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Identification of novel potential virulence associated factors in Haemophilus parasuis

Meike Sack, Nina Baltes

To cite this version:

Meike Sack, Nina Baltes. Identification of novel potential virulence associated factors in Haemophilus parasuis. Veterinary Microbiology, Elsevier, 2009, 136 (3-4), pp.382. �10.1016/j.vetmic.2008.11.008�.

�hal-00532534�

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Accepted Manuscript

Title: Identification of novel potential virulence associated factors in Haemophilus parasuis

Authors: Meike Sack, Nina Baltes

PII: S0378-1135(08)00534-8

DOI: doi:10.1016/j.vetmic.2008.11.008

Reference: VETMIC 4271

To appear in: VETMIC Received date: 21-7-2008 Revised date: 14-11-2008 Accepted date: 17-11-2008

Please cite this article as: Sack, M., Baltes, N., Identification of novel potential virulence associated factors in Haemophilus parasuis, Veterinary Microbiology (2008), doi:10.1016/j.vetmic.2008.11.008

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Identification of novel potential virulence associated factors in Haemophilus parasuis 1

2

MEIKE SACK AND NINA BALTES*

3

Institute for Microbiology, Department of Infectious Diseases, University of Veterinary 4

Medicine Hannover, Foundation, Germany 5

6

running title: Haemophilus parasuis virulence associated factors 7

8

Corresponding author: Nina Baltes 9

Phone: +49 511 856-7595 10

Fax: +49 511 856-827595 11

E-mail: [email protected] 12

13

Address for correspondence: Prof. Dr. Nina Baltes 14

Institut fuer Mikrobiologie 15

Zentrum fuer Infektionsmedizin 16

Stiftung Tierärztliche Hochschule Hannover 17

Bischofsholer Damm 15 18

30173 Hannover 19

Germany 20

21 22

Manuscript

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ABSTRACT 1

Haemophilus (H.) parasuis is best known as the cause of Glässer's disease, a potentially fatal 2

polyserositis in pigs. The mechanisms underlying virulence differences on the molecular level 3

are largely unknown to date. We have compared the serotype 5 (causes polyserositis) and 11 4

(described as avirulent) reference strains by modified representational difference analysis, and 5

identified five potentially virulence associated factors present in the invasive serotype 5 strain, 6

but not in the avirulent serotype 11 strain. Among these, a putative hemolysin operon, hhdBA, 7

was identified, which is also present in half of the serotype reference strains described as 8

virulent, but not in those reference strains that were reported to cause no disease in animal 9

infection experiments. The presence of all identified genes was investigated in serotype 10

reference strains as well as in 26 field isolates from clinically ill pigs. Determining the 11

presence of these genes may be useful in H. parasuis diagnostics to judge a strain's potential 12

to cause disease.

13 14

KEYWORDS 15

Haemophilus parasuis, virulence, hemolysin, toxin, iron transport 16

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INTRODUCTION 1

Haemophilus parasuis, a Gram-negative NAD dependent rod of the Pasteurellaceae family, 2

has gained considerable importance in recent years. Originally recognized as the causative 3

agent of a fibrinous polyserositis termed Glässer's disease, H. parasuis disease is now known 4

to cause a variety of clinical pictures especially in herds of high health status. In addition to 5

polyserositis, the organism can cause meningitis, arthritis, pneumonia, or it can behave like a 6

commensal of the respiratory tract and cause no disease at all (Nielsen, 1993). Fifteen 7

serotypes have been recognized so far, and the pathogenic potential of the serotype reference 8

strains has been determined in animal experiments using SPF piglets (Kielstein and Rapp- 9

Gabrielson, 1992). Unfortunately, there is high variation concerning virulence not just 10

between serotypes, but also between different strains of the same serotype (Oliveira and 11

Pijoan, 2004). In addition, many strains are non-typeable by the current serotyping technique 12

(Turni and Blackall, 2005).

