Unravelling Pseudomonas aeruginosa and Candida albicans communication in coinfections scenarios: insights through network analysis

The Supplementary Material for this article canbe found online at: https://www.frontiersin.org/articles/10.3389/fcimb.2020.550505/ full#supplementary-materialModern medicine is currently facing huge setbacks concerning infection therapeutics as microorganisms are consistently knocking down every antimicrobial wall set before them. The situation becomes more worrying when taking into account that, in both environmental and disease scenarios, microorganisms present themselves as biofilm communities that are often polymicrobial. This comprises a competitive advantage, with interactions between different species altering host responses, antimicrobial effectiveness, microbial pathogenesis and virulence, usually augmenting the severity of the infection and contributing for the recalcitrance towards conventional therapy. Pseudomonas aeruginosa and Candida albicans are two opportunistic pathogens often co-isolated from infections, mainly from mucosal tissues like the lung. Despite the billions of years of co-existence, this pair of microorganisms is a great example on how little is known about cross-kingdom interactions, particularly within the context of coinfections. Given the described scenario, this study aimed to collect, curate, and analyze all published experimental information on the molecular basis of P. aeruginosa and C. albicans interactions in biofilms, in order to shed light into key mechanisms that may affect infection prognosis, increasing this area of knowledge. Publications were optimally retrieved from PubMed and Web of Science and classified as to their relevance. Data was then systematically and manually curated, analyzed, and further reconstructed as networks. A total of 641 interactions between the two pathogens were annotated, outputting knowledge on important molecular players affecting key virulence mechanisms, such as hyphal growth, and related genes and proteins, constituting potential therapeutic targets for infections related to these bacterial-fungal consortia. Contrasting interactions were also analyzed, and quorum-sensing inhibition approaches were highlighted. All annotated data was made publicly available at www.ceb.uminho.pt/ISCTD, a database already containing similar data for P. aeruginosa and Staphylococcus aureus communication. This will allow researchers to cut on time and effort when studying this particular subject, facilitating the understanding of the basis of the inter-species and inter-kingdom interactions and how it can be modulated to help design alternative and more effective tailored therapies. Finally, data deposition will serve as base for future dataset integration, whose analysis will hopefully give insights into communications in more complex and varied biofilm communities.This work was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2020 unit and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020–Programa Operacional Regional do Norte. The authors also acknowledge COMPETE2020 and FCT for the project POCI-01-0145-FEDER-029841 and FCT for the PhD Grant of TG [grant number SFRH/BD/136544/2018].info:eu-repo/semantics/publishedVersio

Design of an antifungal surface embedding liposomal Amphotericin b through a mussel adhesive-inspired coating strategy

Microbial colonisation of urinary catheters remains a serious problem for medicine as it often leads to biofilm formation and infection. Among the approaches reported to deal with this problem, surfaces functionalization to render them with antimicrobial characteristics, comprises the most promising one. Most of these strategies, however, are designed to target bacterial biofilms, while fungal biofilms are much less taken into account. In real-life settings, fungi will be inevitably found in consortium with bacteria, especially in the field of biomaterials. The development of antifungal coating strategies to be combined with antibacterial approaches will be pivotal for the fight of biomaterial-associated infections. The main goal of the present study was, therefore, to engineer an effective strategy for the immobilization of liposomal amphotericin B (LAmB) on polydimethylsiloxane (PDMS) surfaces to prevent Candida albicans colonization. Immobilization was performed using a two-step mussel-inspired coating strategy, in which PDMS are first immersed in dopamine solution. Its self-polymerization leads to the deposition of a thin adherent film, called polydopamine (pDA), which allowed the incorporation of LAmB, afterwards. Different concentrations of LAmB were screened in order to obtain a contact-killing surface with no release of LAmB. Surface characterization confirmed the polymerization of dopamine and further functionalization with LAmB yielded surfaces with less roughness and more hydrophilic features. The proposed coating strategy rendered the surfaces of PDMS with the ability to prevent the attachment of Candida albicans and kill the adherent cells, without toxicity towards mammalian cells. Overall results showed that LAmB immobilization on a surface retained its antifungal activity and reduced toxicity, holding therefore a great potential to be applied for the design of urinary catheters. Since the sessile communities commonly found associated to these devices exhibit a polymicrobial nature, the next challenge will be to co-immobilize LAmB with antibacterial agents to prevent the establishment of catheter urinary-associated infections.This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2019 unit and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020 - Programa Operacional Regional do Norte. The authors also acknowledge the support, through the Programa Operacional Competitividade e Internacionalizacao (COMPETE2020) and by national funds, through the Portuguese Foundation for Science and Technology (FCT), of the POLY-PrevEnTT project (PTDC/BTM-SAL/29841/2017-POCI-01-0145-FEDER-029841).info:eu-repo/semantics/publishedVersio

