Chapter 6 : Adherence Mechanisms in Urinary Tract Infections

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This chapter provides an overview of the bacterial adhesins that promote colonization of the human urinary tract. Particular attention is addressed to the adherence properties that may contribute to symptomatic urinary tract infection (UTI) in patients with underlying urinary defects including urinary catheterization. Recent progress regarding the adherence properties of bacteria associated with acute community-acquired UTI is also reviewed. Unlike other adhesins discussed in the chapter, type 1 pili are present in most and other members of the family Enterobacteriaceae. However, in the Donovan study, many more people experienced bowel colonization with than experienced symptomatic UTI, so that the net benefit of prophylaxis to eliminate from all patients would have been marginal. As investigators move closer to understanding the structural requirements for recognition and binding of bacterial adhesins to tissue and for the assembly of functional adherence organelles, rational design of novel antiadherence or antiassembly agents will become possible. Little is known about the urinary tract adherence mechanisms of , although it is the primary or secondary cause of UTI in certain patient groups. P pili appear to be a risk factor in the progression of kidney infection to urosepsis. The effectiveness of the test strain for preventing subsequent symptomatic disease is under investigation.

Citation: Hull R, Hull S. 1994. Adherence Mechanisms in Urinary Tract Infections, p 79-90. In Miller V, Kaper J, Portnoy D, Isberg R (ed), Molecular Genetics of Bacterial Pathogenesis. ASM Press, Washington, DC. doi: 10.1128/9781555818340.ch6

