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Transcription of the Corynebacterium diphtheriae hmuO gene is regulated by iron and heme.

The hmuO gene is required for the utilization of heme and hemoglobin as iron sources by Corynebacterium diphtheriae. The product of hmuO has homology to eukaryotic heme oxygenases which are involved in the degradation of heme and the release of iron. To investigate the mechanism of hmuO regulation, a promoterless lacZ gene present on the promoter-probe vector pCM502 was placed under transcriptional control of the hmuO promoter. In C. diphtheriae C7, optimal expression from the hmuO promoter was obtained only in the presence of heme or hemoglobin under low-iron conditions. Expression of hmuO in high-iron medium containing heme was repressed five- to sixfold from that seen under low-iron conditions in the presence of heme. Transcription from the hmuO promoter in the absence of heme or hemoglobin was fully repressed in high-iron medium and was expressed at very low levels in iron-depleted conditions. Expression studies with tile hmuO-lacZ fusion construct in C7hm723, a dtxR mutant of C7, and in a hmuO mutant of C. diphtheriae HC1 provided further evidence that transcription of the hmuO promoter is repressed by DtxR and iron and activated by heme. In Escherichia coli, the hmuO promoter was expressed at very low levels under all conditions examined. Gel mobility shift assays and DNase I footprinting experiments indicated that DtxR binds in a metal-dependent manner to a sequence that overlaps the putative hmuO promoter. Total cellular RNA isolated from C. diphtheriae was used to identify the transcriptional start site for the hmuO gene. Northern blot analysis suggested that the hmuO mRNA was monocistronic and that transcription was heme inducible.

Artificial Gene Fusion↗

DNA element of Corynebacterium diphtheriae with properties of an insertion sequence and usefulness for epidemiological studies.

The segment of DNA which is inserted within the tox gene of bacteriophage gamma and is responsible for its Tox- phenotype was found to be present and repeated approximately 30 times in the chromosome of Corynebacterium diphtheriae Belfanti 1030. Other C. diphtheriae strains contained a variable number of copies (1 to 25) of the same element. Sequence analysis showed that this repeated and interspersed DNA element was flanked by 9-base-pair direct repeats and that the 5' and 3' ends of the insertion contained sequences forming an imperfect inverted repeat. Therefore, the DNA segment here described has most of the typical structural features of a bacterial insertion sequence element. We show that different C. diphtheriae isolates derived from the same outbreak of diphtheria have an identical genomic distribution of this DNA element and that such DNA can be useful for epidemiological studies.

Base Sequence↗

Cloning and expression in Escherichia coli of three fragments of diphtheria toxin truncated within fragment B.

We have constructed three different truncated versions of diphtheria toxin (a 535-amino-acid polypeptide) which correspond to the N-terminal 290, 377, and 485 amino acids of the toxin. These lengths include one, three, and all four of the putative membrane-spanning sequences of the toxin which are thought to play a role in the translocation of fragment A into cells. Each of these three genes has been modified at its 3' end to code for a C-terminal cysteine (to allow for disulfide linkage of a targeting ligand) or a gene fusion with alpha-melanocyte-stimulating hormone. We have also substituted the native diphtheria tox promoter (ptox) with the lambda pR promoter in an effort to overexpress these proteins. The truncated genes are expressed in Escherichia coli from both the tox promoter in a constitutive fashion and from the pR promoter by using the heat-inducible cI857 repressor. The clones produce proteins which react with anti-diphtheria toxin serum, which migrate at the anticipated Mr on Western blots, and which have ADP-ribosyltransferase activity. Constitutive synthesis from ptox leads to severe proteolytic degradation even in a protease-deficient strain. High-level expression from the pR promoter in the same lon htpR strain allows the full-length polypeptides to accumulate but also stops the growth of the cells. It appears that removal of as few as 50 amino acids from the C-terminus of diphtheria toxin alters its conformation, making it a target for proteases and causing overexpression lethality in the host cells.

