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Journal of Bacteriology logoLink to Journal of Bacteriology
. 2005 Jul;187(14):4908–4920. doi: 10.1128/JB.187.14.4908-4920.2005

A Cystic Fibrosis Epidemic Strain of Pseudomonas aeruginosa Displays Enhanced Virulence and Antimicrobial Resistance

Prabhakar Salunkhe 1,, Catherine H M Smart 2, J Alun W Morgan 3, Stavroula Panagea 2, Martin J Walshaw 4, C Anthony Hart 2, Robert Geffers 5, Burkhard Tümmler 1, Craig Winstanley 2,*
PMCID: PMC1169510  PMID: 15995206

Abstract

The Liverpool epidemic strain (LES) of Pseudomonas aeruginosa is a transmissible aggressive pathogen of cystic fibrosis (CF) patients. We compared transcriptome profiles of two LES isolates with each other and with a laboratory and genetic reference strain (PAO1) after growth to late exponential phase and following exposure to oxidative stress. Both LES isolates exhibited enhanced antimicrobial resistances linked to specific mutations in efflux pump genes. Although transcription of AmpC β-lactamase was up-regulated in both, one LES isolate contained a specific mutation rendering the ampC gene untranslatable. The virulence-related quorum-sensing (QS) regulon of LES431, an isolate that caused pneumonia in the non-CF parent of a CF patient, was considerably up-regulated in comparison to either isolate LES400, associated with a chronic CF infection, or strain PAO1. Premature activation of QS genes was detected in isolates from both non-CF parents and the CF patient in a previously reported infection episode. LES isolates lacking the up-regulated QS phenotype contained different frameshift mutations in lasR. When fed to Drosophila melanogaster, isolate LES431 killed the fruit flies more readily than either isolate LES400 or strain PAO1, indicating that virulence varies intraclonally. The LES may represent a clone with enhanced virulence and antimicrobial resistance characteristics that can vary or are lost due to mutations during long-term colonization but have contributed to the successful spread of the lineage throughout the CF population of the United Kingdom.


Pseudomonas aeruginosa, the most common pathogen associated with morbidity and mortality in cystic fibrosis (CF), causes chronic lung infections that once established are impossible to eradicate. For many years, the prevailing view was that individual CF patients acquired P. aeruginosa infections separately and thus carried their own unrelated strains. In 1996, Cheng et al. (6) reported the spread of a drug-resistant strain of P. aeruginosa among patients in a children's CF center in Liverpool. Since then, there have been other reports of CF “epidemic” strains (14, 45). An analysis of post-2000 patient samples has indicated that of 80 CF patients (from a total of 92 sampled) in the Liverpool adult center colonized with P. aeruginosa, 79% carry the Liverpool epidemic strain (LES) (35). In a recent study (45) involving over 1,200 isolates from 31 CF centers in England and Wales, the LES was identified as the most common clone, present in 48% of CF centers and accounting for 11% of the isolates. The LES appears to be more aggressive than other strains of P. aeruginosa. It has been able to replace previously established strains of P. aeruginosa (superinfection) (28) and has infected the non-CF parents of a CF patient, causing significant morbidity (29). Furthermore, there is greater morbidity among CF patients colonized with the LES than among those carrying nonepidemic strains of P. aeruginosa (1). Clearly, this strain represents a transmissible and aggressive clone well adapted to the CF environment.

The genome of P. aeruginosa displays a mosaic structure, with all strains possessing a highly conserved backbone comprising the vast majority of their genome and including the recognized virulence factors (9, 56). Variations between strains include the presence or absence of genomic islands, and there is some evidence to suggest that the LES possesses such islands (36). However, variations in gene expression have been shown to influence the virulence of an autoaggressive and highly adherent small-colony variant of a CF isolate, with significant up-regulation of virulence-related genes occurring (51). The success of the LES may be due either to the prior acquisition of genes or islands, to transcriptional variations in gene expression, or to a combination of both. We hypothesize that such changes contribute to greater colonization and/or transmissibility of the strain, enhancing its ability to cause CF infections, and may lead to enhanced virulence manifesting itself in episodes such as the infection of non-CF parents.

To test the hypothesis that the additional properties of the LES may be due to variations in gene expression, we compared the transcriptional signature of two LES isolates (associated with chronic and acute infections, respectively) to each other and to the laboratory and genetic reference strain PAO1 under two different growth conditions designed to maximize the number of expressed genes: late exponential phase and stationary phase with exposure to hydrogen peroxide. Here, we report variations in the expression of virulence-related genes not only between LES isolates and strain PAO1 but between the two LES isolates.

MATERIALS AND METHODS

Bacterial strains.

Isolate LES400 is our laboratory reference isolate for the LES, used in previous genetic analysis (36), and was isolated from a CF patient who had been colonized for at least 6 months (chronic infection). It has an identical pulsed-field gel electrophoresis (PFGE) pattern to the earliest-known LES isolate from 1988. The other LES isolates were sputum culture isolates taken from a case involving respiratory tract infection of the non-CF parents of a CF patient (29). Isolates LES431 and LES430 were both isolated from the CF patient's father, who presented with pneumonia. Isolate LES417 was isolated from the patient's mother, who presented with pyrexia and bilateral chest wheezes. Isolates LES416 and LESB44 were isolated from the CF patient. Isolates LES416, LES417, LES430, and LES431 share an identical PFGE pattern. Strain PAO1 is a widely studied laboratory strain of P. aeruginosa for which the entire genome sequence is known (47). PFGE analysis of SpeI-digested genomic DNA was carried out using 1% (wt/vol) agarose gels and interpreted according to the protocol of Tenover et al. (49).

Growth conditions and RNA isolation for microarray analysis.

In the absence of stress, P. aeruginosa strains were grown up to late exponential phase (optical density at 600 nm [OD600] of 2.7 to 3.0) in Luria broth (LB). For exposure of bacteria to hydrogen peroxide, stationary phase-grown cultures (3 × 1010 cells) were resuspended in fresh LB and kept in a dialysis tube (14-kDa cutoff; 25 mm) with an effective length of 6 cm for the exchange of fluids. Then, the dialysis tube was resuspended in a 1-liter Erlenmeyer flask containing 600 ml of LB with or without 10 mM hydrogen peroxide (Sigma-Aldrich) to generate oxidative stress. The flasks were incubated at 37°C and 200 rpm on a rotary shaker for 2 h.

Total RNA was extracted from approximately 3 × 1010 cells by a modified hot-phenol method (48). The procedure for RNA isolation, purification, and quantification has been described previously (51). For each GeneChip experiment, the culturing of bacteria, exposure to hydrogen peroxide or LB control, and subsequent RNA isolation were performed in triplicate on the same day. Equal amounts of each of three preparations were then pooled to a total of 10 μg for cDNA synthesis and hybridization onto a single GeneChip. This procedure was duplicated. Thus, ultimately, two GeneChips per strain and growth condition were scanned at 570 nm with 3-μm resolution by the Affymetrix scanner.

GeneChip microarray analysis.

