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Infection and Immunity, July 2004, p. 3849-3854, Vol. 72, No. 7
0019-9567/04/$08.00+0 DOI: 10.1128/IAI.72.7.3849-3854.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
The University of Wisconsin School of Pharmacy,1 The University of Wisconsin School of Veterinary Medicine, Madison, Wisconsin2
Received 13 November 2003/ Returned for modification 18 December 2003/ Accepted 22 March 2004
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Listeria monocytogenes is a food-borne pathogen responsible for considerable morbidity and mortality (11, 24). Although multiple sites of invasion have been proposed, the vanguard of the body's interaction with L. monocytogenes is the intestinal epithelial barrier. Intestinal epithelial cells come in contact with not only the bacterium but also numerous secreted and surface-attached L. monocytogenes proteins. Almost 5% of the coding capacity of the L. monocytogenes EGD genome is dedicated to surface proteins. These proteins can be characterized into three categories: (i) LPXTG proteins covalently linked to peptidoglycan by carboxy-terminal domains, (ii) noncovalently bound proteins, including GW proteins, hydrophobic tail proteins, and P60-like proteins, and (iii) lipoproteins attached to the surface by their amino-terminal regions (5). Although a number of epithelial receptors for L. monocytogenes proteins important for invasion have been identified, little is known regarding mechanisms by which the enterocyte resists invasion at the apical membrane (2, 3, 14, 18). Given the intimate contact between the bacterium and intestinal epithelial cells, it is conceivable that some bacterial proteins, either secreted or loosely attached, come in contact with enterocyte proteins such as P glycoprotein. Whether P glycoprotein can prevent the attachment or entry of L. monocytogenes proteins that promote invasion has not previously been determined. The aim of the present study was to test the hypothesis that intestinal P glycoprotein influences the extent of L. monocytogenes invasion. We report that the expression and function of P glycoprotein in vitro and in vivo influence the extent of L. monocytogenes invasion.
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Bacterial cultures. L. monocytogenes EGD (serotype 1/2a) was employed for all studies. Seven hundred fifty microliters of an overnight culture of L. monocytogenes EGD was inoculated into 50 ml of prewarmed brain heart infusion medium and shaken at 37°C until mid-log-phase growth was reached. A 20-ml aliquot of the culture was centrifuged, the supernatant was discarded, and the pellet was resuspended in Caco-2 growth medium. Using the optical density at 600 nm and a growth curve, serial dilutions were made to obtain the desired concentration of bacteria in Caco-2 medium.
Caco-2 invasion assay. Caco-2 medium was aspirated from the 24-well plate and replaced with 1 ml of medium containing 105, 106, 107, or 108 L. monocytogenes EGD organisms/ml (n = 6 per condition). Following a 1-h incubation period, the bacterium-containing medium was drawn off, and the wells were washed five times with Hanks balanced salt solution (HBSS). Subsequently, cells were incubated for 2.5 h with Caco-2 medium containing 5 µg of gentamicin sulfate per ml to kill remaining extracellular bacteria. After the gentamicin phase, cells were again washed five times with HBSS and lysed with 1% Triton X-100 in phosphate-buffered saline (PBS). Viable intracellular L. monocytogenes organisms were quantified by serial dilutions of the cell lysates plated in duplicate on blood agar (Difco Laboratories, Detroit, Mich.). Colonies were counted after 48 h. Data are expressed as the log10 CFU of L. monocytogenes organisms per ml of lysate (means ± standard deviations [SD]).
Modulation of P-glycoprotein expression and function in Caco-2 cells. A P-glycoprotein-overexpressing subclone of Caco-2 cells (designated Caco-2/MDR) was derived by stepwise selection with vinblastine (final concentration, 1.5 ng/ml). Vinblastine was removed from the medium 24 h before the addition of bacteria so that intracellular concentrations would be negligible. For P-glycoprotein functional inhibition studies, growth medium was aspirated 1 h prior to bacterial infection and replaced with 0.5 ml of medium containing the monoclonal antibody MRK16 (20 µg/ml) (Kamiya Biomedical, Seattle, Wash.). Unlike other P-glycoprotein inhibitors, MRK16 is nonpermeative and therefore does not have the ability to accumulate in the cytosol and subsequently interfere with intracellular growth of the organism. The isotype-matched control, mouse monoclonal immunoglobulin G2a (clone NCG2A.01) antibody, was used to confirm the absence of nonspecific antibody effects on invasion (Kamiya). After the 1-h preincubation, 0.5 ml of growth medium containing 2 x 105, 2 x 106, 2 x 107, and 2 x 108 L. monocytogenes EGD organisms/ml was added to yield bacterial concentrations (105 to 108/ml) similar to those used in other invasion assays.
