a multifaceted role for polyamines in bacterial pathogens

MicroReview

A multifaceted role for polyamines in bacterial pathogens

Pratik Shah1* and Edwin Swiatlo1,2**1Department of Microbiology, University of MississippiMedical Center, 2500 N. State Street Jackson, MS39216, USA.2Research Service, Veterans Affairs Medical Center,1500 Woodrow Wilson Drive, Jackson, MS 39216, USA.

Summary

Polyamines are polycationic molecules with ahydrocarbon backbone and multiple amino groups.Descriptions of the physiological roles of polyamineshave often been limited to their interaction with nega-tively charged nucleic acids. Of late, reports linkingpolyamines to microbial carcinogenesis, biofilm for-mation, escape from phagolysosomes, bacteriocinproduction, toxin activity and protection from oxida-tive and acid stress have been published, providinginsights about their other important but lesser knownfunctions. This review focuses on recently discov-ered novel functions of polyamines in microorgan-isms, with an emphasis on bacterial pathogens ofhumans.

Introduction

Microbial pathogens face diverse environmental stressesduring growth in a human host and have consequentlyacquired multiple adaptations to survive and multiply indifficult conditions. Microbial physiology can change sub-stantially during growth in vivo, and acquisition of scarcebut essential nutrients seems to be a critical cell function.Mechanisms used by microbial pathogens to obtain smallmolecule metabolites during colonization and infection ofa host have generally been overlooked due to the prevail-ing emphasis on more traditional virulence factors. A morecomprehensive view of bacterial metabolism and physiol-ogy in a host will lead to a deeper understanding ofmicrobial pathogenesis.

Polyamines are small aliphatic hydrocarbon moleculeswith quaternary nitrogen groups that have a net positivecharge at physiological pH. Efficient DNA replication, tran-scription and translation are essential for a pathogen tocolonize and multiply successfully in its host. Organicpolycationic molecules such as polyamines and inorganiccations such as magnesium and calcium play a crucialrole in maintaining optimal conformation of negativelycharged nucleic acids. In bacteria, the processes ofpolyamine uptake, synthesis and degradation areco-ordinated to regulate stringently intracellularpolyamine levels. Our understanding of polyamines andtheir role in growth and virulence in human pathogens hasrecently increased substantially. Polyamines now appearto be more than trivial organic molecules whose functionsare interchangeable or even dispensable. This reviewsummarizes the recent findings on the contribution ofpolyamines, polyamine biosynthesis and transportsystems to the pathogenesis and virulence of importanthuman bacterial pathogens.

Polyamine metabolism in bacteria

Polyamines such as putrescine (1,4-diaminobutane) andcadaverine (1,5-diaminopentane) are primary diamineswith two amino groups each, while spermidine [N-(3-aminopropyl)butane-1,4-diamine] and spermine [N,N′-bis(3-aminopropyl)butane-1,4-diamine] contain three andfour amino groups respectively (Fig. 1). Unlike cationssuch as Mg+2 and Ca+2, the positive charges onpolyamines are found at regularly spaced intervals alongflexible hydrocarbon chains. Because of their uniquecharge-structure conformation, polyamines can serve aselectrostatic bridges between negative phosphatecharges on nucleic acids and other negatively chargedpolymers.

Putrescine, spermidine, spermine and cadaverine arethe most widely distributed cellular polyamines and areessential for normal cellular growth and multiplication ofboth prokaryotic and eukaryotic cells (Cohen, 1997). Theintracellular content of spermidine (1–3 mM) is higherthan that of putrescine (0.1–0.2 mM) in almost all bacte-ria, although putrescine (10–30 mM) is the predominantpolyamine in Escherichia coli, followed by spermidine

Accepted 15 January, 2008. For correspondence. *E-mail [email protected]; Tel. (+1) 601 362 4471 ext. 5047; Fax (+1)601 364 1390; **E-mail [email protected]; Tel. (+1) 601 3641315; Fax (+1) 601 364 1390

Molecular Microbiology (2008) 68(1), 4–16 � doi:10.1111/j.1365-2958.2008.06126.x

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(1–3 mM) (Cohen, 1997). The presence of spermine inbacterial cells is not well established. In E. coli, an impor-tant model for polyamine research, spermine is not syn-thesized de novo but exogenous spermine can satisfycellular polyamine requirements under laboratory condi-tions (Dubin and Rosenthal, 1960). In almost all otherpathogenic bacteria, spermine is only found in cells whenexogenous spermine is present in the medium. Cadaver-ine is the least prevalent of all naturally occurring bacterialpolyamines and is normally absent in E. coli. However,E. coli synthesizes cadaverine during anaerobic growth inthe presence of its precursor amino acid lysine at a low pH(Watson et al., 1992) or in the absence of putrescinebiosynthesis (Cohen, 1997).

