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Ca(2+)-induced persistent protein kinase C activation in rat hippocampal homogenates.

Protein kinase C (PKC) is thought to play an important role in neuronal function by mediating changes in synaptic strength. Specifically, it has been argued that persistent PKC activation underlies the maintenance of long-term potentiation (LTP) of synaptic transmission in the hippocampus, a model widely used to study mammalian learning and memory. Because the induction of LTP is known to be dependent upon Ca2+ influx into the postsynaptic neuron, we investigated Ca(2+)-dependent mechanisms that operate to elicit persistent PKC activation in the hippocampus. Hippocampal homogenates were incubated with Ca2+ for a brief period and subsequently assayed for persistent changes in basal (Ca(2+)-independent) PKC activity, using the selective PKC substrate neurogranin(28-43) (NG(28-43)). After Ca2+ incubation, basal PKC phosphorylation of NG(28-43) was increased and expression of the increased activity could be inhibited by PKC(19-36), a selective peptide inhibitor of PKC. These data indicate the presence of a persistently activated form of PKC in Ca(2+)-pretreated hippocampal homogenates. The persistently activated PKC was localized to the soluble fraction of homogenates. Generation of the soluble, persistently activated form of PKC was blocked by the calpain inhibitor, leupeptin, suggesting a proteolytic activation of PKC. Column chromatography and Western blots indicated the presence of PKM, a proteolytic fragment of PKC that is active in the absence of calcium, diacylglycerols, or phospholipid cofactors. Thus, Ca2+ induces proteolytic activation of PKC in hippocampal homogenates. This suggests that proteolytic activation is a plausible candidate as a mechanism underlying the persistent activation of PKC associated with LTP.

Animals↗

Mortality associated with acute watery diarrhea, dysentery and persistent diarrhea in rural north India.

Mortality associated with diarrhea was investigated in a longitudinally followed cohort of children under six years of age in rural North India. During the follow-up, 1663 episodes of diarrhea and 23 diarrhea related deaths were recorded in 1467 children followed up for 20 months. The case fatality rate was 0.56% for acute watery diarrhea, 4.27% for dysentery and 11.94% for non-dysenteric persistent diarrhea. Most of the episodes lasted less than a week; 5.2% became persistent (duration > 14 days). The case fatality rate was similar in episodes of one and two weeks' duration (0.64% and 0.8%) and increased to 13.95% for persistent episodes. Of the total 86 persistent episodes, 22.1% were dysenteric; the case fatality rate for such dysenteric persistent episodes was 21.1% and for watery persistent diarrhea 11.4%. Diarrheal attack rates were similar among different nutritional groups, but diarrheal case fatality rates progressively increased with increasing severity of malnutrition, these were 24 times higher in children with severe malnutrition (7.48%) compared to those normally nourished (0.31%). With availability and use of oral rehydration therapy, dysentery and persistent diarrhea emerge as major causes of diarrhea related mortality, with underlying malnutrition as a key associated factor.

Acute Disease↗

A comparison between persistence to therapy in ALLHAT and in everyday clinical practice: a generalizability issue.

BACKGROUND: Persistence to therapy was very high in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and was similar between treatment arms. Most patients were already on antihypertensive therapy before the trial began. Clinically, the results from this trial are more likely to be applied when antihypertensive therapy is initiated. OBJECTIVES: To assess whether the conclusions drawn from ALLHAT could be applied to the initiation of antihypertensive therapy. METHODS: A MEDLINE literature search was performed using the key words 'persistence', 'persistence to therapy', 'compliance' and 'adherence', and these were each linked with 'hypertension'. Studies from pharmaceutical databases were selected when they reported persistence to any antihypertensive therapy at one year according to which initial drug class (calcium channel blockers, angiotensin-converting enzyme inhibitors and thiazides) was initially prescribed. From the reported persistence rates, the number of patients was determined in whom treatment of hypertension results in a waste of health resources when each initial drug class was prescribed. RESULTS: Persistence to antihypertensive therapy at one year reported in the pharmaceutical databases varies from 5% to 75%. It was lower when the initial drug that was prescribed was a diuretic versus an angiotensin-converting enzyme inhibitor or a calcium channel blocker. The number of patients in whom treatment of hypertension resulted in a waste of resource was also higher when a diuretic was initially prescribed. CONCLUSION: Persistence to antihypertensive therapy is low for all the agents initiated and the lowest with diuretics. This should be considered as a word of caution when the ALLHAT conclusions are applied to the clinical setting.