Pitfalls associated with discriminating mixed-species biofilms by flow cytometry

Since biofilms are ubiquitous in different settings and act as sources of disease for humans, reliable methods to characterize and quantify these microbial communities are required. Numerous techniques have been employed, but most of them are unidirectional, labor intensive and time consuming. Although flow cytometry (FCM) can be a reliable choice to quickly provide a multiparametric analysis, there are still few applications on biofilms, and even less on the study of inter-kingdom communities. This work aimed to give insights into the application of FCM in order to more comprehensively analyze mixed-species biofilms, formed by different Pseudomonas aeruginosa and Candida albicans strains, before and after exposure to antimicrobials. For comparison purposes, biofilm culturability was also assessed determining colony-forming units. The results showed that some aspects, namely the microbial strain used, the morphological state of the cells and the biofilm matrix, make the accurate analysis of FCM data difficult. These aspects were even more challenging when double-species biofilms were being inspected, as they could engender data misinterpretations. The outcomes draw our attention towards the need to always take into consideration the characteristics of the biofilm samples to be analyzed through FCM, and undoubtedly link to the need for optimization of the processes tailored for each particular case study.This work was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of the UID/BIO/04469/2020 unit and BioTecNorte operation (NORTE-01-0145-FEDER-000004), which was funded by the European Regional Development Fund under the scope of Norte2020–Programa Operacional Regional do Norte. The authors also acknowledge COMPETE2020 and FCT under the project POCI-01-0145-FEDER-029841 and FCT for the PhD grant to Tânia Grainha (grant number SFRH/BD/136544/2018).info:eu-repo/semantics/publishedVersio

Modulating an antimicrobial release approach by dopamine chemistryto fight infections associated to orthopedic implants

Alongside with orthopedic implants contribution for modern healthcare improvements, theres the risk associated to their microbial colonization and biofilm formation, compromising the performance of the implant itself and representing niches for infection. This study aimed to engineer an antimicrobial release coating for stainless steel surfaces (SS) to empower them with the ability to prevent Staphylococci colonization. Surface modification was based on dopamine chemistry, which self-polymerization results in the deposition of a thin, adhered film called polydopamine (pDA). Chlorohexidine (CHX) was chosen to confer the antimicrobial features. Its immobilization was performed through a 2-step approach, including pDA formation and immersion in CHX solution, and 1-step strategy, in which dopamine and CHX were dissolved together and SS coupons were immersed in this solution. An additional layer of pDA was also performed for both strategies. SEM and AFM confirmed pDA coating by the presence of self-polymerized pDA particles without altering the roughness of SS surfaces. Immobilization of CHX using a 1-step approach yielded surfaces with a more homogenous coating than the 2-step approach. Different pDA-based strategies yielded different CHX release profiles: the amount of CHX released was higher for the 2-step approach and the addition of another pDA layer reduced the amount of CHX released. The antimicrobial performance of the modified surfaces was evaluated against S. aureus and S. epidermidis and the results showed that all the strategies caused a significant reduction (more than 3 LOG) in the number of cells adhered to the surfaces and in suspension, after 24 h. The 2-step approach was able to impart SS surfaces with antimicrobial activity even after 10 days of exposure. In conclusion, dopamine chemistry can modulate CHX release from the surfaces to obtain an antimicrobial coating strategy with great potential to fight infections associated with orthopedic implants.info:eu-repo/semantics/publishedVersio

Pseudomonas aeruginosa-Candida albicans polymicrobial biofilms in ventilator-associated infections (VAP): evaluating the post-antimicrobial effect of amphotericin B/polymyxin B combined activity

