Long-term Stationary Phase Behavior of Streptococcus pyogenes Biofilms Department of Microbiology and Immunology Streptococcus pyogenes is the etiological agent of many human diseases ranging from mild superficial skin infections and pharyngitis to life-threatening necrotizing fasciitis. There can be several complications as a result of S. pyogenes infection including post-streptococcal glomerulonephritis and rheumatic fever, which leads to rheumatic heart disease. Despite the significant virulence associated with the pathogen, the bacteria can also persist asymptomatically in human host carriers. S. pyogenes is characterized by significant strain-to-strain variation with many single nucleotide polymorphisms and differences in genetic content of up to 33% of the genome. Active infection is associated with the rapid growth of the pathogen, whereas survival or carriage is associated with slow growth. Our laboratory has demonstrated that during survival in long-term stationary phase cultures and in eukaryotic cells, S. pyogenes diversifies into a mixed population. Isolates from this population show diversification in their proteome, in metabolism, and in virulence factor transcription patterns. These are stable, heritable changes with unique mutations in global gene regulators in some isolates, suggesting that an accumulation of genetic mutations leads to diversification. There are two proposed modes of survival in the human host; by taking residence intracellularly in host cells and as biofilms. Previous studies showed that isolates surviving within eukaryotic cells acquire heritable changes in metabolism and virulence factor expression. Biofilms are highly organized structures formed by many bacteria, which provide resiliency to harsh environmental conditions. It has been demonstrated that S. pyogenes form biofilms in vivo and in vitro, and up to 90% of clinical isolates can form biofilms. Considering the resiliency of biofilms, and the organized roles played by individual cells in biofilms, we hypothesized that biofilms may provide S. pyogenes with a niche for persistence and diversification. Despite the capacity for survival of planktonic cells, we have found that viable cells could not be isolated from static biofilms after 10 days. No metabolic variants were found among biofilm isolates prior to loss of biofilm viability. Biofilm structure was examined using confocal microscopy to image cells after LiveDead® staining. These experiments revealed that the biofilms lost viability rapidly, and also appeared to disperse. Dispersion of 2-day old biofilms could be induced with culture supernatants collected from 7-day old planktonic cells. Overall, the results of these studies suggest that secreted factors from late stationary phase cultures induce biofilm dispersion and biofilms do not serve as a niche for long-term survival and diversification of S. pyogenes. Therefore, S. pyogenes biofilms may be more critical for initial colonization of the oropharynx. These studies may provide a valuable insight to the role of biofilms in S. pyogenes infections. / Microbiology and Immunology

Streptococcus pyogenes is a human-specific pathogen that can cause a wide variety of diseases. These diseases range from the relatively mild pharyngitis and impetigo to invasive diseases such as necrotizing fasciitis to post-streptococcal sequelae such as rheumatic heart disease. The bacteria are frequently carried asymptomatically and may cause recurrent disease. Corresponding with their etiologic variation amongst diseases, clinical isolates demonstrate diverse virulence factor expression and random genetic mutations. In these studies, we examine the role of intracellular residence during survival as a niche for the diversification of S. pyogenes. Survival was previously studied using two in vitro systems: long-term stationary phase survival in culture and survival within epithelial cells in the presence of extracellular antibiotics. The surviving populations diversified, giving rise to stable strains with alternate colony morphologies, distinct proteomes, and altered metabolic properties. Further analysis in these studies showed that alterations in colony morphology were not solely observed during survival, but could also be induced in models mimicking acute infection. However, diversification in certain metabolic pathways occurred only during survival, and this metabolic diversification was observed at the transcriptional level. Further, one of three clinical isolates from patients with recurrent pharyngitis was altered in its metabolic profile, suggesting metabolic diversification may be occurring in vivo. The survivor strains had varied transcriptional changes in the genes encoding the virulence factors emm, slo, and speB. All of the stationary phase-derived survivor strains and two intracellular survival-derived strains had attenuated virulence in zebrafish. Most of the attenuated strains disseminated to the spleen and were cleared within three days. A whole blood killing assay showed a strong correlation between bacterial killing and emm expression. While the diversification appeared random, these strains retained their multilocus sequence type (MLST). These results suggest S. pyogenes strains with the same MLST, but diverse virulence properties, may arise during survival in the host. / Microbiology and Immunology

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2006. / Titre provenant de l'écran-titre. Bibliogr. f. 66-69.

