SEl-K is commonly present in more than half of all Staphylococcus aureus clinical isolates and is present in almost all USA300 community-acquired methicillin-resistant S. aureus (CA-MRSA) isolates. Sequencing of the sel-k gene in over 20 clinical isolates and comparative analysis with all 14 published sel-k sequences indicate that there are at least 6 variants of the sel-k gene, including one that is conserved among all examined USA300 strains. Additionally, we have developed a highly sensitive enzyme-linked immunosorbent assay (ELISA) that specifically detects and measures SEl-K protein in culture supernatants and biological fluids. Quantification of in vitro SEl-K secretion by various S. aureus isolates using this novel capture ELISA revealed detectable amounts of SEl-K secretion by all isolates, with the highest secretion levels being exhibited by MRSA strains that coexpress SEB. In vivo secretion was measured in a murine thigh abscess model, where similar levels of SEl-K accumulation were noted regardless of whether the infecting strain exhibited high or low secretion of SEl-K in vitro. We conclude that SEl-K is commonly expressed in the setting of staphylococcal infection, in significant amounts. SEl-K should be further explored as a target for passive immunotherapy against complicated S. aureus infection.
Staphylococcus aureus can express a large and diverse repertoire of virulence factors, including many different surface proteins, enzymes, and secreted toxins (1). Among the most potent of these virulence factors are the members of a family of secreted, heatstable proteins known as enterotoxins. More than 20 staphylococcal enterotoxins (SEs) have been discovered that demonstrate superantigenic (SAg) properties against T cells (2, 3). Superantigens can activate 20% to 50% of the T cell population by bypassing the traditional pathway of major histocompatibility complex (MHC)-dependent presentation of antigens to T cell receptors (TCRs). Instead, superantigens bind simultaneously to MHC class II (MHC-II) and TCRs, outside their antigen-binding groove, resulting in an excessive inflammatory response that can lead to toxic shock, multiorgan failure, and death. Superantigens are also associated with other immune-mediated diseases, including Kawasaki disease, atopic dermatitis, and chronic rhinosinusitis (4).The classical superantigens toxic shock syndrome toxin 1 (TSST-1), SEA, and SEB have been extensively studied due to their causative roles in toxic shock syndrome and food poisoning (5). However, advancements in sequencing methodologies have enabled the discovery of many more SEs whose roles in pathogenesis remain unknown (6). One of these toxins, SEl-K, has been shown to exhibit superantigenic properties, including V-specific T cell activation, pyrogenicity, emesis, and lethality in primates (7-9). Epidemiological studies have demonstrated the SEl-K-encoding genes to be among the most common SE genes in S. aureus clinical isolates (10-14). Additionally, SEl-K is the only SE gene to our knowledge that is si...