Escolar de once años con cuadro inicial de monoartritis de rodilla derecha por traumatismo local, fi ebre, trastorno del sensorio y disnea. Es hospitalizado y recibe tratamiento antibiótico empírico. El hemocultivo resulta positivo para Streptococcus pyogenes, por lo que se decide corregir la cobertura antibiótica. Sin embargo, el estado general del paciente empieza a decaer e ingresa a la unidad de cuidados intensivos. A pesar del tratamiento instaurado, el sujeto desarrolla shock séptico y posteriormente falla multiorgánica, requiriendo soporte hemodinámico y ventilatorio. Los síntomas se agravan y fallece a las 38 horas de su admisión hospitalaria. / An 11-year-old scholar arrives in the emergency room with right-knee monoarthritis due to local trauma, fever, sensory loss, and dyspnea. He is hospitalized and receives empiric antibiotic therapy. The blood culture set is positive for Streptococcus pyogenes and the antibiotic spectrum is changed. However, the patient’s general status deteriorates, and he is admitted to the intensive care unit. Even with the treatment received, he develops septic shock and multiorganic failure, requiring hemodynamic and ventilatory support. Thirty-eight hours after his admission, the patient dies.

The bacterium Streptococcus pyogenes requires heme, which is taken up via an ABC transporter. An understanding of this pathway may result in new approaches to antibacterial agents. Both SiaA and NEAT2 (NEAr Transporter 2) are proteins involved in heme binding. One of the axial ligands of SiaA, His 229, was purified to study how mutagenesis affects heme binding. UV-visible studies showed a small band at 420 nm with respect to the protein band at 288 nm which probably indicates that heme was lost easily from this mutant. We have also worked to optimize the yield of Shr-NEAT2 by changing different variables. For each of the batches, the yield of holoNEAT2 was calculated by UV-visible spectroscopy. Increasing oxygen during growth did not improve holoNEAT2 yield. On the other hand, lower temperature, decrease in time after induction, and addition of ALA all increased the protein production.

Group A streptococcus (GAS) is an important pathogen that produces a wide spectrum of suppurative infections and autoimmune sequelae in humans, ranging from less complex pharyngitis, impedigo to more severe manifestations such as necrotizing fasciitis, toxic shock syndrome, rheumatic fever and glomerulonephritis. The worldwide burden of GAS infections and sequelae is considerable, but an immunization program that defends against the hyper-variable GAS is missing. The streptococcal hemoprotein receptor (Shr), is an iron-regulated protein involved in heme acquisition. An unspecified region in the amino terminus of Shr mediates the interactions with hemoglobin and two protein modules named NEAT1 and NEAT2 bind heme. In this study, we analyzed the molecular structure and function of Shr, investigated its antigenic properties and role in GAS disease production. We demonstrated that Shr is a new type of GAS adhesin that contributes to the pathogen interactions with extracellular matrix (ECM) proteins. Shr enabled bacterial adherence to host cells and was important for GAS virulence in vivo. Immunizations with Shr protein by intraperitoneal or intranasal administration conferred resistance to systemic GAS challenge in mice. Shr antiserum allowed bacterial opsonization and defended against GAS diseases in a murine model for passive vaccination. Studies with isolated Shr domains localized ECM-binding to the NEAT domains and showed that most of the protein is exposed on the bacterial surface. In addition, Shr N-terminal region and both of the NEAT modules elicited strong antibody response in rabbits. In conclusion, Shr is a protective antigen that contributes to GAS pathogenesis by facilitating both heme uptake and bacterial adherence. Since Shr is conserved among GAS strains and other pyogenic streptococci, this study demonstrates that Shr may be used to develop a vaccine against GAS strains and related pathogens.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成23年3月25日 亀ヶ谷太一氏の博士論文として提出された