Angiotensin-Converting Enzyme Inhibitors↗

[Assessment of left ventricular ejection fraction and wall motion in patients after myocardial infarction with and without persistent electrocardiographic ST-segment elevation--using gated radionuclide angiography].

UNLABELLED: In everyday practice two-dimensional echocardiography is a routine method used to diagnose left ventricular (LV) wall motion abnormalities and determine ejection fraction (EF). However, in some patients, for technical reasons, it is possible to apply only apical projections and EF and LV wall motion abnormalities cannot be therefore obtained. The aim of the study was to measure LV EF and wall motion abnormalities in the patients healed from MI, with and without persistent electrocardiographic ST segment elevation, in whom echocardiographic diagnosis was difficult. LV wall motion abnormalities and EF were determined using non-invasive method--gated radionuclide angiography. Gated radionuclide angiography was performed in 45 patients, 3 months after previous anterior MI. The study was acquired after technetium 99mTc red cell labeling in vivo. The data were collected using a Toshiba scintillation gamma camera with a MODUMED computer system coupled with a gating device. Patients were divided into two groups. Group I consisted of 24 patients with persistent electrocardiographic ST segment elevation and group II--of 21 patients without persistent elevation of this segment. RESULTS: In the group I, left ventricular ejection fraction ranged between 10 and 36% (mean: 24%). In 9/24 patients (38%) diffuse hypokinesis, in 7/24 patients (29%) regional akinesis and in the last 8/24 patients (33%) regional dyskinesis with impaired dilated left ventricular systolic and diastolic function were observed. In the group II, left ventricular ejection fraction ranged from 19 to 47%. Mean value of this parameter equaled 32% and was statistically significantly higher than in patients from group II. In 9/21 patients (42%) diffuse hypokinesis, in 2/21 patients (10%) regional anterior wall hypokinesis with the normal function of other walls, and in the last 10/21 patients (48%) regional anterior wall akinesis with the diffuse hypokinesis of other walls were localized. In the patients without persistent electrocardiographic ST segment elevation, diffuse hypokinesis was observed in majority of cases. In none of those patients ventricular aneurysm was diagnosed. In the patients with persistent electrocardiographic ST segment elevation, three types of decreased left ventricular function (diffuse hypokinesis, regional akinesis and ventricular aneurysm) were observed. It should be noted that in 1/3 of those patients ventricular aneurysm was diagnosed. Presence of diskinetic wall motion abnormalities in group I (in 8/24 patients) was statistically significantly more frequent (p < 0.01) than in group II (in 0/21 patients). CONCLUSIONS: 1. Presence of persistent electrocardiographic ST segment elevation in a patient with post infarction myocardial failure is a prerequisite for suspicion of post myocardial infarction left-ventricular aneurysm. 2. In patients without persistent electrocardiographic ST segment elevation and post infarction myocardial failure diffuse hipokinesis (sometimes with regional akinesis) is predominantly observed.

Adult↗

Severe acute respiratory syndrome coronavirus persistence in Vero cells.

BACKGROUND: Several coronaviruses establish persistent infections in vitro and in vivo, however it is unknown whether persistence is a feature of the severe acute respiratory syndrome coronavirus (SARS-CoV) life cycle. This study was conducted to investigate viral persistence. METHODS: We inoculated confluent monolayers of Vero cells with SARS-CoV at a multiplicity of infection of 0.1 TCID50 and passaged the remaining cells every 4 to 8 days for a total of 11 passages. Virus was titrated at each passage by limited dilution assay and nucleocapsid antigen was detected by Western blot and immunofluoresence assays. The presence of viral particles in passage 11 cells was assessed by electron microscopy. Changes in viral genomic sequences during persistent infection were examined by DNA sequencing. RESULTS: Cytopathic effect was extensive after initial inoculation but diminished with serial passages. Infectious virus was detected after each passage and viral growth curves were identical for parental virus stock and virus obtained from passage 11 cells. Nucleocapsid antigen was detected in the majority of cells after initial inoculation but in only 10%-40% of cells at passages 2-11. Electron microscopy confirmed the presence of viral particles in passage 11 cells. Sequence analysis at passage 11 revealed fixed mutations in the spike (S) gene and ORFs 7a-8b but not in the nucleocapsid (N) gene. CONCLUSIONS: SARS-CoV can establish a persistent infection in vitro. The mechanism for viral persistence is consistent with the formation of a carrier culture whereby a limited number of cells are infected with each round of virus replication and release. Persistence is associated with selected mutations in the SARS-CoV genome. This model may provide insight into SARS-related lung pathology and mechanisms by which humans and animals can serve as reservoirs for infection.

