Detection of the hypervirulent chimeric <em>emm</em>4 lineage in Australia — ASN Events

Detection of the hypervirulent chimeric emm4 lineage in Australia (#233)

Phoebe K Shaw 1 , Andrew J Hayes 2 , Nichaela Harbison-Price 1 , Amanda J Cork 1 , Mark R Davies 2 , Mark J Walker 1 , Stephan Brouwer 1
  1. Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
  2. Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia

Streptococcus pyogenes (Group A Streptococcus, GAS) is a human-restricted pathogen that causes a wide range of diseases from pharyngitis and scarlet fever to more severe, invasive infections including necrotising fasciitis and streptococcal toxic shock syndrome. A hypervirulent acapsular chimeric emm4 lineage (emm4C) has emerged in the USA, characterised by a gene fusion event between the GAS M protein (emm) and an adjacent M-like protein (enn). Despite exhibiting an in vitro growth defect, emm4C isolates are the dominant emm4 lineage in the USA. A screen of clinical isolates from patients with invasive GAS (iGAS) disease revealed the presence of both a canonical emm4 and chimeric emm4C strain in Australia. Using genomic, phylogenetic and phenotypic analyses, it was determined that the Australian emm4C strain possessed the lineage-defining mutations associated with the US emm4C clone. The emm4C isolate was found to carry superantigen genes speA, speC and ssa, which play an important role in immune cell disruption and severe disease progression. The Australian emm4C strain displayed increased virulence in an invasive murine model compared to the canonical emm4 isolate. This study represents the first report of the presence of the hypervirulent chimeric emm4C clone in Australia. Future work will aim to evaluate the immune response against canonical emm4 and emm4C isolate to determine whether immune escape due to the fusion of the emm and enn genes played a role in the emergence of the chimeric emm4C.

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