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Virulence. 2018;9(1):1008-1018. doi: 10.1080/21505594.2018.1489198.

Inhibition of Pseudomonas aeruginosa secreted virulence factors reduces lung inflammation in CF mice.

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a Department of Diagnostics and Public Health , University of Verona , Verona , Italy.
b Department of Computer Science , University of Verona , Verona , Italy.
c Department of Medicine , University of Verona , Verona , Italy.
d Cystic Fibrosis Center , Azienda Ospedaliera Universitaria Integrata di Verona , Verona , Italy.



Cystic fibrosis (CF) lung infection is a complex condition where opportunistic pathogens and defective immune system cooperate in developing a constant cycle of infection and inflammation. The major pathogen, Pseudomonas aeruginosa, secretes a multitude of virulence factors involved in host immune response and lung tissue damage. In this study, we examined the possible anti-inflammatory effects of molecules inhibiting P. aeruginosa virulence factors.


Pyocyanin, pyoverdine and proteases were measured in bacterial culture supernatant from different P. aeruginosa strains. Inhibition of virulence factors by sub-inhibitory concentrations of clarithromycin and by protease inhibitors was evaluated. Lung inflammatory response was monitored by in vivo bioluminescence imaging in wild-type and CFTR-knockout mice expressing a luciferase gene under the control of a bovine IL-8 promoter.


The amount of proteases, pyocyanin and pyoverdine secreted by P. aeruginosa strains was reduced after growth in the presence of a sub-inhibitory dose of clarithromycin. Intratracheal challenge with culture supernatant containing bacteria-released products induced a strong IL-8-mediated response in mouse lungs while lack of virulence factors corresponded to a reduction in bioluminescence emission. Particularly, sole inactivation of proteases by inhibitors Ilomastat and Marimastat also resulted in decreased lung inflammation.


Our data support the assumption that virulence factors are involved in P. aeruginosa pro-inflammatory action in CF lungs; particularly, proteases seem to play an important role. Inhibition of virulence factors production and activity resulted in decreased lung inflammation; thus, clarithromycin and protease inhibitors potentially represent additional therapeutic therapies for P. aeruginosa-infected patients.


Cystic fibrosis; Pseudomonas aeruginosa; clarithromycin; in vivo imaging; lung inflammation; protease inhibitors; virulence factors

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