The human pathogen Streptococcus pyogenes (group A streptococcus [GAS]) pilus components, suggested to play a role in pathogenesis, are encoded in the variable FCT (fibronectin-and collagen-binding T-antigen) region. We investigated the functions of sortase A (SrtA), sortase C2 (SrtC2), and the FctA protein of the most prevalent type 3 FCT region from a serotype M49 strain. Although it is considered a housekeeping sortase, SrtA's activity is involved in pilus formation in addition to its essentiality for GAS extracellular matrix protein binding, host cell adherence/internalization, survival in human blood, and biofilm formation. SrtC2 activity is crucial for pilus formation but dispensable for the other phenotypes tested in vitro. FctA is the major pilus backbone protein, simultaneously acting as the M49 T antigen, and requires SrtC2 and LepA, a signal peptidase I homologue, for monomeric surface expression and polymerization, respectively. Collagen-binding protein Cpa expression supports pilus formation at the pilus base. Immunofluorescence microscopy and fluorescence-activated cell sorting analysis revealed several unexpected expression patterns, as follows: (i) the monomeric pilus protein FctA was found exclusively at the old poles of GAS cells, (ii) FctA protein expression increased with lower temperatures, and (iii) FctA protein expression was restricted to 20 to 50% of a given GAS M49 population, suggesting regulation by a bistability mode. Notably, disruption of pilus assembly by sortase deletion rendered GAS serotype M49 significantly more aggressive in a dermonecrotic mouse infection model, indicating that sortase activity and, consequently, pilus expression allow a subpopulation of this GAS serotype to be less aggressive. Thus, pilus expression may not be a virulence attribute of GAS per se.Streptococcus pyogenes (group A streptococcus [GAS]) is a bacterial pathogen that is perfectly adapted to colonization, infection, and persistence in its human host (8,10,14,22). Many of the associated virulence factors expressed by this bacterium are encoded in discrete regions of the GAS genome (28). Two of these pathogenicity regions (Mga and FCT [see below]) each comprise genes for secreted and surface-exposed virulence factors and at least one stand-alone transcriptional regulator. These genes have been shown to act together in a growth phase-dependent regulatory network to coordinate GAS host cell adherence, internalization, and intracellular persistence (summarized in references 28 and 29).The FCT region (fibronectin-and collagen-binding T-antigen region) (6) is present in all GAS genomes specifically tested (26). The FCT region always contains a RALP transcriptional regulator whose type correlates with the type of emm pathogenicity region and the preferred infection site of the GAS strain, i.e., the throat or the skin. Since a similar association was also shown for the fibronectin-and collagenbinding proteins encoded by this region, the FCT region gene products could contribute to tissue-specific GAS infecti...