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Severe invasive group A streptococcal (GAS) infections emerged in the late 1980s, yet no single virulence factor has been common to all isolates from infected patients. A strong association was recently found between isolates of such cases (regardless of M type) and the production of NAD glycohydrolase (NADase). Of interest, all M-1 strains isolated after 1988 were positive for NADase, whereas virtually all M-1 GAS were previously negative for NADase. Genetic analysis demonstrated that GAS isolates were &gt;96% identical in nga and &gt;99% identical in their upstream regulatory sequences. Furthermore, because NADase-negative strains did not produce immunoreactive NADase, we concluded that additional regulatory element(s) control NADase production. NADase purified from GAS altered neutrophil-directed migration and chemiluminescence responses and had potent ADP-ribosyltransferase activity. In summary, the temporal relationship of NADase expression, alone or with other streptococcal virulence factors, may contribute to the pathogenesis of invasive GAS infections.

the journal of infectious diseases (online. university of chicago press)/the journal of infectious diseases

Molecular Epidemiology of<i>nga</i>and NAD Glycohydrolase/ADP‐Ribosyltransferase Activity among<i>Streptococcus pyogenes</i>Causing Streptococcal Toxic Shock Syndrome

Molecular Epidemiology ofngaand NAD Glycohydrolase/ADP‐Ribosyltransferase Activity amongStreptococcus pyogenesCausing Streptococcal Toxic Shock Syndrome