Field of the Invention
[0001] The present invention relates to the use of live culture of non-pathogenic, probiotic
bacteria or supernatants of such cultures in the manufacture of a composition the
treatment of bacterial infections, which are mastitis infections. In particular the
invention as defined above relates to the use of live cultures of
Lactococcus lactis or the supernatant from such cultures. This invention as defined above concerns the
exploitation of food-grade "harmless" probiotic bacteria for the treatment of infectious
diseases (or localised infections) in humans and animals. In particular the treatment
involves the application of a non-pathogenic lactic acid bacterium to the infected
animal/human which results in relief in clinical symptoms of the infection/disease.
Background to the Invention
[0002] The notion of "friendly" bacteria contributing to good health and well-being was
first proposed almost a century ago by Prof. E. Metchnikoff, but it is only in the
last two decades that the potential health promoting role of some bacteria has been
fully appreciated. Probiotic therapy uses bacterial interference and immunomodulation
in the control of several infectious, inflammatory, and immunologic conditions. For
instance, there is growing evidence to suggest that while an impoverished or absent
gastrointestinal (GI) tract microflora can lead to digestive problems like hypoallergenic
intolerance; recolonisation by "friendly" bacteria has the capacity to restore oral
tolerance and regain the development of a balanced immune system (Alvarez-Olmos and
Oberhelman, 2001; Cross, 2002). While the intricacies of signalling between the
de novo colonisers and the immune system are not fully elucidated, it is believed that modulation
of the immune response probably occurs through one or a combination of the following
mechanisms (Cross, 2002):
- 1. Localised lactic acid production by probiotics, which may limit the growth of pathogens.
- 2. Production of anti-pathogenic substances by the probiotic strain e.g. bacteriocins,
which are potent bactericidal compounds.
- 3. Limitation of colonisation by competing for colonisation sites- "competitive exclusion".
- 4. Production of immunomodulatory signals by the probiotic strain that stimulate the
host immunity sufficiently to afford a degree of enhanced protection.
Lactic acid bacteria (LAB), including members of the genera
Lactococcus, Lactobacillus, Leuconostoc, Pedicococcus and
Streptococcus have been used for millennia in the production of fermented foods. As a result of
their history as harmless bacteria, these microorganisms are considered as GRAS (Generally
Regarded
As
Safe) for many applications, including human and animal consumption. In recent years,
there has been extensive research into the use of LAB in the control of pathogenic
microorganisms, and as health-promoting agents or "probiotics".
[0003] To date, probiotic therapy has mainly been exploited in the treatment of gastrointestinal
problems. While initially based on hearsay and tradition, the peer-approved scientific
evidence now supporting the protective role of probiotics and in particular the LAB
lactobacilli, in the GI tract is immense. Multiple antimicrobial properties of probiotics
have been suggested as potential protective factors in the human digestive system
against microorganisms such as
Escherichia coli, Helicobacter pylori, Salmonella and
Listeria species (Alvarez-Olmos and Oberhelman, 2001). For instance, mice which were fed
Lactobacillus acidophilus, Lb. casei or a combination of both, prior to oral challenge with
Salmonella typhimurium, had reduced pathogen translocation to the spleen and liver, compared with control
mice. This resulted in increased survival of mice in the probiotic-fed groups, particularly
in the group fed both strains. This study also demonstrated that in the probiotic-fed
groups, macrophages had increased phagocytic activity (Perdigon
et al., 1990a).
[0004] The protective effect of
Lb. casei against
S. typhimurium, E. coli and
Shigella sonnei has also been investigated in mice. Increased protection from oral challenge with
the aforementioned pathogens was observed when mice were pre-fed
Lb. casei. Additionally, increased IgA levels were observed, and probiotic-fed mice challenged
with
Shigella had increased anti-
Shigella antibody titres in the serum and GI tract compared to the control group (Perdigon
et al., 1990b; 1991).
[0005] A growing body of evidence, therefore, links increased anti-microbial protection
with the enhancement of appropriate immune responses by probiotics. Recently, research
has investigated the use of immunomodulatory probiotics as protective agents in the
GI tract, and also at other mucosal surfaces. In one such study, mice pre-fed
Lb. casei were subjected to an aerosolised challenge of
Pseudomonas aeruginosa (Alvarez
et al., 2001). The results demonstrated that probiotic feeding increased the clearance rate
of
P. aeruginosa from the lungs, up-regulated the phagocytic capacity of the alveolar macrophages
and increased the levels of IgA in the serum and broncho-alveolar lavage fluid. It
is apparent from these results that probiotic feeding can influence immuno-responses
in the respiratory tract tissues and that this effect is sufficient to afford protection
against bacterial respiratory tract pathogens. Furthermore,
Lb. rhamnosus GR-1 and
Lb. fermentum RC-14 are well recognised as therapeutic agents in the prevention and treatment of
urogenital infections in women. Restoration of a healthy and normal vaginal flora
occurs following local application of lactobacilli, demonstrating that probiotics
delivered locally, as well as those delivered by the oral route, can provide enhanced
protection against pathogens (Reid
et al., 2001; Gardiner
et al., 2002). Thus, the areas of potential use of probiotics has expanded rapidly in recent
decades, and now includes prevention and treatment of diarrhoeal diseases in adults
and children, prevention of vaginitis and urinary tract infection in adults, food
allergy prevention, and antitumor action in the gut, bladder and cervix (Cross, 2002).
[0006] Apart from the obvious benefits of using GRAS organisms for the latter purposes,
using Gram-positive bacteria like lactococci, lactobacilli and streptococci has the
added advantage that the cell wall of Gram-positive bacteria has been shown to act
as an immune-response activator. Another major attraction of using lactic acid bacteria
as therapeutic agents stems from their ability to produce bacteriocins, potent anti-microbial
peptides (Ross
et al., 1999). These peptides kill other microorganisms rapidly by destroying or permeating
the microbial membrane and impairing the ability to carry out metabolic processes.
Because of their mode of action, these peptides are unlikely to face the same antimicrobial
resistance mechanisms that limit current antibiotic use.
