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Proteus Mirabilis Virulence Factors: Review

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DOI: 10.31838/ijpr/2021.13.01.169

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DOI:https://doi.org/10.31838/ijpr/2021.13.01.169
Review Article

Proteus Mirabilis Virulence Factors: Review

THUALFAKAR HAYDER HASAN1, KASIM KADHIM ALASEDI2, AHMED ABDULJABBAR JALOOB
ALJANABY3
1
Department of Medical Laboratories Techniques; Altoosi University College, Najaf, Iraq
2
Department of Nursing; Altoosi University College, Najaf, Iraq
3
Department of Biology, Faculty of Science, University of Kufa, Iraq
*Corresponding Author
Email ID: [email protected], [email protected], [email protected]
Received: 26.10.20, Revised: 15.11.20, Accepted: 13.12.20

ABSTRACT
A common cause of the urinary tract is Proteus mirabilis. This microorganism has many factors of virulence.
Proteus mirabilis may express adhesins, flagella, toxins, enzymes, quorum sensing, and factors for immune
avoidance. This pathogen is determined as an opportunistic pathogen responsible for many infections like
urinary tract infections (UTIs) and nosocomial infections in immunocompromised patients and who suffer from
various diseases.
Keywords: Swarming; UTIs; Virulence Factors; Immune System

INTRODUCTION It's also identified as Proteus UTI based upon the

The Proteus spp. are part of Enterobacteriaceae, nature and condition of patients as it is
these bacteria are gram-negative rods that reside challenging to handle, or sometimes lethal
under aerobics or anaerobic circumstances, it infection Infection risks are evident in patients with
motile with peritrichous flagella that characterized catheters and non-catheters, including urolithiasis
by the swarming phenomenon (Schaffer and formation, obstruction of the urinary tract, urinary
Pearson,2017). tract infection, stones of the bladder, and kidneys
Many species were belonging to Proteus, one of and bacteriuria (Hasan and Al-Harmoosh,2020).
the most important species is Proteus mirabilis, In kidneys, the infection of Proteus mirabilis is
this pathogen is determined as an opportunistic characterized as severe histological damage
pathogen responsible for many infections like resulting in acute pyelonephritis as well as in
urinary tract infections (UTIs) and nosocomial males than females (Hayder and Aljanaby,
infections in immunocompromised patients and 2019a). Many reports also have shown that the
who suffer from various diseases (Qiao et rates of Proteus mirabilis immunoglobulin M (IgM)
al.,2019). from sera of patients with scientifically
These bacteria are environmental widespread in documented rheumatoid arthritis were high
water pollution, soil, and others due to (Hayder and Aljanaby, 2019b). Rheumatoid
decomposer ability to organic materials.The role patients' sera contain more Proteus mirabilis IgM
of Proteus mirabilis in UTIs is divided into two antibodies than the others (Kadhum and Hasan,
parts, hematogenous infection and ascending 2019). In those sera, substantially higher IgA
infections, where these bacteria colonize the parts were found in Proteus mirabilis antibodies and
of the urinary system one after another starting studies were also shown in all 11 different
from the urethra and ending with the kidney serotypes of the tested Proteus mirabilis and
(Rózalski et al.,1997). The second type of Proteus Proteus spp to be associated with IgM response in
mirabilis infection is more common in patients rheumatoid arthritis patients (Ebringer et
with urinary catheters or structural defects and al.,2006; Majeed et al.,2020).
after the urinary tract surgery, this last type is most
common in UTIs (Jacobsen et al.,2008). Proteus VIRULENCE FACTORS
mirabilis is the most common cause of 1. Adhesins
complicated urinary tract infection after Proteus mirabilis 's bacterial adhesion is a key
Escherichia coli and Klebsiella pneumonia and step in colonizing and developing infections,
one of the most common cause of bacterial which is done by fimbriae (Hasan,2020). There
infections associated with catheters in the long- are five common fimbriae type that implicated in
standing catheter group of patients (Hasan et infection as following:
al.,2020).

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 Thualfakar Hayder Hasan et al / Proteus Mirabilis Virulence Factors: Review

