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Bacterial : Friends or Foes?

Clare K. Schmitt, Karen C. Meysick, and Alison D. O’Brien Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

Many emerging and reemerging bacterial synthesize toxins that serve as primary factors. We highlight seven bacterial toxins produced by well- established or newly emergent pathogenic microbes. These toxins, which affect eukaryotic cells by a variety of means, include aureus α-, , cytotoxic necrotizing factor type 1, heat-stable toxin, botulinum and , and S. aureus toxic- toxin. For each, we discuss the information available on its synthesis and structure, mode of action, and contribution to virulence. We also review the role certain toxins have played in unraveling signal pathways in eukaryotic cells and summarize the beneficial uses of toxins and . Our intent is to illustrate the importance of the analysis of bacterial toxins to both basic and applied sciences.

Since toxin was isolated by Roux ways, inhibiting the release of neurotransmit- and Yersin in 1888 (1), microbial toxins have ters, or activating the immune response. We been recognized as the primary virulence also describe in detail seven toxins: Staphylococ- factor(s) for a variety of pathogenic . cus aureus α-toxin, Shiga toxin (Stx), cytotoxic Bacterial toxins have been defined as “soluble necrotizing factor type 1 (CNF1), E. coli heat- substances that alter the normal of stable toxin (ST), botulinum and tetanus host cells with deleterious effects on the host” (2). neurotoxins, and toxic-shock syndrome toxin Indeed, the major symptoms associated with (TSST) produced by S. aureus. We emphasize disease caused by diphtheriae these toxins because they are produced by (diphtheria), (whooping emerging (Stx of enterohemorrhagic E. coli) or cough), (), reemerging (α-toxin of multidrug-resistant anthracis (), botulinum S. aureus) pathogens or illustrate different (), (tetanus), and structures or modes of action (ST, CNF1, enterohemorrhagic Escherichia coli (bloody neurotoxins, and TSST). and hemolytic uremic syndrome) are all related to the activities of the toxins produced by When It Rains, It Pores these organisms. With the recognition of the Many bacterial have the capacity central role of toxin in these and other diseases to damage the extracellular matrix or the plasma has come the application of inactive toxins membrane of eukaryotic cells. The damage not (toxoids) as . Such vaccines have only may result in the direct of cells but also had an important positive impact on public can facilitate bacterial spread through tissues. health. Toxins that mediate this cellular damage do so by In this review, we provide a summary either enzymatic hydrolysis or pore formation. overview (Table) of a variety of bacterial toxins Bacterial , , and categorized according to mode of action: have the capacity to degrade damaging membranes, inhibiting cellular membranes or matrices. Specific synthesis, activating second messenger path- examples of these types of toxins include the α-toxin of , which has Address for correspondence: Alison D. O’Brien, Uniformed C activity; pyogenes Services University of the Health Sciences, Department of and , 4301 Jones Bridge Road, streptokinase, which can hydrolyze plasminogen Bethesda, MD 20814, USA; fax: 301-295-3773; e-mail: to plasmin and dissolve clots; and the clostridial [email protected]. collagenases (3-5). Pore-forming toxins, as the

