Host and antibiotic jointly select for greater virulence in Staphylococcus aureus

Reviewer #1 (Public review):

Summary:

The authors investigate how methicillin-resistant (MRSA) and sensitive (MSSA) Staphylococcus aureus adapt to a new host (C. elegans) in the presence or absence of a low dose of the antibiotic oxacillin. Using an "Evolve and Resequence" design with 48 independently evolving populations, they track changes in virulence, antibiotic resistance, and other fitness-related traits over 12 passages. Their key finding is that selection from both the host and the antibiotic together, rather than either pressure alone, results in the evolution of the most virulent pathogens. Genomically, they find that this adaptation repeatedly involves mutations in a small number of key regulatory genes, most notably codY, agr, and saeRS.

Strengths:

The main advantage of the research lies in its strong and thoroughly replicated experimental framework, enabling significant conclusions to be drawn based on the concept of parallel evolution. The study successfully integrates various phenotypic assays (virulence, growth, hemolysis, biofilm formation) with whole-genome sequencing, offering an extensive perspective on the adaptive landscape. The identification of certain regulatory genes as common targets of selection across distinct lineages is an important result that indicates a level of predictability in how pathogens adapt.

Weaknesses:

(1) The main limitation of the paper is that its findings on the function of specific genes are based on correlation, not cause-and-effect evidence. While the parallel evolution evidence is strong, the authors have not yet performed the definitive tests (i.e., reconstruction of ancestral genes) to ensure that the mutations identified in isolation are enough to account for the virulence or resistance changes observed. This makes the conclusions more like firm hypotheses, not confirmed facts.

(2) In some instances, the claims in the text are not fully supported by the visual data from the figures or are reported with vagueness. For example, the display of phenotypic clusters in the PCA (Figure 6A) and the sweeping generalization about the effect of antibiotics on the mutation rates (Figure S5) can be more precise and nuanced. Such small deviations dilute the overall argument somewhat and must be corrected.

Reviewer #2 (Public review):

Summary:

The manuscript describes the results of an evolution experiment where Staphylococcus aureus was experimentally evolved via sequential exposure to an antibiotic followed by passaging through C. elegans hosts. Because infecting C. elegans via ingestion results in lysis of gut cells and an immune response upon infection, the S. aureus were exposed separately across generations to antibiotic stress and host immune stress. Interestingly, the dual selection pressure of antibiotic exposure and adaptation to a nematode host resulted in increased virulence of S. aureus towards C. elegans.

Strengths:

The data presented provide strong evidence that in S. aureus, traits involved in adaptation to a novel host and those involved in antibiotic resistance evolution are not traded off. On the contrary, they seem to be correlated, with strains adapted to antibiotics having higher virulence towards the novel host. As increased virulence is also associated with higher rates of haemolysis, these virulence increases are likely to reflect virulence levels in vertebrate hosts.

Weaknesses:

Right now, the results are presented in the context of human infections being treated with antibiotics, which, in my opinion, is inappropriate. This is because
(1) exposure to the host and antibiotics was sequential, not simultaneous, and thus does not reflect the treatment of infection, and
(2) because the site of infection is different in C. elegans and human hosts.

Nevertheless, the results are of interest; I just think the interpretation and framing should be adjusted.

Reviewer #3 (Public review):

Summary:

Su et al. sought to understand how the opportunistic pathogen Staphylococcus aureus responds to multiple selection pressures during infection. Specifically, the authors were interested in how the host environment and antibiotic exposure impact the evolution of both virulence and antibiotic resistance in S. aureus. To accomplish this, the authors performed an evolution experiment where S. aureus was fed to Caenorhabditis elegans as a model system to study the host environment and then either subjected to the antibiotic oxacillin or not. Additionally, the authors investigated the difference in evolution between an antibiotic-resistant strain, MRSA, and an isogenic susceptible strain, MSSA. They found that MRSA strains evolved in both antibiotic and host conditions became more virulent, and that strains evolved outside these conditions lost virulence. Looking at the strains evolved in just antibiotic conditions, the authors found that S. aureus maintained its ability to lyse blood cells. Mutations in codY, gdpP, and pbpA were found to be associated with increased virulence. Additionally, these mutations identified in these experiments were found in S. aureus strains isolated from human infections.

Strengths:

The data are well-presented, thorough, and are an important addition to the understanding of how certain pathogens might adapt to different selective pressures in complex environments.

Weaknesses:

There are a few clarifications that could be made to better understand and contextualize the results. Primarily, when comparing the number of mutations and selection across conditions in an evolution experiment, information about population sizes is important to be able to calculate the mutation supply and number of generations throughout the experiment. These calculations can be difficult in vivo, but since several steps in the methodology require plating and regrowth, those population sizes could be determined. There was also no mention of how the authors controlled the inoculation density of bacteria introduced to each host. This would need to be known to calculate the generation time within the host. These caveats should be addressed in the manuscript.

Another concern is the number of generations the populations of S. aureus spent either with relaxed selection in rich media or under antibiotic pressure in between the host exposure periods. It is probable then that the majority of mutations were selected for in these intervening periods between host infection. Again, a more detailed understanding of population sizes would contribute to the understanding of which phase of the experiment contributed to the mutation profile observed.