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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cell. Infect. Microbiol.</journal-id>
<journal-title>Frontiers in Cellular and Infection Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cell. Infect. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">2235-2988</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fcimb.2014.00035</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Microbiology</subject>
<subj-group>
<subject>Review Article</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Comparative review of <italic>Francisella tularensis</italic> and <italic>Francisella novicida</italic></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Kingry</surname> <given-names>Luke C.</given-names></name>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Petersen</surname> <given-names>Jeannine M.</given-names></name>
<xref ref-type="author-notes" rid="fn001"><sup>&#x0002A;</sup></xref>
</contrib>
</contrib-group>
<aff><institution>Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention</institution> <country>Fort Collins, CO, USA</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Max Maurin, Universit&#x000E9; Aix-Marseille II, France</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Andrey P. Anisimov, State Research Center for Applied Microbiology and Biotechnology, Russia; Max Maurin, Universit&#x000E9; Aix-Marseille II, France</p></fn>
<fn fn-type="corresp" id="fn001"><p>&#x0002A;Correspondence: Jeannine M. Petersen, Division of Vector-Borne Disease, Bacterial Diseases Branch, Centers for Disease Control and Prevention, 3150 Rampart Road, Fort Collins, CO 80523, USA e-mail: <email>nzp0&#x00040;cdc.gov</email></p></fn>
<fn fn-type="other" id="fn002"><p>This article was submitted to the journal Frontiers in Cellular and Infection Microbiology.</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>13</day>
<month>03</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="collection">
<year>2014</year>
</pub-date>
<volume>4</volume>
<elocation-id>35</elocation-id>
<history>
<date date-type="received">
<day>12</day>
<month>12</month>
<year>2013</year>
</date>
<date date-type="accepted">
<day>22</day>
<month>02</month>
<year>2014</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2014 Kingry and Petersen.</copyright-statement>
<copyright-year>2014</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract><p><italic>Francisella tularensis</italic> is the causative agent of the acute disease tularemia. Due to its extreme infectivity and ability to cause disease upon inhalation, <italic>F. tularensis</italic> has been classified as a biothreat agent. Two subspecies of <italic>F. tularensis, tularensis</italic> and <italic>holarctica</italic>, are responsible for tularemia in humans. In comparison, the closely related species <italic>F. novicida</italic> very rarely causes human illness and cases that do occur are associated with patients who are immune compromised or have other underlying health problems. Virulence between <italic>F. tularensis</italic> and <italic>F. novicida</italic> also differs in laboratory animals. Despite this varying capacity to cause disease, the two species share &#x0007E;97% nucleotide identity, with <italic>F. novicida</italic> commonly used as a laboratory surrogate for <italic>F. tularensis</italic>. As the <italic>F. novicida</italic> U112 strain is exempt from U.S. select agent regulations, research studies can be carried out in non-registered laboratories lacking specialized containment facilities required for work with virulent <italic>F. tularensis</italic> strains. This review is designed to highlight phenotypic (clinical, ecological, virulence, and pathogenic) and genomic differences between <italic>F. tularensis</italic> and <italic>F. novicida</italic> that warrant maintaining <italic>F. novicida</italic> and <italic>F. tularensis</italic> as separate species. Standardized nomenclature for <italic>F. novicida</italic> is critical for accurate interpretation of experimental results, limiting clinical confusion between <italic>F. novicida</italic> and <italic>F. tularensis</italic> and ensuring treatment efficacy studies utilize virulent <italic>F. tularensis</italic> strains.</p></abstract>
<kwd-group>
<kwd>tularemia</kwd>
<kwd><italic>Francisella tularensis</italic></kwd>
<kwd><italic>Francisella novicida</italic></kwd>
<kwd>intracellular pathogen</kwd>
<kwd>virulence</kwd>
</kwd-group>
<counts>
<fig-count count="0"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="147"/>
<page-count count="12"/>
<word-count count="12594"/>
</counts>
</article-meta>
</front>
<body>
<sec>
<title>Introduction and overview</title>
<p><italic>F. tularensis</italic> was first isolated in 1912 as the causative agent of a plague-like disease affecting squirrels in Tulare county, California (McCoy and Chapin, <xref ref-type="bibr" rid="B85">1912</xref>). Subsequently, Edward Francis, for whom the genus is named, established that several clinical syndromes in humans were caused by <italic>F. tularensis</italic> and proposed the name &#x0201C;tularemia&#x0201D; to describe the illness (Francis, <xref ref-type="bibr" rid="B42">1925</xref>). In 1950 researchers isolated a bacterium from salt water collected from Ogden Bay, Great Salt Lake, Utah (Larson et al., <xref ref-type="bibr" rid="B73">1955</xref>)<italic></italic>. Initial experiments revealed the bacterium resembled <italic>F. tularensis</italic> morphologically, but fermented sucrose, was of lesser virulence than <italic>F. tularensis</italic> and did not cross-react with serum from rabbits inoculated with heat, ether, formalin, or phenol killed <italic>F. tularensis</italic> (Larson et al., <xref ref-type="bibr" rid="B73">1955</xref>). Based on these phenotypic differences, the isolate was given the unique species name <italic>F. novicida</italic> (Larson et al., <xref ref-type="bibr" rid="B73">1955</xref>)<italic></italic>. The classification of <italic>F. novicida</italic> as a distinct species was further substantiated in 1964 as a result of its less fastidious growth requirements as compared to <italic>F. tularensis</italic> and the lack of heterologous vaccine protection in mice immunized with killed <italic>F. novicida</italic> and challenged with several <italic>F. tularensis</italic> strains (Owen et al., <xref ref-type="bibr" rid="B103">1964</xref>). Additionally, guinea pigs injected subcutaneously with rabbit immune serum against either <italic>F. tularensis</italic> or <italic>F. novicida</italic> followed by challenge with antigen preparations from both <italic>F. tularensis</italic> and <italic>F. novicida</italic> showed antibody adsorption to homologous but not heterologous antigen at the sight of serum injections (i.e., passive cutaneous anaphylaxis assay) (Owen et al., <xref ref-type="bibr" rid="B103">1964</xref>).</p>
<p>DNA-DNA hybridization experiments performed with <italic>F. tularensis</italic> and <italic>F. novicida</italic> in the 1980s indicated a high degree of genetic relatedness between the two (&#x02265;92% at 50&#x000B0;C; &#x02265;86% at 65&#x000B0;C) (Hollis et al., <xref ref-type="bibr" rid="B51">1989</xref>). On this basis, it was proposed, though not validly published that <italic>F. novicida</italic> be reassigned as a subspecies of <italic>F. tularensis</italic> (<italic>F. tularensis</italic> subsp. <italic>novicida</italic>) (Hollis et al., <xref ref-type="bibr" rid="B51">1989</xref>; Lapage, <xref ref-type="bibr" rid="B72">1992</xref>; Tindall et al., <xref ref-type="bibr" rid="B132">2006</xref>). To meet Bacteriological Code requirements, a proposal to transfer <italic>F. novicida</italic> to the subspecies rank of <italic>F. tularensis</italic> (i.e., <italic>F. tularensis</italic> subsp. <italic>novicida</italic>) was validly published in 2010 in the International Journal of Systematic and Evolutionary Microbiology (IJSEM) (Tindall et al., <xref ref-type="bibr" rid="B132">2006</xref>; Huber et al., <xref ref-type="bibr" rid="B53">2010</xref>). This proposal was met with formal objection in IJSEM, as it was based solely on genetic relatedness and did not take into consideration the documented phenotypic and genomic differences between <italic>F. tularensis</italic> and <italic>F. novicida</italic> (Johansson et al., <xref ref-type="bibr" rid="B58">2010</xref>). Indeed, in the 2010 publication proposing reclassification of <italic>F. novicida</italic>, 11 metabolic traits unique to <italic>F. novicida</italic> as compared to <italic>F. tularensis</italic> were identified but not considered with respect to its suggested reassignment as <italic>F. tularensis</italic> subsp. <italic>novicida</italic> (Huber et al., <xref ref-type="bibr" rid="B53">2010</xref>).</p>
<p>In recent decades, an explosion in the amount of basic research focused on understanding and treating tularemia has occurred due to concern about the intentional misuse of <italic>F. tularensis</italic> as a bioweapon (Dennis et al., <xref ref-type="bibr" rid="B38">2001</xref>; Cowley and Elkins, <xref ref-type="bibr" rid="B32">2011</xref>). Research studies using virulent <italic>F. tularensis</italic> strains can be particularly challenging, as they can only be handled under BSL-3 conditions and, in the U.S., within laboratories that are Tier 1 select agent approved (Federal Register, <xref ref-type="bibr" rid="B40">2012</xref>). In contrast, the <italic>F. novicida</italic> type strain U112 is exempt from select agent regulations in the U.S. and can be handled under standard BSL-2 laboratory conditions (Federal Register, <xref ref-type="bibr" rid="B40">2012</xref>). Information about select agent exemptions for <italic>F. tularensis</italic> can be found at the following website <ext-link ext-link-type="uri" xlink:href="http://www.selectagents.gov/Select%20Agents%20and%20Toxins%20Exclusions.html#francisella">www.selectagents.gov/Select%20Agents%20and%20Toxins%20Exclusions.html&#x00023;francisella</ext-link>. The less stringent containment requirement for <italic>F. novicida</italic> U112, its high genetic identity to <italic>F. tularensis</italic>, its ability to infect macrophages <italic>in vitro</italic>, to cause illness in laboratory mice, and ease of genetic manipulation as compared to <italic>F. tularensis</italic> have all contributed to widespread use of <italic>F. novicida</italic> U112 as a surrogate for <italic>F. tularensis</italic> (Anthony et al., <xref ref-type="bibr" rid="B3">1991</xref>; Mdluli et al., <xref ref-type="bibr" rid="B87">1994</xref>; Schmerk et al., <xref ref-type="bibr" rid="B117">2009</xref>; Cowley and Elkins, <xref ref-type="bibr" rid="B32">2011</xref>).</p>
