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Infection and Immunity, April 2003, p. 1733-1739, Vol. 71, No. 4
0019-9567/03/$08.00+0 DOI: 10.1128/IAI.71.4.1733-1739.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.
Laboratoire de Microbiologie A, CHU La Milétrie,1 UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France,2 Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom3
Received 2 July 2002/ Returned for modification 19 September 2002/ Accepted 12 December 2002
| ABSTRACT |
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| INTRODUCTION |
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In order to study the genetic changes in H. pylori that may occur during an infection, we developed a mouse model with strain SS1, previously adapted to this animal, and two strains freshly isolated from human patients (22). We assumed that the genetic modifications would be more pronounced and more easily detected if strains freshly isolated from one host species (human) were used to reinfect a different host species (mouse). The impact of the in vivo interactions between different infecting H. pylori strains was evaluated by comparing the results observed in single and multiple infections. We studied the evolution of the genome structures of these strains during experimental infections by comparing the infecting strains (IS) to the emerging strains (ES) isolated from the animals at different experimental steps. For that purpose, we used randomly amplified polymorphic DNA (RAPD) fingerprinting with six of the primers previously recommended by Akopyanz et al. (1) and PCR to amplify the genes encoding the two main virulence factors: vacA and cagA. The genetic changes detected were further characterized by sequencing of the involved genomic region, and the phenotypic consequences of the modifications were evaluated.
| MATERIALS AND METHODS |
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To prepare the infecting inocula, a single colony of each of the three strains was cultured once on Skirrow medium (BioMerieux, Marcy l'Etoile, France) and then once in brucella broth for 2 days. For coinfection models, the inocula consisted of a mixture of two or three of these IS in brucella broth. Cultures were incubated at 37°C in a microaerobic atmosphere. Each strain was confirmed to belong to the species H. pylori by Gram staining and oxidase, catalase, and urease tests.
Experimental infections. Experimental infections were conducted as previously described with 6-week-old female C57BL/6 inbred mice (13). Prior to the experimental infection, five randomly chosen animals were determined to be Helicobacter free by grinding their entire stomach and searching for H. pylori by (i) culturing on Skirrow medium and (ii) microscopic examination after Gram staining. These five animals were also checked for the absence of serum antibodies to H. pylori by an enzyme-linked immunosorbent assay (4). The animals were kept isolated from each other in cages stored within separate compartments ventilated with filtered air.
Single infections, coinfections, and superinfections were initiated at day 0. Inocula were administered intragastrically, twice at 2-h intervals, as 0.5-ml suspensions adjusted to 1010 CFU per ml. For single infections, 51 animals were infected at day 0 and individually sacrificed at day 3, 8, 15, 21, 45, 90, 150, or 365 postinoculation (p.i.) (Table 1). For coinfections, 10 animals were infected with a mixture of two or three IS (same amount of each) and sacrificed at day 45 p.i. For superinfections, a first IS was given at day 0 and another one was given at day 45 p.i.; the seven animals were sacrificed at day 90 p.i. As controls, 30 mice were given only brucella broth in order to check for the absence of contamination by human strains during the experiment, and 3 of them were sacrificed at each experimental step. The stomachs were entirely removed after sacrifice and ground in 1 ml of brucella broth. The suspensions were serially diluted and cultured on Skirrow medium for the determination of viable counts. The strains recovered were called ES. The numbers of viable H. pylori cells per stomach were determined after an incubation period of 7 days. To characterize the ES strains and to test for their genetic fingerprints, 15 randomly selected colonies were subcultured from culture-positive plates for each animal for RAPD analysis of 10 colonies (see below).
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The number of bacteria necessary to infect 50% of the animals (ID50) was determined for IS Hp141, ES Hp141, or Hp141v by using bacterial suspensions adjusted to 1010, 108, 106, and 104 CFU per ml. The 60 animals (5 per inoculum) were sacrificed at day 15 p.i. The number of viable H. pylori cells was determined as described above.
These experimental infection protocols received the approval of the Ethics Committee of the University of Poitiers (number MIC/2001/07/AC).
