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spindle-shaped bacterial cell especially one swollen at the center by an endospore (同)clostridia

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/20 22:41:34」(JST)

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Clostridium histolyticum is a species of bacteria found in feces and the soil. It is a motile, gram-positive, facultative anaerobe. C. histolyticum is pathogenic in many species, including guinea pigs, mice, and rabbits, and humans. C. histolyticum has been shown to cause gas gangrene, often in association with other bacteria species.

History

In 1916, Weinberg and Séguin isolated this bacterium from patients with gas gangrene and called it Bacillus histolyticus. They discovered this bacteria was pathogenic for guinea pigs, mice, and rabbits, but less so for rats. Intramuscular injection of culture caused extensive local tissue destruction, extrusion of a hemorrhagic muscle pulp, splitting of the skin, denudation of the bone, and sometimes autoamputation. In 1922, Heller renamed the bacterium Weinbergillus histolyticus, and a year later Bergey, Harrison, et al. reclassified it as Clostridium histolyticum.^[1]

Microbiology

Clostridium histolyticum can be isolated from soil during the early stage of soil cultivation, by heating the sample at 60 °C for 30 minutes. C. histolyticum can be plated on Zeissler plate agar, and appear as dewlike colonies of either rough or smooth morphology, surrounded by a zone of weak hemolysis.^[2] On blood agar, colonies appear small, rough, irregularly round, and are surrounded by a zone of weak hemolysis.^[3] These bacteria tend to clump in pairs or short chains and are rods of 3-5μm x 0.5-0.7μm. Cells are richly flagellate and very motile. Clostridium histolyticum produces large endospores and are asaccharolytic and proteolytic.^[1] This bacterium is anaerobic, however minimal growth may be obtained through aerobic culture.^[3]

Clostridium histolyticum is difficult to culture because growth is inhibited by sugars, and spores are not very heat resistant.^[4] In wound smears, C. histolyticum closely resembles C. perfringens, but without the capsule of C. perfringens. This may interfere with diagnosis of C. histolyticum infection.^[3]

Toxigenicity

Studies have shown that the toxigenicity of a strain of Clostridium histolyticum is directly related to its sporulating potency: the higher the sporulating potency, the more toxigenic the strain. Additionally, toxigenic strains possess a stronger potential for growth than less toxigenic or nontoxigenic strains. Smooth substrains of C. histolyticum seem to show higher toxigenicity than rough substrains.^[2]

Toxins of C. histolyticum

Clostridium histolyticum produces five toxins: alpha, beta, gamma, delta, and epsilon.

Alpha-toxin

The alpha-toxin is the major toxigenic factor of C. histolyticum. When injected into muscle, it can cause death in laboratory animals within hours. Alpha-toxin is a necrotizing, but not hemolytic, toxin. This toxin is secreted, as it is isolated from filtrates of C. histolyticum cultures. It is neutralized by antisera produced against toxic filtrates of C. septicum cultures through cross-neutralization.^[4] Additionally, alpha-toxin is readily inactivated by proteolytic enzymes. It has been shown that only about 29% of C. histolyticum strains isolated from soil actually produce this alpha-toxin.^[2]

Beta-toxin

The beta-toxin of C. histolyticum is a group of seven collagenases. Collagenases are zinc metalloproteases that cleave collagen and gelatin into small fragments. The seven collagenases are alpha, beta, gamma, delta, epsilon, zeta, and eta. They are further identified by their molecular masses (68, 115,79,110, 125, and 130 kDa, respectively) to distinguish them from the five toxins. Beta-toxin plays a major role in the pathogenicity of C. histolyticum, due to its ability to destroy collagen fibers in the body and cause necrosis. Beta-toxin has been shown to induce hemorrhage when placed on the surface of lungs of animals, hemorrhage and edema when injected into rat paws, and lethal intrapulmonary hemorrhage when injected intravenously into animals.^[4]

Gamma-toxin

Gamma-toxin is a cysteine-activated proteinase that digests hide powder, gelatin, and casein. It is not active against collagen. The molecular weight of gamma-toxin is 50,000 Da.^[4]

Delta-toxin

Delta- toxin is an elastase activated by Ca2+ ions. This proteolytic enzyme is inhibited by cysteine and reversibly inactivated by reducing agents. The molecular weight is between 10 and 50 kDa.^[4]

Epsilon-toxin

Epsilon-toxin is an oxygen-labile hemolysin similar to the θ-toxin of C. perfringens and the δ-toxins of C. septicum, and C. novyi.^[4]