13

Very few virulence associated factors have been identified in H. parasuis to date, namely 14

neuraminidase activity (Lichtensteiger and Vimr, 1997), transferrin binding proteins 15

(Charland et al., 1995), and fimbriae (Munch et al., 1992). However, while no gene has been 16

identified for neuraminidase so far, fimbriae and transferrin binding protein genes are likely to 17

be present in all strains of H. parasuis (Metcalf and MacInnes, 2007), which precludes an 18

uncomplicated use of these genes for the prediction of the virulence potential of a given 19

strain. Distinct membrane protein patterns have been observed to be correlated with 20

pathogenicity, however, these proteins have not been identified (Oliveira and Pijoan, 2004). A 21

recent attempt to identify virulence factors of H. parasuis employed a differential display 22

technique to identify genes expressed upon iron restriction and during growth in cerebrospinal 23

fluid. Several genes were identified that could be relevant or even required for virulence, but 24

the results suggest that they are present in all serotypes and that differences in virulence 25

resulting from these genes would likely be due to differences in their expression. One such

26

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exampe could be a haloacid hydrogenase which was found to be upregulated in virulent 1

reference strains (Metcalf and MacInnes, 2007).

2

In order to improve the examination of H. parasuis strains for their potential to cause disease, 3

it would be desirable to identify genes that are uniquely present in virulent strains. In the 4

present study, we compared two serotype reference strains of H. parasuis which are known to 5

cause different clinical pictures in order to identify such genes.

6 7

MATERIALS AND METHODS 8

Primers.

9

The primers used in this work are listed in Table 1.

10

Media and growth conditions.

11

Escherichia coli strains were cultured in Luria-Bertani (LB) medium supplemented with the 12

appropriate antibiotics (ampicillin, 100 µg/ml; kanamycin, 50 µg/ml); H. parasuis strains 13

were cultured at 37°C in BHI medium (Difco GmbH, Augsburg, Germany), chocolate agar, 14

PPLO agar (Difco GmbH, Augsburg, Germany) supplemented with NAD (10 µg/ml, E.

15

Merck AG, Darmstadt, Germany), Columbia Sheep Blood agar (CSB, Difco GmbH, 16

Augsburg, Germany) or blood agar containing 7% porcine blood and 10 µg/ml NAD, using a 17

Staphylococcus aureus nurse strain on plates without added NAD.

18

Manipulation of nucleic acids and proteins.

19

Nucleic acid modifying enzymes were purchased from New England Biolabs (Bad 20

Schwalbach, Germany) and used according to the manufacturer's instructions. Taq polymerase 21

was purchased from Invitrogen (Karlsruhe, Germany) and Promega (Mannheim, Germany).

22

Modified Representational Difference Analysis (RDA).

23

A subtractive hybridization protocol based on RDA (Lisitsyn et al., 1993) was employed as 24

described previously (Strommenger et al., 2001). Briefly, DNA from H. parasuis serotype 25

reference strains 5 and 11 (Kielstein and Rapp-Gabrielson, 1992) were digested with DpnI

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and DpnII, followed by the ligation of double stranded oligonucleotide adaptors 1

RBgl12/RBgl24 to serotype 5 DNA fragments only. Then, 0.2 µg of serotype 5 DNA (tester) 2

were hybridized to 20 µg of serotype 11 DNA (driver) at 67 °C for 20 hours, followed by 3

PCR using primer RBgl24 as described for RDA (Lisitsyn et al., 1993). Resulting PCR 4

products were cloned using the StrataClone

PCR cloning kit (Stratagene, USA). Inserts were 5

then amplified from these clones, run on an agarose gel, subjected to Southern blotting, and 6

hybridized to P

32

labeled H. parasuis tester and driver DNA, respectively. Fragments that 7

gave stronger signals with serotype 5 DNA were sequenced (SeqLab GmbH, Göttingen, 8

Germany). To eliminate false positives, the nucleotide sequences were then used to generate 9

primers for PCR. Sequences were then confirmed to be present in serotype 5, but absent from 10

serotype 11 by PCR as well as Southern blotting using the generated PCR products as P

32

11

labeled probes on genomic serotype 5 and 11 DNA.

12

RT-PCR 13

Aerobic H. parasuis cultures were grown in a shaking incubator to OD

600

= 0.4.

14

For RT-PCR, RNA was prepared from 5 ml of liquid culture using RNEasy mini columns 15

(Qiagen, Germany) and DNAse treated (Turbo DNAse, Applied Biosystems, Germany) 16

according to the manufacturers' instructions. Reverse transcription was carried out by setting 17

up a mastermix containing 5 µg of RNA with 50 pmol of random hexamer primers, then 18

splitting up the sample into two equal portions, to one of which reverse transcriptase 19

(SuperScriptII, Invitrogen, Germany) was added. After 60 minutes at 37°C, cDNA template 20

and control samples were diluted 1:100 with ddH

2

O and 5 µl served as template for PCR 21

(94°C 3 min, [94°C 30 sec, 55°C 1 min, 72°C 1:30 sec] x 32, 72 °C 10 min). RT-PCR 22

experiments were performed in triplicate.

