Corynebacterium ulcerans isolates from
humans and dogs: fibrinogen, fibronectin
and collagen-binding, antimicrobial and
PFGE profiles
Liliane Simpson-Louredo, Juliana Nunes
Ramos, Renata Stavracakis Peixoto,
Louisy Sanches Santos, Camila Azevedo
Antunes, et al.
Antonie van Leeuwenhoek
Journal of Microbiology
ISSN 0003-6072
Volume 105
Number 2
Antonie van Leeuwenhoek (2014)
105:343-352
DOI 10.1007/s10482-013-0080-5
1 23
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Author's personal copy
Antonie van Leeuwenhoek (2014) 105:343–352
DOI 10.1007/s10482-013-0080-5
ORIGINAL PAPER
Corynebacterium ulcerans isolates from humans and dogs:
fibrinogen, fibronectin and collagen-binding, antimicrobial
and PFGE profiles
Liliane Simpson-Louredo • Juliana Nunes Ramos • Renata Stavracakis Peixoto •
Louisy Sanches Santos • Camila Azevedo Antunes • Elisa Martins Ladeira •
Cintia Silva Santos • Veronica Viana Vieira • Maria Helena Simões Villas Bôas •
Raphael Hirata Jr. • Ana Luı́za Mattos-Guaraldi
Received: 2 September 2013 / Accepted: 15 November 2013 / Published online: 27 November 2013
Ó Springer Science+Business Media Dordrecht 2013
Abstract Corynebacterium ulcerans has been
increasingly isolated as an emerging zoonotic agent
of diphtheria and other infections from companion
animals. Since pets are able to act as symptomless
carriers, it is also essential to identify virulence
potential for humans of these isolates. In this work
the ability of C. ulcerans to bind to fibrinogen (Fbg),
fibronectin (Fn) and Type I collagen as well the
genetic relationship among strains isolated from
human and asymptomatic dogs in Rio de Janeiro
(Brazil) were analyzed. Five pulsed-field gel electrophoresis (PFGE) profiles were demonstrated (I, II, III,
IV and V). In addition, the IV and V profiles exhibiting
C85 % similarity were expressed by the BR-AD41
and BR-AD61 strains from companion dogs living in
L. Simpson-Louredo and J. N. Ramos contributed equally for
the first authorship in this manuscript.
L. Simpson-Louredo J. N. Ramos
L. S. Santos C. S. Santos R. Hirata Jr.
A. L. Mattos-Guaraldi (&)
Laboratory of Diphtheria and Corynebacteria of Clinical
Relevance-LDCIC, Collaborating Center for Diphtheria of
CGLAB/SVS/MS, School of Medical Sciences,
Universidade do Estado do Rio de Janeiro—UERJ,
Rio de Janeiro, RJ, Brazil
e-mail: guaraldi@uerj.br
the same neighborhood. Independent of the PFGEtypes, human and dog isolates showed affinity to Fbg,
Fn and collagen. Heterogeneity of PFGE profiles
indicated endemicity of C. ulcerans in the Rio de
Janeiro metropolitan area. Differences in the expression of adhesins to the human extracellular matrix may
contribute to variations in the virulence and zoonotic
potential of C. ulcerans strains.
Keywords Corynebacterium ulcerans
Dog Fibrinogen Fibronectin PFGE
Introduction
Infection with Corynebacterium ulcerans is recognised as an emerging zoonotic disease and there is
evidence that the number of cases and the severity of
R. S. Peixoto
Institute of Microbiology Professor Paulo de Góes,
Universidade Federal do Rio de Janeiro (IMPPG/UFRJ),
Rio de Janeiro, RJ, Brazil
C. A. Antunes
Institute of Biological Sciences, Universidade Federal de
Minas Gerais, Belo Horizonte, Brazil
L. Simpson-Louredo J. N. Ramos
E. M. Ladeira V. V. Vieira M. H. S. V. Bôas
National Institute for Quality Control in Health (INCQS),
Fundação Oswaldo Cruz—FIOCRUZ, Rio de Janeiro,
RJ, Brazil
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344
clinical signs is increasing in industrialized and
developing countries (Dewinter et al. 2005; De Zoysa
et al. 2005; Mattos-Guaraldi et al. 2008a; Wagner et al.