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Table. Characteristics of bacterial toxinsa Toxin implicated Organism/toxin Mode of action Target Disease in diseaseb Damage membranes Aeromonas hydrophila/aerolysin Pore-former Glycophorin Diarrhea (yes) Clostridium perfringens/ Pore-former Gas gangrenec ? perfringolysin O Escherichia coli/hemolysind Pore-former Plasma membrane UTIs (yes) monocytogenes/ Pore-former Cholesterol Foodborne systemic (yes) illness, meningitis Staphyloccocus aureus/α-toxin Pore-former Plasma membrane Abcessesc (yes) / Pore-former Cholesterol Pneumoniac (yes) / Pore-former Cholesterol Strep throat, Sfc ? O Inhibit protein synthesis Corynebacterium diphtheriae/ ADP-ribosyltransferase 2 Diphtheria yes E. coli/ dysenteriae/ N-glycosidase 28S rRNA HC and HUS yes Shiga toxins / ADP-ribosyltransferase Elongation factor 2 Pneumoniac (yes) A Activate second messenger pathways E.coli CNF Deamidase Rho G- UTIs ? LT ADP-ribosyltransferase G-proteins Diarrhea yes STd Stimulates guanylate cyclase Diarrhea yes guanylate cyclase CLDTd G2 block Unknown Diarrhea (yes) EAST ST-like? Unknown Diarrhea ? /edema factor Adenylate cyclase ATP Anthrax yes Bordetella pertussis/ dermonecrotic toxin Deamidase Rho G-proteins Rhinitis (yes) ADP-ribosyltransferase G-protein(s) Pertussis yes /C2 toxin ADP-ribosyltransferase Monomeric G- Botulism ? C. botulinum/C3 toxin ADP-ribosyltransferase Rho G-protein Botulism ? Clostridium difficile/ toxin A Rho G-protein(s) Diarrhea/PC (yes) toxin B Glucosyltransferase Rho G-protein(s) Diarrhea/PC ? Vibrio cholerae/ ADP-ribosyltransferase G-protein(s) Cholera yes Activate immune response S. aureus/ TCR and MHC II poisoningc yes exfoliative toxins Superantigen (and TCR and MHC II SSSc yes ?) toxic-shock toxin Superantigen TCR and MHC II TSSc yes S. pyogenes/pyrogenic exotoxins TCR and MHC II SF/TSSc yes Protease B. anthracis/lethal factor Metalloprotease MAPKK1/MAPKK2 Anthrax yes C. botulinum/neurotoxins A-G Zinc-metalloprotease VAMP/, Botulism yes SNAP-25, syntaxin Clostridium tetani/tetanus toxin Zinc-metalloprotease VAMP/synaptobrevin Tetanus yes aAbbreviations: CNF, cytotoxic necrotizing factor; LT, heat-labile toxin; ST, heat-stable toxin; CLDT, cytolethal distending toxin; EAST, enteroaggregative E. coli heat-stable toxin; TCR, T-cell receptor; MHC II, major histocompatibility complex class II; MAPKK, -activated protein kinase kinase; VAMP, vesicle-associated ; SNAP-25, synaptosomal- associated protein; UTI, urinary tract ; HC, hemorrhagic ; HUS, hemolytic uremic syndrome; PC, - associated pseudomembranous colitis; SSS, scalded syndrome; SF, scarlet ; TSS, toxic-shock syndrome. bYes, strong causal relationship between toxin and disease; (yes), role in pathogenesis has been shown in model or appropriate cell culture; ?, unknown. cOther diseases are also associated with the organism. dToxin is also produced by other genera of bacteria.

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name suggests, disrupt the selective influx and staphylococcal accessory regulator (agr) efflux of across the plasma membrane by locus (6,7). The α-toxin is synthesized as a 319 inserting a transmembrane pore. This group of precursor molecule that contains an toxins includes the RTX (repeats in toxin) toxins N- signal sequence of 26 amino acids. from gram-negative bacteria, streptolysin O The secreted mature toxin, or protomer, is a produced by S. pyogenes, and the S. aureus hydrophilic molecule that lacks cysteine resi- α-toxin (described below). dues and has a molecular mass of approximately S. aureus α-toxin can be considered the 33 kDa (6-8). Recently, the crystallographic prototype of oligomerizing pore-forming cytotox- structure of the fully assembled α-toxin pore was ins. The α-toxin gene resides as a single copy on solved (9). On the plasma membrane, seven toxin the of most pathogenic S. aureus protomers assemble to form a 232-kDa mush- strains, and its expression is environmentally room-shaped heptamer comprising three distinct regulated at the transcriptional level by the domains (Figure 1A) (9,10). The cap and rim

