Tricontinental detection of Streptococcus pyogenes M1UK: A call for wider research and active surveillance.

The Streptococcus pyogenes M1UK lineage, characterised by an intrinsic ability to express SpeA toxin and defined by 27 single nucleotide polymorphisms in the core genome, dominates the population of emm1 S. pyogenes isolates throughout Europe, Canada, South America, Japan and Oceania. While not the sole deterministic factor, enhanced SpeA expression is likely to have contributed to M1UK lineage expansion, but was not sufficient to support expansion of intermediate lineage M123SNP, that expresses SpeA at a similar level to M1UK. A single nucleotide polymorphism (SNP) in the ssrA leader sequence upstream of speA is one of a limited number of SNPs that distinguish intermediate sublineages that differ in SpeA production. It was recently shown that this SNP leads to increased ssrA terminator read-through, and consequent increased transcription of speA, which lies downstream of ssrA. In this work, introduction of the ssrA SNP into representative isolates of the widely disseminated M1global clone and the intermediate M113SNP lineage, that cannot otherwise produce readily-detectable SpeA in culture, resulted in SpeA expression, confirming the importance of the ssrA SNP to SpeA phenotype. Consistent with this, correction of the ssrA SNP in M1UK abrogated SpeA expression. However, RNAseq analysis of 8 emm1 clinical pharyngitis strains showed that presence of the SNP was not invariably linked to read-through from the ssrA leader sequence or SpeA expression. Read-through was observed in isolates that did not possess the ssrA SNP. Critical review of existing data suggests that speA mRNA transcript length may be impacted by the two-component regulator CovRS, pointing to a complex regulatory network interaction between the bacterial chromosome and phage-encoded superantigens.