INTRODUCTION
Bacterial pathogens use a repertoire of diverse virulence proteins to establish infection and confer long-term survival in their respective hosts and environments. A central theme to these virulent phenotypes is the expression of surface-exposed and secreted proteins that interact with a variety of macromolecule receptors on host cells (
1–4). In addition, these proteins can be deployed by intracellular bacteria within the host cytoplasm or niche-specific vacuole to confer survival, replication, and dissemination. These phenotypes in Gram-negative bacteria are frequently achieved by using large, multiprotein secretion systems, or nanomachines, divided into six categories (secretion systems for types 1 to 6 [T1SS to T6SS]) (
5). While these are the most common systems to introduce virulence factors into the host or competing bacteria,
Fusobacterium cells are unique in that they lack all of the aforementioned multiprotein secretion systems except for the type 5 secretion system (T5SS) (
6). This system is unique in that it is not a large nanomachine but is divided into five distinct categories (T5aSS to T5eSS) that are composed of only one (5a, 5c, 5d, and 5e) or two proteins (T5bSS). These subtypes can be divided into monomeric autotransporters (5a and 5d) (
7,
8), two-partner secretion systems (5b) (
9), homotrimeric autotransporters (5c) (
10), and intimins (5e) (
11,
12). The majority of characterized autotransporters are large adhesins or proteases of the T5aSS, or homotrimeric T5cSS adhesins that include YadA from
Yersinia species (
13). A large-scale bioinformatic analysis showed that 100% of
Fusobacterium genomes encode T5aSS proteins, the highest percentage in all Gram-negative bacteria tested (
14).
Fusobacterium spp. are Gram-negative, nonmotile, anaerobic bacteria generally isolated from the human oral cavity, but they can also infect other higher mammals, including cattle and sheep (
15–17). A strong correlation has been established between the presence of
F. nucleatum in colorectal cancer (CRC) tumors and a direct induction of increased tumor size, frequency, and stimulation of a proinflammatory tumor microenvironment (
Fig. 1) (
18–20). The interaction of this bacterium with host cells also induces chemoresistance by blocking apoptosis (
21), and viable bacteria have been shown to travel within metastatic cells to the liver (
22). In addition, increased
F. nucleatum loads within patient sampled tumors correlate with decreased human life expectancy (
23).
In a recent large-scale bioinformatic study,
Fusobacterium species were divided into actively invading species that drive their own cellular entry (
F. nucleatum,
F. periodonticum,
F. varium, and
F. ulcerans), passively invading species that require a compromised epithelial barrier for cellular entry (
F. necrophorum and
F. gonidiaformans), and those with unknown invasive potential (
F. mortiferum) (
24). However, it was previously experimentally shown that multiple
F. necrophorum and
F. mortiferum strains were significantly more invasive than
F. nucleatum strains into keratinocytes, which is in direct conflict with bioinformatic reports that place these species in the noninvasive or passively invasive category (
24,
25). While host cell binding and invasion have been deemed critical for
F. nucleatum pathogenesis in connection with colorectal cancer, the role of invasion in non-
F. nucleatum species remains understudied. For instance, it is possible that invasive
F. necrophorum and
F. mortiferum strains could induce similar host cell signaling changes seen in CRC, and yet they might not be associated with specific diseases due to their verified low abundance compared to that of
F. nucleatum. However, this hypothesis has not been tested experimentally, and
F. necrophorum and
F. mortiferum have not been associated with CRC. A recent study reported that
F. nucleatum is able to induce chemoresistance by interacting with surface-exposed toll-like receptors (
21). However, we note that the strain used in that study was highly invasive (
F. nucleatum 25586), while the amount of intracellular bacteria was not determined. Since previously characterized mutants with decreased invasion into human cell lines are also deficient in cellular binding, it could be that there is a complex phenotype that bridges the need for initial host cell docking, and subsequent intracellular modulation of cell signaling. In summary, despite extensive phylogenetic analyses of
Fusobacterium, our knowledge of the specific virulence mechanisms of this bacterial genus remains limited.
