Secreted antigen A peptidoglycan hydrolase is essential for Enterococcus faecium cell separation and priming of immune checkpoint inhibitor cancer therapy

Reviewer #1 (Public Review):

Klupt, Fam, Zhang, Hang, and colleagues present a novel study examining the function of sagA in E. faecium, including impacts on growth, peptidoglycan cleavage, cell separation, antibiotic sensitivity, NOD2 activation, and modulation of cancer immunotherapy. This manuscript represents a substantial advance over their prior work, where they found that sagA-expressing strains (including naturally-expressing strains and versions of non-expressing strains forced to overexpress sagA) were superior in activating NOD2 and improving cancer immunotherapy. Prior to the current study, an examination of sagA mutant E. faecium was not possible and sagA was thought to be an essential gene.

The study is overall very carefully performed with appropriate controls and experimental checks, including confirmation of similar densities of ΔsagA throughout. Results are overall interpreted cautiously and appropriately.

I have only two comments that I think addressing would strengthen what is already an excellent manuscript.

In the experiments depicted in Figure 3, the authors should clarify the quantification of peptidoglycans from cellular material vs supernatants. It should also be clarified whether the sagA need to be expressed endogenously within E. faecium, and whether ambient endopeptidases (perhaps expressed by other nearby bacteria or recombinant enzymes added) can enzymatically work on ΔsagA cell wall products to produce NOD2 ligands?

In the murine experiments depicted in Figure 4, because the bacterial intervention is being performed continuously in the drinking water, the investigators have not distinguished between colonization vs continuous oral dosing of the mice peptidoglycans. While I do not think additional experimentation is required to distinguish the individual contributions of these 2 components in their therapeutic intervention, I do think the interpretation of their results should include this perspective.

Reviewer #2 (Public Review):

Summary:

The gut microbiome contributes to variation in the efficacy of immune checkpoint blockade in cancer therapy; however, the mechanisms responsible remain unclear. Klupt et al. build upon prior data implicating the secreted peptidoglycan hydrolase SagA produced by Enterococcus faecium in immunotherapy, leveraging novel strains with sagA deleted and complemented. They find that sagA is non-essential, but sagA deletion leads to a marked growth defect due to impaired cell division. Furthermore, sagA is necessary for the immunogenic and anti-tumor effects of E. faecium. Together, this study utilizes compelling methods to provide fundamental new insights into E. faecium biology and host interactions, and a proof-of-concept for identifying the bacterial effectors of immunotherapy response.

Strengths:

Klupt et al. provide a well-written manuscript with clear and compelling main and supplemental figures. The methods used are state-of-the-art, including various imaging modalities, bacterial genetics, mass spectrometry, sequencing, flow cytometry, and mouse models of immunotherapy response. Overall, the data supports the conclusions, which are a valuable addition to the literature.

Weaknesses:

Only minor revision recommendations were noted.