Animals↗

How well do the HEDIS asthma inclusion criteria identify persistent asthma?

OBJECTIVES: (1) To determine if the Health Plan Employer Data and Information Set (HEDIS) asthma inclusion criteria consistently identify persistent asthma on a year-to-year basis and (2) to explore whether variation in the number of years of qualification is associated with medication and resource utilization outcomes. STUDY DESIGN: Retrospective observational study. METHODS: We identified 132 414 patients in a large healthcare program who were included in 1 or more HEDIS persistent asthma cohorts between 1999 and 2002 and who had continuous insurance and pharmacy benefit coverage for the entire 4-year observation period. Medication, emergency department, and hospital use in 2002 was identified using electronic claims and pharmacy information. RESULTS: Overall, 47.9% of the patients were identified as having persistent asthma in only 1 of 4 years, 40.8% had at least 2 consecutive years, and 28.2% had at least 3 consecutive years. In bivariate and multivariate analyses, more consecutive years of HEDIS persistent asthma qualification significantly increased the likelihood of frequent short-acting b-agonist use, inhaled antiinflammatory corticosteroid use, at least 1 emergency department visit, and at least 1 hospitalization. The strongest relationship was for 3 or more consecutive years of HEDIS qualification. CONCLUSIONS: A significant portion of the HEDIS persistent asthma cohort does not qualify on a year-to-year basis, suggesting that the current 1-year qualification period or the underlying administrative case definition for persistent asthma may be suboptimal. Further clinical validation studies are needed to determine the optimal criteria for a more useful HEDIS persistent asthma case definition.

Adolescent↗

Spontaneous improvement of persistent ulceration after carotid artery stenting.

BACKGROUND AND PURPOSE: Because carotid plaque ulceration is associated with an increased risk of cerebral embolism, residual carotid plaque ulceration directly around a stent (persistent ulceration) after carotid angioplasty and stent placement (CAS) could still be a risk factor for a stroke. The purpose of this study is to understand the morphologic and clinical prognosis of persistent ulceration. PATIENTS AND TECHNIQUES: CAS was attempted on 91 consecutive stenotic lesions (80 patients). Of these, 54 lesions (48 patients) had ulceration before CAS. Angiograms were evaluated immediately after the procedure. Persistent ulceration was found in 34 lesions (30 patients). The mean depth and length of persistent ulcers were 2.1 mm (range, 1-4.7 mm) and 8.9 mm (range, 1.5-22 mm), respectively. All patients with persistent ulceration were followed with antiplatelet therapy. RESULTS: No ischemic event due to the lesions occurred during the mean follow-up period of 25.5 months (range, 3-48 months). Angiography on 25 lesions (21 patients) at a mean of 5.8 months (range, 1-21 months) after CAS showed that persistent ulceration disappeared in 12 lesions (48%), improved in 11 lesions (44%), and remained unchanged in 2 lesions (8%). Nine lesions (36%) showed restenosis, which were < or =30% and did not require any additional intervention. New ischemic lesions were not detected in any of the 14 patients (17 lesions) who underwent follow-up MR imaging at a mean of 9 months (range, 1-32 months) after CAS. CONCLUSION: We conclude that persistent ulceration after CAS improves spontaneously and is not a risk factor for cerebral embolism.

Aged↗

Prevalence of persistent sleep apnea in patients treated with continuous positive airway pressure.

