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Journal of Bacteriology, May 2005, p. 2967-2973, Vol. 187, No. 9
0021-9193/05/$08.00+0 doi:10.1128/JB.187.9.2967-2973.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Staphylococcus epidermidis Polysaccharide Intercellular Adhesin Production Significantly Increases during Tricarboxylic Acid Cycle Stress
Cuong Vuong,1
Joshua B. Kidder,2,
Erik R. Jacobson,3
Michael Otto,1
Richard A. Proctor,2,4 and
Greg A. Somerville1,5*
Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 903 South 4th Street, Hamilton, Montana 59840,1
Departments of Medical Microbiology and Immunology,2
Medicine, University of Wisconsin Medical School, 1300 University Ave., Madison, Wisconsin 53706,4
University of Nebraska-Lincoln, Department of Biochemistry, Beadle Center, University of Nebraska, Lincoln, Nebraska 68588-0664,3
University of Nebraska-Lincoln, Department of Veterinary and Biomedical Sciences, 120 VBS Fair St., Lincoln, Nebraska 68583-09055
Received 1 December 2004/
Accepted 25 January 2005

ABSTRACT
Staphylococcal polysaccharide intercellular adhesin (PIA) is
important for the development of a mature biofilm. PIA production
is increased during growth in a nutrient-replete or iron-limited
medium and under conditions of low oxygen availability. Additionally,
stress-inducing stimuli such as heat, ethanol, and high concentrations
of salt increase the production of PIA. These same environmental
conditions are known to repress tricarboxylic acid (TCA) cycle
activity, leading us to hypothesize that altering TCA cycle
activity would affect PIA production. Culturing
Staphylococcus epidermidis with a low concentration of the TCA cycle inhibitor
fluorocitrate dramatically increased PIA production without
impairing glucose catabolism, the growth rate, or the growth
yields. These data lead us to speculate that one mechanism by
which staphylococci perceive external environmental change is
through alterations in TCA cycle activity leading to changes
in the intracellular levels of biosynthetic intermediates, ATP,
or the redox status of the cell. These changes in the metabolic
status of the bacteria result in the attenuation or augmentation
of PIA production.

INTRODUCTION
Staphylococcus aureus and
S. epidermidis infections cause a
considerable amount of morbidity in humans and animals. Although
the types and severity of diseases produced by these opportunistic
pathogens vary, both are important causes of infections associated
with indwelling medical devices (e.g., catheters) (
27). Catheter-associated
infections usually involve a two-step process leading to the
formation of a bacterial biofilm. The first step in biofilm
formation involves attachment of the organism to an uncoated
plastic surface, or a plastic surface coated with host proteins
(
39). The second step involves the accumulation of bacteria
on top of the bacteria adhering to the plastic surface, a step
requiring the production of polysaccharide intercellular adhesin
(PIA). PIA is a ß-1,6-linked polysaccharide that is
strongly associated with the staphylococcal cell surface and
mediates cell-to-cell adhesion (
22).
Synthesis of PIA requires the enzymes encoded within the intercellular adhesion (ica) operon (icaADBC) (13). Regulation of the ica operon involves at least one DNA binding protein (IcaR) and the alternative sigma factor
B (Fig. 1). IcaR binds immediately 5' to the icaA transcriptional start site and acts as a transcriptional repressor of the ica operon (4, 14). Compelling evidence also indicates that
B is involved in the production of PIA, although this involvement is likely indirect as the ica operon lacks a
B consensus recognition sequence (15, 28). Recent data from the Mack laboratory provide strong evidence that
B affects PIA production by controlling the expression on icaR (16). In addition to these regulatory elements, staphylococci regulate the production of PIA in response to nutrient availability, environmental signals, and stress-inducing stimuli. Expression of the ica operon is increased during growth in oxygen-limiting (7), nutrient-replete (9, 23), or iron-limiting conditions (8). Additionally, stress-inducing stimuli such as heat (29), ethanol (5), and high concentrations of salt (15) increase ica expression and PIA production. These observations highlight a recurrent theme in pathogenesis: the regulation of many virulence genes is controlled by environmental factors (26).
S. aureus and
S. epidermidis both possess a complete tricarboxylic
acid (TCA) cycle, but lack a glyoxylate bypass (
34; G. A. Somerville
unpublished observations). TCA cycle activity is essential for
the complete catabolism of nonpreferred carbon sources and the
subsequent generation of reducing potential and biosynthetic
intermediates. The activity of TCA cycle enzymes is affected
by the nutritional status of the cell and a variety of stress-inducing
stimuli.
S. aureus represses TCA cycle activity when grown in
nutrient-replete conditions (
3,
32) or under conditions of low
oxygen availability (
35). In addition, the enzymatic activity
of several TCA cycle enzymes requires iron (i.e., aconitase,
succinate dehydrogenase complex, and fumarase); hence, during
growth under conditions of low iron availability TCA cycle activity
is dramatically reduced (
30,
37). TCA cycle activity can also
be disrupted by certain stress-inducing stimuli such as heat
(
36) and ethanol (
17; I. Chatterjee and M. Herrmann, personal
communication). The similarity between the environmental and
nutritional factors influencing TCA cycle activity and PIA production
led us to hypothesize that altering TCA cycle activity would
affect PIA production. In the present study, we tested the hypothesis
that increased PIA production is associated with decreased TCA
activity.

