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Decreased necrotizing fasciitis capacity caused by a single nucleotide mutation that alters a multiple gene virulence axis
Authors:Randall J. Olsen  Izabela Sitkiewicz  Ara A. Ayeras  Vedia E. Gonulal  Concepcion Cantu  Stephen B. Beres  Nicole M. Green  Benfang Lei  Tammy Humbird  Jamieson Greaver  Ellen Chang  Willie P. Ragasa  Charles A. Montgomery  Joiner Cartwright  Jr   Allison McGeer  Donald E. Low  Adeline R. Whitney  Philip T. Cagle  Terry L. Blasdel  Frank R. DeLeo  James M. Musser
Abstract:Single-nucleotide changes are the most common cause of natural genetic variation among members of the same species, but there is remarkably little information bearing on how they alter bacterial virulence. We recently discovered a single-nucleotide mutation in the group A Streptococcus genome that is epidemiologically associated with decreased human necrotizing fasciitis (“flesh-eating disease”). Working from this clinical observation, we find that wild-type mtsR function is required for group A Streptococcus to cause necrotizing fasciitis in mice and nonhuman primates. Expression microarray analysis revealed that mtsR inactivation results in overexpression of PrsA, a chaperonin involved in posttranslational maturation of SpeB, an extracellular cysteine protease. Isogenic mutant strains that overexpress prsA or lack speB had decreased secreted protease activity in vivo and recapitulated the necrotizing fasciitis-negative phenotype of the ΔmtsR mutant strain in mice and monkeys. mtsR inactivation results in increased PrsA expression, which in turn causes decreased SpeB secreted protease activity and reduced necrotizing fasciitis capacity. Thus, a naturally occurring single-nucleotide mutation dramatically alters virulence by dysregulating a multiple gene virulence axis. Our discovery has broad implications for the confluence of population genomics and molecular pathogenesis research.
Keywords:group A streptococcus   invasive infection   molecular epidemiology of strain genotype patient phenotype relationships   nonhuman primate
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