There is a clear gap in our understanding of invasion and virulence in the genus
Fusobacterium and the proteins that are involved in driving diverse phenotypes in hosts from humans to cattle and sheep. Most of our knowledge comes from a limited number of
F. nucleatum strains and a small sampling of outer membrane adhesins that have been experimentally validated as critical for oral interactions, preterm birth, and colorectal cancer. The reason for this lack of molecular studies in
Fusobacterium is its well-known genetic recalcitrance, with only four strains of
F. nucleatum yielding chromosomal modification (
15,
26–28). To aid in our understanding of virulence at the genetic and molecular level, we recently completed nine
Fusobacterium genomes and created the FusoPortal database that includes detailed genomic and bioinformatic analysis of this emerging pathogen (
29,
30). These genomes were used here to identify and correct protein families of the autotransporter, FadA, and MORN2 domain-containing proteins, all of which are predicted to play key roles in cellular binding and invasion. Among the virulence associated proteins that have been experimentally characterized is Fap2, a large (3,786 amino acids [aa] in
F. nucleatum 23726), dual-function, autotransporter adhesin that binds to the natural killer receptor TIGIT to inhibit tumor cell clearance (
40) and initiates host cell docking and altered signaling through the sugar Gal-GalNAc on the surfaces of colorectal cancer cells (
43).
FadA is a small (∼125 aa) adhesin that multimerizes on the surface of
F. nucleatum and has been shown to directly bind to E-cadherin, where it induces β-catenin signaling in human cancer xenografts in mice (
31). For multiple
F. nucleatum genomes, we highlight the identification of two homologues of FadA (FadA2 and FadA3), with multiple identical copies of the FadA3 gene being identified and verified throughout each genome (
28). FadA is directly involved in host cell binding and invasion in the strain
F. nucleatum subsp.
polymorphum 12230 and yet, likely due to genetic restraints, it has not been characterized in other strains.
In
Fusobacterium necrophorum, the leukotoxin LktA (
lktBAC operon) is secreted by the type 5b two-partner secretion system and has been characterized in cattle and sheep infections causing liver abscesses, spontaneous abortion, and foot rot (
F. necrophorum subsp.
necrophorum) (
32,
33). In humans,
F. necrophorum subsp.
funduliforme is the predominant
F. necrophorum subspecies and a native inhabitant of the human oropharynx. This strain is leukotoxin positive and causes infections of the throat and jugular vein in the form of the potentially fatal Lemierre’s syndrome (
62). Despite our knowledge that LktA induces immune cell toxicity, the mechanisms by which these opportunistic subspecies become invasive and establish infection in different organisms are poorly understood. To our knowledge, we have sequenced, annotated, and bioinformatically characterized the only two complete
F. necrophorum genomes in
F. necrophorum subsp.
necrophorum ATCC 25286 (
34) and
F. necrophorum subsp.
funduliforme 1_1_36S (
29), which are highlighted through experimental characterization of host cell binding in this study.
Of the protein families characterized in this study, the most frequent and extensively enriched are MORN2 (membrane ontology and recognition nexus type 2) domain-containing proteins that can have 1 to 27 repeats of this ∼20-amino-acid domain. This expansion of MORN2 domain proteins is highly specific to
Fusobacterium (
24), with the exception of multiple genes found in
Helicobacter bilis, which is involved in colitis and hepatitis, as well as infectious abortions in sheep (
35,
36). No known function has been assigned to the MORN2 domain-containing proteins; however, most contain signal sequences allowing for export into the periplasmic space and potential further export to the outer membrane or secretion into the extracellular environment. As was previously shown, MORN2 domain proteins are enriched in invasive
