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Journal of Lipid Research, Vol. 47, 241-259, February 2006
Bile salt biotransformations by human intestinal bacteria
Department of Microbiology/Immunology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA Published, JLR Papers in Press, November 18, 2005.
1 To whom correspondence should be addressed. e-mail: hylemon{at}hsc.vcu.edu
Secondary bile acids, produced solely by intestinal bacteria, can accumulate to high levels in the enterohepatic circulation of some individuals and may contribute to the pathogenesis of colon cancer, gallstones, and other gastrointestinal (GI) diseases. Bile salt hydrolysis and hydroxy group dehydrogenation reactions are carried out by a broad spectrum of intestinal anaerobic bacteria, whereas bile acid 7-dehydroxylation appears restricted to a limited number of intestinal anaerobes representing a small fraction of the total colonic flora. Microbial enzymes modifying bile salts differ between species with respect to pH optima, enzyme kinetics, substrate specificity, cellular location, and possibly physiological function. Crystallization, site-directed mutagenesis, and comparisons of protein secondary structure have provided insight into the mechanisms of several bile acid-biotransforming enzymatic reactions. Molecular cloning of genes encoding bile salt-modifying enzymes has facilitated the understanding of the genetic organization of these pathways and is a means of developing probes for the detection of bile salt-modifying bacteria. The potential exists for altering the bile acid pool by targeting key enzymes in the 7 /ß-dehydroxylation pathway through the development of pharmaceuticals or sequestering bile acids biologically in probiotic bacteria, which may result in their effective removal from the host after excretion.
Supplementary key words bile acids deoxycholic acid 7 Abbreviations: bai, bile acid-inducible; BSH, bile salt hydrolase; CA, cholic acid; CBAH-1, conjugated bile acid hydrolase from C. perfringens; CDCA, chenodeoxycholic acid; DCA, deoxycholic acid; GDCA, glycodeoxycholate; HSDH, hydroxysteroid dehydrogenase; LCA, lithocholic acid; TDCA, taurodeoxycholate; UDCA, ursodeoxycholic acid
The human large intestine harbors a complex microbial flora (1). Bacterial density in the human colon is among the highest found in nature, approaching 1012 bacteria/g wet weight of feces (2, 3). In contrast, the host suppresses significant bacterial colonization of the small intestine by a variety of mechanisms, including rapid transit times, antimicrobial peptides, proteolytic enzymes, and bile (4). Failure of these mechanisms leads to bacterial overgrowth of the small intestine, resulting in malabsorption as bacteria compete with the host for nutrients. Under normal conditions, bacterial fermentation in the colon represents an important salvage mechanism. Complex carbohydrates, which are intrinsically indigestible or which escape digestion and absorption in the proximal gut, are fermented by colonic bacteria to yield short-chain fatty acids. It has been estimated that these short-chain fatty acids constitute 39% of our daily caloric intake (4). Colonic bacteria also contribute to the salvage of bile salts that escape active transport in the distal ileum. The major bile salt modifications in the human large intestine include deconjugation, oxidation of hydroxy groups at C-3, C-7, and C-12, and 7 /ß-dehydroxylation (Fig. 1). Deconjugation and 7 /ß-dehydroxylation of bile salts increases their hydrophobicity and their Pka, thereby permitting their recovery via passive absorption across the colonic epithelium. However, the increased hydrophobicity of the transformed bile salts also is associated with increased toxic and metabolic effects. High concentrations of secondary bile acids in feces, blood, and bile have been linked to the pathogenesis of cholesterol gallstone disease and colon cancer (5). We present here a current review of the microbiology of bile acid metabolism in the human GI tract, focusing on understanding the biochemical mechanisms and physiological consequences of such metabolism on both the bacterium and the human host.
