INTRODUCTION
The Gram-positive spore-forming bacterium
Clostridium difficile is the leading cause of nosocomial diarrhea and antibiotic-associated colitis in hospital settings (
1). Illness caused by
C. difficile infections (CDI) may range from mild diarrhea to life-threatening, fulminant colitis. Throughout its life cycle,
C. difficile has to cope with multiple changing environments. In the early steps of CDI, in order to colonize the colon and produce toxins,
C. difficile spores first germinate in the intestine in response to stimuli such as the presence of bile salts (
2,
3). Vegetative cells need to reach the colon, likely attaching to and colonizing the gut mucosa, where they proliferate and produce toxins. Hence,
C. difficile arguably needs to sense and integrate multiple environmental stimuli in order to coordinate the expression of its colonization and virulence factors during its journey through the gastrointestinal tract. The mechanisms allowing this adaptability in
C. difficile have been the focus of many recent studies, including those on the
agr quorum-sensing system, alternative sigma factors, two-component systems, the global transcription regulator CodY, and the sigma factor TcdR, which promotes TcdA and TcdB toxin expression (
4–9).
One way by which bacteria sense and respond to changes in their environment is through signal transduction involving secondary messenger molecules. The bacterial second messenger 3′-5′ cyclic diguanosine monophosphate (c-di-GMP) plays multiple key roles in bacterial physiology and virulence (
10–12). c-di-GMP has been shown to antagonistically control the motility of planktonic cells and biofilm formation in several bacterial species. An increase in the intracellular c-di-GMP concentration typically induces exopolysaccharide synthesis and adhesion while inhibiting flagellar motility, thereby favoring biofilm formation. A low concentration of the second messenger has an opposite effect. c-di-GMP also controls cell differentiation in
Caulobacter crescentus (
13) and virulence of important human pathogens, including
Vibrio cholerae (
14),
Borrelia burgdorferi (
15), and
Pseudomonas aeruginosa (
16). c-di-GMP turnover is controlled by two groups of enzymes with antagonistic activities. The diguanylate cyclases (DGCs) contain a GGDEF domain and synthesize c-di-GMP from two GTP molecules, whereas the c-di-GMP phosphodiesterases (PDEs) contain an EAL domain or an HD-GYP domain and hydrolyze c-di-GMP into linear pGpG or two GMP molecules, respectively (
17–21). Several c-di-GMP effectors are responsible for the regulatory function of c-di-GMP through transcriptional, posttranscriptional, translational, and protein-protein interaction mechanisms. A major class of c-di-GMP effector proteins and the first ever described are the PilZ domain c-di-GMP-binding proteins (
22). Although PilZ effectors are numerous, there are also other c-di-GMP-binding effectors, such as the unrelated transcription factors FleQ in
P. aeruginosa and VpsT in
V. cholerae (
23,
24). In addition to protein effectors, c-di-GMP is also sensed by RNA effectors, the type I and type II c-di-GMP riboswitches (
25,
26). Riboswitches are structured RNA regions typically located in the 5′ untranslated regions of diverse bacterial mRNAs. Riboswitches are composed of two modular regions: an aptamer that recognizes and binds a specific metabolite and an expression platform that in most cases controls the expression of the downstream gene(s) (for recent reviews, see references
27 and
28). Ligand binding typically leads to repression of gene expression, most commonly through transcription termination or inhibition of translation initiation.
The genome of
C. difficile 630 codes for 18 predicted DGCs and 19 predicted PDEs, many of which have confirmed enzymatic activity (
29,
30). Sudarsan et al. (
26) revealed the presence of a c-di-GMP-I riboswitch, Cd1, upstream of the
flgB gene, which is part of one of two loci encoding the flagellum genes in
C. difficile.
In vitro studies have shown that binding of c-di-GMP to Cd1 promotes premature termination of transcription, suggesting that the expression of flagella in
C. difficile would be repressed by c-di-GMP (
26). Purcell et al. (
31) demonstrated that overexpression of the DGC DccA (CD1420) in
C. difficile increases the intracellular c-di-GMP level, which was also associated with a decreased transcription of flagellum genes and reduced bacterial motility. In addition to decreasing motility, DccA overexpression seemed to promote aggregation of
C. difficile cells by an unknown mechanism (
31). The antagonistic regulation by c-di-GMP of motility and sessile behaviors, namely, aggregation and biofilm formation, was also recently reported by Souturina et al. (
32). The zinc metalloprotease Zmp1 encoded by CD2830, which is located downstream of the c-di-GMP-I riboswitch Cdi1_12, was recently found to cleave fibronectin, fibrinogen (
33), the putative adhesin CD2831, and the putative surface protein CD3246, the last two encoded by genes located downstream of the c-di-GMP-II riboswitches Cdi2_3 and Cdi2_1, respectively (
34).
