Pan-GWAS of Streptococcus agalactiae Highlights Lineage-Specific Genes Associated with Virulence and Niche Adaptation

GBS is a leading cause of mortality in newborn babies in high- and low-income countries worldwide. Different strains of GBS are characterized by different degrees of virulence, where some are harmlessly carried by humans or animals and others are much more likely to cause disease. The genome sequences of almost 2,000 GBS samples isolated from both animals and humans in high- and low- income countries were analyzed using a pan-genome-wide association study approach. This allowed us to identify 279 genes which are associated with different lineages of GBS, characterized by a different virulence and preferred host. Additionally, we propose that the GBS now carried in humans may have first evolved in animals before expanding clonally once adapted to the human host. These findings are essential to help understand what is causing GBS disease and how the bacteria have evolved and are transmitted.

ABSTRACT

Streptococcus agalactiae (group B streptococcus; GBS) is a colonizer of the gastrointestinal and urogenital tracts, and an opportunistic pathogen of infants and adults. The worldwide population of GBS is characterized by clonal complexes (CCs) with different invasive potentials. CC17, for example, is a hypervirulent lineage commonly associated with neonatal sepsis and meningitis, while CC1 is less invasive in neonates and more commonly causes invasive disease in adults with comorbidities. The genetic basis of GBS virulence and the extent to which different CCs have adapted to different host environments remain uncertain. We have therefore applied a pan-genome-wide association study (GWAS) approach to 1,988 GBS strains isolated from different hosts and countries. Our analysis identified 279 CC-specific genes associated with virulence, disease, metabolism, and regulation of cellular mechanisms that may explain the differential virulence potential of particular CCs. In CC17 and CC23, for example, we have identified genes encoding pilus, quorum-sensing proteins, and proteins for the uptake of ions and micronutrients which are absent in less invasive lineages. Moreover, in CC17, carriage and disease strains were distinguished by the allelic variants of 21 of these CC-specific genes. Together our data highlight the lineage-specific basis of GBS niche adaptation and virulence.

The genome sequences of almost 2,000 GBS samples isolated from both animals and humans in high- and low- income countries were analyzed using a pan-genome-wide association study approach. This allowed us to identify 279 genes which are associated with different lineages of GBS, characterized by a different virulence and preferred host. Additionally, we propose that the GBS now carried in humans may have first evolved in animals before expanding clonally once adapted to the human host.

These findings are essential to help understand what is causing GBS disease and how the bacteria have evolved and are transmitted.

INTRODUCTION

Streptococcus agalactiae (group B streptococcus; GBS) forms part of the normal gastrointestinal and urogenital microbiota, occasionally causing life-threatening invasive disease in infants, pregnant women, and adults with comorbidities (1). Since the 1970s, GBS has been reported as a leading cause of neonatal mortality and morbidity in the United States (2), but it is increasingly recognized that the burden is greatest in low-to-middle income countries. In sub-Saharan Africa, where up to 30% of women carry GBS asymptomatically, the incidence of invasive GBS disease in neonates has been reported to be up to 2.1 per 1,000 live births, with case fatality rates between 13 and 46% (3–5).

In neonates, early onset disease (EOD) in the first week of life typically presents as pneumonia or sepsis (5, 6). Late-onset disease (LOD) develops from 7 days to 3 months after birth and is frequently characterized by meningitis, leading to chronic neurological damage, seizures, blindness, and cognitive impairment in those that survive (5, 7). The gastrointestinal tract is the reservoir for GBS and the most likely source for maternal vaginal colonization (8). This may lead to GBS transmission before or during birth, potentially leading to early onset disease in the infant (5). The route for late-onset colonization and disease is less clear; while vertical transmission is still possible, environmental transmission and acquisition are considered more common (9).

GBS capsular polysaccharide is a key virulence factor (10) and the basis for serotyping. Ten GBS capsular serotypes have been described (11). Serotypes Ia, Ib, II, III, and V account for 98% of human carriage serotypes isolated globally, although prevalence of each serotype varies by region (12). Serotype III accounts for 25% to 30% of strains isolated in Europe and Africa but only 11% of strains isolated in North America or Asia. Serotypes VI, VII, VIII, and IX are frequently isolated in southern, southeastern, and eastern Asia, but are relatively rare elsewhere (12). Multilocus sequence typing (MLST) has identified 6 major clonal complexes (CCs) in humans: CC1, CC10, CC17, CC19, CC23, and CC26 (13, 14). In recent years it has become apparent that some CCs have a greater potential to cause invasive disease, while others are largely associated with asymptomatic carriage. CC1, CC23, and CC19, for example, are the predominant colonizers of pregnant women, well adapted to vaginal mucosa with a limited invasive potential in neonates (15, 16). In contrast, CC17 strains, mostly serotype III, are associated with neonatal sepsis and meningitis, accounting for more than 80% of LOD (1, 17). Comparative phylogeny of human and bovine GBS strains suggested that CC17 emerged recently from a bovine ancestor (CC67) and is characterized by limited recombination (18). However, this has been challenged (1), and the relationship between isolates from these different hosts remains uncertain.

Colonization and persistence of GBS in different host niches depends upon the ability to adhere to the mucosal epithelium (1, 19, 20) utilizing numerous bacterial adhesins, including fibrinogen binding protein (Fbs), C5a peptidase (ScpB), and GBS immunogenic bacterial adhesin (BibA) (21–23). Biofilm formation is essential to promoting colonization, which is also enhanced by bacterial capsule and type IIa pili (24, 25). Biofilm formation also plays a central role in the phenotype switch from commensal to pathogen (26). Deletion of the gene encoding biofilm regulatory protein A (BrpA) was shown to impair both biofilm formation and the ability of the bacterium to colonize and invade the murine host (26). The expression of these virulence factors varies by CC, with the Fbs proteins carried by the hypervirulent lineage CC17, for instance, characterized by specific deletions and frameshift mutations that alter the sequence or expression rate (27). S. agalactiae is able to survive both the acidic vaginal environment and within the blood (23). Transcription analyses have suggested that this transition is largely mediated by the two-component regulator CovRS (28, 29). Recently, specific gene substitutions in the two-component signal transducer (TCS) CovRS have been identified in disease-adapted CC17 GBS clones (30). How widespread these genetic adaptations are among CC17 clones and whether different adaptations confer enhanced colonization and disease potential in other CCs is uncertain.