Bile acids are saturated, hydroxylated C-24 cyclopentanephenanthrene sterols synthesized from cholesterol in hepatocytes. The two primary bile acids synthesized in the human liver are cholic acid (CA; 3 ,7 ,12 -trihydroxy-5ß-cholan-24-oic acid) and chenodeoxycholic acid (CDCA; 3 ,7 -dihydroxy-5ß-cholan-24-oic acid). Bile acids are further metabolized by the liver via conjugation (N-acyl amidation) to glycine or taurine, a modification that decreases the Pka to 5. Thus, at physiological pH, conjugated bile acids are almost fully ionized and may be termed bile salts (6). Bile salts are secreted actively across the canalicular membrane and are carried in bile to the gallbladder, where they are concentrated during the interdigestive period. After a meal, release of cholecystokinin from the duodenum stimulates the gallbladder to contract, causing bile to flow into the duodenum (7). Bile salts are highly effective detergents that promote solubilization, digestion, and absorption of dietary lipids and lipid-soluble vitamins throughout the small intestine. High concentrations of bile salts are maintained in the duodenum, jejunum, and proximal ileum, where fat digestion and absorption take place. Bile salts are then absorbed through high-affinity active transport in the distal ileum (6). Upon entering the bloodstream, bile salts are complexed to plasma proteins and returned to the liver. Upon reaching the liver, they are cleared efficiently from the circulation by active transporters on the sinusoidal membrane of hepatocytes and rapidly secreted into bile. This process is known as the enterohepatic circulation. Figure 2 depicts the enterohepatic circulation in the context of the gastrointestinal anatomy and also indicates the relative numbers and genera of the predominant bacteria inhabiting each section of the GI tract.
During the enterohepatic circulation, bile salts encounter populations of facultative and anaerobic bacteria of relatively low numbers and diversity in the small bowel. Bile salt metabolism by small bowel microbes consists mainly of deconjugation and hydroxy group oxidation. Ileal bile salt transport is highly efficient ( 95%), but approximately 400800 mg of bile salts escapes the enterohepatic circulation daily and becomes substrate for significant microbial biotransforming reactions in the large bowel (6). Comparison of bile acid composition in the gallbladder and feces illustrates the extent of microbial bile acid metabolism in the large intestine (Fig. 3). The secondary bile acids deoxycholic acid (DCA; 3 ,12 -dihydroxy-5ß-cholan-24-oic acid) and lithocholic acid (LCA; 3 -hydroxy-5ß-cholan-24-oic acid) are produced solely by microbial biotransforming reactions in the human large intestine. DCA accumulates in the bile acid pool (LCA to a much lesser extent) as a result of passive absorption through the colonic mucosa and the inability of the human liver to 7 -hydroxylate DCA and LCA to their respective primary bile acids. LCA is sulfated in the human liver at the 3-hydroxy position, conjugated at C-24, and excreted back into bile (6). The resultant bile acid sulfate is poorly reabsorbed from the gut. Even though 3-sulfo-LCA glycine and taurine conjugates are deconjugated and to some extent desulfated by intestinal bacteria, 3-sulfo-LCA/LCA is lost in feces and does not normally accumulate in the enterohepatic circulation (8).