<p>To date, the appropriate nomenclature for <italic>F. novicida</italic> remains controversial and non-standardized. While <italic>F. novicida</italic> is recognized on the Approved List of Bacterial Names (Skerman et al., <xref ref-type="bibr" rid="B122">1980</xref>), <italic>F. tularensis</italic> subsp. <italic>novicida</italic> is validly published (Huber et al., <xref ref-type="bibr" rid="B53">2010</xref>), resulting in two different names and no clear decision on the correct nomenclature. As a result, a variety of names including, but not limited to, <italic>F. tularensis, F. tularensis</italic> subsp. <italic>novicida, Ft novicida, Ftn, Ftt, Fn</italic>, and <italic>F. novicida</italic>, have all been used in the published literature. This lack of standardized terminology is further complicated by non-enforcement of consistent nomenclature by journals and editors. It is particularly problematic when trying to interpret published experimental results obtained using <italic>F. novicida</italic> U112, but described only as <italic>F. tularensis</italic> with no strain information included. Another negative outcome of the proposed classification of <italic>F. novicida</italic> as a subspecies of <italic>F. tularensis</italic> is that other <italic>F. novicida</italic> strains, excluding the exempt U112 strain, are considered select agents in the US, despite the fact they do not cause tularemia. In order to support maintaining separate species designations for <italic>F. novicida</italic> and <italic>F. tularensis</italic>, genomic as well as clinical, virulence, ecologic and pathogenic differences between the two organisms are reviewed here (Table <xref ref-type="table" rid="T1">1</xref>). We also discuss the utility of <italic>F. novicida</italic> as a laboratory surrogate for <italic>F. tularensis</italic> with respect to treatment of tularemia.</p>
<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption><p><bold>Genetic and phenotypic differences between <italic>F. tularensis</italic> and <italic>F. novicida</italic></bold>.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th/>
<th/>
<th valign="top" align="left"><bold><italic>F. tularensis</italic><xref ref-type="table-fn" rid="TN1"><sup>a</sup></xref></bold></th>
<th valign="top" align="left"><bold><italic>F. novicida</italic><xref ref-type="table-fn" rid="TN2"><sup>b</sup></xref></bold></th>
<th valign="top" align="left"><bold>References</bold></th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Genome</td>
<td valign="top" align="left">Size</td>
<td valign="top" align="left">1,892,819 bp</td>
<td valign="top" align="left">1,910,031 bp</td>
<td valign="top" align="left">Larsson et al., <xref ref-type="bibr" rid="B75">2005</xref>; Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Protein coding genes</td>
<td valign="top" align="left">1445</td>
<td valign="top" align="left">1731</td>
<td valign="top" align="left">Larsson et al., <xref ref-type="bibr" rid="B75">2005</xref>; Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Pseudogenes</td>
<td valign="top" align="left">254</td>
<td valign="top" align="left">14</td>
<td valign="top" align="left">Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">FPI</td>
<td valign="top" align="left">2 copies</td>
<td valign="top" align="left">1 copy</td>
<td valign="top" align="left">Nano et al., <xref ref-type="bibr" rid="B97">2004</xref>; Larsson et al., <xref ref-type="bibr" rid="B75">2005</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Restriction modification systems</td>
<td valign="top" align="left">1 gene</td>
<td valign="top" align="left">4 functional systems/6 genes</td>
<td valign="top" align="left">Gallagher et al., <xref ref-type="bibr" rid="B44">2008</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">CRISPR/Cas</td>
<td valign="top" align="left">No</td>
<td valign="top" align="left">Yes</td>
<td valign="top" align="left">Sampson et al., <xref ref-type="bibr" rid="B114">2013</xref>; Schunder et al., <xref ref-type="bibr" rid="B118">2013</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">O-antigen</td>
<td valign="top" align="left">15 genes</td>
<td valign="top" align="left">12 genes; aa identity to Ft 98% to 20%</td>
<td valign="top" align="left">Thomas et al., <xref ref-type="bibr" rid="B130">2007</xref>; Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Recombination</td>
<td valign="top" align="left">No</td>
<td valign="top" align="left">Yes</td>
<td valign="top" align="left">Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">IS element proliferation</td>
<td valign="top" align="left">Yes</td>
<td valign="top" align="left">No</td>
<td valign="top" align="left">Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref></td>
</tr>
<tr>
<td valign="top" align="left">Clinical</td>
<td valign="top" align="left">Tularemia</td>
<td valign="top" align="left">Yes</td>
<td valign="top" align="left">No</td>
<td valign="top" align="left">Francis, <xref ref-type="bibr" rid="B42">1925</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Transmission</td>
<td valign="top" align="left">Vector-borne, animal contact, inhalation of aerosols</td>
<td valign="top" align="left">Salt water; brackish water</td>
<td valign="top" align="left">Larson et al., <xref ref-type="bibr" rid="B73">1955</xref>; Dennis et al., <xref ref-type="bibr" rid="B38">2001</xref>; Brett et al., <xref ref-type="bibr" rid="B16">2012</xref>; Whitehouse et al., <xref ref-type="bibr" rid="B143">2012</xref></td>
</tr>
<tr>
<td valign="top" align="left">Ecology</td>
<td valign="top" align="left">Animal hosts</td>
<td valign="top" align="left">Zoonotic: small mammals, lagomorphs</td>
<td valign="top" align="left">No</td>
<td valign="top" align="left">Hopla, <xref ref-type="bibr" rid="B52">1974</xref>; Jellison, <xref ref-type="bibr" rid="B56">1974</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Arthropod hosts</td>
<td valign="top" align="left">Ticks, flies, mosquitoes</td>
<td valign="top" align="left">No</td>
<td valign="top" align="left">Jellison, <xref ref-type="bibr" rid="B56">1974</xref>; Petersen et al., <xref ref-type="bibr" rid="B107">2009b</xref></td>
</tr>
<tr>
<td valign="top" align="left">Virulence (LD<sub>50</sub> by subcutaneous or intradermal route of infection)</td>
<td valign="top" align="left">Mice</td>
<td valign="top" align="left">1 CFU</td>
<td valign="top" align="left">Range from 10 to &#x0003E;10<sup>7</sup> CFU</td>
<td valign="top" align="left">Bell et al., <xref ref-type="bibr" rid="B12">1955</xref>; Larson et al., <xref ref-type="bibr" rid="B73">1955</xref>; Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>; Owen et al., <xref ref-type="bibr" rid="B103">1964</xref>; Meshcheriakova et al., <xref ref-type="bibr" rid="B91">1995</xref>; Kieffer et al., <xref ref-type="bibr" rid="B64">2003</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Guinea pig</td>
<td valign="top" align="left">1 CFU</td>
<td valign="top" align="left">Range from 10 to &#x0003E;10<sup>5</sup> CFU</td>
<td valign="top" align="left">Bell et al., <xref ref-type="bibr" rid="B12">1955</xref>; Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>; Meshcheriakova et al., <xref ref-type="bibr" rid="B91">1995</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Rabbit</td>
<td valign="top" align="left">1 CFU</td>
<td valign="top" align="left">&#x0003E;10<sup>8</sup> CFU</td>
<td valign="top" align="left">Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>; Meshcheriakova et al., <xref ref-type="bibr" rid="B91">1995</xref></td>
</tr>
<tr>
<td valign="top" align="left">(LD<sub>50</sub> by intranasal or intratracheal route of infection)</td>
<td valign="top" align="left">Mice</td>
<td valign="top" align="left">&#x0003C;10 CFU</td>
<td valign="top" align="left">Approximate LD<sub>50</sub> of 10 CFU</td>
<td valign="top" align="left">Lauriano et al., <xref ref-type="bibr" rid="B76">2004</xref>; Pechous et al., <xref ref-type="bibr" rid="B105">2008</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Fischer 344 rats</td>
<td valign="top" align="left">5 &#x000D7; 10<sup>2</sup> CFU</td>
<td valign="top" align="left">Approximate LD<sub>50</sub> of 5 &#x000D7; 10<sup>6</sup> CFU</td>
<td valign="top" align="left">Ray et al., <xref ref-type="bibr" rid="B110">2010</xref></td>
</tr>
<tr>
<td valign="top" align="left">Mechanisms of pathogenicity</td>
<td valign="top" align="left">Cytokine induction upon cellular uptake</td>
<td valign="top" align="left">No</td>
<td valign="top" align="left">Yes</td>
<td valign="top" align="left">Butchar et al., <xref ref-type="bibr" rid="B19">2008</xref>; Dai et al., <xref ref-type="bibr" rid="B35">2013</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Inflammasome activation</td>
<td valign="top" align="left">Delayed</td>
<td valign="top" align="left">Yes</td>
<td valign="top" align="left">Mariathasan et al., <xref ref-type="bibr" rid="B84">2006</xref>; Weiss et al., <xref ref-type="bibr" rid="B141">2007b</xref>; Fernandes-Alnemri et al., <xref ref-type="bibr" rid="B41">2010</xref>; Dotson et al., <xref ref-type="bibr" rid="B39">2013</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">CRISPR/cas mediated TLR2 evasion</td>
