Next Article 
Infection and Immunity, May 2006, p. 2505-2512, Vol. 74, No. 5
0019-9567/06/$08.00+0 doi:10.1128/IAI.74.5.2505-2512.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
How the Bacterial Pathogen Listeria monocytogenes Mediates the Switch from Environmental Dr. Jekyll to Pathogenic Mr. Hyde
Michael J. Gray,1,
Nancy E. Freitag,2 and
Kathryn J. Boor1*
Department of Food Science, Cornell University, Ithaca, New York,1
Seattle Biomedical Research Institute and the Departments of Pathobiology and Microbiology, University of Washington, Seattle, Washington2

INTRODUCTION
Listeria monocytogenes is a gram-positive bacterium with a Jekyll
and Hyde personality (
108): it is well adapted as a saprophyte
for peaceful survival in soil and decaying vegetation (Dr. Jekyll)
(
36), but it has a second life as an intracellular bacterial
pathogen capable of causing serious infection in humans and
in many animal species (Mr. Hyde) (
28,
96,
115). In its Mr.
Hyde phase, the bacterium is a significant public health hazard,
responsible for an estimated 28% of deaths attributable to known
food-borne pathogens in the United States (
75). How does
L. monocytogenes manage the switch between mild-mannered environmental
bacterium and potentially deadly human pathogen? The transformation
appears to be mediated through complex regulatory pathways that
modulate the expression of virulence factors in response to
environmental cues. This review will summarize the current understanding
of
L. monocytogenes virulence gene regulation and will put forth
a model that depicts how a humble soil-grown bacterium might
transform into a deadly invader.

LIFE IN THE SOIL: THE PEACEFUL EXISTENCE OF A BACTERIAL DR. JEKYLL
L. monocytogenes is a ubiquitous bacterium that sets up home
in a variety of environmental locations.
L. monocytogenes has
been isolated from soil, ground water, silage, and decaying
vegetation (reviewed in reference
36); however, relatively little
is known about the bacterium's potentially peaceful Dr. Jekyll
existence. Genome sequencing indicates the presence of multiple
gene products that may facilitate the utilization by
L. monocytogenes of a variety of carbon sources, including plant sugars (
48,
84). To access nutrient sources,
L. monocytogenes expresses
flagella and exhibits swimming motility at temperatures below
30°C; in many strains (but not all) swimming motility is
repressed at 37°C (
51,
87,
117). Although
L. monocytogenes does not form spores, the bacterium is well known for its ability
to withstand a variety of environmental stresses, including
low temperature and high osmolarity (
99), thus making it a hardy
environmental organism.
It is possible and, perhaps, probable that the existence of L. monocytogenes outside of mammalian host cells is not entirely a quiet and sedate country life but, rather, a constant territorial battle with other single-cell and multicellular organisms that are lurking nearby. Although it is commonly isolated from environmental sources (36), L. monocytogenes maintains an arsenal of gene products that appear to be designed to facilitate survival within mammalian host cells. Maintenance of this arsenal in an organism that is broadly present in the environment suggests the possibility that these gene products may be utilized not only in mammals but also against other eukaryotic organisms in the environment. For example, while protozoa have not been reported as a reservoir for L. monocytogenes, as is the case with Legionella pneumophila, L. monocytogenes does survive and replicate within amoebae (49, 70, 111). L. monocytogenes is an efficient pathogen of at least one insect species (Drosophila melanogaster), although infections must be systemically induced (73). It is likely that further studies will identify additional nonmammalian organisms that serve as hosts for L. monocytogenes.

