Treponema pallidum, formerly known as Spirochaeta pallida, is a microaerophilic, gram-negative, spirochaete bacterium with subspecies that cause the diseases syphilis, bejel (also known as endemic syphilis), and yaws. It is known to be transmitted only among humans and baboons. T. pallidum can enter the host through mucosal membranes or open lesions in the skin and is primarily spread through sexual contact. It is a helically coiled microorganism usually 6–15 μm long and 0.1–0.2 μm wide. T. pallidum's lack of both a tricarboxylic acid cycle and processes for oxidative phosphorylation results in minimal metabolic activity. As a chemoorganoheterotroph, Treponema pallidum is an obligate parasite that acquires its glucose carbon source from its host. Glucose can be used not only as a primary carbon source but also in glycolytic mechanisms to generate ATP needed to power the bacterium given its minimal genome. The treponemes have cytoplasmic and outer membranes. Using light microscopy, treponemes are visible only by using dark-field illumination. T. pallidum consists of three subspecies, T. p. pallidum, T. p. endemicum, and T. p. pertenue, each of which has a distinct related disorder. The ability of T. pallidum to avoid host immune defenses has allowed for stealth pathogenicity. The unique outer membrane structure and minimal expression of surface proteins of T. pallidum has made vaccine development difficult. Treponema pallidum can be treated with high efficacy by antibiotics that inhibit bacterial cell wall synthesis such as the beta-lactam antimicrobial penicillin-G.
Subspecies Three subspecies of T. pallidum are known: Treponema pallidum pallidum, which causes syphilis T. p. endemicum, which causes bejel or endemic syphilis T. p. pertenue, which causes yaws
The three subspecies causing yaws, bejel, and syphilis are morphologically and serologically indistinguishable. The genomes of three of the T. p. pertenue strains are similar to those of the T. p. pallidum strain, differing by only 0.2%, corresponding to virulence factors. The three subspecies can be distinguished by genetics, using restriction fragment length polymorphism (RFLP), which utilizes techniques such as PCR, restriction digest and gel electrophoresis. Genes tprC, tprI, and the 5' flanking region of tpp15 can be used to differentiate between the three subspecies based on DNA fragment lengths and location of bands in gel electrophoresis. These bacteria were originally classified as members of separate species, but DNA hybridization analysis indicates they are members of the same species. Treponema carateum, the cause of pinta, remains a separate species because no isolate is available for DNA analysis. Disease transmittance in subspecies T. p. endemicum and T. p. pertenue is considered non-venereal. T. p. pallidum is the most invasive pathogenic subspecies, while T. carateum is the least invasive of the species. T. p. endemicum and T. p. pertenue are intermediately invasive.
Laboratory identification
Treponema pallidum was first microscopically identified in syphilitic chancres by Fritz Schaudinn and Erich Hoffmann at the Charité in Berlin in 1905. Historically, this bacterium was identified in the clinical laboratory through visualization in dark-field microscopy. This bacterium can be detected with special stains, such as the Dieterle stain. T. pallidum is also detected by serology, including nontreponemal VDRL, rapid plasma reagin, treponemal antibody tests (FTA-ABS), T. pallidum immobilization reaction, and syphilis TPHA test.
Microbiology Physiology
Treponema pallidum is a helically shaped bacterium with high motility consisting of an outer membrane, peptidoglycan layer, inner membrane, protoplasmic cylinder, and periplasmic space. It is often described as gram-negative, but its outer membrane lacks lipopolysaccharide, which is found in the outer membrane of other gram-negative bacteria. It has an endoflagellum (periplasmic flagellum) consisting of four main polypeptides, a core structure, and a sheath. The flagellum is located within the periplasmic space and wraps around the protoplasmic cylinder. The flagellum is arranged in a helical shape. The flagellar motor for T. pallidum lacks a P-ring, normally used for motility, and has a collar component instead, which is imbedded in the periplasm. The peptidoglycan layer interacts with the endoflagellum which may aid in motility. T. pallidum's outer membrane has the most contact with host cells and contains few transmembrane proteins, limiting antigenicity, while its cytoplasmic membrane is covered in lipoproteins. The outer membrane adhesins of T. pallidum, including fibronectin- and laminin-binding proteins, have the main function of attaching to host cells and cell-surface receptors, and they share antigenically related functional domains. The genus Treponema has ribbons of cytoskeletal cytoplasmic filaments that run the length of the cell just underneath the cytoplasmic membrane.
Outer membrane and surface antigens The of T. pallidum has several features that have made it historically difficult to research. These include details such as its fragility. The treponemal outer membrane (OM) proteins are key factors for the bacterium's pathogenesis, persistence, and immune evasion strategies. Treponema's reputation as a "stealth pathogen" is primarily due to this unique (OM) structure, which serves to evade immune detection.
The outer membrane of Treponema pallidum contains a strikingly low concentration of transmembrane proteins, approximately 100-fold lower than other gram-negative bacteria or other spirochetes. This protects the cells from antibodies attacking it, hence they exhibit a "puzzling lack of antigenicity". The genome also revealed a bundle of 12 proteins and some putative hemolysins are potential virulence factors of T. pallidum. One protein, TprK, appears to constantly mutate to avoid immune response from its host.
