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Infection and Immunity, February 2002, p. 974-980, Vol. 70, No. 2
0019-9567/01/$04.00+0 DOI: 70.2.974-980.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
Adherence of Burkholderia pseudomallei Cells to Cultured Human Epithelial Cell Lines Is Regulated by Growth Temperature
Nat F. Brown, Justin A. Boddey, Cameron P. Flegg, and Ifor R. Beacham*
School of Health Science, Griffith UniversityGold Coast Campus, Gold Coast, Queensland, Australia
Received 14 May 2001/
Returned for modification 16 July 2001/
Accepted 27 September 2001

ABSTRACT
We have investigated the adherence of
Burkholderia pseudomallei,
cultured under a number of different conditions, to six human
epithelial cell lines. While several complex medium compositions
had relatively little effect on adherence, growth at 30°C
was found to significantly increase adherence to all cell lines
relative to that of cultures grown at 37°C (
P < 0.001).

INTRODUCTION
Melioidosis is a disease of humans and animals, the etiologic
agent of which is
Burkholderia pseudomallei. The major region
of endemicity encompasses Southeast Asia and northern Australia,
though this is considered to be expanding (
8,
10,
11,
24,
25).
B. pseudomallei is a gram-negative saprophytic bacterium which
can frequently be found inhabiting the soil and water of regions
of endemicity (
9,
35). While infections acquired from the environmental
reservoir via percutaneous inoculation have been documented
and this is considered the major mode of infection, the roles
of inhalation and ingestion are less clear (
7-
9,
17). Person-to-person
or animal-to-person transmission of melioidosis is considered
to be rare (
7-
9). Disease presentation is diverse, including
chronic and acute forms of localized and disseminated infection,
with the lungs, liver, and spleen being the most commonly affected
organs (
25). Melioidosis is associated with a high fatality
rate and is a major cause of death from community-acquired bacteremic
pneumonia in regions of endemicity (
7,
23).
Adherence of pathogens to host surfaces is a prerequisite step in the pathogenesis of almost all infectious diseases. Bacterial adherence requires the specific interaction of bacterial molecules, termed adhesins, with host cell membrane molecules or extracellular matrix proteins (2, 16). A modification of this typical interaction is employed by the attaching and effacing enteropathogens which insert the bacterial protein Tir into host cell membranes for use as the receptor for the bacterial adhesin intimin (21). Disruption of the adhesin-receptor interaction in many paradigm systems, by mutagenesis or competitive inhibition, resulting in a nonadherent phenotype, is typically associated with a significant reduction in virulence of the pathogen (16, 26, 36). Conversely, the elucidation of specific roles of individual adhesins is complicated by redundancy attributable to the presence of multiple adhesins, as is the case with many species, for example Bordetella pertussis (29).
A significant effort has been put into preliminary characterization of B. pseudomallei interactions with eukaryotic cells, in particular the ability of B. pseudomallei to survive within mammalian phagocytic cells. It has been shown that B. pseudomallei has the ability to survive within polymorphonuclear leukocytes (12, 19, 27), macrophages (13, 14, 19, 27), and nonphagocytic cell lines (14, 19). Similar interactions with Acanthamoeba have also been described (18). Recently, B. pseudomallei has been reported to cause mammalian cell fusion (22), an apparently novel phenotype among those displayed by bacterial pathogens. Relative to the interest in intracellular survival, the preceding steps in pathogenesis, including adherence to host surfaces, have received scant attention. There has been one report of adherence of B. pseudomallei to human pharyngeal cells, from which it was concluded that B. pseudomallei displayed low attachment ability (1). Despite this, intrabronchial inoculation of mice with B. pseudomallei resulted in significant bacterial loads in the lungs, indicating that B. pseudomallei has the ability to adhere to the respiratory tract in vivo (1).
Given the importance of adherence to host surfaces in microbial pathogenesis, we decided to investigate the adherence of B. pseudomallei. It was our intention to clarify this situation by developing an in vitro model of adherence using the standard methodology of allowing bacteria to adhere to epithelial cell lines in culture, as opposed to primary cells shaking in suspension (1).