Bacterial polyamine synthesis usually commences withthe decarboxylation of precursor amino acids directly intopolyamines or other intermediates, which are subse-quently modified to yield functional polyamines. In E. coliand many Pseudomonas species, putrescine is synthe-sized via two pathways: (i) decarboxylation of ornithineto putrescine by ornithine decarboxylase (ODC) encodedby the speC gene, and (ii) arginine decarboxylation toagmatine by arginine decarboxylase (speA), followedby the conversion of agmatine to putrescine and urea byagmatine ureohydrolase (speB) (Tabor and Tabor, 1985;Cohen, 1997) (Fig. 2). Pseudomonas aeruginosa has anadditional pathway in which agmatine is converted toputrescine via N-carbamoylputrescine (Nakada and Itoh,2003).

The key enzyme of the putrescine biosynthesispathway, ODC, is regulated by multiple mechanisms.ODC is reversibly inhibited by either putrescine (Morrisand Fillingame, 1974) or spermidine (Cohen, 1997). ODCactivity is also regulated at the transcription level by cyclicAMP (cAMP) and cAMP receptor protein complex, whichrepress speC expression in E. coli (Wright et al., 1986).An antizyme has also been shown to reduce ODC activityin E. coli and some other bacteria (Lioliou and Kyriakidis,2004), whereas GTP binding to ODC enhances enzymeactivity (Oliveira et al., 1997). Arginine decarboxylaseactivity is inhibited by elevated levels of intracellular sper-midine and putrescine in a manner similar to ODC (Mooreand Boyle, 1991).

Spermidine biosynthesis genes speE and speD areorganized as an operon and are distant from the speABCgenes that are involved in putrescine biosynthesis(Xie et al., 1989). Spermidine biosynthesis in E. colicommences with the conversion of methionine intoS-adenosyl methionine (SAM) by the enzyme methionineadenosyltransferase (SAM synthetase) encoded by metK(Fig. 2). Transcription of metK is under the control of atrans-acting regulatory element encoded by metJ (Saint-Girons et al., 1986). The enzyme SAM decarboxylase(speD) then converts SAM into decarboxylated SAM,which acts as a cofactor for spermidine biosynthesis(Tabor et al., 1986). Finally, spermidine synthase (SpeE)converts putrescine to spermdine in the presence ofdecarboxylated SAM. The crystal structure of spermidine

Fig. 1. Structures of common microbialpolyamines.

Polyamines and bacterial pathogenesis 5

Journal compilation © 2008 Blackwell Publishing Ltd, Molecular Microbiology, 68, 4–16No claim to original US government works

synthase from the human pathogen Helicobacter pylorihas been reported (Lu et al., 2007). Spermidine inhibitsSAM decarboxylase activity in E. coli, implying that sper-midine is a major regulator of this enzyme (Kashiwagi andIgarashi, 1988). Interestingly, others have reported thatexogenous spermidine reduces expression of E. coli SAMdecarboxylase in the presence of a plasmid encoding ratSAM decarboxylase (Salmikangas et al., 1989). In Bacil-lus subtilis, spermidine inhibits SAM decarboxylaseexpression in cells in stationary phase (Sekowska et al.,2000). Overall, spermidine seems to be a key regulator ofbacterial SAM decarboxylase activity and expression.

Deletion in either the speE or speD genes in E. coli hasminimal effect on its growth rate, indicating that spermi-dine is not an essential polyamine for E. coli growth(Tabor et al., 1983). Interestingly, E. coli mutated in speA,B and C, but with a functional speD gene, synthesizeslittle spermidine but can synthesize tetra-amines like sper-mine (Hafner et al., 1977). Thus, spermine biosynthesisoccurs in the face of deficiency of other more commonlyoccurring polyamines in E. coli.

Polyamine transport systems

In addition to de novo polyamine synthesis, bacteria havetransport systems that allow uptake of extracellularpolyamines. Polyamine transporters have primarily beencharacterized in E. coli but analysis of microbial genomesequences indicates that they are likely to be present in

many Gram-positive and Gram-negative human patho-gens as well as in archaea, yeast and protozoa. This highdegree of conservation suggests that these systemsprovide a significant adaptive and/or survival advantageto microorganisms (Table 1).

Escherichia coli polyamine transport systems (Pot)include two ABC (ATP-binding cassette) transporters thatare selective for either putrescine or spermidine. Addition-ally, two antiporters, one that exchanges putrescine forornithine (PotE) and one that allows exchange of lysineand cadaverine (CadB), as well as uniporters forputrescine and cadaverine uptake have also beendescribed. The order of preference for extracellularpolyamines in E. coli is: putrescine > spermidine > sper-mine (Kashiwagi et al., 1986).

