Immunization for Prevention of Infective Endocarditis

Rationale for the development of immunotherapy regimens against enterococcal infections

Enterococci are the third most common pathogen isolated in bloodstream infections. Increasing resistance against multiple antimicrobial agents has left few treatment options for enterococcal infections, and alternative therapeutic approaches are needed. Although a variety of virulence factors have been described for Enterococcus faecalis, only aggregation substance (AS) and a teichoic acid-like capsular polysaccharide have been evaluated for their potential for vaccine development. Antibodies raised against purified capsular polysaccharide are highly opsonic and protect mice against bacteremia after active and passive immunization. Since E. faecalis expresses only a limited number of capsular serotypes, this antigen may be an attractive candidate for development of a conjugate vaccine.

The sloABCR operon of Streptococcus mutans encodes an Mn and Fe transport system required for endocarditis virulence and its Mn-dependent repressor

Streptococcus mutans belongs to the viridans group of oral streptococci, which is the leading cause of endocarditis in humans. The LraI family of lipoproteins in viridans group streptococci and other bacteria have been shown to function as virulence factors, adhesins, or ABC-type metal transporters. We previously reported the identification of the S. mutans LraI operon, sloABCR, which encodes components of a putative metal uptake system composed of SloA, an ATP-binding protein, SloB, an integral membrane protein, and SloC, a solute-binding lipoprotein, as well as a metal-dependent regulator, SloR. We report here the functional analysis of this operon. By Western blotting, addition of Mn to the growth medium repressed SloC expression in a wild-type strain but not in a sloR mutant. Other metals tested had little effect. Cells were also tested for aerobic growth in media stripped of metals then reconstituted with Mg and either Mn or Fe. Fe at 10 micro M supported growth of the wild-type strain but not of a sloA or sloC mutant. Mn at 0.1 micro M supported growth of the wild-type strain and sloR mutant but not of sloA or sloC mutants. The combined results suggest that the SloABC proteins transport both metals, although the SloR protein represses this system only in response to Mn. These conclusions are supported by (55)Fe uptake studies with Mn as a competitor. Finally, a sloA mutant demonstrated loss of virulence in a rat model of endocarditis, suggesting that metal transport is required for endocarditis pathogenesis.