Research in Bragonzi&#8217;s laboratory has been funded by the Italian Cystic Fibrosis Foundation (CFaCore) and EU-F7-2009-223670. Part of this work was carried out in ALEMBIC, an advanced microscopy laboratory, and mouse histopathology was performed in the Unit of Pathological Anatomy (San Raffaele Scientific Institute).

1. Preparing Bacteria for Chronic Infection (Three and Two Days prior to Mouse Challenge)
<ol>
	<li>Select the appropriate P. aeruginosa strain to be tested.</li>
	<li>Inoculate a loopful of P. aeruginosa from a -80 &#176;C stock culture to a Trypticase Soy Agar (TSA) plate and incubate at 37 &#176;C overnight.</li>
	<li>Pick a single colony and inoculate into 5 ml Trypticase Soy Broth (TSB) in a 15 ml snap-capped tube and incubate at 37 &#176;C overnight in a shaking incubator at 200 rpm.</li>
</ol>
...

<ol>
	<li>Gibson, R., Burns, J. L., Ramsey, B. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pathophysiology+and+management+of+pulmonary+infections+in+cystic+fibrosis.">Pathophysiology and management of pulmonary infections in cystic fibrosis.</a> Am. J. Respir. Crit. Care. 168, 918-951 (2003).</li><li>Bragonzi, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Murine+models+of+acute+and+chronic+lung+infection+with+cystic+fibrosis+pathogens.">Murine models of acute and chronic lung infection with cystic fibrosis pathogens.</a> IJMM. 300, 584-593 (2010).</li><li>Cash, H. A., McCullough, B., Johanson, W. G., Bass, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+rat+model+of+chronic+respiratory+infection+with+Pseudomonas+aeruginosa.">A rat model of chronic respiratory infection with Pseudomonas aeruginosa.</a> Am. Rev. Respir. Dis. 119, 453-459 (1979).</li><li>Starke, J. R., Langston, C., Baker, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+mouse+model+of+chronic+pulmonary+infection+with+Pseudomonas+aeruginosa+and+Pseudomonas+cepacia.">A mouse model of chronic pulmonary infection with Pseudomonas aeruginosa and Pseudomonas cepacia.</a> Pediatr. Res. 22, 698-702 (1987).</li><li>Pedersen, S. S., Hansen, B. L., Hansen, G. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Induction+of+experimental+chronic+Pseudomonas+aeruginosa+lung+infection+with+P.+aeruginosa+entrapped+in+alginate+microspheres.">Induction of experimental chronic Pseudomonas aeruginosa lung infection with P. aeruginosa entrapped in alginate microspheres.</a> APMIS. 98, 203-211 (1990).</li><li>Bragonzi, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nonmucoid+Pseudomonas+aeruginosa+expresses+alginate+in+the+lungs+of+patients+with+cystic+fibrosis+and+in+a+mouse+model.">Nonmucoid Pseudomonas aeruginosa expresses alginate in the lungs of patients with cystic fibrosis and in a mouse model.</a> J. Infect. Dis. 192, 410-419 (2005).</li><li>van Heeckeren, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Murine+models+of+chronic+Pseudomonas+aeruginosa+lung+infection.">Murine models of chronic Pseudomonas aeruginosa lung infection.</a> Lab. Anim. 36, 291-312 (2002).</li><li>Bragonzi, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pseudomonas+aeruginosa+microevolution+during+cystic+fibrosis+lung+infection+establishes+clones+with+adapted+virulence+AJRCCM.">Pseudomonas aeruginosa microevolution during cystic fibrosis lung infection establishes clones with adapted virulence AJRCCM.</a> 180, 138-145 (2009).</li><li>Kukavica-Ibrulj, I., Facchini, M., Cigana, C., Levesque, R. C., Bragonzi, A., Filloux, S., Ramos, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+Pseudomonas+aeruginosa+virulence+and+the+host+response+using+murine+models+of+acute+and+chronic+lung+infection.">Assessing Pseudomonas aeruginosa virulence and the host response using murine models of acute and chronic lung infection.</a> Methods in Pseudomonas aeruginosa: Humana Press. , (2014).</li><li>Moalli, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Therapeutic+Potential+of+the+Humoral+Pattern+Recognition+Molecule+PTX3+in+Chronic+Lung+Infection+Caused+by+Pseudomonas+aeruginosa.">The Therapeutic Potential of the Humoral Pattern Recognition Molecule PTX3 in Chronic Lung Infection Caused by Pseudomonas aeruginosa.</a> J. Immunol. 186, 5425-5534 .</li><li>Paroni, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Response+of+CFTR-deficient+mice+to+long-term+Pseudomonas+aeruginosa+chronic+infection+and+PTX3+therapeutic+treatment.">Response of CFTR-deficient mice to long-term Pseudomonas aeruginosa chronic infection and PTX3 therapeutic treatment.</a> J. Infect. Dis. In press, .</li><li>Maxeiner, J., Karwot, R., Hausding, M., Sauer, K. A., Scholtes, P., Finotto, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+method+to+enable+the+investigation+of+murine+bronchial+immune+cells,+their+cytokines+and+mediators.">A method to enable the investigation of murine bronchial immune cells, their cytokines and mediators.</a> Nat. Protoc. 2, 105-112 (2007).</li><li>Bragonzi, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pseudomonas+aeruginosa+microevolution+during+cystic+fibrosis+lung+infection+establishes+clones+with+adapted+virulence..">Pseudomonas aeruginosa microevolution during cystic fibrosis lung infection establishes clones with adapted virulence..</a> AJRCCM. In press, (2009).</li><li>Pirone, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Burkholderia+cenocepacia+strains+isolated+from+cystic+fibrosis+patients+are+apparently+more+invasive+and+more+virulent+than+rhizosphere+strains.">Burkholderia cenocepacia strains isolated from cystic fibrosis patients are apparently more invasive and more virulent than rhizosphere strains.</a> Environ. Microbiol. 10, 2773-2784 (2008).</li><li>Bragonzi, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modelling+co-infection+of+the+cystic+fibrosis+lung+by+Pseudomonas+aeruginosa+and+Burkholderia+cenocepacia+reveals+influences+on+biofilm+formation+and+host+response.">Modelling co-infection of the cystic fibrosis lung by Pseudomonas aeruginosa and Burkholderia cenocepacia reveals influences on biofilm formation and host response.</a> PLoS One. 7, .</li><li>Bianconi, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Positive+signature-tagged+mutagenesis+in+Pseudomonas+aeruginosa:+tracking+patho-adaptive+mutations+promoting+long-term+airways+chronic+infection.">Positive signature-tagged mutagenesis in Pseudomonas aeruginosa: tracking patho-adaptive mutations promoting long-term airways chronic infection.</a> PLoS Pathog.. 7, (2011).</li></ol>