[0007] Nisin was the first identified bacteriocin derived from fermentation of a lactic
acid bacterium,
Lactococcus lactis. It is approved for use as a food preservative in the United States, and was awarded
GRAS status in the U.S. Federal Register in 1988. It is also approved as a natural
food preservative by more than 40 other countries as well as the World Health Organisation
and the European Union. In addition to its use as a food additive to inhibit spoilage
organisms and pathogens, several studies have investigated its use as a therapeutic
agent, in the treatment of such diverse diseases as acne, human gastrointestinal infections
and bovine mastitis (Blackburn
et al., 1994; Sears
et al., 1995). It is currently used as a component of a commercial teat-dip product (CONSEPT
®, Babson Bros.).
[0008] Lacticin 3147 is a broad-host range bacteriocin also produced from a lactococcal
strain,
L. lactis DPC3147. It was first identified in an isolate obtained from an Irish kefir-like
grain that had been used domestically for the production of buttermilk. It kills all
Gram-positive bacteria tested to date, including high profile antibiotic resistant
pathogens such as methicillin resistant staphylococci, vancomycin resistant enterococci,
and penicillin resistant pneumococci (Galvin
et al., 1999) in addition to food poisoning organisms such as
Listeria monocytogenes and
Clostridium botulinum (Ross
et al., 1999). Similar to nisin, it is a member of the family of bacteriocins termed lantibiotics.
It is a two-component bacteriocin, with both components required for full activity.
Its mode of action involves the formation of pores which, by damaging the membrane
of sensitive cells, leak potassium and phosphate ions. Importantly, lacticin 3147
has advantages over nisin as a choice of therapeutic agent, including its effectiveness
over a broad pH range (nisin is most effective at acid pH), which suggests additional
possibilities in non-acid foods and in biomedical applications (Ross
et al., 1999). Lacticin 3147 has already been exploited for a wide range of applications,
including use as a powdered biopreservative (Morgan
et al., 1999) and in the treatment of bovine mastitis (Ryan
et al., 1999; Twomey
et al., 2000).
[0009] Nutritional competition is established as an important mechanism by which probiotics
exert their effect. Suppressive factors such as bacteriocins and toxicity of end metabolic
products have also been implicated (Alvarez-Olmos and Oberhelman, 2001; Cross, 2002).
[0010] Mastitis is defined as inflammation of the udder and is indicated by increases in
Somatic Cell Count (SCC). The SCC is an indication of the levels of neutrophils in
the milk, which in turn is an indication of the presence of infection. A normal udder
quarter is free from pathogenic bacteria, has very few neutrophils in the milk, and
thus, a low SCC (<0.2 x 10
6/ml SCC). A rise in SCC usually indicates the presence of an infection.
[0011] When a cow has clinical mastitis, the affected quarter may have obvious signs of
inflammation- heat, pain and swelling, and the cow may have an elevated body temperature.
The SCC is raised above 0.2 x 10
6/ml and pathogens may (specific clinical) or may not (non-specific clinical) be detectable.
Quarters are also considered clinical, if the milk is visibly abnormal- e.g. clots
present, even though there may be no clinical signs on palpation. Clinical mastitis
can be classified on the basis of the appearance of the milk from affected quarters.
A clinical or subclinical infection is referred to as "Chronic" if it has persisted
over a long period and does not respond to antibiotic treatment. Clinical chronic
cases are easily identified by the milker. In subclinical cases, the affected udder
appears normal but the milk has an elevated SCC (>0.2 x 10
6/ml) and pathogens are usually present in the milk. Subclinical chronics are only
identified by repeated sampling and laboratory analysis. An EC Council Directive sets
out regulations for the hygienic production of milk and dairy products.
[0012] Acute and chronic cases are treated routinely with antibiotics. There are cases,
however, that do not respond to antibiotic treatment, or cases which respond briefly,
and then re-occur, even following repeat administration of antibiotic. Repeated antibiotic
administration results in milk loss, as milk must be withheld from the creamery until
the milk is free of antibiotic residues.
[0013] We have investigated the use of a live culture of
L. lactis 3147 in the treatment of bovine mastitis. Use of the bacteriocin-producing culture
in place of a concentrated lacticin preparation has certain advantages. Firstly, the
producing organism,
L. lactis is GRAS, and was isolated from a food source. The use of the live culture for the
treatment of mastitis, can be viewed as a prolonged assault on the pathogen - not
only is bacteriocin produced in a natural and stable manner, but the culture should
also compete with pathogens for colonisation of the teat. Additionally, other antimicrobial
substances, such as organic acids, free fatty acids, ammonia, and hydrogen peroxide
may also be produced as end products of metabolism. Lastly, the infusion
of L. lactis 3147 into the teat duct resulted in an immunomodulatory effect, characterised by
a short-lived rise in SCC, with a concomitant reduction or elimination of pathogens;
followed by a dramatic improvement in both the clinical outcome and the appearance
and the quality of the milk.
Object of the Invention
[0014] It is an object of the invention to provide an improved use according to the claims
for combating the infectious disease mastitis. It is a further object to provide a
pharmaceutical composition for such infection which does not involve the use of antibiotics
and which utilises the properties of non-pathogenic and food grade bacteria.
Summary of the Invention
[0015] According to the present invention there is provided use of a live culture of a non-pathogenic
food-grade probiotic bacterium as defined in the claims.
[0016] The probiotic bacterium is a non-pathogenic lactic acid bacterium. The lactic acid
bacterium may be a Lactococcus strain. One suitable Lactococcus strain is
Lactococcus lactis DPC3147.
[0017] In an alternative embodiment the invention also provides the use of the supernatant
of a live culture of a non-pathogenic food-grade probiotic bacterium as defined above.
[0018] In a still further embodiment the invention provides a pharmaceutical composition
comprising a pharmaceutically effective amount of a non-pathogenic live culture of
a food-grade probiotic bacterium or a pharmaceutically effective amount of the supernatant
of a live culture of a non-pathogenic food-grade probiotic bacterium as defined in
the claims together with a pharmaceutically acceptable carrier or diluent.
