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Journal of Bacteriology, March 2006, p. 1847-1855, Vol. 188, No. 5
0021-9193/06/$08.00+0 doi:10.1128/JB.188.5.1847-1855.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Antibiotic Inducibility of the MexXY Multidrug Efflux System of Pseudomonas aeruginosa: Involvement of the Antibiotic-Inducible PA5471 Gene Product
Yuji Morita,
Mara L. Sobel, and
Keith Poole*
Department of Microbiology and Immunology, Queen's University, Kingston, Ontario, Canada K7L 3N6
Received 14 November 2005/
Accepted 12 December 2005

ABSTRACT
The MexXY components of the MexXY-OprM multidrug efflux system
of
Pseudomonas aeruginosa are encoded by a MexZ repressor-regulated
operon that is inducible by antibiotics that target the ribosome.
Mutant strains disrupted in a gene, PA5471, were shown to be
compromised for drug-inducible
mexXY expression and, therefore,
MexXY-OprM-mediated antimicrobial resistance. The PA5471 gene
was inducible by the same ribosome-targeting agents that induce
mexXY expression. Moreover, vector-driven expression of cloned
PA5471 was sufficient to promote
mexXY expression and MexXY-mediated
resistance in the absence of antibiotic exposure, consistent
with PA5471 directly or indirectly activating
mexXY expression
following its own upregulation in response to antibiotics. The
requirement for PA5471 for
mexXY expression and antimicrobial
resistance was, however, obviated in mutants lacking the MexZ
repressor of
mexXY expression, suggesting that PA5471 directly
or indirectly modulates MexZ activity in effecting
mexXY expression.
While the recruitment of PA5471 and MexXY in response to ribosome
disruption by antimicrobials is consistent with their genes
playing a role in protecting cells from the adverse consequences
of disrupting the translation process, reminiscent of
trans-translation,
these genes appear to operate independently in their contribution
to resistance: mutants defective in
trans-translation showed
a much more modest (twofold) decrease in resistance to ribosome-targeting
agents than those lacking PA5471 or MexXY, and this decrease
was observed whether functional PA5471/MexXY was present or
not.

INTRODUCTION
Multidrug efflux systems of the resistance-nodulation-division
(RND) family contribute significantly to intrinsic and acquired
resistance to antimicrobials in a number of gram-negative bacteria
(
43,
45). Despite their significance as determinants of antibiotic
resistance, however, RND-type multidrug exporters also, in many
instances, accommodate biocides (
42,
45), organic solvents (
48),
detergents (
43), including bile salts (
9,
18,
46,
60), toxic
fatty acids/lipids (
54), and in some instances, plant-derived
antimicrobials (phytoalexins and isoflavonoids) (
7,
39), metabolic
inhibitors (
52), organometallic compounds (tributyltin) (
25),
quorum-sensing effector molecules (
13,
26,
40), and, possibly,
virulence factors (
21) in addition to antibiotics. Clearly,
RND pumps can and do function as other than antibiotic exporters.
Pseudomonas aeruginosa expresses several three-component RND-type multidrug efflux systems, among which four, MexAB-OprM, MexCD-OprJ, MexEF-OprN, and MexXY-OprM, are reported to be significant determinants of multidrug resistance in lab and clinical isolates (41, 44). A clear indication, however, that antimicrobial export may not be the intended function of many of these systems comes from the observation that while these pumps accommodate many of the same antimicrobials, each appears to be independently regulated by linked regulatory genes (44), but not (with the exception of MexXY [30]) in response to antibiotics.
The MexXY-OprM system is unique in P. aeruginosa in that the mexXY operon is induced by exposure to many of the antibiotics that this efflux system exports (30). While this is consistent with efflux of these agents being the intended function of the MexXY-OprM system, it is interesting that not all antibiotic substrates, but only those agents known to target the ribosome, induce mexXY expression (23). Moreover, in contrast to other drug-inducible multidrug efflux systems (e.g., QacA, an MF family exporter in Staphylococcus aureus), where drug binding to the cognate regulator (i.e., QacR) alleviates repression of the efflux gene (i.e., qacA) (16), providing some support for these systems as intended determinants of drug efflux, MexXY antimicrobial substrates that induce mexXY expression do not interact with or directly modulate the activity of the mexXY repressor, MexZ (32). Also, the observation that ribosome protection mechanisms compromise drug-inducible mexXY expression (23) supports this efflux system being recruited in response to ribosome disruption and not to antibiotics per se. One possibility is that the action of these agents on their ribosomal targets induces the expression of MexXY-OprM in order to counter/alleviate some stress or adverse effect resultant from ribosome disruption. Certainly, transcriptomic and proteomic studies confirm that agents that interfere with prokaryotic translation impact the expression of a myriad of genes (1, 5, 14, 27, 38, 47, 50, 55), in some instances including genes associated with stress responses (27, 38, 47, 50). In an effort to define MexXY's role in P. aeruginosa's response to translation inhibition, attempts were made to identify additional genes involved in MexXY-dependent antibiotic resistance by screening a transposon insertion mutant library for mutants compromised for resistance to MexXY substrate antibiotics. We report here the identification of a gene, PA5471, which, like mexXY, is drug inducible and is required for drug-inducible mexXY expression.