Key Concept Ranking

Bacterial Pathogenesis
Type 1 Pili
Urinary Tract Infections
Bacterial Virulence Factors
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1. Abrahamsson, K.,, S. Hansson,, U. Jodal,, and K. Lincoln. 1993. Staphylococcus saprophyticus urinary tract infections in children. Eur. J. Pediatr. 152:6971.
2. Adegbola, R. A.,, D. C. Old,, and B. W. Senior. 1983. The adhesions and fimbriae of Proteus mirabilis strains associated with high and low affinity for the urinary tract. J. Med. Microbiol. 16:427431.
3. Andersson, P.,, I. Engberg,, G. Lindin-Janson,, K. Lincoln,, R. Hull,, S. Hull,, and C. Svanborg. 1991. Persistence of Escherichia coli bacteriuria is not determined by bacterial adherence. Infect. Immun. 59:29152921.
4. Bahrani, F. K.,, S. Cook,, R. A. Hull,, G. Massad,, and H. L. T. Mobley. 1993. Proteus mirabilis fimbriae: N-terminal amino acid sequence of a major subunit and nucleotide sequences of the genes from two strains. Infect. Immun. 61:884891.
5. Bahrani, F. K.,, and H. L. T. Mobley. 1993. Proteus mirabilis MR/P fimbriae: molecular cloning, expression, and nucleotide sequence of the major subunit gene. J. Bacteriol. 475:457464.
6. Beuth, J.,, H. L. Ko,, F. Schuntacher-Perdreau,, G. Peters,, P. Heczko,, and G. Pulverer. 1988. Hemagglutinaton by Staphylococcus saprophyticus and other coagulase-negative staphylococci. Microb. Pathog. 4:379383.
7. Buchanan, K.,, S. Falkow,, R. A. Hull,, and S. I. Hull. 1985. Frequency among Enterobacteriaceae of DNA sequences encoding type 1 pili. J. Bacteriol. 162:799803.
8. Denich, K.,, A. Craiu,, H. Rugo,, G. Muralidhar,, and P. O'Hanley. 1991. Frequency and organization oipapA homologous DNA sequences among uropathogenic digalactoside-binding Escherichia coli strains. Infect. Immun. 59:20892096.
9. Donovan, W. H.,, R. Hull,, D. X. Cifu,, H. D. Brown,, and N. J. Smith. 1990. Use of plasmid analysis to determine the source of bacterial invasion of the urinary tract. Paraplegia 28:573582.
10. Eddeland, A.,, and H. Hedelin. 1983. Bacterial colonization of the lower urinary tract in women with long-term indwelling urethral catheters. Scand. J. Infect. Dis. 15:361365.
11. Firon, N.,, I. Ofek,, and N. Sharon. 1984. Carbohydrate-binding sites of the mannose-specific fimbrial lectins of enterobacteria. Infect. Immun. 43:10881090.
12. Fujita, K.,, T. Yamamoto,, and R. Kitagawa. 1991. Binding sites for P and/or type 1 piliated Escherichia coli in human ureter. J. Urol. 146:217222.
13. Fujita, K.,, T. Yokota,, T. Oguri,, M. Fujime,, and R. Kitagawa. 1992. In vitro adherence of Staphylococcus saprophyticus, Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus aureus to human ureter. Urol. Res. 20:399402.
14. Gatermann, S.,, R. Marre,, J. Heesemann,, and W. Henkel. 1988. Hemagglutinating and adherence properties of Staphylococcus saprophytics: epidemiology and virulence in experimental urinary tract infections of rats. FEMS Microbiol. Immunol. 1:179185.
15. Gatermann, S.,, H.-G. W. Meyer,, and G. Wanner. 1992. Staphylococcus saprophyticus hemagglutinin is a 160-kilodalton surface polypeptide. Infect. Immun. 60:41274132.
16. Guzman, C. A.,, C. Pruzzo,, G. LiPiri,, and L. Calegari. 1989. Role of adherence in pathogenesis of Enterococcus faecalis urinary tract infection and endocarditis. Infect. Immun. 57:18341838.
17. Hacker, J. 1990. Genetic determinants coding for fimbriae and adhesins of extraintestinal Escherichia coli. Curr. Top. Microbiol. Immunol. 151:127.
18. Hagberg, L.,, R. Hull,, S. Hull,, S. Falkow,, R. Freter,, and C. Svanborg-Eden. 1983. Contribution of adhesion to bacterial persistence in the mouse urinary tract. Infect. Immun. 40:265272.
19. Hanson, L. A.,, A. Fasth,, U. Jodal,, B. Kagser,, and C. Svanborg-Eden. 1981. Biology and pathology of urinary tract infections. J. Clin. Pathol. 34:695700.