MATERIALS AND METHODS
Bacterial strains, materials, and growth conditions.
S. epidermidis strain SE1457 is an
agr-positive, biofilm-forming
strain (
23,
40).
S. epidermidis strains were grown in tryptic
soy broth containing 0.5% or 0.3% (wt/vol) glucose (TSB) (BD
Biosciences, Sparks, Md.) or in TSB containing 0.001% phenol
red. All bacterial cultures, unless stated otherwise, were inoculated
1:100 from an overnight culture into TSB, incubated at 37°C,
and aerated at 160 rpm. A flask-to-medium ratio of 4:1 was used
to produce less aeration, whereas, a flask-to-medium ratio of
7:1 was used for greater aeration. Bacterial growth was assessed
by measuring the optical density at 600 nm or by determining
the CFU ml
1. Barium fluorocitric acid (Sigma Chemical,
St. Louis, MO) was dissolved in 2 N HCl, neutralized with 10
N NaOH, centrifuged to remove the BaOH, and the volume was increased
with H
2O to the appropriate concentration. After removal of
the BaOH, the fluorocitric acid was used to specifically inhibit
the TCA cycle enzyme aconitase. Anti-PIA antisera were generated
against purified PIA by Sigma-Genosys.
Free amino acid concentrations in TSB.
The concentrations of free amino acids in TSB were determined with a Beckman model 6300 amino acid analyzer (Scientific Research Consortium, Inc., St. Paul, MN). The µM concentrations of free amino acids in TSB were as follows: Ser, 1,098; Gly, 140; Ala, 720; Glu, 1,840; Gln, 546; Thr, 1,134; Met, 1,136; Ile, 1,556; Arg, 2,014; His, 598; Pro, 184; Leu, 6,426; Lys, 3,360; Val, 2,072; Phe, 2,654; Trp, 482; Asp, 670; Asn, 782; Tyr, 442; and Cys, 190.
Measurement of acetate and glucose in culture supernatants.
Aliquots of bacteria (1.5 ml) were centrifuged for 5 min at 20,800 x g at 4°C, and supernatants were removed and stored at 20°C until use. Acetate and glucose concentrations were determined with kits purchased from R-Biopharm, Inc. (Marshall, MI) and used according to the manufacturer's directions.
PIA immunoblot assay.
The relative amount of PIA produced was determined essentially as described (38). Briefly, equal numbers of S. epidermidis cells (0.51 A600 units) were harvested by centrifugation, and the PIA was extracted in 0.5 M EDTA (pH 8.0) by boiling for 5 min. Aliquots of PIA were applied to a nitrocellulose membrane and blocked with 5% skim milk overnight. The nitrocellulose membrane was incubated for 2 h with anti-PIA antiserum and, subsequently, for 2 h with an anti-rabbit immunoglobulin G (IgG) alkaline phosphatase conjugate. The presence of PIA was detected by the addition of 5-bromo-4-chloro-3-indolylphosphate and nitroblue tetrazolium. The integrated density values of bands on autoradiographs were determined with the TotalLab software (Nonlinear Dynamics Ltd.)
Determination of soluble NAD+ and NADH concentrations.
Intracellular NAD+ and NADH concentrations were determined with an enzymatic cycling assay as described (1). Briefly, aliquots (5 ml) were harvested at 2, 3, and 4 h postinoculation by passing the bacterial culture through a 0.45 µM nitrocellulose filter (Millipore). Depending upon which dinucleotide was being measured, either 0.2 M KOH (NAD+) or 0.2 M HCl (NADH) (1 ml) was added to 15-ml tubes containing the membranes, the tubes were vortexed, and immediately placed in a boiling water bath for 10 min. Cooled lysates were centrifuged for 5 min at 15,000 x g at 4°C, cell-free lysates (400 µl) were transferred to microcentrifuge tubes, and the pH was adjusted to 7.0 with 0.2 M KOH or 0.2 M HCl (volumes were normalized with phosphate-buffered saline). Cycling buffer (800 µl) (4.4 ml of 0.623 M bicine
, 4.4 ml of 0.0026 M methylthiazotetrazolium [MTT], 4.4 ml of 0.026 M EDTA, 3.5 ml of 0.0104 M phenazine ethosulfate [PES], and 0.8 ml ethanol) was added, and the mixtures were equilibrated at room temperature in the dark for 5 min. Quadruplicate aliquots (200 µl) were transferred into 96-well microtiter plates and the reactions were started by the addition of 40 µl of 1.3 mg/ml yeast alcohol dehydrogenase (Sigma). The reaction was followed by monitoring the change in absorbance at 570 nm (A570) every 30 s for a total of 10 min. The intracellular concentrations of NAD+ and NADH were determined by comparing the change in A570 of the samples to the change in absorbance for known concentrations of NAD+ and NADH (2, 4, 16, 64, and 128 µM). All assays were performed in quadruplicate from three independent cultures.
Enzymatic activity assays.
Aconitase and isocitrate dehydrogenase enzymatic activity assays were performed essentially as described (32); except that bacterial suspensions were lysed with a FastPrep instrument using FastProtein Blue kit (Qbiogene, Carlsbad, CA). Protein concentrations were determined by the method of Lowry et al. (20).
Statistical analysis.
Statistical significance was assessed with Student's t test. To determine if a correlation existed between two parameters, a Pearson's correlation coefficient (
) was calculated.

