Functional genomics reveals the mechanism of hypoxic adaptation in nontuberculous mycobacteria

Reviewer #1 (Public Review):

Summary:

Tateishi et al. report a Tn-seq-based analysis of genetic requirements for growth and fitness in 8 clinical strains of Mycobacterium intracellulare Mi), and compare the findings with a type strain ATCC13950. The study finds a core set of 131 genes that are essential in all nine strains, and therefore are reasonably argued as potential drug targets. Multiple other genes required for fitness in clinical isolates have been found to be important for hypoxic growth in the type strain.

Strengths:

The study has generated a large volume of Tn-seq datasets of multiple clinical strains of Mi from multiple growth conditions, including from mouse lungs. The dataset can serve as an important resource for future studies on Mi, which despite being clinically significant remains a relatively understudied species of mycobacteria.

Weaknesses:

The paper lacks clarity in data presentation and organization. For example, some of the key data on cfu counts of clinical Mi strains in a mouse model can be presented along with the Tn-seq dataset in Figure 6, the visualization of which can be improved with volcano plots. etc. Improvement in data visualization is perhaps necessary throughout the paper.

The primary claim of the study that the clinical strains are better adapted for hypoxic growth is not well-supported by the data presented in Figure 7.

The title of the paper is misleading as the study doesn't provide any mechanistic aspect of hypoxic adaptation in Mi.

Reviewer #2 (Public Review):

Summary:

In the study titled "Functional genomics reveals the mechanism of hypoxic adaptation in nontuberculous mycobacteria" by Tateishi et al., the authors have used TnSeq to identify the common essential and growth-defect-associated genes that represent the genomic diversity of clinical M. intracellulare strains in comparison to the reference type strain. By estimating the frequency of Tn insertion, the authors speculate that genes involved in gluconeogenesis, the type VII secretion system, and cysteine desulfurase are relatively critical in the clinical MAC-PD strains than in the type strain, both for the extracellular survival and in a mouse lung infection model.

Based on their analysis, the authors proposed to identify the mechanism of hypoxic adaptation in nontuberculous mycobacteria (NTM) which offer promising drug targets in the strains causing clinical Mycobacterium avium-intracellulare complex pulmonary disease (MAC-PD).

Strengths:

A major strength of the manuscript is the performance of the exhaustive set of TnSeq experiments with multiple strains of M. intracellulare during in vitro growth and animal infection.

Weaknesses:

(1) The study suffers from the authors' preconceived bias toward a small subset of genes involved in hypoxic pellicle formation in ATCC13950.

(2) An important set of data with the ATCC13950 reference strain is missing in the mouse infection study. In the absence of this, it is difficult to establish whether the identified genes are critical for infection/intracellular proliferation, specifically in the clinical isolates that are relatively more adapted for hypoxia.

(3) Statistical enrichment analysis of gene sets by GSEA wrongly involves genes required for hypoxic pellicle formation in ATCC13950 together with the gene sets found essential in the clinical MAC-PD strains, to claim that a significant % of genes belong to hypoxia-adaptation pathways. It could be factually incorrect because a majority of these might overlap with those found critical for the in vitro survival of MAC-PD strains (and may not be related to hypoxia).

(4) Validation of mouse infection experiments with individual mutants is missing.

(5) Phenotypes with TnSeq and CRISPRi-based KD exhibit poor correlation with misleading justifications by the authors.

In summary, this study is unable to provide mechanistic insights into why and how different MAC-PD mutant strains exhibit differential survival (in vitro and in animals) and adaptation to hypoxia. It remains to understand why the clinical strains show better adaptation to hypoxia and what is the impact of other stresses on their growth rates.

Reviewer #3 (Public Review):

Summary:

The study by Tateishi et al. utilized TnSeq in nine genetically diverse M. intracellulare strains, identifying 131 common essential and growth-defect-associated genes across those strains, which could serve as potential drug targets. The authors also provided an overview of the differences in gene essentiality required for hypoxic growth between the reference strain and the clinical strains. Furthermore, they validated the universal and accessory/strain-dependent essential genes by knocking down their expression using CRISPRi technique. Overall, this study offers a comprehensive assessment of gene requirements in different clinical strains of M. intracellular.

(1) The rationale for using ATCC13950 versus clinical strains needs to be clarified. The reference strain ATCC13950 was obtained from the abdominal lymph node of a patient around 10 years ago and is therefore considered a clinical strain that has undergone passages in vitro. How many mutations have accumulated during these in vitro passages? Are these mutations significant enough to cause the behavior of ATCC13950 to differ from other recently sampled clinical strains? From the phylogenetic tree, ATCC13950 is located between M018 and M.i.27. Did the authors observe a similarity in gene essentiality between ATCC13950 and its neighbor strains? What is the key feature that separates ATCC13950 from these clinical strains? The authors should provide a strong rationale for how to interpret the results of this comparison in a clinical or biological context.

(2) Regarding the 'nine representative strains of M. intracellulare with diverse genotypes in this study,' how were these nine strains selected? To what extent do they represent the genetic diversity of the M. intracellulare population? A phylogenetic tree illustrating the global genetic diversity of the M. intracellulare population, with these strains marked on it, would be important to demonstrate their genetic representativeness.

(3) The authors observed a considerable amount of differential gene requirements in clinical strains. However, the genetic underpinning underlying the differential requirement of genes in clinical strains was not investigated or discussed. Because M. intracellulare has a huge number of accessory genes, the authors should at least check whether the differential requirement could be explained by the existence of a second copy of functional analogous genes or duplications.

(4) Growth in aerobic and hypoxic conditions: The authors concluded that clinical strains are better adapted to hypoxia, as reflected by their earlier entry into the log phase. They presented the 'Time at midpoint' and 'Growth rate at midpoint.' However, after reviewing the growth curves, I noticed that ATCC13950 had a longer lag phase compared to other strains under hypoxic conditions, and its phylogenetic neighbor M018 also had a longer lag phase. Hence, I do not believe a conclusion can be drawn that clinical strains are better adapted to hypoxia, as this behavior could be specific to a particular clade. It's also possible that the ATCC13950 strain has adapted to aerobic growth. I would suggest that the authors include growth curves in the main figures. The difference in 'Time at midpoint' could be attributed to several factors, and visualizing the growth curves would provide additional context and clarity.

(5) Lack of statistical statement: The authors emphasized the role of pellicle-formation-associated genes in strain-dependent essential and accessory essential genes. Additionally, the authors observed that 10% of the genes required for mouse infection are also required for hypoxic pellicle formation. However, these are merely descriptive statements. There is no enrichment analysis to justify whether pellicle-formation-associated genes are significantly enriched in these groups.