20. Hull, R. A.,, S. I. Hull,, and S. Falkow. 1984. Frequency of gene sequences necessary for pyelonephritis associated pili expression among isolates of Enterobacteriaceae from human extraintestinal infection. Infect. Immun. 43:10641067.
21. Ikaheimo, R.,, A. Siilonen,, U. Karkkainen,, P. Kuosmanen,, and H. Makela. 1993. Characteristics of Escherichia coli in acute community-acquired cystitis of adult women. Scand. J. Infect. Dis. 25:705712.
22. Iwahi, T.,, Y. Abe,, M. Nakao,, A. Imada,, and K. Tsuchiya. 1983. Role of type 1 fimbriae in the pathogenesis of ascending urinary tract infection induced by Escherichia coli in mice. Infect. Immun. 39:13071315.
23. Johanson, I.,, R. Lindstedt,, and C. Svanborg. 1992. Roles of the pap- and p/\s-encoded adhesins in Escherichia coli adherence to human uroepithelial cells. Infect. Immun. 60:34163422.
24. Johnson, D. E.,, R. G. Russell,, C. V. Lockatell,, J. C. Zulty,, J. W. Warren,, and H. L. T. Mobley. 1993. Contribution of Proteus mirabilis urease to persistence, urolithiasis, and acute pyelonephritis in a mouse model of ascending urinary tract infection. Infect. Immun. 61:27482754.
25. Johnson, J. 1991. Virulence factors in Escherichia coli urinary tract infection. Clin. Microbiol. Rev. 4:80128.
26. Johnson, J. R.,, I. 0rskov,, F. Orskov,, P. Goullet,, B. Picard,, S. L. Moseley,, P. L. Roberts,, and W. Stamm. 1994. O, K, and H antigens predict virulence factors, carboxylesterase B pattern, antimicrobial resistance, and host compromising factors among Escherichia coli strains causing urosepsis. J. Infect. Dis. 169:119126.
27. Johnson, J. R.,, P. L. Roberts,, and W. Stamm. 1987. P fimbriae and other virulence factors in Escherichia coli urosepsis: association with patients' characteristics. J. Infect. Dis. 156:225229.
28. Kaak, M. B.,, L. N. Martin,, S. B. Svenson,, G. Baskin,, R. H. Steele,, and J. A. Roberts. 1993. Protective anti-idiotypic antibodies in the primate model of pyelonephritis. Infect. Immun. 61: 22892295.
29. Karr, J. K.,, B. J. Nowicki,, L. D. Truong,, R. A. Hull,, J. J. Moulds,, and S. I. Hull. 1990. pap-2 encoded fimbriae adhere to the P blood group-related glycosphingolipid stage-specific embryonic antigen 4 in the human kidney. Infect. Immun. 58:40554062.
30. Klann, A. G.,, R. A. Hull,, T. Palzkill,, and S. I. Hull. 1994. Alanine scanning mutagenesis reveals residues involved in binding of pap-3 encoded pili. J. Bacteriol. 176:23122317.
31. Kuehn, M. J.,, D. J. Ogg,, J. Kihlberg,, L. N. Slonim,, K. Flemmer,, T. Bergfors,, and S. Hultgren. 1993. Structural basis of pilus subunit recognition by the PapD chaperone. Science 162:12341241.
32. Kunin, C. M. 1994. Urinary tract infection in females. Clin. Infect. Dis. 18:112.
33. Linder, H.,, I. Engberg,, I. Mattsby Baltzer,, K. Jann,, and C. Svanborg-Eden. 1988. Induction of inflammation by Escherichia coli on the mucosal level: requirement for adherence and endotoxin. Infect. Immun. 56:13091313.
34. Lingstedt, R.,, G. Larson,, P. Falk,, U. Jodel,, H. Leffler,, and C. Svanborg. 1991. The receptor repertoire defines the host range for attaching Escherichia coli strains that recognize globo-A. Infect. Immun. 59:10861092.
35. Lomberg, H.,, B. Cedergren,, H. Leffler,, B. Nilsson,, A.-S. Carlstrom,, and C. Svanborg-Eden. 1986. Influence of blood group on the availability of receptors for attachment of uropathogenic Escherichia coli. Infect. Immun. 51:919926.
36. Lomberg, H.,, P. Larsson,, H. Leffler,, and C. Svanborg-Eden. 1982>. Different binding specificities of Proteus mirabilis compared to E. coli. Scand. J. Infect. Dis. Suppl. 33:3742.
37. Massad, G.,, C. V. Locatell,, D. E. Johnson,, and H. L. T. Mobley. 1994. Proteus mirabilis fimbriae: construction of an isogenic pmfA mutant and analysis of virulence in a CBA mouse model of ascending urinary tract infection. Infect. Immun. 62:536542.
