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Infection and Immunity, July 2006, p. 3880-3889, Vol. 74, No. 7
0019-9567/06/$08.00+0 doi:10.1128/IAI.01891-05
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Type III Secretion-Dependent Modulation of Innate Immunity as One of Multiple Factors Regulated by Pseudomonas aeruginosa RetS
Irandokht Zolfaghar,1
David J. Evans,1,3
Reza Ronaghi,1 and
Suzanne M. J. Fleiszig1,2*
School of Optometry, University of California, Berkeley, California 94720,1
Graduate Groups in Microbiology, Infectious Disease & Immunity, and Vision Science, University of California, Berkeley, California 94720,2
College of Pharmacy, Touro UniversityCalifornia, Vallejo, California 945923
Received 18 November 2005/
Returned for modification 27 January 2006/
Accepted 4 April 2006

ABSTRACT
Mutation of
retS (
rtsM) of
Pseudomonas aeruginosa strain PA103
reduces its virulence in both ocular and respiratory murine
models of infection. In vitro,
retS mutants exhibit loss of
the ExsA-regulated type III secretion system (TTSS), reduced
twitching motility, and a decrease in association with, invasion
of, and survival within corneal epithelial cells. In addition,
transcription of multiple other virulence genes is positively
and negatively affected by
retS mutation. Since our published
data show that ExoU and ExoT, the two TTSS effectors encoded
by strain PA103, each confer virulence in this corneal model,
we hypothesized that loss of virulence of
retS mutants follows
loss of type III secretion. Corneal pathology, bacterial colonization,
and phagocyte infiltration were compared for wild-type PA103,
retS mutants, and various TTSS mutants after infection with

10
6 CFU bacteria. Results showed that either a
retS or an
exsA (TTSS) mutation delayed disease progression, as illustrated
by reduced severity scores and colonization levels during the
first 48 h postinfection. Surprisingly,
retS mutant infections
then became more severe than those involving
exsA mutants. By
day 7, colonization levels of
retS mutants even surpassed those
of wild-type bacteria (more than twofold,
P = 0.028). Although
retS mutants caused more severe opacification of central corneas
than both the wild type and the
exsA mutants, neither mutant
caused the peripheral ring opacity commonly associated with
wild-type infection, suggesting that the TTSS was involved.
Histological experiments with
retS and various TTSS mutants
showed that ring opacification required ExoU but not ExoT and
that it consisted of dense polymorphonuclear phagocyte infiltration
at the corneal periphery and the absence of any cell type in
the central cornea. These data suggest that these
P. aeruginosa TTSS effectors have different effects on innate immunity and
that RetS influences virulence beyond its effects on the TTSS.

