The outcome of any infection is determined by the complex interplay that balances pathogen replication and persistence with host defenses. Integral to this balance is microbial flexibility to adapt to different environments. The release of vesicles is a conserved surface feature that is poised to contribute to the adaptive capabilities of microbial cells. This is supported by the observation that MV production occurs in many pathogens both
in vivo and during interaction with host cells
in vitro. For example,
Salmonella Typhimurium releases MVs during intracellular growth in epithelial cells and macrophages (
24), and
Helicobacter pylori, a causative agent of gastric ulcers, exhibits release of virulence factor-containing MVs upon interaction with gastric tissue (
23,
63,
72,
87). Similarly, increased levels of PagC and OmpX, which are upregulated by
S. Typhimurium under conditions that mimic the host intracellular environment, stimulate MV release (
39). During infections caused by
Neisseria meningitidis, in which the disease pathology is characterized by life-threatening sepsis, the production of endotoxic (LPS-containing) MVs in the bloodstream has been observed, and it likely contributes to pathogenesis of sepsis through Toll-like receptor (TLR)- and nucleotide-binding oligomerization domain-containing protein (NOD)-like receptor (NLR)-mediated inflammatory cytokine production (
62,
88). Complementary to direct microscopic observation of MV release, complexes containing OM proteins and LPS have been isolated from blood during experimental sepsis (
28), suggesting that this material may be vesicular in nature and could persist
in vivo separately from parent bacteria. In addition, systemic effects of heart disease may be promoted by MVs from the oral pathogen
Porphyromonas gingivalis, as MVs have been shown to aggregate platelets
in vitro (
80). Similarly, eukaryotic microbes have also been shown to release vesicular structures during interaction with host cells and tissues, such as the release of vesicles by
Leishmania donovani during macrophage infection
in vitro (
83). Vesicle release is also likely the route by which
Cryptococcus neoformans accumulates capsular polysaccharide on its surface during murine infection (
Fig. 4A) (
20). If microbes possessed the ability to modulate MV formation, potentially in response to environmental cues sensed within the host, it could provide a mechanism to shape the host-pathogen interaction. The presence of serum (
9,
62) or antimicrobial peptides (
10), temperature and pH variations (
83), and as-yet-identified signals within host cells (
20–22,
24,
100) and tissues (
23,
52) stimulate microbial MV release. The ability to release MVs upon host cell interaction is, therefore, a seemingly widespread feature among microbial pathogens.