Abstract
Recently we reported an association between pediatric obstructive sleep apnea syndrome (OSAS) and Group A streptococcus (GAS) sub-acute chronic tonsil colonization. We showed that GAS may contribute to tonsil hyperplasia via a streptolysin O (SLO)-dependent cysteinyl leukotrienes (CysLTs) production, which can trigger T and B cell proliferation. In the present study, we characterized the GAS strains isolated from pediatric OSAS patients in comparison with a panel of age and sex matched GAS strains unrelated to OSAS, but isolated in the same area and during the same period ranging from 2009 to 2013. We found that slaA gene, previously reported to be associated to CysLTs production pathway, was significantly associated to GAS OSAS strains. Moreover, the most numerous group (32%) of the GAS OSAS strains belonged to M75 type, and 6 out of 7 of these strains harbored the slaA gene. Multilocus Sequence Typing (MLST) experiments demonstrated that the clone emm75/ST49/ smeZ, slaA was associated to OSAS cases. In conclusion, we found an association between slaA gene and the GAS OSAS strains, and we showed that the clone emm75/ST49 harboring genes smeZ and slaA was exclusively isolated from patients affected by OSAS, thus suggesting that this genotype might be associated to the pathogenesis of OSAS, although further studies are needed to elucidate the possible role of SlaA in tonsil hypertrophy development.
Highlights
Obstructive sleep apnea syndrome (OSAS) has emerged in children, as the primary indication for surgical removal of adenoids and tonsils (American Thoracic Society, 1996; Marcus et al, 2012; Ramos et al, 2013)
During the characterization of the Group A streptococcus (GAS) strains isolated from pediatric (≤16 years) obstructive sleep apnea syndrome (OSAS) patients (Viciani et al, 2016), we amplified by PCR eight genes encoding virulence factors (Jing et al, 2006) both in the 22 GAS strains isolated from 19 OSAS patients and in 59 GAS strains isolated from 59 age and sex matched non-OSAS subjects recruited in the same period and at the same Hospital of Siena
SlaA gene was found significantly associated (p = 0.002) with GAS strains isolated from OSAS patients as compared with GAS strains isolated from non-OSAS subjects, suggesting a possible role of this virulence factor in the development of tonsil hypertrophy
Summary
Obstructive sleep apnea syndrome (OSAS) has emerged in children, as the primary indication for surgical removal of adenoids and tonsils (American Thoracic Society, 1996; Marcus et al, 2012; Ramos et al, 2013). OSAS has been associated with cardiovascular, growth and neurobehavioral abnormalities, inflammation, and primarily with hypertrophy of the tonsils and adenoids (Goldbart et al, 2004; Marcus et al, 2012; Zautner, 2012; Kheirandish-Gozal et al, 2013). Cysteinyl leukotrienes were able to activate primary T and B cell proliferation in vitro, which is possibly related with the development of tonsil hypertrophy, and with pediatric OSAS (Viciani et al, 2016)
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