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The main bactericidal components of cold atmospheric plasma (CAP) are thought to be reactive oxygen and nitrogen species (RONS) and UV-radiation, both of which have the capacity to cause DNA damage and mutations. Here, the mutagenic effects of CAP on Escherichia coli were assessed in comparison to X- and UV-irradiation. DNA damage and mutagenesis were screened for using a diffusion-based DNA fragmentation assay and modified Ames test, respectively. Mutant colonies obtained from the latter were quantitated and sequenced. CAP was found to elicit a similar mutation spectrum to X-irradiation, which did not resemble that for UV implying that CAP-produced RONS are more likely the mutagenic component of CAP. CAP treatment was also shown to promote resistance to the antibiotic ciprofloxacin. Our data suggest that CAP treatment has mutagenic effects that may have important phenotypic consequences.

Wound infection is commonly observed after surgery and trauma but is difficult to diagnose and poorly defined in terms of objective clinical parameters. The assumption that bacteria in a wound correlate with infection is false; all wounds contain microorganisms, but not all wounds are clinically infected. This makes it difficult for clinicians to determine true wound infection, especially in wounds with pathogenic biofilms. If an infection is not properly treated, pathogenic virulence factors, such as rhamnolipids from Pseudomonas aeruginosa, can modulate the host immune response and cause tissue breakdown. Life-threatening sepsis can result if the organisms penetrate deep into host tissue. This communication describes the sensor development for five important clinical microbial pathogens commonly found in wounds: Staphylococcus aureus, P. aeruginosa, Candida albicans/auris, and Enterococcus faecalis (the SPaCE pathogens). The sensor contains liposomes encapsulating a self-quenched fluorescent dye. Toxins, expressed by SPaCE infecting pathogens in early-stage infected wounds, break down the liposomes, triggering dye release, thus changing the sensor color from yellow to green, an indication of infection. Five clinical species of bacteria and fungi, up to 20 strains each (totaling 83), were grown as early-stage biofilms in ex vivo porcine burn wounds. The biofilms were then swabbed, and the swab placed in the liposome suspension. The population density of selected pathogens in a porcine wound biofilm was quantified and correlated with colorimetric response. Over 88% of swabs switched the sensor on (107-108 CFU/swab). A pilot clinical study demonstrated a good correlation between sensor switch-on and early-stage wound infection.

Catheter-associated urinary tract infections resulting from urease-positive microorganisms are more likely to cause a urinary catheter blockage owing to the urease activity of the microbes. Catheter blockage can be dangerous and increases the risk of severe infections, such as sepsis. Ureases, a virulence factor in Proteus mirabilis, cause an increase in urine pH - leading to blockage. An optimised biosensor “lozenge” is presented here, which is able to detect impending catheter blockage. This lozenge has been optimised to allow easy manufacture and commercialisation. It functions as a sensor in a physiologically representative model of a catheterised urinary tract, providing 6.7 h warning prior to catheter blockage. The lozenge is stable in healthy human urine and can be sterilized for clinical use by ethylene oxide. Clinically, the lozenge will provide a visible indication of impending catheter blockage, enabling quicker clinical intervention and thus reducing the morbidity and mortality associated with blockage.

Burn Wound Infection (BWI) is difficult to define and detect before it manifests with clear clinical symptoms. In this paper, an ex vivo study of a prototype BWI detecting wound dressing is reported. Consenting patients with burns were recruited from four burns services in the United Kingdom, their burn infection state recorded at time of recruitment and retrospectively following treatment. Their wound dressings were used as a source of inoculating bacteria to create an ex vivo biofilm model in the laboratory with reasonable fidelity to the original microbial state of their wound. The prototype infection detecting wound dressing, which responds to cytolytic toxins secreted by bacteria, was placed on the ex vivo biofilm and the response of the dressing correlated with the clinical decision on the patient’s wound infection state. The study illustrated a number of broader issues with clinical BWI diagnosis, notably the absence of objective diagnostic criteria: a ‘reference standard’ for BWI. The absence of such a reference standard made analysis of the relationship between the dressing response and BWI diagnosis challenging, however a point estimate of 68% sensitivity from the study suggests the potential future utility of using a sensor which detects secreted bacterial virulence factors to assist in BWI diagnosis.

