Nontypeable
Haemophilus influenzae (NTHi) is a nearly universal nasopharyngeal commensal that can cause opportunistic airway infections, including bronchopulmonary infections in patients with chronic obstructive pulmonary disease (COPD) and otitis media (OM) and sinusitis infections in children. In the United States, epidemiologic data indicate that COPD affects over 10 million adults, and is a major cause of death, hospitalizations, and emergency-room visits (Wedzicha and Seemungal,
2007). Patients with COPD frequently experience opportunistic airway infections that are a major complicating factor in the clinical course and management of the disease (Sethi and Murphy,
2001), and much recent data have correlated bacterial and viral infections with the inflammatory exacerbations that are the hallmark of this disease (Sethi et al.,
2002,
2007; Watanabe et al.,
2004; Chin et al.,
2005; Berenson et al.,
2006a,
b; Kweon et al.,
2006; Moghaddam et al.,
2007; Tumkaya et al.,
2007). OM is among the most common pediatric infections worldwide, affecting the majority of all children at least once by 3 years of age (Klein,
2000). Clinical presentations of OM include chronic and recurrent infections that feature multiple incidents of overt disease over the course of months to years (Paradise et al.,
1997). The bacteria causing COPD-related and OM infections are opportunists that are normally found within the nasopharyngeal microbiota, including nontypeable
Haemophilus influenzae,
Moraxella catarrhalis, and
Streptococcus pneumoniae (Sethi and Murphy,
2001; Murphy et al.,
2004,
2005a; Pichichero,
2005; Pichichero and Casey,
2007).
Persistent infections caused by NTHi and other mucosal opportunists involve the formation of biofilm communities that enhance bacterial resistance to clearance (Swords et al.,
2004; Hong et al.,
2007a,
b,
2009). Biofilms are typically defined as surface-adherent communities that confer resistance to environmental stress and/or clearance mechanisms (Hall-Stoodley and Stoodley,
2009). In the case of NTHi, it is also clear that specific bacterial factors are important in the formation and maturation of biofilms both
in vitro and within animal models (Swords et al.,
2004; Jurcisek et al.,
2005,
2007; Starner et al.,
2006; Hong et al.,
2007a,
b,
2009; Jurcisek and Bakaletz,
2007; Armbruster et al.,
2009,
2010,
2011). For example, NTHi biofilms contain variants expressing specific subsets of lipooligosaccharide (LOS) glycoforms that are essential to biofilm formation and/or maturation (Greiner et al.,
2004; Swords et al.,
2004; Hong et al.,
2007a,
b). Additional factors associated with NTHi biofilms include pili (Murphy and Kirkham,
2002; Jurcisek et al.,
2007), extracellular DNA (Jurcisek and Bakaletz,
2007), and, possibly, a non-LOS extracellular polysaccharide (Greiner et al.,
2004; Jurcisek et al.,
2005). NTHi biofilms have been observed in tissue from patients with chronic OM (Hall-Stoodley et al.,
2006) and rhinosinusitis (Sanderson et al.,
2006), and in the case of OM a chronic infection involving biofilms has been recapitulated in animal models (Post,
2001). Within the context of COPD, the strongest indication of NTHi biofilms has been provided by expression of biofilm-associated proteins such as peroxiredoxin in sputa from patients with COPD (Murphy et al.,
2005b). In recent work, we have also demonstrated that multicellular NTHi communities are present within the lungs of elastase-treated mice, from which clearance is significantly impaired (Pang et al.,
2008a).
In this study, we used a microarray approach to identify transcripts with increased levels in NTHi 86-028NP biofilms as compared to planktonic growth. One of the factors with increased expression was a homolog of the DNA-binding protein associated with starvation (Dps). An NTHi 86-028NP dps null mutant was generated, and shown to have increased susceptibility to environmental stress, consistent with prior work with other bacterial species. This mutant was also compared with the parental strain using in vitro biofilm assays and in animal infection models for COPD-related infections and OM. The results clearly show that Dps promotes survival of NTHi 86-028NP within biofilm communities, as well as resistance to host clearance in vivo. These data indicate that the NTHi stress-response may promote survival during chronic infection, and may thus be an important target for antimicrobial therapy during chronic infections.