22Group A Streptococcus (GAS) is the etiologic agent of numerous high morbidity and high 23 mortality diseases which commonly have a highly proinflammatory pathology. One factor 24 contributing to this inflammation is the GAS protease SpeB, which directly activates the 25 proinflammatory cytokine interleukin-1β (IL-1β), independent of the canonical inflammasome 26 pathway. IL-1β drives neutrophil activation and recruitment that limits bacterial growth and 27 invasion during invasive skin and soft tissue infections like necrotizing fasciitis. GAS also causes 28 pharyngitis (strep throat), and the upper respiratory tract is its primary nidus for growth and 29 transmission. Since the fitness selection for the species is likely primarily for this site, we 30 examined the process of IL-1β activation in the murine nasopharynx. SpeB still activated IL-1β, 31 which was required for neutrophil migration, but this inflammation instead increased GAS 32 replication. Inhibiting IL-1β or depleting neutrophils, which both promote invasive infection, 33 prevented GAS infection of the nasopharynx. Prior antibiotic exposure increased GAS growth in 34 the murine nasopharynx, and antibiotics were sufficient to reverse the attenuation previously 35 observed when IL-1β, neutrophils, or SpeB were not present to drive inflammation. Therefore, 36 the same fundamental mechanism has opposing effects on virulence at different body sites. 37 Invasive disease may be limited in part due to specific adaptations for inducing host 38 inflammation that are beneficial for pharyngitis.
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IMPORTANCE 40Our previous reports showed that Group A Streptococcus (GAS) protease SpeB directly activates 41 the host proinflammatory cytokine IL-1β and this restricts invasive skin infection. The upper 42 respiratory tract is the primary site of GAS colonization and infection, but the host-pathogen 43 interactions at this site are still largely unknown. We provide the first evidence that IL-1β-44 3 mediated inflammation promotes upper respiratory tract infection. This provides experimental 45 evidence that the notable inflammation of strep throat, which presents with significant swelling, 46 pain, and neutrophil influx, is not an ineffectual immune response, but rather is a GAS-directed 47 remodeling of this niche for its pathogenic benefit. 48 49 50 Group A Streptococcus (GAS, Streptococcus pyogenes) is a top cause of infectious mortality and 51 responsible for over half a million annual deaths (1). Death is primarily due to invasive diseases, 52 including sepsis, necrotizing fasciitis, and toxic shock syndrome, or autoimmune diseases, most 53 prominently acute rheumatic fever and rheumatic heart disease. The nasopharyngeal mucosa and 54 associated lymphoid tissues is the most common site for infection (strep throat pharyngitis) and 55 the primary carriage site for dissemination of GAS between individuals and to other sites of the 56 body (2). Humans are transiently colonized by GAS throughout childhood but can be culture-57 positive at any point in ...