Identification of the B. pseudomallei adherent phenotype.
In order to see if
B. pseudomallei was capable of adhering to
epithelial cells, a number of variables were tested. This was
to consider the possibility that any potential adherent phenotype
could be regulated by growth conditions or possibly be specific
for different types of cells. We decided to test adherence to
six epithelial cell lines, each derived from different tissues.
The cell lines A549, NCI-H
292, HEp-2, KB, Chang, and ME-180
were derived from alveolar, bronchial, laryngeal, oral, conjunctival,
and cervical tissues, respectively.
B. pseudomallei strain 08
(
6) cultures were grown in Luria-Bertani (LB) medium containing
high salt, low salt, and high salt-low iron concentrations at
temperatures of 30 and 37°C. All assays were conducted in
triplicate with the nonadherent
Escherichia coli strain DH5
as a negative control (
32). The statistical significance of
the differences between the means was assessed using a one-way
analysis of variance performed with the Bonferroni post hoc
test. The results from these experiments (Fig.
1A)
show that
B. pseudomallei grown at 30°C adheres to each cell line
significantly more than
B. pseudomallei grown at 37°C or
DH5

(
P < 0.001). While the levels of adherence to each individual
cell line show considerable variation, there is no outstanding
lack of adherence to any particular cell line compared to the
other cell lines. This is perhaps indicative of the broad tropism
of
B. pseudomallei. While this might be the case, experimental
evidence from many groups suggesting the ability of
B. pseudomallei to survive within macrophages (
13,
14,
19,
27) indicates that
organ tropism may be complicated by dissemination within such
cells (
34). Bacteria grown in low-salt and high-salt-low-iron
media adhered to a similar degree to that of those grown in
high-salt media for each tested cell line (results not shown).
Three other strains of
B. pseudomallei (RBH, THP375, and 03)
(
6) grown at 30 and 37°C in standard LB medium were also
tested for adherence to ME-180 cells. While there was some variation
in the degree of adherence displayed by each strain, in each
case the 30 and 37°C phenotypes paralleled that seen with
strain 08 (results not shown).
To examine whether this apparent increase in the adherence of
B. pseudomallei grown at 30°C relative to adherence with
growth at 37°C was an artifact,
E. coli DH5

grown at these
temperatures was tested for adherence to ME-180 cells. Adherence
of cultures grown at 37 and 30°C was found to be 1.33% ±
0.09% and 1.04% ± 0.08%, respectively. Similarly, strain
E264 of the closely related but relatively avirulent species
Burkholderia thailandensis (
3,
4) was grown at 37 and 30°C
and the degrees of adherence to ME-180 cells were 4.76% ±
0.33% and 4.61% ± 1.21%, respectively. This is potentially
another important difference between these species, in addition
to the previously demonstrated difference in virulence (
3,
4).
These results clearly demonstrate that the adherence phenotypes
displayed by
B. pseudomallei grown at 30 and 37°C are not
an artifact of the methods employed in this investigation. The
apparent temperature regulation of adherence could be the reason
why a previous study found
B. pseudomallei to adhere to pharyngeal
cells only at low levels (
1).
All of the preceding experiments were conducted with stationary-phase cultures, and even though cultures grown at 30°C were of an optical density equivalent to that of those grown at 37°C at the time of assay, it was decided that any potential effects of the growth phase should be identified at each temperature. The results shown in Fig. 1B clearly demonstrate that bacteria from stationary-phase 30°C cultures adhered significantly more than logarithmic-phase 30°C cultures and both logarithmic- and stationary-phase 37°C cultures (P < 0.001). A modest increase in adherence was observed in the logarithmic-phase 37°C cultures in comparison to the stationary-phase 37°C cultures. Taken together, with no information regarding the molecular basis of the demonstrated phenotypes, adherence would appear to be regulated in a complex manner.