Polyamine ABC transporter genes in E. coli and manyother human pathogens are organized as four-geneoperons and designated as potABCD (spermidine uptake)and potFGHI (putrescine uptake). In E. coli, PotD andPotF are periplasmic substrate-binding proteins that bindextracellular polyamines, and PotA and PotG proteins aremembrane-associated cytosolic ATPases. The remainingproteins have membrane-spanning a-helices and formtransmembrane channels for polyamine transport(Kashiwagi et al., 1990; Pistocchi et al., 1993). Binding ofspermidine to PotD leads to a conformation change,resulting in a more compact protein structure. Thiscomplex triggers a conformation change in PotBC thatresults in a structural change in PotA that leads to ATP

Fig. 2. Biosynthetic pathways for polyaminesin E. coli. Cadaverine synthesis occurspredominantly when lysine is abundant in thegrowth medium or putrescine synthesis isblocked. Assigned enzyme designations:SpeA – arginine decarboxylase, SpeB –agmatine ureohydrolase, SpeC – ornithinedecarboxylase, SpeD – SAM decarboxylase,SpeE – spermidine synthase, MetK –methionine adenosyltransferase, CadA –lysine decarboxylase.

6 P. Shah and E. Swiatlo �


hydrolysis and spermidine uptake. Non-polar mutationsin any of the genes in the potABCD operon abolishpolyamine transport, indicating that all four gene productsare essential (Furuchi et al., 1991). In E. coli, spermidinecan also bind to PotA and decrease its ATPase activitywith a resultant inhibition of polyamine uptake (Igarashiand Kashiwagi, 2006). PotD can also downregulate tran-scription of the potABCD operon (Antognoni et al., 1999).Thus, both receptor and ligand can function as feedbackregulators of polyamine transport. The crystal structure ofPotD from E. coli indicates that it has two b-a-b domainswith a spermidine-binding cleft in the middle (Sugiyamaet al., 1996). E. coli PotD binds spermidine with a disso-ciation constant of 3.2 mM, and can also bind toputrescine, albeit with a higher Kd of 100 mM (Kashiwagiet al., 1993). The crystal structure of PotF revealed abinding site for putrescine, but unlike PotD it does not bindspermidine as it lacks additional amino acid residues in itsbinding site to accommodate spermidine. Similarly,binding assays with PotF show that it possesses a highbinding affinity to only putrescine (Kd = 2.0 mM) and doesnot bind other polyamines (Vassylyev et al., 1998).

In Streptococcus pneumoniae (pneumococcus), a poly-cistronic mRNA molecule encoding the potABCD genes iscotranscribed with the murB gene involved in peptidogly-can biosynthesis (Ware et al., 2005). The pneumococcalpotABCD genes bear a high degree of sequence identityto the corresponding genes in E. coli, and a proposedmodel for the polyamine transporter is very similar(Fig. 3). Pneumococcal PotD has a typical Gram-positiveleader sequence and is predicted to be a secreted protein.

However, it does not have a readily identifiable surfaceanchor mechanism typical of Gram-positive surfaceproteins. Work in our laboratory has shown that PotDco-purifies with membrane fractions and that it is likely tobe a lipoprotein (Shah et al., 2006), although the precisemechanism for lipidation is unknown and is currentlyunder study.

PotE and the cadaverine transporter CadB eachpossess 12 transmembrane segments with both amino-

Table 1. Polyamine transport systems in representative human bacterial pathogens.

Organism Polyamine transporter Reference

Bacillus anthracis PotABCD Read et al. (2003)Escherichia coli PotABCD; PotFGHI; PotE Igarashi and Kashiwagi (1999)Haemophilus influenzae PotABCD; PotE Fleischmann et al. (1995)Legionella pneumophila PotABCD Chien et al. (2004)Mycoplasma pneumoniae PotABC Himmelreich et al. (1996)Neisseria gonorrhoeae PotABCD GenBank Accession No. AE004969Neisseria meningitidis PotABCD Tettelin et al. (2000)Pseudomonas aeruginosa PotABCD; PotFGHI Stover et al. (2000)Salmonella enterica paratyphiSalmonella enterica typhi

PotABCD; PotFGHI; PotEPotABCD; PotFGHI; PotE

McClelland et al. (2004)Deng et al. (2003)

