First, additional functional P2X7 promoter polymorphisms affecting expression levels (in addition to the promoter −762 locus) may also affect tuberculosis susceptibility (Li et al., 2002). Second, it is possible that the marker allele is in linkage disequilibrium with the true disease-causing variant (Fuller et al., 2009). Third, the differences observed between the respective studies may also be due to the effects of other genes, which may modulate P2X7 function, for example, the major histocompatibility complex class II loci, which is at least 50% linked to disease

risk (Rodríguez et al., 2002). Fourth, associations may be influenced by the ethnic (genetic) makeup of the individuals included in the association studies described. We also explored check details potential sources of heterogeneity. First, the uniformity of the control population (such as the study size, mean age and the latent tuberculosis-infected states) may be used

as characteristics for the assessment of heterogeneity. For example, the study size varies from 100 to 384 of −762 loci in the control population, and the mean age of controls varies from 5.9 to 46.1 years, with one study including children as research participants (Xiao et al., 2009); as for control population, this metaanalysis included a latent tuberculosis population in one study (Fernando et al., 2007), and thus these factors may be associated with the heterogeneity of −762 studies. Second, the discrepancy in the allele frequencies, which vary markedly between different ethnicity groups, may be a possible source of heterogeneity. For example, the 1513AC polymorphism described Silmitasertib concentration in the Gambian population (Li et al., 2002) was

observed to have a lower frequency (7.6%) than that in the Australian-Caucasian population (17.2%) or in the Australian-Vietnamese population (25%) (Fernando et al., 2007), and the −762 C allele frequency was higher in the Russian-Caucasian population (69.3% vs. 68.2%, control vs. case) than that in the Gambian population (32.9% and 25.4%, control vs. case). An additional consideration in exploring the causes of heterogeneity with molecular association studies is the possibility of a gene–environment interaction (Thakkinstian et al., 2005). Cases and controls were not sex-matched, Carnitine palmitoyltransferase II with the exception of one study (Li et al., 2002). However, provided that the ethnic background was similar among patients and controls, the lack of such matching should not have introduced bias in the estimates. The metaanalysis presented in this report demonstrated that the P2X7 1513 C allele appeared to be associated with tuberculosis susceptibility. In contrast, the −762 C allele did not correlate significantly with protection against tuberculosis infection. This analysis further suggests that caution must be exercised when interpreting association studies using small sample sizes that have a low power to detect accurate allelic associations with disease susceptibility.

The human lung is in contact with inhaled airborne selleck kinase inhibitor pathogens and, via expression of a large panel of TLRs, the airway epithelial cells represent the first barrier against invading microbes. Several studies strongly suggest that chronic inflammation increases the risk of carcinogenesis. As lungs are frequently exposed to RNA viruses that are recognized by TLR7 and TLR8, the expression of TLR7 and TLR8 by tumor cells in human lung

cancer in situ and in cell lines was investigated. Stimulation with TLR7 or TLR8 agonists leads to atypical NF-κB activation, up-regulation of Bcl-2 expression, increases tumor cell survival, and induces chemoresistance. Altogether, these data emphasize that TLR signalling occurring during infection in lung cancer patients could directly favor tumor development. Peter Brossart (Bonn, Germany) then discussed current strategies of cancer immunotherapy, focusing on his groups’ studies using DCs presenting tumor antigens 5. DCs are the most powerful antigen presenting cells with the unique ability to initiate and maintain primary immune responses. Due to a better understanding of DC differentiation and function, and the establishment of

protocols for the generation of DC in vitro under GMP conditions, vaccination strategies were developed to treat patients with malignant diseases. Peter Brossart presented data from a recently finished clinical trial using autologous mature DCs pulsed with MUC1-derived HLA-A2 binding peptides. www.selleckchem.com/products/H-89-dihydrochloride.html This approach resulted in the induction of clinical and immunological responses in vaccinated patients with metastatic renal cell carcinoma. Currently, the Brossart group is characterizing novel tumor antigens and analyzing several approaches to improve the efficiency of such vaccines by utilizing in vitro transcribed RNA that code for defined tumor antigens or combinations with tyrosine kinase inhibitors. Peter Šebo (Prague, Czech Republic) delivered a rich and fascinating overview of Bordetella adenylate cyclase toxin (ACT) and suggested