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RESULTS 1

Identification of serotype 5-specific H. parasuis genes.

2

Five genes were identified that are present in the H. parasuis serotype 5 but not in the 3

serotype 11 reference strain. They were found in the incomplete genomic sequence for H.

4

parasuis available at NCBI (http://www.ncbi.nlm.nih.gov): putative iron transporter cirA 5

(NZ_ABKM01000010, positions 26233-25742), two components of a putative hemolysin/

6

export system hhdA/hhdB (ZP_02479317, ZP_02479316) which are organized successively as 7

hhdBA, and two putative phage related genes which were discovered in a single sequenced 8

RDA clone (ZP_02477853, ZP_02477854). On the protein level, H. parasuis cirA is 76 % 9

identical and 88% similar to CirA of "Mannheimia succiniproducens" (YP_088507). Genes 10

hhdB and hhdA are 40% identical and 62 % similar to an uncharacterized hemolysin in H.

11

ducreyi (NP_873758, NP_873759), and they also show homology to similarly organized 12

hemolysins in Serratia and Yersinia species. The two possibly phage related genes are 13

annotated as "hypothetical proteins" in the H. parasuis genome, however, when compared to 14

other species, ZP_02477853 is 83% identical and 89% similar to a phage accociated 15

restriction endonuclease from A. pleuropneumoniae (YP_001968611), and ZP_02477854 is 16

81% identical, 91% similar to a putative phage DNA packaging protein from A.

17

pleuropneumoniae (YP_001968612). Since both genes were originally obtained from a single 18

RDA clone, the sequence obtained from this clone was used for primer generation so that both 19

genes would be picked up in a single PCR reaction. All five genes were confirmed to be 20

present in the serotype 5, but absent in the serotype 11 reference strain by PCR (Fig. 1) and 21

Southern blot (not shown).

22

Presence of serotype 5 strain Nagasaki specific genes in other H. parasuis serotype 23

reference strains and field isolates.

24

PCR analysis was used to test for the presence of the identified genes in all 15 serotype 25

reference strains (Kielstein and Rapp-Gabrielson, 1992, table 2) and in 26 field isolates from

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independent cases of clinically ill pigs in northern Germany (table 3); in addition, Southern 1

blot analysis was performed on the serotype reference strains to confirm PCR results (not 2

shown). Using primer pairs MP_A1/2, MP_B1/ 2 , and MP_CirA1/2, hhdA, hhdB and cirA 3

were shown to be present in 3 of 5 highly virulent serotype reference strains, and in 2 of 5 4

strains that caused polyserositis but not fatal disease. hhdA and hhdB were absent from 5 5

serotype reference strains that had been shown to be avirulent in experimental infection of 6

SPF pigs (3, 6, 7, 9, 11, Kielstein et al., 1991). H. parasuis cirA was present in the avirulent 7

serotype 3 reference strain, but not in the other strains described as avirulent (table 2). The 8

phage related genes were found in serotype reference strains 2, 5, 12.

9

We hypothesized that strains isolated from systemic sites were more likely to represent 10

virulent strains than strains isolated from the lungs which might represent a co-infecting strain 11

rather than the one responsible for disease. Therefore, 26 field isolates (confirmed by PCR 12

according to Oliveira et al., 2001, not serotyped) from clinically ill pigs were divided into two 13

groups: 1) Ten invasive strains which were isolated from the meninges, joints, pericardium, or 14

thoracic or abdominal cavities; 2) sixteen strains isolated from pneumonic lungs at high cfu 15

counts with signs of invasive disease not necessarily present. Half of the invasive field 16

isolates possess hhdA and cirA, but only 2 of 10 strains possess the phage related genes.