Salmonella typhimurium PotABCD; PotFGHI; PotE McClelland et al. (2001)Shigella boydii, Shigella sonnei PotABCD; PotFGHI; PotE Yang et al. (2005)Shigella dysenteria PotABCD; PotFGHI Yang et al. (2005)Shigella flexneri PotABCD; PotFGHI; PotE Wei et al. (2003)Staphylococcus aureus PotABCD Baba et al. (2002)Staphylococcus epidermidis PotABCD Gill et al. (2005)Staphylococcus haemolyticus PotABCD Takeuchi et al. (2005)Streptococcus mutans PotABCD Ajdic et al. (2002)Streptococcus pneumoniae PotABCD Tettelin et al. (2001)Streptococcus pyogenes PotABCD Beres et al. (2002)Treponema pallidum PotABCD Machius et al. (2007)Vibrio cholerae PotABCD; PotE Heidelberg et al. (2000)Yersinia pestis PotABCD; PotFGHI Deng et al. (2002)

Fig. 3. Proposed structure of a polyamine transporter inStreptococcus pneumoniae. PotA – cytoplasmic protein withATP-binding motif that couples ATP hydrolysis to translocation ofpolyamines; PotBC – two polypeptides, with five or sixmembrane-spanning a-helical hydrophobic domains; PotD –extracellular substrate-binding protein.



and carboxy-termini located in the cytoplasm. Thesemembrane proteins represent a different class of trans-porters that are capable of both uptake and extrusion.Polyamine uptake without extrusion, mediated by PotE orCadB, is dependent on membrane potential alone. InE. coli, extrusion of putrescine by PotE is coupled toornithine import and, likewise, CadB couples cada-verine excretion to lysine uptake (Kashiwagi et al., 1997;Soksawatmaekhin et al., 2004).

Genes for lysine decarboxylase (cadA) and a lysine-cadaverine antiporter (cadB) form the cadBA operon inE. coli. This operon is induced in response to acidic pH,resulting in synthesis of cadaverine by CadA, followed bythe excretion of cadaverine, uptake of lysine by CadB andneutralization of the medium (Soksawatmaekhin et al.,2004). The cadC gene, which is separated from cadBA,encodes a 58 kDa inner membrane protein CadC. CadCbinds to operator sites Cad1 and Cad2 upstream of thecadBA promoter region and acts as a transcriptional acti-vator of the cadBA operon, whereas LysP and H-NSrepress cadBA expression under non-inducing conditions(Shi et al., 1993; Neely et al., 1994). In a proposed modelfor transcriptional regulation of the cadBA operon, H-NS isinvolved in the formation of a repression complex undernon-inducing conditions. This complex is dissociated bybinding of CadC to Cad1 under inducing conditions, whileCadC binding to Cad2 activates the expression of the cadoperon (Kuper and Jung, 2005).

Interaction with nucleic acids

Intracellular polyamines are primarily found as complexeswith RNA and work in conjunction with Mg+2 to stabilizehigher orders of structure. In fact, polyamines can accel-erate in vitro protein synthesis compared with Mg+2 alone.Polyamine binding to RNA molecules might cause uniquestructural changes that are different from those inducedby magnesium (Igarashi et al., 1974). Polyamines canalso bind to ribosomes and increase accuracy of codonusage during protein synthesis (Ito and Igarashi, 1986),facilitate translational read-through of mRNAs with a UAAstop codon (Higashi et al., 2006) and increase the effi-ciency of nonsense mutation suppression in T4 phageusing a tRNA containing an amber mutation (Tabor andTabor, 1982). Supplemental putrescine can restore viru-lence gene expression in Shigella flexneri mutants thatare unable to synthesize modified nucleosides necessaryfor tRNA synthesis. It is possible that a direct interactionbetween putrescine and virulence gene mRNAs results inmore efficient translation and expression of these viru-lence genes (Durand and Bjork, 2003).

In addition, translation of the mRNA for OppA, a peri-plasmic substrate-binding protein of the E. coli oligopep-tide uptake system, is enhanced by the binding of

spermidine to a GC-rich double-stranded region near theShine–Dalgarno (SD) sequence of the OppA mRNA. Thisinteraction causes a structural change in the SDsequence leading to an interaction between the AUGcodon and 30S ribosomal subunit, allowing the formationof an initiation complex (Yoshida et al., 1999). A similarmechanism is observed in polyamine-mediated transla-tional enhancement of a transcription regulator (FecI) ofan iron transporter operon and a transcriptional regulator(Fis) of rRNA, tRNA synthetases and adenylate cyclase(Yoshida et al., 2001; Yoshida et al., 2004). The transla-tion of RpoN, H-NS and Cra mRNA is more efficient whenE. coli polyamine auxotrophic mutants are supplementedwith polyamines. RpoN and H-NS mRNA transcripts haveunusual SD sequences, while the Cra mRNA has aninefficient initiation codon (GUG) (Terui et al., 2007).Overall, polyamine binding appears to cause a conforma-tional change in a stretch of relatively unstable double-stranded RNA containing the SD sequence and theinitiation codon, leading to enhancement of translation.