RAPD analysis. Genomic DNAs of the IS and the ES were extracted with purification columns (QIAmp DNA minikit) according to the protocol described by the manufacturer (Qiagen, Courtaboeuf, France). Six primers were chosen from those described by Akopyanz et al. (1): 1254, 1283, 1247, 1281, 1290, and D9355. PCR amplification was performed with a 50-µl reaction mixture containing 10 mM Tris-HCl (pH 8.3), 50 mM KCl, 6 mM MgCl2, 200 µM each deoxynucleoside triphosphate, 50 pM each primer, 1.25 U of Taq polymerase (Amersham-Pharmacia-Biotech, Orsay, France), and 40 ng of template DNA. In total, 30 colonies of IS and 630 colonies of ES were analyzed by RAPD analysis.
Amplification was performed with a Perkin-Elmer (Courtaboeuf, France) 9600 thermal cycler. The cycling program for the six primers was as follows: 4 cycles of 94°C for 5 min, 36°C for 5 min, and 72°C for 5 min; 35 cycles of 94°C for 1 min, 36°C for 1 min, and 72°C for 2 min; and then 72°C for 10 min. RAPD products were analyzed by electrophoresis in 2% agarose gels, stained with ethidium bromide, and then visualized with UV light. DNA marker VI (Roche Molecular Biochemicals, Meylan, France) was used as a size marker in all gels. All DNA extractions and RAPD analysis were repeated three times to ensure reproducibility.
Cloning and sequencing. DNA from the additional 950-bp fragment that appeared in the Hp141v RAPD profile was eluted from agarose by using a Wizard PCR Preps DNA purification system (Promega, Madison, Wis.). After PCR amplification with primer 1254, the fragment was cloned by using a TOPO TA cloning kit for sequencing and One Shot TOP 10 chemically competent Escherichia coli (Invitrogen, Cergy-Pontoise, France). Plasmid DNA was extracted by using a QIA Prep Spin miniprep kit (Qiagen) and PCR amplified by using the T3 and T7 primers included in the cloning kit. Sequencing of the insert was carried out with an ABI Prism DNA sequencing kit and an ABI Prism 310 genetic analyzer (Applied Biosystems, Warrington, United Kingdom). Sequence analysis was carried out with Sequencing Analysis and Sequence Navigator software (Applied Biosystems). The obtained genomic sequence was compared with the genomic sequences of H. pylori 26695 and J99 in the genome databases of The Institute for Genomic Research (www.tigr.org) (2, 42).
PCR amplifications. (i) vacA and cagA genes. Genomic DNAs of the IS and the ES were extracted by using the same method as that used for RAPD analysis. The cagA status of the H. pylori strains was determined with primers and PCR conditions previously described by Tummuru et al. (43). For typing of the vacA gene, fragments m1, m2, s1a, s1b, and s2 were PCR amplified with primers and PCR conditions recommended by Atherton et al. (3).
(ii) ppk gene. Five sets of primers were chosen on the basis of the H. pylori 26695 and J99 ppk genetic sequences (Table 2). PCR amplification was performed with a 50-µl reaction mixture containing 10 mM Tris-HCl (pH 8.3), 50 mM KCl, 3 mM MgCl2, 200 µM each deoxynucleoside triphosphate, 50 pM each primer, 1.25 U of Taq polymerase (Roche), and 40 ng of DNA extracted as described above. The cycling conditions consisted of an initial denaturation at 94°C for 7 min followed by 35 cycles of 94°C for 1 min, 52°C for 1 min, and 72°C for 1 min and then by a final elongation at 72°C for 7 min.
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| RESULTS |
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Analysis of experimental infections (Table 1). Ten randomly selected colonies obtained from each animal were studied independently by RAPD analysis and PCR of the cagA and vacA genes. RAPD analysis showed that each mouse was colonized by a unique strain regardless of the inoculation model. The cagA status and the vacA genotype of the different ES were the same as those of the IS.
In single infections, all 51 mice were successfully infected. H. pylori was recovered at each experimental step during the 1-year follow-up. Nevertheless, differences in colonization levels were found between SS1 and the two clinical strains, Hp141 and Hp145. The latter two strains led to similar colonization levels, which varied between 102 and 104 CFU per stomach, with a maximum at day 45 p.i. The colonization levels obtained with SS1 reached 107 CFU per stomach during the first 2 weeks of infection and then decreased to reach the values observed with the other two strains at day 150 p.i. All of the ES had the same RAPD pattern as the IS, except at day 365 p.i. for the two mice inoculated with Hp141: 16 out of the 20 emerging colonies had the RAPD profile of IS Hp141 with five out of the six primers. However, with primer 1254, an additional 950-bp DNA fragment appeared. This modified ES was called Hp141v.
