Global gene expression profiling of the asymptomatic bacteriuria Escherichia coli strain 83972 in the human urinary tract

Urinary tract infections (UTIs) are an important health problem worldwide, with many million cases each year. Escherichia coli is the most common organism causing UTIs in humans. The asymptomatic bacteriuria E. coli strain 83972 is an excellent colonizer of the human urinary tract, where it causes long-term bladder colonization. The strain has been used for prophylactic purposes in patients prone to more severe and recurrent UTIs. For this study, we used DNA microarrays to monitor the expression profile of strain 83972 in the human urinary tract. Significant differences in expression levels were seen between the in vivo expression profiles of strain 83972 in three patients and the corresponding in vitro expression profiles in lab medium and human urine. The data revealed an in vivo lifestyle of microaerobic growth with respiration of nitrate coupled to degradation of sugar acids and amino acids, with no signs of attachment to host tissues. Interestingly, genes involved in NO protection and metabolism showed significant up-regulation in the patients. This is one of the first studies to address bacterial whole-genome expression in humans and the first study to investigate global gene expression of an E. coli strain in the human urinary tract.     

Molecular characterization of the Escherichia coli asymptomatic bacteriuria strain 83972: the taming of a pathogen

Escherichia coli 83972 is a clinical asymptomatia bacteriuric isolate that is able to colonize the human urinary bladder without inducing an immune response. Here we demonstrate that one of the mechanisms by which this strain has become attenuated is through the mutation of its genes encoding type 1 and P fimbriae.     

P-antigen-recognizing fimbriae from human uropathogenic Escherichia coli strains.

P-antigen-recognizing fimbriae (P fimbriae) from four pyelonephritogenic Escherichia coli strains and type 1 fimbriae from an E. coli strain and a Salmonella typhimurium strain were purified. The P fimbriae were morphologically similar to type 1 fimbriae. The purified P fimbriae agglutinated neuraminidase-treated human P1 and P2k erythrocytes but not p erythrocytes, which lack all P-blood group-specific glycosphingolipids. However, coating of neuraminidase-treated p erythrocytes with globoside rendered such erythrocytes agglutinable by the P fimbriae. The hemagglutinations were in all instances fully inhibited by the synthetic alpha-D-Galp-(1-4)-beta-D-Galp-1-O-Me glycoside. The binding specificity of the P fimbriae could also be demonstrated by using fimbriae coated onto latex particles and nontreated erythrocytes. It was thus concluded that the P fimbriae recognize and bind to the alpha-D-Galp-(1-4)-beta-D-Galp carbohydrate sequence occurring in the series of P-blood group antigen-specific glycosphingolipids. In contrast to both type 1 fimbriae, all four P fimbriae preparations showed multiple bands in sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Antisera were raised in rabbits against the various E. coli fimbriae. In enzyme-linked immunosorbent assays each one of the antisera to the P fimbriae reacted to titers of log 4 to 7 with both the homologous and the heterologous P fimbriae, but not with the type 1 fimbriae of E. coli. In a reciprocal fashion, the antiserum to the type 1 fimbriae of one E. coli strain reacted only with the homologous type 1 but not with any of the P fimbriae preparations.     

Virulence potential of Escherichia coli strains causing asymptomatic bacteriuria during pregnancy

We compared the virulence properties of a collection of asymptomatic bacteriuria (ABU) Escherichia coli strains to urinary tract infection (UTI) strains isolated from pregnant women in a university hospital over 1 year. The in vitro and in vivo studies suggest that ABU strains presented a virulence behavior similar to that of strains isolated from cases of cystitis.     

Interaction of human serum and neutrophils with Escherichia coli strains: differences between strains isolated from urine of patients with pyelonephritis or asymptomatic bacteriuria.

Strains of Escherichia coli isolated from the urine of children with pyelonephritis (n = 18) or asymptomatic bacteriuria (ABU) (n = 20) were serotyped and compared with respect to opsonic requirements, sensitivity to serum, amount of chemiluminescence produced by normal neutrophils during phagocytosis of the various strains, and amount of capsular antigen. Strains isolated from cases of ABU more often had the capacity to activate the alternative complement pathway than had strains causing pyelonephritis. The ABU strains were also better opsonized in fresh human serum and were more often serum sensitive than the pyelonephritic strains. There were individual variations in neutrophil chemiluminescence during phagocytosis of the various strains, but the two groups of strains did not differ significantly. The strains from pyelonephritis cases produced a greater amount of capsular antigens than the ABU strains. There was no correlation between presence of a particular O or K antigen and capacity to activate the alternative complement pathway. The observed differences between strains isolated from patients with ABU and those isolated from patients with pyelonephritis may be relevant for further studies on differences in bacterial virulence or host defense factors.     

Nutritional requirements for growth of uropathogenic Escherichia coli in human urine.