Surface structures and polyamines

Polyamines play a crucial role in outer membrane func-tions, primarily by their effects on the production andfunction of porins (Dela Vega and Delcour, 1996). Porinsare homo-trimeric transmembrane channels that allow thediffusion of hydrophilic compounds across the outer mem-brane of Gram-negative cells. Porins OmpC and OmpF inE. coli interact with polyamines in a concentration- and atransmembrane voltage-dependent manner (Iyer andDelcour, 1997). Putrescine and spermidine bind to aspar-tic acid residues of OmpF and OmpC, altering the chargeand pore size, resulting in channel closure and subse-quently decreasing outer membrane permeability (Iyeret al., 2000).

Streptococcus pneumoniae requires the amino alcoholcholine for synthesis of teichoic and lipoteichoic acids.Choline anchors proteins that play important roles inpneumococcal virulence. Putrescine can substitute forcholine in vitro during pneumococcal growth in a choline-deficient environment (Ware et al., 2005). However, incor-poration of putrescine in the pneumococcal cell wallresults in the loss of surface-bound choline-binding pro-teins, suggesting that polyamine substitution wouldattenuate virulence. Putrescine is also a constituent of theouter membrane in some Gram-negative bacteria like Sal-monella enterica SP Typhimurium, E. coli and Proteusmirabilis (Koski and Vaara, 1991; Vinogradov and Perry,2000), while, cadaverine is linked to the peptidoglycan ofVeillonella alcalescens (Kamio, 1987) and covalentlyattached to the D-glutamic acid residues in a peptidecontaining diaminopimelic acid in Selenomonas rumina-tum (Kamio et al., 1986). Although polyamines are prima-



rily considered intracellular constituents, accumulatingevidence indicates their importance in maintainingsurface structures in bacteria.

Response to physiological stress

Microbial pathogens face oxidative stress in vivo thatinduces an adaptive response involving production of pro-teins with protective functions. Reactive oxygen speciescause double-strand breaks and base modifications inDNA sequences with high GC content. Superoxide dismu-tase (SOD) is a key enzyme that protects cellular nucleicacids from the damaging effects of superoxide radicals.Spermine and spermidine function as free radical scav-engers and, in conjunction with SOD, reduce DNA strandbreakage by oxygen radicals (Khan et al., 1992a, b; Haet al., 1998). Concentrations of oxygen that are non-toxicto wild-type E. coli cells are lethal to polyamine-deficientmutants (Chattopadhyay et al., 2003). Polyamines there-fore seem to play an important adjunctive role in protect-ing cells from the toxic effects of reactive oxygen species.

On the other hand, exposure of a polyamine-deficientmutant to paraquat results in increased expression ofsoxS, which codes for a key regulator of the response tooxidative stress in E. coli, while addition of exogenousputrescine to the mutant leads to a decrease in soxSexpression (Jung and Kim, 2003b). In addition, anotheroxidative stress response regulator SoxR regulates thecadBA operon in Vibrio vulnificus in a CadC-independentmanner. SoxR binds to the promoter region of the cadBAoperon, resulting in increased synthesis of cadaverine,which scavenges superoxide radicals and increases toler-ance to oxidative stress and also reduces SOD expression(Kim et al., 2006). Furthermore, pneumococcal potD tran-scription increases in response to oxidative and tempera-ture stress, choline limitation and more importantly duringmurine bacteraemia (P. Shah and E. Swiatlo, submitted).Polyamine uptake from the environment may potentiallyhelp pneumococci to survive various host microenviron-ments. Thus, polyamine-mediated protection against oxi-dative stress in bacteria might involve direct binding ofpolyamines and nucleic acids, scavenging of the reactiveoxygen species or differential expression of protectiveenzymes like SOD. All of these mechanisms most likelycontribute to variable degrees, with the relative contribu-tion depending, for example, on the metabolic state of thecell, growth medium and the type of oxidative insult.

Survival in an acidic environment under nutrient limita-tion is a key requirement for intestinal pathogens andcommensals. Polyamines seem to be key mediators inthe response to acid stress in bacteria. In E. coli, the gadAand gadB genes encode glutamate decarboxylase, whichis induced in an acidic environment and contributes toacid resistance. Expression of gadA and gadB is regu-

