Search tips
Search criteria 


Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
J Immunol. Author manuscript; available in PMC 2013 December 1.
Published in final edited form as:
PMCID: PMC3517878

Pneumococcal surface protein A inhibits complement deposition on the pneumococcal surface by competing with the binding of C-reactive protein to cell-surface phosphocholine


In the presence of normal serum, complement component C3 is deposited on pneumococci primarily via the classical pathway. Pneumococcal surface protein A (PspA), a major virulence factor of pneumococci, effectively inhibits C3 deposition. PspA’s C-terminal has a choline-binding domain that anchors PspA to the phosphocholine (PC) moieties on the pneumococcal surface. C-reactive protein (CRP), another important host defense molecule, also binds to PC and CRP binding to pneumococci enhances complement C3 deposition through the classical pathway. Using flow cytometry of PspA+ and PspA strains we observed that the absence of PspA led to exposure of PC, enhanced the surface binding of CRP, and increased the deposition of C3. Moreover, when the PspA mutant was incubated with a pneumococcal eluate containing native PspA, there was decreased deposition of CRP and C3 on the pneumococcal surface compared to incubation with an eluate from a PspA strain. This inhibition was not observed when a recombinant PspA fragment, which lacks the choline-binding region of PspA, was added to the PspA mutant. Also, there was much greater C3 deposition onto the PspA pneumococcus when exposed to normal mouse serum from wild-type (WT) mice as compared to that from CRP knockout mice. Furthermore, when CRP knockout mouse serum was replenished with CRP, there was a dose-dependent increase in C3 deposition. The combined data reveal a novel mechanism of complement inhibition by a bacterial protein: inhibition of CRP surface binding and thus diminution of CRP-mediated complement deposition.


Streptococcus pneumoniae (pneumococcus) is a Gram-positive bacterium responsible for much of the pneumonia, bacteremia, meningitis, otitis media and septicemia in children < 2 years of age, the elderly, and immunocompromised hosts (1). Pneumococci asymptomatically colonize the nasopharynx in about 30% of normal children and a lower percentage of adults. It is only when the bacterium successfully migrates to organs such as the lungs, nasal sinuses, brain, and middle ear that symptomatic disease can occur (2). The World Health Organization estimates that about 2 million children under 5 years of age die of pneumonia each year and the pneumococcus is the largest cause of these deaths (3).

The complement system consists of over 30 circulating and membrane-bound proteins that play a major effector role in the immune response to pathogens. Complement must be activated to mediate antimicrobial activity. Serum components, such as C-reactive protein (CRP) and antibody, can initiate the complement cascade. There are at least three overlapping pathways of complement activation: the classical pathway, the alternative pathway, and the lectin pathway, of which the best known is the mannose-binding pathway (4). These pathways converge on the activation of C3, which leads to downstream events responsible for most of complement’s effector functions. Complement eliminates bacteria through two major mechanisms: opsonization and membrane attack complex-mediated lysis. Pneumococci and other Gram-positive bacteria are normally protected from complement-mediated lysis by their rigid cell wall (5, 6). Opsonization of microbes, via covalent attachment of C3 and its fragments, fosters the recognition of the bacteria by complement receptors on professional phagocytes and promotes bacterial ingestion. Complement dependent opsonophagocytosis is critical for the clearance of pneumococci from the bloodstream of the host (5, 7). Complement activation also results in the release of soluble bioactive fragments (eg. C3a, C4a, C5a) that stimulate mast cells, macrophages, and neutrophils during the inflammatory response.

Pneumococci produce several molecules that help them evade complement deposition (8). Among these is pneumococcal surface protein A (PspA), which is present on virtually all strains of pneumococci and is highly immunogenic (912). There are two major families of PspA, family 1 and family 2, which are further divided into clades (13, 14). Any given strain expresses only a single PspA allele and thus expresses PspA of only one family. Strains of each major capsular type includes strains that express PspA family 1 and strains that express PspA family 2 (10, 14). Both families of PspA are able to inhibit C3 deposition on the pneumococcal surface and confer virulence on pneumococci (12). Proteins within PspA families are immunologically cross-reactive (15, 16); and immunity to a member of either family is generally protective against members of the same family and frequently cross-protective against strains of the other PspA family (9, 17, 18).

Full-length native PspA (FL-PspA) consists of five distinct domains. From N-terminal to C-terminal these are: a signal peptide, a highly charged anti-parallel coiled coil alpha helical domain, a proline-rich region, a choline-binding domain, and a C-terminal 17-amino-acid tail (1921). PspA is a member of a family of choline binding proteins on the pneumococcus, which are anchored to the pneumococcal surface via their choline-binding domains (22). Choline-binding domains recognize the phosphocholine (PC) on the cell wall and cell-membrane-associated teichoic acids (23). Mutant PspA proteins lacking the choline-binding repeats are largely absent from the bacterial surface (12, 23, 24), and mutant strains lacking surface PspA show reduced virulence and greater complement deposition in normal serum (11, 12, 25). An isogenic strain lacking 6 of its 10 choline-binding repeats showed intermediate surface-expression of PspA, reduced virulence, and intermediate deposition of C3 (12). It has been shown using normal serum lacking detectable anti-pneumococcal Ab that complement deposition on pneumococci occurs via the classical pathway (26, 27). In the absence of PspA, the classical-pathway-dependent, C1q-dependent, deposition of complement on pneumococci in normal serum is greatly increased (12, 27). Accordingly, PspA strains show greater clearance from blood compared to PspA+ strains (11, 28). However, the mechanism accounting for PspA’s effect on complement has not been described.

CRP is found in low amounts (generally 1–3 μg/ml) in the serum of healthy humans but can increase 500-fold or more in response to inflammation or infection (29, 30). CRP is evolutionarily conserved and healthy mice have blood concentrations of CRP comparable to healthy humans (31). Importantly, however, mouse CRP is a minor acute phase reactant and can only increase in concentration about two-fold during inflammation (31). Like PspA, CRP can bind PC on the pneumococcal cell surface (32) where it activates the classical pathway in a C1q-dependent manner (33, 34) and can protect against invasive infection (35, 36). Since PspA is the most abundant pneumococcal choline-binding protein (22, 37), its absence should significantly increase 1) PC exposure on pneumococcal surface, 2) binding by CRP, 3) complement activation, and 4) greater opsonization of pneumococci. In this study, we tested the hypothesis that surface-bound PspA minimizes the binding of CRP, thus decreasing CRP-mediated activation of the complement pathway. PspA+ and PspA strains were examined for their exposure of PC and their ability to bind both CRP and natural Ab to PC. We also examined the ability of these strains to be targets of complement deposition when exposed to complement from wild-type (WT) versus CRP knockout (CRPKO) mice.