Infection and blockage of indwelling urinary catheters is significant owing to its high incidence rate and severe medical consequences. Bacterial enzymes are employed as targets for small molecular intervention in human bacterial infections. Urease is a metalloenzyme known to play a crucial role in the pathogenesis and virulence of catheter-associated Proteus mirabilis infection. Targeting urease as a therapeutic candidate facilitates the disarming of bacterial virulence without affecting bacterial fitness, thereby limiting the selective pressure placed on the invading population and lowering the rate at which it will acquire resistance. We describe the design, synthesis, and in vitro evaluation of the small molecular enzyme inhibitor 2-mercaptoacetamide (2-MA), which can prevent encrustation and blockage of urinary catheters in a physiologically representative in vitro model of the catheterized urinary tract. 2-MA is a structural analogue of urea, showing promising competitive activity against urease. In silico docking experiments demonstrated 2-MA’s competitive inhibition, whilst further quantum level modelling suggests two possible binding mechanisms.

Summary Background Wound infection in burn patients is common and has an impact on outcomes. There is no objective method to diagnose infection at point of care (PoC). Early diagnosis prevents progression to sepsis. Diagnostic subjectivity supports over-diagnosis, unnecessary hospitalization, and antibiotic overuse. Aim This pilot study aimed to investigate the accuracy of a novel PoC wound infection diagnostic in burn patients. Methods We produced, and in vitro tested, a PoC diagnostic for early wound infection diagnosis. The prototype SPaCE diagnostic uses a patented lipid vesicle suspension into which a clinical swab is placed. The diagnostic delivers a colour-response to Staphylococcus aureus, Pseudomonas aeruginosa, Candida species and Enterococcus faecalis at toxin release. A pilot clinical diagnostic accuracy study was undertaken. The reference standard was a retrospective decision made by an expert clinical panel using routinely available data. Findings Data was available from 33 of 34 patients. Of these, 52% were considered to have a wound infection, 42% not, and two (6%) were equivocal. The diagnostic results showed 24% were infected, 42% were not and 33% produced intermediate results. Agreement between clinical judgement and diagnostic result, assessed using a weighted Kappa, was 0.591 suggesting moderate agreement. If the intermediate results were excluded, 22 sets of data with definitive results achieved a Kappa statistic of 0.81 suggesting ‘almost perfect’ agreement. Sensitivity and specificity were 57% (8/14) and 71% (12/17), respectively. Conclusion This pilot study provided evidence that the SPaCE diagnostic could provide valuable and timely data to support clinical decision-making at PoC for wound infection.

Here, a reaction-based indicator displacement hydrogel assay (RIA) was developed for the detection of hydrogen peroxide (H2O2) via the oxidative release of the optical reporter Alizarin Red S (ARS). In the presence of H2O2, the RIA system displayed potent biofilm inhibition for Methicillin-resistant Staphylococcus aureus (MRSA), as shown through an in vitro assay quantifying antimicrobial efficacy. This work demonstrated the potential of H2O2-responsive hydrogels containing a covalently bound diol-based drug for controlled drug release.

Formation of crystalline biofilms following infectionby Proteus mirabilis can lead to encrustation and blockage of longterm indwelling catheters, with serious clinical consequences. We describe a simple sensor, placed within the catheter drainage bag, to alert of impending blockage via a urinary color change. The pHresponsive sensor is a dual-layered polymeric “lozenge”, able to release the self-quenching dye 5(6)-carboxyfluorescein in response to the alkaline urine generated by the expression of bacterial urease.Sensor performance was evaluated within a laboratory model of the catheterized urinary tract, infected with both urease positive and negative bacterial strains under conditions of established infection, achieving an average “early warning” of catheter blockage of 14.5 h.Signaling only occurred following infection with urease positive bacteria. Translation of these sensors into a clinical environment would allow appropriate intervention before the occurrence of catheter blockage, a problem for which there is currently noeffective control method.

