Variability in the Distribution of Genes Encoding Virulence Factors and Putative Extracellular Proteins of Streptococcus pyogenes in India, a Region with High Streptococcal Disease Burden, and Implication for Development of a Regional Multisubunit Vaccine

Streptococcus pyogenes causes a wide variety of human diseases and is a significant cause of morbidity and mortality. Attempts to develop a vaccine were hampered by the genetic diversity of S. pyogenes across different regions of the world. This study sought to identify streptococcal antigens suitable for a region-specific vaccine in India. We used a two-step approach, first performing epidemiological analysis to identify the conserved antigens among Indian isolates. The second step consisted of validating the identified antigens by serological analysis. The 201 streptococcal clinical isolates from India used in this study represented 69 different emm types, with emm12 being the most prevalent. Virulence profiling of the North and South Indian S. pyogenes iso-lates with a custom-designed streptococcal virulence microarray identified seven conserved putative vaccine candidates. Colla-gen-like surface protein (SCI), putative secreted 5=-nucleotidase (PSNT), and C5a peptidase were found in 100 % of the isolates, while R28, a putative surface antigen (PSA), and a hypothetical protein (HYP) were found in 90 % of the isolates. A fibronectin binding protein, SfbI, was present in only 78%of the isolates. In order to validate the identified potential vaccine candidates, 185 serum samples obtained frompatientswith different clinicalmanifestationswere tested for antibodies. Irrespective of clinicalmanifestations, serum samples showedhigh antibody titers to all proteins except for SCI andR28. Thus, the data indicate that PSNT,C5a peptidase, PSA,HYP, and SfbI are promising candidates for a region-specific streptococcal vaccine for the different parts of India. Streptococcus pyogenes (group A streptococcus [GAS]) is exclu-sively a human pathogen and the etiological agent of a wide variety of diseases that vary in clinical severity, while also being