rhesus macaques

恒河猴
  • 文章类型: Journal Article
    一些与年龄相关的口腔健康问题与神经退行性疾病相关,如阿尔茨海默病(AD)。然而,健康衰老中的口运动功能障碍与病理性衰老中的不同尚不清楚。部分原因是对健康衰老中的皮质和生物力学(“神经机械”)控制的变化知之甚少。为此,我们调查了年轻和老年恒河猴(Macacamulatta)的自然摄食行为,以了解与年龄相关的舌头和下颌运动学差异。我们使用高分辨率双平面视频放射摄影和X线运动形态重建(XROMM)在3D中跟踪舌头和颌骨的运动。与年轻受试者相比,年龄较大的受试者在咀嚼过程中舌头运动的刻板印象减少,舌头运动相对于下颌运动的滞后更大。总的来说,我们的发现揭示了舌头和下颌运动学的年龄相关变化,这可能表明舌-颌协调受损。我们的研究结果对于发现用于AD早期诊断的潜在神经机械生物标志物具有重要意义。
    Several age-related oral health problems have been associated with neurodegenerative diseases such as Alzheimer\'s Disease (AD), yet how oromotor dysfunction in healthy aging differ from those found in pathological aging is still unknown. This is partly because changes in the cortical and biomechanical (\"neuromechanical\") control of oromotor behavior in healthy aging are poorly understood. To this end, we investigated the natural feeding behavior of young and aged rhesus macaques (Macaca mulatta) to understand the age-related differences in tongue and jaw kinematics. We tracked tongue and jaw movements in 3D using high-resolution biplanar videoradiography and X-ray Reconstruction of Moving Morphology (XROMM). Older subjects exhibited a reduced stereotypy in tongue movements during chews and a greater lag in tongue movements relative to jaw movements compared to younger subjects. Overall, our findings reveal age-related changes in tongue and jaw kinematics, which may indicate impaired tongue-jaw coordination. Our results have important implications for the discovery of potential neuromechanical biomarkers for early diagnosis of AD.
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  • 文章类型: Journal Article
    黄热病病毒(YFV)在40多个国家流行,导致内脏疾病,死亡率高达20%-60%。成功的黄热病减毒活疫苗(YF)是在1930年代中期开发的,但是在包括婴儿在内的脆弱人群中,它们的使用受到限制或被正式禁止,老年人,和免疫系统受损的人。在这些研究中,我们描述了下一代过氧化氢灭活YF疫苗的开发,并基于对数中和指数(LNI)和中和滴度-50%(NT50)研究确定了免疫保护的相关性.此外,我们比较了过氧化氢灭活的YF候选疫苗与活减毒YFV-17D(YF-VAX)在恒河猴内脏性YF模型中的中和抗体应答和保护效力.我们的结果表明,优化的,灭活的YF疫苗可引发保护性抗体反应,以防止恒河猴的病毒传播和致命感染,并且可能是为不符合接受复制减毒活活YF疫苗的脆弱人群接种疫苗的合适替代方案。
    Yellow fever virus (YFV) is endemic in >40 countries and causes viscerotropic disease with up to 20%-60% mortality. Successful live-attenuated yellow fever (YF) vaccines were developed in the mid-1930s, but their use is restricted or formally contraindicated in vulnerable populations including infants, the elderly, and people with compromised immune systems. In these studies, we describe the development of a next-generation hydrogen peroxide-inactivated YF vaccine and determine immune correlates of protection based on log neutralizing index (LNI) and neutralizing titer-50% (NT50) studies. In addition, we compare neutralizing antibody responses and protective efficacy of hydrogen peroxide-inactivated YF vaccine candidates to live-attenuated YFV-17D (YF-VAX) in a rhesus macaque model of viscerotropic YF. Our results indicate that an optimized, inactivated YF vaccine elicits protective antibody responses that prevent viral dissemination and lethal infection in rhesus macaques and may be a suitable alternative for vaccinating vulnerable populations who are not eligible to receive replicating live-attenuated YF vaccines.