<td valign="top" align="left">No</td>
<td valign="top" align="left">Yes</td>
<td valign="top" align="left">Dai et al., <xref ref-type="bibr" rid="B35">2013</xref>; Sampson and Weiss, <xref ref-type="bibr" rid="B115">2013a</xref>,<xref ref-type="bibr" rid="B116">b</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">PI3K/Akt signaling</td>
<td valign="top" align="left">No; miR-155 suppressed</td>
<td valign="top" align="left">Yes; miR-155 induced</td>
<td valign="top" align="left">Cremer et al., <xref ref-type="bibr" rid="B34">2009</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Pulmonary cell association</td>
<td valign="top" align="left">Alveolar M&#x003A6; /dendritic cells</td>
<td valign="top" align="left">Alveolar M&#x003A6; /neutrophils</td>
<td valign="top" align="left">Hall et al., <xref ref-type="bibr" rid="B50">2008</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">O-antigen role</td>
<td valign="top" align="left">Intracellular replication</td>
<td valign="top" align="left">Complement resistance</td>
<td valign="top" align="left">Thomas et al., <xref ref-type="bibr" rid="B130">2007</xref>; Case et al., <xref ref-type="bibr" rid="B21">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Knockout of <italic>iclR</italic> or <italic>galE</italic> genes attenuates virulence in mice</td>
<td valign="top" align="left">No</td>
<td valign="top" align="left">Yes</td>
<td valign="top" align="left">Mortensen et al., <xref ref-type="bibr" rid="B95">2010</xref>; Thomas et al., <xref ref-type="bibr" rid="B131">2011</xref></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="TN1">
<label>a</label>
<p><italic>Specific numbers given are in reference to F. tularensis subsp. tularensis Schu S4, except for virulence which is from (Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>) strain Schu</italic>.</p></fn>
<fn id="TN2">
<label>b</label>
<p><italic>Specific numbers given are in reference to F. novicida U112</italic>.</p></fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec>
<title>Human disease and transmission</title>
<p><italic>F. tularensis</italic> is one of the most infectious bacterial pathogens known. Studies in human volunteers in the 1960s demonstrated that infection was established with as few as 25 organisms when aerogenically exposed to <italic>F. tularensis</italic> subsp. <italic>tularensis</italic>, with clinically overt disease occurring 3&#x02013;5 days post exposure (McCrumb, <xref ref-type="bibr" rid="B86">1961</xref>). Two subspecies of <italic>F. tularensis, tularensis</italic> (also called type A) and <italic>holarctica</italic> (also called type B), cause human tularemia (Petersen and Molins, <xref ref-type="bibr" rid="B108">2010</xref>). Between these two subspecies, disease outcome and geographic distribution differs (Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>). <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> causes disease only in North America and is associated with higher mortality in humans as compared to <italic>F. tularensis</italic> subsp<italic>. holarctica</italic>, which causes less severe illness throughout the Northern Hemisphere (Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>). Human infection due to a third subspecies, <italic>F. tularensis</italic> subsp. <italic>mediasiatica</italic>, has never been documented in the published literature.</p>
<p>Within both <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> and subsp. <italic>holarctica</italic>, distinct subpopulations have been delineated by a number of different genotyping methods (Petersen and Molins, <xref ref-type="bibr" rid="B108">2010</xref>). In the case of <italic>F. tularensis</italic> subsp. <italic>tularensis</italic>, pulsed field gel electrophoresis defined three subpopulations, A1a, A1b, and A2, which differ with respect to clinical outcome (Kugeler et al., <xref ref-type="bibr" rid="B70">2009</xref>). Among patients infected with A1b strains, significantly higher fatality rates were observed as compared to those patients infected with A1a or A2 strains (Kugeler et al., <xref ref-type="bibr" rid="B70">2009</xref>). The higher mortality rate for infection with an A1b strain was not associated with host factors (age, sex, underlying illness), indicating an intrinsic characteristic of A1b strains (i.e., virulence) is responsible for the observed difference (Kugeler et al., <xref ref-type="bibr" rid="B70">2009</xref>).</p>
<p><italic>F. tularensis</italic> causes the zoonotic, vector-borne disease tularemia. Clinical expression of tularemia in humans depends primarily on the route of transmission (T&#x000E4;rnvik and Berglund, <xref ref-type="bibr" rid="B127">2003</xref>; WHO, <xref ref-type="bibr" rid="B144">2007</xref>). Humans acquire infections by a variety of different mechanisms, including arthropod bites (ticks, flies, mosquitoes), direct contact with infected animals (e.g., skinning animals after hunting), ingestion of water or food contaminated by infected animals, and inhalation of infective aerosols (Dennis et al., <xref ref-type="bibr" rid="B38">2001</xref>; WHO, <xref ref-type="bibr" rid="B144">2007</xref>). For all forms, fever and acute symptoms are hallmarks of tularemia in healthy individuals. Arthropod transmission of <italic>F. tularensis</italic> causes glandular and ulceroglandular forms of tularemia, with the latter form of disease presenting as an ulcer at the site of the arthropod bite. Skinning infected animals also leads to ulceroglandular tularemia. Other forms of tularemia include oculoglandular tularemia, acquired via direct inoculation of the eye; oropharyngeal tularemia, acquired through ingestion of water or food contaminated by infected animals; and pneumonic (respiratory) tularemia, acquired through inhalation of infective aerosols during landscaping, farming, or laboratory activities. It is the pneumonic form of tularemia that is the most severe and of highest concern with respect to an intentional aerosol event (Dennis et al., <xref ref-type="bibr" rid="B38">2001</xref>).</p>
<p>In comparison to <italic>F. tularensis, F. novicida</italic> infection is not associated with healthy individuals. <italic>F. novicida</italic> infection in humans is exceedingly rare and therefore often difficult to diagnose accurately (Brett et al., <xref ref-type="bibr" rid="B16">2012</xref>; Birdsell et al., <xref ref-type="bibr" rid="B15">2009</xref>). Only 12 cases have been documented (Hollis et al., <xref ref-type="bibr" rid="B51">1989</xref>; Clarridge et al., <xref ref-type="bibr" rid="B28">1996</xref>; Leelaporn et al., <xref ref-type="bibr" rid="B77">2008</xref>; Birdsell et al., <xref ref-type="bibr" rid="B15">2009</xref>; Brett et al., <xref ref-type="bibr" rid="B16">2012</xref>; Respicio-Kingry et al., <xref ref-type="bibr" rid="B111">2012</xref>; Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>; Whitehouse et al., <xref ref-type="bibr" rid="B143">2012</xref>). An <italic>F. novicida</italic>-like infection was reported in an Australian patient, however, genome comparisons indicate the strain is more similar to <italic>F. hispanensis</italic> (Whipp et al., <xref ref-type="bibr" rid="B142">2003</xref>; Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>). Illness caused by <italic>F. novicida</italic> does not resemble tularemia. Clinical information available for 11 reported cases indicate that 9 of the <italic>F. novicida</italic> cases occurred in patients who were immuno-compromised or had underlying health problems (Hollis et al., <xref ref-type="bibr" rid="B51">1989</xref>; Clarridge et al., <xref ref-type="bibr" rid="B28">1996</xref>; Leelaporn et al., <xref ref-type="bibr" rid="B77">2008</xref>; Birdsell et al., <xref ref-type="bibr" rid="B15">2009</xref>; Brett et al., <xref ref-type="bibr" rid="B16">2012</xref>; Respicio-Kingry et al., <xref ref-type="bibr" rid="B111">2012</xref>; Whitehouse et al., <xref ref-type="bibr" rid="B143">2012</xref>). Fever and acute disease, hallmarks of tularemia in healthy individuals, were only observed for <italic>F. novicida</italic> infections in compromised patients (Hollis et al., <xref ref-type="bibr" rid="B51">1989</xref>; Clarridge et al., <xref ref-type="bibr" rid="B28">1996</xref>; Leelaporn et al., <xref ref-type="bibr" rid="B77">2008</xref>; Brett et al., <xref ref-type="bibr" rid="B16">2012</xref>; Respicio-Kingry et al., <xref ref-type="bibr" rid="B111">2012</xref>; Whitehouse et al., <xref ref-type="bibr" rid="B143">2012</xref>). In the two healthy individuals with <italic>F. novicida</italic> infection, regional lymphadenopathy, lacking fever or other symptoms, was reported (Hollis et al., <xref ref-type="bibr" rid="B51">1989</xref>; Birdsell et al., <xref ref-type="bibr" rid="B15">2009</xref>). Classic forms of tularemia, including ulceroglandular, pneumonic, oropharyngeal, and oculoglandular, have not been observed for <italic>F. novicida</italic> infection in healthy individuals.</p>
<p>Given the rarity of <italic>F. novicida</italic> infection in humans, little is known with regards to how the organism is transmitted. Reported human infections are associated with uncertain routes of exposure. For those cases where the mode of infection was ascertained, two cases were due to near-drowning events in salt water and three cases were associated with environmental contamination of outdoor ice machines (Brett et al., <xref ref-type="bibr" rid="B16">2012</xref>; Respicio-Kingry et al., <xref ref-type="bibr" rid="B111">2012</xref>; Whitehouse et al., <xref ref-type="bibr" rid="B143">2012</xref>). No evidence exists to suggest that <italic>F. novicida</italic> is transmitted by animals or arthropod vectors (see Ecology section).</p>
</sec>
<sec>
<title>Ecology</title>
