Fulminant group A streptococcal infections

Summary We describe two female patients presenting with spontaneous peritonitis and fulminant Streptococcus pyogenes (Strep. pyogenes) septicemia and shock. Both patients recovered completely upon immediate antibiotic therapy, initially with broad range combination therapy effective againstStrep. pyogenes, which was switched to penicillin G when culture results became available. The isolated strain in case 1 was M-type 28, which is the M-type most often isolated from vaginal swabs (as commensal) and from blood from patients with puerperal sepsis. Patient 1 had signs and symptoms of a toxic shock-like syndrome, including rapid onset of fever and shock, skin rash, desquamation of palms and soles, and multisystem involvement with vomiting, diarrhea, myalgia, renal failure, and severe disorientation without focal neurological deficits.Abbreviations Strep. pyogenes Streptococcus pyogenes (=group A beta-hemolytic streptococcus)     

Binding of group B streptococcal phosphoglycerate kinase to plasminogen and actin

The glycolytic enzyme, phosphoglycerate kinase (PGK) of group B streptococci (GBS), has previously been identified as expressed on the GBS cell surface. The data presented describes the ability of group B streptococcal phosphoglycerate kinase (GBS-PGK) to bind to plasminogen and to bind actin. GBS-PGK binding to plasminogen was inhibited by the lysine analogue, 6-aminocaproic acid, suggesting plasminogen binding is achieved through GBS-PGK lysine residues. In addition to GBS-PGK surface expression, GBS-PGK was also found to be released from the bacterial cell suggesting GBS-PGK may affect its environment independent of GBS. To determine the effect of GBS-PGK on the actin cytoskeleton within a host cell, GBS-PGK attached to green fluorescent protein was transfected into and expressed in HeLa cells. Transfected GBS-PGK disrupted the actin cytoskeleton resulting in a compact or ovoid shaped HeLa cell rather than a typical epithelioid appearance.In conclusion, we have shown GBS-PGK binds to plasminogen and actin. We have also shown that GBS-PGK can be released from the bacterial cell and that transfected GBS-PGK can alter the epithelial cell cytoskeleton.     

尼古丁对血管内皮细胞释放t-PA及PAI-1的影响

目的: 研究尼古丁对人脐静脉内皮细胞(HUVECs)释放组织型纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制物-1(PAI-1)的影响。方法: HUVECs培养后接种于24孔培养板中,随机分为对照组及实验组,分别进行以下实验。(1)以0.1、1、10、100 μmol/L 尼古丁孵育HUVECs,12 h后收集各组上清液;(2)以100 μmol/L尼古丁与HUVECs孵育0、4、6、8、12 及24 h,收集各组上清液。采用ELISA法测定各组t-PA和PAI-1的浓度。结果: HUVECs与不同浓度尼古丁孵育12 h后,100 μmol/L尼古丁组PAI-1蛋白较对照组明显增加(P<0.01);0.1、1及10 μmol/L尼古丁组PAI-1蛋白与对照组比较,均无显著差异(均P>0.05);各浓度组t-PA蛋白与对照组比较,均无显著差异(均P>0.05)。HUVECs 与100 μmol/L的尼古丁分别孵育4 、6 、8 、12 及24 h,各组PAI-1蛋白均较对照组明显升高(P<0.05),且其升高呈时间依赖性;各组t-PA与对照组比较,均无显著差异(均P>0.05)。结论: 尼古丁可抑制HUVECs的纤溶活性,对内皮细胞具有损伤作用。     

辛伐他汀对尼古丁诱导脐静脉 内皮细胞分泌t-PA和PAI-1的影响

目的: 研究不同浓度辛伐他汀对尼古丁诱导人脐静脉内皮细胞(HUVECs)分泌组织纤溶酶原激活物(t-PA)和1型纤溶酶原激活物抑制剂(PAI-1)及其基因表达的影响。方法: 将3-6代体外培养的HUVECs随机分为对照组、尼古丁组及不同浓度辛伐他汀组,辛伐他汀组分别以1、10、100 μmol/L辛伐他汀预处理细胞2 h,再以100 μmol/L尼古丁孵育24 h。酶联免疫吸附双抗体夹心法(ELISA)检测细胞上清液t-PA和PAI-1含量;逆转录聚合酶链反应(RT-PCR)检测细胞t-PA和PAI-1 mRNA的表达。结果: 尼古丁组PAI-1分泌和mRNA表达较对照组显著升高(P<0.05)。不同浓度辛伐他汀组PAI-1分泌和mRNA表达均较尼古丁组显著降低,且PAI-1分泌和mRNA表达的降低呈浓度依赖性(均P<0.05),以100 μmol/L辛伐他汀组最为显著。100 μmol/L辛伐他汀组PAI-1分泌和mRNA表达与对照组比较,无显著差异(P>0.05)。尼古丁组t-PA mRNA表达较对照组显著降低(P<0.05)。10、100 μmol/L辛伐他汀组t-PA mRNA表达较尼古丁组显著升高(P<0.05),各组间t-PA分泌无显著差异(均P>0.05)。结论: 在体外,辛伐他汀可降低尼古丁所致的PAI-1分泌和mRNA的表达,并升高t-PA mRNA的表达,从而逆转尼古丁介导的HUVECs纤溶活性减低。     

