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Infection and Immunity, November 2005, p. 7161-7169, Vol. 73, No. 11
0019-9567/05/$08.00+0 doi:10.1128/IAI.73.11.7161-7169.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Bryan A. Coburn,1,2,
Andrew A. Potter,3
Susantha Gomis,4
Kuldip Mirakhur,3
Yuling Li,1 and
B. Brett Finlay1,2*
Michael Smith Laboratories,1 Department of Microbiology and Immunology,2 University of British Columbia, Vancouver, British Columbia V6T 1Z4, Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4,3 Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada4
Received 1 April 2005/ Returned for modification 15 June 2005/ Accepted 8 July 2005
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Two major virulence determinants involved in Salmonella pathogenesis are encoded in large chromosomal pathogenicity islands called Salmonella pathogenicity island 1 (SPI-1) (9) and SPI-2 (20, 24). Both SPI-1 and SPI-2 encode separate type III secretion systems that introduce virulence proteins (called effectors) into the host environment either by translocation directly into host cells or possibly by secretion into the vicinity of host cells (10, 14, 18). Effector proteins translocated by the SPI-1 type III secretion system influence early host cell cytoskeletal and membrane rearrangements involved in bacterial uptake into target cells (8) whereas SPI-2 is generally thought to play a role during intracellular infection by allowing the formation of Salmonella replicative vacuoles and evading host cell defenses (30).
Animal models are available to study both intestinal and systemic phases of salmonellosis caused by S. enterica serovar Typhimurium. Cattle have been used to study the enteric disease caused by this organism, whereas infected mice develop a systemic infection that shares features with human typhoid. S. enterica serovar Dublin is also commonly used in bovine infection models because this particular serotype is able to initiate both intestinal and systemic phases of infection in cows.
An important theme to emerge from these models is the seemingly dichotomous role played by the SPI-1 and SPI-2 type III secretion systems during the intestinal and systemic phases of salmonellosis. Whereas the SPI-1-encoded type III secretion system plays an essential role in colonization of the bovine intestine and in bovine enteropathogenesis (12, 19, 29, 31), this virulence trait has been reported to play little to no role in systemic infection (11). Conversely, the SPI-2-encoded type III secretion system is more strongly associated with systemic virulence and associated pathology (4, 17, 20, 23) than intestinal disease. The role of the SPI-2-encoded type III secretion system in enteric disease has been less studied and appears more contentious. Earlier work demonstrated that SPI-2 mutants maintain intestinal virulence during oral infection of cows (26) and in ileal loops in rabbits (7). However, one study using bovine ileal loops infected with S. enterica serovar Dublin (2) indicated that mutations in SPI-2 reduced the intestinal secretory response compared to wild-type serovar Dublin. Another study using oral infections of calves with a bovine isolate of serovar Typhimurium (26) indicated that SPI-2 mutants produced intestinal lesions of reduced severity in calves but nevertheless caused mortality and acute diarrhea. One of the confounding factors for the study of enteric disease in cattle caused by S. enterica serovar Dublin is the highly invasive nature of the infection that results in a disseminating bacteremia (33). In contrast, natural and experimental infection of calves with S. enterica serovar Typhimurium results in an enteric disease localized to the gut without systemic involvement, which shares similar pathological and clinical features to human enterocolitis caused by this same organism (33).
Recently, a mouse model of Salmonella-induced colitis has been developed that relies on the pretreatment of animals with streptomycin (1). This model has been used to demonstrate that Salmonella-induced colitis at day 2 after infection requires the SPI-1 effectors SipA, SopE and SopE2 (15), plus flagella and chemotaxis (25). Using this model, we (5) and others (16) have extended these findings by showing that the SPI-2 type III secretion system contributes to the intestinal inflammatory phenotype in the cecum and proximal colon between day 2 and day 5 following oral infection of mice with S. enterica serovar Typhimurium. Although these studies have identified a role for SPI-2 in the ceca of susceptible mice after 2 days of infection, as yet these data have not been extended to the bovine ileal loop infection model at the same time points.
