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Infection and Immunity, June 2002, p. 2787-2795, Vol. 70, No. 6
0019-9567/02/$04.00+0 DOI: 10.1128/IAI.70.6.2787-2795.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
Mycobacterium tuberculosis Genes Induced during Infection of Human Macrophages
Eugenie Dubnau,1 Patricia Fontán,1 Riccardo Manganelli,1,2 Sonia Soares-Appel,1 and Issar Smith1*
TB Center, The Public Health Research Institute, Newark, New Jersey 07103,1
Department of Histology and Microbiology and Medical Biotechnologies, Medical School, University of Padua, 63 35121 Padua, Italy2
Received 27 September 2001/
Returned for modification 23 November 2001/
Accepted 21 February 2002

ABSTRACT
We identified
Mycobacterium tuberculosis genes preferentially
expressed during infection of human macrophages using a promoter
trap adapted for this pathogen.
inhA encodes an enoyl-acyl carrier
protein reductase that is required for mycolic acid biosynthesis
(A. Quemard et al., Biochemistry
34:8235-8241, 1995) and is
a major target for isoniazid (INH) in mycobacterial species
(A. Banerjee et al., Science
263:227-230, 1994). Since overexpression
of
inhA confers INH resistance in
Mycobacterium smegmatis (Banerjee
et al., Science
263:227-230, 1994), we designed a promoter trap
based on this gene. A library of clones, containing small fragments
of
M. tuberculosis DNA cloned upstream of
inhA in a plasmid
vector, was electroporated into
M. tuberculosis, and the resulting
culture was used to infect the human monocytic THP-1 cell line.
Selection was made for clones surviving INH treatment during
infection but retaining INH sensitivity on plates. The DNA upstream
of
inhA was sequenced in each clone to identify the promoter
driving
inhA expression. Thirteen genes identified by this method
were analyzed by quantitative reverse transcription-PCR (R.
Manganelli et al., Mol. Microbiol.
31:715-724, 1999), and eight
of them were found to be differentially expressed from cultures
grown in macrophages compared with broth-grown cultures. Several
of these genes are presumed to be involved in fatty acid metabolism;
one potentially codes for a unique DNA binding protein, one
codes for a possible potassium channel protein, and the others
code for proteins of unknown function. Genes which are induced
during infection are likely to be significant for survival and
growth of the pathogen; our results lend support to the view
that fatty acid metabolism is essential for the virulence of
M. tuberculosis.

INTRODUCTION
Virulence genes are generally defined as genes that are necessary
for survival of the pathogen in a host and are involved in pathogenicity
but are not necessary for growth in culture medium. Several
virulence genes of
Mycobacterium tuberculosis have been identified
by comparing the pathogenicity of strains with mutations in
the genes to the pathogenicity of isogenic strains carrying
the wild-type alleles. These genes include
katG, encoding a
catalase peroxidase (
35),
hspX (
acr), encoding a homologue of

-crystallin, (
36), and
erp, encoding an uncharacterized exported
protein (
2). Specific modifications of mycolic acids are essential
for virulence since strains carrying disruptions in
hma, required
for the biosynthesis of oxygenated mycolic acids (
8), and in
pcaA, a gene coding for a mycolic acid cyclopropane synthetase
(
11), are attenuated in mice. Synthesis of the exported phthiocerol
dimycocerosate (
3,
6) is also required for virulence in mice.
Fatty acid degradation is implicated in pathogenicity since
a strain carrying a mutated
aceA gene, which is required for
synthesis of isocitrate lyase, was attenuated in mice (
23).