mafosfamide its possible use in cellular therapies. ACT targets myeloid phagocytes bearing the αMβ2 integrin CD11b/CD18 (Mac-1 or CR3), such as neutrophils, macrophages, or dendritic cells (DC, CD11bhigh) 6. ACT penetrates across the cell membrane, promotes an influx of calcium ions, binds cytosolic calmodulin, and converts ATP to cAMP, thus causing phagocyte impotence. In DCs, partial maturation by ACT is induced that compromises their capacity to stimulate T cells. The AC domain of detoxified ACT, having the enzyme activity ablated genetically (dACT), in turn, exhibits an amazing capacity to accommodate foreign T-cell antigens and convey them into the cytosol of dendritic cells both in vitro and in vivo. This allowed the development of dACT toxoids into a particularly efficient tool for antigen delivery for cytosolic processing and MHC class I-restricted presentation to cytotoxic CD8+ T lymphocytes.

4 Albendazole is effective treatment for infection with Encephalitozoon species but is less effective for Enterocytozoon infections. Fumagillin is considered more effective for Enterocytozoon infections but it has significant bone marrow toxicity. To our knowledge, only 21 cases of disseminated microsporidiosis have been reported worldwide in non-HIV, solid organ transplant and bone marrow transplant recipients.5E. bieneusi was the most commonly isolated microsporidia and disseminated disease with Encephalitozoon species in non-HIV-infected,

transplant recipients is considered rare with only five such cases being reported worldwide.3 Selleckchem STA-9090 Moreover, mortality rates are high and diagnosis was established post-mortem in many instances. This case is the first Lenvatinib clinical trial disseminated microsporidiosis with Encephalitozoon species in a non-HIV, solid organ transplant recipient to be reported and successfully treated in Australia. None. “
“Cystatin-C (CysC) has been demonstrated as a sensitive and reliable biomarker to predict the onset of acute kidney injury (AKI). However, there are few studies concerned about the relationship between CysC and the outcomes of AKI. The aim of the present study was to determine whether CysC elevation prior to definite diagnosis of AKI is related to higher prevalence of death and dialysis

need outcome. A meta-analysis was conducted by searching PubMed, EMBASE and Cochrane Library database Terminal deoxynucleotidyl transferase using the terms related to AKI combined with ‘cystatin-C’. Bibliographies of relevant papers were reviewed manually. Eligible studies were those investigating death and dialysis need outcomes after AKI with CysC measurement, and were limited to English articles. Non-human studies were excluded. Random effect Mantel-Haenszel statistical method was used. Six studies were finally enrolled, consisting of 2332 patients. All of these studies were hospital-based prospective cohort studies. The follow-up duration varied from 5 days to 1 year. The odds ratio values for baseline CysC elevation and death as well as baseline CysC elevation and dialysis

need were 2.34 (95% confidence interval [CI] 1.46–3.75) and 4.40 (95% CI 1.58–12.22), respectively (both P < 0.05). Patients with CysC elevated prior to AKI diagnosis have higher risk to develop death and need dialysis during short- and long-term follow-up after AKI, thus having worse outcomes. This population deserves more careful observation and might benefit from more frequent follow-up visits in the clinic. Future work is needed to get a consensus cut-off value defining CysC elevation. "
“Aim:  To identify the variations in paediatric renal biopsy pathology and clinicopathological features during the past 31 years. Methods:  A retrospective analysis of paediatric renal biopsies performed at a single institution in Shanghai from January 1979 to December 2009 was conducted.

To determine the functional characteristics of the increased CD45RA− CD27− and CD45RA+ CD27− CD4+ T-cell populations in CMV-seropositive subjects we first examined their surface expression of markers

that were previously shown to be associated with migration (CCR7), co-stimulation (CD28), responsiveness to cytokines (IL7-Rα) and end-stage differentiation (CD57). We found that CD45RA− CD27− and CD45RA+ CD27− CD4+ T cells both showed low CCR7, CD28 and Selleckchem MG-132 IL-7Rα but higher CD57 expression compared with naive CD45RA+ CD27+ and CD45RA− CD27+ populations indicating that they were more differentiated (Fig. 3a). In addition, on the basis of CD28, IL-7Rα and CD57 expression, the CD45RA+ CD27− subset was significantly more differentiated than the CD45RA− CD27− population (Fig. 3a). We next investigated Epigenetics inhibitor the functional properties of the CD45RA− CD27− and CD45RA+ CD27− subsets of CD4+ T cells. We showed that the expression of molecules associated with cytolytic potential such as granzyme B and perforin were not detectable in naïve CD45RA+ CD27+ and CD45RA− CD27+ CD4+ T cells (Fig. 3b). In contrast, both CD45RA− CD27− and CD45RA+ CD27− CD4+ T cells expressed granzyme B and perforin, the levels of which were significantly higher in CD45RA+ CD27− cells when these populations were compared (Fig. 3b). Other

indicators of CD4+ T-cell functionality include production of cytokines such as IFN-γ, IL-2 and TNF-α, and the expression of the CD40 ligand. The co-expression of more than one function in individual Y-27632 2HCl cells may be associated with enhanced viral control.29

