Insulin treatment modulates the host immune system to enhance Pseudomonas aeruginosa wound biofilms

Infect Immun. 2014 Jan;82(1):92-100. doi: 10.1128/IAI.00651-13. Epub 2013 Oct 14.

Abstract

Diabetes affects 25.8 million people in the United States, or 8.3% of the population, and these numbers are even higher in developing countries. Diabetic patients are more susceptible to the development of chronic wounds with debilitating bacterial infections than nondiabetics. Previously, we compared the ability of the opportunistic pathogen Pseudomonas aeruginosa to cause biofilm-associated infections in chronic wounds of diabetic and nondiabetic mice (C. Watters, K. DeLeon, U. Trivedi, J. A. Griswold, M. Lyte, K. J. Hampel, M. J. Wargo, and K. P. Rumbaugh, Med. Microbiol. Immunol. 202:131-141, 2013). Unexpectedly, we observed that insulin-treated diabetic mice had significantly more biofilm in their wounds, which correlated with higher antibiotic tolerance. Here, we investigated whether insulin treatment modulates the diabetic immune system to favor P. aeruginosa biofilm formation. Utilizing a murine chronic wound model, we found that DNA protected P. aeruginosa in the wounds of insulin-treated diabetic mice from antibiotic treatment. We also observed increased numbers of neutrophils, reduced numbers of macrophages, and increased cell death in the wounds of diabetic mice on insulin therapy. Taken together, these data suggest that high levels of lysed neutrophils in the wounds of diabetic mice on insulin, combined with fewer macrophages to remove the cellular debris, contribute to increased DNA levels, which enhance P. aeruginosa biofilms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anti-Bacterial Agents / pharmacology
  • Apoptosis / physiology
  • Biofilms / growth & development*
  • Cell Death / immunology
  • Chronic Disease
  • DNA, Bacterial / analysis
  • Diabetes Mellitus, Experimental / drug therapy
  • Diabetes Mellitus, Experimental / immunology*
  • Disease Models, Animal
  • Drug Resistance, Bacterial / immunology
  • Female
  • Hypoglycemic Agents / pharmacology*
  • Insulin / pharmacology*
  • Macrophages / cytology
  • Mice
  • Microbial Sensitivity Tests
  • Neutrophils / cytology
  • Pseudomonas Infections / complications
  • Pseudomonas Infections / microbiology*
  • Pseudomonas Infections / pathology
  • Pseudomonas aeruginosa / drug effects*
  • Pseudomonas aeruginosa / physiology
  • Wound Healing / physiology
  • Wound Infection / complications
  • Wound Infection / microbiology*
  • Wound Infection / pathology

Substances

  • Anti-Bacterial Agents
  • DNA, Bacterial
  • Hypoglycemic Agents
  • Insulin