Materials and Methods

Bacterial strains and cultures

The strains used in this study included capsular serotype 2 pneumococci D39 (PspA+) (38) and its isogenic mutants (JY182) and (TRE108) lacking PspA or pneumococcal surface protein C (PspC), respectively (24, 27, 39). The PspA of D39 is family 1, clade 2 (40). We confirmed that the respective PspA and PspC proteins were not expressed in these mutants by immunoblot assay. For the PspA mutants we also examined PspA expression by flow cytometry where JY182 showed only background fluorescence with anti-PspA and D39 showed 7-fold higher mean fluorescence intensity (MFI). PspA expression was not changed in the pspC mutant. Both JY182 and TRE108 showed somewhat more capsule than strain D39; however, this difference was not statistically significant (data not shown). Capsule quantitation was done using a multiplex immunoassay developed in Dr. Moon Nahm’s lab at UAB (41). Strains D39, JY182, and TRE108 were grown in triplicate in 3ml volumes of Todd-Hewitt broth supplemented with 5% yeast extract (THY), with or without erythromycin (0.3ug/ml), to OD600 0.5. Next, 500 μl of each culture was lysed in 14x lysis buffer (41). 10-fold dilutions ranging from 1/10 to 1/107 lysates were used to inhibit the ability of type 2 anti-capsule antibodies to bind polysaccharide-coated latex beads. Purified type 2 polysaccharide ATCC 16-X (ATCC, Manassas, Virginia) was used as the standard.

Strain Rx1 (PspA+) (11, 42) is a non-encapsulated derivative of D39. WG44.1 is a pspA-null mutant of Rx1. PspA+ wild type (WT) strains TIGR4, P.765, P.1547, and P.1121 are capsular types 4, 6B, 6A, and 23F, respectively (4345). A pspA mutant in the 6A strain was made by double crossover insertion-deletion as described previously (44). The pspA mutation was transferred to the type 4, 6B and 23F strains by sequential back transformation and selecting with 200 μg/ml spectinomycin (Sigma-Aldrich, St. Louis, MO). A 6B revertant was prepared by transforming the 6B pspA mutant with a PCR product of the 6B pspA gene including approximately 800 bp flanking regions and screening for PspA protein expression by colony immunoblot with clade specific anti-PspA sera (46). The revertant was confirmed by loss of spectinomycin resistance and by DNA sequence analysis. Strains P.765, P.1547, and P.1121 are PspA family 1, and are PspA clades 1, 2, and 1 respectively. Capsular type 4 strain TIGR4 is family 2, clade 3 PspA.

Bacteria that were used in the CRP binding and C3 deposition assays were grown directly from frozen stocks on the day of assay and washed in PBS prior to use. The cells were grown in THY (with erythromycin added to the mutant strains) to an OD600 0.4, diluted back to an OD600 0.1, and then regrown in THY to an OD600 0.4 for use in the assays. For enumeration of pneumococci, cultures were serially diluted, plated on blood agar with or without erythromycin, and grown in a candle jar overnight.

Sera and buffers

Fresh frozen “normal” mouse serum from non-immunized mice (NMS) was obtained from CBA/CaHN-Btkxid/J (CBA/N) mice, which have no natural Ab to PC (47); and BALB/cJ mice, which have natural Ab to PC (48); and CRPKO mice (Crp−/− (C57BL/6J background)) which do not express any CRP (49). NMS for use as a complement source was pooled from groups of 8–10 mice of each genotype. The sera from all sources were aliquoted and stored at −80°C. In assays to measure CRP or C3 deposition, all buffers had a pH of ~7.3, all dilutions were in gelatin veronal buffer (GVB) containing 0.1% gelatin, 5mM veronal, 0.15 mM calcium, and 0.5 mM magnesium (GVB2+, CompTech, Tyler, TX), and all the washing steps were performed using PBS without Mg2+ or Ca2+ (Mediatech Inc, Manassas, VA). These studies were conducted in accordance with the principles set forth in the Guide for Care and Use of Laboratory Animals (Institute of Laboratory Animal Resources, National Research Council, revised 1996), and approved by The University of Alabama at Birmingham Institutional Animal Care and Use Committee.

Isolation of eluates containing FL-PspA

Rx1 and WG44.1 pneumococci were grown to an OD600 0.4 in 200 ml of chemically defined medium containing 0.03% choline chloride. FL-PspA was isolated and dialyzed as previously described (37).

To qualitatively detect PspA, 1/4 serial dilutions of cell eluates were immunoblotted on nitrocellulose membranes, blocked with 1% BSA in PBS, incubated with PspA specific mAb, XiR278 (50), and developed with biotinylated goat anti-mouse Ig, alkaline phosphatase conjugated streptavidin (Southern Biotechnology Associates Inc., Birmingham, AL) and nitrobluetetrazolium substrate with 5-bromo-4-chloro-3-indoyl phosphate p-toluedene salt (Fisher Scientific, Norcross, GA). The presence of eluted PspA was further confirmed by a Western immunoblot assay (37, 50). The amount of total protein in these bacterial eluate samples was determined by Bio-Rad protein assay (Bio-Rad, Hercules, CA), and the amount of BSA added in the FL-PspA isolation step was subtracted to yield net (total) bacterial eluate protein.

The amount of PspA in the cell eluate from Rx1 was determined using an ELISA. Microtiter 96-well plates (NUNC Weisbaden, Germany) were coated overnight at 4°C with 100 μl of a mixture of mAb XiR278 (50) and RX1003 (Genschmer and Briles, manuscript in preparation) at 2 μg/ml PBS total concentration (1μg/ml each). Plates were washed, blocked with 150 μl 1% BSA/0.2% casein (BSA/casein) for 1 h, washed, and then Rx1 (PspA+) and WG44.1 (PspA) cell eluates were titrated out on the plate in 1/3 dilutions in BSA/casein starting at 100, 10, and 1 μg/ml total protein. Finally, the plates were incubated at room temperature for 1 h with rabbit anti-PspA (1:1000) (14), washed, incubated for 1 h with 1:10,000 biotin-conjugated donkey anti-rabbit immunoglobulin antiserum IgG (H+L) (Southern Biotechnology Associates, Birmingham, AL), washed, incubated for 1 h with 1:4000 streptavidin conjugated to alkaline phosphatase (Southern Biotechnology Associates, Birmingham, AL), and developed with p-nitrophenyl phosphate (Sigma-Aldrich, St. Louis, MO) and the absorbance read at 405 nm. rUAB055 (51) was used as a standard at 60 ng/ml titered 1:3 in BSA/casein. The total PspA concentration in the cell eluate was calculated and expressed as ng/ml PspA.

Detection of exposed PspA and PC on the pneumococcal surface

Pneumococci (D39, JY182, TRE108, Rx1, and WG44.1) were grown as above and resuspended to 1×109CFU/ml in GVB. For the PspA expression assay, D39, JY182 and TRE108 were incubated in 100 μl of 1:500 PspA specific mAb (XiR278) at 37°C for 30 minutes with shaking. Samples were then washed and incubated with 50 μl of FITC labeled goat anti-mouse Ab (Southern Biotechnology Associates Inc., Birmingham, AL) diluted 1:100 in GVB at 37°C for 30 minutes with shaking. They were then washed and fixed with 500 μl 2% paraformaldehyde (PFA) (Electron Microscopy Sciences, Hatfield, PA) for analysis by flow cytometry. The PC exposure assay was carried out the same way as the PspA expression assay except that the IgA hybridoma TEPC15 (Sigma-Aldrich, St. Louis, MO) was used to detect PC on strains and mutants for 20,000 gated events.

Ab binding to pneumococcal surface

Types 6B, 4, 6A and 23F, along with their pspA mutants (and revertant, in the case of 6B), were grown to mid-log phase, washed, and resuspended in 1% BSA/PBS containing primary Ab. Ab for primary incubation was as follows: human IgG to PC (1:10) purified from pooled gamma globulin as previously described (52), normal human serum (NHS) (1:100) obtained from healthy adults, and NMS (1:10) pooled from BALB/C mice. Bacteria was incubated with primary Ab at 37°C for 30 minutes, washed, and bound Ab was detected using the appropriate species-specific anti-IgG or anti-IgM conjugated to FITC (1:200) (Sigma-Aldrich, St. Louis, MO) at room temperature for 30 minutes. Finally, bacteria were washed and resuspended in 2% PFA for analysis by flow cytometry for 20,000 gated events.

