1/THREAD
Have you ever wondered why Pseudomonas aeruginosa smells like grapes 🍇?

The answer relates to the ability of Pseudomonas to cause chronic airway infections and also coincidentally explains certain spoiled wine flavors.

#medtwitter #tweetorial
2/
Pseudomonas was first isolated in 1882 by the French pharmacist Carle Gessard, after he cultured it from the blue-green pus on bandages of injured soldiers.

academic.oup.com/cid/article/6/…
3/
It was widely observed that Pseudomonas aeruginosa produces a grape-like smell when growing in cultures or on wounds.

By the 1970s, microbiologists even used this characteristic odor to preliminarily identify Pseudomonas on agar plates.

ncbi.nlm.nih.gov/pmc/articles/P…
4/
The chemical source of Pseudomonas' grape-like smell was identified by Mann in 1966.

He isolated a compound with a grape-ish odor from 20-day-old plate cultures of P. aeruginosa using thin layer chromatography.

link.springer.com/article/10.100…
5/
Mann discovered that the source of Pseudomonas' odor is a volatile organic compound called 2-aminoacetophenone (2-AA).

2-AA is a metabolite produced by the bacterium from the tryptophan catabolic pathway and, for whatever reason, smells like grapes.

pubmed.ncbi.nlm.nih.gov/25960261/
6/
2-AA has even been studied as a potential biomarker for Pseudomonal airway colonization/infection in cystic fibrosis (CF) patients.

A breath test detecting exhaled 2-AA was 94% sensitive and 69% specific for airway Pseudomonas in a CF cohort.

pubmed.ncbi.nlm.nih.gov/21054900/
7/
It isn't totally clear whether 2-AA plays a part in the ability of Pseudomonas to be a human pathogen, or if 2-AA is simply a grape-scented metabolite.

But there is evidence that it might contribute to Pseudomonas' ability to cause chronic pulmonary airway infections.
8/
First, 2-AA may actually inhibit the immune response to Pseudomonal infection, allowing it to chronically colonize the airway.

Pre-treatment with 2-AA in mice infected with Pseudomonas led to decreased inflammatory cytokine responses.

pubmed.ncbi.nlm.nih.gov/23166496/
9/
Even more strikingly:

In animal models 2-AA has been shown to modulate genetic expression in Pseudomonas in a way that favors persistent infection (decreased virulence and a longer lifespan).

pubmed.ncbi.nlm.nih.gov/21829370/
10/
2-AA's role in chronic Pseudomonal infection is still being worked out.

The current model:
🦠2-AA is released and accumulates in airway biofilms 🦠 This modulates immune response and genetic expression, allowing for chronic infection

pubmed.ncbi.nlm.nih.gov/21829370/
11/
Let's conclude with a cool (and surprising) viticultural correlate.

It turns out that 2-Aminoacetophenone (2-AA) is one source of spoiled wine flavor, as an unwanted post-fermentation metabolite from grapes, especially in white wines.

sciencedirect.com/science/articl…
12/
Wine spoiled by 2-AA has the flavor of "acacia blossom, naphthalene note, furniture polish, fusel alcohol, damp cloth...".

This seems to be a more of a concern for vintners, as they will reject wine spoiled by 2-AA before sending to consumers.

pubmed.ncbi.nlm.nih.gov/17014858/
13/SUMMARY
🍇The characteristic grape odor from Pseudomonas aeruginosa results from 2-aminoacetophenone (2-AA)
🍇2-AA ⬇️ immune responses and ⬆️ the lifespan of Pseudomonas, possibly contributing to chronic airway infection
🍇2-AA also is a source of spoiled white wine flavor

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More from @AvrahamCooperMD

Sep 18
1/THREAD
Why would adenosine, a purine nucleoside, be able to treat supraventricular tachycardias (SVT)?

And why are its effects so short lived (e.g. <2 seconds)?

The answers will change the way you think about this drug.

#tweetorial #medtwitter
2/
Adenosine is an endogenous purine nucleoside that gets incorporated into RNA, ATP, and cAMP.

It has pleomorphic effects as a signaling molecule via A1, A2A, A2B, and A3 receptors.

pubmed.ncbi.nlm.nih.gov/25687993/
3/
Adenosine was first found to be able to terminate supraventricular tachycardias (SVT) in 1927 in animal experiments.

