INTRODUCTION
Bacteria, like eukaryotes, have a strict requirement for transition metals that often function as enzyme cofactors or provide protein structural support (
1). Though essential for survival, metal ions can also be toxic, and to successfully survive within a host, pathogens must coordinate ion uptake and efflux to maintain intracellular metal homeostasis (
2–4). To antagonize the nutritional requirements of invading pathogens, the vertebrate host immune system has evolved elaborate mechanisms for restricting access to metal ions, a process termed nutritional immunity (
5,
6). The hosts’ efforts to limit access to metal ions can dampen pathogen metalloenzyme function, restricting growth and the ability to cause disease (
7–9). Widely recognized host iron-binding proteins include transferrin, lactoferrin, and lipocalin-2 that sequester iron(III) or iron-bound siderophores (
10–12) from pathogens. Calprotectin, another metal-binding host protein, is unique in that it can interact with multiple metal ions (
2). Calprotectin is a tetraheterodimer of two members of the S100 protein family, S100A8/S100A9, or calgranulin A/B and MRP-8/14 (
6,
13) and makes up approximately 50% of the neutrophilic cytoplasmic protein content (
13). S100A8 and S100A9 form a heterodimer that, upon calcium-dependent conformational change, create two metal-binding sites that bind zinc with picomolar/femtomolar affinity (
14–16) and manganese at nanomolar affinities (
7,
16,
17). More recent studies have shown that calprotectin can additionally chelate iron(II) (
18–20), copper (
20,
21), and nickel
in vitro (
22), but the implications of the binding of these metals during infection are not understood. Calprotectin is abundant during inflammation or at sites of infection, where a stool concentration of >250 μg/g indicates active intestinal inflammation in patients with Crohn’s disease (
23,
24) and concentrations can exceed 1 mg/ml in tissue abscesses; therefore, invading pathogens must be able to cope with these pressures to cause disease (
17,
25).
Streptococcus agalactiae, or group B
Streptococcus (GBS), is a pathobiont that colonizes the vaginal tract but can be a severe threat to the fetus and newborn. The onset of GBS invasive disease in the neonate can occur as a result of aspiration during passage through a colonized birth canal (
26), bacterial transmigration through the bloodstream (
27), and penetration of the blood-brain barrier (BBB) (
28). To combat the risk of infection in newborns, many countries have implemented the use of prophylactic antibiotics administered to colonized pregnant mothers at the time of delivery (
29); however, despite these widespread efforts, GBS remains a leading cause of neonatal pneumonia, sepsis, and meningitis (
30). Bacterial meningitis is a severe and potentially lethal pathology of the central nervous system that develops when pathogens overcome host defenses and successfully penetrate the BBB. Meningitis is characterized by an overwhelming cytokine response and immune cell influx to the site of infection (
31). Meningitis is a particularly complex disease and results in a neonatal mortality rate as high as 40% (
31,
32). Furthermore, the associated inflammation results in neuronal damage and brain injury, with nearly 20% to 50% of surviving patients suffering permanent neurological sequelae, including hearing and vision impairment, cognitive deficiencies, and seizures (
33,
34).
During acute bacterial meningitis, neutrophils predominate in the cerebral spinal fluid, which is often used as a diagnostic marker. Following interaction with human cerebral microvascular endothelial cells (hCMEC)
in vitro, GBS induces a characteristic neutrophilic inflammatory response, including expression of chemoattractants interleukin-8 (IL-8), C-X-C motif chemokine ligand 1 (CXCL-1), and CXCL-2 (
35–37). Similar results are observed in animal models of experimental GBS meningitis, as brain tissue of GBS-infected mice shows increased neutrophil and monocyte infiltration compared to that of naive controls (
37), indicating a close interaction between GBS and granulocytic cells during active infection. Additional studies have shown that, in response to GBS, neutrophils elaborate extracellular traps decorated with lactoferrin (
38) and that S100A9, a calprotectin subunit, is present in the blood and amniotic fluid during intrauterine GBS infection (
39). These observations suggest that GBS experiences metal limitation during infection, but the mechanisms used by GBS to overcome nutritional immunity remain unknown.
