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Microb Genom. 2019 Apr 4. doi: 10.1099/mgen.0.000265. [Epub ahead of print]

Insertion sequences drive the emergence of a highly adapted human pathogen.

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†​Present address: Evotec ID (Lyon) SAS, Marcy l'Étoile, France.
1​Université Grenoble Alpes, CNRS ERL5261, INSERM U1036, CEA, Laboratory Biology of Cancer and Infection, Bacterial Pathogenesis and Cellular Responses, Biosciences and Biotechnology Institute of Grenoble, 38000 Grenoble, France.
‡​Present address: Department of Microbiology and Immunology, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA.
2​Université Grenoble Alpes, CEA, Inserm, BIG-BGE, 38000 Grenoble, France.
§​Present address: Biozentrum, University of Basel, Basel, Switzerland.
3​Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA.


Pseudomonas aeruginosa is a highly adaptive opportunistic pathogen that can have serious health consequences in patients with lung disorders. Taxonomic outliers of P. aeruginosa of environmental origin have recently emerged as infectious for humans. Here, we present the first genome-wide analysis of an isolate that caused fatal haemorrhagic pneumonia. In two clones, CLJ1 and CLJ3, sequentially recovered from a patient with chronic pulmonary disease, insertion of a mobile genetic element into the P. aeruginosa chromosome affected major virulence-associated phenotypes and led to increased resistance to the antibiotics used to combat the infection. Comparative genome, proteome and transcriptome analyses revealed that this ISL3-family insertion sequence disrupted the genes for flagellar components, type IV pili, O-specific antigens, translesion polymerase and enzymes producing hydrogen cyanide. Seven-fold more insertions were detected in the later isolate, CLJ3, than in CLJ1, some of which modified strain susceptibility to antibiotics by disrupting the genes for the outer-membrane porin OprD and the regulator of β-lactamase expression AmpD. In the Galleria mellonella larvae model, the two strains displayed different levels of virulence, with CLJ1 being highly pathogenic. This study revealed insertion sequences to be major players in enhancing the pathogenic potential of a P. aeruginosa taxonomic outlier by modulating both its virulence and its resistance to antimicrobials, and explains how this bacterium adapts from the environment to a human host.

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