Enrichment with D-cycloserine was used to identify Escherichia coli auxotrophic mutants that exhibited limited growth in human urine. Bacterial synthesis of guanine, arginine, and glutamine was found to be required for optimal growth in urine. Mutants that required leucine, methionine, serine, phenylalanine, or proline also exhibited reduced growth in urine. Several other nutritional mutants, including nicotinamide auxotrophs, which are found frequently among cystitis isolates, exhibited normal growth in urine.     

P-fimbriated clones among uropathogenic Escherichia coli strains.

A total of 237 Escherichia coli strains isolated from the urine of patients with various forms of urinary tract infection or from feces of healthy children were analyzed for O group, possession of K1 capsule, type 1 fimbriae, P fimbriae, X adhesin, and production of hemolysin. Some of the strains were also analyzed for K and H antigens, outer membrane protein pattern, and plasmid content. P fimbriation, hemolysin production, and certain O groups were found to be significantly correlated with pyelonephritogenicity. Possession of type 1 fimbriae or of K1 capsule or plasmid content did not significantly correlate with virulence. Outer membrane protein patterns in 139 strains of the more common O groups were analyzed. Only one to three patterns, which varied between serotypes, were usually found within any one O group. Distinctive groups (clones) were found when the strains were grouped according to complete serotype, fimbriation, hemolysin production, and outer membrane protein pattern; also, the mean number of plasmids was typical of the strains in a given clone. Seven clones associated with pyelonephritis were found; together they accounted for 57% of the O serotypable strains from the pyelonephritis patients. The seven clones were P fimbriated but differed in their serotypes as follows: O1:K1:H7, O4:K12:H1, O4:K12:H5, O6:K2:H1, O16:K1:H6, or O18ac:K5:H7. All O1:K1:H7 strains observed fell into two clones according to the presence or absence of type 1 fimbriae and hemolysin production. One clone associated with cystitis was also found; this consisted of O6:K13:H1 strains lacking P fimbriae. Not a single representative of these eight clones was found among the fecal strains from the healthy children. They are proposed to represent virulent clones with special ability to cause human urinary tract infection.     

Virulence properties of asymptomatic bacteriuria Escherichia coli

In asymptomatic bacteriuria (ABU), bacteria colonize the urinary tract without provoking symptoms. Here, we compared the virulence properties of a collection of ABU Escherichia coli strains to cystitis and pyelonephritis strains. Specific urinary tract infection (UTI)-associated virulence genes, hemagglutination characteristics, siderophore production, hemolysis, biofilm formation, and the ability of strains to adhere to and induce cytokine responses in epithelial cells were analyzed. ABU strains were phylogenetically related to strains that cause symptomatic UTI. However, the virulence properties of the ABU strains were variable and dependent on a combination of genotypic and phenotypic factors. Most ABU strains adhered poorly to epithelial cells; however, we also identified a subgroup of strongly adherent strains that were unable to stimulate an epithelial cell IL-6 cytokine response. Poor immune activation may represent one mechanism whereby ABU E. coli evade immune detection after the establishment of bacteriuria.     

Growth of uropathogenic Escherichia coli strains at solid surfaces.

The adhesion and growth of two catheter-associated (O2K2 and O83K?) and two non catheter-associated (O111K58 and O157K-) uropathogenic Escherichia coli strains on glass, poly(methyl methacrylate) (PMMA), a negatively charged copolymer of MMA and methacrylic acid (MAA) and a positively charged copolymer of MMA and trimethylaminoethyl methacrylate chloride (TMAEMA-Cl) were studied. The solid surfaces were placed in a parallel plate perfusion system. After preadhesion of the bacteria onto the surfaces, growth was initiated by perfusing the system with MacConkey broth. Growth was measured by counting adherent bacteria as a function of time. Bacterial strains were characterized by means of water contact angle, microbial adhesion to hydrocarbon (MATH), anion exchange resin retention (ARR) and zeta potential measurements. Solid surfaces were characterized by means of water contact angle and zeta potential measurements. The catheter-associated strains had significantly higher water contact angles, zeta potentials and ARR values than the non catheter-associated strains. Non catheter-associated strains did not grow at the surfaces used. Catheter-associated strains did not grow at the positively charged surface but exhibited growth at the other surfaces. Strains grew more rapidly at surfaces with a relatively high negative zeta potential and a low water contact angle than at surfaces with a relatively low negative zeta potential and a high water contact angle. The growth of strain O2K2 on glass was significantly reduced when urine instead of MacConkey broth was used as perfusion medium.     

Genetics of digalactoside-binding adhesin from a uropathogenic Escherichia coli strain.