[0019] Also provided is the use as defined in the claims for the treatment of mastitis.
[0020] It could not be predicted that these live cultures would be effective in disease
treatment for many reasons. Firstly, in most probiotic applications the organism used
is one which is normally found at the site of treatment, and most such applications
are for the treatment of gastrointestinal tract problems. The effectiveness of
L. lactis is particularly surprising in that it is not an enteric organism and moreover it
is not found normally in the udder. Furthermore there has never been a suggestion
in the prior art that non-pathogens could be successfully used to stimulate the immune
system for these applications.
[0021] In another embodiment the invention provides use of a live culture of a non-pathogenic
food-grade probiotic bacterium or the supernatant of a live culture of a non-pathogenic
food-grade probiotic bacterium as defined in the claims for stimulation of the immune
system for these applications.
Brief Description of the Drawings
[0022]
Figures 1A and B: Somatic Cell Count values and bacterial counts in quarters of treated
animals.
Figure 2A. Appearance of milk from Cow 1154LF sampled pre- and post-infusion of Lactococcus lactis DPC 3147.
Figure 2B. Graphs of Somatic Cell Count and Clinical Score in milk from Cow 1154LF
sampled pre- and post-infusion of L. lactis DPC 3147.
Figure 3A. Appearance of milk from Cow 1178LH sampled pre- and post-infusion of Lactococcus lactis DPC 3147.
Figure 3B. Graphs of Somatic Cell Count and Clinical Score in milk from Cow 1178LH
sampled pre- and post-infusion of L. lactis DPC 3147.
Figure 4A. Appearance of milk from Cow 1850RF sampled pre- and post-infusion of Lactococcus lactis DPC 3147. Samples shown on Day 0 and 9 days post-infusion.
Figure 4B. Graphs of Somatic Cell Count and Clinical Score in milk from Cow 1850RF
sampled pre- and post-infusion of L. lactis DPC 3147.
Figure 5A. Appearance of milk from Cow 1163RH sampled pre- and post-infusion of Lactococcus lactis DPC 3147.
Figure 5B. Graphs of Somatic Cell Count and Clinical Score in milk from Cow 1163RH
sampled pre- and post-infusion of L. lactis DPC 3147.
Figure 6A. Appearance of milk from Cow 1184RF sampled pre- and post-infusion of Lactococcus lactis DPC 3147.
Figure 6B. Graphs of Somatic Cell Count and Clinical Score in milk from Cow 1184RF
sampled pre- and post-infusion of L. lactis DPC 3147.
Figure 7A. Appearance of milk from Cow 14LH sampled pre- and post-infusion of Lactococcus lactis DPC 3147.
Figure 7B. Graphs of Somatic Cell Count and Clinical Score in milk from Cow 14LH sampled
pre- and post-infusion of L. lactis DPC 3147.
Figure 8A. Appearance of milk from Cow 717RF sampled pre- and post-infusion of Lactococcus lactis DPC 3147.
Figure 8B. Graphs of Somatic Cell Count and Clinical Score in milk from Cow 717RF
sampled pre- and post-infusion of L. lactis DPC 3147.
Figure 9A. Appearance of milk from Cow 264LF sampled pre- and post-infusion of Lactococcus lactis DPC 3147.
Figure 9B. Graphs of Somatic Cell Count and Clinical Score in milk from Cow 264LF
sampled pre- and post-infusion of L. lactis DPC 3147.
Figure 10. PMN and lymphocyte numbers in individual quarters before and after treatment
with either L. lactis DPC3147 (Cow 273RH and Cow 1850RF); or sterile broth (Cow 273 LH).
Figure 11. PMN and lymphocyte numbers in individual quarters in Cow 1803 before and
after treatment with either L. lactis DPC3147 (RH); intra-mammary antibiotic (LF); cell-free supernatant (LH) or untreated
control (RF).
Figure 12A. Superoxide Anion Production by PMN in each of four quarters in one cow
(Cow 1803) before and after treatment with either Lactococcus lactis DPC3147 (RH); intra-mammary antibiotic (LF); cell-free supernatant (LH) or untreated
control (RF).
Figure 12B. Levels of superoxide anion fluorescence intensity in each of the four
quarters of Cow 1803 before and after treatment with either L. lactis DPC3147 (RH); intra-mammary antibiotic (LF); cell-free supernatant (LH) or untreated
control (RF).
Figure 13. Somatic cell counts in the four quarters of Cow 1803 after infusion with
either L. lactis DPC3147 (RH); intra-mammary antibiotic (LF) ; cell-free supernatant (LH) or untreated
control (RF). Day 0 = pre-infusion.
Figure 14. PMN numbers in individual quarters in Cow 1137, Cow 1852 and Cow 1570 before
(Day 0) and after treatment with either live L. lactis DPC3147, dead L. lactis DPC3147, sterile saline or untreated control.
Figure 15. PMN numbers in individual quarters before and after treatment with either
L. lactis DPC3147 (L. lactis); L. lactis DPC5399 (Bact neg); Lb. plantarum DPC4922 (plantarum) or untreated controls.
Figure 16. Relative proportional post-treatment increase in milk-derived PMN relative
to pre-treatment in Cow 1163, Cow 1171 and Cow 1181 respectively.
Figure 17. The effect of infusing different preparations of L. lactis DPC3147 on PMN numbers from Cow 275, Cow 1134 and Cow 2810. Quarters of each cow
were treated with either an overnight culture of L. lactis DPC3147 (O/N) ; a freeze-dried culture of L. lactis DPC3147 (FD) or left untreated. PMN numbers were then analysed from each quarter
over two days.
