Public release date: 11-Nov-2007
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Contact: Ken Pekoc
NIH/National Institute of Allergy and Infectious Diseases

Factor key to severity of community-associated methicillin-resistant staph infections identified

Newly described proteins in drug-resistant strains of the Staphylococcus aureus bacterium attract and then destroy
protective human white blood cells—a key process ensuring that S. aureus survives and causes severe disease,
according to scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National
Institutes of Health.

S. aureus disease is a global public health concern because some strains, including community-associated methicillin
resistant S. aureus (CA-MRSA), have developed resistance to existing antibiotics. The NIAID scientists hope to use
this finding to advance development of new therapeutic treatments.

In a study published online in Nature Medicine, Michael Otto, Ph.D., and his colleagues at NIAID’s Rocky Mountain
Laboratories (RML) describe how novel members of the phenol-soluble modulin (PSM) protein family help determine
disease severity and eliminate immune defense mechanisms against CA-MRSA.

“This elegant work helps reveal the complex strategy that S. aureus has developed to evade our normal immune
defenses,” says Anthony S. Fauci, M.D., NIAID director. “Understanding what makes the infections caused by these
new strains so severe and developing new drugs to treat them are urgent public health priorities.”

Up until a year ago, most scientists studying S. aureus believed they had narrowed their search for the cause of
severe CA-MRSA infections, focusing on the Panton-Valentine leukocidin (PVL) toxin produced by certain strains. But
then last year, Dr. Otto and his RML colleagues published a study indicating that PVL does not play a major role in
CA-MRSA infections (

Given the scope of the problem in the United States, Dr. Otto’s group continued its search to understand why the CA-
MRSA strains cause widespread and often severe infections in otherwise healthy people. Until now, no one had
examined what role PSMs have in Staphylococcus infection.

The RML group identified previously unknown PSMs secreted by S. aureus and identified the genes that encode
those PSM proteins. They then compared PSM production between CA-MRSA and the most prominent hospital-
associated MRSA strains. The research team found PSM genes in all MRSA strains, but production of the proteins
was typically higher in CA-MRSA strains known for severe virulence, according to Dr. Otto.

To determine whether PSMs contribute to virulence, the scientists developed test strains using the most widespread
isolates of CA-MRSA, called USA300 and USA400. Each test strain had a certain combination of PSM-encoding
genes removed so the researchers could ascertain whether those genes affected virulence. The scientists then
observed how laboratory mice responded to the test strains. By doing so, they pinpointed the psm-alpha gene cluster
(which makes PSM-alpha protein) as playing an essential role in determining CA-MRSA virulence and, ultimately,
disease severity.

To understand how PSMs contribute to virulence, Dr. Otto and colleagues next examined the role of the molecules in
S. aureus evasion of human immune defenses. They observed that the psm-alpha genes generated the most
resistance activity and the PSM-alpha proteins were best at destroying most immune cells that help protect against
infection and disease. In all instances, the PSM-alpha molecules caused the greatest destruction of white blood cells,
an effect that occurred rapidly.

What was remarkable, says Dr. Otto, is that a specific sensing mechanism likely enabled S. aureus to secrete PSMs
at the ideal time when host immune cells were weakest and most vulnerable to destruction. Likewise, PSM production
slowed when the bacterial survival was most jeopardized.

“We’re not saying the psm-alpha gene cluster is the only element contributing to the virulence and survival of CA-
MRSA, but it is a major factor,” says Dr. Otto.

Next, he and his RML colleagues will examine whether the simple presence of the psm-alpha genes create havoc with
the immune system, or whether some unknown trigger causes these genes to be expressed in a harmful way. Dr. Otto’
s group also is continuing to study the molecular details of how PSMs function. Ultimately they hope to identify new
candidate therapeutics for CA-MRSA by studying the roles of the different PSM genes.

NIAID is a component of the National Institutes of Health. NIAID supports basic and applied research to prevent,
diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza,
tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on basic
immunology, transplantation and immune-related disorders, including autoimmune diseases, asthma and allergies.

The National Institutes of Health (NIH)—The Nation's Medical Research Agency—includes 27 Institutes and Centers
and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for
conducting and supporting basic, clinical and translational medical research, and it investigates the causes,
treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit

References: R Wang et al. Identification of novel cytolytic peptides as key virulence determinants of community-
associated MRSA. Nature Medicine DOI: 10.1038/nm1656 (2007).

J Voyich et al. Is Panton-Valentine leukocidin the major virulence determinant in community-associated methicillin-
resistant Staphylococcus aureus disease? The Journal of Infectious Diseases 194(12) (2006).

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