The critical steps in the P. aeruginosa-beads preparation and mouse challenge are reported below.
The P. aeruginosa strain used for mice challenge is critical. Mortality, chronic infection or clearance may differ significantly depending on the bacterial strain used for the challenge. The P. aeruginosa RP73 clinical strain was preferred over the PAO1 reference laboratory strain since it resulted in a comparatively lower mortality, more severe lesions, and higher chron...

Cystic fibrosis (CF) is a genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This gene encodes for a chloride channel expressed on the membrane of most epithelial cells. Bronchiectasis, mucus plugging and parenchymal destruction caused mainly by Pseudomonas aeruginosa infections progressively lead to severe lung disease and mortality in most of the CF patients1. Understanding CF pathogenesis and further development of novel therapies rely on animal model with characteristic features of CF. Several mice, genetically modified for the Cftr gene, have been generated, but limitations in the ability of these species to recapitulate CF-like lung disease and several other organ abnormalities seen in CF patients have been widely documented2.
	
	Development of infection is one of the major challenges in CF animal model. The literature clearly suggests that a chronic infection lasting more than one month can be achieved only if mice are inoculated with bacteria embedded in an immobilizing agent such as agar, agarose, or seaweed alginate3-5. These immobilizing agents provide the microaerobic/anaerobic conditions that allow bacteria to grow in the form of microcolonies, similarly to the growth in the mucus of CF patients6. This model of chronic infection leads to the persistence of the bacteria in the lungs causing airway inflammation and damage7. However, depending on the method used, the bacterial strain and the dose inoculated in the lungs, the percentage of chronic infected mice and the bacterial load recovered in the lungs at different time points can differ considerably. In particular, the main challenge for long-term chronic infection remains the low bacterial burden by P. aeruginosa and the low percentage of infected mice weeks after challenge, indicating that bacterial cells are progressively cleared by the host. By selecting the P. aeruginosa RP73 clinical strain from a collection of CF isolates8 we successfully obtained low mortality, more severe lesions, and high percentage of chronic infection with a stable bacterial load up to one month in C57Bl/6NCrl mice.
	
