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Antimicrobial Agents and Chemotherapy, July 2005, p. 2807-2815, Vol. 49, No. 7
0066-4804/05/$08.00+0 doi:10.1128/AAC.49.7.2807-2815.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Department of Oral Microbiology, Matsumoto Dental University, Shiojiri, Japan,1 Department of Wadsworth Anaerobe Laboratory, GLAVAHCS, and Department of Medicine, UCLA School of Medicine, Los Angeles, California,2 Department of Institute for Oral Science, Matsumoto Dental University, Shiojiri, Japan,3 Department of Microbiology, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan4
Received 1 September 2004/ Returned for modification 17 October 2004/ Accepted 14 March 2005
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Gram-negative bacteria including B. fragilis are usually more resistant to a large number of antibiotics and other noxious agents than are gram-positive bacteria. Clinically significant levels of antibiotic resistance are caused by interplay between the efficient outer membrane (OM) permeability barrier, ubiquitous periplasmic ß-lactamases, and recently recognized multidrug resistance (MDR) efflux pumps (17). These pumps have broad substrate specificity and may act synergistically with the permeability barrier to result in significant intrinsic resistance to many antimicrobials. These pumps expel the antimicrobial from the cell into the surrounding space, and the antimicrobials then have to pass through the OM permeability barrier to regain entry to the cell (18). Thus, the MDR pumps can effect significant resistance even when their transporter activity is quite low, as long as the OM functions as an effective barrier. Antimicrobials which are expelled by these pumps include fluoroquinolones, chloramphenicol, and ß-lactam antibiotics that have lipophilic side chains (34). For many ß-lactams and carbapenems that are not hydrolyzed by periplasmic enzymes, synergy between efflux and the permeability barrier is necessary for effective drug resistance (18). Pumps belonging to the resistance-nodulation-division (RND) family of transporters are the major multidrug efflux pumps in both Escherichia coli and Pseudomonas aeruginosa. The pumps in this family consist of three components: the inner membrane transporter, a periplasmic lipoprotein, and an OM channel (31).
The first multidrug efflux operon described was mexAB-oprM in P. aeruginosa; acrAB-tolC comprises the corresponding system in E. coli. Both systems have broad substrate specificities. In Pseudomonas, the products MexA, MexB, and OprM (in this order in the operon) are the linker protein, transporter, and OM channel, respectively (9, 21, 22, 34). This system is the major efflux pump associated with intrinsic resistance among 17 possible RND efflux pumps in P. aeruginosa. P. aeruginosa is intrinsically more resistant than E. coli due to both a highly impermeable OM and the presence of multiple efflux systems (5, 23). Inactivation of this pump renders P. aeruginosa even more susceptible to most antibiotics than the average E. coli strain. Therefore, we decided to investigate the presence and function of RND type systems in B. fragilis, a gram-negative anaerobic bacterium that is the major cause of anaerobic infections. Like P. aeruginosa, B. fragilis has a relatively large chromosome (6.3 Mb and 5.2 to 5.4 Mb, respectively).
Little is known about efflux pumps in obligate anaerobic bacteria. The BexA pump, a member of the multidrug and toxic compound extrusion class (MATE), was described in Bacteroides thetaiotaomicron and XepCAB, a member of RND pump family, was described in Porphyromonas gingivalis (6, 13). The aim of this study was to determine whether genes for RND efflux pumps are present in the B. fragilis genome and to determine their involvement in resistance to antimicrobials. Since the B. fragilis ATCC 25285 genome has been completed, we used genomic analysis to locate RND homologs in B. fragilis. This report describes the identification of 16 homologs of the MDR pump system in B. fragilis, construction and characterization of disruption mutants of four of these homologs, and the cloning of a portion of one of the homologs, bmeAB, in a hypersusceptible strain of E. coli. This is the first description of the RND pump system in the genus Bacteroides.
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TABLE 1. Bacterial strains and plasmids used in this study
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Construction of disruption mutants. DNA manipulations were carried out by standard procedures as described by Sambrook and Russell (28). The primers used in PCR are shown in Table 2. The pGERM suicide vector (gift of Abigail Salyers, University of Illinois, Urbana) was used in insertion-mediated mutagenesis to construct gene disruption mutants (27). pGERM cannot replicate in Bacteroides spp. but confers erythromycin resistance for Bacteroides spp. when inserted into the chromosome. Thus, a single homologous recombination event occurring in the internal homologous locus of a potential gene for an efflux pump (e.g., bmeB) will result in the insertion of pGERM::bmeB' into the chromosome.