Les Streptocoques Béta-hémolytiques du groupe A (GAS) sont responsables de manifestations cliniques variées et de séquelles non suppuratives comme notamment le rhumatisme articulaire aigu (RAA). Les affections sévères à GAS tuent plus de 500.000 personnes chaque année. Le pouvoir pathogène du GAS est encore mal compris. Il semble être notamment lié à la présence de nombreux gènes codant pour des facteurs de virulence dans le génome du GAS, dont celui codant la protéine emm. La protéine transmembranaire M joue un rôle essentiel dans la virulence du GAS. Le typage moléculaire des GAS se base sur la séquence de la partie hypervariable de ce gène (emm-typing). L’épidémiologie du GAS semble varier au cours du temps et en fonction de la localisation géographique et/ou du contexte socio-économique. Cependant, les différences dans les critères d’inclusion des différentes études épidémiologiques disponibles dans la littérature rendent les comparaisons difficiles. <p>Pour mieux évaluer ces variations, nous avons mené une analyse prospective de l’épidémiologie clinique et moléculaire d’isolats de GAS provenant d’enfants présentant une infection à GAS, simultanément en deux localisations géographiques différentes (Bruxelles et Brasília, Brésil).<p>Un des points importants de notre étude a été la mise en évidence de la diversité génétique de la protéine M des isolats belges et brésiliens. Alors que de nombreux emm-types différents sont retrouvés à Brasília (48 emm-types sur 128 isolats), ceux retrouvés à Bruxelles sont relativement peu nombreux (20 emm-types sur 200 isolats) et sont ceux communément retrouvés dans les pays industrialisés. Afin de mieux comprendre les bases moléculaires de cette différence, une analyse phylogénétique basée sur la quasi-totalité de la séquence de la protéine M exposée à la surface de la bactérie a été réalisée. Cette analyse a permis de montrer que les emm-types belges sont génétiquement éloignés les uns des autres alors que les emm-types brésiliens sont génétiquement plus proches. De manière intéressante, cette analyse a montré que les souches belges présentent une grande diversité au niveau de la région de la protéine M dite ‘constante’. En conséquence, la diversité génétique globale des protéines M belges et brésiliennes est similaire, mais elle se situe dans des régions différentes de la protéine M, ce qui pourrait indiquer l’existence de pressions de sélection différentes entre les deux pays. D’un point de vue vaccinal, ces résultats indiquent qu’un vaccin dirigé contre certaines des parties constantes de M présenterait une bonne couverture théorique dans les deux pays. Par contre, le vaccin 26-valent, en cours d’évaluation clinique, aurait une couverture théorique de 76% à Bruxelles et de 32% à Brasília. <p>Notre analyse phylogénétique a également permis de montrer que la non-sensibilité à la ciprofloxacine (observée dans 22,5 % et 9% des souches belges et brésiliennes respectivement) survient dans des souches génétiquement éloignées, contrairement à ce qui est proposé actuellement dans la littérature. De plus, nous avons mis en évidence un polymorphisme au sein des gènes codant les topoisomérases cibles de la ciprofloxacine. L’identification de mutations responsables du phénotype de non-sensibilité nécessite par conséquent une confirmation expérimentale.<p>Les manifestations cliniques sont assez différentes entre Bruxelles et Brasília. Les infections cutanées sont beaucoup plus fréquentes à Brasília. De manière intéressante au Brésil, des souches de GAS présentant un tropisme cutané sont isolées du pharynx. Ces souches ‘cutanées’ pourraient avoir acquis des déterminants génétiques leur permettant de se développer dans des tissus pharyngés. De plus, ces résultats pourraient remettre en question le postulat que seules les souches de tropisme pharyngé sont impliquées dans le développement du RAA. D’autres études épidémiologiques dans des pays où le RAA est endémique devront être réalisées afin de préciser nos résultats et de mieux comprendre les mécanismes moléculaires menant au développement du RAA.<p>Cependant, étant donné la prévalence du RAA et l’accès limité au diagnostic microbiologique des pharyngites dans le réseau public de soins au Brésil, nous avons développé un score clinique permettant de limiter les traitements antibiotiques chez les enfants probablement atteints de pharyngites virales. L’utilisation de ce score permettrait de réduire le nombre de prescriptions antibiotiques dans les pharyngites de l’enfant de 41 à 55% à Brasília.<p>Le choc toxi-infectieux est une pathologie relativement rare et le RAA n’est quasi plus décrit dans les pays développés. Cependant, deux nourrissons ont présenté un choc toxi-infectieux suivi d’un RAA (HUDERF, Bruxelles). A notre connaissance, cette association clinique n’a jamais été décrite. L’analyse de ces deux cas du point de vue de la virulence bactérienne a révélé la présence de nombreux gènes de facteurs de virulence, portés par des phages et différents dans les deux souches. Nos résultats illustrent la complexité de la relation hôte-pathogène. <p>La capacité des bactéries à s’adapter à leurs hôtes et à causer des pathologies dépend de nombreux facteurs, qui varient d’un isolat à l’autre, et dont l’importance varie d’un hôte à l’autre. Notre travail a permis d’exemplifier la diversité génétique des GAS, aussi bien au niveau du gène emm qu’au niveau des facteurs de virulence, et de l’implication de ceux-ci dans le développement de pathologies streptococciques rares. <p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Escolar de once años con cuadro inicial de monoartritis de rodilla derecha por traumatismo local, fi ebre, trastorno del sensorio y disnea. Es hospitalizado y recibe tratamiento antibiótico empírico. El hemocultivo resulta positivo para Streptococcus pyogenes, por lo que se decide corregir la cobertura antibiótica. Sin embargo, el estado general del paciente empieza a decaer e ingresa a la unidad de cuidados intensivos. A pesar del tratamiento instaurado, el sujeto desarrolla shock séptico y posteriormente falla multiorgánica, requiriendo soporte hemodinámico y ventilatorio. Los síntomas se agravan y fallece a las 38 horas de su admisión hospitalaria. / An 11-year-old scholar arrives in the emergency room with right-knee monoarthritis due to local trauma, fever, sensory loss, and dyspnea. He is hospitalized and receives empiric antibiotic therapy. The blood culture set is positive for Streptococcus pyogenes and the antibiotic spectrum is changed. However, the patient’s general status deteriorates, and he is admitted to the intensive care unit. Even with the treatment received, he develops septic shock and multiorganic failure, requiring hemodynamic and ventilatory support. Thirty-eight hours after his admission, the patient dies.

