Contribution of the periplasmic chaperone Skp to efficient presentation of the autotransporter IcsA on the surface of Shigella flexneri

Vectorial transport and folding of an autotransporter virulence protein during outer membrane secretion

Autotransporter (AT) proteins are a large and diverse family of extracellular virulence proteins from Gram-negative bacteria, characterized by a central beta-helix domain within the mature virulence protein. It is not clear how these proteins cross the outer membrane (OM) quickly and efficiently, without assistance from an external energy source such as ATP or a proton gradient. Conflicting results in the literature have led to several proposed mechanisms for AT OM secretion, including a concerted process, or vectorial secretion with different directionalities. We introduced pairs of cysteine residues into the passenger sequence of pertactin, an AT virulence protein from Bordetella pertussis, and show that OM secretion of the passenger domain stalls due to the formation of a disulphide bond. We further show that the C-terminus of the pertactin passenger domain beta-helix crosses the OM first, followed by the N-terminal portions of the virulence protein. In vivo proteolytic digestion shows that the C-terminus is exposed to the extracellular milieu during stalling, and forms stable structure. These AT secretion and folding features can potentially facilitate efficient secretion.

Recent advances in techniques of liver resection

The role of liver resection for benign and malignant hepatobiliary diseases is expanding because of the markedly reduced operative mortality in recent years, as the result of better patient selection, improved surgical techniques, and better perioperative management. The major technical challenge of liver resection is control of bleeding during transection of liver parenchyma. Ultrasonic dissector and clamp crushing are the two techniques used most frequently in liver transection. In recent years, new instruments have been developed for liver transection with an aim to reduce bleeding. Other important advances in liver surgery that have contributed to improved perioperative outcomes include intraoperative ultrasound (IOUS), use of vascular staplers, and reduced bleeding by the development of low central venous pressure anesthesia. Laparoscopy is useful for staging purposes, and laparoscopic liver resection is gaining popularity due to the availability of new laparoscopic instruments for liver transection. Development of local ablative therapies for liver tumors, such as radiofrequency (RF) ablation, is posing a competition to liver resection. However, such techniques also have allowed expansion of indication for hepatic resection to patients with bilobar tumors, and thermal ablative technologies have been used for liver transection. This chapter reviews the current techniques of liver resection.