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Antimicrobial Agents and Chemotherapy, December 2006, p. 4070-4076, Vol. 50, No. 12
0066-4804/06/$08.00+0 doi:10.1128/AAC.00799-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Institute of Microbiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
Received 3 July 2006/ Returned for modification 26 August 2006/ Accepted 21 September 2006
| ABSTRACT |
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| INTRODUCTION |
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Specific resistance only to lincosamides is due to enzymatic inactivation of the antibiotic. Genes lnu(A) and lnu(A') (formerly lin), encoding lincosamide O-nucleotidyltransferase, have been described for Staphylococcus haemolyticus and Staphylococcus aureus, respectively (9, 10). Another five variants of lincomycin nucleotidyltransferases inactivating lincosamides by adenylation have been reported for gram-positive (1, 8) and gram-negative (18, 39) microorganisms. With the exception of the gene lnu(F), conferring cross-resistance to lincomycin and clindamycin in Escherichia coli, the lnu genes confer resistance only to lincomycin, although their protein products modify and inactivate both lincomycin and clindamycin (1, 21).
Proteins belonging to either the major facilitator or the ATP-binding cassette (ABC) family can mediate the active efflux of lincosamides. A member of the major facilitator family, Lmr(A), confers resistance to lincomycin in the lincomycin producer Streptomyces lincolnensis (43). The lmr(A) gene is part of the chromosomal lincomycin production gene cluster, as is the other lincosamide resistance gene, lmr(C), which belongs to the ABC transporter family (26). Other members of this family have been reported for clinical isolates. The lsa(A) gene is responsible for the characteristic intrinsic resistance to lincosamides and streptogramin A (LSA resistance phenotype) in Enterococcus faecalis (15, 35). A related determinant, lsa(B), has been observed on a plasmid in Staphylococcus sciuri. The protein Lsa(B) is 41% identical and 69% similar to Lsa(A) and confers resistance to clindamycin; the potential resistance to streptogramin A was not tested (19). The vga genes have been characterized as determinants of streptogramin A resistance. Nevertheless, a study by Chesneau et al. (13) has recently confirmed the ability of vga(A) and vga(A)V (83.2% nucleotide identity) to confer low-level lincomycin resistance in S. aureus and Staphylococcus epidermidis, and it has been suggested that the LSA phenotype occasionally found in staphylococcal isolates may be due to these elements. Another vga gene, vga(B), has 59% nucleotide identity with vga(A) and confers only low-level resistance to streptogramin A but substantially increases the level of resistance to pristinamycin, a mixture of streptogramin A and streptogramin B (4, 13). A new determinant, vmlR, conferring inducible virginamycin M (streptogramin A) and lincomycin resistance has been found in Bacillus subtilis (24). The predicted amino acid sequence of VmlR has 32%, 33%, and 29% amino acid identity to Vga(B), Vga(A), and Lmr(C), respectively. All of the mentioned ABC proteins, i.e., Lmr(C) Lsa, Lsa(B), Vga(A), Vga(A)v, Vga(B), and Vml(R), together with Msr(A), Msr(C), and Orf5, have been classified as class 2 ABC transporters (14). Proteins of this subfamily have duplicated ATP-binding domains and lack any obvious membrane-spanning domain, raising questions about their ability to function as drug exporters (14, 20, 30).
In a previous study, we screened methicillin-resistant coagulase-negative staphylococci from the Czech Republic for the presence of macrolide and/or lincosamide resistance and subsequently for some of the respective resistance genes, erm(A), erm(C), msr(A), and lnu(A) (23). We noted that 10 genetically related Staphylococcus haemolyticus isolates, resistant to lincomycin and clindamycin (LC) but susceptible to erythromycin, failed to hybridize to any of the above-mentioned resistance gene probes. In this study, we tested the possible mechanisms of lincosamide resistance in these strains. Consequently, we isolated and characterized a new variant of the streptogramin A resistance gene, vga(A)LC, encoding an ABC transporter with shifted substrate specificity in favor of lincosamides. In addition, a region determining the substrate specificity of Vga(A) and Vga(A)LC has been localized in the interdomain sections of the proteins.
