Staphylococcal exfoliative toxins: "Molecular scissors" of bacteria that attack the cutaneous defense barrier in mammals

Koji Nishifuji, Motoyuki Sugai, Masayuki Amagai

Research output: Contribution to journalReview articlepeer-review

127 Citations (Scopus)


Bullous impetigo and its generalized form, staphylococcal scalded-skin syndrome (SSSS), are highly contagious, blistering skin diseases caused by Staphylococcus aureus infection. Virulent strains of the bacteria produce exfoliative toxins (ETs) that cause the loss of keratinocyte cell-cell adhesion in the superficial epidermis. Recent studies have indicated that the three isoforms of ETs, i.e., ETA, ETB, and ETD, are glutamate-specific serine proteases that specifically and efficiently cleave a single peptide bond in the extracellular region of human and mouse desmoglein 1 (Dsg1), a desmosomal intercellular adhesion molecule. In addition, four isoforms of S. hyicus exfoliative toxin, ExhA, ExhB, ExhC, and ExhD, cleave swine Dsg1, resulting in skin exfoliation similar to that observed in pigs with exudative epidermitis. In this review, we describe recent advances in our knowledge of the mechanisms of action of staphylococcal exfoliative toxins, which act as "molecular scissors" to facilitate percutaneous bacterial invasion of mammalian skin by cleavage of keratinocyte cell-cell adhesion molecules. The species-specificity of staphylococcal exfoliative toxins to cleave Dsg1 in certain mammalian species is discussed.

Original languageEnglish
Pages (from-to)21-31
Number of pages11
JournalJournal of Dermatological Science
Issue number1
Publication statusPublished - 2008 Jan


  • Desmoglein
  • Exfoliative toxin
  • Exudative epidermitis
  • Impetigo
  • Staphylococcal scalded-skin syndrome

ASJC Scopus subject areas

  • Biochemistry
  • Molecular Biology
  • Dermatology


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