F. nucleatum species and are frequently present in genomic regions with type 5a autotransporter genes.
With the recent development of a selectable gene knockout system in
F. nucleatum 23726 (
27), the need to identify accurate gene boundaries and surrounding gene clusters is critical for identifying and characterizing virulence proteins used by these bacteria to establish infection. We believe this study will provide a critical tool to drive the improvement of genetic manipulation, therefore allowing previously difficult or impossible cloning and recombinant expression of proteins for the development of antibodies and protein structure-function studies. In addition, these data will ultimately help us answer the question of how a genus of Gram-negative bacteria that lack multiprotein secretion machinery has evolved an alternative mechanism of driving host cell interactions and colonization through an abundance of outer membrane presented adhesins and enzymes. In summary, this study provides a foundation for an increased understanding of how
Fusobacterium spp. infect a diverse range of host tissues.
DISCUSSION
Fusobacterium spp. are opportunistic pathogens that cause diverse infections and show strong connections and contributions to multiple diseases in humans and higher mammals (
15).
F. nucleatum has garnered significant attention as an “oncobacterium” that contributes to the progression and severity of colorectal cancer and has also been implicated in malignant oral leukoplakia (
45), oral squamous cell carcinoma (
46,
47), and pancreatic cancer (
48,
49). Because
F. nucleatum is an oncomicrobe,
F. nucleatum infection studies have shown that administration of the antibiotic metronidazole reduces the tumor burden in human tumor-generated xenografts in mice (
22). Since antibiotic therapy to treat disease could result in altered gut flora that changes the efficacy of chemotherapy drugs, a new paradigm would be to control infections at the disease site without antibiotics or to block this pathogen from leaving its native human oral cavity. For
F. necrophorum strains, mostly of the subspecies
funduliforme, infections of the jugular vein and subsequent progression to Lemierre’s syndrome can be fatal in humans.
F. necrophorum subsp.
necrophorum is the primary causative agent of bovine hoof rot and liver abscess, causing severe monetary loss in the livestock industry. The prediction of
Fusobacterium virulence overall has been complicated and speculative, especially with respect to species outside of
F. nucleatum . For instance,
F. varium has been identified in the colonic mucosa of ulcerative colitis patients, and supernatants from these colonic mucosa samples were able to induce ulcerative colitis in mice (
50,
51). However,
F. varium is not associated with colorectal cancer, and this species is not predicted to be highly invasive like
F. nucleatum. Since ulcerative colitis is defined as inflammation of the intestines and since we generally associate
Fusobacterium cellular invasion with host-induced inflammation, there could be an alternative molecular mechanism other than cellular entry that allows
F. varium to experimentally induce ulcerative colitis. As discussed below, there is a vast difference in our predicted virulence factors between
F. nucleatum and
F. varium, which still needs to be experimentally validated.
There have been several bioinformatic studies of
Fusobacterium, but none of these used databases that were entirely populated with complete genomes. This lack of complete genomes led us to sequence, assemble, annotate, and create the FusoPortal database (
29) of
Fusobacterium genomes to aid in the bioinformatic and molecular experiments found in this study. These data provide highly accurate gene boundaries and therefore will greatly facilitate the design and production of recombinant proteins for structural and functional studies, an area that is severely lacking in the
Fusobacterium field. Our data confirmed that
Fusobacterium spp. are unique in that they lack functional protein secretion machinery of the type 1, 2, 3, 4, and 6 varieties, and yet they are still opportunistic pathogens. However, a recent proteomic analysis of
Fusobacterium nucleatum revealed that secreted outer membrane vesicles contain proteins from each of the virulence factor families we analyzed in this study, potentially providing an additional mechanism for protein dispersal (
52).