The ability of plasma-generated hydrogen peroxide (H 2O 2) to traverse bacterial biofilms and the subsequent fate of the generated H 2O 2 has been investigated. An in vitro model, comprising a nanoporous membrane impregnated with artificial wound fluid and biofilms of varying maturity was treated with a helium-driven, cold atmospheric pressure plasma (CAP) jet. The concentration of H 2O 2 generated below the biofilms was quantified. The results showed that the plasma-generated H 2O 2 interacted significantly with the biofilm, thus exhibiting a reduction in concentration across the underlying nanoporous membrane. Biofilm maturity exhibited a significant effect on the penetration depth of H 2O 2, suggesting that well established, multilayer biofilms are likely to offer a shielding effect with respect to cells located in the lower layers of the biofilm, thus rendering them less susceptible to plasma disinfection. This may prove clinically significant in the plasma treatment of chronic, deep tissue infections such as diabetic and venous leg ulcers. Our results are discussed in the context of plasma-biofilm interactions, with respect to the fate of the longer lived reactive species generated by CAP, such as H 2O 2

We explore how to configure an argon atmospheric-pressure plasma jet for enhancing its production of hydrogen peroxide (H2O2) in deionised water (DIW). The plasma jet consists of a quartz tube of 1.5 mm inner diameter and 3 mm outer diameter, with an upstream internal needle electrode (within the tube) and a downstream external cylindrical electrode (surrounding the tube). The plasma is operated by purging argon through the glass tube and applying a sinusoidal AC voltage to the internal needle electrode at 10 kV (peak–peak) with a frequency of 23.5 kHz. We study how the following operational parameters influence the production rate of H2O2 in water: tube length, inter-electrode separation distance, distance of the ground electrode from the tube orifice, distance between tube orifice and the DIW, argon flow rate and treatment time. By examining the electrical and optical properties of the plasma jet, we determine how the above operational parameters influence the major plasma processes that promote H2O2 generation through electron-induced dissociation reactions and UV photolysis within the plasma core and in the plasma afterglow; but with a caveat being that these processes are highly dependent on the water vapour content from the argon gas supply and ambient environment. We then demonstrate how the synergistic action between H2O2 and other plasma generated molecules at a plasma induced low pH in the DIW is highly effective at decontaminating common wound pathogens Gram-positive Staphylococus aureus and Gram-negative Pseudomonas aeruginosa. The information presented in this study is relevant in the design of medical plasma devices where production of plasma reactive species such as H2O2 at physiologically useful concentrations is needed to help realise the full clinical potential of the technology.

We investigate the ability to disrupt and limit growth biofilms of Pseudomonas aeruginosa using application of cold atmospheric pressure (CAP) plasma. The effect of the bio-film's exposure to a helium (CAP) jet was assessed at varying time points during biofilm maturation. Results showed that the amount of time during biofilm growth that CAP pressure was applied has a crucial role on the ability of biofilms to mature and recover after CAP exposure. Intervention during the early stages of biofilm formation (0-8 h) results in a 4-5-log reduction in viable bacterial cells (measured at 24 h of incubation) relative to untreated biofilms. However, CAP treatment of biofilm at 12 h and above only results in a 2-log reduction in viable cells. This has potentially important implications for future clinical application of CAP to treat infected wounds.

This work presents an electrochemical sensor concept for bacterial toxin detection using biomimetic lipid vesicles containing potassium ferricyanide. The toxin mediated release of redox couples from the vesicles was quantified by measuring the redox current on screen printed electrodes, and the detection limits to rhamnolipid, delta toxin and bacterial supernatants from clinical wound pathogens were examined. Overall detection limits of both redox and carboxyfluorescein containing vesicles were one order of magnitude lower than the cytotoxic dose of studied toxins to T lymphocytes. Keywords: Staphylococcus aureus, Pseudomonas aeruginosa, Lipid vesicles, Potassium ferricyanide, Rhamnolipid, Delta toxin

It is becoming increasingly accepted that to understand and model the bacterial colonization and infection of abiotic surfaces requires the use of a biofilm model. There are many bacterial colonizations by at least two primary species, however this is difficult to model in vitro. This study reports the development of a simple mixed-species biofilm model using strains of two clinically significant bacteria: Staphylococcus aureus and Pseudomonas aeruginosa grown on nanoporous polycarbonate membranes on nutrient agar support. Scanning electron microscopy revealed the complex biofilm characteristics of two bacteria blending in extensive extracellular matrices. Using a prototype wound dressing which detects cytolytic virulence factors, the virulence secretion of 30 single and 40 mixed-species biofilms was tested. P. aeruginosa was seen to out-compete S. aureus, resulting in a biofilm with P. aeruginosa dominating. In situ growth of mixed-species biofilm under prototype dressings showed a real-time correlation between the viable biofilm population and their associated virulence factors, as seen by dressing fluorescent assay. This paper aims to provide a protocol for scientists working in the field of device related infection to create mixed-species biofilms and demonstrate that such biofilms are persistently more virulent in real infections. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 129-137, 2019.

