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Revista mexicana de ciencias pecuarias

versión On-line ISSN 2448-6698versión impresa ISSN 2007-1124

Rev. mex. de cienc. pecuarias vol.12 no.4 Mérida oct./dic. 2021  Epub 06-Jun-2022

https://doi.org/10.22319/rmcp.v12i4.5699 

Review

Caseous lymphadenitis: virulence factors, pathogenesis and vaccines. Review

Maria Carla Rodríguez Domíngueza 

Roberto Montes de Oca Jiméneza  * 

Jorge Antonio VarelaGuerreoa 

a Universidad Autónoma del Estado de México. Centro de Investigación y Estudios Avanzados en Salud Animal (CIESA). Facultad de Medicina Veterinaria y Zootecnia. km 15.5 Carretera Panamericana Toluca-Atlacomulco, Toluca, Estado de México, México.


Abstract

Caseous lymphadenitis is a disease that affects sheep and goat production worldwide. The etiological agent is a Gram-positive, facultative intracellular bacterium called Corynebacterium pseudotuberculosis biovar ovis. The disease can occur with a cutaneous or visceral development, causing deterioration in the physical condition of the animal, as well as losses in the production of milk and meat, carcass confiscation, skin rejection and consequently, great economic losses. The study of virulence factors and pathogenesis mechanisms have made it possible to understand this disease, as well as to establish the target molecules for the development of new vaccines. There are commercial vaccines available globally; however, the protection conferred by them has not been effective in controlling the disease. Currently, the use of new technologies has allowed the obtaining and characterization of proteins with immunogenic potential for the development of new vaccines, which could be an alternative to increase protection. In the present work, the main factors of virulence of Corynebacterium pseudotuberculosis, their implications in the pathogenesis and the current trends in the vaccine formulations are presented.

Key words Caseous lymphadenitis; Corynebacterium pseudotuberculosis; Virulence factors; Pathogenesis; Vaccines

Resumen

La linfadenitis caseosa es una enfermedad que afecta la producción ovina y caprina a nivel mundial. El agente etiológico es una bacteria Gram positiva, intracelular facultativa denominada Corynebacterium pseudotuberculosis biovar ovis. La enfermedad puede cursar con un desarrollo cutáneo o visceral, provocando deterioro en la condición física del animal, así como pérdidas en la producción de leche y carne, decomiso de las canales, rechazo de las pieles y como consecuencia, grandes pérdidas económicas. El estudio de los factores de virulencia y los mecanismos de patogénesis han permitido comprender esta enfermedad, así como establecer las moléculas diana para el desarrollo de nuevas vacunas. Existen vacunas comerciales disponibles a nivel mundial; sin embargo, la protección conferida por éstas no ha sido eficaz en el control de la enfermedad. Actualmente el uso de nuevas tecnologías ha permitido la obtención y caracterización de proteínas con potencial inmunogénico para el desarrollado de nuevas vacunas, las cuales podrían ser una alternativa para incrementar la protección. En el presente trabajo se exponen los principales factores de virulencia de Corynebacterium pseudotuberculosis, sus implicaciones en la patogénesis y las tendencias actuales en las formulaciones vacunales.

Palabras clave Linfadenitis caseosa; Corynebacterium pseudotuberculosis; Factores de virulencia; Patogénesis; Vacunas

Introduction

Caseous lymphadenitis (CLA) is one of the diseases that most affects sheep and goat production worldwide1. The etiological agent of the disease, Corynebacterium pseudotuberculosis biovar ovis, causes a chronic infection that is characterized by the formation of abscesses in cutaneous or visceral lymph nodes. This disease causes deterioration in the physical conditions of animals, decreased production of wool2, meat3 and milk4, as well as reproductive disorders5. In Australia, the analysis of three farms in the Western region, for a total of 600 animals evaluated, allowed establishing that infection by C. pseudotuberculosis caused a decrease in the production of greasy wool by 3.8-4.8 % and clean wool by 4.1-6.6 %. Based on the data obtained, the annual loss in wool production would be around $17 million Australian dollars (AUD)2. Losses in meat production have been estimated around $12-13 million AUD6. Other studies indicate that overall losses would be around $30 to 40 million dollars, considering the rejection of meat and carcasses7. In Canada, it was identified that between 3 and 5 % of meat and 0.02 to 0.03 % of animals are rejected during inspection processes of producing plants8. These facts have a negative impact on exports, decreasing the possibilities of trading9.

Corynebacterium pseudotuberculosis is a zoonotic microorganism, so it also affects man, with the personnel who work in the production of small ruminants being more vulnerable10. CLA has been reported in several countries such as China11, Australia12, Brazil13, Canada14, the United States8 and Mexico15,16. The spread of the disease could have been caused by sick sheep exported from Spain to South America and from Australia to North America and the Middle East17.The disease is poorly reported, according to the results of a survey of 264 veterinarians and 510 farmers in the UK. Only 18 % of veterinarians had seen at least one case of the disease and 45 % of farmers had noticed abscess formation in their sheep. Few producers investigate the cause of abscesses, but of 32 farms that were studied by laboratory diagnosis, 24 were confirmed with the presence of the disease18.The frequency of the appearance of CLA in each region or country depends mainly on the type of farm, management and control programs. Herds in extensive production, grazing and shearing condition the appearance of the disease19. Antibiotic treatment, surgical interventions and the application of disinfectant solutions to external abscesses20,21 are not always effective options. The purulent content of abscesses can contaminate soil, food and handling equipment22,23 and although, in vitro, C. pseudotuberculosis exhibits sensitivity to a wide range of antibiotics24, in vivo, treatment is difficult due to the intracellular nature of the bacterium25 and the thick, dry and fibrous content of the abscess8,9. The World Organisation for Animal Health (OIE) considers CLA within the list of diseases that require the development of effective vaccines to reduce the indiscriminate use of antimicrobials26. There are commercial vaccines against CLA worldwide; however, the protection conferred by these has not been efficient in controlling the disease11.Currently, the use of new generation technologies has allowed the development of new experimental vaccines, which could be an alternative to improve protection. The new formulations seek to include molecules, the main virulence factors, that allow the activation of the humoral and cellular immune system27. This literature review addresses the issues related to the main virulence factors, their relationship in pathogenesis and the strategies used for the development of new vaccine formulations against caseous lymphadenitis.