The ligated ileal loop model in cattle is a proven tool for studying enteropathogenesis of Salmonella serotypes (28, 33). However, due to obstruction of the small bowel with multiple ligatures, one recognized limitation of this model in its present usage is the inability to monitor pathological changes in response to Salmonella at times longer than 12 h postinfection (34). This has precluded the investigation of the relative contribution of SPI-1 and SPI-2 to the progression of intestinal disease in bovine loops and the comparison to other intestinal inflammatory models of serovar Typhimurium infection. To address this limitation, we have developed a novel calf ileal loop model that restores the patency of the small intestine following surgery. This feature overcomes the time constraints of traditional loop experiments, permitting the examination of virulence determinants at later stages of enteric disease in a highly controlled environmental context. Here, we establish the relative contributions of S. enterica serovar Typhimurium SPI-1 and SPI-2 type III secretion to early and late intestinal inflammation. Our results identify novel phenotypes for S. enterica serovar Typhimurium mutants with deficiencies in SPI-1 and SPI-2 type III secretion systems, which we have demonstrated in a murine model of infectious colitis and confirmed in the extended bovine ileal loop model. The working model presented here supports the view that during the progression of enteric disease, the presence of SPI-2 overcomes the previously reported requirement of SPI-1 for intestinal inflammatory disease.
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ssaR [cows];
ssaR bearing pAT113-GFP [mice]) (3) were isogenic derivatives of this strain. An S. enterica serovar Typhimurium double mutant defective for both SPI-1 and SPI-2-mediated type III secretion was constructed by generalized P22 transduction of a marked invA::Kan mutation to a strain with an unmarked, in frame deletion of ssaR (6). For infection of experimental animals, bacterial cultures were grown for 18 h at 37°C with shaking in Luria-Bertani (LB) medium and then diluted to the appropriate concentration in phosphate-buffered saline (PBS). Mouse infection experiments. Male C57BL/6 mice (6 to 8 weeks old) were purchased from Jackson Laboratories (Maine, USA). Mice were housed in sterilized, filter-top cages under specific pathogen-free conditions at the University of British Columbia Animal Facility. The protocols used here were in direct accordance with animal care guidelines as outlined by the University of British Columbia Animal Care Committee and the Canadian Council on the Use of Laboratory Animals. The streptomycin pretreatment model of murine infectious colitis was used as described previously (1, 5). Mice were deprived of food and water for four hours and then given 20 mg of streptomycin by oral gavage. Two hours after antibiotic treatment, food and water were provided for twenty hours. Four hours prior to infection, food and water were removed once again and then mice were infected orally with 3 x 106 or 3 x 108 bacteria in a 0.1 ml volume. Control mice were given 0.1 ml of sterile LB medium. Water and food were provided ad libitum following infection. Mice were euthanized with CO2 at 2 days and 5 days after infection and tissues were harvested for bacterial enumeration and histopathology.
Bacterial enumeration from mouse tissue. Mouse colon, cecum, spleen, and liver were collected into 1.5 ml of cold sterile PBS and homogenized using a tissue homogenizer (Polytron MR-21; Kinematic). Serial dilutions of the homogenized organs were spread on LB agar plates containing 100 µg/ml streptomycin and incubated overnight at 37°C.
Murine histopathology. Colons, ceca and ilea of experimental animals were fixed in 3% formalin for 18 h followed by 18 h in 70% ethanol and then embedded in paraffin, sectioned at 5 µm and stained with hematoxylin and eosin. For pathological scoring, six fields per sample were examined and scored as described previously (5). This scoring system was as follows: for lumen, sum of empty (score = 0), necrotic epithelial cells (scant = 1, moderate = 2, dense = 3), and polymorphonuclear cells (PMNs) (scant = 2, moderate = 3, dense = 4); for surface epithelium, sum of no pathological change (score = 0), regenerative change (mild = 1, moderate = 2, severe = 3), desquamation (patchy = 1, diffuse = 2), and PMNs in epithelium (score = 1), ulceration (score = 1); for mucosa, sum of no pathological change (score = 0), crypt abscesses (rare [<15%] = 1, moderate [15% to 50%] = 2, abundant [>50%] = 3), presence of mucinous plugs (= 1), and presence of granulation tissue (= 1); for submucosa, sum of no pathological change (= 0), mononuclear cell infiltrate (1 small aggregate = 0, more than one aggregate = 1, large aggregates plus increased single cells = 2), PMN infiltrate (none = 0, single = 1, aggregates = 2), and edema (mild = 0, moderate = 1, severe = 2).
