The ability of uropathogenic
E. coli (UPEC) to colonize the urinary tract involves adhesins (e.g., type 1 and P fimbriae) and toxins (e.g., hemolysin) (
27,
33). Adherence to the urinary tract epithelium enables the bacteria to resist the hydrodynamic forces of urine flow, to trigger host and bacterial cell signaling pathways, and to establish an infection. Among the adhesins, P fimbriae show the strongest disease association in clinical studies. P fimbriae contribute to the establishment of bacteriuria by binding to the α-
d-galactopyranosyl-(1-4)-β-
d-galactopyranoside receptor epitope in the globoseries of glycolipids (
29) and activate innate immune responses in animal models and in the human urinary tract (
3,
37,
38,
54-
56). Type 1 fimbriae also enhance colonization and induce immune responses in the mouse UTI model (
8). Type 1 fimbriae confer binding to α-
d-mannosylated proteins, such as uroplakins, which are abundant in the bladder (
53). Both P and type 1 fimbriae recognize their receptor targets by virtue of organelle tip-located adhesins (PapG and FimH, respectively) (
27).
The phase-variable surface-located adhesin antigen 43 (Ag43) is also associated with urovirulence (
1). Ag43 is a representative member of the autotransporter (AT) family. AT proteins are unique in that their primary sequence is sufficient to direct their transport across the bacterial membrane system and final routing of a variable passenger domain (alpha-domain) to the cell surface. AT proteins are generally very similar with respect to the structure of the transporter module (beta-domain) that assists the transport of the alpha-domain across the outer membrane, whereas they differ substantially in the alpha-domain, which determines the unique functional characteristics of AT proteins (
17,
18). Once at the bacterial surface, the alpha-domain may be processed and released into the extracellular surroundings (e.g., Pet and EspP), or it may be cleaved but remain in contact with the cell surface via noncovalent interactions with the beta-domain (e.g., Ag43 and AIDA) (
18). Thus, AT proteins have diverse functions and range from cell-associated adhesins to secreted toxins (
17,
18).
Ag43 (encoded by the
flu gene) is a self-recognizing AT adhesin that confers characteristic surface properties on host cells, such as autoaggregation and a frizzy colony morphology (
14,
15). Large amounts of this protein are expressed (approximately 50,000 copies per cell), and the protein promotes bacterial biofilm formation (
9,
24-
26,
36,
42,
43,
44). The phase-variable expression of Ag43 occurs at switching rates of ∼10
−3 per cell per generation due to the concerted actions of Dam methylase (positive regulation) and OxyR (negative regulation) (
19,
43,
46,
52). Glycosylation of Ag43 occurs in some wild-type UPEC strains, and Ag43 glycosylation in recombinant
E. coli enhances binding to HEp-2 cells (
47).
A recent genome comparison analysis revealed that the sequenced genome of UPEC strain CFT073 encodes at least 10 putative AT proteins (
35). CFT073 has two copies of the Ag43-encoding
flu gene, both of which are located on pathogenicity islands. The two genes (
fluA/
upaF and
fluB/
upaD) are not identical; they share 91% conservation at the nucleotide sequence level and 90% identity at the amino acid level. The predicted alpha-domain of their protein products (Ag43a and Ag43b) shares 81.7 and 78.4% amino acid identity, respectively, with the K-12 Ag43 alpha-domain. The two predicted proteins themselves share 85% amino acid identity in the entire alpha-domain. Recently, the region of Ag43 responsible for autoaggregation was localized to the first 160 amino acids of the mature protein (
26). The Ag43a and Ag43b proteins share only 76% amino acid identity in this region.
While the function of Ag43 is well documented, its precise role in UPEC disease pathogenesis remains to be elucidated. Ag43 is expressed on the surface of UPEC cells located within intracellular biofilm-like bacterial pods in the bladder epithelium, indicating that it may contribute to survival and persistence during prolonged infection (
1). The in vivo expression of Ag43 by UPEC has also been demonstrated via direct examination of infected human urine using immunofluorescence microscopy (
34). The biological significance of multiple copies of the
flu gene is also unclear. Here, we characterized the function of both Ag43 variants of UPEC CFT073 and investigated their role in virulence. The
fluA and
fluB genes were cloned, their protein products were characterized, and their functions were studied both in the heterologous
E. coli K-12 host and in UPEC CFT073. Deletion and expression-controlled mutants were compared to wild-type CFT073 in a mouse UTI model, and the results revealed an important contribution of Ag43a to long-term persistence in the bladder. The findings indicate a role for distinct Ag43 variants in UPEC disease pathogenesis and identify Ag43 as another class of pathogenicity-adapted cell surface proteins that possess amino acid alterations that are associated with distinct virulence-related functions.
