Nontypeable
Haemophilus influenzae (NTHI) strains are normal commensal flora of the human nasopharynx but can act as opportunistic pathogens, causing multiple upper respiratory tract illnesses, including sinusitis and acute as well as chronic and recurrent otitis media (OM), when the conditions for them to do so are optimal (
3,
4). NTHI strains are also associated with diseases of the lower respiratory tract, including exacerbations of chronic obstructive pulmonary disease and bronchitis. In recent years, NTHI has been shown to be capable of forming a biofilm in vitro and in vivo (
13-
15,
17,
19,
24,
34,
36,
41). A biofilm is defined as a group of bacteria growing as a community and encased in a self-produced polymeric matrix (
33). Residence within a biofilm matrix, wherein oxygen is limited and the metabolic rate of these sessile microbes is altered, serves several functions, including protection from environmental threats such as host immune defenses, antibiotics, and surfactants. Thus, bacteria in biofilms are characteristically highly resistant to immune-mediated clearance (
7,
8,
30,
39). The biofilm matrix can also provide a scavenging system to trap and filter nutrients from the environment. The composition of this matrix can be quite diverse, depending on the organism that induced its formation and the environment in which the biofilm was produced. Based on these characteristics, the ability to form a biofilm in the airway of its mammalian host is considered to be a likely contributing factor to the recurrent and/or chronic nature of NTHI-induced diseases of the respiratory tract (
10,
11,
14,
29,
34).
In an attempt to better understand the role of biofilm production in the pathogenesis of NTHI-induced disease; several groups have begun to characterize these sessile communities of bacteria in greater detail. Toward this end, we and others have investigated the biochemical nature of the NTHI-induced biofilm and have shown that lipooligosaccharide (LOS) is heavily distributed throughout biofilms formed in vitro (
16) and in vivo (
19). Murphy and Kirkham used a panel of monoclonal antibodies to demonstrate that middle ear isolates of NTHI resident within a biofilm produced in a 96-well plate assay show altered expression of an LOS epitope, as well as selected epitopes within the outer membrane proteins (OMPs) P2, P5, and P6, compared to planktonically grown cells (
24). Gallaher and colleagues later used a proteomic approach to identify 265 proteins, including OMPs P5 and P6, in the biofilm matrix of an NTHI biofilm produced by on-filter growth (
15), whereas Webster et al. used electron microscopy to similarly localize LOS to the biofilm matrix and OMP P6 to the bacterial membrane (
40). The latter group also demonstrated the presence of two NTHI adhesins and immunoglobulin A1 protease within these in vitro-formed biofilm matrices. Swords et al. further showed that sialylation of NTHI LOS promotes biofilm formation by NTHI (
36) and that when growing in a biofilm, the phosphorylcholine content of NTHI LOS increases, resulting in a decrease in its net bioactivity (
41).
Based on our initial observations of particular sialylated glycoforms of LOS incorporated into the biofilm formed by NTHI in the middle ear of the chinchilla (
19), a predominant rodent host used to study the pathogenesis and prevention of OM, here we wanted to more extensively characterize both immature and more mature in vivo-formed biofilms biochemically. Therefore, we were interested in determining, primarily via the use of a chinchilla model of NTHI-induced OM combined with immunofluorescence confocal microscopy, whether the biochemical character of LOS contained within the biofilm changed over time, whether the major subunit protein of the recently described twitching pilus of NTHI (
5) could be detected within these biofilms, and whether we could now better describe what initial observations suggested might be monocyte-like host cells that appeared to be both surface associated and infiltrating the NTHI-induced biofilm matrix (
19).