We therefore performed multiparameter flow cytometric analysis to identify simultaneously the relative expression of IFN-γ, IL-2, TNF-α and CD40 ligand in individual CD4+ T cells at different stages of differentiation defined by relative expression of CD45RA and CD27 (Fig. 3c; see Supplementary Information, Fig. S2 and Table S2). The CD45RA− CD27+, CD45RA− CD27− and CD45RA+ CD27− subsets contained more cells with three and four functions compared with the CD45RA+ CD27+ CD4+ naive T-cell population (functions expressed are detailed in Supplementary Information, Table S2). These differences were highly significant (Wilcoxon matched pairs test; for all comparisons naive versus other subsets P < 0·0001; Fig. 3c). Both CD45RA− CD27− and CD45RA+ CD27− CD4+ T cells showed equivalent multifunctionality (P = ns), which was higher than in the CD45RA− CD27+ and naive CD45RA+ CD27+ CD4+ T-cell populations (P < 0·01). This indicates that although CD45RA+ CD27− CD4+ T cells bear phenotypic characteristics of highly differentiated T cells, they are not exhausted functionally but instead are capable of potent effector function.

The plasma separation columns seem to trigger

the formation of proinflammatory complement factors including C3a and C5a, while the find more same anaphylatoxins are adsorbed by the LDL apheresis columns, however, to varying degree. Proinflammatory cytokines are to some extent adsorbed by the LDL apheresis columns, while some of the anti-inflammatory cytokines increase during treatment. Finally, we discuss the effect of apheresis on different biomarkers including C-reactive protein, fibrinogen, adhesion molecules, myeloperoxidase and HDL cholesterol. In conclusion, even if there are differences between pro- and anti-inflammatory biomarkers during LDL apheresis, the consequences for the patients are largely unknown and larger studies need to be performed. Preferably, they should be comparing the effect of different LDL apheresis columns Cyclopamine price on the total inflammatory profile, and this should be related to clinical endpoints. Patients with familial hypercholesterolemia (FH) carry a high risk of premature atherosclerosis if not adequately treated [1], owing to high levels of low-density lipoprotein (LDL) cholesterol. In most instances, LDL cholesterol can be reduced by means

of HMG-CoA reductase inhibitors (statins). However, for some patients, the medication is not effective or the patients do not tolerate the medication owing to side effects. In these instances, extracorporeal treatment with LDL apheresis effectively lowers

LDL cholesterol and clinical endpoints [2–4]. Extracorporeal treatment, however, is hampered by blood–biomaterial interaction that in turn may trigger inflammatory responses. These responses may be both pro- and anti-inflammatory, and the net result of these reactions is important to the patient [5]. Thus, measures to attenuate the inflammatory responses elicited by the extracorporeal treatment should be taken to obtain optimal biocompatibility. FH is an autosomal dominant inherited disease leading to high levels of LDL cholesterol and increased risk of premature atherosclerotic disease. The landmark studies IMP dehydrogenase by Brown and Goldstein firmly documented the link between familial hypercholesterolemia and the structure of the LDL-receptor [6–10]. The prevailing form is heterozygous (heFH) in which approximately 50% of the LDL-receptors are missing. Other forms of familial hypercholesterolemia have since been discovered [11–14]. heFH is quite common; most studies indicate a prevalence of 1/500 in white Caucasians [15]. The increased risk for atherosclerotic diseases in FH [1, 16] is reduced when patients are treated with statins [17–19]. FH homozygotes (hoFH) are rare (1/1000 000) and often develop atherosclerotic complications early [15], even if new register data show a survival benefit of modern lipid-lowering therapy [20]. Thus, there is general consensus that reduction in LDL cholesterol is mandatory in FH [21–23].