Proteinases

Toxigenic strains of C. histolyticum secrete proteinases and collagenases that can degrade and necrotize organs and muscles in the human body. Clostridium histolyticum proteinases, including gamma- and delta-toxin, digest native and denatured proteins to amino acids with the production of ammonia. They can also clot milk and later digest the clot, and hemolyze sheep blood.^[1] The proteinases are capable of digesting burn eschars, and may be useful for removal of burn tissue from wounds.^[5] By themselves, the C. histolyticum proteinases gamma-toxin and delta-toxin are not active in the human body. It seems they only attack collagenous material already partially degraded by the beta-toxin, and aid in the nutrition of C. histolyticum.^[3]

C. histolyticum proteinases are unique in their efficiency of converting tissue proteins to amino acids and peptides. Further, these enzymes are unique in that they do not produce isoacids (isobutyric acid and isocaproic acid) as metabolic end products.^[2]

Collagenase

Collagenase clostridium histolyticum is secreted by the bacteria and can destroy connective tissue of muscles. This collagenase has been used to treat Dupuytren's contracture, a disease of pathological collagen production and deposition in the hands. This disease causes flexion contractures of the joints, severely limiting hand function, most often in the ring and little fingers. Studies have shown that injection of collagenase clostridium histolyticum significantly reduces the contractures by lysing the collagen and disrupting the contracted cords. This treatment has restored contractured fingers to full extension 30 days after the last injection in 64% of joints injected with collagenase costridium histolyticum. Side effects are mild, and this treatment is preferred to surgical options because no extensive hand therapy is required post-treatment. Collagenase clostridium histolyticum is manufactured and marketed by Auxilium Pharmaceuticals in the US, and marketed by SOBI in the EU Auxilium / SOBI agreement, and by Actelion in Canada and Australia Auxilium / Actelion agreement.

Role in disease

Clostridium histolyticum secretes potent exotoxins that have proteolytic and necrotizing properties, causing severe local necrosis. However, there have been few cases of human infection by this species. From 1984 to 2004, only one case of C. histolyticum necrotizing infection was reported, in an agricultural worker with a crushed-hand injury.^[6]

In 2000, an 18-year-old female drug user in Turkey was diagnosed with infective endocarditis caused by C. histolyticum. This was the first documented case where this bacterium has been identified as the cause of infective endocarditis. All diagnostic tests in this case were negative or normal until an anaerobic blood culture identified C. histolyticum as the infectious agent isolated from the heart valve tissue.^[7]

A 2002 study of the intestinal flora of inflammatory bowel disease (IBD) patients found that in patients who had ulcerative colitis, a form of IBD, 21% of the total bacteria in the colon were Clostridium histolyticum. Control specimen did not contain this species at all. In healthy adults, the amount of clostridia species in the feces is rarely higher than 106 cells/g feces, less than 1% of the total flora. This suggests that C. histolyticum may play a role in the pathogenesis of ulcerative colitis as putative pathogens.^[8]

In 2004, there was an outbreak of C. histolyticum infections in necrotic lesions in 11 injecting drug users in England and Scotland. All patients were heroin users, and had injected the drug into the muscle rather than a vein. It was thought that C. histolyticum spores had contaminated a batch of heroin early in production, and survived the production process before being distributed across the United Kingdom.^[6]

Diagnosis and treatment of infection

C. histolyticum can cause gas gangrene, an acute infection of pain, fever, myonecrosis, and massive edema. If not controlled, the infection can result in systemic toxemia, multiorgan failure, and even death. Further, this infection can progress to life-threatening in a matter of hours.^[9]

While gas gangrene is easily diagnosed by the visible necrosis and characteristic smell, identifying Clostridium histolyticum as the causative agent is more difficult. With the exception of protein tests, all commonly used culture tests are negative.^[4] There is little or no gas production, and this bacterium is negative for lecithinase and lipase reactions. Anaerobic blood cultures are necessary for identification of C. histolyticum infection.^[10]

For most infections, clindamycin and penicillin treatment is recommended. Further, a cocktail of antimicrobials targeting aerobic and anaerobic gram-positive and gram-negative bacteria may be used in necrotizing infections caused by multiple species, including C. histolyticum.^[10] C. histolyticum is also susceptible to metronidazole and imipenem.^[7] However, advanced gas gangrene infections caused by C. histolyticum may only be treatable through amputation of the infected limb.