2010; Kamada et al. 2012; Urakawa et al. 2013).
Human infections by C. ulcerans may be fatal and
mostly occur in adults with close animal contact
(Wellinghausen et al. 2002; Lartigue et al. 2005).
Lately, C. ulcerans has been increasingly isolated as
emerging zoonotic agent from companion animals
such as cats and dogs (Dias et al. 2011a; Zakikhany
and Efstratiou 2012). There is, therefore, a potentially
large reservoir of infection with little knowledge about
the risks of zoonotic transmission. The majority of the
cases of diphtheria caused by C. ulcerans has occurred
in adult patients who had been fully or partially
immunized with diphtheria toxoid vaccine (Leek et al.
1990; Dias et al. 2011a). In Europe, C. ulcerans is
currently isolated in more frequency from diphtheria
cases than Corynebacterium diphtheriae (De Zoysa
et al. 2005; Perkins et al. 2010; Taylor et al. 2010;
Wagner et al. 2010). C. ulcerans does not cause large
epidemics and human-to-human transmission remains
uncertain (Bonnet and Begg 1999; Mattos-Guaraldi
et al. 2008a).
The aim of this study was to investigate the affinity
of C. ulcerans to human plasma fibrinogen (Fbg),
fibronectin (Fn) and Type I collagen as a virulence
property. In addition, the antimicrobial susceptibility
profiles and the genetic relationship among C. ulcerans strains isolated from asymptomatic dogs and a
human patient in Rio de Janeiro metropolitan area,
Brazil were also determined.
Materials and methods
Origin of bacterial strains and culture conditions
Three C. ulcerans strains isolated from asymptomatic
dogs and one from human patient in Rio de Janeiro
metropolitan area, during the period of 2000–2012,
were analyzed (Table 1): BR-AD41 and BR-AD61
strains currently isolated, respectively, from nares to
skin wounds of two domestic dogs in Duque de Caxias
city; BR-AD22 strain, previously isolated from nares
of a shelter dog in Niterói city (Dias et al. 2010); 809
strain previously isolated from an elderly woman with
a fatal pulmonary infection and history of leg skin
ulcers in the Rio de Janeiro city (Mattos-Guaraldi et al.
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2008a). C. ulcerans CDC KC279 strain, Corynebacterium pseudotuberculosis 1002 strain; C. diphtheriae
subsp. mitis ATCC 27010 (C7 s (-) tox- [NCTC
11397]) and ATCC 27012 strains were also analyzed
for comparison.
To rule out the presence of any infectious or
debilitating diseases, including dermatoses and the
more obvious physical and behavioral abnormalities, a
general assessment of each animal’s condition and
nutritional status was recorded as previously described
(CCAC 2013). Swabs from skin lesions, nares and ears
samples from companion to shelter dogs were collected with sterile swabs and inoculated onto the
chocolate tellurite agar plates and incubated at
35–37 °C for 72 h as described by Dias et al.
(2011b). Stock cultures in 10 % skim milk with
25 % added glycerol were maintained at -70 °C and
recovered as required by cultivation in Trypticase Soy
Agar (TSA; Difco Laboratories, Detroit, MI.) at 37 °C
for 24 h under aerobic conditions (Dias et al. 2010).
Phenotyping, molecular characterization
and toxigenicity testing
The identification of C. ulcerans strains was achieved
using both phenotypic and genotypic methods.
Positive bacterial cultures for irregular Gram-positive
rods were preliminarily characterized by colonial
morphology, pigmentation, hemolysis and DNAse
activity. The suspect bacterial isolates were identified
as C. ulcerans by conventional biochemical assays and
the semi-automatized API-Coryne System V3.0 (bioMérrieux, Lyon, France) with the API web decoding
system http://www.apiweb.biomerieux.com (Efstratiou and George 1999; Funke and Bernard 2007; Pimenta et al. 2008; Dias et al. 2010). The production of
phospholipase D (Pld) was evaluated by the CAMP
test (i.e., inhibition of hemolysis by Staphylococcus
aureus).
