Introduction
ExoU as a major virulence factor
Exoproduct | Gene symbol | Pseudomonas genome database locus tag | Secretory type | Activity | Effect on host |
---|---|---|---|---|---|
Alkaline protease |
aprA
| PA1249 | I | Proteolysis | Blocks complement activation |
Elastase (LasA and LasB) | lasA and lasB | PA1871 and PA3724 | II | Elastolytic activity | Tissue destruction |
Exotoxin A |
toxA
| PA1148 | II | ADP-ribosyltransferase | Cytotoxin |
Phospholipase C | plcH and plcN | PA0844 and PA3319 | II | Phospholipase C | Heat-labile hemolysis |
ExoS (exoenzyme S, 49-kDa) |
exoS
| PA3841 | III | ADP-ribosyltransferase, GAP | Anti-phagocytosis |
ExoT (exoenzyme S, 54-kDa |
exoT
| PA0044 | III | GAP activity | Blocks wound healing |
ExoU |
exoU
| - | III | Phospholipase A2 | Cytotoxin, anti-phagocytosis |
ExoY |
exoY
| PA2191 | III | Adenylate cyclase | Edema formation |
Genomic organization of ExoU
Enzymatic action of ExoU
ExoU cytotoxicity and its various effects
Activation mechanism of ExoU
Clinical epidemiology of Pseudomonas aeruginosatype III secretory-associated genotypes
Reference | Year | Country | Target population | Clinical association |
---|---|---|---|---|
Roy-Burman et al. [24] | 2001 | USA | 108 isolates from respiratory tract or blood | TTSS-positive phenotype was a predictor of poor clinical outcome. |
Hauser et al. [80] | 2002 | USA | 35 patients with VAP | In VAP, type III secretory isolates were associated with worse clinical outcomes. |
Schulert et al. [74] | 2003 | USA | 35 isolates from patients with hospital-acquired pneumonia | ExoU is a marker for highly virulent strains. |
Wareham and Curtis [75] | 2007 | UK | TTSS genotypes and phenotypes of 163 clinical isolates | The exoS −/exoU + genotype was associated with strains isolated from blood. |
Garey et al. [81] | 2008 | USA | Hospitalized patients with bacteremia | Mortality did not differ among patients infected with exoS or exoU isolates. |
Wong-Beringer et al. [12] | 2008 | USA | 45 isolates susceptible to fluoroquinolones | exoU + strains exhibited increased cytotoxicity compared with ExoS-secreting strains. |
Bradbury et al. [76] | 2010 | Australia | 184 clinical, nosocomial, and environmental isolates | Isolates collected from the environment of intensive therapy units were more likely to possess exoU. |
Agnello and Wong-Beringer [82] | 2012 | USA | 270 respiratory isolates | Strains with fluoroquinolone resistance correlate with TTSS effector genotype and the more virulent exoU + subpopulation. |
El-Solh et al. [83] | 2012 | USA | 85 cases of bloodstream infection | Expression of TTSS toxins in isolates from bacteremic patients confers poor clinical outcomes. |
Jabalameli et al. [84] | 2012 | Iran | 96 isolates collected from wound infections of burn patients | exoU gene is disseminated among isolates from burn patients. |
Sullivan et al. [11] | 2014 | USA | 218 adult patients with positive respiratory cultures | Fluoroquinolone-resistant phenotype in exoU strains contributes to pneumonia. |