Figure 1. Diagrammatic representation of the mode of action of several bacterial toxins. A. Damage to cellular membranes by α-toxin. After binding and oligomerization, the stem of the - shaped α-toxin heptamer inserts into the target cell and disrupts membrane permeability as depicted by the influx and efflux of ions represented by red and green circles. B. Inhibition of protein synthesis by Shiga toxins (Stx). Holotoxin, which consists of an enzymatically active (A) subunit and five binding (B) subunits, enters cells through the globotriasylceramide (Gb3) receptor. The N-glycosidase activity of the A subunit then cleaves an adenosine residue from 28S ribosomal RNA, which halts protein synthesis. C. Examples of bacterial toxins that activate secondary messenger pathways. Binding of the heat-stable enterotoxins (ST) to a guanylate cyclase receptor results in an increase in cyclic GMP (cGMP) that adversely effects electrolyte flux. By ADP- ribosylation or glucosylation respectively, the C3 exoenzyme (C3) of Clostridium botulinum and the Clostridium difficile toxins A and B (CdA & CdB) inactivate the small Rho GTP-binding proteins. Cytotoxic necrotizing factor (CNF) of E. coli and the dermonecrotic toxin (DNT) of Bordetella activate Rho by deamidation.

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domains of the α-toxin heptamer are situated at Stxs are potent cytotoxins that can be the surface of the plasma membrane, while the divided into two antigenically distinct groups stem domain serves as the transmembrane that share 50% to 60% homology: Stx/Stx1 and channel. Stx2 (15-17). Stx and Stx1 are elaborated by Alpha-toxin is cytolytic to a variety of cell S. dysenteriae serotype 1 and E. coli, types, including , lympho- respectively, and differ at only one amino acid. cytes, erythrocytes, platelets, and endothelial Stx2-type toxins have been found only in E. coli cells (6,8). For α-toxin to damage cellular isolates and are quite diverse. While Stx2 is membranes, three sequential events are re- considered the prototype of this group, variants quired. Toxin protomers must first bind to target have been found that differ antigenically, in membranes by either unidentified high-affinity receptor specificity and in activation by receptors or through nonspecific absorption to intestinal mucus. Some of these attributes are substances such as phosphotidylcholine or the result of only one or two nucleotide cholesterol on the bilayer (6-8). Second, differences in the toxin . membrane-bound protomers must oligomerize The stx of S. dysenteriae is invariably into a nonlytic prepore heptamer complex. Third, chromosomally located. The genes that encode the heptamer must undergo a series of Stx1 and Stx2 are carried chromosomally or by conformational changes that create the stem lysogenic . The genes that code domain of the toxin, which is then inserted into for the A and B subunits of Stxs, stxA and stxB, the membrane (9,10). The α-toxin pore allows the are organized within an operon. The operator influx and efflux of small molecules and ions that region of Stx/Stx1 (but not Stx2) contains a eventually to the swelling and of consensus fur box that is responsible for the iron- nucleated cells and the osmotic lysis of regulation of Stx and Stx1 production. Neither erythrocytes. Pore formation has also been iron nor any other environmental factors shown to trigger secondary events that could examined affect the expression of Stx2. However, promote development of pathologic sequelae. intestinal mucus enhances the activity of some These events include endonuclease activation, Stx2 variants (18). The Stxs, which carry typical increased platelet exocytosis, release of N-terminal leader sequences, are not actively and inflammatory mediators, and production of secreted from the bacterial cell and are thought eicosanoids (6,8). Several animal models have to be released into the milieu during cell lysis. demonstrated that α-toxin is required for Stxs display an AB-toxin structure; an S. aureus virulence in these systems (6,8); enzymatically active A subunit is noncovalently however, the precise role of α-toxin in associated with a binding, or B, component. The staphylococcal diseases in remains crystal structures of the Stx1 B pentamer (19) unclear. and the Stx holotoxin have been solved (20) (Figure 2). Other toxins that share this AB Stop, in the Name of Toxin structure are the E. coli heat-labile toxin (21), A second class of toxins intoxicates target cholera toxin, and pertussis toxin (22) (Figure 2). cells by inhibiting protein synthesis. Substrates The molecular masses of mature Stx A and B for toxins in this group are elongation factors and monomeric subunits are approximately 35 kDa ribosomal RNA. Diphtheria toxin and Pseudomo- and 7.5 kDa, respectively, although holotoxin nas exotoxin A act by ADP-ribosylating contains five B subunit molecules. The B subunit elongation factor 2 (EF2) (11,12). The modified pentamer directs the binding of the holotoxin to EF2 is no longer able to function in protein sensitive eukaryotic cells via specific synthesis. Stxs, also called verotoxins, are receptors. Once internalized, the A polypeptide