INTRODUCTION
Recently, we reported that
retS, a gene encoding a novel
Pseudomonas aeruginosa hybrid sensor-response regulator protein, is involved
in corneal virulence in vivo during the first 24 h of the disease
(
42). In vitro analysis revealed that mutation of
retS in strain
PA103 caused loss of type III secretion and a reduction in multiple
epithelium-associated virulence mechanisms, including; twitching
motility, epithelial association, invasion, and intracellular
survival (
42). Two other recent publications by others show
that RetS (regulator of exopolysaccharide and type III secretion),
also designated RtsM (regulator of type III secretion), participates
in virulence during acute pneumonia (16 to 18 h postinoculation)
(
20,
27). These studies also showed loss of the ExsA-regulated
type III secretion system (TTSS) in
retS and
rtsM mutants in
vitro. This could be restored by overexpression of ExsA (
27).
One of these studies also showed that RetS positively and negatively
affects the expression of many genes in addition to regulation
of type III secretion (
20). For example,
retS mutation caused
downregulation of genes involved in type IV pilus expression
and type II secretion and upregulation of the
psl and
pel operon
genes that are involved in exopolysaccharide production and
biofilm formation (
20).
Type III secretion contributes to the pathogenesis of septic shock and the virulence of P. aeruginosa in the cornea (28, 29), burn wounds (24, 25), and the airways (1, 2, 11, 26, 30, 32, 33, 36, 39). Four known effector proteins are delivered into mammalian cells by this TTSS: ExoS, ExoT, ExoU, and ExoY. Each effector can significantly alter mammalian cell function in vitro. For example, ExoS and ExoT each have both ADP-ribosyltransferase (C-terminal) and RhoGAP (N-terminal) activities, ExoU is a potent phospholipase, and ExoY is an adenylate cyclase (3, 35). Although each effector has been shown to affect cellular health in vitro, e.g., ExoU is cytotoxic to epithelial cells and phagocytes (12, 21) and ExoT is antiphagocytic and inhibits epithelial wound healing (7, 17-19), the contributions of these in vitro biological activities to disease pathogenesis in vivo are not fully understood.
Of the known TTSS effectors of P. aeruginosa, strain PA103 expresses only ExoU and ExoT; it does not encode either ExoS or ExoY. Using strain PA103 in a murine model, we previously showed that ExoU and ExoT were each sufficient, when exposed alone, to promote corneal colonization and pathology (28). Double mutation of both exoU and exoT was required to reduce corneal disease severity, coinciding with a >1,000-fold decrease in bacterial tissue colonization. That finding shows requirement redundancy between ExoU and ExoT, yet these effectors have no known common activities. In animal models of acute pneumonia, double mutation of exoU and exoT attenuates lung injury (11). ExoU has been found to be critical for causing local disease pathology (2, 12, 36), with ExoT contributing to disease by enhancing the systemic spread of bacteria (17).
Since the TTSS is involved in corneal disease, it is likely that at least part of the attenuated virulence of retS mutants during the first 24 h of the disease process involves loss of type III secretion. However, other virulence mechanisms regulated by retS are also thought to contribute to P. aeruginosa infection and disease pathology. These include type II secretion and type IV pili, the latter contributing to P. aeruginosa virulence in vivo via their role in surface-associated twitching motility and likely through their contributions to epithelial association, invasion, and cytotoxicity (6, 14, 15, 37, 41, 43).
In this study, we explored the relationship between reduced virulence of retS mutants of P. aeruginosa and loss of the TTSS. We hypothesized that loss of the TTSS would account for the reduced virulence of P. aeruginosa retS mutants. To test this hypothesis, we compared retS mutant infections to disease caused by wild-type P. aeruginosa strain PA103 and that caused by an isogenic exsA (transcriptional activator of the TTSS), exoU, exoT, or exoU exoT mutant by using the 6-h healing model of corneal infection (29). Infected eyes were examined for disease severity and bacterial colonization and by histological methods during the first 7 days postinfection.

MATERIALS AND METHODS
Bacterial strains.
The
P. aeruginosa strains and mutants used in this study are
presented in Table
1. Bacterial inocula were prepared from overnight
cultures grown on Trypticase soy agar plates at 37°C before
suspension in minimal essential Eagle medium with Hanks' salts
and
L-glutamine (Sigma, St. Louis, MO) buffered with 1 M HEPES-NaOH
(pH 7.6) and 0.35 g of NaHCO
3 and 6 g of bovine serum albumin
(Sigma, St. Louis, MO) per liter (MEM). The bacteria were initially
prepared to a concentration of

1
x 10
9 CFU/ml of MEM as determined
by spectrophotometry (optical density at 650 nm of

1.0). Bacterial
numbers were confirmed by viable counts after serial dilution.
Corneal infection model.
The 6-h healing murine model of corneal infection was used since
we had previously used it to demonstrate the role of ExsA in
P. aeruginosa corneal penetration in vivo and the contribution
of RetS to early (<24 h) corneal virulence (
29,
42). Following
anesthesia, three full-thickness epithelial abrasions were produced
on the left corneas of 6-week old female C57BL/6 mice (Jackson
Laboratories, Bar Harbor, ME) with a sterile 26-guage needle.
After a 6-h healing period, the corneas were inoculated with
5 µl of a bacterial suspension (containing between