Molecular identification of the isolates was carried
out by a multiplex PCR (mPCR) used to provide
simultaneous identification and toxigenicity of these
corynebacterial species with zoonotic potential in
addition to C. diphtheriae, based on primers targeting
the following genes: rpoB (Corynebacterium spp.),
16S rRNA (C. ulcerans and C. pseudotuberculosis),
pld (specific for C. pseudotuberculosis), dtxR (C.
diphtheriae) and tox gene (diphtheria toxin-DT)
(Torres et al. 2013).
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Table 1 Corynebacterium ulcerans strains isolated from human and asymptomatic dogs in Rio de Janeiro metropolitan area, Brazil
City/year
Source
Clinical detail
API-Coryne
code (probability,
T = 0.99)
References
Rio de
Janeiro/2000
Lung
Fatal pulmonary infection
0111326 (99.7 %)
Mattos-Guaraldi
et al. (2008a),
Trost et al. (2011)
Niterói/2010
Nare
Asymptomatic
0111324 (7.2 %)
Dias et al. (2010),
Trost et al. (2011)
BR-AD41
Duque de
Caxias/2012
Tick bite skin lesion
Asymptomatic
0111326 (99.7 %)
This study
BR-AD61
Duque de
Caxias/2012
Nare
Asymptomatic
0111306 (96.6 %)
This study
C. ulcerans
isolates
Human
809
Dog shelter
BR-AD22
Companion
RJ Rio de Janeiro, DC Duque de Caxias, N Niterói
Antimicrobial susceptibility profiles
The sensitivity to antimicrobial agents (Oxoid, Hampshire, UK), penicillin G (10 U), ampicillin (10 lg),
cefotaxime (30 lg), imipenem (10 lg), erythromycin
(15 lg), clindamycin (2 lg), tetracycline (30 lg),
ciprofloxacin (5 lg), gentamicin (10 lg), rifampicin
(5 lg), linezolid (30 lg) and vancomycin (30 lg) was
determined by the disk diffusion method using inoculum equivalent to a 0.5 McFarland standard, according to previously adopted by other authors (MartinezMartinez et al. 1995; CLSI 2007; Dias et al. 2010).
Plates were incubated at 37 °C for 24 h and reconfirmed at 48 h using a cation-adjusted Mueller–Hinton
agar with 5 % sheep blood. Breakpoints for the
susceptible strains were used as suggested by the
CLSI for bacteria excluded from table 2A to 2K. As
there is not yet a defined standard for interpreting these
results, the one proposed in the CLSI document M45A (ISBN 1-56238-607-7) was used (CLSI 2007). The
breakpoints for S. aureus established by CLSI were
considered in the cases of penicillin and ampicillin.
Minimum inhibitory concentrations (MIC) of penicillin G and clindamycin were also evaluated by the Etest (AB Biodisk, Solna, Sweden), as previously
described (Martinez-Martinez et al. 1995).
ECM and plasma proteins binding assays
Bacterial binding assays using biotinylated Fbg, Fn
and Type I collagen (all from Sigma Chemical Co.)
were performed in 96 wells Elisa Microtiter plates
(Costar 96 Well EIA/RIA Plate; Corning, NY, USA).
Bacterial cultures grown for 24 h at 37 °C in trypticase soy broth—TSB medium were washed 29 with
phosphate buffered saline (PBS), and resuspended in
0.1 M NaHCO3, pH 9.6 to a suspension of OD 0.2 at
k = 650 nm (equivalent to 5 9 109 CFU/mL). The
wells were sensitised with 100 lL of bacterial
suspensions for 1 h at 37 °C, and overnight at 8 °C.
A standard curve was also performed by diluting the
biotinylated protein solutions to concentrations varying from 5 to 0.05 lg (1 h/37 °C). After blocking with
2 % bovine serum albumin (BSA Type V, Sigma) in
PBS added of 0.05 % Tween-20 (PBST) for 1 h at
37 °C, the wells were washed 39 with PBST. The
bacterial strains were reacted with 20 lg/mL of
biotinylated ECM/plasma proteins for 1 h at 37 °C.