Here, we report a pan-genome-wide association study of genome sequence data from 1,988 GBS carriage- or invasive disease-associated isolates from different hosts and countries. This study revealed that GBS CCs possess distinct collections of genes conferring increased potential for persistence, including genes associated with carbohydrate metabolism, nutrient acquisition, and quorum sensing. Within CC17, allelic variants of these crucial genes distinguish carriage from invasive strains. The differences in the GBS CCs analyzed are not geographically restricted, and we postulate that they may have emerged from an original ancestral GBS strain in animal hosts before crossing to humans.

RESULTS

GBS whole-genome sequencing data set.

A total of 358 Malawian GBS genome sequences were initially available. Of these, 55 samples did not pass the quality checks, therefore the final Malawian data set was composed of 303 GBS strains (Table 1), including 131 isolated from invasive disease in children and 166 isolated from healthy mothers, in which draft genome assemblies had an average N₅₀ of 163,462 bp (range 12,593 to 717,849 bp), average contig number of 70 (range 20 to 377), and average longest contig of 30,148 bp (range 44,691 to 1,019,176 bp).

TABLE 1.

Characteristics of GBS isolates

Isolate type	Country	Source	Count	No. invasive	No. missing data
Human	Malawi	This worka	303	131	6
	Kenya	Seale et al. (63)	1034	71	0
	USA	Flores et al. (64)	99	99	0
	Canada	Teatero et al. (31)	141	141	0
	The Netherlands	PRJEB14124b	300	unknown	300
	Unknown	***c	24	unknown	24
Animald	Italy	***	3
	Kenya	***	2
	Germany	***	1
	Brazil	***	1
	Unknown	***	80

^aIsolated from Queen Elizabeth Central Hospital, Blantyre.

^bJamrozy et al. (65).

^c***, Genomes retrieved from https://pubmlst.org/. Full metadata are reported in Table S1.

^dAnimal isolates are reported to be isolated from cattle (n = 49), fish (n = 23), frogs (n = 3), or other animal sources (n = 12).

TABLE S1

Metadata of each GBS isolate described in this work. From left to right each column shows the isolate name, the clonal complex to which the isolate belongs (CC1, CC6, CC10, CC19, CC17, CC23, single ST, or N/D), the source of isolation (animal or human, in which case it is reported as carrier, invasive, or unknown), the country of isolation, the serotype, the year of isolation (where available), the MLST-type, and the accession number of each isolate (where available). Download Table S1, PDF file, 0.3 MB ^{(256KB, pdf)} .

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A further 1,598 clinical isolates were included: these comprised 1,034 Kenyan, 99 American, 141 Canadian, and 300 Dutch strains randomly selected from 1,512 isolates from the Netherlands (Table 1). Animal isolates (87) sampled in several different countries were also included (Table 1). Where information was available, 446 (22.4% of the 1,988 total) strains were associated with invasive disease (bacteremia or meningitis) and 1,125 (56.6%) from healthy carriers. Meta-data consisting of country of origin, year of isolation, capsular serotype, MLST, and accession number are reported in Table S1 in the supplemental material. The genome sequences from 1,988 isolates were used for the analysis.

Clonal complex assignment and core genome phylogeny.

Six CCs were identified: CC1, CC6, CC10, CC19, CC17, and CC23 according to the BURST algorithm (31) and core genome phylogeny (Table S1 and S2). Several sequence types (STs) were found in just one country (e.g., ST 866 was found exclusively in Malawi or ST 196 was found only in Kenya); however, these STs were always represented by less than 20 isolates. With the exception of the United States, where isolates were intentionally selected to represent only CC1 (31), and the rare CC6 represented by 22 isolates, CCs were distributed across all of the countries analyzed.

TABLE S2

Sequence type defining each clonal complex and number of STs isolated per country. The table is divided into 8 horizontal sectors (CC1, CC6, CC10, CC19, CC17, CC23, single ST, or N/D). In each sector columns show (from left to right) which ST is represented in each CC; number of isolates belonging to a particular ST are found in each of the countries where the isolates described in this study were sourced (Brazil, Canada, Germany, Italy, Kenya, Malawi, Netherlands, USA, or unknown source). Download Table S2, PDF file, 0.04 MB ^{(39.9KB, pdf)} .

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While each serotype in the clinically derived WGS was predominantly associated with only one or two CCs, the animal isolates were more variable (Fig. 1). SNPs identified in the part of the genome shared by all isolates (∼26,000 polymorphisms) were used to infer the ML phylogenetic trees (Fig. 2, Fig. S1). Similar results were obtained calculating recombination-censored maximum-likelihood core-genome phylogeny on five different 140-strain subsets using ClonalFrame-ML, as shown in Fig. S2. CCs clustered in distinct branches of the tree; in particular, CC17 and CC23 produced two clusters. A group of 41 animal-derived WGS data clustered within a separate clade (Fig. 2), branching from human-associated CC17, hence suggesting a human origin for these animal strains. However, 46/87 isolates were located in clades associated with human-derived samples and CCs: three animal isolates for instance (MRI Z1 201, MRI Z1 200, and MRI ZI 203) clustered within the clinical isolates in the CC23 clade. We also observed several cases of CC17 animal isolates (classified as CC17 with eBurst which indicates a close relatedness to the CC17 clade but clustering within these animal strains, such as FSL S3 603 and LDS 623). This pattern could be interpreted as zoonotic transfer, with the human-associated CCs arising in animals before undergoing clonal expansion after infection of the human host. However, given the fragmented sampling frame of this data set, as well as the lack of rooting in this phylogenetic analysis (Fig. 2), we can only speculate on this matter.

FIG 1.

