Purpose of Review: Interactions between microorganisms can alter subsequent disease outcomes. Human papilloma virus (HPV) and Chlamydia trachomatis (CT) establish human genital co-infections, and CT infection is a co-factor for HPV-induced cervical cancer. This review focuses upon (i) data indicating that clinically significant interactions occur and (ii) proposed mechanisms underlying these outcomes. Recent Findings: Epidemiological surveys indicate that (i) simultaneous HPV/CT genital co-infections are common; (ii) CT co-infection accelerates HPV-induced cytopathology; and (iii) HPV infection facilitates CT infection. Single-infection studies suggest specific molecular mechanisms by which co-infection alters clinical outcomes, including (i) HPV E6/E7 protein modification of host cell pathways enhances CT replication or immune evasion and (ii) CT-mediated host cell or neutrophil dysfunctions promote HPV-mediated neoplasia. Summary: There are multiple avenues for future dissection of HPV/CT interactions. Moreover, the known and potential health consequences of co-infection highlight the need for improving current HPV vaccines and developing an effective CT vaccine.

The secondary analysis undertaken for this MPH dissertation examines the global prevalence of trichiasis in relation to gender in trachoma endemic countries. Part A is the research protocol which outlines the background and the process of this research. This study is a population-based analytical study using data from the Global Trachoma Mapping Project (GTMP). GTMP was a standardized population-based trachoma prevalence survey undertaken to provide trachoma prevalence estimates. GTMP data was collected using the World Health Organisation–recommended population based prevalence survey methodology. Trachoma suspect district were identified for inclusion and multistage random sampling was used to sample households for examination of residents for clinical trachoma. Part B presents the background and highlights the importance of this research by exploring the existing theoretical and empirical literature relevant to the topic. It describes how trachoma is transmitted, its clinical manifestations, and the way it can lead to blindness. Results from previous studies on gender and trichiasis are presented. Part C presents the research project in a format suitable for journal submission. The background of this research project is summarized and the meta-analysis is conducted at the global level, at the country level, the regional level, the state level and at the EU level but all in accordance to prevalence of trichiasis in the EUs. The implications of the findings are discussed and limitations in interpretation presented.

Chlamydia trachomatis is a sexually transmitted disease, and its incidence has been increasing in recent years in the U.S. population. Certain demographic factors have been identified as posing an increased risk to acquire this disease. The purpose of this mixed-methods research was to examine how population demographics (quantitative section) and cultural and behavioral factors (qualitative section) affect risk for contracting chlamydia trachomatis in the Miami-Dade, Florida area. The theory of reasoned behavior was the theoretical framework of the study. The quantitative component used secondary data from Jackson Health System (2012- 2018) pertaining to 333 Miami-Dade young adult individuals with incidents of chlamydia trachomatis by gender, ethnicity, and race. For the qualitative component, 13 health care providers were interviewed using purposeful sampling, and the qualitative data were transcribed verbatim and analyzed thematically. Quantitatively, proportion of sample data was compared to national data using z statistics. Chlamydia cases were more often in the Black versus White group and Hispanics versus non-Hispanics group in Miami-Dade area compared to the similar national proportions (z=4.9, p<0.0001, and z=6.4, p<0.0001, respectively). Qualitatively, health care providers reported a significant lack of education and awareness on the infection, especially in young populations in the Miami-Dade area. Social change can be achieved by using findings of this research to develop more effective public health initiatives regarding the spread of chlamydia trachomatis in the Black and Hispanic population as well as with health care providers.