Introduction: Mixed bacterial-fungal colonization of the endotracheal tubes is now evident, with microbial interplay withstanding common antimicrobial therapy and paying for persistent and severe VAP infections. While alternative therapeutic strategies effectively targeting inter-kingdom biofilms are required, the role of each microorganism need to be appraised to deliver effective treatments. Hypothesis and aims: We earlier reported the combination therapy involving polymyxin B (PMB) and amphotericin B (AMB) as holding an attractive therapeutic option to treat dual-species biofilms. This study aimed to determine the post-antimicrobial phenomenon of PMB/AMB combined action in P. aeruginosa (PA) +Candida albicans (CA) biofilms, and to ascertain the events underlying biofilm growth restoration. Methodology: Post-antimicrobial effect of PMB combined with AMB was assessed in 24-h dual-species biofilms. Cell culturability and viability were evaluated by CFU and Live/Dead staining, respectively. The gene expression profile was assessed by qPCR. Results: Results showed that PA+CA biofilms lost their culturability straightaway being exposed to PMB/AMB combined solution. However, 24h was enough to both species recover their growth onto agar medium, with microbial counts approximating those observed for pre-treated biofilms. Following the subsequent treatment cycle, CFU estimation was only slightly disturbed. L/D results revealed that PA and CA populations displayed a compromised status at the end of the first PMB/AMB treatment cycle. Finishing the 24-h-regrowth cycle, most biofilm-encased species exhibited viability, which endured after the second treatment period. Transcriptional analysis of dual-species biofilms exposed to PMB/AMB combined action showed a high expression level in all PA resistance-encoded genes anrB, galU, mexA and algD and in ERG3 and ALS2 CA genes. Conclusion: Our finsings showed that PA+CA biofilms were able to escape to the combined action of PMB/AMB, and both species had a preeminent role while retaining adaptive resistance mechanisms that likely contributed for their recovery and adaptation on the ensuing treatments.info:eu-repo/semantics/publishedVersio

Insights into Pseudomonas aeruginosa and Candida albicans consortia challenged by antimicrobials

Ventilator associated pneumonia (VAP), an usual nosocomial infection in the intensive care units and the most common in mechanically ventilated patients, is a serious problem due to high mortality and morbidity rates associated. The presence of the endotracheal tube is the principal risk factor for developing VAP because its surface is prone to microbial adhesion and the formation of biofilms, deserving thus high attention in clinical settings. Cell-to-cell communication is an important mechanism of interaction between VAP microorganisms, being involved in the process known as quorum-sensing (QS) that regulate the expression of virulence. To evaluate bacteria fungi cross-talk in co-infection, the biofilm-forming ability of Pseudomonas aeruginosa and Candida albicans, individually or jointly, before and after antibiotic and antifungal co-treatment was tested. Biofilms were characterized in terms of total mass and cell viability. Results showed that no antimicrobial combination was successful in the binary biofilms eradication. In some cases, the tolerance of the polymicrobial consortia was higher than that of single biofilms, highlighting that P. aeruginosa and C. albicans established synergistic relationships. To gain knowledge helping to explain those interactions, a quantitative real-time PCR approach was followed to inspect the expression profiles of some cell-cell communication genes involved in biofilm resistance. To overcome the tolerance issues, new antimicrobial combinatorial approaches using QS-inhibitors are being tested. Some combinations involving chlorogenic acid and ciprofloxacin displayed promising anti-biofilm potential

Antimicrobial resistance three ways: healthcare crisis, major concepts, and the relevance of biofilms

Worldwide, infections are resuming their role as highly effective killing diseases, as current treatments are failing to respond to the growing problem that is antimicrobial resistance (AMR). The social and economical burden of AMR seems ever rising, with health- and research-related organizations rushing to collaborate on a worldwide scale to find effective solutions. Resistant bacteria are spreading even in first-world nations, being found not only in healthcare-related settings, but also in food and in the environment. In this mini-review, the impact of AMR in healthcare systems and the major bacteria behind it are highlighted. Ecological aspects of AMR evolution and the complexity of its molecular mechanisms are explained. Major concepts, such as intrinsic, acquired, and adaptive resistance, as well as tolerance and heteroresistance, are also clarified. More importantly, the problematic of biofilms and their role in AMR, namely its main resistance and tolerance mechanisms, is elucidated. Finally, some of the most promising anti-biofilm strategies being investigated are reviewed. Much is still to be done regarding the study of AMR and the discovery of new anti-biofilm strategies. Gladly, considerable research on this topic is generated every day and increasingly concerted actions are being engaged globally to try and tackle this problem.This work was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2019 unit and COMPETE 2020 (POCI-01-0145-FEDER-006684) and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020 - Programa Operacional Regional do Norte. The authors also acknowledge COMPETE2020 and FCT for the project POCI-01-0145-FEDER-029841, and FCT for the PhD Grants of Andreia Magalhães [grant number SFRH/BD/132165/2017] and Tânia Grainha [grant number SFRH/BD/136544/2018].info:eu-repo/semantics/publishedVersio