<p>Gram-positive pathogens, such as <italic>Streptococcus pyogenes</italic> and <italic>Staphylococcus aureus</italic>, are etiological agents of a large array of human diseases. Unfortunately, our ability to treat these infections is increasingly limited due to the development of bacterial resistance to many existing therapies. Thus, novel targets for antimicrobial development are urgently needed. An attractive candidate for a new class of anti-virulence chemotherapeutics is the sortase class of enzymes. Sortases are extracellular transpeptidases unique to Gram-positive bacteria. Their function is to covalently attach secreted virulence factors to the bacterial cell wall. Deletion or inhibition of sortases results in severe attenuation of bacteria for infection. In order to develop novel effective antimicrobial agents, a robust understanding of the biological and chemical mechanisms of the target are required. To this end, this dissertation endeavors to further illuminate the biochemical mechanism of sortase enzymes and to extend the current knowledge of the roles of sortases and their substrates during infection.</p><p>Through steady-state kinetics, active site reactivity measurements, three-dimensional structure determination via X-ray crystallography, and computational modeling of substrate binding, the basic enzyme mechanism of <italic>S. pyogenes</italic> sortase A (SrtA) has been revealed. In general, <italic>S. pyogenes</italic> SrtA displays many of the same mechanistic characteristics as previously studied sortases, including a reverse protonation mechanism, a conserved tertiary structure arrangement, and utilization of similar substrate binding interfaces and conserved active site residue functions. These findings suggest a general sortase mechanism, conserved among classes and species.</p><p>Initial steps have also been taken to characterize <italic>S. pyogenes</italic> sortase C (SrtC). SrtC enzymes are unique in that they covalently polymerize secreted proteins, rather than attach them to peptidoglycan. Full length and truncation mutant constructs of SrtC and its substrate, T3, and peptide substrate mimics have been produced in soluble form for use in kinetic assays. Additionally, initial crystallization conditions have been identified for <italic>S. pyogenes</italic> SrtC towards the goal of three-dimensional structure determination. A homology model of the structure has also been produced, displaying many of the general features observed for other sortase enzymes.</p><p>Additionally, a computational analysis of the mechanism of isopeptide bond formation in <italic>S. pyogenes</italic> SPy0128, a substrate of <italic>S. pyogenes</italic> SrtC, has been performed. Isopeptide bonds have previously been found in structural studies of Gram-positive bacterial adhesins in each domain of these multi-domain proteins. The bonds are typically formed between conserved lysine and asparagine residues, and formation is likely catalyzed by adjacent conserved glutamates. A direct nucleophilic attack mechanism, starting from an inverse protonation state, is supported in this study. Of note, there appears to be temporal regulation of isopeptide bond formation in the different domains of <italic>S. pyogenes</italic> SPy0128, with the C-terminal domain isopeptide bond forming prior to or simultaneously with the N-terminal domain isopeptide bond.</p><p>Previous studies suggest that SrtA activity is required for <italic>S. aureus</italic> to survive phagocytosis by a macrophage. The production of reactive oxygen species by professional phagocytes could lead to inhibition of SrtA via oxidation of a conserved nucleophilic cysteine residue in the active site. Through determination of inhibition kinetics, identification of oxidative modifications, reduction potential measurements, and analyses of SrtA in vivo activity in the presence of reactive oxygen species, it has been demonstrated that <italic>S. aureus</italic> SrtA is resistant to oxidative inhibition. These findings support SrtA activity inside the phagolysosome of a professional phagocyte and likely contribute to the ability of <italic>S. aureus</italic> to evade the innate immune system.</p><p>The roles of sortases and their substrates during <italic>S. aureus</italic> survival inside professional phagocytes have not been thoroughly investigated. Through analysis of the regulation of these surface proteins under phagolysosomal conditions and macrophage phagocytosis survival assays, initial characterization of the functions of sortases and their substrates in this environment has been completed. Previous studies have suggested a role for SrtA and its substrate, Protein A, and these genes and two other sortase-substrates were upregulated in response to phagolysosomal conditions. However, neither sortases nor their substrates demonstrated a direct function in phagocytosis survival. These findings imply a complex interplay between <italic>S. aureus</italic> and professional phagocytes. Further studies are necessary to delineate the direct activities of surface anchored proteins during phagocytosis of <italic>S. aureus</italic> by professional phagocytes.</p> / Dissertation

Thesis (Ph.D.)--University of Wollongong, 2006. / Typescript. Includes bibliographical references: leaf 148-160.

Thesis (Ph. D.)--University of Oklahoma. / Bibliography: leaves 143-155.

Thesis (honors)--Georgia State University, 2007. / Title from file title page. Under the direction of Dabney White Dixon. Electronic text (88 p. : col. ill.) : digital, PDF file. Description based on contents viewed Sept. 30, 2008. Includes bibliographical references (p. 46-47).

The human pathogen Streptococcus pyogenes (Group A Streptococcus or GAS) are a versatile Gram-positive cocci that havw shown complex modes of regulation of its different virulence factors. Discoveries of a few small non-coding RNAs (sRNAs) in S. pyogenes and their influence on the expression of virulence factors revealed an important role of sRNAs on S. pyogenes virulence. The genome-wide analysis of bacterial genomes for the discovery of sRNAs through computational methods has become an effective way to discover new sRNAs. In this study we provided a computational scheme where three different algorithms (RNAz, eQRNA, and sRNAPredict) were combined to increase the probabilities of predicting putative sRNAs within S. pyogenes' intergenic regions (IGR). A total of 46 candidates were chosen based on our criteria, and through Northern blot we analyzed each candidate. We obtained hybridization signals from twelve newly discovered sRNAs in S. pyogenes. Subsequently, we analyzed their sequence and their location within the IGR to find a putative -10 promoter region and possible Rho-independent terminator site, and their possible targets through computational methods. We further expanded our analysis of the new sRNAs by using Real-Time RT-PCR to determine the expression of sRNAs during different phases of growth. Our results showed that our computational scheme and experimental method was effective in predicting sRNAs previously undiscovered in S. pyogenes, and that more sRNAs are yet to be discovered and characterized, helping to further understand the regulation of virulence factors in S. pyogenes

