“…Perhaps the most consistent transcriptional change observed for VISA strains is the downregulation of the spa gene (74,122,169,199,201,251,303). A possibly incomplete list of genes where the gene product has been shown to affect the transcription of spa includes agr (76,343), sarA (51,76,343), sarS (50), arlSR (85,86), sarT (304), srrAB (262), tcaR (200), mgrA (138), rot (240), ccpA (307), and sarZ (342). Potentially, a mutation in any of these regulatory genes could simultaneously increase vancomycin resistance and decrease protein A production.…”