38. McTaggart, L. A.,, R. C. Rigby,, and T. S. J. Elliot. 1990. The pathogenesis of urinary tract infection associated with Escherichia coli, Staphylococcus saprophyticus, and S. epidermidis. J. Med. Microbiol. 32:135141.
39. Mobley, H. L. T.,, G. R. Chippendale,, J. H. Tenney,, R. A. Hull,, and J. W. Warren. 1987. Expression of type 1 fimbriae may be required for persistence of Escherichia coli in the catheterized urinary tract. J. Clin. Microbiol. 25:22532257.
40. Mobley, H. L. T.,, G. R. Chippendale,, J. H. Tenney,, A. R. Mayrer,, L. J. Crisp,, J. L. Penner,, and J. W. Warren. 1988. MR/K hemagglutination of Providencia stuartii correlates with adherence to catheters and with persistence in catheter-associated bacteriuria. J. Infect. Dis. 157:264271.
41. Mobley, H. L. T.,, K. G. Jarvis,, J. P. Elwood,, D. I. Whittle,, C. V. Lockatell,, R. G. Russell,, D. E. Johnson,, M. S. Donnenberg,, and J. Warren. 1993. Isogenic P-fimbrial deletion mutants of pyelonephritogenic Escherichia coli: the role of aGal(l-4)(3Gal binding in virulence of a wild-type strain. Mol. Microbiol. 10:143155.
42. Nowicki, B.,, A. Labigne,, S. Moseley,, R. Hull,, S. Hull,, and J. Moulds. 1990. The Dr hemagglutinin, afimbrial adhesins AFA-I and AFA-III, and F1845 fimbriae of uropathogenic and diarrhea-associated Escherichia coli belong to a family of hemagglutinins with Dr receptor recognition. Infect. Immun. 58:279281.
43. Nowicki, B.,, C. Svanborg-Eden,, R. Hull,, and S. Hull. 1989. Molecular analysis and epidemiology of the Dr hemagglutinin of uropathogenic Escherichia coli. Infect. Immun. 57:446451.
44. Nowicki, B.,, L. Truong,, J. Moulds,, and R. Hull. 1988. Presence of the Dr receptor in normal tissues and its possible role in the pathogenesis of urinary tract infection. Am. J. Pathol. 133:14.
45. Ott, M.,, H. Hoschützky,, K. Jann,, I. Van Die,, and J. Hacker. 1988. Gene clusters for S fimbria! adhesin (sfa) and F1C fimbriae (foe) of Escherichia coli: comparative aspects of structure and function. J. Bacteriol. 170:39833990.
46. Otto, G.,, T. Sandberg,, B.-I. Marklund,, P. Ulleryd,, and C. Svanborg. 1993. Virulence factors and pap genotype in Escherichia coli isolates from women with acute pyelonephritis with or without bacteremia. Clin. Infect. Dis. 17:448456.
47. Parkkinen, J.,, G. N. Rogers,, T. Korhonen,, W. Dahr, and Jukka Finne. 1986. Identification of the O-linked sialyloligosaccharides of glycophorin A as the erythrocyte receptors for S-fimbriated Escherichia coli. Infect. Immun. 54:3742.
48. Parsons, C. L.,, C. Stauffer,, S. G. Mulholland,, and D. Griffith. 1984. Effect of ammonium on bacterial adherence to bladder transitional epithelium. J. Urol. 132:365366.
49. Paulsson, M.,, A. Ljunge,, and T. Wadstrom. 1992. Rapid identification of fibronectin, vitronectin, laminin, and collagen ceil surface binding proteins on coagulase-negative staphylococci by particle agglutination assays. J. Clin. Microbiol. 30:20062012.
50. Pawelzik, M.,, J. Heesemann,, J. Hacker,, and W. Opferkuch. 1988. Cloning and characterization of a new type of fimbria (S/FlC-related fimbria) expressed by an Escherichia coli 075:N0K1: NOH7 blood culture isolate. Infect. Immun. 56:29182924.
51. Reid, G.,, A. W. Bruce,, J. A. McGroarty,, K.-J. Cheng,, and J. W. Costerton. 1990. Is there a role for lactobacilli in prevention of urogenital and intestinal infections? Clin. Microbiol. Rev. 3: 335344.
52. Rhen, M.,, P. Klemm,, and T. Korhonen. 1986. Identification of two new hemagglutinins of Escherichia coli, N-acetyl-D-glucosamine-specific fimbriae and a blood group M-specific agglutinin, by cloning the corresponding genes in Escherichia coli K-12. J. Bacteriol. 168:12341242.
53. Sareneva, T.,, H. Holthofer,, and T. Korhonen. 1990. Tissue-binding affinity of Proteus mirabilis fimbriae in the human urinary tract. Infect. Immun. 58:33303336.
