Toxicity of pneumolysin to pulmonary endothelial cells in vitro

Pneumococcal pneumonia and bacteremia are associated with appreciable mortality, most of which occurs very early in the course of infection. An initial step in the pathogenesis of pneumococcal pneumonia may include disruption of the pulmonary endothelial barrier with subsequent alveolar hemorrhage. We sought to determine whether soluble factors from Streptococcus pneumoniae can directly injure pulmonary endothelial cells in vitro and to identify pneumococcal toxins that may be involved in endothelial cell injury. Suspensions of S. pneumoniae (10(8) organisms per ml) caused significant injury to cultured bovine pulmonary artery endothelial cells in a time-dependent manner. The degree of endothelial cell cytotoxicity differed among S. pneumoniae strains; among the strains tested, a type 14 strain was the most cytotoxic and a type 3 strain was the least cytotoxic. During autolysis, type 14 S. pneumoniae released a soluble endothelial cell cytotoxin that was distinct from S. pneumoniae capsular and cell wall polysaccharides. The soluble cytotoxin was further characterized as a thiol-activated, heat-sensitive protein that coeluted with purified pneumolysin during gel filtration. The identity of the S. pneumoniae endothelial cell cytotoxin as pneumolysin was further supported by the ability of purified pneumolysin and the inability of S. pneumoniae mutants which lack pneumolysin to injure endothelial cells, as well as by the inhibition of the soluble S. pneumoniae cytotoxin by a neutralizing antibody to pneumolysin. Pneumolysin appears to be the major S. pneumoniae soluble cytotoxin for pulmonary endothelial cells in vitro and may be an important factor in the pathogenesis of alveolar hemorrhages in S. pneumoniae infections.