The findings of this study are the first to indicate that PLA2 is
an important host defense molecule of the rabbit tear film and to
demonstrate that this enzyme in rabbit tears kills
S.
aureus. The action of PLA2 in the tear film explains the observed
death of
S. aureus after bacterial inoculation topically
onto the scarified rabbit cornea. Although the antibacterial action of
tears has been traditionally associated with lysozyme, complement,
lactoferrin, and IgA antibody,
1 2 4 5 6 the data presented
herein and that of another study
13 demonstrate that PLA2
is a very potent bactericidal factor of the tear film. Although the
present study demonstrates the susceptibility of
S. aureus to PLA2, other ocular pathogens are reported to be susceptible to
digestion by PLA2 from leukocytes.
33 Qu and
Lehrer
13 have shown that PLA2 in human tears can kill a
variety of Gram-positive pathogens. Thus, PLA2 activity in rabbit tears
probably protects against multiple types of bacteria pathogens that
contact the tear film.
The defensive role of PLA2 in rabbit tears was overcome by the addition
of inhibitors of the PLA2 reaction. These inhibitors significantly
reduced the release of arachidonic acid from bacteria incubated in
tears and promoted the survival and growth of bacteria in potentially
lethal quantities of tears (60 μl). The data do not exclude the
possibility that, in addition to PLA2 digestion of bacterial membranes,
other components of tears contribute to bacterial killing. However, the
data show that PLA2 must be active for the bactericidal reaction to
occur.
The results of this study help explain the difference in bacterial
survival and growth after inoculation by intrastromal injection as
opposed to topical inoculation. Injection of relatively small numbers
of
S. aureus (100 CFU) into the rabbit corneal stroma
(remote from the tear film) results in keratitis characterized by rapid
increases in the number of CFU per cornea and by a steady increase in
inflammation and tissue damage.
18 However, Matoba et
al.
20 showed that topical inoculation of
S.
aureus onto scarified rabbit corneas failed to result in
keratitis. The present study as well as previous studies from this
laboratory
26 and from Rhem et al.
34 demonstrates that the application of
S. aureus onto the
rabbit cornea can lead to inflammation. Inflammation noted by this
laboratory included chemosis, injection, and accumulation of pus on the
corneal surface. Such inflammation could be stimulated at least in part
by the release of arachidonic acid during PLA2 digestion of the
bacterial inoculum. The release of arachidonic acid could also
stimulate inflammation during other ocular infections associated with
Staphylococcus such as conjunctivitis or blepharitis.
Although inflammation was apparent in previous
studies,
20 26 34 an increase in bacterial CFUs in the
cornea after topical inoculation has not been previously described. In
fact, numerous methods to mechanically compromise the cornea before
topical inoculation have failed to yield a topical model of
Staphylococcus keratitis with extensive bacterial
replication.
26 The methods tested include enhanced
scarification, vertical incisions of various depths into the stroma
using a diamond knife, and removal of the epithelium. Pretreatment of
the cornea with hydrolytic enzymes and the testing of numerous
bacterial strains and growth conditions have also failed to yield an
infection in which extensive and rapid bacterial replication followed
topical inoculation. The successful infection of the rabbit cornea
after inoculation by intrastromal injection and the repeated failures
of topical
Staphylococcus inoculations each appear
appropriate now that the bactericidal potency of PLA2 in the rabbit
tear film has been determined.
The killing of
Staphylococcus in rabbit tears appeared
greater at 33°C than at 37°C. This observation, however, represents
the sum of two reactions: the killing of bacteria by PLA2 in tears and
the growth of bacteria in a rich medium (TSB) at 37°C. Release of
radioactive arachidonic acid from bacterial membranes was as extensive
at 37°C as at 33°C, indicating that PLA2 is fully active at 37°C
(unpublished finding). Most experiments in the present study were
conducted at 33°C because the lower temperature (33°C vs. 37°C)
is essentially that of the normal rabbit corneal
surface.
28
The effect of tears on
Staphylococcus survival was clearly
concentration dependent. Low volumes of tears mixed with bacteria in
buffer resulted in bacterial growth, indicating that tears contain a
relatively high concentration of nutrients suitable for bacterial
replication. However, at higher tear concentrations the bactericidal
properties of tears offset the nutritive effects, and the bacteria were
killed. These results are significant because they suggest that even a
partial loss of PLA2 activity in the tear film could leave the corneal
surface covered with a nutritive layer instead of a bactericidal layer.
A loss in the bactericidal activity of PLA2 in tears could be an
unrecognized hallmark of some diseases that predispose patients to
bacterial infection (e.g., Sjögren’s syndrome). If so, the
topical application of exogenous PLA2 could represent a prophylactic
therapy for such patient populations. Saari et al.
35 have
suggested that PLA2 of human tears declines with age. This decline of
PLA2 could increase the possibility of ocular infection among the
elderly.
Two findings of potential significance were that tetracaine inhibits
the PLA2 reaction responsible for the killing of bacteria in tears and
that tetracaine is itself toxic to
S. aureus. Tetracaine is
only one topical anesthetic commonly used in ophthalmology that has
reported inhibitory activity for PLA2.
22 We have found
that proparacaine is another topical ocular medication that is
inhibitory for PLA2 digestion of bacterial membranes (unpublished
finding). These findings imply that the use of an ocular anesthetic
inhibitory for PLA2 activity on bacteria could compromise this major
host defense of the tear film and precondition the eye to infection
with bacteria resistant to the anesthetic. The bactericidal activity of
these anesthetics could be an under-recognized yet important factor in
avoiding nosocomial ocular infections. Studies are needed to determine
the ability of various drugs to inhibit the protective PLA2 reaction,
the susceptibility of various ocular bacterial pathogens to the PLA2
activity, and the susceptibility of these ocular pathogens to ocular
anesthetics.
This study has demonstrated that bacterial killing in the tear film of
rabbits is mediated by PLA2 and that this defense mechanism is
apparently of sufficient potency to protect the scarified cornea
against topical inoculation of Staphylococcus. Although the
data presently available do not exclude the involvement of other host
components in the bacterial killing reactions, inhibition of PLA2
activity by spermidine was sufficient to protect bacteria from the
lethal effects of tears. Impairment of PLA2 activity by use of drugs
inhibitory to this protective enzyme could be a predisposing factor for
ocular infections, especially those after surgery or other invasive
techniques. Further studies of this protective reaction as a
broad-based ocular host defense system are needed to understand the
interaction of the tear film with invading bacteria.
The authors thank Hinh Keith Nyugen, Kiana Nelson, and Quentin
Booker for their technical assistance with this manuscript.