To build upon our understanding of
Fusobacterium virulence, this study reports whole-genome phylogenetic analysis combined with protein sequence similarity networks and cellular invasion studies to probe complex interactions between the host and various
Fusobacterium species. Although we know that
Fusobacterium spp. contribute to several diseases, our understanding of the overarching molecular mechanisms driving the virulence of these bacteria remains limited. We focused our virulence factor analyses on the type 5 secreted autotransporters, FadA adhesins, and MORN2 domain protein families previously hypothesized to drive bacterial invasion into host cells. We show the importance of having accurate and complete genomes in identifying large proteins; the majority being type 5a autotransporters that have been characterized as virulence factors in a wide range of Gram-negative bacteria. Previous reports highlight the importance of the type 5a autotransporter protein Fap2 in
F. nucleatum virulence. We highlight several additional observations from our bioinformatic data and note that a key contribution of this work is the identification of Fap2 homologues in multiple
Fusobacterium genomes, and we report that
F. necrophorum subsp.
necrophorum 25286 has two close homologues of this adhesin. However, our CRC cell binding studies (
Fig. 4) show that
F. necrophorum 25286, despite having multiple Fap2 homologues, binds more weakly to host cells than does
F. nucleatum 23726, which has a single copy of
fap2. In addition, previous whole-genome phylogenetic studies hypothesized that strains of
F. necrophorum are passive invaders that needed an injured epithelial barrier to induce entry into host cells. However, our experimental data show that
F. necrophorum 1_1_36S is quite competent at binding human colonocytes, a phenotype shared with
F. nucleatum 23726. Bioinformatic analysis hints that this adhesive phenotype in
F. necrophorum 1_1_36S is not because of an overabundance of type 5a autotransporters, since it lacks a
fap2 gene, but could be more adhesive due to 11 type 5c trimeric autotransporter adhesins (6 more than
F. nucleatum 23726) that have been well characterized in other bacteria for cellular binding and invasion (
53). We show that both
F. necrophorum strains analyzed virtually lack MORN2 domain-containing proteins, whereas
F. nucleatum strains are generally rich (>20 open reading frames) in this protein family, leading us to rethink the role of MORN2 domain proteins in cellular binding, invasion, and
Fusobacterium virulence.
F. nucleatum in the oral cavity serves as a bridge for bacterium-bacterium aggregation and interactions with mammalian cells and inert tooth surfaces within the gingival pocket (
64,
65). The T5aSS proteins RadD and CmpA are critical for interspecies adherence and the overall architecture of multispecies biofilms (
66). Therefore, type 5a autotransporters play key roles in coaggregation, cell-cell interaction, and biofilm formation during healthy and pathogenic states. Our data suggest that newly identified subsets of T5aSS autotransporters are present in a variety of
Fusobacterium species, and therefore new genetic and biochemical studies should be designed to characterize these proteins in virulence. Oddly, RadD from
F. nucleatum clusters with the
F. varium and
F. ulcerans adhesins and not Fap2 in
F. nucleatum. It remains to be determined whether RadD plays a critical role in cellular invasion or the progression of colorectal cancer associated with
F. nucleatum. More evidence for this comes from the fact that RadD drives interactions with a diverse set of bacteria (
67) and is present in a single copy in the two
F. nucleatum strains analyzed. An alternative hypothesis is that RadD-like adhesins have unidentified functions that drive the inflammation seen in
F. varium-induced ulcerative colitis but are not critical for direct cellular entry. In addition,
F. varium and
F. ulcerans share the most similar profile of T5aSS autotransporters, with an uncharacterized subset of proteins that are not found in the other seven
Fusobacterium strains analyzed.
Although
Fusobacterium have been reported as nonmotile, we sought to determine whether
F. nucleatum T5aSS autotransporters share homology with IcsA from
Shigella flexneri or with T5cSS proteins with BimA from
Burkholderia species, since these proteins localize to a single bacterial pole (old pole) and coordinate intracellular actin-based motility (
68,
69). Using our custom BLAST server that is built into the FusoPortal database, we show no homology to IcsA and low homology to the membrane-associated β-barrel of BimA. These data agree well with a lack of actin-based motility reported by all previous studies and our own observation of intracellular
F. nucleatum. Although actin-based motility is not used for intracellular movement, another intriguing observation was that actin localizes to intracellular
F. nucleatum in human keratinocytes and that inhibition of new actin synthesis blocked intracellular entry (
25). The protein or proteins involved in this direct or indirect actin recruitment have yet to be identified. Determining whether intracellular
F. nucleatum cloaks itself or a host vacuole in actin to evade host clearance through ubiquitination and xenophagy, as seen for
Listeria monocytogenes and
Chlamydia trachomatis (
70,
71), could be a key piece in understanding the intracellular persistence and dissemination of this pathogen.
