Group B Streptococcus is the most common cause of bacterial infection in the newborn. Infection in many cases causes persistent pulmonary hypertension, which impairs gas exchange in the lung. We purified the bacterial components causing pulmonary hypertension and identified them as cardiolipin and phosphatidylglycerol. Synthetic cardiolipin or phosphatidylglycerol also induced pulmonary hypertension in lambs. The recognition that bacterial phospholipids may cause pulmonary hypertension in newborns with Group B streptococcal infection opens new avenues for therapeutic intervention.G roup B Streptococcus (GBS) is the most frequent cause of sepsis and meningitis in the human newborn (1). Despite prompt treatment with antibiotics, neonates with GBS infection are often quite ill and the fatality rate is 5% (2). Respiratory distress, a prominent sign in these babies, is caused by pulmonary hypertension induced by the GBS infection (3). The pulmonary hypertension reflects an increase in pulmonary vascular resistance, which impairs exchange of oxygen and carbon dioxide. Infusion of live or heat-killed GBS into sheep promptly induces pulmonary hypertension, with little or no effect on systemic pressure (4). This response has been reproduced by many investigators, who also established that the pulmonary hypertension is not a consequence of simple embolization because infusion of latex beads of the same size as GBS caused no change in pulmonary physiology (5). The hypertension is mediated by an increase in thromboxane A 2 , so that treatment with cyclooxygenase inhibitors such as indomethacin or with thromboxane synthesis inhibitors prevents or reverses the increase in pulmonary pressure (5, 6). However, the component(s) of GBS that activate thromboxane synthesis are unknown. Guided by bioassays performed in neonatal lambs (7), we undertook the purification and identification of these components, using standard biochemical techniques.
Materials and Methods
Purification and Analysis of Pulmonary Hypertensive Compounds fromGBS. Biochemical fractionation procedures were linked in series to develop an initial purification protocol, which was modified to give the final protocol described here. At each step, fractions were assayed for pulmonary arterial hypertensive activity in 3-to 12-day-old lambs of Ϸ5 kg, as described (7). We previously demonstrated that pulmonary arterial pressure measurements were a valid surrogate for measurement of pulmonary vascular resistance in this animal model (7). Fractions were infused peripherally into the femoral vein, not directly into the pulmonary artery. Fractions were considered active if they increased pulmonary arterial pressure by at least 50% in at least two lambs tested on different days.GBS type III, strain 878 was grown to mid-or late-log phase (7), washed with sterile normal saline, heat-killed by incubation in a 60°C water bath for 90 min, pelleted by centrifugation, and resuspended in saline to an OD of 2.0 at 650 nm. Heat-killed GBS (3-gm wet weight) were extracted with 40 ml of ...