Characteristics of bile salt hydrolase(s) Deconjugation refers to the enzymatic hydrolysis of the C-24 N-acyl amide bond linking bile acids to their amino acid conjugates. This reaction is substrate-limiting and goes to completion in the large bowel. Bile salt hydrolases (BSHs) are in the choloylglycine hydrolase family (EC 3.5.1.24) and have been isolated and/or characterized from several species of intestinal bacteria (Table 1). The importance of the position, charge, shape, and chirality of various analogs of taurine/glycine conjugates on the rate of hydrolysis by BSHs has also been investigated (9). BSHs differ in subunit size and composition, pH optimum, kinetic properties, substrate specificity, gene organization, and regulation. BSHs do, however, share in common several conserved active site amino acids [cysteine 2 (Cys2), arginine 18 (Arg18), aspartic acid 21 (Asp21), asparagine 175 (Asn175), and arginine 228 (Arg228)] and share a high degree of amino acid sequence similarity with the penicillin V amidase of Bacillus sphaericus (Fig. 4). The conservation of tyrosine 82 (Tyr82) in penicillin V amidase and Asn82 in BSH are likely a result of differing steric requirements for their respective substrates (10). Recently, a bsh from Clostridium perfringens was crystallized both in the apoenzyme form and in complex with taurodeoxycholate (TDCA; hydrolyzed product) at resolutions of 2.1 and 1.7 Å, respectively (11). The structure revealed that the Cys2 residue is in position for nucleophilic attack of the N-acyl amide bond. Site-directed mutagenesis of the Cys2 residue from the BSH of Bifidobacterium longum and Bi. bifidum (10, 18) as well as sulfhydryl inhibition of several BSHs have shown the importance of this residue in catalysis (10, 13, 14). Alignment of amino acid sequences from BSHs shows that the Cys2 residue is conserved in all BSHs characterized to date (Fig. 4). The broad substrate specificities reported (Table 1) are potentially a function of a lack of conservation observed in residues making up the substrate binding pocket of the conjugated bile acid hydrolase gene product of C. perfringens (CBAH-1) and the corresponding residues predicted in amino acid multiple sequence alignment with other BSHs (Fig. 4). The sterol moiety is bound primarily through hydrophobic interactions in the CBAH-1 (residues highlighted in gray in Fig. 4) as well as hydrogen bonds to the carboxylate group. Although the crystal structure of CBAH-1 did not reveal specific recognition of the taurine/glycine moiety, kinetic data from several BSHs suggest that the conjugates are important in substrate specificity (Table 1). Therefore, additional crystallization and site-directed mutagenesis (preferably with mutagenesis of Cys2) of BSHs from different species will be helpful in explaining the kinetic observations of substrate specificity.
Distribution, genetic organization, and regulation of BSH Genes encoding BSHs have been cloned from C. perfringens (15), Lactobacillus plantarum (16), La. johnsonii (12, 17), Bi. longum (10), Bi. bifidum (18), Bi. adolescentis (19), and Listeria monocytogenes (20, 21). Homologs and putative bsh genes have also been identified recently through microbial genome analysis. The organization and regulation of genes encoding BSH differ between species and genera. Monocistronic BSH genes have been reported in La. plantarum (16), La. johnsonii (12), Li. monocytogenes (21), and Bi. bifidum (18). A gene encoding BSH (CBAH-1) cloned from C. perfringens (15) differed significantly in size and amino acid sequence from a BSH purified from a different strain of C. perfringens (13). The inactivation of the gene encoding CBAH-1 resulted in only partial reduction in BSH activity (BSH activity was 86% of that in the wild type), suggesting multiple BSH genes in C. perfringens. Furthermore, the crystal structure showed that the enzyme encoded by the CBAH-1 gene forms an active homotetramer (11). These observations, coupled with the detection of both intracellular and extracellular BSHs, provide further evidence for multiple isoforms, although the organization and regulation of the bsh gene(s) from C. perfringens are not known at present (22). Polycistronic operons encoding three genes involved in bile salt deconjugation (cbsT1, cbsT2, and cbsHß) have been characterized in La. johnsonii and La. acidophilus (12). Genes cbsT1 and cbsT2 appear to be gene duplications that encode taurocholate/CA antiport proteins of the major facilitator superfamily, whereas cbsHß encodes the BSH ß-isoform (23). In addition, an uncharacterized extracellular factor has been detected in La. johnsonii 100-100, which stimulates BSH activity and uptake of conjugated bile salts during the stationary growth phase (12, 24). BSH expression is also growth phase-dependent. Stationary phase expression has been reported in Bacteroides fragilis (25), and exponential phase expression was reported for Bi. longum (10).