The generation of cDNA and subsequent biotin-ddUTP terminal-labeling steps were performed as described in the manufacturer's instructions for the P. aeruginosa GeneChip (Affymetrix), using the 10 μg of total RNA mixed with random primers (Invitrogen) and control in vitro transcripts of 10 non-Pseudomonas gene sequences (kindly provided by S. Lory and coworkers, University of Washington), as described previously (51). GeneChip hybridization and washing were carried out following the manufacturer's instructions (Affymetrix) and as described previously (51).

The P. aeruginosa PAO1 GeneChip contains oligonucleotide probes for 5,549 protein-coding genes, 18 tRNA genes, a representative rRNA cluster, and 199 intergenic regions selected from the annotated genome of P. aeruginosa strain PAO1 (47). In addition, there are probes for 117 genes from P. aeruginosa strains other than PAO1 and 14 genes from other species, which can serve as controls (31). Data analysis was performed using the Affymetrix Microarray Suite software (version 5.0) with Affymetrix default parameters. The average microarray hybridization signal intensity was scaled to 150. Two GeneChips for each strain per condition were compared by the four-comparison survival method (3, 5) as follows. The data were imported into a Microsoft Access database capable of searching for genes that significantly changed their signal intensities by the Wilcoxon rank test, with a minimum of a twofold change in all four comparisons. The arithmetic average and the standard deviation of the four comparisons were calculated. As an independent criterion for significantly changed signal intensities, a Bonferroni correction of the signal ratios obtained from the MicroArray Suite software was applied to account for the number of tests (40), which in this case was the total number of open reading frames (ORFs) on the chip. First, the ratio of calibrated and corrected hybridization signals per gene (Si) obtained from cultures grown under identical conditions was verified to follow a Gaussian distribution, and the variance (σ) was calculated. mRNA transcript levels of a gene (i) were considered to be significantly differentially expressed, if the ratio S(i)A/S(i)B or S(i)B/S(i)A exceeds the threshold (1 + uσ), whereby the factor u defines that upper boundary of the normalized Gaussian integral Φ(u) where Φ(u) = xn matches the Bonferroni-corrected 95% confidence interval in the expression (1 − α) = xn (here, n = 5,900, α = 0.025, and 0.975 ≪ x <1.0).

In summary, changes were only classified as significant if they fulfilled the criteria of the four-comparison survival method and exceeded the threshold of the Bonferroni correction for multiple testing. Data were combined with the latest annotation (15 December 2004) from the website of the P. aeruginosa PAO1 sequence and the community annotation project provided at http://www.pseudomonas.com.

Generation of targets from genomic DNA hybridization.

For hybridization of genomic DNA from isolates LES400 and LES431 on the PAO1 GeneChip, 25 μg of genomic DNA from stationary-phase-grown cells was fragmented with 7.5 U of DNase I (Amersham) at 37°C for 10 min. This enzyme produced a majority of fragments in the range of 50 to 200 bp, which is suitable for GeneChip hybridization. The fragmented DNA from two independent genomic DNA preparations for each LES isolate was denatured at 95°C, labeled, and then hybridized on a GeneChip as described for the cDNA expression analysis. The absence or presence of genes was classified as described previously (56).

Exoproduct secretion assays.

All cultures were inoculated in either King's A medium or in LB to an OD600 of approximately 0.05 and then incubated at 37°C with shaking (300 rpm). The amount of pyocyanin in culture supernatants was quantified by measuring the OD695 value (16). LasA protease and elastase activities were measured by determination of the ability of P. aeruginosa culture supernatants to lyse boiled Staphylococcus aureus cells, leading to a decrease in OD600 (15), and by the elastin Congo red assay (38), respectively. In the latter assay, insoluble elastin Congo red was removed by centrifugation, and the increase in the OD495 value in supernatants was used as a measure of elastase activity.

Antimicrobial sensitivity tests and β-lactamase activities.

MICs for antimicrobial agents were determined using E-test strips according to the manufacturer's instructions (AB Biodisk).

PCR amplification and nucleotide sequencing.

Details of the oligonucleotide primers (Sigma-Genosys) used in PCR assays and for nucleotide sequencing will be made available on request. PCR amplicons were purified using S-400 microspin columns (Amersham-Pharmacia Biotech) and sequenced by Lark Technologies, Inc., using the same oligonucleotide primers employed in the PCR amplification and internal primers.

Virulence against fruit flies.

Virulence against Drosophila melanogaster was assessed essentially as described by Chugani et al. (8). The fruit flies were obtained from Blades Biological, Ltd. (Cowden, Kent, United Kingdom), and three independent assays were run consecutively.

RESULTS AND DISCUSSION

Whole-genome comparisons.

PFGE of the three isolates used in the microarray analysis indicated that the LES isolates shared few bands in common with strain PAO1 and differed from each other by two bands (Fig. 1). Size estimations using PFGE gels indicated that the LES did not have a larger genome than strain PAO1.

FIG. 1.

FIG. 1.

PFGE comparisons of LES isolates and strain PAO1. M, pulse marker, 50 to 1,000 kb (Sigma-Aldrich); lane 1, PAO1; lane 2, LES400; lane 3, LES431.

GeneChip analysis using DNA from isolates LES400 and LES431 indicated the presence in LES strains of at least 95% of PAO1 genes and confirmed the additional presence of O6 antigen genes and PAGI-1 genes, as reported previously (36). In accordance with the known pyoverdine type of the LES (type III) (36), PAO1 pyoverdine sythesis and receptor genes were identified as absent from LES isolates. Among other absent genes/gene clusters were a transport-related cluster (PA0202 to PA0206), two bacteriophage-related clusters (PAO632 to PA0648 and PA0715 to PA0759) and a lipopolysaccharide-related cluster (PA3142 to PA3160). Also absent from LES isolates was the putative polysaccharide-related cluster PA1378 to PA1393, a cluster of type IV pilus genes (PA4525 to PA4527; pilABC), and several other clusters of unknown function (PA0980 to PA0985, PA2100 to PA2106, PA2218 to PA2228, PA2730 to PA2736, and PA3500 to PA3513). PCR assays targeting PA0203, PA0641, and PA1384 (galE) supported the notion that these genes were absent from the LES isolates. Variations in the pilABC cluster between strains of P. aeruginosa have been reported previously (7, 18). Initially, PCR amplification assays using primers designed to the PA4526 (pilB) sequence of strain PAO1 were negative for both LES isolates. However, when primers designed on the basis of conservation between strains PAO1 and PA14 were used (PILBF2 and PILBR2), isolates LES400 and LES431 were PCR positive for pilB, suggesting that the pil genes are present in LES isolates but vary in sequence from their equivalents in strain PAO1.

Although PAGI-1 coding sequences 1 to 31 were detected in the LES isolates, coding sequences 34 to 51 were lacking. This observation was supported by PCR assays for one of the missing genes, suggesting that the LES carries a truncated version of the PAGI-1 island, lacking the region with a G+C content significantly below that of the genome average (23). This island is also only partially present in the other P. aeruginosa strain that has been genome sequenced (PA14). Only minor differences in gene content were detected between the two LES isolates.

Global GeneChip expression analysis.

Gene expression microarrays were used to compare the transcriptomes of the two LES isolates against strain PAO1 and against each other, following growth to late exponential phase in LB and after exposure to hydrogen peroxide. Tables listing all those genes identified as up- or down-regulated are available at C. Winstanley's website (http://www.liv.ac.uk/mmgum/). A summary of the numbers of differentially expressed genes in the various comparisons is shown in Table 1. The following text serves to highlight some of the main features of the expression analysis.