CRP binding assay

D39, JY182, and TRE108 strains were grown fresh from frozen stocks. Cultures were centrifuged at 3000 rpm, washed twice, and pneumococci were resuspended in GVB to a concentration of 1×109 CFU/ml. 200 μl of bacterial suspension were incubated with the indicated concentrations of human recombinant CRP (US Biologicals, Swampscott, MA) at 37°C for 30 minutes. For the assays where cell eluates from Rx1 and WG44.1 were used, bacteria were first incubated with appropriate concentration of eluate for 1 h at 37°C followed by the incubation step with CRP. These were washed twice and then incubated with 50 μl FITC-conjugated mouse anti-human CRP (1:50) (HyTest Ltd., Turku, Finland) at 37°C for 30 minutes. Finally, bacteria were then washed and fixed with 500 μl of 2% PFA. The controls included bacteria incubated with only GVB and bacteria incubated only with FITC-conjugated secondary Ab. Flow cytometric analysis was carried out using a FACSCalibur instrument (Becton Dickinson, Mountain View, CA) for 40,000 gated events. To make sure that the rCRP was not agglutinating pneumococci, bacteria were examined by slide agglutination. Even at concentrations as high as 250 μg/ml, rCRP was not able to aggregate strains D39, JY182, TRE108, and a non encapsulated mutant of D39, AM1000 (53) (data not shown). We also failed to see evidence of CRP-induced aggregation in our flow cytometry studies with D39, JY182, and TRE108. These findings are consistent with the fact the all PC binding sites of CRP are on the same face of the CRP pentamer (54, 55).

Complement deposition assay

Pneumococci at 1×109 CFU/ml in GVB were prepared as above. Fresh-frozen NMS (complement) from CBA/N mice or CRPKO mice was quick-thawed and added to the bacterial culture at a final concentration of 10%, incubated for 30 min at 37°C, and washed twice. 50 μl of FITC-conjugated goat IgG Ab to C3 (1:100) was added to the washed cells and incubated at 37°C for 30 minutes. The bacteria were subsequently washed and fixed with 500 μl of 2% PFA for flow cytometric analysis using 40,000 gated events. Most of the assays had three controls: 1) bacteria incubated with GVB, 2) bacteria incubated with FITC conjugated to secondary Ab, and 3) bacteria incubated with complement alone. In all cases, control values were at or near background levels and less than 5% of maximum MFI. For assays using pneumococcal eluates or rPspA to inhibit C3 deposition, comparable amounts of Rx1 or WG44.1 eluate were added to 200 μl of bacteria, incubated for 1 h at 37°C, and the bacteria were washed and fixed in 2% PFA prior to the addition of the complement source. Flow cytometric analysis was carried out for 40,000 gated events.


All experiments were conducted two or more times under the same conditions and in some cases representative experiments are shown. In most experiments, data points were obtained from duplicates or triplicates and error bars show SE or the range of the duplicates. Since duplicates invariably had very similar results, additional data points were not examined and no further attempt was made to statistically analyze those data. In the study where the PspA-containing eluate was used to inhibit C3 binding, three studies were done in singlicate at two different levels of inhibitor with similar results at each dose of inhibitor in each study. In that study, the results within each inhibitor in each experiment were ranked. Since both doses of inhibitor gave similar results, all 6 ranked data points for each inhibitor were analyzed together. The ranked data from the three experiments were analyzed in a single two-tailed Mann-Whitney two sample rank test as is indicated in the text describing this experiment. Unpaired t-tests were used for some data, as indicated in the relevant figure legends.


There is more PC exposed on the surface of PspA than on WT pneumococci

Our hypothesis was that PspA bound to PC blocks CRP binding to PC. If this was the case, then there should be more PC exposed on PspA pneumococci than on PspA+ pneumococci. To test this we evaluated PC expression on WT strain D39 and its pspA and pspC mutants. The pspA mutant of D39 had about 10-fold more exposure of PC as compared to WT. The absence of PspC also increased the exposure of PC but it was only a 2-fold change (Fig. 1A, panel 1). Similar results were seen when we compared PC exposure on the pspA mutant WG44.1 (11) with that of its parent strain Rx1 (42), a non-encapsulated variant of D39 (data not shown). We also looked at 3 additional strains of encapsulated pneumococci with isogenic mutations in pspA (Fig. 1A, panels 2–4). In the case of the capsular type 6B and 6A strains, an absence of PspA resulted in 7.5-fold and 10.5-fold increased exposure of PC, respectively, compared to their respective WT strains. When the PspA deficiency on the 6B mutant strain was restored by replacing the original pspA gene, the PC exposure was reduced back to WT levels (Fig. 1A, panel 2 and Fig. 1B). This observation confirmed that the increase in PC exposure on the pspA mutant of the type 6B strain was due to the lack of PspA expression and not the result of an unintended genetic event. In the case of the 23F strain, the PspA mutation caused only a modest 1.36-fold increase in PC exposure in the pspA mutant (Fig. 1A, panel 4). The reason for this much smaller effect of the PspA mutant on the type 23F strain is unknown but may indicate that PspA covered up a much smaller fraction of the PC on that particular strain than it had on the three other serotypes we tested.

Effect of PspA on PC surface exposure. (A) Representative flow histograms of TEPC 15 IgA MAb binding to PC on four wild-type strains of pneumococci of capsular types 2 (D39), 6B, 6A, and 23F, along with their PspA mutants. Also shown is the effect on ...

Since NHS and NMS contain antibodies to PC (47, 52, 56) it was also expected that the pspA mutants incubated with NHS or NMS would bind more human and mouse Ig than would WT strains. This expectation was confirmed for both NHS and BALB/c NMS for three pspA mutant strains (supplemental Figure 1). Human IgG to PC purified from pooled NHS (52) was observed to bind 2-fold better in the absence of PspA to 6B pneumococci. This increase in binding was lost in the revertant (Fig. 1C). These combined data with natural Ab to PC support the hypothesis that the absence of PspA exposes PC. The smaller effect seen with NHS versus mAb to PC probably reflects the fact that NHS invariably contains Ab to PspA (57), which would bind more strongly to WT than mutant pneumococci.

There is greater binding of CRP to the surface of the pspA mutant strain than to its WT parent

CRP is known to efficiently deposit C3 on encapsulated pneumococci (32, 34), so it was likely that CRP might contribute to increased complement deposition on PspA deficient pneumococci. The WT D39 strain was examined along with its pspA mutant (JY182) and pspC mutant (TRE108) to determine the relative effects of PspA and PspC on the binding of CRP. As predicted, the pspA mutant showed an increase of 2.28-fold in CRP-binding as compared to the WT strain (Fig. 2). A measurable increase in CRP binding to the pspC mutant was not observed, consistent with PspC’s smaller effect on PC exposure (Fig. 2).

Relative effects of pspA and pspC mutations on CRP binding. Wild type (D39), PspA mutant (JY182), and PspC mutant (TRE108) strains were examined for their ability to bind CRP in the presence of 100 μg/ml of human recombinant ...