produced by serotype 1 and is cleaved into an enzymatically active A1 portion the emerging pathogens designated Stx-produc- and an A2 portion; these fragments remain ing E. coli (STEC). Stxs inactivate ribosomal associated through a bond. The A2 RNA (by a mechanism described below) so that portion serves to link the A1 fragment and the B the affected can no longer interact with pentamer. elongation factors (13,14). The inhibition of The enzymatic A subunit acts as a protein synthesis by this group of toxins specific N-glycosidase to cleave a single adenine ultimately results in death of the target cell. residue from 28S ribosomal RNA (13,14). This

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Figure 2. Ribbon crystal structures of Shigella dysenteriae Shiga toxin (20), Escherichia coli heat-labile toxin I (LT-I) (21), and pertussis toxin (22). The Shiga toxin figure was contributed by Marie Frasier. The LT-I and pertussis figures were contributed by Ethan Merritt. The figures were drawn in MOLSCRIPT (75).

depurination ultimately results in the inhibition that are regulators of the actin of protein synthesis within intoxicated cells (28,29). Most members of this toxin family, which (Figure 1B). Prokaryotic are as includes the large clostridial cytotoxins and the sensitive to the N-glycosidase activity of Stx as C3 exoenzyme of C. botulinum, inactivate Rho eukaryotic ribosomes (23). (29). CNF1, CNF2, and the dermonecrotic toxins STEC are considered emerging pathogens from Bordetella species form a unique subset in (24) because they were first described less than this family, since these toxins have the capacity 20 years ago, during a 1983 of to activate Rho (Figure 1C) (29-32). CNF1 and hemorrhagic colitis associated with undercooked CNF2 share 99% amino acid similarity; however, hamburger (25,26). STEC O157:H7 causes we will discuss only CNF1 in detail because of approximately 20,000 cases of hemorrhagic its association with extraintestinal E. coli colitis each year in the (27). in humans, most notably urinary Approximately 1,000 cases of the life-threaten- tract infections. ing sequelae hemolytic uremic syndrome and The gene for CNF1 is chromosomally approximately 100 are also attributed to encoded and resides on a in E. coli O157:H7 annually in the United States (27). uropathogenic E. coli (33,34). The toxin is synthesized as a hydrophilic polypeptide of Don’t Shoot the Messenger approximately 115 kDa that remains primarily Bacterial toxins can also target and alter the cytoplasmic because of the lack of a signal function of a variety of cellular proteins without sequence (33). Recent structure and function directly killing the intoxicated cell. Toxin analysis of CNF1 indicates that the toxin has activation or modification of secondary messen- distinct binding and enyzmatic domains (35). gers can cause dramatic alterations to signal The N-terminal half of CNF1, which includes two pathways critical in maintaining a potential transmembrane domains, contains the variety of cellular functions. To demonstrate the cellular binding domain. This region of the diversity among the toxins that belong to this molecule shows amino acid similarity to the category, we will describe CNF type 1 and the Pasteurella multicoda toxin, a potent mitogen heat-stable enterotoxins. thought to be the etiologic agent of progressive atrophic rhinitis in pigs (33,35). The C-terminal Cytotoxic Necrotizing Factor (CNF) portion of CNF1 represents the toxin’s enzymatic CNF types 1 and 2 (CNF1/2) from E. coli domain and shows homology with dermonecrotic belong to a group of bacterial toxins that modify toxins in a 100-amino acid stretch that may Rho, a subfamily of small GTP-binding proteins represent the of the toxin (33,35).