TABLE 1.

Numbers of differentially expressed genes

Growth condition and changeb No. of expressed genesa
LES400 vs PAO1 LES431 vs PAO1 LES431 vs LES400
LB up 222 225 211
    QS activated 8 127 142
    QS repressed 5 6 4
    Antimicrobial 12 8 5
LB down 119 (137) 103 (112) 137
    QS activated 10 6 1
    QS repressed 11 9 3
    Antimicrobial 1 1 3
H2O2 up 146 349 219
    QS activated 18 70 6
    QS repressed 1 3 0
    Antimicrobial 5 12 3
H2O2 down 350 (367) 251 (299) 90
    QS activated 8 9 11
    QS repressed 10 21 5
    Antimicrobial 0 1 3
a

Values for down-regulated genes when LES isolates were compared to strain PAO1 were adjusted by subtracting genes that were recorded as absent from LES isolates. The figure prior to this adjustment is shown in parentheses.

b

Up- or down-regulation under either growth condition (LB or H2O2 exposed) was at least twofold. QS, number of quorum-sensing regulated genes previously reported as either QS activated or QS repressed (43, 51); antimicrobial, genes associated with antimicrobial susceptibility.

The most striking finding was that in isolate LES431 grown under LB growth conditions and compared to either strain PAO1 or isolate LES400, the majority (56% and 67% for strain PAO1 and isolate LES400, respectively) of up-regulated genes were among those reported previously as activated by quorum sensing (QS) (Tables 1 to 3). Thus, isolate LES431 expressed substantially elevated levels of mRNA transcripts for many of the known P. aeruginosa virulence genes (44, 52), including those encoding alkaline protease, elastase, LasA protease, Clp proteases, CbpD, phenazine biosynthesis, hydrogen cyanide synthesis, aminopeptidase, and lectin. Notably, mRNA levels were elevated to similar ratios whether compared to another member of the same clone (isolate LES400) or to a member of another clone (strain PAO1).

TABLE 3.

Summary of quorum-sensing-related genes that were down regulated in (i) isolate LES400 compared to strain PAO1, (ii) isolate LES431 compared to strain PAO1, and (iii) isolate LES431 compared to isolate LES400

ORFa Gene name LB LES400 ↓ vs PAO1 H2O2 LES400 ↓ vs PAO1 LB LES431 ↓ vs PAO1 H2O2 LES431 ↓ vs PAO1 LB LES431 ↓ vs 400 H2O2 LES431 ↓ vs 400 Product description
QS activated
    PA0026 4.3 Hypothetical protein
    PA0105 coxB 6.6 Cytochrome c oxidase subunit II
    PA0107 14 Conserved hypothetical protein
    PA1317 cyoA 13 Cytochrome o ubiquinol oxidase subunit II
    PA1319 cyoC 4.56 Cytochrome o ubiquinol oxidase subunit III
    PA1404 4.8 Hypothetical protein
    PA1431 rsaL 35 Regulatory protein RsaL
    PA1432 lasI 12 Autoinducer synthesis protein LasI
    PA2365 3.2 Conserved hypothetical protein
    PA2445 gcvP2 3.8 2.9 Glycine cleavage system protein P2
    PA2446 gcvH2 3.9 2.2 Glycine cleavage system protein H2
    PA3181 9.7 2-Keto-3-deoxy-6-phosphogluconate aldolase
    PA3182 pgl 2.6 6-Phosphogluconolactonase
    PA3183 zwf 5.9 2.1 Glucose-6-phosphate 1-dehydrogenase
    PA3188 74 26 Probable permease of ABC sugar transporter
    PA3190 46 9.6 38 34 Probable binding protein component of ABC sugar transporter
    PA3195 gapA 6.0 Glyceraldehyde 3-phosphate dehydrogenase
    PA3369 4.0 Hypothetical protein
    PA3418 ldh 6.4 Leucine dehydrogenase
    PA3691 3.6 Hypothetical protein
    PA3692 4.5 Probable outer membrane protein precursor
    PA3923 5.9 Hypothetical protein
    PA4131 7.2 Probable iron-sulfur protein
    PA4133 4.1 Cytochrome c oxidase subunit (cbb3 type)
    PA4311 5.7 Conserved hypothetical protein
    PA4496 8.1 4.9 2.5 11 Probable binding protein component of ABC transporter
    PA4498 14 34 3.1 31 Probable metallopeptidase
    PA4876 osmE 8.0 Osmotically inducible lipoprotein OsmE
    PA4880 3.3 Probable bacterioferritin
    PA4916 12 Hypothetical protein
    PA4917 5.0 Hypothetical protein
    PA5027 9.5 Hypothetical protein
QS repressed
    PA0509 nirN 4.4 12 Probable c-type cytochrome
    PA0510 40 Probable uroporphyrin-III c-methyltransferase
    PA0512 8.4 15 17 Conserved hypothetical protein
    PA1559 3.9
    PA2007 maiA 18 Maleylacetoacetate isomerase
    PA2008 fahA 19 Fumarylacetoacetase
    PA2009 hmgA 7.8 Homogentisate 1,2-dioxygenase
    PA2259 ptxS 2.8 5.1 Transcriptional regulator PtxS
    PA2260 4.3 Hypothetical protein
    PA2261 11 Probable 2-ketogluconate kinase
    PA2540 4.8 Conserved hypothetical protein
    PA3174 3.2 Probable transcriptional regulator
    PA3205 2.6 Hypothetical protein
    PA3364 amiC 24 4.6 12 Aliphatic amidase expression-regulating protein
    PA3365 6.6 5.7 5.1 10 Probable chaperone
    PA3391 nosR 13 38 Regulatory protein NosR
    PA3392 nosZ 62 23 42 56 Nitrous oxide reductase precursor
    PA3393 nosD 5.9 4.6 7.3 NosD protein
    PA3394 nosF 8.1 NosF protein
    PA3575 2.7 Hypothetical protein
    PA3662 4.2 7.7 12 20 Hypothetical protein
    PA3790 oprC 9.7 37 7.4 Putative copper transport outer membrane porin OprC precursor
    PA3872 narI 2.8 Respiratory nitrate reductase gamma chain
    PA3877 narK1 9.1 Nitrite extrusion protein 1
    PA3913 10 4.7 9.7 Probable protease
    PA4442 cysN 2.3 ATP sulfurylase GTP-binding subunit/APS kinase
    PA4587 ccpR 10 3.6 5.6 44 12 Cytochrome c551 peroxidase precursor
    PA4770 lldP 2.9 l-lactate permease
    PA4918 3.2 4.5 35 43 8.3 Hypothetical protein
a

These genes have been reported previously as being regulated by quorum sensing (either QS activated or QS repressed) (43, 51).

Among the genes up-regulated in isolates LES400 and LES431 compared to strain PAO1 under both growth conditions were several associated with antimicrobial susceptibility, including the ampC β-lactamase gene, the MexAB-OprM and MexXY efflux pumps (Table 4), and the pyochelin biosynthesis genes (PA4221 to PA4231). Regulatory genes associated with alginate production (algU and mucA) were up-regulated following growth in LB only in isolate LES400. Notable genes up-regulated in isolate LES431 following oxidative stress compared to either strain PAO1 or isolate LES400 included a bacteriophage-related gene cluster (PA0611to PA0628).