STUDY OBJECTIVE: There are limited data on the prevalence of persistent obstructive sleep apnea (OSA) in patients who are clinically asymptomatic with continuous positive airway pressure (CPAP). Our objectives were to estimate the prevalence of persistent OSA and to explore the parameters that may be capable of discriminating these patients. DESIGN: Prospective survey. SETTING: A tertiary-care sleep-disorders clinic. PARTICIPANTS: Consecutive patients treated with single-pressure CPAP for at least 3 months were studied. All had undergone CPAP titrations and were compliant with treatment. They denied snoring or persistent excessive daytime somnolence. Of 114 who qualified, 101 were studied. INTERVENTIONS: Subjects underwent 16-channel polysomnography with electroencephalogram and pneumotachometer while using their CPAP. MEASUREMENTS AND RESULTS: Seventeen of 101 subjects (17%) had an apnea-hypopnea index of over 10. Fifty-one had only split-night protocols for CPAP titration. There was no significant difference between participants with persistent OSA and those with an apnea-hypopnea index < 5 with regard to age, sex, time since diagnosis, reported snoring, change in weight, or quality of life (all p > .10). Mean current CPAP level was higher, with a mean +/- SD 10.6 +/- 2.8 versus 8.6 +/- 2.3 cm H2O (p = .002). Unresolved air leak related to CPAP was more frequent in the patients with persistent OSA. Morning headaches, nonrestorative sleep, and frequent central apneas on the CPAP titration were all associated with persistent OSA. CONCLUSIONS: Persistent OSA is frequent in patients treated with CPAP. This is more frequent in patients with high body mass index, higher prescribed pressures, and unresolved mask leak.

Apnea↗

[The effect of myelopeptides on the persistence of tick-borne encephalitis virus in monkeys].

Myelopeptides (MP), bioregulatory molecules of bone marrow origin, exert a protective effect in persistence of tick-borne encephalitis virus in cynomolgus monkeys (Macaca fascicularis). The experiments involved 32 monkeys. The effect of MP was observed after one or two subcutaneous injections in a dose of 1 mg within 1.5-2 months after virus infection. The effect consists in 25-fold reduction of the frequency of virus persistence, marked limitation of the zone of spread of the persisting virus, including the central nervous system (CNS), decrease in virulence of the persisting virus, and lack of morphological signs of progress of the pathological process in the CNS. The protective effect was also observed when the infected monkeys were treated with MP and inactivated concentrated TBE vaccine. At the same time, the vaccine alone exerted a much less marked effect on the persisting TBE virus producing only a 2-fold reduction in the frequency of persistence without limitation of the zones of virus spread. In acute TBE in BALB/c mice, the effect of MP is observed irregularly. The marked protective effect of MP in TBE virus persistence in monkeys is not associated with stimulation of humoral immunity but is mediated by other immunological mechanisms requiring further study.

Acute Disease↗

Persistence of Mycoplasma hominis after therapy: importance of tetracycline resistance and of coexisting vaginal flora.

In past studies Mycoplasma hominis has persisted after treatment with placebo, penicillins, or rifampin in 88-97% of women and 49-77% of men with infections of the lower genital tract. Among women with nonspecific vaginitis, M. hominis persisted in only a third of those treated with metronidazole as compared with at least 70% of those treated with ampicillin (P = 0.01), even though M. hominis is resistant in vitro to metronidazole and to its acid and hydroxy metabolites. Persistence of M. hominis after treatment with metronidazole was significantly associated with persistence of Bacteroides species in the vagina (P = .03). These results suggest that colonization of the vagina with M. hominis is partly dependent on other components of the vaginal microbial flora. In prior studies, M. hominis has persisted in zero to 50% of women and in zero to 30% of men after treatment with tetracycline or lincomycin, but the role of tetracycline resistance in treatment failure was not defined. The susceptibility of M. hominis to tetracycline is bimodal; and the minimal inhibitory concentration (MIC) of tetracycline for strains isolated before or soon after treatment was greater than or equal to 16 micrograms/ml for seven (78%) of nine that did persist and for two (17%) of 12 that did not persist after tetracycline therapy for cervicitis in women (P = .002). The MIC of tetracycline was greater than or equal to 16 micrograms/ml for two (12%) of 17 isolates from women in Seattle in 1972-1973, as compared with 27 (34%) of 79 isolates from Seattle men and women in 1979-1982.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Subcutaneous cuff removal in persistent exit-site/tunnel infections in peritoneal dialysis.

