This study in rabbit eyes demonstrated an age-related reduction in susceptibility to
S. aureus keratitis and to the administration of purified α-toxin. α-Toxin has been found, in several studies, to be responsible for most of the bacterial virulence in the rabbit keratitis model, causing corneal epithelial cell sloughing, corneal edema, corneal infiltration, and severe iritis.
18 20 22 23 43 It is estimated that α-toxin accounts for between 50% and 70% of the ocular damage in this model of keratitis.
22 24 A reduction in the susceptibility to α-toxin could explain the less severe outcome of the corneal infection in aged rabbits. The decrease in susceptibility to keratitis and to toxin action observed herein correlated with a reduced susceptibility of erythrocytes from aged rabbits to α-toxin–mediated lysis. These age-related changes suggest that advanced age causes alterations in the rabbit erythrocyte surface such that the toxin is less able to cause hemolysis. Presumably, a similar age-related change could occur in the surfaces of corneal cells, accounting for their reduced toxin susceptibility. The major difference between young and aged rabbits in keratitis and in the response to toxin administration could be mediated by a significant decline in the effectiveness of α-toxin to act on the surfaces of corneal cells.
The interaction between α-toxin and the cell surface has been analyzed in some detail, but it is not yet fully understood. α-Toxin is known to be a monomer of 34 kDa that can bind to high-affinity receptors on rabbit cells or to a wide spectrum of low-affinity receptors on the same cell surface.
16 48 To form toxin heptamers, the monomers must react with a membrane protein, caveolin 1, that is found in lipid rafts.
49 50 The interaction between the toxin and caveolin 1 allows the heptamer to undergo conformational changes that facilitate toxin penetration of the membrane, forming a lethal pore in the cell.
49 51 The chemistry of the lipid raft (e.g., cholesterol content) is known to change with age, and such changes could alter the susceptibility of the host cell to toxin action.
52
Injection of 10, 25, or 50 HU α-toxin into rabbit corneas demonstrated significantly greater pathologic effects in young than in aged rabbits. Each of these three quantities of toxin produced similar pathologic effects. The lack of a dose-response effect for the toxin between 10 and 50 HU implies that these doses were saturating in terms of their ability to induce maximal pathologic effects. In contrast to active toxin injected in doses at or above 10 HU, injection into the cornea of heat-inactivated toxin in substantial quantities or active toxin at only 1 HU caused essentially no pathologic effects.
The effect of age on the susceptibility to
S. aureus keratitis and to toxin administration is not specific to one bacterial strain or to one animal species. The effect of age on the symptoms of keratitis was found herein to occur with a well-characterized laboratory strain and a clinical corneal isolate. Furthermore, a second laboratory strain (strain Newman) produced a similar effect (data not shown). With regard to animal species, studies of
S. aureus keratitis in mice have shown an age-related effect on the symptoms of keratitis.
17 Girgis et al.
17 demonstrated that the advanced age of mice caused an increase in susceptibility, an effect opposite that of aging in rabbits. The increased susceptibility of the mouse with age suggested a possible linkage of toxin susceptibility to a declining immune response, a decline noted to be important in
Pseudomonas keratitis.
53 However, the rabbit is expected to undergo a decline in the immune system similar to that found in the mouse. In addition, animals used in this series of experiments included aged rabbits lacking protective antibody (data not shown).
23 Thus, the reduced α-toxin susceptibility in the aged rabbit is opposite that of the aged mouse, indicating that toxin interactions with cell surfaces could be a more important mechanism of pathogenesis than a decline in the innate immune system. The findings with
S. aureus in the rabbit are also unlike those for
Pseudomonas in the mouse. Hazlett et al.
54 55 have shown that the corneas of mature mice (1 year old) fail to recover from
Pseudomonas keratitis, whereas the corneas of young mice (6–8 weeks old) almost completely recover.
The ability to essentially recover from S. aureus keratitis was observed in aged, but not in young, rabbits. This difference occurred with equivalent numbers of PMNs present in the corneas of both groups of animals. The effects of purified native toxin on the eyes of young and aged rabbits suggest that a difference in the direct action of the toxin in young versus aged rabbits determines the outcome of the infection. This concept is supported by the difference in toxin susceptibility in the erythrocytes of young and aged rabbits.
The present study describes differences between young and aged rabbits in their susceptibility to S. aureus keratitis, to corneal administration of α-toxin, and to erythrocyte lysis by α-toxin in vitro. These results are consistent with the concept that the toxin causes direct pathologic cellular effects, the extent of which could determine both the amount of direct tissue damage and the amount of immunopathology induced by S. aureus keratitis.
The authors thank Julian M. Reed, Aihua Tang, and Charles Balzli for their assistance in this study. Special recognition goes to Kathryn S. Monds for her major contribution to this research.