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Journal of Clinical Microbiology, March 1999, p. 852-857, Vol. 37, No. 3
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
hsp65 Sequencing for Identification of
Rapidly Growing Mycobacteria
H.
Ringuet,1
C.
Akoua-Koffi,1
S.
Honore,1
A.
Varnerot,2
V.
Vincent,2
P.
Berche,1
J. L.
Gaillard,1 and
C.
Pierre-Audigier1,*
Service de Microbiologie, Hôpital
Necker-Enfants Malades, 75015 Paris,1 and
Centre National de Référence des
Mycobactéries, Institut Pasteur, 75724 Paris,2 France
Received 20 May 1998/Returned for modification 25 June
1998/Accepted 19 November 1998
 |
ABSTRACT |
Partial sequencing of the hsp65 gene was used for the
identification of rapidly growing mycobacteria (RGM). A 441-bp fragment (A. Telenti, F. Marchesi, M. Balz, F. Bally, E. Böttger, and T. Bodmer, J. Clin. Microbiol. 31:175-178, 1993) was amplified and
sequenced by an automated fluorescence-based method involving capillary
electrophoresis. Type strains of 10 RGM species were first studied.
Each species had a unique nucleotide sequence, distinguishing it
clearly from the other species. A panel of strains from the four main
RGM species responsible for human infections, Mycobacterium
abscessus, Mycobacterium chelonae,
Mycobacterium fortuitum, and Mycobacterium
peregrinum, was also studied. There were few sequence differences
within each of these species (<2% of bases were different from the
type strain sequence), and they had no effect on species assignment.
hsp65 sequencing unambiguously differentiated M. chelonae and M. abscessus, two species difficult to
identify by classical methods and 16S rRNA gene sequencing. The devised
procedure is a rapid and reliable tool for the identification of RGM species.
 |
TEXT |
Rapidly growing mycobacteria (RGM)
are increasingly recognized as a cause of human infections (3, 25,
26). This group of mycobacteria is heterogeneous in terms of
epidemiology, clinical disease spectrum, and drug susceptibility. It is
therefore important to identify RGM to the species level.
Identification of RGM by conventional biochemical methods is cumbersome
and time-consuming. Phenotypic tests sometimes fail to discriminate
between closely related species, such as Mycobacterium
abscessus and Mycobacterium chelonae (14).
Precise identification is not always possible, even with the powerful
techniques used in reference laboratories, such as thin-layer
chromatography of mycolic acids or mycobactin analysis.
Genotypic methods for the identification of mycobacteria have been
developed in recent years. Approaches based on the polymorphism of the
16S rRNA gene have been of value for the identification of slowly
growing mycobacterial species. They involve hybridization with
species-specific nucleotide probes, PCR-restriction fragment length
polymorphism analysis (PRA) (10, 24), or direct sequencing of PCR-amplified products (5, 6, 10, 17). However, there is
little variability within the mycobacterial 16S rRNA gene sequence in
RGM, making this target a poor discriminator for closely related species such as M. abscessus and M. chelonae
(5, 7).
The hsp65 gene, which is present in all mycobacteria, is
more variable than the 16S rRNA gene sequence and is therefore
potentially useful for the identification of genetically related
species. Sequence variations in the hsp65 gene can be
exploited to identify both slowly growing mycobacteria and RGM to the
species level (11, 18, 22, 23, 27). hsp65 PRA has
been widely used for identification, and an algorithm based on this
approach has recently been developed for differentiating 34 mycobacterial species, including members of the RGM group
(1). hsp65 gene sequencing is an alternative
approach that has been little used with RGM (4, 9, 18).
hsp65 sequences from very few species of RGM have been
published or deposited in databases. A sequence-based strategy has
several potential advantages. It generates direct, unambiguous data and
can distinguish medically relevant subspecific phylogenetic lineages.
Recent advances in automated DNA sequencing have also made this
approach much easier. The aim of this work was to evaluate the
potential of partial hsp65 sequencing for the rapid
identification of RGM.
Bacterial strains.