Mahan et al. (19, 20) were the first workers to develop a promoter trap, known as an in vivo expression technology (IVET) system, to select for genes of Salmonella enterica serovar Typhimurium specifically induced in host tissues. This method has also been used to study pathogenesis in Staphylococcus aureus, Vibrio cholerae, and other bacteria (4). Using the same approach, we created an IVET method for M. tuberculosis to select for genes specifically upregulated during growth in macrophages derived from the human monocytic cell line THP-1. Our goal was to identify genes expressed during infection of macrophages as a means of analyzing the environmental conditions faced by the pathogen during infection, as well as to identify targets for diagnosis and treatment of tuberculosis. Selection was based upon increased expression of inhA, driven by promoters which are upregulated specifically during infection. inhA codes for an enoyl-ACP reductase, which is required for mycolic acid biosynthesis (26) and is a major target for isoniazid (INH) in M. tuberculosis. Overproduction of this enzyme confers resistance to INH in Mycobacterium smegmatis (1) and in M. tuberculosis (this communication). Specific induction of several candidate genes during growth in macrophages was confirmed by using real-time reverse transcription (RT)-PCR with molecular beacons (mbRT-PCR) (21).

MATERIALS AND METHODS
Construction of the promoter trap.
The plasmid promoter trap vector pJD32 was constructed by cloning
a promoterless PCR-amplified
M. smegmatis inhA gene containing
an INH resistance mutation (
1) into pYUB378, an
Escherichia coli-Mycobacterium shuttle vector conferring kanamycin resistance
in both organisms (
9). This vector has a unique
BamHI site upstream
of
inhA, and a derivative pJD33 plasmid was constructed with
the
hsp60 promoter from
Mycobacterium bovis BCG cloned into
this site. A library of small DNA fragments from
M. tuberculosis was made by partial
SauIIIA digestion and cloned into the
BamHI
site of pJD32. The plasmid library consisted of 1
x 10
6 clones
in
E. coli, and the minimum insertion frequency, measured by
PCR, was 62%. Assuming that the average insertion size was 300
bp, as estimated by PCR, our library consisted of 192 Mb (6.4
x 10
5 clones
x 0.3 kb) of DNA from
M. tuberculosis. Since the
size of the genome was 4.4 Mb, this library represented the
entire genome reiterated about 43 times. We electroporated the
plasmid library into
M. tuberculosis H37Rv and selected for
kanamycin resistance in broth culture. An aliquot of the transformation
mixture was plated onto solid medium containing kanamycin, and
a total of about 9
x 10
4 M. tuberculosis clones were obtained.
With an insertion frequency of 62% and an average insertion
size of 300 bp, this represented about 16.7 Mb of the 4.4-Mb
genome and thus represented the entire genome about four times.
A small percentage (0.01%) of the clones from the broth culture
grew on plates containing INH (1 µg/ml), and these clones
were presumed to contain a promoter upstream of
inhA which was
active when
M. tuberculosis was grown on plates. The low incidence
of INH-resistant clones in the library was presumably due to
the low probability of a promoter fragment being inserted in
the correct orientation upstream of
inhA. Most of the small
DNA inserts were expected to be internal fragments of various
genes or sequences oriented in the wrong direction for transcription,
and therefore the frequency of INH-resistant clones was expected
to be low. In addition, since we plated the
M. tuberculosis library on plates containing 1 µg of INH per ml, a rather
high concentration, our estimate of the frequency of INH-resistant
clones may have been low.
Growth of strains.
Cultures of M. tuberculosis H37Rv obtained from Barry Kreiswirth (TB Center, Public Health Research Institute) were grown in 7H9 broth supplemented with albumin, dextrose, and NaCl (ADN) and Tween 80, as previously described (17). Kanamycin was added when appropriate at a concentration of 10 µg/ml, and INH was added at a concentration of 0.5 µg/ml. Cultures in the exponential phase of growth were obtained by diluting logarithmically growing cultures at least 20-fold, followed by incubation on a rotator at 37°C.
Selection for INH resistance during infection of THP-1 cells.
