Enterococcal bacteremia in mice is prevented by oral administration of probiotic <i>Bacillus</i> spores

Abstract

Whether and how probiotics promote human health is a controversial issue. Their claimed benefit for counteracting gastrointestinal infection is linked predominantly to reducing pathogen abundance within the intestinal microbiota. Less understood mechanistically is the reported value that probiotics could have in reducing systemic infections. <i>Enterococcus faecalis</i> is an opportunistic pathogen that causes systemic infection after translocation through the intestinal epithelium, particularly in hospitalized and immune-depleted patients receiving antibiotic therapy. In this study, we used an <i>E. faecalis</i> mouse infection model with wild-type and isogenic mutant strains deficient in genes of the <i>E. faecalis</i> Fsr (fecal streptococci regulator) quorum-sensing system. We show that <i>E. faecalis</i> translocation from the mouse gut into the blood is mediated by the Fsr quorum-sensing system through production of the protease GelE, which compromises intestinal epithelium integrity. Furthermore, we demonstrate that orally administered probiotic <i>Bacillus subtilis</i> spores blocked <i>E. faecalis</i> translocation from the gut to the bloodstream and subsequent systemic infection in mice by inhibiting Fsr activity. These findings demonstrate that a key aspect of <i>Enterococcus</i> pathogenesis is controlled by quorum sensing, which can be targeted with probiotic <i>Bacillus</i> spores.