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Infection and Immunity, August 2002, p. 4406-4413, Vol. 70, No. 8
0019-9567/02/$04.00+0 DOI: 10.1128/IAI.70.8.4406-4413.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
Loss of Regulatory Protein RfaH Attenuates Virulence of Uropathogenic Escherichia coli
Gábor Nagy,1,2 Ulrich Dobrindt,2 György Schneider,1 A. Salam Khan,2 Jörg Hacker,2 and Levente Emödy1*
Institute of Medical Microbiology and Immunology, University of Pécs, 7624 Pécs, Hungary,1
Institut für Molekulare Infektionsbiologie, Universität Würzburg, 97070 Würzburg, Germany2
Received 14 February 2002/
Accepted 5 April 2002

ABSTRACT
RfaH is a regulatory protein in
Escherichia coli and
Salmonella enterica serovar Typhimurium. Although it enhances expression
of different factors that are proposed to play a role in bacterial
virulence, a direct effect of RfaH on virulence has not been
investigated so far. We report that inactivation of
rfaH dramatically
decreases the virulence of uropathogenic
E. coli strain 536
in an ascending mouse model of urinary tract infection. The
mortality rate caused by the wild-type strain in this assay
is 100%, whereas that of its isogenic
rfaH mutant does not exceed
18%. In the case of coinfection, the wild-type strain 536 shows
higher potential to colonize the urinary tract even when it
is outnumbered 100-fold by its
rfaH mutant in the inoculum.
In contrast to the wild-type strain, serum resistance of strain
536
rfaH::
cat is fully abolished. Furthermore, we give evidence
that, besides a major decrease in the amount of hemin receptor
ChuA (G. Nagy, U. Dobrindt, M. Kupfer, L. Emody, H. Karch, and
J. Hacker, Infect. Immun. 69:1924-1928, 2001), loss of the RfaH
protein results in an altered lipopolysaccharide phenotype as
well as decreased expression of K15 capsule and alpha-hemolysin,
whereas levels of other pathogenicity factors such as siderophores,
flagella, Prf, and S fimbriae appear to be unaltered in strain
536
rfaH::
cat in comparison to the wild-type strain.
trans complementation
of the mutant strain with the
rfaH gene restores wild-type levels
of the affected virulence factors and consequently restitutes
virulence in the mouse model of ascending urinary tract infection.

INTRODUCTION
Pathogenic strains of
Escherichia coli produce virulence factors
that differentiate them from commensal variants of the same
species and enable them to cause disease. Constitutive expression
of virulence determinants, however, would be needless and energetically
exhausting for bacteria. Moreover, the presence of some virulence
factors could even be disadvantageous at certain points of the
infectious process. For effective pathogenesis, bacteria sense
their environment and regulate the expression of genes encoding
virulence factors. This response to environmental signals is
usually mediated by specific or global regulators, which often
form a correlative, complex network (for a review, see reference
15). A regulatory protein has been described in gram-negative
bacteria which was first demonstrated to have an influence on
lipopolysaccharide (LPS) core synthesis and therefore was named
RfaH (
23).
The RfaH protein acts as a transcriptional regulator in E. coli, Salmonella enterica serovar Typhimurium, and possibly in other gram-negative bacteria (3). During the last two decades, several operons that are dependent on RfaH for full expression were identified in various strains. These include rfa, rfb, hly, tra, chu, cps, and kps, whose altered expressions in the absence of RfaH result in a decreased amount of LPS core (23), O-antigen (42), alpha-hemolysin (5, 22), F-factor (35), hemin receptor (29), and group I (32), group II (39), and group III (9) capsules, respectively. The exact mechanism by which RfaH enhances expression of these components is not yet fully understood. According to the present view, RfaH regulation takes place at the level of transcriptional antitermination, hence suppressing operon polarity (3). The effect of RfaH is highly dependent on a cis-acting region termed JUMPStart sequence. Recently, the association of RfaH with an 8-bp motif located within the JUMPStart sequence (the ops element) was described (4).