The following reference strains were
used in this study (other designations are shown in
parentheses): M. abscessus IP140420023 (ATCC
19977T) and IP140420009 (ATCC 14472);
Mycobacterium brumae IP144010001 (CIP
103465T); M. chelonae IP140420003 (ATCC
35752T), IP140420006 (ATCC 19236), IP140420005 (JS
133), and IP140420019; Mycobacterium chitae IP141150001
(ATCC 19627T); Mycobacterium confluentis
IP141540001 (DSM 44017T); Mycobacterium
fortuitum IP140410001 (ATCC 06841T), biovariant
IP980015 (ATCC 4903), biovariant IP980016 (ATCC 4904);
Mycobacterium mucogenicum IP140430001 (ATCC
49650T); Mycobacterium peregrinum IP140410020
(ATCC 14467T); Mycobacterium senegalense
IP141350002 (ATCC 35796T); and Mycobacterium
smegmatis IP141330001 (ATCC 19420T). M. abscessus ATCC 14472, M. chelonae ATCC 19236, and JS
133 were used in a previous DNA relatedness study of the M. fortuitum-M. chelonae complex (8). Fifty-seven clinical
and environmental isolates were also studied; these were 16 M. abscessus isolates (IP970515, IP971181, N94130020, N96118308,
N96125674, N96127994, N97119238, N94050100, N96117130, N96147159,
IP970272, IP970453, IP140420009, N92129889, N94117403, and
N95120337), 13 M. chelonae isolates (IP970212, IP970640,
IP970663, IP970691, IP970838, IP140420005, IP140420006, N93107077,
IP140420019, IP970474, IP970475, IP970476, and IP970570), 14 M. fortuitum isolates (IP970186, IP970196, IP970218, IP970323,
IP970331, IP970376, IP970396, IP970420, IP970436, IP971263, L97117576,
L97124472, N96113001, and IP970522), and 14 M. peregrinum isolates (IP970300, IP970301, IP970432, IP970477, N97100967,
L97109695, IP970227, IP970674, IP971262, IP971265, L97105494, IP970455,
IP970407, and IP970408). These isolates were recovered from
samples of water (n = 7), sputum (n = 30), abscess (n = 6), bronchial aspirate (n = 4), gastric aspirate (n = 3),
urine (n = 3), lymph node (n = 2), pleural
fluid (n = 1), and spleen (n = 1).
Strains were obtained from the Centre National de Référence
des Mycobactéries (Institut Pasteur [IP], Paris, France),
Laennec Hospital (L), and Necker-Enfants Malades Hospital (N). Clinical
and environmental isolates were identified by using conventional
phenotypic tests and PRA with the enzymes BstEII and
HaeIII (23).
PCR amplification and sequencing.
For hsp65
sequencing, RGM strains were cultivated at 30°C on
Löwenstein-Jensen medium. DNA was extracted from a loopful of bacterial cells by using acid-washed glass beads (Sigma, St. Louis, Mo.), as previously described (6). The
21M13 forward
primer Tb11
(5' - TGTAAAACGACGGCCAGTACCAACGATGGTGTGTCCAT-3')
and M13 reverse primer Tb12
(5'-CAGGAAACAGCTATGACCCTTGTCGAACCGCATACCCT-3') were used to amplify a 441-bp portion of the
hsp65 gene as previously described (positions 396 to 836 of
the published sequence from Mycobacterium tuberculosis)
(13). The primers were designed to contain either the
21M13 forward primer or the M13 reverse primer (underlined
nucleotides) to facilitate sequencing. Lysate (10 µl of a 1/100
dilution) was subjected to amplification in a final volume of 100 µl
containing 0.25 µM each oligonucleotide primer, 200 µM (each) dATP,
dCTP, dGTP, and dTTP (Pharmacia Biotech, Uppsala, Sweden), 10 mM
Tris-HCl (pH 9), 5 mM KCl, 0.01% (wt/vol) gelatin, 1.5 mM
MgCl2, 5% dimethyl sulfoxide (DMSO), and 0.5 U of DNA
Taq polymerase (ATGC; Biotechnologies, Noisy-le-Grand, France). PCR was performed for 35 cycles of 20 s at 94°C,
20 s at 60°C, and 45 s at 72°C in a 9600 thermal cycler
(Perkin-Elmer). Amplified product (10 µl) was subjected to
electrophoresis in an agarose gel, and the gel was viewed under UV to
check for DNA amplification. The PCR product (50 µl) was purified by
filtration through a Pharmacia S400 HR purification column (Pharmacia
Biotech). The DNA was sequenced with the Taq Dye Primer
Cycle Sequencing kit (Applied Biosystems, Inc., Foster City, Calif.)
