The genome sequence of
S. flexneri offers new candidate genes with potential for involvement in pathogenicity, including predicted proteins similar to virulence factors in other organisms. Among these data, missing links in
S. flexneri pathogenesis may be found (Table ). For example, the molecular mechanisms of species and tissue tropism, including the adhesins potentially specific for the human colonic epithelium, remain hidden. This is due in part to the lack of a suitable animal model. Mice do not become infected following oral inoculation of
S. flexneri; therefore, mouse models have been restricted to pulmonary and conjunctival infections, which differ in important respects from colonic infection. Among the island ORFs of
S. flexneri are 7 that are similar to adhesins from other pathogenic organisms and 68 that lack significant similarity to proteins of known function, including 9 predicted to encode secreted or membrane proteins, which are therefore strong candidates for mediating direct interactions with host cells. The unique complement of fimbrial adhesins in
S. flexneri presumably underlies host specificity, as has been suggested for
S. enterica serovar Typhi, another exclusively human pathogen (
66). Of particular interest are the ORFs similar to the
Salmonella SafABC. As
S. enterica serovar Typhimurium is also an intracellular pathogen of intestinal epithelial cells and macrophages, this locus may encode components of an adhesin contributing to host or tissue specificity. In addition, ORFs S3961 and S4048 encode a major type 1 fimbrial subunit and usher protein essentially identical to proteins of enterohemorrhagic
E. coli O113:H21, which is pathogenic for humans and cattle.
While a specific host cell receptor may not be the only valid explanation for host specificity, it is consistent with experimental data and in vivo observations. We emphasize that there are clear differences among the consequences of infection of cultured mammalian cells and inoculation of mice or humans. When grown as a nonpolarized and nonconfluent monolayer, cells from a wide variety of hosts and anatomic origins are readily invaded by
S. flexneri. When grown as a polarized and confluent monolayer,
S. flexneri invades cells only at the basolateral membrane (
50). However, in the context of an intact animal host, only cells of the human or monkey colonic mucosa or mouse respiratory epithelium have been shown to be infected by
S. flexneri. S. flexneri strains have not been shown to cause intestinal disease in nonprimates, and in mice,
S. flexneri strains appear not to invade the colonic mucosa (M. B. Goldberg, unpublished data). Thus, while alternative explanations of
S. flexneri species and tissue specificity exist, a specific receptor on polarized primate colonic cells might be involved in the specific invasion of this tissue. In particular, such a receptor might be important to
S. flexneri gaining access to the basolateral sides of these cells.
Expression of receptor candidate proteins in nonpathogenic
E. coli and screening for adherence to appropriate human tissue (
24) might then allow the unique human cellular receptor to be identified (
36). From there, the construction of a transgenic mouse model for
S. flexneri infection is possible, as reported for
Listeria monocytogenes (
37), another human-specific intestinal pathogen that causes disease in humans but not mice. An improved animal model will greatly facilitate evaluation of candidate genes with possible roles in virulence.
Experimental evidence suggests that IpaH proteins may play a role in modulating the host response to infection. IpaH
7.8 on the invasion plasmid was shown to help
S. flexneri escape from macrophage vacuoles (
16). Mutations in two
ipaH genes on the invasion plasmid induce an exaggerated keratoconjunctivitis response with greater-than-normal inflammation in guinea pig eyes, and IpaH
9.8 encoded on the plasmid was shown to translocate to the host nuclei in tissue culture cells (
67), but the precise functions of these proteins remain unknown. Unlike the
ipaH genes on the invasion plasmid, the genome-encoded
ipaH genes are mostly associated with prophage-like islands, reminiscent of the
Salmonella lambda-like Gifsy prophages, which encode effector proteins of the YopM/IpaH family (
48). Lysogenic conversion with these phages is responsible for much of the diversity of the effector protein repertoires observed among
Salmonella spp. (
48). The finding that
ipaH genes on the plasmid and chromosome may show strain-specific differences in sequences is a novel observation and might suggest that, like in
Salmonella, the
ipaH gene family might contribute to diversity of effector molecules. This remains to be tested.