Benefits of BSHs to the bacterium Strategies to resist bile salt toxicity have been observed in pathogens that colonize the intestinal tract (3133). Recently, a BSH from Li. monocytogenes was shown to be a novel virulence factor (21). Comparative genome analysis revealed the absence of a bsh gene in the closely related nonvirulent Li. innocua (20). The bsh gene is positively regulated by PrfA, which is a transcriptional activator of numerous virulence genes in Li. monocytogenes. Deletion of the bsh gene results in decreased resistance to bile salts and significantly reduced infectivity in vivo. These results demonstrate the importance of BSH activity for survival in vivo and infection in the intestinal and hepatic phases of listeriosis. The mechanism by which BSH activity in Li. monocytogenes enhances survival and virulence is currently unknown. Deconjugation may provide a means of obtaining cellular carbon, nitrogen, and sulfur for some bacterial species. This has been demonstrated in bacteroides (34) and is suggested in Bi. longum (10). In fact, the bsh gene from Bi. longum is cotranscribed with the gene encoding glutamine synthetase adenylyltransferase (glnE), a component of the nitrogen regulation cascade (10). In this regard, hydrolysis of the conjugated bile acid may provide amino nitrogen, providing a possible explanation for the coordinated regulation of these seemingly physiologically unrelated genes (10). Taurine utilization is also widespread and can serve as an energy source under both aerobic and anaerobic conditions (35). Glycine can be used as an energy source by certain clostridia by the Stickland reaction (36). The Stickland reaction is a form of amino acid fermentation in which one amino acid donates electrons that are accepted by another amino acid distinct from the electron donor. Another hypothesis suggests that BSHs are detergent shock proteins enabling survival during stress (37). De Smet et al. (26) found no evidence for this in lactobacilli after growth with various detergents. The widespread distribution of BSHs across Gram-negative and Gram-positive intestinal bacteria coupled with a wide range of substrate specificities, genetic regulation, and the occurrence of multiple isoforms in certain strains have created conflicting reports regarding the physiological benefit to the bacterium in hydrolyzing bile acid conjugates. Determining the mechanism(s) by which BSHs aid bacteria in the colonization of the mammalian intestine will be of great interest, especially with regard to bacterial pathogenesis.
Taurine, hydrogen sulfide production, and colon cancer
A diet high in meat has been shown to significantly increase both the levels of taurine conjugation to bile acids (46, 47) and the production of hydrogen sulfide in the colon (48). A relationship exists between the generation of hydrogen sulfide in the colon and chronic GI illness, such as inflammatory bowel disease and colon cancer (5, 49). Populations such as native black Africans with low incidence of colon cancer consume low-meat diets (50). Native black Africans also have low ratios of taurine to glycine conjugation (1:9) and low hydrogen sulfide production compared with populations consuming a "Western diet" (46, 47). In human fecal slurries obtained from individuals consuming a Western diet, taurine addition generated some of the highest sulfide levels of any organic or inorganic sulfur source added (43). Taurine addition to a coculture of a species of bacteroides and an unidentified 7
Although the extent to which taurine metabolism contributes to total colonic sulfide production has yet to be established, several key points have been made: 1) the extent of taurine conjugation in the bile acid pool is largely affected by diet; 2) the same dietary factors that increase taurine conjugation are hypothesized to increase colon cancer risk; 3) taurine metabolism by intestinal bacteria results in hydrogen sulfide generation; 4) sulfide generation is linked to the carcinogenesis process through enhanced cell proliferation, inhibition of butyrate metabolism, and activation of cell signaling pathways; and 5) sulfide generation may enhance DCA formation in the gut through stimulation of the microbial bile acid 7
Oxidation and epimerization Oxidation and epimerization of the 3-, 7-, and 12-hydroxy groups of bile acids in the GI tract are carried out by hydroxysteroid dehydrogenase (HSDH) expressed by intestinal bacteria (Fig. 1). Epimerization of bile acid hydroxy groups is the reversible change in stereochemistry from to ß configuration (or vise versa) with the generation of a stable oxo-bile acid intermediate. Epimerization requires the concerted effort of two position-specific, stereochemically distinct HSDHs of intraspecies or interspecies origin. For example, the presence of both 7 - and 7ß-HSDH in C. absonum allows epimerization by a single bacterium (51), whereas epimerization also can be achieved in cocultures of intestinal bacteria, one possessing 7 -HSDH and the other 7ß-HSDH (52, 53). The extent of the reversible oxidation and reduction of bile acid hydroxy groups by HSDH depends in part on the redox potential of the environment. Addition of oxygen to the culture medium increases the accumulation of oxo-bile acids (51). Generation of oxo-bile acids may be more favorable under the higher redox potentials found on the mucosal surface (4), whereas reduction of oxo-bile acids may be more favorable under the low redox potential (200 to 300 mV) in the large intestinal lumen. Thus, although the redox potential of the colon is net reductive, microenvironments at the mucosa may provide oxidizing conditions favorable for certain microbial reactions. HSDHs differ in their reductive and oxidative pH optima, NAD(H) or NADP(H) requirements, molecular weight, and gene regulation (Table 2).