Cloning, Molecular↗

Corynebacterium imitans sp. nov. isolated from patients with suspected diphtheria.

A 5-month-old boy of a Romanian family traveling via Ukraine to Poland developed a respiratory disease that resembled and that was initially diagnosed as pharyngeal diphtheria. The child recovered after treatment with antidiphtheria antitoxin. A coryneform bacterium had been isolated from a nasopharyngeal specimen from the child and was initially identified as an atypical Corynebacterium diphtheriae strain. Seven adults who had contact with either the child or an adult contact person also developed symptoms of pharyngeal diphtheria, were also treated with antitoxin, and recovered uneventfully. Coryneform bacteria similar to that originating from the index patient were also isolated from the throat swabs of three adults. Detailed biochemical and chemotaxonomic investigations revealed that the coryneform bacteria belonged to the genus Corynebacterium and could be differentiated from all other defined species of this genus. Ribotyping and pulsed-field gel electrophoresis demonstrated that all four patients' isolates were of clonal origin. The diphtheria toxin gene and its product were not detected either by PCR assays or by the Elek test, making a possible disease association of the Corynebacterium more unlikely. Comparative 16S rRNA gene sequence analysis revealed that the coryneform bacterium represented a new subline within the genus Corynebacterium, for which the name Corynebacterium imitans sp. nov. is proposed. The type strain is NCTC 13015 (DSM 44264; CCUG 36877).

Corynebacterium↗

Enhanced ceramide generation and induction of apoptosis in human leukemia cells exposed to DT(388)-granulocyte-macrophage colony-stimulating factor (GM-CSF), a truncated diphtheria toxin fused to human GM-CSF.

DT(388)-GM-CSF, a targeted fusion toxin constructed by conjugation of human granulocyte-macrophage colony-stimulating factor (GM-CSF) with the catalytic and translocation domains of diphtheria toxin, is presently in phase I trials for patients with resistant acute myeloid leukemia. HL-60/VCR, a multidrug-resistant human myeloid leukemia cell line, and wild-type HL-60 cells were used to study the impact of DT(388)-GM-CSF on metabolism of ceramide, a modulator of apoptosis. After 48 hours with DT(388)-GM-CSF (10 nM), ceramide levels in HL-60/VCR cells rose 6-fold and viability fell to 10%, whereas GM-CSF alone was without influence. Similar results were obtained in HL-60 cells. Examination of the time course revealed that protein synthesis decreased by about 50% and cellular ceramide levels increased by about 80% between 4 and 6 hours after addition of DT(388)-GM-CSF. By 6 hours this was accompanied by activation of caspase-9, followed by activation of caspase-3, cleavage of caspase substrates, and chromatin fragmentation. Hygromycin B and emetine failed to elevate ceramide levels or induce apoptosis at concentrations that inhibited protein synthesis by 50%. Exposure to C(6)-ceramide inhibited protein synthesis (EC(50) approximately 5 microM) and decreased viability (EC(50) approximately 6 microM). Sphingomyelinase treatment depleted sphingomyelin by about 10%, while increasing ceramide levels and inhibiting protein synthesis. Diphtheria toxin increased ceramide and decreased sphingomyelin in U-937 cells, a cell line extremely sensitive to diphtheria toxin; exposure to DT(388)-GM-CSF showed sensitivity at less than 1.0 pM. Diphtheria toxin and conjugate trigger ceramide formation that contributes to apoptosis in human leukemia cells through caspase activation and inhibition of protein synthesis.

Acute Disease↗

Malaria chemoprophylaxis and the serologic response to measles and diphtheria-tetanus-whole-cell pertussis vaccines.

