Streptococcus pyogenes (group A Streptococcus [GAS]) is an obligate human pathogen responsible for a broad spectrum of human disease. GAS has a requirement for metal homeostasis within the human host and, as such, tightly modulates metal uptake and efflux during infection. Metal acquisition systems are required to combat metal sequestration by the host, while metal efflux systems are essential to protect against metal overload poisoning. Here, we investigated the function of PmtA (PerRregulated metal transporter A), a P 1B-4 -type ATPase efflux pump, in invasive GAS M1T1 strain 5448. We reveal that PmtA functions as a ferrous iron [Fe(II)] efflux system. In the presence of high Fe(II) concentrations, the 5448ΔpmtA deletion mutant exhibited diminished growth and accumulated 5-fold-higher levels of intracellular Fe(II) than did the wild type and the complemented mutant. The 5448ΔpmtA deletion mutant also showed enhanced susceptibility to killing by the Fe-dependent antibiotic streptonigrin as well as increased sensitivity to hydrogen peroxide and superoxide. We suggest that the PerRmediated control of Fe(II) efflux by PmtA is important for bacterial defense against oxidative stress. PmtA represents an exemplar for an Fe(II) efflux system in a host-adapted Gram-positive bacterial pathogen.KEYWORDS iron efflux, PmtA, oxidative stress response, PerR, group A Streptococcus, Streptococcus pyogenes D efense against peroxide is recognized as one of the most widespread stress responses in prokaryotes. A characteristic of the peroxide stress response is the increased expression of peroxidases that can directly remove hydrogen peroxide as well as the induction of systems that can repair damaged proteins and nucleic acids (1, 2). Streptococcus pyogenes (group A Streptococcus [GAS]) coordinates oxidative stress responses through the action of the regulator PerR, which functions as a repressor of oxidative stress defense genes under normal conditions through binding to DNA at per boxes upstream of these genes (3, 4). This stable complex typically exists with Fe as a prosthetic group; in the presence of hydrogen peroxide, Fe causes metal-catalyzed oxidation and damage of the complex, leading to its dissociation and the subsequent transcription of peroxide response genes (3-6). In GAS, the PerR-regulated oxidative stress response encompasses both direct mechanisms, involving the detoxification of reactive oxygen species (ROS), and indirect mechanisms, which involve the repair of biomolecules damaged by oxidative stress. Direct mechanisms involving the enzymatic detoxification of reactive oxygen species are achieved through alkyl hydroperoxidases and glutathione peroxidases (1, 2, 5) as well as a single superoxide dismutase, SodA, which is Mn dependent (7). An example of an indirect response mechanism is PolAI, a DNA polymerase that repairs oxidatively damaged DNA (8).