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Infection and Immunity, April 2004, p. 2240-2247, Vol. 72, No. 4
0019-9567/04/$08.00+0 DOI: 10.1128/IAI.72.4.2240-2247.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
Yakult Central Institute for Microbiological Research, Kunitachi, Tokyo 186-8650,1 Research Institute, International Medical Center of Japan, Shinjuku, Tokyo 162-8655,2 Faculty of Human Life Sciences, Jissen Women's University, Hino, Tokyo 191-8510, Japan3
Received 11 August 2003/ Returned for modification 14 October 2003/ Accepted 17 December 2003
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Shiga toxin-producing Escherichia coli (STEC) infection models in streptomycin (SM)-treated mice have been the most popular (15, 20, 22, 41). An increased susceptibility to STEC infection by treating mice with antibiotics can be explained by the disruption of colonization resistance. However, high dosages of inoculum (more than 106 CFU/body) are usually required to establish an STEC infection. These effects were not precisely examined (determination of viable STEC counts or quantification of Shiga-like toxins) in previous studies. We have developed an SM-treated murine STEC infection model in which 100% lethality was achieved after inoculation with only
5 x 103 CFU of STEC, followed by multiple mitomycin C (MMC) treatments (29). Moreover, a periodic quantitative analysis of Stx production in the intestines showed that there was a transient but dramatic increase of Stxs (especially Stx2) in the lower intestines after multiple MMC treatments during the early stationary phase of STEC growth in the lower intestines.
Probiotics are viable cell preparations or foods containing viable bacterial cultures or components of bacterial cells that have beneficial effects on the health of the host (19). Many of these probiotics are lactic acid bacteria, and anaerobic bifidobacteria have been reported to be useful in the treatment of disturbed intestinal microflora and diarrheal diseases (for a review, see reference 18). Feeding probiotic bifidobacteria to experimental animals has been reported to prevent gram-negative bacterial infections (23, 30, 32). Some probiotic bifidobacterial strains have been reported to lessen the severity of oral STEC infection in murine experimental infection models. Most of these reports, however, utilized gnotobiotic animal models (2, 31, 37, 38), and definite data have not been obtained in studies with conventional animals. Moreover, the precise mechanism of protection has not yet been clarified. The main purpose of the present study was to test the hypothesis that intestinal colonization by probiotic bifidobacteria prevents antibiotic-induced disruptions in the intestinal environment and reduces the lethal toxicity of STEC by using our previously reported lethal murine STEC infection model (29).
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Bifidobacteria. Bifidobacterium breve strain Yakult, Bifidobacterium pseudocatenulatum DSM 20439, Bifidobacterium bifidum ATCC 15696, and Bifidobacterium catenulatum ATCC 27539T were used after the selection of the strains had been confirmed by growth in PY broth (16) containing SM at a dose of 4 mg/ml. All bifidobacterial strains were identified by PCR assay with the corresponding species-specific primers for 16S rRNA (21). Each bifidobacterial strain was cultivated separately in GAM broth (Nissui Pharmaceutical, Tokyo, Japan) for 24 h at 37°C, washed with saline twice, and then suspended in saline at a concentration of 109 CFU/ml. Colonization by bifidobacteria was established by three consecutive daily administrations of the bacteria to separate groups of mice receiving SM in their drinking water. Periodic examinations of viable counts of B. breve in stools were performed in subsets of 6 mice from each group. Briefly, fresh stool specimens (1 to 2 pellets) were weighed and placed in an Eppendorf tube containing 1 ml of sterilized anaerobic buffer solution [KH2PO4, 0.0225% wt/vol; K2HPO4, 0.0225% wt/vol; NaCl, 0.045% wt/vol; (NH4)2SO4, 0.0225% wt/vol; CaCl2, 0.00225% wt/vol; MgSO4, 0.00225% wt/vol; Na2C03, 0.3% wt/vol; L-cysteine hydrochloride, 0.05% wt/vol; resazurin, 0.0001% wt/vol] and homogenized with a pestle. TOS agar (33) supplemented with 0.625 g of SM/ml and 1 µg of carbenicillin disodium salt (Sigma)/ml (T-CBPC agar) was used for the quantitation of the B. breve strain Yakult, and CPLX agar (42) supplemented with 0.625 g of SM/ml was used for the selective isolation of other Bifidobacterium strains. The media were cultured anaerobically in an atmosphere of 7% H2 and 5% CO2 in N2 at 37°C for 72 h, and the colonies on the plates were counted.
