Evaluation of a Novel MALDI Biotyper Algorithm to Distinguish Mycobacterium intracellulare From Mycobacterium chimaera

Accurate and timely mycobacterial species identification is imperative for successful diagnosis, treatment, and management of disease caused by nontuberculous mycobacteria (NTM). The current most widely utilized method for NTM species identification is Sanger sequencing of one or more genomic loci, followed by BLAST sequence analysis. MALDI-TOF MS offers a less expensive and increasingly accurate alternative to sequencing, but the commercially available assays used in clinical mycobacteriology cannot differentiate between Mycobacterium intracellulare and Mycobacterium chimaera, two closely related potentially pathogenic species of NTM that are members of the Mycobacterium avium complex (MAC). Because this differentiation of MAC species is challenging in a diagnostic setting, Bruker has developed an improved spectral interpretation algorithm to differentiate M. chimaera and M. intracellulare based on differential spectral peak signatures. Here, we utilize a set of 185 MAC isolates that have been characterized using rpoB locus sequencing followed by whole genome sequencing in some cases, to test the accuracy of the Bruker subtyper software to identify M. chimaera (n = 49) and M. intracellulare (n = 55). 100% of the M. intracellulare and 82% of the M. chimaera isolates were accurately identified using the MALDI Biotyper algorithm. This subtyper module is available with the MALDI Biotyper Compass software and offers a promising mechanism for rapid and inexpensive species determination for M. chimaera and M. intracellulare

A randomized controlled trial to investigate the influence of low dose radiotherapy on immune stimulatory effects in liver metastases of colorectal cancer

<p>Abstract</p> <p>Background</p> <p>Insufficient migration and activation of tumor specific effector T cells in the tumor is one of the main reasons for inadequate host anti-tumor immune response. External radiation seems to induce inflammation and activate the immune response. This phase I/II clinical trial aims to evaluate whether low dose single fraction radiotherapy can improve T cell associated antitumor immune response in patients with colorectal liver metastases.</p> <p>Methods/Design</p> <p>This is an investigator-initiated, prospective randomised, 4-armed, controlled Phase I/II trial. Patients undergoing elective hepatic resection due to colorectal cancer liver metastasis will be enrolled in the study. Patients will receive 0 Gy, 0.5 Gy, 2 Gy or 5 Gy radiation targeted to their liver metastasis. Radiation will be applied by external beam radiotherapy using a 6 MV linear accelerator (Linac) with intensity modulated radiotherapy (IMRT) technique two days prior to surgical resection. All patients admitted to the Department of General-, Visceral-, and Transplantion Surgery, University of Heidelberg for elective hepatic resection are consecutively screened for eligibility into this trial, and written informed consent is obtained before inclusion. The primary objective is to assess the effect of active local external beam radiation dose on, tumor infiltrating T cells as a surrogate parameter for antitumor activity. Secondary objectives include radiogenic treatment toxicity, postoperative morbidity and mortality, local tumor control and recurrence patterns, survival and quality of life. Furthermore, frequencies of systemic tumor reactive T cells in blood and bone marrow will be correlated with clinical outcome.</p> <p>Discussion</p> <p>This is a randomized controlled patient blinded trial to assess the safety and efficiency of low dose radiotherapy on metastasis infiltrating T cells and thus potentially enhance the antitumor immune response.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01191632">NCT01191632</a></p

Randomized controlled phase I/II study to investigate immune stimulatory effects by low dose radiotherapy in primarily operable pancreatic cancer

<p>Abstract</p> <p>Background</p> <p>The efficiencies of T cell based immunotherapies are affected by insufficient migration and activation of tumor specific effector T cells in the tumor. Accumulating evidence exists on the ability of ionizing radiation to modify the tumor microenvironment and generate inflammation. The aim of this phase I/II clinical trial is to evaluate whether low dose single fraction radiotherapy can improve T cell associated antitumor immune response in patients with pancreatic cancer.</p> <p>Methods/Design</p> <p>This trial has been designed as an investigator initiated; prospective randomised, 4-armed, controlled Phase I/II trial. Patients who are candidates for resection of pancreatic cancer will be randomized into 4 arms. A total of 40 patients will be enrolled. The patients receive 0 Gy, 0.5 Gy, 2 Gy or 5 Gy radiation precisely targeted to their pancreatic carcinoma. Radiation will be delivered by external beam radiotherapy using a 6 MV Linac with IMRT technique 48 h prior to the surgical resection. The primary objective is the determination of an active local external beam radiation dose, leading to tumor infiltrating T cells as a surrogate parameter for antitumor activity. Secondary objectives include local tumor control and recurrence patterns, survival, radiogenic treatment toxicity and postoperative morbidity and mortality, as well as quality of life. Further, frequencies of tumor reactive T cells in blood and bone marrow as well as whole blood cell transcriptomics and plasma-proteomics will be correlated with clinical outcome. An interim analysis will be performed after the enrolment of 20 patients for safety reasons. The evaluation of the primary endpoint will start four weeks after the last patient's enrolment.</p> <p>Discussion</p> <p>This trial will answer the question whether a low dose radiotherapy localized to the pancreatic tumor only can increase the number of tumor infiltrating T cells and thus potentially enhance the antitumor immune response. The study will also investigate the prognostic and predictive value of radiation-induced T cell activity along with transcriptomic and proteomic data with respect to clinical outcome.</p> <p>Trial registration</p> <p>ClinicalTrials.gov - <a href="http://www.clinicaltrials.gov/ct2/show/NCT01027221">NCT01027221</a></p