Chlamydia are obligate intracellular bacterial pathogens that are responsible for infectious blindness, sexually transmitted infections, and acute respiratory disease in humans. These pathogens undergo an essential biphasic developmental cycle differentiating between two functionally distinct forms known as the infectious elementary body (EB) and the replicative reticulate body (RB). Identifying the signals and regulatory mechanisms that enable Chlamydia to establish infection, differentiate between the two developmental forms, and survive within the host cell is critical to understanding chlamydial pathogenesis and developing future therapeutic strategies. In pathogenic bacteria, serine, threonine, and tyrosine (Ser/Thr/Tyr) protein kinases and phosphatases are critical for development, metabolism, and virulence. Chlamydia encode two validated protein kinases (pkn1 and pknd), a putative protein phosphatase (ctl0511; CppA), and appear capable of global phosphorylation that differs between the developmental forms. While these findings support a role for protein phosphorylation in chlamydial pathogenesis, a validated cognate protein phosphatase for Pkn1 and PknD mediating reversible phosphorylation was lacking. We hypothesized that CppA is the partner phosphatase for the chlamydial protein kinases, and in this study we validated and characterized CppA as a broad specificity protein phosphatase type 2C. Using in vivo and in vitro approaches we demonstrated that CppA acts on P-Ser/Thr/Tyr residues and can dephosphorylate multiple chlamydial protein substrates including PknD and the FHA 2 domain of CdsD, a component of the type 3 secretion apparatus. The importance of CppA for chlamydial growth and development was determined using a chemical “knock-out” approach and study of CppA missense mutations identified in slow growing C. trachomatis L2 chemical mutants. Treatment of C. trachomatis L2, C. trachomatis D, and C. muridarum with CppA inhibitors significantly reduced progeny levels and inclusion size in a time dependent manner with more significant growth inhibition in the first 12 hours post infection. Collectively, our findings support that CppA works in conjunction with PknD, and likely Pkn1, to mediate reversible phosphorylation of multiple protein substrates leading to changes in chlamydial physiology that appear to be key for early steps in development.

Indiana University-Purdue University Indianapolis (IUPUI) / Inflammation of the urethra—urethritis—is commonly diagnosed in men and women who have sexually transmitted infections (STI). Characteristic signs and symptoms of urethritis include urethral discharge and burning pain during urination (dysuria). However, these findings are non-specific and can be elicited by STI for which optimal treatment approaches differ. We wanted to investigate if immunoglobulins (antibodies) in the urine of men with acute urethritis could determine the etiologies of these cases. Previously, we conducted an observational case-control study of biological males to compare the urethral microbiota of participants with unambiguous, laboratory-confirmed urethritis (cases) and participants without urethral inflammation (controls). This revealed that nearly 2 in 5 men with nongonococcal urethritis tested negative for all common STI. We identified atypical urethral pathogens in approximately 1/3 of these STI-negative individuals using shotgun metagenomic sequencing. However, we did not detect microorganisms suspected to be urethral pathogens in the remaining 2/3 of STI-negative participants. We hypothesized that these men with “pathogen-negative” urethritis had persisting inflammation from a recent STI that already cleared spontaneously by the time of testing. We observed that urine IgA antibodies against Chlamydia trachomatis (Ctr) infectious particles were significantly more prevalent among men with pathogen-negative urethritis compared to controls. In contrast, we found that the prevalence of urine anti-Ctr IgA was similar between controls and urethritis cases with atypical infections. However, our efforts to detect antibodies against another common STI, Mycoplasma genitalium (Mgen), were complicated by low abundance in urine and the unexpected prevalence of Mgen-reactive antibodies among controls. Collectively, our results suggest that signs and symptoms of urethritis can continue after the causative STI(s) have been eliminated. Furthermore, male urine represents a practical, non-invasive source of pathogen-reactive antibodies that could be evaluated using point-of-care diagnostic tests to elucidate urethritis etiologies. Importantly, our results also suggest that sexual partners of men with pathogen-negative, nongonococcal urethritis are an unrecognized chlamydia reservoir. / 2024-05-22