THP-1 (= ATCC TIB-202) is a monocytic human cell line which can be induced with phorbol esters to a macrophage-like state (32). THP-1 cells were grown in RPMI 1640 medium (Gibco-BRL) supplemented with 10% fetal calf serum, 0.45% glucose, 0.15% sodium pyruvate, and 4 mM L-glutamine. Cultures were maintained at concentrations of 1 x 105 to 5 x 105 cells/ml, and the cells were induced to the macrophage-like state by 24 h of treatment with 40 nM 12-O-tetradecanoylphorbol-13-acetate (PMA) (32). The cells were infected with the M. tuberculosis library for 4 h at a multiplicity of infection of about 1; this was followed by washing with phosphate-buffered saline and replacement of the medium with fresh medium. The number of CFU was estimated based on the optical density of the culture, as previously determined experimentally. After 1 day, the medium was replaced with medium containing 0.5 µg of INH per ml, and the infected cultures were incubated five more days, with changing of the medium after 4 days. Most cells remained adherent throughout the infection. Intracellular bacteria were isolated after lysis of the macrophages with 0.05% sodium dodecyl sulfate (SDS), collection of the bacteria by centrifugation, and resuspension in fresh broth for reinfection of THP-1 cells. An aliquot of the culture was plated on plates containing kanamycin.
PCR primers and molecular beacons.
PCR primers were designed to anneal to their targets at the same temperature (60°C) and to amplify DNA fragments internal to the coding sequences of the genes. The molecular beacons, synthesized as previously described, were designed to hybridize to the relevant PCR products (33). The primer pair and the molecular beacon for sigA have been described previously (21), and the sequences of all primers and beacons are shown in Table 1.
Preparation of RNA from M. tuberculosis growing in THP-1 cells .
THP-1 cells were differentiated with PMA as described above
and seeded in 24-well tissue culture plates at a density of
7.5
x 10
5cells/well. After 24 h of PMA treatment, cells were
infected with an exponentially growing broth culture of
M. tuberculosis H37Rv at a multiplicity of infection of 0.5 to 1 CFU/macrophage.
In several experiments larger volumes of macrophages were seeded
into either 75- or 175-cm
2 flasks pretreated with 0.2% gelatin
overnight at 4°C. These macrophages were incubated with
RPMI 1640 medium containing 20% fetal calf serum instead of
10% fetal calf serum. These conditions improved the ability
of the differentiated THP-1 cells to adhere to the flasks (
27).
After 2 h of infection, the cells were washed twice with phosphate-buffered
saline and incubated with fresh RPMI 1640 medium containing
50 µg of gentamicin per ml; at different time points the
medium was removed, and each monolayer was lysed with an appropriate
volume of TRI reagent (Molecular Research Center) mixed with
polyacrylamide carrier provided by the manufacturer. The lysate
was immediately transferred to a 2-ml screw-cap microcentrifuge
tube with O-rings containing 0.5 ml of zirconia-silica beads
(diameter, 0.1 mm; Biospec Products, Inc.), frozen in dry ice,
and stored at -80°C. Aliquots of the rolling culture used
for infection and bacteria incubated for 2 h in RPMI 1640 medium
were collected by centrifugation, resuspended in 1 ml of TRI
reagent with glass beads, and frozen as described above. The
viability of intracellular bacteria was assayed in separate
wells, infected as described above, by plating for CFU after
lysis of the macrophages with 0.05% SDS.
M. tuberculosis cells
in the frozen samples were disrupted by two 1-min pulses in
a miniBeadBeater; the samples were kept on ice for 2 min between
the pulses. The liquid was removed from the beads, incubated
at room temperature for 10 min, and centrifuged for 10 min at
12,000
x g. The supernatant was transferred to a clean tube,
100-µl portions of BCP reagent (Molecular Research Center)
were added to 1-ml samples in TRI reagent, and then the tubes
were shaken vigorously for 15 s, incubated for 10 min at room
temperature, and then centrifuged for 15 min at 12,000
x g.
The supernatant was recovered and precipitated with 600 µl
of isopropanol. After the RNA was washed with 75% ethanol, it
was resuspended in 30 to 100 µl of diethyl pyrocarbonate
(DEPC)-treated H
2O, 300 to 1,000 µl of TRI reagent containing
polyacrylamide carrier was added, and the extraction procedure
was repeated. The RNA was dissolved in 30 µl of DEPC-treated
H
2O, treated with RNase-free DNase (Ambion) as recommended by
the manufacturer, precipitated again with 95% ethanol, washed
with 75% ethanol, dissolved in 30 µl of DEPC-treated H
2O,
and stored at -80°C.
mbRT-PCR.