10
6 and

10
7 CFU of bacteria). Three mice were assigned to each sample
group for pilot experiments; five mice per group were used for
experiment repeats. Disease was assessed at 1, 2, 4, and 7 days
postinoculation by a masked investigator with a stereomicroscope,
and corneal pathology was photographed. The following grading
scheme was used (
5): grade 0, eye macroscopically identical
to the uninfected contralateral control eye; grade 1, faint
opacity partially covering the pupil; grade 2, dense opacity
covering the pupil; grade 3, dense opacity covering the entire
anterior segment; grade 4, perforation of cornea and/or phthisis
bulbi (shrinkage of the eyeball following inflammatory disease).
All procedures were conducted in accordance with the policies
established by the Association for Research in Vision and Ophthalmology
and were approved by the University of California, Berkeley,
Animal Care and Use Committee.
Bacterial colonization.
To assess bacterial ocular colonization, mice were euthanatized and infected eyes were then immediately enucleated and homogenized in tryptic soy broth (1 ml). Viable counts were then performed on the homogenates.
Histological examination of infected corneas.
Eyes were fixed in 4% paraformaldehyde and embedded in medium-grade LR white, and then 1-µm sections were cut with an ultramicrotome (Leica Ultracut R). These were stained with toluidine blue and observed with an Olympus IX-70 inverted microscope. Representative sections were photographed and analyzed with the Improvision computer analysis system, which was also used to quantify polymorphonuclear phagocyte (PMN) numbers and corneal thickness in the same sections of infected corneas.
Statistical analysis.
Bacterial colonization data were expressed as a median with lower and upper quartiles. Differences between these groups were compared for statistical significance by a nonparametric test, i.e., the Mann-Whitney test (two groups) or the Kruskal-Wallis test (three or more groups). Other data were expressed as a mean with a standard deviation, and differences between groups were compared for statistical significance by Student's t test and analysis of variance.

RESULTS
P. aeruginosa retS and exsA mutant infections showed delayed development compared to wild-type infections.
Corneal infections caused by wild-type PA103 were compared to
those caused by
retS and
exsA (type III secretion) mutants at
days 1, 2, 4, and 7 postinfection by using photographs of infected
corneas (Fig.
1A and B) and disease severity scores (Table
2).
Infections with either of the mutants were less severe than
wild-type infections at days 1, 2, and 4 (
P < 0.05, Mann-Whitney
test, comparison of
retS and
exsA mutants versus wild-type PA103
at each time point) but by day 7 were of similar overall severity
to those caused by wild-type bacteria (
P > 0.05, Mann-Whitney
test) (Fig.
1B; Table
2). Between days 2 and 7,
retS-induced
corneal disease pathology developed more rapidly than that induced
by the
exsA mutant, as evidenced by a significant increase in
disease severity scores at day 4 (
P < 0.05, Mann-Whitney
test) (Fig.
1B; Table
2). Although the
retS mutant did not differ
from the wild type in overall disease severity scores (Table
2), it was evident that
retS mutants caused more severe opacification
of the central cornea than the wild type at day 7 (Fig.
1B).
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TABLE 2. Ocular disease severity scores of mouse corneas over 7 days postinoculation with P. aeruginosa strain PA103 or the retS or exsA mutant in the 6-h healing model of corneal infection (29)
|
P. aeruginosa retS and exsA mutants showed reduced ocular colonization compared to the wild type at 48 h but not at 7 days.
Bacterial viable counts were used to compare colonization of
infected eyes at 4 h, 48 h, and 7 days postinoculation with
wild-type bacteria and each of the mutants (Tables
3,
4, and
5). No significant differences were found in early (4 h) colonization
between eyes infected with PA103 or the
retS or
exsA mutant
(Table
3). By 2 days postinfection, however, both the
retS and
exsA mutants showed significantly reduced ocular colonization
compared to the wild type (

27-fold reduction for the
retS mutant;