The CRP present in normal serum is sufficient for C3 deposition on WT pneumococci and pspA mutant pneumococci

CRP is known to efficiently deposit C3 on encapsulated pneumococci (32, 34), so it was likely that increased CRP binding due to the absence of PspA might contribute to increased complement deposition on PspA deficient pneumococci. Despite low levels of CRP in NMS, we suspected that there would be enough CRP to support the classical pathway dependent C3 deposition that has been observed on WT and PspA deficient pneumococci in NMS (26, 27). In the presence of WT NMS we observed much stronger C3 deposition than in the presence of NMS from CRPKO mice (Fig. 3A). Moreover, in the presence of normal serum there was more complement deposition on PspA versus PspA+ D39 pneumococci. However, when CRPKO serum was the complement source the amount of C3 deposited was essentially the same as when we incubated the bacteria without complement (Fig. 3A). These data confirmed that CRP was necessary for the deposition of C3 on pneumococci.

Effect of CRP on complement C3 deposition on pneumococci. (A) D39 (PspA+) and JY182 (PspA) were incubated with 10% NMS from either CBA/N or CRPKO mice as the complement source for 30 minutes at 37°C with shaking. The cells were then incubated ...

The deposition of C3 onto the surface of PspA pneumococci is CRP-dose dependent

The interpretation that CRPKO NMS failed to support complement deposition because of its lack of CRP (Fig. 3A) depends in part on the assumption that the CRPKO NMS contained sufficient C3 to cause detectable deposition onto pneumococci if CRP had been present. To test this, JY182 (PspA) was incubated with NMS from CRPKO mice at 37°C, with and without the addition of recombinant human CRP. C3 binding to the surface of JY182 was measured by flow cytometry. As a negative control pneumococci received neither CRP nor CRPKO NMS. Compared to pneumococci incubated with CRPKO sera, there was a 1.5-, 2.2-, and 2.8-fold increase in C3 binding after addition of 50 μg/ml, 100 μg/ml and 150 μg/ml CRP, respectively (Fig. 3B). Thus, these data make it clear that the very low C3 deposition in the presence of CRPKO NMS is due to a lack of CRP and not due to inadequate complement levels.

A pneumococcal eluate containing FL-PspA inhibited CRP binding to the surface of JY182

The above data are consistent with the premise that PspA on pneumococci reduces PC exposure leading to impaired binding by CRP and the deposition of C3. Even though independent pspA mutants were used in some of the experiments and all mutants are well characterized, the possibility exists that differences between the WT and mutant strains may have been caused by unknown changes in non-pspA genes. To independently determine whether PspA can inhibit CRP deposition and C3 deposition, we added FL-PspA to JY182 prior to the addition of CRP or NMS.

FL-PspAs, in contrast to rPspA fragments that lack the choline-binding domain, are quite unstable and cannot be isolated and concentrated without extensive denaturation and loss. However, FL-PspA can be recovered in 2% choline-chloride eluates of WT pneumococci (37). A cell eluate containing FL-PspA was isolated in this manner from the non-encapsulated strain Rx1 that had been grown in a chemically defined medium. A control lysate was prepared from WG44.1, a pspA null-mutant of strain Rx1. Rx1 and WG44.1 cell eluates were incubated separately at 5 and 10 μg/ml of total eluate protein with JY182 (PspA), washed to remove unbound FL-PspA, incubated with CRP, and developed to detect CRP binding to the bacteria. The eluates of Rx1 (PspA+) at 5 and 10 μg/ml contained 9.9 and 19.8 ng/ml of PspA, respectively, as determined by a PspA-capture assay. This assay detected no PspA (<0.1 ng/ml) in the 5 and 10μg/ml concentrations of the eluate of WG44.1 (PspA). The eluate from Rx1, but not WG44.1, inhibited CRP deposition onto JY182 (Fig. 4A). Based on MFI in the presence of 5 and 10 μg/ml of total protein from the two eluates, there was 1.13-fold and 1.37-fold more CRP deposition, respectively, in the presence of the WG44.1 versus the Rx1 extract. Since the only difference between the two eluates was the presence of PspA, the results indicate that FL-PspA can inhibit CRP deposition on JY182.

Inhibition of CRP and C3 binding with a cell eluate containing FL-PspA. Cell eluate from strains Rx1 (PspA+) and WG44.1 (PspA) were incubated with JY182 (PspA) for 1 h at 37°C with shaking prior to the addition of CRP or C3. ...

A FL-PspA-containing pneumococcal eluate inhibited C3 deposition onto the surface of JY182

The FL-PspA-containing eluate of Rx1 and the control eluate from WG44.1 lacking FL-PspA were added to JY182 prior to the addition of NMS to measure its blocking effect on C3 deposition (Fig. 4B). The PspA-containing Rx1 cell eluate reduced C3 deposition compared to the WG44.1 eluate. At 20 μg/ml and 40 μg/ml protein added there was a 1.32-fold and 1.28-fold greater deposition of C3 on bacteria treated with WG44.1 cell eluate compared to those treated with Rx1 (Fig. 4B). Although these differences were small, they were significant at p =0.002 (see caption Fig. 4B). The fact that the effect was not larger with the higher dose may mean that the lower dose had already saturated the binding sites for PspA. These results show that treatment of PspA pneumococci with an extract containing FL-PspA was able to inhibit subsequent C3 deposition. Importantly, when the same experiment was repeated using CRPKO NMS as the complement source, there was about 1/15th as much C3 deposited on the surface of JY182. Moreover, in the presence of CRPKO NMS no significant difference was seen between the C3 deposited in the presence of the PspA+ and PspA eluates (data not shown). These results confirm a role for CRP in complement activation and deposition on the surface of PspA pneumococci. Furthermore, CRP-dependent activity could be inhibited by the addition of PspA expressing an intact choline-binding domain.

To test the hypothesis that the choline-binding domain was essential to inhibit the deposition of CRP and C3, we repeated the inhibition studies using rPspA, UAB055 (51), that contains the N-terminal alpha helical region of PspA and 14 amino acids of the proline-rich domain but completely lacks PspA’s choline-binding domain. There was no blocking effect with either 5 or 10 μg/ml rPspA on the binding of CRP to pneumococci or the deposition of C3 on pneumococci (Fig. 5). This lack of inhibition is especially striking since the concentrations of rPspA used were up to 500 times the concentration of FL-PspA used in the prior experiments. This observation is consistent with our hypothesis that because native PspA binds to PC, it is able to inhibit CRP binding and thus indirectly blocks CRP-dependent activation of C3 and deposition of C3b onto the pneumococcal surface.

Effect of rPspA, lacking the choline-binding domain, on CRP and C3 deposition on the surface of JY182. These studies were carried out and depicted similarly to those in Figure 4 except that rPspA UAB055, which lacks the choline-binding domain, was used ...


Both the classical and alternative complement pathways are known to be important for host defense against pneumococci (12, 26, 27, 58). Total complement deposition is greatly affected by defects in the alternative pathway since it acts to amplify any complement deposited on the pneumococcus via the classical or lectin pathways. However, the classical pathway appears to be the primary trigger for almost all complement deposition on highly virulent strains of pneumococci. This is true even in the presence of non-immune sera where complement deposition on pneumococci is dependent on the initial complement activation by the classical pathway (26, 27, 59). PspA is a choline-binding protein of pneumococci that binds to the PC epitopes on teichoic acids (23) and its virulence role of PspA in bacteremia and sepsis has been attributed largely to its ability to interfere with Ab-independent activation of the complement system (12, 27, 60).