Interestingly, all determinants affected by RfaH encode components that are exported from the bacterial cell or anchored in the outer membrane. Furthermore, they all are somehow related to bacterial virulence: they provide shelter against host defense mechanisms (capsules and intact LPS), supply bacteria with essential substances (hemin receptor), or serve as a cytotoxin (alpha-hemolysin) during infection.
However, observations on RfaH-dependent regulation of individual operons are derived from various strains belonging to different pathogroups of E. coli and S. enterica serovar Typhimurium. Furthermore, there have been no data available on the impact on virulence of the altered expression of these determinants. In this paper we show that disruption of the rfaH gene in uropathogenic E. coli strain 536 results in a significant decrease in virulence. Moreover, evidence is provided that RfaH is a global regulator which modifies expression of several virulence factors within a single strain.

MATERIALS AND METHODS
Animal experiments.
Animal experiments were conducted according to the principles
set forth in the Guide for the Care and Use of Laboratory Animals
(
30) in a laboratory authorized by the Hungarian rule (decree
no. XXVII, 1998) and by the subsequent regulation (order no.
243/1998).
Bacterial strains, plasmids, and culture conditions.
The bacterial strains and plasmids used are described in Table 1. Uropathogenic E. coli strains RZ430, RZ451, and RZ532 were provided by Gabriele Blum-Oehler (Institut für Molekulare Infektionsbiologie, Würzburg, Germany). E. coli strain 536 was isolated from a patient suffering from acute pyelonephritis (7). Construction of its rfaH mutant is described below. Bacteria were grown routinely in Luria-Bertani (LB) broth or LB solidified with 1.5% agar (Biolab, Budapest, Hungary). For hemolytic activity tests, supernatants were obtained from cultures grown in 2xYT medium. For the determination of siderophores, bacteria were grown in M9 medium. When appropriate, media were supplemented with the following concentrations of antibiotics: ampicillin (Ap), 100 µg/ml; chloramphenicol (Cm), 30 µg/ml; and streptomycin (Sm), 50 µg/ml.
Inactivation of the rfaH gene in E. coli strain 536.
In order to inactivate the
rfaH gene in
E. coli strain 536 by
gene disruption with a chloramphenicol acetyltransferase (
cat)
cassette, the entire
rfaH gene together with approximately 0.5
kb of each the flanking up- and downstream regions was amplified
by PCR. The resulting 1.6-kb
E. coli strain 536-specific PCR
product obtained with primer pair rfaH1 (5'-GTC GGC ATG TTC
AAT ACT TGC-3') and rfaH2 (5'-TAC ATC CTC ACG ACA GCA GC-3')
was cloned into plasmid pGEM T-Easy (Promega, Heidelberg, Germany),
giving rise to pSMK1 (Table
1). The sequence analysis of
rfaH536 revealed the presence of a
PstI restriction site at position
+131 to +136 with respect to the
rfaH translational start. The
subcloned
rfaH gene of
E. coli strain 536 was subsequently disrupted
by the integration of a
cat cassetteobtained by
PstI
restriction of the plasmid pMSC1 (
27)into the
PstI restriction
site located within
rfaH536. The resulting
rfaH536::
cat::
rfaH536 construct flanked by
rfaH536 up- and downstream sequences was
cloned into suicide vector pCVD442 for allelic exchange with
the chromosomal
rfaH up- and downstream regions of
E. coli strain
536. The resulting plasmid was designated pSMK5. Allelic exchange
was performed as previously outlined (
26). Western blot analysis
confirmed that in the resulting strain, 536
rfaH::
cat, no functional
RfaH protein was expressed due to the
rfaH gene disruption (data
not shown). The mutant strain was supplemented either with pGEM
T-Easy or the cloned
rfaH gene (pSMK1). Introduction of pSMK1
into the mutant restored expression of RfaH, which was verified
by Western blotting (data not shown).
Antisera.
