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Infection and Immunity, March 2007, p. 1214-1222, Vol. 75, No. 3
0019-9567/07/$08.00+0 doi:10.1128/IAI.01459-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Center for Clinical Pharmacy and Clinical Sciences, School of Pharmaceutical Sciences,1 Kitasato Institute for Life Sciences & Graduate School of Infection Control Sciences, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan,2 Center for Basic Research,3 Department of Internal Medicine, Kitasato Institute Hospital, The Kitasato Institute, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8642, Japan,4 Third Department of Internal Medicine, Kyorin University, Mitaka, Tokyo 181-8611, Japan,5 Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan6
Received 12 September 2006/ Returned for modification 13 October 2006/ Accepted 14 December 2006
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In animal models, MALT lymphomas have been reported following infection with Helicobacter mustelae in ferrets (7), following infection with Helicobacter felis in normal BALB/c mice (6), following infection with H. pylori in neonatally thymectomized BALB/c mice (9), and following infection with "Candidatus Helicobacter heilmannii" in normal BALB/c mice (19, 21). In this study, we used the "Candidatus Helicobacter heilmannii" previously obtained from a cynomolgus monkey to infect C57BL/6 mice for up to 24 months. We observed the development of low-grade MALT lymphomas in the fundic regions of the stomachs of mice infected with this pathogen. The characteristics of the pathological changes were determined by immunohistochemical, electron microscopic, and in situ hybridization methods.
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DNA extraction. The entire bacterial and host cell DNA mixture was extracted from the gastric homogenates with phosphate-buffered saline containing 0.001% (wt/vol) gelatin (pH 7.4) by using an UltraClean microbial DNA isolation kit (MO Bio, Solana Beach, CA) according to the manufacturer's instructions. The DNA was stored at 20°C until it was required.
PCR amplification and sequencing. PCR was used to amplify the 16S rRNA and urease genes from gastric samples. The reaction mixtures each contained universal eubacterial primers TM16S-27F and TM16S-1492R (12) for the 16S rRNA gene and either primers U430F and U1735R or primers U430F and U2235R (20) for the urease genes. The cycling conditions for the 16S rRNA gene were initial denaturation at 94°C for 1 min and then 35 cycles of 94°C for 45 s, 55°C for 30 s, and 72°C for 2 min, followed by an extension step of 72°C for 5 min. The cycling conditions for the urease genes were initial denaturation at 94°C for 3 min and then 35 cycles of 94°C for 10 s, 52°C for 30 s, and 72°C for 1.5 min, followed by a final extension step of 72°C for 5 min. Alternatively, for the urease gene, the conditions were the same as those described above but with the following modifications: annealing at 42°C for 30 s and extension at 72°C for 2 min. Both strands were sequenced using a BigDye Terminator v3.1 cycle sequencing kit (Applied Biosystems, Foster City, CA) with an ABI PRISM 3100-Avant genetic analyzer (Applied Biosystems). Sequences were analyzed by using the NCBI BLAST programs (1).
Quantitative real-time PCR. Real-time PCR was performed using a Bio-Rad iCycler iQ detection system (Bio-Rad Laboratories, Hercules, CA) with the SYBR green fluorophore. Reactions were performed in 20-µl (total volume) mixtures which included 10 µl of 2x SYBR green PCR master mix (Bio-Rad Laboratories), 5 µl of each primer at a concentration of 5 µM, and 1 µl of the template DNA. A 112-bp fragment of the 16S rRNA gene was amplified with primers HeilF (5' AAG TCG AAC GAT GAA GCC TA 3') and HeilR (5' ATT TGG TAT TAA TCA CCA TTT C 3') (3). Data analyses were performed with an iCycler iQ real-time detection system (Bio-Rad Laboratories). The following protocol was used: 50 cycles consisting of 95°C for 15 s, 55°C for 15 s, and 72°C for 30 s. A melting curve analysis was performed following every run to ensure that there was a single amplified product for every reaction. At the extension time, the PCR fluorophore was acquired. All reactions were carried out at least three times for each sample. The same reference standard dilution series was used on every experimental plate, and semiquantification of 16S rRNA gene normalization was based on the averaged results. We used the PCR products amplified with primers TM16S-27F and TM16S-1492R as the standards. The copy number of the 16S rRNA gene of "Candidatus Helicobacter heilmannii" has not been identified yet, but it has been reported that H. pylori has two separate sets of rRNA genes on its chromosome (28). Based on this information, we calculated the number of 16S rRNA genes in "Candidatus Helicobacter heilmannii," which is thought to have two sets of 16S rRNA genes on its chromosome (13). Duplicate negative controls (no template DNA) were also included on every experimental plate in order to assess specificity and to detect potential contamination.