Contributos para a compreensão de interações entre espécies, perfil fenotípo e suscetibilidade a antimicrobianos num microbioma artificial da pneumonia associada à ventilação mecânica

Dissertação de mestrado em BioengineeringVentilator associated pneumonia (VAP) is the second most common nosocomial infection in the intensive care units (ICU) and the most common in mechanically ventilated patients. VAP presents a serious problem in ICU due to high mortality and morbidity rates associated, because it is often biofilm-mediated and polymicrobial. Therefore, understanding the impact of microorganisms in VAP and their interaction is a major challenge posed. Additionally, the ineffective current treatment strategies have led to the emergence of new approaches to fight these polymicrobial consortia, with a great number intervening in the quorum-sensing (QS) intercellular communication. This work aimed to give insights into the behavior of bacterial-fungal communities involving Pseudomonas aeruginosa and Candida albicans associated to VAP, when exposed to different antimicrobial approaches. For this, single- and mixed-species biofilms were thoroughly characterized in terms of cultivable cells and biomass after 24 h treatment with conventional drugs (amphotericin B, AmB; polymyxin B, PolyB) and alternative agents, in particular QS inhibitors (QSI) from different sources (commercial drugs: salicylic acid, ciprofloxacin (CIP), azithromycin (AZT); natural sources: chlorogenic acid, farnesol, linalool, patulin) and enzymes (alginate lyase, desoxirribonuclease), tested alone or in combination. Results showed that the combination AmB+PolyB did not affect the pre-established P. aeruginosa and C. albicans consortia. Interestingly, excepting for patulin, QSI agents were effective at reducing biofilm-encased cells, in particular single-species biofilms. CIP showed a great potential to inhibit both single-and mixed-species biofilms. Linalool was also effective in disturbing C. albicans in single and mixed biofilms. Contrariwise, enzymes had no effect against biofilms. Regarding double combinations, the addition of farnesol or linalool to CIP led to similar results from that obtained with CIP alone, with reductions observed in biofilm-encased cells. In general, the addition of a third agent - particularly in the case of chlorogenic acid - did not significantly improve the effect of AmB+PolyB or farnesol/linalool+CIP combinations. Additionally, efforts were made to characterize the un- and treated dual-species biofilms by flow cytometry and RNA sequencing (RNA-seq), however no accurate results were obtained due to unexpected methodological hitches. In conclusion, the use of new approaches seems to be a promise in treating bacterial-fungal consortia often involved in VAP. This work showed that combining different agents from distinct sources is a valuable option to control P. aeruginosa and C. albicans biofilms. Nevertheless, optimization on the antimicrobial doses and further clinical studies are urgently required to improve therapy effectiveness and avoid additional costs.A pneumonia associada à ventilação (PAV) é a segunda infeção nosocomial mais comum em unidades de cuidados intensivos (UCI) e a mais comum em pacientes sob ventilação mecânica. A PAV apresenta um problema grave na UCI devido às elevadas taxas de mortalidade e morbilidade associadas, porque muitas vezes é mediada por biofilmes e tem caráter polimicrobiano. Compreender o impacto dos microrganismos em PAV e suas interações é um grande desafio que se coloca. Além disso, a ineficiência das estratégias de tratamento atuais levaram ao surgimento de novas abordagens para combater esses consórcios polimicrobianos, com um grande número intervindo na comunicação intercelular quorum-sensing (QS). Este trabalho teve como objetivo o conhecimento do comportamento das comunidades bacterianas-fúngicas envolvendo Pseudomonas aeruginosa e Candida albicans associadas a PAV, quando expostas a diferentes estratégias antimicrobianas. Para isso, os biofilmes simples e mistos foram caracterizados em termos de células cultiváveis e biomassa após 24 h de tratamento com medicamentos convencionais (anfotericina B, AmB; polimixina B, PolyB) e com agentes alternativos, em particular, inibidores de QS (QSI) obtidos de diferentes fontes (medicamentos comerciais: ácido salicílico, ciprofloxacina (CIP), azitromicina (AZT); fontes naturais: ácido clorogénico, farnesol, linalol, patulina); enzimas (alginato liase, desoxirribonuclease), testados isoladamente ou em combinação. Os resultados mostraram que a combinação AmB+PolyB não afetou os consórcios préestabelecidos de P. aeruginosa e C. albicans. Curiosamente, com exceção de patulina, os agentes IQS foram eficazes na redução de células de biofilme, em particular nos biofilmes formados por uma única espécie. A CIP mostrou grande potencial para inibir biofilmes simples e mistos. O linalol também foi eficaz contra C. albicans em biofilmes simples e mistos. Pelo contrário, as enzimas não tiveram efeito contra os biofilmes. No que se refere às combinações duplas, a adição de farnesol ou linalol à CIP conduziu a resultados semelhantes obtidos apenas com CIP, com reduções observadas em células envolto-biofilme. Em geral, a adição de um terceiro agente - em particular no caso do ácido clorogénico - não melhorou significativamente o efeito das combinações AmB+PolyB ou farnesol/linalol+CIP. Adicionalmente, foram feitos esforços para caraterizar os biofilmes de dupla espécie, não tratados e tratados, por citometria de fluxo e sequenciação de RNA (RNA-seq), contudo não foram obtidos resultados fiáveis devido a dificuldades metodológicas inesperadas. Em conclusão, o uso de novas estratégias parece ser uma promessa no tratamento de consórcios bacterianos-fúngicos frequentemente envolvidas em PAV. Este trabalho mostrou que a combinação de diferentes agentes obtidos a partir de fontes distintas é uma opção valiosa para controlar biofilmes de P. aeruginosa e C. albicans. No entanto, é necessário a otimização das doses de antimicrobianos e mais estudos clínicos para melhorar a eficácia da terapia e evitar custos adicionais.Fundação para a Ciência e Tecnologia (FCT) - Under the scope of the strategic funding of UID/BIO/04469/2013 unit and COMPETE 2020 (POCI-01-0145-FEDER-006684);FCT and the European Community fund FEDER, through Program COMPETE, under the scope of project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462);This work was supported by ESCMID Research Grants 2014