General characteristics: Corynebacterium pseudotuberculosis

The genus Corynebacterium includes numerous species of great importance for the medical, biotechnology and veterinary industries. The PATRIC Database had, in 2017, the report of 466 genomes and 83 species of Corynebacteria28. Corynebacterium pseudotuberculosis belongs to the family Corynebacteriaceae, genus Corynebacterium. It has a coccobacillary morphology with an amplitude from 0.5 to 0.6 μm and 1.0 to 3.0 μm in length. This microorganism is a non-spore- or capsule-forming, non-flagellated, facultative intracellular pathogen. It has the ability to grow anaerobically, degrades galactose, maltose, L- and D-arabinose and glucose without gas production. In simple broth culture medium, growth is scarce without turbidity; however, in Brain-Heart Infusion (BHI) broth, abundant growth with yellowish-white sediment is obtained1.The cell wall of the bacterium is formed by a layer of peptidoglycan composed of meso-diaminopimelic (meso-DAP) acid, arabinose and galactose as main sugars. In the reactions of the peptidoglycan II biosynthesis pathway; meso-DAP acid is the product of the reaction catalyzed by UDP-N-acetylmuramyl-tripeptide synthetase, an enzyme that has been identified in strains of Corynebacterium29. Peptidoglycan in turn is covalently bound with arabinogalactans that form a lattice, which is bound to an outer layer of corynomicolic acids (22 to 36 carbon atoms), which bind to trehalose, with the end of the wall most exposed to the outside30.This lipid structure acts as a barrier, with selective permeability mediated by integral membrane proteins called porins31. The Phospholipase D (PLD) exotoxin is considered the main virulence factor and can be detected by a synergistic hemolysis assay against Rhodococcus equi or by inhibition of the ß-hemolysin of Staphylococcus aureus. Strains of C. pseudotuberculosis are classified into biovar equi for isolates that have nitrate reductase (nitrate-positive) enzymatic activity, and biovar ovis for those strains that do not have such capacity (nitrate-negative)1. Biovar ovis is the causative agent of CLA disease and has been isolated from sheep15, goats16, antelopes32, cows33, alpacas34, llamas35, ibex36 and pigs37.

Biovar equi causes the formation of abscesses in muscle tissue of the pectoral area of horses and to a lesser extent internal injuries38, it has also been isolated from camels39 and buffaloes40. C. pseudotuberculosis causes infection in humans, with the existence of cases reported mainly in countries engaged in the farming of small ruminants. Clinical symptoms include axillary, inguinal or cervical adenopathies, fever and myalgia, with chronic or subacute evolution, in some cases it can also generate pneumonia10.

Virulence factors

Virulence factors are the structures and molecules that give the bacterium the ability to be pathogenic. The acquisition of genes by horizontal transfer has been transcendental in the evolution of the pathogenicity of bacteria; since the functions of the acquired genes have allowed it to adapt to different environmental conditions, including survival in different niches during infection to the hosts. Most of the virulence genes of C. pseudotuberculosis are clustered in the genome in regions called pathogenicity islands (PAIs). In C. pseudotuberculosis, 16 PAIs have been identified, called PiCp, where the presence of a transposase gene in PiCp1 possibly allowed the incorporation of PAIs into the genome29,41. These regions contain several genes involved in adhesion, invasion, colonization, spread within the host, survival inside infected cells and evasion of the immune system. PiCp sequences have a high level of intra-biovar similarity (82-100 %) in ovis strains, which exhibit from 78 to 91 % similarity with respect to biovar equi. However, biovar equi strains contain large deletions and a lower level of intra-biovar similarity (77-88 %) and also compared to PiCp of biovar ovis (62-74 %)41.

Corynomicolic acids

Corynomicolic acids are part of the outer layer of the cell wall of the bacterium, which constitutes a protective and permeable barrier. The binding of these to trehalose molecules leads to the formation of curved structures, which blocks the access of molecules (antibiotics or lysozymes) to the peptidoglycan, conferring mechanical protection30,31. Unlike the linear fatty acids of phospholipids, corynomicolic acids are 𝛽-hydroxy-branched fatty acids, which require carboxylation and condensation of two fatty acids for synthesis. The AccD2 and AccD3 enzymes are carboxylases widely conserved in the family Corynebacteriaceae, involved in the generation of intermediates for the synthesis of corynomicolic acids. Other enzymes involved in synthesis are AccD1, for the elongation of the mycolic acid chain, and FadD, an AMP ligase29. Inoculation of corynomycolic acids in sheep showed that haptoglobin (Hp) increased its concentration three times, as well as twice the levels of serum amyloid A (SAA), proteins that indicate inflammation and acute infections42. These results indicate their virulent potential, since on their own, they are able to induce reactions of inflammation in the host, which contributes to the formation of granulomas.

Phospholipase D, PLD

The Phospholipase D exotoxin is considered the main virulence factor of C. pseudotuberculosis. The pld gene was identified and sequenced in 1990, is part of the pathogenicity island PiCp1 and encodes a 31.4KDa protein43. Comparison of the sequence of the PLD protein of C. pseudotuberculosis revealed that it has greater similarity with Phospholipase A2; however, PLD does not belong to the family of phospholipases because it lacks the HKD motif conserved in this family43. PLD is classified as a Sphingomyelinase D (SMasaD; EC 3.1.4.41), also known as sphingomyelin phosphodiesterases D or phospholipase D (PLD), which catalyzes the hydrolytic cleavage of sphingomyelin to produce choline and ceramide 1-phosphate or choline and lysophosphatidic acid (LPA)44. Compounds derived from sphingomyelin degradation cause platelet aggregation, endothelial hyperpermeability, and pro-inflammatory responses45. The enzymatic action of PLD hydrolyzes sphingomyelin, the main component of cell membranes, which leads to an alteration of the morphology of the target membrane. PLD contributes to the spread and persistence of the bacterium inside macrophages46. The pld gene presents a widely conserved sequence in the strains of C. pseudotuberculosis, and when this is modified, the ability to produce the disease is hindered41.