	This paper details the methodology for embedding P. aeruginosa in the agar beads; we have infected mice by intratracheal instillation, measured the bacterial load and cytokines in lungs, collected BAL fluid and performed histological examination. Overall, this protocol will aid researchers in addressing fundamentally important questions on pathogenesis8,9 and testing novel therapies against P. aeruginosa chronic infection10,11.

<table border="0" cellpadding="0" cellspacing="0" width="605">
	<colgroup>
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Bacto Tryptic Soy Broth</td>
			<td style="width:191px;">Becton Dickinson</td>
			<td style="width:143px;">211823</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Difco Agar, granulated</td>
			<td style="width:191px;">Becton Dickinson</td>
			<td style="width:143px;">214510</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Heavy mineral oil</td>
			<td style="width:191px;">Sigma-Aldrich</td>
			<td style="width:143px;">330760-1L</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">S-(+)-Ketamine hydrochloride</td>
			<td style="width:191px;">Sigma-Aldrich</td>
			<td style="width:143px;">K1884</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Xylazine hydrochloride</td>
			<td style="width:191px;">Sigma-Aldrich</td>
			<td style="width:143px;">X1251</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:272px;">1 ml syringe 25 G 5/8&#39;&#39;&#160;0.5 x 16 mm</td>
			<td style="width:191px;">PIC</td>
			<td style="width:143px;">3071250300350</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:272px;">Catheter 22GA 0.9 x 25 mm</td>
			<td style="width:191px;">Becton Dickinson</td>
			<td style="width:143px;">381223</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:272px;">Graefe Forceps - 0.5 mm Tips Curved</td>
			<td style="width:191px;">Fine Science Tools</td>
			<td style="width:143px;">11152-10</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:272px;">Scissors, Iris, 11 cm, straight</td>
			<td style="width:191px;">World Precision Instruments</td>
			<td style="width:143px;">501758</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Suture clips</td>
			<td style="width:191px;">Fine Science Tools</td>
			<td style="width:143px;">12040-01</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Suture thread</td>
			<td style="width:191px;">Fine Science Tools</td>
			<td style="width:143px;">18020-40</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">RPMI 1640</td>
			<td style="width:191px;">Lonza</td>
			<td style="width:143px;">BE12-167F</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Complete protease inhibitor cocktail</td>
			<td style="width:191px;">Roche</td>
			<td style="width:143px;">11836145001</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:272px;">Fast-Read 102 Burker disposable chamber</td>
			<td style="width:191px;">Biosigma</td>
			<td style="width:143px;">390497</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Tuerk solution</td>
			<td style="width:191px;">Fluka</td>
			<td style="width:143px;">93770</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">RBC lysis buffer</td>
			<td style="width:191px;">Biolegend</td>
			<td style="width:143px;">420301</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Fetal bovine serum</td>
			<td style="width:191px;">Lonza</td>
			<td style="width:143px;">DE14-801F</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">EZ cytofunnel</td>
			<td style="width:191px;">Thermo Scientific</td>
			<td style="width:143px;">A78710021</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:272px;">Superfrost ultra plus microscope slides</td>
			<td style="width:191px;">Thermo Scientific</td>
			<td style="width:143px;">J3800AMNZ</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Diff-Quik Romanowsky staining set</td>
			<td style="width:191px;">Medion Diagnostics</td>
			<td style="width:143px;">130832</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:272px;">Hexadecyltrimethylammonium chloride</td>
			<td style="width:191px;">Sigma-Aldrich</td>
			<td style="width:143px;">52366-10G</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">96-well EIA/RIA plate</td>
			<td style="width:191px;">Costar</td>
			<td style="width:143px;">3590</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">3,3&#8217;,5,5&#8217;- tetramethylbenzidine</td>
			<td style="width:191px;">Sigma-Aldrich</td>
			<td style="width:143px;">T8665-1L</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Sulfuric acid</td>
			<td style="width:191px;">Sigma-Aldrich</td>
			<td style="width:143px;">320501-1L</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">10% neutral buffered formalin</td>
			<td style="width:191px;">Bio-optica</td>
			<td style="width:143px;">05-01005Q</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Harris haematoxylin non Papanicolau</td>
			<td style="width:191px;">Bio-optica</td>
			<td style="width:143px;">05-M06004</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:272px;">Eosin plus alcoholic solution</td>
			<td style="width:191px;">Bio-optica</td>
			<td style="width:143px;">05-M11007</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;"></td>
			<td></td>
			<td></td>
<td>[header]</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;"></td>
			<td style="width:191px;"></td>
			<td style="width:143px;"></td>
<td>Equipment</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Shaking incubator</td>
			<td style="width:191px;">Amerex Instruments</td>
			<td style="width:143px;">Steady Shake 757</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Water bath</td>
			<td style="width:191px;">Grant</td>
			<td style="width:143px;">SUB14</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Homogenizer</td>
			<td style="width:191px;">Ystral</td>
			<td style="width:143px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Precision balance</td>
			<td style="width:191px;">KERN</td>
			<td style="width:143px;">440-47N</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Cytocentrifuge</td>
			<td style="width:191px;">Thermo Scientific</td>
			<td style="width:143px;">A78300003</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Low Cost Heating Pad</td>
			<td style="width:191px;">2biol</td>
			<td style="width:143px;">LCHP</td>
		</tr>
		<tr height="21">
			<td height="42" rowspan="2" style="height:42px;width:272px;">Homogenization probe</td>
			<td rowspan="2" style="width:191px;">Ystral</td>
			<td style="width:143px;">2366931(great)</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:143px;">2366925(small)</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Inverted optical microscope</td>
			<td style="width:191px;">Zeiss</td>
			<td style="width:143px;">Axioplan2</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:272px;">Camera (microscope)</td>
			<td style="width:191px;">Zeiss</td>
			<td style="width:143px;">Axiocam MRc5</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:272px;">Rotary microtome</td>
			<td style="width:191px;">Leica</td>
			<td style="width:143px;">RM2255</td>
		</tr>
	</tbody>
</table>