RESULTS
"Deoptimization" of PIA production.
S. epidermidis growth conditions have been optimized to permit
maximal PIA production in the laboratory setting (e.g., nutrient-rich
media). The same conditions that enhance PIA production repress
TCA cycle activity. Hence, in order to determine if TCA cycle
activity affected PIA production, it was necessary to increase
TCA cycle function. To do this, strain SE1457 was grown under
PIA inducing conditions (TSB containing 0.5% glucose, aerated
at 160 rpm, and with a flask-to-medium ratio of 4:1 [
41]) and
TCA cycle function was assessed by determining the concentration
of acetate in the culture medium throughout the growth cycle
(Fig.
2). Acetate catabolism is an indictor of TCA cycle activity,
because the catabolism of acetate requires a fully functioning
TCA cycle (
31,
33). Using PIA-inducing growth conditions, glucose
remained in the culture medium until the bacterial culture had
reached the stationary phase; this coincided with the accumulation
of acetate in the medium. These same conditions also prevented
the depletion of acetate from the culture medium, suggesting
that TCA cycle activity was inhibited in the post-exponential-growth
phase (Fig.
2A). Decreasing the glucose concentration to 0.3%
and increasing the aeration in the bacterial culture (flask-to-medium
ratio of 7:1) resulted in the complete catabolism of glucose
and acetate from the culture medium (Fig.
2B), suggesting the
TCA cycle was functioning. Importantly, altering the growth
conditions to favor TCA cycle activity reduced PIA production
(Fig.
2A and B), but did not eliminate PIA production.
Fluorocitrate significantly enhances PIA production.
Altering the growth conditions to favor TCA cycle function facilitated
acetate catabolism and reduced PIA production (Fig.
2B), consistent
with our hypothesis that reduced PIA production is associated
with increased TCA cycle activity. To test this hypothesis further,
we incubated
S. epidermidis strain SE1457 with a TCA cycle specific
inhibitor, fluorocitrate, and determined the amount of cell-associated
PIA. Fluorocitrate is a highly toxic compound when metabolized
to 4-hydroxy-
trans-aconitate by the TCA cycle enzyme aconitase
(
19,
25). The toxicity is due to very tight, noncovalent binding
of 4-hydroxy-
trans-aconitate to aconitase (
19). As the concentration
of fluorocitrate in the culture medium was increased, the amount
of PIA produced increased (