MATERIALS AND METHODS
Bacterial strains and growth conditions.
The bacterial strains and plasmids used for this study are listed
in Table
1. Bacterial cells were cultured in Luria broth (L
broth) and on Luria agar (
8) with antibiotics, as necessary,
at 37°C. Plasmid pEX18Tc and its derivatives were maintained
in
Escherichia coli with 10 µg/ml of tetracycline. Plasmids
pUCP20T and pMMB190 and their derivatives were maintained in
E. coli with 100 µg/ml ampicillin and in
P. aeruginosa PAO1 strain K767 and its derivatives with 200 µg/ml carbenicillin.
DNA methods.
Standard protocols were generally used for restriction endonuclease
digestion, ligation, transformation, plasmid isolation, and
agarose gel electrophoresis, as described by Sambrook and Russell
(
51). Plasmid DNAs were also prepared from
E. coli or
P. aeruginosa using a QIAprep Spin miniprep kit or QIAfilter Plasmid Midi
kit (QIAGEN Inc., Mississauga, Ontario, Canada) according to
the protocols provided by the manufacturer. Genomic DNA of
P. aeruginosa was extracted following the protocol of Barcak et
al. (
6). DNA fragments used for cloning were extracted from
agarose gels using a QIAquick gel extraction kit (QIAGEN). PCR
products were purified using a QIAquick PCR purification kit
(QIAGEN) and, when cloned, sequenced to verify that no mutations
were introduced during PCR. Competent
P. aeruginosa (
10) and
E. coli (
51) cells were prepared as described previously. Chromosomal
DNA flanking the mini-Tn
5-
tet element in aminoglycoside-susceptible
K2162 insertion mutants was sequenced using the primer mini-Tn5-Right
(
8). Oligonucleotide synthesis was carried out by Cortec DNA
Services (Kingston, Ontario, Canada), and nucleotide sequencing
was carried out by ACGT Corp. (Toronto, Ontario, Canada). Once
the flanking DNA sequences were obtained, disrupted genes were
identified by BLASTN (
http://www.ncbi.nlm.nih.gov/BLAST/) searches
of the available
P. aeruginosa genome sequence (
59;
http://www.pseudomonas.com).
Transposon insertion mutagenesis.
P. aeruginosa strain K2162, a MexXY-expressing, pan-aminoglycoside-resistant clinical isolate of P. aeruginosa (Table 1), was mutagenized with mini-Tn5-tet (12) as described previously (8), with mini-Tn5-tet-carrying K2162 mutants selected on L agar containing tetracycline (64 µg/ml) and imipenem (0.5 µg/ml; to counterselect donor E. coli used to mobilize plasmid-borne mini-Tn5-tet into K2162). Mutants showing increased aminoglycoside susceptibilities were screened initially for lack of growth on L agar containing either paromomycin (1,024 µg/ml) or spectinomycin (256 µg/ml) and later for increased susceptibilities to multiple aminoglycosides using a broth assay (see below).
RT-PCR.
Total bacterial RNAs were isolated from log-phase P. aeruginosa L broth cultures (with and without subinhibitory concentrations of antibiotics, as follows: kanamycin, cefotaxime, and norfloxacin at one-fourth the MIC and erythromycin, tetracycline, and chloramphenicol at one-eighth the MIC), using a QIAGEN RNeasy mini kit, RNase-free DNase (QIAGEN), and a protocol provided by the manufacturer. Reverse transcriptase PCR (RT-PCR) was performed with ca. 500 ng RNA and primer pairs internal to rpoD, mexX, PA5471, PA5470, and mexZ (Table 2), using a QIAGEN One Step RT-PCR kit according to a protocol provided by the manufacturer. To assess whether PA5470 and PA5471 were expressed from a polycistronic message, the primer pair PA5471-F and PA5470-R (Table 2) was used. RT-free (i.e., PCR) controls were carried out to ensure that there was no DNA contamination of RNA preparations.
Cloning of PA5471 and PA5470.
The PA5471 gene was amplified using primers EPA5471-F and XPA5471-R
(Table
2) in a 50-µl PCR mixture containing 10 ng of chromosomal
DNA, a 0.6 µM concentration of each primer, a 0.2 mM concentration
of each deoxynucleoside triphosphate, 1 mM MgSO
4, 1 U of KOD
Hot Start DNA polymerase (EMD Biosciences, Inc., Madison, WI),
1
x KOD Hot Start polymerase buffer, and 4.0% (vol/vol) dimethyl
sulfoxide. The mixture was heated for 2 min at 94°C, followed
by 35 cycles of 0.25 min at 94°C, 0.5 min at 60°C, and
2 min at 68°C and a final step of 10 min at 68°C. The
PA5471-containing PCR product was cloned into pSportI (Invitrogen,
Carlsbad, CA), released by digestion with EcoRI and BamHI, and
cloned into pUCP20T to yield pYM010. To clone the PA5471-PA5470
operon into pUCP20T, PA5470 was excised from pCR-PA5470+DD (see
below) following digestion with XbaI and BamHI, cloned into
pSportI, and subsequently released from this vector by BsiWI-BamHI
digestion. This fragment and a PA5471-containing fragment released
from pSportI (see above) following digestion with EcoRI and
BsiWI were then jointly cloned into pUCP20T to yield pYM013.
