Evidence for the importance of these Type 1 secretion system effectors to O. tsutsugamushi pathobiology continues to mount, as the bacterium transcriptionally expresses its entire Ank repertoire during infection of mammalian cells and select Anks have been shown to co-opt or modulate SCF1 ubiquitin ligase assembly, Golgi-to-endoplasmic reticulum (ER) retrograde trafficking, ER stress, ER-associated degradation, and protein secretion [22–26]. The gene discussed is ANKRD46; the disease is infection.