Penetration of toxic shock syndrome toxin-1 across porcine vaginal mucosa ex vivo: permeability characteristics, toxin distribution, and tissue damage

Am J Obstet Gynecol. 2003 Dec;189(6):1785-91. doi: 10.1016/s0002-9378(03)00873-1.


Objective: The purpose of this study was to evaluate transvaginal penetration of toxic shock syndrome toxin-1 and its effects on permeability and tissue integrity in vitro with the use of excised porcine vaginal mucosa.

Study design: Permeability to tritiated water (1 and 10 microg/mL applied toxin) and transmucosal flux of (35)S-methionine-labeled toxic shock syndrome toxin-1 (10 and 20 microg/mL) for up to 12 hours were assessed with the use of a continuous flow perfusion system. The location of labeled toxin that penetrated the mucosal tissue strata was determined. The integrity of toxin-treated, intact, scalpel-incised tissue was evaluated histopathologically.

Results: Toxic shock syndrome toxin-1 caused a non-dose-dependent increase in mucosal permeability and traversed the intact mucosa at a low rate without disrupting tissue integrity. In incised vaginal mucosa, toxic shock syndrome toxin-1 induced subepithelial separation and atrophy that were analogous to clinically relevant vaginal lesions that were reported in fatal cases of menstrual toxic shock syndrome.

Conclusion: An in vitro model could be used to demonstrate that toxic shock syndrome toxin-1 permeates the vaginal mucosa and distributes throughout the tissue. Histologic evaluation of tissues that were exposed to toxic shock syndrome toxin-1 demonstrated lesions that were similar to those lesions that were reported in cases of menstrual toxic shock syndrome.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bacterial Toxins*
  • Cell Membrane Permeability / drug effects*
  • Culture Techniques
  • Enterotoxins / pharmacology*
  • Enterotoxins / toxicity*
  • Female
  • Immunohistochemistry
  • Mucous Membrane / drug effects
  • Mucous Membrane / pathology
  • Sensitivity and Specificity
  • Shock, Septic / pathology
  • Superantigens*
  • Swine
  • Vagina / drug effects
  • Vagina / pathology*


  • Bacterial Toxins
  • Enterotoxins
  • Superantigens
  • enterotoxin F, Staphylococcal