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Eukaryotic cells intoxicated with CNF1 Heat-Stable Toxin (ST) exhibit membrane ruffling; the formation of focal Two families of diarrheagenic STs have been adhesions and actin stress fibers; and DNA described: STa (or STI) and STb (or STII). replication in the absence of cell division, a Distinct STas are produced by a variety of phenomenon that results in enlarged multi- enteric pathogenic organisms: enterotoxinogenic nucleated cells (Figure 3). The drastic changes E. coli (ETEC) (the focus of this section), apparent in CNF1-treated cells are a result of the V. cholerae, Vibrio mimicus, Yersinia toxin’s capacity to modify Rho (29,30,32). This enterocolitica, Citrobacter freundii, and Kleb- modification has recently been identified as a siella. deamidation of the residue at position Strains of ETEC associated with human 63 of Rho to a . This amino acid disease may produce either STa, heat-labile change produces a dominant active Rho protein toxin I, or both. STas from ETEC isolates are unable to hydrolyze bound GTP (30,32). In vivo, related but distinct toxins (38). STh is produced CNF1 causes in rabbit skin following by strains of human origin, while STp is found intradermal injection and persistent inflamma- predominantly in porcine strains. The STa genes tion in a mouse footpad assay (36). Epidemiologic (estA) of ETEC are encoded within a transpos- data support the role of CNF1 as a virulence able element and have been found on a variety of factor in human extraintestinal infections, replicons (39,40). STa is translated as a although direct proof of the toxin’s role in disease precursor molecule of 72 amino acids and remains to be determined (29,37). undergoes two cleavage events before the of the mature form into the culture supernatant. Mature STs are small that range from 17 to 53 amino acids. STh and STp contain 19 and 18 residues, respectively. STas share a conserved C-terminal region of 13 amino acids essential for and the heat-stable nature of the toxin. Six cysteine residues are present within this domain, and the three disulphide bonds formed between the cysteine residues are necessary for toxicity of the molecule. Binding of STa to its cellular receptor results in the stimulation of membrane-bound guanylate cyclase, which in turn to an increase in intracellular cyclic GMP (Figure 1C) (41). This increase in cyclic GMP affects electrolyte flux in the bowel; sodium absorption is inhibited and chloride secretion is stimulated. These flux changes result in the secretory diarrhea characteristic of ETEC infection. ETEC cause traveler’s diarrhea and are a major source of childhood diarrhea in many parts of the world.

The Nerve of Some Toxins The C. botulinum neurotoxins (BoNTs, serotypes A-G) and the C. tetani tetanus (TeNT) constitute another category of bacterial toxins on the basis of similarities in structure, enzymatic activity, and the targeting to cells of the . BoNTs are most Figure 3. The effect of cytotoxic necrotizing factor type commonly associated with and foodborne 1 (CNF1) on eukaryotic cells. A. HEp-2 cells, botulism and exist in nature as large complexes magnification 10X. B. HEp-2 cells intoxicated with comprised of the neurotoxin and one or more CNF1, magnification 10X. associated proteins believed to provide protection