<p>In nature, <italic>F. tularensis</italic> and <italic>F. novicida</italic> occupy distinct ecological niches; <italic>F. tularensis</italic> is a classic vector-borne zoonotic pathogen, whereas <italic>F. novicida</italic> is not. As an intracellular pathogen, <italic>F. tularensis</italic> (both subsp. <italic>tularensis</italic> and subsp. <italic>holarctica</italic>) infects and causes disease and mortality in a large number of animal hosts (Hopla, <xref ref-type="bibr" rid="B52">1974</xref>; Jellison, <xref ref-type="bibr" rid="B56">1974</xref>). The bacterium is most often associated with lagomorphs and rodents, including voles, squirrels, and beavers. <italic>F. tularensis</italic> is also found in nature in a number of arthropod vectors, including ticks, flies, and mosquitoes, which bite both animal and human hosts and thereby transmit the organism (Petersen et al., <xref ref-type="bibr" rid="B107">2009b</xref>). Maintenance of <italic>F. tularensis</italic> in nature involves a cycle in which mammals serve as the amplifying hosts and arthropod vectors feed on these bacteremic hosts to disseminate the bacterium to other animals (Petersen et al., <xref ref-type="bibr" rid="B107">2009b</xref>).</p>
<p>In contrast to <italic>F. tularensis</italic>, the identification of <italic>F. novicida</italic> has never been reported in wild animals (healthy or moribund), indicating that in nature <italic>F. novicida</italic> is not a zoonotic bacterium. <italic>F. novicida</italic> has also never been identified in arthropod vectors in nature. Moreover, in the case of arthropods, the lack of identification of <italic>F. novicida</italic> does not appear to be due to inadequate testing methods as numerous <italic>Francisella</italic>-like endosymbionts have been identified in ticks via PCR and sequencing (Scoles, <xref ref-type="bibr" rid="B119">2004</xref>; Goethert and Telford, <xref ref-type="bibr" rid="B47">2005</xref>; Kugeler et al., <xref ref-type="bibr" rid="B69">2005</xref>; Machado-Ferreira et al., <xref ref-type="bibr" rid="B79">2009</xref>; De Carvalho et al., <xref ref-type="bibr" rid="B37">2011</xref>; Ivanov et al., <xref ref-type="bibr" rid="B55">2011</xref>; Kreizinger et al., <xref ref-type="bibr" rid="B68">2013</xref>). As arthropod vectors characteristically acquire infection from bacteremic animal hosts, the lack of identification of <italic>F. novicida</italic> in arthropods is consistent with the presumed inability <italic>F. novicida</italic> to cause bacteremia in wild animals. It is likely that <italic>F. novicida</italic> resides in an environmental niche and is propagated in nature via a mechanism that does not involve mammalian or arthropod hosts. Indeed, the sole source of <italic>F. novicida</italic> isolates to date has been salt water. This includes the <italic>F. novicida</italic> U112 type strain as well as 9 other <italic>F. novicida</italic> isolates (Larson et al., <xref ref-type="bibr" rid="B73">1955</xref>; Petersen et al., <xref ref-type="bibr" rid="B106">2009a</xref>; Whitehouse et al., <xref ref-type="bibr" rid="B143">2012</xref>). Additional environmental sources of <italic>F. novicida</italic>, including brackish water and soil, have been implicated based on PCR detection and sequencing analysis (Barns et al., <xref ref-type="bibr" rid="B9">2005</xref>; Kuske et al., <xref ref-type="bibr" rid="B71">2006</xref>; Berrada and Telford, <xref ref-type="bibr" rid="B14">2010</xref>).</p>
</sec>
<sec>
<title>Genomics</title>
<p>Genome sequencing has been performed on several <italic>F. tularensis</italic> and <italic>F. novicida</italic> strains, with a limited number of genomes fully assembled and annotated (Larsson et al., <xref ref-type="bibr" rid="B75">2005</xref>; Beckstrom-Sternberg et al., <xref ref-type="bibr" rid="B11">2007</xref>; Chaudhuri et al., <xref ref-type="bibr" rid="B25">2007</xref>; Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>; Barabote et al., <xref ref-type="bibr" rid="B6">2009</xref>; Champion et al., <xref ref-type="bibr" rid="B24">2009</xref>; Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>; Modise et al., <xref ref-type="bibr" rid="B92">2012</xref>; Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>; Svensson et al., <xref ref-type="bibr" rid="B126">2012</xref>; Antwerpen et al., <xref ref-type="bibr" rid="B4">2013</xref>). Consistent with the high degree of genetic similarity previously determined via DNA-DNA re-association (Hollis et al., <xref ref-type="bibr" rid="B51">1989</xref>), the average nucleotide identity observed across 1.1 MB of genomic sequence from 3 <italic>F. novicida</italic> strains and 13 <italic>F. tularensis</italic> strains (8 subsp. <italic>holarctica</italic>, 1 subsp. <italic>mediasiatica</italic>, 2 subsp. <italic>tularensis</italic> A1, and 2 subsp. <italic>tularensis</italic> A2) is &#x02265;97.7% (Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>). Despite this high degree of nucleotide identity, differences are apparent between their respective genomes. <italic>F. novicida</italic> U112 has a larger genome of 1,910,031 bases with more protein coding genes (1731) as compared to <italic>F. tularensis</italic>. The genome size of <italic>F. tularensis</italic> subsp <italic>holarctica</italic> LVS and <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 is 1,895,998 and 1,892,819 bases, with 1380 and 1145 protein coding genes, respectively (Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>; Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>).</p>
<p>Selective genome reduction in the intracellular pathogen <italic>F. tularensis</italic> is clear; the <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 and <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> LVS genomes contain 254 and 303 pseudogenes, respectively (Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>). In contrast, only 14 pseudogenes are evident in the <italic>F. novicida</italic> U112 genome (Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>). Larsson et al. identified a total of 279 gene losses present in six <italic>F. tularensis</italic> genomes (3 subsp. <italic>holarctica</italic>, 1 subsp. <italic>mediasiatica</italic>, and 2 subsp. <italic>tularensis</italic> strains) as compared to the <italic>F. novicida</italic> U112 genome (Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>). Frequently it is components of metabolic pathways that are deleted during the transition to an intracellular pathogen, as the nutrients can be acquired from the host. Indeed, metabolic differences between <italic>F. novicida</italic> and <italic>F. tularensis</italic> date back to early characterization of <italic>F. novicida</italic>, when it was found to be less fastidious compared to <italic>F. tularensis</italic> (Owen et al., <xref ref-type="bibr" rid="B103">1964</xref>). More recently, Huber <italic>et al</italic>. identified 11 different metabolic traits present only in <italic>F. novicida</italic> as compared to <italic>F. tularensis</italic> subsp. <italic>tularensis, F. tularensis</italic> subsp. <italic>holarctica</italic>, and <italic>F. tularensis</italic> subsp. <italic>mediasiatica</italic> (Huber et al., <xref ref-type="bibr" rid="B53">2010</xref>). Genomic analyses of <italic>F. novicida</italic> U112, <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4, and <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> LVS indicate 41.2 percent of the genes predicted to be involved in amino acid biosynthesis in <italic>F. novicida</italic> U112 are inactivated in one or both <italic>F. tularensis</italic> strains (Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>). <italic>F. novicida</italic> U112 appears to have 3 incomplete amino acid synthesis pathways (lysine, histidine, and methionine) whereas in <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 there are 9 incomplete pathways (arginine, histidine, lysine, tyrosine, methionine, cysteine, threonine, valine, and isoleucine) (Larsson et al., <xref ref-type="bibr" rid="B75">2005</xref>; Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>; Meibom and Charbit, <xref ref-type="bibr" rid="B89">2010</xref>; KEGG, <xref ref-type="bibr" rid="B63">2014</xref>).</p>
<p>The <italic>F. novicida</italic> U112 genome encodes 84 genes (including those involved in amino acid biosynthesis) that are inactivated in both <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 and <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> LVS (Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>). The predicted function of these genes (carbohydrate metabolism, amino acid biosynthesis, metabolite transport, energy metabolism, transport, and DNA restriction/modification) is consistent with <italic>F. novicida</italic> maintaining the ability to exist in the environment, outside animal hosts. For example, <italic>F. novicida</italic> U112 encodes 4 intact restriction barrier systems in its genome that impair acquisition of foreign methylated DNA by as much as 10<sup>6</sup> fold over native <italic>F. novicida</italic> U112 DNA, suggesting <italic>F. novicida</italic> resides in a niche where it encounters foreign DNA (Maier et al., <xref ref-type="bibr" rid="B81">2004</xref>; Gallagher et al., <xref ref-type="bibr" rid="B44">2008</xref>). The majority of genes encoding restriction barrier systems in <italic>F. tularensis</italic> genomes (subsp. <italic>tularensis</italic> Schu S4 and WY96-3418, subsp. <italic>holarctica</italic> LVS, FTA, and OSU18, and subsp. <italic>mediasiatica</italic>) are present in the form of pseudogenes, suggesting that with its transition to an intracellular pathogen, restriction barrier systems were no longer necessary for survival (Gallagher et al., <xref ref-type="bibr" rid="B44">2008</xref>). This evolutionary phenomenon is also present in strains of increasing virulence in both <italic>Yersinia</italic> and <italic>Burkholderia</italic> (Ong et al., <xref ref-type="bibr" rid="B102">2004</xref>; Kim et al., <xref ref-type="bibr" rid="B65">2005</xref>; Gallagher et al., <xref ref-type="bibr" rid="B44">2008</xref>). Another example of <italic>F. novicida</italic> retaining functions for environmental survival and persistence is the identification of 5 genes (FTN_0451-0456) encoded in the <italic>F. novicida</italic> U112 genome that are responsible for the synthesis and breakdown of the secondary messenger, bis&#x02014;(3&#x02032;&#x02013;5&#x02032;)&#x02014;cyclic dimeric GMP (cdGMP) (Zogaj et al., 2012). Overproduction of cdGMP in <italic>F. novicida</italic> U112 initiates biofilm formation as well as attenuates its ability replicate within mouse macrophages. The absence of these genes in <italic>F. tularensis</italic> suggests their elimination provided a selective advantage to its pathogenic intracellular life-cycle (Zogaj et al., <xref ref-type="bibr" rid="B147">2012</xref>).</p>