L. MONOCYTOGENES WITHIN MAMMALIAN HOSTS: A BACTERIAL MR. HYDE
Although
L. monocytogenes is well adapted to persistence in
the environment (
36), the majority of studies focused on
L. monocytogenes have investigated infection of mammalian hosts,
or the Mr. Hyde phase of the organism: the invasion and survival
within mammalian host cells and the immune response to bacterial
infection (reviewed in references
28,
66, and
86).
L. monocytogenes is capable of invading and replicating within a wide range of
animal cell types, including macrophages and nonprofessional
phagocytes (
45,
64,
71,
89). A number of bacterial gene products
have been identified that facilitate the intracellular growth
and spread of the bacterium to adjacent host cells (
88,
90),
and the functions of these gene products have been discussed
in several excellent recent reviews (
20,
28,
57,
63,
115). Briefly,
these gene products include the invasion-associated surface
proteins internalin A and B (InlA and InlB), gene products associated
with escape from the host cell vacuole (the
hly-encoded cholesterol-dependent
cytolysin listeriolysin O [LLO] as well as phospholipases encoded
by
plcA and
plcB), and ActA, a protein required for actin-based
intracellular bacterial motility and cell-to-cell spread. Additional
gene products, such as Mpl, a zinc-dependent metalloprotease
that processes PlcB to its mature form, and Hpt, a hexose phosphate
transporter that allows bacteria to utilize phosphorylated sugars
such as glucose-1-phosphate within the host cell cytosol, also
contribute to bacterial life within the mammalian host cell.
Other gene products, such as the bile salt hydrolase encoded
by
bsh (
4,
27) and the bile exclusion locus
bilE (
104), may
function to promote bacterial survival in the liver or in extracellular
environments within the mammalian host, such as the small intestine
or within the gall bladder (
52). For nearly every gene product
identified thus far as contributing to
L. monocytogenes survival
within the host, gene expression is regulated by a transcriptional
activator known as positive regulatory factor A (PrfA) (
12,
40,
76,
78). Strains lacking functional PrfA are highly attenuated
in animal models of infection and are forever locked into a
docile and nonthreatening state.
As L. monocytogenes is clearly capable of adapting to multiple environments, including those outside as well as inside host cells, it is important to ask what the mechanisms are that control the switch that changes L. monocytogenes from a quiet soil bacterium to a ruthless invader. At least some of the answers appear to lie in the regulation of the key regulatory protein PrfA and include both the regulation of prfA transcription and PrfA protein activity.

INITIAL CONTROL OF THE BACTERIAL BEAST: REGULATION OF prfA EXPRESSION
Transcriptional control of
prfA is the first mechanism used
by
L. monocytogenes to regulate the expression of its virulence
gene products. Three promoter regions have been identified that
contribute to the regulation of
prfA expression (Fig.
1A). Two
promoter regions, P
prfAP1 and P
prfAP2, are located just upstream
of the
prfA coding sequence and direct the expression of monocistronic
prfA transcripts. The upstream
plcA promoter (P
plcA) directs
both a monocistronic
plcA transcript and a bicistronic transcript
encoding
plcA and
prfA (
11).
Transcription of DNA in bacteria is driven by RNA polymerase,
whose specificity is determined by regulatory proteins known
as sigma (