17

Except for two systemic strains which were only positive for hhdA, hhdB and hhdA were 18

always detected together in the same strain. In the lung-derived isolates, 6 of 16 strains carried 19

hhdBA and the phage terminase, whereas cirA was found in 14 of 16 strains isolated from pig 20

lungs (table 3). Notably, across all the strains tested in this study, those carrying hhdA also 21

carried cirA. To test for the presence of different alleles of hhdB and cirA genes in the 22

reference strains that tested negative in PCR and Southern blot, primer pairs oHHD503/502 23

and oCirA101/102, were used. While the cirA primers yielded the same results as previous 24

analyses, we obtained hhdB products for serotypes 2, and 7-11, which had previously been 25

negative. The nucleotide sequence of these PCR products was identical to serotype 5 hhdB.

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Transcription.

1

In order to demonstrate that the five genes were expressed in H. parasuis serotype 5 strain 2

"Nagasaki", RNA was prepared and subjected to reverse transcription and PCR. Transcripts 3

were found for all five genes and confirmed by nucleotide sequencing (Fig. 2).

4 5

DISCUSSION 6

The ability of some strains of H. parasuis to colonize the porcine respiratory tract without 7

causing disease poses a major difficulty for H. parasuis diagnostics. The variability of the 8

strains of a given serotype together with the frequent occurrence of nontypeable isolates limits 9

the usefulness of serotyping to assess a particular strain's potential for virulence (Blackall et 10

al., 1997). In order to properly characterize a strain, the presence or absence of virulence 11

associated factors needs to be investigated. In the study presented here, we have identified 12

several previously undescribed potential virulence-accociated genes and investigated their 13

distribution between serotype reference strains and 26 field isolates. All five genes are 14

expressed by H. parasuis serotype 5 reference strain Nagasaki in vitro.

15

We identified a novel potential hemolysin/export system, hhdBA. In H. ducreyi, hhdB is 16

expressed during infection in human volunteers, but does not seem to be crucial for virulence 17

(Throm and Spinola, 2001). However, it has been shown to be immunogenic (Dutro et al., 18

1999). H. parasuis is nonhemolytic on CSB and pig blood agar, which indicates that hhdBA is 19

either functional only in the host or it might be a toxin with a different function, perhaps 20

active at sublytical concentrations. It appears that different alleles of hhdBA exist in the H.

21

parasuis species, as demonstrated by differing PCR and Southern blot results. The currently 22

available data suggests that hhdBA of different serotypes contains conserved as well as 23

variable regions, similar to the situation with transferrin receptor subunit tbpB in A.

24

pleuropneumoniae (Strutzberg et al., 1995). The frequent occurrence of serotype 5 hhdBA in 25

invasive strains is notable, however, about half of the invasive field isolates we investigated

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do not possess the same hhdBA as serotype 5. In addition, there was no marked difference 1

between systemic and lung-derived isolated concerning the presence of hhdBA. Possible 2

explanations could be that hhdBA does not play a pivotal role for invasion or virulence, or that 3

its function is compensated by different genes in the other invasive strains. Since the 4

prediction of hhdBA function relies on in silico analysis and similarity to known proteins, 5

hhdBA needs to be further investigated before its exact role as a potential hemolysin/toxin in 6

H. parasuis pathogenesis can be determined. Genetic variation of hhdBA could be useful for 7

typing purposes.

8

The cirA gene appears to be widely distributed among H. parasuis strains. It is the only gene 9

present in almost all field strains. In E. coli, cirA is iron-regulated and postulated to be in 10

involved in enterobactin transport, and can also serve as a receptor for antibiotics like colistin 11

and catechol-substituted cephalosporins (Nikaido and Rosenberg, 1990). Interestingly, all hhd 12

positive H. parasuis strains were also positive for cirA. Its role in H. parasuis remains to be 13

elucidated; however, iron-regulated proteins have been shown to be involved in or even 14

required for virulence in many bacteria including members of Pasteurellaceae and 15

Neisseriaceae (Cornelissen et al., 1998, Baltes et al., 2002).

16

The two phage related genes are only present in a small number of H. parasuis strains. As 17

shown by RT-PCR analysis, the two genes identified from the RDA clone are transcribed on a 18

single mRNA. Without any further data on a complete phage, nothing can be said about its 19

possible contribution to virulence. However, phages are implicated in virulence in many 20

organisms due to their ability to carry and transmit virulence-associated genes, such as toxins, 21

famous examples being the cholera toxin of Vibrio cholerae and the Shiga toxin of E.coli 22

(Waldor and Friedman, 2005).

