King Jessica M, Kulhankova Katarina, Stach Christopher S, Vu Bao G, Salgado-Pabón Wilmara
Department of Microbiology, University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA.
mSphere. 2016 Jun 8;1(3). doi: 10.1128/mSphere.00071-16. eCollection 2016 May-Jun.
Staphylococcus aureus diseases affect ~500,000 individuals per year in the United States. Worldwide, the USA100, USA200, USA400, and USA600 lineages cause many of the life-threatening S. aureus infections, such as bacteremia, infective endocarditis, pneumonia, toxic shock syndrome, and surgical site infections. However, the virulence mechanisms associated with these clonal lineages, in particular the USA100 and USA600 isolates, have been severely understudied. We investigated the virulence of these strains, in addition to strains in the USA200, USA300, and USA400 types, in well-established in vitro assays and in vivo in the rabbit model of infective endocarditis and sepsis. We show in the infective endocarditis and sepsis model that strains in the USA100 and USA600 lineages cause high lethality and are proficient in causing native valve infective endocarditis. Strains with high cytolytic activity or producing toxic shock syndrome toxin 1 (TSST-1) or staphylococcal enterotoxin C (SEC) caused lethal sepsis, even with low cytolytic activity. Strains in the USA100, USA200, USA400, and USA600 lineages consistently contained genes that encode for the enterotoxin gene cluster proteins, SEC, or TSST-1 and were proficient at causing infective endocarditis, while the USA300 strains lacked these toxins and were deficient in promoting vegetation growth. The USA100, USA200, and USA400 strains in our collection formed strong biofilms in vitro, whereas the USA200 and USA600 strains exhibited increased blood survival. Hence, infective endocarditis and lethal sepsis are multifactorial and not intrinsic to any one individual clonal group, further highlighting the importance of expanding our knowledge of S. aureus pathogenesis to clonal lineages causative of invasive disease. IMPORTANCE S. aureus is the leading cause of infective endocarditis in the developed world, affecting ~40,000 individuals each year in the United States, and the second leading cause of bacteremia (D. R. Murdoch et al., Arch Intern Med 169:463-473, 2009, http://dx.doi.org/10.1001/archinternmed.2008.603, and H. Wisplinghoff et al., Clin Infect Dis 39:309-317, 2004, http://dx.doi.org/10.1086/421946). Even with current medical advances, S. aureus bloodstream infections and infective endocarditis carry mortality rates of 20 to 66% (S. Y. Tong et al., Clin Microbiol Rev 28:603-661, 2015, http://dx.doi.org/10.1128/CMR.00134-14). S. aureus lineages associated with human disease worldwide include clonal complex 5 (CC5)/USA100, CC30/USA200, CC8/USA300, CC1/USA400, and CC45/USA600. The CC5/USA100, CC30/USA200, and CC45/USA600 lineages cause invasive disease yet remain poorly characterized. USA300 and cytotoxins are central to most S. aureus virulence studies, and yet, we find evidence that clonal groups are quite heterogeneous in parameters canonically used to measure virulence, including cytotoxicity, biofilm formation, and blood survival, and that the superantigen profile is an important parameter to consider when defining the virulence of S. aureus strains.
在美国,金黄色葡萄球菌疾病每年影响约50万人。在全球范围内,USA100、USA200、USA400和USA600谱系导致许多危及生命的金黄色葡萄球菌感染,如菌血症、感染性心内膜炎、肺炎、中毒性休克综合征和手术部位感染。然而,与这些克隆谱系相关的毒力机制,特别是USA100和USA600分离株,一直未得到充分研究。我们通过成熟的体外试验以及在感染性心内膜炎和败血症的兔模型中进行体内研究,调查了这些菌株以及USA200、USA300和USA400型菌株的毒力。我们在感染性心内膜炎和败血症模型中发现,USA100和USA600谱系的菌株具有高致死率,并且擅长引起天然瓣膜感染性心内膜炎。具有高细胞溶解活性或产生中毒性休克综合征毒素1(TSST-1)或葡萄球菌肠毒素C(SEC)的菌株即使细胞溶解活性较低也会导致致命性败血症。USA100、USA200、USA400和USA600谱系的菌株始终含有编码肠毒素基因簇蛋白、SEC或TSST-1的基因,并且擅长引起感染性心内膜炎,而USA300菌株缺乏这些毒素,在促进赘生物生长方面存在缺陷。我们收集的USA100、USA200和USA400菌株在体外形成强大的生物膜,而USA200和USA600菌株在血液中的存活率增加。因此,感染性心内膜炎和致命性败血症是多因素的,并非任何一个单独克隆组所固有,这进一步凸显了扩大我们对导致侵袭性疾病的金黄色葡萄球菌致病机制知识的重要性。重要性:金黄色葡萄球菌是发达国家感染性心内膜炎的主要病因,在美国每年影响约4万人,是菌血症的第二大病因(D. R. Murdoch等人,《内科学文献》169:463 - 473,2009年,http://dx.doi.org/10.1001/archinternmed.2008.603;以及H. Wisplinghoff等人,《临床感染病杂志》39:309 - 317,2004年,http://dx.doi.org/10.1086/421946)。即使有当前的医学进展,金黄色葡萄球菌血流感染和感染性心内膜炎的死亡率仍为20%至66%(S. Y. Tong等人,《临床微生物学综述》28:603 - 661,2015年,http://dx.doi.org/10.1128/CMR.00134 - 14)。全球范围内与人类疾病相关的金黄色葡萄球菌谱系包括克隆复合体5(CC5)/USA100、CC30/USA200、CC8/USA300、CC1/USA400和CC45/USA600。CC5/USA100、CC30/USA200和CC45/USA600谱系导致侵袭性疾病,但特征仍不明确。USA300和细胞毒素是大多数金黄色葡萄球菌毒力研究的核心,但我们发现有证据表明克隆组在通常用于衡量毒力的参数(包括细胞毒性、生物膜形成和血液存活率)方面差异很大,并且超抗原谱是定义金黄色葡萄球菌菌株毒力时需要考虑的一个重要参数。
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