) factors (reviewed in reference
50). The primary
sigma factor determining RNA polymerase specificity in actively
growing, unstressed cells is
A (
50,
81). The P
prfAP1 promoter
has characteristics of a
A-dependent promoter (
83). Transcripts
are produced from this promoter by actively growing
L. monocytogenes in broth culture. The RNA transcript of
prfA directed by P
prfAP1 contains a thermosensitive structure that inhibits translation
of PrfA at temperatures lower than 30°C but melts at higher
temperatures, allowing translation (
56). The reduced efficiency
of PrfA translation at low temperatures may explain the reduced
transcription of PrfA-dependent genes observed at low temperatures
in broth culture. The production of monocistronic
prfA transcript
is independent of temperature, while bicistronic
plcA-
prfA transcript,
which is dependent on PrfA activation, is only produced at higher
temperatures (
67). The presence of a pool of untranslated
prfA transcripts may allow rapid synthesis of PrfA following infection
of warm-blooded mammalian and avian host organisms, which generally
have temperatures higher than the surrounding environment. Temperature
regulation of bacterial protein levels is not unique to
L. monocytogenes PrfA. To illustrate, the
Escherichia coli heat shock response
associated with
32 is dependent upon the presence of a pool
of untranslated
rpoH mRNA to achieve rapid increases in
32 under
increased temperature conditions (
82,
109).
A second prfA promoter region, PprfAP2, also directs monocistronic prfA transcripts (42) (Fig. 1A and B). The P2prfA region contains a putative PrfA binding box, which provides an autoregulatory loop (42, 100). The P2prfA region comprises both a
A- and a
B-dependent promoter (91).
B-Dependence of the PprfAP2 promoter has been demonstrated (83, 91, 98). RNA polymerase complexed with
B recognizes the promoters of a number of genes whose products contribute to the ability of L. monocytogenes to withstand environmental stresses including low pH, high osmolarity, oxidative stress, and carbon starvation (3, 15, 37, 38, 39, 58, 118, 119). The products of a number of stress response genes have been implicated in virulence; these genes include bsh, whose product is important for resisting the stresses imposed by exposure to bile salts (27), the gad system, involved in resisting acid shock (22), and hfq, a general stress response gene involved in resistance to osmotic and ethanol stress (15). Transcription of the invasion-associated internalin genes inlA and inlB is also influenced by
B (59, 60). L. monocytogenes cells exposed to environmental stress conditions (specifically, 0.3 M NaCl or growth to stationary phase) show a relative increase in monocistronic prfA transcripts initiated from PprfAP2 (M. Kazmierczak, M. Wiedmann, and K. J. Boor, submitted for publication). As the PprfAP2--directed message does not contain the thermosensitive RNA secondary structure present in PprfAP1-directed messages (56), translation of the PprfAP2 transcript may thus account for the observed expression of PrfA in some low-temperature environments, such as the cytosol of insect cells, where PrfA-dependent gene products are expressed and functional (13, 26, 73).
Finally, bicistronic plcA-prfA transcripts are produced from the upstream PrfA-dependent PplcA promoter (Fig. 1A) (11, 13, 73). PrfA thereby upregulates its own production, and this autoregulation is required for bacterial cell-to-cell spread within tissue culture cells and for bacterial virulence in animal models of infection (11, 41).

ADDITIONAL CONTROL OF THE BACTERIAL BEAST: REGULATION OF PrfA ACTIVITY
In addition to the existence of transcriptional and posttranscriptional
mechanisms that control
prfA expression and translation, PrfA
activity is controlled on a posttranslational level. PrfA is
a member of the Crp/Fnr transcription regulator family (
65,
112). As a group, Crp/Fnr regulators respond to a broad array
of signals, both intracellular and exogenous, such as the presence
of small molecular cofactors (e.g., cyclic AMP for Crp) (
53),
as well as changes in redox potential, oxygen availability,
or temperature (reviewed in reference
62). Mutants of Crp, known
as Crp*, have been identified that contain amino acid substitutions
that appear to lock the protein into a constitutively active
form, even in the absence of the signal molecule, cyclic AMP
(
53). Ripio et al. (
95) were the first to describe a similar
mutation in PrfA (PrfA G145S, or PrfA*), which was identified
in an
L. monocytogenes strain (NCTC 7973) that constitutively
expressed high levels of PrfA-dependent gene products. Recent
evidence suggests that the PrfA G145S mutation may stabilize
the helix-turn-helix motif relative to that of the wild-type
PrfA to enhance the protein's DNA-binding affinity (
29). Since
the identification of PrfA G145S, additional PrfA mutations
have been identified that also appear to result in a constitutively
activated form of the protein (PrfA I45S, PrfA E77K, PrfA L140F,
and PrfA G155S) (
54,
103,
116,
121). Interestingly, recent data
suggest that strains containing PrfA* mutations may be locked
into a Mr. Hyde state that can increase bacterial virulence
in animal models (
103). For example, strains containing the
PrfA G155S mutation were approximately fivefold more virulent
than wild-type strains following intravenous injection of mice
(
103).
It is clear that PrfA exists in high- and low-activity states, with the transitions between activation states occurring in response to environmental signals; however, the nature of the potential small molecule cofactor bound by PrfA (or PrfA posttranslational modification) that triggers PrfA activation is not yet known (65, 92). A number of environmental conditions influence the expression of PrfA-dependent gene products (106). Growth in rich medium or in medium supplemented with readily metabolized carbohydrates (such as glucose, fructose, maltose, or cellobiose) inhibits transcription of PrfA-dependent virulence genes (hly, plcA, plcB, mpl, and actA) without affecting PrfA protein levels (32, 77). Repression of virulence gene expression by cellobiose, a common carbohydrate in plant materials but not in animal hosts, appears to be mediated by at least three different mechanisms (5, 6, 9, 55, 69, 77). In contrast to the repression of virulence gene expression by these readily metabolized sugars, the presence of phosphorylated sugars, such as glucose-1-phosphate, supports bacterial growth with no repression of PrfA-dependent virulence gene expression (94). Phosphorylated sugars present within the cytosol of mammalian host cells are postulated to serve as molecular cues signaling the opportunity for rapid intracellular L. monocytogenes growth (14).
Other environmental signals are known to influence virulence gene expression in L. monocytogenes. PrfA-dependent LLO production and actA expression are both activated in iron-depleted medium (17, 23). As free iron levels are extremely low in mammalian host cells (
1018 M) (68), available iron may serve as a cue used by L. monocytogenes to assess its location. It is well established that expression of PrfA-dependent genes increases following treatment of the culture medium with activated charcoal (31, 32, 47, 93). Ermolaeva et al. (33) have presented evidence to suggest that activated charcoal acts by absorbing a small diffusible autorepressor molecule which L. monocytogenes produces during exponential growth. This strategy is reminiscent of quorum sensing mechanisms used in other bacteria to regulate genes in a bacterial cell concentration-dependent fashion (1, 34), but whether this form of virulence gene repression occurs in L. monocytogenes remains undetermined. In summary, several environmental conditions have been shown to influence virulence gene expression, presumably by influencing the state of PrfA activation, but the molecular mechanism responsible for the conversion of PrfA to its fully active state remains unknown.