lated by polyamines via reduction in intracellular cAMPlevels; polyamine-deficient mutants fail to produceglutamate decarboxylase and show greatly reduced sur-vival in an acidic medium (Jung and Kim, 2003a). Theviability of E. coli cells starved of inorganic phosphate (Pi)is severely reduced in either aerobic or anaerobicconditions. Addition of lysine to a Pi-limited mediuminduces expression of the cadBA operon. Expression oflysine decarboxylase, in conjunction with glutamatedecarboxylase, increases the pH of the medium and mostlikely allows the cells to tolerate higher levels of formateproduced during anaerobic, Pi-limited conditions (Moreau,2007). A similar mechanism for acid resistance is seen inSalmonella, where both lysine decarboxylase and RpoS-dependent acid-shock proteins are required for survival atlow pH (Park et al., 1996). It was recently shown that thecadBA operon in S. enterica, and ompF and ompC genetranscription regulator OmpR, are regulated by CadC inresponse to low pH (Lee et al., 2007). Overall, the induc-tion of amino acid decarboxylases like CadA in responseto acid stress might facilitate survival of microbial patho-gens in vivo.

Polyamines and microbial pathogenesis

Role of cadaverine biosynthesis in escape fromphagolysosomes and decreased adherence

Assessment of polyamine biosynthesis in bacterial patho-gens is often limited to a few well-characterized pathwaysprimarily in the context of physiology. Likewise, character-ization of polyamine transport systems is mostly restrictedto evaluating their role in response to physiological stress.This focus seems to be changing, as a number of recentlypublished reports have recognized polyamines,polyamine biosynthesis and transport mechanisms as‘classical’ virulence factors involved in multiple aspects ofbacterial pathogenesis.

The human pathogen Shigella is closely related toE. coli and the four common Shigella species associatedwith humans are thought to have arisen from a commonE. coli progenitor strain. These genetic exchanges oftenresult in acquisition of virulence determinants that areabsent in less pathogenic ancestors. In some cases, lossof genes is also associated with increased virulence. ThecadA gene is present in most E. coli strains but absent inShigella. Expression of cadA in Shigella results in theinhibition of enterotoxin activity. Pre-treatment of eukary-otic cells with cadaverine makes them less susceptible tothe effects of Shigella enterotoxins (Maurelli et al., 1998).This may occur through polyamine interactions with cellmembranes or toxin receptors, or alterations in intracellu-lar signalling cascades. However, polyamines mayperhaps also directly interact with enterotoxin in a manner



similar to polyamine inactivation of anthrax lethal factor(Goldman et al., 2006).

Cadaverine also inhibits lysis of phagosomes byS. flexneri and prevents bacterial dissemination within theintestinal epithelium. Mechanistic details about the role ofcadaverine in phagolysosome stability are not known.Enhancement of the stability of the phagolysosome mem-brane or interaction with components critical to the forma-tion and maintenance of the phagolysosomal vacuolehave been offered as possible explanations (Fernandezet al., 2001). It has become evident that cadaverine hasan important role in the pathogenesis of Shigella infec-tions and further work remains to examine the role ofpolyamines and other intracellular pathogens.

The cad operon is absent in certain Shiga toxin-producing E. coli strains. Restoration of lysine decarboxy-lase activity leads to reduced production of intimin, anadhesin required for the formation of attaching and effac-ing lesions in toxigenic strains (Torres et al., 2005).Cadaverine may be an inhibitor of E. coli adherence,however, exogenous cadaverine does not significantlyreduce adherence of cad deficient strains. Some aspectof in situ cadaverine synthesis other than end-productpotentially exerts a strong negative effect on intimin syn-thesis and the adherence phenotype.

Microbial carcinogenesis and polyamines

Polyamine biosynthesis in eukaryotic cells is controlledmainly by the activity of ODC and SAM decarboxylase.Uncontrolled ODC expression and polyamine biosynthe-sis lead to malignant transformation and cancer in certainhuman cells (Gerner and Meyskens, 2004). Targetingpolyamine metabolism in tumour cells and other hyper-proliferative diseases might be a promising therapeuticoption (Casero and Marton, 2007). Gastric infection byH. pylori is considered to be an important risk factor forgastric carcinoma (El-Omar et al., 2000). Polyamines arekey effector molecules of carcinoma caused by H. pyloriinfection. ODC activity is upregulated in H. pylori-infectedcells, and eradication of the infection leads to decreasedhost cell ODC activity (Alam et al., 1994). Elevated ODCactivity from Helicobacter infection may be a marker ofpremalignant lesions (Patchett et al., 1996).

Multiple mechanisms are involved in dysregulation ofODC by H. pylori. Upregulation of ODC activity by bacte-rial lipopolysacchride (LPS) is one potential mechanismcontributing to H. pylori-induced carcinoma. Bacterial LPSis a potent mitogen that activates a variety of immuneresponses. LPS binds to CD14, which is a co-receptorwith Toll-like receptor 4 for LPS and is present on thesurfaces of mononuclear cells neutrophils (Mai et al.,1991). Helicobacter LPS appears to facilitate tumour pro-gression in enterochromaffin-like cells by activating ODC

via CD14 (Kidd et al., 2000). However, it is important tonote that, under most circumstances, spermine inhibitspro-inflammatory cytokines in human mononuclear cellsin response to LPS stimulation (Zhang et al., 1999). Thus,polyamines can stimulate uncontrolled proliferation intransformed cells as well as participate in counter-regulatory mechanisms against monocyte activation ininjured and infected tissues.

