Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
Focal Area Infection Biology, Biozentrum, University of Basel, 4056 Basel, Switzerland.
Proc Natl Acad Sci U S A. 2021 Feb 16;118(7). doi: 10.1073/pnas.2014920118.
causes invasive infections and easily acquires antibiotic resistance. Even antibiotic-susceptible can survive antibiotic therapy and persist, requiring prolonged treatment and surgical interventions. These so-called persisters display an arrested-growth phenotype, tolerate high antibiotic concentrations, and are associated with chronic and recurrent infections. To characterize these persisters, we assessed recovered directly from a patient suffering from a persistent infection. We show that host-mediated stress, including acidic pH, abscess environment, and antibiotic exposure promoted persister formation in vitro and in vivo. Multiomics analysis identified molecular changes in in response to acid stress leading to an overall virulent population. However, further analysis of a persister-enriched population revealed major molecular reprogramming in persisters, including down-regulation of virulence and cell division and up-regulation of ribosomal proteins, nucleotide-, and amino acid-metabolic pathways, suggesting their requirement to fuel and maintain the persister phenotype and highlighting that persisters are not completely metabolically inactive. Additionally, decreased aconitase activity and ATP levels and accumulation of insoluble proteins involved in transcription, translation, and energy production correlated with persistence in , underpinning the molecular mechanisms that drive the persister phenotype. Upon regrowth, these persisters regained their virulence potential and metabolically active phenotype, including reduction of insoluble proteins, exhibiting a reversible state, crucial for recurrent infections. We further show that a targeted antipersister combination therapy using retinoid derivatives and antibiotics significantly reduced lag-phase heterogeneity and persisters in a murine infection model. Our results provide molecular insights into persisters and help explain why persistent infections are so difficult to treat.
导致侵袭性感染,并且容易获得抗生素耐药性。即使是抗生素敏感的 也能在抗生素治疗后存活并持续存在,需要延长治疗和手术干预。这些所谓的持续存在者表现出停滞生长的表型,能耐受高浓度的抗生素,并与慢性和复发性感染有关。为了表征这些持续存在者,我们评估了直接从患有持续性感染的患者中分离出的 。我们表明,宿主介导的应激,包括酸性 pH 值、脓肿环境和抗生素暴露,在体外和体内促进了持续存在者的形成。多组学分析确定了 对酸应激的分子变化,导致了整个毒力种群。然而,对持续存在者富集群体的进一步分析表明,持续存在者中存在主要的分子重编程,包括毒力和细胞分裂下调,以及核糖体蛋白、核苷酸和氨基酸代谢途径上调,表明它们需要为持续存在者表型提供燃料和维持,突出了持续存在者并非完全没有代谢活性。此外,降低的 aconitase 活性和 ATP 水平以及涉及转录、翻译和能量产生的不溶性蛋白质的积累与 中的持续性相关,为驱动持续存在者表型的分子机制提供了依据。在重新生长时,这些持续存在者恢复了它们的毒力潜力和代谢活跃的表型,包括不溶性蛋白质的减少,表现出一种可逆状态,这对于复发性感染至关重要。我们进一步表明,使用视黄酸衍生物和抗生素的靶向抗持续存在者联合治疗显著降低了鼠感染模型中的迟滞期异质性和持续存在者。我们的研究结果为持续存在者提供了分子见解,并有助于解释为什么持续性 感染如此难以治疗。