Phospholipid vesicles have been the focus of attention as potential vehicles for drug delivery, as they are biomimetic, easy to produce, and contain an aqueous compartment which can be used to carry hydrophilic material, such as drugs or dyes. Lipid vesicles used for this purpose present a particular challenge, as they are not especially stable and can rapidly break down and release their contents away from the target area, especially at physiological temperatures/environments. This study aims to investigate optimum methods for vesicle stabilization where the vesicles are employed as part of a system or technology that signals the presence of pathogenic bacteria via the effect of secreted cytolytic virulence factors on a sensor interface.(1) A number of approaches have been investigated and are presented here as a systematic study of the long-term (14 day) stability at 37 C, and at various pHs. The response of vesicles, both in suspension and within hydrogels, to Staphylococcus aureus (RN 4282) and Pseudomonas aeruginosa (PAO1) whole bacteria, and supernatants from overnight cultures of both (containing secreted proteins but free of cells), was measured via a sensitive encapsulated carboxyfluorescein release assay. The results showed that lipid chain length, cholesterol concentration, and stabilization via photopolymer stable components were critical in achieving stability. Finally, dispersion of the optimum vesicle formulation in hydrogel matrixes was investigated, culminating in the in vivo demonstration of a simple prototype wound dressing. Refereed/Peer-reviewed

This paper describes a biosensing concept for exotoxins secreted by Staphylococcus aureus and Pseudomonas aeruginosa based on the toxin mediated breakdown and subsequent fluorescent dye release from phospholipid vesicles (liposomes). The sensitivity of vesicles to toxins was tuned by altering the lipid and fatty acid composition of the membranes such that vesicles could be engineered to respond to toxins/enzymes from S. aureus only; P. aeruginosa only; and both S. aureus and P. aeruginosa. Nineteen types of vesicle were made with varying compositions of phosphocholine (PC), phosphoethanolamine (PE), cholesterol and the photo-polymerizable ampiphile 10,12-tricosadiynoic acid (TCDA). The selectivity of the vesicles was measured via a simple fluorescence "switch on" assay. Sensitivity of the vesicles to 40 clinically derived strains of S. aureus and P. aeruginosa was also demonstrated. This work suggests that this technology could be utilised in a diagnostic tool to discriminate between the species of S. aureus and P. aeruginosa in wound dressings. Refereed/Peer-reviewed

We describe a novel infection-responsive coating for urinary catheters that provides a clear visual early warning of Proteus mirabilis infection and subsequent blockage. The crystalline biofilms of P. mirabilis can cause serious complications for patients undergoing long-term bladder catheterisation. Healthy urine is around pH 6, bacterial urease increases urine pH leading to the precipitation of calcium and magnesium deposits from the urine, resulting in dense crystalline biofilms on the catheter surface that blocks urine flow. The coating is a dual layered system in which the lower poly(vinyl alcohol) layer contains the self-quenching dye carboxyfluorescein. This is capped by an upper layer of the pH responsive polymer poly(methyl methacrylate-co-methacrylic acid) (Eudragit S100®). Elevation of urinary pH (>pH 7) dissolves the Eudragit layer, releasing the dye to provide a clear visual warning of impending blockage. Evaluation of prototype coatings using a clinically relevant in vitro bladder model system demonstrated that coatings provide up to 12 h advanced warning of blockage, and are stable both in the absence of infection, and in the presence of species that do not cause catheter blockage. At the present time, there are no effective methods to control these infections or provide warning of impending catheter blockage., Graphical abstract A pH-responsive diagnostic coating for urinary catheters is presented, to provide advance warning of encrustation and blockage by P. mirabilis. Diagnosis is facilitated by the stimulated release of 5(6)-carboxyfluorescein from a hydrogel reservoir in response to increased urinary pH. Catheter prototypes are tested using a clinically relevant continuous flow in vitro bladder model system, and artificial urine. fx1, Highlights • Development of a dual-layered diagnostic coating sensor for urinary catheter. • Provides advance warning of infection by P. mirabilis in response to alkaline urine. • Read out via release of carboxyfluorescein dye from coating into urine leg bag. • Catheter prototypes ‘report’ infection 12 h before blockage by P. mirablis.

