Escherichia coli is the most common cause of early-onset sepsis in newborns1,2,3. The mortality rate of neonatal E. coli bacteremia can reach 40%, and meningitis is a possible complication that is associated with severe neurodevelopmental disabilities2. The ingestion of maternal E. coli strains by the newborn can produce neonatal bacteremia; this process has been replicated in animal models2,4. Once ingested, pathogenic bacteria travel from the neonatal gut lumen across the intestinal barrier and enter the bloodstream, causing septicemia. Neonatal invasive E. coli strains that produce bacteremia vary in their ability to invade intestinal epithelial cells1,5. However, their ability to transcytose the intestinal epithelium after invasion has not been completely characterized.
This intestinal transcytosis model is a useful in vitro method to emulate bacterial passage across the intestinal epithelium. The overall goal of the methods presented in this manuscript is to compare the ability of neonatal E. coli isolates to transcytose the intestinal epithelium. The model described here utilizes T84 cells, which are immortalized human intestinal adenocarcinoma cells6,7. T84 cells are grown to confluence on a semipermeable membrane with two separate compartments. The rationale for using this technique is that, as happens in vivo, these intestinal cells polarize and develop mature tight junctions6,8. The side in contact with the membrane becomes the basal side. The opposite side of the cells becomes the apical side, resembling the intestinal lumen where ingested pathogens adhere and invade. The transwell membrane is permeable to bacteria, but the polarized intestinal cells form tight junctions, which impair bacterial paracellular movement9. Thus, this method provides the advantage of a controlled in vitro environment utilizing a human cell line to study the process of bacterial transcytosis, including the transcellular route. While other methods exist to investigate the transcytosis of bacteria across the intestinal epithelium, the transwell method presented here provides greater ease and accessibility. Alternative techniques, such as those utilizing ex vivo samples set up in Ussing chamber systems, are available. However, they utilize tissue specimens that may not be easily accessible, particularly if the research intends to study human physiology10. Intestinal organoids represent another example of an in vitro alternative for studying host-bacteria interactions11. While organoid monolayers can also be used in the transwell system to study bacterial transcytosis, they require the isolation and growth of stem cells and the use of specific growth factors to induce differentiation12. Thus, their use is more time-consuming and associated with greater costs as compared to the transwell method described in this manuscript.
The assessment of bacterial passage across the intestinal epithelium using this in vitro transwell system has been successfully performed for various pathogens. These studies have shown the utility of the transwell system using T84 cells to characterize the transcytosis of bacteria across the polarized intestinal epithelium13,14,15. However, the application of this transwell method to compare the transcytosis ability of bacteremia-producing neonatal E. coli strains has not been described in detail. This manuscript provides other researchers with a standard transwell protocol that is reliable and easy to use and does not require resources that are too expensive.
To compare the ability of neonatal invasive E. coli strains to transcytose the intestinal epithelium, the apical side of the intestinal epithelial monolayer can be infected with a known number of bacterial cells. After incubation, the medium on the basal side of the epithelium can be collected and the bacteria quantified to determine the amount of bacterial transcytosis over time. In this manuscript, the methods presented are utilized to study the transcytosis ability of neonatal E. coli clinical strains recovered from newborns hospitalized with bacteremia. The inclusion criteria for the selection of these neonatal clinical isolates for transcytosis studies have been published previously1,2,16. When this method is performed using different E. coli strains, their transcytosis abilities can be compared. Through this process, the intestinal transcytosis model provides valuable data to characterize the virulence factors of E. coli that contribute to the multistep process that culminates in the development of neonatal bacteremia.