Endoglycosidase, CP40

The CP40 protein is encoded by a gene with an open reading frame of 1,137 bp, which is located downstream of the pld gene in PiCp1. It was described as an enzyme with serine protease activity47, but in another study, the analysis of the sequence allowed its grouping closer next to endoglycosidases and further away from serine protease sequences48. In this work, it was proposed that its enzymatic activity is endoglycosidase, mediator of the hydrolysis of glycosidic bonds, proteins of the GH18 family, similar to the EndoE domain belonging to Enterococcus faecalis. GH18 enzymes contain a conserved consensus sequence motif (LIVMFY) - (DN) -G- (LIVMF) - (DN) - (LIVMF) - (DN) -X-E, where terminal glutamic acid is essential for enzymatic activity. By aligning the GH18 active site in CP40, its similarity to the EndoE and EndoS enzymes was established, only with changes in one or two amino acids respectively. The function as a virulence factor has been associated with the demonstrated ability in vitro to degrade the Fc region of IgG antibodies. CP40 endoglycosidase does not hydrolyze glycans in bovine and caprine IgG, while sheep IgG is partially hydrolyzed and equine IgG completely. The analysis was also performed with subclasses of human IgG, presenting activity in all and partially in IgG4. There was no detectable enzymatic activity in other glycoproteins, including some of the other immunoglobulin isotypes (IgA, IgD, and IgE)48.

Secreted proteins PLD and CP40

According to various reports, proteins exported or secreted by bacteria are actively involved in the infection process49. For this reason, the expression and secretion of the PLD and CP40 proteins have been highly studied. The development of an experimental infection showed by immunoblot that the production of antibodies was directed 88 % to the recognition of proteins of 30-31Kda (PLD) and in 75 to 88 % towards proteins of 38-41KDa (CP40), range in which are both proteins50. The attenuated strain 1002, after several passes in a mouse model, was able to reverse the virulence. The analysis by mass spectrometry allowed the identification of the PLD and CP40 proteins only in the reactivated strain 1002, which indicates the participation of these proteins in the virulence51. On the other hand, through real-time PCR, the expression of several genes involved in virulence was identified in vitro and in vivo, including pld and cp40. This analysis made it possible to verify that, in the strains isolated from lymph nodes, the expression of these genes was higher compared to the strains obtained from in vitro cultures52.

Virulence factors involved in iron acquisition

In PiCp1 is the operon (fag ABCD)29, composed of four genes, fagA, fagB, fagC, fagD, that are located downstream of the pld gene. These genes respectively encode an integral membrane protein, an iron-transporting enterobactin, an ATP-binding cytoplasmic membrane protein, and an iron-binding siderophore protein. FagA was identified as a membrane-associated protein with pathogenic potentialities, by mass spectrometry analysis of proteins expressed in a strain of C. pseudotuberculosis grown with animal serum53. The culture of C. pseudotuberculosis in media with iron chelators (dipyridyl) caused the decrease in a logarithm order in the count of colony-forming units (CFUs), compared to bacteria grown in iron-enriched media. The evaluation of the transcriptional response of C. pseudotuberculosis, with iron restriction, allowed identifying the negative regulation of genes involved in the energy metabolism of the Krebs cycle (sdhC, sdhB, lpd), ATP production (atpF, atpH), pyruvate metabolism (lpd), oxidative phosphorylation (qcrC, qcrA, qcrB, ctaC, ctaF, ctaE, ctaD), ribosome processes, transport (rplJ, rplL, rplM, rpmA, rpsC, rpsI, rpsL, rpsM) and EF-G and EF-Ts elongation factors associated with the translation of mRNA (fusA, tsf). The gene analogous to dtxR of C. diphteriae was identified, with 79 % similarity in sequence, which encodes an iron-binding dependent protein, which acts as a regulatory factor for more than 40 genes54. In PiCp3 and PiCp4, the genes belonging to the operon ciuABCDE involved in iron absorption, transport and biosynthesis of siderophores have been studied29.

TetA Protein

In PiCp2, the tetA gene encodes a tetracycline efflux transporter protein that protects against the action of this antibiotic and confers resistance to the bacterium. The tetA gene is often carried by transmissible elements such as plasmids, transposons and integrons and has been identified in C. pseudotuberculosis29.

Virulence factors for macrophage infection

On the pathogenicity island PiCp2 are the potG, sigK and dipZ genes, which respond to the mechanisms responsible for the intramacrophagic lifestyle of C. pseudotuberculosis. The potG gene encodes an ATP-binding membrane protein that provides energy for absorption of putrescine (polyamine) from the periplasmic space, it functions as a putrescine transporter system29. Putrescines are polyamides produced by macrophages that induce decreased production of reactive nitrogen species and synthesis of pro-inflammatory cytokines. The dipZ gene has been identified in the phylum Actinobacteria, is regulated by sigK55 and is activated during macrophage infection by Mycobacterium tuberculosis. In PiCp4, the presence of the gene that encodes the Sigma factor confers the ability to protect against oxidative stress, specifically against the action of nitrogen intermediate products, produced by macrophages56. The FCR41 strain of C. pseudotuberculosis was used in the study of genes related to pili synthesis. The structure of the pili is composed of the major pili SpaA and SpaD; the minor pili SpaB and SpaE; and the pili type, SpaC, SpaF. A complete pili structure or even the minor pili can make initial contact with host cell receptors to facilitate the entry of microorganisms. In this strain, the spaC gene was identified, which encodes a protein responsible for anchoring the pili to the cell wall, which can allow initial contact with the cell receptors, to then facilitate intracellular invasion. It also presented the namH gene, which encodes an extracellular neuraminidase, which catalyzes the elimination of sialic acid groups present in a wide variety of glycoconjugates of the extracellular matrix of the host cell, which favors adherence to cells. In FCR41, the sodC gene was detected, which encodes a superoxide dismutase, an enzyme anchored to the membrane with extracellular domain, which eliminates oxygen free radicals, products of respiratory burst in macrophages57.