with fluorescent primers (Genset, Paris, France). The labeled extension
products were precipitated, washed, and dried before being loaded on
the sequencing gel. The samples were suspended in 20 µl of Template Suppression reagent (Applied Biosystems), denatured by heating for 2 min at 95°C, and passed through POP6 capillary columns (Applied Biosystems, Inc.) on an ABI PRISM 310 Genetic Analyzer (Perkin-Elmer). The sequences of both strands were determined.
Analysis of sequence data.
Sequences were edited with the
Sequence Navigator (Applied Biosystems) program and aligned by using
the Clustal X program (Higgins, Heidelberg, Germany). Amino acid
sequences were deduced from nucleotide sequences and restriction enzyme
sites identified by using DNA strider 1.2 (CEA, Gif-sur-Yvette,
France). Phylogenetic relationships were reconstructed by using PHYLIP
software (DNADIST) to estimate the matrix of pairwise sequence
distances, and then phylogenetic trees were constructed by the
neighbor-joining method by using NEIGHBOR software. This software was
part of the Genetic Data Environment package. The degree of confidence
in phylogenetic branching was assessed by using 1,000 bootstrap resamplings.
Results and discussion.
hsp65 sequences from type
strains are shown in Fig. 1. Each species
had a unique sequence, consistent with the results of hsp65
PRA. All species studied were readily discriminated from each other.
M. fortuitum and M. senegalense, the two species
with the highest degree of similarity, had sequences differing by three nucleotides. The M. chelonae and M. abscessus sequences differed by nearly 30 nucleotides, whereas
their 16S rRNA genes differed by only four nucleotides. These two
species were the only RGM studied with the sequence AAG at positions
549 to 551. This short sequence may thus constitute a signature for
M. chelonae and M. abscessus within the RGM
group. However, it is not unique to these species within the
Mycobacterium genus, because it is also found in other
species, such as Mycobacterium gordonae (2).
Nucleotide differences were found along the length of the amplified
hsp65 fragment but were particularly frequent in two regions
(positions 624 to 664 and positions 683 to 725). These regions thus
appear to be hypervariable regions of the hsp65 gene. Most
nucleotide substitutions led to codon changes that either were
conservative or encoded functionally similar amino acids (data not
shown). This suggests that Hsp65 is functionally constrained by high
selection pressure. This is consistent with the key role of this
protein in the resistance of bacterial cells to environmental stresses (15).

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FIG. 1.
Alignment of partial hsp65 sequences from RGM
type strains. M. tuberculosis was used as a reference;
