LXR Signaling Mediates Protection from Bacterial Toxins

Abstract Necrotizing fasciitis (NF) is an aggressive skin and soft tissue infection characterized by massive tissue destruction. Current treatment strategies are limited to aggressive and repeated surgical debridement, coupled with systemic antibiotics. Thus, new therapeutic approaches that preserve tissue integrity would be beneficial. Cholesterol-dependent cytolysins (CDCs) are toxins produced by select gram-positive microbes implicated in NF. CDCs recognize cholesterol in membranes of cells for pore formation and subsequent cellular and tissue damage. Recently, we have shown that interferon signaling is able to protect cells from CDCs via reprogramming cholesterol homeostasis. This observation led to us to ask if pharmacological targeting of cholesterol metabolism provide similar protection. Liver X Receptor (LXRs) are key transcriptional regulators of cholesterol metabolism. We find that pharmacological LXR activation protects mice from Streptolysin O (SLO)-induced tissue damage. LXR stimulation in various cell types, such as macrophages, neutrophils, and endothelial cells induced resistance to CDCs by abrogating the ability of CDCs to directly bind to cholesterol in the plasma membrane. Ongoing mechanistic studies are investigating which metabolic pathways induced by LXRs (e.g., cholesterol efflux, biosynthesis, import, or trafficking) are responsible for the protective effects. Translationally, LXR stimulation may serve as an adjunctive therapeutics for necrotizing fasciitis and other CDC-mediated pathologies (e.g., pneumonia, pharyngitis, and septic cardiomyopathy). P01 HL146358