DISCUSSION
The literature on the role of biofilms in OM is still relatively young, as this paradigm-shifting hypothesis was originally put forth by Rayner et al. in 1998 (
28). Nevertheless, data to date clearly show that NTHI, like most if not all bacteria, is readily capable of forming a biofilm both in vitro (
15,
24,
41) and in vivo (
13,
14,
17,
19,
34,
36). Work from several groups has now begun to both characterize the proteome of biofilm-growing NTHI (
15,
40), as well as to determine that the proteins, or epitopes thereof, expressed by NTHI when grown in a sessile manner are different from those growing planktonically (
24). Moreover, Greiner and colleagues (
16) and later Jurcisek et al. (
19) demonstrated that sialylated LOS, or endotoxin, with sialic acid in a specific linkage group to galactose was a key component of in vitro- as well as in vivo-formed biofilms, respectively. Bouchet and colleagues (
9) further showed that sialylated LOS is a major virulence factor in experimental OM induced by NTHI, whereas the Swords lab has demonstrated that sialylation of LOS promotes biofilm formation by NTHI (
36). By increasing the phosphorylcholine content of LOS, biofilm-growing NTHI is also capable of reducing the net bioactivity of this molecule, suggesting that by inducing less inflammation, NTHI may be promoting its ability to resist clearance (
18,
41). Ehrlich and colleagues (
14) were the first to show that mature NTHI-induced biofilms formed in the middle ear of the chinchilla host within 5 days of challenge, and later this group demonstrated that NTHI, as well as
Streptococcus pneumoniae and
Moraxella catarrhalis, had formed biofilms on middle ear mucosal samples recovered from children with recurrent and/or chronic OM (
17).
In the present study, we hypothesized that due to immunological pressure put on NTHI in vivo, there may be differences in the components that comprise the biofilm matrix over time. Further, due to the fact that there appear to be multiple components, in addition to sialylated LOS, that are incorporated into the NTHI-induced matrix formed in vitro, this likely might also be true for those formed in vivo. Thus, here we attempted to expand upon our initial characterization of an in vivo-formed NTHI biofilm. To this end, we were interested in determining whether or not type IV pilin protein might be associated with, or incorporated into, the biofilms formed in vivo by NTHI, as these structures have been shown to play a key role in biofilms formed by
Pseudomonas aeruginosa and
Neisseria gonorrhoeae (
21,
26). We also wanted to determine if the presence of sialylated LOS in specific linkage groups changed over time, and finally, we were interested in following up on a previous observation (
19) which suggested that host cells (likely monocytes or polymorphonuclear leukocytes) were intimately associated with the biofilms formed by NTHI in vivo.
Immunofluorescent confocal images showed that immature (day 4 or 5), as well as mature (day 21), biofilms were highly organized and contained both viable NTHI and numerous characteristic water channels. Both day 4 (or 5) and day 21 biofilms were labeled with
S. nigra and
M. amurensis, indicating the presence of sialylated LOS that was removed or diminished by treatment with neuraminidase. Labeling of type IV pilin protein was also evident throughout the biofilm matrix, both as small aggregates and tracking along thin dsDNA strands. A similar phenomenon has been reported for
P. aeruginosa by both Walker et al. (
38), and Allesen-Holm and colleagues (
2), which resulted in the latter group hypothesizing that since type IV pili are known to bind DNA (
1,
12,
37), the presence of DNA in the matrix might provide a substrate on which these bacteria could migrate in order to organize into the characteristic mushroom-like structures built in a
P. aeruginosa biofilm. The observation of pilin protein on top of or tracking along strands of dsDNA present in in vivo-formed biofilms here not only confirmed that Tfp were expressed by NTHI within the middle ear, as we described recently (
20; Jurcisek et al., submitted for publication), but further suggested that these pili (or pilin protein) may also provide some structural stability to the biofilm, perhaps by serving as an intrabacterial bridge. This hypothesis was supported by SEM examination of NTHI growing in a biofilm community on the surface of NHBE cells. These data are additionally supported by our observation that a
pilA mutant of NTHI strain 86-028NP, while able to survive in the middle ear of the chinchilla host, formed a less robust biofilm that was notably incapable of maintaining adherence to the mucosal epithelial surface lining the middle ear compared to the parental isolate (
20; Jurcisek et al., submitted for publication).