THE TRANSITION TO MR. HYDE FOLLOWING BACTERIAL INVASION OF THE MAMMALIAN HOST
Animals have a wide array of defense mechanisms specifically
designed to prevent pathogenic bacteria from settling in and
making themselves at home. Once
L. monocytogenes is ingested
by a mammalian host organism, its survival within that host
depends upon the bacterium's ability to withstand a number of
defense mechanisms. Exposure to stresses imposed by host defense
mechanisms may actually help prepare
L. monocytogenes for its
Mr. Hyde existence. Specifically, accumulating evidence suggests
that environmental stress conditions encountered during passage
through the stomach to the gut contribute to the infectious
life cycle of
L. monocytogenes (
18,
19,
21,
74,
85,
97). For
example, one early host defense encountered by
L. monocytogenes following ingestion is the low pH environment of the stomach.
A clear connection has been established between acid tolerance
and virulence in
L. monocytogenes, in that mutants with increased
acid tolerance show increased virulence in mice (
85), and decreased
acid tolerance is correlated with decreased virulence (
21,
74).
The genetic mechanism(s) of this effect is not well understood,
but preadaptation of
L. monocytogenes (by exposure to pH 4.5
to 5.5, similar to the pH found in the stomach after eating
[
22]) increases the invasiveness of the bacteria in cell culture
(
18) as well as bacterial survival following macrophage infection
(
18,
19,
44) and following intragastric inoculation of mice
(
97).
The acid tolerance response of L. monocytogenes is at least partially dependent on
B (37, 38, 119), and at low pH, the production of monocistronic prfA transcript is strongly increased; this transcript accumulation may serve to prime the bacterium for its responses to subsequent host environments (19). As expression of a variety of stress response genes and invasion-associated internalins is regulated by the stress-responsive
B (58, 59, 60), the predicted net effect of L. monocytogenes passage through the stomach and intestine may be an increase in the production of a variety of proteins important for invasion and infection. Indeed, recent data indicate that
B plays a critical role during the gastrointestinal stage of listeriosis in guinea pigs (46). While passage of L. monocytogenes through the gut clearly is not essential for virulence, as infections in animals can be established by intraperitoneal or intravenous injection (11, 14, 27, 30, 44, 71, 119), it may increase the efficiency of infection under natural conditions.