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and stability to the toxin molecule while in the respectively) are the direct result of the specific gut (42,43). TeNT, which is synthesized from affected and the type of neurotransmit- vegetative C. tetani in wounds, does not appear ters blocked (45-47). to form complexes with any other protein components (42,43). Bacterial Superantigens: Too Much of a The BoNTs and TeNT are either plasmid Good Thing encoded (TeNT, BoNTs/A, G, and possibly B) or Several bacterial toxins can act directly on encoded (BoNTs/C, D, E, F), and the T cells and -presenting cells of the the neurotoxins are synthesized as inactive . Impairment of the immunologic polypeptides of 150 kDa (44). BoNTs and TeNT functions of these cells by toxin can lead to are released from lysed bacterial cells and then human disease. One large family of toxins in this activated by the proteolytic cleavage of an category are the pyrogenic toxin superantigens exposed loop in the neurotoxin polypeptide (45). (PTSAgs), whose hallmark biological activities Each active neurotoxin molecule consists of a include potent stimulation of the immune cell heavy (100 kDa) and light chain (50 kDa) linked system, pyrogenicity, and enhancement of by a single interchain disulphide bond (42,45). endotoxin shock (49-51). These stable, secreted The heavy chains of both the BoNTs and TeNT toxins of 22 kDa to 30 kDa include staphylococcal contain two domains: a region necessary for enterotoxins serotypes A-E, G, and H; group A toxin translocation located in the N-terminal streptococcal pyrogenic exotoxins serotypes A-C half of the molecule, and a cell-binding domain and F; group A streptococcal superantigen; and located within the C-terminus of the heavy chain staphylococcal TSST-1, which we discuss below. (45,46). The light chains of both the BoNTs and All PTSAgs share common biological activi- TeNT contain zinc-binding motifs required for ties, but TSST-1 is the most divergent member of the zinc-dependent protease activities of the the toxin family, with less than 30% amino acid molecules (45,46). homology to other family members (52-54). The cellular targets of the BoNTs and TeNT TSST-1 is chromosomally encoded, and the tst are a group of proteins required for docking and gene is located in a variable genetic element fusion of synaptic vesicles to presynaptic plasma in S. aureus (49,52,55). The toxin is synthesized membranes and therefore essential for the as a precursor molecule of 234 residues with the release of . The BoNTs bind to first 40 amino acids acting as a signal sequence receptors on the presynaptic membrane of motor that is cleaved to generate the mature 22 kDa neurons associated with the peripheral nervous toxin (49). Expression of TSST-1 depends on system. Proteolysis of target proteins in these , temperature, pH and glucose levels, and neurons inhibits the release of , is regulated by the S. aureus agr locus (49,51). thereby preventing (47,48). On the basis of crystallographic analysis, TSST- BoNTs/B, D, F, and G cleave the vesicle- 1 appears structurally similar to several other associated membrane protein and synaptobrevin, PTSAgs in that the toxin consists of two distinct BoNT/A and E target the synaptosomal- domains; however, unlike other family members, associated protein SNAP-25, and BoNT/C TSST-1 does not require a zinc cofactor (51-54). hydrolyzes syntaxin and SNAP-25 (42,45,46). Domain A of TSST-1 (amino acid residues 1-17 TeNT affects the and and 90-194) exists as a ß-grasp motif, and domain does so by entering two types of neurons. TeNT B consists of a five-stranded ß-barrel motif that initially binds to receptors on the presynaptic forms an oligosaccharide/oligonucleotide bind- membrane of motor neurons but then migrates ing fold. by retrograde vesicular transport to the spinal In general, the potent immunostimulatory cord, where the neurotoxin can enter inhibitory properties of PTSAgs are a direct result of toxin interneurons (45,47). Cleavage of the vesicle- binding to distinct regions outside the associated membrane protein and synaptobrevin binding cleft of the major histocompatibility class in these neurons disrupts the release of II molecules (expressed on the surface of and gamma-amino-butyric acid, which, in turn, antigen-presenting cells) and to specific induces muscle contraction (47,48). The con- Vß elements on the T-cell receptor. In particular, trasting clinical manifestations of BoNT or TeNT the domain B of TSST-1 binds primarily to the intoxication (flaccid and spastic , α-chain of -DR1