BACKGROUND: Acute malaria has been associated with a decreased antibody response to tetanus and diphtheria toxoids, meningococcal, salmonella, and Hib vaccines. Interest in giving malaria drug therapy and prevention at the time of childhood immunizations has increased greatly following recent trials of intermittent preventive therapy during infancy (IPTi), stimulating this re-analysis of unpublished data. The effect of malaria chemoprophylaxis on vaccine response was studied following administration of measles vaccines and diphtheria-tetanus-whole cell pertussis (DTP) vaccines. METHODS: In 1975, six villages divided into two groups of children < or = 74 months of age from Burkina Faso, were assigned to receive amodiaquine hydrochloride chemoprophylaxis (CH+) every two weeks for seven months or no chemoprophylaxis (CH-). After five months, children in each group received either one dose of measles or two doses of DTP vaccines. RESULTS: For recipients of the measles vaccine, the seroconversion rates in CH+ and CH- children, respectively, were 93% and 96% (P > 0.05). The seroresponse rates in CH+ and CH- children respectively, were 73% and 86% for diphtheria (P > 0.05) and 77% and 91% for tetanus toxoid (P > 0.05). In a subset analysis, in which only children who strictly adhered to chemoprophylaxis criteria were included, there were, likewise, no significant differences in seroconversion or seroresponse for measles, diphtheria, or tetanus vaccines (P > 0.05). While analysis for pertussis showed a 43% (CH+) and 67% (CH-) response (P < 0.05), analyses using logistic regression to control for sex, age, chemoprophylaxis, weight-for-height Z-score, and pre-vaccination geometric mean titer (GMT), demonstrated that chemoprophylaxis was not associated with a significantly different conversion rate following DTP and measles vaccines. Seven months of chemoprophylaxis decreased significantly the malaria IFA and ELISA GMTs in the CH+ group. CONCLUSION: Malaria chemoprophylaxis prior to vaccination in malaria endemic settings did not improve or impair immunogenicity of DTP and measles vaccines. This is the first human study to look at the association between malaria chemoprophylaxis and the serologic response to whole-cell pertussis vaccine.

Amodiaquine↗

IgG and IgG subclass specific antibody responses to diphtheria and tetanus toxoids in newborns and infants given DTP immunization.

To evaluate immune responses to diphtheria and tetanus toxoids in infants we used enzyme-linked immunosorbent assays to detect total IgG and specific IgG-1, IgG-2, IgG-3, and IgG-4 antibody. One group of infants received a newborn dose and subsequently received the usual three doses of DTP. A second group of infants received only the routine dosage at 2, 4, and 6 months of age. In sera acquired at birth, 6, and 9 months of age, there were no statistically significant differences between the two vaccine groups in IgG antibody responses to diphtheria or tetanus, or in IgG subclass tetanus-specific antibody responses. In individual children, tetanus-specific subclass responses were similar in pattern to that for total IgG tetanus antibody, i.e. each IgG subclass response appeared to be regulated by similar mechanisms in that child, but the regulation differed between children. In contrast to a prior study of pertussis immunity, maternally acquired antibody did not significantly affect immune responses to diphtheria or tetanus toxoid by 9 months of age. There was no discernible tolerance due to early tetanus or diphtheria immunization or to high levels of maternally acquired antibody.

Antibodies, Bacterial↗

Protein translocation by bacterial toxin channels: a comparison of diphtheria toxin and colicin Ia.

Regions of both colicin Ia and diphtheria toxin N-terminal to the channel-forming domains can be translocated across planar phospholipid bilayer membranes. In this article we show that the translocation pathway of diphtheria toxin allows much larger molecules to be translocated than does the translocation pathway of colicin Ia. In particular, the folded A chain of diphtheria toxin is readily translocated by that toxin but is not translocated by colicin Ia. This difference cannot be attributed to specific recognition of the A chain by diphtheria toxin's translocation pathway because the translocation pathway also accommodates folded myoglobin.

Colicins↗

Reduced-antigen combined diphtheria-tetanus-acellular pertussis vaccine (Boostrix).