Host cell apoptosis and polyamines

Helicobacter infection also causes activation of neutro-phils, monocytes and macrophages; however, theseresponses are ineffective in preventing disease. H. pyloridecrease macrophage survival by modulating host cellpolyamine biosynthesis. Transcription of c-myc is upregu-lated in H. pylori-infected macrophages. c-Myc binds tothe ODC promoter region resulting in elevated ODCexpression and macrophage apoptosis. Conversely,inhibition of either ODC or c-Myc binding to the ODCpromoter region reduces apoptosis of infected cells(Cheng et al., 2005).

In eukaryotic cells polyamines are oxidized bypolyamine oxidase (PAOh1) that converts spermine tospermidine without the intermediate acetylation stepcatalysed by spermine N1-acetyltransferase (SSAT).Oxidation of spermine results in production of H2O2,which can cause apoptosis by mitochondrial membranedepolarization (Vujcic et al., 2002). Helicobacter inducesexpression of PAOh1 in a mouse model of infection.Reduction of PAOh1 expression by siRNA resulted insignificant reduction in H2O2 production and Helicobacter-induced apoptosis, while overexpression of PAOh1resulted in enhanced H2O2 production, membrane depo-larization and caspase activation leading to apoptosis(Chaturvedi et al., 2004; Xu et al., 2004).

Other microbial pathogens also disrupt host cellpolyamine metabolism during infection. Bronchoalveolarlavage (BAL) fluid from animals infected with Pneumo-cystis jiroveci contains high levels of spermidine,N1-acetylspermine and N1-acetylspermidine which arethought be derived from P. jiroveci metabolism. This BALfluid can induce apoptosis of alveolar macrophages(Lasbury et al., 2007). Similarly, polyamines derivedprimarily from bacterial metabolism are present in highconcentrations in human gingival crevicular fluid frominflamed periodontal pockets (Lamster et al., 1987). Oralcrevicular polymorphonuclear leukocyte cells (PMN) playa crucial role in preventing bacterial invasion of periodon-tal tissue (Miyasaki, 1991). Spermine, spermidine and, toa lesser extent, putrescine have all been shown to accel-erate PMN apoptosis in a dose-dependent manner(Mariggio et al., 2004). Other reports have implicatedpolyamines found in gingival fluid in facilitating granule



release, respiratory burst (Walters and Chapman, 1995)and impairment of chemotaxis (Walters et al., 1995).

Polyamines and innate defence mechanisms

Inducible nitric oxide synthase (iNOS)-derived nitric oxide(NO) is a key effector in the innate immune response.H. pylori upregulates iNOS production in gastric mucosabut does not necessarily result in increased NO produc-tion in H. pylori-infected macrophages (Fu et al., 1999).Helicobacter uses two strategies to counter the increasein host cell iNOS production. First, H. pylori arginasedecreases NO levels by competing with host cell iNOS forthe common substrate L-arginine (Gobert et al., 2001).Second, Helicobacter induces arginase II as well as ODCactivity in infected macrophages. Arginase II convertsL-arginine to L-ornithine which is converted to spermineand spermidine (Gobert et al., 2002). Interestingly, sper-mine synthesized by the arginase II/ODC pathway alsoinhibits iNOS translation. Knockdown of ODC expressionwith siRNA in macrophages infected with H. pylori resultsin a significant increase in iNOS production and enhancedbacterial killing. On the other hand, exogenous spermineattenuates iNOS translation and, consequently, NOproduction; furthermore, it decreases killing in aconcentration-dependent manner (Bussiere et al., 2005).This relationship between ODC, spermine and iNOS rep-resents a unique feature of H. pylori pathogenesis.

Polyamine transporters as vaccine antigens

Components of polyamine ABC transporters also seem tobe promising vaccine antigens. S. pneumoniae has apotABCD operon with a high degree of similarity to thatfound in E. coli (Ware et al., 2005). A functional polyaminetransporter appears to be necessary for full expression ofpneumococcal virulence (Polissi et al., 1998; Ware et al.,2006). Systemic immunization with recombinant PotDelicits a protective antibody response against otherwisefatal pneumonia and bacteraemia in a mouse model(Shah and Swiatlo, 2006). In addition, mucosal immuni-zations with PotD reduce nasopharyngeal colonization ofS. pneumoniae clinical isolates in mice (P. Shah and E.Swiatlo unpubl. results). These data suggest that PotDmight be effective as a component of a protein-basedpneumococcal vaccine. Similarly, immunization withrecombinant PotF protects mice against lethal challengewith Burkholderia pseudomallei (Harland et al., 2007).