For RT, 2 µl of RNA was added to 1.2 µl of 10x PCR buffer II (Perkin-Elmer), 2.4 µl of MgCl2 (25 mM), 0.24 µl of dimethyl sulfoxide, and enough water to bring the volume to 6 µl. After denaturation at 95°C for 1.5 min, annealing between the RNA and the antisense primers was carried out for 3 min at 65°C and then for 5 min at 57°C. Subsequently, 5 µl of the annealing mixture was added to 2.5 µl of 10x PCR buffer II (Perkin-Elmer), 5 µl of MgCl2 (25 mM), 1 µl of a deoxynucleoside triphosphate mixture (25 mM each), 1.5 µl (6 U) of C. therm RT polymerase (Roche), 1.3 µl of dimethyl sulfoxide, 1.3 µl of dithiothreitol (100 mM), and enough water to bring the volume to 20 µl. Samples were incubated for 1 h at 60°C, heated to 95°C for 1 min, and then chilled on ice. Control samples that were not treated with C. therm RT polymerase were also prepared. These template samples for PCRs were then diluted with 70 µl of H2O and stored at -20°C. The PCR conditions were identical for all reactions. Each 25-µl reaction mixture consisted of 1x DNA polymerase buffer, 4 mM MgCl2, each deoxynucleoside triphosphate at a concentration of 0.25 mM, 1.25 U of AmpliTaq Gold polymerase (Perkin-Elmer), each primer at a concentration of 1 µM, 50 ng of the appropriate molecular beacon, and 10 µl of template. After incubation for 10 min at 94°C to activate the DNA polymerase, the first set of 10 cycles was run with an annealing temperature of 65°C. The denaturation step was 30 s at 94°C, and the extension step was 30 s at 72°C. In the second set of 30 cycles, denaturation was at 94°C for 30 s, annealing was at 60°C for 30 s, and extension was at 72°C for 30 s. The reactions were carried out in sealed tubes in an Applied Biosystems 7700 Prism spectrofluorometric thermal cycler (Perkin-Elmer). Fluorescence was measured during the annealing step of the second set of cycles and was plotted automatically for each sample. Quantitative analysis of the data was performed as previously described (21). In order to obtain standard curves for the mbRT-PCR, a PCR was performed with each primer-beacon set using different amounts of H37Rv chromosomal DNA, and these reactions were performed at the same time as the mbRT-PCR. The standard curves (data not shown) were used to calculate the amount of cDNA for each gene present in the different samples. All values were normalized to the amount of sigA mRNA. The values obtained with the RNA sample from the bacteria incubated in 7H9 medium were used as arbitrary standards for the calculations. RNAs from bacterial cultures initially grown in 7H9 medium and then incubated for 2 h in RPMI 1640 medium were also analyzed by mbRT-PCR.

RESULTS
Construction of a promoter trap for M. tuberculosis.
Drug resistance can result from a decreased ratio of drug to
target (
7), and this mechanism explains the observation that
overexpression of
inhA confers INH resistance to
M. smegmatis (
1). InhA, in the presence of NADH, binds INH (
25), consistent
with its role as a major target for this antibiotic. These considerations
led us to predict that
inhA would be suitable for construction
of a promoter trap which could allow selection (INH resistance)
for promoters driving
inhA expression in
M. tuberculosis. We
cloned the
inhA gene from
M. smegmatis (
1) without its promoter
into the shuttle vector pYUB378 (
9) to form the vector pJD32.
To test if increased expression of
inhA could confer INH resistance
in
M. tuberculosis, we cloned the
hsp60 promoter (
Phsp60) (
30)
upstream of
inhA in pJD32 to form pJD33. This promoter is expressed
constitutively at high levels when it is present on a multicopy
plasmid (
30). The
inhA promoterless plasmid (pJD32) and the
plasmid containing
Phsp60 driving
inhA (pJD33) were electroporated
into
M. tuberculosis H37Rv, and the resulting strains were tested
for INH resistance during growth in broth and during infection
of human monocytic cell line THP-1 (
32) after differentiation
into macrophage-like cells with phorbol ester. The strain with
Phsp60 driving
inhA expression conferred INH resistance under
both growth conditions, whereas the strain carrying the promoterless
inhA gene remained relatively sensitive to INH (Fig.