The uropathogenic strain Escherichia coli J96 mediates mannose-resistant hemagglutination owing to production of a digalactoside-binding adhesin. A cosmid clone from this strain has been isolated that, when harbored in E. coli K-12, expressed Pap pili and this adhesin (R. Hull et al., Infect. Immun. 33:933-938, 1981). By transposon mutagenesis and by the construction of a number of hybrid plasmid derivatives, we have demonstrated that about 8.5 kilobases of DNA is required to generate a mannose-resistant hemagglutination-positive phenotype in E. coli K-12 strain P678-54. The structural gene for the Pap pili monomer, papA, has been identified and mapped close to the promotor-proximal end of the Pap operon. Although strain P678-54 that harbored a Tn5 insertion within papA showed a mannose-resistant hemagglutination-positive phenotype, it was negative in a competitive enzyme-linked immunosorbent assay with anti-Pap pilus serum. This could mean that a Pap adhesin is encoded by a region on the Pap operon that is distinct from papA.     

Expression of P fimbriae of uropathogenic Escherichia coli strains

The occurrence of P fimbriae in a total of 222 uropathogenic Escherichia coli (UPEC) strains was investigated. Out of the total, 31 (14%) were P fimbriated. Of 24 pyelonephritogenic E. coli strains, three (13%) with P fimbriae occurred in children with clinical pyelonephritis, and of 198 E. coli strains 29 (15%) occurred in children with cystitis. Prevalence of P fimbriae of E. coli strains was found to be quite similar in patients with cystitis and pyelonephritis     

Growth of uropathogenic Escherichia coli strains at solid surfaces

The adhesion and growth of two catheter-associated (O2K2 and O83K?) and two non catheter-associated (O111K58 and 0157K-) uropathogenic Escherichia coli strains on glass, poly(methyl methacrylate) (PMMA), a negatively charged copolymer of MMA and methacrylic acid (MAA) and a positively charged copolymer of MMA and trimethylaminoethyl methacrylate chloride (TMAEMA-Cl) were studied. The solid surfaces were placed in a parallel plate perfusion system. After preadhesion of the bacteria onto the surfaces, growth was initiated by perfusing the system with MacConkey broth. Growth was measured by counting adherent bacteria as a function of time. Bacterial strains were characterized by means of water contact angle, microbial adhesion to hydrocarbon (MATH), anion exchange resin retention (ARR) and zeta potential measurements. Solid surfaces were characterized by means of water contact angle and zeta potential measurements. The catheter-associated strains had significantly higher water contact angles, zeta potentials and ARR values than the non catheter-associated strains. Non catheter-associated strains did not grow at the surfaces used. Catheter-associated strains did not grow at the positively charged surface but exhibited growth at the other surfaces. Strains grew more rapidly at surfaces with a relatively high negative zeta potential and a low water contact angle than at surfaces with a relatively low negative zeta potential and a high water contact angle. The growth of strain O2K2 on glass was significantly reduced when urine instead of MacConkey broth was used as perfusion medium.     

Virulence factors in uropathogenic E. coli

Escherichia coli isolates from urinary tract infections often exhibit characters different from those isolated from normal faecal samples. Adherence to uroepithelial cells, nature of lipopolysaccharide O antigen and mannose resistant haemagglutination of human erythrocytes are some of the important virulence factors proposed in the pathogenesis of urinary tract infections caused by E. coli. In the present study a total of 100 strains of E. coli isolated from symptomatic cases of urinary tract infections (with significant bacteriuria) were studied for these properties. Faecal isolates of E. coli from adult healthy individuals were also studied as controls. As many as 58 uropathogenic strains showed high affinity for attachment to uroepithelial cells while 28 strains showed adherence at moderate degree. Agglutination of human erythrocytes was induced by as many as 70 uropathogenic strains while in 32 strains haemagglutination was not affected by D-mannose. In control group, adherence was observed in eight strains while 28 strains were haemagglutinating. Of these 28 strains, D-mannose resistant haemagglutination was observed in only one faecal strain. In uropathogenic group O4 was isolated with maximum frequency (12%) followed by O101, O135 and O6.     

Inhibition of bacterial adhesion of uropathogenic Escherichia coli strains by the urine of patients treated with nitroxoline

The present study evaluates the effects of sub-inhibitory concentrations of nitroxoline, (oxyquinoline derivative) widely used in the treatment of uncomplicated, urinary tract infections, on the adherence of uropathogenic strains of Escherichia coli. These bacterial strains showed mannose sensitive and/or mannose resistant hemagglutinating activity (HA). In the presence of nitroxoline and at sub-MIC concentrations, inhibition of adherence is 90% (MIC/4), 87% (MIC/8), and 70% (MIC/16), whatever HA's are expressed by the E. coli strains. The inhibitory effect on adherence is also observed in the urine after oral administration of 400 mg of nitroxoline. The concentrations of nitroxoline in the urine are determined by microbiological assay (anti-bacterial activity) and by physico-chemical assay (total nitroxoline and free nitroxoline). The percentages of inhibition are related to the concentrations of free and conjugated nitroxoline. For a 1/16 dilution of urine, the inhibitory effect is 70% and 87% respectively 1 h 30 and 2 h 30 after oral administration of nitroxoline. After 5 h, a similar inhibitory effect is observed for a 1/2 dilution of urine. These results justify the performance of a clinical trial on the prophylaxis of recurrent urinary tract infections by nitroxoline.