Isolates used in this study, stratified per serotype, CC, and source. Clinical isolates are grouped as invasive (including strains isolated from children and adults affected by any GBS invasive disease), carrier (including healthy carrying mothers), and unknown, where metadata were not available.

FIG 2.

Core genome-based population structure of GBS. The phylogenetic tree is annotated with 4 colored strips representing the clonal complex, the country of isolation, the origin, and the serotype of each strain. The three binary heatmaps represent the presence (blue) or absence (yellow) of the genes identified by the pan-GWAS pipeline. The tree is rooted at midpoint. The reference strain used in this analysis was COH1, reference HG939456. The red square in the CC10 heatmap highlights the cluster of CC10-associated genes found in CC19 clones. Trees built with different reference strains are shown in Fig. S1 in the supplemental material and show analogous topology.

FIG S1

Core genome-based population structure of GBS built with alternative reference strains. Trees showing the GBS population structure as in Fig. 1, produced with different reference strains. Reference strains used for the four trees are: NC_021485, strain 09mas018883; NC_007432, strain A909; NC_018646, strain GD201008; NC_004368, strain NEM316. For each tree, the annotation is analogous to the one described for Fig. 1. Download FIG S1, PDF file, 0.1 MB ^{(1.8MB, pdf)} .

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FIG S2

Recombination-censored maximum-likelihood phylogenetic trees on 5 random 140-strain subsets of the GBS genome dataset used in this work. Twenty isolates were selected randomly from each CC. The annotation of each tree is reported in the legend and is analogous to Fig. 1 for CC, origin, serotype, and country of isolation. Trees are unrooted. Download FIG S2, PDF file, 0.2 MB ^{(2.9MB, pdf)} .

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Pangenome and pan-GWAS.

Scoary has previously been used for a similar pan-GWAS analysis of three CC17 strains (30). In this study, we applied it on a data set of 1,988 strains, representing 6 different clonal complexes (Fig. 1): 1,374 genes were included in the core genome (i.e., present in more than 95% of the strains, “core” and “soft-core” genes), and 12,457 genes in the accessory genome (i.e., less than 95% of the strains, “shell” and “cloud” genes) (32). We observed that pangenome saturation was achieved. A total of 51, 41, 39, 102, and 64 genes associated, respectively, with CC1, CC10, CC19, CC17, and CC23 were identified (Table 2 and Table S3), with a specificity and sensitivity in defining the CC given the annotated CDS (and vice versa) greater than 90% (P < 0.05). The pipeline was not applied to CC6, which was represented by only 22 genomes in our data set. BLASTn was used to confirm whether gene sequences associated with each CC in the pan-GWAS were completely absent in different CCs, or had accumulated sufficient mutations to fail recognition by automated annotation (i.e., Prokka). We identified 57 such genes in CC17 out of the 102 identified by the Scoary pipeline, 22 genes in CC23, 4 genes in CC1, 9 genes in CC10, and 5 in CC19 (Fig. S3 and Table S3). This suggests that the genes characterizing a particular CC may have been rendered nonfunctional (i.e., pseudogenes) in other CCs. Table S3 highlights which CC-associated genes are completely absent and which genes are characterized by mutations (SNPs or indels) that alter the protein sequence with point mutations or truncation. Table 2 summarizes the number of genes driving the pan-GWAS analysis and the nature of the mutations encountered.

TABLE 2.

Summary of the number of genes driving the pan-GWAS in each clonal complex and type of mutations encountered

Clonal complex	Presence/absence	Nonsynonymous SNPs	Synonymous SNPs	Nonsense SNPs	Total	GWAS-genes islanda
CC1	47	3	0	1	51	0
CC10	32	3	2	4	41	0
CC17	38	42	10	12	102	0
CC19	34	5	0	0	39	1
CC23	42	14	3	5	64	0

^aA GWAS-gene island is defined as a region of the genome of at least 200kbp where > 90% of the coding regions are GWAS-driving genes.

FIG S3

Heatmaps based on the BLASTn score of each CC-characterizing gene for each isolate. Heatmaps were produced with pheatmap package in R (clustering of rows and columns was performed using the Euclidean method). Each heatmap shows 1,988 isolates on the rows and the CC-associated genes on the column. Each row-clustering tree (related to the isolates) is annotated with colored strips representing the clonal complex. Cells are colored according to the normalized BLAST bitscore score (red = 0, green = 1), as described in the Materials and Methods. Strains belonging to CC10-ST327 and CC10-ST328 are reported as CC327 in this representation. Download FIG S3, PDF file, 0.4 MB ^{(429.1KB, pdf)} .

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TABLE S3

Genes defining each CC as identified by pan-GWAS. The table is divided into five sections, relative to CC1, CC10, CC19, CC17, and CC23. Each column shows (from left to right) the name of the gene identified by pan-GWAS, the length of the putative protein produced by each gene, the KEGG database id (where available), a short annotation of each gene (according to KEGG and/or Prokka where available, otherwise reported as hypothetical protein), the functional class to which each gene belongs (metabolic, reported as “met”; environmental information processing, “env”; or cellular processes, “cell”; according to the KEGG annotation, the type of variation between different clonal complexes (“point mutations”, “synonymous point mutations”, “truncated protein”, or “gene absent”). Where neither Prokka nor KEGG annotation reported a gene name, an arbitrary gene name was assigned to the hypothetical gene following the scheme, “g”, followed by the clonal complex and an incremental number. Download Table S3, PDF file, 0.1 MB ^{(70.6KB, pdf)} .

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TEXT 1

Representative sequences of CC-specific genes. Download Text S1, TXT file, 0.2 MB ^{(251KB, txt)} .

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Gene location identified from the pan-GWAS analyses in CC1, CC10, CC17, and CC23 was evenly spread across the chromosome and not clustered in particular areas, consistent with the observed gene associations not resulting from a chromosomally integrated plasmid or transposon pathogenicity island acquired through horizontal gene transfer (Fig. 3). One exception was CC19, where the majority of the 39 genes were clustered in a 200-kbp region of the chromosome. Gene synteny was conserved across different isolates; in Fig. S4 the parallel vertical lines show how the genes conserved among the CC17 isolates are present in the same relative location (represented as different colored blocks in the mauve representation) in three representative genomes.