Resistance and adaptation virulence factors

Chaperone proteins (HSPs) are highly conserved and are expressed under heat stress, as well as nutrient reduction, hypotaxia, breakdown of metabolism and other cellular processes. In C. pseudotuberculosis, Hsp10 (groES) and Hsp60 (groEL)58 have been studied. In strain 1002, resistance to various types of abiotic stress, such as acidity, high temperatures and osmotic stress, associated with the presence of these proteins, was evaluated59. The hspR gene encodes the regulatory factor of the expression (repressor protein) of the operon with the genes dnaK, grpE, dnaJ and hspR, which encode heat shock proteins. In the absence of stress, the HspR protein attaches to an inverted repeat sequence that represses the promoters responsible for controlling the expression of the Hsp operon. In another study, the separation of proteins by two-dimensional electrophoresis allowed the identification of 11 new extracellular proteins, 3 with unknown functions and 8 related to the elongation factor Tu, GroEL (HSP60), enolase, glyceraldehyde-3-phosphate dehydrogenase and superoxide dismutase (SodA), which depend on a non-classical secretion method via SecA. Both SecA genes (SecA1 and SecA2) were identified in the strains studied, possibly involved in the secretion system of C. pseudotuberculosis60. The study of the virulence factors of C. pseudotuberculosis as candidate molecules for the development of more powerful and effective vaccines is still being continued.

Pathogenesis and immune system evasion mechanisms

The cutaneous manifestation of CLA is characterized by the formation of abscesses in subcutaneous lymph nodes, which are visible and palpable through the skin and their location depends on the point of entry of the microorganism. Lesions can appear as organized abscesses, with inflammation, fibrous encapsulation, overlapping hair loss and eventual rupture, resulting in the discharge of purulent content. In the visceral form, abscesses occur in the internal lymph nodes, as well as in the lungs, liver and kidneys, causing deterioration in the organic condition of the animal towards the development of a chronic course61. In atypical forms of the disease, macroscopic lesions do not correspond to caseous nodes, with neonatal toxemia or icterohemoglobinuria of newborns, arthrosynovitis, endometritis, mastitis and orchitis being described62.

The infection begins with the entry of the bacterium through skin lesions generated during the handling of sheep, such as tail cuttings, ear marking, castration, shearing or in some cases, lesions generated during feeding with spiny fodder that damage the oral mucosa. Sanitary baths also contribute to infection, favoring the entry of the microorganism through small wounds of the skin1. Primary infection occurs at the site of entry of the bacterium, with hematogenous and lymphatic spread forming abscesses in the lymph nodes closest to the site of infection (parotid, submandibular, prefemoral, prescapular, popliteal or mammary). Then a secondary infection occurs with the formation of abscesses in lymph nodes (thoracic, bronchial and mediastinal) and various organs63,64. In sheep, the morphological appearance of the abscessed nodes is the characteristic of an onion layer as they present a distribution in fibrous concentric layers separated by caseous material. In goats, the affected nodes usually form a dry uniform purulent paste. This difference could be due to the nature of phagocytic enzymes, being of greater lytic activity in goats than in sheep8,9.

The mechanisms involved in the adherence and intracellular survival of C. pseudotuberculosis in non-phagocytic cells are still being studied by various researchers. In in vitro studies, C. pseudotuberculosis was able to adhere to and invade the FLK-BLV-044 fibroblast line of sheep kidney embryonic cells, with cell replication for 24 h and bacterial viability of 120 h, with a positive correlation between the rate of adhesion and invasion65. These results suggest that the establishment of infection, as well as persistence, may be favored by intracellular infection in tissue of the site of entry of the microorganism and not only by infection of phagocytic cells. C. pseudotuberculosis is phagocytosed by macrophages that are recruited to the site of infection, and it has been shown that they have the ability to remain viable within these for up to 72 h, evading the mechanisms of elimination of pathogens presented by macrophages66. Macrophages infected with C. pseudotuberculosis activate the production of reactive oxygen intermediate (ROI) compounds, which cause damage at the DNA level. The binding of bacteria to the receptors of the macrophage phagosome membrane causes the so-called respiratory burst that favors the production of NADH. Before the lysosome fuses with the phagosome, in the latter, a reduction of molecular oxygen (O2) catalyzed by NADPH-oxidase present in the phagosome membrane occurs. The resulting superoxide anion (O- 2) is toxic to the bacterium, but in turn gives rise to other short-lived toxic radicals, such as hydrogen peroxide (H2O2), hydroxyl radical (OH), and singlet oxygen (O1 2). When the lysosome fuses with the phagosome, the myeloperoxidase enzyme is released, which acts on peroxides in the presence of halides (I- and Cl-), to produce highly toxic and long-lived halogenated compounds (hypohalides): hypochlorous acid (ClOH) and hypoiodous acid 66. However, C. pseudotuberculosis has developed resistance mechanisms to protect against O2-free radicals.

Superoxide dismutases (SODs) constitute a family of three metalloenzymes (FeSOD, MnSOD and CuZnSOD) with different intracellular localization and distribution, which catalyze the conversion of superoxide radicals into H2O and O2. The presence of Mn/FeSODs in C. pseudotuberculosis has been verified and the phylogenetic analysis allowed establishing the evolutionary differences and similarities of the sequences of this enzyme in hosts of the sheep, goat, bovine, equine and human species, as well as with different species of Corynebacterium. This would explain the ability of the same strain of C. pseudotuberculosis biovar ovis to remain in macrophages of different types of hosts67. C. pseudotuberculosis presents the catalase enzyme1 that provides protection against the action of H2O2, since they decompose it into H2O and O2. Also, the intermediate products of the enzyme during the dismutation reaction can bind to NADPH oxidase, which functions as a regulator of enzymatic activity and decreases the formation of other oxidative stress products such as hydroxyl radical and singlet oxygen (O1 2).

Also, in macrophages, reactive nitrogen products (RNI) act as another mechanism of elimination of pathogens. The in vitro study of sigma factor mutant strains of C. pseudotuberculosis, they were more susceptible to concentrations of nitric oxide, so it is proposed that its presence protects against this type of oxidative stress56. The presence of corynomicolic acids gives C. pseudotuberculosis mechanical and possibly biochemical protection, allowing it to resist digestion by hydrolytic enzymes present in lysosomes and the action of antimicrobial proteins66. Inoculation of corynomycolic acid extracts, in female goats, caused hemorrhage, congestion, degeneration, necrosis, edema and leukocytic infiltrations in reproductive organs and associated lymph nodes, as well as increased the concentration of estrogenic hormones62. They have also been associated with decreased testosterone and loss of semen quality, with increased production of pro-inflammatory cytokines5. PLD exotoxin catalyzes the dissociation of sphingomyelin, an important component of cell membranes, whose hydrolysis causes cell lysis, increasing vascular permeability, with the consequent formation of edema1. PLD acts directly on endothelial cells around the point of infection and on macrophages once the bacterium has been phagocytosed. The action of this toxin facilitates colonization, regional and systemic spread of the bacterium, with the generation of abscesses in the lymph nodes66.