Bacteria utilize a number of strategies to obtain zinc during infection, including direct uptake of the metal, the use of metallophores, and piracy from zinc-bound host proteins. While there is a myriad of strategies employed to obtain zinc, the AdcABC/ZnuABC family of ATP-binding cassette transporters are present in most bacteria. Streptococcal pathogens
S. pneumoniae and
S. pyogenes harbor two zinc-binding proteins, AdcA and AdcAII/Lmb, whereas GBS is particularly distinct as it possesses three zinc-binding proteins, AdcA, AdcAII, and Lmb (
40,
41). AdcA and AdcAII/Lmb have been shown to utilize distinct mechanisms to bind zinc ions and shuttle them through the AdcBC transporter and are important for growth in zinc-restricted environments and infection (
42–45).
Here, we investigated GBS fitness during calprotectin stress using a newly constructed saturated transposon mutant library and targeted amplicon sequencing. We characterized the global requirements for GBS survival during nutritional immunity, identifying 258 mutants, 123 underrepresented and 135 overrepresented, that impact calprotectin sensitivity. We show here that characterized and putative metal transporters are important for calprotectin survival in vitro and that the zinc uptake machinery contributes to survival during calprotectin-induced starvation and invasive disease progression. These results provide insight into zinc-dependent mechanisms that GBS employs to evade the host immune response and nutritional immunity to successfully cause disease and establish a groundwork to study the comprehensive effects of chelation on multimetal transport in GBS.
DISCUSSION
GBS infections are known to result in increased immune cell influx and inflammation, specifically, neutrophilic infiltrate (
35,
61). As these are characteristic signs of bacterial meningitis, GBS would encounter high concentrations of granulocyte-derived calprotectin (
62) during infection. Calprotectin makes up more than 50% of the neutrophil cytosol and has been proven to be an effective molecule at starving incoming pathogens of nutrient metal ions (
7,
63). However, despite this mechanism employed by the immune system to impede bacterial growth, GBS continues to cause life-threatening illnesses, suggesting that this bacterium possesses machinery to thwart host defenses and permit survival. Here, we have examined the global effect of calprotectin stress on GBS fitness using a newly developed
mariner GBS transposon mutant library. We identified systems involved in zinc and manganese/iron homeostasis as well as putative metal-transport systems that were not previously described in GBS to be important for growth in the presence of calprotectin. Through mutagenesis and functional analyses, we determined that the Adc zinc acquisition system, comprising three zinc-binding proteins, promotes survival during calprotectin stress and contributes to systemic infection
in vivo. Furthermore, the loss of calprotectin
in vivo ablates the requirement of zinc homeostasis for GBS virulence. These data support the growing appreciation for the role of zinc uptake in bacterial pathogenesis and provide new insight into the mechanisms by which GBS resists nutritional immune challenge (
Fig. 7).
In this study, we demonstrate, for the first time, the global impact of calprotectin-mediated metal chelation on GBS fitness using transposon library screening. We observed that growth of both GBS disease and colonizing clinical isolates was inhibited by physiologically relevant concentrations of recombinant calprotectin. Serotype V isolates were significantly more resistant to chelation than serotype Ia isolates
in vitro, but the basis for this requires further investigation. As our current understanding of GBS metal homeostasis is limited, we sought to characterize the global effects of calprotectin-mediated metal chelation on GBS fitness, utilizing a newly constructed
Krmit transposon mutant library. This screen identified COG categories of GBS gene function during calprotectin stress, with the most abundant genes of known function involved in inorganic ion transport, amino acid and carbohydrate transport and metabolism, transcription, cell wall biogenesis, and defense mechanisms. Some of the most significant underrepresented factors identified were those involved in metal transport, including zinc/manganese/iron uptake and efflux. Our data also identified GBS essential genes for growth in rich media, including THY and mRPMI, and our results were consistent with a previous study using transposon sequencing of a different GBS strain, which identified essential genes in tRNA synthesis pathways, glycolysis, and nucleotide metabolism (
64). We did, however, observe some differences. The transcriptional regulator
ccpA was previously deemed part of the GBS essential genome (
64), though in our analysis,
ccpA was only essential in mRPMI. Similarly, the global nutritional regulator
codY, which is essential for
Streptococcus pneumoniae growth (
65) and nonessential for GBS in rich medium (
64), was found in our study to be nonessential for growth in THY but essential for GBS growth in mRPMI. Together, these data suggest that the essential genome of GBS is largely similar across strains, although this is dependent on the growth medium.