CRP, when bound to the PC of teichoic acids, is able to bind C1q and activate complement via the classical pathway (34). CRP can activate complement when bound to S. pneumoniae and Haemophilus influenzae (61, 62). CRP is present at a few micrograms per ml in all human and mouse sera (29, 31). It can protect mice from pneumococcal infection (35, 36) and this protection requires complement (61). PspA can significantly reduce complement deposition on pneumococci in normal serum and this additional complement deposition is all C1q dependent (27). In this study we hypothesized that the ability of PspA to reduce C1q-dependent complement activation (27) by pneumococci in normal serum was by inhibiting the binding of CRP to pneumococci, thus reducing CRP-mediated C1q-dependent activation of the classical complement pathway (26, 34).

Our prior studies have shown that in addition to exhibiting greater complement deposition in normal serum, PspA pneumococci exhibit greater in vitro phagocytosis and faster clearance in non-immune mice as compared to PspA+ WT strains (11, 12, 25, 63). In this study, we showed that mutant pneumococci lacking PspA had significantly higher exposure of PC, greater deposition of rCRP, and greater deposition of C3 from NMS than was observed with WT pneumococci that expressed PspA. Moreover, enhanced C3 deposition on the strain lacking PspA was not observed in the presence of non-immune mouse serum from CRPKO mice. However, when recombinant human CRP was added to CRPKO serum, the deposition of C3 was restored. The role of PspA’s choline-binding activity in inhibiting C3 deposition was strengthened by the observation that FL-PspA, but not rPspA lacking a choline binding domain, could inhibit CRP binding and C3 deposition. These results support our hypothesized mechanism of classical pathway inhibition by PspA. The results also indicate that in normal serum complement activation via the classical pathway can be largely attributed to CRP. The importance of this inhibitory effect by PspA on complement deposition is probably magnified during a pneumococcal infection in man where CRP is an acute phase protein, which can increase in concentration over 500-fold during an infection (30).

Virtually all mice, except for Xid mice, produce Ab to PC in their NMS (47, 64), and these antibodies can have a protective effect against in vivo infection (47, 63). However, the fact that so little C3 deposition was observed with the CRPKO sera indicates that it is the CRP, and not the Ab to PC, that accounts for the bulk of the C3 deposition on WT pneumococci in NMS. In fact, in figure 3A, we observed much higher C3 deposition using CBA/N NMS, which lack Ab to PC but have CRP, than we did with CRPKO NMS, which lacks CRP but should contain IgM antibody to PC.

The absence of another choline-binding protein, PspC, resulted in only a small exposure of PC, did not increase CRP binding (present study), and does not increase classical pathway complement deposition (27). It is likely that the reason PspA, but not PspC, significantly inhibited CRP binding was because PspA is present in much higher concentrations on the pneumococcal surface than PspC and is thus able to cover much more PC. Although strict comparisons have not been made between the numbers of molecules of PspA and PspC expressed, it is noted that the PspC (CbpA) protein, and other choline binding proteins, could not be originally detected in pneumococcal surface extracts without using pneumococci with a pspA mutation to remove the co-isolated PspA from the extracts (22). It was also noted in early studies where PspA was isolated by elution with choline chloride from the pneumococcal surface that the major product was PspA (23, 37).

The observation that PspA’s effect on complement deposition resided in its choline-binding domain is in contrast to the observation that all known protective mAb to PspA are directed against the alpha-helical or proline-rich domains of PspA (50, 6567). Thus, the protective effects of Ab to PspA are not because they interfere with PspA’s ability to inhibit complement. Rather, the ability of Ab to PspA to enhance complement deposition on pneumococci and be protective (59, 68) probably depends on its ability to bind C1q and activate the classical pathway in the same manner as antibodies to other antigens.

The alpha-helical and proline-rich regions of PspA are highly exposed to Ab at the pneumococcal surface (66, 69) where they can be targeted by protective Ab (50, 6567). To evolutionarily justify the surface exposure of PspA, there must be a function mediated by the exposed portions of the molecule. The alpha-helical end of PspA blocks the bactericidal activity of cationic bactericidal peptides released by the degradation of apolactoferrin by binding strongly to the bactericidal peptides (21, 70, 71). PspA may block the bactericidal function of cationic peptides in general since it has been observed to bind and inhibit killing by other bactericidal peptides (S. Mirza, B. Hatcher, and D. Briles, unpublished observations).

Like CRP, serum amyloid p (SAP) is another PC-binding pentraxin that has been shown to opsonize pneumococci with C3b via the classical pathway and reduce infection in vivo in mice (33). SAP, however, has a different fine specificity from CRP in that it binds better to phosphorylethanolamine (72, 73), which is not normally expressed on pneumococci (74). Few direct in vivo comparisons between the two pentraxins have been conducted, but in early studies performed in mice SAP was less protective against pneumococcal infection than CRP (36). Even so, it is anticipated that SAP and CRP each contribute to complement deposition on pneumococci and subsequent bacterial clearance.

Finally, many mucosal pathogens, including S. pneumoniae, H. influenzae, Pseudomonas aeruginosa, Neisseria meningitidis (62, 75), Salmonella enterica Typhimurium (76), Proteus morganii (77), and the non-mucosal parasitic worms Brugia malayi (78) express PC on their surface. In most cases the PC can be detected with the same T15 idiotype antibodies to PC that are optimally protective against pneumococci (79). The expression of PC may aid these pathogens in the mucosal environment by facilitating adherence and colonization (62, 80). The frequent expression of PC by such pathogens may explain, in part, why mammalian hosts have evolved choline-binding triggers of innate immunity such as CRP and SAP. Mice and men also make strong (in the case of mice, germ-line (81)) anti-PC Ab responses. Both mouse (79) and human (52, 63) antibodies to PC can protect against pneumococcal infection. Not only have pneumococci developed a means to mask their PC with PspA (present study), they (43), and some gram negative mucosal pathogens (62, 75), modify PC exposure by phase variation. In pneumococci, the invariant PC epitope has been masked by PspA, which, unlike PC, is not detected by the innate immune system and is antigenically variable.

Supplementary Material


This work was supported by National Institutes of Health Grants AI 021458 (DEB), KL2 TR000370 (SM), AI138446 (JNW) and DA-026914 (AJS); Robert Austrian Research Award (AMR), Dixon Foundation Fellowship (RWW), and the Korean government WCU R33-10045 (DKR).

The authors are indebted to Janice King and Mark A. McCrory for help with the organization of many of these studies, Kristopher Genschmer for showing that CRP does not aggregate pneumococci, the Fujihashi lab for the use of their FACSCalibur machine, and to Moon H. Nahm and Jiqui Yu for their interest in the work and for making laboratory reagents available for some of these studies.

Abbreviations used in this paper

CBA/CaHN-Btkxid/J mice
C-reactive protein
CRP knockout
full-length native PspA
gelatin veronal buffer
mean fluorescence intensity
normal human sera
mouse serum from non-immunized mice
pneumococcal surface protein A
pneumococcal surface protein C
Todd-Hewitt broth supplemented with 5% yeast extract


The online version of this article contains supplemental material.