23

Our study is the first report of a putative hemolysin in H. parasuis. It must be noted that the 24

observation that a certain allele of hhdBA appears to be associated with an ability to cause 25

disease is currently limited to the serotype reference strains which were the only strains in our

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study for which virulence has been individually investigated in animal experiments (Wiegand 1

et al., 1997).

2

Only about half of the 26 H. parasuis field isolates from clinically ill pigs carried the genes 3

we identified, and the genes cannot be used to discriminate between pneumonic and systemic 4

strains. Obviously, taking into account the absence of these genes in some virulent reference 5

strains, the absence of these genes cannot be interpreted as an indicator of avirulence for any 6

given field isolate. However, assuming the genes we identified are indeed associated with 7

virulence, it is likely that other virulent strains will either possess different alleles of these 8

genes, or entirely different factors that remain to be identified. Alternatively, since more than 9

one strain can colonize the same animal (Smart et al., 1988), it is possible that a particular 10

clinical isolate is not the one responsible for the outbreak of disease. Further work is required 11

to determine the distribution of these genes among strains of a single serotype, as well as their 12

contribution to virulence. In comparison to the study by Metcalf and MacInnes (Metcalf and 13

MacInnes, 2007), our study focused on the presence or absence of genes rather than 14

differences in expression levels. The authors found a correlation between elevated haloacid 15

dehydrogenase expression with virulence for a subset of the reference strains, but did not 16

investigate all reference strains, or additional field strains, and the role of haloacid 17

dehydrogenases in virulence has not been fully investigated in H. parasuis or in other 18

organisms. Perhaps a multifaceted approach, looking at the presence, variability and 19

expression level of genes will be able to predict the pathogenic potential of H. parasuis strains 20

more reliably when more data is available.

21 22

ACKNOWLEDGMENTS 23

This work was funded by the Akademie für Tiergesundheit, Bonn, Germany. The authors 24

wish to thank Astrid Raßbach for providing H. parasuis serotype reference strains, and

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Jürgen Mumme, Jutta Verspohl, Alexander Maas and Christoph Baums for providing H.

1

parasuis field isolates.

2 3

REFERENCES 4

Baltes, N., Hennig-Pauka, I., and Gerlach, G. F., 2002. Both transferrin binding proteins are 5

virulence factors in Actinobacillus pleuropneumoniae serotype 7 infection. FEMS Microbiol.

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Haemophilus parasuis by multilocus enzyme electrophoresis. Vet. Microbiol. 56, 125-134.

9

Charland, N., D'Silva, C. G., Dumont, R. A., and Niven, D. F., 1995. Contact-dependent 10

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Microbiol. 41, 70-74.

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Cornelissen, C. N., Kelley, M., Hobbs, M. M., Anderson, J. E., Cannon, J. G., Cohen, M. S., 13

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Lichtensteiger, C. A. and Vimr, E. R., 1997. Neuraminidase (sialidase) activity of 4

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5

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complex genomes. Science 259, 946-951.

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Metcalf, D. S. and MacInnes, J. I., 2007. Differential expression of Haemophilus parasuis 8

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9

Munch, S., Grund, S., and Kruger, M., 1992. Fimbriae and membranes on Haemophilus 10

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Nielsen, R. 1993. Pathogenicity and immunity studies of Haemophilus parasuis serotypes.

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Acta Vet. Scand. 34, 193-198.

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Nikaido, H. and Rosenberg, E. Y., 1990. Cir and Fiu proteins in the outer membrane of 14

Escherichia coli catalyze transport of monomeric catechols: study with beta-lactam antibiotics 15

containing catechol and analogous groups. J. Bacteriol. 172, 1361-1367.

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Oliveira, S., Galina, L., and Pijoan, C., 2001. Development of a PCR test to diagnose 17

Haemophilus parasuis infections. J. Vet. Diagn. Invest 13, 495-501.

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Oliveira, S. and Pijoan, C., 2004. Computer-based analysis of Haemophilus parasuis protein 19

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Turni, C. and Blackall, P. J., 2005. Comparison of the indirect haemagglutination and gel 12

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expression. Curr. Opin. Microbiol. 8, 459-465.

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Wiegand, M., Kielstein, P., Pohle, D., and Rassbach, A., 1997. [Examination of primary SPF 16

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25, 226-232.