Detailed Description of the Invention
Materials and Methods
Preparation of infusion mixture
[0023] Lactococcus lactis DPC3147 was isolated previously from a kefir grain. It was routinely propagated at
30°C in M17 broth (Difco Laboratories, Detroit, USA) supplemented with 0.5% glucose
or lactose. This culture (3ml, ∼10
9 cfu ml
-1) was either used directly, or an infusion mixture was prepared in the following way:
2ml of an overnight culture of
L. lactis DPC3147 were mixed with 3ml sterile water for injection (Antigen Pharmaceuticals)
to produce a working culture concentration of approximately 10
9 cfu ml
-1. Control infusion mixtures included uninoculated broth, incubated overnight at 30°C
and then diluted in a similar fashion to the culture.
Infusion techniques
[0024] The diluted
L. lactis DPC3147 cultures were infused directly into the teat sinus
via the streak canal. The culture was inoculated to a depth of 17mm using a syringe with
a blunted smoothed tip to prevent injury to the teat. Infusion of the mixture was
usually performed after the evening milking. For the six chronic disease cases, a
single application of 3 mls of undiluted culture was performed. For the nine clinical
mastitis cases, infusion was performed twice at a 24h interval for seven quarters
(Cow 1163RH, 14LH, 717RF, 1154LF, 1850RF, 1184RF, 1176LH), twice with a 72h interval
for one quarter (1178LH) and four times for Cow 264LF, with 24h between and first
and second infusions, 84h between the second and third infusion and 48h between the
third and fourth infusions (Appendix 1-9). 5ml of the infusion mixture prepared as
described above were used when infusing the quarters with clinical mastitis.
Selection of cows for treatment
[0025] Before
in vivo experiments commenced, foremilk quarter samples were collected in an aseptic manner
from all prospective cows and these were screened for mastitis-causing pathogens by
streaking 10 µl on separate quadrants on the surface of ABA plates and incubating
for 16h at 37°C. Somatic cell counts (SCC) or CMT results were also determined for
each quarter before treatment. Previous history of infection was also considered during
selection. Six udder quarters from 4 cows with a history of chronic infection were
initially selected for treatment. Nine quarters from 9 cows with newly acquired clinical
infections were also treated subsequently.
Bacterial enumeration
[0026] Eighteen hours post-infusion, foremilk samples were taken in an aseptic manner for
microbiological analysis from all of the treated quarters. One hundred microlitres
of each milk sample was streaked on the surface of an Aesculin blood agar plate (ABA)
containing blood agar base No. 2 (Oxoid), supplemented with 7% citrated whole calf
blood and 0.1% aesculin (Sigma, St. Louis, MO, USA) and incubated for 24h at 37°C.
Following incubation, colonies were enumerated and identified on the basis of haemolytic
activity and colony appearance on ABA. One hundred microlitres of each milk sample
was also streaked on the surface of a M17 agar plate supplemented with 0.5% glucose
or lactose and incubated overnight at 30°C.
Assay for Bacteriocin Activity
[0027] The antimicrobial activity of
L. lactis colonies was assessed against
L. lactis HP, using the agar well diffusion assay described previously (Parente and Hill, 1992).
Additionally, colonies isolated on GM17 or LM17 from milk were selected randomly,
purified and assayed to confirm isolation of
L. lactis DPC3147 from udder quarters.
Immunological studies
[0028] Two independent studies were performed to investigate the effect of
L. lactis DPC 3147 on the immunity of the cow. In the first study, two cows were used, an uninfected
animal (Cow 273) and an infected animal with high SCC (Cow 1850). One quarter of Cow
273 was infused with sterile broth as a control (Left Hind, LH) and one quarter was
infused with the
L. lactis culture (Right Hind, RH). One quarter of Cow 1850 was also infused with the
L. lactis culture (RF). Milk samples were taken immediately prior to intramammary infusion
(Day 0) to determine baseline levels of leukocyte subpopulations. Milk samples were
also collected 16 hours following treatment (Day 1). In a second study, an infection-free
cow with SCC counts in all udder quarters of < 100, 000/ml was chosen for immunological
studies. One quarter (RH) was inoculated with the
L. lactis DPC3147 preparation, a second quarter (LH) was infused with cell-free supernatant
from an overnight culture of
L. lactis DPC3147, a third quarter (LF) was infused with the contents of one intra-mammary
antibiotic syringe containing 250mg of Neomycin Sulphate, 100mg of Procaine Penicillin,
10mg of Oxytetracycline Hydrochloride and 10mg of Prednisolone (Multimast L.C., Bimeda
Ltd., Dublin) and one quarter (RF) was left untreated. Milk samples were taken just
prior to intra-mammary injections (Day 0) and also at 24 and 48 hours following treatment.
All samples from both trials were stored at room temperature following milking and
were analysed within three hours of collection. Neutrophils and lymphocytes were identified
using a combination of bovine-specific antibodies (BN15.6 and CD3 respectively) and
precise gating techniques in flow cytometry. Superoxide anion production assays were
performed to assess the functional activity of neutrophils. In the second trial, milk
samples were also taken every 24h for up to 7 days to monitor the Somatic Cell Count
(SCC).
Effect of using dead cells
[0029] An experiment was performed to investigate the effect of infusing dead
L. lactis DPC3147 cells on the immune response of cows. Three low SCC cows were selected (Cow
1852, 1135, and 1570) and the teats were randomised and infused with either live lactococci,
dead lactococci or sterile saline (0.85% NaCl {w/v}). The live lactococci infusion
mixtures were prepared as described above. Dead cells were prepared by growing
L. lactis DPC3147 in LM17 overnight as described above, followed by boiling at 100°C for 10
min. Following boiling, the bacteria were plated on LM17 agar and incubated overnight
to confirm lack of viability. The dead culture was mixed with sterile water for injection
in a ratio of 2:3, and this mixture was used for infusion as described above. Similarly,
sterile saline was also mixed with sterile water for injection and infused as a control.
A fourth quarter was left untreated in each cow as a negative control. Milk samples
were taken just prior to intra-mammary injections (Day 0) and on Days 1, 3, 6, 7 and
10 following treatment. All samples were then analysed for immunological activity
as described above.
Effect of using other Lactic Acid Bacteria
[0030] Lactobacillus plantarum DPC4922 was grown anaerobically at 37°C in MRS medium.