Bacteria not controlled by the abscess wall enter the capillaries and form colonies that occlude the blood vessels, generating ischemia that, together with toxins, destroy the cells of healthy tissue, increasing the necrotic mass. Viable bacteria spread through the lymphatic vessels and penetrate other lymph nodes and blood vessels, reaching different organs where abscess formation is repeated. This behavior originates the clinical manifestations of the visceral type of the disease, which affects internal lymph nodes and organs, especially lungs and liver 61,64.

C. pseudotuberculosis is released from inside the cells as a result of a process that leads to the death of phagocytes. Although the specific mechanisms are not yet clear, it is proposed that cell death of macrophages is not induced by autophagy or apoptosis. Studies carried out in vitro by infection of the macrophage line J774 with C. pseudotuberculosis, allowed determining that the levels of protein I associated with light chain 3 microtubules (autophagy mechanism) and the activity of caspase-3 (apoptosis mechanism) remained stable without variation in infected cells25. In other studies, necrosis has been favored instead of apoptosis, in macrophages infected with C. pseudotuberculosis, causing degenerative changes such as the rupture of the plasma membrane, alterations in the mitochondria, changes in the nuclear envelope, dilation of the nuclear envelope and membrane of the rough endoplasmic reticulum and formation of vesicles in the cytoplasm68,69.

Another characteristic of the disease is the formation of pyogranulomas, as a result of uncontrolled bacterial growth within macrophages, the host tries to restrict and limit infection through the formation of these structures. Immunohistochemical studies on the cellular composition of lung lesions in sheep infected with C. pseudotuberculosis have revealed a predominance of large macrophages in the walls of the abscess and surrounding the pulmonary parenchyma, with expression of molecules of the major histocompatibility complex (MHC) class II. T lymphocytes were prominent in the lesions, while B lymphocytes and granulocytes comprised a smaller portion in the cell infiltrates. Within the encapsulated lesions, lymphocytes and MHC class II cells were found in the center of the necrotic mass. Surrounding this region, CD5+ cells, as well as CD4+ and CD8+ cells distributed through the lymphatic tissue, were identified. Generally, in immature caseous lesions, CD4+ lymphocytes are found and in more developed lesions, the concentration of CD8+ cells is predominant, which is related to the mechanism of the immune system to combat the spread of infected macrophages70,71.

In goats, the histopathological changes observed in the reproductive tract and lymph nodes after experimental inoculation with C. pseudotuberculosis revealed leukocytic infiltration, as well as generalized congestion, degeneration, infiltration of stromal cells and necrosis in the ovaries71. The study of the response of the immune system in an experimental model allowed establishing that the humoral response begins between day 6 and 11 post-infection. From day 5 of infection, the expression of IFN-γ with values from 0.5 to 1.0 (DO450) occurs, followed by a second production from day 16 post-infection with maximums from 2.5 to 3.0, high values that keep until day 42-56 of the infection, where the response begins to decline. Primary production of IFN-γ has been associated with the innate response that involves NK cells, while the secondary response of longest duration is associated with the acquired immune response with the involvement of T cells70. The production of pro-inflammatory cytokines TNF-α and IL6 occurs at the inoculation site, while IFN-γ is found in drained lymph nodes72.

Commercial vaccines

Most commercial vaccines available for CLA are composed of polyvalent formulations, presenting a combination of antigens of several pathogenic agent including the PLD exotoxin, considered the antigen with the highest immunogenic capacity for C. pseudotuberculosis11,27. They have been employed for several decades, however, they are not yet available in all small ruminant producing countries, including Mexico.

The Glanvac 3 vaccine (Zoetis, London)73 combines toxins of Clostridium perfringens Type D, Clostridium tetani and C. pseudotuberculosis and evaluated in sheep from the United Kingdom, it reported that only 20.8 % of the total of six animals vaccinated and challenged with a virulent strain presented lesions from which the bacterium was isolated. The Glanvac 6 vaccine (Zoetis, West Ryde, Australia) has a multicomponent formulation that includes toxins of C. pseudotuberculosis, Clostridium perfringens type D, Clostridium tetani, Clostridium novy type B, Clostridium septicum and Clostridium chauvoei. This vaccine reduces the clinical manifestations of the disease and the development of lung lesions8,13. In Australia, it is administered to both sheep and goats, and several field assays have shown variable protection rates, with values ranging from 25 to 90 % of the total herd. In 1995, the average prevalence of CLA in adult sheep in vaccinated herds was 97 % in New South Wales, 91 % in Victoria and 88 % in Western Australia. By 2003, the estimated average prevalence of CLA in the adult sheep population had declined to 29 % in New South Wales, 26 % in Victoria and 20 % in Western Australia; and from 26 % overall to 5.9 % in 2009. In addition, the study allowed establishing that only 43 % of producers used the vaccine and of these, only 12 % adequately followed the manufacturer’s instructions6,12. However, these vaccines of the Glanvac series do not prevent infection and present adverse reactions with the formation of cutaneous granulomas at the injection site, both in sheep and goats, with anaphylactic shock in the latter7,8. In Canada in 1998, an evaluation of the efficacy of Glanvac 6 was carried out compared to the commercial Case-Bac vaccine (Colorado Serum, USA), and an experimental vaccine composed of muramyl dipeptide. The Glanvac 6 vaccine and the experimental vaccine had a higher antibody titer than Case-Bac for 6 to 12 months; however, Glanvac 6 caused a high number of allergy manifestations at the inoculation site74.

The Caseous D-T vaccine (Colorado Serum, USA) composed of toxins of Clostridium perfringens type D, Clostridium tetani and inactivated whole cultures of C. pseudotuberculosis in combination with PLD has been used in the United States, demonstrating that it helps to decrease the presence of internal and external abscesses, although with side effects such as mild lameness (pain) in lambs and lethargy in a high percentage of mature animals. On the other hand, the Case-Bac vaccine (Colorado Serum, USA), composed of PLD toxin, has been used mainly in sheep. This vaccine also causes adverse reactions at the inoculation site, lethargy, stiffness and fever, these symptoms being more severe in goats, including manifestations of ventral edema, ataxia and seizures, which leads to this prophylactic not being approved for use in this species. The use of this vaccine in sheep reduced the formation of abscesses, where only 10 of a total of 18 animals presented external abscesses compared to the control group where all developed these lesions. Moreover, only 2 of the 18 vaccinated sheep had internal abscesses, while 9 out of 10 control sheep had internal abscesses8,9.