100-fold reduction for the
exsA mutant) (Table
4). The 3.7-fold
colonization advantage shown by the
retS mutant over the
exsA mutant at 48 h was statistically significant (
P < 0.05, Mann-Whitney
test) (Table
4). This colonization advantage continued later
in the disease; indeed, at 7 days, the
retS mutant showed greater
ocular colonization (more than twofold) than either
exsA mutant
or wild-type bacteria (
P < 0.05, Mann-Whitney test in each
case) (Table
5). Ocular colonization by PA103 and that by the
exsA mutant did not differ at 7 days (
P = 0.754, Mann-Whitney
test).
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TABLE 3. Ocular colonization by P. aeruginosa strain PA103 and the retS and exsA mutants at 4 h postinoculation in the 6-h healing murine model of corneal infection
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TABLE 4. Ocular colonization by P. aeruginosa strain PA103 and the retS and exsA mutants at 48 h postinoculation in the 6-h healing murine model of corneal infection
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TABLE 5. Ocular colonization by P. aeruginosa strain PA103 and the retS and exsA mutants at 7 days postinoculation in the 6-h healing murine model of corneal infection
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P. aeruginosa retS and exsA mutants differ from the wild type in PMN infiltrative responses.
Wild-type
P. aeruginosa caused peripheral ring infiltration
(solid arrows) at all time points (Fig.
1A and B). In contrast,
retS and
exsA mutant infections were each associated with dense
infiltrates of the central cornea (dashed arrows, Fig.
1A and B).
Histological examination of wild-type-infected eyes at 48 h
postinoculation indicated an absence of PMN infiltration of
the central cornea with dense clusters of PMNs localized at
the corneal periphery (Fig.
2A, top). In contrast, in eyes infected
with the
retS or
exsA mutant (Fig.
2A, middle and bottom, respectively),
PMNs infiltrated both the central and peripheral regions of
the cornea. PMN distribution gradients observed histologically
correlated with peripheral ring and dense central infiltration
pathology observed macroscopically for wild-type versus mutant
bacterial infections, respectively (Fig.
2B). These results
showed that ring infiltration involved repression of PMN infiltration
of the central cornea and was a property of the TTSS. Subsequently,
the role of the TTSS effectors expressed by PA103 (ExoU and
ExoT) in this effect was explored.
ExoU is required for repression of PMN infiltration of the central cornea.
Corneal infections involving wild-type
P. aeruginosa (PA103)
or the
retS mutant were compared with those caused by the
exoU,
exoT, and
exoU exoT mutants at 48 h to determine the relative
contributions of ExoU and ExoT to repression of PMN infiltration
and the relationship to bacterial colonization. Double mutation
of
exoU and
exoT caused loss of ring infiltration, similar to
retS and
exsA mutants, showing that one or both of these effectors
was required (Fig.
3, dashed arrows). Experiments with mutants
with only one mutated effector showed that ExoU was required
for ring infiltration since the
exoT mutant (still expresses
ExoU) caused ring infiltrates (Fig.
3, solid arrows) while the
exoU mutant did not. Histological analysis (Fig.
4) confirmed
these macroscopic observations by showing localization of PMNs
in the corneal periphery for the
exoT mutant (Fig.
4C, left)
similar to the wild type (Fig.
4A, left) with the central corneas
devoid of PMNs but loaded with bacteria (Fig.
4A and C, right).
In contrast, central and peripheral corneas each contained large
numbers of PMNs when infected with the
exoU mutant (Fig.
4B),
similar to those infected with the
exoU exoT double mutant (Fig.
4D).
PMN distribution within infected murine corneas at 48 h postinoculation
with wild-type
P. aeruginosa (strain PA103) or the
exoU,
exoT,
or
exoU exoT mutant was quantified (Fig.
5). Results confirmed
the histological observations. There were PMN concentration
gradients among the peripheral, precentral, and central regions
of the infected corneas. Significantly more PMNs per square
micrometer of tissue were counted in the peripheral versus the
precentral and central regions of corneas infected with wild-type
P. aeruginosa or the
exoT mutant. The inverse relationship existed
in corneas infected with the
exoU mutant and the
exoU exoT double
mutant. Differences in PMN distribution correlated with differences
in corneal thickness, a measure of the overall inflammatory
response, for wild-type bacteria and the