After washing 39 with PBST, the wells were reacted
for 30 min at 37 °C with 0.001 lg/mL Extravidinperoxidase (Sigma) prepared in PBST 1 % BSA. After
washing 39 with PBST, the reaction was verified by
adding 3,30 ,5,50 -tetramethylbenzidine liquid substrate
(TMB, Sigma) for 20 min and the reaction blocked
with 50 lL of 1 M HCl. The reaction was read in
k = 450 nm in a microtiter plate reader. The colour
intensity of the wells sensitised with the microorganisms was compared to the standard curve by GraphPad
Prism 6.0 version. The results were expressed in
micrograms of adhered proteins, in a mean ± SD of
three independent assays performed in triplicate. The
mean of the binding properties were compared by
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Tukey’s multiple comparison test (Harlow and Lane
1988; Sabbadini et al. 2010).
Pulsed-field gel electrophoresis (PFGE)
Genomic DNA was prepared following a method
described previously (Baio et al. 2013). The DNA was
cleaved with SfiI (New England BioLabs) according to
the manufacturer’s instructions. PFGE was carried out
in 0.59 TRIS–borate–EDTA–1.2 % agarose gels at
13 °C with a CHEF DRII system (Bio-Rad). The pulse
times were 1–30 s over 20 h. A lambda DNA concatemer (New England BioLabs) was used as a molecular
size marker. Similarities among macrorestriction
patterns were identified according to the criteria
established by Tenover et al. (1995). The BioNumerics Fingerprinting software (Version 4.0, Applied
Math, Sint-Martins-Latem, Belgium) was used to
confirm the findings provided by visual observation.
The similarity index of the strains was calculated using
the Dice correlation coefficient with a band position
tolerance of 1 % and unweighted-pair group method
using average linkages (UPGMA) was used to
construct a dendrogram. Strains were considered to
belong to the same PFGE group if the similarity index
was C85 % percentage band-based similarity coefficients as cut-off values.
Ethical procedures
The study was performed in compliance with the
guidelines outlined in the Canadian Council on
Animal Care (CCAC) and with the Brazilian government’s ethical guidelines for research involving animals (Fiocruz Ethic Committee for Animal
Experiments-CEUA/FIOCRUZ-LW-64/12).
Antonie van Leeuwenhoek (2014) 105:343–352
glycogen fermentation were variable characteristics.
Pld production was demonstrated by the positive
reverse CAMP test. Amplification profiles by mPCR
identified BR-AD22, BR-AD41 BR-AD61 and 809
Brazilian strains as C. ulcerans (Fig. 1) with negative
results for tox gene.
Antimicrobial susceptibility profiles
C. ulcerans BR-AD22, BR-AD41, BR-AD61 and 809
strains showed moderate susceptibility to penicillin G
and clindamycin (Table 2). All C. ulcerans strains tested
showed susceptibility to other antimicrobial agents
tested, including erythromycin and vancomycin.
ECM/plasma proteins binding properties
The ability of C. ulcerans to bind to human Fbg, Fn
and Type I collagen molecules was demonstrated at
varied levels (Fig. 2; Table 2). The three dog isolates
(BR-AD22, BR-AD41, BR-AD61 strains) were capable to binding over than 10 % of biotinylated proteins,
when reacted with 100 lL of a solution containing
20 lg/mL for 1 h/37 °C. Data showed a higher
affinity of the dog isolates BR-AD22, BR-AD41,
BR-AD61 strains to Fbg while a higher affinity of BRAD22 and BR-AD61 strains to Fn; and higher affinity
of BR-AD22 to Type I collagen was shown. ELISA
results showed the highest affinity to Fbg, Fn and Type
I collagen for BR-AD22 strain (P \ 0.001). Conversely, 809 strain (isolated from a human patient with
lethal pneumonia) adhered to human ECM/plasma
proteins in lower intensities (P \ 0.001). CDC KC279
strain adhered to collagen and Fn in similar intensities
of BR-AD61 and BR-AD41 strains, respectively
(P [ 0.05). BR-AD41 and BR-AD61 showed similar
adherence levels to Fbg (P [ 0.05).
