A Novel Gene Amplification Causes Upregulation of the PatAB ABC Transporter and Fluoroquinolone Resistance in Streptococcus pneumoniae
ABSTRACTOverexpression of the ABC transporter genespatAandpatBconfers efflux-mediated fluoroquinolone resistance inStreptococcus pneumoniaeand is also linked to pneumococcal stress responses. Although upregulation ofpatABhas been observed in many laboratory mutants and clinical isolates, the regulatory mechanisms controlling expression of these genes are unknown. In this study, we aimed to identify the cause of high-level constitutive overexpression ofpatABin M184, a multidrug-resistant mutant of S.pneumoniaeR6. Using a whole-genome transformation and sequencing approach, we identified a novel duplication of a 9.2-kb region of the M184 genome which included thepatABgenes. This duplication did not affect growth and was semistable with a low segregation rate. The expression levels ofpatABin M184 were much higher than those that could be fully explained by doubling of the gene dosage alone, and inactivation of the first copy ofpatAhad no effect on multidrug resistance. Using a green fluorescent protein reporter system, increasedpatABexpression was ascribed to transcriptional read-through from a tRNA gene upstream of the second copy ofpatAB. This is the first report of a large genomic duplication causing antibiotic resistance inS. pneumoniaeand also of a genomic duplication causing antibiotic resistance by a promoter switching mechanism.