exoU exoT double mutant
but not for the
exoU or
exoT mutant (Fig.
6).
The colonization results of these experiments (Table
6) confirmed
our previously published data (
28). There were significant reductions
in ocular colonization at 48 h for the
exoU exoT double mutant
(
28) compared to both wild-type bacteria and
retS mutant bacteria
(
P < 0.05, Mann-Whitney test) (Table
6). Mutation of either
exoU or
exoT did not cause a loss of tissue colonization (Table
6), despite PMN migration into the central cornea when the eye
was colonized by the
exoU mutant (still expresses ExoT).
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TABLE 6. Tissue colonization by wild-type PA103 and retS, exoU, exoT, and exoU exoT mutants in the 6-h healing murine model of corneal infection at 48 h postinoculation
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DISCUSSION
The results of this study showed that the attenuation of
P. aeruginosa virulence by the
retS mutation is temporary, only
lasting for the first few days of the disease. By day 7 postinfection,
colonization rates by the
retS mutant exceeded those of wild-type
bacteria. Similarities between
retS and TTSS mutants included
lack of peripheral ring opacity, which in wild-type-infected
eyes was found to consist of dense peripheral PMN infiltrates
with a corresponding absence of cells at the central cornea.
Peripheral ring opacity was shown to require ExoU, one of two
type III secreted effectors encoded by
P. aeruginosa strain
PA103. Comparison of TTSS and
retS mutants later in the disease
process (48 h through 7 days) revealed significant increases
in both colonization rates and disease severity scores in favor
of the
retS mutants showing that
retS mutation influences virulence
through mechanisms additional to loss of the TTSS.
We, and others, have previously reported attenuation of virulence during the first 24 h postinfection with retS mutant P. aeruginosa (20, 27, 42). In the present study, we found attenuation of virulence for the retS mutant at 48 h and 4 days. Since TTSS mutants were also attenuated at these time points, it is likely that the defect in TTSS contributes to virulence loss for the retS mutant. However, virulence loss could also involve downregulation of genes involved in type IV pilus expression, type II secretion, and/or a reduced ability to associate with, invade, and survive within epithelial cells (20, 41-43).
RetS has been shown to negatively regulate the expression of various genes. Therefore, it is interesting that the retS mutant caused more severe disease (central corneal opacification) and colonized more efficiently than both TTSS mutant and wild-type bacteria at later time points. Genomic transcriptional profiling suggested that retS mutation switched the P. aeruginosa phenotype from one suited to acute infection to one more suited to chronic colonization and disease (20). For example, both psl and pel operons encoding exopolysaccharide expression and promoting biofilm formation are upregulated in the retS mutant (20). This could compensate for loss of TTSS by directly contributing to increased bacterial colonization and corneal disease pathology or indirectly if it were to inhibit bacterial clearance by professional phagocytes (31).
Neither the retS mutant nor the exsA mutant caused peripheral ring opacity during disease, which required the TTSS effector ExoU and involved repression of PMN infiltration of the central cornea. The ability of ExoU to affect innate immune responses in this fashion is likely to relate to the mechanism by which it promotes colonization in vivo (2, 28). PMN infiltration of the cornea in response to bacterial infection represents a key part of the ocular innate immune response to bacterial infection (22). During infection, these cells migrate into the cornea and anterior chamber from the limbus (junction of the peripheral cornea and conjunctiva), from the tear film, and/or from other vascularized ocular tissues, e.g., the uveal tract. Chemotactic cytokines, e.g., interleukin-1 and macrophage inflammatory protein 2 (murine equivalent of interleukin-8) play an important role in PMN recruitment (22, 34, 40). PMN infiltration assists in clearing bacteria but also contributes greatly to corneal pathology during infection (5, 22, 23, 34).