TABLE 4.

Summary of expression variations for genes associated with antimicrobial susceptibilitya

ORF Gene name LB LES400 ↑ vs PAO1 H2O2 LES400 ↑ vs PAO1 LB LES400 ↓ vs PAO1 LB LES431 ↑ vs PAO1 H2O2 LES431 ↑ vs PAO1 LB LES431 ↓ vs PAO1 H2O2 LES431 ↓vs PAO1 LB LES431 ↑ vs 400 H2O2 LES431 ↑ vs 400 LB LES431 ↓ vs 400 H2O2 LES431 ↓ vs 400
PA0424 mexR 18 9.0 7.2 10
PA0425 mexA 3.4 2.6
PA0426 mexB 2.4
PA0427 oprM 3.9 2.9
PA0958 oprD 16 5.0 12
PA2018 mexY 7.9 11
PA2019 mexX 8.0 17 4.1 33
PA2020 mexZ 3.2
PA2493 mexE 16 66 18 295 5.1
PA2494 mexF 57
PA2495 oprN 6.0
PA4110 ampC 12 46 137 178 11 4.0
PA4205 mexG 45 8.7 5.9
PA4206 mexH 11 6.7 9.2
PA4207 mexI 15 8.4 6.2 4.9
PA4208 opmD 4.3 8.0 5.5
PA4599 mexC 28 10 32 43
PA4776 pmrA 6.7 6.6
PA4777 pmrB 9.2
a

Arrows indicate isolates in which the gene is up-or down-regulated. LB or H2O2 indicate the two growth conditions used in this study. Values represent the average change in gene expression from replicate experiments.

Genes down-regulated in both LES isolates compared to strain PAO1 under both growth conditions included genes from clusters involved in anaerobic metabolism (nirJLFCMSQ [PA0511 to PA0520], norBC [PA0523 to PA0524], nosRZDF [PA3391 to PA3394], and arcDABC [PA5170 to PA5173]), motility/chemotaxis (flgBCDEGJK [PA1077 to PA1086], fliCD [PA1092 to PA1096], and pctCAB [4307 to 4310]), and twitching motility (pilGIJK [PA0408 to PA0412]). Type IV pilus-associated genes of the cluster pilMNOPQ were down-regulated in isolate LES400 under both growth conditions but in isolate LES431 only under stress. The presence of this cluster has been associated with CF and may confer an early colonization or persistence advantage (18). We confirmed that following growth on Luria agar both LES isolates, unlike strain PAO1, lacked any visible flagella or pili, were nonmotile, and lacked twitching activity (data not shown).

Under oxidative stress, a large cluster of ribosomal proteins (PA4237 to PA4274) was down-regulated in isolate LES400 when compared to either strain PAO1 or isolate LES431. Genes associated with ribosomal biogenesis are known to be down-regulated following exposure to hydrogen peroxide (34). Similarly, several general secretory pathway genes (secA, secB, secE, and secY) were down-regulated in isolate LES400 in comparison to strain PAO1 or isolate LES431. Of the 13 nuo genes mostly clustered at PA2638 to PA2649 and encoding NADH dehydrogenase complex I, 10 were down-regulated in isolate LES400 and 5 were down-regulated in isolate LES431 when compared to strain PAO1. nuoAL genes were down-regulated in isolate LES400 compared to isolate LES431. F1F0 ATP synthase genes (PA5554 to PA5560) were also down-regulated in isolate LES400 compared to either strain PAO1 or isolate LES431. These data indicate a somewhat enhanced oxidative stress response, especially in isolate LES400, compared to strain PAO1.

Under stress, there was modest up-regulation (2.2 to 4.9 fold) of genes associated with DNA repair (recA, lexA, recN; PA0670 to PA0671) and of sodB (superoxide dismutase; 13 fold) in isolate LES431 compared to strain PAO1. recA was also up-regulated in isolate LES400.

Up-regulation of genes involved in antimicrobial susceptibility in LES isolates.

We reported previously that antibiotic susceptibility profiles of LES isolates sharing PFGE genotypes can vary widely (35). The sensitivities of both LES isolates used in the microarray analysis and strain PAO1 to a number of antimicrobial agents are detailed in Table 5. Both LES isolates were less sensitive than strain PAO1 to β-lactams, aminoglycosides, and quinolones but with some notable variations between isolates LES400 and LES431. In particular, isolate LES431 was more resistant to the β-lactams piperacillin (in combination with the β-lactamase inhibitor tazocin) and imipenem (Table 5). Changes in gene expression that are likely to contribute to these variations in antimicrobial susceptibility are shown in Table 4 (12, 13, 19, 33, 50, 58).

TABLE 5.

Antimicrobial agent susceptibility profiles of the isolates

Antimicrobial agent MIC value (μg/ml)
LES400 LES431 PAO1
Piperacillin/tazocin 8 64 1
Aztreonam 48 32 0.75
Ceftazidime 16 16 0.5
Imipenem 0.2 4 0.38
Meropenem 6 6 0.25
Imipenem (+ EDTA) 0.2 1 <1
Gentamicin 4 2 0.5
Amikacin 16 12 1
Tobramycin 1 0.75 0.19
Colistin 0.19 0.19 0.19
Ofloxacin 4 3 0.5
Ciprofloxacin 0.5 1 0.032
Cotrimoxazole 2 0.25 0.15

We found a number of mutations in loci associated with antimicrobial susceptibility (summarized in Table 6). Expression of ampC was up-regulated in both LES isolates compared to strain PAO1, but the level of expression in isolate LES431 was >10-fold higher (Table 4). To resolve the variation in ampC expression between the two LES isolates, we sequenced the ampR genes and ampR-ampC intergenic regions, including the start of ampC. The predicted AmpR protein sequence for the LES isolates differed in one internal position compared to PAO1 (D135→G). A similar mutation (D135→N) has been reported previously in a strain exhibiting high levels of β-lactamase activity (2). However, the major difference was the replacement of the ampR ATG start codon with the sequence TTG, a mutation likely to render the sequence untranslatable. Since AmpR is reported to be a positive regulator for ampC (24), this observation was counter to what might be expected. It has been reported that mutations in AmpR can lead to enhanced expression of chromosomal β-lactamase in P. aeruginosa (2), but isolate LES431 in particular is a strain with high constitutive expression of ampC that lacks a functional AmpR, which suggests that activation by AmpR is not a prerequisite for high levels of AmpC.

TABLE 6.