L. monocytogenes protein transport studies. Bacterial cultures were grown to the mid-log phase and resuspended in Caco-2 medium without methionine. Two-milliliter aliquots were placed in glass tubes containing 100 µCi of [35S]methionine (ICN Biomedicals, Irvine, Calif.). Radioactive methionine was incorporated into newly synthesized proteins at 37°C over a period of 2 h with shaking. L. monocytogenes proteins in the supernatant were removed with a 0.22-µm calcium acetate filter, and the fraction containing whole bacteria was discarded. Separated radioactive proteins were placed in either the apical or basolateral chamber for 150 min, and the bidirectional flux across the Caco-2 cell monolayer was measured. Aliquots (10 µl) were taken from the opposite chamber at 0, 30, 60, 90, 120, and 150 min, and 35S activities were determined by liquid scintillation counting. Flux in the apical-to-basolateral and basolateral-to-apical directions (Ja-b and Jb-a) was determined from the slope of the linear regression line of flux versus time (in micrograms per square centimeter per minute). In selected wells, cells were preincubated with Dulbecco's modified Eagle's medium containing MRK16 or the isotype control as described above to confirm P-glycoprotein specificity. In addition to MRK16, cyclosporine (10 µM) or verapamil (100 µM) was also employed to inhibit P glycoprotein. For each condition, the assay was performed in triplicate. L. monocytogenes protein concentrations in the experiments were similar to those seen when the bacteria were present. Epithelial integrity was confirmed prior to and following each experiment by determining the transepithelial resistance (EVOM Epithelial Voltohmmeter; WPI, Sarasota, Fla.).
[3H]digoxin competition experiments. To further confirm that L. monocytogenes proteins exhibited high affinity for P glycoprotein, a digoxin competition assay was performed. Substrates with higher affinities for P glycoprotein will compete with other known substrates such as digoxin for transport, resulting in an increased intracellular accumulation of digoxin. Therefore, competition assays can serve as a tool to corroborate P-glycoprotein substrate specificity of unknown substances. Caco-2 cells were washed three times with uptake buffer (HBSS with 0.1% fetal bovine serum; pH 7.0) and allowed to equilibrate for 15 min. After equilibration, 0.5 ml of uptake buffer containing [3H]digoxin and cold digoxin (0.5 µCi/well) at a final concentration of 30 nM was placed in each well, with and without various concentrations of L. monocytogenes proteins. Proteins were isolated as described above with the exception that proteins were not radioactive. After 1 h, uptake buffer was removed, and cells were washed three times with ice-cold uptake buffer and treated with 0.5 ml of 1% Triton X-100 in PBS prior to being scraped from the wells. The entire mixture was transferred to glass vials containing 5 ml of liquid scintillation cocktail (Scintisafe Econo 1; Fisher Scientific, Pittsburgh, Pa.). Albumin, in concentrations similar to those of the L. monocytogenes proteins, was used as a control for amount of protein in each well. Each condition was tested in triplicate.
Inoculation of mdr1a/ and FVB mice. Animal experiments were performed according the NIH Guide for Care and Use of Laboratory Animals and the animal protocol was approved by the Research Animal Resource Center at the University of WisconsinMadison. Male 8-week-old mdr1a/ mice and the wild-type controls, FVB mice, were obtained from Taconic Laboratories (Germantown, N.Y.) and housed in microisolator cages throughout the study. Mice acclimated to the environment with access to food and water ad libitum for 7 days prior to study. Five hours prior to inoculation, food was removed from the cage. For intragastric challenge, mice were mildly sedated with intraperitoneal pentobarbital (0.75 to 1 mg per 25 g of body weight), and 107 organisms in 0.2 ml of PBS were delivered into the stomach by using a 24-gauge pediatric feeding needle. For intravenous challenge, mice were administered 104 organisms in 0.2 ml of PBS via tail vein. To measure the dissemination of L. monocytogenes from the gastrointestinal tract, mice were euthanized by CO2 asphyxiation at days 1 and 3 postinfection, and the livers and spleens were aseptically harvested and weighed (five to six per strain per study day). The tissues were homogenized in 1 ml of sterile saline, and serial dilutions were plated in duplicate on blood agar to allow the enumeration of CFU. The plates were allowed to dry and then incubated at 37°C for 48 h. The colonies were counted after 48 h, and data were expressed as the log10 CFU of L. monocytogenes per gram (wet weight) of tissue (mean ± SD).
Statistics. Data were analyzed by one-way analysis of variance using SigmaStat Statistical Software 2.03 (SPSS, Chicago, Ill.). If significant differences were detected, pairwise comparisons were made using a Tukey post-hoc test. Significance was defined as a P value of <0.05.