Results
PFGE analysis
Corynebacterium ulcerans phenotypic
and genotypic characterization
C. ulcerans strains were positive for catalase, urease,
alkaline phosphatase and a-glucosidase. Nitrate
reduction, pyrazinamidase, gelatinase, and esculin
hydrolysis tests gave negative results. Fermentation
tests were positive for glucose, ribose; negative for
xylose, mannose, sucrose and lactose. Maltose and
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PFGE of the SfiI-digested DNA of 5 strains revealed
distinct PFGE profiles which were designated I, II, III,
IV and V (Fig. 3). The PFGE profile IV differed by
more than three bands from PFGE profile V by visual
inspection. According to the interpretation criteria by
Tenover et al. (1995), the BR-AD41 strain belonging
to profile IV and BR-AD61 strain, profile V were
considered related. These strains were isolated from
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Fig. 1 Amplification profile by multiplex polymerase chain
reaction of Corynebacterium ulcerans (lanes 1–5), Corynebacterium diphtheriae (lanes 6 and 7), Corynebacterium pseudotuberculosis (lane 8): lane 1 BR-AD22 (tox-); 2 BR-AD41
(tox-); 3 BR-AD61 (tox-); 4 809; 5 CDC KC279 (tox?); 6
ATCC 27010 (tox-); 7 ATCC 27012 (tox?); 8 1002 (tox-); 9
molecular weight (100-bp DNA ladder)
Table 2 Phenotypic and genotypic characteristics of Corynebacterium ulcerans strains isolated from human and dogs in Rio de
Janeiro metropolitan area, Brazil (2000–2012)
Strain
number
Antimicrobial agents
CDC
KC
279a
Binding (lg)c
PFGE
type
tox gene/
Pld/
DNAse
Fbg
Fn
Collagen
Penicillin G (MIC 0.19 C mg/
L); clindamycin
(MIC C 1.5 mg/L)
1/1/1
0.2000 ± 0.0005774
0.4067 ± 0.006642
0.4680 ± 0.01328
I
809
Penicillin G, clindamycin
2/1/1
0.1270 ± 0.003464
0.1367 ± 0.007219
0.1650 ± 0.02801
II
BRAD22
BRAD41
Penicillin G, clindamycin
2/1/1
0.2690 ± 0.004041
0.7160 ± 0.004619
0.1650 ± 0.02801
III
Penicillin G, clindamycin
2/1/1
0.2290 ± 0.008660
0.3937 ± 0.001453
0.3280 ± 0.004041
IVd
BRAD61
Penicillin G, clindamycin
2/1/1
0.2370 ± 0.0005774
0.6200 ± 0.001386
0.4557 ± 0.005487
Vd
Moderate susceptibility to
b
NI not informed, PLD phospholipase D, DNAse deoxyribonuclease, Fbg fibrinogen, Fn fibronectin, ? positive, - negative
a
Control strain
b
Evaluated by disk diffusion method and E-test
c
Results expressed as a mean of three independent assays performed in triplicate
d
PFGE-types epidemiologically related
dogs in the same neighborhood and exhibited C85 %
similarity, so they were considered as belonging to the
same PFGE group. The other PFGE profiles exhibited
more than six bands of difference, indicating that they
were epidemiologically unrelated.
Discussion
Toxigenic C. ulcerans and C. diphtheriae can lead to
life-threatening disease that requires urgent treatment
with diphtheria antitoxin (DAT) without waiting for
laboratory confirmation. Antibiotic treatment of diphtheria-like illness caused by C. ulcerans should follow
clinical guidelines for patients infected with C.
diphtheriae. An appropriate antibiotic (penicillin or
erythromycin) should be used to eliminate the causative organisms, stop exotoxin production and reduce
communicability (Pickering et al. 2009; CDC 2011,
2012; Sekizuka et al. 2012). Clindamycin was formerly considered as an alternative in the treatment of
the carrier of diphtheria bacilli, especially in those
who were sensitive to penicillin (Zamiri and McEntegar 1972).
Similar PFGE profiles or ribotypes have been
previously observed in C. ulcerans strains isolated
from human and animal colonization or infectious
processes (Katsukawa et al. 2009, 2012; Komiya et al.