One of the four predicted c-di-GMP-II riboswitches in
C. difficile 630, Cdi2_4, is located less than 200 bp upstream of a predicted locus for type IV pili (T4P) (
25) (
Fig. 1A). T4P are surface appendages involved in many phenotypes in Gram-negative bacteria such as
P. aeruginosa and
Neisseria spp., including but not limited to adhesion, surface motility (twitching and gliding), biofilm formation and development, cell aggregation, DNA uptake, and phage absorption (for reviews, see references
35 and
36). T4P are thin fibers (6 to 9 nm) that can extend several micrometers in length (
37). These fibers are made by the T4P secretion machinery, a type II-related secretion system that promotes pilus elongation by addition of pilin subunits, and may also retract pili by depolymerization of pilin subunits, both at the proximal end of the pilus. T4P gene loci have been predicted for many other Gram-positive bacteria, including several
Clostridium species (
38–40).
C. difficile T4P genes are mainly located in one primary cluster of genes extending from CD3513 to CD3503 that is predicted to code for all proteins sufficient for T4P formation (
Fig. 1A; see also Table S1 in the supplemental material) (
41,
42). Herein, we demonstrate a role for T4P in cell aggregation of
C. difficile and the regulation of T4P expression through binding of the second messenger c-di-GMP to Cdi2_4, a transcriptional riboswitch upstream of the primary T4P locus.
DISCUSSION
Insightful studies have revealed the versatility of functions conferred by T4P as well as the complexity of their assembly and regulation in Gram-negative bacteria. Recently, T4P were predicted to be also encoded by many Gram-positive bacteria (
38–40). Yet, the role of T4P in Gram-positive bacteria has only been determined for the cellulolytic bacterium
Ruminococcus albus, for which T4P are important for adhesion to cellulose (
65), and
Clostridium perfringens, for which T4P pilins appear at the bacterial surface and T4P are involved in gliding motility and biofilm formation (
39,
66).
In this work, we have unraveled the contribution of T4P in the aggregation of
C. difficile and the regulation of their synthesis by a c-di-GMP-dependent transcriptional riboswitch activator. Although our study represents the first genetic and functional characterization of T4P in
C. difficile, these structures were most likely observed much earlier. Borriello et al. (
67) reported filaments measuring 4 to 9 nm in diameter and up to 6 μm long located at the poles of agar-grown cells, mostly gathered in bundles, although only 0 to 6% of the cells presented pilus-like structures depending on the strains. This is similar to the size of the T4P on the liquid-grown planktonic cells reported herein, which we only observed as single filaments. And while most cells displayed T4P at their surface, we also observed a noticeable population of cells devoid of T4P with high c-di-GMP levels. Although this observation could simply result from pilus breakages during sample preparation, we cannot rule out that T4P synthesis is subject to additional stochastic regulation mechanisms.
Recently Piepenbrink et al. (
68) reported the display of T4P at the surface of
C. difficile R20291 after anaerobic growth at 37°C on Columbia agar plates and prolonged incubation at room temperature. Composition analysis of these appendages by double immunogold staining revealed the presence of both PilA1 and PilJ in
C. difficile R20291 pili (
68). Despite that PilA1 is hypothesized to be the major pilin, the individual role of PilJ and PilA1 in the biogenesis of T4P in
C. difficile 630 remains unknown. Yet, we clearly show that disruption of
pilA1 (or
pilB1) abolished pilus formation and significantly reduced cell aggregation. Incidentally, the low residual pilus formation observed in the
pilB1 mutant background could result from a partial complementation by the second PilB protein, encoded by the
pilB2 gene. Ectopic expression of
pilA1 complemented the
pilA1 mutant of
C. difficile 630 in cell aggregation experiments, confirming that PilA1 is a key factor for both T4P biogenesis and aggregation. We speculate that if PilJ or another pilin is the main component of
C. difficile T4P, PilA1 might play a key regulatory role in the assembly of the pilus structure, as demonstrated for some minor pilins in other species (
69–71). Therefore, the PilA1 pilin may indirectly contribute to T4P-mediated aggregation. Additional studies are required to understand the relative contribution of PilJ and PilA1 to T4P formation in
C. difficile as well as the possible contribution of the three other predicted pilins encoded by the primary T4P locus, PilK, PilU, and PilV, and the two predicted pilins PilW and PilA2.