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Table 1: Primers used in this study

primers description source

RBgl12 RBgl24

5’ GATCTGCGGTGA 3’

5’ AGCACTCTCCAGCCTCTCACCGCA 3’

Primer pair to generate RDA adaptor

(Lisitsyn et al., 1993)

HPS-forward HPS-reverse

5’ GTGATGAGGAAGGGTGGTGT 3’

5’ GGCTTCGTCACCCTCTGT 3’

Primer pair for amplification of 16 S rRNA gene fragment, product size 821 bp

(Oliveira et al., 2001)

MP_A1 MP_A2

5’ GGTTCTAGTTCACAAACAGCCAATAC 3’

5’ GATATTTACCCCTGCCTTCATTGTATC 3’

Primer pair for amplification of hhdA gene fragment, product size 964 bp

this work

MP_B1 MP_B2

5’ ATCTTGCCCTGATTAGAGAGTAGGAGT 3’

5’ GTGAATATAGCCCTTATCCAAATAGGC 3’

Primer pair for amplification of hhdB gene fragment, product size 557 bp

this work

oHhdB1 oHhdB2

5’-CTTACGCCTTGTTTGATCTG-3’

5’-TATGTTGCATGGGTGCTA-3’

product size 348 bp

this work

oHHD503 oHHD502

5’-AGCGAGTATCATCGGTGGTC-3’

5’-CTTGGCTGACAATTCAGCTT-3’

product size 509 bp

this work

MP_CirA1 MP_CirA2

5’ GTATGCAGAATAAAGCCCTGCTAAAC 3’

5’ AAAGAGCCGAGAAATATCGTAGATGTG 3’

this work

Table 1

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Primer pair for amplification of cirA gene fragment in RT-PCR, product size 161 bp

MP_CirA1 MP_CirA4

5’ GTATGCAGAATAAAGCCCTGCTAAAC 3’

5’ CTGTAAAGCAATGCAATTACCGTAGTG 3’

Primer pair for amplification of cirA gene fragment, product size 215 bp

this work

oCIR101 oCIR102

5’ CGCACACGGATCAGAGAGTA 3’

5’ GGTGGTAAACCGCTTGATCT 3’

Primer pair for amplification of cirA gene fragment, product size 1593 bp

this work

oPhage13-1 oPhage13-2

5’ GCTTGCGGGTAATCTGTTGT 3’

5’ AGAATCAACCTCAGCCGAAA 3’

Primer pair for amplification of phage related genes (upstream primer in ZP_02477853, downstream primer in, ZP_02477854), product size 301 bp

this work

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Accepted Manuscript

Table 2: PCR of H. parasuis serotype reference strains, sorted by virulence according to Kielstein and Rapp-Gabrielson, 1992, presence of identified genes

serotype reference strain gene death within 4 days polyserositis, but no

death within 4 days

no clinical symptoms

1 5 10 12 13 14 2 4 8 15 3 6 7 9 11

hhdA - + - + + + - - - + - - - - -

hhdB - + - + + + - - - + - - - - -

cirA - + - + + + - - - + + - - - -

phage - + - + - - + - - - - - - - -

Table 2

(19)

Accepted Manuscript

Table 3: PCR analysis of H. parasuis field isolates, presence of identified genes 1

in strains isolated from systemic locations

in strains isolated from lungs

hhdA 5/10 6/16

hhdB 3/10 6/16

cirA 5/10 14/16

phage 2/10 6/16

2

Table 3

(20)

Accepted Manuscript

FIGURE LEGENDS 1

2

Fig. 1: PCR analysis of identified genes in H. parasuis serotype reference strains 1-15.

3

+: H. parasuis serotype 5 "Nagasaki" as positive control, -: no DNA template 4

5

Fig. 2: Transcription of identified genes in H. parasuis serotype 5 reference strain 6

"Nagasaki", assessed by reverse transcriptase PCR. 1: hhdA, 2: hhdB, MP_B1/2. 3: cirA, 4:

7

phage related genes, 5: H. parasuis 16S RNA (Oliveira et al., 2001). +RT: samples with 8

reverse transcriptase, - RT: samples without reverse transcriptase. DNA: positive controls 9

containing genomic DNA template. -: no DNA template 10

11

figure legends

(21)

Accepted Manuscript

Figure 1

(22)

Accepted Manuscript

Figure 2

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