Viable but non-cultivable state: a strategy for Staphylococcus aureus survivable in dual-species biofilms with Pseudomonas aeruginosa?

Accepted ArticleSummary Pseudomonas aeruginosa and Staphylococcus aureus are two of the most prevalent respiratory pathogens in cystic fibrosis (CF) patients. Both organisms often cause chronic and recalcitrant infections, in large part due to their ability to form biofilms, being these mixed-species infections correlated with poor clinical outcomes. In this study, the hypothesis that S. aureus adopts phenotypes allowing its coexistence with P. aeruginosa during biofilm growth was put forward. We noticed that S. aureus undergoes a viable but non-cultivable (VBNC) state in the dominated P. aeruginosa dual-species consortia, whatsoever the strains used to form the biofilms. Moreover, an increased expression of genes associated with S. aureus virulence was detected suggesting that the phenotypic switching to VBNC state might account for S. aureus pathogenicity and, in turn, influence the clinical outcome of the mixed-species infection. Thus, P. aeruginosa seems to induce both phenotypic and transcriptomic changes in S. aureus, helping its survival and co-existence in the dual-species biofilms. Overall, our findings illustrate how interspecies interactions can modulate bacterial virulence in vitro, contributing to a better understanding of the behaviour of P. aeruginosa-S. aureus dual-species biofilms. This article is protected by copyright. All rights reserved.Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2020 unit and BioTecNorte operation (NORTE-01-0145-FEDER-000004) funded by the European Regional Development Fund under the scope of Norte2020–Programa Operacional Regional do Norte. The authors also acknowledge the support, through the Programa Operacional Competitividade e Internacionalização (COMPETE2020) and by national funds, through the Portuguese Foundation for Science and Technology (FCT), of the POLY-PrevEnTT project (PTDC/BTMSAL/29841/2017-POCI-01-0145-FEDER-029841), and for the Scientific Employment Stimulus 2017 (CEECIND/01507/2017)info:eu-repo/semantics/publishedVersio