The mechanism by which ExoU inhibits phagocyte infiltration might involve direct killing of these infiltrating cells (21). Alternatively, it might follow ExoU-mediated killing of other cell types that normally reside in the central cornea and that would otherwise produce the chemotactic cytokines that recruit phagocytes into infected corneas (22, 34, 40). Indeed, corneas with ring opacities were found to be completely devoid of all types of resident corneal cells in the central region.
It was interesting that ExoT did not also suppress PMN infiltration, since our previous studies have shown ExoT to be almost as effective as ExoU in promoting bacterial colonization. It is most possible that ExoT promotes bacterial survival, despite infiltration of numerous PMNs, by inhibiting phagocytosis through its N-terminal RhoGAP activity (17), as has been shown in vitro. Alternatively, ExoT promotion of colonization could involve antiphagocytic effects on epithelial cells (7), since sloughing of surface corneal epithelial cells containing bacteria that have invaded is thought to represent a defense against infection (15). Inhibition of epithelial wound healing by ExoT (19) could also contribute to P. aeruginosa persistence in the cornea by enhancing bacterial tissue binding (13) or by promoting epithelial penetration to the underlying stroma, which we have shown to involve an ExsA-regulated factor(s) (29).
TTSS effectors of some other pathogens, including Pseudomonas syringae and Yersinia and Salmonella spp., have been found to suppress cellular innate immune responses by interfering with pathogen recognition receptors, e.g., Toll-like receptors, and their associated signal transduction pathways, that upregulate chemokines, antimicrobial peptides, and other components of innate immunity in response to pathogen-associated molecular patterns (4, 10). It is not known whether any of the TTSS effectors of P. aeruginosa exert this type of activity. Interestingly, in rodent models of acute pneumonia, the P. aeruginosa TTSS can contribute to elevated proinflammatory cytokine levels in bronchoalveolar lavage fluid via TLR4 signaling and coinciding with reduced PMN numbers and increased bacterial colonization (1, 11). However, the relationship, if any, between increased TTSS-mediated cytokine expression and reduced PMN numbers in the airways has not yet been elucidated.
Modulation of innate immunity by ExoU of P. aeruginosa may not be specific to the cornea. During lung infection, an exoU exoT double mutant of PA103 has been reported to cause increased PMN numbers in bronchoalveolar lavage fluid of mice compared to the wild-type bacterium (1). Whether or not ExoU is involved has yet to be determined. However, a different study with a rat lung infection model reported that another P. aeruginosa strain that does not encode ExoU (but does encode ExoS and ExoT) also demonstrates TTSS-dependent modification of PMN infiltration (1). Thus, TTSS-encoded proteins other than ExoU likely contribute to reduced PMN numbers in the airways, perhaps via cytotoxicity against these and other phagocytes, as reported in vitro (8, 9, 21).
In conclusion, the data presented in this report suggest that RetS (RtsM) contributions to P. aeruginosa virulence in the cornea include regulation of ExsA-mediated repression of phagocyte infiltration via ExoU and most likely other contributions by the TTSS. However, they also show that other factors regulated by RetS (RtsM) actually dampen pathological effects at later stages of the disease process irrespective of competence for type III secretion. This was evidenced by enhanced colonization and virulence of a type III secretion-disabled retS mutant compared to both exsA mutants and type III secretion-competent wild-type bacteria during later (4 to 7 days postinfection) stages of disease. Whether this involves factors negatively regulated by retS or even more complicated cross talk between the host and pathogen has yet to be determined.

ACKNOWLEDGMENTS
This work was supported by National Institutes of Health research
grant EY11221 (S.M.J.F.) and by a research fellowship grant
from Alcon Laboratories, Fort Worth, TX (I.Z.).
We thank Dara Frank, Medical College of Wisconsin, for generously providing the P. aeruginosa TTSS mutants used in this study.

FOOTNOTES
* Corresponding author. Mailing address: School of Optometry, University of California, Berkeley, CA 94720-2020. Phone: (510) 643-0990. Fax: (510) 643-5109. E-mail:
fleiszig{at}berkeley.edu.

Editor: V. J. DiRita

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Infection and Immunity, July 2006, p. 3880-3889, Vol. 74, No. 7
0019-9567/06/$08.00+0 doi:10.1128/IAI.01891-05
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
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