Specific antiserum against RfaH was kindly provided by Vassilis Koronakis (Department of Pathology, Cambridge University, United Kingdom). P-related fimbriae (Prf) and SfaI fimbriae were harvested from recombinant strains HB101(pRF1) and HB101(pANN801-13) by using a commercial blender (Omnimixer; Waring) and were purified essentially as described by Khan and Schifferli (18). In order to obtain purified flagella, wild-type E. coli strain 536 was cultured in petri dishes for 36 h. From these bacteria, flagella were harvested and purified by the same procedure described above for fimbriae. Polyclonal antibodies against purified Prf, SfaI fimbriae, and flagella were raised in rabbits (EUROGENTEC, Herstal, Belgium). Antisera were exhaustively absorbed with HB101 nonfimbriated host strain before use.
Capsule-specific serum was produced according to the methods described by Kiesewalter and Seltmann (19). Briefly, bacteria (E. coli strain 536) were incubated in 50% ethanol overnight at 4°C to denature protein antigens. After washing, bacteria were diluted to 2 x 108 CFU/ml in phosphate-buffered saline (PBS). Rabbits were immunized with 0.2, 0.5, 1.0, and twice 2.0 ml of bacterial suspensions at 4-day intervals. Four days following the last inoculation, serum samples were taken and tested by tube agglutination. Afterwards, rabbits were sacrificed and sera were collected and diluted to 1:10 in sterile saline containing 0.3% phenol as preservative. Removal of nonspecific antibodies was achieved by absorption with live and boiled cells of uropathogenic E. coli strain RZ532 (O6:K+:H31) (19). A 0.5-g aliquot of wet bacteria was suspended in 1 ml of the diluted serum and the suspension was incubated for 1 h at 37°C and overnight at 4°C. The next day, bacterial cells were harvested, resuspended in saline, and boiled for 1 h. Following centrifugation, the pellet was resuspended in the same serum and suspensions were incubated again for 1 h at 37°C and subsequently overnight at 4°C. After centrifugation, aliquots of sera were stored at -20°C. Through this procedure sera became free of any immunoreactive antibodies except those against K15 antigen, as proven by enzyme-linked immunosorbent assay (ELISA).
Ascending urinary tract infection model.
Intravesical infection of 3-to-4-day-old CFLP mice (Gödöllõ, Hungary) was performed as previously described (1). Bacteria were grown overnight at 37°C in LB, harvested by centrifugation, washed once, and normalized to the required inoculum density (107 CFU/ml) in PBS by adjusting the suspension to the appropriate optical density at 600 nm (OD600) value justified by viable counts. A 25-µl aliquot of this bacterial suspension containing 0.05% Pontamin Sky Blue dye (Searle Pharmaceuticals, High Wycombe, United Kingdom) was introduced into the bladder directly through the abdominal wall. The stain, which had no toxic or antibacterial effects, served as an indicator for successful inoculation (i.e., the stain became localized only to the bladder, which was visible through the hairless skin). In order to exclude the possibility of vesicoureteral reflux caused by the inoculum, in an additional experiment mice were sacrificed immediately after inoculation. Neither dye nor bacteria were detectable in the kidneys, verifying this experiment to be a suitable model of ascending urinary tract infection. Six to 14 infant mice were injected simultaneously with each strain, and assays were repeated four times. Mice that survived infection were sacrificed 21 days postinfection. The bladder and both kidneys were removed under sterile conditions and homogenized in PBS, and aliquots were plated onto agar plates containing a selective antibiotic. Additionally, bacterial counts were determined from the blood obtained by puncturing the heart.
Coinfection experiments.