Summary of mutations in regions associated with antimicrobial susceptibility and QS

Locus LES isolate(s)a Mutation(s) Comment(s) Relevant reference(s)
Antimicrobial Susceptibility
    mexR LES400 and LES431 R83→C Mutation not reported previously 13, 24, 32, 57
    mexA-R intergenic LES400 and LES431 Ribosome-binding site for mexA AGGA → AGGG Previous report of mutation in the ribosome-binding site leading to down-regulation (AGGA → CGGA) 13
    ampR LES400 and LES431 D135→G; Previous report of D135→N mutation in strain with high levels of β-lactamase activity; disruption of AmpR translation 2
    ampR-C intergenic LES400 only ATG→TTG (start codon) −71 with respect to the start codon of ampG5 C→T Effect of mutation is unknown
    ampC LES400 only ATG→ATT (start codon) Disruption of AmpC translation
    ampD LES400 and LES431 G148→A and S175→L Same substitutions observed previously in strains with high AmpC activity but discounted as cause of up-regulation 2, 19
    PA4523-ampD intergenic LES400 and LES431 76 bp upstream of the ampD start codon; A→C Effect of mutation is unknown
    mexZ LES400 and LES431 Q164→termination (CAA→TAA) Similar though not identical truncations associated with aminoglycoside resistance among CF isolates 49
QS related
    rhlR-rhlI intergenic LES400 and LES431 30 bp upstream of the rhlI start codon, TTTTTTTTCTC → TTTTTTT-CTC Effect of mutation is unknown
    rhlB LES400 and LES431 Downstream of P3 (one rhlR transcription start site), AGGGAGGGGGATGCTC → AGGGAGGGGGATGCGC Effect of mutation is unknown
    lasR LES400 only Repetition of GGTGCTC leading to divergence from G123 onward Loss of the HTH DNA-binding LuxR motif
    lasR LES430 only Deletion of GTGGATGCTC leading to divergence from position W152 onward Loss of the HTH DNA-binding LuxR motif
    lasR LESB44 only Insertion of GAAG leading to divergence from position I35 onward Loss of most of LasR
    rsaL-lasI intergenic LES400 and LES431 In between the lux-box-like sequence NNCT-(N)12-AGNN and the lasI start codon, located 6 bp away from the lux box-like sequence Effect of mutation is unknown
    PA2587 and gacA intergenic LES400 and LES431 6 bp different from PAO1; nearest mutation was 160 bp upstream from the gacA start codon Effect of mutation is unknown
a

LES isolates refers to LES400 and LES431 only, with the exception of the mutations found in the lasR gene of isolates LES430 and LESB44.

Intriguingly, there were two further mutations in isolate LES400 when compared to both isolate LES431 and strain PAO1, one in the ampR-ampC intergenic region and another leading to mutation of the ampC start codon (Table 6). Thus, although expression of ampC transcription may be up-regulated in isolate LES400 compared to that in strain PAO1, it is likely that the AmpC protein cannot be translated.

Inactivation of the ampD gene has been associated with increased levels of AmpC β-lactamase in P. aeruginosa (2, 19). We amplified and sequenced the ampD genes and the PA4523-ampD intergenic regions of isolates LES400 and LES431 and found them to be identical. The AmpD predicted protein sequence differed in two positions when compared to strain PAO1 (Table 6). Identical substitutions have been observed in more than one other strain associated with high basal levels of AmpC activity (19). However, the same mutations were also present in strains with low basal levels and inducible AmpC, suggesting that such mutations cannot explain the high basal levels observed in strain LES431 (19). In addition, there was a single nucleotide variation between LES strains and strain PAO1 in the PA4523-ampD intergenic region (Table 6).

In support of the gene expression data, using the chromogenic cephalosporin nitrocefin we were able to detect strong β-lactamase activity in isolate LES431. In contrast, β-lactamase activity in isolate LES400 was barely detectable (unpublished data). It has been reported previously that imipenem is not a substrate for the MexAB-OprM or MexXY efflux pumps (27). Since imipenem resistance changes in the presence of a metallo-β-lactamase inhibitor (EDTA) (Table 5), it seems more likely that imipenem resistance and the variation in MICs between the LES isolates are largely due to the production of β-lactamase from the ampC gene. MICs for ceftazidime were the same for LES400 and LES431, suggesting that although ceftazidime resistance has been used to measure of ampC activity (2), other factors can contribute. It has been reported previously that some P. aeruginosa isolates can be more susceptible to β-lactam antibiotics such as ceftazidime despite overproduction of both AmpC and MexAB-OprM, although the mechanisms behind this are unclear (12).

Overproduction of MexAB-OprM can significantly enhance resistance by P. aeruginosa to a range of drugs (17, 22, 32, 57, 58). A number of different mutations associated with overexpression of the MexAB-OprM efflux pump have been reported. nalB mutants arise from nucelotide sequence variations in the adjacent mexR repressor gene (37, 39, 46, 58). Cao et al. (4) have reported that nalC mutants carry mutations in the gene PA3721 (renamed nalC), whose product appears to repress the genes PA3720 and PA3719. Up-regulation of these genes may contribute to the nalC mutant phenotype. However, we did not observe any alterations in expression between LES strains and PAO1 for the PA3719 to PA3721 genes.

We sequenced the mexR gene and the mexA-mexR intergenic region of the two LES isolates. Both LES400 and LES431 carry a single amino acid change in the predicted MexR protein when compared to PAO1. Isolates LES400 and LES431 also carry a single nucleotide change in the intergenic region between mexR and mexA in the putative ribosome-binding site for mexA. In a previous study, Hocquet et al. (12) complemented various mexR mutations but concluded that this efflux pump contributed only marginally to β-lactam and fluoroquinilone resistance. However, it has been suggested that the MexAB-OprM pump plays a role in P. aeruginosa invasiveness and may be involved in the delivery of virulence factors to host cells (11). Hocquet et al. (12) have speculated that overexpression of this efflux system may contribute to the success of an epidemic clone by playing an important role in virulence rather than antibiotic resistance. It has been reported that a QS autoinducer can enhance mexAB-oprM without MexR-mediated regulation (41). This activity is repressed by MexT (PA2492). However, we observed no variation in expression of mexT.

In a study of P. aeruginosa clinical isolates, carbapenem resistance was linked with the loss of or decreased levels of OprD (33). In isolates LES400 and LES431, expression of oprD was down-regulated (Table 4) compared to PAO1. MICs of meropenem were reported to be two to four times higher for isolates expressing MexAB-OprM in a background of low OprD levels (33). It seems likely that these variations in gene expression also contributed to the 24-fold increase in MICs for meropenem in the LES strains compared to PAO1.

The MexXY system enables P. aeruginosa to become resistant to aminoglycosides, tetracyclines, and macrolides (13, 26) and has been specifically implicated in the emergence of resistance to aminoglycosides in CF isolates (50). There was evidence of up-regulation of the MexXY system in LES strains compared to PAO1 under the conditions used for growth in this study (Table 4). Expression of this system is normally inducible by aminoglycosides under the control of the MexZ repressor. It has been demonstrated that mutations in mexZ are associated with overproduction of the MexXY efflux system and increased resistance to aminoglycosides (50), and CF isolates have been shown to overproduce this system constitutively (53). Sequencing of the mexZ genes and mexZ-mexX intergenic regions of isolates LES400 and LES431 revealed that the gene was identical in the two LES isolates, differing by five nucleotides from the PAO1 sequence. Although four of these five mutations were synonymous nucleotide substitutions, the fifth introduced a stop codon leading to premature termination of the MexZ protein after 163 amino acids, compared to the length in strain PAO1 of 210 amino acid residues (Table 6). Similar although not identical truncations have been reported previously and implicated strongly in the development of stable aminoglycoside resistance among CF isolates of P. aeruginosa (50). The mexZ-mexX intergenic regions were identical in the three strains. These data suggest that the mutation in mexZ contributes to the up-regulation of the MexXY system and the greater resistance to aminoglycosides in the LES isolates.