Considering the role of CD146 in lymphocyte/endothelial interactions [9], CD146 expression might correlate with adhesion and homing

markers. Expression of the proinflammatory chemokine receptor, CCR5, varied between HDs. Within the CD4, but not the CD8 subset, CCR5+ cells were over-represented on CD146+ T cells (Fig. 10). The expression of CXCR3, another chemokine receptor, also varied between donors, independently of CD146 expression (Supporting information, Fig. S7). HD CD4 and CD8 T cells expressed CD31/platelet endothelial cell adhesion molecule (PECAM) (Supporting information, Fig. S8) and CD54/ intercellular adhesion molecule 1 (ICAM-1) (Supporting information, Fig. S9) at varying frequencies. CD146+ HD CD4 T cells, but not CD8 cells, were depleted www.selleckchem.com/products/Sunitinib-Malate-(Sutent).html slightly but systematically of CD31+ cells, and very Palbociclib molecular weight slightly enriched for CD54+ cells. Throughout this study, dead cells were only excluded by scatter; non-specific binding of isotype control antibody to 0·1–0·2% of cells was seen in some experiments (Fig. 1). However, CD4 and CD8 cells differed in their co-expression patterns; some markers were enriched whereas others

were depleted, and the associations between CD146 and other markers in CD4+ T cells were consistent between donors and, where previously studied, consistent with earlier work. Taken together, the results are not explained by non-specific staining. Surprisingly few CTD patients showed evidence of CD146 up-regulation MRIP ex vivo (Fig. 3). The median frequency of CD146+CD4+ T cells remained normal in patients with SLE (1·60%), SSc (2·0%) and pSS (1·80%; one patient was just above the normal range). In contrast to previously described patients with SLE and pSS [30-32], including patients from our CTD clinic (C. Bryson and F.C. Hall, unpublished data), these patients showed no T cell activation or derangement of memory subsets or adhesion markers (Figs 4-10 and Supporting information, Figs S4–S9, middle panels). In these patients, systemic T cell dysregulation appeared to be minor or well controlled by therapy. This contrasts with

other studies of blood T cell activation in patients with SLE or pSS, with implications for the interpretation of our results (see Discussion). In contrast, the five sSS patients in our study had significantly increased CD146 expression on CD4 cells (median: 4·0%) and, to a lesser extent, on CD8 cells (Fig. 3). These patients harboured elevated frequencies of CD4 and CD8 cells expressing the activation markers CD25 and OX-40 (Figs 4 and 5; asterisks symbolize significant differences from HDs or other CTD groups by non-parametric anova). Moreover, the correlation of CD146 with activation markers was more extensive in the sSS patients. In all five patients, each of the activation markers tested (CD25, HLA-DQ, OX-40, CD69 and CD70) was over-represented in the CD146+ subpopulation of CD4 cells (Figs 4-6, Supporting information, Figs S4 and S5).

Interestingly,

this is not the case for the phosphorylation at sites Ser199–202–Thr205. Using the AT8 marker, we found that the total number of structures does Stem Cell Compound Library supplier not show differences when reaching advanced AD stages, suggesting that at some point during the tau processing this phosphorylation reaches a stable level (Figure 5); conversely PHF-1 during advanced stages remains significantly increased (Figure 5). Again, these data show important differences between events in the carboxyl terminus vs. the middle of the molecule, suggesting that the carboxyl terminus is exposed to phosphorylation events from early to advanced processing stages. To further evaluate the role of phosphorylation of tau protein at sites Ser396–404, we studied the abnormal processing of tau protein in DS. In this study, we found that hyperphosphorylated tau protein

at sites Ser199–202–Thr205 and Ser396–404 is present in the cytopathology found in DS. Here again, PHF-1 detected both early aggregates (iNFT) and mature NFTs (Figure 6), and finally, the density of structures displaying phosphorylation at sites Ser396–404 was significantly increased compared with those phosphorylated at Ser199–202–Thr205 or Ser262 (Figure 6). According to these data, we propose that phosphorylation at Ser396–404 is followed by phosphorylation at sites Ser199–202–Thr205 Protease Inhibitor Library and possibly some other phosphorylations like Ser262 (Figure 6). However using the same criteria, we cannot rule out the possibility that phosphorylation at site Ser262 is also an early event, mainly due to the fact that most of the structures comprising this event were found in a pretangle like stage (Figure 6). Here, we suggest that abnormal aggregation of this protein, in a different tau disease, is conducted by common mechanisms promoting its hyperphosphorylated state. To further

analyse if processing of tau protein was similar to what we Amisulpride saw during AD, we studied the presence of cleavage events at sites D421 and E391. Some NFT pathology showed a considerable level of cleavage at site D421 and small amount of pathology with of the E391 truncated tau (Figure 6). These data show a clear difference between AD and DS. Tau protein does not seem to reach late stages of abnormal processing during DS (Figure 7). Despite this finding, the presence of E391 truncated tau in DS may suggest that NFTs during DS are exposed to proteolytic events and processed similarly to intracellular NFTs during AD. In sum, like in AD, in DS phosphorylated tau was observed in a nonfibrillar state suggesting again that phosphorylation at the carboxyl terminus could be critically related to the pathogenesis of the disease.