The early detection of wound infection in-situ can dramatically improve patient care pathways and clinical outcomes. There is increasing evidence that within an infected wound the main bacterial mode of living is a biofilm: a confluent community of adherent bacteria encased in an extracellular polymeric matrix. Here we have reported the development of a prototype wound dressing, which switches on a fluorescent color when in contact with pathogenic wound biofilms. The dressing is made of a hydrated agarose film in which the fluorescent dye containing vesicles were mixed with agarose and dispersed within the hydrogel matrix. The static and dynamic models of wound biofilms, from clinical strains of Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecalis, were established on nano-porous polycarbonate membrane for 24, 48 and 72 hours, and the dressing response to the biofilms on the prototype dressing evaluated. The dressing indicated a clear fluorescent / color response within four hours, only observed when in contact with biofilms produced by a pathogenic strain. The sensitivity of the dressing to biofilms was dependent on the species and strain types of the bacterial pathogens involved, but a relatively higher response was observed in strains considered good biofilm formers. There was a clear difference in the levels of dressing response, when dressings were tested on bacteria grown in biofilm or in planktonic cultures, suggesting that the level of expression of virulence factors is different depending of the growth mode. Colorimetric detection on wound biofilms of prevalent pathogens (S. aureus, P. aeruginosa and E. faecalis) is also demonstrated using an ex-vivo porcine skin model of burn wound infection.

The use of hydrogels as safe, biocompatible materials for wound healing has been widely utilized in recent years. Here, we investigated the use of a composite hydrogel to impart a “trigger” mechanism into an antimicrobial hydrogel system. The system was comprised of a bilayer hydrogel architecture: a lower agarose layer containing the antimicrobial virus Bacteriophage K (ΦK) and an upper layer formed of photo-cross-linkable hyaluronic acid methacrylate (HAMA) which creates the hydrogel trigger. This trigger is sensitive to the enzyme hyaluronidase, an enzyme known to be secreted by the majority of Staphylococcus aureus strains. In the presence of hyaluronidase, HAMA is degraded, releasing ΦK into the surrounding environment which consequently go on to kill surrounding bacteria. Our results show that on incubation with hyaluronidase (purified or from S. aureus), large pores form in HAMA as degradation goes on, which facilitates ΦK release.

Liposomes containing lipids and polydiacetylene (PDA) are hybrid systems encompassing both a fluid phospholipid membrane and a polymer scaffold (PDA). However, the biophysical role of PDA in such liposomes is not well understood. In this report, we studied the effects of photopolymerization of PDA on the stability of lipid-PDA liposomes, and their sensitivity to selected purified toxins and bacterial supernatants, using a fluorescence assay. Of the three different types of liposomes with variable lipid chain lengths that were chosen, the degree of polymerization had a significant impact on the long-term stability, and response, to external microbial exotoxins secreted by pathogenic bacteria, namely, Staphylococcus aureus and Pseudomonas aeruginosa. The degree of polymerization of TCDA played an important role in lipid-chain-length- dependent stabilization of lipid-PDA liposomes, as well as in their response to bacterial toxins of S. aureus and P. aeruginosa.

A synthetic biological sensor was developed to monitor the interaction of plasma with soft, hydrated biological material. It comprises phospholipid vesicles in a hydrated proteinaceous environment comprising 5% (w/v) gelatin. The vesicles contained a self-quenched dye, which was activated by vesicle destruction giving a clear fluorescent switch on. The interaction of bacterial toxins with the sensor was measured in a proof of principle experiment, then the effect of atmospheric plasma jets with the sensor, was studied in order to assess the cytolytic effect of plasma jets in biological systems. When the plasma contacted the gelatin surface perpendicular to the surface, the treatment resulted in the formation of a star-shaped pattern of microchannels that radiated out from the centre of the treatment area within the gelatin matrix, and locally damaged vesicles within the microchannels at a depth of 150 µm below the gelatin surface. Plasma jets applied in parallel to the surface of the matrix resulted in the formation of a single microchannel with damage to the vesicles only evident at the walls of the channel, and a much reduced penetration depth within the gelatin. Our data show that the effects of plasma can be deep in the gelatin material and that the angle of treatment significantly influenced the nature and level of damage to the gelatin and vesicles. Potentially this gelatin model can be used to unravel the roles of different plasma species and the direct effect of whole plasma contact, from those of primary and secondary species—i.e. primary, those emanating directly from the plasma and secondary, those species created in the 'target' tissue. This type of insight could be useful in the future development of safe and effective plasma medical technologies. Refereed/Peer-reviewed