3 - and 3ß-HSDHs3 /ß-HSDHs specifically catalyze the reversible, stereospecific oxidation/reduction between 3-oxo-bile acids and 3 - or 3ß-hydroxy bile acids. 3 -HSDHs have been detected in some of the most prevalent intestinal bacteria, including C. perfringens (54), Peptostreptococcus productus (55), and Eggerthella lenta (formerly Eubacterium lentum) (56, 57), as well as in intestinal bacteria present in lower numbers ( 105/g wet weight of feces), including C. scindens (58) and C. hiranonis (59), and in nonintestinal bacteria, including Pseudomonas testosteroni (60, 61). 3ß-HSDH activity has been described in species of Clostridium and Rumminococcus (6264). It appears that intraspecies 3-epimerization favors the 3 -position. In fact, growing cultures of C. perfringens in the presence of 3-oxo-CDCA formed CDCA (84%) preferentially over iso-CDCA (16%) under anaerobic conditions (65).
Pyridine nucleotide cofactor requirements differ between 3
3
7
7
7
Crystal structures of the E. coli 7
12 - and 12ß-HSDHs12 /ß-HSDHs have been detected mainly among members of the genus Clostridium. NADP-dependent 12 -HSDHs have been detected in C. leptum (89) in Clostridium group P (90), whereas NAD-dependent 12 -HSDH activity was reported in Eg. lenta (56) and C. perfringens (54). 12ß-HSDHs have been detected in C. tertium, C. difficile, and C. paraputrificum (91, 92). 12 /ß-HSDHs characterized to date are constitutively expressed and noninducible, with the exception of the 12ß-HSDH from C. paraputrificum, which is induced by 12-oxo-bile acid substrates (92). 12 /ß-HSDHs generally have higher affinity for dihydroxy bile acids (DCA) than for trihydroxy bile acids (CA and iso-CA) and for free versus conjugated bile acids. The 12 -HSDH from C. leptum is an exception, demonstrating higher affinity for CA conjugates than for free CA (89). 12 -HSDHs appear to be repressed by the addition of bile acid substrates (DCA > CDCA > CA) to the growth medium at 1 mM concentrations. It has been suggested that these enzyme activities should be repressed in bacteria colonizing the large intestine (56, 92), although 12-oxo-bile acids have been detected at low levels in the feces of healthy individuals (Fig. 3) (93, 94).
Benefits of bile acid hydroxysteroid oxidoreductases to the bacterium
Bile acids are potent antimicrobial agents provided that the proper concentration and proportion of hydrophobic bile acids (CDCA, LCA, and DCA) are present (95). Alteration of hydroxy group stereochemistry has a marked influence on the physiochemical properties of bile acids (96, 97). The epimerization of the 7
Interplay between HSDH enzymes in human liver and intestinal bacteria
Introduction Secondary bile acids (DCA and LCA) predominate in human feces (Fig. 3). Therefore, 7 -dehydroxylation is the most quantitatively important bacterial bile salt biotransformation in the human colon. The rapid rate of conversion of primary to secondary bile acids is surprising given current estimates that this metabolic pathway is found in 0.0001% of total colonic flora (102104). Human intestinal bacteria capable of bile acid 7 -dehydroxylation have been isolated (104, 105), and 16S rDNA phylogenetic analysis has led to their classification to the genus Clostridium (106108).