Calf intestinal loop surgeries.
All animal experiments were conducted in accordance with the Guide to the Care and Use of Experimental Animals, provided by the Canadian Council on Animal Care. One month old, male Holstein calves were housed in single isolation cubicles at the Vaccine and Infectious Disease Organization (VIDO) animal facility. All animals were clinically healthy prior to surgery and rectal swabs from all calves were tested for Salmonella prior to experimentation and were found to be negative in all cases. The calves were fasted for 24 h prior to surgery and then premedicated with butorphanol (0.2 mg/kg of body weight) and diazepam (0.1 mg/kg). Anesthesia was induced with 6 to 8 ml of 5% thiopental sodium prior to placement of an endotracheal tube and maintenance with isoflurane. The intestinal ileal loop model developed in sheep (13) was adapted for use in one-month old male calves. A laparotomy was performed and the small intestine was exteriorized until six consecutive Peyer's patches were identified. The exposed small intestine was frequently moistened with sterile PBS prewarmed to 37°C. An intestinal segment containing two Peyer's patches separated by interspaces without Peyer's patches was demarcated by intestinal clamps approximately 30 cm proximal and 30 cm distal to the first and last Peyer's patch and then transected. This intestinal segment was flushed twice with 100 ml of warm sterile saline to clean the gut of its contents. The patency of the intestine was restored with end-to-end anastomoses by aligning the mesenteric and antimesenteric borders of the transected intestine and closing with interrupted and continuous sutures. Silk ligatures were tied approximately 8 cm proximal and distal to each Peyer's patch to create
16- to 18-cm isolated segments containing a Peyer's patch, separated by interspaces of various length that lacked Peyer's patches. Three anastamoses were created in each animal, generating three intestinal segments each containing two loops that provided two independent sites for duplicate samples. For each animal, the intestinal segments received (i) sterile saline, (ii) wild-type Salmonella, and (iii) a Salmonella mutant under investigation. The loops were infected with 3 ml of sterile PBS or 3 ml of a bacterial suspension diluted in PBS to contain either 1x 103 or 1 x 106 CFU. Intestinal segments were marked by silk sutures and the succession and size of each internal loop and interspace was recorded. The loops were then replaced into the abdominal cavity and the surgical incision in the abdominal wall was sutured. This surgery was completed in a total of six animals with two calves euthanized at 24 h postsurgery and four calves euthanized at 5 days postsurgery.
Calf intestinal tissue collection, specimen handling and histopathology. Immediately after euthanasia, intestinal loops were exposed from the abdominal cavity and the fluid volume was collected. Samples of lumenal fluid were taken for bacteriologic isolation and intestinal tissues from loops were taken for histopathology. For histopathology of intestines, sections of ileum were fixed in 10% neutral-buffered formalin, embedded in paraffin, sectioned at a 5-µm thickness, and stained with hematoxylin and eosin. A standard histology scoring system similar to previous studies using bovine ileal loops was used. A histological score from 0 to 4 was assigned based on the tissue reactions to the various doses of mutant and wild-type Salmonella as follows: 0, no visible lesions; 1+, mild inflammatory cell infiltration, submucosal edema with villus atrophy; 2+, moderate inflammatory cell infiltration, submucosal edema with villus atrophy; 3+, moderate inflammatory cell infiltration, submucosal edema, necrosis, vascular thrombosis with villus atrophy; 4+, severe inflammatory cell infiltration, submucosal edema, necrosis, vascular thrombosis with villus atrophy.
Statistical analysis. Total pathological scores were compared using Dunn's Multiple Comparison and Kruskal-Wallis nonparametric tests. Bacterial load was compared using analysis of variance with Tukey's multiple-comparisons posttest. All analyses were performed using Graphpad Prism, version 3.0.
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FIG. 1. (A) Pathological scores in streptomycin-pretreated mice 48 h postinfection with wild-type S. enterica serovar Typhimurium or strains lacking functional SPI-1, SPI-2 or both type III secretion systems. (B) Pathological scores from mice infected for 120 h (5 days). Pathological scores are stacked averages from 8 mice per group, error bars indicate the standard deviation of the total score. Bacterial loads in the colon (C) and spleen (D) of streptomycin-treated mice for above strains at 48 h and 120 h postinfection. Each black circle represents data from one mouse. Bars represent the geometric mean for the group. The type III secretion status of each strain is given below each panel next to the respective locus. All P values are derived from comparisons to wild-type Salmonella (SPI-1+, SPI-2+).
