E. PR epitopes are protective against infection in mice. PR regions of both PspA and PspC were antibody accessible on the pneumococcal surface. Our results indicate that while PspA could serve as a target of these protective antibodies in invasive infections, PspC might not. When antibody responses to rPR immunogens were evaluated by using flow cytometry to measure antibody binding to live pneumococci, it was observed that the mice that survived subsequent challenge produced significantly higher levels of antibodies reactive with exposed PR epitopes than the mice that became moribund. Due to their conservation and cross-reactivity, the PR regions and NPB regions represent potential vaccine targets capable of eliciting cross-protection immunity against pneumococcal infection. Pneumonia is the leading cause of mortality for children under the age of 5 years worldwide, and Mollugin its most common etiology is (42). also Mollugin cause otitis media and life-threatening meningitis. A 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in the United States in 2000. PCV7 use reduced the number of cases of infections with vaccine capsular types in both immunized children (43) and nonimmunized individuals (18) in the same communities. But less than 5 years after the Mollugin implementation of PCV7, reports of serotype replacement (increases in the number of invasive infections caused by strains of capsular serotypes not covered by the vaccine) began to appear (20, 22, 25, 40). The observation of this serotype replacement within a few years after vaccine implementation and the fact that there are at least 91 capsular types CANPL2 (36) raise concerns about the long-term effectiveness of capsule-based vaccines and stress the need for continued development of effective, noncapsular serotype-dependent pneumococcal vaccines (2, 39). Surface proteins of pneumococci are important nonpolysaccharide vaccine candidates. Two of the more promising vaccine candidates are pneumococcal surface protein A (PspA) and pneumococcal surface protein C (PspC; also called CbpA). These two proteins have some similar structural features, and both proteins have been shown to elicit antibody-mediated protection against invasive pneumococcal infection (1, 8, 30, 31, 35). Antibodies to PspA generated in mice (28, 29) or humans (7, 34) are capable of passively protecting mice against infection. Strains of various Mollugin capsule and PspA types can be protected against by immunizing with a single PspA (7). Recombinant alpha-helical regions of PspAs of different alpha-helical PspA families are cross-reactive and can be cross-protective (6, 7, 21, 24, 34), but the strongest protection in mice against some challenge strains is often observed when the immunizing and challenge PspAs are of the same alpha-helical PspA family (13, 38). A gap in our knowledge of PspA and PspC immunogenicity exists, because with few exceptions, the published active and passive immunization experiments focused on immunity to the N-terminal alpha-helical regions of the protein or monoclonal antibodies (MAb) directed at the same alpha-helical regions. Although protection-eliciting sites exist within the N-terminal regions of PspA and PspC, these regions are diverse in their sequences and antigenic epitopes (8, 21, 23, 32). A proline-rich (PR) region, present in all PspAs and almost all PspCs, is not part of the alpha-helical regions of PspA or PspC molecules, and its immunogenicity has not been previously examined in detail. The PR region is remarkably similar within the paralogous PspA and PspC protein families and is much more conserved than the alpha-helical regions of either PspA or PspC proteins. The PR region consists of irregular repeats marked by the presence of a proline residue every two or three amino acids. The most common other amino acids are alanine and lysine. The most common sequence motif is PAPAP interrupted occasionally by PKP or, less commonly, by PEKP. About 56% of PspAs and 77% of PspCs are interrupted by a highly conserved block of amino acids termed the nonproline block (NPB) (8, 21-23, 45). The NPB is present in either PspA or PspC in about 90% of pneumococci. The NPB contains 33 amino acids,.