Adherence of uropathogenic E. coli to differentiated human uroepithelial cells grown in vitro

Integrin-mediated host cell invasion by type 1-piliated uropathogenic Escherichia coli

Uropathogenic Escherichia coli (UPEC), the primary causative agent of urinary tract infections, typically express filamentous adhesive organelles called type 1 pili that mediate both bacterial attachment to and invasion of bladder urothelial cells. Several host proteins have previously been identified as receptors for type 1 pili, but none have been conclusively shown to promote UPEC entry into host bladder cells. Using overlay assays with FimH, the purified type 1 pilus adhesin, and mass spectroscopy, we have identified β1 and α3 integrins as key host receptors for UPEC. FimH recognizes N-linked oligosaccharides on these receptors, which are expressed throughout the urothelium. In a bladder cell culture system, β1 and α3 integrin receptors co-localize with invading type 1–piliated bacteria and F-actin. FimH-mediated bacterial invasion of host bladder cells is inhibited by β1 and α3 integrin–specific antibodies and by disruption of the β1 integrin gene in the GD25 fibroblast cell line. Phosphorylation site mutations within the cytoplasmic tail of β1 integrin that alter integrin signaling also variably affect UPEC entry into host cells, by either attenuating or boosting invasion frequencies. Furthermore, focal adhesion and Src family kinases, which propagate integrin-linked signaling and downstream cytoskeletal rearrangements, are shown to be required for FimH-dependent bacterial invasion of target host cells. Cumulatively, these results indicate that β1 and α3 integrins are functionally important receptors for type 1 pili–expressing bacteria within the urinary tract and possibly at other sites within the host.

Strains of bacteria called uropathogenic Escherichia coli (UPEC) are the primary cause of urinary tract infections (UTIs), which by some estimates are the second most common type of infectious disease in the world today. UPEC strains typically express hair-like fibers called type 1 pili on their surface that allow them to bind and invade the host cells that line the urinary tract. The ability of UPEC to enter these host cells likely promotes the establishment and persistence of UTIs. The invasion process requires that the incoming pathogens first bind specific receptor molecules on the target cell surface. Here, we identify two host proteins known as β1 and α3 integrin as key receptors for type 1 pili–expressing UPEC. The adhesive tips of type 1 pili recognize sugars that decorate these integrin receptors, thereby activating a signaling cascade that stimulates the host plasma membrane to zipper around and envelop bound bacteria. β1 and α3 integrins have important roles in a number of host cell functions and are widely distributed within the urinary tract and in other tissues. Interestingly, type 1 pili are expressed by many different types of bacteria in addition to UPEC, raising the possibility that interactions between type 1 pili and integrin receptors can facilitate bacterial colonization within diverse niches throughout the host.

Adhesion and entry of uropathogenic Escherichia coli

To effectively colonize a host animal and cause disease, many bacterial pathogens have evolved the mechanisms needed to invade and persist within host cells and tissues. Recently it was discovered that uropathogenic Escherichia coli, the primary causative agent of urinary tract infections, can invade and replicate within uroepithelial cells. This can provide E. coli with a survival advantage, allowing the microbes to better resist detection and clearance by both innate and adaptive immune defence mechanisms. Adhesive organelles, including type 1, P, and S pili along with Dr adhesins, promote both bacterial attachment to and invasion of host tissues within the urinary tract. Interactions mediated by these adhesins can also stimulate a number of host responses that can directly influence the outcome of a urinary tract infection.

The significance of the difference in bacterial adherence between bladder and ileum using rat ileal augmented bladder

OBJECTIVES

Intestinal segments are frequently used in the reconstruction of the urinary tract. Chronic bacteriuria is frequently observed in these patients, but the reason is not clearly understood. Therefore, we studied the difference in bacterial adherence between bladder and ileum using the rat ileal augmented bladder model to investigate the cause of chronic bacteriuria.

MATERIALS AND METHODS

Augmentation of the bladder using ileum and a sham operation were performed under sodium pentobarbital in 102 and 10 Sprague-Dawley rats, respectively. At three months after the operation, urinary pH and plasma concentration of sodium, chloride and potassium were measured and urinary culture was done. Urovirulence factors of Escherichia coli aspirated from augmented bladder were detected by polymerase chain reaction (PCR). Five to six rats with negative urinary cultures after the augmentation were used for each experimental cystitis. E. coli with type I pili aspirated from augmented rats and three clinically isolated strains of E. coli, C5 (type I pili, aerobactin), C92 (type I pili, aerobactin, P fimbriae), and C189 (type I pili, aerobactin, P fimbriae, CNF), were transurethrally inoculated into the augmented bladder of rats. Fourteen days after inoculation, rats were sacrificed and colony-forming units (CFU) per mg. of tissue of bladder and ileum were measured.

RESULTS

After operation, urinary pH and the serum level of chloride in all augmented groups were higher than those of the controls. Bacterial colonization was observed in 56 of 89 rats. Most of them were E. coli having only type I pili as a virulence factor. In contrast, the sham operated group revealed no bacterial colonization. In experimental cystitis, E. coli with only type I pili aspirated from augmented rats and E. coli C5 were clearly adhered to ileum rather than to bladder, but E. coli C92 and C189 showed no significant difference with respect to adherence to the two tissues. In experimental cystitis II, E. coli C5 with D-mannose were washed out in 3 of 5 rats by 14 days, while E. coli C5 without D-mannose were not washed out in all rats by 14 days.

CONCLUSIONS

These results suggested that the difference in bacterial adherence due to urovirulence factors, especially type I pili, is one of the main causes of asymptomatic bacteriuria after urinary reconstruction.