体外培养的血管内皮细胞低氧低糖损伤后tPA、PAI-1表达变化

目的：观察体外培养的血管内皮细胞低氧低糖损伤后组织型纤溶酶原激活剂(tPA)、Ⅰ型纤溶酶原激活物抑制因子(PAI-1)表达变化，探讨脑缺血后纤溶系统的变化及机制。材料和方法：制备体外内皮细胞低氧低糖损伤模型，利用HE染色、免疫细胞化学染色观察tPA、PAI-1表达变化。结果：低氧低糖损伤后，tPA、PAI-1表达均明显增强。结论：成功制备体外内皮细胞低氧低糖损伤模型。内皮细胞低氧低糖损伤可以诱导tPA、PAI-1表达增多，进一步说明脑缺血损伤后tPA、PAI-1表达增加并参与损伤过程。     

Immunological analysis of plasminogen activators from cultured human cancer cells

Summary Immunological similarities or differences between urokinase and plasminogen activators from 9 lines of cultured human caner cells with varying degrees of fibrinolytic activity were examined with antibodies against human urokinase.The antibodies completely inhibited the fibrinolytic activity of 4 lines of gastric cancer, 2 lines of lung cancer, 1 line of urinary bladder cancer and 1 line of renal cancer, indicating that the plasminogen activators from these cell lines were immunologically identical to urokinase. In 5 out of these cell lines, immunological identity was also confirmed by double diffusion analysis.The plasminogen activator from 1 line of lung cancer was found to be immunologically dissimilar to urokinase by a neutralization experiment and double diffusion analysis.These findings indicate that there are at least two immunologically distinguishable forms of plasminogen activators from human cancer cells.     

Epidemiological considerations following long-term surveillance of invasive group A streptococcal disease in The Netherlands, 1992–2003

A nationwide laboratory-based surveillance system for invasive group A streptococcal (GAS) infections was conducted in The Netherlands from March 1992 until December 2003. Until 1996, all isolates submitted were evaluated clinically and demographically. During this period there was a transition from passive to active surveillance for some of the participating laboratories, corresponding to a national coverage of 50%. During active surveillance, participating laboratories submitted twice as many isolates from invasive GAS disease, whereas the relative submission of isolates representing very severe manifestations (toxic shock-like syndrome, fatality) did not increase. From 1997 onwards, invasiveness was defined solely on the basis of source of isolation (without clinical evaluation). During the period of microbiological and clinical evaluation, microbiological evaluation alone was found to be specific (> 99%), but had limited sensitivity (66%). Estimation of the true rate of invasive GAS disease should be based on an active surveillance system with inclusion of both microbiological and clinical data.     

Streptococcal pyrogenic exotoxin B causes mitochondria damage to polymorphonuclear cells preventing phagocytosis of Group A streptococcus

The streptococcal pyrogenic exotoxin B (SpeB) is known to be involved in group A streptococcus (GAS) survival in blood, but the detailed mechanism is not clear. For clarification of this issue, speB isogenic mutants of strains M6 and M49 were constructed by using an integrational plasmid and confirmed by Southern blot analysis. The resistance to phagocytosis of wild-type strains and their speB isogenic mutants was analyzed. The results demonstrated a five-fold increase in phagocytosis of speB mutants compared to that of wild-type strains in whole blood, but no significant difference in plasma. To further clarify whether this effect is due to a functional SpeB protein, recombinant SpeB (r-SpeB) and a SpeB mutant protein lacking proteinase activity (r-C192S) were purified and incubated with a speB mutant in whole blood. The results showed a two- to threefold increase in resistance to phagocytosis when the M6 speB mutant was incubated with r-SpeB, but not with r-C192S. Incubation with the wild-type strain, speB mutant, or the r-SpeB protein did not affect the total cell number of polymorphonuclear (PMN) cells in whole blood under laboratory conditions. However, the PMN cells’ mitochondria showed decreasing dehydrogenase activity and loss of membrane potential after r-SpeB treatment. These data indicate that SpeB could cause the mitochondria damage to the PMN cells, preventing immune clearance at an early infectious stage.     