long term chronic pseudomonas aeruginosa airway infection in mice

A mouse model of chronic airway infection is a key asset in cystic fibrosis (CF) research, although there are a number of concerns regarding the model itself. Early phases of inflammation and infection have been widely studied by using the Pseudomonas aeruginosa agar-beads mouse model, while only few reports have focused on the long-term chronic infection in vivo. The main challenge for long term chronic infection remains the low bacterial burden by P. aeruginosa and the low percentage of infected mice weeks after challenge, indicating that bacterial cells are progressively cleared by the host.
This paper presents a method for obtaining efficient long-term chronic infection in mice. This method is based on the embedding of the P. aeruginosa clinical strains in the agar-beads in vitro, followed by intratracheal instillation in C57Bl/6NCrl mice. Bilateral lung infection is associated with several measurable read-outs including weight loss, mortality, chronic infection, and inflammatory response. The P. aeruginosa RP73 clinical strain was preferred over the PAO1 reference laboratory strain since it resulted in a comparatively lower mortality, more severe lesions, and higher chronic infection. P. aeruginosa colonization may persist in the lung for over three months. Murine lung pathology resembles that of CF patients with advanced chronic pulmonary disease.
This murine model most closely mimics the course of the human disease and can be used both for studies on the pathogenesis and for the evaluation of novel therapies.

When the protocol is done correctly, the P. aeruginosa agar-beads will measure between 100-200 &#181;m and can be observed with an inverted light microscope by pipetting a small volume of the agar-beads suspension on a slide. Single bacterial cells are visible in the agar beads, as shown in detail in Figure 1.
The choice of P. aeruginosa strain used in the agar-beads preparation is critical. Figure 2 and Table 1 show the data...

Watch this Scientific Journal Video about Long Term Chronic Pseudomonas aeruginosa Airway Infection in Mice at JoVE.com

Long Term Chronic Pseudomonas aeruginosa Airway Infection in Mice

We describe the agar-beads method to establish persistent long-term chronic Pseudomonas aeruginosa airway infection in the mouse model.

Long Term Chronic Pseudomonas aeruginosa Airway Infection in Mice

A mouse model of chronic airway infection is a key asset in cystic fibrosis (CF) research, although there are a number of concerns regarding the model ...

long-term-chronic-pseudomonas-aeruginosa-airway-infection-in-mice

Research

JoVE Journal

Immunology and Infection

22.1K Views.  San Raffaele Scientific Institute.  Descriviamo il metodo di agar-perle di stabilire persistente a lungo termine infezione delle vie respiratorie Pseudomonas aeruginosa cronica nel modello di topo. 