| MATERIALS AND METHODS |
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Antibiotic susceptibility testing. Lincomycin and clindamycin were purchased from Sigma-Aldrich (St. Louis, Mo.). Separate compounds of streptogramins pristinamycin IIA (PIIA) and pristinamycin IA (PIA) and their combination (PRI) were kindly provided by Aventis Pharma (Vitry-sur-Seine, France). MICs of antibiotics were determined by the agar dilution method (37) after 24 h of incubation at 37°C. A 10-µl inoculum of a 0.5 McFarland suspension was spotted on Mueller-Hinton agar with a twofold dilution series of the antibiotics at the following concentrations: LIN, 0.125 to 256 µg/ml; P, PIA, and PIIA, 0.125 to 64 µg/ml; and CLI, 0.125 to 16 µg/ml. For recombinant strains, the MICs were determined three times in parallel after 48 h of incubation.
Lincosamide inactivation. Lincomycin inactivation by resting cells was determined in a liquid medium as described previously, with modifications (21, 28). Cells were resuspended in 0.01 M phosphate buffer (pH 7.0) to an absorbance of 2 at 600 nm. Aliquots (50, 25, 10, 5, and 1 ml) of the cell suspension were centrifuged and resuspended in 1 ml of 0.01 M phosphate buffer containing 80 µg/ml lincomycin. After a 24-h incubation at 37°C, 20 µl of the mixture was spotted onto a paper disc, and inactivation was determined by the Gots test (16) with Kocuria rhizophila CCM552 as the indicator organism.
DNA manipulations. Total DNA was isolated from staphylococcal strains as described previously (23). E. coli plasmids, DNA fragments, and PCR products were purified using the Wizard Plus Midipreps DNA purification system and Wizard SV gel and PCR Clean-Up system (Promega, Madison, WI). The PCR primers (Sigma-Genosys, Steinhein, Germany) used in the study are listed in Table 1. Cycle conditions varied according to the empirical melting temperature of the primers and expected length of the product. Amplifications with the degenerate primers, used to search for the determinant of resistance to both lincomycin and clindamycin but susceptibility to erythromycin (LC resistance), were done in triplicate at different annealing temperatures (48, 52, and 58°C) in a T-gradient cycler (Biometra, Göttingen, Germany). All PCR products were sequenced directly, after separation by agarose gel electrophoresis and extraction from the gel. Control sequencing of cloned vga(A), vga(A)LC, and their hybrids was carried out with the primers listed in Table 1. Labeling of probes and hybridization experiments were performed as described previously (23).
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Preparation of constructs for Vga(A) and Vga(A)LC expression. Amplification and cloning of the genes vga(A) and vga(A)LC were performed as described previously (13). For amplification of a full-length sequence of vga(A)LC, forward primer vgaLBamF (Table 1) was used instead of the primer VG1-F. Amplicons were inserted into pBluescript II KS, giving plasmids pJVA and pJVALC, respectively. The plasmids were used for construction of protein hybrids by reciprocal exchanges of BamHI/BsaBI fragments encoding the N-terminal parts and/or XbaI fragments encoding the C-terminal parts of Vga(A) and Vga(A)LC proteins (Table 2). The correctness of all constructs was verified by DNA sequencing of replaced regions. The BamHI/EcoRI fragments encoding full-length proteins were subcloned into the shuttle vector pRB374 (11) and electroporated in to Staphylococcus aureus RN4220 as described previously (34).
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Nucleotide sequence accession number. The nucleotide sequence of the vga(A)LC gene has been submitted to GenBank under accession no. DQ823382.
| RESULTS |
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Inactivation was tested on three LC-resistant S. haemolyticus isolates (CCM7296, 61UL, and 1051KR). The lincomycin-resistant strain S. haemolyticus 123PL, in which lincomycin is inactivated due to lnu(A), and S. aureus ATCC 25923 served in the experiment as positive and negative controls, respectively. No inactivation of lincomycin was detected in the three isolates analyzed or in the negative control strain, in contrast to complete antibiotic inactivation in the positive control.