<p>Gene amplification is evidenced in <italic>F. tularensis</italic> genomes as compared to <italic>F. novicida</italic> genomes. Most notably, genomic analyses of <italic>F. tularensis</italic> (6 subsp. tularensis, 12 subsp. holarctica, and 2 subsp. mediasiatica strains) and <italic>F. novicida</italic> (9 strains) indicate a duplication of the 30 kbp Francisella Pathogenicity Island (FPI) in <italic>F. tularensis</italic> as compared to <italic>F. novicida</italic> which contains only a single copy (Nano et al., <xref ref-type="bibr" rid="B97">2004</xref>; Larsson et al., <xref ref-type="bibr" rid="B75">2005</xref>, <xref ref-type="bibr" rid="B74">2009</xref>; Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>). The FPI consists of 16&#x02013;19 genes comprising a Type VI secretion system (T6SS) (Nano et al., <xref ref-type="bibr" rid="B97">2004</xref>; Nano and Schmerk, <xref ref-type="bibr" rid="B96">2007</xref>; De Bruin et al., <xref ref-type="bibr" rid="B36">2011</xref>). Deletion of most genes within the FPI of both <italic>F. tularensis</italic> and <italic>F. novicida</italic> generates mutants that are defective for intra-macrophage growth and severely attenuated for virulence in mice (Tempel et al., <xref ref-type="bibr" rid="B129">2006</xref>; Maier et al., <xref ref-type="bibr" rid="B80">2007</xref>; Nano and Schmerk, <xref ref-type="bibr" rid="B96">2007</xref>; Br&#x000F6;ms et al., <xref ref-type="bibr" rid="B18">2010</xref>; De Bruin et al., <xref ref-type="bibr" rid="B36">2011</xref>; Chou et al., <xref ref-type="bibr" rid="B27">2013</xref>). Given the importance of the FPI for intracellular replication and virulence, it seems likely duplication in <italic>F. tularensis</italic> represents a unique adaptation to its intracellular niche.</p>
<p>Only 7 genes unique to <italic>F. tularensis</italic> were identified via comparative genomic analysis of 20 <italic>F. tularensis</italic> strains (6 subsp. <italic>tularensis</italic>, 12 subsp. <italic>holarctica</italic>, and 2 subsp. <italic>mediasiatica</italic>); counterparts to these genes are absent in 9 <italic>F. novicida</italic> strains (Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>). All 7 genes are predicted to encode components necessary for the outer surface of <italic>F. tularensis</italic> cells (Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>). FTT0794, FTT0795, and FTT0796 are part of 12.5 kb locus important for formation of a capsule-like complex on the surface of <italic>F. tularensis</italic> (Bandara et al., <xref ref-type="bibr" rid="B5">2011</xref>; Zarrella et al., <xref ref-type="bibr" rid="B145">2011</xref>). The proteins encoded by these genes contain conserved domains for methyltransferase (FTT0795) and phosphocholine metabolism (FTT0794 and FTT0796) (Thomas et al., <xref ref-type="bibr" rid="B131">2011</xref>). FTT1453c (wzx), FTT1454c (wbtJ), and FTT1458 (wzy) encode proteins involved in lipopolysaccharide O-antigen synthesis (Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>). The wbtJ gene of <italic>F. tularensis</italic> encodes an N-formyltransferase which converts the O-antigen sugar, dTDP-4,6-dideoxy-4-amino-D-glucose to dTDP-4,6-dideoxy-4-formamido-D&#x02014;glucose, while the wzy gene product is an O-antigen polymerase whose function is to catalyze addition of newly synthesized O-antigen repeat units (Kim et al., <xref ref-type="bibr" rid="B66">2010</xref>; Zimmer et al., <xref ref-type="bibr" rid="B146">2013</xref>). FTT1188 encodes a hypothetical membrane protein lacking significant homology to known proteins (Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>).</p>
<p>Genomic analyses indicate that <italic>F. tularensis</italic> and <italic>F. novicida</italic> evolved as two distinct populations (Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>). <italic>F. tularensis</italic> strains are highly clonal, differentiating them from <italic>F. novicida</italic> strains, which are characterized by a propensity for recombination. Recombination was noted in 10% of the 742 <italic>Francisella</italic> core genes tested in seven <italic>F. novicida</italic> genomes, whereas there was no evidence of recombination in these same genes when 20 <italic>F. tularensis</italic> genomes were examined (Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>; Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>). Additionally, the <italic>F. tularensis</italic> Schu S4 genome shows evidence of 79 IS element insertions compared to only 26 IS element insertions in the <italic>F. novicida</italic> U112 genome (Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>). Genome decay due to IS element proliferation is clear in <italic>F. tularensis;</italic> IS elements in <italic>F. tularensis</italic> are responsible for at least 22 percent of inactivated genes (Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>). IS element proliferation in <italic>F. tularensis</italic> is also proposed to be responsible for duplication of the FPI in <italic>F. tularensis</italic> (Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>; Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>). Between <italic>F. novicida</italic> and <italic>F. tularensis</italic>, substantial differences are also observed in the ratio of substitution rates at non-synonymous and synonymous sites (dN/dS), with high dN/dS ratios for all <italic>F. tularensis</italic> branches, and considerably lower ratios for <italic>F. novicida</italic> (Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>). Overall, these findings are consistent with the idea that niche restricted bacteria, such as intracellular pathogens, tend to have monomorphic genomes, whereas environmental bacteria are under weaker purifying selection and therefore retain the capacity to adapt to differing conditions by undergoing genomic changes (Moran, <xref ref-type="bibr" rid="B94">2002</xref>; Achtman, <xref ref-type="bibr" rid="B2">2008</xref>; Larsson et al., <xref ref-type="bibr" rid="B74">2009</xref>).</p>
</sec>
<sec>
<title>Virulence</title>
<p>The differing virulence between <italic>F. tularensis</italic> subspecies was classically determined by measuring the number of organisms required to kill 50&#x02013;100% of infected mice, guinea pigs, and rabbits (Francis and Felton, <xref ref-type="bibr" rid="B43">1953</xref>; Bell et al., <xref ref-type="bibr" rid="B12">1955</xref>; Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>). Variation in the time-to-death of <italic>F. tularensis</italic>-infected animals was also linked to virulence differences between <italic>F. tularensis</italic> subspecies (Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>). Summarized in this section are results of virulence testing for <italic>F. novicida</italic> and <italic>F. tularensis</italic> by two routes of infection (subcutaneous and pulmonary) in mice, guinea pigs, rabbits, and rats. We note that the intent of this section is not to discuss the merits of using one animal model over another for tularemia research.</p>
<p>Both mice and guinea pigs are highly susceptible to <italic>F. tularensis</italic> (both subsp. <italic>tularensis</italic> and subsp. <italic>holarctica</italic>) when introduced via routes that mimic infection due to arthropod bite, with an observed LD<sub>100</sub> of only 1 organism for subcutaneous inoculation (Bell et al., <xref ref-type="bibr" rid="B12">1955</xref>; Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>). The differing virulence between <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> and <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> in guinea pigs and mice manifests as a shortened time to death; <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> infected mice and guinea pigs (&#x0003C;1000 organisms) die markedly earlier as compared to those infected with <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> (Bell et al., <xref ref-type="bibr" rid="B12">1955</xref>; Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>). Differences in time to death of infected mice are also detected between subpopulations of <italic>F. tularensis</italic> subsp. <italic>tularensis</italic>. Intradermal infection of C57BL/6 mice with 10&#x02013;20 CFUs results in significantly shortened survival times for those mice infected with A1b strains as compared to those infected with either A1a or A2 strains (Molins et al., <xref ref-type="bibr" rid="B93">2010</xref>), consistent with human epidemiologic data indicating A1b strains have higher virulence than other <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> strains (Kugeler et al., <xref ref-type="bibr" rid="B70">2009</xref>).</p>
