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Fighting Bacteria With Its Own Weaponry?Fighting Bacteria With Its Own Weaponry? FREE TO VIEW

Dimitrios Ntelios, MD
Author and Funding Information

From the Volos General Hospital, Department of Internal Medicine.

CORRESPONDENCE TO: Dimitrios Ntelios, MD, Volos General Hospital, Department of Internal Medicine, Polymeri 134, 38222, Volos, Greece; e-mail: ntdimitris@yahoo.gr


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):e71. doi:10.1378/chest.14-0497
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To the Editor:

For many years, intrapleural administration of fibrinolytics and deoxyribonuclease (DNase) was a controversial issue in the management of complicated parapneumonic effusion and empyema.1 Their effectiveness was assessed in a large clinical trial (the second Multicenter Intrapleural Sepsis Trial).2 Coadministration of tissue plasminogen activator and DNase was beneficial in terms of radiographic progression, days of hospitalization, and surgical referral. Instead, DNase alone increased the need for surgery.2 The rationale behind DNase use was to facilitate effusion drainage via chest tube. So why did DNase monotherapy lead to an unfavorable outcome?

First, the main pathogens detected in pleural infections (the Streptococcus milleri group, Staphylococcus aureus, Streptococcus pneumoniae) encode DNases in their genomes. Those nucleases are emerging as potential virulence factors, due to their ability to degrade neutrophil extracellular traps (NETs).3 Released from neutrophils, NETs, composed mainly of chromatin and certain proteins, entrap and kill bacteria extracellularly. Furthermore, those weblike structures are in abundance in pus,4 thus, their disassembly may explain the appreciable viscosity reduction after DNase treatment. Another issue is the DNases’ biofilm-dispersing activity. Indeed, DNases have been reported to degrade biofilms,5 but their role in acute infections is an open question. To refine our therapeutic strategies, the exact nature of the tissue plasminogen activator-DNase synergism and NETs disruption impact on clinical course are areas in which further insight must be gained.

References

Corcoran JP, Rahman NM. Rebuttal from Drs Corcoran and Rahman. Chest. 2014;145(1):20-21. [CrossRef] [PubMed]
 
Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011;365(6):518-526. [CrossRef] [PubMed]
 
Beiter K, Wartha F, Albiger B, Normark S, Zychlinsky A, Henriques-Normark B. An endonuclease allowsStreptococcus pneumoniaeto escape from neutrophil extracellular traps. Curr Biol. 2006;16(4):401-407. [CrossRef] [PubMed]
 
Brinkmann V, Zychlinsky A. Neutrophil extracellular traps: is immunity the second function of chromatin? J Cell Biol. 2012;198(5):773-783. [CrossRef] [PubMed]
 
Nijland R, Hall MJ, Burgess JG. Dispersal of biofilms by secreted, matrix degrading, bacterial DNase. PLoS ONE. 2010;5(12):e15668. [CrossRef] [PubMed]
 

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References

Corcoran JP, Rahman NM. Rebuttal from Drs Corcoran and Rahman. Chest. 2014;145(1):20-21. [CrossRef] [PubMed]
 
Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med. 2011;365(6):518-526. [CrossRef] [PubMed]
 
Beiter K, Wartha F, Albiger B, Normark S, Zychlinsky A, Henriques-Normark B. An endonuclease allowsStreptococcus pneumoniaeto escape from neutrophil extracellular traps. Curr Biol. 2006;16(4):401-407. [CrossRef] [PubMed]
 
Brinkmann V, Zychlinsky A. Neutrophil extracellular traps: is immunity the second function of chromatin? J Cell Biol. 2012;198(5):773-783. [CrossRef] [PubMed]
 
Nijland R, Hall MJ, Burgess JG. Dispersal of biofilms by secreted, matrix degrading, bacterial DNase. PLoS ONE. 2010;5(12):e15668. [CrossRef] [PubMed]
 
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