Mechanisms of Bacterial Pathogenicity J W Wilson, M J Schurr, C L Leblanc, R Ramamurthy, K L Buchanan, C a Nickerson
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216 REVIEW Postgrad Med J: first published as 10.1136/pmj.78.918.216 on 1 April 2002. Downloaded from Mechanisms of bacterial pathogenicity J W Wilson, M J Schurr, C L LeBlanc, R Ramamurthy, K L Buchanan, C A Nickerson ............................................................................................................................. Postgrad Med J 2002;78:216–224 Pathogenic bacteria utilise a number of mechanisms to CAPSULE cause disease in human hosts. Bacterial pathogens Some bacteria overproduce and excrete copious amounts of high molecular weight polysaccha- express a wide range of molecules that bind host cell rides, also called exopolysaccharides, when iso- targets to facilitate a variety of different host responses. lated from clinical samples. This extracellular The molecular strategies used by bacteria to interact sugar coating is termed capsule. Different species of bacteria utilise diverse sugars to produce the with the host can be unique to specific pathogens or capsule. Capsule production is one of the major conserved across several different species. A key to virulence factors utilised by bacteria to evade fighting bacterial disease is the identification and clearance from an infectious site. Specifically, the capsule provides bacteria with protection from characterisation of all these different strategies. The the host immune response as well as antibiotics. availability of complete genome sequences for several Some capsules have also been shown to have bacterial pathogens coupled with bioinformatics will immunomodulatory effects. The capsule protects bacteria from phagocytosis by not allowing lead to significant advances toward this goal. opsonising antibodies to be recognised by phago- .......................................................................... cytic host defence cells (for example, macro- phages and neutrophils). This “frustrated phago- nfectious diseases are the leading cause of cytosis” leads to enhanced inflammatory death worldwide. Not only are new infectious response as the macrophages and neutrophils diseases emerging, but the re-emergence of produce more inflammatory cytokines in an I attempt to clear the bacteria. The enhanced deadly infectious diseases, and the increasing prevalence of antimicrobial resistant strains, inflammatory response leads to increased tissue present a formidable threat to public health and damage as more neutrophils and macrophages welfare. Recently, significant evidence has are recruited to the site of infection. emerged which indicates that markedly different The most notorious species of bacteria that microbial pathogens use common strategies to produce capsules are Streptococcus pneumoniae cause infection and disease. For example, many (pneumococcus), Neisseria meningitidis (meningo- diverse bacterial pathogens share common coccus), and Pseudomonas aeruginosa. The pneumo- http://pmj.bmj.com/ mechanisms in terms of their abilities to adhere, coccus capsular polysaccharide has been identi- invade, and cause damage to host cells and fied as one of its primary virulence factors. The pneumococci utilise 24 biosythetic genes to tissues, as well as to survive host defences and 2 establish infection. A diagrammatic overview of produce their capsule. There are at least 90 some of these mechanisms is given in fig 1. Many different capsular types, although only a subset of 23 types causes more than 90% of invasive disease of these commonalities of infection appear to be 3 related to the acquisition of large blocks of worldwide. Differences in capsular polysaccha- ride chemical structure determine the meningo- on October 1, 2021 by guest. Protected copyright. virulence genes from a common microbial ances- 4 tor, which can be disseminated to other bacteria coccal serogroups. Meningococci of serogroups B, via horizontal transfer. The horizontal transmis- C, Y, and W-135 express capsules composed entirely of polysialic acid or sialic acid linked to sion of large blocks of virulence determinants is 45 also directly attributable to the constant emer- glucose or galactose, while the capsule of gence of new strains of bacterial pathogens, many serogroup A is composed of N-acetyl mannosamine-1-phosphate.4 The P aeruginosa See end of article for of which are resistant to multiple antibiotics. authors’ affiliations Indeed, antibiotic resistance of bacterial patho- capsule is composed of alginate (acetylated man- ....................... gens has emerged as one of the most important nuronic and guluronic acid). The biosynthetic issues facing critical care practitioners. A more enzymes for alginate have been elucidated and Correspondence to: much is known about the genetic regulation