In coinfections, animals were inoculated with a mixture of two or three H. pylori strains. After 45 days, H. pylori was recovered from the stomachs of 7 out of the 10 animals, and the colonization levels in the infected mice were found to be 102 to 103 CFU per stomach. We never detected Hp145. Each time that SS1 was present in the infecting inoculum, it was recovered as an ES, except in one mouse having received the three H. pylori strains. In this case, the 10 emerging colonies had the same RAPD profile. This profile was identical to the Hp141v profile (Fig. 1).
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The presence of the variant in low quantities in the infecting inocula was checked a posteriori by PCR with primers ppk1 and ppk4. Within a 48-h culture of IS Hp141 initially given to the animals, we detected only one PCR fragment corresponding to wild-type polyphosphate kinase (PPK) (Fig. 2).
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| DISCUSSION |
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The experimental infections were carried out with C57BL/6 mice, preceding studies having shown that this mouse strain has the best characteristics for both susceptibility to colonization and persistence of infection (22, 36; X. Wang, R. Willen, T. Wadstrom, and P. Aleljung, Proc. 3rd Int.Workshop Pathogenesis Host Response Helicobacter Infect., abstr. no. J8, 1998). The IS were either mouse adapted (SS1) or freshly isolated from a human host. We expected more adaptive modifications during the mouse infection when the two clinical strains considered to be human adapted were used.
A 1-year follow-up of the single infections allowed us to establish the timing of the events occurring during a long-term infection. Analysis of single infections, coinfections, and superinfections provided interesting data regarding the ability of a strain to colonize the gastric mucosa and the ecologic rules governing the establishment of a strain at the expense of another strain. Regardless of the infection model, we did not detect, among the 10 studied colonies of the strain emerging from each animal and subjected to RAPD analysis, the simultaneous presence of different strains in the stomach of a given animal. Colonization levels were lower in multiple infections than in single infections. In multiple infections carried out with the clinical strains, Hp145 was detected only once, in a superinfection model when it was given first. Thus, Hp141 seems to be more mouse adapted than Hp145, and the order of inoculation of the strains seems important. Once established, a strain could interfere with the establishment of a subsequent strain even when the latter was more fit to colonize mice. This phenomenon was previously described by Danon et al., who showed that the implantation of a first strain in the mouse could prevent the implantation of a mixture of other strains (7). This finding could be the consequence of the immune response against the first strain (IS) being strong enough to inhibit the implantation of the second strain. It could also be due to competition between strains for nutritional factors and/or to differences in the virulence of the inoculated strains. In this work, Hp141 was cagA positive and produced an active vacuolizing cytotoxin, while Hp145 did not. Despite the fact that the roles of these factors in the extent of colonization are quite controversial, it should be noted that the more virulent strain (Hp141) was also better able to colonize mice. In some studies, the presence of the two markers was considered essential for the success of mouse colonization (6, 33), while in other studies, colonization ability did not depend on the cagA status or the vacA genotype of the strains (5, 17, 35, 37; L. J. Thompson, S. Danon, J. Wilson, J. O'Rourke, N. Salama, S. Falkow, H. Mitchell, and A. Lee, Int. J. Med. Microbiol. 291:137, abstr. O.25, 2001). Other studies showed that mice or rhesus monkeys infected with mixtures of H. pylori strains were only transiently infected by more than one strain. However, they became persistently infected by only one strain for weeks or months (7, 8, 37; Wang et al., Proc. 3rd Int.Workshop Pathogenesis Host Response Helicobacter Infect., abstr. no. J8). Nevertheless, polycolonizations in humans have been reported (11, 15, 38, 44). This difference between humans and animals may be due to the major susceptibility of humans, the natural host of H. pylori, but may also be due to differences between H. pylori strains.
