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Joye R, Cousin VL, Malaspinas I, Mwizerwa L, Bouhabib M, Nalecz T, Sologashvili T, Beghetti M, L’Huillier AG, Wacker J. Infective Endocarditis Due to Kingella kingae. Microorganisms 2024; 12:164. [PMID: 38257992 PMCID: PMC10819173 DOI: 10.3390/microorganisms12010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Infective endocarditis due to Kingella kingae is a rare but serious invasive infection that occurs mostly in children. Recent advances in nucleic acid amplification testing as well as in cardiac imaging have enabled more accurate diagnosis. A good understanding of the epidemiology and virulence factors remains crucial to guide the therapeutic approach. Here, we synthesize the current state of knowledge on epidemiological features, pathophysiological insights, complications, and therapy regarding Kingella kingae endocarditis in children and adults. Finally, throughout this comprehensive review, knowledge gaps and areas for future research are also identified.
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Affiliation(s)
- Raphael Joye
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Vladimir L. Cousin
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Iliona Malaspinas
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Leonce Mwizerwa
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Maya Bouhabib
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Tomasz Nalecz
- Pediatric Cardiac Surgery Unit, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (T.N.); (T.S.)
| | - Tornike Sologashvili
- Pediatric Cardiac Surgery Unit, Department of Surgery, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (T.N.); (T.S.)
| | - Maurice Beghetti
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
| | - Arnaud G. L’Huillier
- Pediatric Infectious Disease Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland;
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (V.L.C.); (I.M.); (L.M.); (M.B.); (J.W.)
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Osickova A, Knoblochova S, Bumba L, Man P, Kalaninova Z, Lepesheva A, Jurnecka D, Cizkova M, Biedermannova L, Goldsmith JA, Maynard JA, McLellan JS, Osicka R, Sebo P, Masin J. A conserved tryptophan in the acylated segment of RTX toxins controls their β 2 integrin-independent cell penetration. J Biol Chem 2023; 299:104978. [PMID: 37390987 PMCID: PMC10392135 DOI: 10.1016/j.jbc.2023.104978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023] Open
Abstract
The acylated Repeats in ToXins (RTX) leukotoxins, the adenylate cyclase toxin (CyaA) or α-hemolysin (HlyA), bind β2 integrins of leukocytes but also penetrate cells lacking these receptors. We show that the indoles of conserved tryptophans in the acylated segments, W876 of CyaA and W579 of HlyA, are crucial for β2 integrin-independent membrane penetration. Substitutions of W876 by aliphatic or aromatic residues did not affect acylation, folding, or the activities of CyaA W876L/F/Y variants on cells expressing high amounts of the β2 integrin CR3. However, toxin activity of CyaA W876L/F/Y on cells lacking CR3 was strongly impaired. Similarly, a W579L substitution selectively reduced HlyA W579L cytotoxicity towards cells lacking β2 integrins. Intriguingly, the W876L/F/Y substitutions increased the thermal stability (Tm) of CyaA by 4 to 8 °C but locally enhanced the accessibility to deuteration of the hydrophobic segment and of the interface of the two acylated loops. W876Q substitution (showing no increase in Tm), or combination of W876F with a cavity-filling V822M substitution (this combination decreasing the Tm closer to that of CyaA), yielded a milder defect of toxin activity on erythrocytes lacking CR3. Furthermore, the activity of CyaA on erythrocytes was also selectively impaired when the interaction of the pyrrolidine of P848 with the indole of W876 was ablated. Hence, the bulky indoles of residues W876 of CyaA, or W579 of HlyA, rule the local positioning of the acylated loops and enable a membrane-penetrating conformation in the absence of RTX toxin docking onto the cell membrane by β2 integrins.
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Affiliation(s)
- Adriana Osickova
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Sarka Knoblochova
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Ladislav Bumba
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Petr Man
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Zuzana Kalaninova
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic; Faculty of Sciences, Charles University, Prague, Czech Republic
| | - Anna Lepesheva
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic; Faculty of Sciences, Charles University, Prague, Czech Republic
| | - David Jurnecka
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Monika Cizkova
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Lada Biedermannova
- Institute of Biotechnology of the Czech Academy of Sciences, BIOCEV, Vestec, Czech Republic
| | - Jory A Goldsmith
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, USA
| | - Jennifer A Maynard
- Department of Chemical Engineering, The University of Texas at Austin, Austin, USA
| | - Jason S McLellan
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, USA
| | - Radim Osicka
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Peter Sebo
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic.
| | - Jiri Masin
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic.
