The overall goal of this competitive renewal is to further understand why some individuals develop Staphylococcus aureus infection;and of those with S. aureus bacteremia (SAB), why only some develop adverse outcomes. Increasing rates of S. aureus infection and the identification of clinical S. aureus strains resistant to all currenly available antibiotics demand an increased understanding of the genetic basis for host response to this emerging pathogen. The specific hypothesis to be tested in this application is that identifiable host genetic factors are important determinants of susceptibility to S. aureus infection. This hypothesis is based upon 1) higher rates of SAB among ethnically distinct populations, including African Americans;2) higher rates of SAB among patients with specific rare genetic conditions;and 3) our discovery in the original application of differing genetic susceptibility to S. aureus in inbred mice. Despite recent advances in human and molecular genetics, no large-scale studies of human genetic susceptibility to S. aureus have been published. This is largely due to the lack of a well-characterized collection of DNA and corresponding bacterial isolate from patients with S. aureus infection. Our group has created the S. aureus Bacteremia Group (SABG), one of the world's largest collections of paired human DNA and bloodstream isolates from patients with SAB. Building upon the discoveries of our original R01, our renewal combines the unique SABG resource with state of the art technology and strong collaborations with authorities in human genetics to pursue a multi-faceted approach to discovering novel genetic variants in patients with SAB. To do this we propose four Specific Aims: 1) identify candidate genes associated with susceptibility to S. aureus infection in a murine sepsis model;2) identify candidate genes associated with susceptibility to S. aureus infection in African Americans (AA) using admixture mapping;3) identify and prioritize genes containing rare, functional, coding sequence variants underlying SAB overall, and complicated SAB in particular, via exome sequencing;and 4) test the relevance of existing candidate genes discovered in the original R01 and new candidate genes in Aims 1-3 in the overall SABG cohort (1200cases/1200controls). The long-term objectives of this project are to: 1) identify genes responsible for susceptibility to S. aureus;2) investigate the clinical importance of these genes in humans with S. aureus bacteremia;and 3) ultimately use these genes to identify novel interventions for the control of S. aureus infections. The products of this grant will include an increased understanding of the role of genetic susceptibility to S. aureus in determining the development and severity of infection. The full value of the current application also includes the potential benefit to the research community as a whole if links between host genotype and clinical outcome (only possible to identify using such a large and well-characterized collection of DNA from infected patients) can be defined. This work is critical to furthering the understanding of a crucial medical problem because: 1) S. aureus is an emerging pathogen, and 2) interventions to reduce S. aureus morbidity require a better knowledge of the determinants of both the development and severity of infection. Understanding the host genetic determinants of this disease will advance our understanding of staphylococcal pathogenesis and will enable key advances in protecting the public health from this pathogen.

Public Health Relevance

competitive renewal is highly relevant to the health of the American Public, as it seeks to understand the pathophysiology of Staphylococcus aureus. S. aureus is one of the leading pathogens plaguing the American public. Rates of both infections and antibiotic resistance in S. aureus are increasing. These alarming trends indicate the possibility of a pathogen impervious to all currently approved therapy. This application seeks to improve our understanding of this persistent pathogen by pursuing the question, Why do some, but not all patients develop S. aureus bacteremia, and of those infected, why do only some go on to develop life- threatening complications? By increasing our understanding of the genetic basis of host response to S. aureus, this application could aid our ability to intervene in the disease process, focus healthcare resources onto S. aureus-infected patients at highest risk for complications, and lead to improved interventions and diagnostics.

National Institute of Health (NIH)
Research Project (R01)
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Study Section
Infectious Diseases, Reproductive Health, Asthma and Pulmonary Conditions Study Section (IRAP)
Program Officer
Huntley, Clayton C
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Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
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Nelson, Charlotte L; Pelak, Kimberly; Podgoreanu, Mihai V et al. (2014) A genome-wide association study of variants associated with acquisition of Staphylococcus aureus bacteremia in a healthcare setting. BMC Infect Dis 14:83
Fowler Jr, V G; Proctor, R A (2014) Where does a Staphylococcus aureus vaccine stand? Clin Microbiol Infect 20 Suppl 5:66-75
Kaasch, Achim J; Barlow, Gavin; Edgeworth, Jonathan D et al. (2014) Staphylococcus aureus bloodstream infection: a pooled analysis of five prospective, observational studies. J Infect 68:242-51
Tong, Steven Y C; Sharma-Kuinkel, Batu K; Thaden, Joshua T et al. (2013) Virulence of endemic nonpigmented northern Australian Staphylococcus aureus clone (clonal complex 75, S. argenteus) is not augmented by staphyloxanthin. J Infect Dis 208:520-7
van Hal, Sebastiaan J; Fowler Jr, Vance G (2013) Is it time to replace vancomycin in the treatment of methicillin-resistant Staphylococcus aureus infections? Clin Infect Dis 56:1779-88
Ahn, Sun Hee; Tsalik, Ephraim L; Cyr, Derek D et al. (2013) Gene expression-based classifiers identify Staphylococcus aureus infection in mice and humans. PLoS One 8:e48979
Andersen, P S; Larsen, L A; Fowler Jr, V G et al. (2013) Risk factors for Staphylococcus aureus nasal colonization in Danish middle-aged and elderly twins. Eur J Clin Microbiol Infect Dis 32:1321-6
Moehring, Rebekah W; Sloane, Richard; Chen, Luke F et al. (2013) Delays in appropriate antibiotic therapy for gram-negative bloodstream infections: a multicenter, community hospital study. PLoS One 8:e76225
Federspiel, Jerome J; Stearns, Sally C; Peppercorn, Amanda F et al. (2012) Increasing US rates of endocarditis with Staphylococcus aureus: 1999-2008. Arch Intern Med 172:363-5
Tong, Steven Y C; Chen, Luke F; Fowler Jr, Vance G (2012) Colonization, pathogenicity, host susceptibility, and therapeutics for Staphylococcus aureus: what is the clinical relevance? Semin Immunopathol 34:185-200

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