1). These
results show that as previously reported for
M. smegmatis (
1),
overproduction of InhA confers INH resistance to
M. tuberculosis. We concluded that a promoter trap based upon INH resistance
caused by overexpression of
inhA should be suitable for identification
of
M. tuberculosis promoters induced during infection. We should
note that
M. tuberculosis carrying the plasmid with no promoter
driving
inhA is more sensitive to INH in broth culture (Fig.
1A) than in THP-1 cells (Fig.
1B). This could be due to lower
actual levels of INH in the macrophages than in broth or to
decreased INH sensitivity of the macrophage-grown
M. tuberculosis.
Thus, it is possible that clones with a weak, constitutively
expressed promoter might appear to be INH resistant during infection
of THP-1 cells while remaining INH sensitive in broth. Therefore,
all clones identified by this system must be further evaluated
to eliminate false positives (see below).
Selection of M. tuberculosis INH-resistant clones during infection of THP-1 cells.
We constructed a library using small (100- to 500-bp)
M. tuberculosis DNA fragments cloned upstream of
inhA in the pJD32 vector. This
plasmid library was electroporated into
M. tuberculosis, with
selection for kanamycin resistance; 0.01% of the clones resulting
from the electroporation procedure were INH resistant prior
to further selection. This low frequency was presumably due
to the fact that most clones contained small DNA fragments with
no promoter activity at all; pos sibly there were also some
promoters that conferred resistance to levels of INH lower than
that used in the original selection. A culture from the library
was used to infect THP-1 cells that had been differentiated
into macrophage-like cells by the addition of phorbol esters.
Treatment with INH was imposed after 1 day of infection, and
clones that survived a 5-day treatment with 0.5 µg of
INH per ml were selected. Surviving clones were isolated from
the macrophages, diluted into broth, and used to reinfect THP-1
cells, again with treatment with INH for 5 days. Passaging of
the library in this manner was repeated four times. Each time,
an aliquot of the culture containing survivors of the INH treatment
was plated on medium with no INH, and single colonies were picked
and tested individually for INH resistance by streaking on plates
containing INH (0.5 µg/ml). Clones completely sensitive
to this level of INH were analyzed by PCR for the presence of
a cloned insert by using primers for
inhA and vector sequences
that flanked the insert.
Clones were analyzed for the frequency of inserts and the frequency of INH resistance before and after selection in macrophages in order to determine if INH selection was working during growth in macrophages. It was expected that the frequency of clones resistant to INH on plates, as well as the frequency of inserts in INH-sensitive clones, would increase with each selection round. The presence of an insert was determined by PCR analysis with heat-killed bacteria by using primers flanking the cloning site, and INH resistance was assayed by streaking on plates with 0.5 µg of INH per ml. The enrichment of the frequency of INH-resistant clones and INH-sensitive clones containing inserts is shown in Fig. 2. Only 59% of the INH-sensitive clones from the original library had inserts, whereas after four passages with selection with INH in macrophages, 93% of the INH-sensitive clones had inserts and 72% were INH resistant.
Identification of promoters driving inhA in clones surviving INH treatment during macrophage infection.
Plasmid DNAs from individual
M. tuberculosis clones that survived
INH treatment during growth in THP-1 cells, that were INH sensitive
on plates, and that carried DNA inserts upstream of
inhA, as
determined by direct PCR analysis of the
M. tuberculosis colonies,
were isolated from
M. tuberculosis cultures and used to transform
E. coli. Plasmid DNAs were then prepared from the
E. coli kanamycin-resistant
transformants, and the sequences of the inserts upstream of
inhA were determined by using a primer specific for the adjacent
5' region of
M. smegmatis inhA. The DNA sequences of the inserts
were then compared to the
M. tuberculosis H37Rv genome database
(
5). Whereas only 24% (4 of 17) of the INH-sensitive clones
from the second passage contained sequences 5' to an open reading
frame in the correct orientation for transcription of
inhA,
41% (12 of 41) of the clones from the third passage and 69%
(45 of 65) of the comparable clones from the fourth passage
contained such sequences. Our initial conclusion was that these
sequences contained promoters that drove expression of
inhA during
M. tuberculosis infection of macrophages, resulting in
overexpression of InhA and conferring INH resistance during
infection. A list of the open reading frames found downstream
from these putative promoter sequences is shown in Table
2.