In Spain, the company Zoetis sells the Biodectin™ vaccine, which is composed of six antigenic fractions: Clostridium septicum, Clostridium novyi Type B, Clostridium tetani, Clostridium perfringens Type D, C. pseudotuberculosis and Clostridium chauvoei, aluminum hydroxide, Thiomersal and Moxidectin (compound with antiparasitic activity)75. There are also commercial vaccines made from live attenuated strains, such as LinfoVac (Laboratorios Vencofarma do Brasil), developed by the Company Baiana de Desarrollo Agrícola (www.ebda.ba.gov.br) in collaboration with the Institute of Health Sciences of the Federal University of Bahia, which contains the live attenuated strain 1002 of C. pseudotuberculosis and its use is authorized in Brazil. Experimental studies in a mouse model indicated that the protection conferred by this vaccine is 80 %10.

The protection provided by commercial vaccines is associated with the production of anti-exotoxin PLD antibodies, which protect against tissue damage and the spread of the microorganism. However, they confer partial protection, since these vaccines do not favor the activation of the cellular immune response, mainly cytotoxic T-type necessary to eliminate intracellular bacteria. For this reason, different groups of researchers have worked on the development of experimental vaccines to improve protection.

Experimental vaccines

Inactivated vaccines and toxoids

Inactivated vaccines are composed of non-viable whole cultures of the bacterium or inactivated toxins, either by chemical or physical methods. In these formulations, the microorganism is dead, so they do not confer danger of development of the disease; however, the response is mainly humoral, less intense, requires high concentrations of the microorganism and several doses. They are not subjected to any purification procedure, so they contain all the biochemical components of the bacterium, which are more reactogenous and can produce adverse effects. The protein precipitate of a strain of C. pseudotuberculosis isolated from alpaca in Peru was evaluated in a group of 20 BALB/c mice, where it induced protection from challenge with 104 CFUs of a virulent strain of C. pseudotuberculosis. The vaccine reduced the toxic effects caused by the bacterium, which was observed with the decrease in the number and size of abscesses in the animals of the vaccinated group (40 % affected) compared to the multiple abscesses of greater size at the subcutaneous level and in kidney and liver in the animals of the control group (95 % affected)76.

Vaccine formulations based on 250 - 500 mg/ml of cell wall and 133-265 mg/ml of PLD toxin, all supplemented with 20 mg/ml of muramyl dipeptide as an adjuvant, were evaluated in alpacas, subjected to the challenge with 106 CFUs of a virulent strain of C. pseudotuberculosis. The animals vaccinated with the highest dose of PLD did not show abscesses, unlike the vaccinated group with the lowest concentration, where the formation of abscesses at the inoculation site and in renal lymph nodes was observed. Formulations that included cell wall showed a lower degree of protection, with the formation of superficial and internal abscesses. The results suggest that the concentration of PLD toxin may influence the protective capacity, being dose dependent on the immunization of alpacas77.

The degree of protection conferred by vaccination with PLD toxin adsorbed in aluminum hydroxide gel (Group 1) or its combination with toxins of Clostridium perfringens D, Clostridium novyi B, Clostridium tetani, Clostridium septicum and Clostridium chauvoei (Group 2), as well as toxins of Clostridium spp., PLD and 1.2 mg/ml of sodium selenate (Group 3); it was evaluated in an ovine model, challenged with 1.3 x 108 CFU of a virulent strain of C. pseudotuberculosis. The percentage of affected animals in group 1 was 10.5 % (4 of 38 animals showed a superficial lesion), for group 2 7.9 % (3 of 38 animals showed a superficial lesion) and 8.3 % in group 3 (2 of 24 animals, each with a superficial lesion and at the lung level), in contrast to the results obtained in the control group of unvaccinated animals with an impact of 51.5 % (17/33), with 60 lesions at the lung level and 16 in carcasses, with 4.5 lesions per animal. The results indicated that there was no reduction of protective potency as a result of the combination of PLD with Clostridium antigens78.

The efficacy of four non-commercial vaccines based on PLD as an antigen was evaluated in sheep challenged with a virulent strain. The levels of superoxide ions were determined as a non-specific immune response, these being elevated in the group vaccinated with PLD + inactivated bacterium, followed by the group vaccinated with PLD Toxoid. Lysozyme activity was higher in the group vaccinated with PLD + inactivated bacterium, followed by PLD Toxoid, PLD + commercial Covexin8 vaccine and a local experimental vaccine. The group vaccinated only with PLD showed a marked positive response of lymphocyte proliferation compared to the rest of the groups. The results indicated that PLD stimulated the specific and non-specific cellular immune response79.

Four different antigenic extracts obtained from the attenuated strain T1 were evaluated in goats of Canindé breed, for the study of the humoral and cellular immune response. Animals in group 1 (immunized with 0.5ml of the culture supernatant of the T1 strain in 1:1 ratio with Freund’s incomplete adjuvant, FIA) and group 3 (immunized with 100 mg of extracellular concentrate, 250 mg of CpG oligodeoxynucleotides and 0.5 ml of adjuvant FIA) showed the highest levels of antibodies and IFN-ɣ after immunization, as well as post-challenge with 105 CFUs of the virulent strain VD57, compared to groups 2 (1ml of suspension of 2 x 106 CFU/ml strain T1), group 4 (formulation of group 3 without FIA) and control group. Only 25 % of the animals in group 1, 33.3 % in group 2 and 22.2 % in group 3 did not develop lesions, in group 4 and 5, 100 % of the animals developed some type of lesion80. These results show that the production of specific anti-PLD antibodies only decreases the spread of the bacterium and the appearance of lesions in tissues other than the inoculation site, not controlling the infection. Bacterin or toxoid vaccines contribute to reducing the clinical manifestations of the disease, being more efficient in sheep than goats, although in neither species is it possible to control the infection, leaving a percentage of affected animals that can spread the disease.