nucleotides differing from those of the M. tuberculosis
sequence are indicated; dots indicate identity. The first nucleotide
shown corresponds to position 416 of the published sequence from
M. tuberculosis (21).
|
|
A target gene must be sufficiently conserved among the strains of the
species for use in genotypic identification. hsp65 allelic diversity among mycobacterial species has been reported in previous studies based on PRA and DNA sequencing (1, 4, 9, 19, 20,
23). We checked that allelic diversity within hsp65
was not detrimental to the identification of the main RGM species affecting humans by studying a representative panel of strains from the
species M. abscessus, M. chelonae, M. fortuitum, and M. peregrinum. Some degree of
intraspecific allelic diversity was found for RGM hsp65
(Table 1), consistent with the results of
previous studies (1, 4, 9, 27) which developed the use of
hsp65 as a target for routine identification. For the main species of the M. fortuitum complex, values of intraspecific
divergence were <1.4% for M. chelonae, <1.4% for
M. abscessus, 0% for 80% of the isolates within the
M. fortuitum group (<2% when the sorbitol-negative biovariant was included), and <2% for the M. peregrinum
species. This diversity is much lower than the interspecies divergence, even for the most closely related species such as M. abscessus and M. chelonae, and never affected species
assignment. The 16S RNA sequencing that is now the reference sequencing
method does not permit the differentiation of closely related RGM
species. Even if the 16S RNA gene is highly conserved, some allelic
intraspecific diversity (as occurs for Mycobacterium
intracellulare, for example) that affects its use for
identification is observed. The hsp65 sequencing method was
developed for RGM species because it displays more polymorphism than
does the 16S RNA gene sequence. The effects of allelic diversity on
amino acid sequence were also studied (data not shown). Only a small
proportion of variants would carry amino acid substitutions, and most
amino acid substitutions would be isofunctional. This observation
supports the notion that Hsp65 is highly conserved among mycobacteria.
A sequence-based strategy requires that the databases used are totally
reliable. This is not always the case with RGM sequences.
It is not
uncommon to find sequences in databases that are obviously
from
misidentified strains. This is not particularly surprising
because
identification of RGM at the species level by means of
phenotypic tests
alone is difficult. There are reports of strains
being initially
identified as
M. abscessus by conventional biochemical
tests
and later shown to be
M. fortuitum by genotypic methods
and
reassessment of the biochemical test results (
9). The
commonest
error we found in databases was the misidentification of
M. abscessus as
M. chelonae. Several strains
described as
M. chelonae had
hsp65 sequences
typical of
M. abscessus (0 to 6 base differences from
M. abscessus ATCC 19977
T versus 30 to 32 base
differences from
M. chelonae ATCC 35752
T). We
overcame these problems by sequencing type strains or strains
previously used in taxonomic studies based on DNA-DNA hybridization.
Sequences from these strains may serve as "gold standards" for
subsequent studies of
RGM.
The taxonomy of RGM was not the main focus of this study, but
phylogenetic trees constructed based on
hsp65 and 16S rRNA
sequences
were compared. Figure
2 shows
the
hsp65 phylogenetic tree obtained
with the 10 type
strains studied in this work.
M. fortuitum,
M. senegalense,
M. peregrinum, and
M. smegmatis
clustered together.
This result is consistent with a phylogeny based on
16S rRNA sequences
(
17), as is the fact that
M. abscessus and
M. chelonae formed
a distinct subgroup.
However, unlike 16S rRNA sequencing,
hsp65 sequencing
clearly differentiated these species as distinct entities.
We studied
the positions of the
M. abscessus,
M. chelonae,
M. fortuitum, and
M. peregrinum strains of our
panel in the
hsp65-based
tree constructed from type strain
sequences (data not shown).
Strains were located close to the type
strain from the same species
except for three
M. peregrinum
isolates (IP 970455, IP970407,
and IP970408), which formed a distinct
subgroup intermediate between
M. peregrinum and
M. fortuitum type strains. Each of the four
species formed a tight
group that was clearly separate from the
others. The lack of overlap
between
hsp65 sequences from
M. abscessus and
M. chelonae is particularly valuable for the accurate
identification
of these species.

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FIG. 2.
Unrooted phylogenetic tree based upon hsp65
sequences from RGM type strains. The tree was constructed by using the
neighbor-joining method. The bar indicates 1% estimated sequence
divergence.
|
|
Although the results of
hsp65 sequencing of type strains
were similar to those for
hsp65 PRA, there are several
problems associated
with
hsp65 PRA. Major disadvantages of
PRA are that fragments
of similar sizes are not always well
discriminated and that small
fragments may be difficult to identify.
