Table 1– Virulence approaches by Pseudomonas aeruginosa, their role in pathogenicity and opportunities for intervention.
| Virulence approaches | Mechanism of action/activity | Therapeutic strategies |
| Alginate biofilm# | Biofilm formation [29] | Alginate lyase [30] |
| Quorum sensing# [31] | Coordination of virulence factor production Immune modulation [32] |
QS inhibitors |
| Phenotypic transfer and variability | Resistance acquisition [12] Environmental adaptation | Anti-sense inhibitors [33] |
| Pili# | Adhesion [34] Twitching motility [34] Biofilm formation [34] Horizontal gene transfer [35] (natural transformation) |
Immunisation |
| RND efflux pumps# [36] | Antibiotic removal [37] QS molecule release |
Efflux pump inhibitors |
| Lectin# | Cell aggregation proteins [38] Ciliary dysregulation [39] |
Lectin binding site competitive inhibition |
| Flagella | Motility [34] | Immunisation [40] |
| Flagellin | Immune induction | |
| Immune modulation# [32] | AHL/AQ signal | QS inhibition |
| Rhamnolipid# [41] | Biosurfactants – diffusible nutrition Swarming/motility PMNL necrotic killing |
QS inhibition |
| Iron sequestration# | Pyoverdin Pyochelin PQS [42] |
QS inhibition Iron metabolism inhibition/chelation [43] |
| Enzymes | Elastases | QS inhibition β-lactamase inhibitors |
| Invasion-mediating# |
Phospholipase Lecithinase (alkaline protease) |
|
| Antibiotic modifying | β-lactamases Cephalosporinase Aminoglycoside-modifying enzymes | |
| Toxins | Lipopolysaccharide (endotoxin) Exotoxin A Exoenzyme S |
Immunotherapy and Immunisation [44] Antibody to secretion system apparatus [45] |
| Host-cardiovascular effects [46] | AHL-mediated vasodilatation – increasing blood flow for nutrient delivery | QS inhibition |
QS: quorum sensing; AHL: N-acylhomoserine lactone; AQ: alkylquinoline; PMNL: polymorphonuclear leukocyte; PQS: Pseudomonas quinolone signal. #: quorum sensing regulated factor.