LDL receptor-mediated endocytosis of Escherichia coli α-hemolysin mediates renal epithelial toxicity

Pore-forming toxins (PFTs) are secreted bacterial effector molecules that disrupt host cell membranes. The α-hemolysin (HlyA) of uropathogenic Escherichia coli (UPEC) can exert damage to various mammalian cell types. While a candidate toxin receptor (CD11a/CD18 [LFA-1] integrin) exists on myeloid cells, the mechanism of HlyA cytotoxicity to epithelial cells remains undefined. We show that HlyA secretion by UPEC exacerbates renal tubular epithelial injury during ascending pyelonephritis in mice. A CRISPR-Cas9 loss-of-function screen in renal collecting duct cells identified clathrin-mediated endocytosis as required for HlyA cytotoxicity. HlyA internalization induces lysosomal permeabilization, facilitating protease release, cytoplasmic acidification, and mitochondrial dysfunction leading to rapid cell death. This mechanism contrasts with the described actions of other PFTs (plasma membrane poration and osmotic cytolysis). We also identify the low-density lipoprotein receptor (LDLR) as an epithelial receptor for HlyA; genetic or competitive inhibition of the HlyA-LDLR interaction prevented cytotoxicity. Our studies define a new mechanism of action for HlyA, in which its toxicity to epithelial cells requires LDLR-mediated, clathrin-dependent internalization. These results suggest therapeutic avenues for mitigating HlyA-induced damage during E. coli infections.