L. lactis DPC5329, a derivative of
L. lactis DPC3147, which is incapable of producing bacteriocin (Bac-), was grown in an identical
manner to
L. lactis DPC3147 (as described above). Three cows (Cow 1163, Cow 1171 and Cow 1181) were selected
to investigate the effects of infusing potential probiotic bacterial strains on the
immune response of the mammary gland of cows with low somatic cell counts. Three cows
were used to monitor the immune responses amongst different animals. Each quarter
received a different treatment, with the treatments randomised amongst teats.
[0031] Milk samples were taken just prior to intramammary injections (Day 0), to determine
baseline levels of leukocyte subpopulations. Milk samples were also collected 1, 2,
3, 7 and 10 days following treatment. All samples were stored at room temperature
following milking and were analysed within three hours of collection. Neutrophils
and lymphocytes were identified using a combination of bovine-specific antibodies
and flow cytometry.
Preparation of freeze dried L. lactis DPC 3147.
[0032] LM17 (200ml) was inoculated with 1%(v/v)
L. lactis DPC3147 and incubated overnight at 30°C. The cells were then harvested by centrifugation
at 4°C and 4500rpm in a Sorvall RC
3Cplus centrifuge. The supernatant was removed and the cells were resuspended in ∼150ml
sterile distilled water. The cells were then harvested again by centrifugation and
the pellet was resuspended in ∼100ml sterile distilled water. The resuspended cells
were then freeze-dried to a powder preparation overnight using a Modulyo Freeze Dryer
(Edwards). A sample of the resulting powder was then resuspended in sterile distilled
water as a 10% solution and bacteria were enumerated by plating dilutions on LM17
agar and incubating overnight at 30°C. Appropriate amounts of powder were then added
to 5ml of sterile water for injection such that the final concentration was equivalent
to 10
9 cfu ml
-1 approximately. Powder resuspended in this way was then used as an infusion mixture.
Comparison of different preparations of L. lactis DPC3147
[0033] An infusion mixture containing resuspended freeze-dried
L. lactis DPC3147 cells was prepared as described above. This mixture, and a standard infusion
mixture (diluted broth culture) were then infused randomly into teats of three different
cows. Three different cows were used to allow for variation between different cows
in immunological response. One quarter in each cow was left untreated as a negative
control. Milk samples were taken just prior to intramammary injections (Day 0), to
determine baseline levels of leukocyte subpopulations. Milk samples were also collected
at 24h and 48h following treatment. All samples were stored at room temperature following
milking and were analysed within three hours of collection. Neutrophils and lymphocytes
were identified as outlined above.
Comparison of L. lactis treatment using broth cultures with antibiotic therapy
[0034] A small-scale trial was performed to assess the efficacy of treatment with
L. lactis DPC3147 in comparison to a commonly used intra-mammary antibiotic containing amoxycillin
(200mg) and clavulanic acid (50mg), (Synulox, Pfizer animal Health). 24 infected quarters
in 12 cows were used, and quarters were infused with either
L.
lactis DPC3147 (285LH, 370RH, 400LH, 598LF, 1157LF, 1170LF, 1183LH, 1658RF, 1807LF, 1827RH,
1867LH, 1868LF) or Synulox (285RF, 370RF, 400RH, 598RF, 1157RF, 1157LH, 1170LH, 1183LF,
1807RH, 1807LH, 1867RH, 1868RF). The antibiotic was administered three times, at 12
hour intervals, as per the manufacturer's instructions. The
L. lactis DPC3147 infusion mixture was administered twice, with a 24h interval between infusions.
SCC and standard microbiological analysis were performed before and after infusion,
and samples were also taken 7 days post-infusion and 12 days post-infusion.
The treatment of clinical mastitis using a resuspended freeze-dried preparation of
L. lactis DPC3147 in a comparison with a positive control (antibiotic therapy)
[0035] This study was performed over a 6-month period. 50 cases of clinical mastitis in
48 cows were detected by farm staff during routine milking and were selected for the
trial. The quarters were classified as having either mild (C1/C2 mastitis, 25 quarters)
or severe (C3/C4 mastitis, 25 quarters) clinical mastitis. Quarters were treated with
the antibiotic Leo Yellow Milking Cow
® (Penethamate Hydriodide 150mg, Dihydrostreptomycin 150mg, Framycetin sulphate 5mg,
Leo Laboratories Ltd., Dublin, Ireland) or with a resuspended freeze-dried culture
of
L. lactis DPC 3147 prepared as described above. Infusions of the culture or the antibiotic
were administered three times, with a 24h interval between each infusion. Milk samples
were taken on Day 1 prior to treatment and on Day 7 and Day 14 post-treatment. Pathogens
were enumerated and the SCC or CMT was determined for all samples as described previously.
Quarters were also assessed at every milking during the 14-Day trial period to detect
any adverse effects of treatment. Analysis of the Day 14 sample allowed quarters to
be classified as a "cure" or "no cure". Cured quarters were defined as having a "clinical
cure" if the milk had no visible clots or flakes, and the SCC was < 9x10
6 cells ml
-1. The presence or absence of pathogens was not taken into account when classifying
as a "clinical cure". Quarters were defined as having a "bacteriological cure" if
the SCC of the Day 14 sample was <1x10
6 cells ml
-1 and the pathogen count was <0.5 cfu µl
-1 in the milk sample.
Results
Treatment of chronic infections
[0036] Six udder quarters from 4 cows with a history of chronic infection were selected
for treatment. Eighteen hours after infusing the
L. lactis DPC3147 culture, milk samples were taken from each udder. Samples were taken at intervals
up to approximately 30 days post-infusion and bacteria enumerated as described above.
Colonies were identified as
L. lactis DPC3147 by the production of lacticin 3147. Staphylococci and streptococci were identified
on the basis of their characteristic haemolysis on blood agar. In three of the quarters
(714RH, 714LF and 96RF), infusion of
L. lactis DPC3147 was followed by a sharp rise in SCC, and a concomitant reduction/elimination
of the pathogen (staphylococci) (Fig. 1A). In three of the quarters (714LH, 700RH
and 408RH) the infection persisted despite infusion of the lactococcal culture (Fig.