<p>In contrast to mice and guinea pigs, virulence is markedly different in rabbits between <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> and <italic>F. tularensis</italic> subsp. <italic>holarctica</italic>. When introduced subcutaneously, an LD<sub>100</sub> of 1 organism is observed for <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> opposed to 10<sup>9</sup> organisms for <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> (Bell et al., <xref ref-type="bibr" rid="B12">1955</xref>; Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>). White rats are less susceptible to <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> infection as compared to rabbits; an LD<sub>100</sub> of 10<sup>8</sup>&#x02013;10<sup>9</sup> was reported for subcutaneous infection by either <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> or <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> (Olsufiev et al., <xref ref-type="bibr" rid="B101">1959</xref>).</p>
<p>The virulence of <italic>F. novicida</italic> upon subcutaneous introduction appears to be less than <italic>F. tularensis</italic> in mice, guinea pigs and rabbits, although the exact extent of the difference is difficult to quantify. There is limited data in the literature with respect to the number of <italic>F. novicida</italic> organisms required to kill animals as determined by LD<sub>50</sub> or LD<sub>100</sub> studies. Similarly, there is a lack of published data comparing time to death of animals infected with <italic>F. tularensis</italic> vs. <italic>F. novicida</italic>. Initial experiments performed with <italic>F. novicida</italic> U112 indicated 50 organisms introduced subcutaneously was sufficient to kill 100% (4 of 4) of infected mice and guinea pigs (Larson et al., <xref ref-type="bibr" rid="B73">1955</xref>). Owen et al. subsequently reported that 10&#x02013;100 cells of <italic>F. novicida</italic> U112 were required to kill a mouse and 10&#x02013;1000 cells required to kill a guinea pig, although no primary data or route of infection was provided (Owen et al., <xref ref-type="bibr" rid="B103">1964</xref>). Experiments using BALB/cByJ mice infected intradermally with <italic>F. novicida</italic> U112 determined an LD<sub>50</sub> of 2400 CFU (Kieffer et al., <xref ref-type="bibr" rid="B64">2003</xref>). Much higher lethal doses for <italic>F. novicida</italic> introduced subcutaneously were reported in a study published in the Russian literature (Meshcheriakova et al., <xref ref-type="bibr" rid="B91">1995</xref>). An LD<sub>50</sub> of 1.3 &#x000D7; 10<sup>4</sup> organisms and LD<sub>100</sub> of &#x0007E;10<sup>7</sup>, &#x0003E;10<sup>8</sup>, &#x0003E;10<sup>8</sup> organisms was determined upon subcutaneous infection of outbred mice with <italic>F. novicida</italic> U112, <italic>F. novicida</italic> F6168, and <italic>F. novicida</italic> D9876, respectively (Meshcheriakova et al., <xref ref-type="bibr" rid="B91">1995</xref>). In the same study, an LD<sub>100</sub> &#x0003E;10<sup>5</sup> organisms was identified for all three <italic>F. novicida</italic> strains (U112, F6168, D9876) via subcutaneous infection of guinea pigs, and in rabbits no mortality was observed with 10<sup>8</sup> organisms of each strain (Meshcheriakova et al., <xref ref-type="bibr" rid="B91">1995</xref>).</p>
<p>In recent years, the intranasal route of infection has been used to induce respiratory illness in mice, given the severity of pneumonic tularemia and the potential impact of an intentional aerosol release of <italic>F. tularensis</italic>. Published studies are consistent with a difference in virulence between <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 and <italic>F. novicida</italic> U112 via this route of infection. An LD<sub>50</sub> of &#x0003C;10 CFUs was determined for <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 in BALB/c mice (Pechous et al., <xref ref-type="bibr" rid="B105">2008</xref>) and 100% mortality is reported for infection of C57BL/6, BALB/c, and BALB/cByJ with 13-25 CFU (Qin et al., <xref ref-type="bibr" rid="B109">2008</xref>; Cong et al., <xref ref-type="bibr" rid="B31">2009</xref>; Child et al., <xref ref-type="bibr" rid="B26">2010</xref>; Okan et al., <xref ref-type="bibr" rid="B99">2013</xref>; Richard et al., <xref ref-type="bibr" rid="B112">2014</xref>). For <italic>F. novicida</italic> U112, an approximate LD<sub>50</sub> of 10 CFU was determined in inbred mice by intranasal inoculation, with two of five BALB/c mice surviving an inoculum of 30 CFU, and one of five surviving an inoculum of 300 CFU (Lauriano et al., <xref ref-type="bibr" rid="B76">2004</xref>). In C57BL/6 and BALB/c mice, 100% mortality is reported using doses ranging from 100 to 445 CFU of <italic>F. novicida</italic> U112 (Pammit et al., <xref ref-type="bibr" rid="B104">2004</xref>; Mares et al., <xref ref-type="bibr" rid="B83">2008</xref>; Sharma et al., <xref ref-type="bibr" rid="B120">2009</xref>).</p>
<p>Significant virulence differences between <italic>F. tularensis</italic> and <italic>F. novicida</italic> are evident upon pulmonary infection of Fischer 344 rats via intratracheal instillation (Ray et al., <xref ref-type="bibr" rid="B110">2010</xref>). Fischer 344 rats show the highest sensitivity to <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 (approximate LD<sub>50</sub> of 5 &#x000D7; 10<sup>2</sup> CFU) as compared to <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> OR96-0246 (approximate LD<sub>50</sub> of 1 &#x000D7; 10<sup>5</sup> CFU) (Ray et al., <xref ref-type="bibr" rid="B110">2010</xref>). In contrast, Fischer 344 rats are highly resistant to <italic>F. novicida</italic> U112 infection, with an approximate LD<sub>50</sub> of 5 &#x000D7; 10<sup>6</sup> CFU (Ray et al., <xref ref-type="bibr" rid="B110">2010</xref>). Of note, a rapid time to death (MTD &#x0003D; 3 days) was observed in the rats which succumbed to infection with <italic>F. novicida</italic>, as compared to rats which died due to infection with <italic>F. tularensis</italic> (MTD &#x0003D; 10 days), suggesting death due to <italic>F. novicida</italic> was likely a toxic effect from the large number of organisms rather than from a productive infection (Ray et al., <xref ref-type="bibr" rid="B110">2010</xref>).</p>
</sec>
<sec>
<title>Mechanisms of pathogenesis</title>
<p>As described in this review, the genomes of <italic>F. novicida</italic> and <italic>F. tularensis</italic> are highly similar, with the vast majority of genes in <italic>F. tularensis</italic> also found in <italic>F. novicida</italic>. Despite this overall genetic similarity, evidence indicates differential regulation of and distinct roles for homologous genes in <italic>F. tularensis</italic> and <italic>F. novicida</italic> as pertains to pathogenesis. Moreover, <italic>F. tularensis</italic> has developed strategies distinct from <italic>F. novicida</italic> to evade host immune responses. This section will focus on some of the differences that have been described to date.</p>
<p>Evidence that the same genes in <italic>F. novicida</italic> and <italic>F. tularensis</italic> play distinct roles in pathogenesis comes from knockout studies of homologous genes. For example, inactivation of the genes encoding the transcriptional regulator IclR or the UDP-glucose-4-epimerase GalE resulted in attenuation of <italic>F. novicida</italic> U112, but not <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 in a mouse model of infection (Weiss et al., <xref ref-type="bibr" rid="B140">2007a</xref>; Mortensen et al., <xref ref-type="bibr" rid="B95">2010</xref>; Thomas et al., <xref ref-type="bibr" rid="B131">2011</xref>). In the case of the <italic>dsbB</italic> gene, which encodes disulfide bond formation B protein, deletion mutants were attenuated in both <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 and <italic>F. novicida</italic> U112. However, <italic>F. novicida</italic> U112 knockouts provided protection from challenge with <italic>F. novicida</italic> U112, while <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 mutants provided no homologous protection (Tempel et al., <xref ref-type="bibr" rid="B129">2006</xref>; Qin et al., <xref ref-type="bibr" rid="B109">2008</xref>). Intramacrophage secretion of FPI proteins also differs between <italic>F. tularensis</italic> and <italic>F. novicida</italic>. Upon infection of macrophages, 8 FPI proteins (IglE, IglC, IglI, IglJ, IglF, VgrF, PdpE, and PdpA) were secreted by <italic>F. tularensis</italic> subsp<italic>. holarctica</italic> LVS, whereas only 4 (IglE, IglC, PdpE, and PdpA) were secreted by <italic>F. novicida</italic>, suggesting fundamental differences may exist between the two species with respect to the Type VI secretion mechanism (Br&#x000F6;ms et al., <xref ref-type="bibr" rid="B17">2012</xref>).</p>