Streptococcus pyogenes infections can give rise to a diverse array of long-term secondary sequelae, including those in the brain characterized by both motor and neuropsychiatric disorders: Sydenham’s chorea and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS). These conditions are thought to be mediated by neuroinflammatory responses and autoantibody entry into the brain, but the mechanisms are not well understood.Previous work by our laboratory has demonstrated that recurrent intranasal S. pyogenes (Group A Streptococcus, or GAS) inoculations in mice cause infiltration of CD4 T cells into the anterior brain, disruption of the blood-brain barrier (BBB), increased numbers of activated myeloid cells and degradation of excitatory synapses leading to neural circuitry deficits. However, the molecular mechanisms underlying these phenotypes have not been fully explored. To understand how the neurovasculature and myeloid cells respond to recurrent GAS infections at the transcriptome level, I profiled cells from mouse olfactory bulb (OB) and nasal lymphoid tissue by single-cell RNA sequencing (scRNAseq). I found marked shifts in both endothelial cell and microglia populations at the transcriptome level after GAS infections, including downregulation of BBB-associated transcripts by endothelial cells (ECs), and increased production of inflammatory cytokines and chemokines, type I interferon response, and antigen presentation genes by microglia (Chapter 3). I validated several differentially expressed genes using flow cytometry, immunosorbant assays, RNA fluorescence in situ hybridization (FISH), and multiplexed error-robust FISH (MERFISH). Single-cell spatial transcriptomics of the OB revealed regional heterogeneity among microglial responses to GAS, possibly driven by proximity to infiltrating T cells. Analysis of transgenic CX3CR1/TMEM119 dual myeloid reporter mice confirmed that perivascular and meningeal macrophage numbers increase in response to GAS, but, unlike in other neuroinflammatory diseases, few macrophages infiltrate the brain parenchyma. Our laboratory has previously shown that Th17 cells are critical for BBB damage and activated microglia in response to repeated intranasal GAS infections, but the contribution of T helper (Th) 17 cell-derived cytokines in this process, as well as the transcriptional effects of Th17 cells on endothelial cells and microglia are unknown. To expand on these findings, I performed scRNAseq on retinoic acid-related orphan receptor γt (RORγt) mutant mice (Chapter 4) which showed a significant rescue in BBB-associated genes (e.g. Mfsd2a, Itm2a and Itih5) in endothelial cells. Chemokine production and type I interferon gene expression by microglia was also significantly rescued in RORγt mutants; surprisingly antigen presentation by microglia in response to GAS was exacerbated, at both the gene and protein level. Interleukin (IL)-17A is a major cytokine produced by Th17 cells. To examine the role of IL-17A in disease pathogenesis, I treated wild-type mice with an IL-17A neutralizing antibody during the course of GAS infections (Chapter 4). This treatment was sufficient to recapitulate the transcriptional effects on microglia and endothelial cells, as well as rescue BBB permeability previously found in RORγt mutants, indicating that IL-17A may play a critical role in transcriptional responses of endothelial cells and microglia to recurrent GAS infections in vivo. However, IL-17A did not disrupt tight junctions or induce transcytosis on ECs in vitro, suggesting that its effects on ECs in vivo are indirect. Th17 cells are capable of considerable phenotypic plasticity in response to chronic inflammation. To understand this process during recurrent GAS infections, I performed a time course analysis of CD4 T cell subsets after two, three, four and five infections (Chapter 5). This analysis revealed that proportions of “pathogenic” interferon γ-expressing Th17 cells increased over time, as did the number of CD4 T cells expressing granulocyte-macrophage colony stimulating factor (GM-CSF), a cytokine with pleiotropic effects on autoimmunity. Moreover, I determined that RORγt mutants have decreased proportions of GM-CSF+ CD4 T cells in their nasal mucosa, raising the question of whether GM-CSF may also contribute to CNS pathology (BBB permeability or microglial activation) in addition to IL-17A. To address this question, I generated mice deficient for GM-CSF in T cells and found that conditional deletion of GM-CSF in CD4+ cells partly rescued type I interferon and antigen presentation responses in microglia by scRNAseq, but did not rescue BBB leakage, suggesting that GM-CSF and IL-17A have distinct roles in the neurovascular and neuroinflammatory responses to GAS. To relate the findings in mice to the human disease, in Chapter 6 we performed cytokine profiling in sera from PANDAS/PANS patients at the acute phase of the disease using a multiplex bead-based immunoassay. We found that many chemokines and cytokines produced by activated microglia or macrophages in the mouse model were also highly elevated in the sera of PANDAS/PANS patients. These findings suggest an important link to the human disorder both to understand disease mechanisms in humans and to use them as future clinical biomarkers for diagnosis and treatment monitoring.