for Dr Cheryl A Nickerson, thorough comprehension of the common themes Program in Molecular in microbial pathogenicity is essential to under- the overproduction of alginate. The unique characteristic of the P aeruginosa capsule is that all Pathogenesis and standing the molecular mechanisms of microbial Immunity, Department of P aeruginosa strains have the genetic capability to virulence and to the development of novel Microbiology and produce alginate but it is most frequently found Immunology, SL38, Tulane vaccines and other therapeutic agents for the in cystic fibrosis isolates.6 Though these capsules University Health Sciences treatment and prevention of infectious diseases. have different chemical composition and immu- Center, 1430 Tulane While it is beyond the scope of this review to dis- Avenue, New Orleans, LA nomodulatory effects, they serve to protect the 70112, USA; cuss in-depth details of the molecular mecha- [email protected] nisms of bacterial pathogenesis (the reader inter- ested in such detail is referred to a recent review ................................................. Submitted 25 July 1), this review focuses on a Accepted by Finlay and Falkow Abbreviations: LPS, lipopolysaccharide; PAMPs, 27 November 2001 number of common mechanisms used by bacte- pathogen associated molecular patterns; TNF-α, tumour ....................... rial pathogens to cause infectious disease. necrosis factor-alpha www.postgradmedj.com Mechanisms of bacterial pathogenicity 217 A Capsule "Frustrated" phagocytosis Postgrad Med J: first published as 10.1136/pmj.78.918.216 on 1 April 2002. Downloaded from LPS/cell wall components Septic shock Human host Toxins Invasion/host cell damage Bacterial pathogen Adhesins Binding to host surface B – Proteases Extracellular invasion – Glycanases of host tissues Adhered bacterial pathogen Host tissue cells Host cell invasion Residence within: via phagocytosis 1. Phagolysosomal (macrophage vacuole or neutrophil) 2. Unfused or induced uptake phagosome (type III secretion) 3. Host cell cytosol Host cell membrane Figure 1 An overview of bacterial mechanisms for pathogenicity. (A) Upon encountering a human host, a bacterial pathogen may illicit several host responses and use a variety of mechanisms to evade the host defences. The bacterial components that interact with the host include: (1) capsules that act to “frustrate” phagocytosis and protect the pathogen from macrophage and neutrophil engulfment, (2) lipopolysaccharide (LPS) and cell wall components which can cause septic shock, (3) toxins that can serve to damage host cells and aid invasion, and (4) adhesins which facilitate binding of the pathogen to host surfaces. The degree to which these various mechanisms play a part in the pathogenesis of an infection depends on the bacterial species or strain, the site of pathogen entry, the immune status of the host and other similar factors. (B) Once adhered to a host surface, a bacterial pathogen may further invade host tissues. Pathogens may “burrow” further into a tissue by expressing and secreting proteases and glycanases that digest host extracellular matrix proteins and polysaccharides. In addition, a pathogen may also invade the host tissue cells and gain access to the intracellular environment. This can be facilitated by the natural phagocytosis mechanisms of macrophages and neutrophils or by induced uptake where the pathogen signals the host cell to engulf adhered bacteria. A common strategy for pathogens to induce uptake is the use of a type III secretion system which injects bacterial signalling proteins into the host cell. Within the host cell, the pathogen may reside within a phagolysome (a phagosome which has fused with a lysosome), a phagosome which has not fused with a lysosome, or within the host cell cytosol. bacteria from the host inflammatory response (that is, considered to be the principal component responsible for the complement activation and phagocyte mediated killing). induction of septic shock that often accompanies severe infec- tions with these microbes. The primary receptor for LPS is http://pmj.bmj.com/ CELL WALL CD14, a cell surface marker of macrophages.10 Lipid A, the Bacteria can be divided into two major groups based on toxic portion of the LPS molecule, causes release of numerous differences in cell wall structure: Gram positive and Gram host proinflammatory cytokines and activates the comple- negative bacteria. The cell wall of both Gram positive and ment cascade and the coagulation cascade. Recent studies Gram negative bacteria contain toxic components that are suggest that toll-like receptors, inflammatory cytokines, potent virulence factors and have central roles in the eicosanoids, free radicals, macrophage migration inhibitory pathogenesis of bacterial septic shock, a frequently lethal con- factor, signal protein kinases, and transcription