= 0.91) (Fig.
3A). Of importance,
the concentrations of fluorocitrate used in these experiments
did not affect the ability of
S. epidermidis to catabolize glucose,
the growth rate, or the growth yields at 6 h (data not shown
and Fig.
3B). However, increasing concentrations of fluorocitrate
caused partial TCA cycle inhibition, resulting in significant
(
P 
0.05) increases in the post-exponential-growth-phase (6-h)
accumulation of acetate in the culture medium, an indication
of altered TCA cycle function (Fig.
3B). In other words, the
increased concentrations of acetate in the culture medium demonstrated
that fluorocitrate was entering into the bacteria and partially
inhibiting TCA cycle function, but the absence of effects on
glucose catabolism and growth demonstrate that low levels of
fluorocitrate are not inducing a stress response. While the
increase in the concentration of acetate in the culture medium
at 6 h was statistically significant, in our experience, these
minor differences in acetate concentrations are not biologically
significant, suggesting that another TCA cycle-derived product
was responsible for the increased PIA production. Taken together,
these data demonstrate that small perturbations in the TCA cycle
can significantly increase PIA production.
Fluorocitrate alters the intracellular redox status.
The addition of fluorocitrate to the growth medium increased
the exponential-growth-phase synthesis of PIA per
A600 unit
(Fig.
4A). The TCA cycle provides biosynthetic intermediates
(

-ketoglutarate, succinyl-coenzyme A [CoA], and oxaloacetate),
ATP, and reducing potential; therefore, altering TCA cycle activity
alters the metabolic status of the cell. TSB is a nutrient-rich
medium containing high concentrations of free amino acids and
peptides (Materials and Methods); hence, minor alterations in
TCA cycle activity are unlikely to affect the intracellular
availability of biosynthetic intermediates during the exponential
phase of growth. The majority of the ATP derived from TCA cycle
activity comes from the oxidation of NADH during respiration.
Thus, if an alteration in TCA cycle activity resulted in a decreased
concentration of ATP, then the likely cause would be a change
in the redox status of the bacteria. For these reasons, we chose
to examine the effects of fluorocitrate on the concentrations
of unbound NAD
+ and NADH (Fig.
4B and C). As expected, the addition
of 100 µM fluorocitrate to the culture medium significantly
decreased the intracellular concentrations of free NAD
+ and
NADH. Surprisingly, this effect occurred early in the growth
cycle, suggesting the TCA cycle was active during the early
exponential growth phase. The early induction of TCA cycle activity
differs somewhat from that found in
S. aureus, which induces
the TCA cycle late in the exponential growth phase when readily
catabolizable carbon sources become limiting (
32).
S. epidermidis TCA cycle activity.
Growth of strain SE1457 in the presence of fluorocitrate altered
the redox status of the bacteria early in the exponential phase
of growth (Fig.
4B and C), indicating the TCA cycle was active
early in the growth cycle. Consistent with this hypothesis,
the nonstoichiometric accumulation of acetate (1 glucose = 2
acetate) in the culture medium (Fig.
2) suggested that glucose
carbons were being diverted from substrate-level phosphorylation.
These data, in addition to the absence of lactate in the culture
medium (data not shown), led us to postulate that strain SE1457
was diverting acetyl-CoA into the TCA cycle. Enzymatic assays
of isocitrate dehydrogenase and aconitase (Fig.
5) confirmed
that
S. epidermidis had a low level of TCA cycle activity early
in the exponential growth phase. As stated, these same growth
conditions are known to repress TCA cycle activity in
S. aureus (
32). These data strongly suggest that the early exponential
growth phase difference in the intracellular concentration of
NAD
+ and NADH was due to an early induction of TCA cycle activity.