In addition, we provide the most thorough characterization of several understudied and potential virulence protein families in
Fusobacterium, including the T5bSS (two-partner secretion), T5cSS (trimeric autotransporter adhesins), and MORN2 domain proteins. To our knowledge, two-partner secretion systems, or T5bSS effectors, have not been experimentally analyzed in any
F. nucleatum studies. T5bSS analyses in multiple pathogenic bacteria report that these secreted effectors contain multiple hemagglutinin domains and function as cytolysins, hemolysins, adhesins, and proteins that initiate contact-dependent growth inhibition to fight off neighboring bacteria (
72,
73). For example, a T5bSS filamentous hemagglutinin in
Bordetella pertussis serves as an adhesin and is essential for colonization of tissues (
74). Furthermore, ShlA in
Serratia marcescens plays a cytotoxic role by contributing to the colonization of tissues (
75). Thus, while it remains possible that type Vb autotransporters play a role in tissue colonization, they could alternatively be involved in survival and bacterial competition in oral and colorectal niche environments. Within the
Fusobacterium species that we analyzed, there is a wide range of these uncharacterized proteins, with the largest number of functional genes being found in
F. nucleatum 23726. Since no active released classic toxins have been reported for
F. nucleatum, it could be that these proteins instead act as uncharacterized effectors on or within peripheral blood mononuclear cells (PBMCs), for which
F. nucleatum has been shown to induce apoptosis (
61,
76). Within the T5bSS toxin family, both
F. necrophorum 25286 and
F. necrophorum 1_1_36S express the LktA leukotoxin that induces the activation and apoptosis of leukocytes (
77,
78). The
lktBAC operon responsible for the production of this T5bSS secreted toxin is absent in all other strains of
Fusobacterium analyzed and could explain the severe abscess phenotype induced by this species. Since
F. necrophorum 25286 is associated with serious livestock infections, these data, combined with the potential to perform genetic manipulation in these strains, could lead to a more effective live, attenuated vaccine for bovine hoof rot and liver abscesses.
Recently the first
F. nucleatum TAA CbpF (FN1499) was characterized and was shown to bind to CEACAM1 on human cells (
86). The TAA protein family consists of important virulence factors in other pathogenic Gram-negative bacteria, including YadA from
Yersinia pestis and
Yersinia pseudotuberculosis (
13,
53), Hia from
Haemophilus influenzae (
79), and SadA of
Salmonella enterica (
80). TAAs form long fibrous proteins that can extend more than 100 nm from the surfaces of the bacteria, thereby presenting the adhesive head domains to dock with host cells. YadA binds to the human extracellular matrix proteins fibronectin and collagen, drives invasion into epithelial and phagocytic cells, and inhibits activation of the serum complement (
81). Previous bioinformatic analysis implied that a genetic expansion of T5cSS autotransporters in less-invasive strains indicates that these proteins are likely not used by
Fusobacterium for cellular invasion, despite evidence of the TAAs being critical for virulence in multiple human-pathogenic Gram-negative bacteria. We propose that TAAs from pathogenic
F. nucleatum could play a role in cellular invasion and that genetic and biochemical studies need to complement one another before we discount the TAAs as unimportant for
Fusobacterium virulence.