Some authors have ignored
restriction fragments shorter than 60 bp, as
they may be primer
or primer dimer bands (
1,
23). Others
take into account fragments
up to 50 bp (
18). Another
difficulty with PRA is that a single
base change may lead to the
appearance or disappearance of a restriction
site. Different alleles
may therefore give different restriction
patterns. For example, a C at
position 542 in the
M. abscessus hsp65 gene gives an
HaeIII restriction site, whereas a T does
not. The commonest
PRA-based
hsp65 alleles have been described
for the main RGM
species (
1,
18). However, migration patterns
have not been
determined for all possible alleles for each of
the RGM
species.
Other target genes have been proposed for the identification of
mycobacteria by PCR-based sequencing. They include the 32-kDa
protein
gene (
16), the
dnaJ gene (
21), the
superoxide dismutase
(SOD) gene (
28), and the internal
transcribed spacer of the
16S-23S rRNA gene (
12). These
targets have been evaluated mostly
for the identification of slowly
growing mycobacteria. There are
few available sequence data for RGM.
Very few RGM species have
been sequenced, and only one strain from each
species was tested
in most studies. The inter- and intraspecific
variability of these
targets is, therefore, difficult to assess. The
few sequence data
available suggest that the 32-kDa protein gene, the
dnaJ gene,
and the internal transcribed spacer of the
16S-23S rRNA gene are
much more variable than the
hsp65 gene
in RGM.
M. fortuitum and
M. smegmatis type
strains had 36 base differences within a 120-bp
region of the gene
encoding the 32-kDa protein (ca. 30% divergence
versus ca. 4% for
hsp65) (
16). The
M. fortuitum and
M. chelonae dnaJ sequences were 29% different (versus ca.
10% difference for
hsp65 sequences from type strains)
(
21). These targets may be
too variable to be used for
discrimination of RGM species. They
may, however, be useful for
delimiting subspecific groups. The
SOD gene is slightly more variable
than
hsp65. For example, Zolg
and Schulz found 9%
nucleotide divergence between
M. fortuitum and
M. smegmatis SOD gene sequences and 11% divergence between
M. fortuitum and
M. chelonae (versus ca. 4% and ca. 10%,
respectively,
for
hsp65 sequences from type strains)
(
28). The SOD gene may
be as suitable as
hsp65
for species assignment within the RGM
group. However, more information
is required to evaluate the intraspecific
variability of this
target.
The automated fluorescence-based sequencing method incorporating
capillary electrophoresis gave rapid and reliable results.
The entire
process was performed within a few hours (from cell
pellet preparation
to nucleotide sequence determination). We used
DyeDeoxy Primer Cycle
Sequencing reactions because this system
was found to give the best
performance when this work was begun.
Rhodamine DyeDeoxy Terminator
Cycle Sequencing kits, which are
more convenient and give better
results, are now available. This
new sequencing technology makes it
possible to obtain unambiguous
sequence data for both strands of the
entire amplified 441-bp
hsp65 fragment. We now use it
routinely for the identification
of RGM by
hsp65 sequencing.
Thus, automated fluorescence-based
hsp65 sequencing
incorporating capillary electrophoresis is a rapid and reliable method
for the identification of RGM at the species level. It unambiguously
differentiates between genetically related species with restricted
biochemical differences, such as
M. chelonae and
M. abscessus.
Allelic diversity within
hsp65 does not
preclude the use of this
target for the identification of RGM and may
even serve as the
basis for recognition of medically important
subspecific strain
groups, an area worthy of further
study.
 |
ACKNOWLEDGMENTS |
We thank P. Descamps, M. L. Chaix, C. Tinsley, and V. Escuyer
for helpful discussions, C. Offredo for providing strains, and E. Abachin, G. Quesne, and J. L. Beretti for technical assistance.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Laboratoire de
Microbiologie, Hôpital Necker-Enfants Malades, 149 rue de
Sèvres, 75743 Paris Cedex 15, France. Phone: (33) 01 44 49 49 61. Fax: (33) 01 44 49 49 60. E-mail: berche{at}necker.fr.
 |
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Journal of Clinical Microbiology, March 1999, p. 852-857, Vol. 37, No. 3
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Copyright © 1999, American Society for Microbiology. All rights reserved.
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