Mice were infected with a bacterial suspension containing 2 x 104 CFU/ml (150% lethal dose [LD50]) of the wild-type strain 536 mixed with either 2 x 105 or 2 x 106 CFU of its isogenic rfaH mutant/ml (providing 1:10 or 1:100 concentration ratios, respectively). The procedure of injecting the mixture into the bladder was as described above. Urine samples were taken daily for 20 days. Urine was diluted in saline and plated onto LB agar plates containing either streptomycin alone or in combination with chloramphenicol. Since both wild-type strain 536 and its rfaH mutant were resistant to streptomycin but only the mutant possessed chloramphenicol resistance, CFU counts for both strains could be established this way. Feces of dams were checked and found to be negative for streptomycin-resistant strains, indicating that no fecal contamination of the samples could occur. Furthermore, randomly taken colonies were identified by slide agglutination using specific antisera. On the 21st day postinfection, mice were sacrificed and colony counts were determined from the blood, the bladder, and the kidneys as described above.
Serum bactericidal test.
Bacteria grown in LB medium were washed in saline and diluted to 106 CFU/ml. One hundred-microliter aliquots of bacterial suspensions were mixed with an equal volume of human serum and incubated at 37°C for 4 h in microtiter plates. Samples were taken at 0, 0.5, 1, 2, 3, and 4 h. Viable cell counts were determined by plating aliquots onto LB plates and incubating overnight at 37°C. The assays were performed both with normal and heat-inactivated (56°C for 30 min) serum. Triplicates were used for each strain, and assays were repeated three times.
Assay of hemolytic activity.
Hemolytic activities of culture supernatants were determined using a formerly described method (14) with minor modifications. Briefly, erythrocytes were obtained from a healthy individual and washed three times with 150 mM NaCl, 20 mM CaCl2. Two-percent suspensions of erythrocytes were incubated for 40 min at 42°C with 1:10 diluted cell-free supernatants of bacterial cultures grown at 37°C in 2xYT medium. After a short centrifugation, the amount of released hemoglobin was measured photometrically (A543). The degree of hemolysis was quantified as the percentage of total hemolysis induced by Triton X-100 (Sigma).
Lung toxicity assay.
The assay was performed as previously described (12). Briefly, 3-week-old CFLP mice (Gödöllõ) weighing 10 to 12 g were infected intranasally under superficial ether anesthesia with 50 µl of bacterial suspension (3 x 109 CFU/ml) grown overnight in LB medium. Twenty mice were treated for each strain. The animals were observed for 24 h and death rates were recorded.
LPS analysis.
Bacteria grown on solid LB were suspended in distilled water and boiled for 30 min. Suspensions were sonicated in a Realsonic Cleaner apparatus for 10 min. LPS was purified by the procedure of Hitchcock and Brown (16). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was performed on a 12.5% gel according to the method of Laemmli (21). Gels were fixed overnight in a solution of 7% acetic acid and 25% 2-propanol and were silver stained as described by Nelson et al. (31).
ELISA.
The 96-well plates (CML-CEB, Nemours, France) were coated overnight with 0.2-ml aliquots of the bacterial suspensions (109 CFU/ml) in carbonate buffer (pH 9.5) at 4°C. The following day, plates were washed with PBS containing 0.05% Tween 20 and then blocked with PBS containing 2% bovine serum albumin (BSA; Sigma) for 1 h at 37°C. K15-specific serum was diluted in PBS containing 0.5% BSA and incubated with the antigen-coated plates for 90 min. Serial dilutions were conducted across the plates. After three washes, plates were probed with anti-rabbit immunoglobulin conjugated with horseradish peroxidase (DAKO A/S, Copenhagen, Denmark). The ELISA substrate was o-phenylenediamine (Sigma) dissolved in citric acid buffer containing H2O2. The OD was measured at 490 nm on a conventional ELISA plate reader. Duplicates were used for each strain and dilution, and the assays were repeated twice.
Western blotting.
