Influência de pré-tratamentos de células epiteliais com penicilina e eritromicina na aderência e na viabilidade intracelular de Corynebacterium diphtheriae / Influence of epithelial cells pre-treatment with penicilin and erythromycin in adherence and intracellular viability of Corynebacterium diphtheriae

Renata Stavracakis Peixoto

Diphtheria is a syndrome caused by Toxigenic Corynebacterium diphtheriae. Although immunization programs have kept diphtheria under control in the great majority of developed countries, the disease remains endemic in many parts of the world, especially in individuals partially immunized to diphtheria toxoid. Additionally, an increase in the number of cases of systemic infections caused by non-toxigenic strains has been observed along the last 20 years. Penicillin and erythromycin have long been the drugs of choice for the treatment of C. diphtheriae infections, though the studies reviewing the choice of treatment and the influence of antibiotics in the process of bacterial interaction with human epithelial cells are scarce, and comprise the aspects that justify the present investigation. The main objective was to analyze the influence of pre-treatment of HEp-2 epithelial cells with the penicillin and erythromycin in adherence and intracellular viability of C. diphtheriae strains. HEp-2 monolayers were pre-treated for 24 hours with the serum concentration doses of penicillin (5g mL-1) and erythromycin (1.92 mg mL-1), and antibiotics were removed by washing with PBS before infection with bacterial suspension (MOI of 107). Three hours post-infection, the adherence pattern was investigated, and both percentage of viable cell-associated bacteria and intracellular bacteria was determined. Penicillin treatment induced the bacterial strains to exhibit diffuse adherence patterns (DA). Microorganisms that usually express localized adherence patterns (LA) began to express DA pattern after pre-treatment of monolayers with both antibiotics. Erythromycin did not influence the aggregative adherence pattern (AA). Penicillin and erythromycin reduced the number of viable HEp-2 cell-associated bacteria for the most of the strains. However, penicillin interfered in this process in a greater magnitude. The C. diphtheriae invasive strains (HC01, HC04 and BR5015) showed higher ability to survive within the intracellular compartment, regardless of pre-treatment. The expression of adherence patterns as well as the ability to survive in the intracellular environment of pre-treated cells, proved to be independent of toxin production and the usual percentage of association with HEp-2 cells. A higher efficiency in the reduction of intracellular viability with the use of erythromycin was observed for the majority of strains, and reinforces the clinical use of erythromycin in the treatment of patients alongside the eradication of the carrier state. Further studies will be necessary to investigate the changes in the expression of virulence factors in C. diphtheriae during the interaction with HEp-2 cells pre-treated with antimicrobials and the influence on the clinical evolution of corynebacterial infections

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