Unraveling CRP/cAMP-Mediated Metabolic Regulation In Escherichia coli Persister Cells

Reviewer #1 (Public Review):

Summary:

The authors set out to understand the role played by a key global metabolic regulator called Crp/cAMP in the formation of persister Escherichia coli that survive antibiotic treatment without acquiring genetic mutations.

In order to achieve this aim, the authors employ an interdisciplinary approach exquisitely integrating standard microbiology assays with cutting-edge genomic, metabolomic, and proteomics screening.

The data presented by the authors convincingly demonstrate that the deletion of two key genes that are part of the Crp/cAMP complex (i.e. crp and cyaA) leads to a significant decrease in the number of persisters, thus pointing towards a key role played by the Crp/cAMP complex in the formation of persisters in E. coli.

The data presented also demonstrate that deletion of the crp gene leads to an overall decrease in energy metabolism and an overall increase in anabolic metabolism at the population level. It is not clear either what the contribution of the cyaA gene is in this respect, or why the deletion of cyaA has an opposite effect on cAMP concentration compared to crp deletion, although the authors present two reasonable untested hypotheses in the discussion. The authors might also want to explicitly acknowledge that these key data are obtained at the whole population level rather than at the level of the persister subpopulation.

Finally, the authors convincingly show that the persisters they investigated are non-growing and have a higher redox activity and that the deletion of key genes involved in energy metabolism leads to a decrease in the number of persisters.

These data will be key for future investigations on the biochemical mechanisms that allow bacteria to adapt to stressors such as nutrient depletion or exposure to antibiotics. As such this work will likely have an impact in a variety of fields such as bacterial biochemistry, antimicrobial resistance research, and environmental microbiology.

Strengths:

Interdisciplinary approach.
Excellent use of replication and ensuring reproducibility.
Excellent understanding and presentation of the biochemical mechanisms underpinning bacterial physiology via an integrated genomic, metabolomic, and proteomic screening.

Weaknesses:

Two genes from the Crp/cAMP complex (crp and cyaA) are hypothesised to be key for persistence but key metabolomics and proteomics data are obtained from only one deletion mutant in the crp gene.

The deletion of crp and cyaA have opposite effects on the concentration of cAMP, a comparison of metabolomics and proteomics data obtained using both mutants might aid in understanding this difference.

Metabolomics, proteomics, and metabolic activity data are obtained at the whole population level rather than at the level of the persister sub-population.

Reviewer #2 (Public Review):

Summary:

The manuscript by Ngo et al investigated how bacterial persisters form in early and late stationary phases and found that cAMP-Crp regulated metabolic reprogramming affects persister formation that occurs in the late but not early stationary phase. Further metabolomic, proteomic, and genomic screening studies point to TCA cycle, ATP synthesis, respiratory chains, and oxidative phosphorylation correlating with persister abundance. If these conclusions can be solidly drawn, the work would add some new understanding of the underexplored topic of how persisters form.

Strengths and weaknesses:

Although the topic of understanding how persisters form is interesting and thus can be counted as a strength of the paper, most of the conclusions drawn by the authors are, at best, on shaky ground due to the following weakness.

(1) The approaches used here are aimed at the major bacterial population, but yet the authors used the data reflecting the major population behavior to interpret the physiology of persister cells that comprise less than 1% of the major bacterial population. How they can pick up a needle from the hay without being fooled by the spill-over artifacts from the major population? Although it is probably very difficult to isolate and directly assay persister cells, firm conclusions for the type proposed by the authors cannot be firmly established without such assays. Perhaps introducing cyaA/crp mutation into the best example of persistence, the hipA-7 high persistence phenotype may clarify this issue to a certain extent.