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molecules, while domain A specifically binds to “magic bullets,” hybrids of the enzymatically human T-cell receptor Vß2 elements (51-53,56). active portion of a toxin molecule and monoclonal Binding of TSST-1 to Vß2 T-cell receptor (or a receptor), are in clinical trials for elements results in a massive proliferation of up the treatment of persons with B-cell lymphomas, to 20% of peripheral T cells, an event that leukemia, and bone marrow transplants. drastically skews the T-cell Vß repertoire Several clinical applications have also been (53,56). T cells that undergo this expansion can found for the powerful botulinum neurotoxin subsequently exist in a state of anergy or type A (BoNT/A) (46,68). The disorders that undergo (56). Concomitant to T-cell respond to BoNT/A involve muscle hyperactivity. proliferation is a massive release of both A minuscule amount of purified toxin injected (interleukin [IL]-2, tumor necrosis into specific sites results in paralysis of the factor ß, gamma interferon)-derived and mono- target muscle and ablation of the muscle . cyte (IL-1, IL-6, α)-derived Therapy must be continual since the effect of the cytokines (51,56). These cytokines serve as toxin usually lasts for no more than several mediators of the , high fever, and months. The first maladies treated with BoNT/A diffuse erythematous that are characteris- were eye movement abnormalities (69). How- tic of toxic-shock syndrome. Long established as ever, the therapeutic value of BoNT/A has been a key substance in causing staphylococcal toxic- shown for many other disorders including shock syndrome, TSST-1 has more recently been cervical and laryngeal , writer’s cramp, linked with Kawasaki syndrome, a leading cause hemifacial spasm, tremors, and tics (46,68). BoNT/ of acquired disease in children in the A is also used cosmetically to reduce deep United States (50,54). wrinkles caused by the contraction of facial muscles (70). Dr. Jekyll or Mr. Hyde? Another toxic bacterial product with medical Some of these powerful disease-causing applications is streptokinase, a potent plasmino- toxins have been exploited to further basic gen activator produced by several pathogenic knowledge of or for medical purposes. streptococcal strains. The proteolytic activity of For example, cholera toxin and the related labile- streptokinase is used to clear blocked in toxin of E. coli, as well as B. pertussis toxin, have patients who have heart attacks (71,72). been used as biologic tools to understand the mechanism of adenylate cyclase activation and Vaccinate, Don’t Procrastinate the role of cyclic AMP as a second messenger in Vaccines directed at the toxic component of the eukaryotic cell (57-59). Derivatives of some of bacterial pathogens have proven quite effective these toxins, cholera toxin and labile toxin, have in preventing certain diseases. Most licensed also been incorporated into human vaccines toxoid vaccines are relatively crude, but because of the adjuvant properties of these effective, preparations. These vaccines consist of molecules (60,61). partially purified toxin preparations obtained Similarly, the activities of several potent from culture supernatants of bacteria such as cytotoxins have been harnessed as potential C. diphtheriae, C. tetani, or B. anthracis. therapies for certain . Such toxins can treatment is used to detoxify the either be used directly in treatment or as diphtheria and tetanus toxins for components of (62-64). For formulation. The anthrax vaccine contains the example, Stx binds to the cell surface glycolipid protective antigen and small amounts of the CD77, which is expressed by B cells in certain lethal factor and edema factor toxins. The B-cell lymphomas (65,66). This finding led to current botulinum vaccine is an investigational studies that showed that Stx can purge murine composed of crude preparations of five (and potentially human) bone marrow of botulinum toxoids and is distributed by the malignant CD77+ B cells before an autologous Centers for Disease Control and Prevention to bone marrow transplant (67). Other toxins that researchers that work with the toxin or inhibit protein synthesis, such as diphtheria organism. Acellular pertussis vaccines that toxin, A, or the contain pertussis toxoid, alone or as one of toxin , are frequently engineered as the cell- several components, are as effective as killed killing component of immunotoxins. These whole-cell vaccines but less reactogenic (73);