Attenuated vaccines

Attenuated vaccines have live immunizing agents that can replicate in the body without causing disease, since they lack certain structures or molecules that decrease their virulence. In principle, they confer a very intense and long-lasting immune response, since they give rise to an infection similar to the natural one, but they constitute a risk, since in some cases the virulence can be reversed. The first experimental attenuated vaccines for CLA used a strain called Toxminus, whose pld gene was modified by site-specific mutation. The necropsy of the animals vaccinated with 105 to 107 CFUs of the attenuated strain Toxminus allowed observing that no abscesses formed in the animals challenged with 106 CFUs of a virulent strain, compared to the control group where abscesses of 2.5 cm developed in popliteal ganglia. However, the vaccine produced an undesirable abscess at the inoculation site, the antibody titer in the groups vaccinated with 105 to 107 CFUs was similar, so the response was non-dose dependent and the virulent challenge strain induced a superior antibody response at weeks 5 and 9. There was also a reduction in the ability of the Toxminus strain to remain in the host, due to the absence of PLD, an antigen that favors persistence, in addition to highly activating the humoral immune response81.

In another study, the Toxminus strain was transformed with a plasmid containing the pld gene modified to obtain the exotoxin with a change of histidine for a tryptophan at position 20, which eliminates enzymatic activity. Immunization with the orally administered Toxminus strain induced a predominant humoral response of IgG1 type, while IgG2 isotype levels were higher in subcutaneously vaccinated sheep. Th1 cells are responsible for cell-mediated cellular immunity, they produce IFN-ɣ, IL-2, and tumor necrosis factor beta (TNF-β), cytokines that activate macrophages and complement the activation of B lymphocytes to produce antibodies of the IgG2 isotype. On the other hand, Th2 clones secrete IL-4 and preferably induce the production of IgG1, IgA and IgE in B cells. Consequently, with the results obtained, the orally vaccinated animals did not present significant levels of protection, because the increase in IgG1 is indicative of the absence of a Th1 response, which is essential for the activation of cytotoxic T cells, essential for the elimination of intracellular pathogens, such as C. pseudotuberculosis. The incidence and degree of abscess formation were very low (abscesses of 0.2 cm and 1 cm), occurring only in two animals at the site of inoculation of the virulent strain for the challenge. In the group of animals vaccinated with the non-modified Toxminus strain, 50 % of the sheep developed abscesses, as well as 66 % of animals in the unvaccinated control group. The Toxminus strain did not allow for elevated PLD expression and evidence of the excretion of the live attenuated bacterium through feces was found82.

The CZ171053 strain mutated in the ciuA gene, by means of the transposon-TnFuZ system, presented a reduced ability to survive in vitro within the macrophages of the J774 cell line. The immunization of BALB/c mice with this attenuated strain allowed the survival of 80 % of the animals challenged with 106 CFUs of the virulent strain MIC-6. These results suggest that the CZ171053 strain could be evaluated as a live attenuated vaccine in the target hosts of the disease.

The behavior of the humoral and cellular immune response was evaluated in BALB/c mice inoculated with 107 CFUs of the attenuated strain T1. An increase in the titer of of IgG1 and IgG2 was observed, no lesions characteristic of the disease were shown and the culture of spleen cells, stimulated in vitro with antigens secreted by T1, presented a greater proliferation compared to cells stimulated with intracellular antigens83.

DNA vaccines

Advances in molecular biology techniques have allowed the development of new generation vaccines, among which are naked DNA vaccines. These vaccines are only DNA (plasmids with the genes of interest), they do not have envelopes or protein structures, so the route of administration, the dose, and re-immunization are very important, since they are factors that influence the potency and type of immune response. The disadvantage of this type of vaccine lies in the ability to express the antigen of interest, since in most cases, the particles have a low adsorption and the quantity of plasmids that are introduced into the cells is limited.

The design of a plasmid carrying the gene encoding the extracellular domain of bovine CTLA-4 fused to the inactivated pld gene (boCTLA-4-HIg-ΔPLD) was evaluated as a naked DNA vaccine in sheep. CTLA-4 binds with high affinity to B7 membrane antigen in antigen-presenting cells (APCs), improving the humoral immune response. Although the antibody titer increased significantly, the protection of immunized sheep was partial against the experimental challenge with a virulent strain84. Different immunization routes were evaluated: intramuscular, subcutaneous and gene gun bombardment. The maximum levels of total IgG antibodies were 12x103 in the group vaccinated intramuscularly, while in the groups with the other routes of administration, values of 3-4 x 103 were reached. The protection conferred by the intramuscular vaccine was 45 % (9 of 20 animals), compared to the rest of the groups (subcutaneously and with gene gun) that only protected 10 % of the animals85.

The potential of a DNA vaccine formulated based on the pTARGET plasmid transformed with the protein esterase cp0972086 was compared with a subunit vaccine with recombinant CP09720 adjuvated with aluminum hydroxide. Both were evaluated in BALB/c mice, with the recombinant protein vaccine being the one that induced the highest titer of IgG1 and IgG2 antibodies. The two vaccines were able to increase IFN-γ expression, although the subunit vaccine presented the highest levels of IFN-γ mRNA. Protection levels against the challenge were 58.3 % in animals vaccinated with recombinant esterase, while the pTARGET DNA/protein esterase cp09720 vaccine only protected 16.6 %.

Recombinant protein subunit vaccines

Subunit vaccines combine antigens such as lipopolysaccharides, recombinant proteins, or synthetic peptides. These vaccines are very safe, but not very immunogenic, so adjuvant substances that enhance the response of the immune system are used. The PLD protein obtained by recombinant route has been one of the most used for the development of subunit vaccines. A group of researchers from the United Kingdom determined the potentialities of a vaccine from 50 μg of PLD obtained recombinantly (PLDr) in E. coli and its combination with 1.25×1010 cells/ml of whole cultures of C. pseudotuberculosis inactivated with formalin. In this work, the control group was vaccinated with the commercial Glanvac 3 vaccine (Commonwealth Serum Laboratories (CSL) Ltd., Victoria, Australia). The highest levels of antibodies were detected in the groups immunized with the PLDr vaccine and the vaccine of PLDr + inactivated whole cells, compared to the control groups73.