Characterization of temperature effects on B. pseudomallei adherence.
The fact that
B. pseudomallei cells grown at 30°C adhered
significantly more to epithelial cells than those grown at 37°C
led us to consider the optimal growth temperature for bacterial
adherence to ME-180 cells. Cultures were therefore grown at
5°C intervals from 22 to 37°C. As can be seen from the
results shown in Fig.
2A,
the optimal temperature for adherence
appeared to be 27°C.
The temperature regulation of adherence is interesting when
the following is considered. Bacteria grown at 37°C do not
show appreciable adherence to host cells, whereas bacteria grown
at 30°C do show significant degrees of adherence, and these
bacteria are adhering during incubation at 37°C. We therefore
investigated the effect of incubation with ME-180 cells at 37°C
by performing a time course experiment, in order to see if the
incubation at 37°C progressively decreased the levels of
adherence. This involved quantifying adherence following incubation
for up to 8 h during the assay itself. The results for the 30
and 37°C cultures indicate that levels of adherence progressively
increased with incubation time (Fig.
2B), presumably due to
the longer period, which allowed attachment and increases in
bacterial cell numbers. Given this result, adherence assays
were then performed using cultures grown to stationary phase
at 30°C, followed by incubation at 37°C for defined
lengths of time, before use in a standard 2-h incubation adherence
assay. The results shown in Fig.
2C clearly illustrate that,
following growth at 30°C, an incubation of 15 min at 37°C
prior to conducting the assay is enough to cause a significant
reduction in adherence (
P < 0.005). These results are not
due to a decrease in bacterial viability following the temperature
shift from 30 to 37°C (results not shown). The mechanism
for the reduction of adherence manifested following a temperature
shift in LB medium from 30 to 37°C could involve a requirement
for de novo protein synthesis for the maintenance of adhesins,
assuming adhesins are not synthesized at 37°C in LB medium.
Indeed, it has been demonstrated that
Haemophilus influenzae adherence requires de novo protein synthesis (
31). To test this
hypothesis, we incubated strain 08 cultures grown overnight
at 30°C with tetracycline (10 µg ml
-1) at 30°C
and without tetracycline at 37°C for 2 h prior to assaying
adherence. The results for these experiments were 10.01% ±
1.07% for the tetracycline culture and 11.93% ± 2.97%
for the 30-to-37°C temperature-shifted culture, which were
both significantly different from the result for the 30°C
control culture without tetracycline (50.00% ± 3.92%,
P < 0.001). This indicates that de novo protein synthesis
is required for
B. pseudomallei adherence. In addition, the
similarity of results for protein synthesis inhibition at 30°C
and the temperature shift to 37°C could indicate that adhesin
molecules are not synthesized at 37°C.
The temperature shift experiments described above present an interesting point: bacteria grown at 30°C and incubated at 37°C in LB medium without epithelial cells show a significant reduction in adherence, whereas those incubated at 37°C with epithelial cells in cell culture medium during the assay maintain high levels of adherence. To address this, another temperature shift experiment was devised to uncouple any potential influence of the cell culture medium from the epithelial cells on adherence. Cultures used in the assay were grown at 30°C to stationary phase, pelleted by centrifugation, resuspended in cell culture medium (McCoy's 5a medium), and incubated at either 30 or 37°C for 4 h prior to adherence assays. Respectively, these results were 91.65% ± 21.19% and 31.96% ± 2.94%. Comparison with the results shown in Fig. 2C indicates that incubation of 30°C-grown stationary-phase bacteria at 37°C in cell culture medium allows for a substantial maintenance of adherence relative to incubation in LB medium (P < 0.005). Incubation of 30°C-grown stationary-phase bacteria in cell culture medium at 30°C also appeared to increase the levels of detectable adherence to ME-180 cells when compared to that of bacteria from 30°C stationary-phase cultures grown in LB medium. Hence, the regulation of adherence appears to involve signals in addition to growth temperature. In Pseudomonas aeruginosa, the type III secreted protein, ExoS, has been shown to be induced in response to growth in cell culture medium (33), and it is perhaps likely that B. pseudomallei adhesins are similarly induced.
The relevance to pathogenesis of a highly adherent phenotype only when bacteria are grown at temperatures below 37°C certainly merits discussion. It is especially noteworthy that B. pseudomallei is an environmental bacterium, and infection is almost exclusively acquired from soil and water rather than from infected animals or humans. Taking into account the temperature regulation of adherence indicated by these experiments, we propose that this may be important for initial adherence to the host following an encounter from the environmental reservoir. A similar temperature regulation of adherence is shown by Bordetella bronchiseptica (28). In this case, the relative increase in adherence of bacteria grown at the lower temperature is less than that seen with B. pseudomallei, due mainly to the fact that B. bronchiseptica displays relatively high levels of adherence when grown at 37°C (28). Importantly, this temperature regulation of adherence in B. bronchiseptica is reflected by colonization levels in vivo, suggesting an important role in overcoming initial clearance mechanisms (5). The precise temperatures of typical environmental reservoirs of B. pseudomallei are unknown, and as such the potential relevance of such regulation is speculative. A major paradigm of virulence gene regulation is the ToxR regulon of Vibrio cholerae, and this system is influenced by a number of environmental stimuli, including temperature (30). Included in the ToxR regulon are the toxin coregulated pilus and accessory colonization factors (30). During in vitro growth of classical biotype strains in LB medium, the growth temperature for optimal expression of the regulon is 30°C (30), though this is not considered to be relevant to natural infections. Hence, it remains a formal possibility that the temperature regulation of adherence described herein is simply an artifact of in vitro culture of B. pseudomallei.