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  • 文章类型: Journal Article
    肝纤维化是慢性肝病和肝硬化的重要病理进程。近年来研究发现肠道菌群与肝纤维化的发生发展密切相关。为了确定患有肝纤维化(MG)的恒河猴与正常恒河猴(MN)之间的肠道菌群是否存在差异,从8个雄性MG和12个雄性MN收集粪便样品。然后使用16SrRNA基因测序检测肠道微生物群的生物组成。结果显示,MG和MN之间的肠道微生物群的α-多样性和β-多样性在ASV和Chao1上具有统计学上的显着差异。两组都共享普雷沃氏菌和乳酸杆菌作为共同的优势微生物群。然而,有益菌如乳酸菌在MG中的丰度明显较低(P=0.02)。使用PICRUSt2基因预测的预测功能分析显示,MG表现出与物质转运和代谢途径相关的功能的相对丰度较高。这项研究可能为进一步探索肠道微生物群影响肝纤维化的机制及其在治疗肝纤维化中的潜在未来用途提供了见解。
    Liver fibrosis is an important pathological process in chronic liver disease and cirrhosis. Recent studies have found a close association between intestinal microbiota and the development of liver fibrosis. To determine whether there are differences in the intestinal microbiota between rhesus macaques with liver fibrosis (MG) and normal rhesus macaques (MN), fecal samples were collected from 8 male MG and 12 male MN. The biological composition of the intestinal microbiota was then detected using 16S rRNA gene sequencing. The results revealed statistically significant differences in ASVs and Chao1 in the alpha-diversity and the beta-diversity of intestinal microbiota between MG and MN. Both groups shared Prevotella and Lactobacillus as common dominant microbiota. However, beneficial bacteria such as Lactobacillus were significantly less abundant in MG (P = 0.02). Predictive functional analysis using PICRUSt2 gene prediction revealed that MG exhibited a higher relative abundance of functions related to substance transport and metabolic pathways. This study may provide insight into further exploration of the mechanisms by which intestinal microbiota affect liver fibrosis and its potential future use in treating liver fibrosis.
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  • 文章类型: Journal Article
    柯萨奇病毒B1(CVB1),具有多种临床表现的肠道病毒,与潜在的长期后果有关,包括手,脚,和口蹄疫(HFMD),在一些病人。然而,相关的动物模型,传输动力学,CVB1的长期组织嗜性尚未得到系统表征。在这项研究中,我们建立了恒河猴CVB1呼吸道感染模型,并评估了临床症状,病毒载量,急性期(0-14天)和长期恢复期(15-30天)的免疫水平。我们还调查了分布情况,病毒清除,使用感染后30天(d.p.i.)收集的35个死后恒河猴组织样本,以及长期恢复期的病理学。结果表明,感染的恒河猴对CVB1易感,并表现出手足口病症状,病毒清除,细胞因子水平改变,以及中和抗体的存在。尸检显示心脏病毒载量呈阳性,脾,脾胰腺,软腭,和嗅球组织。HE染色显示肝脏病理损伤,脾,脾肺,软腭,和气管上皮.在d.p.i.30,在内脏中检测到病毒抗原,免疫,呼吸,和肌肉组织,但不在肠或神经组织中。脑组织检查显示病毒性脑膜炎样改变,并在枕骨中检测到CVB1抗原表达,脑桥,小脑,和30d.p.i.的脊髓组织。这项研究为HFMD的非人灵长类动物模型中CVB1的发病机理提供了第一个见解,并证实了CVB1在长期感染后表现出组织嗜性。
    Coxsackievirus B1 (CVB1), an enterovirus with multiple clinical presentations, has been associated with potential long-term consequences, including hand, foot, and mouth disease (HFMD), in some patients. However, the related animal models, transmission dynamics, and long-term tissue tropism of CVB1 have not been systematically characterized. In this study, we established a model of CVB1 respiratory infection in rhesus macaques and evaluated the clinical symptoms, viral load, and immune levels during the acute phase (0-14 days) and long-term recovery phase (15-30 days). We also investigated the distribution, viral clearance, and pathology during the long-term recovery period using 35 postmortem rhesus macaque tissue samples collected at 30 days postinfection (d.p.i.). The results showed that the infected rhesus macaques were susceptible to CVB1 and exhibited HFMD symptoms, viral clearance, altered cytokine levels, and the presence of neutralizing antibodies. Autopsy revealed positive viral loads in the heart, spleen, pancreas, soft palate, and olfactory bulb tissues. HE staining demonstrated pathological damage to the liver, spleen, lung, soft palate, and tracheal epithelium. At 30 d.p.i., viral antigens were detected in visceral, immune, respiratory, and muscle tissues but not in intestinal or neural tissues. Brain tissue examination revealed viral meningitis-like changes, and CVB1 antigen expression was detected in occipital, pontine, cerebellar, and spinal cord tissues at 30 d.p.i. This study provides the first insights into CVB1 pathogenesis in a nonhuman primate model of HFMD and confirms that CVB1 exhibits tissue tropism following long-term infection.
