Repurposed drugs block toxin-driven platelet clearance by the hepatic Ashwell-Morell receptor to clear Staphylococcus aureus bacteremia

J Sun, S Uchiyama, J Olson, Y Morodomi… - Science translational …, 2021 - science.org
J Sun, S Uchiyama, J Olson, Y Morodomi, I Cornax, N Ando, Y Kohno, MMT Kyaw, B Aguilar…
Science translational medicine, 2021science.org
Staphylococcus aureus (SA) bloodstream infections cause high morbidity and mortality (20
to 30%) despite modern supportive care. In a human bacteremia cohort, we found that
development of thrombocytopenia was correlated to increased mortality and increased α-
toxin expression by the pathogen. Platelet-derived antibacterial peptides are important in
bloodstream defense against SA, but α-toxin decreased platelet viability, induced platelet
sialidase to cause desialylation of platelet glycoproteins, and accelerated platelet clearance …
Staphylococcus aureus (SA) bloodstream infections cause high morbidity and mortality (20 to 30%) despite modern supportive care. In a human bacteremia cohort, we found that development of thrombocytopenia was correlated to increased mortality and increased α-toxin expression by the pathogen. Platelet-derived antibacterial peptides are important in bloodstream defense against SA, but α-toxin decreased platelet viability, induced platelet sialidase to cause desialylation of platelet glycoproteins, and accelerated platelet clearance by the hepatic Ashwell-Morell receptor (AMR). Ticagrelor (Brilinta), a commonly prescribed P2Y12 receptor inhibitor used after myocardial infarction, blocked α-toxin–mediated platelet injury and resulting thrombocytopenia, thereby providing protection from lethal SA infection in a murine intravenous challenge model. Genetic deletion or pharmacological inhibition of AMR stabilized platelet counts and enhanced resistance to SA infection, and the anti-influenza sialidase inhibitor oseltamivir (Tamiflu) provided similar therapeutic benefit. Thus, a “toxin-platelet-AMR” regulatory pathway plays a critical role in the pathogenesis of SA bloodstream infection, and its elucidation provides proof of concept for repurposing two commonly prescribed drugs as adjunctive therapies to improve patient outcomes.
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