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FIG. 1. L. monocytogenes invasion of Caco-2 monolayers. (A) Caco-2 cells, Caco-2/MDR cells, or Caco-2 cells treated with MRK16 (final concentration, 10 µg/ml) were incubated with 108, 107, 106, and 105 L. monocytogenes EGD organisms, and invasion was measured after 1 h (n = 6 per condition). Caco-2/MDR cells were less susceptible and MRK16-treated cells were more susceptible to L. monocytogenes invasion. *, P < 0.05 compared to untreated Caco-2 cells. (B) An isotype control antibody had no effect on invasion (n = 3 per condition). Data are means plus SD. (C) Real-time PCR results confirming no difference in E-cadherin mRNA expression between Caco-2 and Caco-2/MDR cell lines (P > 0.05). The relative concentration of E-cadherin mRNA was normalized to GAPDH mRNA levels. Values are means plus SD from duplicate experiments.
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FIG. 2. Bidirectional transport of 35S-labeled L. monocytogenes proteins across Caco-2 cells grown on permeable inserts. 35S-labeled proteins were placed into either the apical or basolateral compartment, and their flux into the other compartment was measured. A-B, apical-to-basolateral transport; B-A, basolateral-to-apical transport. (A) MRK16 was used to inhibit P-glycoprotein-mediated B-A transport (n = 3 per condition). (B) Additional P-glycoprotein inhibitors, cyclosporine (CsA) and verapamil (Ver), decrease the B-A transport of 35S-labeled proteins (n = 3 per condition). An isotype control to MRK16 did not alter B-A flux of 35S-proteins. Data are means ± SD.
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FIG. 3. Effect of L. monocytogenes proteins on the intracellular accumulation of the P-glycoprotein substrate digoxin. Cells were treated with [3H]digoxin (30 nM); its uptake into Caco-2 cells was measured after 1 h (n = 3 per condition) in the presence and absence of increasing amounts of L. monocytogenes proteins (x axis). L. monocytogenes proteins preferentially compete for P-glycoprotein binding, resulting in increased intracellular accumulation of digoxin. Data are means plus SD. *, P < 0.05 compared to digoxin alone.
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FIG. 4. Dissemination of L. monocytogenes from the gastrointestinal tract to the spleen and liver is greater in P-glycoprotein knockout (mdr1a/) mice than wild-type mice after oral inoculation (five per group per study day). Mice were given 107 L. monocytogenes organisms in the stomach, and dissemination was measured on days 1 and 3 postinoculation. Data are means plus SD. *, P < 0.05.
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FIG. 5. Dissemination of L. monocytogenes to the spleen and liver does not differ in P-glycoprotein knockout (mdr1a/) and wild-type mice after intravenous inoculation. Mice were given 104 L. monocytogenes EGD organisms via tail vein injection, and dissemination was measured on day 1 postinoculation. No differences in numbers of CFU per organ were detected (P > 0.05). Data are means plus SD (n = 5 for wild-type mice and 6 for mdr1a/ mice).
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Undoubtedly, there are numerous host defense mechanisms in place which interfere with the invasion of pathogenic bacteria such as L. monocytogenes (4, 6, 9, 20). P glycoprotein appears to be one important protein at the epithelial level, most likely working in concert with these other factors to protect the host. However, since inhibition and overexpression of P glycoprotein in Caco-2 cells did lead to significant changes in invasion, the role of P glycoprotein cannot be discounted. Although the dissemination differences at day 1 in the mdr1a/ mice were almost fivefold greater than differences in wild-type mice, one may argue that these are not representative data, since gene deletion is not a realistic occurrence in humans. However, use of the mdr1a/ mice does allow the assessment of maximal changes in invasion and assists with the elucidation of the role of P glycoprotein. Furthermore, differences in dissemination potentially may have been due to disparities in gut flora between the mdr1a/ and wild-type mice. Unfortunately, there is no way to confirm if there were differences in flora, since fecal testing was not performed immediately prior to shipping (as confirmed by Taconic). However, all animals were housed in the same facility under identical conditions, and therefore we believe it is unlikely that flora were different, since environmental exposures were similar once the animals arrived at our facility.
One recent investigation elegantly determined that mdr1a/ mice have altered intestinal intraepithelial lymphocyte (IEL) populations which are linked to changes in proliferation and cytokine secretion (8). Although one might suggest that altered IELs may have influenced our findings with L. monocytogenes dissemination, we believe that it is unlikely that these differences in IEL populations explain the results that we observed. First, in the previous study the total number of IEL were not significantly different between mdr1a/ and wild-type mice. Second, the proportions of CD8
ß and T-cell receptor
ß+ IELs were significantly increased, whereas CD8 
and T-cell receptor 
+ IELs were diminished. Given the overall makeup of the IEL imbalance, one would not predict significant changes in host response to an enteric pathogen. Third, cell proliferation and phorbol myristate acetate- and ionomycin-stimulated gamma interferon secretion by IELs from mdr1a/ mice were actually greater (P < 0.05) than those by normal IELs. Because gamma interferon is essential for host response to L. monocytogenes, any cytokine changes in the present study would not be in a direction detrimental to host defense (19, 20, 23). Lastly, peripheral-T-cell proliferation, cytokine secretion, and cytotoxic function are unaffected by a lack of the mdr1a gene in mice (7). Thus, we believe it to be unlikely that any IEL differences in the mdr1a/ mice negatively affected resistance to the L. monocytogenes challenge.