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FIG. 2. Histopathological changes at 48 h (A, C, E, and G) and 120 h (B, D, F, and H) postinfection in streptomycin-pretreated mice infected with wild-type S. enterica serovar Typhimurium (A and B) or strains lacking functional SPI-1 (SPI-1) (C and D) or SPI-2 (SPI-2) (E and F) type III secretion systems or both (SPI-1, SPI-2) (G and H). Tissues were paraffin embedded, section and stained with hematoxylin and eosin. Photographs are of representative tissues for each group.
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Calf intestinal loops infected with SPI-1 and SPI-2 mutants show reduced secretory response and similar pathological changes at 24 h postinfection. Using a 12-h calf ileal loop model with S. enterica serovar Dublin, Bispham and colleagues (2) reported that an sseD mutant (a component of the SPI-2 translocation machinery that probably introduces a pore in host cell plasma membranes) induced a weaker secretory and inflammatory response than the parental wild-type strain. Unlike serovar Dublin, which progresses to a systemic infection in calves, serovar Typhimurium produces an enteric infection in the small intestine that rarely progresses beyond the cow gut (33). Because the maximum infection time achievable with the existing bovine ileal loop model is 12 h, we developed an alternative model that overcomes this time constraint, and examined intestinal pathology at 24 h and 5 days following infection with wild-type S. enterica serovar Typhimurium, or SPI-1 and SPI-2 mutants. Ileal loops infected with wild-type Salmonella, the SPI-1 apparatus mutant (invA) or the SPI-2 apparatus mutant (ssaR) were examined for secretory response into the loop and for pathological changes at 24 h after infection. At 24 h postinoculation, intestinal fluid accumulation was higher in loops infected with wild-type Salmonella (Fig. 3A). This secretory response was consistent with other studies that measured fluid accumulation in ileal loops at 12 h postinfection (2). Loops infected with either SPI-1 or SPI-2 mutants showed a reduction in the secretory response at 24 h compared to the response in loops infected with wild-type Salmonella (Fig. 3A). At 24 h after infection, there was little difference in the degree of colonization between wild-type Salmonella and the SPI-1 or SPI-2 mutants. However, by 5 days after infection, a role for SPI-2, but not SPI-1, in intestinal colonization was apparent (Fig. 3B). These colonization data at day 2 and day 5 after infection parallel those seen in the colon of streptomycin-pretreated mice. Mucosal necrosis and edema with acute inflammation of the intestinal loops due to inoculation with wild-type Salmonella or the ssaR or invA mutants was similar at 24 h after infection (Fig. 4A, Fig. 5). As another measure of pathological change in the epithelium, we measured the villus height in several tissue sections of intestinal epithelium from loops infected with wild-type Salmonella and each of the SPI-1 and SPI-2 mutants. Villus height correlated with the pathological score and demonstrated more severe villus atrophy in tissues with greater pathological changes (Fig. 4C). At 24 h after infection, there was little correlation between the degree of pathological change and the initial infectious dose of Salmonella.
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FIG. 3. (A) Secretory responses in ileal loops 24 h after infection with wild-type S. enterica serovar Typhimurium, or mutants lacking SPI-2 (SPI-2) or SPI-1 (SPI-1) type III secretion. The secretory response in control loops inoculated with physiological saline was also determined (saline). The secretory response is expressed as the volume of fluid divided by the length of the loop. Data are the means with standard deviation from two duplicate loops. (B) Bacterial loads in calf ileal loops at day 5 after infection. Loop contents were collected and the number of Salmonella contained in this fluid was enumerated by selective plating. Values are expressed as the mean number of CFU per ml of loop fluid from two to four infected loops with standard errors.