Samples of LB cultures grown at 37°C were taken at different time points. Cells were pelleted, washed, and resuspended to the same OD (0.5 at 600 nm). Equal quantities of bacterial suspensions were centrifuged, resuspended in lysing buffer, and separated by SDS-PAGE as described by Laemmli (21). Samples were blotted onto a nitrocellulose membrane using a Mini Trans-Blot cell (Bio-Rad). Membranes were blocked for 90 min with 10% skimmed milk in Tris-buffered saline (pH 7.5) containing 0.05% Tween 20 (TBST). Separate membranes were incubated with Prf-, SfaI-, or H31-specific antisera diluted 1,000-, 1,500-, and 2,500-fold, respectively, in TBST containing 2% skimmed milk. Membranes were incubated for 1 h at room temperature. After washing, membranes were treated for 1 h at room temperature with anti-rabbit immunoglobulin-horseradish peroxidase conjugate (DAKO A/S) diluted 2,500-fold in TBST with 2% skimmed milk. Membranes were washed thoroughly and then developed by luminography using a Western blotting chemiluminescence kit (NEN Life Science, Boston, Mass.).
Detection of siderophores.
The amount of secreted siderophores was determined using a CAS (chrome azurol S) assay (37) with minor modifications. Bacteria were grown overnight in M9 medium. To induce siderophore production, the iron chelator 2,2'-dipyridyl was added at a final concentration of 0.1 to 0.4 mM. The cultures were incubated for an additional 3 h at 37°C. After centrifugation, bacteria-free supernatants were mixed with an equal volume of CAS assay solution (37). Samples were incubated for 2 h to reach equilibrium, and the absorbance was measured at 640 nm.

RESULTS
The rfaH mutant of E. coli 536 is reduced in urovirulence.
E. coli 536 is a virulent uropathogenic strain that was isolated
from a patient suffering from acute pyelonephritis. The strain's
urovirulence has already been proven in mouse uropathogenicity
models (
12). To assess whether RfaH plays any role in the uropathogenicity
of the strain, we infected infant mice intravesically with the
wild-type strain and its isogenic
rfaH mutant, as well as with
the mutant carrying either pGEM T-Easy or pSMK1 (
rfaH gene cloned
into pGEM T-Easy). The results are summarized in Table
2. While
all mice injected with strain 536 died within 3 to 4 days, 82%
of the animals receiving 536
rfaH::
cat survived for as long as
3 weeks without any sign of severe infection. Introduction of
pGEM T-Easy (vector control) into the
rfaH mutant did not influence
the mortality rate. On the contrary, supplementation of the
mutant with pSMK1 partially restored virulence. All mice surviving
for 3 weeks were sacrificed and the bacterial counts were determined
from the blood, the bladder, and the kidneys. The number of
bacteriaif anywas found to be very low (data not
shown), indicating no or moderate bacterial colonization in
these mice.
Coinfection experiments.
Wild-type strain 536 and its isogenic
rfaH mutant were used
to coinfect infant mice intravesically. The inoculum contained
a standard concentration of the wild-type strain (2
x 10
4 CFU/ml),
which was complemented with either 2
x 10
5 or 2
x 10
6 CFU of
its
rfaH mutant/ml, leading to bacterial ratios of 1:10 (experiment
1) or 1:100 (experiment 2), respectively. Several of the infected
mice died within a few days. Mortality rates were 25% (3 of
12) and 77% (17 of 22), in experiments 1 and 2, respectively.
From the surviving animals, urine samples were taken daily for
20 days and viable counts of strains 536 and 536
rfaH::
cat were
determined. The obtained results are shown in Fig.
1. Wild-type
strain 536 was permanently present in the urine of infected
mice throughout the study period. Although its concentration
was constantly decreasing, it still exceeded 10
7 CFU/ml on day
20 postinoculation in both experiments. On the contrary, mutant
strain 536
rfaH::
cat disappeared from the urinary tract within
10 days, even when inoculated at a 10-times-higher concentration
(experiment 1) (Fig.
1A). Higher doses of the mutant strain
in the inoculum (experiment 2) resulted in tedious elimination;
however, after 3 weeks the urine was virtually free of the mutant
strain (Fig.
1B).
On the 21st day postinfection, mice were sacrificed and colony
counts were determined from the blood, the bladder, and the
kidneys. The results are shown in Fig.