DISCUSSION
A common mechanism by which staphylococci induce disease is
through the formation of a biofilm on an indwelling medical
device (
6,
12). One important step in the formation of a staphylococcal
biofilm is production of the exopolysaccharide PIA (
39). Numerous
studies have demonstrated that
S. epidermidis regulates the
production of PIA in response to nutrient availability, environmental
signals, and stress-inducing stimuli (
4,
8,
9,
15,
23,
29),
leading to considerable speculation about the nature of
ica/PIA
regulatory elements. Recent data have led to the hypothesis
that PIA production might be limited, even in the presence of
the Ica proteins, due to a shortage of PIA precursors and/or
energy (
9). These observations and the similarity of environmental
stimuli affecting PIA production to those that affect TCA cycle
activity led us to examine the role of the TCA cycle in PIA
production.
The metabolism of PIA production.
Staphylococcal PIA is a ß(1-6)-linked N-acetylglucosamine polymer (24) of at least 130 residues (21); hence, production of PIA creates a need for UDP-activated N-acetylglucosamine (11). The synthesis of UDP-N-acetylglucosamine is a multistep process that begins with the transamination of the glycolytic intermediate fructose 6-phosphate (Fig. 6). Growth of S. epidermidis in TSB medium containing glucose will produce abundant levels of fructose 6-phosphate through the glycolytic (Embden-Meyerhof-Parnas) pathway. In the absence of glucose, as occurs during the postexponential growth phase (Fig. 2B), fructose 6-phosphate can be synthesized by gluconeogenesis from the TCA cycle intermediate oxaloacetate (Fig. 6). Gluconeogenesis requires energy and withdraws carbon from the TCA cycle, necessitating anaplerotic reactions at a time when carbon is limiting; thus, it is unlikely that sufficient fructose 6-phosphate can be made to maintain PIA production and growth. This inability to produce sufficient fructose 6-phosphate during the post-exponential-growth phase is exacerbated by the absence of a carbon salvage pathway (i.e., the glyoxylate bypass). In the absence of a glyoxylate bypass, two carbons are lost as CO2 for every two carbons that enter into the TCA cycle. Therefore, to produce PIA during the post-exponential-growth phase, S. epidermidis must overcome a large carbon deficit. Interestingly, the predicted decrease in the availability of fructose 6-phosphate coincides with the post-exponential-growth-phase repression of PIA biosynthetic genes (ica operon) (9). Taken together, these observations suggest the post-exponential-growth-phase decrease in PIA accumulation (Fig. 2B) occurs through a synchronization of metabolism and icaR-dependent regulation of ica transcription. This suggestion is supported by the fact that addition of fluorocitrate to the culture medium correlates with a significant increase in the synthesis of PIA (Fig. 3A and 4A), demonstrating a close association between PIA production and metabolism.
The role of the TCA cycle in PIA production.
Increased PIA production is associated with decreased TCA activity,
whether it is the result of slowing the TCA cycle by fluorocitrate
(Fig.
3A) or by reduced culture aeration (Fig.
2A and B), leading
us to hypothesize that impairment of TCA cycle function shunts
metabolites toward PIA production. In support of this hypothesis,
the addition of fluorocitrate to the culture medium increases
the concentration of acetate in the culture medium (Fig.
3B),
demonstrating carbon is diverted from the TCA cycle. The diversion
of carbon to PIA is suggested by an increase in the amount of
PIA produced per
A600 unit when
S. epidermidis is grown in the
presence of fluorocitrate (Fig.
4A). Additionally, the shunting
of metabolites away from the TCA cycle during growth in a medium
containing fluorocitrate is indicated by an increase in the
strength of the correlation between the decrease in glucose
concentration (Fig.
2B) and the increase in PIA spot density
(Fig.
3A) relative to the untreated culture medium (untreated
medium,

= 0.907; 100 µM fluorocitrate-containing
medium,

= 0.996). Taken together, these data suggest
that one effect of TCA cycle stress is the shunting of carbon
away from the TCA cycle and toward PIA production.
In addition to biosynthetic intermediates, the TCA cycle provides the reducing potential (NADH) to drive ATP synthesis, suggesting that TCA cycle stress will alter the redox status of S. epidermidis. As anticipated, incubation of S. epidermidis with fluorocitrate decreases the intracellular concentration of NADH and NAD+ (Fig. 4B and C). Surprisingly, this alteration occurred early in the exponential phase of growth (Fig. 3B and C), suggesting the TCA cycle was active early in the growth cycle (Fig. 5). These data lead us to speculate that events early in the growth cycle of S. epidermidis, such as the availability of NAD+ or NADH, determine the amount of PIA that will be produced. Furthermore, we predict a regulatory protein is responding to the redox status of the bacteria to affect ica transcription or PIA production. We note that several NADH sensor proteins have been identified in other organisms (e.g., Rex [2], NmrA [18], and CcpA [10]). Our laboratories are actively investigating these possibilities.

ACKNOWLEDGMENTS
We thank R. G. Barletta for critical review of the manuscript.
G.A.S. wishes to acknowledge J. M. Musser and the NIAID for providing financial assistance during the initial phase of this research. Portions of this publication were made possible with Nebraska Tobacco Settlement Biomedical Research Enhancement Funds and by NIH Grant Number P20 RR-17675-02 from the COBRE Program of the National Center for Research Resources. Public Health Service Grant AI42072 from the National Institutes of Health supported R.A.P.

FOOTNOTES
* Corresponding author. Mailing address: Department of Veterinary and Biomedical Sciences, University of Nebraska-Lincoln, 202 VBS Fair St., Lincoln, NE 68583-0905. Phone: (402) 472-6063. Fax: (402) 472-9690. E-mail:
gsomerville3{at}unl.edu.

Present address: 106 Hawthorne Way, #304, S. Lawrence, MA 01843. 

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Journal of Bacteriology, May 2005, p. 2967-2973, Vol. 187, No. 9
0021-9193/05/$08.00+0 doi:10.1128/JB.187.9.2967-2973.2005
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