The purpose of this study was to analyze catheter outcome of persistent exit-site/tunnel infections (ESI/TIs) in peritoneal dialysis patients who underwent removal of the subcutaneous cuff due to persistent ESI/TI from January 1989 to June 1994. One hundred and sixty-eight patients (98 male, 70 female) from our tertiary university hospital underwent 177 double-cuff coiled Swan neck catheter implantations surgically. Nineteen patients (11%) had persistent ESI/TIs for more than 6 months. Thirteen persistent ESI/TIs responded to subcutaneous cuff removal. One hundred and fifty-four episodes of ESI/TI in 168 patients were observed over 3189 patient-months (0.58 episodes/patient-year). Nineteen patients (11%) had persistent ESI/TI with Staphylococcus aureus in 12 and Pseudomonas aeurginosa in 7 patients without episode of peritonitis except 2 patients with Staphylococcus aureus. Thirteen persistent ESI/TI resolved after subcutaneous catheter removal without catheter loss, 8 with Staphylococcus aureus and 5 with Pseudomonas. Sixteen catheters were lost due to fungal peritonitis and two secondary to recurrent bacterial peritonitis. None of the catheters were removed as a result of ESI/TI and related peritonitis. Subcutaneous cuff removal in persistent ESI/TI in peritoneal dialysis patients can significantly reduce catheter loss related to ESI/TI.

Bacteria↗

Does Rota virus infection cause persistent diarrhoea in childhood?

Rota virus is the commonest agent for infectious diarrhoea in childhood. Whether an acute diarrhoea episode due to Rota virus constitutes a risk factor for persistence of diarrhoeal episode has not been well evaluated. This study aimed at evaluating the role of antecedent Rota virus infection in the causation of persistent diarrhoea. One hundred twenty children with acute watery diarrhoea were investigated for evidence of recent Rota virus infection and were followed up for 2 weeks to determine the proportion developing persistent diarrhoea. Rota virus antigen in stool and IgM class antibodies in serum were detected in 33 (27.5%) of the cases, only 2 (6.06%) of whom developed persistent diarrhoea. On the other hand 11.3% children without evidence for antecedent Rota virus infection developed persistent diarrhoea. The prevalence of Rota virus antigen in stools of children who developed persistent diarrhoea was 16.7%. In another group of 25 children with persistent diarrhoea definite evidence for a Rota virus infection was detected in only 2 (8%) cases. It was therefore concluded that antecedent Rota virus infection does not increase the risk for abnormal prolongation of an episode of acute diarrhoea.

Acute Disease↗

A persistent double-strand break destabilizes human DNA in yeast and can lead to G2 arrest and lethality.

Double-strand breaks (DSBs) are an important source of genomic change in many organisms. We have examined the consequences of a persistent versus a rapidly repaired DSB on cell progression, viability, and stability of human DNA contained in dispensable yeast artificial chromosomes (YACs) within the yeast Saccharomyces cerevisiae. An Alu-URA3-YZ integrating plasmid was used to target the YZ sequence to repetitive Alu sequences within the human YAC. The YZ site can be cut by an inducible HO-endonuclease resulting in a DSB. Two classes of DSBs had been identified previously: those that could be rapidly repaired (RR-DSB), through recombination between flanking Alus; and persistent DSBs (C. B. Bennett et al., Mol. Cell. Biol., 16: 4414-4425, 1996). These persistent DSBs (type 1) resulted in G2 delay and lethality. A third class of DSB is now identified corresponding to a persistent DSB that does not lead to G2 arrest or lethality (type 2). Unlike YACs in which the DSB was rapidly repaired, the two types of persistent DSBs destabilized the human YAC DNA, resulting in a high likelihood of YAC loss (approximately 85% of surviving colonies). Furthermore, both types of persistent DSBs could be misrepaired, resulting in mostly large internal or terminal deletions in the retained YACs. Therefore, recovery of these altered YACs can occur regardless of the effect of the DSBs on G2 arrest and cell lethality. If similar events occur in mammalian cells, persistent DSBs could be the initiating events that lead to a loss of heterozygosity and the expression of recessive oncogenes seen in malignant cells.