54. Silverblatt, F. J. 1974. Host parasite interaction in the rat pelvis. J. Exp. Med. 140:16961711.
55. Silverblatt, F. J.,, and I. Ofek. 1978. Influence of pili on the virulence of Proteus mirabilis in experimental hematogenous pyelonephritis. J. Infect. Dis. 138:664667.
56. Smith, H. W.,, and M. A. Linggood. 1971. Observations on the pathogenic properties of the K88, Hly, and Ent plasmids of Escherichia coli with particular reference to porcine diarrhea. J. Med. Microbiol. 4:467486.
57. Stamm, W. E.,, T. M. Hooton,, J. R. Johnson,, C. Johnson,, A. Stapleton,, P. L. Roberts,, S. L. Moseley,, and S. D. Finn. 1989. Urinary tract infections: from pathogenesis to treatment. J. Infect. Dis. 159: 400406.
58. Stapleton, A.,, S. Moseley,, and W. E. Stamm. 1991. Urovirulence determinants in Escherichia coli isolates causing first-episode and recurrent cystitis in women. J. Infect. Dis. 163:773779.
59. Svanborg-Eden, C.,, B. Anderson,, G. Aniansson,, R. Lindstedt,, P. deMan,, A. Neilsen,, H. Leffler,, and A. Wold. 1990. Inhibition of bacterial attachment: examples from the urinary and respiratory tracts. Curr. Top. Microbiol. Immunol. 151:167184.
60. Svanborg-Eden, C.,, L. A. Hanson,, U. Jodel,, U. Lindberg,, and A. Sohl Akerlund. 1976. Variable adherence to normal human urinary tract epithelial cells of Escherichia coli strains associated with various forms of urinary-tract infection. Lancet 11:490492.
61. Svanborg-Eden, C.,, S. Hausson,, U. Jodal,, G. Lidin-Jansson,, K. Lincoln,, H. Linder,, H. Lomberg,, P. de Mann,, S. Marild,, J. Martinell,, K. Plos,, T. Sandberg,, and K. Stenqvist. 1988. Host parasite interaction in the urinary tract. J. Infect. Dis. 157:421426.
62. Tarkkanen, A.-M.,, B. L. Allen,, B. Westerlund,, H. Holthdfer,, P. Kuusela,, L. Risteli,, S. Clegg,, and T. K. Korhonen. 1990. Type V collagen as the target for type-3 fimbriae, enterobacterial adherence organelles. Mol. Microbiol. 4:13531361.
63. Teti, G.,, M. S. Chiofalo,, F. Tomasello,, C. Fava,, and P. Mastroeni. 1987. Mediation of Staphylococcus saprophyticus adherence to uroepithelial cells by lipoteichoic acid. Infect. Immun. 55:839842.
64. Tullus, K. 1986. Fecal colonization with P-fimbriated Escherichia coli in newborn children and relation to development of extraintestinal E. coli infections. Acta Paediatr. Scand. Suppl. 334: 135.
65. Uehling, D. T.,, L. J. James,, W. J. Hopkins,, and E. Balish. 1991. Immunization against urinary tract infection with a multi-valent vaginal vaccine. J. Urol. 146:223226.
66. Virkola, R.,, B. Westerlund,, H. Holthdfer,, J. Parkkinen,, M. Kekomaki,, and T. K. Korhonen. 1988. Binding characteristics of Escherichia coli adhesins in the human urinary bladder. Infect. Immun. 56:26152622.
67. Warren, J. W. 1987. Catheter-associated urinary tract infections. Infect. Dis. Clin. North Am. 1: 823854.
68. Wold, A.,, D. A. Caugant,, G. Lidin-Janson,, P. de Man,, and C. Svanborg. 1992. Resident colonic Escherichia coli strains frequently display uropathogenic characteristics. J. Infect. Dis. 165:4652.
69. Wray, S. K.,, S. I. Hull,, R. G. Cook,, J. Banish,, and R. A. Hull. 1986. Identification and characterization of a uroepithelial cell adhesin from a uropathogenic isolate of Proteus mirabilis. Infect. Immun. 54:4349.
70. Wray-Cook, S. K.,, and R. Hull. Unpublished data.


Generic image for table
Table 1

UTI-associated adhesins for which receptors are known

Comprehensive listings of other fimbrial and nonfimbrial adhesins associated with extraintestinal infections can be found in references and .

Families include genetically related adhesins.

Citation: Hull R, Hull S. 1994. Adherence Mechanisms in Urinary Tract Infections, p 79-90. In Miller V, Kaper J, Portnoy D, Isberg R (ed), Molecular Genetics of Bacterial Pathogenesis. ASM Press, Washington, DC. doi: 10.1128/9781555818340.ch6

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