(2) The authors overlooked/omitted a recently published work regarding cyaA and crp (PMID: 35648826). In that work, a deficiency in cyaA or crp confers tolerance to diverse types of lethal stressors, including all lethal antimicrobials tested. How a mutation conferring pan-tolerance to the major bacterial population would lead to a less protective effect with a minor subpopulation? The authors are kind of obligated to discuss such a paradox in the context of their work because that is the most relevant literature for the present work. It is also very interesting if the cyaA/crp deficiency really has an opposing effect on tolerance and persistence. As a note, most of the conclusions from the omics studies of the present work have been reached in that overlooked literature, which addresses mechanisms of tolerance, a major rather than a minor population behavior. That supports comment #1 above. The inability of the authors to observe tolerance phenotype with the cyaA or crp mutant possibly derived from extremely high antimicrobial concentrations used in the study prevents tolerance phenotype from being observed because tolerance is sensitive to antimicrobial concentration while persistence is not.

(3) The authors overly stressed the effect of cyaA/crp on persister formation but failed to test an alternative explanation of their effect on persister waking up after antimicrobial treatment. If the cyaA/crp-derived persisters are put into deeper sleep during antimicrobial treatment than wildtype-derived persisters, a 16-h recovery growth might have underestimated viable bacteria. This is often the case especially when extremely high concentrations of antimicrobials are used in performing persister assay. Thus, at least a longer incubation time (e.g. 48 and 72h) of agar plates for persister viable count needs to be performed to test such a scenario.

(4) The rationale for using extremely high drug concentrations to perform persister assay is unclear. There are 2 issues with using extremely high drug concentrations. First, when overly high concentrations are used, drug removal becomes difficult. For example, a two-time wash will not be able to bring drug concentration from > 100 x MIC to below MIC. This is especially problematic with aminoglycoside because drug removal by washing does not work well with this class of compound. Second, overly high concentrations of drug use may make killing so rapidly and severely that may mask the difference from being observed between mutants and the control wild-type strain. In such cases, you would need to kill over a wide range of drug concentrations to find the right window to show a difference. The gentamicin data in the present work is likely the case that needs to be carefully examined. The mutants and the wild-type strain have very different MICs for gentamicin, but a single absolute drug concentration rather than concentrations normalized to MIC was used. This is like to compare a 12-year-old with a 21-year-old to run a 100-meter dash, which is highly inappropriate.

Reviewer #3 (Public Review):

Summary:

The authors describe how E. coli in the late stationary phase have an active TCA cycle and respiration. Mutation of crp results in the down-regulation of TCA cycle genes and an upregulation of anabolic pathways and reduced persisters. Mutation of a variety of metabolic genes also resulted in fewer persisters in the late-stationary phase.

Strengths:

The work is vast, including metabolomic analysis and characterization of a large number of mutant strains. The identification of active respiration being required for persister cell survival in the late stationary phase is interesting. The induction of anabolic pathways resulting in the sensitization of bacteria to antibiotics is possibly the most interesting part of the paper.

Weaknesses:

The authors try to draw too many conclusions and it's difficult to identify what their actual findings are. For instance, they do not have any interesting findings with aminoglycosides but include the data and spend a lot of time discussing it, but it is really a distraction. The correlation between the induction of anabolic pathways in the crp mutant in the late stationary phase and the reduction in persisters is potentially very interesting but is buried in the paper with the vast quantities of data, and observations and conclusions that are often not well substantiated.

The discussion section is particularly difficult to read and I recommend a large overhaul to increase clarity. For instance, what are the authors trying to conclude in section (iii) of the discussion? That persisters in the stationary phase have higher energy than other cells? Is there data to support that? All sections are similarly lacking in clarity.

The large number of mutants characterized is a strength, but the quality of the data provided for those experiments is poor. Did some of these mutants lose fitness in the deep stationary phase in the absence of antibiotics? Did some reach a far lower cfu/ml in the stationary phase? These details are important and without them, it is difficult to interpret the data.

There is ample analysis of persister formation in mutants in the pts/CRP pathway that is not discussed (Zeng et al PNAS 2022, Parsons et al PNAS, 2024).

The authors do not discuss ROS production and antibiotic killing in these experiments. Presumably, the WT would have a greater propensity to produce ROS in response to antibiotics than the crp mutant, but it survives better. Is ROS not involved in antibiotic killing in these conditions?