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Virulence Genes and Prevention of Haemophilus Influenzae Infections

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Virulence Genes and Prevention of Haemophilus Influenzae Infections Arch Dis Child: first published as 10.1136/adc.60.12.1193 on 1 December 1985. Downloaded from Archives of Disease in Childhood, 1985, 60, 1193-1196 Current topic Virulence genes and prevention of Haemophilus influenzae infections E R MOXON Infectious Disease Unit, Department of Paediatrics, John Radcliffe Hospital, Oxford The bacterium Haemophilus influenzae causes a infections) are encapsulated.3 H influenzae may wide spectrum of important childhood diseases that make any one of six chemically and antigenically includes meningitis, epiglottitis, cellulitis, acute distinct polysaccharide capsules (designated a-f), pneumonitis, septic arthritis, and otitis media. but strains expressing type b antigen account for Meningitis, the commonest of the systemic infec- most serious infections. The second important tions, in addition to being life threatening, is of observation was that serum factors (later identified particular importance to paediatricians because the as antibodies) with specific activity against the type damage it causes to the developing brain is often b antigen are critical in host defence against systemic permanent. H influenzae is a major cause of H influenzae infections.4 Given these facts, it is pyogenic meningitis in childhood throughout the reasonable to ask what is so important about the how does it differ world, and occurs in about one child in every type b capsule of H influenzae, copyright. thousand, usually within three years of birth. from the five other polysaccharide capsules, and to Although the availability of antibiotics has de- what extent other surface antigens, such as outer creased mortality dramatically (from greater than membrane proteins and lipopolysaccharide, modu- 90% to less than 10%), the occurrence of central late H influenzae virulence or serve as targets for the nervous system damage among survivors has not lethal effects of host immune responses. Answers to declined substantially during the past three decades. these questions should provide rational approaches Deafness, convulsions, mental retardation, hemiple- to the prevention of H influenzae infections. gia, impaired language skills, and other neurological The analysis of microbial virulence has depended deficits are among the common sequelae,l and the traditionally on identifying characteristics of mi- http://adc.bmj.com/ emergence of antibiotic resistant strains of H in- crobes that correlate with their potential for fluenzae threatens to compromise even further the pathogenicity (a familiar example is the use of the limited efficacy of current treatments. coagulase test to identify virulent strains of staphylo- A different example of H influenzae pathogenicity cocci). This sort of empirical correlation, despite its is its role in causing about 20% of cases of otitis practical use, does not necessarily enhance under- media in childhood. Although this is less dramatic standing of the mechanisms of microbial injury or of than meningitis, it is extremely common and is an host immunity. This is because these phenotypic important cause of hearing impairment leading to markers may correlate with virulence potential on September 27, 2021 by guest. Protected school failure. A more controversial problem is the without necessarily being instrumental in the role of H influenzae as a lower respiratory tract pathogenic process. To determine whether or not pathogen; there is now a growing body of evidence this is so, one must compare the virulence of that it is one of the commonest causes of severe isogenic variants, that is strains which are identical pneumonia in infants in underdeveloped countries.2 except that they are either sufficient or deficient in There can be no doubt that the successful preven- the gene or genes required for the expression of a tion of H influenzae infections would represent a particular virulence determinant. This can now be major step forward. To this end, substantial gains achieved through the application of recently de- are now in evidence. veloped techniques of genetic manipulation of bac- Recent progress builds upon two pivotal observa- teria. Indeed, the application of recombinant DNA tions made more than 50 years ago. The first, technology to the study of microbes is revolutionis- contributed by Margaret Pittman, was the recog- ing the study of the epidemiology, diagnosis, treat- nition that the strains of H influenzae that cause ment, and prevention of infectious diseases. As a meningitis (as well as most other bacteraemic result, basic mechanisms of microbial virulence are 1193 Arch Dis Child: first published as 10.1136/adc.60.12.1193 on 1 December 1985. Downloaded from 1194 Moxon now immensely