2. The blood never contained
any bacteria (data not shown). However, the bladder and the
kidneys in all mice contained high numbers of the wild-type
strain. In contrast, strain 536
rfaH::
cat was never present in
the kidneys and was detectable in the bladder only in experiment
2. Even in this case, the bacterial counts for strain 536 exceeded
that of its
rfaH mutant by a factor of more than 10
5.
An intact RfaH protein is required for serum resistance.
Serum resistance of uropathogenic
E. coli strain 536 and its
derivatives is shown in Fig.
3. The wild-type strain was able
to survive in 50% normal human serum for at least 4 h, whereas
its isogenic
rfaH mutant survived no longer than 30 min.
trans complementation of the mutant strain with the
rfaH gene restored
resistance to the bactericidal effect of human serum. All three
strains could, however, survive for 4 h in a similar experiment
when heat-inactivated serum was used (data not shown).
Expression of several virulence factors is coregulated by RfaH.
RfaH has been reported to influence the expression of different
operons in various
E. coli strains. In order to investigate
whether several virulence factors are coregulated by RfaH, we
determined hemolytic activity, LPS structure, the amount of
specific K-antigen, expression of flagella and various fimbriae,
and siderophore-mediated iron binding in strain 536 and its
derivatives. We have previously reported the regulatory influence
of RfaH on the expression of hemin receptor ChuA in this strain
(
29).
Figure 4A shows hemolytic activity derived from culture supernatants of wild-type strain 536, mutant strain 536rfaH::cat, and its trans-complemented variant. The wild-type strain exhibited strong hemolytic activity during the exponential phase of growth, reaching a plateau at mid-exponential phase (Fig. 4B). On the other hand, hemolysis elicited by the rfaH mutant was hardly detectable. Introduction of the cloned rfaH gene (pSMK1) into the mutant restored high hemolytic activity. In vivo hemolytic activity was tested in the lung toxicity assay, in which the acute toxicity of bacteria can be assessed (12). In this experimental model, mice die within a few hours from hemorrhagic lung edema elicited by alpha-hemolysin. The 100% mortality rate caused by wild-type strain 536 was reduced to 10% in the case of its isogenic rfaH mutant. Supplementation of the mutant with an intact rfaH gene on pSMK1 increased the death rate to 65% (data not shown).
The LPS structure of strains 536 (Fig.
5, lane A), 536
rfaH::
cat (Fig.
5, lane B), and 536
rfaH::
cat (pSMK1) (Fig.
5, lane C)
were compared with SDS-PAGE. The presence of a functionally
active
rfaH gene (lanes A and C) resulted in intact LPS structures,
whereas the mutant strain (lane B) showed a rough phenotype.
To evaluate the amount of K15 capsule expressed by strain 536
and its derivatives, we performed an ELISA using a K15-specific
serum. The results are shown in Fig.
6. In comparison to the
wild-type strain, the
rfaH mutant showed decreased immunoreactivity
to this serum. Introduction of pSMK1 into the mutant strain,
but not that of the control vector pGEM T-Easy, restituted higher
immunoreactivity to the K15 antiserum. In order to verify that
these variations were due to differential expression of the
capsule (i.e., the serum was specific for K15 antigen), we used
additional O6:H31 uropathogenic
E. coli strains possessing either
K18/22 or no capsular antigens as negative controls. Indeed,
these strains showed low immunoreactivity to the serum used.
Expression of Sfa
I- and P-related (Prf) fimbriae as well as
H31 flagella was determined by Western blotting at various phases
of growth in each case. Expression of Sfa
I and Prf does not
seem to be influenced by RfaH in strain 536. Similarly, no major
differences could be shown in H31 flagellar expression between
strain 536 and its
rfaH mutant (data not shown).
Siderophore-mediated iron utilization was determined by a highly sensitive chemical assay. In this test, we assessed the total siderophore-mediated iron binding, which was activated by 2,2'-dipyridyl in a dose-dependent manner. However, we could show no significant difference between the iron binding capacities of strain 536 and its rfaH mutant (data not shown).

