Phage therapy involves the application of lytic bacteriophages for treatment of clinical infections but bacterial resistance may develop over time. Isolated from nosocomial infections, small colony variants (SCVs) are morphologically distinct, highly virulent bacterial strains that are resistant to conventional antibiotics. In this study, SCVs was derived from Pseudomonas aeruginosa exposed to the lytic bacteriophage PB1 and these cells were resistant to subsequent phage infection by PB1. To elucidate the mechanism of the SCV phage resistance, we performed phenotypic assays, DNA microarrays and whole-genome sequencing. Compared with wild-type P. aeruginosa, the SCV isolate showed impaired biofilm formation, decreased twitching motility, reduced elastase and pyocyanin production. The SCV is also more susceptible to the antibiotic ciprofloxacin and exhibited higher syrface hydrophobicity than the wild-type, indicative of changes to cell surface lipopolysaccharide (LPS) composition. Consistent with these results, transcriptomic studies of SCV revealed up-regulation of genes involved in O-specific antigen (OSA) biosynthesis, suggesting the regulation of surface moieties may account for phage resistance. Western blot analysis showed a difference in OSA distribution between the two strains. Simultaneously, genes involved in aromatic and branched chain amino acid catabolism were down-regulated. Whole genome sequencing of the SCV revealed multiple single nucleotide variations within the Pf1 prophage region, a genetic locus known to play a crucial role in biofilm formation and to provide survival advantage via gene transfer to a subpopulation of cells. Insights into phenotypic and genetic changes in SCV gained here should help direct future studies to elucidate mechanisms underpinning phage resistance, leading to novel counter resistance measures.

Aptamers are single-stranded oligonucleotides that are capable of binding wide classes of targets with high affinity and specificity. Their unique three-dimensional structures present numerous possibilities for recognizing virtually any class of target molecules, making them a promising alternative to antibodies used as molecular probes in biomedical analysis and clinical diagnosis. In recent years, cell-systematic evolution of ligands by exponential enrichment (SELEX) has been used extensively to select aptamers for various cell targets. However, aptamers that have evolved from cell-SELEX to distinguish the "stimulus-response cell" have not previously been reported. Moreover, a number of cumbersome and time-consuming steps involved in conventional cell-SELEX reduce the efficiency and efficacy of the aptamer selection. Here, we report a "two-step" methodology of cell-SELEX that successfully selected DNA aptamers specifically against "inflamed" endothelial cells. This has been termed as stimulus-response cell-SELEX (SRC-SELEX). The SRC-SELEX enables the selection of aptamers to distinguish the cells activated by stimulus of healthy cells or cells isolated from diseased tissue. We report a promising aptamer, N55, selected by SRC-SELEX, which can bind specifically to inflamed endothelial cells both in cell culture and atherosclerotic plaque tissue. This aptamer probe was demonstrated as a potential molecular probe for magnetic resonance imaging to target inflamed endothelial cells and atherosclerotic plaque detection.

Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogen that is found ubiquitously in the environment. It is also the cause of nosocomial infections, which affects patients with cystic fibrosis (CF) and cathether-related infections. Treatment and eradication of P. aeruginosa is an uphill task as it has already developed resistance to many commonly used antibiotics. Some of the resistance mechanisms that P. aeruginosa employ are having low cell wall permeability, developing efflux system to pump antibiotics out, producing enzymes to inactivate antibiotics, modifying antibiotic targets, forming biofilm as a protection layer against antibiotics, and turning into more pathogenic small colony variant form. In addition, P. aeruginosa uses a host of signaling mechanisms, such as secretion system and quorum sensing, to aid its virulence. With numerous resistance mechanisms developed against conventional antibiotics, new strategies to treat P. aeruginosa infection are required. Bacteriophages such as natural bacteria viruses and studies have suggested that they can be used as an alternative to antibiotics for treatment against P. aeruginosa infections. However, phage therapy also shares the same problem with that of antibiotics, i.e., the development and emergence of bacteria resistance by masking or altering surface recognition features, inhibiting phage DNA injection and employing abortive infection (Abi) system. Another alternative treatment strategy is to use antimicrobial peptides, which are small cationic peptides that are naturally found in most organisms’ immune system. These peptides disrupt cell membrane and key cellular processes, which requires major gene alteration if evasion is needed. Hence, lowering likelihood of resistance development. This paper aims to review our current understanding of the clinical implications of P. aeruginosa infections, the mechanisms of antibiotic resistance, phage-inspired and antimicrobial peptide approaches for treatment of P. aeruginosa infections.