Value of prostate cancer screening in a comprehensive community cancer center

Early detection of prostate cancer may help decrease cancer deaths from this disease despite the increased incidence of prostate cancer. In 1990 and 1991 we conducted one-day "screens" for prostate cancer. This analysis was undertaken to determine the value of the screening procedures for detecting prostate cancer in the community. A total of 579 men, aged 39-84 years (mean 58 years), were evaluated by digital rectal examination (DRE) by a urologist, serum prostate specific antigen (PSA) determination by monoclonal antibody assay, and completion of a detailed questionnaire. Forty-eight percent had not seen a physician in over 2 years; 17% had a 1st- or 2nd-degree relative with prostate cancer. There was a 25% "suspicious" rate including 76 (13%) men with abnormal DRE only, 48 (8%) with abnormal PSA only, and 21 (4%) with abnormal DRE and PSA. Patients with findings suspicious for cancer were recontacted by telephone at 2-month intervals for 6 months to determine outcome because subsequent diagnostic management was at the discretion of practicing physicians. By 6 months, 84% of patients with abnormal findings had seen a physician as recommended. Of the 76 with abnormal DRE only, 11 were biopsied and only one cancer was found (9%). Of 48 with an elevated PSA only, 19 were biopsied; 11 (58%) had cancer (9/9 positive transrectal ultrasound) and 8 had no cancer at biopsy (5/5 negative transrectal ultrasound). Of 21 with both tests suspicious, 11 were biopsied and 9 had cancer (82%). Thus, by 6 months after each screen there was a 3.5% overall cancer detection rate for the whole population screened, a 67% positive biopsy rate among those with an elevated PSA, a 45% positive biopsy detection rate among those with an abnormal DRE, and a 51% positive biopsy rate among all those biopsied. Eighty percent of the PSA elevations were between 4.1 and 10.0 ng/ml. This screening experience yielded several new diagnoses of prostate cancer, and the use of serum PSA levels and ultrasound-guided biopsy was associated with a high positive biopsy rate for cancer.

Congenital immunodeficiencies in mice increase susceptibility to urinary tract infection

Severe combined immunodeficient (SCID), T cell deficient, and immunocompetent mice were challenged intravesically with viable uropathogenic Escherichia coli. In comparison to immunocompetent controls, SCID mice had significantly greater numbers of viable E. coli in their bladders and kidneys 7 days after inoculation. Splenic anti-E. coli antibody-forming cells (AFC) were virtually absent in SCID mice at 7.0 days after infection. Adoptive transfer of spleen cells from E. coli-immunized immunocompetent mice to SCID mice enhanced their resistance to urinary tract infection (UTI), as evidenced by lower bacterial counts in bladder and kidneys following an induced infection. Congenitally T cell deficient nude mice and immunocompetent heterozygous controls had equivalent bladder and kidney infection levels at 2 and 7 days after UTI. Immunocompetency thus appears to play a significant role in resistance to E. coli UTI in this animal model. Since mice deficient only in T cells did not show increased UTI susceptibility, T cell-independent antibody responses may be an important immunologic defense mechanism.

Is Escherichia coli invading tubuloepithelial cells?

The adhesion of Escherichia coli to host epithelium cells is the very first step of urinary tract infections followed by the internalization of the bacteria into these cells. These steps are influenced by several surface antigens or products of the pathogen, e.g. fimbriae or adhesins, K antigen, and hemolysin. The bacterial adherence and the internalization of several isogenic E. coli O18 strains differing in the expression of K5 antigen, hemolysin, and type of fimbriae were measured by using a permanent line of porcine tubuloepithelial cells (LLC-PK1). Strains with K5 antigen were reduced in their adherence and internalizability as compared to the K-negative strains. The expression of hemolysin by these strains lead to an increase of adherence and internalization. The internalization of bacteria is influenced mainly by their adherence to the epithelial cells. Thus, the engorgement of attached bacteria is rather a kind of endocytosis than an invasion of bacteria.

Adherence to and cytotoxicity of Escherichia coli for eucaryotic cell lines quantified by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide)

Adherence of Escherichia coli to human epithelial cells (HEp-2) was studied using MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) which is cleaved by enzymes of eucaryotic or procaryotic cells to formazan. This method allows to quantify adherence of Escherichia coli to HEp-2 cells and offers the advantage of assaying a large number of eucaryotic cells without using specific antisera or radioactive material. Furthermore, toxic effects of isolated hemolysin cloned in Escherichia coli onto a renal tubular cell line (LLC-PK1) was investigated by this method, showing reduced cellular viability of tubular cells after an incubation period of 10 to 20 min. MTT is therefore considered to be useful to assay the adherence of Escherichia coli to eucaryotic cells and to quantify toxic effects in eucaryotic cells induced by bacterial virulence factors.

Binding sites for P and/or type 1-piliated Escherichia coli in human ureter

Adherence sites for uropathogenic Escherichia coli in the excised human ureter were studied by using scanning electron microscopy. P-piliated E. coli adhered to younger epithelial cells which had microvilli on their surfaces, but did not to mature epithelial cells which had microfolds on their surfaces. This adherence was D-mannose resistant and alpha-D-Galactopyranosyl-(1----4)- beta-D-Galactopyranoside sensitive. Type-1 piliated E. coli adhered to both types of epithelial cells, but it was prevented by D-mannose. Entrapment of adherent type 1-piliated E. coli was observed only on the epithelial cells with microfolds. This model system allowed quantitative estimates of bacterial adherence to the luminal surface of the human ureteral mucosa in vitro, and demonstrated different manners of adherence of P and type 1-piliated E. coli.