Patients with Chlamydia-associated arthritis have ocular (trachoma), not genital, serovars of C. trachomatis in synovial tissue

Abstract

Some individuals with a genital Chlamydia trachomatis infection develop inflammatory arthritis, but it is unknown whether particular chlamydial serovar(s) engender the disease more often than others. We defined serovar in synovial tissues from arthritis patients infected with this organism. DNA from synovial biopsies of 36 patients with PCR-confirmed synovial C. trachomatis was analyzed. Diagnoses included reactive arthritis, undifferentiated oligoarthritis, rheumatoid arthritis, and osteoarthritis. The chlamydial omp1 and trpA genes were amplified, cloned, and 10 or more clones from each sample were sequenced. The cytotoxin locus also was analyzed. omp1 sequences showed 2 patients having only C. trachomatis A serovar, 1 with only B, and 33 having only C, all ocular serovars. Analyses of trpA and the cytotoxin locus uniformly displayed standard ocular serovar characteristics for each patient. Identification of ocular chlamydial serovars in the synovia of arthritis patients is unexpected. These observations suggest that urogenital chlamydial infections, while consisting primarily of organisms of genital serovars, include some of ocular serovar(s). They further suggest that during such infections unknown selection pressures favor establishment of the latter in the synovium to the exclusion of genital serovar chlamydiae.

Chronic Chlamydial Diseases: From Atherosclerosis to Urogenital Infections

“…Indirect evidence supports the concept that the Chlamydia persistent state may contribute to pathogenesis of CiA. A study evaluating 36 patients with confirmed CiA, all with synovial samples positive for C. trachomatis by PCR, exclusively identified ocular, not genital, strains of C. trachomatis [93]. This lead the authors to surmise C. trachomatis ocular strains might have a particular capacity for dissemination from the genital tract, and the small percentage of C. trachomatis cases progressing to CiA might reflect the small percentage of cases of in which ocular strains are found in genital infection [93].…”

“…A study evaluating 36 patients with confirmed CiA, all with synovial samples positive for C. trachomatis by PCR, exclusively identified ocular, not genital, strains of C. trachomatis [93]. This lead the authors to surmise C. trachomatis ocular strains might have a particular capacity for dissemination from the genital tract, and the small percentage of C. trachomatis cases progressing to CiA might reflect the small percentage of cases of in which ocular strains are found in genital infection [93]. C. trachomatis ocular strains and C. pneumoniae human strains, the chlamydiae commonly demonstrated to be involved in CiA, are unable to synthesize tryptophan and thus have increased sensitivity to the host IFN gamma response and subsequent tryptophan deprivation, a characteristic that might facilitate persistence as a means of initiating and maintaining chronic infection [94,95].…”

Immunity to Sexually Transmitted Infections

“…Under these conditions in vitro, chlamydial DNA synthesis continues but cytokinesis stops so that RBs become large, aberrant RBs and remain a phenotypic hallmark of persistent chlamydial infection. Hudson and colleagues helped to define the persistent infection state at the molecular level both in vitro, in peripheral blood mononuclear cells, and in vivo, in clinical Chlamydia-associated reactive arthritis (Gerard et al, 1998(Gerard et al, , 2001(Gerard et al, , 2002(Gerard et al, , 2004(Gerard et al, , 2010. Interestingly, the chlamydial serovars associated with persistent infection in reactive arthritis are trachoma biovars, not urogenital biovars (Gerard et al, 2010;Carter et al, 2012).…”

“…Hudson and colleagues helped to define the persistent infection state at the molecular level both in vitro, in peripheral blood mononuclear cells, and in vivo, in clinical Chlamydia-associated reactive arthritis (Gerard et al, 1998(Gerard et al, , 2001(Gerard et al, , 2002(Gerard et al, , 2004(Gerard et al, , 2010. Interestingly, the chlamydial serovars associated with persistent infection in reactive arthritis are trachoma biovars, not urogenital biovars (Gerard et al, 2010;Carter et al, 2012). To date, the molecular signals for the transition to enter or leave the persistent states of chlamydial development remain unknown, as do most of the signals for transition from the EB to the RB and back to the EB form during development.…”

New aspects of spondyloarthritis pathogenesis. Part II – environmental factors, microbiome disturbances, extra-articular symptoms

“…Najnowsze badania wskazują, że równie istotne w wyjaśnieniu przyczyn predylekcji do zapalenia stawów mogą być właściwości bakterii, nawet różnice pomiędzy serotypami. Na przykład, wbrew oczekiwaniom, okazało się, że u chorych na ReZS rozwijające się po zakażeniu wywołanym przez Chlamydia trachomatis, w tkankach stawu są obecne serotypy 2A, 1B i 33C tej bakterii powodujące zapalenie oczu (spojówek i rogówki oka), a nie -jak można by się spodziewać -serotypy typowe dla zakażeń układu płciowego [14]. To wskazuje, że serotypy powodujące zapalenie oczu (trachoma) rozsiewają się łatwiej, a ich lokalizacja w stawie indukuje zapalenie.…”