Chlamydia trachomatis (Ct) is an obligate intracellular human pathogen. It causes blinding trachoma and sexually transmitted disease such as chlamydia, pelvic inflammatory disease and lymphogranuloma venereum. Ct has a unique biphasic development cycle and replicates in an intracellular vacuole called inclusion. Normally it has two forms: the infectious form, elementary body (EB); and the non-infectious form, reticulate body (RB). Ct is not easily amenable to genetic manipulation. Hence, to understand the infection process, it is crucial to study how the metabolic activity of Ct exactly evolves in the host cell and what roles of EB and RB play differentially in Ct metabolism during infection. In addition, Ct was found regularly coinfected with other pathogens in patients who got sexually transmitted diseases (STDs). A lack of powerful methods to culture Ct outside of the host cell makes the detailed molecular mechanisms of coinfection difficult to study. In this work, a genome-scale metabolic model with 321 metabolites and 277 reactions was first reconstructed by me to study Ct metabolic adaptation in the host cell during infection. This model was calculated to yield 84 extreme pathways, and metabolic flux strength was then modelled regarding 20hpi, 40hpi and later based on a published proteomics dataset. Activities of key enzymes involved in target pathways were further validated by RT-qPCR in both HeLa229 and HUVEC cell lines. This study suggests that Ct's major active pathways involve glycolysis, gluconeogenesis, glycerolphospholipid biosynthesis and pentose phosphate pathway, while Ct's incomplete tricarboxylic acid cycle and fatty acid biosynthesis are less active. EB is more activated in almost all these carbohydrate pathways than RB. Result suggests the survival of Ct generally requires a lot of acetyl-CoA from the host. Besides, both EB and RB can utilize folate biosynthesis to generate NAD(P)H but may use different pathways depending on the demands of ATP. When more ATP is available from both host cell and Ct itself, RB is more activated by utilizing energy providing chemicals generated by enzymes associated in the nucleic acid metabolism. The forming of folate also suggests large glutamate consumption, which is supposed to be converted from glutamine by the glutamine-fructose-6-phosphate transaminase (glmS) and CTP synthase (pyrG). Then, RNA sequencing (RNA-seq) data analysis was performed by me in a coinfection study. Metatranscriptome from patient RNA-seq data provides a realistic overview. Thirteen patient samples were collected and sequenced by our collaborators. Six male samples were obtained by urethral swab, and seven female samples were collected by cervicovaginal lavage. All the samples were Neisseria gonorrhoeae (GC) positive, and half of them had coinfection with Ct. HISAT2 and Stringtie were used for transcriptomic mapping and assembly respectively, and differential expression analysis by DESeq2, Ballgown and Cuffdiff2 are parallelly processed for comparison. Although the measured transcripts were not sufficient to assemble Ct's transcriptome, the differential expression of genes in both the host and GC were analyzed by comparing Ct positive group (Ct+) against Ct-uninfected group. The results show that in the Ct+ group, the host MHC class II immune response was highly induced. Ct infection is associated with the regulation of DNA methylation, DNA double-strand damage and ubiquitination. The analysis also shows Ct infection enhances host fatty acid beta oxidation, thereby inducing mROS, and the host responds to reduce ceramide production and glycolysis. The coinfection upregulates GC's own ion transporters and amino acid uptake, while it downregulates GC's restriction and modification systems. Meanwhile, GC has the nitrosative and oxidative stress response and also increases the ability for ferric uptake especially in the Ct+ group compared to Ct-uninfected group. In conclusion, methods in bioinformatics were used here in analyzing the metabolism of Ct itself, and the responses of the host and GC respectively in a coinfection study with and without Ct. These methods provide metabolic and metatranscriptomic details to study Ct metabolism during infection and Ct associated coinfection in the human microbiota. / Chlamydia trachomatis (Ct) ist ein obligater intrazellulärer Pathogen des Menschen. Er verursacht Trachoma und sexuell übertragbare Krankheiten, wie Chlamydiose, Unterleibsentzündung und Lymphogranuloma venereum. Ct besitzt einen biphasischen Entwicklungszyklus und vermehrt sich in intrazellulären Vakuolen, sogenannten Einschlusskörperchen. Normalerweise können zwei Formen beobachtete werden: Die infektiöse Form, Elementarkörperchen (EK); und die nicht-infektiöse Form, Retikularkörperchen (RK). Ct ist nicht einfach genetisch zu manipulieren. Um den Infektionsablauf besser zu verstehen, ist es wichtig, zu untersuchen, wie sich genau die metabolische Aktivität von Ct in der Wirtszelle entwickelt und welche Rolle EK und RK im Metabolismus von Ct während der Infektion spielen. Zusätzlich wurde Ct häufig bei Patienten mit sexuell übertragbaren Krankheiten (STD) in Co-Infektion mit anderen Erregern gefunden. Ein Mangel an leistungsfähigen Methoden zur Kultivierung von Ct außerhalb der Wirtszelle macht es schwierig die genauen molekularen Mechanismen von Co-Infektionen zu untersuchen. In dieser Arbeit wurde erstmals ein genomweites metabolisches Model mit 321 Metaboliten und 277 Reaktionen aufgebaut, um die metabolische Adaption von Ct in der Wirtzelle während der Infektion zu untersuchen. Dieses Model wurde erstellt und umfasst 84 „extreme pathways“ (Grenz-Stoffwechselwege). Darauf aufbauend wurde die metabolische Fluss-Stärke berechnet. Die Zeitpunkte 20 hpi (20 Stunden nach der Infektion), 40 hpi und die anschließende Infektionsphase wurden durch Nutzung von Proteom-Daten modelliert. Die Aktivitäten von Schlüsselenzymen, welche in wichtigen Stoffwechselwegen involviert sind, wurden zusätzlich durch RT-qPCR überprüft. Dabei wurden die Ergebnisse sowohl für HeLA229- als auch HUVEC-Zellen nachgemessen. Diese Untersuchungen zeigten, dass Ct’s wichtigste aktive Stoffwechselwege die Glykolyse, die Gluconeogenese und der Pentosephosphatweg sind, während der unvollständige Zitronensäurezyklus und die Fettsäuresynthese weniger aktiv sind. Gegenüber RK sind bei EK fast alle diese Kohlenhydratwege stärker aktiviert. Im Allgemeinen benötigt Ct eine größere Menge an Acetyl-CoA. Außerdem können sowohl EK, als auch RK die Folsäurebiosynthese nutzen, um NAD(P)H zu generieren. Dabei werden möglicherweise unterschiedliche Pathways genutzt, abhängig vom Bedarf an ATP. Sobald mehr ATP sowohl durch die Wirtszellen als auch von der Ct-Zelle selbst zur Verfügung steht, wird die Nutzung von Energieträgern, produziert durch Enzyme des Nukleinsäurestoffwechsels, in RK stärker aktiviert. Die Bildung von Folsäure lässt den Schluss zu, dass große Mengen von Glutamat umgesetzt werden, welches vermutlich aus der Umwandlung von Glutamin durch die Glutamine-fructose-6-phosphate-transaminase (glmS) und CTP-Syntase (pyrG) stammt. Anschließend wurde eine Analyse von RNA-Sequenzierungsdaten (RNA-seq) aus einer Co-Infektions-Studie (Chlamydien und andere Keime, insbesondere Gonokokken (GC)) durchgeführt. Dafür wurden Proben von dreizehn Patienten gesammelt und von Kollaborationspartnern sequenziert. Sechs Proben männlicher Patienten wurden durch Abstrich der Harnröhre und sieben Proben weiblicher Patientinnen durch cervicovaginale Lavage gewonnen. Alle Proben waren Neisseria gonorrhoeae (GC) positiv, wobei die Hälfte eine Co-Infektion mit Ct aufwies. Die Programme HISAT2 and Stringtie wurden zum Abbilden der transgenomischen Reads beziehungsweise zur Assemblierung des Genoms verwendet, und eine Analyse der differentiellen Expression wurde jeweils mit DESeq2, Ballgown und Cuffdiff2 durchgeführt und die Ergebnisse verglichen. Obwohl nicht ausreichend viele Transkripte von Ct gewonnen werden konnten, um das Transkriptom komplett assemblieren zu können, wurde die differentielle Expression der Gene sowohl von Wirt als auch von GC durch den Vergleich zwischen der Gruppe der Ct-positiven (Ct+) der Gruppe der Ct-unifizierten Patienten analysiert. Die Ergebnisse zeigten, dass in der (Ct+)-Gruppe die auf der MHC-Klasse-II basierte Immunantwort stark induziert war. Die Infektion von Ct ist mit der Regulation der DNA-Methylierung, DNA-Doppel-Strang-Schädigung und Ubiquitinierung verbunden. Die Analyse zeigte zusätzlich, dass die Infektion mit Ct die Fettsäure β-Oxidation des Wirts steigert, dadurch mROS induziert, und sowohl die Ceramid-Produktion als auch die Glycolyse reduziert. Die Co-Infektion reguliert GC’s eigene Eisentransporter und Aminosäureaufnahme hoch, während Restriktions- und Modifikationssysteme herunterreguliert werden. Gleichzeitig zeigt GC sowohl eine stickstoffsensitve Stress Antwort als auch eine oxidative. Dies verstärkt zusätzlich die Fähigkeit für die Aufnahme von Eisen, insbesondere in der (Ct+)-Gruppe. Zusammenfassend wurden Methoden der Bioinformatik genutzt, um den Metabolismus von Ct selbst, und die Antwort des Wirtes respektive GC‘s in einer Co-Infektionsstudie mit und ohne Ct zu analysieren. Diese Methoden lieferten wichtige metabolische und metatranskriptomische Details, um den Metabolismus von Ct während der Infektion, aber auch das Mikrobiom während einer Ct assoziierter Co-Infektion zu untersuchen.