Search for and identification of a new variant of the vga(A) resistance gene. A set of degenerate PCR primers was designed according to the sequence alignment of resistance proteins Lsa(A), Lsa(B), Lmr(C), Msr(A), Vga(A), and Vga(A)V of the ABC transporter class 2 family, which were selected for their lincosamide substrate specificity and/or for their origin in staphylococci. The primers were so designed in order to positively discriminate the proteins Lsa(A) and Lsa(B) for their lincosamide substrate specificity (see ABC primers in Table 1). Twenty-four combinations of sense and antisense primers were tested on genomic DNA of LC-resistant S. haemolyticus CCM7296. Amplifications resulted in nine different products, with six of them being identified by sequencing. Two overlapping fragments, A (709 bp) and B1 (652 bp), amplified from the primers ABC2aF-ABC1bR and ABC2bF-ABC1bR, respectively, corresponded to the sequence of the resistance gene vga(A), as well as the 154-bp fragment B2, which was synthesized as a side product of B1. Sequence C (primer pair ABC4F-ABC4bR) was 100% homologous to the sequence encoding the hypothetical ABC transporter SH2642 from S. haemolyticus JCSC1435. Based on Blastx analysis, two sequences, D1 and D2, amplified from the primer pair ABC2aF-ABC1aR, have 92% amino acid identity with a hypothetical protein similar to glycosyltransferase SH0332 and 93% amino acid identity with the GTP-binding elongation factor homolog SH1843 from S. haemolyticus JCSC1435, respectively.
A correlation with the LC phenotype was confirmed by dot blot hybridization only for vga(A)-related sequences: the vga(A)-specific hybridization probe hybridized with the total DNAs of all 10 LC-resistant isolates and simultaneously failed to hybridize with the DNAs of 15 LC-susceptible S. haemolyticus isolates. Conversely, hybridization with probes specific for sequences C and D1 did not show any correlation with the LC phenotype.
Sequencing of part of the 5-kb ClaI/NcoI insert isolated from lincosamide-resistant S. haemolyticus CCM7296 (see Materials and Methods) revealed a 1,569-bp-long open reading frame differing from the published sequence of vga(A) (5) by 10 nucleotide substitutions, and 7 of these resulted in changes at the amino acid level (Table 2). Five of them (L212S, G219V, A220T, G226S, and S247R) are concentrated in a central region between two ATP-binding domains, and two (M4L and N9H) are situated at the extreme N terminus of the protein. The variant of the gene vga(A), suspected to confer resistance to both lincosamides in S. haemolyticus, was named vga(A)LC.
Upstream (575-bp) and downstream (548-bp) regions surrounding the gene vga(A)LC were homologous to the plasmid sequences of pIP1629 (98% identity, AF045240) and pIP680 (99% identity, AF117259), respectively, indicating the plasmid location of the gene.
Resistance to streptogramins in strains with vga(A)LC. The genes vga have been characterized as determinants of streptogramin A resistance. Consequently, susceptibilities to pristinamycin IIA (streptogramin A), pristinamycin IA (streptogramin B), and pristinamycin (mixture of streptogramins A and B) were tested in all 58 clinical isolates of S. haemolyticus described in a previous study. In addition to 10 strains with the LC phenotype and harboring vga(A)LC, another 5 isolates were found to be resistant to PIIA. These five strains were also resistant to both lincosamides, but the LC phenotype was masked by the presence of additional resistance genes (Table 3). The gene vga(A)LC was confirmed by PCR and by sequencing in all 15 isolates simultaneously resistant to lincosamides and streptogramin A. As summarized in Table 3, if the gene vga(A)LC was present alone, MICs of LIN and CLI were 32 µg/ml and 8 µg/ml, respectively, whereas the additional presence of the resistance gene lnu(A) or erm(C) increased the MIC of lincomycin and possibly that of clindamycin. Resistance to PRI (MIC = 8 µg/ml), detected in three strains, was caused by the presence of the resistance gene vga(A)LC conferring resistance to PIIA, together with the gene erm(C) or msr(A) conferring resistance to PIA (MIC = 64 µg/ml).