STEC O157:H7 infection. A clinically isolated STEC O157:H7 strain 89020087, which produces both Stx1 and Stx2, was used throughout the study. Cells were grown overnight in Casamino Acids-yeast extract broth (14) at 37°C. A murine gastrointestinal infection model (29) was developed based on the methods of Wadolkowski et al. (41). Briefly, STEC cells were suspended at a concentration of 5 x 104 CFU/ml in saline, and a 100-µl portion of the suspension was administered orally to mice. MMC (0.25 mg/kg; Kyowa Hakko Kogyo, Tokyo, Japan) was administered intraperitoneally a total of three times, once each at 18, 21, and 24 h postinoculation, when the fecal excretion levels of STEC reached as much as 109 CFU/g of feces. To assess the viable STEC counts in the feces, intestinal contents, livers, and mesenteric lymph nodes, samples were removed aseptically from the mice and homogenized in 1 ml (5 ml for liver) of sterile saline solution by using a Teflon grinder. The number of viable STEC cells was determined by their growth on sorbitol-MacConkey agar (Nissui Seiyaku, Tokyo, Japan) supplemented with cefixime (2.5 mg/ml; Sigma) and potassium tellurite (0.05 mg/ml; Oxoid, Bashingstoke, Hampshire, United Kingdom) at 37°C for 24 h.
Stx assay. Stxs (Stx1 and Stx2) in the intestinal contents (both free and bacterium associated) were extracted as follows. Briefly, sections of the gastrointestinal tracts were prepared as described above. After homogenization, samples were sonicated at 28 kHz for 60 min in ice-cold water to completely disrupt the bacteria and then centrifuged at 30,000 x g for 10 min to remove undisrupted debris. The supernatants were then filtered through a 0.45-µm-pore-size membrane filter and then ultrafiltrated (molecular weight cutoff, 20,000; 5,000 x g for 60 min) to remove low-molecular-weight substances, such as SM sulfate, which can affect Stx quantification when the reversed passive latex agglutination (RPLA) test (Denka Seiken, Tokyo, Japan) is used. After centrifugation, the resulting fraction on the membrane in the tube was reconstituted in the original volume of phosphate-buffered saline and then serial twofold diluted with phosphate-buffered saline supplemented with 0.5% bovine serum albumin and 0.1% NaN3. Both Stx1 and Stx2 were then quantified by the RPLA test. The Stx concentrations in the intestinal contents were then calculated relative to a standard curve of purified Stx1 or Stx2 and expressed as micrograms per tissue weight.
Histopathology. Mice were dissected on day 2 or 7 after STEC infection. The mesenteric lymph nodes, femur, thymus, lungs, bronchus, heart, small intestine, cecum, colon, liver, spleen, kidneys, suprarenal gland, and brain were divided longitudinally and fixed overnight in 10% neutral buffered formalin. Paraffin-embedded sections stained with hematoxylin and eosin were then examined by light microscopy.
Detection of organic acids in cecal contents. The cecal contents were homogenized in 1 ml of distilled water, and the homogenate was centrifuged at 13,000 x g at 4°C for 10 min. A mixture of 0.9 ml of the resulting supernatant and 0.1 ml of 1.5 mM perchloric acid was mixed well in a glass tube and allowed to stand at 4°C for 12 h. The suspension was then passed through a filter with a pore size of 0.45 µm (Millipore Japan, Tokyo, Japan). The organic acid content of the sample was analyzed by high-performance liquid chromatography as described in a previous report (18). The high-performance liquid chromatography was performed with a Waters system (Waters 432 Conductivity Detector; Waters, Milford, Mass.) equipped with two columns (Shodex Rspack KC-811; Showa Denko, Tokyo, Japan). The concentrations of organic acids were calculated by using external standards.
Combined effect of pH and AA on STEC growth and Stx production. The pH and concentration of acetic acid (AA) were adjusted in tryptic soy broth so that the conditions were the same as those found in the cecal contents of the STEC-infected control group (pH 7.15; AA concentration, 28 mM) or in the B. breve-colonized cecum (pH 6.75; AA concentration, 56 mM). Then, STEC in media at a concentration of 105 CFU/ml was added and cultivated anaerobically in an atmosphere of 100% N2 at 37°C; MMC at a final concentration of 1 µg/ml was added after 8 h of cultivation. Viable bacterial counts were determined periodically after 0, 2, 4, 6, 8, 12, and 16 h of incubation. Stx concentrations were determined after 16 h of cultivation (8 h after the addition of MMC).