DISCUSSION
Since the first report describing RfaH as a regulator of the
rfa locus (
23), several other operons have been identified which
depend for full expression on the presence of this regulatory
protein (for a review, see reference
3). Nevertheless, a global
regulatory function has not been attributed to RfaH, as distinct
observations have been reported from different pathogenic isolates
of
S. enterica serovar Typhimurium and
E. coli. In the present
study, together with formerly described results (
29), it is
shown for the first time that expression of several components
(LPS, K15 capsule, alpha-hemolysin, and hemin receptor ChuA)
are coregulated by RfaH in a single
E. coli strain. What could
be the basis of common regulation of these structures? Interestingly,
although these factors are different in their composition and
function, they all are transported through both membranes of
a bacterium; they are anchored in the outer membrane or transported
out of the cell. Common regulatory systems for LPS and K15 (group
II) capsule synthesis could be explained with similarities in
synthesis, assembly, and transport mechanisms, in spite of the
distinct genes involved. Furthermore, activity of secreted alpha-hemolysin
was reported to be dependent on intact LPS (
6,
38,
41). Similarly,
the function of the hemin receptor ChuA is speculated to depend
on the activity of alpha-hemolysin, i.e., the toxin that liberates
heme by destroying erythrocytes (
29). All these observations
suggest that these components have evolved to coutilize the
regulatory protein RfaH, as proposed by Bailey et al. (
3).
Since all structures whose expression has been shown to be influenced by RfaH are potential virulence factors, we proposed that mutation of the rfaH gene results in a decrease in virulence. Indeed, in an ascending mouse model of urinary tract infection, the virulence of wild-type strain 536 was almost completely abolished through the loss of the regulatory protein RfaH. Decreased virulence of the rfaH mutant, however, could not be explained by inappropriate growth potential, since the in vitro growth curve of 536rfaH::cat did not differ from that of the wild-type strain 536. Moreover, both strains were shown to be able to grow equally ex vivo in the urine of healthy individuals (data not shown), indicating that there are no differences in growth abilities between the two strains at the beginning of the infectious process.
Colonization, however, is a more complex process requiring effective adhesion mechanisms and rapid multiplication through utilization of limited nutrients. By destroying epithelial cells, the possibility of tissue invasion and dissemination arises. On the other hand, bacteria have to face different host defense mechanisms. The inability of bacteria to overcome different attacks by the immune system results in localized infections only or, in most cases, total elimination of the infectious agent. The first line of defense against dissemination is the action of the complement system. In contrast to commensal gram-negative bacteria, extraintestinal clinical isolates of enterobacteria often show resistance to the killing effect of serum, suggesting that the abilities of bacteria to cause disease correlate with their resistance to the bactericidal effect of serum. Thus, serum resistance has been a virulence parameter for many pathogens, including extraintestinal isolates of E. coli. Resistance to serum killing is multifactorial and has been associated with several surface components of E. coli, among which capsule and LPS are thought to be the most important ones (17). We have shown that loss of the regulatory protein RfaH results in high susceptibility to human serum in strain 536rfaH::cat, which might be explained by altered expression of both LPS and K15 capsule due to inactivation of the rfaH gene.
The coinfection assay provides an objective model to compare the colonization capacity of the rfaH mutant with that of the wild-type strain without involving individual differences of the host. The usefulness of similar models has recently been shown in investigations aimed to clarify the pathogenic role of cytotoxic necrotizing factor type 1 (33) and different iron transport systems (40) in the virulence of uropathogenic E. coli strains. Even though we had to face a negative selection of our experimental animals (i.e., those mice having the most fulminant infections died within a few days), the difference in colonization potentials between the two strains has become clear. Our results provide evidence that, in contrast to the wild-type strain, the rfaH mutant is not able to cause ascending uroinfection, since it was never detectable in the upper urinary tract.