Heterologous expression and analysis of the resistance gene vga(A)LC. To decide whether the gene vga(A)LC is able to confer resistance to lincosamides more efficiently than vga(A), both genes were introduced into antibiotic-susceptible S. aureus RN4220 (Table 2). The MICs of lincosamides for S. aureus RN4220 harboring vga(A) increased from 1 to 2 µg/ml for LIN and from 0.125 to 0.25 µg/ml for CLI (twofold). However, the gene vga(A)LC increased the MIC of LIN from 1 to 8 µg/ml (8-fold) and that of CLI from 0.125 to 2 µg/ml (16-fold). In contrast, resistance to PIIA was higher in the transformants harboring vga(A) (16-fold increase of MIC, from 2 to 32 µg/ml) than it was in S. aureus RN4220 with the gene vga(A)LC (4-fold increase of MIC, from 2 to 8 µg/ml). To distinguish precisely which of the seven amino acid substitutions was responsible for the alteration of the phenotype, a set of protein hybrids of Vga(A) and Vga(A)LC was constructed. Three appropriate DNA fragments (encoding the N-terminal part with two amino acid substitutions [M4L and N9H], the central part with four amino acid substitutions [L212S, G219V, A220T, and G226S], and the C-terminal part with one substitution [S247R]) were combined (Table 2), and the plasmid constructs were transformed into S. aureus RN4220. Whereas derivatives with four central amino acid residues (L212, G219, A220, and G226) corresponding to Vga(A) conferred significant resistance only to pristinamycin IIA, all derivatives with the central part corresponding to Vga(A)LC (amino acid residues S212, V219, T220, and S226) conferred moderate resistance to both lincosamides and pristinamycin IIA (Table 2). Interestingly, the Vga(A)LC-derived hybrids Vga(A)LCba and Vga(A)LCbaxa, with N-terminal amino acid residues corresponding to Vga(A) (M4 and N9), conferred resistance to lincosamides and streptogramin A even more effectively than wild-type Vga(A)LC when expressed in a heterologous host.
The biochemical properties of Vga(A)LC in its original host were studied. The uptake of [3H]LIN in S. haemolyticus harboring vga(A)LC was compared with that in LC-susceptible S. haemolyticus 74OV (Fig. 1). The results showed that (i) the lincosamide-susceptible strain accumulated about a twofold-higher level of the drug than did the resistant strain and (ii) in the resistant strain, the addition of 1 mM CCCP increased the accumulation to the level in the susceptible strain.
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| DISCUSSION |
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Since we had disproved that the resistance involved a mutation in the target site or inactivation of lincosamides, this pointed to the presence of some efflux mechanism in these S. haemolyticus isolates. Subsequently, we identified a new variant of the Vga(A) protein, in spite of the degenerate primers being designed to prefer the Lsa protein group for their apparent lincosamide substrate specificity. The new variant, Vga(A)LC, differing from the Vga(A) in seven amino acid substitutions, was present exclusively in lincomycin-resistant (MIC =
32 µg/ml), clindamycin-resistant (MIC =
4 µg/ml), and pristinamycin IIA-resistant (MIC = 32 µg/ml) S. haemolyticus isolates. This strong correlation of the LSA phenotype with the presence of the gene vga(A)LC suggested that the gene conferred resistance to both lincosamides.