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  • 文章类型: Journal Article
    戊型肝炎病毒(HEV)是病毒性肝炎的主要病原。受HEV感染的免疫功能低下的个体容易患慢性肝炎,并增加肝细胞癌(HCC)的风险。生长抑制剂家族成员5(ING5)是在癌症肿瘤或细胞中以低水平表达的肿瘤抑制剂。然而,ING5与HEV感染之间的潜在关系尚不清楚.在本研究中,急性和慢性HEV动物模型用于探索ING5和HEV之间的相互作用。值得注意的是,在急性HEV感染的BALB/c小鼠和慢性HEV感染的恒河猴的肝脏中,ING5的表达均显着增加。此外,在人肝癌(HepG-2)细胞中进一步鉴定了HEV感染与ING5表达之间的关系。总之,HEV感染在体内和体外强烈上调ING5表达,这对于进一步了解HEV感染的致病机制具有重要意义。
    Hepatitis E virus (HEV) is the major pathogen of viral hepatitis. Immunocompromised individuals infected by HEV are prone to chronic hepatitis and increase the risk of hepato-cellular carcinoma (HCC). Inhibitor of growth family member 5 (ING5) is a tumor suppressor that is expressed at low levels in cancer tumors or cells. However, the underlying relationship between ING5 and HEV infection is unclear. In the present study, acute and chronic HEV animal models are used to explore the interaction between ING5 and HEV. Notably, the expression of ING5 is significantly increased in both the livers of acute HEV-infected BALB/c mice and chronic HEV-infected rhesus macaques. In addition, the relationship between HEV infection and ING5 expression is further identified in human hepatoma (HepG-2) cells. In conclusion, HEV infection strongly upregulates ING5 expression both in vivo and in vitro, which has significant implications for further understanding the pathogenic mechanism of HEV infection.
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  • 文章类型: Journal Article
    TIGIT是与癌症和HIV中的T细胞耗尽相关的负免疫检查点受体。HIV/SIV感染期间病毒特异性CD8+T细胞和NK细胞中的TIGIT上调导致功能失调的效应能力。在CD8+T细胞上靶向TIGIT的体外研究表明TIGIT阻断是恢复SIV特异性T细胞应答的可行策略。这里,我们在非人灵长类动物中使用TIGIT阻断在体内扩展这些研究,以在SIV感染的情况下逆转T细胞和NK细胞耗竭.我们证明了人源化抗TIGIT单克隆抗体(mAb)的体内给药在食蟹猴和恒河猴中均具有良好的耐受性。尽管抗TIGITmAb的血浆浓度持续,我们没有观察到NK或T细胞溶细胞能力的持续改善。TIGIT阻断在量级和广度上最低限度地增强T细胞增殖和病毒特异性T细胞应答,尽管治疗动物的血浆病毒载量保持稳定,表明单独的抗TIGITmAb治疗不足以增加抗SIVCD8+T细胞功能。用TIGIT和/或PD-1的单一或双重阻断在体外观察到的病毒特异性T细胞增殖应答的增强突出了TIGIT作为逆转T细胞功能障碍的潜在靶标。我们的研究,然而,揭示在病毒血症的背景下,仅靶向TIGIT途径可能不足,并且将免疫检查点阻断与其他免疫治疗剂相结合可能是改善病毒控制或消除HIV的未来途径.免疫检查点受体TIGIT的表达与HIV介导的T细胞功能障碍相关,并与HIV疾病进展相关。针对免疫检查点受体途径存在令人信服的证据,这些途径可能会增强免疫力并将效应细胞的努力重新集中在病毒清除上。在这份报告中,我们研究了在HIV感染的非人类灵长类动物模型中,TIGIT阻断作为逆转慢性SIV/SHIV感染期间免疫耗竭的免疫治疗方法.我们表明,单独干扰TIGIT信号轴不足以改善病毒控制,尽管在T细胞免疫方面有适度改善。我们的数据证实了靶向多种免疫检查点受体以促进协同作用并最终消除HIV感染细胞的用途。
    TIGIT is a negative immune checkpoint receptor associated with T cell exhaustion in cancer and HIV. TIGIT upregulation in virus-specific CD8+ T cells and NK cells during HIV/SIV infection results in dysfunctional effector capabilities. In vitro studies targeting TIGIT on CD8+ T cells suggest TIGIT blockade as a viable strategy to restore SIV-specific T cell responses. Here, we extend these studies in vivo using TIGIT blockage in nonhuman primates in an effort to reverse T cell and NK cell exhaustion in the setting of SIV infection. We demonstrate that in vivo administration of a humanized anti-TIGIT monoclonal antibody (mAb) is well tolerated in both cynomolgus macaques and rhesus macaques. Despite sustained plasma concentrations of anti-TIGIT mAb, we observed no consistent improvement in NK or T cell cytolytic capacity. TIGIT blockade minimally enhanced T cell proliferation and virus-specific T cell responses in both magnitude and breadth though plasma viral loads in treated animals remained stable indicating that anti-TIGIT mAb treatment alone was insufficient to increase anti-SIV CD8+ T cell function. The enhancement of virus-specific T cell proliferative responses observed in vitro with single or dual blockade of TIGIT and/or PD-1 highlights TIGIT as a potential target to reverse T cell dysfunction. Our studies, however, reveal that targeting the TIGIT pathway alone may be insufficient in the setting of viremia and that combining immune checkpoint blockade with other immunotherapeutics may be a future path forward for improved viral control or elimination of HIV.IMPORTANCEUpregulation of the immune checkpoint receptor TIGIT is associated with HIV-mediated T cell dysfunction and correlates with HIV disease progression. Compelling evidence exists for targeting immune checkpoint receptor pathways that would potentially enhance immunity and refocus effector cell efforts toward viral clearance. In this report, we investigate TIGIT blockade as an immunotherapeutic approach to reverse immune exhaustion during chronic SIV/SHIV infection in a nonhuman primate model of HIV infection. We show that interfering with the TIGIT signaling axis alone is insufficient to improve viral control despite modest improvement in T cell immunity. Our data substantiate the use of targeting multiple immune checkpoint receptors to promote synergy and ultimately eliminate HIV-infected cells.
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  • 文章类型: Journal Article
    Understanding gene expression variations between species is pivotal for deciphering the evolutionary diversity in phenotypes. Rhesus macaques ( Macaca mulatta, MMU) and crab-eating macaques ( M. fascicularis, MFA) serve as crucial nonhuman primate biomedical models with different phenotypes. To date, however, large-scale comparative transcriptome research between these two species has not yet been fully explored. Here, we conducted systematic comparisons utilizing newly sequenced RNA-seq data from 84 samples (41 MFA samples and 43 MMU samples) encompassing 14 common tissues. Our findings revealed a small fraction of genes (3.7%) with differential expression between the two species, as well as 36.5% of genes with tissue-specific expression in both macaques. Comparison of gene expression between macaques and humans indicated that 22.6% of orthologous genes displayed differential expression in at least two tissues. Moreover, 19.41% of genes that overlapped with macaque-specific structural variants showed differential expression between humans and macaques. Of these, the FAM220A gene exhibited elevated expression in humans compared to macaques due to lineage-specific duplication. In summary, this study presents a large-scale transcriptomic comparison between MMU and MFA and between macaques and humans. The discovery of gene expression variations not only enhances the biomedical utility of macaque models but also contributes to the wider field of primate genomics.
    了解物种间基因表达差异对于揭示物种表型进化及其多样性至关重要。恒河猴( Macaca mulatta)和食蟹猴( M. fascicularis)作为生物医学研究中关键的非人灵长类动物模型,具有不同的表型特征。然而,两个物种之间的大规模转录组比较研究仍有待开展。本研究利用新测序的RNA-seq数据,对包括14种常见组织在内的84个样本(41个食蟹猴样本和43个恒河猴样本)进行了系统分析。我们的研究发现,只有少数基因(约3.7%)在两个猕猴物种之间显示出差异性表达,而约36.5%的基因在两种猕猴中均呈现出组织特异性表达。我们还对猕猴和人类的基因表达进行了比较,发现约有22.6%的同源基因在至少两种组织中存在表达差异。此外,约19.41%的猕猴谱系特有结构变异位点基因更可能在人类与猕猴之间展现出表达差异。其中, FAM220A基因在人类基因中表达水平较高,这一现象可归因于谱系特异性的重复事件。综上,该研究提供了恒河猴和食蟹猴之间,以及猕猴与人类之间转录组差异的大规模分析,为提升猕猴模型在生物医学领域的应用价值和其在灵长类基因组学中的研究提供了新见解。.
