Robert P. Jechorek

Role of intestinal anaerobic bacteria in colonization resistance

The purpose of this study was to clarify the role of the intestinal anaerobe bacteria in colonization resistance. Germfree mice were associated withEscherichia coli C25 and either (a) no other species; (b) enterococcus; (c)Escherichia coli M14 andProteus mirabilis, or (d)Bacteroides fragilis andBacteroides vulgatus. All species colonized the cecum in high numbers, but only enterococcus significantly limited the translocation ofEscherichia coli C25 to mesenteric lymph nodes. However, the overall translocation rates were similar in all groups and ranged from 60% to 100%, due to translocation of other intestinal flora in addition toEscherichia coli C25. Conventionally reared mice were given either streptomycin, bacitracin/streptomycin or metronidazole which selectively eliminated facultative gramnegative bacteria, nearly all bacterial species or strictly anaerobic bacteria respectively. Only metronidazole significantly increased the rates of translocation of normal intestinal bacteria into mesenteric lymph nodes. Cohort groups of mice were then orally inoculated with drug resistantEscherichia coli C25, which actively colonized the cecum of all drug treated mice and translocated to the mesenteric lymph nodes of approximately half the streptomycin and metronidazole treated mice and nearly all the bacitracin/streptomycin treated mice. These results indicate that anaerobic bacteria play a pivotal role in limiting the translocation of normal intestinal bacteria, but that other bacterial groups also have a role in preventing the intestinal colonization and translocation of potential pathogens.

Inhibitory effect of bile on bacterial invasion of enterocytes: possible mechanism for increased translocation associated with obstructive jaundice.

OBJECTIVE To clarify the effect of bile salts on internalization of enteric bacteria by intestinal epithelial cells. DESIGN Randomized study. SETTING Research laboratory. SUBJECTS Cultured human intestinal epithelial cells, namely HT-29 cells. INTERVENTIONS The effect of bile was studied by adding bile during the time period in which bacterial cells were permitted to interact with enterocytes. In subsequent experiments, bile was added to the culture medium used to grow bacteria, and bacterial cells were washed before adding bacteria to enterocytes. Three different concentrations of three different bile preparations were tested. MEASUREMENTS AND MAIN RESULTS Salmonella typhimurium and Proteus mirabilis were each incubated with HT-29 cells for 1 hr; the numbers of internalized bacteria were subsequently quantified following enterocyte lysis. The presence of bile during bacteria-enterocyte incubation had no effect on the numbers of internalized bacteria. However, if S. typhimurium or P. mirabilis were grown in the presence of bile, these washed bacterial cells were generally internalized by HT-29 cells in significantly fewer numbers, compared with bacterial cells grown in medium without bile supplementation. Enterocyte viability and morphologic ultrastructure did not appear to be affected by the presence of bile itself, or by the interaction with bacterial cells that had been cultivated in unsupplemented medium or in bile-supplemented medium. CONCLUSIONS Exposure to bile during bacterial growth resulted in bacterial cells with decreased invasiveness for cultured intestinal epithelial cells. This observation is consistent with previous in vivo studies of obstructive jaundice, where the absence of bile in the intestinal lumen, not bile duct ligation, appeared to facilitate bacterial translocation in obstructed animals. Thus, the presence of bile in the intestinal lumen may decrease bacterial translocation by a mechanism that involves decreased epithelial internalization of enteric bacteria.

Effects of clindamycin and metronidazole on the intestinal colonization and translocation of enterococci in mice.

The intestinal colonization and translocation of enterococci was studied in mice treated intramuscularly with metronidazole or clindamycin, with or without oral streptomycin. Treatment with metronidazole resulted in selective elimination of strictly anaerobic cecal bacteria, with a 100-fold increase in the numbers of aerobic and facultative gram-negative bacilli and a 10,000-fold increase in the numbers of aerobic and facultative gram-positive species. Clindamycin had a similar effect on the cecal flora except that the numbers of aerobic and facultative gram-positive bacteria decreased at least 10-fold. The predominating gram-positive species in the cecal flora or metronidazole-treated mice was an enterococcus, but this organism could not be recovered from the ceca of clindamycin-treated mice. Translocating bacteria (primarily gram-negative enteric bacteria) were recovered from the mesenteric lymph nodes of the majority of mice given metronidazole or clindamycin. Gram-positive bacteria were not recovered from the mesenteric lymph nodes of 20 clindamycin-treated mice, whereas 26% of 19 metronidazole-treated mice had translocating enterococci. With addition of streptomycin to the metronidazole and clindamycin regimens, mice treated with metronidazole-streptomycin became colonized predominantly with an enterococcus, and this was the only translocating species recovered from 13% of 23 mice; however, enterococci could not be detected in the ceca of clindamycin-streptomycin-treated mice, and Bacillus spp. were recovered from the mesenteric lymph nodes of 8% of 24 mice, reflecting the composition of the cecal flora. The apparent elimination of enterococci from the ceca of clindamycin and clindamycin-streptomycin-treated mice was inconsistent with the observation that the average (n=6) peak levels of clindamycin in blood and ceca were 25 and 21 microgram/ml, respectively, whereas the in vitro MIC was 128 microgram/ml. However, this apparent in vivo activity of clindamycin against enterococci was not evident in mice given 10(9) oral enterococci; the concentrations of cecal enterococci in both clindamycin-streptomycin- and metronidazole-streptomycin-treated mice were 10(10) to 10(11) enterococci per g, with translocating enterococci recovered from approximately half of these antibiotic-treated mice. Thus antibiotic therapy with metronidazole, clindamycin, metronidazole-streptomycin, and clindamycin-streptomycin resulted in a wide variation in the cecal population levels and translocation frequencies of enterococci. This variation appeared to be related to the discrepancy between the in vivo and in vitro activities of clindamycin against enterococci.

