘pay-to-stay’ PS, ‘risk avoidance’ RA, or (future) reproductive benefits RB. We also assessed whether helper food intake was reduced under risk, because this might reduce investments in other behaviours to save energy. Methodology/Principal Findings Medium and large helpers fed less under predation risk. Despite this effect helpers invested more in territory defence, but not territory maintenance, under the risk of predation (supporting PS). Experimentally covering only the breeding shelter with sand induced more helper digging under predation risk compared to the control treatment (supporting PS). Aggression towards the introduced predator did not differ between the two predator treatments and increased with group member size and group size (supporting PS and RA). Large helpers increased their help ratio (helping effort/breeder aggression received, ‘punishment’ by the dominant pair in the group) in the predation treatments compared to the control treatment, suggesting they were more willing to PS. Medium helpers did not show such effects. Large helpers also showed a higher submission ratio (submission/ breeder aggression received) in all treatments, compared to the medium helpers (supporting PS). Conclusions/Significance We conclude that predation risk reduces helper food intake, but despite this effect, helpers were more willing to support the breeders, supporting PS. Effects of breeder punishment suggests that PS might be more important for large compared to the medium helpers. Evidence for RA was also detected. Finally, the results were inconsistent with RB.

Experimental Infection of Bats with Geomyces destructans Causes White-nose Syndrome

White-nose syndrome (WNS) has caused recent catastrophic declines among multiple species of bats in eastern North America1, 2. The disease’s name derives from a visually apparent white growth of the newly discovered fungus Geomyces destructans on the skin (including the muzzle) of hibernating bats1, 3. Colonization of skin by this fungus is associated with characteristic cutaneous lesions that are the only consistent pathological finding related to WNS4. However, the role of G. destructans in WNS remains controversial because evidence to implicate the fungus as the primary cause of this disease is lacking. The debate is fuelled, in part, by the assumption that fungal infections in mammals are most commonly associated with immune system dysfunction5, 6, 7. Additionally, the recent discovery that G. destructans commonly colonizes the skin of bats of Europe, where no unusual bat mortality events have been reported8, 9, 10, has generated further speculation that the fungus is an opportunistic pathogen and that other unidentified factors are the primary cause of WNS11, 12. Here we demonstrate that exposure of healthy little brown bats (Myotis lucifugus) to pure cultures of G. destructans causes WNS. Live G. destructans was subsequently cultured from diseased bats, successfully fulfilling established criteria for the determination ofG. destructans as a primary pathogen13. We also confirmed that WNS can be transmitted from infected bats to healthy bats through direct contact. Our results provide the first direct evidence that G. destructans is the causal agent of WNS and that the recent emergence of WNS in North America may represent translocation of the fungus to a region with a naive population of animals8. Demonstration of causality is an instrumental step in elucidating the pathogenesis14 and epidemiology15 of WNS and in guiding management actions to preserve bat populations against the novel threat posed by this devastating infectious disease.

Chlamydia infection, pelvic inflammatory disease, ectopic pregnancy and infertility: cross-national study

Objectives To describe, using routine data in selected countries, chlamydia control activities and rates of chlamydia infection, pelvic inflammatory disease (PID), ectopic pregnancy and infertility and to compare trends in chlamydia positivity with rates of PID and ectopic pregnancy. Methods Cross-national comparison including national data from Australia, Denmark, the Netherlands, New Zealand, Sweden and Switzerland. Routine data sources about chlamydia diagnosis and testing and International Classification of Disease-10 coded diagnoses of PID, ectopic pregnancy and infertility in women aged 15–39 years from 1999 to 2008 were described. Trends over time and relevant associations were examined using Poisson regression. Results Opportunistic chlamydia testing was recommended in all countries except Switzerland, but target groups differed. Rates of chlamydia testing were highest in New Zealand. Chlamydia positivity was similar in all countries with available data (Denmark, New Zealand and Sweden) and increased over time. Increasing chlamydia positivity rates were associated with decreasing PID rates in Denmark and Sweden and with decreasing ectopic pregnancy rates in Denmark, New Zealand and Sweden. Ectopic pregnancy rates appeared to increase over time in 15–19-year-olds in several countries. Trends in infertility diagnoses were very variable. Conclusions The intensity of recommendations about chlamydia control varied between countries but was not consistently related to levels of chlamydia diagnosis or testing. Relationships between levels of chlamydia infection and complication rates between or within countries over time were not straightforward. Development and validation of indicators of chlamydia-related morbidity that can be compared across countries and over time should be pursued.

Analysis Methodology for Flow-level Evaluation of a Hybrid Mobile-Sensor Network

Our society uses a large diversity of co-existing wired and wireless networks in order to satisfy its communication needs. A cooper- ation between these networks can benefit performance, service availabil- ity and deployment ease, and leads to the emergence of hybrid networks. This position paper focuses on a hybrid mobile-sensor network identify- ing potential advantages and challenges of its use and defining feasible applications. The main value of the paper, however, is in the proposed analysis approach to evaluate the performance at the mobile network side given the mixed mobile-sensor traffic. The approach combines packet- level analysis with modelling of flow-level behaviour and can be applied for the study of various application scenarios. In this paper we consider two applications with distinct traffic models namely multimedia traffic and best-effort traffic.

Role of the environment in the development of canine atopic dermatitis in Labrador and golden retrievers

Canine and human atopic dermatitis are multifaceted diseases whose clinical development may be influenced by several factors, such as genetic background, environment, secondary infections, food and psychological effects. The role of the environment has been extensively examined in humans but remains unclear in dogs. The aim of this study was to examine environmental factors in two genetically close breeds, Labrador and golden retrievers. Using standard criteria, atopic dogs in Switzerland and Germany were selected and compared with healthy individuals. Information on environmental factors was collected using a 46-question survey encompassing date and place of birth, way of life at the breeder's and owner's home, food and treatments. Univariate and multivariate logistic regression were used to assess the association between potential risk factors and disease status. The following parameters were associated with an increased risk of disease development: living in a shed during puppyhood, adoption at the age of 8-12 weeks and washing the dog regularly. In contrast, the following factors were associated with a lower risk: living in a rural environment, living in a household with other animals and walking in a forest. These associations do not prove causality but support the primary hypothesis that certain environmental factors may influence the development of canine atopic dermatitis. Further studies are warranted to confirm these results and conclusions.