1. Gray BM, Musher DM. The history of pneumococcal disease. In: Seiber GR, Klugman KP, Makela PH, editors. Pneumococcal Vaccines. ASM Press; Washington, D. C: 2008. pp. 3–18.
2. Fedson DS, Musher DM. Pneumococcal Polysaccharide Vaccine. In: Plotkin SA, Orenstein WA, editors. Vaccines. W. B. Saunders; Philadelphia: 2004. pp. 529–588.
3. Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet. 2005;365:1147–1152. [PubMed]
4. Frank MM, Atkinson JP. Complement System. In: Austin KF, Frank MM, Atkinson JP, Cantor H, editors. Samter’s Immunologic Diseasse. Lippincott Williams and Wilkins; New York: 2001. pp. 282–298.
5. Joiner K, Brown E, Hammer C, Warren K, Frank M. Studies on the mechanism of bacterial resistance to complement-mediated killing. III. C5b-9 deposits stably on rough and type 7 S. pneumoniae without causing bacterial killing. J Immunol. 1983;130:845–849. [PubMed]
6. Hyams C, Camberlein E, Cohen JM, Bax K, Brown JS. The Streptococcus pneumoniae capsule inhibits complement activity and neutrophil phagocytosis by multiple mechanisms. Infect Immun. 2010;78:704–715. [PMC free article] [PubMed]
7. Yuste J, Ali S, Sriskandan S, Hyams C, Botto M, Brown JS. Roles of the alternative complement pathway and C1q during innate immunity to Streptococcus pyogenes. J Immunol. 2006;176:6112–6120. [PubMed]
8. Jarva H, Jokiranta TS, Wurzner R, Meri S. Complement resistance mechanisms of streptococci. Mol Immunol. 2003;40:95–107. [PubMed]
9. Briles DE, Hollingshead SK, King J, Swift A, Braun PA, Park MK, Ferguson LM, Nahm MH, Nabors GS. Immunization of humans with rPspA elicits antibodies, which passively protect mice from fatal infection with Streptococcus pneumoniae bearing heterologous PspA. The Journal of infectious diseases. 2000;182:1694–1701. [PubMed]
10. Croney CM, Coats MT, Nahm MH, Briles DE, Crain MJ. PspA family distribution, unlike capsular serotype, remained unaltered following introduction of the heptavalent-pneumococcal conjugate vaccine. Clin Vaccine Immunol. 2012;19:891–896. [PMC free article] [PubMed]
11. McDaniel LS, Yother J, Vijayakumar M, McGarry L, Guild WR, Briles DE. Use of insertional inactivation to facilitate studies of biological properties of pneumococcal surface protein A (PspA) J Exp Med. 1987;165:381–394. [PMC free article] [PubMed]
12. Ren B, Szalai AJ, Thomas O, Hollingshead SK, Briles DE. Both family 1and family 2 PspAs can inhibit complement deposition and confer virulence to a capsular 3 serotype Streptococcus pneumoniae. Infect Immun. 2003;71:75–85. [PMC free article] [PubMed]
13. Hollingshead SK, Baril L, Ferro S, King J, Coan P, Briles DE. Pneumococcal surface protein A (PspA) family distribution among clinical isolates from adults over 50 years of age collected in seven countries. J Med Microbiol. 2006;55:215–221. [PubMed]
14. Melin MM, Hollingshead SK, Briles DE, Hanage WP, Lahdenkari M, Kaijalainen T, Kilpi TM, Kayhty HM. Distribution of pneumococcal surface protein A families 1 and 2 among Streptococcus pneumoniae isolates from children in finland who had acute otitis media or were nasopharyngeal carriers. Clin Vaccine Immunol. 2008;15:1555–1563. [PMC free article] [PubMed]
15. Coral MCV, Fonseca N, Castaneda E, Di Fabio JL, Hollingshead SK, Briles DE. Families of pneumococcal surface protein A (PspA) of Streptococcus pneumoniae invasive isolates recovered from Colombian children. Emerging Infectious Diseases. 2001;7:832–836. [PMC free article] [PubMed]
16. Nabors GS, Braun PA, Herrmann DJ, Heise ML, Pyle DJ, Gravenstein S, Schilling M, Ferguson LM, Hollingshead SK, Briles DE, Becker RS. Immunization of healthy adults with a single recombinant pneumococcal surface protein A (PspA) variant stimulates broadly cross-reactive antibodies to heterologous PspA molecules. Vaccine. 2000;18:1743–1754. [PubMed]
17. Briles DE, Hollingshead SK, Nabors GS, Paton JC, Brooks-Walter A. The potential for using protein vaccines to protect against otitis media caused by Streptococcus pneumoniae. Vaccine. 2000;19:S87–S95. [PubMed]
18. Roche H, Ren B, McDaniel LS, Hakansson A, Briles DE. Relative roles of genetic background and variation in PspA in the ability of antibodies to PspA to protect against capsular type 3 and 4 strains of Streptococcus pneumoniae. Infect Immiun. 2003;71:4498–4505. [PMC free article] [PubMed]
19. Yother J, Briles DE. Structural properties and evolutionary relationships of PspA, a surface protein of Streptococcus pneumoniae, as revealed by sequence analysis. J Bacteriol. 1992;174:601–609. [PMC free article] [PubMed]
20. McDaniel LS, McDaniel DO, Hollingshead SK, Briles DE. Comparison of the PspA sequence from Streptococcus pneumoniae EF5668 to the previously identified PspA sequence from strain Rx1 and ability of PspA from EF5668 to elicit protection against pneumococci of different capsular types. Infect Immun. 1998;66:4748–4754. [PMC free article] [PubMed]
21. Senkovich O, Cook WJ, Mirza S, Hollingshead SK, Briles DE, Chattopadhyay D. Structure of a complex of human lactoferrin N-lobe with pneumococcal surface protein a provides insight into microbial defense mechanism. J Mol Biol. 2007;370:703–713. [PubMed]
22. Rosenow C, Ryan P, Weiser JN, Johnson S, Fontan P, Ortqvist A, Masure HR. Contribution of novel choline-binding proteins to adherence, colonization and immunogenicity of Streptococcus pneumoniae. Mol Microbiol. 1997;25:819–829. [PubMed]
23. Yother J, White JM. Novel surface attachment mechanism for the Streptococcus pneumoniae protein PspA. J Bacteriol. 1994;176:2976–2985. [PMC free article] [PubMed]
24. Yother J, Handsome GL, Briles DE. Truncated forms of PspA that are secreted from Streptococcus pneumoniae and their use in functional studies and cloning of the pspA gene. J Bact. 1992;174:610–618. [PMC free article] [PubMed]
25. Ren B, Li J, Genschmer K, Hollingshead SK, Briles DE. The absence of PspA or the presence of antibody to PspA each facilitate the complement-dependent phagocytosis of pneumococci in vitro. in Press. s,s:s. [PMC free article] [PubMed]
26. Brown JS, Hussell T, Gilliland SM, Holden DW, Paton JC, Ehrenstein MR, Walport MJ, Botto M. The classical pathway is the dominant complement pathway required for innate immunity to Streptococcus pneumoniae infection in mice. Proc Natl Acad Sci U S A. 2002;99:16969–16974. [PubMed]
