{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T08:33:22Z","timestamp":1773131602809,"version":"3.50.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T00:00:00Z","timestamp":1558569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/M020193\/1"],"award-info":[{"award-number":["MR\/M020193\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Since 2009, increases in the incidence of invasive meningococcal disease have occurred in the United Kingdom due to a sublineage of the Neisseria meningitidis serogroup W ST-11 clonal complex (hereafter, the \u201coriginal UK strain\u201d). In 2013, a descendent substrain (hereafter, the \u201c2013 strain\u201d) became the dominant disease-causing variant. Multiple outer-membrane proteins of meningococci are subject to phase-variable switches in expression due to hypermutable simple-sequence repeats. We investigated whether alterations in phase-variable genes may have influenced the relative prevalence of the original UK and 2013 substrains, using multiple disease and carriage isolates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Repeat numbers were determined by either bioinformatics analysis of whole-genome sequencing data or polymerase chain reaction amplification and sizing of fragments from genomic DNA extracts. Immunoblotting and sequence-translation analysis was performed to identify expression states.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Significant increases in repeat numbers were detected between the original UK and 2013 strains in genes encoding PorA, NadA, and 2 Opa variants. Invasive and carriage isolates exhibited similar repeat numbers, but the absence of pilC gene expression was frequently associated with disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Elevated repeat numbers in outer-membrane protein genes of the 2013 strain are indicative of higher phase-variation rates, suggesting that rapid expansion of this strain was due to a heightened ability to evade host immune responses during transmission and asymptomatic carriage.<\/jats:p><\/jats:sec>","DOI":"10.1093\/infdis\/jiz275","type":"journal-article","created":{"date-parts":[[2019,5,21]],"date-time":"2019-05-21T19:14:33Z","timestamp":1558466073000},"page":"1109-1117","source":"Crossref","is-referenced-by-count":12,"title":["Potentiation of Phase Variation in Multiple Outer-Membrane Proteins During Spread of the Hyperinvasive Neisseria meningitidis Serogroup W ST-11 Lineage"],"prefix":"10.1093","volume":"220","author":[{"given":"Luke R","family":"Green","sequence":"first","affiliation":[{"name":"Department of Genetics and Genome Biology, University of Leicester, Leicester"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neelam","family":"Dave","sequence":"additional","affiliation":[{"name":"Department of Genetics and Genome Biology, University of Leicester, Leicester"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adeolu B","family":"Adewoye","sequence":"additional","affiliation":[{"name":"Department of Genetics and Genome Biology, University of Leicester, Leicester"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Lucidarme","sequence":"additional","affiliation":[{"name":"Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen A","family":"Clark","sequence":"additional","affiliation":[{"name":"Meningococcal Reference Unit, Public Health England, 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