A. Mannose-resistant / Proteus-like (MR/P) 2. Motility

fimbriae: The motility is the most important virulence factor
This kind of fimbria is the most appropriate form in Proteus mirabilis that influence in invading and
in Proteus mirabilis, constructed along the spreading of infection in urinary tract parts (Kuan
pathway of the chaperone – usher. The cluster et al.2014). The infection begins with the invasion
gene MR / P consists of mrpABCDEFGHJ and of the periurethral region, then it travels through
mrpl (Aljanaby and Aljanaby,2018). The main the urethra and progresses to the bladder, other
fimbrial structural subunit codes for mrpA, the areas of the urinary tract (Hickling et al.,2017).
smaller subunits for mrPBEFG, the chaperone Motility strongly promotes interaction with these
encoding of mrpD, mrpC for usher, mrpH sites (Batirel et al.,2020). Proteus mirabilis is a
encoding fimbria pilin, and the protein for mrpJ flagellar peritrichous bacterium (Fattorini et
encoding repressive flagellar regulon al.,2020). The motility of this microorganism is
transcription. mrpI encodes the invertible portion swarming, when this microorganism is swarming,
of the recombinase from ON to OFF (mrp operon the expression of virulence is increased (Kotian et
transcription) or from OFF to ON stopping mrp al.,2020).
operon transcriptions. Pyelonephritis was
consistent with the development of this fimbriae 3. Toxins and Enzymes
(Majeed and Aljanaby,2019). A. Hemolysin:
B. Uroepithelial cell adhesion (UCA/NAF) Hemolysin is a toxin that enters the target
fimbriae: membrane of the eukaryotic cell and causes
This type of fimbriae is taking the form of long pores that trigger ion efflux and then cell
flexible rods, the UCA/NAF fimbriae have an disruption (Cabezas et al.,2017). Hemolysin
essential adhesion role to the uroepithelial cells promotes bacterial infection spread in the kidney
also it has an important role in the colonization of and pyelonephritis develops in ascending UTIs
the urinary tract (Jiang et al.,2018). The genes of (Los et al.,2013). Proteus mirabilis hemolysin
the HI43201 genome sequence called PMI0532- genes are a two-part secretion (hpmA and hpmB)
PMI0536 are found in this uca operon (Chahales (Dal Peraro and Van Der Goot,2016). HpmB
and Thanassi,2017). holds HpmA and activates it, while HpmA is
C. Ambient-temperature fimbriae (ATF): observed to be placed beyond membranes that
In the ambient way of Proteus mirabilis, the ATF take part in the HpmA secretion cycle in the
fimbriae are important (Hasan, 2020b). The periplasm. HpmA exhibits cytotoxic effect on
optimal expression of these fimbriae is only at 23 proximal tubular epithelial cells produced in the
° C (Roh et al.,2010). These fimbriae in the human renal (Etxaniz et al.,2020). There is no
Proteus mirabilis colonization host are not difference that can occur in colonization between
important for the ATF mutant strain and wild the wild type strain and the hpmA mutant Proteus
strain involving urinary tract infection (Simms and mirabilis infection (Hertle,2005). This Hemolysin
Mobley,2008). is presumably not as present during in vivo
D. Proteus mirabilis fimbriae (PMF): infection or hides its contribution because of the
The PMF fimbriae are genetically organizing by presence of certain virulence factors (Ostolaza et
five functional genes pmfACDEF (Bode et al.,2019).
al.,2016). The role of PMF fimbriae that shown is B. Proteus toxic agglutinin (Pta):
in old studies is introducing in the bacterial cells Proteus toxic agglutinin is a protein that is
colonizing of urinary tract lower part but not the designated as the outer membrane
kidneys, recently, the studies proved that the role autotransporter that mediates aggregation of the
of PMF fimbriae is vital in the colonization of cell and includes the catalytic α-domain that can
bacterial cells to bladder and kidneys (Sarshar et lyse the kidney and bladder cells (Gupta et
al.,2020). al.,2019). The Proteus mirabilis negative pta gene
E. Proteus mirabilis P-like pili (PMP) fimbriae: had reduced pathology, as well as a serious
PMP fimbriae were first identified from a dog with colonization defect in urine, kidneys, and spleen
urinary infection by Proteus mirabilis strain (Engel et al.,2007).
(Debnath et al.,2018). The human Proteus C. Urease:
mirabilis uropathogenic strain HI4320 includes Urease is significant in Proteus mirabilis
PMP (Sun et al.,2019). There are nine genes pathogenesis, which catalyzes stones formation in
(PMI2216-PMI2224) of the human operon the kidney and bladder or inhibits the urinary
structure (Baldo and Rocha,2014). Additional tract (Flannery et al.,2009). Urease is extremely
studies are required to confirm PMP fimbriae 's important for Proteus mirabilis pathogenesis
participation in Proteus mirabilis pathogenesis (Ranjbar et al.,2015). This enzyme catalyzes the
(Tsai et al.,2017). formation of stones in the kidney and bladder or

2146| International Journal of Pharmaceutical Research | Jan - Mar 2021 | Vol 13 | Issue 1
 Thualfakar Hayder Hasan et al / Proteus Mirabilis Virulence Factors: Review

encrusts or obstructs the urinary tract (Armbruster CONFLICT OF INTEREST

et al.,2017). The cluster of urease genes None to declare
(ureRDABCEFG) codifies the multimeric nickel-
metalloenzyme, which hydrolyzes urea into CONSENT OF ETHICS
ammonia and dioxide, increases the PH, and All data was approved and carried out in
induces multipurpose urinary ions precipitation accordance with approved guidelines
that leads to stone formation (Alamuri et
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