The upper respiratory tract (URT) of humans is complex and interconnected region and comprises several major ecosystems including the oral cavity, oropharynx, nasal cavity, sinuses, nasopharynx and middle ear. Most of the anatomical locations within the URT are colonised with a normal bacterial microbiota, within which are often organisms having the potential to cause disease. The diseases of the URT are both varied and frequent in their occurrence, and conditions such as otitis media, rhinosinusitis and pharyngitis are sources of morbidity and mortality in adults and children in both developing and developed countries. The study of diseases of the URT has traditionally been based on application of culture-based methods in which the infection-implicated organisms are first grown in vitro and then studied further. Ongoing advances in DNA-based techniques have led to the development of new molecular tools for the study of infectious diseases. One such technique is PCR-denaturing gradient gel electrophoresis (PCR-DGGE). This is a PCR-based tool that allows the investigation of microbial communities independent of culture. Although this technique has been applied extensively in the study of the gastrointestinal tract, the vagina and endodontic infections in humans, there have been few reports of its application to URT infections. PCR-DGGE was applied in the present study to investigate (a) the bacteria present in the middle ear of children suffering from otitis media with effusion (OME), (b) the microbiota associated with the sinuses in patients with chronic rhinosinusitis (CRS) and (c) perioperative changes in the bacterial population of the middle meatus of patients undergoing nasal or sinus surgery. The analysis of the middle ear fluid samples indicated an increased role in OME for the newly-discovered pathogen Alloiococcus otitidis and also the possible involvement of certain coryneform bacteria and coagulase-negative staphylococci in the aetiology of this condition. PCR-DGGE analysis of patients with CRS revealed a polymicrobial disease with considerable variability in the predominant species detected when multiple, serial samples were evaluated. The perioperative audit showed that when good clinical practice is adhered to, there was no apparent introduction of potentially-harmful organisms into the middle meatus. Streptococcus salivarius is a common, commensal inhabitant of the oral cavity of humans and has also been shown to inhabit the nasopharynx of infants. S. salivarius is also a well known producer of bacteriocins with activity directed against Streptococcus pyogenes. One such strain, S. salivarius K12, is now marketed in New Zealand as the probiotic, K12 Throat Guard[TM]. In the present study, S. salivarius K12 was compared with two additional strongly-inhibitory S. salivarius (strains T18A and T30A) for activity against the common causative pathogens of otitis media. A paediatric formulation of strain K12 was also tested in a pilot clinical trial for its ability to colonise the URT of young children. Although the levels of colonisation of these subjects was not as high as typically obtained with use of the K12 Throat Guard[TM] formulation, it was considered that further development of the paediatric formulation is warranted, particularly with respect to use of a different pre-treatment regimen. In other studies, the molecular basis for the unusual in vitro inhibitory activity of S. salivarius strain T30A was investigated. Although this still remains unresolved, other observations made during the course of this study have led to the introduction of a schema for the division of inhibitory S. salivarius into three groups based on (a) their sensitivity to the lantibiotic salivaricin A and (b) the structure of their salivaricin A genetic locus. This grouping is analogous to the "rock-paper-scissors" system previously described for colicin-producing strains of E. coli. Streptococcus pneumoniae is a major human pathogen responsible for a variety of diseases in humans. There have been very few reports of bacteriocin production by S. pneumoniae when compared to other streptococcal species. In the present study a putative cluster of bacteriocins encoded by the blp locus has been investigated. The distribution of the individual blp determinants within this locus was evaluated in a collection of S. pneumoniae strains using PCR. The blp genes were detected in 92% of 57 tested strains and a variant form (termed the B-form) of the cluster was identified that appeared to have arisen due to a genetic recombination event. In this case an approximately 250 bp portion of the blpMNO cluster appears to have recombined into blpK of the blpIJK cluster. Attempts were made to express the putative bacteriocin peptide genes in an Escherichia coli expression system. Failure to achieve expression was taken to indicate that these bacteriocin-like peptides may be toxic for the host producer cells under these test conditions. Future attempts to achieve expression of the Blp peptides, could explore the use of different fusion proteins, a Gram-positive expression host or a cell-free protein expression system.