Unlike bile acid oxidation and epimerization, 7
Elucidating the bile acid 7
The induction of 7 -dehydroxylation activity in C. scindens by unconjugated C24 primary bile acids resulted in the appearance of several new polypeptides, as observed by one- and two-dimensional SDS-PAGE (119, 120). Purification and N-terminal sequencing of these bai polypeptides facilitated the cloning of bai genes through the design of degenerate probes (121123). Northern blot analysis indicated the presence of a large CA-inducible ( 10 kb) mRNA transcript and a smaller transcript ( 1.5 kb) in C. scindens (121, 124). These studies led to the discovery of a bai regulon encoding at least 10 open reading frames (Fig. 7). Individual bai genes have been subcloned into E. coli and the functions of many of them determined (58, 67, 123, 125130; P. B. Hylemon, unpublished data). The proposed bile acid 7 /ß-dehydroxylation pathway in C. scindens is shown in Fig. 8. A bai operon has also been characterized from C. hiranonis (59), although the discussion below of the 7 /ß-dehydroxylation pathway will center on C. scindens, from which the functions of the gene products have been determined.
bai genes: a regulon for 7 /ß-dehydroxylationThe transport of unconjugated primary bile acids into C. scindens is facilitated by the baiG gene product, which belongs to a major pump/facilitator superfamily of protein transporters (126). The baiG gene has been cloned into E. coli and shown to encode a 50 kDa H+-dependent bile acid transporter (126). BaiG facilitates the transport of unconjugated CA and CDCA but not of the secondary bile acids DCA and LCA (126). Computer-aided modeling suggests that the baiG polypeptide contains 14 membrane-spanning domains (126).
After transport, ligation to CoA is the first step in activating CA and CDCA for 7
The 3
The baiCD gene from C. scindens has been cloned and expressed in E. coli and was recently demonstrated to encode a steroid oxidoreductase specific for the CoA conjugates of 3-dehydro-4-cholenoic acid and 3-dehydro-4-chenodeoxycholenoic acid (Fig. 8) (P. B. Hylemon et al., unpublished data). The
The baiF gene encodes a 47.5 kDa polypeptide containing 426 amino acids that was shown to have bile acid CoA hydrolase activity (122, 130). However, baiF is hypothesized to encode a CoA transferase because of energy conservation (Fig. 8) and homology to the type III family of CoA transferases (131). The first few cycles of 7
7
Genes involved in the reductive arm of the 7 /ß-dehydroxylation pathway have not been isolated. These genes should encode oxidoreductases catalyzing the reduction of 3-dehydro-4,6-deoxycholdienoic acid to 3-dehydro-4-deoxycholenoic acid to 3-dehydro-deoxycholic acid to DCA as well as a bile acid exporter to remove secondary bile acid end products from the bacterium (Fig. 8). Genes encoding putative transcriptional regulators have been detected upstream of the bile acid-inducible promoter region (Table 3) (D. H. Mallonee and P. B. Hylemon, unpublished data). Additional studies will be required to determine the mechanism of induction/repression of this pathway and to identify additional bai genes.
The benefits of 7 /ß-dehydroxylation to the bacteriumThe ability to use bile acids as electron acceptors is an important niche for 7 -dehydroxylating bacteria in the human colon. The 7 /ß-dehydroxylation pathway requires multiple oxidative and reductive steps with a net 2 electron reduction (Fig. 8). The hypothesized energy benefits of this pathway assume, however, that the baiF gene encodes a CoA transferase and the toxic end products, the secondary bile acid, are removed from the microenvironment in vivo (precipitation and binding to insoluble fiber). The generation of secondary bile acids may also function to exclude bacteria sensitive to these hydrophobic molecules.
In humans, DCA accumulates in the bile acid pool to high levels in some individuals. An increase in DCA in the bile acid pool is associated with a decrease in CDCA (Fig. 11). Unlike rodents, the human liver cannot 7 -hydroxylate DCA, forming CA. Hence, under normal physiological conditions, there is no metabolic pathway for removing DCA from the bile acid pool in humans. The amount of DCA in the bile acid pool is a function of at least three variables: 1) the rate of formation and absorption of DCA through the colon (input) (132); 2) colonic transit time (133); and 3) colonic pH (134).
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