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TABLE 2. Primers used for PCR
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FIG. 1. Schematic map of bmeABC in B. fragilis. The main figure consists of a hypothetical operon composed of bmeA (a mexA homolog), bmeB (a mexB homolog), and bmeC (an oprM homolog). A schematic diagram of the insertion-mediated mutagenesis is included. For example, the pGERM recombinant carrying an internal DNA fragment of bmeB (indicated by the black hexagon) is integrated into the recipient by a single homologous recombination event (crossed black lines) to result in FMB271, a disruption mutant of bmeB. Small arrows indicate positions and directions of primers. Abbreviations: ERYs, erythromycin sensitive; ERYr, erythromycin resistant; ermG, erythromycin-resistant marker for Bacteroides spp.
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TABLE 3. Sixteen homologs of B. fragilis mexAB-oprMa
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Cloning of bmeAB in E. coli.
The bmeAB region (4,891 bp) of B. fragilis was amplified by PCR using primers MDU-4 and MDU-5 (Table 2) and cloned into an E. coli
acrAB mutant KAM3 as a host ((14), a kind gift of T. Tsuchiya, Okayama University). The MDU-4 primer was designed about 350 bp upstream from the start codon of bmeA to include the promoter sequence. The PCR product (4,891 bp) carrying bmeAB was ligated into the TOPO-XL cloning vector (Invitrogen Corp., Carlsbad, CA), resulting in pTPOUT25; E. coli KAM3 was transformed with pTPOUT25, and transformants were selected with kanamycin. The insertion fragment, bmeAB, of pTPOUT25 was sequenced to verify that no misamplification occurred. A truncated bmeAB was also cloned as a control, using primers MDU-1 and MDU-3 (Fig. 1). The plasmid containing the truncated bmeAB was named pTPIN5.
Susceptibility testing. The MICs of a variety of antimicrobial agents for E. coli and B. fragilis strains were determined by broth microdilution assays in LB broth (overnight assay) and GAM broth (48-h assay) (15), respectively. MICs were originally measured in a twofold dilution series and then redone with smaller dilution intervals (for example, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 µg/ml) to more accurately measure changes in MIC between the parental and mutant strains.
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We chose the four genes most homologous to Pseudomonas mexB and constructed insertion mutants using the pGERM suicide vector in an insertion-mediated mutagenesis scheme as described above. We isolated mutants FMB1, FMB241, FMB271, and FMB771, corresponding to homolog number 1, 2, 3 (BmeB), and 4, respectively (Table 3).
Susceptibilities of the four individual disruption mutants to various antimicrobial agents were determined. Changes in MIC were seen only with FMB271 (Table 4). MICs of FMB1, FMB241, and FMB771 were unchanged (data not shown). The mexB3 homolog that was disrupted in FMB271 (renamed bmeB) showed 38% identity to P. aeruginosa mexB (E value, 3.1 x 10183) (Table 3). The bmeB gene hypothetically encoded a protein with 1,067 amino acids; hydropathy analysis, using GENETYX-MAC v10.1 software (Genetyx Co., Tokyo, Japan), indicated that it contained 12 transmembrane segments, as do other RND pumps. In addition, BmeB had a high degree of similarity to consensus sequences of conserved motifs in the RND family (Fig. 2) (24). Further, a mexA homolog, named bmeA (encoding 384 amino acids; E value of 1.3 x 1035 compared to P. aeruginosa MexA), and an oprM homolog, named bmeC (E value of 3.2 x 1046 compared to P. aeruginosa OprM), were found at the adjacent upstream and downstream positions of bmeB, respectively, corresponding to the order of the mexAB-oprM operon in P. aeruginosa (22). Thus, bmeABC appeared to be a member of the mexB-type RND family of efflux pumps. Based on our finding that bmeB was important in antimicrobial efflux, we constructed disruption mutants of the other components of the bme operon as described above and listed in Table 1.