Macroscopic, immunohistochemical, and electron microscopic observations. The percentage of surface area for the protrusive lesions in the entire fundic mucosa was estimated by obtaining macroscopic images with a stereomicroscope (Keyence VHX-500; Keyence, Osaka, Japan) and by measuring the lesions and fundic mucosa in three mice in each group using the NIH Image public domain image processing and analysis program for Macintosh.
After the macroscopic observations had been carried out, some of the tissues were fixed with Zamboni's fixative (26), and immunohistochemical studies were performed using monoclonal antibodies against CD3 (R&D Systems, Minneapolis, MN), CD45R (clone RA3-6B2; Chemicon International, Temecula, CA), and Bcl-2 (R&D Systems) and VEGF-A (Santa Cruz Biotechnology, Inc., Santa Cruz, CA).
Polyclonal anti-H. pylori antisera were prepared by immunization of two male New Zealand White rabbits with a formalin-killed bacterial lysate of H. pylori Sydney strain SS-1. Subsequently, polyclonal anti-H. pylori antibody was used in order to observe the localization of "Candidatus Helicobacter heilmannii" using cross-reactivity. After treatment with Zamboni's fixative (25), 10-µm cryostat sections were obtained, and indirect immunohistochemical procedures using a diaminobenzidine reaction were carried out; the sections were then postfixed with a 1% osmium tetroxide solution and embedded in Epon. Ultrathin sections were then cut, counterstained with uranyl acetate, and observed with a JEOL 1200 EX-II electron microscope at an accelerating voltage of 80 kV.
Some of the tissues were embedded in paraffin, and 4-µm sections were cut; in situ hybridization using a microprobe method (30) was then carried out with previously described specific primers (Hhe1, Hhe2, Hhe3, Hhe4, and Hhe5) (29). Sense probes were used in the control experiment.
Statistics. All data were expressed as means ± standard deviations. Comparisons between groups were made by using a two-tailed Student's t test. P values of <0.05 were considered significant.
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Macroscopic observation. Macroscopic observation of the stomach revealed several small, round, protrusive lesions located primarily in the fundic area in one-half of the infected mice at 3 months after infection; moreover, the number of lesions increased gradually in almost all of the infected mice that were infected for more than 6 months (Fig. 1). Quantitative analysis of the protrusive lesion area revealed significant increases in lesion density at 3 months after infection, and significant, gradual increases were observed thereafter (Fig. 2). In the control mouse, no protrusive lesions were observed.
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FIG. 1. Macroscopic observation of control and "Candidatus Helicobacter heilmannii"-infected mouse gastric mucosal surfaces. (a) Uninfected surface. (b) Three months after infection, several round protrusive lesions were observed in the fundic area. (c) Six months after infection, the number of protrusive lesions increased. (d) Twelve months after infection, almost all fundic mucosa samples contained round, protrusive lesions. (e) Eighteen months after infection, the lesions united to form larger lesions.
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FIG. 2. Time course of occupancy of the protrusive lesions in the entire fundic mucosa. The surface area occupied by round, protrusive lesions gradually increased. *, P < 0.05 for a comparison with the control group; #, P < 0.05 for a comparison with the 3-month group; &, P < 0.05 for a comparison with the 12-month group; @, P < 0.05 for a comparison with the 18-month group.