The reduced-antigen combined diphtheria-tetanus-acellular pertussis vaccine (dTpa) is intended for use as a booster dose in individuals aged > or =4 years. A single dose of dTpa elicited generally similar levels of antibodies against pertussis antigens (pertussis toxoid [PT], filamentous haemagglutinin [FHA] and pertactin [PRN]) as a similar monovalent pertussis booster vaccine (ap) in adolescents or adults, irrespective of their prevaccination serological status or vaccination history. Levels of antibodies directed against diphtheria toxoid were similar in recipients of dTpa or a licensed reduced-antigen combined diphtheria-tetanus booster vaccine (Td). However, levels of antitetanus antibodies were significantly higher in recipients of Td vaccines compared with those receiving dTpa. Similar serological response rates were observed for anti-PT, -FHA and -PRN between those receiving dTpa or ap and a similar high percentage of recipients of dTpa and the Td vaccines had seroprotective levels of antibodies against diphtheria and tetanus toxoid. The most frequently reported local adverse reactions following immunisation with dTpa included pain, redness and swelling; general symptoms included fatigue, headache and fever.

Clinical Trials as Topic↗

Reduced-antigen, combined diphtheria-tetanus-acellular pertussis vaccine, adsorbed (Boostrix) US formulation): use as a single-dose booster immunization in adolescents aged 10-18 years.

black triangle Boostrix US formulation (hereafter referred to as Tdap) is a formulation of reduced-antigen, combined diphtheria-tetanus-acellular pertussis vaccine, adsorbed onto aluminium approved in the US for use as a single-dose booster immunization in adolescents aged 10-18 years. The diphtheria and tetanus toxoid components of Tdap elicited serologic immune responses comparable to those induced by an approved diphtheria-tetanus (Td) booster vaccine in a large (n = 4114), randomized, observer-blind, multicenter, pivotal trial in US adolescents aged 10-18 years. In addition, antibody levels against pertussis antigens (pertussis toxoid, filamentous hemagglutinin, and pertactin) induced by Tdap were non-inferior to, and numerically higher than, those induced in infants who completed a three-dose primary immunization course with combined diphtheria-tetanus-acellular pertussis vaccine (Infanrix), which conferred 89% protection against pertussis. Tdap had a similar reactogenicity profile, including solicited local reactions and general symptoms, to that of the approved Td vaccine in the pivotal US study. In particular, Tdap was similar (non-inferior) to Td with respect to the primary safety endpoint, namely the incidence of grade 3 pain at the injection site within the 15-day post-vaccination period. No serious adverse events of potential autoimmune origin or of a new-onset, chronic nature were reported during the 6-month post-vaccination period in the pivotal US study and a smaller (n = 319) German-based trial that also evaluated Tdap.

Adolescent↗

Antitoxin antibody levels and the outcome of illness during an outbreak of diphtheria among alcoholics.

During an outbreak of diphtheria among alcoholics in Göteborg, Sweden, a study was made of the diphtheria-antitoxin antibodies in serum samples from 8 clinical cases and 36 carriers of toxin-producing Corynebacterium diphtheriae. 33/36 carriers were antibody-positive and had antitoxin titres greater than 0.01 IU/ml, a level which is regarded as relative protective, while only 1/8 clinical cases had such a titre. This patient presented a mild illness with no complications. The results of the study of this outbreak stress the importance of maintaining adequate antibody levels against diphtheria in highly developed societies.

Alcoholism↗

Diphtheria toxin effects on human cells in tissue culture.

