Survival mechanisms of Burkholderia cepacia complex cells grown in biofilms

Burkholderia cepacia. Photo courtesy of Janice Haney Carr
and CDC

Cara N. Wilder, Ph.D.

The Burkholderia cepacia complex (Bcc) is a group of Gram-negative bacteria composed of 17 closely related species. Of these strains, Burkholderia cenocepacia is an opportunistic pathogen frequently associated with high rates of transmission and mortality among immune-compromised people, such as those suffering from cystic fibrosis. Unfortunately, infections caused by B. cenocepacia and other Bcc strains are very difficult to eradicate due to a variety of  intrinsic antibiotic-resistance mechanisms including the expression of multidrug efflux pumps, inducible β-lactamases, altered penicillin-binding proteins, and the ability to form biofilms.

In particular, biofilms are multicellular microbial communities that can form on various environmental, clinical, and abiotic surfaces. These groups of sessile cells are often more tolerant to antibiotics than free-living, planktonic cells due to decreased growth rates, differential gene expression, and reduced penetration of the biofilm. Thus, upon exposure to antibiotic therapies, a small subpopulation of cells within the biofilm is able to persist by entering a dormant multidrug-tolerant state. Following the removal of the antibiotic, these “persister cells” are then able to reestablish growth and create a new biofilm.

To elucidate the mechanisms behind the emergence of persister cells in Bcc biofilms, Acker et al. analyzed B. cenocepacia biofilms following treatment with Tobramycin, a bactericidal antibiotic known to induce the formation of harmful reactive oxygen species (ROS). Through the use of transcriptome analysis, flow cytometry, ROS-staining, and inhibitor studies, the group discovered that surviving persister cells were able to escape cell death through the down-regulation of the tricarboxylic acid (TCA) cycle, allowing cells to avoid ROS production, and through the activation of the glyoxylate shunt, which is an anaplerotic pathway of the TCA cycle. This finding may provide novel approaches for the treatment of Bcc biofilms as the glyoxylate shunt is absent in humans, and inhibition of this pathway prior to treatment with Tobramycin was found to decrease the number of persisters. Thus, this pathway may be an ideal target for combination therapy.

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