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VU Research Portal Molecular insight into the pathogenetic synergy between E. coli and B. fragilis in secondary peritonitis Sijbrandi, R. 2006 document version Publisher's PDF, also known as Version of record Link to publication in VU Research Portal citation for published version (APA) Sijbrandi, R. (2006). Molecular insight into the pathogenetic synergy between E. coli and B. fragilis in secondary peritonitis. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. E-mail address: [email protected] Download date: 09. Oct. 2021 MOLECULAR INSIGHT INTO THE PATHOGENIC SYNERGY BETWEEN E. COLI AND B. FRAGILIS IN SECONDARY PERITONITIS This thesis has been reviewed by: dr. W. Bitter, VU medisch centrum, Amsterdam dr. K. Bosscha, Jeroen Bosch Ziekenhuis, 's Hertogenbosch dr. E.N.G. Houben, University of Basel, Basel, Switzerland dr. L. Rutten, Universiteit Utrecht, Utrecht prof.dr. J.R.H. Tame, Yokohama City University, Yokohama, Japan dr. J.P. van Ulsen, Universiteit Utrecht, Utrecht Printed by Wöhrmann Print Service, Zutphen The studies presented in this thesis were carried out at the Department of Molecular Microbiology at the Vrije Universiteit Amsterdam in cooperation with the Genetics and Biochemistry Branch at the National Institutes of Health (Bethesda, MD, USA), the Protein Design Laboratory at the Yokohama City University (Yokohama, Japan), the Department of Crystal and Structural Chemistry and the Department of Molecular Microbiology at the Universiteit Utrecht, and the Department of Molecular Cytology at the Universiteit van Amsterdam. VRIJE UNIVERSITEIT Molecular insight into the pathogenic synergy between E. coli and B. fragilis in secondary peritonitis ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad Doctor aan de Vrije Universiteit Amsterdam, op gezag van de rector magnificus prof.dr. T. Sminia, in het openbaar te verdedigen ten overstaan van de promotiecommissie van de faculteit der Aard- en Levenswetenschappen op maandag 27 maart 2006 om 13.45 uur in de aula van de universiteit, De Boelelaan 1105 door Robert Sijbrandi geboren te Ermelo promotor: prof.dr. B. Oudega copromotoren: dr. B.R. Otto dr. J. Luirink Contents Chapter 1 General introduction 7 Chapter 2 Signal Recognition Particle (SRP)-mediated targeting and Sec- 37 dependent translocation of an extracellular Escherichia coli protein Chapter 3 Crystal structure of Hemoglobin protease, a heme binding 55 autotransporter protein from pathogenic Escherichia coli Chapter 4 Purification, folding and preliminary structure of the translocator 71 domain of the Escherichia coli autotransporter Hbp Chapter 5 Characterization of an iron-regulated α-enolase of 89 Bacteroides fragilis Chapter 6 Cloning and preliminary characterization of Pbp, a putative 109 plasminogen binding lipoprotein of Bacteroides fragilis Chapter 7 Summarizing discussion 127 References 143 Nederlandse samenvatting 161 Dankwoord 167 Chapter 1 General introduction Chapter 1 Introduction The discovery of antibiotics was an enormous advance in medicine, which enabled mankind to fight bacterial diseases that could not be eradicated before. Nevertheless, with the ongoing process of bacterial resistance against (new) antibiotics, bacterial infections still pose a significant threat to human and animal health. Bacterial infections in humans can be categorized in multiple ways. A very easy way is the distinction between mono-infections, where only one bacterial species is the causative agent, and polymicrobial infections, where multiple bacterial species can be isolated from the site of infection. Mono-infections are well known to the general public because of news reports about Salmonella in chicken meat, methicillin resistant Staphylococcus aureus (MRSA) in hospitals and childhood immunization programs. Although less known to the public, community acquired as well as hospital acquired polymicrobial infections occur very frequently and can pose serious threats to human health. This thesis is focused on polymicrobial infections in the human intra- abdominal cavity. The abdomen is located between the thorax and the pelvis. The abdominal cavity is lined by the peritoneum: a serous sac, consisting of mesothelium and a thin layer of irregular connective tissue, that covers most of the viscera (internal organs) contained therein. Some abdominal organs, like the kidneys, are located retroperitoneally, but