FIG 3.

Location of genes identified by the pan-GWAS pipeline on a strain belonging to CC1 (A), CC10 (B), CC17 (C), CC19 (D), and CC23 (E). Gene location on each chromosome is represented by a red mark. Gene names correspond to the ones reported in Table S3.

FIG S4

Synteny of CC17-characterizing genes. The image shows the alignment of three CC17 S. agalactiae genomes (strains 874391, BM110, and SGM6) and 104 CC17-associated genes (at the bottom). Each vertical line represents a sequence found in the same location in all the analyzed sequences. Image obtained with the software Mauve. Download FIG S4, JPG file, 0.2 MB ^{(236KB, jpg)} .

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The majority of the pan-GWAS-identified genes were associated with only one CC, but a particular cluster of genes associated with CC10 (including the gatKTEM system for galactose metabolism) was also present in a set of isolates belonging to CC19 (Fig. 2). These isolates were all from Africa (Malawi and Kenya) and were ST-327 and ST-328.

Functional pathways affected by CC-specific genes.

A total of 279 genes were found to be CC-specific (Table S3). Genes characteristic of CC17 and CC23 were classified into five functional categories (Table 3): metabolism, environmental information processing, cellular processes, human disease, and genetic information processing. In both CCs, the most-represented functional families were in these categories, including metabolic genes and environmental information processes.

TABLE 3.

Pathways and functional categories identified by KEGG annotation in the five groups of CC-associated genes^a

Clonal complex	Kegg no.	Pathway
CC1
Metabolism (09100)	01130	Biosynthesis of antibiotics
	00052	Galactose metabolism
	00999	Biosynthesis of secondary metabolites—unclassified
Environmental Information Processing (09130)	02060	Phosphotransferase system (PTS)
CC10
Metabolism (09100)	01100	Metabolic pathways
	01110	Biosynthesis of secondary metabolites
	01120	Microbial metabolism in diverse environments
	01130	Biosynthesis of antibiotics
	00010	Glycolysis/gluconeogenesis
	00040	Pentose and glucuronate interconversions
	00051	Fructose and mannose metabolism
	00052	Galactose metabolism
	00561	Glycerolipid metabolism
	00600	Sphingolipid metabolism
	00603	Glycosphingolipid biosynthesis—globo and isoglobo series
Environmental Information Processing (09130)	02060	Phosphotransferase system (PTS)
CC19
Metabolism (09100)	01100	Metabolic pathways
	00270	Cysteine and methionine metabolism
	00760	Nicotinate and nicotinamide metabolism
Environmental Information Processing (09130)	03070	Bacterial secretion system
CC17
Metabolism (09100)	00010	Glycolysis/gluconeogenesis
	00020	Citrate cycle (TCA cycle)
	00052	Galactose metabolism
	00500	Starch and sucrose metabolism
	00520	Amino sugar and nucleotide sugar metabolism
	00620	Pyruvate metabolism
	00630	Glyoxylate and dicarboxylate metabolism
	00640	Propanoate metabolism
	00680	Methane metabolism
	00910	Nitrogen metabolism
	00561	Glycerolipid metabolism
	00230	Purine metabolism
	00240	Pyrimidine metabolism
	00250	Alanine, aspartate and glutamate metabolism
	00260	Glycine, serine, and threonine metabolism
	00280	Valine, leucine, and isoleucine degradation
	00220	Arginine biosynthesis
	01007	Amino acid related enzymes
	00430	Taurine and hypotaurine metabolism
	01003	Glycosyltransferases
	01005	Lipopolysaccharide biosynthesis proteins
	01011	Peptidoglycan biosynthesis and degradation proteins
	00760	Nicotinate and nicotinamide metabolism
	00770	Pantothenate and CoA biosynthesis
	01001	Protein kinases
	01002	Peptidases
	03021	Transcription machinery
	03016	Transfer RNA biogenesis
CC17 (continued)
	00970	Aminoacyl-tRNA biosynthesis
	03110	Chaperones and folding catalysts
	03060	Protein export
	03420	Nucleotide excision repair
	03400	DNA repair and recombination proteins
Environmental Information Processing (09130)	02000	Transporters
	02010	ABC transporters
	02060	Phosphotransferase system (PTS)
	03070	Bacterial secretion system
	02020	Two-component system
	02044	Secretion system
	02022	Two-component system
Cellular Processes (09140)	04147	Exosome
	02048	Prokaryotic defense system
	02024	Quorum sensing
	02026	Biofilm formation-Escherichia coli
Unclassified (09190)	99982	Energy metabolism
	99984	Nucleotide metabolism
	99999	Others
	99977	Transport
CC23
Metabolism (09100)	00630	Glyoxylate and dicarboxylate metabolism
	00061	Fatty acid biosynthesis
	01040	Biosynthesis of unsaturated fatty acids
	01004	Lipid biosynthesis proteins
	00260	Glycine, serine, and threonine metabolism
	00550	Peptidoglycan biosynthesis
	01011	Peptidoglycan biosynthesis and degradation proteins
	00780	Biotin metabolism
	00670	One carbon pool by folate
	01008	Polyketide biosynthesis proteins
	01053	Biosynthesis of siderophore group nonribosomal peptides
	00333	Prodigiosin biosyntheses
	01002	Peptidases
Cellular Processes (09140)	02000	Transporters
	02010	ABC transporters
	02020	Two-component system
	02042	Bacterial toxins
Human Disease (09100)	02048	Prokaryotic defense system
	02024	Quorum sensing
	01502	Vancomycin resistance
	01504	Antimicrobial resistance genes
Unclassified (09190)	99988	Biosynthesis and biodegradation of secondary metabolites
Genetic Information Processing (09120)	03000	Transcription factors

^aFor each clonal complex the functional categories of the GWAS-associated genes are shown. The metabolic pathways affected by those genes and their Kegg reference numbers are reported.