Protein kinase A regulates Lewis lung carcinoma adherence to extracellular matrix components and spontaneous metastasis

Tumor cell adhesion to and migration through the extracellular matrix (ECM) can influence their capacity to disseminate. Since prior studies with Lewis lung carcinoma (LLC) tumors had shown metastatic clones to have more protein kinase A (PKA) activity than nonmetastatic clones, the present study assessed if PKA regulates the interaction between tumor and the ECM, and how this may be associated with the metastatic capacity of the tumor cells. This was accomplished with the use of metastatic (LLC-LN7) and nonmetastatic (LLC-C8) variants that had been stably transfected to overexpress the PKA Ca subunit or to have blocked PKA activity. Cells with increased PKA activity were less adherent to vitronectin, laminin, and collagen I, and could more readily migrate through these ECM components than could transfectants with reduced PKA activity. PKA did not regulate adhesion to or migration through fibronectin, and did not appear to be associated with changes in expression of surface integrins. In addition to modulating tumor adhesion and migration in vitro, PKA activation caused an increased formation of metastases from s.c. tumors, but did not regulate formation of experimental metastases by i.v. injected tumor cells. These results suggest that PKA signaling is important for modulating the tumor-ECM interaction and can facilitate tumor transit from the primary tumor site.     

内皮细胞损伤对组织型纤溶酶原激活物结合力的影响

组织型纤溶酶原激活物（ｔ－ＰＡ）在人体纤溶中起主导作用，与内皮细胞结合后可提高自身催化活性并免受其抑制物灭活。本实验用联胺诱发内皮细胞过氧化损伤，以硒做为抗氧化剂，用放射性核素测定及放射自显影的方法观察内皮细胞损伤前后与ｔ－ＰＡ结合力的改变。结果表明：过氧化损伤后内皮细胞与ｔ－ＰＡ结合力明显下降，硒对该结合力的下降有一定抑制作用。提示内皮细胞损伤后纤溶活性降低可能与二者结合力下降有关。     

Decidual stromal cells recruit Th 17 cells into decidua to promote proliferation and invasion of human trophoblast cells by secreting IL-17

T helper 17 （Th17） cells have both regulatory and protective roles in physiological conditions. The Th17 subset and the cytokine interleukin-17A （IL-17A） have been implicated in the pathogenesis of certain autoimmune diseases, several types of cancer and allograft rejection. However, the role of Th17 cells at the maternal/fetal interface remains unknown. Here, we demonstrate that Th17 cells are present in decidua and are increased in the peripheral blood of 10 clinically normal pregnancies based on intracellular cytokine analysis. Our results suggest a potential role of Th17 cells in sustaining pregnancy in humans. Furthermore, we demonstrate that decidual stromal cells （DSCs） but not trophoblast cells recruit peripheral Th17 cells into the decidua by secreting CCL2. The recruited Th17 cells promote proliferation and invasion and inhibit the apoptosis of human trophoblast cells by secreting IL-17 during the first trimester of pregnancy. These findings indicate a novel role for Th17 cells in controlling the maternal-fetal relationship and placenta development.     

Aggregation of group A streptococci by human saliva and effect of saliva on streptococcal adherence to host cells.

The aggregation of group A streptococci by whole, stimulated human saliva (WHS) and the effect of saliva on streptococcal adherence to host cells was investigated. WHS samples from 11 individuals were found to aggregate both M+ and M- group A streptococci to various degrees. The aggregating activity was sensitive to heat, EDTA, EGTA [ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid], sodium dodecyl sulfate, and lipoteichoic acid. None of the simple sugars tested, mercaptoethanol, albumin, or nonionic detergents had any effect on aggregation. The aggregating activity of EDTA-treated saliva was restored by 0.1 mM Ca2+ and 1.0 mM Mn2+ but not by up to 5 mM Mg2+. Only streptococci from the stationary phase were aggregated. Hyaluronidase treatment of streptococci from the exponential phase of growth restored their ability to be aggregated, suggesting that the hyaluronic acid capsule interferes with agglutination. Adsorption of WHS by one strain of Streptococcus pyogenes removed aggregating activity for other strains of S. pyogenes and Streptococcus sanguis but not agglutinins for Escherichia coli, suggesting that the agglutinin is specific for certain gram-positive bacteria. Molecular sieve chromatography of WHS and identification of streptococcus-binding components of saliva suggest that either a glycoprotein of approximately 360 kDa or a mucin of saliva of greater than 1,000 kDa mediates aggregation of streptococci. WHS also inhibited adherence of S. pyogenes to buccal epithelial cells.     