retroperitoneal infections are not considered here. Intra-abdominal infections and peritonitis In clinical practice, the term intra-abdominal infection (IAI) is often used as a synonym for peritonitis. However, these two are not the same (Fig. 1). Peritonitis is defined as an inflammation of the peritoneum, but this is not necessarily caused by bacteria (Farthmann and Schöffel, 1998). IAIs comprise a heterogeneous group of conditions encompassing bacterial peritonitis, intra-abdominal abscesses and infections of intra-abdominal organs like appendicitis and pancreatitis (Farthmann and Schöffel, 1998). IAIs are a common cause of hospitalization with approximately two million intra-abdominal procedures carried out annually in the USA (Onderdonk et al., 1990). These infections can be community acquired (e.g. appendicitis, stab wounds or traffic accidents) or hospital acquired, often as a complication of intra- abdominal surgery where the contents of the gut came into contact with the peritoneal cavity. 8 General introduction Fig. 1. Bacterial peritonitis in relation to intra-abdominal infections and peritonitis. The morbidity and mortality of IAI is significant. Data from hospitals in The Netherlands show that there are over 5300 new patients with serious forms of peritonitis each year (Bosscha et al., 1999). Extrapolated to the western world, this means that there must be more than half a million cases per year. Intra-abdominal abscesses occur in approximately 25% of patients treated for generalized peritonitis (Reijnen et al., 2003). Depending on the anatomic origin of the bacterial contamination, mortality ranges from 5 tot 50% (Brook, 1989; Farthmann and Schöffel, 1998). Complications like bacteremia and multiple-organ failure (MOF) frequently occur, increasing mortality rates up to 80% (Anaya and Nathens, 2003). IAIs have been found in 25% of the patients with MOF on a surgical intensive care unit (ICU) (Darling et al., 1988). The high morbidity of peritonitis indicates that the annual cost of treatment of these infections is significant. Bacterial peritonitis can be divided into three classes (Farthmann and Schöffel, 1998; Marshall, 2004). Primary peritonitis refers to spontaneous bacterial invasion of the peritoneal cavity. This mainly occurs in cirrhotic and immuno- compromised patients and the infections are characteristically aerobic and monomicrobial (Wittmann et al., 1996). Secondary peritonitis refers to peritoneal infections secondary to intra-abdominal lesions like perforation of the hollow viscus, bowel necrosis or penetrating infectious processes. Tertiary peritonitis is defined as peritonitis arising at least 48 hours after the apparently successful treatment of primary or secondary peritonitis. It is characterized by persistent or recurrent 9 Chapter 1 infections with organisms of low intrinsic virulence that are different from the organisms involved in primary or secondary peritonitis and it has a significant mortality. Host defense systems Once peritoneal contamination occurs, the body attempts to defend against this invasion with powerful mechanisms devised to deal with breaches in the integrity of the gut (Table 1) (reviewed by Hall et al., 1998). The first mechanism involves physical clearance of the infectious agent using the circa 100 ml of serous peritoneal fluid (Robinson, 1962). Bacteria are removed through gaps (stomata) in the mesothelial lining of the diaphragm into the lymph system (Tsilibary and Wissig, 1983; Nakatani et al., 1996). The second mechanism is destruction of the bacteria using the innate immune system. Complement activation is involved in the opsonization of microorganisms, enhancement of inflammatory responses, clearance of immune complexes and cell lysis (Pascual and French, 1995). The migration of polymorphonuclear neutrophils (PMNs) into the peritoneum is enhanced and also other cells of the innate immune system like macrophages and mast cells are involved (Caldwell and Watson, 1994). Table 1. Host defense systems in peritoneal infections System Mechanism 1. Clearance Serous peritoneal fluid Stomata 2. Innate immune system Polymorphonuclear neutrophyls Macrophages and mast cells 3. Abscess formation Coagulation favored over fibrinolysis Fibrin clot formation The third defense mechanism of the peritoneal cavity is containment of the infection as an abscess. This is the result of a shift in the balance between the coagulation