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TABLE 4. Antibiotic susceptibilities of various strainsa
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FIG. 2. Multiple sequence alignments of B. fragilis MexB1, MexB2, BmeB (MexB3), and MexB4. Conserved motifs were aligned using ClustalX 1.8 and visualized with MacBoxshade 2.15. The motifs were identified by Putman et al. (24). Black and gray shaded residues are identical and similar to each other, respectively. The consensus sequences of the motifs are displayed as follows: x, any amino acid; uppercase letters, amino acid occurring in >70% of the examined sequences; lowercase letters, amino acid occurs in >40% of sequences examined.
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TABLE 5. RT-PCR analysis of disruption mutants
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Cloning of bmeAB in E. coli. To further investigate the function of bmeAB, we cloned the entire bmeAB locus into the hypersusceptible E. coli KAM3 as a host (KAM3/pTPOUT25). A truncated portion of the gene including the C-terminal portion of bmeA and the N-terminal part of bmeB was also cloned as a negative control (KAM3/pTPIN5). MICs of various antimicrobials for E. coli transformants carrying the genes were determined (Table 4). KAM3/pTPOUT25 (carrying the intact bmeAB) showed moderately increased resistance to some of the drugs that showed lower MICs in the disruption mutant, suggesting that the genes were expressed and functional as a multidrug efflux pump in E. coli, especially for cephems, colistin, polymyxin B, and puromycin.
Effects of efflux inhibitors on the B. fragilis multidrug efflux pump. Carbonyl cyanide m-chlorophenylhydrazone (CCCP), a proton conductor, and Phe-Arg ß-naphthylamide (MC-207,110), the first specific inhibitor described for RND pumps in P. aeruginosa, were used to characterize the BmeAB pump (10, 26). As shown in Table 6, addition of either CCCP or MC-207,110 resulted in two- to fourfold-lower MICs of cephalexin, polymyxin-B, fusidic acid, and novobiocin for the parental strain. These effects occurred at concentrations well below the inhibitory concentrations of either CCCP or MC-207,110. When the BmeB pump was disrupted (FMB 271), the effects of CCCP and MC-207,110 were not seen. As CCCP is a proton pump inhibitor, this suggests that the BmeB pump is driven by a proton gradient, consistent with other RND pumps. The finding that FMB271 is still fairly resistant to certain agents suggests that there are other pumps that are active in efflux of these agents. However, it appears that bmeB is the only pump affected by CCCP and MC-207,110 that is active in efflux of these agents. Apparently, the other pumps were not affected by these two efflux inhibitors. Further study will more fully resolve these issues.
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TABLE 6. Susceptibility of the BmeB pump to potential inhibitorsa
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We constructed disruptions of four B. fragilis mexB homologs to evaluate their contribution to antimicrobial resistance. We chose the genes to be disrupted by ranking in order of degree of homology with P. aeruginosa mexB. Of these mexB-like disruption mutants, FMB271 was the only mutant that was more susceptible than the parental strain for the drugs tested. There are several possible explanations for these results. First, only 4 of the 16 mex-like homologs were tested. Although these were the four homologs most like Pseudomonas mexB, other homologs may be important. Second, the drugs tested might not be the appropriate substrates for the pumps investigated. Third, potential mexB homologs may not be expressed constitutively and may be "silent" or unexpressed under the conditions tested. Also, any efflux pump impaired by mutation may be compensated for by increased action of the other pumps.
Analysis of the disruption mutants of the bme homolog (homolog 3) indicated that the genes are transcribed in a polycistronic manner. Analysis of the susceptibility patterns of the various disruptants is consistent with the results of the transcription analysis. Thus, if bmeA is disrupted, none of the downstream genes is transcribed. The patterns of FMA1, FMB271, and FMAB1 (in which transcription of both bmeA and bmeB [FMA1] or bmeB [FMB271 and FMAB1] are disrupted) are similar. The pattern of FOM1 (the outer membrane channel disruptant), in which both bmeA and bmeB are transcribed, is similar to that of the parental strain, suggesting that another outer membrane channel may be utilized when bmeC is unavailable. This pattern is also seen with other MDR pumps (31).