HeLa cells exposed to a single sublethal concentration of diphtheria toxin were found to have diminished sensitivity when subsequently reexposed to the toxin. Three cells strains exhibiting toxin resistance were developed. In the cells that had previously been exposed to toxin at 0.015 mug/ml, 50% inhibition of protein synthesis required a toxin concentration of 0.3 mug/ml, which is more than 10 times that required in normal HeLa cells. There appears to be a threshold level of diphtheria toxin action. Concentrations of toxin greater than that required for 50% inhibition of protein synthesis (0.01 mug/ml) are associated with cytotoxicity, whereas those below this concentration may not be lethal. Several established human cell lines of both normal and neoplastic origin were tested for their sensitivity to the effects of the toxin. No special sensitivity was observed with the cells of tumor origin. Fifty % inhibition of protein synthesis of HeLa cells was achieved with diphtheria toxin (0.01 mug/ml) as compared to the normal human cell lines tested (0.03 and 0.5 mug/ml) and a cell line derived from a human pancreatic adenocarcinoma (0.2 mug/ml). A human breast carcinoma cell line showed a maximum of 45% inhibition of protein synthesis. This required a diphtheria toxin concentration of 5 mug/ml. These results suggest that different human cell lines show wide variation in their sensitivity to the toxin.

Breast Neoplasms↗

[Prevalence of antibodies against tetanus, diphtheria and Bordetella pertussis in health care professionals].

AIM: The aim of the present study was to determine the prevalence of antibodies versus tetanus, diphtheria and Bordetella pertussis in a population of health care personnel. PATIENTS AND METHODS: A transversal study was carried out in a population of healthy health care professionals from two hospitalary centers in the Community of Madrid (Spain). The ELISA method was used for antibody determinations. The determination of antibodies versus tetanus and diphtheria was performed in a total of 344 individuals (mean age 32 years) and that of whooping cough in 104 subjects (mean age 23 years). RESULTS: The global prevalence of tetanus, diphtheria and whooping cough was of 76.5, 48 and 57%, respectively. The prevalence of antibodies versus tetanus was significantly greater in males than in females. CONCLUSIONS: Revaccination versus tetanus and diphtheria is recommended every 10 years to guarantee protector antibody concentrations in adults. With regard to whooping cough, revaccination could be a strategy to consider in the future, particularly in risk groups in contact with cases of this disease.

Adult↗

A nontoxic diphtheria toxin analogue inhibits neonatal bladder smooth muscle cell proliferation.

PURPOSE: The response of the neonatal bladder to infravesical obstruction, such as posterior urethral valves or detrusor-sphincter dyssynergia, may result in structural and functional changes that persist well after obstruction is treated. A pharmacological means of inhibiting smooth muscle cell proliferation would likely serve to halt or reverse this deleterious process. Heparin binding (HB) epidermal growth factor (EGF) is a known smooth muscle cell mitogen, while its membrane bound precursor serves as the diphtheria toxin receptor. We report the effects of the nontoxic diphtheria toxin analogue cross reacting material (CRM) 197 on neonatal sheep bladder smooth muscle cell proliferation. MATERIALS AND METHODS: Neonatal sheep smooth muscle cell cultures were obtained from whole bladder explants. Immunohistochemical staining was performed for desmin and alpha-smooth muscle actin. HB-EGF messenger RNA was detected by reverse transcriptase polymerase chain reaction using primers to the human sequence, while pro-HB-EGF peptide was confirmed using a diphtheria toxin sensitivity assay with incorporation of tritiated leucine. Cells grown in 96 well plates were exposed to 1, 10 and 100 microg./ml. CRM 197 for 5 days, after which relative cell number was determined using an 3-[4,5-dimethylthiazol-2-yl] -2,5-diphenyltetrazolium bromide; thiazolyl blue based assay read at a wavelength of 550 nm. Statistical analysis was performed using Student's t test. RESULTS: Primary cell cultures stained positive for desmin and alpha-smooth muscle actin, confirming a smooth muscle origin. Reverse transcriptase polymerase chain reaction yielded a 453 bp product with 88% homology to human HB-EGF. Total protein synthesis significantly decreased when cells were incubated with diphtheria toxin, confirming the presence of membrane bound pro-HB-EGF. CRM 197 inhibited bladder smooth muscle cell growth in a dose dependent fashion at a concentration of 10 microg./ml., resulting in a 40% decrease in proliferation (p <0.0001). CONCLUSION: CRM 197 inhibits bladder smooth muscle cell proliferation in a dose dependent, nontoxic fashion through its interaction with HB-EGF. These data suggest that molecular strategies designed to inhibit HB-EGF mediated cell growth may prove beneficial for the prevention and/or treatment of detrusor hypertrophy secondary to anatomical or functional bladder outlet obstruction.