No description available.

A Chlamydia trachomatis heat shock protein 60kDa (chsp60) exhibits increased expression in response to iron limitation. Genome sequencing revealed three genes encoding chsp60s. The objective of this study was to generate peptide antisera that would selectively recognize each chsp60. The DNA sequence for each C. trachomatis serovar E chsp60 was determined and compared with existing genome sequences. Predictive amino acid sequences were evaluated for peptides unique to each chsp60. Synthetic peptides were used to generate antisera; the resultant sera were purified by affinity chromatography and adsorbed to reduce cross-reactivity and increase monospecificity. Antisera were evaluated against each recombinant chsp60 protein by Western blotting. Reactivity against native chsp60s was visualized by transmission electron microscopy. Initial experiments indicate that expression of the second chsp60 (encoded by groEL_2) is increased during iron limitation. The production of chsp60 antibodies in human patients is associated with damaging sequelae in chlamydial genital and ocular infections.

Chlamydia trachomatis is an obligate intracellular bacterium and the most prevalent cause of bacterial sexually transmitted disease. Genital chlamydial infections, marked by chronic, intense inflammation, can lead to genital tissue scarring and infertility and is a contributing factor to development of pelvic inflammatory disease and ectopic pregnancy. Iron is required as a cofactor for numerous highly conserved pathways, and nearly all studied organisms rely on iron for growth. In response to iron restriction, the chlamydial developmental cycle arrests at the intracellular reticulate body stage, resulting in a phenomenon termed persistence. Persistence likely plays a role in chlamydial pathogenesis through the expression of virulence factors and antigens in addition to sustaining chronic infection; however, little is known concerning how chlamydiae respond to iron limitation at the molecular level, and no systems for iron acquisition have been identified in Chlamydia. This dissertation presents an investigation into the chlamydial response to iron restriction. Chlamydial heat shock protein 60 (cHsp60) has been implicated in development of the more severe disease sequelae and has been found to increase in expression following iron restriction; however, three cHsp60 homologues were identified following the sequencing of the chlamydial genome. Here, iron restriction is shown to increase expression of cHsp60-2 but not the two other homologs, cHsp60-1 or -3. Next, in order to investigate an alternate model for restricting iron availability to chlamydiae, a cell line with inducible expression of recombinant ferroportin, a eukaryotic iron efflux protein, was examined. Lastly, 10 chlamydial proteins differentially expressed during growth in iron-restricted host cells were identified by proteomic analysis of radiolabeled proteins followed by mass spectrometry analysis; transcripts encoding 5 iron responsive proteins were examined across a timecourse of infection and revealed increased transcript levels at 18 and/or 24 hours post infection. Together, these studies have examined the molecular response of chlamydiae to reduced iron availability and have underlined the importance for pathways involved in protection against oxidative damage and adaptation to stress.

When presented with certain unfavorable environmental conditions, C. trachomatis reticulate bodies (RBs) enter into a viable, yet noncultivable state called persistence. Two hallmarks of persistent chlamydiae are swollen, aberrantly shaped RBs, as viewed by transmission electron microscopy and a decrease in infectious progeny. Several models of chlamydial persistence have been described, including interferon-γ (IFN-γ), IFN-α, IFN-β, and tumor necrosis factor-α-exposure and nutrient deprivation. Previously, we established an in vitro co-infection model of two of the most common sexually transmitted pathogens in the United States, C. trachomatis and Herpes Simplex Virus-2 (HSV). Data from this tissue culture model indicate that: i) viral co-infection stimulates the formation of persistent chlamydiae and ii) productive HSV replication is not required for persistence induction. Further studies indicate that, co-infection-induced persistence is not mediated by: i) any known anti-chlamydial cytokine; ii) activation of inducible nitric oxide synthase or indoleamine 2, 3-dioxygenase; iii) inhibition of vesicular trafficking or sphingomyelin transport to the inclusion or; iv) amino acid, iron or glucose deprivation. These data demonstrate that co-infection-induced persistence is mediated by a previously undescribed, novel mechanism. During long-term co-infection with UV-inactivated HSV-2, chlamydiae recover following an initial suppression of chlamydial infectivity. These data indicate that HSV-induced persistence, like other persistence models, is reversible. Co-incubation of fixed, HSV-2-infected inducer cells with viable, C. trachomatis infected responder cells suppresses production of infectious chlamydial progeny and stimulates the formation of swollen, aberrantly shaped RBs. Antibody neutralization of HSV glycoprotein D (gD), which prevents viral attachment to one of four known HSV co-receptors on the host cell surface, also prevents co-infection-induced persistence, suggesting that HSV gD interaction with host cell surface receptors can provide the necessary stimulus to alter C. trachomatis development. Finally, exposure of C. trachomatis infected cells to soluble, recombinant HSV-2 gD:Fc fusion proteins decreases production of infectious EBs to a similar degree observed in co-infected cultures. Thus, we hypothesize that interaction of HSV gD with the host cell surface triggers a novel host anti-chlamydial pathway that restricts chlamydial development.