Genetic and biochemical studies of FadA in
F. nucleatum 12230 showed that this small (∼125 aa) adhesin multimerizes on the bacterial surface and subsequently binds to E-cadherin to modulate endothelial barrier permeability, signaling, and inflammatory responses in models of human cancer (
31). This implicates FadA in the entry and exit of blood vessels to translocate
F. nucleatum to the fetal-placental unit, where multiple studies support a role for this bacterium in preterm birth (
82,
83). The identification of up to six FadA family proteins in a genome leads us to hypothesize that there is cooperativity among this protein family and that the FadA homologues, FadA2 and FadA3, could have similar functions as adhesins but have unidentified host receptor molecules. These include a gene triplication of
fadA3 in
F. nucleatum 23726 and
F. nucleatum 25586. In
F. nucleatum 12230, a Δ
fadA mutant shows greatly reduced proliferation of human cancer cells (HCT116 and HT29), but this procarcinogenic phenotype was recovered by
fadA complementation and the addition of purified active FadA to cell cultures. Bioinformatic analysis of the
F. nucleatum 12230 genome (GenBank assembly accession no. GCA_003226385.1) revealed a single copy of
fadA and a single copy of
fadA3 that appears to encode a protein with N-terminal amino acids missing, hinting that FadA and not FadA3 drives cellular binding and cancer cell proliferation. In addition, FadA is also important for the colonization of
F. nucleatum 12230 in mouse placenta (
83). With five FadA family proteins in the genetically tractable
F. nucleatum 27326, it will be crucial to delete multiple copies of these genes to determine whether they act synergistically during infection or whether FadA, FadA2, and FadA3 play distinct roles in virulence and colonization in diverse tissue niches, including the subgingival microbial community, human placenta, or the colon. Finally, we show that the greatest number of
fadA genes are found in
F. varium and
F. ulcerans, two species with lower predicted invasive potential than the experimentally tested FadA positive strain
F. nucleatum 12230. Since FadA was shown to drive host cell signaling in
F. nucleatum 12230, it could be that this protein family plays a similar role in
F. varium-induced ulcerative colitis.
Despite a great interest in the potential role of MORN2 domain proteins in cellular invasion due to their genomic proximity to T5aSS proteins and expansion in invasive
F. nucleatum strains, no studies, to our knowledge, have shown a direct role for this hypothesis. MORN2 domain-containing proteins could enhance adhesive and active invasive traits since their genes clustered near those for FadA, RadD, and additional T5aSS autotransporter adhesins. Since this study, a role for these proteins in interspecies interactions has been suggested (
15), as they are predicted surface-associated proteins, and some of them are part of the “FusoSecretome” (
84). More recently, MORN2 domain-containing proteins were found to be secreted into
F. nucleatum outer membrane vesicles (
52). In addition, the fact that these proteins possess a YwqK domain suggests that they could be acting as toxin-antitoxin systems for interspecies competition or as bacterial abortive infection systems that limit viral replication and are activated by phage infection (
85).
Though not analyzed here, Fad-I is an outer membrane protein that was shown to induce human beta defensin 2 (hBD-2) through a Toll-like receptor-mediated host response. The immune modulation induced by Fad-I in
F. nucleatum strains 23726 and 25586 was far more potent than that seen in
F. nucleatum 10953 (
54). As with all protein families, this is a great example of how small sequence variations in key proteins could account for altered virulence between phylogenetically similar strains of
Fusobacterium.
In conclusion, we provide bioinformatic identification and analysis of virulence factors, as well as host-pathogen infection studies to dissect the role of the role of potential virulence protein families in cellular binding and invasion. We hypothesize that autotransporters, FadA, and MORN2 proteins synergistically form a host cell docking and invasion network that confer the host, tissue, and disease mechanism of the diverse range of Fusobacterium species. These results show that a more detailed analysis of invasion using additional strains is warranted and could help in creating more accurate predictive models of invasive potential from genome sequences. This study will benefit from future work that expands upon our nine genome analysis to include additional Fusobacterium species and clinical strains, which will ultimately lead to a deeper understanding of individual proteins in disease. It is our hope that these genomes, bioinformatic analyses, and Fusobacterium invasion studies spark the discovery of new virulence factors and drive studies that further our understanding of virulence mechanisms at the molecular level in the diverse bacterial Fusobacterium genus.