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Fig. 2 Binding to human fibrinogen (Fbg), fibronectin (Fn) and
Type I collagen by Corynebacterium ulcerans evaluated by
enzyme linked immunosorbent assay (ELISA): BR-AD22, BRAD41 and BR-AD61 strains isolated from dogs, 809 strain from
human; control CDC KC279 strain. Data showed the highest
affinity to Fbg, Fn and Type I collagen for BR-AD22 strain
(P \ 0.001). The results were expressed in mean ± SD of three
independent assays performed in triplicate. The mean of the
binding properties were compared by Tukey’s multiple comparison test
2010; Berger et al. 2011). In Japan, 45 C. ulcerans dog
isolates including 39 strains of a predominant PFGE
type (A2), showed resistance or decreased sensitivity
to clindamycin. The authors suggested that transmission among asymptomatic dogs might have occurred
(Katsukawa et al. 2012). In our study, heterogeneity of
PFGE profiles observed in strains isolated from human
and dogs indicated endemicity of C. ulcerans in Rio de
Janeiro metropolitan area. C. ulcerans strains of five
different PFGE types showed moderate susceptibility
to penicillin G and clindamycin, as previously
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demonstrated for other Brazilian C. diphtheriae strains
(Pereira et al. 2008). Interestingly, two epidemiologically related PFGE profiles (profiles IV and V) were
found in the BR-AD41 and BR-AD61 dog isolates
from Duque de Caxias city in 2012.
Virulence mechanisms of C. ulcerans should
become a matter of higher interest especially due to
the increase in the number and severity of cases of
infection in immunized or partially immunized individuals. C. ulcerans strains seem to be endowed with
an array of virulence factors other than DT such as
catalase, proteases, deoxyribonuclease (DNAse),
neuraminidase H (NanH), endoglycosidase E (EndoE), Pld toxin and subunits of adhesive pili of the
SpaDEF type (Trost et al. 2011).
Corynebacterium ulcerans strains producing Pld,
but not DT toxin, are able to cause severe disease in
humans, such as lymphadenitis, dermatitis, subcutaneous abscess and acute pharyngitis and lower respiratory tract infections (pneumonia and granulomatous
nodules in pulmonary tissues) (Desseau et al. 1995;
Hommez et al. 1999; Hatanaka et al. 2003; Dias et al.
2011a). Consequently, C. ulcerans strains unable to
produce DT toxin should not be underestimated. Pld
may cause an increase in vascular permeability, has
dermonecrotic properties, and reduces viability of
neutrophils and macrophages (Schmiel and Miller
1999). In an attempt to further investigate possible
mechanisms that promote C. ulcerans infection and
hematogenic dissemination, a previous study revealed
a strain-dependent arthritogenic potential independent
of catalase, DNAse, Pld and DT production. Some C.
ulcerans strains showed a higher arthritogenic and
mortality potential when compared to C. diphtheriae
strains during an in vivo experimental infection in
mice. C. ulcerans arthritis also had a hematogenic
spread and viable bacteria were recovered from joints,
blood, kidneys, liver, and spleen but not from the heart
and lungs of mice (Gaede and Heesemann 1995; Tissi
et al. 1999; Puliti et al. 2006; Dias et al. 2011b). C.
ulcerans 809 human isolate (tox gene negative) caused
skin lesions with a large extent of yellowish-white
fibrinous (fibrin) deposits in the lower limb of the
patient (Mattos-Guaraldi et al. 2008a). Dermonecrotic
activity was also observed for both human 809 and dog
BR-AD22 isolates in experiments performed with
guinea pigs (Mattos-Guaraldi et al. 2008b).
Comparative analysis of the complete genomes of
C. ulcerans 809 and BR-AD22 strains and detection of
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Fig. 3 Pulsed-field gel electrophoresis (PFGE) profiles of
Brazilian Corynebacterium ulcerans strains isolated from
human and dogs. a Dendrogram of results of PFGE data. The
percent similarity scale is based on UPGMA clustering of Dice
coefficients generated by BioNumerics software v 4.0; b PFGE
assay. Lane 1 k DNA ladder PFGE marker; lane 2 CDC KC 279
control strain (USA), profile I; lane 3 809 (human), profile II;
lane 4 BR-AD22 (dog), profile III; lane 5 BR- AD41 (dog),
profile IV; lane 6 BR-AD61 (dog), profile V
candidate virulence factors was recently performed
(Trost et al. 2011). The detection and functional
assignments of singletons confirmed that the repertoire
of potential virulence factors of the sequenced C.
ulcerans were different in the two selected isolates
from a human and animal source (809 and BR-AD22
strains, respectively). Two genes encoding surfaceanchored proteins with LPXTG motif, including the
SPAD gene for the major pilin subunit of an adhesive
pilus structure, were also detected as singletons. SpaD
protein of C. ulcerans BR-AD22 differs in its amino
acid sequence when compared with the functional
counterpart CULC809-01952 from C.ulcerans 809,
demonstrated that pili of the two C. ulcerans strains
varied significantly in the primary sequence of their
major pilins that in principle constitute the shaft of the
corynebacterial pilus structure. Data suggested differences in the adhesive properties of C. ulcerans strains.