Whereas we were indeed able to label what appeared (based on uniform size and shape) to be the nuclei of many host cells in association with in vivo-formed biofilms, we also observed an extensive interlaced meshwork or matrix comprised of dsDNA which was similarly labeled with DAPI. Treatment with DNase, but not RNase, removed DAPI labeling of both host cell nuclei and this intricate meshwork of dsDNA strands. The amount and arrangement of these DNA strands gave the impression not only that DNA was a key component of an NTHI-induced biofilm, shown here to notably increase in density with time in vivo, but also that this DNA-containing matrix could likely impart significant structural stability to the biofilm community. The relatively greater density of DNA at the outer edges of a biofilm mass compared to that observed within deeper aspects further suggested a compartmentalization of components within these NTHI-induced biofilms. A similar compartmental distribution of additional individual components has recently been reported for biofilms formed by NTHI in vitro (
40).
Our data thus show that, like for
S. pneumoniae,
Streptococcus mutans,
P. aeruginosa,
Pseudomonas putida,
Rhodococcus erythropolis, and
Variovorax paradoxus, release of DNA into a biofilm appears to be a common theme among a group of bacteria (
2,
31,
35) that now includes NTHI. The presence of DNA in the biofilm matrix has recently been noted to play an important role in both biofilm development and stability (
2,
22,
23,
27,
31,
32,
35). In the latter regard, extracellular DNA has been shown to act as a cell-to-cell interconnecting component in biofilms produced by
P. aeruginosa and
S. pneumoniae (
2,
23,
27,
31). However, whereas LOS in a specific linkage group as well as several outer membrane proteins, surface proteins, and adhesins (
15,
16,
19,
25,
36,
40) have been identified in NTHI-produced biofilms, the presence of dsDNA in these matrices has, to the best of our knowledge, never been described. In fact, to date, studies characterizing the presence of DNA in any biofilm matrix have focused on those formed in vitro. Here, we describe the presence of DNA in the extracellular matrix of an NTHI biofilm formed in vivo and present evidence which suggests that due to the intricate arrangement and density of the dsDNA strands, this abundant DNA likely plays a key role in providing structural stability to the biofilm. Given the basket weave-like matrix of DNA, it is also possible that dsDNA contributes to providing an element of protection from phagocytic cells, as well as possibly effectors of innate and acquired immunity. Whereas the DNA present in the biofilm matrix formed by NTHI in vivo could be derived from the bacteria, from host cells, or from a combination of both, as there is evidence in the literature for each possibility (
2,
31,
38), here we showed that a biofilm formed by NTHI in vitro in the absence of eukaryotic cells also contained an abundant amount of dsDNA. This observation suggested that the bacterial cells themselves served as a primary source of dsDNA present in the biofilm matrix. Understanding the mechanism(s) by which NTHI contributes dsDNA to its own biofilm matrix is currently an area of active investigation in our lab.
Here we have employed immunofluorescent labeling of cryopreserved biofilms recovered from the middle ears of chinchillas, which serve as a rodent model of experimental OM, to demonstrate that both immature and mature NTHI-induced biofilms contained sialylated LOS; OMPs, including type IV pilin protein; and a significant amount of dsDNA. The DNA present within the biofilm matrix formed a structural scaffold of sorts by assembling into a network of closely spaced interwoven strands, as well as extending as sparse but thicker rope-like strands, across water channels. Whereas no differences were seen between immature (day 4 or 5) or mature (day 21) in vivo-formed biofilms in terms of OMP content; LOS content or biochemistry, or bacterial viability, mature biofilms incorporated a notably increased amount of dsDNA that had now assumed a dense mesh or basket weave of strands. This meshwork appeared to be particularly concentrated at the outer margins of the biofilm mass, whereas there was a less dense distribution of finer strands located throughout the interior of the biofilm. NTHI could be seen heavily populating these multicomponent biofilm matrices. We are currently investigating the mechanism of dsDNA release into NTHI-formed biofilms.