Analysis of Biofilm Communities in Breweries

The main objective of this study was the characterization of surface associated microbial communities in breweries. In addition, the beer-spoiling potential of isolated strains and biofilm samples was investigated. Some studies reported the identity of cultivatable organisms from industrial plants. However, there were no data available about the composition of biofilm communities from these habitats for cultivation-independent techniques. Consequently, the fatty acid methyl esters (FAMEs) analysis, the fluorescence in situ hybridization (FISH) and the construction and investigation of 16S rRNA gene clone libraries were applied to reveal the structure of these communities. All of these methods have different advantages and therefore, they complement each other to get a more reliable picture of the biofilm communities. The cultivation method was included in this study because it enables a verification of results from other studies. Furthermore, the obtained strains are genuine brewery isolates and can be used for physiological tests. Isolates were obtained from seven different sample sites (Chapter 1 and 5). They were identified and affiliated to 25 different genera. Some of these strains were inoculated in beer but none of them was able to grow in it (Chapter 1 and 5). However, these strains can still be harmful for the industry, e.g. if they are able to form biofilms. This aspect was investigated by analyzing the potential of the isolates to produce acyl-homoserine lactones (AHLs) (Chapter 6). These quorum sensing mediating molecules are involved in the maturation process of biofilms. Indeed, some strains were found to secrete these autoinducer molecules, they mainly belonged to the genus Pseudomonas. An abundant proportion among the isolates was constituted by members of the Enterobacteriaceae (Chapter 7). In the beginning of this study, there was a minor suspicion concerning their beer-spoiling potential. Indeed, all isolated Enterobacteriaceae were found to be able to multiply in non-alcoholic beer under access of oxygen but they represented no risk for filled beer. The beer-spoiling potential of biofilm communities was investigated by inoculating them in beer (Chapter 3). These enrichments allowed the detection of minor proportions of beer-spoiling organisms. About 25% of the biofilms contained microorganisms which were able to multiply in beer with 4.8% of ethanol (v/v). The absence of anaerobic beer-spoiling bacteria in most of the biofilms was confirmed by using specific FISH probes for Pectinatus and Megasphaera cells (Chapter 9). However, Pectinatus cells constituted one of the most abundant groups in two biofilm communities. These samples clearly demonstrated that brewery biofilms can become hazardous for the quality of the product. The acetic acid bacteria were supposed to be abundant brewery biofilm organisms. This was not confirmed by any method used (Chapter 8). Instead, FISH signals were found for many other taxa in considerable proportions, e.g. communities from the conveyors consisted of members of the Eukarya, Archaea, Alpha-, Beta-, Gammaproteobacteria, Cytophaga-Flavobacteria, Planctomycetales, Actinobacteria and Firmicutes (Chapter 1). Such diverse communities were also evidenced for three other biofilms analyzed by FISH (Chapter 2 and 9). Whereas the FISH technique allows the specific detection of single cells, the FAME analysis targets all organisms present, except the Archaea. The fatty acid profiles of 78 biofilms indicated significant differences between the communities, even between those which were exposed to similar conditions. In addition, repeated sampling of identical sites revealed a temporal variability of the microbial communities (Chapter 3). Characteristical fatty acids of beer-spoiling bacteria were almost absent. Typical fatty acids of Eukarya dominated nearly half of all biofilms. The high proportions of Eukarya in some biofilms was not confirmed, as these samples were also investigated by FISH. This divergence was found to be due to the higher biomass of eukaryotic cells compared to bacterial cells (Chapter 3). As some wild yeast strains were isolated and characterized, they are a potential source of these fatty acids. In contrast to the revealed bacterial diversity, most of the isolated yeasts were assigned to Saccharomyces or Candida spp. (Chapter 4). The Saccharomyces spp. showed a high beer-spoiling potential and many Candida species were able to form biofilms. The construction of 16S rRNA gene clone libraries and the analysis of the clones with amplified ribosomal DNA restriction analysis (ARDRA) was performed with two biofilm communities (Chapter 2). Clones with identical ARDRA patterns were grouped and some representatives were identified by sequencing. These clone sequences were affiliated to 30 different genera, most of which were members of the Alpha- and Gammaproteobacteria and the Bacteroidetes. In addition, some clone sequences were assigned to uncultured organisms. Despite of the presence of 53 and 59 different ARDRA patterns in the two clone libraries, respectively, they had only four patterns in common. This result underlined the differences in the microbial composition of these communities. In conclusion, breweries represent a habitat with high cleaning and disinfecting pressure, which might have selected for a limited number of more resistant or adopted species. Instead, the community structures of biofilms in industrial environments were found to be diverse and variable in their compositions

Community Structure and Diversity of Biofilms from a Beer Bottling Plant as Revealed Using 16S rRNA Gene Clone Libraries

The microbial composition of biofilms from a beer bottling plant was analyzed by a cultivation independent analysis of the 16S rRNA genes. Clone libraries were differentiated by amplified 16S rRNA gene restriction analysis and representative clones from each group were sequenced. The diversity of the clone libraries was comparable with the diversity found for environmental samples. No evidences for the presence of strictly anaerobic taxa or important beer spoilers were found, indicating that biofilms developed for more than 6 months at the plant formed no appropriate habitat for those microorganisms. The genus Methylobacterium was one of the dominating groups of the clone libraries. The size of this population was assessed by fluorescence in situ hybridization and fatty acid analysis. In addition, considerable numbers of clones were assigned to uncultivated organisms