1B). However, interestingly, in the latter three udder quarters, the lactococcal culture
did not appear to colonise the udder quarter (Fig. 1B), whereas in the "cured" quarters,
the presence of
L. lactis DPC 3147 was evident (Fig. 1A). The lactococcal culture did not survive long-term
in any of the udder quarters. Somatic cell counts returned rapidly to, and remained
at acceptable levels in all quarters.
Treatment of clinical mastitis
[0037] The above results prompted us to investigate the effect of infusing of
L. lactis DPC3147 into clinically affected quarters. Nine quarters from 9 cows with newly acquired
clinical signs of mastitis were treated. After treatment, milk samples were collected
daily for up to 14 days and intermittently for up to 55 days. Bacterial cultures were
enumerated on ABA or GM17 as described above. In all cases the quality and appearance
of the milk improved dramatically following the infusion of the lactococcal culture
(Figs 2-9). In some cases, despite the clinical nature of the milk, no pathogen was
cultured prior to infusion. Where a pathogen was identified, however, infusion of
the
L. lactis DPC3147 culture resulted in the elimination/reduction of the pathogen. Pathogens
eliminated included
Staphylococcus epidermidis (Cow 14 LH), S.
aureus (Cow 1184 RF) non-haemolytic
E. coli (Cow 1163 RH), and
Strep. uberis (Cow 1154 LF and Cow 264 LF) (Table 1). In two cases, while treatment resulted in
an improved appearance and quality in the milk, the pathogen was not eliminated. These
cases included one
Strep. uberis infection (Cow 1176LH) and one S.
aureus infection (Cow 1850RF) (Table 1). The data from this trial, including historical
data on all the cows used can be viewed in Appendices 1-9.
Immunological studies
[0038] The effect of the probiotic
L. lactis DPC3147 on the immune systems of cows was investigated by analysing leukocyte levels
and phenotypes in milk. In an initial pilot trial, the effect of
L. lactis on the immune response of two cows was investigated. Both an infected animal and
an infection-free cow were used. The results (Fig. 10) indicated that infusion of
the
L. lactis DPC3147, but not the infusion of sterile broth, resulted in a massive recruitment
of PMN to the udder, indicating the
L.
lactis may be a specific trigger of the mammary immune response and elicits PMN migration
and accumulation. Superoxide anion production assays were also performed and indicated
that the newly recruited neutrophils had a higher respiratory burst capacity than
resident neutrophils, thus providing the mammary gland with an effective mechanism
for the elimination of mastitis pathogens.
[0039] In light of these results, a second trial was performed. An uninfected animal (Cow
1803) was chosen to investigate the effects of the
L. lactis culture. As controls, one quarter (LF) was infused with a lactating-cow antibiotic
(Multimast L.C.) and one quarter (RF) was left untreated. A third quarter (LH) was
infused with cell-free supernatant from an overnight culture of
L. lactis DPC3147, and the final quarter (RH) was infused with the diluted
L. lactis DPC3147 culture. Milk samples were collected pre- and post-infusion and analysed
for SCC and differential cell (leukocyte) count. Figure 11 presents neutrophil (PMN)
and lymphocyte (CD3) proportions in milk samples before treatment (0 hour) and after
treatment (24 and 48 hours). Actual values were calculated using the percentage of
positive cells from live/dead flow cytometry analysis and results from the Bentley
Somacount Somatic Cell Counter. PMN levels in the control quarter (RF) remained unchanged
during the trial period. The probiotic-injected quarter (RH) experienced a dramatic
increase in neutrophils over the first 24h period from 2.85x10
2 cells/ml before treatment to 1.46x10
4 cells/ml at 24h after treatment (Fig. 11 and Table 2). The supernatant and antibiotic
treatments also induced an increase, albeit not as pronounced (from 4-29x10
2 cells/ml to 1.68x10
3 cells/ml and 5.5x10
2 to 1.3x10
3 respectively), in PMN levels in milk (Table 2). At 48 hours the PMN levels appeared
to decrease in the
L. lactis treated and in the Multimast-treated quarter, but continued to rise in the supernatant-treated
quarter (Table 2). Considering these results, it can be concluded that the injection
of the
L.
lactis culture resulted in a massive recruitment of PMN to the udder in the 24-hour period
following treatment. The culture supernatant also induced a recruitment of PMN to
the udder and this was a more sustained induction increasing over 24 hours and continuing
to rise, up to 48 hours after treatment. The antibiotic Multimast generated a weaker
transient recruitment of PMN to the udder. These results suggest that both the
L. lactis culture and the culture supernatant could be specific triggers of the mammary immune
system response and elicit PMN migration and accumulation. It is possible that the
factor responsible for the immune response could be released into the growth medium,
which would explain the significant PMN migration in response to the culture supernatant.
Levels of lymphocytes were also investigated. The
L. lactis culture, and the culture supernatant to a lesser extent, triggered an influx of lymphocytes
to the udder; the antibiotic, however, did not alter the level of lymphocytes present
when compared to the control values (Table 2).