DISCUSSION
Attachment to host tissues is the first critical step in colonization and is mediated by bacterial adhesins. UPEC produces a range of fimbrial and nonfimbrial adhesins that play a role in virulence and contribute to persistent infection of the urinary tract. Some UPEC fimbrial adhesins, including type 1 and P fimbriae, have been well characterized with respect to their expression, regulation, receptor-binding target, and role in virulence. Of the nonfimbrial adhesins, the AT family of proteins represent a novel group of virulence factors because of their role in adhesion, invasion, and biofilm formation in other organisms. Although UPEC possesses multiple AT-encoding genes, very little is known about their function and role in virulence. Here, we characterize two AT adhesins of UPEC CFT073 (Ag43a and Ag43b) and demonstrate that the Ag43a variant is able to promote biofilm formation and contributes to long-term persistence in the urinary bladder.
Our approach to studying the function of the UPEC CFT073 Ag43a and Ag43b proteins involved the use of two host strains, K-12 MG1655Δ
flu and CFT073. The K-12 MG1655Δ
flu strain is well characterized and has been shown to be an ideal background strain to assess the function of AT adhesins (
24,
25). The Ag43a and Ag43b proteins had marked differences in the ability to mediate aggregation, and Ag43a-mediated aggregation was stronger. These different biological properties were not due to variations in the levels of Ag43a and Ag43b protein expression, as determined by SDS-PAGE analysis and Western blotting. The Ag43a- and Ag43b-mediated aggregation phenotype could be blocked by the concomitant expression of type 1 fimbriae, a finding that is consistent with other studies which demonstrated that the intimate cell-cell contact required for AT adhesin interaction can be physically blocked by the expression of larger surface structures, such as fimbriae, flagella, lipopolysaccharide, and the capsule (
2,
14,
42,
48,
51). We also observed that Ag43-mediated aggregation was not manifested in CFT073 when the proteins were constitutively expressed or following deletion of the
oxyR repressor. We attempted to address this issue by constructing a deletion in the type 1 fimbrial genes and the capsule-encoding
kpsD gene; however, this did not have any effect on cell aggregation or biofilm formation, suggesting that additional factors may also mask the Ag43 function in CFT073.
One of the mechanisms by which UPEC promotes the formation of biofilms is via the expression of proteins that mediate cell-cell aggregation. Our previous work demonstrated that Ag43 (from
E. coli K-12) is associated with the early stages of biofilm development (
44). However, Ag43 has also been shown to be dispensable for biofilm formation as it can be replaced by alternative factors, such as conjugative pili (
12,
36). Here we demonstrated that in a K-12 background only Ag43a is able to promote strong biofilm formation using dynamic flow model systems. The biofilm produced by the strain expressing Ag43a is similar to the biofilm reported for the K-12 Ag43 in terms of thickness and structure (
25).
In UTI caused by UPEC, biofilm formation occurs within superficial umbrella cells of the bladders of mice after infection (
1). The biofilms are pod-like structures that contain polysaccharide-encased cell clusters expressing Ag43, and their formation is postulated to be associated with long-term persistence in the urinary bladder (
10). The strain used in these studies, UTI89, was recently sequenced and contains only one copy of the
flu gene (c1139) (
7). The corresponding gene product shares only 67% amino acid identity with the Ag43a and Ag43b adhesins of CFT073, and the vast majority of the differences occur in the passenger (exposed) domain of the protein. Therefore, it is not possible to associate the biofilm phenotype of UTI89 with that observed for Ag43a from CFT073. It is likely that sequence divergence within the passenger domain of Ag43 has resulted in the evolution of many different pathogenicity-adapted variants that possess enhanced biofilm formation properties. This may also be associated with the glycosylation of some Ag43 variants, as has been observed in UPEC strain 536 (
47). Interestingly, UPEC CFT073 was a poor biofilm former in all of our assays. Although we were able to detect expression of the
fluA and
fluB genes by RT-PCR, we detected only a low level of Ag43a by immunodetection analysis using heat-extracted protein samples prepared from wild-type cultures. This type of differential expression of Ag43 variants has also been reported for UPEC strain 536, in which one of the two Ag43 variants, ORF52
III, is expressed at higher levels than the other, ORF47
V (
2).