Accordingly, we proved that the gene vga(A)LC from S. haemolyticus CCM7296 increased the level of resistance to both lincosamides when introduced into antibiotic-susceptible S. aureus RN4220. Nevertheless, the resistance did not reach the levels found in the original host. Despite this, we propose that vga(A)LC is responsible for the significant resistance to both lincosamides and streptogramin A in LC-resistant S. haemolyticus strains. It has been previously described that the level of resistance conferred by this type of ABC transporter depends on the host organism. Chesneau et al. (13) have reported a fourfold increase of MICs of LIN and a twofold increase of MICs of CLI in S. aureus RN4220 but an eightfold increase for both lincosamides in S. epidermidis BM3302 after vga(A) transformation. On the other hand, MICs of PIIA due to vga(A) were identical (MIC = 32 µg/ml) for both S. aureus RN4220 and S. epidermidis BM3302. Host-dependent expressions of resistance have also been reported in other studies on class 2 ABC transporters (13, 29, 33), and the level of resistance could depend on different expression in the heterologous host or on inadequate interaction with a putative partner encoded by the host chromosome (13). As mentioned above, class 2 ABC proteins contain two ATP-binding domains but lack an identifiable transmembrane domain. The two ABC domains are separated by an interdomain section, which tends to be rich in glutamine and other hydrophilic amino acids, with a characteristic periodic spacing of hydrophobic residues (41). The so called "Q linker" was found in Msr(A), Msr(C), and Vga(B), but it is not typical for Vga(A) proteins, where the proportion of glutamine in the inter-ATP-binding domain region is similar to that found in the rest of the protein (5). Experiments investigating the function of the ABC domains indicated an essential structural or functional role of the interdomain region (13, 31). In the present study, we demonstrated the importance of this spacer for antibiotic recognition: four amino acid residues concentrated into a mere 15-amino-acid region are crucial for determining the phenotype, i.e., for determining substrate specificity (Table 2). Moreover, the hybrid proteins Vga(A)LCba and Vga(A)LCbaxa were even more effective than the wild-type Vga(A)LC. One of the explanations for this is that these two residues situated at the N terminus of the first ABC domain allow for a better adaptation of Vga(A)LC to the heterologous S. aureus environment, probably by improving the interaction with a putative transmembrane partner.
Chesneau et al. (13) have found that the Vga(A) protein was colocalized with the ß subunit of the F1F0 ATPase in the membrane fractions of staphylococcal cells. In the same work, resistance patterns and localization of truncated versions of Vga(A) and its chimeras with Msr(A) protein were studied. None of the studied plasmid constructs promoted the resistance; nevertheless, chimeras of Vga(A) and Msr(A) were found in the membrane fraction. This indicates that ABC domains could mediate an interaction with the membrane, or a membrane-located partner, independent of the integrity of the interdomain region that is most probably essential for antibiotic recognition.
In an analogous way to the experiments on Msr(A) (22, 32), we observed a decreased accumulation of [3H]lincomycin in the lincosamide-resistant S. haemolyticus CCM7296 compared to the susceptible strain (Fig. 1). Likewise, the proton conductor CCCP had the same effect as in the case of Msr(A). However, it is still not clear if the "efflux" observed with Msr(A) and Vga(A) is due to the active transport of the drug. Alternatively, it could be just a consequence of the decreased accumulation of the ribosome-associated drug in the cells, caused by a reduced accessibility of the ribosomal target to macrolide-lincosamide-streptogramin B antibiotics (20, 30). Nevertheless, we expect that the mechanism of lincosamide resistance in S. haemolyticus, no matter what that should turn out to be, is identical to that conferred by Msr(A) for erythromycin (22, 32). The consistency of the resistance mechanisms supports the conclusion that LC resistance is conferred solely by Vga(A)LC in S. haemolyticus.
| ACKNOWLEDGMENTS |
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This work was supported by the Czech Science Foundation (grant no. 204/04/0801), the Ministry of Education, Youth and Sports of the Czech Republic (grant 1M06011), and Institutional Research Concept (grant AVOZ50200510). S. aureus NRS144 (RN4220) was obtained through the Network on Antimicrobial Resistance in Staphylococcus aureus (NARSA) Program, supported under NIAID/NIH contact no. N01-Al-95359.
| FOOTNOTES |
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Published ahead of print on 2 October 2006. ![]()
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ková, P. 1998. Rezistence bakterií k antibiotik
m. Vybrané metody. Trios, Prague. [In Czech.]This article has been cited by other articles:
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