Gene arrangement of the MDR pumps in B. fragilis differs from other well-characterized systems. In P. aeruginosa, 17 possible RND family secondary transporters have now been identified (http://www.membranetransport.org/). Among them, at least six RND efflux pumps (MexAB-OprM, MexCD-OprJ, MexEF-OprN, MexXY-OprM, MexHI-OpmD, and MexJK-OprM) have been characterized (2, 11, 22, 29, 31). In Pseudomonas MDR pump operons, genes encoding the RND transporter (MexB homolog) and periplasmic membrane fusion protein (MexA homolog) are always present, while the gene encoding the OM channel (OprM homolog) is not always present (34). In E. coli RND pumps, the genes for transporter and membrane fusion proteins (acrAB) occur together as an operon, and the gene for the TolC OM channel occurs elsewhere on the genome (34). In contrast, each of the 16 MDR pump operons in B. fragilis contains all three of the components of the tripartite pump complex. In addition, to our knowledge, there are no other homologs in which the OprM portion is transcribed as a fusion protein at the end of MexB (Mex10).
Pseudomonas MexAB-OprM is expressed constitutively in cells under the standard conditions and contributes to intrinsic resistance to many antimicrobials; its disruption mutant becomes hypersusceptible to various antimicrobial agents, indicating a significant level of expression of this operon in the wild-type strain (9, 17). To date, none of the pumps we identified in B. fragilis appeared to have such a significant effect on the susceptibility of the organism. However, it is possible that insertion mutagenesis of one pump gene may be compensated for by increased expression of another pump gene. Investigations are under way with multiple deletion mutants and assays of pump transcription and expression to further investigate this possibility. Also, we are investigating the role of potential regulators in pump expression. While our early searches with E. coli AcrR and P. aeruginosa MexR (efflux pump regulators) (23) did not reveal any homologs in B. fragilis, subsequent analysis using a MexR conserved domain sequence revealed at least two potential regulators (one adjacent to Mex homolog 10 and one adjacent to Mex homolog 15). Subsequently, the AcrR consensus sequence was used to BLAST search the NCBI Protein database; the resulting hits above an E value threshold of e8 (247 sequences) were then used to BLAST search the B. fragilis ATCC 25285 genome at the Sanger Center, resulting in three additional putative homologs. One of these potential regulators is immediately upstream of the mex5 operon. Mutations within the repressor have been shown to lead to overexpression of the corresponding efflux pumps in other organisms (17). Experiments to determine the effect of disrupting these selected regulator genes in B. fragilis are under way.
Phenograms indicating the phylogenetic relatedness of these proteins to the E. coli and P. aeruginosa efflux pumps were constructed (data not shown). The 16 pumps can be roughly separated into three groups, and the groups are generally, but not always, consistent among the MexB, MexA, and OprM families. Mex 1, Mex 2, Bme, and Mex 4 are the most homologous to P. aeruginosa MexAB-OprM, and thus were initially chosen for the disruption experiments. Among the OprM homologs, nine have the typical conserved domain structure (two adjacent OEP [outer membrane efflux protein] motifs) and seven have some combination of an OEP and/or TolC motif (but not necessarily a double OEP). The MexA and MexB homologs all have the expected motifs.
To date, the only multidrug efflux pump described in Bacteroides has been BexA (12, 13) (a MATE family pump) in B. thetaiotaomicron. XepCAB (6), an RND family pump, has been described in P. gingivalis (16), a related gram-negative anaerobic rod. XepCAB was the first example of an RND pump in an anaerobic organism, and the order of genes in the operon was xepC, xepA, and xepB. With B. fragilis, we have identified at least 16 RND-type pumps in the genome. We have constructed disruptions in four of these pumps. Thus far, we have demonstrated efflux activity only with the BmeABC homolog. B. fragilis and the related anaerobe, B. thetaiotaomicron, carry numerous homologs of a variety of pump genes; both genera also carry many MATE family efflux pumps, and B. thetaiotaomicron contains 60 proteins predicted to be components of drug efflux systems (13, 33). The sheer number of pump genes carried by both B. fragilis and B. thetaiotaomicron suggests that active efflux is a major mechanism underlying antimicrobial resistance in these anaerobes. Future studies will involve systematic investigation on the function and expression of each of the efflux pump homologs of the various families in the genome.
This study was supported by a Scientific Research Special Grant from Matsumoto Dental University (to O.U.), by a Grant-in-Aid for Scientific Research (C) (15591957 to F.Y.) from the Japan Society for the Promotion of Science (JSPS) and the AGU High-Tech Research Center Project for Private Universities, by a matching fund subsidy from MEXT (Ministry of Education, Culture, Sports, Science and Technology), Japan (1001 to O.U. and F.Y.), and by Merit Review Funds from the U.S. Department of Veterans Affairs (to H.M.W.).
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