IpaH proteins belong to the superfamily of LRR-containing proteins, which includes members from bacteria, plants, and vertebrates (
6,
27). The conservation level of these proteins indicates that the LRR probably has structural or functional significance. IpaH-like proteins are found in the animal pathogens
Salmonella,
Yersinia, and
Listeria, as well as the plant pathogens
Rhizobium,
Bradyrhizobium, and
Ralstonia, again often associated with prophage (
9,
18,
20,
35). In many host organisms, including plants, receptors involved in recognizing invading pathogens are also LRR proteins: for example, mammalian Toll-like receptors and the NB/LRR family in plants (
1,
26). Experimental evidence accumulating from various studies of host-pathogen interactions is beginning to suggest that the bacterial effector proteins might interfere with or modulate the host receptor activity, presumably enabling the pathogen to evade the host's defensive response.
Acquisition of new traits by horizontal transfer has enabled microorganisms to survive in new niches. A complementary loss-of-function mechanism has been proposed (
52,
64) by which virulence is enhanced through mutation of ancestral genes encoding factors that interfere with the expression or function of traits necessary for success in the new environment. Acquisition of the virulence plasmid enabled
S. flexneri to enter the highly specialized intracellular environment in human intestinal epithelial cells. In this new niche, genes that were required in the intestinal lumen may be deleterious or are no longer beneficial and may accumulate mutations without a selective force to maintain them. Lysine decarboxylase (CadA) produces cadaverine, which inhibits the escape of
S. flexneri from the vacuole into the cell cytosol (
15,
46). Since
S. flexneri replication and spread are dependent upon its access to the cytosol, biosynthesis of cadaverine attenuates virulence. In 2457T,
cadA and
cadC, which encodes a transcriptional activator of the
cad operon, are deleted (entirely absent from the genome). Lack of surface structures such as flagella, fimbriae, and curli in
S. flexneri provides the advantage of fewer antigens that can be easily recognized by the host immune system. In 2457T, of 14 dysfunctional genes of flagellar biosynthesis, 11 (
fliF,
fliJ,
fliP,
flgC,
flgE,
flgF,
flgK,
flgL,
flhA,
flhB, and
cheR) contain frameshifts and 1 (
fliA) contains a point mutation, while IS
1 elements truncate
flhD and
flhE.
Although invasion and intercellular spread are well studied (
51), many of the signaling and gene expression controls that orchestrate these processes are unknown (Table ) and might provide new points of therapeutic intervention. Although
S. flexneri is an intracellular pathogen, adaptive immunity to
S. flexneri may be restricted to B-lymphocyte-dependent humoral responses. Human adaptive immunity is serotype specific, and exposure induces production of specific immunoglobulins (
17,
59). In mouse models, adaptive immunity is completely independent of T-lymphocyte function (
72). However, the mechanism by which
S. flexneri modulates T-lymphocyte responses is unknown. With the sequence known, gene chips could now be used to interrogate expression profiles during infection, identifying all of the genes responding to the various changing conditions of particular interest, including oxidation, temperature shift, and iron depletion, which are specifically induced in the intracellular environment.
The high incidence of shigellosis and the proliferation of drug resistance have spurred serious efforts in vaccine development. Some success has been reported with live attenuated bacteria with mutations in the plasmid gene
virG (necessary for intercellular spread), both alone and in combination with chromosomal deletions of
aroA (aromatic amino acid synthesis),
iuc (aerobactin),
set (enterotoxin), or
guaBA (purine biosynthesis pathway) (
29-
31). New candidate genes, when characterized, will provide alternative routes to further attenuation while maintaining antigenicity.
Because of its ability to enter into the cytosol of mammalian cells,
S. flexneri strains have been developed as a delivery vehicle of antigens to major histocompatibility complex class I for immunization or of DNA into target cells for gene therapy (
3,
12,
14,
63). Again, optimization of these approaches will require sufficient attenuation of the
S. flexneri vehicle, specific binding to target cells, and controlled modulation of the immune response.
Knowledge of all the proteins encoded in the 2457T genome provides the entire repertoire of surface proteins that are potential vaccine targets, and candidates found to be adequately antigenic could therefore be used singly or in combination, engineered for expression from recombinant constructs, or even used directly in DNA vaccines. The sequence will also facilitate identification of many of the corresponding vaccine candidate genes in other S. flexneri serotypes, both type specific or in common. Comparison with the genome of nonpathogenic E. coli will reveal factors that, like cadaverine, block or limit survival of S. flexneri in host tissue. Thus, functions no longer active (pseudogenes) in S. flexneri but expressed in nonpathogenic E. coli may lead to the development of novel S. flexneri-specific therapies by virtue of a suppressive effect on bacterial growth or tissue invasion. These genome-driven research activities will serve as starting points for a new phase of vaccine and molecular pathogenicity investigation.