Differential expression of selected genes measured by RT-PCR.
Since some of the promoters identified by our system could be
false positives, selected on the basis of artifactual increased
expression from a multicopy plasmid or because they were low-level
constitutive promoters, as discussed above, we set out to verify
whether they were indeed induced during growth of wild-type
M. tuberculosis in macrophages. We determined the ratio of specific
mRNAs from
M. tuberculosis H37Rv grown in broth to specific
mRNAs found in bacteria infecting THP-1 cells by using mbRT-PCR
(
21). Normalization is necessary for quantitative analysis by
RT-PCR, and since initial experiments had shown that the
sigA mRNA/total bacterial RNA ratio was the same in log-phase broth-grown
and macrophage-grown cultures (data not shown), we performed
an experiment to verify that
sigA mRNA could be used for normalization
of the mRNAs of the genes identified by the promoter trap selection
procedure. We monitored the relative levels of
sigA DNA by PCR
and the levels of
sigA mRNA by RT-PCR with samples prepared
during growth of
M. tuberculosis in THP-1 cells. At the same
time, we measured the CFU. The levels of
sigA mRNA increase
in parallel with the levels of
sigA DNA and the CFU (Fig.
3).
This shows that as expected for a housekeeping gene,
sigA mRNA
accumulates in proportion to DNA levels and bacterial replication
under conditions of growth in THP-1 macrophages, validating
the use of
sigA mRNA to normalize the mRNA levels of the genes
analyzed.
Next, we tested if our methods would work for a gene whose expression
was known to be induced in
M. tuberculosis during growth in
macrophages.
hspX, coding for the

-crystallin-like protein,
had previously been shown to be highly induced (
36), as was
the protein itself (
24). Therefore, we measured the relative
levels of
hspX mRNA during infection and during growth in broth.
As expected,
hspX was induced very dramatically (maximum, 366-fold)
in bacteria grown in THP-1 cells after only 6 h of incubation
(Fig.
4). This result validated the mbRT-PCR method for quantitating
mRNA levels in bacteria grown in macrophages. We chose 13 of
the 43 genes identified by the selection system for validation
by mbRT-PCR (
21). We made the selection based upon genes which
could be involved in a variety of functions. Some of these genes
encoded proteins postulated to be involved in fatty acid degradation,
others could be involved in export or import, others with DNA
binding motifs are potential transcriptional activators, and
others encoded proteins whose functions are completely unknown.
We determined the ratios of the mRNAs of these genes in broth-grown
and THP-1-grown cultures of
M. tuberculosis. In order to be
sure that our RNA preparations were not contaminated with RNA
from a small population of extracellular bacteria which had
not been removed by washing, we added gentamicin (50 µg/ml)
to the medium after the infected monolayer was washed, and the
antibiotic was present throughout the infection. This treatment
did not significantly affect the yield of intracellular bacteria
but was effective in killing extracellular bacteria (data not
shown). In an earlier series of experiments, we infected the
cells in the absence of gentamicin and obtained the same results
with mbRT-PCR (R. Manganelli, E. Dubnau, and I. Smith, unpublished
data). Eight of the 13 genes tested (Rv2224c, Rv3237c, Rv3321c,
Rv2520c,
pckA,
echA19,
fadA4, and
aceA) were upregulated more
than twofold during growth in THP-1 cells relative to growth
in broth culture (Table
3). Similar data were obtained with
two separate infections and, in the case of Rv2520c and
aceA,
with three separate infections. Therefore, 61% (8 of 13) of
the genes tested were found to be actually induced during growth
in THP-1 cells. In order to control for differential expression
of bacterial genes in response to the tissue culture medium
(RPMI 1640 medium) during the 2 h of incubation allowed for
uptake of the bacteria, we also compared the levels of mRNAs
from bacteria incubated in RPMI 1640 medium for 2 h with the
levels of RNAs from bacteria grown in broth culture. Most of
the genes showed no significant differences in RNA levels, but
aceA and
echA19 were induced by this treatment (9.5- and 4.2-fold,
respectively), albeit at lower levels than during growth in
THP-1 cells (85.4- and 25-fold, respectively) (Table
3). This
induction may have been due to the high levels of fetal calf
serum (20%) added to the RPMI 1640 medium. We expected that
this component would be very rich in fatty acids and could cause
induction of genes postulated to be involved in fatty acid metabolism.