An important factor in effective pathogenesis within the urinary tract is the production of cytotoxins. Alpha-hemolysin has been proven to contribute to the virulence of E. coli strains causing extraintestinal infections (17, 24, 43). By destroying eukaryotic cells, the toxin not only provides an opportunity for deeper invasion, but in addition supplies bacteria with nutrients liberated from host cells (e.g., iron-containing substances, such as heme). Expression of alpha-hemolysin has been reported to be under the control of RfaH in E. coli strains (2, 5, 22). We have reported here that no considerable hemolysis derives from strain 536rfaH::cat at any phase of growth in vitro.
The lung toxicity assay serves as an ideal model for the assessment of in vivo hemolysin production (12). In this assay, mice die from the immediate toxic effect of bacteria before extensive bacterial multiplication. Since loss of the pathogenicity islands carrying the hly determinants of E. coli 536 results in an avirulent phenotype in this model (28), we consider hemolysin as the major factor to determine the outcome of intranasal instillation of bacteria. Mutation within rfaH significantly decreases death rates in this assay, suggesting decreased in vivo hemolytic activity elicited by the mutant strain.
In addition to a major loss in the level of effective HlyA toxin produced in the absence of RfaH, in vivo iron acquisition of bacteria could be further hindered by decreased expression of hemin receptor ChuA, as has been reported elsewhere by Nagy and colleagues (29). Although an essential role for this receptor in iron supply is questionable, its contribution to bacterial virulence was recently proven in uropathogenic E. coli (40). Utilization of hemin, however, is not an exclusive means of iron acquisition. E. coli strain 536 produces at least two different siderophore systems, namely, enterobactin (34) and yersiniabactin (36). The presence of an additional siderophore receptor (IroN), whose ligand is not yet identified, was recently described in strain 536 (10). The CAP assay used in the present study is based on the affinity of siderophores for iron and is therefore independent of the structure. Total siderophore-mediated iron acquisition does not seem to be under the regulatory control of RfaH; therefore, it may compensate the effect of decreased hemin receptor ChuA quantities on the in vivo iron supply of bacteria.
Bacterial pathogenesis is a complex phenomenon which is attained through a concerted action of virulence factors. An exclusive role of a single virulence factor is rare; they usually function synergistically, amplifying or complementing the effect of each other. Therefore, total abolishment of virulence is rarely caused by the loss of individual virulence factors (25). Nevertheless, mutation in one single gene can result in a significant loss of virulence if the related gene product has an impact on several virulence determinants simultaneously. We have presented evidence that the absence of functional RfaH protein results in parallel underexpression of several virulence factors, which probably all contribute to the complete virulence of E. coli strain 536. Further experiments are needed, however, to clarify the potential global regulatory role of RfaH in other pathogroups of E. coli and additional gram-negative bacteria.

ACKNOWLEDGMENTS
We are grateful to Vassilis Koronakis (Department of Pathology,
Cambridge University, Cambridge, United Kingdom) and Gabriele
Blum-Oehler (Institut für Molekulare Infektionsbiologie,
Würzburg, Germany) for providing the RfaH antiserum and
the uropathogenic
E. coli strains RZ430, RZ451, and RZ532, respectively.
We thank Rózsa Lajkó for excellent technical assistance
and Tibor Pál for critical reading of the manuscript.
This study was supported by grants OTKA T026019, T037833, and ETT 086/2001. The work of the Würzburg group was supported by the Deutsche Forschungsgemeinschaft (Ha1434/8-2 and Sonderforschungsbereich 479) and by the "Fonds der Chemischen Industrie." G.N. was supported by a grant from the Bayerische Forschungsstiftung.

FOOTNOTES
* Corresponding author. Mailing address: Institute of Medical Microbiology and Immunology, University of Pécs, Szigeti út 12, 7643 Pécs, Hungary. Phone: 36 72 536252. Fax: 36 72 536253. E-mail:
levente.emody{at}aok.pte.hu.

Editor: A. D. O'Brien

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Infection and Immunity, August 2002, p. 4406-4413, Vol. 70, No. 8
0019-9567/02/$04.00+0 DOI: 10.1128/IAI.70.8.4406-4413.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
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