T4P were previously shown to be regulated by c-di-GMP in other bacteria. Most interestingly, the c-di-GMP-binding PilZ domain retains its name from the PilZ protein from
P. aeruginosa, which is required for twitching motility and T4P biogenesis in this species (
22,
72). Ironically, PilZ is the only one of the eight proteins containing a PilZ domain in
P. aeruginosa that was unable to bind c-di-GMP in
in vitro assays (
73). However, the c-di-GMP-binding protein FimX is required for T4P biogenesis and twitching motility in
P. aeruginosa (
74–76). In
Xanthomonas axonopodis pv.
citri, the orthologous PilZ protein was shown to bind to both FimX and the ATPase PilB required for pilin polymerization (
77). In these species, current evidence suggests that c-di-GMP regulates T4P biogenesis and function by mechanisms relying on protein-protein interactions. Riboswitch-mediated transcription regulation reported herein is a novel mechanism of T4P biogenesis regulation by c-di-GMP signaling.
While elevating intracellular c-di-GMP in
C. difficile increased
pilA1 transcript levels by 30 to 40-fold, c-di-GMP increased Cdi2_4 riboswitch read-through transcription from 50% to 80%
in vitro. Yet, it is not uncommon to observe a relatively modest change in transcription in single-round
in vitro transcription assays compared to the observed cellular transcript levels (
78–81). As for other
in vitro assays, single-round transcription assays provide clear evidence of a biological process, although the results obtained may suffer from the inherent lack of complexity and/or from inaccuracy compared to biological systems. Nonetheless, the hypothesized transcriptional termination switch of riboswitch Cdi2_4 confirmed
in vitro echoes recent unexplained results. Recently, Soutourina et al. (
32) have identified regulatory RNAs in the whole genome of
C. difficile 630 and confirmed the expression of the 12 c-di-GMP-I and 4 c-di-GMP-II predicted riboswitches. The authors reported increased
pilA1 (CD3513) transcript levels and observed only full-length transcripts upon increasing c-di-GMP levels. They reasonably hypothesized that the full-length transcripts were stabilized only under the condition of elevated c-di-GMP because of active translation of PilA1, assuming that all 4 c-di-GMP-II riboswitches have the same expression platform as Cdi2_1, which contains an ∼600-nt self-splicing group I intron promoting translation of the CD3246 putative surface protein upon binding of c-di-GMP to the aptamer (
25,
82). However, this self-splicing group I ribozyme is the only one among the 10 representative ribozymes predicted in strain 630 to be located near a c-di-GMP riboswitch (
25). Although translation of the full-length transcripts upon increasing c-di-GMP levels may still contribute to
pilA1 transcript stability, our results suggest that c-di-GMP increases
pilA1 transcript levels through binding to a transcriptionally activating c-di-GMP riboswitch rather than by promoting
pilA1 translation.
The exact mechanism leading to T4P-dependent cell aggregation and its role in the physiology and pathogenesis of
C. difficile remain to be determined. It is reasonable to presume that T4P may also be involved in other phenotypes in
C. difficile, such as biofilm formation, which was recently reported to be induced by c-di-GMP (
32).
C. difficile cells can grow
in vitro on abiotic surfaces embedded within a biofilm matrix containing exopolysaccharides, DNA, and proteins, which increases resistance of vegetative cells to oxidative stress and vancomycin (
83,
84). Hypothetically, autoaggregation could promote biofilm formation in its early stages. However, preliminary experiments did not show a clear contribution of T4P or c-di-GMP to biofilm formation, as the phenotype was weak and variable under our experimental conditions. Biofilm formation in
C. difficile was reported to be weaker with strain 630 than with strain R20291 (
84), and perhaps the latter, and other strains, should be used in future studies to ascertain the role of T4P in
C. difficile.
Nevertheless, we speculate that T4P are involved in the pathogenicity of
C. difficile. Multicellular structures of
C. difficile cells, described as cell aggregates, were observed in a mouse model of colonization and suggest that aggregation and/or biofilm could be important for colonization (
85). Goulding et al. (
86) also detected the presence of pilus-like structures at the surface of
C. difficile cells within the intestinal crypts of infected hamsters and detected the predicted pilin CD3507
in vivo. These observations and our results confirmed that T4P are produced at the cell surface and suggest that these appendages are important for host colonization and pathogenesis of
C. difficile.