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Therefore, studying IgG4-specific antibody responses against<jats:named-content content-type=\"genus-species\">Staphylococcus aureus<\/jats:named-content>might generate new insights into the respective host-pathogen interactions and the microbial virulence factors involved. Using a bead-based flow cytometry assay, we determined total IgG (IgGt), IgG1, and IgG4 antibody responses to 40 different<jats:named-content content-type=\"genus-species\">S. aureus<\/jats:named-content>virulence factors in sera from healthy persistent nasal carriers, healthy persistent noncarriers, and patients with various staphylococcal infections from three distinct countries. IgGt responses were detected against all tested antigens. These were mostly IgG1 responses. In contrast, IgG4 antibodies were detected to alpha-toxin, chemotaxis inhibitory protein of<jats:named-content content-type=\"genus-species\">S. aureus<\/jats:named-content>(CHIPS), exfoliative toxins A and B (ETA and -B), HlgB, IsdA, LukD, -E, -F, and -S, staphylococcal complement inhibitor (SCIN), staphylococcal enterotoxin C (SEC), staphylococcal superantigen-like proteins 1, 3, 5, and 9 (SSL1, -3, -5, and -9), and toxic shock syndrome toxin 1 (TSST-1) only. Large interpatient variability was observed, and the type of infection or geographical location did not reveal conserved patterns of response. As persistent<jats:named-content content-type=\"genus-species\">S. aureus<\/jats:named-content>carriers trended toward IgG4 responses to a larger number of antigens than persistent noncarriers, we also investigated sera from patients with epidermolysis bullosa (EB), a genetic blistering disease associated with high<jats:named-content content-type=\"genus-species\">S. aureus<\/jats:named-content>carriage rates. EB patients responded immunologically to significantly more antigens than noncarriers and trended toward even more responses than carriers. Altogether, we conclude that the IgG4 responses against a restricted panel of staphylococcal antigens consisting primarily of immune modulators and particular toxins indicate important roles for these virulence factors in staphylococcal pathogen-host interactions, such as chronicity of colonization and\/or (subclinical) infections.<\/jats:p>","DOI":"10.1128\/iai.02286-14","type":"journal-article","created":{"date-parts":[[2014,11,18]],"date-time":"2014-11-18T05:15:52Z","timestamp":1416287752000},"page":"492-501","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":26,"title":["IgG4 Subclass-Specific Responses to Staphylococcus aureus Antigens Shed New Light on Host-Pathogen Interaction"],"prefix":"10.1128","volume":"83","author":[{"given":"Jasper","family":"Swierstra","sequence":"first","affiliation":[{"name":"Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The 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