Statistical analysis. The average number of bacteria was analyzed by using the Dunnet test to determine significant differences between the treatment and control groups. Differences in survival ratios were determined by using Fisher's exact probability test followed by correction with the Bonferroni inequality equation. A significant difference was defined as a P value of <0.05.
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FIG. 1. Inhibition of lethal intestinal STEC infection by B. breve colonization in SM-treated mice. SM sulfate at a concentration of 5 mg/ml in drinking water was given to 28 mice from day -6 until day 16. B. breve strain Yakult (1 x 108 to 3 x 108 CFU/mouse/day) in 0.1 ml of saline was administered to half of the mice once a day from day -5 to -3, and the other half of the mice were administered saline on the same schedule as that for the B. breve treatment. Mice were infected orally with STEC (5 x 103 CFU) on day 0 and then treated with MMC at an inoculum dose of 0.25 mg/kg of body weight three times at 18, 21, and 24 h after the STEC infection. (A) Feces for bacteriological analysis were obtained from 6 randomly selected mice in each group on days 0 (at 3, 6, 9, 12, 15, and 18 h), 1, 3, 4, 7, 10, and 16 after the STEC infection, with the exception of the control group on days 10 to 16 (n = 2). Viable counts of STEC and B. breve were examined as described in the text. Symbols: , number of STEC organisms in the STEC-infected control mice; , number of STEC organisms in the B. breve-treated mice; , number of B. breve organisms in B. breve-treated mice. (B) All 14 mice in each group were weighed every day until day 8. Symbols: , STEC-infected control; , B. breve-treated mice. (C) The STEC-infected control mice () and B. breve-treated mice ( ) were observed for survival for 14 days after the challenge infection. **, a significant difference was observed between the B. breve-treated and the untreated control groups (P < 0.01).
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In the next series of experiments, mice were dissected at various intervals after MMC treatment, and the Stx levels in the cecal contents were analyzed by RPLA. Transient but dramatic increases in the concentrations of both types of Stx were observed 3 to 9 h after the last MMC treatment in the STEC-infected control group (Fig. 2). The Stx2 titers were relatively higher than those of Stx1 throughout the experimental period (Fig. 2). No significant increases in the Stx titers were detected in the B. breve-treated group after MMC treatment, and the titers were less than 1/50 (Stx1) and 1/500 (Stx2) of those in the controls, respectively (Fig. 2). The Shiga toxins were produced mainly in the lower parts of the intestine, whereas B. breve markedly inhibited production of both types of the toxin (Table 1).
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FIG. 2. Inhibition of MMC-induced production of Shiga toxins by B. breve colonization. Mice were infected with STEC and treated with MMC as described in the legend to Fig. 1 and then dissected at the indicated periods after STEC infection to examine Stx production. The concentrations of Stx1 (A) and Stx2 (B) in the intestinal contents were determined by RPLA test as described in the text. The results were expressed as the means and standard deviations of the results from 6 mice. Significant differences in Stx concentration were observed between the B. breve-treated and the untreated control groups (*, P < 0.05; **, P < 0.01; ***, P < 0.001).
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TABLE 1. Inhibition of MMC-induced production of Shiga toxins by B. breve colonizationc
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FIG. 3. Histopathological analysis. Hematoxylin and eosin staining of the ileum (A and E), kidney (B and F), bone marrow (C and G), and mesenteric lymph node (D and H) from a mouse in the STEC-infected control group (STEC inoculum, 3.8 x 103 CFU) (A to D) and a mouse in the B. breve-treated group (E to H). Organs were obtained on day 2 (A and E) or 7 (B to D and F to H) after STEC infection. Black arrows: panel A, changes suggestive of apoptosis; panel B, necrotic tubular endothelial cells with distention; panel D, changes suggestive of apoptotic bodies; panel G, erythroblasts. Magnifications in both groups: ileum, x520; kidney, x520; bone marrow, x260; mesenteric lymph node, x520.
