Staphylococcus aureus and Staphylococcus epidermidis both synthesize the surface polysaccharide poly-Nacetyl--(1-6)-glucosamine (PNAG), which is produced in vitro with a high level (>90%) of the amino groups substituted by acetate. Here, we examined the role of the acetate substituents of PNAG in generating opsonic and protective antibodies. PNAG and a deacetylated form of the antigen (dPNAG; 15% acetylation) were conjugated to the carrier protein diphtheria toxoid (DT) and used to immunize animals. Mice responded in a dose-dependent fashion to both conjugate vaccines, with maximum antibody titers observed at the highest dose and 4 weeks after the last of three weekly immunizations. PNAG-DT and dPNAG-DT vaccines were also very immunogenic in rabbits. Antibodies raised to the conjugate vaccines in rabbits mediated the opsonic killing of various staphylococcal strains, but the specificity of the opsonic killing was primarily to dPNAG, as this antigen inhibited the killing of S. aureus strains by both PNAG-and dPNAG-specific antibodies. Passive immunization of mice with anti-dPNAG-DT rabbit sera showed significant levels of clearance of S. aureus from the blood (54 to 91%) compared to control mice immunized with normal rabbit sera, whereas PNAG-specific antibodies were ineffective at clearing S. aureus. Passive immunization of mice with a goat antiserum raised to the dPNAG-DT vaccine protected against a lethal dose of three different S. aureus strains. Overall, these data show that immunization of animals with a conjugate vaccine of dPNAG elicit antibodies that mediated opsonic killing and protected against S. aureus infection, including capsular polysaccharide types 5 and 8 and an untypable strain.Staphylococcus aureus and coagulase-negative staphylococci (CoNS), principally Staphylococcus epidermidis, are the most frequent causes of hospital acquired bloodstream infections accounting for 40 to 60% of all nosocomial bloodstream infections (52). S. aureus causes diverse infections such as endocarditis, septic arthritis, osteomyelitis, meningitis, skin infections, and abscesses (1,2,7,16,23,27) and there appears to be an increase in the recognition of community-acquired S. aureus infections, often involving methicillin-resistant S. aureus strains (16,27). It is now well appreciated that the emergence of antibiotic resistance among staphylococcal isolates has made the treatment of these infections increasingly difficult, which has amplified the call for new approaches to treat and prevent staphylococcal infections, such as immunotherapy.Ongoing efforts to design vaccines for S. aureus have targeted various virulence factors of this organism, including capsular polysaccharides (CP) (i.e., CP serotypes 5 and 8) (8, 9), cell wall-associated proteins (i.e., clumping factor A, fibronectin binding proteins, and collagen binding protein) (11,36,48), toxins (i.e., alpha-toxin, enterotoxins, and toxic shock syndrome toxin 1) (6,14,15,21,33), and the surface-associated polysaccharide, poly-N-acetyl--(1-6)-glucosamine (PNAG) ...