Qualitative investigation of B. pseudomallei adherence using microscopy.
In order to confirm both that
B. pseudomallei strain 08 was
indeed adhering to epithelial cells and that the levels were
increased in cultures grown at 30°C, monolayers were Giemsa
stained (pH 6.7) and examined by light microscopy. These experiments
were conducted using ME-180 cells grown on coverslips. Light
microscopy indeed confirmed that bacteria were adhering to cells
and that they were far more prevalent in cultures grown at 30°C
(Fig.
3).
Typically, bacteria grown at 30°C could often
be seen clustered together in microcolonies, adhering to one
or a few adjacent epithelial cells, while many neighboring epithelial
cells in the monolayer were left relatively free of bacteria.
Observation of the adherence of bacteria grown at 37°C showed
that while the number of bacterium-cell contacts was considerably
lower, adherent microcolonies were essentially absent compared
with that seen in bacteria grown at 30°C. At the incubation
time used (2 h), there was no consistent and obvious cytopathic
effect common to cells with adherent bacteria when compared
to uninfected controls.
Scanning electron microscopy was utilized to investigate the
possible existence of any specific structural features associated
with the adherence of
B. pseudomallei to epithelial cells. Adherence
to all six previously tested cell lines was investigated, and
no outstanding structural feature on the surface of the epithelial
cells was associated with bacteria-epithelial cell contacts.
Likewise, no bacterial structure could be seen mediating attachment
to the epithelial cells or to other bacteria. The microcolony
formation of adherent bacteria observed was consistent with
the results recorded with light microscopy. Epithelial cells
associated with adherent microcolonies, in many instances, were
associated with many bacteria independent of bacterium-bacterium
interactions, and it was apparent that these interactions were
intimate (Fig.
4).
This illustrates the potential importance
of both bacterium-epithelial cell and bacterium-bacterium interactions
in the adherence of
B. pseudomallei to epithelial cells. It
is noteworthy that mechanisms of microcolony formation of other
pathogens may involve bacterial as well as host molecules (
15,
20).

Concluding remarks.
This study clearly shows that
B. pseudomallei is capable of
adhering efficiently to epithelial cell lines. It would appear
that the adherent phenotype is regulated in a complex manner
by growth temperature, medium composition, and growth phase
and that it is dependent on de novo protein synthesis. The development
of an animal model which tests preliminary steps in pathogenesis
is necessary to test whether this temperature regulation of
adherence is important in the pathogenesis of melioidosis. This
investigation provides a basis on which to begin the molecular
characterization of the bacterial molecules responsible for
the initial interactions with host cells as well as the bacterium-bacterium
interactions. Since any adhesins are likely to be regulated,
experiments involving expression in heterologous hosts may prove
challenging. Molecular characterization of the regulatory mechanisms
will also be of interest, as will the characterization of the
host molecules required for attachment to
B. pseudomallei.

ACKNOWLEDGMENTS
We are grateful to P. Timms for the gift of the HEp-2 cell line.
N.F.B. is an Australian Postgraduate Award recipient.

FOOTNOTES
* Corresponding author. Mailing address: School of Health Science, Griffith UniversityGold Coast Campus, PMB 50 Gold Coast Mail Centre, QLD 4217, Australia. Phone: 61 7 5552 8185. Fax: 61 7 5552 8908. E-mail:
i.beacham{at}mailbox.gu.edu.au.

Editor: V. J. DiRita

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Infection and Immunity, February 2002, p. 974-980, Vol. 70, No. 2
0019-9567/01/$04.00+0 DOI: 70.2.974-980.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
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