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TABLE 2. Comparison of antitoxic activity among several strains of bifidobacteria with natural resistance to SM sulfatea
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FIG. 4. Changes in intestinal pH and concentrations of organic acids after STEC infection in SM-treated mice. Mice were treated as shown in Table 2. Cecal contents were obtained from mice both at the time of STEC infection (0 h) and 30 h after STEC infection. pH and organic acid concentrations were determined as described in the text. Results are expressed as the means and standard deviations of the results from 6 mice. Columns: grey, nontreated healthy mice; black, SM-treated mice; white, B. breve strain Yakult-treated mice; hatched, B. pseudocatenulatum DSM20439-treated mice; slashed, B. bifidum ATCC 15696-treated mice; vertically lined, B. catenulatum ATCC 27539T-treated mice. **, significant differences are shown for the Bifidobacterium-treated groups versus the untreated control group (P < 0.01).
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FIG. 5. Inhibition of Stx production but not STEC proliferation at higher AA concentrations and lower pH values in vitro. The pH and concentration of AA were adjusted in the growth medium so that the conditions were the same as those in the control cecum () (pH 7.15; AA concentration, 28 mM) or the B. breve-colonized cecum ( ) (pH 6.75; AA concentration, 56 mM). STEC was added to each medium at a final concentration of 105 CFU/ml and cultivated at 37°C for 8 h. Cultures were then divided into two groups, and either 20 µl of fresh medium or MMC at a final concentration of 1 µg/ml in 20 µl of medium was added to each group, and the tubes were incubated for an additional 8 h. (A) Viable bacterial counts were determined at the indicated periods during incubation. The straight line and the dotted line show growth without (-) and with (+) MMC, respectively. (B) Stx2 concentrations were determined after incubation for 16 h. Columns: black, control, white, B. breve. Results are expressed as the means and standard deviations of the results from triplicate cultures. ***, significant differences are shown for growth under the B. breve colonization conditions versus growth under control conditions (P < 0.001).
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Treatment of mice with SM depleted the facultative intestinal flora, which appeared to allow the explosive opportunistic proliferation of SM-resistant STEC cells (Fig. 1A), and the initial logarithmic phase of STEC proliferation in the intestines was not influenced by the B. breve cocolonization. Organic acids, such as AA, lactic acid, and citric acid, have been reported to possess a higher bactericidal activity than inorganic acids, such as hydrochloric acid; furthermore, the bactericidal activity of organic acids depends mainly on their undissociated form (6, 13). Undissociated organic acids can permeate the cell membrane by diffusion and release protons within the cell. The influx of protons is thought to induce cytoplasm acidification and dissipate the membrane proton potential (6, 10, 13). This leads to the disruption of the proton motive force and the inhibition of substrate transport mechanisms, energy-yielding processes, and macromolecule synthesis (7, 12). In addition, anion accumulation is assumed to exert a bacterial toxicity (28). In a previous study, it was reported that the cytotoxic properties of undissociated lactic acid on STEC strain 89020087 in vitro was divided into two phases: a bacteriostatic phase (between 3.2 to 62 mM) and a bactericidal phase (over 62 mM) (27). Several investigators have noted the ability of STEC O157:H7 to survive in acidic conditions; a possible explanation for this survival ability could be an acid tolerance response (5, 9, 12). We analyzed the cytotoxic properties of undissociated AA against the STEC strain and found that an undissociated AA concentration of more than 20 mM was needed to exert cytotoxic or growth-inhibitory activity against the STEC strain in vitro (data not shown), and the higher acetate concentration and lower pH in the B. breve-colonized cecum, when reproduced in vitro, was not found to inhibit STEC growth (Fig. 5A). Taken together, these results may explain the reason why B. breve colonization did not inhibit STEC growth in vivo.
On the other hand, the higher concentration of AA and the lower pH in the B. breve-colonized intestines appear to play a somewhat important role in the inhibition of toxin production because the inhibitory effect of the combination of pH and acetate on Stx production was confirmed by in vitro experiments (Fig. 5B). The mechanism by which the acetate concentration and the pH of the intestines inhibit Stx production is not clear. Quorum sensing is a mechanism through which gene expression in bacteria is regulated by cell density (11). Recently, quorum-sensing systems have been reported to be involved in the expression of several pathogenic genes such as LEE, which encodes a component of a type III secretion system in STEC (17, 34, 36); the expression levels of such genes vary with the bacterial growth phases (1). Little is known about the regulatory mechanisms of Stx production (35), and both the host- and bacterium-related factors affecting Stx production remain to be elucidated. The present results suggest that environmental regulation via molecules in the intestine, such as AA, is an important regulator of Stx gene expression in intestinal colonies of STEC. Studies to determine the mechanism of Stx production in STEC at the gene expression level are in progress.
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