To survive in metal-limited environments, bacterial pathogens possess tightly regulated, high-affinity metal uptake systems, and many Gram-positive bacteria are known to use the ZnuABC/AdcABC zinc transport systems (
66–68). In the case of pathogens such as
Staphylococcus aureus and
Bacillus anthracis, each possesses a single zinc-binding protein, AdcA and ZnuA, respectively (
69,
70), and their associated ATP-binding cassette transporter permease and ATPase are AdcB/ZnuB and AdcC/ZnuC (
40,
71). The zinc uptake machinery of streptococcal pathogens
S. pneumoniae and
S. pyogenes possess two zinc-binding lipoproteins, AdcA and AdcAII/Lmb. GBS is particularly unique in that in addition to AdcA and AdcAII, it harbors a third zinc-binding protein, annotated as Lmb (
72), encoded on a mobile element that is cotranscribed with a second streptococcal histidine triad protein, ShtII. Lmb is thought to have been acquired by horizontal gene transfer and shares homology with Lsp of
Streptococcus pyogenes (
73), but the direct origin remains unknown. Originally annotated as laminin-binding proteins, Lmb and Lsp were thought to contribute to adherence, though this interaction has been debated and may be species or strain dependent (
44,
74,
75). The GBS zinc uptake machinery is encoded by four distinct operons and is under the regulation of the zinc-dependent AdcR repressor (
40). AdcR is involved in maintaining intracellular zinc homeostasis and has been shown to be important for growth under zinc-limited conditions (
40,
41). Components of this system are also significantly upregulated during GBS murine vaginal colonization and following incubation with human blood (
76,
77). In addition to the ABC transporters, bacteria have evolved other mechanisms to maintain zinc homeostasis, examples include the metallophore staphylopine produced by
Staphylococcus aureus that binds zinc ions and is imported by the CntABCDF machinery (
70) and the TdfH transporter of
Neisseria gonorrhoeae that binds calprotectin directly to hijack and secure zinc ions (
78). Although, similar systems have not been described in GBS.
Our transposon mutant screen during calprotectin treatment identified loss-of-function mutations in the zinc-binding protein AdcA as the most significantly underrepresented metal mutation. Mutants in the AdcC subunit of the zinc-dependent ABC transporter, zinc-binding proteins AdcA and AdcAII, and the streptococcal histidine triad protein ShtII were also underrepresented in our screen. Interestingly, mutations in Lmb and Sht did not result in fitness defects in our transposon library screen, suggesting that in a competitive growth environment, loss of either AdcA or AdcAII reduced GBS fitness in the presence of calprotectin. However, in monoculture, while loss of all three solute-binding proteins sensitized GBS to calprotectin, their individual losses did not. Expression of adcAII and lmb were both induced to greater extent than adcA by both calprotectin and TPEN, and mutations in AdcAII were specifically observed in inhibitory calprotectin treatment. Collectively, these observations could indicate that the GBS zinc importers may uniquely contribute to resisting metal limitation or other aspects of infection, but further investigation is needed.
Additional systems of interest that were underrepresented in our calprotectin transposon library screen were
mtsABC (
SAK_1554 to
1556),
mntH (
SAK_0871),
sczA (
SAK_0515),
czcD (
SAK_0514), and
cadD (
SAK_2051).