Chromosomes, Artificial, Yeast↗

[Periventricular leukomalacia and persistent hyperechogenicity: relationship between ultrasound findings and sequelae].

OBJECTIVES: The objective of this study was to know the incidence of periventricular leukomalacia and persistent periventricular echodensities in neonates with a birth weight < 1,500 g and to correlate cranial ultrasound findings with the developmental outcome of these babies at 18 months of corrected age. PATIENTS AND METHODS: We performed a cohort study of 319 newborns weighing 1500 g or less who were admitted to the Neonatal Intensive Care Unit of "12 de Octubre" Hospital between July 1990 and April 1994. Scans were performed while they were hospitalized and 183 surviving infants were followed up to 18 months of corrected age. Relative risks (rr) and 95% confidence intervals (95% CI) were calculated for sequelae according to neonatal cranial ultrasound abnormalities. Ninety-six infants with normal scans were considered as the control group. Persistent periventricular echodensities were classified as mild, moderate or severe. RESULTS: The incidence of periventricular leukomalacia was 3% (10/319) and of persistent periventricular echodensites was 11.2% (36/319). The percentage of sequelae was 5% for control infants, 15.6% (rr = 3, CI 95% = 0.94-8.8) for persistent periventricular echodensities, independent of its severity, 50% (rr = 9.7, CI 95% = 2.6-35) for moderate persistent periventricular echodensities and 78% (rr = 15.6, CI 95% = 6-38) for periventricular leukomalacia. CONCLUSIONS: Periventricular leukomalacia multiplies the number of sequelae by 15. Persistent periventricular echodensities, independent of its severity, does not multiply the number of sequelae significantly. However, moderate persistent periventricular echodensities multiply the number of sequelae by 9.

Echoencephalography↗

Persistent diarrhoea in children admitted to Port Moresby General Hospital.

A retrospective study of the records of children admitted to Port Moresby General Hospital with diarrhoea during 1992 and 1993 was carried out to determine the morbidity, mortality and risk factors associated with persistent diarrhoea. 858 admissions of children under five years of age who had diarrhoea were identified from the ward admission registers, and case records for 724 were studied. Persistent diarrhoea occurred in 20%, and nearly half of these were in the 12-23 months age group. Children with persistent diarrhoea had a case fatality rate of 4.9%. Seasonality was similar for both persistent and non-persistent diarrhoea. In the crude analysis children of 12 months and older had a greater risk of developing persistent diarrhoea than those less than 12 months (odds ratio for children 12-23 months was 2.0 and for children 24-59 months 1.7; confidence intervals were 1.2-3.1 and 1.0-2.9 respectively); however, this difference was not found after logistic regression analysis. Poor nutritional status was a significant risk factor for persistent diarrhoea and remained so after controlling for confounding variables (odds ratio 2.7; confidence interval 1.8-4.0).

Age Factors↗

Using a hierarchical approach to investigate residual auditory cognition in persistent vegetative state.

Persistent vegetative state is arguably one of the least understood and most ethically troublesome neurological conditions in modern medicine. The term describes a rare disorder in which patients who emerge from coma appear to be awake, but show no signs of awareness. In recent years, a number of studies have demonstrated an important role for functional neuroimaging in the identification of residual cognitive function in patients meeting the clinical criteria for persistent vegetative state. Such studies, when successful, may be particularly useful where there is a concern about the accuracy of the diagnosis and the possibility that residual cognitive function has remained undetected. Unfortunately, functional neuroimaging in persistent vegetative state is extremely complex and subject to numerous methodological, clinical and theoretical difficulties. In this chapter, we argue that in order to most effectively define the degree and extent of preserved cognitive function in persistent vegetative state, a hierarchical approach to cognition is required. To illustrate this point, a series of functional neuroimaging paradigms in the auditory domain are described, which systematically increase in complexity in terms of the auditory and/or linguistic processes required and, therefore, the degree of preserved cognition that can be inferred from "normal" patterns of activation in persistent vegetative patients. Preliminary results in a small series of patients provide a strong basis for the systematic study of possible residual cognitive function in persistent vegetative state.

Auditory Perception↗

Adaptation for Staphylococcus aureus to hosts via insertion mutation in the accessory gene regulator agrC gene: decreased virulence and enhanced persistence capacity.