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Morreale DP, Porsch EA, Kern BK, St Geme JW, Planet PJ. Acquisition, co-option, and duplication of the rtx toxin system and the emergence of virulence in Kingella. Nat Commun 2023; 14:4281. [PMID: 37460464 DOI: 10.1038/s41467-023-39939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
The bacterial genus Kingella includes two pathogenic species, namely Kingella kingae and Kingella negevensis, as well as strictly commensal species. Both K. kingae and K. negevensis secrete a toxin called RtxA that is absent in the commensal species. Here we present a phylogenomic study of the genus Kingella, including new genomic sequences for 88 clinical isolates, genotyping of another 131 global isolates, and analysis of 52 available genomes. The phylogenetic evidence supports that the toxin-encoding operon rtxCA was acquired by a common ancestor of the pathogenic Kingella species, and that a preexisting type-I secretion system was co-opted for toxin export. Subsequent genomic reorganization distributed the toxin machinery across two loci, with 30-35% of K. kingae strains containing two copies of the rtxA toxin gene. The rtxA duplication is largely clonal and is associated with invasive disease. Assays with isogenic strains show that a single copy of rtxA is associated with reduced cytotoxicity in vitro. Thus, our study identifies key steps in the evolutionary transition from commensal to pathogen, including horizontal gene transfer, co-option of an existing secretion system, and gene duplication.
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Affiliation(s)
- Daniel P Morreale
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Eric A Porsch
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brad K Kern
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joseph W St Geme
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Paul J Planet
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Comparative Genomics, American Museum of Natural History, New York, NY, USA.
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Rahman WU, Fiser R, Osicka R. Kingella kingae RtxA toxin interacts with sialylated gangliosides. Microb Pathog 2023:106200. [PMID: 37315629 DOI: 10.1016/j.micpath.2023.106200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/16/2023]
Abstract
The membrane-damaging RTX family cytotoxin RtxA is a key virulence factor of the emerging pediatric pathogen Kingella kingae, but little is known about the mechanism of RtxA binding to host cells. While we have previously shown that RtxA binds cell surface glycoproteins, here we demonstrate that the toxin also binds different types of gangliosides. The recognition of gangliosides by RtxA depended on sialic acid side groups of ganglioside glycans. Moreover, binding of RtxA to epithelial cells was significantly decreased in the presence of free sialylated gangliosides, which inhibited cytotoxic activity of the toxin. These results suggest that RtxA utilizes sialylated gangliosides as ubiquitous cell membrane receptor molecules on host cells to exert its cytotoxic action and support K. kingae infection.
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Affiliation(s)
- Waheed Ur Rahman
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Radovan Fiser
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic; Department of Genetics and Microbiology, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Radim Osicka
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic.
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Yagupsky P. Kingella kingae Reveals Its Secrets. Microorganisms 2022; 10:microorganisms10071261. [PMID: 35888980 PMCID: PMC9325099 DOI: 10.3390/microorganisms10071261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 12/10/2022] Open
Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
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Porsch EA, Hernandez KA, Morreale DP, Montoya NR, Yount TA, St Geme JW. Pathogenic determinants of Kingella kingae disease. Front Pediatr 2022; 10:1018054. [PMID: 36304526 PMCID: PMC9592894 DOI: 10.3389/fped.2022.1018054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/16/2022] [Indexed: 01/18/2023] Open
Abstract
Kingella kingae is an emerging pediatric pathogen and is increasingly recognized as a leading etiology of septic arthritis, osteomyelitis, and bacteremia and an occasional cause of endocarditis in young children. The pathogenesis of K. kingae disease begins with colonization of the upper respiratory tract followed by breach of the respiratory epithelial barrier and hematogenous spread to distant sites of infection, primarily the joints, bones, and endocardium. As recognition of K. kingae as a pathogen has increased, interest in defining the molecular determinants of K. kingae pathogenicity has grown. This effort has identified numerous bacterial surface factors that likely play key roles in the pathogenic process of K. kingae disease, including type IV pili and the Knh trimeric autotransporter (adherence to the host), a potent RTX-family toxin (epithelial barrier breach), and multiple surface polysaccharides (complement and neutrophil resistance). Herein, we review the current state of knowledge of each of these factors, providing insights into potential approaches to the prevention and/or treatment of K. kingae disease.
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Affiliation(s)
- Eric A Porsch
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kevin A Hernandez
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel P Morreale
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nina R Montoya
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Taylor A Yount
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Joseph W St Geme
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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