We are currently investigating the induction patterns of these
genes in various media.
Several genes identified by our selection system, (Rv0977, Rv1774,
Rv1171,
fadA5, and
nirA) were not upregulated, and in fact,
two of these genes (Rv1171 and Rv1774) seemed to be actually
repressed in macrophages, suggesting that our system does identify
some false positives.
nirA appears to be downregulated both
in RPMI 1640 medium and in macrophages. Therefore, the other
genes listed in Table
2 must be considered candidate genes prior
to further validation.

DISCUSSION
The virulence of any pathogen is determined by its ability to
adapt to the host environment. Our approach to describe adaptation
by
M. tuberculosis to the macrophage environment, in which a
promoter trap screen was used, resulted in identification of
43 genes, 9 of which may code for proteins involved directly
or indirectly in fatty acid metabolism:
aceA,
echA19,
fadA4,
pcKA,
ephF, Rv0610c, Rv1144,
fadA5, and Rv1774. It is expected
that microarray analysis of gene expression in macrophages should
produce a far more extensive list of genes that are transcriptionally
upregulated during growth in macrophages, and several laboratories,
as well as our laboratory, are currently doing this sort of
analysis. Our survey was certainly not extensive enough to detect
all
M. tuberculosis genes upregulated in macrophages since various
genes, including iron-regulated genes,
sigE,
sigH,
hspX, and
fbpB, known to be upregulated in macrophages (
12,
18,
28,
36),
were not identified by our screening procedure. None of the
genes identified as upregulated during growth in the presence
of INH (
34), several of which are also involved in fatty acid
metabolism, were identified by our method. Obviously, the main
reason for this is the fact that we selected against this group
of genes by choosing only clones which are sensitive to INH
on plates. Promoters induced by INH would confer resistance
to INH.
Thirteen genes were selected for quantitative analysis by mbRT-PCR from RNAs prepared from broth-grown cultures and THP-1-grown cultures. It is important to emphasize that this analysis was done with wild-type M. tuberculosis H37Rv and not with strains carrying plasmids containing inhA under the control of cloned promoters. Thus, the measurements of mRNA were based upon transcription from the native promoters of the genes in their normal chromosomal location. hspX was highly induced under our conditions, validating our methods, since it has been shown previously that this gene is upregulated in macrophages (24, 36). Some workers reported high levels of hspX mRNA in log-phase cultures of M. tuberculosis (16), but we found this molecule to be present at very low levels in such cultures and we assume that the different results arose from differences in bacterial growth conditions.
Expression of eight genes was shown to be induced during growth in THP-1 cells. Five genes were not found to be induced, and therefore it is important to stress that the genetic screening method does pick up false positives. There are several different sources of false positives: (i) promoter activity due to multicopy effect, (ii) low-activity promoters leading to survival in vivo and sensitivity in vitro, (iii) lower sensitivity to INH in vivo because of lower levels of INH in the macrophages, decreased levels of catalase, or other unknown reasons, and (iv) induced expression which is below the detection limit of the RT-PCR. Although most of the genes which we identified coded for unknown functions, 9 of the 43 genes are predicted to be involved in fatty acid metabolism. The genome of M. tuberculosis has approximately 250 open reading frames which are annotated to be involved in fatty acid metabolism, out of a total of about 4,000 open reading frames. The probability of detecting 9 of these 250 open reading frames in 43 genes simply by chance is very low (P < 0.001, as determined by chi-square test).