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FIG. 4. Pathological changes in calf ileal loops at 24 h postinfection. (A) Pathology scores from calf ileal loops at 24 h after infection with either saline alone, wild-type S. enterica serovar Typhimurium or mutants lacking SPI-2 or SPI-1 type III secretion (SPI-2, SPI-1, respectively). White bars and black bars indicate initial infectious doses of 1 x 103 and 1 x 106 CFU per loop, respectively. Saline groups are similarly colored but are not differentially dosed. Pathology scores for loops infected with wild-type bacteria are from 2 animals while scores for the SPI-2 and SPI-1 mutants are from one animal each. Pathology was scored on a scale from 1 to 4 according to the criteria defined in the Materials and Methods. (B) Pathology scores from calf ileal loops at 5 days after inoculation with either saline alone, wild-type S. enterica serovar Typhimurium or mutants lacking SPI-2 or SPI-1 type III secretion (SPI-2 and SPI-1, respectively). White bars and black bars indicate initial infectious doses of 1 x 103 and 1 x 106 CFU per loop, respectively. Pathology scores for wild-type-infected loops are from four individual loops from two animals. Pathology scores for loops infected with SPI-1 and SPI-2 mutants are from two separate loops from two animals each. Villus height from matched tissue sections was also determined from loops infected with 1 x 103 (solid squares) and 1 x 106 (solid circles) CFU at 24 h (C) and 5 days (D) after infection.
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FIG. 5. Histopathological changes in calf ileal loops at 24 h and 5 days after inoculation with either saline alone (A, B, and B'), wild-type S. enterica serovar Typhimurium (C, D, and D'), or mutants lacking SPI-1 (E, F, and F') or SPI-2 (G, H, and H') type III secretion systems. Shown are hematoxylin- and eosin-stained sections of the intestinal epithelium. White bars, 0.250 mm.
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SPI-1 mutants produce severe intestinal pathology in calf ileal loops at 5 days postinfection. Previous studies employing the 8 to 12 h infection model of calf ileal loops have established a role for SPI-1 in the early stages of intestinal pathology (26, 34). In order to examine whether the pathology at later times after infection was also SPI-1-dependent, we infected calf ileal loops for 5 days prior to examination of intestinal pathology. As observed previously, tissue damage and inflammation in the intestinal loops infected with wild-type Salmonella was severe, demonstrating tissue necrosis, submucosal edema and fluid accumulation in the intestinal lumen (Fig. 4B). Similarly, intestinal tissues infected with SPI-1 mutant Salmonella displayed severe pathological lesions characterized by severe inflammatory cell infiltration, submucosal edema, necrosis, and vascular thrombosis with villus atrophy at 5 days after infection (Fig. 4B and 5). Loops inoculated with saline or with SPI-2 mutants (described above) did not show these pathological changes indicating that neither the surgical procedure nor the presence of Salmonella per se in the intestinal loops contributed to this associated pathology. Loops infected with SPI-1 mutants also showed a greater degree of villus atrophy compared to loops infected with SPI-2 mutants (Fig. 4D). These data indicate that the later progression of bovine enteric disease induced by S. enterica serovar Typhimurium is dominated by the SPI-2, and not the SPI-1, type III secretion system.
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By using the murine model of Salmonella-induced colitis and by extending the duration of bovine ileal loop infections we have assessed the contribution of two major virulence factors, the SPI-1 and SPI-2 type III secretion systems, to intestinal disease progression. The 5-day ileal loop model confirmed a critical role for SPI-2 in the pathogenesis of Salmonella enterocolitis and revealed a previously unrecognized pathological phenotype for SPI-1 mutants in the intestine of cows. In this model SPI-1 mutants retain the ability to induce severe inflammation and intestinal pathology similar to that induced by infection with wild-type Salmonella. This pathology is dependent on a functional SPI-2 apparatus since SPI-2 mutants produced only a mild inflammatory response at day 5 after infection of ileal loops.