Therefore, we have hypothesized Selleckchem Opaganib that the combination of these two drugs in donor animals could have a synergetic effect to decrease necrosis and apoptosis. Male Wistar rats weighing 280–350 g were used for both organ donors and recipients of the kidney graft. Animals were submitted to a 12-h day/night

cycle with access to water and standard laboratory chow ad libitum. All animal experiments were performed according to guidelines set by the US National Institutes of Health (NIH publication no. 28, revised 1996). We used tacrolimus (Prograf, Gador, Bs As, Argentina), medical grade, donated by Gador Argentina, and rapamycin (Sirolimus, Wyeth, Bs As, Argentina), medical grade, donated by Wyeth Argentina. Donor rats were anaesthetized CHIR-99021 chemical structure with intraperitoneal (i.p.) atropine 0·01 mg/kg, buprenorphine 0·04 mg/kg, diazepam 10 mg/kg

and, 10 min later, with ketamine 100 mg/kg body weight. The donors’ blood vessels and ureter were fully separated. Subsequently, the kidney was flushed via the aorta with 3 ml of 4°C cold Ringer lactate solution until it turned homogeneously pale. The left kidney was then removed with its vascular and ureteral pedicle and stored for 180 ± 15 min in cold Ringer lactate solution at 4°C. Recipients animals were nephrectomized bilaterally and underwent transplantation as described elsewhere [31,32]. Briefly, after flushing grafts with 5 ml normal Ringer’s solution, arterial and venous anastomoses were performed as end-to-side anastomoses to the aorta and inferior vena cava, respectively. Finally, the anastomosis of the ureter with the urinary bladder was constructed. The rat’s body temperature

was monitored and kept constant between 35 and 37°C in all cases. Rats were allowed to recover on a warm blanket with free access to water and standard laboratory chow ad libitum. Twenty-four hours after the transplant procedure, blood samples were Quisqualic acid obtained for analysis, then animals were sacrified and kidneys were removed for histological evaluation. One dose of immunosuppressive drugs was administered to donor animals 12 h before nephrectomy. Doses and administration route were chosen according to previous reports [17]. Donor rats were divided randomly into four groups: Group 1 (control, n = 6): no immunosuppression was administered. Group 2 (rapa, n = 6): rapamycin (2 mg/kg, Sirolimus, Wyeth, Argentina) by gavage. Group 3 (FK506, n = 6): tacrolimus (0, 3 mg/kg, Prograf, Gador, Argentina) by gavage. Group 4 (rapa+ FK506, n = 6): tacrolimus (0, 3 mg/kg) + rapamycin (2 mg/kg) by gavage. None of the recipient animals received any immunosuppressive drug after transplantation. In addition, six rats underwent a sham procedure. Twenty-four hours before and after transplant the following blood determinations were performed: blood urea nitrogen (BUN), creatinine and C3 complement fraction (C3). C3 was measured by radial immunodiffusion and BUN and creatinine by ultraviolet kinetic and colorimetric-kinetic, respectively (Mindray 300).

g. pathogen infection, protein ligands, endotoxins, and so on) and the recruited leukocyte subtypes. Given

such heterogeneity, it is difficult to make conclusion about the involvement of transcellular vs. paracellular translocation. Further, the majority of in vivo reports of transcellular translocation have been shown using methods that are often unequivocal (e.g. scanning electron microscopy, transmission electron microscopy, or confocal fluorescence microscopy); however, it is important to note when discussing such reports that some have employed single-section transmission electron microscopy only, selleck inhibitor which cannot conclusively determine the route of translocation. It is noteworthy that some pathogens may choose the easiest way for BBB translocation. Pathogens and infected leukocytes may preferentially translocate using paracellular route during in vitro experiments owing to the fact that cell–cell junctions are not well formed and developed compared to their in vivo counterparts (Hoshi & Ushiki, 1999). Moreover,