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FIG. 3. Time course showing the copy numbers of "Candidatus Helicobacter heilmannii," as determined by real-time PCR. At 3, 6, 12, and 18 months after infection, the number of "Candidatus Helicobacter heilmannii" obtained from the gastric homogenate was about 105 CFU per stomach, and this number decreased until it reached approximately 5 x 103 CFU at 24 months after infection. The asterisk indicates that the P value is <0.01 for a comparison with the data for 18 months.
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FIG. 4. Light microscopic observation of hematoxylin- and eosin-stained, "Candidatus Helicobacter heilmannii"-infected fundic mucosa. (a) Lymphocytic accumulation is recognized in the lamina propria mucosa (arrow) just above the muscularis mucosa 3 months after infection. Magnification, x60. (b) Lymphoid follicle in the gastric body mucosa, with some accumulation of lymphocytes in the adjacent submucosal layer of mice infected for 6 months. Magnification, x400. (c) Mouse infected for 12 months with a low-grade MALT lymphoma involving the submucosal layer. Multiple follicles are spanned by profuse bridging aggregates of the hypochromic marginal zone. Magnification, x80. (d) At higher magnification, clear cell variety is predominant, with larger CCL cells with predominant nucleoli. Magnification, x1,000.
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FIG. 5. Light and electron microscopic observations of lymphoid follicles and lymphoepithelial lesions. (a) Lymphoid follicle (L) observed in the fundic mucosa of a mouse infected for 6 months. Toluidine blue-stained 1-µm Epon section. Magnification, x100. (b) Lymphoepithelial lesion in the stomach of a mouse infected for 6 months. Toluidine blue-stained 1-µm Epon section. Magnification, x600. (c) Invasion of a lymphocyte between fundic glandular cells in a mouse infected for 6 months. Magnification, x3,000. (d) Accumulation of centrocyte-like cells in a lymphoid follicle. Magnification, x2,000.
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FIG. 6. Localization of "Candidatus Helicobacter heilmannii" by in situ hybridization, immunohistochemistry, and electron microscopic cytochemistry. (a and b) Many reactive bacilli were recognized by in situ hybridization at the luminal side of the body of the fundic gland (a). No reaction was detected with a sense probe (b). Magnification, x800. (c and d) Indirect fluorescent immunohistochemistry using anti-H. pylori polyclonal antibody revealed immunoreactive bacilli at the luminal side of the body of the fundic gland (c), and Alexa-phalloidin fluorescence (d) revealed that the localization of bacilli coincided approximately with the localization of f-actin-rich parietal cells. Magnification, x800. (e, f, and g) Electron microscopy revealed the presence of extremely tortuous bacilli (arrows) in the fundic glandular lumen near the parietal cells (e and f) and in the intracellular canaliculi (e and g). (e) Magnification, x1,500; (f and g) Magnification, x6,000. (h and i) Some bacilli (white arrow) were detected in the lamina propria mucosae. An adjacent parietal cell (P) was destroyed. (h) Magnification, x2,000; (i) Magnification, x6,000. Just adjacent to the disrupted nucleus of the cell (arrowheads), a substance (arrow) having the same electron density as the bacilli was recognized.
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FIG. 7. Immunohistochemistry and in situ hybridization of MALT lymphomas. (a and b) In situ hybridization revealed a positive reaction in a lymphoid follicle that reacted with primer Hhe1. (a) Magnification, x400; (b) Magnification, x1,000. (c) Positive B220 immunoreactivity was recognized in the lymphoid tissue (L). Magnification, x400. (d) Only a few CD3-immunoreactive cells were detected in the lymphoid follicle (L). Magnification, x400. (e) Some of the lymphocytes in and near the lymphoid follicle (L) were immunoreactive with Bcl-2. Magnification, x400. (f) Most of the lymphocytes in the lymphoid follicle (L) were immunoreactive with VEGF-A. Magnification, x400.