Gastrointestinal colonization by Candida albicans mutant strains in antibiotic-treated mice.

ABSTRACT Antibiotic-treated mice orally inoculated with one of threeCandida albicans strains (including two mutant strains) or indigenous Candida pelliculosa showed levels of candidal gastrointestinal colonization that were strain specific. However, regardless of strain, the numbers of viable candida were intermediate to high in the stomach, were consistently lowest in the upper small intestine, and increased progressively down the intestinal tract.

Effect of hypoxia on enterocyte endocytosis of enteric bacteria.

OBJECTIVE To clarify the effect of hypoxia on bacteria-enterocyte interactions. DESIGN Randomized. SETTING Research laboratory. SUBJECTS Enteric bacterial and cultured human intestinal epithelial cells, HT-29 cells. INTERVENTIONS The effect of hypoxia on bacterial internalization and intracellular survival was studied, using enterocytes cultured for 21 days in either 20%, 10%, or 5% oxygen. The effect of bacterial growth conditions on bacterial internalization by enterocytes was studied, using bacterial cells in either the log phase or stationary phase of aerobic growth, and using bacterial cells in stationary phase, grown either under low oxygen conditions or under anaerobic conditions. MEASUREMENTS AND MAIN RESULTS Individual strains of enteric bacteria were incubated with HT-29 cells for 1 hr. Numbers of internalized bacteria were subsequently quantified after enterocyte lysis. Bacterial growth conditions (anaerobic vs. aerobic and log-phase vs. stationary-phase bacterial cells) had no noticeable effect on the numbers of Salmonella typhimurium, Proteus mirabilis, and Escherichia coli internalized by enterocytes. Enterocytes cultivated in 20%, 10%, or 5% oxygen were >95% viable. Enterocytes cultivated in 20% oxygen were confluent, but those enterocytes cultivated in hypoxia were not confluent and were fewer in number compared with enterocytes cultivated in normoxia. Compared with enterocytes grown in normoxia, enterocytes cultivated in 5% and 10% oxygen internalized greater numbers of each of seven strains of enteric bacteria, including Listeria monocytogenes (two strains), Enterococcus faecalis (two strains), and P. mirabilis, E. coli (two strains), with statistically significant increases noted for five of these seven bacterial strains. Intracellular survival of L. monocytogenes and P. mirabilis was assayed. Both species survived intracellularly for 22 hrs, with no noticeable differences in the numbers of intracellular bacteria recovered from enterocytes cultivated in 20%, 10%, and 5% oxygen. CONCLUSION These in vitro results suggest that augmented bacterial endocytosis by enterocytes might at least partially explain the increased frequency of bacterial translocation associated with tissue ischemia.

Bacterial translocation in cultured enterocytes: magnitude, specificity, and electron microscopic observations of endocytosis.

Previous in vivo evidence has shown that bacterial phagocytosis by enterocytes may be an initial step in bacterial translocation across the intestinal epithelium. This study analyzed the interactions of cultured enterocytes, namely Caco-2 cells, with nine strains of enteric bacteria, tested in pure culture and in mixed culture. These nine strains had a spectrum of invasive potential and included Salmonella typhimurium, Listeria monocytogenes (three strains), Escherichia coli (three strains), Proteus mirabilis, and Enterococcus faecalis. Numbers of viable intracellular bacteria recovered from Caco-2 cells were: L. monocytogenes>S. typhimurium>P. mirabilis>E. coli>E. faecalis. Uptake of a given microbe by enterocytes was strain-specific and was not influenced by the presence of another strain, regardless of the invasive ability of the coinfecting strain. Electron microscopic visualization of bacterial adherence and uptake by Caco-2 cells indicated that the epithelial interactions of normal enteric bacteria were similar to these observed with invasive strains of salmonella and listeria.