Differences in metabolic pathways between CC17 and CC23 included carbohydrate, amino acid, nitrogen compound, and fatty acid metabolism. Siderophores for the uptake and transport of micronutrients (i.e., iron or nickel), and essential for successful colonization of the human host in several bacterial pathogens (33–35), also exhibited significant variation, for instance with genes for nickel uptake (nikE and nikD) and iron transport (feuC) truncated or characterized by SNPs in non-CC17 strains (Table S3).

CC17 and CC23 also showed differences in the genes affecting the environmental information processing functional pathways characterized by the presence of phosphotransferase (PTS) systems and two-component systems (TCS), used for signal transduction and sensing of environmental stimuli. Moreover, in the same functional category, differences were present in secretion systems, transporters, quorum sensing, and bacterial toxins. These pathways are used by GBS not only in colonization of the host, but also to gain competitive advantage against other microorganisms occupying a particular ecological niche (36).

Genes for prokaryotic defense systems, such as the CRISPR-Cas9 system, were also found, as well as proteins involved in genetic information processing such as transcription factors and regulators that may affect the expression of multiple genes (37). Finally, antibiotic resistance also appears among the lineage-specific characteristics; in particular, CC23 is the only CC showing typical genes involved in vancomycin resistance. CC17 also showed the presence of genes belonging to the KEGG group for “nucleotide excision repair” and “DNA repair/recombination protein” (KO numbers 03420/03400; Table 3), which could indicate a variation in mutagenesis rate and thus capacity to respond to changes in environmental conditions and presence of stresses.

In contrast, the genes defining CC1, CC10, and CC19 were confined to metabolism, environmental information processing, and genetic information processing. Genes involved with regulation and environmental sensing (PTS systems), as well as secretion systems, were identified in this group of CCs. In particular, a gene encoding the VirD4 type IV secretion system protein was associated with CC19. CC10 was characterized by an array of genes involved in carbohydrate metabolism and uptake, such as the ABC transport system for multiple sugar transport.

The majority of genes characteristic for CC1 were of unknown function, with the exception of genes involved with genetic regulation and a complete toxin/antitoxin system phd/doc (38). These systems are often described as a tool for stabilizing extrachromosomal DNA (i.e., plasmids), but they are often found integrated chromosomally in both Gram-positive and Gram-negative bacterial species—though their function in this setting is unclear (39).

In relation to the CC17-associated genes, we also checked for allelic variants specific to strains isolated from invasive disease or carriage. Figure S4 shows the proportion of CC17 invasive or carriage strains, and the frequency of each allelic variant. We identified 21 genes with alleles that statistically differentiated strains isolated from carriage and invasive disease (Fisher test, P < 0.05; Table 4). The DNA sequence of the allelic variant differed by a single polymorphism in all cases. In 15/21 cases this nucleotide change was translated into an amino acid change (missense), while in a single case the mutation resulted in a truncated protein (nonsense). Figure S6 shows these mutations in relation to the population structure of CC17. The tree shows how these mutations are associated with particular clades, rather than the disease phenotype. This suggests that the mutations have been acquired historically by the CC17 bacterial population, and have become fixed in each clade. Nonetheless, each CC17 cluster is not equally represented by disease and carriage strains, suggesting that these mutations may have contributed to the development of an invasive phenotype. These genes have the potential to affect the metabolism and virulence of the bacterial strains. For example, although the major pilin synthesis gene is known to be characterized by locus variants which are associated with biofilm and virulence (namely, variants PI-I, PI-IIa and PI-IIb) (40), CC17 is characterized by the presence of PI-I/PI-IIb. Smaller variations within the locus PI-IIb appear to be associated with CC17 isolated from carriage, suggesting that this gene may be impaired in functionality. Similarly, the prtP gene and the efrB genes, encoding, respectively, for a virulence-associated protease and for the ATP-binding cassette of a multidrug-efflux pump, have alleles that are more common in strains isolated from disease, highlighting the potential for these allelic variations to result in a more virulent phenotype (41).

TABLE 4.

CC17-associated genes showing at least one allele statistically associated with strains isolated from either invasive disease or from carriage

Gene	Allele 1		Allele 2		No. mismatches (aa)	% difference (aa)
	P valuea	Odds ratio	P value	Odds ratio
gdh	8.98E−18	84.47	1.67E−03	0.19	0	0
dinG	5.48E−10	0.08	0.063	0.55	0	0
gcc178	1.19E−19	0.09	0.151	1.41	0	0
metN	6.27E−18	0.10	2.97E−14	0.10	1	0.4
yhjX	0.028	0.24			1	0.2
pta	0.018	0.19			1	0.3
strA	0.006	5.86			0	0
gcc1730	5.72E−03	5.93			1b	0.3b
gpp1725	1.11E−04	0.47			1	0.6
endA	7.42E−05	0.46			1	0.9
dtpT	2.41E−05	0.43			1	0.2
cadR	1.48E−05	0.42			1	0.3
pyrB	3.80E−08	0.10			1	0.3
gcc171	3.27E−09	0.15			1	1.1
gcc176	5.64E−10	3.56			1	0.2
gcc1713	5.48E−10	3.55			0	0
natA	1.04E−10	3.69			1	0.9
inlA_2	2.42E−15	0.09			1	0.1
prtP_2	1.71E−16	42.87			1	0.1
glgD	1.78E−17	83.77			1	0.9
efrB	1.78E−18	49.48			1	0.2

^aP values are Benjamini-Hochberg corrected.

^bgcc1730 showed only one mismatch in the protein alignment, which introduced a stop codon in position 122.

FIG S5

Genes showing alleles statistically associated with carriage or invasive disease in CC17 strains. Each bar plot shows the frequency of each allele in each of the 21 CC17-associated genes observed to have at least one allele associated with disease or carriage. Different numbers on the x axis represent different allelic configuration of the gene. P value < 0.05, *, not significant. Download FIG S5, PDF file, 0.3 MB ^{(291.5KB, pdf)} .