<p>The cell surface, a critical pathogenicity determinant, differs between <italic>F. tularensis</italic> and <italic>F. novicida</italic>. Early studies indicated a lack of serum cross-reactivity between <italic>F. tularensis</italic> and <italic>F. novicida</italic>. More recently all genes unique to <italic>F. tularensis</italic> as compared to <italic>F. novicida</italic> were predicted to encode outer surface components (see Genomics section) (Larson et al., <xref ref-type="bibr" rid="B73">1955</xref>; Owen et al., <xref ref-type="bibr" rid="B103">1964</xref>; Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>). Indeed, distinct structures for the core oligosaccharide and O-antigen of <italic>F. tularensis</italic> and <italic>F. novicida</italic> LPS have been described. The core oligosaccharide of <italic>F. tularensis</italic> lacks a glucose residue attached to the &#x003B2;-glucose branch as compared to <italic>F. novicida</italic> (Vinogradov et al., <xref ref-type="bibr" rid="B138">2002</xref>; Vinogradov and Perry, <xref ref-type="bibr" rid="B137">2004</xref>; Gunn and Ernst, <xref ref-type="bibr" rid="B49">2007</xref>; Okan and Kasper, <xref ref-type="bibr" rid="B100">2013</xref>), while the O-antigen of <italic>F. tularensis</italic> contains two distinct sugar moieties at either end of the tetra-saccharide repeat and is present in longer oligomer chains as compared to <italic>F. novicida</italic> (Vinogradov et al., <xref ref-type="bibr" rid="B136">2004</xref>; Thomas et al., <xref ref-type="bibr" rid="B130">2007</xref>; Barker et al., <xref ref-type="bibr" rid="B7">2014</xref>). Reflecting the observed structural variation, three of the genes in the O-antigen encoding locus are unique to <italic>F. tularensis</italic> (see Genomics section) and among the other 12 genes, amino acid identity ranges from 98% to as low as 20% (Thomas et al., <xref ref-type="bibr" rid="B130">2007</xref>; Sj&#x000F6;din et al., <xref ref-type="bibr" rid="B121">2012</xref>). The structurally and antigentically unique O-antigens from <italic>F. tularensis</italic> and <italic>F. novicida</italic> appear to play different roles in the pathogenicity of each strain. In <italic>F. tularensis</italic>, the O-antigen is critical for intracellular survival as an O-antigen mutant (<italic>wbtDEF</italic>) (Thomas et al., <xref ref-type="bibr" rid="B130">2007</xref>; Jones et al., <xref ref-type="bibr" rid="B60">2012</xref>) is significantly attenuated for intracellular growth as compared to a similar <italic>wbtDEF</italic> mutant in <italic>F. novicida</italic>, which replicates normally in macrophages (Thomas et al., <xref ref-type="bibr" rid="B130">2007</xref>). Recent evidence indicates that the O-antigen of <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 protects it from autophagic detection once it reaches the cytosol (Case et al., <xref ref-type="bibr" rid="B21">2014</xref>).</p>
<p>The cell surface of <italic>F. tularensis</italic> also plays an important role in cell entry and evasion of the host innate immune response. Within host serum, the function of complement proteins is to recognize pathogens and protect the host by direct lysis of the pathogen or opsonization leading to phagocytosis. Both <italic>F. tularensis</italic> and <italic>F. novicida</italic> have been shown to fix human complement protein C3 on their surface, but are resistant to complement mediated lysis due to rapid conversion of C3b to C3bi (Clay et al., <xref ref-type="bibr" rid="B29">2008</xref>). This conversion of C3 leads to the interaction of C3bi with complement receptor protein C3R on host cells and cellular uptake by phagocytosis (Clemens et al., <xref ref-type="bibr" rid="B30">2005</xref>; Ben Nasr and Klimpel, <xref ref-type="bibr" rid="B13">2008</xref>; Clay et al., <xref ref-type="bibr" rid="B29">2008</xref>; Dai et al., <xref ref-type="bibr" rid="B35">2013</xref>). Deposition of C3 on <italic>F. novicida</italic> has been shown to increase both the production of reactive oxygen species (ROS) by human neutrophils and the production of TNF&#x003B1;, IL-6, and IL-1&#x003B2; by human monocytes (Barker et al., <xref ref-type="bibr" rid="B8">2009</xref>; Dai et al., <xref ref-type="bibr" rid="B35">2013</xref>). In stark contrast, C3 deposition on <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> LVS resulted in significantly less ROS production by human neutrophils, and C3 deposition on <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 was directly linked to suppression of the host immune response as monitored by the decreased production of the proinflammatory cytokines, TNF&#x003B1;, IL-6, and IL-1&#x003B2;, during uptake by human monocytes (Barker et al., <xref ref-type="bibr" rid="B8">2009</xref>; Dai et al., <xref ref-type="bibr" rid="B35">2013</xref>). Taken together, these results suggest different means of cellular entry for <italic>F. tularensis</italic> and <italic>F. novicida</italic> and also differential effects on the early host immune response.</p>
<p>A side-by-side comparison of pulmonary infection by <italic>F. tularensis</italic> or <italic>F. novicida</italic> in C57BL/6 mice demonstrated dissimilar cell types were infected <italic>in vivo</italic>. One day post-infection, via the intranasal route, <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4, <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> LVS, and <italic>F. novicida</italic> U112 were preferentially associated with alveolar macrophages, although this proportion differed at 78.9, 70.3, and 51.6%, respectively (Hall et al., <xref ref-type="bibr" rid="B50">2008</xref>). Strikingly, 27.3% of <italic>F. novicida</italic> infected cells on day 1 were neutrophils as compared to only 0 and 0.4% for <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 and <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> LVS, respectively (1000 fold difference in the number of neutrophils), indicating that neutrophils responded to and phagocytosed <italic>F. novicida</italic> U112 to a significantly greater extent than they did <italic>F. tularensis</italic> (Hall et al., <xref ref-type="bibr" rid="B50">2008</xref>). Moreover, increasing numbers of alveolar macrophages and dendritic cells were infected from day 1 to 3 following inhalation with either <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> Schu S4 or <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> LVS, but not for <italic>F. novicida</italic> U112, suggesting more rapid killing of <italic>F. novicida</italic> infected cells (Hall et al., <xref ref-type="bibr" rid="B50">2008</xref>).</p>
<p>Within host cells, <italic>F. tularensis</italic> and <italic>F. novicida</italic> display distinct abilities to evade the host immune response. The formation of the inflammasome, a multi-protein complex present in the host cell cytoplasm, is activated by microbial components to induce maturation of the inflammatory cytokines, interleukin IL-1&#x003B2; and IL-18, thereby leading to death of infected cells (Bauernfeind and Hornung, <xref ref-type="bibr" rid="B10">2013</xref>). <italic>F. novicida</italic> is unable to efficiently evade this host innate immune response, and is recognized by the inflammasome upon escape from the phagosome and entry into the host cell cytoplasm (Mariathasan et al., <xref ref-type="bibr" rid="B84">2006</xref>; Weiss et al., <xref ref-type="bibr" rid="B141">2007b</xref>; Fernandes-Alnemri et al., <xref ref-type="bibr" rid="B41">2010</xref>; Jones et al., <xref ref-type="bibr" rid="B60">2012</xref>; Dotson et al., <xref ref-type="bibr" rid="B39">2013</xref>). In contrast, <italic>F. tularensis</italic> successfully escapes inflammasome activation early in infection (&#x0007E;12 h) via a mechanism involving suppression of TLR2 signaling (Dotson et al., <xref ref-type="bibr" rid="B39">2013</xref>). Presumably, this early suppression of the inflammasome allows <italic>F. tularensis</italic> time to successfully replicate to high levels in the cytoplasm prior to host cell death (Dotson et al., <xref ref-type="bibr" rid="B39">2013</xref>).</p>
<p>Toll-like receptors (TLRs) play a central role in initiating innate cellular immune responses (Lim and Staudt, <xref ref-type="bibr" rid="B78">2013</xref>). Evasion of TLR2 signaling has been shown to be involved in the intracellular replication of both <italic>F. tularensis</italic> and <italic>F. novicida</italic>, although the mechanism utilized diverges between the two bacteria (Telepnev et al., <xref ref-type="bibr" rid="B128">2003</xref>; Katz et al., <xref ref-type="bibr" rid="B61">2006</xref>; Malik et al., <xref ref-type="bibr" rid="B82">2006</xref>; Abplanalp et al., <xref ref-type="bibr" rid="B1">2009</xref>; Dai et al., <xref ref-type="bibr" rid="B35">2013</xref>). Within the phagosome, <italic>F. novicida</italic> down-regulates the production of an endogenous transcript (FTN_1103), encoding a TLR2 stimulating lipoprotein, in a CRISPR/Cas system dependent manner (Sampson et al., <xref ref-type="bibr" rid="B114">2013</xref>; Sampson and Weiss, <xref ref-type="bibr" rid="B115">2013a</xref>,<xref ref-type="bibr" rid="B116">b</xref>). In contrast, <italic>F. tularensis</italic> lacks both the functional CRISPR/Cas system as well as the FTN_1103 homolog; genomic analyses indicate significant disruption/degradation of these genes (Schunder et al., <xref ref-type="bibr" rid="B118">2013</xref>; Sampson and Weiss, <xref ref-type="bibr" rid="B116">2013b</xref>). Rather, <italic>F. tularensis</italic> appears to evade TLR2 activation via a mechanism that involves the PI3K/Akt pathway, which when activated leads to production of the pro-inflammatory cytokines IL-6, IL-8, and IL-1&#x003B2; (Butchar et al., <xref ref-type="bibr" rid="B19">2008</xref>; Cremer et al., <xref ref-type="bibr" rid="B34">2009</xref>, <xref ref-type="bibr" rid="B33">2011</xref>; Medina et al., <xref ref-type="bibr" rid="B88">2010</xref>). The P13K/Act pathway is subject to negative regulation by the enzyme SHIP and a cellular micro-RNA, miR-155 (Cremer et al., <xref ref-type="bibr" rid="B34">2009</xref>, <xref ref-type="bibr" rid="B33">2011</xref>). Induction of miR-155 down-regulates SHIP to promote activation of the P13/Act pathway and inflammatory cytokine production. <italic>F. tularensis</italic> subverts or suppresses the induction of miR-155, thereby repressing the PI3K/Akt pathway. In contrast, <italic>F. novicida</italic> strongly induces miR-155, leading to activation of the P13K/Act pathway and the production of TNF&#x003B1; and IL-6 by human monocytes (Cremer et al., <xref ref-type="bibr" rid="B34">2009</xref>, <xref ref-type="bibr" rid="B33">2011</xref>).</p>
</sec>
<sec>
<title>Treatment</title>
<p>Development of novel therapeutics for the treatment of tularemia is an area of active research given concern regarding the potential misuse of <italic>F. tularensis</italic> as a bioweapon. Standard antimicrobial therapy is effective for the treatment of tularemia, with aminoglycosides, tetracyclines, and chloramphenicol approved for treatment of tularemia by the U.S. Food and Drug Administration. Although ciprofloxacin and other fluoroquinolones are not currently FDA-approved for treatment of tularemia, they show very good efficacy against <italic>F. tularensis in vitro</italic>, in animals, and in humans (Johansson et al., <xref ref-type="bibr" rid="B57">2000</xref>, <xref ref-type="bibr" rid="B59">2002</xref>; Steward et al., <xref ref-type="bibr" rid="B124">2006</xref>; Klimpel et al., <xref ref-type="bibr" rid="B67">2008</xref>; Meric et al., <xref ref-type="bibr" rid="B90">2008</xref>; Urich and Petersen, <xref ref-type="bibr" rid="B134">2008</xref>; Nelson et al., <xref ref-type="bibr" rid="B98">2010</xref>; Weber et al., <xref ref-type="bibr" rid="B139">2012</xref>).</p>