Clinical strains that simultaneously overproduce the MexAB-OprM and MexXY efflux pumps have been reported previously (25). The LES isolates overexpress both efflux pumps and the AmpC β-lactamase. It has been suggested that simultaneous expression of two or three Mex pumps (MexAB-OprM, MexCD-OprJ, and MexEF-OprN) has an additive effect on the MICs of relevant antimicrobial agents (21). Clearly, the LES produces a considerable armory with which to defend itself from antimicrobial agents. Yet as well as some isolates displaying this prowess to the full, LES populations include isolates, such as LES400, with mutations removing some of these weapons.

Premature expression of QS-regulated genes in some LES isolates.

In P. aeruginosa, numerous genes, including many known virulence genes, are regulated by the two lux-like QS systems rhl and las (44, 52), and these genes were up-regulated in isolate LES431 (Tables 1 to 3). Assays for elastase, LasA, and pyocyanin confirmed the high-level expression of these QS-regulated activities in isolate LES431 and indicated premature induction of the QS system (Fig. 2). Interestingly, we detected premature pyocyanin production in an isolate from the infected non-CF father of a CF patient (LES431) and in isolates from the non-CF mother (LES417) and CF patient (LES416) from the same infection episode (Fig. 2c) (29).

FIG. 2.

FIG. 2.

Expression of QS-regulated phenotypes. Production of elastase (a), LasA (b), and pyocyanin (c) in P. aeruginosa PAO1 (▴), LES400 (○), LES431 (⧫), LES416 (▪), LES417 (x), and LES430 (□). ▵, LB control.

To identify mutations in important QS regulatory genes that could account for the observed variations in transcription of QS-related genes, we sequenced the lasR-rsaL-lasI, rhlIR, vfr, gacA, and qscR regions of the LES400 and LES431 isolates. The mutations found are summarized in Table 6. Significantly, in isolate LES400 alone, there was a repetition of a heptanucleotide sequence (GGTGCTC) within the coding region of LasR, leading to divergence from the normal LasR sequence from position G123 onwards, resulting in the complete loss of the HTH DNA-binding LuxR motif. Interestingly, a second isolate from the non-CF father in the infection episode (LES430) did not share the QS phenotype of isolate LES431 (Fig. 2c). In isolate LES430, there was a 10-bp deletion within the LasR-coding sequence, again leading to loss of the DNA-binding domain (Table 6). We also identified an LES isolate from the CF patient (LESB44) that lacked the unusual QS phenotype and carried a different mutation in lasR (Table 6). Isolates LES430 and LESB44 both had pyocyanin and elastase activities that were similar to those of isolate LES400. The only other difference between LES isolates and PAO1 in the lasR-rsaL-lasI region was a mutation close to the lux-box-like element thought to control both rsaL and lasI expression (Table 6) (54). This mutation was also carried by isolates LES416, LES417, and LES430.

A number of previous studies have identified genes with a role in the regulation of the QS system, including qscR (8), gacA (20), vfr (30), rpoS (43, 55), and rpoN (10). Neither nucleotide sequencing nor analysis of gene expression data yielded any compelling evidence for the involvement of these genes in the QS phenotype of isolate LES431. We did identify in both LES isolates a 6-bp difference in the intergenic region between PA2587 and gacA. gacA is up-regulated in isolate LES400 compared to strain PAO1 (2.4 fold) following growth in LB and in isolate LES431 compared to strain PAO1 following oxidative stress (3.2 fold), but these variations cannot account for the QS phenotype of isolate LES431.

Although the predicted RhlI and RhlR protein sequences for the LES isolates were identical to those of strain PAO1, there was a 1-bp deletion in both LES400 and LES431 30 bp upstream of the rhlI start codon (Table 6). The intergenic region between rhlB and rhlR was identical in all three strains. However, it has been reported that the P. aeruginosa PAO1 rhlR gene has four transcription start sites (P1 to P4), two of which are within the rhlB coding region (30). We observed a 1-bp difference between the LES strains and strain PAO1 near the end of the rhlB coding region (Table 6). This mutation is also present in the sequence reported by Medina et al. (30) as PAO1, even though it differs from the strain PAO1 genome sequence. Since during growth in LB medium, rhlR is expressed from promoter P2, and promoter P3 is thought to be σ54 dependent (30), this mutation is unlikely to play a role in the observed differences in transcription during growth in LB.

A recent report highlighted the existence of QS-deficient clinical isolates of P. aeruginosa (42), concluding that QS-deficient strains are capable of causing infections. In the study by Schaber et al. (42), PCR assays suggested that two of five QS-deficient strains lacked lasR and rhlR genes. In our study, we show that the same strain (LES) can exhibit phenotypes from premature and excessive production of the QS system to QS deficiency, the latter being due to naturally occurring frameshift mutations in the lasR gene. Although we do not unequivocally identify mutations that account for the up-regulation in LES431 and other isolates, the mutation upstream of lasI may play a role in this phenotype.

Evidence from an infection model of the greater virulence of isolate LES431.

Chugani et al. (8) demonstrated the increased virulence of a qscR mutant of strain PAO1 compared to the wild type in a D. melanogaster infection assay. We compared the virulence of isolate LES431, which shares a similar QS phenotype to qscR mutants, with isolate LES400, which carries a lasR mutation, and strain PAO1. Isolate LES431 clearly gave the phenotype described previously as hypervirulence (Fig. 3). It is interesting that isolate LES400 was more virulent than strain PAO1 in this infection model, which suggests that even LES isolates lacking the QS-regulated virulence genes cannot be considered avirulent.

FIG. 3.

FIG. 3.

Virulence of P. aeruginosa in fruit flies. Deaths of flies over time when fed P. aeruginosa PAO1 (•), LES400 (▾), LES431 (▪), or buffer (⧫) are shown.

The LES may represent a transmissible, hypervirulent clone.

In common with chronic CF infections by P. aeruginosa, the LES exhibits considerable phenotypic diversity in properties such as antimicrobial sensitivity and colony morphology (34). What distinguishes the LES from most other P. aeruginosa strains is its inherent ability to transmit between CF patients and, in the case of isolate LES431, to cause infections in non-CF parents of CF patients. Although our study does not definitively identify the factors responsible for these additional abilities, we demonstrate the flexibility and adaptability of this strain. In particular, isolate LES431, which because of its history might be considered a highly virulent variant of the clone, has high levels of β-lactamase activity coupled with up-regulation of QS-regulated virulence genes. In contrast, isolate LES400, associated with a chronic CF infection, carries a specific LasR mutation leading to loss of QS activity and has also lost AmpC β-lactamase activity, due to a point mutation in the ampC start codon. It may be that either during the course of chronic CF infections or during laboratory culture, isolate LES400 lost the requirement for these and other properties. However, both LES isolates retained resistance to several other antimicrobials, some of which are due to shared mutations.

von Götz et al. (51) have demonstrated previously that CF strains can evolve into variants expressing higher levels of virulence genes, contradicting the general assumption that selection during CF will have a tendency to reduce such expression. It is possible that the QS phenotype displayed by isolate LES431 may have contributed to its aggressive abilities. This raises the possibility that isolate LES431 represents a novel variant of LES that has evolved from a clone already known to be a successful colonizer of CF patients. However, we have observed that the QS phenotype of isolate LES431 is shared by not only isolates from other CF patients, but also the oldest known LES isolate (from 1988). This suggests that rather than evolving from a successful CF clone, the novel QS phenotype was an intrinsic characteristic of the LES that has been lost subsequently by some isolates, due to mutations such as those we have observed with the lasR gene. It may be that the hypervirulence phenotype is a rare, short-lived phenomenon creating an opportunity for transmission and infection beyond what is normal but placing a burden on the bacterium, leading to the selection for subsequent mutations and then loss of the QS system. In the context of CF infections, the emergence of a hypervirulent, transmissible strain constitutes a potential concern for infection control, which at present is aimed solely at CF patients and not at non-CF parents and health workers.