The first step in the infectious process of extracellular pathogens like C. diphtheriae is generally
considered to be attachment to and colonization of
host tissue surfaces. Evidence from other Grampositive pathogens suggests that bacterial surface
adhesins recognizing adhesive matrix molecules or
plasma proteins may serve as potential antigenic
candidates for the development of novel immunotherapies, including diphtheria-like illness and invasive
infections caused by C. ulcerans (Rivera et al. 2007).
Fbg is a major protein in human plasma that has its
synthesis dramatically upregulated during inflammation
or under exposure to stress such systemic infections. It
is, therefore, not surprising that many bacterial pathogens can interact with Fbg and manipulate its biology
(Rivera et al. 2007). Fbg is primarily involved in the
coagulation cascade system through its conversion to
insoluble fibrin. Both Fbg and fibrin play overlapping
roles in blood clotting, fibrinolysis, inflammatory
response, cellular and matrix interactions and wound
healing. Many bacterial pathogens exploit mechanisms
involved in coagulation systems to colonize exposed
tissue matrix proteins or evade immune mechanisms of
bacterial clearance (Doolittle 1984; Lantz et al. 1985;
Mosesson 2005; Sun 2006). The presence of Fbg onto
bacterial surfaces may be an efficient trait to avoid
phagocytosis in human hosts, as previously described
with other Gram-positive pathogens (Schubert et al.
2002; Rennermalm et al. 2004; Pierno et al. 2006),
including C. diphtheriae (Gomes et al. 2009; Sabbadini
et al. 2010).
Fn is a complex glycoprotein found in a soluble
form in many body fluids (blood, saliva) and in an
insoluble form as a component of cell surfaces,
basement membranes, and the extracellular matrices.
Soluble plasma Fn interacts with various bacteria and
cell surfaces. Fn may serve as a receptor in the
adherence of bacteria to host epithelial cell and may
play an important role in tissue tropism. Fn can
simultaneously bind to Fbg, fibrin, collagen, human
cells and bacteria (Mosher 1975; Ruoslahti and Vaheri
1975; Engvall and Ruoslahti 1977; Engvall et al. 1978;
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Livornese and Korzeniowski 1992). Type I collagen is
the most prevalent form of several distinct types of
collagen observed in the arterial walls, bone, dentin,
dermis, tendon, and uterine wall. All types of collagen
are active in Fn binding, but to a different degrees
(Engvall et al. 1978). The binding to collagen and Fbg
is mediated by the same binding site in Fn.
The ability of all five PFGE-types of C. ulcerans to
bind to human Fbg, Fn and Type I collagen molecules
was demonstrated, but at varied levels. Similar to C.
diphtheriae, qualitative and quantitative differences in
the expression of Fbg, Fn and Type I collagen-binding
adhesins may contribute to variations in the virulence
potential to the human host and pseudomembrane
formation by C. ulcerans strains (Sabbadini et al.
2010). The fact that the animal isolates adhered to
human ECM/plasma proteins in higher intensities
indicated that some C. ulcerans strains have evolved
mechanisms to target human defense, resulting in a
microbial invasion of cells constitutive of host barriers, disruption of barrier integrity, and systemic
dissemination and invasion of deeper tissues.
Acknowledgments This work was supported by Coordenação
de Aperfeiçoamento de Pessoal de Nı́vel Superior (CAPES),
Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro
(FAPERJ), Conselho Nacional de Desenvolvimento Cientı́fico e
Tecnológico (CNPq), Programa Estratégico de Apoio à
Pesquisa em Saúde-Fundação Oswaldo Cruz (PAPES
V-FIOCRUZ), Sub-Reitoria de Pós-graduação e Pesquisa da
Universidade do Estado do Rio de Janeiro (SR-2/UERJ).
Conflict of interest The authors declare that they no have
conflict of interest.
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