Animals↗

[Vaccine protection of Swedish children. Time for revision of replacing doses of diphtheria, tetanus, polio and pertussis].

The Swedish vaccination programme against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b is characterized by few, widely spaced doses. Swedish schoolchildren have low diphtheria antibody levels compared to children in other countries. The introduction of acellular pertussis vaccine in 1996 has markedly cut the pertussis incidence in all ages except school-age children. There are now reasons to consider replacing the present fourth dose of inactivated polio vaccine given at 5 years of age and the diphtheria-tetanus toxoids given at 10 years of age with a combined diphtheria-tetanus-polio-acellular pertussis vaccine dose to be given at 5-6 years of age. A fifth dose of a DTPaPolio vaccine should be considered at 15-18 years of age.

Adolescent↗

[Suspected diphtheria. Immediately start therapy!].

Only those strains of corynebacteria that carry the gene for diphtheria toxin may cause diphtheria. The only known reservoir of C. diphtheriae is man. The past decade has seen a return of diphtheria in the newly independent states of the former Soviet Union. Owing to a lack of immunization of the population, more than 150,000 people went down with the disease. In Germany, too, contact resulted in a number of cases and two deaths. The sole effective protection is immunization. Although more than 90% of children and adolescents are protected, only 40% to 60% of adults are.

Adolescent↗

[Novelty of laboratory diagnosis for diphtheria].

Selected elements of simplified, bacteriological diagnosis of diphtheria were presented. The procedure of Corynebacterium strains isolation from diphtheria suspected persons and performing of toxin testing of potentially toxigenic isolates: C. diphtheriae, C. ulcerans and C. pseudotuberculosis were shortened. The role of selective tellurite media was underlined but Loeffler medium was rejected. Columbia blood agar plate was utilized for preliminary culture. Biochemical tests and toxin testing were performed from this medium. Presented diphtheria diagnosis scheme may have practical application for the laboratory work in Poland.

Corynebacterium↗

Influence of stannous chloride on the adhesive properties of Corynebacterium diphtheriae strains.

Stannous ion, as a chloride salt, influenced on the survival and adhesive properties of two toxigenic Corynebacterium diphtheriae of the sucrose-fermenting (241 strain) and non-sucrose-fermenting (CDC-E8392 strain) biotypes. Differences in survival fractions suggested differences in susceptibility of strains to bactericidal effect of stannous chloride (SnCl2). A number of 0.3% bacterial cells of 241 strain and 0.02% of CDC-E8392 strain survived after 220 micro l ml(-1) SnCl2 treatment. Results of polystyrene and spontaneous autoaggregation tests showed an increase in hydrophobicity of SnCl2 treated-bacteria. Spontaneous bacterial autoaggregation was induced in the presence of SnCl2. Stannous chloride also induced adherence to glass and totally inhibited the haemagglutinating activity of the non-sucrose-fermenting CDC-E8392 strain (original titer 32). Decrease in haemagglutination was dependent on SnCl2 concentration used. The presence of SnCl2 exerted differences in the expression of diphtheria bacilli surface carbohydrates possibly related with differences in degrees of haemagglutination and adherence to glass. Lectin-binding assays showed increase in the expression of cell surface receptors to the lectin Canavalia ensiformis (Con A) with affinity for mannose-like residues. The occurrence of cell filamentation suggests genotoxicity of SnCl2 to diphtheria bacilli. SnCl2 treatment was capable of modifying cell morphology, hydrophobins and adhesin expression, suggesting ability of C. diphtheriae to withstand oxidative stressing environment. Therefore, the SnCl2, widely used in nuclear medicine as reducing agent in the 99mTc-labelling process, may influence the outcome of bacterial infections.

Bacterial Adhesion↗