27. Li J, Glover DT, Szalai AJ, Hollingshead SK, Briles DE. PspA and PspC minimize immune adherence and transfer of pneumococci from erythrocytes to macrophages through their effects on complement activation. Infect Immun. 2007;75:5877–5885. [PMC free article] [PubMed]
28. Briles DE, Tart RC, Swiatlo E, Dillard JP, Smith P, Benton KA, Ralph BA, Brooks-Walter A, Crain MJ, Hollingshead SK, McDaniel LS. Pneumococcal diversity: considerations for new vaccine strategies with an emphasis on pneumococcal surface protein A (PspA) Clin Microbiological Rev. 1998;11:645–657. [PMC free article] [PubMed]
29. Claus DR, Osmand AP, Gewurz H. Radioimmunoassay of human C-reactive protein and levels in normal sera. The Journal of laboratory and clinical medicine. 1976;87:120–128. [PubMed]
30. Szalai AJ, Agrawal A, Greenhough TJ, Volanakis JE. C-reactive protein: structural biology and host defense function. Clin Chem Lab Med. 1999;37:265–270. [PubMed]
31. Whitehead AS, Zahedi K, Rits M, Mortensen RF, Lelias JM. Mouse C-reactive protein. Generation of cDNA clones, structural analysis, and induction of mRNA during inflammation. Biochem J. 1990;266:283–290. [PubMed]
32. Volanakis JE, Kaplan MH. Specificity of C-reactive protein for choline phosphate residues of pneumococcal C-polysaccharide. Proc Soc Exp Biol Med. 1971;136:612–614. [PubMed]
33. Yuste J, Botto M, Bottoms SE, Brown JS. Serum amyloid P aids complement-mediated immunity to Streptococcus pneumoniae. PLoS Pathog. 2007;3:1208–1219. [PMC free article] [PubMed]
34. Volanakis JE, Kaplan MH. Interaction of C-reactive protein complexes with the complement system. II. Consumption of guinea pig complement by CRP complexes: requirement for human C1q. J Immunol. 1974;113:9–17. [PubMed]
35. Mold C, Nakayama N, Holzer TJ, Gewurz H, Clos TWD. C-reactive protein is protective against Streptococcus pneumoniae infection in mice. J Exp Med. 1981;154:1703–1708. [PMC free article] [PubMed]
36. Yother J, Volanakis JE, Briles DE. Human C-reactive protein is protective against fatal Streptococcus pneumoniae infection in mice. J Immunol. 1982;128:2374–2376. [PubMed]
37. Briles DE, King JD, Gray MA, McDaniel LS, Swiatlo E, Benton KA. PspA, a protection-eliciting pneumococcal protein: Immunogenicity of isolated native PspA in mice. Vaccine. 1996;14:858–867. [PubMed]
38. Avery OT, MacLeod CM, McCarty M. Studies on the chemical nature of the substance inducing transformation of pneumococcal types. Induction of transformation by a desoxyribonucleic acid fraction isolated from pneumococcus type III. J Exp Med. 1944;79:137–158. [PMC free article] [PubMed]
39. Balachandran P, Brooks-Walter A, Virolainen-Julkunen A, Hollingshead SK, Briles DE. The role of pneumococcal surface protein C in nasopharyngeal carriage and pneumonia and its ability to elicit protection against carriage ofStreptococcus pneumoniae. Infect Immun. 2002;70:2526–2534. [PMC free article] [PubMed]
40. Hollingshead SK, Becker RS, Briles DE. Diversity of PspA: mosaic genes and evidence for past recombination in Streptococcus pneumoniae. Infect Immun. 2000;68:5889–5900. [PMC free article] [PubMed]
41. Yu J, Lin J, Kim KH, Benjamin WH, Jr, Nahm MH. Development of an automated and multiplexed serotyping assay for Streptococcus pneumoniae. Clin Vaccine Immunol. 2011;18:1900–1907. [PMC free article] [PubMed]
42. Shoemaker NB, Guild WR. Destruction of low efficiency markers is a slow process occurring at a heteroduplex stage of transformation. Mol Gen Genet. 1974;128:283–290. [PubMed]
43. Kim JO, Weiser JN. Association of intrastrain phase variation in quantity of capsular polysaccharide and teichoic acid with the virulence of Streptococcus pneumoniae. The Journal of infectious diseases. 1998;177:368–377. [PubMed]
44. Roche AM, King SJ, Weiser JN. Live attenuated Streptococcus pneumoniae strains induce serotype-independent mucosal and systemic protection in mice. Infect Immun. 2007;75:2469–2475. [PMC free article] [PubMed]
45. McCool TL, Weiser JN. Limited Role of Antibody in Clearance of Streptococcus pneumoniae in a Murine Model of Colonization. Infect Immun. 2004;72:5807–5813. [PMC free article] [PubMed]
46. Darrieux M, Moreno AT, Ferreira DM, Pimenta FC, de Andrade AL, Lopes AP, Leite LC, Miyaji EN. Recognition of pneumococcal isolates by antisera raised against PspA fragments from different clades. J Med Microbiol. 2008;57:273–278. [PubMed]
47. Briles DE, Nahm M, Schroer K, Davie J, Baker P, Kearney J, Barletta R. Antiphosphocholine antibodies found in normal mouse serum are protective against intravenous infection with type 3 Streptococcus pneumoniae. J Exp Med. 1981;153:694–705. [PMC free article] [PubMed]
48. Claflin JL. Clonal nature of the immune response to phosphocholine. VII. Evidence throughout inbred mice for molecular similarities among antibodies bearing the T15 idiotype. J Immunol. 1980;125:551–558. [PubMed]
49. Jones NR, Pegues MA, McCrory MA, Kerr SW, Jiang H, Sellati R, Berger V, Villalona J, Parikh R, McFarland M, Pantages L, Madwed JB, Szalai AJ. Collagen-induced arthritis is exacerbated in C-reactive protein-deficient mice. Arthritis and rheumatism. 2011;63:2641–2650. [PMC free article] [PubMed]
50. McDaniel LS, Ralph BA, McDaniel DO, Briles DE. Localization of protection-eliciting epitopes on PspA of Streptococcus pneumoniae between amino acid residues 192 and 260. Microb Pathog. 1994;17:323–337. [PubMed]
51. Brooks-Walter A, Briles DE, Hollingshead SK. The pspC gene of Streptococcus pneumoniae encodes a polymorphic protein PspC, which elicits cross-reactive antibodies to PspA and provides immunity to pneumococcal bacteremia. Infect Immun. 1999;67:6533–6542. [PMC free article] [PubMed]
52. Goldenberg HB, McCool TL, Weiser JN. Cross-reactivity of human immunoglobulin G2 recognizing phosphorylcholine and evidence for protection against major bacterial pathogens of the human respiratory tract. J Infect Dis. 2004;190:1254–1263. [PubMed]
53. Magee AD, Yother J. Requirement for capsule in colonization by Streptococcus pneumoniae. Infect Immun. 2001;69:3755–3761. [PMC free article] [PubMed]
54. Roux KH, Kilpatrick JM, Volanakis JE, Kearney JF. Localization of the phosphocholine-binding sites on C-reactive protein by immunoelectron microscopy. J Immunol. 1983;131:2411–2415. [PubMed]
55. Du Clos TW, Mold C. Pentraxins (CRP, SAP) in the process of complement activation and clearance of apoptotic bodies through Fcγ receptors. Current opinion in organ transplantation. 2012 Jun 9; published ahead of print:000 – 000. [PMC free article] [PubMed]