Effects on biofilm formation and phenotypes

Polyamines have been implicated in the control of biofilmformation in several human pathogens. In Yersinia pestis,mutations in either speA or speC reduced attachment to a

solid surface yet had minimal effect on biofilm thickness.A speA-speC double mutant, however, was incapable ofproducing any detectable biofilm and had a markedlyreduced intracellular putrescine level. Addition ofputrescine restored biofilm production in a dose-dependent manner. Surprisingly, complementation of thespeA-speC double mutant with a wild-type speA allelealone was sufficient for biofilm formation (Patel et al.,2006).

Norspermidine, which contains one carbon less thanspermidine, is the most prevalent polyamine in Vibriospecies. The mbaA (maintenance of biofilm architecture)gene is part of an operon that also encodes a norspermi-dine sensor, NspS, and a hypothetical cytoplasmic proteinin Vibrio cholerae (Karatan et al., 2005). MbaA, a putativeintegral membrane protein, is thought to have periplasmicdomains and function as a regulator of biofilm formation.Increasing environmental concentrations of norspermi-dine activates biofilm formation in V. cholerae in the pres-ence of NspS and MbaA. Deletion of nspS showsreduction in transcription of genes involved in exopolysac-charide synthesis and biofilm formation. Norspermidinebinding to NspS can purportedly change the nature of itsinteraction with the periplasmic domains of MbaA andderepress genes involved in biofilm formation. Furtherinvestigations of the interactions between NspS andMbaA, as well as NspS and norspermidine, will helpdefine the role of environmental polyamine sensing inVibrio biofilm formation.

The swarming phenotype of P. mirabilis is usually linkedto the expression of virulence genes such as haemolysin,IgA protease and urease (Allison et al., 1992). Transpo-son inactivation of speAB genes in P. mirabilis leads to aloss of the swarming phenotype that can be reversed byexogenous putrescine (Sturgill and Rather, 2004). Themechanisms by which putrescine regulates swarming arenot known. Because of their pleiotropic effects on tran-scription and translation polyamines may affect the globalexpression of myriad regulatory proteins controlling theswarming phenotype.

Biosynthesis of molecules involved in pathogenesis

Spermidine is used in the synthesis of the siderophorepetrobactin by Bacillus anthracis. Petrobactin plays animportant role in iron acquisition and virulence, and doesnot bind to siderocalin, a host protein that binds bacterialsiderophores (Oves-Costales et al., 2007). Vibriobactinand vulnibactin, iron-scavenging molecules of V. choleraeand V. vulnificus, contain norspermidine, suggesting anessential role for this polyamine in iron-limited environ-ments (Okujo et al., 1994; Keating et al., 2000).

Colicins are a family of protein toxins produced byE. coli that kill other susceptible E. coli cells. In response



to the colicin-ColE7 treatment, increase in polyamine bio-synthesis, as well as expression of PotD and OppA, isobserved in E. coli. Conversely, mutants deficient inputrescine and spermidine biosynthesis show significantreduction in ColE7 production that can be restored byaddition of polyamines to the medium. These results indi-cate that polyamines play an important role in ColE7production. Polyamine-deficient mutants are also moresusceptible to ColE7. Finally, in wild-type E. coli, exposureto polyamines reduces expression of TolA, BtuB, OmpFand OmpC proteins that are involved in colicin uptake(Pan et al., 2006). Taken together these observationssuggest that polyamines stimulate colicin production andpossibly downregulate proteins essential for colicinuptake simultaneously, conferring a survival advantage oncolicin producing cells implying an essential role forpolyamines in toxin immunity.

Conclusion

Polyamines constitute a ubiquitous family of small mol-ecules that have diverse functions in both eukaryotic andprokaryotic cellular physiology. Their role in the pathogen-esis of bacterial infections has often been overlooked butrecent experimental evidence emphasizes the importanceof polyamines in several key aspects of pathogenesis,survival and virulence of many human microbialpathogens. The contribution of polyamines to the naturalhistory of bacterial infections is blurring the traditionaldichotomy between bacterial physiology and virulence. Asinformation on polyamine metabolism in bacterial patho-gens continues to expand, potentially novel targets forprevention or treatment of infectious diseases willundoubtedly emerge.

Acknowledgements

The authors are thankful to Stephen Stray and Payal Vyas forcritical evaluation of the manuscript.

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a multifaceted role for polyamines in bacterial pathogens

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