The PLDr protein together with whole cultures of C. pseudotuberculosis biovar ovis and equi, inactivated with formalin were used for the immunization of sheep. The detection of anti-PLD antibody levels by ELISA allowed detecting that the vaccinated animals presented an increase in IgG after the second booster dose, but after the challenge, there was a decrease in the OD from 0.65 to 0.55, although the levels remained above the cut-off value for 20 weeks. No lesions were observed in external and internal lymph nodes, compared to the unvaccinated control group where 80 % of the animals presented lesions and manifestations of the disease. Both vaccines were able to protect the animals from the challenge with a virulent strain. In this work for the first time, sheep are immunized with a biovar equi strain in combination with PLDr87.

Different recombinant proteins rCP09720 (esterase), rCP01850 (L14 protein binding to the 50S rRNA subunit) and PLD (rPLD) have also been evaluated in the immunization of BALB/c mice. In this study, survival rates after challenge with a virulent strain were 30 % (rPLD), 40 % (rPLD + rCP09720) and 50 % (rPLD + rCP01850). The vaccine rPLD + rCP01850 was able to induce a cellular immune response, significantly increasing levels of IFN-γ and TNF-α, while IL4 and IL12 production was not detected88.

A live attenuated strain of Mycobacterium bovis BCG (Bacillus-Calmette-Guerin) was also used for the expression of recombinant PLD in the pUS2000 plasmid. The system was not efficient for elevated expression of the PLD protein but was effective for vaccination and protection in a mouse model. Immunization of BALB/c mice with 106 CFUs of M. bovis pUS2000/PLD for PLD expression, as well as with M. bovis pUS2000/PLD + 50μg of purified PLDr and the unmodified M. bovis strain, induced elevated antibody production compared to the negative control (100 μl of NaCl 0.9 %), but without significant differences between the vaccinated groups. This is because the M. bovis strain alone is able to induce an elevated humoral and cellular immune response. However, faced with the challenge with 2 x 104 CFUs of the virulent strain MIC-6, the group vaccinated with M. bovis pUS2000/PLD experienced a significant increase in IgG levels compared to the rest of the groups. The cellular immune response was evaluated by measuring the production levels of IFN-γ and IL-10 in the spleen cell culture supernatants of the vaccinated animals, after being stimulated with 8 μg/ml of PLDr. The levels of IFN-γ and IL-10 were higher in the cell culture of the group that received a reactivation of the vaccination with 50 μg of PLDr. The level of protection conferred by these formulations was 88 % in animals vaccinated with M bovis pUS2000/PLD+ 50 μg of PLDr, 77 % for group M. bovis pUS2000/PLD and 66 % for the non-modified M. bovis group. The protective immune response generated by this whole cell vaccine of M. bovis BCG modified to express PLD could cause the activation of several populations of T cells due to the variety of antigens (lipids, proteins and carbohydrates) of the formulation. Then re-immunization with 50 μg of PLD obtained recombinantly stimulates increased proliferation of T cells specific to this particular antigen89.

Subunit vaccines have also been developed using the recombinant CP40 protein. The preparation of PLD vaccines from C. pseudotuberculosis culture supernatants usually contain other antigens which could be contributing to the protective immune response. The CP40 protein was identified in inactivated vaccine preparations through immunoblot assays, where it was observed that sera from animals vaccinated with Glanvac 6 could intermittently recognize this protein, suggesting that it was present in some vaccine batches82. In an experimental study in sheep, immunization with 100 μg of recombinant CP40 protected 82 % of the animals, with a decrease in lung lesions by 98 %. No relationship was found between decreased development of lung lesions and antibody titer, so it was assumed that cellular response, as antibody-dependent cellular cytotoxicity, could be responsible for protection43.

Subsequently, the comparative evaluation of four vaccine formulations was carried out, which used as immunogens the recombinant CP40 protein and the CP09 strain attenuated by induced mutagenesis. The live attenuated strain CP09 of C. pseudotuberculosis was not able to induce a humoral immune response in the vaccinated mice, nor challenged with a virulent strain. Animals vaccinated with formulations that included CP40r had a significant increase in the titer of IgG1 antibodies. However, these groups, after the challenge, experienced a significant increase in IgG2 levels, the maximum being reached by animals immunized with CP40r. The formulation based on CP40r protected 90 % of the animals from the challenge with the virulent strain, followed by the vaccinated group with the attenuated strain CP09 + CP40r with 70 %, while vaccination with CP40r followed by re-immunization with CP09 only protected 60 %90.

Another group of researchers performed the evaluation in BALB/c mice of a CP40r subunit vaccine with different adjuvants, saponin or Freud’s complete adjuvant (FCA). Animals immunized with CP40r/saponin showed elevated values in complete levels of antibodies and IgG2a, IgG2b and IgG3, with statistically significant differences with respect to the control group. The group vaccinated with CP40r/ACF showed significant differences in complete levels of IgG, IgG2a and IgG2b. Both vaccine formulations protected 100 % of the animals challenged with 104 CFUs of the virulent strain C57 of C. pseudotuberculosis, with a tendency towards a Th1 response. Reactivity and production of specific isotypes IgG2a, IgG2b and IgG3 are associated with the action of pro-inflammatory cytokines such as IFN-γ and CD8+ T cells, which activate B cells by modifying the immunoglobulin heavy chain. The use of different adjuvants did not influence the antibody response, so the use of saponin is proposed to replace Freud’s adjuvant, which is toxic in sheep91.

Conclusions

Caseous lymphadenitis continues to be a challenge for sheep and goat producers worldwide. The most recent studies have focused on the identification of new molecules involved in the mechanisms of pathogenicity and virulence of C. pseudotuberculosis, for subsequent evaluation as vaccine candidates. To date, encouraging results have been obtained with formulations based on PLD exotoxin or CP40 endoglycosidase, obtained recombinantly. It should be noted that the combination of these molecules has not been evaluated in the same vaccine, which would be a proposal that would favor the activation of the humoral and cellular immune response. On the other hand, the application of computational analysis in reverse vaccinology studies is currently one of the most used tools in the search for vaccine candidate molecules. Undoubtedly, work with the use of these technologies that constitute an efficient alternative for the identification of new virulence factors should continue, as well as the in-silico evaluation of molecules with immunogenic potential for the development of effective vaccines.

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Received: June 01, 2020; Accepted: January 08, 2021

Conflict of interests

The authors declare that there is no conflict of interests.

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