56. Briles DE, Scott G, Gray B, Crain MJ, Blaese M, Nahm M, Scott V, Haber P. Naturally occuring antibodies to phosphocholine as a potential index of antibody responsiveness to polysaccharides. J Infect Dis. 1987;155:1307–1314. [PubMed]
57. Virolainen A, Russell W, Crain MJ, Rapola S, Kayhty H, Briles DE. Human antibodies to pneumococcal surface protein A, PspA. Ped Infect Dis J. 2000;19:134–138. [PubMed]
58. Ren B, McCrory MA, Pass C, Bullard DC, Ballantyne CM, Xu Y, Briles DE, Szalai AJ. The virulence function of Streptococcus pneumoniae surface protein A involves inhibition of complement activation and impairment of complement receptor-mediated protection. J Immunol. 2004;173:7506–7512. [PubMed]
59. Ren B, Szalai AJ, Hollingshead SK, Briles DE. Effects of PspA and antibodies to PspA on activation and deposition of complement on the pneumococcal surface. Infect Immun. 2004;72:114–122. [PMC free article] [PubMed]
60. Tu AHT, Fulgham RL, McCory MA, Briles DE, Szalai AJ. Pneumococcal surface protein A (PspA) inhibits complement activation by Streptococcus pneumoniae. Infect Immun. 1999;67:4720–4724. [PMC free article] [PubMed]
61. Szalai AJ, Briles DE, Volanakis JE. The role of complement in C-reactive-protein-mediated protection of mice from Streptococcus pneumoniae. Infect Immun. 1996;64:4850–4853. [PMC free article] [PubMed]
62. Weiser JN, Pan N, McGowan KL, Musher D, Martin A, Richards J. Phosphorylcholine on the lipopolysaccharide of Haemophilus influenzae contributes to persistence in the respiratory tract and sensitivity to serum killing mediated by C-reactive protein. J Exp Med. 1998;187:631–640. [PMC free article] [PubMed]
63. Briles DE, Forman C, Horowitz JC, Volanakis JE, Benjamin WH, Jr, McDaniel LS, Eldridge J, Brooks J. Antipneumococcal effects of C-reactive protein and monoclonal antibodies to pneumococcal cell wall and capsular antigens. Infect Immun. 1989;57:1457–1464. [PMC free article] [PubMed]
64. Lieberman RM, Potter M, Mushinski EB, Humpery W, Jr, Rudikoff S. Genetics of a new IgVH (T15 idiotype) marker in the mouse regulating natural antibody to phosphorylcholine. J Exp Med. 1974;139:983–1001. [PMC free article] [PubMed]
65. Roche H, Hakansson A, Hollingshead SK, Briles DE. Regions of PspA/EF3296 Best Able To Elicit Protection against Streptococcus pneumoniae in a Murine Infection Model. Infect Immun. 2003;71:1033–1041. [PMC free article] [PubMed]
66. Daniels CC, Coan P, King J, Hale J, Benton KA, Briles DE, Hollingshead SK. The proline-rich region of pneumococcal surface proteins A and C contains surface-accessible epitopes common to all pneumococci and elicits antibody-mediated protection against sepsis. Infect Immun. 2010;78:2163–2172. [PMC free article] [PubMed]
67. Darrieux M, Miyaji EN, Ferreira DM, Lopes LM, Lopes AP, Ren B, Briles DE, Hollingshead SK, Leite LC. Fusion proteins containing family 1 and family 2 PspAs elicit protection against Streptococcus pneumoniae that correlates with antibody-mediated enhancement of complement deposition. Infect Immun. 2007;75:5930–5938. [PMC free article] [PubMed]
68. Ochs MM, Bartlett W, Briles DE, Hicks B, Jurkuvenas A, Lau P, Ren B, Millar A. Vaccine-induced human antibodies to PspA augment complement C3 deposition on Streptococcus pneumoniae. Microb Pathog. 2008;44:204–214. [PMC free article] [PubMed]
69. Daniels CC, Briles TC, Mirza S, Hakansson AP, Briles DE. Capsule does not block antibody binding to PspA, a surface virulence protein of Streptococcus pneumoniae. Microb Pathog. 2006;40:228–233. [PubMed]
70. Mirza S, Wilson L, Benjamin WH, Jr, Novak J, Barnes S, Hollingshead SK, Briles DE. Serine Protease PrtA from Streptococcus pneumoniae Plays a Role in the Killing of S. pneumoniae by Apolactoferrin. Infect Immun. 2011;79:2440–2450. [PMC free article] [PubMed]
71. Mirza S, Hollingshead SK, Benjamin WH, Jr, Briles DE. PspA protects Streptococcus pneumoniae from killing by apolactoferrin and antibody to PspA enhances killing of pneumococci by apolactoferrin. Infect Immun. 2004;72:5031–5040. [PMC free article] [PubMed]
72. Omtvedt LA, Wien TN, Myran T, Sletten K, Husby G. Serum amyloid P component in mink, a non-glycosylated protein with affinity for phosphorylethanolamine and phosphorylcholine. Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis. 2004;11:101–108. [PubMed]
73. Mikolajek H, Kolstoe SE, Pye VE, Mangione P, Pepys MB, Wood SP. Structural basis of ligand specificity in the human pentraxins, C-reactive protein and serum amyloid P component. Journal of molecular recognition : JMR. 2011;24:371–377. [PubMed]
74. Tomasz A. Biological consequences of the replacement of choline by ethanolamine in the cell wall of pneumococcus: chain formation, loss of transformability, and loss of autolysis. Proc Natl Acad Sci USA. 1968;59:86–93. [PubMed]
75. Weiser JN, Goldberg JB, Pan N, Wilson L, Virji M. The phosphorylcholine epitope undergoes phase variation on a 43- kilodalton protein in Pseudomonas aeruginosa and on pili of Neisseria meningitidis and Neisseria gonorrhoeae. Infect Immun. 1998;66:4263–4267. [PMC free article] [PubMed]
76. Allaoui-Attarki K, Pecquet S, Fattal E, Trolle S, Chachaty E, Couvreur P, Andermont A. Protective immunity against Salmonella typhimurium elicited in mice by oral vaccination with phosphorylcholine encapsulated in poly(DL-lactide-co-glycolide) microspheres. Infect Immun. 1997;65:853–857. [PMC free article] [PubMed]
77. Claflin JL, George J, Dell C, Berry J. Patterns of mutations and selection in antibodies to the phosphocholine-specific determinant in Proteus morganii. J Immunol. 1989;143:3054–3063. [PubMed]
78. Lal RB, Paranjape RS, Briles DE, Nutman TB, Ottesen EA. Circulating parasite antigen(s) in lymphatic filariasis: Use of monoclonal antibodies to phosphocholine for immunodiagnosis. J Immunol. 1987;138:3454–3460. [PubMed]
79. Briles DE, Forman C, Hudak S, Claflin JL. Anti-PC antibodies of the T15 idiotype are optimally protective againstStreptococcus pneumoniae. J Exp Med. 1982;156:1177–1185. [PMC free article] [PubMed]
80. Cundell DR, Gerard NP, Gerard C, Idanpaan-Helkklla I, Tuomanen EI. Streptococcus pneumoniae anchor to activated human cells by the receptor for platlet-activating vactor. Nature. 1995;377:435. [PubMed]
81. Perlmutter RM, Crews ST, Douglas R, Sorensen G, Johnson N, Nivera N, Gearhart PJ, Hood L. The generation of diversity in phosphorylcholine-binding antibodies. Adv Immunol. 1984;35:1–37. [PubMed]