UNLABELLED: Staphylococcus aureus is an important human pathogen due to its vast array of virulence factors regulated by multiple regulatory mechanisms, including the accessory gene regulator. In this study, two S. aureus strains were simultaneously isolated from the blood of a febrile patient, belonging to the same clone, designated as 23H with a complete hemolytic phenotype, and 23B, exhibiting an incomplete hemolytic phenotype. The genomic comparison between strains 23B and 23H revealed that 23B had a single adenine base insertion at position 923 in the agrC gene, leading to a functional loss of the encoded AgrC. Experimental findings showed that strain 23B had decreased hemolytic activity, lower cytotoxicity against human alveolar epithelial A549 cells and in the Galleria mellonella model, and a reduced ability to survive intracellularly after infecting macrophages, in comparison to 23H. Conversely, 23B exhibited enhanced biofilm formation, greater adherence to A549 cells, and increased persistence in the face of vancomycin and daptomycin treatment. Transcriptomic analysis revealed that 23B upregulated surface protein-encoding genes while simultaneously reducing the expression levels of virulence factors, highlighting the intricate regulatory adjustments facilitating its persistence and reducing pathogenic potential. ATP assay results indicated that 23B maintained elevated ATP levels during the exponential phase yet exhibited reduced levels in the stationary phase when compared with 23H. Our findings suggested that the mutation in the agrC gene of S. aureus results in diminished virulence but markedly enhances persistence. This mutated strain warrants clinical attention because it may lead to treatment failures and persist in patients. IMPORTANCE: In clinical antimicrobial therapy, bacterial strains often develop resistance to antimicrobial agents. Additionally, mutations in their gene regulatory networks can increase their persistence, especially in immunocompromised patients. This study identified an insertion mutation in the accessory gene regulator, agrC gene, carried by a Staphylococcus aureus strain isolated from the blood of a febrile patient, leading to the functional loss of AgrC. Further research revealed that despite the reduced virulence of the mutated strain, it significantly bolstered the capacity to adapt and endure within the host during prolonged infections. This was evidenced by increased adhesion and biofilm formation capabilities, development of antimicrobial tolerance, and decreased ATP levels linked to persistence. Therefore, monitoring these mutations in S. aureus is crucial clinically, as they can complicate treatment strategies.

Staphylococcus aureus↗

Teicoplanin associated gene tcaA inactivation increases persister cell formation in Staphylococcus aureus.

Staphylococcus aureus is part of normal human flora and is widely associated with hospital-acquired bacteremia. S. aureus has shown a diverse array of resistance to environmental stresses and antibiotics. Methicillin-resistant S. aureus (MRSA) is on the high priority list of new antibiotics discovery and glycopeptides are considered the last drug of choice against MRSA. S. aureus has developed resistance against glycopeptides and the emergence of vancomycin-intermediate-resistant, vancomycin-resistant, and teicoplanin-resistant strains is globally reported. Teicoplanin-associated genes tcaR-tcaA-tcaB (tcaRAB) is known as the S. aureus glycopeptide resistance operon that is associated with glycopeptide resistance. Here, for the first time, the role of tcaRAB in S. aureus persister cells formation, and &#x394;tcaA dependent persisters' ability to resuscitate the bacterial population was explored. We recovered a clinical strain of MRSA from a COVID-19 patient which showed a high level of resistance to teicoplanin, vancomycin, and methicillin. Whole genome RNA sequencing revealed that the tcaRAB operon expression was altered followed by high expression of glyS and sgtB. The RNA-seq data revealed a significant decrease in tcaA (p =&#x2009;0.008) and tcaB (p =&#x2009;0.04) expression while tcaR was not significantly altered. We knocked down tcaA, tcaB, and tcaR using CRISPR-dCas9 and the results showed that when tcaA was suppressed by dCas9, a significant increase was witnessed in persister cells while tcaB suppression did not induce persistence. The results were further evaluated by creating a tcaA mutant that showed &#x394;tcaA formed a significant increase in persisters in comparison to the wild type. Based on our findings, we concluded that tcaA is the gene that increases persister cells and glycopeptide resistance and could be a potential therapeutic target in S. aureus.

MRSA↗