Copyright © 2020 Gori et al.

This content is distributed under the terms of the Creative Commons Attribution 4.0 International license.

FIG S6

Population structure of CC17 isolates and presence of alleles associated with disease or carriage. Vertical colored strips show the clinical origin of each isolate (disease or carriage) and the alleles associated with disease or carriage for the genes reported in Fig. S4. The genes are reported in the tree annotation in the following order: cadR, dinG, dtpT, efrB, endA, gcc171, gcc 176, gcc178, gcc1713, gcc1730, gdh, glgD, gpp1725, inlA_2, metN, natA, prtP_2, pta, pyrB, srtA, yhjX. Download FIG S6, TIF file, 0.4 MB ^{(448.8KB, tif)} .

Copyright © 2020 Gori et al.

This content is distributed under the terms of the Creative Commons Attribution 4.0 International license.

In order to test the impact of the mutations targeting the efrB multidrug-efflux pump, we assessed susceptibility (MIC) to a range of unrelated compounds previously shown to be informative in S. pneumoniae (42) (Table 5). For three out of five molecules (erythromycin, chloramphenicol, and norfloxacin), the CC17 strain we tested had the highest MIC, although this was also seen in other non-CC17 strains. The acriflavin MIC did not vary between the different strains. The berberine MICs for CC17 and CC1 were lower than for CC23 and CC19.

TABLE 5.

Susceptibility of four S. agalactiae strains against five antimicrobial agents

Antimicrobial	MIC (μg/ml)a
	COH1 (serotype III, cc17)	NEM316 (serotype III, cc23)	2603V/R (serotype III, cc19)	H36B (serotype Ib, cc1)
Erythromycin	0.25	0.125	0.25	0.25
Chloramphenicol	4	4	4	2
Norfloxacin	>8b	>8b	4	4
Acriflavine	8	8	8	8
Berberine	32	64	64	32

^aMICs were determined from 3 experiments.

^bValue of 8 μg/ml was the higher detection limit for norfloxacin due to acidification and precipitation of media components.

DISCUSSION

S. agalactiae isolated from human and animal sources is characterized by a range of clonal complexes and sequence types. Each CC appears to be phenotypically different, with CC1 being commonly isolated in adult disease, and CC17 (associated with capsular serotype III) commonly isolated in neonatal disease and demonstrating hypervirulence (1, 16). We show that these different CCs are characterized by different gene sets belonging to functional families involved in niche adaptation and virulence. This is in part reflected in the various potential of different CCs to cause invasive diseases in different human hosts, as illustrated by the hypervirulence of CC17 in neonates, the lower neonatal invasive potential of CC1, CC19, and CC23 clones, and the propensity of CC1 to cause disease in adults with comorbidities (15, 16). Importantly, these CC-specific genetic characteristics and the pattern of gene presence and absence are independent of geographical origin, with the exception of the CC10 gene cluster present in the strains isolated from Africa belonging to ST327 and ST328. Furthermore, within CC17 we have identified several, functionally important allelic variants associated with either carriage or disease.

Among the hypervirulent CC17-specific genes, there were several examples of previously identified genes associated with human disease due to GBS and other related bacteria. For instance, the transporter Nik that controls the uptake of nickel is essential for survival in the human host. A homolog of Nik has been shown to be essential for Staphylococcus aureus in the causation of UTIs (43). The dldh gene, encoding the dihydrolipoamide dehydrogenase enzyme (44), has been implicated in several virulence-related processes in Streptococcus pneumoniae, such as survival within the host and production of capsular polysaccharide. Mutants lacking the dldh gene are unable to cause sepsis and pneumonia in mouse models (44). Surface proteases in S. agalactiae are described to have several virulence-associated functions, such as inactivation of chemokines that recruit immune cells at the site of infection or facilitate invasion of damaged tissue (45, 46). We have identified PrtP and ScpA proteases, both characterized by the presence of C5a peptidase domains and a signal peptidase SpsB, specific to this complex. Genes known to be associated with CC17 hypervirulence have also been identified in this analysis, including the Pi-IIb locus (40), part of which is represented by the CC17-associated genes gcc1732, lepB, inlA_2, and gcc1733 (Table S3), supporting the validity of this analysis. Allelic variation of virulence-associated genes has previously been used to identify genes classifying invasive and noninvasive strains in other streptococcal species (41). A proportion of CC17-specific genes also showed unique alleles associated with invasive disease or carriage strains. Sixteen of twenty-one allelic variants resulted in a difference that was translated into the protein sequence, including regulatory proteins and virulence- or metabolism-associated proteins, such as ABC transport systems, a major pilin protein, and a C5a peptidase. These data suggest there have been further selection processes within hypervirulent CC17 that could result in strains characterized by different virulence levels.

A phenotypic analysis was carried out to identify the potential effect of mutations in the efrB multidrug efflux pump that differentiated CC17 from the other clonal complexes. Using the MIC for a panel of antimicrobial molecules, we have not conclusively been able to show that mutations in efrB gene alone change the MIC. This is likely to be confounded by other differences in the non-CC17 genomes. CC23, for instance, encodes several ABC transporters in its accessory genome (such as such as the wxdM gene; Table S3) and we cannot exclude that some of these would be involved with efflux of deleterious molecules.

Further work is needed to assess the effect of the GWAS-driving mutations in an isogenic CC17 background.

CC23-specific genes identified are putatively involved in virulence and host invasion, including mntH, a gene encoding a manganese transport protein. During a bacterial infection the host limits access to manganese, among other micronutrients, and it has been shown that S. aureus responds to this host-induced starvation by expressing metal transporters, such as MntH (35). Interestingly, CC23 is also associated with vanY, a gene implicated in vancomycin resistance in other streptococci (47). GBS is typically susceptible to vancomycin (48), an antibacterial glycopeptide obtained from Streptomyces orientalis, which inhibits cell wall synthesis, alters the permeability of the cell membrane, and selectively inhibits RNA synthesis (49). Whether the presence of this gene also facilitates niche adaptation in the context of complex host-microbiota environment remains to be determined.