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H. pylori infection has been thought to be a prerequisite for the formation of MALT lymphomas, and chronic inflammation is probably a factor leading to malignant transformation via chronic stimulation of the lymphoid tissue (5, 11, 26, 27). However, the diagnosis of H. pylori infection in these previous reports was dependent on pathological data showing the presence of bacteria that were longer and more spiral than H. pylori obtained by hematoxylin and eosin or Warthin-Starry silver staining and immunostaining with polyclonal antibodies against H. pylori. Now that the 16S rRNA gene sequence of "Candidatus Helicobacter heilmannii" is available, as it has been since 2003, the previous conclusions should be reevaluated by performing PCR analyses.
The difference between the length of the period before MALT lymphoma occurrence in the study of O'Rourke et al. (19) and the length of the period in our study may have been due to differences between the experimental animals and the bacteria used. When the animal species used in the studies are considered, the differences may have resulted from the Th1/2 status of the Th1-predominant C57BL/6 mice and the Th2-predominant BALB/c mice. In this context, the report of Fukui and colleagues (9) is of interest, because these workers demonstrated the formation of MALT lymphomas induced by H. pylori in neonatally thymectomized BALB/c mice, which suggested that Th1 predominance was important in the formation of MALT lymphomas; however, in that study, Fukui et al. did not provide an explanation for why MALT lymphomas did not form in normal C57BL/6 mice, which are neonatally Th1 predominant.
Another common feature of "Candidatus Helicobacter heilmannii"-infected C57BL/6 mice and thymectomized BALB/c mice is the hypoacidity induced by parietal cell damage. In neonatally thymectomized BALB/c mice, autoimmune gastritis has been found (18). Administration of H. pylori to these mice decreased parietal cell damage, but antiparietal cell antibodies were still detectable. In the present study, direct invasion of parietal cell intracellular canaliculi and the cytoplasm by "Candidatus Helicobacter heilmannii" was observed. Several previous reports demonstrated this characteristic of "Candidatus Helicobacter heilmannii" infection in rhesus monkeys and C3H mice, although identification of the bacteria was based on morphology (4), which could have a tremendous effect on parietal cell function; it is well known that parietal cells change their cytoskeletal structure according to acid secretion status (8). When differences between bacillus species are considered, more prompt and effective formation of MALT lymphomas by "Candidatus Helicobacter heilmannii" is expected. O'Rourke and colleagues used "Candidatus Helicobacter heilmannii"-like isolates whose DNA sequences have yet to be identified (20), whereas we used genetically well-defined "Candidatus Helicobacter heilmannii," which was classified as having cluster 1 16S rRNA and cluster A urease genes, although it should be noted that in the present study, the bacilli were obtained from a cynomolgus monkey stomach.
We previously observed a sustained increase in myofibroblasts (i.e., activated fibroblasts) in "Candidatus Helicobacter heilmannii"-infected C3H mice (16); this finding is in good agreement with the bacterial copy number observed in the present study. The continuous influence of "Candidatus Helicobacter heilmannii" on the gastric mucosa may also be related to the formation of MALT lymphomas.
With regard to the mechanism of formation of gastric MALT lymphomas, soluble FAS antigen and apoptosis have been reported to be associated with the malignancy grade of MALT lymphomas. Thus, the relationship between parietal cell damage and apoptosis still needs to be clarified. In situ hybridization revealed the presence of some bacilli in the lymphoma tissues, which was suggestive of a direct influence of this bacterium or its DNA on the formation of lymphomas. Relevant to this point, Serna et al. (22) reported the presence of Helicobacter-like organisms within the lymphoid follicles in cats, suggesting that the bacteria could serve as a stimulus for the development of lymph follicles.
The immunological cross-reactivity of H. pylori with "Candidatus Helicobacter heilmannii" (11) and "Candidatus Helicobacter suis" is well known and has been considered one of the criteria for identification of these helicobacters (20). The present study also clearly revealed the cross-reactivity of "Candidatus Helicobacter heilmannii" with the anti-H. pylori antibody.
This study was supported by the Research Fund of Mitsukoshi Health and Welfare Foundation 2005 and in part by a grant from the 21st Century COE Program, Ministry of Education, Culture, Sports, Science, and Technology (MEXT).
Published ahead of print on 28 December 2006. ![]()
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