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Chapter I: Introduction and Literature Review WestminsterResearch http://www.westminster.ac.uk/research/westminsterresearch Aspergillosis: Interactions of Aspergillus fumigatus and Human Airway Cells Maryam Safari School of Life Sciences This is an electronic version of a PhD thesis awarded by the University of Westminster. © The Author, 2013. This is an exact reproduction of the paper copy held by the University of Westminster library. The WestminsterResearch online digital archive at the University of Westminster aims to make the research output of the University available to a wider audience. Copyright and Moral Rights remain with the authors and/or copyright owners. Users are permitted to download and/or print one copy for non-commercial private study or research. Further distribution and any use of material from within this archive for profit-making enterprises or for commercial gain is strictly forbidden. Whilst further distribution of specific materials from within this archive is forbidden, you may freely distribute the URL of WestminsterResearch: (http://westminsterresearch.wmin.ac.uk/). In case of abuse or copyright appearing without permission e-mail [email protected] Aspergillosis: Interactions of Aspergillus fumigatus and Human Airway Cells Maryam Safari A Thesis submitted in partial fulfilment of the requirements of the University of Westminster for the degree of Doctor of Philosophy May 2013 i AUTHOR’S DECLARATION I declare that the present work was carried out in accordance with the Guidelines and Regulations of the University of Westminster. The work is original except where indicated by special reference in the text. The submission as a whole or part is not substantially the same as any that I previously or am currently making, whether in published or unpublished form, for a degree, diploma or similar qualification at any university or similar institution. Until the outcome of the current application to the University of Westminster is known, the work will not be submitted for any such qualification at another university or similar institution. Any views expressed in this work are those of the author and in no way represent those of the University of Westminster. Signed: Date ii Abstract Aspergillus fumigatus is a filamentous fungus that colonises the lungs of immunosuppressed patients and causes aspergillosis. Despite recent medical advances, infectious diseases caused by opportunistic pathogens such as A. fumigatus are still one of the main causes of morbidity and mortality among immunosuppressed patients. Gliotoxin is a mycotoxin and a secondary metabolite of A. fumigatus. This toxin possesses immusuppresive activity affecting cells of immune system. This research shows that human adenocarcinoma alveolar epithelial cells (A549) are highly susceptible to gliotoxin- induced cell death. Wild type strains of A. fumigatus cause death in these cells whereas mutant strains (gliotoxin deficient) do not. Gliotoxin induced cell death is mostly via apoptosis programmed cell death rather than necrosis. Long term incubation of A549 cells with gliotoxin-deficient strain causes morphology changes (swelling/partial damage) in these cells. This research proposes that gliotoxin induced death/ inflammation of pneumocytes by programmed apoptosis may contribute to the pathogenesis of aspergillosis, particularly invasive aspergillosis. In addition, other produced metabolites (e.g. proteases or other toxins) also contribute (to a lesser extent) to the lung tissue damage in the absence of gliotoxin. One of the key risk factors in developing aspergillosis is corticosteroid therapy. This is due to the effect of glucocorticoids on suppressing body’s defence mechanism. As hydrocortisone is present during Aspergillus infection, understanding the ability of the fungus to perceive this host-factor enhances the understanding of A. fumigatus interaction with the host within the host environment. Previous reports have shown that physiological and pharmacological concentrations of hydrocortisone enhance the growth-rate of A. fumigatus in vitro. The present work demonstrates the effect of hydrocortisone on cultures of A. fumigatus at both morphological and molecular levels. Hydrocortisone causes an early onset of sporulation and seems to play a role in regulation of haemostasis and stress response in this fungus. Expression of stress- related proteins (hsp70, catalase), proteases (e.g. serine protease, metalloprotease), and carbohydrate metabolism-related proteins increased after supplementation of A..fumigatus cultures with hydrocortisone. Stimulation studies investigating the effect of secondary metabolites of A. fumigatus on A549 cells with and without pre-treatment of the fungal cultures with hydrocortisone indicated subtle increases in the number of dead cells after hydrocortisone pre-treatment. This study shows further that hydrocortisone treatment of the lung alveolar cells enhances the binding of A..fumigatus spores to these cells. The obtained data suggests that presence of hydrocortisone may contribute to the survival of this pathogen within the host environment. This study provides additional knowledge at molecular and cellular level where complications exist as a result of infection by A. fumigatus fungus and during treatment with glucocorticoids. iii “The most beautiful experience we can have is the mysterious - the fundamental emotion which stands at the cradle of true art and true science.” Albert Einstein (1879 - 1955) iv Acknowledgement I would like to take this opportunity to express my gratitude to those who have been instrumental in the successful completion of this PhD research project. A special gratitude I give to my supervisor, Prof. Tajalli Keshavarz, whose support and encouragement, helped me to manage my project. Thank you for giving me the freedom to pursue my ideas without any objection, for helping me to realise the power of critical thinking and the inspiration of becoming an independent research scientist. I am also very grateful to my second supervisors, Dr. Mark Clements and Dr. Nino Porakishvili, for lending me their expertise and intuition to my scientific and technical enquires. In particular, to Dr. Clements for his scientific advice and many insightful discussions and suggestions. To Dr. Pamela Greenwell and Dr. Anatoliy Markiv, I appreciate your specialised scientific direction and input. Many thanks also to the University of Westminster Cavendish Scholarship; the funding source that made my Ph.D work possible. Furthermore, I would also like to acknowledge with appreciation the technical staff within the school of Life Sciences, particularly Mr. Thakor Tandel for his help and encouragements throughout my studies. I am indebted to my many friends who supported me. I could not forget those who cheered me up through the hard times, and celebrated each accomplishment with me. To Omeco White: I want to acknowledge your support and friendship and tell you how much they have meant to me. You are one of the most encouraging and helpful friends I ever had and a great teacher. To Daniela DeVizo, Patricia Fernanda Reffattie, Rana Amache, Artun Sukan, Eustace Fernando, Andrea Bagdadi, Pooja Basnet, Ngozi Mokwe, Ketki Vispute, Payman Moayedi, Karima Brimah, Souraya Yearoo and Dr. Nasrin Hamedi who have always been helpful and encouraging. Also to all other fellow Ph.D. students for all the fun memories shared. Finally, I would like to dedicate this work to my family: My mum and dad: Mrs Shahnaz Janjani and Dr. Latif Safari; my brothers and sister: Amirhossein, Kassan, and Neshat Safari; and my sister in-law: Shima Shokrani. Without your unending support and love from childhood to now, I would never have made it through this process or any of the tough times in my life. I am grateful for having you in my life. Thank you. v Table of contents Contents AUTHOR’S DECLARATION ............................................................................................................... ii Abstract .......................................................................................................................................... iii Acknowledgement .......................................................................................................................... v Table of contents ........................................................................................................................... vi List of Figures ................................................................................................................................. xi List of Tables ................................................................................................................................ xiii List of Abbreviations .................................................................................................................... xiv 1 Introduction and Literature Review ........................................................................................2 1.1 Host-pathogen interactions ............................................................................................2 1.2 An introduction to epidemiology and socioeconomic factors associated with aspergillosis .................................................................................................................................4 1.3 An overview of Aspergillus species .................................................................................6 1.3.1 Morphology .............................................................................................................8
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