The bacterium Streptococcus pyogenes requires heme, which is taken up via an ABC transporter. An understanding of this pathway may result in new approaches to antibacterial agents. Both SiaA and NEAT2 (NEAr Transporter 2) are proteins involved in heme binding. One of the axial ligands of SiaA, His 229, was purified to study how mutagenesis affects heme binding. UV-visible studies showed a small band at 420 nm with respect to the protein band at 288 nm which probably indicates that heme was lost easily from this mutant. We have also worked to optimize the yield of Shr-NEAT2 by changing different variables. For each of the batches, the yield of holoNEAT2 was calculated by UV-visible spectroscopy. Increasing oxygen during growth did not improve holoNEAT2 yield. On the other hand, lower temperature, decrease in time after induction, and addition of ALA all increased the protein production.

Group A streptococcus (GAS) is an important pathogen that produces a wide spectrum of suppurative infections and autoimmune sequelae in humans, ranging from less complex pharyngitis, impedigo to more severe manifestations such as necrotizing fasciitis, toxic shock syndrome, rheumatic fever and glomerulonephritis. The worldwide burden of GAS infections and sequelae is considerable, but an immunization program that defends against the hyper-variable GAS is missing. The streptococcal hemoprotein receptor (Shr), is an iron-regulated protein involved in heme acquisition. An unspecified region in the amino terminus of Shr mediates the interactions with hemoglobin and two protein modules named NEAT1 and NEAT2 bind heme. In this study, we analyzed the molecular structure and function of Shr, investigated its antigenic properties and role in GAS disease production. We demonstrated that Shr is a new type of GAS adhesin that contributes to the pathogen interactions with extracellular matrix (ECM) proteins. Shr enabled bacterial adherence to host cells and was important for GAS virulence in vivo. Immunizations with Shr protein by intraperitoneal or intranasal administration conferred resistance to systemic GAS challenge in mice. Shr antiserum allowed bacterial opsonization and defended against GAS diseases in a murine model for passive vaccination. Studies with isolated Shr domains localized ECM-binding to the NEAT domains and showed that most of the protein is exposed on the bacterial surface. In addition, Shr N-terminal region and both of the NEAT modules elicited strong antibody response in rabbits. In conclusion, Shr is a protective antigen that contributes to GAS pathogenesis by facilitating both heme uptake and bacterial adherence. Since Shr is conserved among GAS strains and other pyogenic streptococci, this study demonstrates that Shr may be used to develop a vaccine against GAS strains and related pathogens.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成23年3月25日 亀ヶ谷太一氏の博士論文として提出された

The protein SiaA (Streptococcal iron acquisition) is involved in heme uptake in the bacterium Streptococcus pyogenes. It is difficult to obtain this protein in its fully holo form (completely loaded with heme). To increase the concentration of heme in the growing cell, we added ä-aminolevulinic acid (ALA) and ferrous sulfate (FeSO4), precursors of heme, to the growth media. Neither increasing the concentration of heme in vivo, nor growth at lower temperature for longer times, increased the production of holoprotein. The classical method of measuring the concentration of heme in a newly discovered heme protein is cumbersome. We have developed an improved method, which gives a solution that is more stable and has a cleaner spectrum. With further development, this new technique may replace the classical assay. Background information on S. pyogenes, SiaA, ABC transporters, heme biosynthesis, and the pyridine hemochrome assay are described.