Lineage CC10, and the sublineage CC19 that includes the strains belonging to ST327 and ST328, are mostly characterized by metabolic genes, consistent with the lower virulence of these clonal complexes. The genes galTKEM are present in these two lineages only, and encode the “Leloir pathway” in other streptococci, such as S. mutans, S. thermophilus, and S. pneumoniae (50–52). This pathway in S. pneumoniae is finely tuned by CbpA and activated in tandem with the tagatose-6-phosphate pathway in order to maximize growth (53). The functionality of this pathway is yet to be described in GBS, but we hypothesize that accessing different methods to metabolize carbohydrates facilitates nutrient competition and survival. Among the nonmetabolic genes that are associated with CC19, we identified a virD4 gene, which is part of a previously identified type IV secretion system (T4SS) (54) present in numerous bacterial species and associated with virulence effector translocation and conjugation (55, 56).

GBS is widely thought to be a zoonosis (57–61). Based on the nature and the distribution of CC-characterizing genes, and their location in the GBS genome, we hypothesize that S. agalactiae lineages that colonize humans may have initially evolved in animals and then subsequently expanded clonally in humans. Our analysis is limited by the availability of data sets from across the world and from putative animal hosts, and therefore this hypothesis needs further confirmation. However, in line with the observation that S. agalactiae has undergone genome reduction (62), we postulate that the human-adapted clones evolved in animals through loss of function of redundant genes. Having escaped the animal niche, they were then able to evade the human immune system and establish successful colonization. Recently, the “missing link” between animal and human adaptation of GBS was described to be CC103 (57). However, we have identified animal isolates belonging to human-associated CCs (e.g., CC17 and CC23) which, in the case of the CC23 strains, cluster together with human clinical isolates in the GBS population structure.

Our analysis has a number of additional limitations. First, we were confined to the current publicly available GBS human and animal genomes retrieved from https://pubmlst.org/sagalactiae/ (a total of 3,028 isolates, including the full data set from the Netherlands), plus a further 303 genomes from Malawi. Second, the GWAS pipeline we used relies on the automated annotation of software Prokka. The use of this software required the use of Roary and Scoary to produce the pangenome and the pan-GWAS. This was extremely efficient when used to annotate the thousands of bacterial genomes in this analysis, and although the genome annotations and the pangenome were manually screened for consistency and quality (such as saturation of the core and accessory genome), it could potentially introduce artifacts. Confirming the GWAS findings with the sequence alignments allowed us to identify several genes that were characterized by nonsynonymous mutations and small indels, as well as unraveling the potential artifacts that require further investigation. Finally, as our analysis is confined to the genomic differences between the different clades, further laboratory and epidemiological analysis will be needed to fully appreciate the biological consequences of these CC-specific genes.

In conclusion, we have shown that the CCs of Streptococcus agalactiae responsible for neonatal meningitis and adult colonization are characterized by the presence of specific gene sets that are not limited to particular geographical areas. In the context of GBS control measures, such as vaccination, we speculate that as the human gastrointestinal and urogenital niches are vacated by vaccine serotypes, serotype replacement could occur as a result of new GBS strains arising from animals, including cattle and fish, which are reservoirs of GBS genetic diversity.

MATERIALS AND METHODS

Bacterial strains, genomes, and origin.

Publicly available genome sequences from 1,574 human isolates from Kenya, the United States, Canada, and the Netherlands, together with 87 genomes from animal isolates, were analyzed (16, 63–65) (Table 1). 24 further genomes derived from human isolates were retrieved from https://pubmlst.org/sagalactiae/ and were included. The genome assemblies were not available for the isolates from Kenya and the Netherlands. In those cases, short read sequence data were retrieved from the European Nucleotide Archive (ENA, https://www.ebi.ac.uk/ena). Raw DNA reads were trimmed of low-quality ends and cleaned of adapters using Trimmomatic software (ver. 0.32) (66). De novo assembly was performed with SPAdes software (ver 3.8.0) (67), using a sample of 1,400,000 reads and k-mer values of 21, 33, 55, and 77. De novo assemblies were checked for plausible length (between 1,900,000 and 2,200,000 bp), annotated using Prokka (ver. 1.12) (68), and checked for low-level contamination using Kraken (ver. 0.10.5) (69). In cases for which more than 5% of the contigs belonged to a species different from Streptococcus agalactiae, the genome sequence was not included in any further analysis. Resulting assemblies were deposited in the pubmlst.org/sagalactiae database, which runs the BIGSdb genomics platform (70).

In addition, 303 carriage and invasive disease strains isolated in Malawi between 2004 and 2016 in the context of carriage and invasive disease surveillance were sequenced. DNA was extracted from an overnight culture using DNAeasy blood and tissue kit (Qiagen) following the manufacturer’s guidelines, and sequenced using HiSeq4000 (paired-end library 2 × 150) platform at Oxford Genomics Centre UK. Sequences were then assembled as described above.

MLST and serotype definition.

Serotypes were determined via DNA sequence (63). BLASTn was used to align the DNA fragments typical of each serotype to the DNA assemblies (parameters: E value 1e−10, minimum 95% identity, minimum 90% query coverage). Accession numbers for the serotype-specific sequences are AB028896.2 (from 6982 to 11695, serotype Ia); AB050723.1 (from 2264 to 6880, serotype Ib); EF990365.1 (from 1915 to 8221, serotype II); AF163833.1 (from 6592 to 11193, serotype III); AF355776.1 (from 6417 to 11656, serotype IV); AF349539.1 (from 6400 to 12547, serotype V); AF337958.1 (from 6437 to 10913, serotype VI); AY376403.1 (from 3403 to 8666, serotype VII); and AY375363.1 (from 2971 to 7340, serotype VIII). Only one fragment matched each genome under these parameters, defining each isolate’s serotype. If no match was identified, the isolate was described as nontypeable (NT).