TABLE 2.

Summary of quorum sensing-related genes that were up-regulated in (i) isolate LES400 compared to strain PAO1, (ii) isolate LES431 compared to strain PAO1, and (iii) isolate LES431 compared to isolate LES400

ORFa Gene name LB LES400 ↑ vs PAO1 H2O2 LES400 ↑ vs PAO1 LB LES431 ↑ vs PAO1 H2O2 LES431 ↑ vs PAO1 LB LES431 ↑ vs LES400 H2O2 LES431 ↑ vs LES400 Product description
QS activated
    PA0026 2.6 11 Hypothetical protein
    PA0050 3.3 Hypothetical protein
    PA0059 osmC 4.6 6.3 Osmotically inducible protein OsmC
    PA0106 coxA 64 26 Cytochrome c oxidase, subunit 1
    PA0107 24 21 5.0 Conserved hypothetical protein
    PA0122 15 14 Conserved hypothetical protein
    PA0143 nuh 11 24 Nonspecific ribonucleoside hydrolase
    PA0176 3.1 Probable chemotaxis transducer
    PA0355 pfpI 2.8 Protease PfpI
    PA0364 5.4 4.6 Probable oxidoreductase
    PA0366 4.0 3.3 Probable aldehyde dehydrogenase
    PA0447 gcdH 2.4 Glutaryl-CoA dehydrogenase
    PA0567 16 9.2 Conserved hypothetical protein
    PA0586 4.3 8.2 Conserved hypothetical protein
    PA0588 5.2 6.9 Conserved hypothetical protein
    PA0852 cbpD 44 55 Chitin-binding protein CbpD precursor
    PA0996 pqsA 3.5 9.3 16 Probable coenzyme A ligase
    PA0997 pqsB 6.5 5.8 7.3 Homologous to β-ketoacyl-acyl carrier protein synthase
    PA0998 pqsC 4.6 6.5 5.0 Homologous to β-ketoacyl-acyl carrier protein synthase
    PA0999 pqsD 5.3 5.3 6.5 3-Oxoacyl-acyl carrier protein synthase III
    PA1000 pqsE 6.2 Quinolone signal response protein
    PA1001 phnA 12.1 4.6 Anthranilate synthase component I
    PA1173 napB 5.6 Cytochrome c-type protein NapB precursor
    PA1174 napA 3.5 4.4 Periplasmic nitrate reductase protein NapA
    PA1175 napD 3.0 5.0 NapD protein of periplasmic nitrate reductase
    PA1176 napF 6.4 Ferredoxin protein NapF
    PA1177 napE 5.8 4.4 Periplasmic nitrate reductase protein NapE
    PA1247 aprE 7.5 Alkaline protease secretion protein AprE
    PA1248 aprF 12 Alkaline protease secretion outer membrane protein AprF precursor
    PA1250 aprI 16 7.5 Alkaline proteinase inhibitor AprI
    PA1323 11 6.7 Hypothetical protein
    PA1324 7.5 5.3 3.3 5.8 Hypothetical protein
    PA1404 16.9 4.1 3.8 3.6 Hypothetical protein
    PA1431 rsaL 20 14 655 16 Regulatory protein RsaL
    PA1432 lasI 21 Autoinducer synthesis protein LasI
    PA1656 3.3 Hypothetical protein
    PA1657 14 11 Conserved hypothetical protein
    PA1658 4.4 24 Conserved hypothetical protein
    PA1660 11 Hypothetical protein
    PA1662 15 Probable ClpA/B-type protease
    PA1667 12 Hypothetical protein
    PA1784 3.6 3.6 5.9 Hypothetical protein
    PA1869 78 28 68 Probable acyl carrier protein
    PA1871 lasA 4.9 5.2 12 LasA protease precursor
    PA1874 5.3 Hypothetical protein
    PA1881 31 3.8 Probable oxidoreductase
    PA1891 5.9 Hypothetical protein
    PA1893 6.2 Hypothetical protein
    PA1894 3.4 11 4.8 6.1 Hypothetical protein
    PA1895 8.9 3.8 Hypothetical protein
    PA1896 11 Hypothetical protein
    PA1897 4.2 13 24 Hypothetical protein
    PA1901 phzC2 38 126 Phenazine biosynthesis protein PhzC
    PA1902 phzD2 49 77 Phenazine biosynthesis protein PhzD
    PA1903 phzE2 31 35 Phenazine biosynthesis protein PhzE
    PA1904 phzF2 86 91 Probable phenazine biosynthesis protein
    PA1905 phzG2 22 70 Probable pyridoxamine 5′-phosphate oxidase
    PA1999 2.8 2.6 Probable CoA transferase, subunit A
    PA2000 2.9 2.8 Probable CoA transferase, subunit B
    PA2001 atoB 3.5 2.5 Acetyl-CoA acetyltransferase
    PA2030 15 10 Hypothetical protein
    PA2031 6.2 10 Hypothetical protein
    PA2066 6.0 4.4 Hypothetical protein
    PA2067 8.5 11 Probable hydrolase
    PA2068 20 18 Probable MFS transporter
    PA2069 25 45 Probable carbamoyl transferase
    PA2080 5.4 Hypothetical protein
    PA2143 33 Hypothetical protein
    PA2146 29 13 18 14 Conserved hypothetical protein
    PA2157 4.1 Hypothetical protein
    PA2159 13 3.8 12 Conserved hypothetical protein
    PA2165 5.4 5.0 Probable glycogen synthase
    PA2166 6.5 117 7.0 18 Hypothetical protein
    PA2171 14 5.4 12 Hypothetical protein
    PA2172 6.5 3.2 Hypothetical protein
    PA2180 2.3 Hypothetical protein
    PA2190 16 25 Conserved hypothetical protein
    PA2193 hcnA 58 35 Hydrogen cyanide synthase HcnA
    PA2194 hcnB 15 111 Hydrogen cyanide synthase HcnB
    PA2195 hcnC 12 40 Hydrogen cyanide synthase HcnC
    PA2274 4.1 2.6 6.7 Hypothetical protein
    PA2300 chiC 7.7 7.0 Chitinase
    PA2305 9.4 23 Probable nonribosomal peptide synthetase
    PA2328 4.3 Hypothetical protein
    PA2329 4.9 Probable ATP-binding component of ABC transporter
    PA2330 2.5 Hypothetical protein
    PA2331 3.6 Hypothetical protein
    PA2345 2.8 Conserved hypothetical protein
    PA2365 32 12 7.3 Conserved hypothetical protein
    PA2366 13 7.7 6.3 13 Conserved hypothetical protein
    PA2367 15 6.2 Hypothetical protein
    PA2423 5.6 Hypothetical protein
    PA2433 15 6.9 2.9 2.8 Hypothetical protein
    PA2512 antA 7.6 Anthranilate dioxygenase large subunit
    PA2513 antB 18 50 Anthranilate dioxygenase small subunit
    PA2552 2.2 Probable acyl-CoA dehydrogenase