References

^ ^a ^b ^c Oakley, CL, Warrack GH (1950). "The alpha, beta and gamma antigens of Clostridium histolyticum (Weinberg & Séguin, 1916).". J Gen Microbiol. 4: 365–373. doi:10.1099/00221287-4-3-365.
^ ^a ^b ^c ^d Nishida S, Imaizumi M. (1966). "Toxigenicity of Clostridium histolyticum". J Bacteriol 91: 477–483.
^ ^a ^b ^c ^d MacLennan JD. (1962). "The histotoxic clostridial infections of man". Bacteriol Rev 26: 117–274.
^ ^a ^b ^c ^d ^e ^f ^g Hatheway, CL (1990). "Toxigenic Clostridia". Clin Microbiol Rev 3: 86–87.
^ Jozwiak, J; Komar A; Jankowska E; Martirosian G. (2005). "Determination of the cytotoxic effect of Clostridium histolyticum culture supernatant on HeLa cells in the presence of protease inhibitors". FEMS Immunol Med Mic 45: 137–142. doi:10.1016/j.femsim.2005.03.005.
^ ^a ^b Brazier, JS; Gal M; Hall V; Morris TE (2004). "Outbreak of Clostridium histolyticum infections in injecting drug users in England and Scotland". Euro Surveill 9: 15–16.
^ ^a ^b Durmaz, B; Agel HE; Sonmez E; Turkoz R; Aydin E (2000). "Infective endocarditis due to clostridium histolyticum". Clin Microbiol Infec 6: 561–563. doi:10.1046/j.1469-0691.2000.00110.x.
^ Kleessen, B; Kroesen AJ; Buhr HJ; Blunt M (2002). "Mucosal and invading bacteria in patients with inflammatory bowel disease compared with controls". Scand J Gastroentero 9: 1034–1041.
^ Flores-Díaz, M; Alape-Girón A (2003). "Role of Clostridium perfringens phospholipase C in the pathogenesis of gas gangrene". Toxicon 42: 979–986. doi:10.1016/j.toxicon.2003.11.013.
^ ^a ^b Stevens, DL; Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin Infect Dis 41: 1373–406. Cite uses deprecated parameters (help)

UpToDate Contents

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English Journal

Re: Clinical Efficacy, Safety and Tolerability of Collagenase Clostridium Histolyticum for the Treatment of Peyronie Disease in 2 Large Double-Blind, Randomized, Placebo Controlled Phase 3 Studies: M. Gelbard, I. Goldstein, W. J. Hellstrom, C. G. McMahon, T. Smith, J. Tursi, N. Jones, G. J. Kaufman and C. C. Carson, III J Urol 2013; 190: 199-207.

Jain S1, Mavuduru RM2, Agarwal MM1, Singh SK1, Mandal AK1.
The Journal of urology.J Urol.2014 Feb;191(2):561-3. doi: 10.1016/j.juro.2013.09.037. Epub 2013 Nov 12.
PMID 24239419

Collagenase Clostridium histolyticum in patients with Dupuytren's contracture: results from POINT X, an open-label study of clinical and patient-reported outcomes.

Warwick D, Arner M, Pajardi G, Reichert B, Szabo Z, Masmejean EH, Fores J, Chapman DS, Gerber RA, Huard F, Seghouani A, Szczypa PP; on behalf of the POINT X Investigators.Author information 1University Hospital Southampton, NHS Foundation Trust, UK.AbstractIn POINT X, a study designed to reflect clinical practice and patient treatment choices, 254 European patients received open-label collagenase for Dupuytren's contracture. The most severely affected joint was treated first in 74% of patients. In total, 52%, 41%, 7%, and 1% of patients selected the little, ring, middle, and index finger, respectively; 79% had one or two joints treated. Only 9% of patients (n = 24) received 4 or 5 injections. The mean improvement in total passive extension deficit (TPED) was 34° on day 1, improving further by day 7 to 42°. This secondary improvement was maintained by day 90 and month 6. The mean number of injections/joint was 1.2 for the metacarpophalangeal joint and 1.25 for the proximal interphalangeal joint. Median time to recovery was 4 days; the mean improvement in hand function was clinically relevant as measured by the Unité Rhumatologique des Affections de la Main (URAM) score. In total, 87% and 86% of patients and physicians, respectively, were very satisfied or satisfied with treatment at month 6, although correlation between TPED and patient satisfaction was weak (Spearman -0.18, 95% CI -0.32 to -0.06). Collagenase was well tolerated, with 10 (3.9%) patients experiencing severe adverse events. As a real-world study, the POINT X findings can be generalized to the at-large population.
The Journal of hand surgery, European volume.J Hand Surg Eur Vol.2014 Jan 26. [Epub ahead of print]
In POINT X, a study designed to reflect clinical practice and patient treatment choices, 254 European patients received open-label collagenase for Dupuytren's contracture. The most severely affected joint was treated first in 74% of patients. In total, 52%, 41%, 7%, and 1% of patients selected the l
PMID 24470559

Minimally Invasive Treatment of Peyronie's Disease: Evidence-Based Progress.