The genes identified by our selection procedure include fadA4 and echA19, which are annotated as genes involved in ß-oxidation of fatty acids, as well as aceA (icl) coding for isocitrate lyase, an enzyme of the glyoxylate shunt pathway. This pathway is required to replenish substrates for the Krebs cycle during growth on fatty acids. The fact that aceA appeared among the selected genes validated our approach since it was shown previously that aceA was upregulated during infection of macrophages (13, 23) and that the levels of isocitrate lyase increase during infection (15, 31). Significantly, this gene is necessary for virulence in mice (23). pckA, although not directly involved in fatty acid metabolism, is required to produce phosphoenolpyruvate from the tricarboxylic acid cycle during metabolism of acetate, the product of fatty acid ß-oxidation. Other genes identified by our selection procedure which may be involved in fatty acid metabolism include ephF, encoding an annotated epoxide hydrolase, Rv0610c, encoding an annotated monooxygenase, and Rv1144, encoding an annotated short-chain alcohol dehydrogenase. This group of genes has not yet been validated. Compared with the 50 genes in E. coli, the number of genes presumed to be involved in ß-oxidation of fatty acids in M. tuberculosis is astounding (5). There are 36 fadD, 36 fadE, 21 echA, 5 fadB, and 6 fadA paralogs in M. tuberculosis, whereas there is only one copy of each of these genes in E. coli. This, together with biochemical data on the differences in metabolism of M. tuberculosis growing in mouse lungs and in broth (29), has led to a consensus that fatty acid degradation may provide a major source of energy during infection.
It is interesting that pckA, aceA, and seven fad genes are also upregulated in M. tuberculosis by treatment with SDS (22), a stress condition which may cause cell envelope damage and require remodeling of the cell envelope. S. enterica serovar Typhimurium modifies the structure of lipid A during growth in macrophages; the modifications require phoP-phoQ, a two-component system activated in macrophages, and are postulated to function by attenuating the host cell innate immune response (10, 14). It is possible that M. tuberculosis also remodels its cell envelope upon entry into macrophages, a process that would require degradation followed by resynthesis of various lipids in the cell envelope. Consistent with this hypothesis is the fact that our search identified Rv3717, encoding N-acetyl-muramyl-L-alanine amidase.
There are several other interesting genes which are also induced in THP-1 macrophages. Rv3321c is a member of a subfamily of genes with helix-turn-helix motifs typical of DNA binding proteins (http://cbcsrv.watson.imb.com/servlets/Utility); all of these motifs are upstream of a family of open reading frames with some similarity to one another. Rv3237c is annotated as a possible potassium channel protein gene.
Our findings highlight the significance of fatty acid metabolism for M. tuberculosis during growth in macrophages. It is interesting that fadB, coding for an enzyme required for ß-oxidation of fatty acids, was upregulated in S. enterica serovar Typhimurium during infection of mice, and this in vivo induction was thought to be due to the high concentration of fatty acids encountered by the pathogen during infection (19). Lipids have long been postulated to be an energy source for M. tuberculosis during infection, but it is also possible that lipid biosynthesis and degradation may be important for the remodeling of the cell envelope upon entry into the macrophage. Ultimately, we are interested in defining new M. tuberculosis drug targets, and we are currently conducting experiments to determine if any of the genes identified by our approach are required for virulence. This is being done by assaying the virulence in macrophages and mice of mutant strains inactivated for the various genes.

ACKNOWLEDGMENTS
We express our deep appreciation to Leonard Mindich, Marcela
Rodriguez, Salvatore Marras, David Dubnau, and Benjamin Gold
for helpful discussions and critical reading of the manuscript.
We thank Juliano Timm for designing the primers and beacons
for
aceA,
fadA4, and
fadA5.
This work was supported by NIH grant AI 44856 awarded to I.S.

FOOTNOTES
* Corresponding author. Mailing address: Public Health Research Institute, 225 Warren Street, Newark, NJ 07103. Phone: (973) 972-9150. Fax: (973) 972-9150. E-mail:
smitty{at}phri.org.

Editor: S. H. E. Kaufmann 
Publication no. 71 from the TB Center. 

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Infection and Immunity, June 2002, p. 2787-2795, Vol. 70, No. 6
0019-9567/02/$04.00+0 DOI: 10.1128/IAI.70.6.2787-2795.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
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