THE MAMMALIAN CYTOSOL AND THE FULL UNLEASHING OF MR. HYDE
When
L. monocytogenes leaves the lumen of the intestine and
enters a host cell, it once again encounters several changes
in its immediate environment. In contrast to the relatively
high available iron and carbohydrate levels in the intestinal
lumen, the phagocytic vacuole is postulated to have low quantities
of available iron and carbohydrates. Low iron and low carbohydrate
concentrations activate transcription from some PrfA-dependent
virulence gene promoters (
8,
16,
17,
32,
77). Exposure of
L. monocytogenes to H
2O
2 increases transcription of
prfA and
hly,
suggesting that the presence of reactive oxygen intermediates,
such as those generated in activated macrophages, also may up-regulate
virulence gene expression (
72). The phagocytic vacuole of a
macrophage rapidly becomes acidified to a pH of approximately
5.5 to 6 (
2). Hence, following engulfment, the
L. monocytogenes invader is subjected to multiple rapid environmental changes,
including exposure to oxygen radicals, reduced pH, and reduced
nutrient density.
Some PrfA-dependent gene products have clearly targeted roles within specific cellular locations and are differentially expressed depending upon their cellular location (10). For example, actA expression is primarily confined to the host cell cytosol, where it directs actin polymerization (10, 43, 80). Differential expression of PrfA-dependent promoters is influenced by sequence variations within a promoter region's PrfA box, with relative activation reflecting the similarity of a given promoter's PrfA box to the PrfA-box consensus sequence (24, 100, 120). The promoters with perfect PrfA-box sequences, Phly and PplcA, are the most efficiently transcribed and produce transcripts at relatively low PrfA concentrations (100).
Activation of transcription from the plcA promoter by PrfA initiates an important regulatory circuit within the host by which PrfA upregulates its own production (11, 76) and produces an increase in PrfA concentrations to enable the bacteria to establish themselves in a host cell and to move to infect new cells. Mutants that produce very small amounts of PrfA are capable of escaping from vacuoles but not of polymerizing actin or spreading between host cells (41). Cell-to-cell spread is mediated by the actin nucleating protein ActA (61, 87, 113), which is transcribed from two promoters, PactA and Pmpl (61, 114). These promoters each have a single mismatched base in their PrfA boxes; therefore, transcription activation from these promoters requires an increased concentration of PrfA, such as that produced by L. monocytogenes present in host cytosol (100). PC-PLC, the product of the plcB gene, is also produced by transcription from PactA and Pmpl (61, 114), and its production is important for efficient bacterial cell-to-cell spread, as it permits bacterial escape from the secondary vacuoles created when an L. monocytogenes cell moves into a neighboring host cell (105, 114). Two additional PrfA-dependent genes that contribute to virulence, inlC and hpt, also have single mismatches in their PrfA boxes (14, 30, 74). inlC encodes a small, secreted protein called internalin C (30). Expression of inlC is enhanced in the cytoplasm of mammalian cells (10, 30), and
inlC mutants have reduced virulence in mice (30). The function of internalin C has not yet been fully established, although recent results show that it supports internalin A in stimulating invasion of mammalian cells (7). The hpt gene encodes a hexose phosphate transporter which allows L. monocytogenes to grow using phosphorylated sugars such as glucose-1-phosphate as a carbon source (14). Deletion of the hpt gene results in bacteria with a significantly reduced intracellular growth rate and attenuated virulence in mice (14), suggesting that hexose phosphates serve as important carbon sources for growth of L. monocytogenes in the cytoplasm.