[0040] The functional activity of PMNs in the quarter milk samples was investigated for
all samples before and after injection. The results of the superoxide anion production
assays are presented in Figure 12A and 12B. The fold increase refers to the proportional
increase in superoxide anion production by PMN, from a resting state (T0) to an activated
state following activation by phorbol myristate acetate (PMA; incubation for 10 minutes,
{T10}). The most obvious activation occurred in the LH quarter which was treated with
cell-free supernatant, with a massive activation of neutrophils at 24 hours. Surprisingly,
treatment with the
L. lactis culture did not result in a huge fold activation of neutrophils (Fig. 12A). This
can be explained, however, by results of analysis of the fluorescence intensity of
all samples (Fig. 12B). The relative fluorescence intensity is a measurement of the
fluorescence emitted by the cells; a stronger fluorescence indicates a higher capacity
to generate superoxide anion. The resting resident neutrophils in the
L.
lactis-treated quarter (T0) already possessed a very high superoxide anion production capacity
(elevated fluorescence intensity) at 24 hours, and, therefore, could not exhibit a
marked increase in activation following PMA treatment. In conclusion,
L. lactis treatment resulted in a massive recruitment of PMN to the udder which were in a highly
activated state. The Multimast treatment did not alter superoxide anion production
in the treated quarter and the control quarter did not change significantly over the
trial period (Figure 12A and 12B). The PMNs recruited in response to culture supernatant
treatment also possessed an elevated superoxide anion production capacity, which appeared
to peak over the first 24-hour period following treatment. The results indicated that
intramammary treatment with
L.
lactis DPC3147 or with the cell-free supernatant generated from this culture, activated
the mammary immune response by triggering the influx of neutrophils to the mammary
gland (Fig. 11). These newly recruited neutrophils appeared to possess a higher respiratory
burst capacity than resident neutrophils (Fig. 12).
[0041] The somatic cell count was monitored every 24 hours up to 7 days following treatment
and cell counts are presented in Figure 13 and Table 3. From Figure 13 and Table 3,
it is clear that
L. lactis DPC3147 elicits an enormous cellular response by 24 hours resulting in an elevated
SCC, which peaks after 48 hours resulting in a mild clinical infection and gradually
drops back to normal over the course of 3-4 days. Treatment with the culture supernatant
appeared to elicit a similar response. Our analysis of leukocyte populations and neutrophil
activity levels confirm these findings up to 48 hours.
Effects of using dead cells
[0042] In order to investigate if viable
L. lactis DPC3147 were required to produce the immune response generated above, infusion mixtures
containing either live or dead cells were prepared and infused randomly into the teats
of three cows as outlined in Table 4. Both live and dead cells generated a rise in
SCC (data not shown), and, as can be seen from Fig. 14, the dead cells elicited a
weak influx of both PMN in each of the cows. An increase in lymphocyte numbers was
also observed (data not shown). This recruitment of PMN and lymphocytes in the quarters
treated with the dead culture, however, was insignificant compared to the influx in
response to the live culture. Thus, it would appear that viable
L. lactis, but not a killed culture, can specifically elicit recruitment of PMN and lymphocytes
to the mammary gland.
Effect of using other LAB
[0043] On analysis of results, the question arose as to whether the phenomenon of PMN recruitment
was limited to
L. lactis DPC3147 itself, or if other bacterial strains could also exert this effect. It was
decided, therefore, to examine the effect of infusing other food-grade, non-pathogenic
bacteria into the udder of lactating cows. A bacterial strain,
Lb. plantarum DPC4922 was selected on the basis of its evolutionary divergence from
L. lactis (quite distantly related) as well as the fact that as it was originally isolated
from a food source, it can, like
L. lactis DPC3147, be regarded as a GRAS organism. A third strain,
L. lactis 5329 (a Bac- derivative of
L. lactis DPC3147) was also used because of its close similarity to
L. lactis DPC3147. The infusion mixtures were prepared as described in the Materials and Methods
and the mixtures were then infused randomly into the teats of three cows as outlined
in Table 5. Figures 15 and 16 present neutrophil (PMN) proportions in milk samples
from the three cows over the 10 day trial period. Actual values were calculated using
the percentage of positive cells from live/dead flow cytometry analysis and the Somacount
readings. The response in the three cows was variable but a similar trend was observed
in each case. PMN levels in all the untreated quarters remained relatively unchanged
over the trial period (Figure 15). Treatment with
Lb. plantarum DPC4922 resulted in a slight increase in PMN in all quarters, approaching similar
levels to that resulting from
L. lactis DPC3147 treatment by day 3 in Cow 1181 (Fig. 15). However, the
L. lactis DPC3147 response in Cow 1181 was somewhat reduced compared to the other two animals
(Fig. 15).
[0044] Infusion of
L. lactis DPC3147 in each animal resulted in a dramatic increase in neutrophils in the first
24-hour period after treatment. The Bac- culture (
L. lactis DPC5399) also induced an increase in all treated quarters, with particularly higher
levels of PMN obtained in milk from Cow 1163. However, if the proportional increases
in PMN relative to D0 are compared (Figure 16), it can be seen that there is a significant
proportional increase in PMN in the
L. lactis DPC3147-treated quarter compared to the
L. lactis DPC5399- treated quarter. The PMN influx seems to occur earlier in the
L. lactis DPC3147-treated quarters (by day 1) compared to the quarters treated with
L. lactis DPC5399 (Bac-) or
Lb. plantarum DPC4922 (Fig. 15). In the quarters treated with the latter two treatments, a significant
increase was only observed on Day 2 (Fig. 15). Thus, it appears that
L. lactis DPC 3147 can elicit a stronger and more rapid immune response than either a bacteriocin
negative derivative of the same strain or another LAB strain, though the latter strains
may also elicit a weaker response.
Comparison of different preparations of L. lactis DPC3147
[0045] In order to investigate if different preparations of
L. lactis DPC3147, other than the standard overnight culture (broth preparation) could produce
the immune response generated above, infusion mixtures containing either freeze-dried
cells, or broth cultures were prepared. The mixtures were then infused randomly into
the teats of three cows as outlined in Table 6. The results (Fig. 17) show an increase
in PMN by Day 1 in both treated quarters compared to the untreated quarter in each
animal tested. There seems to be a greater influx in two of the overnight culture-treated
quarters compared to quarters treated with the freeze-dried culture (Cow 275 and Cow
1134) with a higher number of PMN elicited by the freeze-dried culture in the remaining
animal (Cow 2810). The variation in response is due to the typical variations in immune
response between different animals. Thus, both "fresh" and freeze-dried preparations
of
L. lactis DPC3147 are capable of eliciting an immune response in the mammary gland.
Comparison of L. lactis DPC3147 treatment with intra-mammary antibiotic treatment
[0046] The effects of using
L. lactis DPC3147 treatment versus using a commonly used antibiotic treatment both for treatment
and prevention of intramammary infections caused by
S. aureus are shown in Table 7. As can be seen in the Table, by Day 7, the
L. lactis results were very promising, with staphylococci isolated from only two quarters of
the 7 quarters originally infected with this organism. In comparison, the quarters
treated with Synulox were still shedding
S.