It has been reported previously using the mouse streptomycin-pretreatment model that the SPI-1 effectors, SipA, SopE and SopE2, are required for Salmonella-induced intestinal pathology at day 2 after oral infection (15). Indeed, in our studies using the similar model, we observed that Salmonella mutants lacking a functional SPI-1 type III secretion system are significantly attenuated for the induction of colitis after 2 days of infection. However in the former study, time points longer than 2 days were not examined for intestinal pathology. Here, we have extended these results by showing that during later stages of the disease process, mutants lacking a SPI-1 type III secretion system but retaining a functional SPI-2 secretion system produce severe intestinal pathology, similar to that induced by wild-type Salmonella, at 5 days after oral infection. We confirmed the requirement of SPI-2 for this pathology by using single and double mutants defective for both SPI-1 and SPI-2-mediated type III secretion, which had a similar phenotype in the 5-day murine model more resembling that of a single SPI-2 mutant. It has been reported previously using the mouse model of Salmonella colitis that SPI-1 mutants produced a delayed colitis at day 4 after oral infection, but that this disease was still significantly attenuated in magnitude compared to colitis induced by wild-type Salmonella (16). Our results using this mouse model showed that SPI-2 mediates significant intestinal inflammation in the absence of SPI-1 at 5 days after oral infection. While SPI-2 mutants were significantly attenuated for induction of cecal pathology at day 2 and day 5 postinfection, SPI-1 mutants were not significantly attenuated in their ability to induce intestinal pathology at day 5 after infection. One difference between our study and that reported previously using streptomycin-pretreated mice (16) is the class of SPI-2 type III mutant used. While we used a type III secretion system apparatus mutant (ssaR), incapable of secreting SPI-2 effectors, Hapfelmeier and colleagues used a translocon mutant (sseD), incapable of translocating protein into the host cell during intracellular infection but still potentially able to secrete effectors out of the bacteria. The observation that SPI-2 is actively expressed in the lumen of the gut (N. Brown and B. Finlay, unpublished observations) supports the involvement of SPI-2-mediated type III secretion in the extracellular phenotype we observed. One other difference includes the sex of mice infected, as our studies exclusively used males, which appear less susceptible to inflammation than females (B. Coburn and B. Finlay, unpublished data). Together, these data suggest that the pathological basis of enteric Salmonella disease at later stages of the infection process is more dependent on the SPI-2 type III secretion system and its associated effectors rather than the contribution of the SPI-1 type III secretion system. This notion was supported in the bovine ileal loop model where SPI-2 mediated significant intestinal inflammation in the absence of SPI-1 at 5 days after infection.
One of the important findings of this work was the concordance between the mouse model of infectious colitis and the 5-day ileal loop model in calves for discriminating the phenotypes associated with major Salmonella virulence factors. A similar requirement for SPI-2 in the progression of intestinal inflammation was found in both animal models despite noteworthy differences between murine and bovine infections. Such differences include (i) the presence of co-occurring systemic infection in mice and the absence of this systemic component in cows, (ii) the induction of inflammation in the small bowel in bovine infection and in the large bowel in murine infection, and (iii) the necessity to treat mice with antibiotics in order to induce intestinal disease, without any such requirement in cows. The dependence on SPI-2 for the progression of intestinal disease in an infection model largely confined to the intestine (bovine) is noteworthy, as the superimposed systemic disease in streptomycin treated mice can confound the interpretation of intestinal phenotypes. A similar progression of S. enterica serovar Dublin infection of cattle, in which the highly invasive bacteria disseminate to systemic sites of infection, can also encumber the interpretation of enteric phenotypes of certain bacterial mutants under study. Although the microenvironment and physiology of a ligated intestinal loop and a patent gut likely differ, the use of ligated loops affords desirable experimental conditions and endpoints for the study of S. Typhimurium pathogenesis. Likewise, the early colonization by Salmonella of the murine intestine following streptomycin treatment requires careful interpretation due to the absence of normal microbiota. These caveats notwithstanding, we suggest that the streptomycin-treated mouse model and the extended duration bovine ileal loop model presented here can provide complementary approaches to the study of Salmonella enteric disease. These new models provide a framework to further investigate the SPI-2 effectors that contribute to inflammatory pathology and persistence during the intestinal phase of salmonellosis in cows and mice.
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Funding for this work was provided by grants to B.B.F. from the Canadian Institutes of Health Research (CIHR) and the Howard Hughes Medical Institute (HHMI) and to A.A.P. from CIHR, the Canadian Bacterial Disease Network and the Natural Sciences and Engineering Research Council of Canada (NSERC). B.K.C. is the recipient of postdoctoral fellowships from the CIHR and Michael Smith Foundation for Health Research (MSFHR), and B.A.C. is the recipient of postgraduate scholarships from the CIHR and MSFHR. B.B.F. is a CIHR Distinguished Investigator, an HHMI International Research Scholar, and the University of British Columbia Peter Wall Distinguished Professor. A.A.P. holds an NSERC Senior Industrial Research Chair position.
B.K.C. and B.A.C. contributed equally to this work. ![]()
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