Multilocus sequence types (MLST) STs were derived from the allelic profiles of 7 housekeeping genes (adhP, pheS, atr, glnA, sdhA, glcK, and tkt). This grouped strains into 91 unique STs. Strains which did not show a full set of housekeeping gene alleles or were not assigned to any previously described ST (n = 68) were double-checked for sequence contamination and assigned to a non-sequence-typeable (NST) group.

Phylogeny inference.

BURST (71) was used to evaluate the relatedness between different STs, and to define CCs. Five random subsets, each containing 1,000/1,988 isolates, were analyzed using eBURST on PubMLST (70). This grouped STs sharing at least five out of seven MLST loci, and identified the central ST (i.e., the ST with the highest number of single or double locus variants), and was used to define CCs. Each of the five subsets showed the same six CCs (CC1, CC6, CC10, CC19, CC17, and CC23) plus a series of singletons (STs not belonging to any CC). CCs were defined as the set of STs associated with a particular CC in at least one eBURST result.

Core-genome phylogeny of GBS data sets was inferred using the software Parsnp (from Harvest package, ver. 1.1.2) (72), which performs a core genome SNP typing and uses Fastree2 (73) to reconstruct whole-genome maximum-likelihood phylogeny under a generalized time-reversible model. Parsnp requires a reference to calculate the core SNPs shared by all isolates: complete reference genomes from 5 different strains were used separately (accession numbers: NC_021485, strain 09mas018883 [CC1]; NC_007432, strain A909 [CC6]; HG939456, strain COH1 [CC17]; NC_018646, strain GD201008 [CC6]; NC_004368, strain NEM316 [CC23]). Trees were rooted at midpoint. Visualization of the phylogenetic analysis was performed via iTol (74). The recombination effect on phylogeny was assessed via ClonalFrameML ver. 1.12 (75) on five 140-strain random subsets of the entire data set.

Pangenome construction and genome-wide association analysis.

A pangenome was generated from the combined human (African isolates from Malawi and Kenya [64], Canadian [32], American [65], and Dutch isolates, and isolates of unkown geographical origin [Table 1])- and animal-derived strains using Roary (ver. 3.8.0). Parameters for each run were: 95% of minimum BLASTp identity; MLC inflation value 1.5; with 99% of strains in which a gene must be present to be considered “core.”

Recently, several pipelines were developed for bacterial genome wide association studies (GWAS), such as PLINK, PhyC, ROADTRIPS, and SEER (76–79). Scoary (80) was designed to highlight genes in the accessory pangenome of a bacterial data set associated with a particular bacterial phenotype. Here, Scoary (ver. 1.6.16) was used to establish which genes were typical of each CC via a pan-genome-wide association study (pan-GWAS). The CC of each isolate was depicted as a discrete phenotype, e.g., belonging to CC17 or not, and defined as “positive” or “negative,” respectively, with the Scoary algorithm evaluating which gene feature is statistically associated with a particular CC (80). The cutoff for a significant association was a P value lower than 1e−10 and a sensitivity and specificity greater than 90%. CC-associated genes were plotted on the circular representation of the chromosome of 5 GBS isolates belonging to each CC (strains ST-1, NCTC8187, 2603V/R, SGM4, 874391, and NGBS572) using BRIG (ver. 0.8) (81). Gene synteny was also evaluated for the CC-associated genes; three genomes belonging to each CC and the genes identified in the pan-GWAS analysis were aligned using ProgressiveMauve (82). Mauve (ver. 2.3.1) (83) was used to produce a graphical representation of the alignment and gene synteny was qualitatively evaluated.

The sequence diversity of genes identified from the pan-GWAS analysis was investigated by selecting one representative nucleotide gene sequence associated with each CC (sequences reported in supplemental material file 1) and aligning this against each genome included in the analysis using BLASTn. The bitscore value of each gene alignment was used to produce the heatmaps shown in Fig. S2, using the R package pheatmap (ver. 1.0.10; https://CRAN.R-project.org/package=pheatmap). Bitscores were normalized against the highest scoring isolate for each gene: the normalized bitscore was 0 > x ≥ 1, where 1 corresponds to the highest identified bitscore, 0 corresponds to the absence of the gene, and values in between highlight a different level of gene similarity. For the identification of alleles that distinguish strains isolated from disease and carriage, we calculated the allelic profiles of the genes identified by the pan-GWAS pipeline in 545 CC17 strains (for which the isolation source was non-animal and known). For each gene we selected the alleles present in at least 10 strains and calculated the proportion of strains isolated from invasive source and carriage. Significance for alleles unevenly distributed between carriage and disease was calculated with a Fisher test.

Assessment of ABC transporter activity by MIC.

Routine expansion of S. agalactiae strains was done in Todd-Hewitt (TH) broth or on TH agar (TH broth with 15% agar) at 37^°C, 5% CO₂.

The MICs of erythromycin, chloramphenicol, norfloxacin, acriflavin, and berberine against S. agalactiae strains COH1, NEM316, 2603V/R, and H36B were determined using the broth microdilution method with MH-F broth (Mueller-Hinton broth supplemented with 5% clarified lysed horse blood and 20 mg/liter β-NAD), as recommended by EUCAST (84, 85) and described in Robertson et al. in 2005 (42).

Briefly, GBS strains grown statically in TH broth at 37^°C, 5% CO₂ to logarithmic phase were harvested and resuspended in prewarmed MH-F broth at ∼5 × 10⁵ CFU/ml. A bacterial suspension (50 μl) was added to individual wells of a 96-well plate containing 50 μl MH-F supplemented with various concentrations of antimicrobial compounds (ranging from 0.06 to 32 μg/ml). The MIC was read after incubation of the 96-well plate at 37^°C, 5% CO₂ for 18 to 24 h.

Ethical approval for Malawi GBS collection.

Collection of carriage isolates was approved by the College of Medicine Research Ethics Committee (COMREC), University of Malawi (P.05/14/1574) and the Liverpool School of Tropical Medicine Research Ethics Committee (14.036). Invasive disease surveillance in Malawi was approved by COMREC (P.11/09/835 and P.08/14/1614).