PrfA HELPS MEDIATE THE L. MONOCYTOGENES SWITCH FROM ENVIRONMENTAL DR. JEKYLL TO PATHOGENIC MR. HYDE
Increasing evidence suggests that PrfA is a key part of the
potion that transforms Dr. Jekyll into pathogenic Mr. Hyde.
Overall, if one were to generate a model (or write a novel)
describing the fateful Jekyll-and-Hyde transition of
L. monocytogenes,
it might be best put forward as follows: in response to environmental
signals outside of a host,
L. monocytogenes maintains its Dr.
Jekyll persona by repressing both PrfA production and activity
through transcriptional (promoter expression), posttranscriptional
(RNA thermosensor), and posttranslational mechanisms (PrfA activation),
thereby cloaking the expression of its primary virulence factors
except for the internalins, which appear to be produced in advance
of infection (
12,
59). Once the bacteria are ingested by a mammalian
host, the increase in temperature and exposure to reduced pH
in the stomach stimulates increased production of stress response
proteins, internalins, and PrfA, thus beginning the transition
to virulence. In the intestine, internalin A mediates attachment
and invasion of host epithelial cells with the support of other
internalin proteins. Once within the cell phagosome, low iron
and low carbohydrate concentrations repress internalin production
while PrfA-dependent activation of the P
hly and P
plcA promoters
allows production of LLO and PlcA to promote lysis of the phagocytic
vacuole, thereby enabling entry of the bacteria into the cytosol.
Within the cytosol, the full transformation of the
L. monocytogenes Dr. Jekyll into Mr. Hyde is completed when high levels of active
PrfA protein activate transcription from the P
actA and P
mpl promoters. The resulting production of ActA and PlcB enables
spread of the bacteria to adjacent cells.
While this story in progress features PrfA as the protagonist controlling the L. monocytogenes transition from the outside environment to the inside of the host, additional characters are clearly required. Full induction of ActA expression, for example, seems to require additional unknown steps or factors beyond what can be explained by PrfA binding (102, 103). Secondary structure of the 150-bp 5' untranslated region of the actA mRNA has recently been shown to be important in full ActA expression, but the detailed mechanism is as yet unknown (122). Posttranscriptional mechanisms also contribute to synthesis of internalin A and B (110) and LLO (101). Mutations mapping outside of the PrfA locus that affect virulence gene expression in L. monocytogenes have been identified (69, 103), suggesting the potential presence of other transcription factors, regulatory elements, and signaling molecules required for the regulation of virulence in L. monocytogenes.

THE FINALE: THE GOOD NEWS AND THE BAD NEWS
While the bad news is that
L. monocytogenes is capable of undergoing
the dangerous transition from an environmental Dr. Jekyll to
a pathogenic Mr. Hyde within the host, the good news may be
that the Mr. Hyde form seems to suffer a competitive disadvantage
outside the host.
L. monocytogenes prfA mutants that contain
constitutively activated alleles of
prfA (and are thus locked
into the Mr. Hyde phase) are fully virulent, and in some cases
hypervirulent, in mouse models of infection; however, these
mutants are severely compromised for flagellum-mediated swimming
motility and therefore may be hindered in nutrient acquisition
in environments outside the host. It therefore appears that
L. monocytogenes must maintain a balance between life in the
outside environment and life within the host; thus, bacteria
that can undergo the switch back to the humble Dr. Jekyll form
may be favored over the evolution of increasingly dangerous
Mr. Hydes.
The last decade has seen an enormous expansion in our understanding of how L. monocytogenes regulates the transition from peaceful saprophyte to deadly pathogen. The switch from environmental microbe to pathogen is mediated by a diverse array of microorganisms encompassing both bacteria and fungi. In addition to L. monocytogenes, the organisms able to make the transition from the outside environment to inside a mammalian host include important pathogens such as Vibrio cholerae (107), Bacillus anthracis (25), Cryptosporidium parvum (35), and L. pneumophila (79). In most cases there is limited understanding of what molecular mechanisms serve to mediate the switch from life outside the host to life within a host, and, thus, the more we know of the strategies used by one environmental pathogen, L. monocytogenes, the better we may understand whether similar strategies might exist and be used by other pathogens to mediate deadly transitions.

ACKNOWLEDGMENTS
L. monocytogenes research in the authors' laboratories is supported
by the National Institutes of Health (grants AI41816 and AI055651
to N.E.F. and AI052151 to K.J.B.) and by the Cooperative State
Research, Education, and Extension Service, National Research
Initiative Competitive Grants Program (NRI Proposal 2005-35201-15330
to K.J.B.) of the U. S. Department of Agriculture.

FOOTNOTES
* Corresponding author. Mailing address: Department of Food Science, Cornell University, 413 Stocking Hall, Ithaca, NY 14853. Phone: (607) 255-3111. Fax: (607) 254-4868. E-mail:
kjb4{at}cornell.edu.

Editor: J. B. Kaper
Present address: Department of Bacteriology, University of Wisconsin, Madison, WI 53706. 

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