TP0126
The TP0126 protein has been linked to the outer membrane protein family (OMP). This protein will sit in the outer membrane like a porin, which is supported by circular dichroism recombinant TP0126, and will increase the virulence factor. Researchers have classified the TP0126 protein in this class due to the homology between the protein and the porins of the OMPs. This protein is encoded by the TP0126 gene, which is conserved over all strains of T. pallidum.
TP0326 TP0326 is an ortholog of the β-barrel assembly machine Bam A. BamA apparatus inserts newly synthetized and exported outer membrane proteins into the outer membrane.
TP0453 TP0453 is a 287 amino acid protein associated with the inner membrane of the microbe's outer membrane. This protein lacks the extensive beta sheet structure that is characteristic of other membrane proteins, and does not traverse the outer membrane. This protein's function has been hypothesized to be involved with control of nutrient uptake.
TP0624 Outer Membrane Protein A (OmpA) domain-containing proteins are necessary for maintaining structural integrity in gram-negative bacteria. These domains contain peptidoglycan binding sites which creates a "structural bridge between the peptidoglycan layer and the outer memebrane." The protein TP0624 found in T. pallidum has been proposed to facilitate this structural link, as well as interactions between outer membrane proteins and corresponding domains on the thin peptidoglycan layer.
TP0751
The TP0751 protein is a protein that is unique to T. pallidum, and it is thought to aid in attachment to the host's extra cellular membrane. Since this protein aids in the attachment to the host, it sits on the surface of the cells, and in 2005, it was discovered that the TP0751 protein will attach to the laminin component in the host's extracellular matrix. With that, it is thought that the TP0751 protein plays a key role in dissemination with the host.
TP0965 TP0965 is a protein that is critical for membrane fusion in T. pallidum, and is located in the periplasm. TP0965 causes endothelial barrier dysfunction, a hallmark of late-stage pathogenesis of syphilis. It does this by reducing the expression of tight junction proteins, which in turn increases the expression of adhesion molecules and endothelial cell permeability, which eventually leads to disruption of the endothelial layer.
Treponema repeat family of proteins The Treponema repeat family of proteins (Tpr) are proteins expressed during the infection process. Tprs are formed by a conserved N-terminal domain, an amino-terminal stretch of about 50 amino acids, a central variable region, and a conserved C-terminal domain. The many different types of Tpr include TprA, TprB, TprC, TprD, and TprE, but variability of TprK is the most relevant due to the immune escape characteristics it allows.
Antigen variation in TprK is regulated by gene conversion. In this way, fragments of the seven variable regions (V1–V7), by nonreciprocal recombination, present in TprK and the 53 donor sites of TprD can be combined to produce new structured sequences. TprK antigen variation can help T. pallidum to evade a strong host immune reaction and can also allow the reinfection of individuals. This is possible because the newly structured proteins can avoid antibody-specific recognition. It is also suspected that the genes that encode for the TprK protein are essential in pathogenesis during the infection of syphilis.
To introduce more phenotypic diversity, T. pallidum may undergo phase variation. This process mainly happens in TprF, TprI, TprG, TprJ, and TprL, and it consists of a reversible expansion or contraction of polymeric repeats. These size variations can help the bacterium to quickly adapt to its microenvironment, dodge immune response, or even increase affinity to its host.
Culture In the past century since its initial discovery, culturing the bacteria in vitro has been difficult. Without the ability to grow and maintain the bacteria in a laboratory setting, discoveries regarding its metabolism and antimicrobial sensitivity were greatly impaired. However, successful long-term cultivation of T. pallidum in vitro was reported in 2017. This was achieved using Sf1Ep epithelial cells from rabbits, which were a necessary condition for the continued multiplication and survival of the system. The medium TpCM-2 was used, an alteration of more simple media which previously only yielded a few weeks of culture growth. This success was the result of switching out minimal essential medium (MEM) with CMRL 1066, a complex tissue culture medium. With development, new discoveries about T. pallidum's requirements for growth and gene expression may occur and in turn, yield research beneficial for the treatment and prevention of syphilis, outside of a host. However, continuous efforts to grow T. pallidum in axenic culture have been unsuccessful, indicating that it does not satisfy Koch's postulates. The challenge likely stems from the organism's strong adaptation to residing in mammalian tissue, resulting in a reduced genome and significant impairments in metabolic and biosynthetic functions.
Optimal growth occurs at 33-35 °C, hence infection and lesion development occur on warmer skin areas, but not on colder ones such as the colder ear.
Metabolism The bacteria rely on the enzyme glycerol-3-phosphate dehydrogenase (GPDH). GPDH is an alternative when managing electrons that are produced during metabolism. In the absence of the electron transport chain, T. pallidum uses GPDH to recycle the NAD+ by oxidizing glycerol-3-phosphate to dihydroxyacetone phosphate and make NAD+ to keep glycolysis and other redox-dependent energy reactions. By doing this, it helps balance the ATP yield without weighing down the protein's limited supply for essential tasks.
T. pallidum uses an enzyme called pyrophosphate-dependent phosphofructokinase rather than ATP as a way to save energy and optimize its limited resources.