登革2型病毒调控血管内皮细胞纤溶系统相关蛋白的表达

目的观察登革2型病毒（DV2）对人脐静脉血管内皮细胞（HUVEC）表达组织纤溶酶原激活物（tPA）和纤溶酶原激活物抑制物1（PAI-1）的影响。方法应用胰酶消化分离HUVEC并进行传代培养，用生长良好的第2．3代细胞进行试验。用cell counting kit-8（CCK-8）测定DV2感染后细胞活性变化；发色底物法测定感染DV2组和对照组培养液中tPA、PAI-1活性；RT-PCR检测细胞内tPA和PAI-1 mRNA水平。结果DV2感染对细胞活力的影响与对照组相比差异无统计学意义。感染DV2组培养液中tPA活性在12～72h显著升高（P〈0．05）；DV2诱导HUVEC表达tPA mRNA的水平显著上调，12h达到峰值，以后渐降，72h mRNA表达水平仍高于对照组（P〈0．01）。而DV2感染组培养液中PAI-1活性和PAI-1 mRNA的表达与对照组比较差异无统计学意义（P〉0．05）。结论DV2感染可显著上调HUVEC的tPA mRNA转录，增强内皮细胞tPA蛋白的分泌，而不影响PAI-1 mRNA的转录或改变内皮细胞PAI-1的分泌。结果提示DV2可活化但并不损伤内皮细胞，诱发内皮细胞增强表达纤溶酶原激活物而致使纤溶系统失衡，引起纤溶亢进，这可能是诱发DHF／DSS患者急性期出血、低血容量性休克等体征的主要因素之一。     

Capsular hyaluronic acid of group A streptococci hampers their invasion into human pharyngeal epithelial cells.

Group A streptococci (GAS) cause various diseases, from uncomplicated noninvasive, to severe invasive infections. Capsular hyaluronic acid (HA) is known to resist phagocytosis, however, interaction between HA and epithelial cells have not been clearly understood. In this study, both HA-producing wild strains and HA-nonproducing mutants were employed to examine their invasiveness into confluent cultures of HEp-2, a nonphagocytic human epithelial cell line. Invasion of HEp-2 cells by GAS strains increased over time. The hasA gene encoding hyaluronate synthase of GAS strains was inactivated by allelic replacement. It was found that hasA-inactivated mutants were internalized into HEp-2 cells more efficiently than their parent strains under various conditions in terms of incubation time and inoculum size. Taken together, these findings indicate that GAS can be internalized into HEp-2 cells with considerably high frequencies and that the presence of HA of GAS decreased the invasion efficiency.     

The interaction between bacterial enolase and plasminogen promotes adherence of Streptococcus pneumoniae to epithelial and endothelial cells

Binding and conversion of the plasma protein plasminogen is an important pathogenesis mechanism of the human pathogen Streptococcus pneumoniae. Once converted into plasmin, the proteolytic activity of this major fibrinolysis component promotes degradation of extracellular matrix and the dissolution of fibrin clots. Here, we present the exploitation of plasminogen-binding as a further pivotal strategy of pneumococci facilitating adherence to eukaryotic cells. Flow cytometric measurements demonstrated the immobilization of plasminogen on host cell surfaces of human alveolar type II pneumocytes (A549), nasopharyngeal epithelium (Detroit 562) and brain-derived endothelial cells (HBMEC). These host-derived cells were employed in cell culture infection analyses followed by confocal microscopy to monitor the plasminogen-mediated adherence. Results of these studies revealed that host cell-bound plasminogen promotes pneumococcal adherence to human epithelial and endothelial cells in dose-dependent manner, whereas pneumococcal internalization was not enhanced. As an opposed effect pneumococcal-bound plasminogen reduced attachment to the epithelial and endothelial cells, and increased the interaction with neutrophil granulocytes. Moreover, the surface-displayed enolase, which serves as major pneumococcal plasminogen receptor, was identified as a key factor for plasminogen-mediated bacterial attachment in infection analyses with S. pneumoniae enolase mutants.     