💡It's mechanism of action was unknown.

pubmed.ncbi.nlm.nih.gov/16994064/
Read 16 tweets
Aug 14
1/🧵
Why is a ketogenic diet a potentially effective treatment for refractory epilepsy?

There's something almost magical about the idea that a specific type of diet could reduce the risk of epileptic seizures.

Let's explore why that might be.

#medtwitter #tweetorial
2/
First let's define a ketogenic diet.

Ketogenic diets have ⬆️ fat and ⬇️ carbohydrates. This leads to ⬆️ serum free fatty acids and ketone body production by the liver (acetoacetate, acetone, beta-hydroxybutyrate) for use as cellular fuel.

pubmed.ncbi.nlm.nih.gov/17241207/
3/
Ketogenic diets induce a pseudostarvation state, as carbohydrates = typical primary cellular fuel.

In the 1900s it was noted that fasting helped control epileptic seizures.

By 1921, RM Wilder proposed that ketogenic diets might replicate this effect.

neslazeno.cz/wilder-1921-th…
Read 19 tweets
Jul 3
1/🧵
Ever wonder why tick bites can lead to a red meat allergy, including even anaphylaxis?

The answer requires us to examine sugars, tick saliva, and an anti-cancer drug.

#medtwitter #tweetorial
2/
The first inclination that a link b/w tick bites and meat allergy might exist occurred in Georgia in 1991.

10 cases were reported (but not published) of people developing hives or anaphylaxis w/ red meat ingestion, weeks to months after tick bites.

pubmed.ncbi.nlm.nih.gov/25747720/
3/
A 2009 case series described 25 patients who developed red meat allergies 1-6 months after tick bites. Reactions to meat again ranged from urticaria to full anaphylaxis.

🔑There seemed to be a clear association b/w tick bites and meat allergy onset.

pubmed.ncbi.nlm.nih.gov/19413526/
Read 19 tweets
May 29
1/ 🧵
Clostridioides difficile (C. Diff) colitis is exceedingly rare in infants, almost as if they're protected from it.

But why would infants somehow be resistant to C. diff infection?

#medtwitter #tweetorial
2/
C.Diff was first isolated from 4 healthy newborn babies in 1935 by Hall and O'Toole.

💡The babies were all asymptomatic, but inoculation of this newfound bacteria in animals caused severe colitis.

They called this new strain Bacillus Difficilis.

jamanetwork.com/journals/jamap…
3/
Not until 1978 was the association made between antibiotic-associated colitis and C.Diff, after its isolation from a patient w/ post-clindamycin colitis.

The authors noted that a toxin was crucial for virulence of the bacteria.

pubmed.ncbi.nlm.nih.gov/85818/
Read 17 tweets
Apr 10
1/🧵
Ever wonder why rheumatic heart disease almost always damages heart valves?

And why is the mitral valve by far the most commonly affected?

The answer involves a case of mistaken identity.

#medtwitter #tweetorial Image
2/
The association between "rheumatism" and heart disease was first noted in the the late 1700s.

By 1832, the British physician James Hope observed that rheumatic heart disease (RHD) patients had valvular involvement, w/ loud cardiac murmurs on exam.

dp.la/item/29f298168… ImageImage
3/
By the first half of the 20th century, an association b/w acute rheumatic fever from streptococcal infection and eventual mitral stenosis was made.

This case series from 1951 followed 1,000 patients w/ rheumatic fever over 20 years. 653 had RHD.

pubmed.ncbi.nlm.nih.gov/14879491/ Image
Read 16 tweets
Feb 20
1/🧵
Ever wonder why corticosteroids like dexamethasone treat cerebral edema related to brain tumors?

I assumed the answer involved "anti-inflammatory effects", but there's much more going on.

#medtwitter #tweetorial
2/
The anti-edema effects of corticosteroids were first noted in 1955, when neurosurgeons gave cortisone perioperatively prior to craniopharyngioma resection.

⚡️The authors observed improved postoperative outcomes in the patients who received cortisone.

pubmed.ncbi.nlm.nih.gov/13272046/
3/
A 1961 case series (14 patients, various types of brain tumors) further described clinical effects after steroid treatment.

Dexamethasone improved signs of intracranial pressure elevation and neurological status in most patients, within 48 hours.

pubmed.ncbi.nlm.nih.gov/13703072/
Read 16 tweets

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