22Staphylococcus aureus is an important pathogen responsible for nosocomial and 23 community acquired infections in humans, and methicillin-resistant S. aureus (MRSA) infections 24 have continued to increase despite wide-spread preventative measures. S. aureus can colonize the 25 female vaginal tract and reports have suggested an increase in MRSA infections in pregnant and 26 postpartum women as well as outbreaks in newborn nurseries. Currently, little is known about 27 specific factors that promote MRSA vaginal colonization and subsequent infection. To study S. 28 aureus colonization of the female reproductive tract in a mammalian system, we developed a 29 mouse model of S. aureus vaginal carriage and demonstrated that both hospital-associated and 30 community-associated MRSA isolates can colonize the murine vaginal tract. 31Immunohistochemical analysis revealed an increase in neutrophils in the vaginal lumen during 32 MRSA colonization. Additionally, we observed that a mutant lacking fibrinogen binding 33 adhesins exhibited decreased persistence within the mouse vagina. To further identify novel 34 factors that promote vaginal colonization, we performed RNA-sequencing to determine the 35 transcriptome of MRSA growing in vivo during vaginal carriage at 5 hours, 1-day, and 3-days 36 post-inoculation. Over 25% of bacterial genes were differentially regulated at all time points 37 during colonization compared to laboratory cultures. The most highly induced genes were those 38 involved in iron acquisition, including the Isd system and siderophore transport systems. Mutants 39 deficient in these pathways did not persist as well during in vivo colonization. These results 40 reveal that fibrinogen binding as well as the capacity to overcome host nutritional limitation are 41 important determinants of MRSA vaginal colonization. 42
43
IMPORTANCE 44Staphylococcus aureus is an opportunistic pathogen able to cause a wide variety of 45 infections in humans. Recent reports have suggested an increasing prevalence of MRSA in 46 pregnant and postpartum women, coinciding with the increased incidence of MRSA infections in 47 the NICU and newborn nurseries. Vertical transmission from mothers to infants at delivery is a 48 likely route of MRSA acquisition by the newborn, however, essentially nothing is known about 49 host and bacterial factors that influence MRSA carriage in the vagina. Here, we established a 50 mouse model of vaginal colonization and observed that multiple MRSA strains can persist in the 51 vaginal tract. Additionally, we determined that MRSA interactions with fibrinogen as well as 52 iron uptake can promote vaginal persistence. This study is the first to identify molecular 53 mechanisms which govern vaginal colonization by MRSA, the critical initial step preceding 54 infection and neonatal transmission. 55 56 treated with 17-estradiol 1-day before inoculation with 10 7 CFU of either USA300 or 131 MRSA252. The next day the vaginal lumen was swabbed and then we euthanized the animals 132 and collected the vagina, c...