Molecular Biology of Group A Streptococcus and its Implications in Vaccine Strategies

Infections due to Streptococcus pyogenes and their complications are a problem of major concern in many countries, including India. Primary prophylaxis with benzathine penicillin is the key to control and prevent sequelae such as acute rheumatic fever and rheumatic heart disease (RF/RHD) or post-streptococcal glomerulonephritis (PSGN). Non-compliance to prophylaxis due to fear of injection and anaphylaxis is major issues in RF/RHD control in India and leads to continued high prevalence of infection and post-streptococcal sequelae. Differing reports on the efficacy of two weekly, three weekly or monthly injections raise questions on the actual dosages to be administered. Availability of more effective antibiotics with better dosages has replaced the use of penicillin; hence, companies are reluctant to manufacture penicillin preparations in India. It is in this context that a concept of a Group A streptococci vaccine is looked at and whether or not a globally designed vaccine will be useful in the Indian context. Modern molecular techniques and genomic analysis of S. pyogenes have identified many molecules as vaccine candidates among which the M-protein has attracted the most attention. High diversity of M (emm) types in endemic regions raises questions about the efficacy of such a vaccine. A recent 30-valent M-protein-based vaccine that elicits antibodies to homologous as well as non-vaccine M types looks promising. This review will discuss the genomics of S. pyogenes, the various candidate vaccine molecules and highlight their efficacy in the Indian context where control of post-streptococcal sequelae remains a challenge.     

睾酮对人血管内皮细胞纤溶活性影响及机制

目的：观察睾酮对人血管内皮细胞分泌纤溶酶原激活物（tPA）、纤溶酶原激活物抑制物1（PAI-1）的影响及其机制。方法： 将体外培养的人血管内皮细胞（HUVEC）分为5个浓度睾酮组及单纯培养基对照组，MTT实验观察睾酮对细胞生长及活性影响。ELISA 法测各组tPA、 PAI-1含量。用雄激素受体拮抗剂(flutamide)预处理细胞后重复实验。结果： 生理及略低于生理剂量睾酮（3×10-10 mol/L-3×10-8 mol/L）可明显促进tPA 分泌（P＜0.01）；而大剂量则使tPA 含量明显减少（P＜0.01）。各睾酮组PAI-1含量均明显低于对照组（P＜0.05）。Flutamide 能有效消除睾酮的上述作用。结论： 生理浓度睾酮通过雄激素受体促进tPA分泌，降低PAI-1浓度而增强纤溶系统活性，有利于防止血栓性疾病的发生。     

Prolonged and large outbreak of invasive group A Streptococcus disease within a nursing home: repeated intrafacility transmission of a single strain

Objectives

Multiple invasive group A Streptococcus (GAS) infections were reported to public health by a skilled nursing facility (facility A) in Illinois between May 2014 and August 2016. Cases continued despite interventions including antibiotic prophylaxis for all residents and staff. Two other geographically close facilities reported contemporaneous outbreaks of GAS. We investigated potential reasons for ongoing transmission.

Cysteine protease SpeB expression in group A streptococci is influenced by the nutritional environment but SpeB does not contribute to obtaining essential nutrients

Group A streptococcal (GAS) cysteine protease is a major virulence factor involved in the pathogenesis of purulent and invasive infections. The secreted enzyme cleaves a number of different bacterial and host proteins which could contribute to different stages of the infective processes. It has been proposed that, among these functions, SpeB plays a role in obtaining nutrients during late growth phases. In the present study, speB mutants of various GAS serotypes were found to exhibit unaltered growth characteristics in several complex and chemically defined media (CDM). When amino acid-depleted CDM was prepared, neither SpeB activity on whole proteins added to the medium during incubation nor the addition of SpeB-digested proteins was able to support bacterial growth. SpeB also was unable to liberate iron from iron-containing protein sources added to iron-deficient CDM. However, SpeB levels in culture supernatants changed in response to the protein and glucose content of the media. Using a speB promoter-luciferase reporter, speB expression levels were found to correspond to peptide concentrations in the culture media. The effect appeared to be specific for peptides since addition of peptides derived from various proteins had an affect on expression, while addition of the whole proteins had no effect. Addition of glucose to CDM had no effect on speB expression, while glucose addition to complex medium decreased speB expression. Overall, SpeB did not appear to be directly involved in providing the bacteria with nutritional factors but expression of the speB gene responded to ratios of peptides and carbohydrates in the culture medium. Received: 10 April 1999