This is the first report of the occurrence of genetic modifications during both a single infection and multiple infections, indicating that they do not result from genetic exchanges between H. pylori strains. The variant was not detected by PCR in the infecting inoculum and was isolated during the last steps of the single infection. This result suggests that the modified strain appeared during the infection or was present in the infecting inoculum but was below the limit of detectability of the method used and was selected for by the mouse environment. Moreover, the selection of Hp141v two times independently strongly suggests that the genetic modifications lead to an advantage for the colonization of mice.
The occurrence of genetic modifications during a single infection is rare. In the study of Bjorkholm et al. (6), colonization experiments in animals were simply too short for any discernible genetic changes to occur. Interestingly, in our work, the emerging variant appeared after one full year of infection. Several years of follow-up of strains from infected patients with common genotyping methods, such as RAPD analysis, pulsed-field gel electrophoresis, and PCR-restriction fragment length polymorphism analysis, revealed no modifications. Only whole-genome DNA microarray analysis or sequencing revealed the emergence of subclones with micromodifications (6, 12, 34). These data suggest that the diversity of H. pylori may be due in part to continuous microevolution that would be detectable only after a long-term infection.
Analysis of Hp141v allowed us to identify a genetic modification consisting of a 102-bp deletion in the gene encoding PPK. This enzyme reversibly catalyzes the transfer of the gamma phosphate of ATP to PolyP (18). Several studies based on disruption of the ppk gene have shown that PolyP levels are directly proportional to PPK activity (30, 41). In order to study the consequences of the observed deletion for PPK activity, we determined PolyP levels in IS Hp141, ES Hp141, and Hp141v. Our data are consistent with better enzymatic activity of Hp141v, since PolyP levels in this strain were considerably higher than those in wild-type Hp141 and ES Hp141.
The results of the coinfections suggested that Hp141v should have better colonization properties than the wild-type strain, since it overcame the mouse-adapted strain, SS1. This point was confirmed by additional competition experiments with SS1 and IS Hp141, ES Hp141, or Hp141v. It can be expected that after some additional weeks of experimental competition, only one strain will emerge, as in the 45-day coinfections, and that SS1 will disappear from the isolates recovered from the mice inoculated with Hp141v.
The ability of Hp141v to compete with other strains for mouse colonization is notably better than that of the wild-type strain or a nonvariant ES. Moreover, Hp141v seems irreversibly better adapted to mice than SS1. The infectivity of Hp141v was also compared with the infectivities of IS Hp141 and ES Hp141 by determination of the ID50s. The important difference between the ID50s of Hp141v and the other two strains is consistent with the better ability of Hp141v to colonize mice. These data strongly suggest that the ppk gene is crucial for the virulence of H. pylori in the colonization of mice. However, the construction of an isogenic mutant by disruption of the ppk gene in Hp141v and testing of its ability to colonize mice would be of great interest for excluding the implication of other mutations not detected by the methods used and for confirming the role of PPK in this phenomenon.
It is now well known that PPK is active in numerous and various bacterial mechanisms designed for the reservation of energy and phosphate; chelation of divalent cations; resistance to the action of complement; serving as a component of capsules; buffering against pH variations; "channeling" for DNA entry during bacterial transformation; motility; quorum sensing of bacterial pathogens; inhibition of RNA degradation; and resistance to heat, oxidants, osmotic shock, and amino acid starvation by promoting ribosomal degradation during the stationary phase of growth (18, 19, 20, 28, 30, 31, 41). PPK may therefore play important roles in the physiological adaptation of microbial cells during growth and development and in their responses to nutritional and environmental stresses. In this respect, our results are consistent with an adaptive change of Hp141 and imply that, like those of other bacterial pathogens, the PPK of H. pylori is an essential virulence factor that could be used as a target for antimicrobial drugs (19, 20, 31).
In conclusion, we described several experimental mouse infections and reported genetic events that might improve the adaptation of strains to the current host. Thus, genetic modifications occurring during the course of an H. pylori infection may be involved in the acquisition of the genetic polymorphism of this bacterial species.
| ACKNOWLEDGMENTS |
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We are grateful to the Ligue Contre le Cancer, Comité de Charente Maritime, and to Université de Poitiers and CHU La Milétrie, Poitiers, France, for financial support.
| FOOTNOTES |
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