Does aggregation substance of Enterococcus faecalis contribute to development of endocarditis?

Aggregation substance (AS) of Enterococcus faecalis which is encoded by so-called sex pheromone plasmids enables the bacteria to bind to in vitro-cultured pig kidney tubular cells. It is reported that the presence of AS is not of pivotal importance for the ability of E. faecalis to cause infective endocarditis (EN). The lines of evidence for this are twofold: 1) sex pheromone plasmids and, therefore, the gene for AS were not present more often in epidemiologically unrelated strains of E. faecalis isolated from human cases of EN than in isolates from well-water (26 vs. 18%); 2) the presence of the adhesin did not correlate with the establishment of EN in an animal (rat) model. The data are discussed with respect to the specificity of interaction of AS with eukaryotic cells and the results of other studies.