more accessible, and over the next other paediatric journals which require a grasp of several years infectious diseases research should recombinant DNA techniques will not daunt those prove as exciting a field as at any time since the role with a little determination and patience, even of microbes as causes of disease was discovered just though it may seem that some authors are deter- over a century ago. mined to obscure their essential messages in the As in other areas of medicine, the application of sophistry of this new and exciting field! this new technology has moved quickly from the A general strategy used in tackling the challenge basic science laboratory into the clinical setting, and of H influenzae is illustrated in the Figure. This paediatricians are therefore being encouraged (even bacterium possesses a single, circular chromosome urged!) to ensure that they possess a modicum of consisting of almost two million paired nucleotides. 'literacy' in molecular genetics. Only a modest If we consider the type b capsule, its expression investment of time is required to capture the basic must depend on genes that control the biosynthesis, principles and a number of admirable, succinct transport, polymerisation, and surface assembly of essays have been published in general medical the polysaccharide. To identify these genes, chro- journals which provide the practising physician with mosomal DNA from a representative strain is cut as simple and rewarding a task as possible. Thus into hundreds of pieces using restriction enzymes primed, the occasional articles published in this and (Figure (a)). These constituent pieces of DNA are (i) Isolation of virulence (Vi+) gene Constructionof isogenc virulent (Vi')and aviruert (Vi-) H influenzae by DNAtmsformation Charon 4 H. DDNA v- -l. Vi+ ~~~influenzaeDNA yr' competence regimen Idigest EcoR I EcoR digest EcoR I log phase competent copyright. iH influenzae (Vi- H influenzae _ vi+ "iJ LRRIR+ RII Vi+ cohesive end ligation ation of Vi+ uptake of cloned DNA :ombination containing Vi+ _ )duce transformant http://adc.bmj.com/ I ir vitro phage packaging Figure General schemefor studying pathogenicity of * amplification in Haemophilus influenzae. (a) Fragments ofchromosomal I Escherichia coli DNA are cloned into a suitable vector to isolate virulence .i, genes. (b) These genes can be introduced by DNA on September 27, 2021 by guest. Protected transformation into H influenzae strains which lack the specific virulence determinant. (c) Transformed and untransformed H influenzae are then compared in a suitable animal model, eg infant rats, to allow an unambiguous © Virulence assay in experimental model infection analysis ofthe role ofspecific genes in pathogenicity. Asymptomatic colonisation Intranasal inoculation -01. t-X Systitemic infection Arch Dis Child: first published as 10.1136/adc.60.12.1193 on 1 December 1985. Downloaded from Virulence genes and prevention of Haemophilus influenzae infections 1195 then introduced into a vector, for example the an enormous body of circumstantial evidence modified bacteriophage Charon 4, using appropriate already existed implicating the type b capsule as a (commercially available) ligation and packaging major factor in preventing the efficient ingestion of steps. Since the recombinants contain random in- H influenzae by phagocytic cells. Experiments along serts of H influenzae DNA, the result is a library of similar lines are now establishing the role of other fragments cloned into the vector. If sufficient virulence genes, such as those needed for the recombinants are generated, then the entire genome expression of other proteins and lipopolysaccharides will be represented. The recombinants, each con- that make up the bacterial cell envelope. Also, taining passenger DNA, are allowed to infect their strains of H influenzae with and without an enzyme natural host, the bacterium Escherichia coli, thus known to cleave human immunoglobulin have been allowing the numbers of each of the representative constructed.6 Thus, a relatively comprehensive recombinants to be replicated many fold. The next analysis of the unique contribution of different step is to identify the relevant recombinants with virulence determinants is now feasible. inserts of haemophilus DNA required for the An exciting bonus of this approach is the use of expression of a particular virulence determinant. the cloned virulence genes as probes to analyse Several approaches could be useful here. One clinical isolates from all over the world using the obvious ploy is the use of antibody to identify clones simple but enormously powerful technique of South- expressing a particular protein; another strategy is ern hybridisation. Readers of this journal have been to search the library for cloned DNA capable of recently introduced to the excitement that has been restoring virulence
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