in vivo experiments may also depend on the microenvironment of the brain and BMECs that seems to be responsible for the differentiation of the BBB phenotype and astrocytic end-feet cover (Kacem et al., 1998; Rubin & Staddon, 1999; Abbott, 2002), which may influence the route of pathogen translocation. Relatively small number of pathogens is responsible for bacterial meningitis. Group B streptococci (GBS), L. monocytogenes, and S. pneumoniae account for the most cases of neonatal and early childhood bacterial meningitis (Garges et al., 2006). Streptococcus pneumoniae, Kinase Inhibitor Library supplier N. meningitidis, and H. influenzae

type b remain the most common causes of meningitis (Hart & Thomson, 2006), while meningococcus and pneumococcus cause 95% of cases of acute bacterial meningitis in children. Sporadic cases related to E. coli, M. tuberculosis, B. burgdorferi, and T. pallidum continue to be important. Fungal meningitis caused by C. neoformans, C. albicans, and Histoplasma capsulatum; and parasitic cerebral infestations caused by Acanthamoeba, Plasmodium falciparum, Trypanosoma, and Toxoplasma gondii are sporadic types of meningitis, often 3-oxoacyl-(acyl-carrier-protein) reductase observed in patients with immune deficiency. Some GBS molecules, like fibrinogen-binding protein A (Tenenbaum et al., 2005), PilA, PilB (Maisey et al., 2007), laminin-binding protein (Tenenbaum et al., 2007), beta-hemolysin/cytolysin (Doran et al., 2003), serine-rich repeat-1 (van Sorge et al., 2009), and lipoteichoic acid (LTA) (Doran et al., 2005), mediate interaction of the pathogen with BMECs and penetration of the BBB. Many of these GBS ligands are known to bind ECM molecules such as fibronectin, fibrinogen, and laminin, which successively bind host-cell-surface proteins such as integrins. GBS ligands and their receptors on BMECs described earlier are depicted in Table 1.

In addition to standard microbiological culture, we examined explanted suture and tissue specimens using CM to determine whether bacterial Talazoparib purchase biofilms were present. Specimens were prepared as described previously (Kathju et al., 2009a, b). Briefly, suture

and tissue recovered at surgery were placed in Hanks balanced salt solution (HBSS) and placed on wet ice, directly after removal. After rinsing in the HBSS (to remove unattached bacteria) and blotting on sterile paper, specimens were mounted on the bottom of a 35-mm Petri plate on partially solidified agar (Kathju et al., 2009a, b). Specimens were stained for viability assessment using Molecular Probes BacLight Live/Dead kit (Molecular Probes, Eugene, OR). The BacLight kit consists of two nucleic acid stains, Syto9 (green), which enters all bacteria, and propidium iodide (red), which can only enter bacteria with porous cell walls. Once inside the bacteria, the propidium iodide suppresses the Syto9 fluorescence so that live bacteria appear green, whereas dead or damaged cells appear red. In some cases, bacteria stain with both dyes

and appear yellow – these have been interpreted as live, but nonculturable. The nuclei of human cells also take up these nucleic acid stains, but rapidly turn red. They are readily distinguished from bacteria on the basis of size and morphology. In addition, these stains have been used to stain extracellular bacterial DNA Phosphoprotein phosphatase (eDNA), which is commonly found in the EPS and appears as a diffuse staining click here surrounding the bacterial cells (Böckelmann et al., 2006; Thomas et al.,

2008). Fully hydrated specimens were then imaged by CM using a Leica DM RXE upright microscope attached to a TCS SP2 AOBS confocal system (Leica Microsystems, Exton, PA) using either a × 20 air objective or a × 63 long working distance water immersion objective. Live (green) and ‘dead’ (red) bacteria were imaged using 488 and 594 nm lasers; the suture and xenograft were imaged using reflected CM (blue) and bright-field microscopy (gray). Examination of one of the pieces of explanted Surgisis xenograft by CM showed heterogeneously distributed patches of live and dead bacteria and evidence of associated eDNA attached to the xenograft material (Fig. 2a). These organisms had a primarily coccal appearance, consistent with the solitary finding by culture of staphylococci. Interestingly, only one of the four specimens yielded a positive culture result, illustrating the inherent difficulty in detecting biofilm infections and making the case for multiple specimens to be sent for clinical culture, as well as the utility of using independent culture-free methods. Biofilms are commonly patchy on surfaces and this heterogeneity might partly explain the inconsistency in culture data. Examination of explanted suture material also showed evidence of attached and viable biofilm bacteria (Fig. 2c and d).