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  • 文章类型: Journal Article
    对于生活在人为地区的非人类灵长类动物来说,大型捕食者的捕食相对罕见。然而,较小的捕食者,比如自由放养和驯养的狗,可以塑造城市非人灵长类动物的社会生态,要么直接通过攻击和杀死他们,要么间接通过改变他们的活动模式。这里,我们描述了三起(两起可能致命的)狗袭击成年恒河猴的案例,这些案例居住在印度北部的人为景观中,以及围绕这些事件的情况。我们讨论了在人为梯度研究非人类灵长类种群时考虑人类存在和干预狗与非人类灵长类动物关系的重要性,及其对群体社会动态和人畜共患病原体传播的潜在影响。
    For nonhuman primates living in anthropogenic areas, predation by larger predators is relatively rare. However, smaller predators, such as free-ranging as well as domesticated dogs, can shape the socioecology of urban nonhuman primates, either directly by attacking and killing them or indirectly by modifying their activity patterns. Here, we describe three (two probably fatal) cases of dog attacks on adult rhesus macaques inhabiting an anthropogenic landscape in Northern India and the circumstances surrounding these incidents. We discuss the importance of considering human presence and intervention in dog-nonhuman primate relationships while studying nonhuman primate populations across anthropogenic gradients, and its potential influences on group social dynamics and transmission of zoonotic agents.
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  • 文章类型: Journal Article
    补体系统可以被视为先天免疫的“调节者”,体液免疫的“指导者”,和适应性免疫的“调节器”。虽然已知性别会影响体液和细胞免疫系统,它对人类和恒河猴补体的影响,一种常用的非人灵长类动物模型系统,没有得到很好的研究。为了解决这个知识差距,我们分析了90个人和72只恒河猴的血清样本中补体系统成分的丰度和活性。虽然级联蛋白的序列是高度保守的,在物种之间观察到明显不同的水平。鉴于在恒河猴样本中检测到的低水平引发了关于该测试是否适合与猕猴样本一起使用的问题,在男性和女性中观察到补体蛋白水平的差异。C1q和C3b在糖基化抗原上的总和抗体依赖性沉积水平在人类和恒河猴之间有所不同。提示聚糖的差异识别以及经典和替代激活途径之间的平衡。在多种测定中观察到补体介导的抗体致敏细胞裂解的功能差异,表明人类雌性经常表现出比人类雄性或恒河猴更高的裂解活性,通常不表现出这种与性别相关的差异。在更狭窄的环境中观察到物种和性别之间的其他差异-仅针对某些抗体,抗原,或化验。总的来说,这些结果扩展了人类补体系统中与性别相关的差异的知识,识别恒河猴缺乏的差异。补体系统是宿主防御许多细菌的关键部分,真菌,和病毒感染。并行,丰富的流行病学,临床,生物医学研究证据表明,性别是免疫的重要生物学变量,免疫系统的许多性别特异性差异与疾病结局密切相关.这项研究着重于这两个因素的交集,以定义性别对补体途径成分和活性的影响。这项工作扩展了我们对人类补体系统中与性别相关的差异的了解,并且还确定了恒河猴似乎不存在的差异,一种流行的非人类灵长类动物模型.尽管物种之间的差异表明猕猴模型在概括人类生物学的能力方面存在潜在的局限性,人类性别差异的知识有可能为临床研究和实践提供信息。
    The complement system can be viewed as a \"moderator\" of innate immunity, \"instructor\" of humoral immunity, and \"regulator\" of adaptive immunity. While sex is known to affect humoral and cellular immune systems, its impact on complement in humans and rhesus macaques, a commonly used non-human primate model system, has not been well studied. To address this knowledge gap, we analyzed serum samples from 90 humans and 72 rhesus macaques for the abundance and activity of the complement system components. While sequences of cascade proteins were highly conserved, dramatically different levels were observed between species. Whereas the low levels detected in rhesus samples raised questions about the suitability of the test for use with macaque samples, differences in levels of complement proteins were observed in male and female humans. Levels of total and antibody-dependent deposition of C1q and C3b on a glycosylated antigen differed between humans and rhesus, suggesting differential recognition of glycans and balance between classical and alternative activation pathways. Functional differences in complement-mediated lysis of antibody-sensitized cells were observed in multiple assays and showed that human females frequently exhibited higher lytic activity than human males or rhesus macaques, which typically did not exhibit such sex-associated differences. Other differences