    PA2553 2.7 Probable acyl-CoA thiolase
    PA2587 pqsH 5.7 28 Probable FAD-dependent mono-oxygenase
    PA2588 26 22 Probable transcriptional regulator
    PA2591 vqsR 6.0 12 Probable transcriptional regulator
    PA2592 4.3 5.4 4.9 Probable periplasmic spermidine/putrescine-binding protein
    PA2747 6.6 5.4 Hypothetical protein
    PA2939 147 134 Probable aminopeptidase
    PA3032 snr1 10 5.9 Cytochrome c Snr1
    PA3104 xcpP 3.7 Secretion protein XcpP
    PA3181 5.4 3.5 10 2-Keto-3-deoxy-6-phosphogluconate aldolase
    PA3182 pgl 5.7 3.8 4.8 6-Phosphogluconolactonase
    PA3183 zwf 6.2 2.9 11 Glucose-6-phosphate 1-dehydrogenase
    PA3326 14 11 14 Probable Clp family ATP-dependent protease
    PA3327 5.6 Probable nonribosomal peptide synthetase
    PA3328 6.1 9.1 8.1 Probable FAD-dependent mono-oxygenase
    PA3329 37 34 33 Hypothetical protein
    PA3330 34 46 55 Probable short-chain dehydrogenase
    PA3331 6.1 16 8.6 Cytochrome P450
    PA3332 26 30 13 Conserved hypothetical protein
    PA3333 fabH2 6.6 52 6.0 3-Oxoacyl-acyl carrier protein synthase III
    PA3334 20 Probable acyl carrier protein
    PA3335 19 Hypothetical protein
    PA3347 3.1 Hypothetical protein
    PA3361 lecB 26 6.0 Fucose-binding lectin PA-IIL
    PA3369 9.4 11 6.3 Hypothetical protein
    PA3370 5.2 4.8 Hypothetical protein
    PA3418 ldh 10 4.2 3.3 Leucine dehydrogenase
    PA3476 rhlI 11 Autoinducer synthesis protein RhlI
    PA3477 rhlR 6.5 2.7 12 Transcriptional regulator RhlR
    PA3478 rhlB 12 9.3 57 Rhamnosyltransferase chain B
    PA3479 rhlA 28 16 46 Rhamnosyltransferase chain A
    PA3520 38 9.0 Hypothetical protein
    PA3535 10 12 Probable serine protease
    PA3688 4.0 Hypothetical protein
    PA3691 11 8.7 2.9 8.5 Hypothetical protein
    PA3692 8.2 6.5 7.8 Probable outer membrane protein precursor
    PA3724 lasB 413 4.0 597 Elastase LasB
    PA3888 3.4 2.8 Probable permease of ABC transporter
    PA3904 9.9 21 Hypothetical protein
    PA3906 9.5 21 Hypothetical protein
    PA3907 7.4 24 Hypothetical protein
    PA3923 5.9 27 Hypothetical protein
    PA4117 3.2 Probable bacteriophytochrome
    PA4129 6.7 4.1 Hypothetical protein
    PA4130 7.2 3.8 Probable sulfite or nitrite reductase
    PA4131 6.6 7.0 Probable iron-sulfur protein
    PA4133 3.9 28 16 Cytochrome c oxidase subunit (cbb3 type)
    PA4134 4.9 42 Hypothetical protein
    PA4139 6.9 3.8 Hypothetical protein
    PA4141 66 33 102 Hypothetical protein
    PA4142 9.6 5.5 Probable secretion protein
    PA4171 10 13 Probable protease
    PA4175 prpL 19 52 Pvds-regulated endoprotease, lysyl class
    PA4205 mexG 45 8.7 5.9 Hypothetical protein
    PA4206 mexH 11 6.7 9.2 Probable RND efflux membrane fusion protein precursor
    PA4207 mexI 15 8.4 6.2 4.9 Probable RND efflux transporter
    PA4208 opmD 4.3 8.0 5.5 Probable outer membrane protein precursor
    PA4209 phzM 31 37 Probable phenazine-specific methyltransferase
    PA4210 phzA1 19 27 Probable phenazine biosynthesis protein
    PA4211 phzB1 124 525 Probable phenazine biosynthesis protein
    PA4217 phzS 55 69 Flavin-containing mono-oxygenase
    PA4296 4.1 8.1 Probable two-component response regulator
    PA4306 9.0 Hypothetical protein
    PA4311 13 4.0 2.9 Conserved hypothetical protein
    PA4496 3.4 Probable binding protein component of ABC transporter
    PA4498 4.6 Probable metallopeptidase
    PA4590 pra 27 10 Protein activator
    PA4648 10 18 Hypothetical protein
    PA4649 19 Hypothetical protein
    PA4738 7.8 19 5.0 18 Conserved hypothetical protein
    PA4739 13 26 8.1 18 Conserved hypothetical protein
    PA4778 6.4 6.6 Probable transcriptional regulator
    PA4869 5.4 Hypothetical protein
    PA4876 osmE 8.3 4.6 Osmotically inducible lipoprotein OsmE
    PA4880 6.1 8.2 Probable bacterioferritin
    PA5058 phaC2 3.1 4.1 Poly(3-hydroxyalkanoic acid) synthase 2
    PA5061 3.1 2.9 Conserved hypothetical protein
    PA5220 26 21 Hypothetical protein
    PA5481 38 8.7 29 Hypothetical protein
    PA5482 19 12 29 Hypothetical protein
QS repressed
    PA0887 acsA 3.5 Acetyl-coenzymeA synthetase
    PA1559 15 4.1 Hypothetical protein
    PA2007 maiA 15 16 Maleylacetoacetate isomerase
    PA2008 fahA 8.1 6.9 Fumarylacetoacetase
    PA2009 hmgA 7.8 9.5 Homogentisate 1,2-dioxygenase
    PA2540 28 Conserved hypothetical protein
    PA3038 2.3 2.8 Probable porin
    PA3234 3.6 4.0 Probable sodium:solute symporter
    PA3235 2.9 2.9 5.4 Conserved hypothetical protein
    PA3205 6.7 2.7 Hypothetical protein
a

These genes have been reported previously as being regulated by quorum sensing (either QS regulated or QS repressed) (43, 51). CoA, coenzyme A; MFS, major facilitator superfamily; FAD, flavin adenine dinucleotide.

Acknowledgments

We acknowledge the Pseudomonas Genome Project and the Pseudomonas aeruginosa Community Annotation Project. We are grateful for the excellent technical assistance of Tanja Toepfer during microarray hybridization and to John Corkill for assistance with PFGE.

C.A.H. and C.W. acknowledge funding from the United Kingdom Cystic Fibrosis Trust.

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