Gelatinase regulates the egress of intracellular replicating populations during Enterococcus faecalis infection

Abstract

Enterococcus faecalis is a common opportunistic pathogen, frequently isolated from chronic wounds, yet the mechanisms underlying its virulence and persistence in this niche remain incompletely understood. We previously showed that a subpopulation of E. faecalis can survive intracellularly for several days during murine wound infection and can replicate within macrophages, revealing an unexpected intracellular phase for this traditionally extracellular bacterium. Here, we identify the secreted metalloprotease gelatinase (GelE) and its regulator, the Fsr quorum sensing system, as key modulators of E. faecalis intracellular survival and replication. Mechanistically, Fsr quorum sensing is induced during intracellular replication, promoting GelE-dependent host cell lysis and bacterial egress. In the absence of active GelE, E. faecalis accumulates as large intracellular clusters, a phenotype observed consistently across GelE deficient wound isolates. In a mouse wound model, GelE deficient E. faecalis similarly exhibited higher intracellular numbers within wound infection-associated host cells. Together, our study uncovers GelE as a central effector that orchestrates the transition between intracellular and extracellular lifestyles of E. faecalis, providing a possible explanation for its persistence in chronic wound infection. Author summaryPathogenic bacteria are traditionally classified as either "intracellular" or "extracellular", but growing evidence suggests that many extracellular bacteria also adopt transient intracellular lifestyles that promote persistent and recurrent infection. Enterococcus faecalis, a leading cause of chronic wound infection, exemplifies this duality. We discovered that E. faecalis strains lacking the secreted protease gelatinase accumulate to high numbers inside host cells such as macrophages. Our data indicate that gelatinase facilitates bacterial escape following intracellular replication, regulating the transition between an intracellular and extracellular lifestyle. During infection, gelatinase-deficient bacteria remain hidden within various wound cell types, potentially evading immune clearance and antibiotic treatment. This work reveals a previously unrecognized role for gelatinase in controlling E. faecalis intracellular dynamics, highlighting a mechanism that may underline chronic and persistent infection.