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Pseudomonas aeruginosa infection and inflammation during contact lens wear: a review
1Institute for Eye Research, Vision CRC and School of Optometry and Vision Science, University of New South Wales, Australia. m.willcox@ier.org.au
Abstract:
Infection and inflammation during contact lens wear is often associated with microbial contamination of lenses. Several different types of microbes that colonize lenses can lead to infection and inflammation, but the most common cause of infection (microbial keratitis; MK) remains the Gram-negative bacterium Pseudomonas aeruginosa. P. aeruginosa has a battery of cell-associated and extracellular virulence factors it can use to initiate and maintain infection. Its ability to produce proteases, to either invade or kill corneal cells, and to coordinate expression of virulence factors via quorum-sensing have been shown to be important during MK. Another important factor that contributes to the destruction of the cornea during MK is excessive activation of the host defense system. P. aeruginosa can activate several pathways of the immune system during MK, and activation often involves receptors on the corneal epithelial cells called toll-like receptors (TLRs). These TLRs recognize e.g., lipopolysaccharide or flagella from P. aeruginosa and activate the epithelial cells to produce inflammatory mediators such as cytokines and chemokines. These cytokines or chemokines recruit white blood cells, predominantly polymorphonuclear leukocytes, to the infection in order that they can phagocytose and kill the P. aeruginosa. However, continued recruitment and presence of these polymorphonuclear neutrophils and other white blood cells in the corneal tissue leads to destruction of corneal cells and tissue components. This can ultimately lead to scarring and vision loss.
Insights
Pseudomonas aeruginosa infections in contact lens wearers cause microbial keratitis (MK) by damaging corneal cells. The host immune response, while fighting the bacteria, can also lead to corneal scarring and vision loss.
Area of Science:
- Ophthalmology
- Microbiology
- Immunology
Background:
- Contact lens wear is associated with microbial contamination, leading to eye infections and inflammation.
- Pseudomonas aeruginosa (P. aeruginosa) is the most common cause of microbial keratitis (MK), a severe contact lens-related infection.
- P. aeruginosa employs virulence factors like proteases and quorum-sensing to establish infection and damage corneal cells.
Purpose of the Study:
- To elucidate the mechanisms by which P. aeruginosa causes corneal damage during MK.
- To understand the role of the host immune response in P. aeruginosa-induced corneal inflammation and destruction.
- To identify key bacterial and host factors involved in the pathogenesis of MK.
Main Methods:
- Review of P. aeruginosa virulence factors relevant to MK.
- Analysis of host immune pathways activated by P. aeruginosa during corneal infection.
- Examination of the role of toll-like receptors (TLRs) in P. aeruginosa-mediated inflammation.
Main Results:
- P. aeruginosa utilizes proteases and quorum-sensing for invasion and virulence.
- Bacterial components like lipopolysaccharide and flagella activate corneal epithelial toll-like receptors (TLRs).
- TLR activation leads to inflammatory mediator release, recruiting polymorphonuclear leukocytes (PMNs).
Conclusions:
- Excessive host immune cell infiltration, primarily PMNs, contributes significantly to corneal tissue destruction in MK.
- While P. aeruginosa causes direct damage, the host inflammatory response exacerbates corneal pathology, potentially leading to scarring and vision loss.
- Targeting both bacterial virulence and host inflammatory pathways may be crucial for managing P. aeruginosa-induced MK.
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