<p>Antibiotic resistance to frontline therapeutics recommended for treatment of tularemia has never been identified in naturally occurring strains of <italic>F. tularensis</italic> or <italic>F. novicida</italic> (Ik&#x000E4;heimo et al., <xref ref-type="bibr" rid="B54">2000</xref>; Garcia Del Blanco et al., <xref ref-type="bibr" rid="B45">2004</xref>; Tomaso et al., <xref ref-type="bibr" rid="B133">2005</xref>; Urich and Petersen, <xref ref-type="bibr" rid="B134">2008</xref>; Valade et al., <xref ref-type="bibr" rid="B135">2008</xref>; Georgi et al., <xref ref-type="bibr" rid="B46">2012</xref>). Although treatment failure has been documented for human cases of tularemia, it is not associated with spontaneous antibiotic resistance, but rather a delay in antibiotic initiation (Celebi et al., <xref ref-type="bibr" rid="B22">2006</xref>; Meric et al., <xref ref-type="bibr" rid="B90">2008</xref>; Kaya et al., <xref ref-type="bibr" rid="B62">2011</xref>). Nonetheless, antibiotic resistance remains a concern, whether spontaneous or intentionally engineered. <italic>In vitro</italic> experiments demonstrate that both <italic>F. tularensis</italic> and <italic>F. novicida</italic> have the ability to rapidly acquire resistance to quinolones. Passage of either <italic>F. tularensis</italic> subsp. <italic>holarctica</italic> LVS or <italic>F. novicida</italic> U112 on increasing concentrations of ciprofloxacin resulted in resistance to homologous classes of drugs (Sutera et al., <xref ref-type="bibr" rid="B125">2014</xref>). Of note, in the case of <italic>F. novicida</italic>, but not <italic>F. tularensis</italic> subsp. <italic>holarctica</italic>, cross-resistance to heterologous classes of antimicrobials, including doxycycline and erythromycin, was observed (Sutera et al., <xref ref-type="bibr" rid="B125">2014</xref>). This suggests <italic>F. novicida</italic> U112 encodes other genes not present in <italic>F. tularensis</italic> that confer multidrug resistance and is consistent with genomic comparisons indicating more transporters are present in the genome of <italic>F. novicida</italic> U112 (Rohmer et al., <xref ref-type="bibr" rid="B113">2007</xref>; Sutera et al., <xref ref-type="bibr" rid="B125">2014</xref>).</p>
<p>New therapeutic approaches for tularemia range from targeting the organism itself to modulating the host response in order to mount a protective response. These therapeutic approaches are covered in other chapters of this series. For approval and licensure of new therapeutics for tularemia, direct evaluation of the product&#x00027;s efficacy in a clinical setting is needed. Because therapeutic efficacy testing is not always feasible in a clinical setting (e.g., limited numbers of cases), the U.S. Food and Drug Administration developed the &#x0201C;Animal Rule&#x0201D; (21 CFR 314.610 and 21 CFR 601.91) to allow animal efficacy data to support product licensure or approval. Of note with respect to <italic>F. tularensis</italic> and <italic>F. novicida</italic>, the &#x0201C;Animal Rule&#x0201D; states that the etiological agent used in animal studies generally should be identical to the one that causes human disease. As discussed above, <italic>F. novicida</italic> does not cause tularemia in humans and differences between <italic>F. novicida</italic> and <italic>F. tularensis</italic> are also apparent in animals, indicating that <italic>F. novicida</italic> should not substitute for <italic>F. tularensis</italic> in efficacy testing of therapeutics. As recent studies indicate virulence differs among <italic>F. tularensis</italic> subsp. <italic>tularensis</italic> strains in humans (Kugeler et al., <xref ref-type="bibr" rid="B70">2009</xref>; Molins et al., <xref ref-type="bibr" rid="B93">2010</xref>), the use of more virulent A1b strains should be considered for therapeutic efficacy testing in animals.</p>
</sec>
<sec>
<title>Conclusions and perspective</title>
<p>Bacterial species have traditionally been defined on the basis of DNA-DNA hybridization values (Lapage, <xref ref-type="bibr" rid="B72">1992</xref>; Stackebrandt et al., <xref ref-type="bibr" rid="B123">2002</xref>). The importance of phenotypic differences, however, cannot be understated with respect to classification of bacterial species. In 2002, the <italic>ad-hoc</italic> committee for the re-evaluation of bacterial species definition stated: &#x0201C;Phenotype, including chemotaxonomic markers, will remain important diagnostic properties in a species description. The ecological role can, in certain cases, decide on the species status. For example, medical organisms with defined clinical symptoms may continue to bear names that may not necessarily agree with their genomic relatedness so as to avoid unnecessary confusion among microbiologists and non-microbiologists [&#x02018;<italic>nomen periculosum</italic>&#x02019; according to Rule 56a(5) of the International Code of Nomenclature of Bacteria (Lapage, <xref ref-type="bibr" rid="B72">1992</xref>)]&#x0201D; (Stackebrandt et al., <xref ref-type="bibr" rid="B123">2002</xref>). A classic example of the value in utilizing phenotypic data to maintain distinct species designations comes from the bacteria <italic>Yersinia pestis</italic> and <italic>Yersinia pseudotuberculosis</italic>. Although these two bacteria share &#x0003E;97% nucleotide identity across 75% of their genes, they retain individual species names, due to their striking clinical and ecological differences (Chain et al., <xref ref-type="bibr" rid="B23">2004</xref>; Carniel et al., <xref ref-type="bibr" rid="B20">2006</xref>)<italic>. Y. pestis</italic> causes the highly fatal vector-borne disease, plague, whereas <italic>Y. pseudotuberculosis</italic> is transmitted by the fecal-oral route and infection rarely leads to death.</p>
<p>In this review, we have highlighted clinical, ecological, genomic, virulence, and pathogenic differences between <italic>F. novicida</italic> and <italic>F. tularensis</italic> that when considered in conjunction with genetic identity clearly warrants maintaining <italic>F. novicida</italic> and <italic>F. tularensis</italic> as separate species (Table <xref ref-type="table" rid="T1">1</xref>)<italic>. F. tularensis</italic> causes the zoonotic vector-borne disease tularemia, whereas <italic>F. novicida</italic> does not. As determined by whole genome comparisons, <italic>F. tularensis</italic> evolved independently of <italic>F. novicida</italic>, which is consistent with its completely distinct ecological niche (<italic>F. tularensis</italic> is a zoonotic pathogen whereas <italic>F. novicida</italic> is not) and mechanisms of transmission (<italic>F. tularensis</italic> is transmitted by arthropod vectors whereas <italic>F. novicida</italic> is not). Moreover, as part of <italic>F. tularensis&#x00027;</italic> pathogenic intracellular lifestyle, it has developed strategies distinct from <italic>F. novicida</italic> to evade host immune responses and successfully propagate in animal hosts.</p>
<p><italic>F. novicida</italic> and its mutants have clearly contributed to our understanding of the biology of <italic>F. tularensis</italic>. A classic example was the discovery of the 30 kbp FPI in <italic>F. novicida</italic> (Gray et al., <xref ref-type="bibr" rid="B48">2002</xref>; Nano et al., <xref ref-type="bibr" rid="B97">2004</xref>). In more recent years, side-by-side experiments including both <italic>F. novicida</italic> and <italic>F. tularensis</italic> have highlighted the value of direct comparison between the two as pertains to understanding the unique pathogenic mechanisms <italic>F. tularensis</italic> has evolved to elicit its extreme virulence (Vinogradov et al., <xref ref-type="bibr" rid="B138">2002</xref>, <xref ref-type="bibr" rid="B136">2004</xref>; Vinogradov and Perry, <xref ref-type="bibr" rid="B137">2004</xref>; Thomas et al., <xref ref-type="bibr" rid="B130">2007</xref>; Butchar et al., <xref ref-type="bibr" rid="B19">2008</xref>; Hall et al., <xref ref-type="bibr" rid="B50">2008</xref>; Cremer et al., <xref ref-type="bibr" rid="B34">2009</xref>; Mortensen et al., <xref ref-type="bibr" rid="B95">2010</xref>; Br&#x000F6;ms et al., <xref ref-type="bibr" rid="B17">2012</xref>; Dai et al., <xref ref-type="bibr" rid="B35">2013</xref>; Dotson et al., <xref ref-type="bibr" rid="B39">2013</xref>; Sutera et al., <xref ref-type="bibr" rid="B125">2014</xref>). As we move forward, findings utilizing the select agent exempt <italic>F. novicida</italic> U112 strain will no doubt continue to provide novel insight into the closely related species, <italic>F. tularensis</italic>. It is essential, however, to keep the two species separate and utilize standardized nomenclature for <italic>F. novicida</italic>. The recognition of <italic>F. novicida</italic> as a separate species via consistent and accepted nomenclature will limit misinterpretation of experimental results as pertains to the human disease tularemia caused by <italic>F. tularensis</italic>, avoid confusion between <italic>F. tularensis</italic> and <italic>F. novicida</italic> in clinical settings and ensure <italic>F. tularensis</italic> strains are used for treatment efficacy studies.</p>
<sec>
<title>Conflict of interest statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
</sec>
</body>
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