mtsABC encodes the manganese/iron-dependent ABC transporter, and
mtsA is a component of the core GBS genome and could be a conserved system for survival during calprotectin-mediated stress within the host (
53,
79). Additionally,
mntH encodes the manganese/iron NRAMP and is known to be important for survival under acidic conditions similar to what GBS would encounter during inflammation or within the phagolysosome (
57). Similar to what has been shown for zinc import, the
mtsABC transporter was shown to be upregulated in human blood and during vaginal colonization (
76,
77). In the context of metal ion efflux, we identified mutations in
sczA,
czcD, and
cadD, which all resulted in fitness defects when grown in media containing calprotectin. SczA is a zinc-dependent transcriptional activator of the cation diffusion facilitator protein CzcD. This system has been shown to contribute to bacterial survival during zinc toxicity, neutrophil and macrophage killing, and GAS virulence (
80–83). To date, SczA has been suggested to be an activator in GBS (
80), but the functional roles of SczA and CzcD in metal efflux and GBS survival have not been described. Additionally, the
cadDX operon in
Streptococcus salivarius has been shown to have both cadmium- and zinc-inducible repression (
84); thus, CadD may function similarly in GBS, but this warrants further investigation. Recently, a new highly virulent GBS sequence type (ST), ST485 of the clonal complex 103, has become increasingly common in China, specifically, with the frequency of isolation quickly climbing from 1% to 14% (
85). These isolates have evolved from a genetic lineage capable of causing both human and bovine disease, and both the increase in virulence and rapid emergence of these isolates are thought to be due to the acquisition of the
cadDX operon (
85).
An additional strength of our study is the sensitivity of our screen to detect genes involved in overcoming various degrees of metal starvation. We identified 30 genes that were essential for GBS growth in a subinhibitory concentration of calprotectin (see
Table S1 in the supplemental material), representing genes that are necessary for overcoming low-level metal sequestration but are nonessential for survival in extreme metal limitation. Genes of importance include those encoding two ribosomal proteins, key enzymes involved in glycolysis, two enzymes involved in folate metabolism, and a cobalt transporter ATPase. We also identified 55 uniquely essential genes for survival in inhibitory levels of calprotectin. These genes represent those that are important for growth when GBS encounters high degrees of starvation or the starvation of multiple metals. Systems of interest in these data were genes encoding four ribosomal proteins, six prophage-related proteins, phosphotransferase systems, and the stress response serine protease HtrA (
Table S1). These differential findings are significant, as it is becoming increasingly appreciated that metal starvation/intoxication occurs across a gradient and that the maintenance of metal homeostasis is dynamic and requires numerous fine-tuned responses. These data are supported by previous studies that show streptococcal metabolism (
86,
87) to be dependent on metal ions and that ribosomal proteins serve as reservoirs for intracellular zinc during metal limitation (
88).
As the relative contribution of zinc homeostasis to GBS virulence had not been previously characterized, we utilized a murine model of GBS systemic infection to compare WT and Δ
adcAΔ
adcAIIΔ
lmb strains. These experiments demonstrated that the Δ
adcAΔ
adcAIIΔ
lmb mutant was significantly attenuated compared to WT GBS in two different GBS strain backgrounds and in different mouse strains. These data further validate our
in vitro results and confirm the importance of zinc uptake machinery to the pathogenesis of GBS infection. To determine the contribution of host calprotectin to the GBS disease process, we utilized a calprotectin knockout mouse strain (
S100A9−/−) (
89,
90). In contrast to the phenotypes observed in WT mice,
S100A9−/− mice were equally susceptible to GBS WT and Δ
adcAΔ
adcAIIΔ
lmb strains (
Fig. 7A), suggesting that zinc transport machinery is expendable when the zinc-limiting pressure of calprotectin is absent. Furthermore, we observed that WT mice exhibited increased mortality due to GBS infection compared to that of
S100A9−/− mice. In our studies, nearly 90% of WT mice infected with WT GBS succumbed to illness by 48 h, whereas the
S100A9−/− mice infected with WT GBS did not reach 50% lethality until 90 h postinfection. Similar trends were recently observed in
S100A9−/− mice challenged with
S. pyogenes (
91). Additionally, these data are consistent with previous findings that suggest a role for calprotectin as an immunological alarmin in promoting inflammatory signaling (
92–94). Studies to determine the specific role of calprotectin in inflammation during GBS disease progression warrant further investigation.
Here, we report the generation and utilization of a highly saturated GBS mariner transposon library to investigate bacterial response to calprotectin-mediated metal chelation. Genome-wide screening revealed numerous metabolic pathways and metal transport systems that may contribute to the ability of GBS to overcome calprotectin stress and nutritional immunity. Our results emphasize the importance of zinc transport to the development of GBS systemic infection, highlighting the significance of zinc homeostasis to disease progression. As zinc uptake machinery is highly conserved across streptococcal pathogens, they present a promising target for the development of novel antimicrobials.