Biomedical Sciences Graduate Program, UC San Diego, La Jolla, CA 92093, USA.
Department of Pediatrics, UC San Diego, La Jolla, CA 92093, USA.
Sci Transl Med. 2021 Mar 24;13(586). doi: 10.1126/scitranslmed.abd6737.
(SA) bloodstream infections cause high morbidity and mortality (20 to 30%) despite modern supportive care. In a human bacteremia cohort, we found that development of thrombocytopenia was correlated to increased mortality and increased α-toxin expression by the pathogen. Platelet-derived antibacterial peptides are important in bloodstream defense against SA, but α-toxin decreased platelet viability, induced platelet sialidase to cause desialylation of platelet glycoproteins, and accelerated platelet clearance by the hepatic Ashwell-Morell receptor (AMR). Ticagrelor (Brilinta), a commonly prescribed P2Y12 receptor inhibitor used after myocardial infarction, blocked α-toxin-mediated platelet injury and resulting thrombocytopenia, thereby providing protection from lethal SA infection in a murine intravenous challenge model. Genetic deletion or pharmacological inhibition of AMR stabilized platelet counts and enhanced resistance to SA infection, and the anti-influenza sialidase inhibitor oseltamivir (Tamiflu) provided similar therapeutic benefit. Thus, a "toxin-platelet-AMR" regulatory pathway plays a critical role in the pathogenesis of SA bloodstream infection, and its elucidation provides proof of concept for repurposing two commonly prescribed drugs as adjunctive therapies to improve patient outcomes.
血流感染尽管有现代支持性治疗,仍会导致高发病率和死亡率(20%至 30%)。在人类菌血症队列中,我们发现血小板减少症的发展与死亡率增加以及病原体α-毒素表达增加相关。血小板衍生的抗菌肽在血流防御 SA 中很重要,但α-毒素降低血小板活力,诱导血小板唾液酸酶导致血小板糖蛋白去唾液酸化,并通过肝 Ashwell-Morell 受体(AMR)加速血小板清除。替卡格雷(Brilinta)是一种常用于心肌梗死后的常用 P2Y12 受体抑制剂,可阻断α-毒素介导的血小板损伤和由此导致的血小板减少症,从而在小鼠静脉内挑战模型中提供对致死性 SA 感染的保护。AMR 的基因缺失或药理学抑制稳定了血小板计数并增强了对 SA 感染的抵抗力,抗流感唾液酸酶抑制剂奥司他韦(Tamiflu)提供了类似的治疗益处。因此,“毒素-血小板-AMR”调节途径在 SA 血流感染的发病机制中起着关键作用,其阐明为重新利用两种常用药物作为辅助治疗以改善患者预后提供了概念验证。
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