Dallas: An upset in the body’s natural balance of gut bacteria that may lead to life-threatening bloodstream infections can be reversed by enhancing a specific immune defense response, UT Southwestern Medical Center researchers have found. Research assistant Laura Coughlin, seated, Dr. Andrew Koh, and Dr. Tiffany Simms-Waldrip use an anaerobic chamber as part of a study investigating how the gut’s bacteria defense system fights off Candida albicans infection.
In the study, published online in Nature Medicine, scientists
identified how a certain transcription factor – a protein that that
turns genes on and off – works in partnership with a naturally occurring
antibiotic to kill infection-causing fungi called Candida albicans.
These particular fungi, best known as a cause of yeast infections and
oral thrush, can be lethal if they overgrow and invade the bloodstream
from the gut. At high risk for this type of infection are stem cell
transplant and leukemia patients whose immune systems are suppressed
during treatment. Up to 25 percent of cancer patients develop
bloodstream infections from bacteria or fungi.
“For a cancer patient with a Candida bloodstream infection, the fatality rate is about 30 percent. Candida is the No. 1 fungal pathogen,” said senior author Dr. Andrew Koh,
Assistant Professor of Pediatrics and Microbiology, and a member of the
Harold C. Simmons Comprehensive Cancer Center at UT Southwestern.
Certain antibiotics do fight invasive Candida infection, but
they are not always effective and antibiotic resistance increasingly has
become an issue. Dr. Koh’s research team aimed to uncover how the
body’s natural immune defense system might be enhanced to fight a Candida infection.
About half of the population carries Candida in the gut, where
the yeast is usually harmless. When the organism overgrows, it may
leave the gut and cause infection. Commensal bacteria, the resident
bacteria of the gut, normally defend against disease by inhibiting
growth of potentially pathogenic organisms.
By studying how mice infected with Candida responded in
different scenarios, the researchers discovered how to enhance the
body’s natural ability to eradicate infection, in this case Candida.
“The commensal bacteria stimulate gut tissue to make a transcription factor and a natural antibiotic, which then kills the Candida
fungus,” said Dr. Koh, Director of the Pediatric Hematopoietic Stem
Cell Transplantation Program at UT Southwestern and Children’s Medical
Center Dallas. “When we gave the mice a pharmacologic agent called L-mimosine that stimulates the transcription factor, the agent knocked down Candida 100-fold, which translated into a 50 percent reduction in mortality from invasive Candida infection.”
Specifically, the researchers found that enhancing the transcription factor HIF-1α with L-mimosine led to increased production of the natural antibiotic peptide LL-37, which in turn killed the fungi. L-mimosine
is a natural product derived from seeds of the koa haole tree that is
not approved as a drug but is known to boost HIF-1α activity. The study
also suggested that certain gut bacteria – Cloistridial Firmicutes and
Bacteroidetes – may be important in producing short-chain fatty acids
that help fight infection.
More study is needed to pinpoint the optimal method of inducing the
body’s gut defense system, whether through use of an agent like L-mimosine or by administering short-chain fatty acids such as vinegar.
“Can we modulate the gut system to maintain balance so that it never
gets to the point of pathogens invading the bloodstream?” asked Dr. Koh.
“Boosting GI mucosal immune effectors to reduce fungal burden may be
the key to tipping the balance back toward normal and preventing
invasive fungal disease.”
Study lead author Di Fan formerly worked in Dr. Koh’s lab. Other
contributing authors were Laura Coughlin, research assistant in
Pediatrics; Jiwoong Kim and Minsoo Kim, computational biologists in
Clinical Sciences; Dr. Xiaowei Zhan, Assistant Professor of Clinical Science and in the Center for the Genetics of Host Defense; Dr. Tiffany Simms-Waldrip, Assistant Professor of Pediatrics and member of the Pediatric Hematopoietic Stem Cell Transplantation Program; Dr. Yang Xie, Associate Professor of Clinical Science; and Dr. Lora Hooper,
Professor of Immunology, Microbiology, and in the Center for the
Genetics of Host Defense. Dr. Hooper, a Howard Hughes Medical Institute
(HHMI) Investigator, holds the Jonathan W. Uhr, M.D., Distinguished
Chair in Immunology and is Nancy Cain and Jeffrey A. Marcus Scholar in
Medical Research, in Honor of Dr. Bill S. Vowel.
The research was funded by the National Institutes of Health, the
Howard Hughes Medical Institute, the Roberta I. and Norman L. Pollock
Fund, and a Global Probiotics Council Young Investigator Grant for
UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center
includes 13 major cancer care programs with a focus on treating the
whole patient with innovative treatments, while fostering groundbreaking
basic research that has the potential to improve patient care and
prevention of cancer worldwide. In addition, the Center’s education and
training programs support and develop the next generation of cancer
researchers and clinicians.
The Simmons Cancer Center is among only 30 U.S. cancer research
centers to be named a National Clinical Trials Network Lead Academic
Participating Site, a prestigious new designation by the NCI, and the
only cancer center in North Texas to be so designated. The designation
and associated funding is designed to bolster the cancer center’s
clinical cancer research for adults and to provide patients access to
cancer research trials sponsored by the NCI, where promising new drugs
often are tested.