Several lines of evidence support the concept of a role of intestinal P glycoprotein in host defense against bacteria. Decreased P glycoprotein or the lack of P glycoprotein on the apical surface of the enterocyte may constitute a "functional defect" in the intestinal epithelial barrier, rendering the host susceptible to bacteria. Bacteria have long been hypothesized to play a central role in the development of inflammatory bowel disease (IBD) (30). Knockout mice demonstrating cytokine imbalances or T-cell abnormalities do not develop IBD in germ-free environments; however, when placed in conventional housing, they develop severe colitis, presumably due to exposure to commensal organisms (26, 29). Panwala and colleagues were the first to report that mdr1a/ mice spontaneously develop colitis when housed under conventional housing conditions over a long period of time (21). Because mdr1a/ mice are immunologically normal, it has been suggested that lack of P glycoprotein led to diminished barrier function against colitis-inducing luminal bacteria. These authors conducted a follow-up study which demonstrated that inoculation of mdr1a/ mice with Helicobacter bilis, an organism known to cause inflammation in other murine IBD models, accelerated the development of colitis (16). Helicobacter-induced colitis in mdr1a/ mice and other models may be due to a family of cytolethal distending toxins (31). Thus, P glycoprotein may protect the enterocyte against these toxins, and the lack of the efflux transporter may explain the accelerated inflammation in the mdr1a/ mice.
Altered intestinal P-glycoprotein levels due to polymorphic variations and ulcerative colitis (UC) in humans has also been detected (25). Polymorphisms are relatively common in the MDR1 gene, with some mutations being linked to altered transport of P-glycoprotein substrates. Specifically, individuals homozygous for the T allele of the mutation on exon 26 (C3435T) have considerably lower intestinal P-glycoprotein levels than those with the 3435CC genotype. This correlates with decreased oral absorption of the P-glycoprotein substrate digoxin (10). Because of these altered expression levels with the C3435T mutation, Schwab and colleagues hypothesized that lower expression levels of intestinal P glycoprotein may result in altered barrier function and decreased resistance to inflammation-inducing bacteria (25). In their case-control study involving 145 patients with UC and sex-matched healthy controls, UC patients were found to have significantly higher frequencies of the TT genotype than the sex-matched controls, supporting the concept that intestinal P glycoprotein is important for host defense against bacteria and inflammation-inducing toxins.
Our data are not the first to suggest a protective role for efflux transporters in protecting the host against pathogenic bacteria. Schultz and colleagues investigated the efflux transporter, mrp1, in protection against Streptococcus pneumoniae-induced pneumonia (25). In addition to the excretion of anticancer drugs and glutathione-S conjugates of drugs, mrp1 transports cysteinyl leukotrienes (LT) which are important for defense against bacterial pathogens. mrp1/ mice challenged with S. pneumoniae were more resistant to infection than wild-type controls. The mechanism for increased protection is believed to involve increased production of LTB4, which is important for resistance to S. pneumoniae and occurs as a result of decreased secretion of LTC4 by mrp1. Thus, efflux transporters may play a role in host defense not only by the secretion of virulence proteins, as in our study, but also by alterations of metabolic pathways which subsequently lead to increased production of antibacterial mediators.
It is interesting that P glycoprotein is also highly expressed in other tissues serving as primary barriers to L. monocytogenes invasion: the blood brain barrier and the placenta (13, 22). Furthermore, populations at high risk for listeriosis (immunocompromised persons, human immunodeficiency virus-seropositive individuals, and those with renal insufficiency) may take drugs known to affect P-glycoprotein function (cyclosporine, steroids, human immunodeficiency virus protease inhibitors, calcium channel blockers, etc.) or have baseline P-glycoprotein dysfunction (15, 17). Granted, these patients also have decreased cellular immunity, but modulation of P glycoprotein may also affect early resistance to L. monocytogenes infection and therefore cannot be ruled out.
In summary, the present work indicates that the expression and function of intestinal P glycoprotein is important for host defense against L. monocytogenes. These results, combined with those from the mdr1a/ IBD studies, suggest that the current research paradigm of P glycoprotein in the intestine must be expanded to include host defense against pathogenic bacteria.
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