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such vaccines have recently been approved for Acknowledgments use in as well as older children. We thank Drs. Ethan Merritt and Marie Frasier for New vaccines aimed at toxins are in various generating and contributing the figures on toxin crystal structures. stages of development: research and develop- Work in Dr. O’Brien’s laboratory is supported by grants ment, preclinical, phase I, phase II, or phase III from the National Institutes of Health (AI20148-16, AI33525- (74). The next generation of toxoid vaccines falls 5, AI38281-3), the Department of Agriculture (97-35201- into three general categories: purified toxoids 4578), and the Uniformed Services University of the Health Sciences (R073EQ). that have been inactivated by chemical or genetic means; live, attenuated strains of the Dr. Schmitt is a research assistant professor in the causative agent that produce a genetically Department of Microbiology and Immunology, Uni- derived toxoid; or live, attenuated unrelated formed Services University of the Health Sciences, bacterial vector strains, such as V. cholerae or Bethesda, Maryland, USA. Research interests include , that produce the target toxoid. virulence factors and pathogenesis of disease caused by Shiga toxin-producing E. coli and regulation of Salmo- Examples of each of these approaches and nella virulence. progress in development of specific toxoid vaccines are described annually in the Jordan Report (74). References raised against diphtheria, teta- 1. Roux E, Yersin A. Contribution a l’etude de la diphtherie. Annales de l’Institut Pasteur 1888;2:629-61. nus, and botulinum toxoids have also been used 2. Schlessinger D, Schaechter M. Bacterial toxins. In: for many years to treat seriously ill patients. Schaechter M, Medoff G, Eisenstein BI, editors. specific for the Stx toxins produced by Mechanisms of microbial disease. 2nd ed. Baltimore: E. coli O157:H7 and other STEC is under Williams and Wilkins; 1993. p. 162-75. development for the treatment and prevention of 3. Songer JG. Bacterial phospholipases and their role in virulence. Trends Microbiol 1997;5:156-61. hemolytic uremic syndrome, a life-threatening 4. Lottenberg R, Minning-Wenz D, Boyle MD. Capturing sequela of these infections. host plasmin(ogen): a common mechanism for invasive pathogens? Trends Microbiol 1994;2:20-4. Summary 5. Harrington DJ. Bacterial collagenases and collagen- Microbial toxins capable of interrupting or degrading and their potential role in human disease. Infect Immun 1996;64:1885-91. hyperstimulating many essential functions and 6. Bhakdi S, Tranum-Jensen J. Alpha-toxin of pathways of eukaryotic cells have evolved along Staphylococcus aureus. Microbiological Reviews with the carrier bacterium. Presumably these 1991;55:733-51. toxins confer some benefit to the bacterium, 7. Tomita T, Kamio Y. Molecular biology of the pore- either during a stage of the host-parasite forming from Staphylococcus aureus, α- and gamma- and . Bioscience, interaction or in some environmental niche Biotechnology, and 1997;61:565-72. encountered by the bacterium. Certain bacterial 8. Bhakdi S, Bayley H, Valeva A, Walev I, Walker B, Weller toxins act on the target cell surface to irreparably U, et al. Staphylococcal alpha-toxin, streptolysin-O and damage the or alter normal Escherichia coli : prototypes of pore-forming cellular signal transduction. Other toxins bacterial cytolysins. Arch Microbiol 1996;165:73-9. 9. Song L, Hobaugh MR, Shustak C, Cheley S, Bayley H, exhibit enzymatic activity once the molecule has Gouaux JE. Structure of staphylococcal alpha- gained access to the of the sensitive hemolysin, a heptameric transmembrane pore. Science cell by . Yet other bacterial toxins act 1996;274:1859-66. by either turning off or locking on a normal host 10. Lesieur C, Vecsey-Semjen B, Abrami L, Fivaz M, Gisou cell function. van der Goot F. Membrane insertion: the strategies of toxins. Mol Membr Biol 1997;14:45-64. Although detrimental to the susceptible host 11. Collier RJ. In: Moss J, Vaughan M, editors. ADP- during an infection, the activities of several ribosylating toxins and g proteins. Washington: bacterial toxins have been exploited as probes of American Society for Microbiology; 1990. p. 3-19. eukaryotic cellular pathways and for medicinal 12. Wick MJ, Iglewski BH. In: Moss J, Vaughan M, editors. applications. Thus, research on a ADP-ribosylating toxins and g proteins. Washington: American Society for Microbiology; 1990. p. 31-43. produced by an established, emerging, or 13. Endo Y, Tsurugi K, Yutsudo T, Takeda Y, Ogasawara Y, reemerging is likely to yield novel Igarashi K. Site of action of a Vero toxin (VT2) from information about the role of that toxin in disease Escherichia coli O157:H7 and of Shiga toxin on as well as the properties of host cells that are eucaryotic ribosomes. Eur J Biochem 1988;171:45-50. subverted by the toxin.

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