Jordan GH, Carson CC, Lipshultz LI.Author information Department of Urology, Eastern Virginia Medical School, Norfolk, VA, USA.AbstractPeyronie's disease (PD) is often physically and psychologically devastating for patients, and the goal of treatment is to improve symptoms and sexual function without adding treatment-related morbidity. The potential for treatment-related morbidity following more invasive interventions, such as surgery, creates a need for effective minimally invasive treatments. We critically examined the available literature using levels of evidence to determine the reported support for each treatment. Most available minimally invasive treatments lack critical support for effectiveness due to the absence of randomized, placebo-controlled trials (RCTs) or nonsignificant results after RCTs. Iontophoresis, oral therapies (vitamin E, potassium para-aminobenzoate, tamoxifen, carnitine, and colchicine), extracorporeal shock wave therapy, and intralesional injection with verapamil or nicardipine have shown mixed or negative results. Treatments that have decreased penile curvature deformity in level 1 or level 2 evidence-based, placebo-controlled studies include intralesional injection with interferon α-2b or collagenase clostridium histolyticum.
BJU international.BJU Int.2014 Jan 21. doi: 10.1111/bju.12634. [Epub ahead of print]
Peyronie's disease (PD) is often physically and psychologically devastating for patients, and the goal of treatment is to improve symptoms and sexual function without adding treatment-related morbidity. The potential for treatment-related morbidity following more invasive interventions, such as surg
PMID 24447536

Japanese Journal

Purification and characterization of an eggshell membrane decomposing protease from Pseudomonas aeruginosa strain ME-4(ENZYMOLOGY, PROTEIN ENGINEERING, AND ENZYME TECHNOLOGY)

Cheng Minyi,Takenaka Shinji,Aoki Shunsuke [他],Murakami Shuichiro,Aoki Kenji
Journal of bioscience and bioengineering 107(4), 373-378, 2009-04
… The enzyme acted on various proteins and showed higher activity with collagen than collagenase from Clostridium histolyticum. …
NAID 110007225812

Matrix metalloproteinase-1 (MMP-1)分解によるI型コラーゲン会合体の構造解析

森本康一,國井沙織
Memoirs of the School of Biology-Oriented Science and Technology of Kinki University 19, 57-65, 2007-03-31
… 異なることが予想される.また,コラーゲンのテロペプチド領域を除いたペプシン処理コラーゲンとアクチニダイン処理コラーゲンの構造変化がMMP-1の反応特性に変化を及ぼす可能性が考えられる.本研究では,Clostridium菌とStreptomyces菌由来のMMP-1を用いて,キハダマグロとニワトリから調製したペプシン処理コラーゲンとアクチニダイン処理コラーゲンに対する反応速度や特異性などの酵素特性をポリアクリルアミドゲル電気 …
NAID 110006423463

Collagen-Binding Domain of a Clostridium histolyticum Collagenase Exhibits a Broad Substrate Spectrum Both in vitro and in vivo

TOYOSHIMA TETSUHIKO,MATSUSHITA OSAMU,MINAMI JUNZABURO,NISHI NOZOMU,OKABE AKINOBU,ITANO TOSHIFUMI
Connective tissue research 42(4), 281-290, 2001-08-01
NAID 10023892793

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リンク元	「クロストリジウム属」「クロストリジウム性ガス壊疽」「ヒストリチクス菌」「ヒストリチクム菌」「クロストリジウム・ヒストリチクム」
関連記事	「clostridium」「histolyticum」「Clostridium」

「クロストリジウム属」

Clostridium histolyticum
Scientific classification
Kingdom:	Bacteria
Division:	Firmicutes
Class:	Clostridia
Family:	Clostridiaceae
Genus:	Clostridium
Species:	C. histolyticum
Binomial name
	Clostridium histolyticum; (Weinberg and Séguin 1916); Bergey, Harrison, Breed, Hammer, and Huntoon 1923