Loss of viability and induction of apoptosis in human keratinocytes exposed to Staphylococcus aureus biofilms in vitro
Kirker, Kelly R.
Secor, Patrick R.
James, Garth A.
Olerud, John E.
Stewart, Philip S.
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Bacteria colonizing chronic wounds are believed to exist as polymicrobial, biofilm communities; however, there are few studies demonstrating the role of biofilms in chronic wound pathogenesis. This study establishes a novel method for studying the effect of biofilms on the cell types involved in wound healing. Cocultures of Staphylococcus aureus biofilms and human keratinocytes (HK) were created by initially growing S. aureus biofilms on tissue culture inserts then transferring the inserts to existing HK cultures. Biofilm-conditioned medium (BCM) was prepared by culturing the insert-supported biofilm in cell culture medium. As a control planktonic-conditioned medium (PCM) was also prepared. Biofilm, BCM, and PCM were used in migration, cell viability, and apoptosis assays. Changes in HK morphology were followed by brightfield and confocal microscopy. After only 3 hours exposure to BCM, but not PCM, HK formed dendritelike extensions and displayed reduced viability. After 9 hours, there was an increase in apoptosis (p 0.0004). At 24 hours, biofilm-, BCM-, and PCM-exposed HK all exhibited reduced scratch closure (p 0.0001). The results demonstrated that soluble products of both S. aureus planktonic cells and biofilms inhibit scratch closure. Furthermore, S. aureus biofilms significantly reduced HK viability and significantly increased HK apoptosis compared with planktonic S. aureus. Keratinocytes are the major cell type of the epidermis, which serves as the primary barrier between the external environment and the internal tissues. In this capacity, the epidermis also functions as a barricade to microorganisms, toxins, and various antigens. When the barrier is breached due to wounding, basal keratinocytes from the wound edges or dermal appendages migrate over the open wound to reestablish the barricade in a process called reepithelialization. Chronic wounds, such as diabetic foot ulcers, venous leg ulcers, and pressure ulcers, are characterized by prolonged inflammation, an altered wound matrix, and the failure to reepithelialize. Chronic wounds are also characterized as supporting a diverse microbial flora. A literature review by Bowler examined culture data from 62 published studies dating between 1969 and 1997.1 The most predominant wound isolate in both chronic and acute wounds was Staphylococcus aureus (reported in 63% of the studies), followed by coliforms (45%), Bacteroides spp. (39%), Peptostreptococcus spp. (36%), Pseudomonas aeruginosa (29%), Enterococcus spp. (26%), and Streptococcus pyogenes (13%).1 Using molecular techniques, Dowd et al.2 also demonstrated vast bacterial diversity within chronic wounds. The most prevalent species included Staphylococcus, Pseudomonas, Peptoniphilus, Enterobacter, Stenotrophomonas, Finegoldia, and Serratia spp. It has been speculated that bacteria colonizing chronic wounds exist as a biofilm.3–7 Biofilms represent bacterial communities surrounded by extracellular polysaccharide matrix. Such communities are often polymicrobial and resistant to antimicrobials. Chronic wounds are an ideal environment for bacterial infection and biofilm formation. The wound remains open for a prolonged period of time, increasing the odds of bacterial infection. The wound bed provides a surface for growth, and poor blood flow and hypoxia discourage native defenses.8 Studies have shown that wounds inoculated with bacteria form biofilms.6,9 Furthermore, in a recent study by James et al.,10 60% of chronic wound specimens were characterized as containing biofilm compared with 6% of acute wound specimens. Despite the prevalence of biofilms in wounds, there are few data illustrating the role of biofilms in chronic wound pathogenesis. This study establishes a novel method for directly studying the effect of biofilms on the cell types involved in wound healing. Specifically, it examines the effect of S. aureus biofilms on keratinocyte morphology, viability, and scratch closure. METHOD ANDMATERIALS Cell culture Normal human keratinocytes (HK) were isolated from newborn foreskin using methods previously described11 and in accordance with the University of Washington 690 Wound
Kirker KR, Secor PR, James GA, Fleckman P, Olerud JE, Stewart PS, "Loss of viability and induction of apoptosis in human keratinocytes exposed to Staphylococcus aureus biofilms in vitro," Wound Repair Regen 2009 17(5):690-699