Figure 3.

Biofilm-associated infections within cystic fibrosis airways. The biofilm development is a multistep process starting with planktonic P. aeruginosa cells inhibiting the host immune responses including neutrophiles and macrophages (step 1) within the thickened mucus accumulated in cystic fibrosis airways (CFTR deficient). Bacterial survivors lose motility, accumulate extracellular polymeric substances, and form biofilm aggregates with heterogeneous populations (step 2). The biofilm populations exhibit genotypic and phenotypic convergence (step 3) to yield a fully mature biofilm with tolerance to antibiotics and persistent populations, which can cause recurring infections (step 4). CFTR, cystic fibrosis transmembrane conductance regulator; ROS, reactive oxygen species; PA, P. aeruginosa. The figure was created using biorender.com, accessed on 28 May 2023.