Two strategies were employed to determine the role of Ag43a and Ag43b in virulence in the mouse urinary tract. First, deletion mutants were constructed and revealed a novel role for Ag43a in long-term persistence in the bladder. The second strategy employed an approach analogous to the previously described RExBAD system (
40), with the exception that we inserted a constitutive promoter (PcL) upstream of each target gene (S. Da Re et al., submitted). Since the two Ag43 proteins are phase variable, this avoids reliance on the natural promoter for
flu expression and circumvents any pleiotropic effects that would have resulted from the use of our
oxyR mutants. Furthermore, since the physiological conditions required for expression of Ag43a and Ag43b are not known, this enabled us to compare the survival of CFT073 mutants containing deletions in each gene. Expression of Ag43a in CFT073 was required for optimum colonization of the mouse bladder when it was assessed at 5 days as a prolonged infection model. This requirement for Ag43a for colonization was observed irrespective of Ag43b expression, although Ag43b appeared to have a detrimental effect on bacterial colonization after 1 day of infection. It is possible that Ag43b impedes the ability of CFT073 to establish early colonization in the bladder by virtue of its weaker aggregation- and biofilm-related properties. The differential roles of these two homologous proteins in survival in the urinary tract raise the possibility that they have evolved to possess different functional properties. Indeed, our in vitro aggregation and biofilm studies with these two proteins alluded to such differences. The sequence of the promoter region of the CFT073
fluA and
fluB genes is not identical to the sequence of the corresponding promoter region of the K-12
flu gene. In the 300-bp region upstream of the protein-encoding sequence,
fluA shares 89% (266/300) nucleotide sequence identity with the same region in K-12, while
fluB shares 81% (243/300) nucleotide sequence identity. Despite these differences, derepression of both Ag43a expression and Ag43b expression was observed in a CFT073
oxyR background, demonstrating that OxyR represses the expression of both
fluA and
fluB in CFT073. The fact that the three GATC sites found in the K-12
flu promoter region are also conserved upstream of
fluA and
fluB in CFT073 suggests that Ag43a and Ag43b are both phase variable and that the mechanism by which this occurs is analogous to the mechanism for Ag43 in K-12 and is coordinated by the combined action of Dam and OxyR. The introduction of a constitutive promoter to control expression of each gene, therefore, provided the added advantage of allowing us to study the function of these adhesins in the context of a defined wild-type UPEC strain and bypassing of the phase variation mechanism for these two proteins. Our results suggest that the phase variation of Ag43a and Ag43b in the mouse urinary tract may be coordinated together with as-yet-undefined environmental or other factors that favor Ag43a expression and therefore persistence in the bladder. The ability of Ag43a to promote longer-term colonization in the bladder may be due to its capacity to enhance biofilm formation, which plays a role in resistance to host defenses and therefore the establishment of longer-term infection. Alternatively, Ag43 may exert its effect by influencing the susceptibility of UPEC to stress, a process that could be coordinately regulated via OxyR. In line with this, Ag43-mediated aggregation has been shown to enhance tolerance to bactericidal agents such as H
2O
2 (
43).
Ag43a contributes to long-term persistence after establishment of an initial infection, suggesting that its function comes into play after fimbria-mediated specific adhesion. We detected a low level of
fluA and
fluB gene expression by RT-PCR, and Ag43a expression was observed by Western blot analysis. The failure to detect Ag43b may have been due to a combination of lower expression and weak cross-reactivity with our Ag43 antiserum. Although we did not observe a direct in vitro phenotype for CFT073 strains constitutively expressing Ag43a or Ag43b, our in vivo findings imply that phase variation of fimbriae may be an important aspect of long-term survival and adaptation in the mouse bladder. While cells expressing fimbriae would not be able to aggregate, cells devoid of fimbriae would be able to adapt to niche environments that favor aggregation and biofilm development. In our forced Ag43 expression strains this effect would be enhanced even further as a result of constitutive gene expression (i.e., the genes are already “on”). In support of this model others have demonstrated the existence of an inverse relationship between type 1 fimbrial gene expression and P fimbrial gene expression (
20,
50,
57). It has been proposed that during the course of an infection type 1 fimbriae are important in the early stages; however, as the infection progresses, increased expression of motility and P fimbrial genes occurs at the expense of type 1 fimbrial expression (
5). Such a model is also consistent with a previous report of fimbria-mediated coordination of Ag43 expression (
46). The long-term survival of UPEC in the urinary tract has been linked to the formation of biofilm-like intracellular bacterial communities and the formation of quiescent intracellular reservoirs within the urinary bladder epithelium (
21,
32). It would be now be interesting to determine the role of Ag43 in these survival mechanisms and to differentiate between the contributions of Ag43a and Ag43b to persistence in the bladder.
E. coli is a highly diverse species, and over 250 serotypes have been identified based on O, H, and K antigens. There is extensive variation in the DNA content in different strain types. The differences account for the versatility of E. coli with respect to disease since different strains have acquired different sets of virulence genes, which are typically located on pathogenicity islands or on plasmids. A PCR screen using primers designed for predicted conserved regions of the flu gene revealed a difference in the prevalence of this gene between uropathogenic and commensal E. coli strains. Three UPEC strains have now been entirely sequenced, and a different picture has emerged in each case with respect to the location and sequence of the flu gene. It therefore seems reasonable to conclude that the pathogenicity island localization of the flu gene contributes to its multiplicity in different E. coli strains. The variable sequence of the alpha-encoding domain of Ag43 is consistent with data for other AT adhesins and suggests that characterization of additional variants from other clinical isolates may reveal novel phenotypic properties of this versatile adhesin.