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Imke Grimm, Melanie Weinstock, Ingvild Birschmann, Jens Dreier, Cornelius Knabbe, Tanja Vollmer

• \(\textbf {Background:}\) \(\textit {Streptococcus gallolyticus}\) subsp. \(\textit {gallolyticus (S. gallolyticus)}\) is the causative pathogen in up to 20% of streptococcal-induced infective endocarditis (IE) cases. However, the underlying mechanisms of pathogenesis in \(\textit {S. gallolyticus}\) have not yet been solved. Pathogens causing IE need to employ virulent strategies to initiate and establish infections, such as escape the bloodstream, invade the host-cell, and persist intracellularly. In this study, we examined the induction of inflammation by different \(\textit {S. gallolyticus}\) strains in relation to their survival in whole blood and cell culture models as well as their ability to induce platelet aggregation. Phagocytosis of these bacteria by macrophages, followed by intracellular survival, was also quantified. \(\textbf {Methods:}\) In whole blood and THP-1 cell culture assays bacterial growth kinetics was determined by plating, followed by colony counting. Induction of interleukin (IL)-6 expression in whole blood of three healthy volunteers, caused by different strains, was quantified by ELISA. Gene expression of cytokines \(\textit {(IL1B, IL6 and IL8)}\) was quantified by real-time PCR after stimulating THP-1 monocytes with bacteria. Induction of platelet aggregation was analyzed by light transmission aggregometry using the BORN method. A macrophage model was used to analyze phagocytosis of strains and their survival in macrophages within 48 h. \(\textbf {Results:}\) Strains promoted IL-6 secretion in a time-dependent fashion. For example, DSM16831 induced IL-6 secretion in whole blood earlier than other isolates, and was eliminated in the whole blood of one volunteer, whereas UCN34 could grow. Platelet aggregation depended on the different isolates used and on the individual platelet donor. Two strains (AC1181 and 010672/01) induced cytokine gene expression in THP-1 monocytes only marginally, compared to other strains. The phagocytosis rate of \(\textit {S. gallolyticus}\) isolates differed significantly, and the isolates UCN34 and BAA-2069 could persist for a considerable time in the phagocytes. \/\textbf {Conclusion:}\) The strain-dependent differences of \(\textit {S. gallolyticus}\)isolates, observed during interaction with human blood cells, support the hypotheses that divergences in individual virulence factors determine a distinct pathogenicity of the isolates. These data constitute an additional step towards the elucidation of mechanisms in the complex, multifactorial pathogenesis of this IE pathogen.