aureus from 6 of the 8 quarters originally infected. However, by day 12, two more of the
quarters infused with
L.
lactis were also shedding
S.
aureus, giving a total of 3/7 "cured" by
L. lactis treatment as opposed to 2/8 "cured" by the synulox treatment. These data indicate
that the
L. lactis DPC3147 treatment is as effective at eliminating infections as the Synulox treatment.
The treatment of clinical mastitis using a resuspended freeze-dried preparation of
L. lactis DPC3147 in comparison with a positive control (antibiotic therapy)
[0047] In this study, the efficacy of infusing a resuspended freeze-dried preparation of
L.
lactis DPC3147 (approximately 10
9 cfu ml
-1) for treatment of clinical mastitis was compared to the efficacy of using an established
intramammary antibiotic. Overall, 18 of the 25 cases treated with the antibiotic were
defined as having a "clinical cure" on Day 14. Of these 18 quarters, nine were defined
as having a "bacteriological cure"-i.e., the SCC was <1 x 10
6 cells ml
-1 and the bacteriological count was <0.5 cfu µl
-1 in the milk sample. This corresponds to an overall clinical cure rate of 72% and
a bacteriological cure rate of 36% for the antibiotic treated quarters. For the quarters
treated with the resuspended freeze-dried preparation of
L. lactis DPC3147, 16 (out of 25) cases had a "clinical cure" and 7 (out of 25) cases had a
"bacteriological cure". This corresponds to a clinical cure rate of 64% and a bacteriological
cure rate of 28% for the probiotic-treated quarters. Comparing the two treatments,
the clinical cure rate was 72% versus 64% and the bacteriological cure rate was 36%
versus 28% for the antibiotic versus
L. lactis treatments, respectively. When these values were compared using Fischer's Exact Probability
Test, no statistical difference was found between treatments. This indicates that
infusion of a resuspended freeze-dried preparation of
L. lactis DPC3147 was as effective as an antibiotic in the treatment of clinical mastitis.
When the treatment groups were subdivided according to the severity of the mastitis
in the quarter (i.e C1/C2 subgroups or C3/C4 subgroups) a similar trend was observed.
In the C1/C2 group, 8 out of 12 cases treated with the antibiotic had a clinical cure
(66.7%). Of these, 4 cases had a "bacteriological cure" (33.3%). Thirteen quarters
with C1/C2 mastitis were treated with
L. lactis DPC3147, and these quarters achieved a clinical cure rate of 76.9% and a bacteriological
cure rate of 30.8%. In the C3/C4 group, 10 out of 13 cases treated with the antibiotic
had a clinical cure (76.9%). Of these, 5 cases had a "bacteriological cure" (38.5%).
Of the twelve quarters with C3/C4 mastitis that were treated with
L. lactis DPC3147, 6 achieved a clinical cure (50%) and 3 were defined as having a bacteriological
cure (25%). Comparison of all these values using Fischer's Exact Probability Test
indicated that there was no significant difference in either the clinical or bacteriological
cure rate, regardless of treatment in either the quarters with C1/C2 mastitis or the
quarters with C3/C4 mastitis. Thus we can conclude that intramammary infusion of a
resuspended freeze-dried preparation of
L. lactis DPC 3147 is as effective as an intramammary antibiotic in the treatment of clinical
mastitis.
Conclusions
[0048] From these results several conclusions may be drawn. Firstly, it is apparent that
intramammary infusion of
L. lactis DPC3147 into cows with chronic infections results in a rapid rise in SCC, often followed
by eradication of infection. Additionally, infusion into cows with newly acquired
clinical mastitis results in a rapid improvement in milk quality.
L. lactis DPC3147 treatment has also been shown to be as effective as using a widely used commercial
intra-mammary antibiotic in the treatment and prevention of intramammary infections
caued by
S.
aureus. It is possible, therefore, that the infusion of
L. lactis acts as a stimulus which induces release of proinflammatory factors and a prompt
recruitment of neutrophils to the mammary gland. The results of immunological studies
highlight a number of important findings that may shed some light on the mechanism
of action of the probiotic bacteria
L. lactis in the mammary gland. These findings include the following:
- Intramammary treatment with either L. lactis culture or the culture supernatant activates the mammary immune response by triggering
the influx of neutrophils to the mammary gland.
- The L. lactis culture and culture supernatant appear to be specific in eliciting recruitment of
PMN to the udder, when compared to the antibiotic Multimast L.C.
- These newly recruited neutrophils possess a higher respiratory burst capacity than
resident neutrophils thus providing the mammary gland with an effective mechanism
for the elimination of mastitis pathogens.
- The factor(s) responsible for eliciting an immune response in the udder may be a soluble
factor(s) released into the growth medium, this factor(s) must be either be heat labile
or destroyed/utilised rapidly when cells are killed, as dead cells plus supernatant
did not elicit an immune response.
- The L. lactis culture must be viable to elicit an adequate immune response, although a freeze dried
preparation is also effective at stimulating the immune system in the mammary gland.
- Other LAB may also be capable of eliciting an immune response in the mammary gland,
in a similar fashion to L. lactis DPC 3147, though possibly not to the same extent as L. lactis DPC 3147. This implies that other LAB may also be capable of curing clinical mastitis
in dairy cows and other animals if infected quarters were infused with these cultures.
- Treatment with L. lactis culture or a resuspended freeze-dried preparation of L. lactis DPC3147 is as effective at eliminating infections as intra-mammary antibiotic treatment.
[0049] The words "comprises/comprising" and the words "having/including" when used herein
with reference to the present invention are used to specify the presence of stated
features, integers, steps or components but does not preclude the presence or addition
of one or more other features, integers, steps, components or groups thereof.
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