between species and sexes were observed in more narrow contexts-for only certain antibodies, antigens, or assays. Collectively, these results expand knowledge of sex-associated differences in the complement system in humans, identifying differences absent from rhesus macaques.IMPORTANCEThe complement system is a critical part of host defense to many bacterial, fungal, and viral infections. In parallel, rich epidemiological, clinical, and biomedical research evidence demonstrates that sex is an important biological variable in immunity, and many sex-specific differences in immune system are intimately tied with disease outcomes. This study focuses on the intersection of these two factors to define the impact of sex on complement pathway components and activities. This work expands our knowledge of sex-associated differences in the complement system in humans and also identifies the differences that appear to be absent in rhesus macaques, a popular non-human primate model. Whereas differences between species suggest potential limitations in the ability of macaque model to recapitulate human biology, knowledge of sex-based differences in humans has the potential to inform clinical research and practice.
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  • 文章类型: Journal Article
    这项研究旨在加深我们对无症状和腹泻圈养恒河猴(RM)肠道细菌耐药性和毒力特征的了解。共有31个样本,包括8个无症状RM,10个腹泻RM,和1个死亡的RM,是从四川的一个育种基地收集的,中国,用于细菌分离。因此,大肠杆菌(n=23),克雷伯菌(n=22),奇异变形杆菌(n=10),肠球菌(n=10),沙门氏菌(n=2),分离葡萄球菌(n=2)。对所有分离株进行抗菌药物敏感性试验和全基因组测序,其中一些大肠杆菌,肺炎克雷伯菌,和奇异假单胞菌进行GalleriaMellonella和小鼠感染测试。左氧氟沙星的耐药率,恩诺沙星,与腹泻相关的分离株和头孢噻肟高于无症状分离株。与抗菌素耐药表型一致,腹泻分离株对qnrS1,blaTEM-1B和blaCTX-M-27的患病率高于无症状分离株.此外,与无症状的分离株相比,腹泻分离株对幼虫和小鼠具有较高的致病潜力。此外,首先对大肠杆菌中的序列类型(ST)14179-14181和产气克雷伯菌中的ST625和ST630-631进行了表征。我们的证据强调了有效治疗腹泻RM的高细菌耐药性所带来的巨大挑战。
    This study aims to deepen our understanding of the drug resistance and virulence characterization among gut bacteria in asymptomatic and diarrheal captive rhesus macaques (RMs). A total of 31 samples, including 8 asymptomatic RMs, 10 diarrheal RMs, and 1 dead RM, were collected from a breeding base in Sichuan, China, for bacterial isolation. As a result, Escherichia coli (n = 23), Klebsiella (n = 22), Proteus mirabilis (n = 10), Enterococcus (n = 10), Salmonella (n = 2), and Staphylococcus (n = 2) were isolated. All isolates were subjected to antimicrobial susceptibility testing and whole-genome sequencing, among which some E. coli, K. pneumoniae, and P. mirabilis were subjected to the Galleria mellonella and mice infection testing. The antimicrobial resistance rates of levofloxacin, enrofloxacin, and cefotaxime in diarrhea-associated isolates were higher than those of asymptomatic isolates. Consistent with the antimicrobial resistance phenotype, diarrheal isolates had a higher prevalence rate to qnrS1, blaTEM-1B and blaCTX-M-27 than asymptomatic isolates. Furthermore, compared with asymptomatic isolates, diarrheal isolates demonstrated a higher pathogenic potential against larvae and mice. Additionally, sequence types (STs) 14179-14181 in E. coli and ST 625 and ST 630-631 in Klebsiella aerogenes were firstly characterized. Our evidence underscores the considerable challenge posed by high rates of bacterial drug resistance in the effective treatment of diarrheal RMs.
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