Exposure Of The Lateral Enterocyte Membrane By Dissociation Of Calcium-dependent Junctional Complex Augments Endocytosis Of Enteric Bacteria

Intestinal bacterial translocation is facilitated in a variety of clinical conditions involving increased intestinal permeability, such as shock and trauma. Because there is both in vivo and in vitro evidence that enteric bacteria can be internalized by intestinal epithelial cells, experiments were designed to test the effect of increased intestinal permeability on enterocyte endocytosis of enteric bacteria. Mature, confluent cultures of HT-29 enterocytes were placed in a calcium-free solution for 1 h. Enterocyte viability was not noticeably altered, but transepithelial electrical resistance was significantly decreased (indicating a decrease in epithelial junctional integrity), and the enterocytes were pulled apart. Electron microscopic observations revealed enteric bacteria preferentially adherent on the exposed enterocyte lateral surface, and the numbers of viable enteric bacteria (Listeria monocytogenes, Salmonella typhimurium, Proteus mirabilis, Escherichia coli, and Enterococcus faecalis) internalized by these enterocytes were significantly increased. Restoration of calcium restored confluency to enterocyte cultures, and bacterial internalization reverted to control levels. Thus, calcium-dependent junctional integrity might play a role in augmenting bacterial translocation in clinical conditions associated with increased intestinal permeability.

The Candida albicans INT1 gene facilitates cecal colonization in endotoxin-treated mice.

Increased intestinal colonization with Candida albicans is believed to be a major predisposing factor to systemic candidiasis. Previous evidence has implicated the C. albicans INT1 gene in hyphal development, epithelial adherence, and mouse virulence. The effect of INT1 on mouse cecal colonization was measured using a parent strain (CAF2, INT1/INT1), an int1 deletion homozygote (CAG3, int1/int1), and a heterozygous reintegrant (CAG5, int1/int1 + INT1). Forty-eight hours after oral inoculation of 10(7) C. albicans into normal mice, only low numbers of each strain were recovered from the cecal flora. In mice pretreated with oral bacitracin/streptomycin, cecal colonization of each C. albicans strain was increased compared to the corresponding strain inoculated into untreated mice, with the CAF2 parent strain greater (P < 0.01) than the two mutant strains, and with the heterozygous and homozygous mutants not different from each other. In mice pretreated with parenteral lipopolysaccharide (LPS), in addition to oral antibiotics, numbers of cecal CAF2, CAG5, and CAG3 were increased (P < 0.01) compared to the corresponding strain inoculated into mice treated with antibiotics alone. In LPS-treated mice, numbers of cecal C. albicans CAF2 (INT1/INT1) were greater (P < 0.05) than C. albicans CAG3 (int1/int1). Thus, parenteral LPS had an additive effect on C. albicans cecal colonization in antibiotic-treated mice, and the presence of two functional copies of the INT1 gene appeared to facilitate colonization in both antibiotic-treated mice and in mice treated with antibiotics plus parenteral endotoxin.

Bacterial translocation and lipopolysaccharide-induced mortality in genetically macrophage-deficient op/op mice.

Genetically macrophage-deficient op/op mice have a total absence of macrophage colony-stimulating factor (also known as colony-stimulating factor 1 or CSF−1), and therefore an absence of a population of macrophages dependent on CSF−1. op/op mice also have profound secondary deficiencies in certain cytokines secreted by this macrophage population, such as tumor necrosis factor, interleukin−1, and granulocyte colony-stimulating factor. In the present study, op/op mice were used to clarify the role of the macrophage in two clinical processes: (a) bacterial translocation in response to antibiotic-induced intestinal overgrowth, and (b) endotoxin-induced bacterial translocation, morbidity, and mortality. The results were unexpected, in that bacterial translocation and endotoxin-induced morbidity and mortality were similar in op/op mice and their functionally normal littermates. These data indicated either that a specific macrophage population and its cytokines (including tumor necrosis factor and interleukin 1) might not play pivotal roles in the pathogenesis of bacterial translocation and endotoxin-induced septic shock, or alternatively, as yet unknown redundancies in vivo might compensate for the genetic deficiencies associated with the op/op mutation.

Effect of Oral Genistein and Isoflavone-Free Diet on Cecal Flora and Bacterial Translocation in Antibiotic-Treated Mice

BACKGROUND There are several reports indicating that the isoflavone genistein may augment the integrity of the intestinal epithelial barrier as well inhibit bacterial internalization by cultured enterocytes. We speculated that oral genistein might enhance the integrity of the intestinal epithelial barrier as monitored by the extraintestinal dissemination of intestinal bacteria. METHODS Mice were treated with oral antibiotics to induce cecal bacterial overgrowth accompanied by bacterial translocation of antibiotic-resistant enterobacteria, especially Escherichia coli. These mice were divided into separate groups that included chow-fed mice orally inoculated either with saline, vehicle, or genistein, and mice fed isoflavone-free diet and orally inoculated with either saline, vehicle, or genistein. Intestinal bacterial overgrowth was monitored by quantitative culture of excised ceca and bacterial translocation was monitored by quantitative culture of draining mesenteric lymph nodes. RESULTS Mice fed the isoflavone-free diet had decreased populations of cecal bacteria compared with chow-fed mice, and bacterial translocation was reduced in chow-fed mice compared with mice fed isoflavone-free diet. However, bacterial translocation was similar in mice given oral genistein compared with appropriate control mice. CONCLUSIONS Oral genistein had no noticeable effect on bacterial translocation in this model. However, the isoflavone-free diet had an antibacterial effect on cecal flora, and the isoflavone-free diet was associated with decreased numbers of cecal bacteria and decreased incidence of bacterial translocation.