Cloning of mexXY.
The mexX gene was amplified with primers EHmexX-F and NmexX-R (Table 2) from plasmid pTEM4 (1 ng). The reaction mixture was formulated as described above for the amplification of PA5471, using the same parameters. The blunt-ended PCR fragment was first cloned into plasmid pCR-BluntII-TOPO (Invitrogen, Carlsbad, CA) before being released as an EcoRI-NotI fragment and cloned into pSportI. The mexY gene was subsequently excised from pTEM4 via digestion with NotI and BamHI and cloned into mexX-carrying pSportI, after which the mexXY gene pair was released via digestion with EcoRI and cloned into pMMB190 to yield pYM004.
Cloning of mexZ.
The mexZ gene was amplified with primers mexZ-F and mexZ-R (Table 2) in a reaction mixture formulated as described above for PA5471, with the exception that dimethyl sulfoxide was included at 4.0% (vol/vol) and Vent DNA polymerase (2 U; New England Biolabs, Ltd., Pickering, Ontario, Canada) in 1x ThermoPol buffer (New England Biolabs, Ltd., Pickering, Ontario, Canada) replaced the KOD enzyme. Reaction mixtures were heated for 3 min at 94°C, followed by 35 cycles of 0.5 min at 94°C, 0.75 min at 65°C, and 1 min at 72°C and a final 10-min elongation at 72°C. The mexZ-containing PCR product was first cloned into pCR-BluntII-TOPO as described above, excised from this vector using HindIII and XbaI, and then cloned into pUCP20T, yielding pYM017.
Construction of gene deletions in P. aeruginosa.
To introduce in-frame gene deletions into strains of P. aeruginosa, deletion constructs were first prepared in plasmid pEX18Tc by cloning PCR-amplified 1-kb DNA fragments corresponding to the regions upstream and downstream of the gene sequences to be deleted. Typically, these were amplified from the chromosome of P. aeruginosa PAO1 strain K767 and first cloned individually into pCR-BluntII-TOPO, from which they were sequenced to verify the absence of PCR-introduced mutations before being excised following restriction digestion (PCR primers were tagged with restriction sites [Table 2]) and sequentially cloned into pEX18Tc. While the upstream fragment used for construction of the PA5471 deletion served for construction of a
PA5471-PA5470 double deletion, attempts to amplify sequences 3' of PA5470 failed to yield a correct product. Thus, the PA5470 gene together with sequences ca. 1 kb downstream of it were amplified using primers XPA5470-F and PA5470DD-R (Table 2) and cloned into pCR-BluntII-TOPO, and the PA5470 downstream fragment was then excised from this vector (pCR-PA5470+DD) via digestion with KpnI and EcoRI for cloning into pEX18Tc. PCR mixtures were formulated as described above for the amplification of mexZ and heated for 3 min at 95°C, followed by 35 (
PA5471,
PA547-PA5470, and
mexZ) or 40 (
ssrA and
smpB) cycles of 0.5 min at 95°C, 0.75 min at 60°C, and 2 min at 72°C and a final step of 10 min at 72°C. The resulting deletions lacked all but the first 2 (including the ATG start) and last 14 codons (
PA5471), all but the GTG start codon and the last 11 codons (
mexZ), all but the first 25 and last 61 bp (tmRNA gene ssrA), and all but the start codon and the last 27 codons (
smpB). The
PA547-PA5470 construct lacked all but the first two codons of PA5471 and all of the PA5470 codons.
The deletion-carrying pEX18Tc derivatives were mobilized into P. aeruginosa from E. coli S17-1 (8). Briefly, 100 µl of log-phase E. coli S17-1 cultured in tetracycline-containing (10 µg/ml) L broth was transferred to L agar plates and immediately overlaid with an equal volume of a log-phase L broth culture of P. aeruginosa. Following incubation at 37°C for 18 h, the bacterial cells were resuspended in 1 ml of 0.85% NaCl and diluted 10-fold before being plated onto L agar plates containing tetracycline (75 µg/ml) and chloramphenicol (5 µg/ml; to counterselect E. coli S17-1). P. aeruginosa transconjugants harboring chromosomal inserts of the plasmid were recovered from these plates and streaked onto L agar containing sucrose (10% [wt/vol]). Sucrose-resistant colonies were then screened for the appropriate deletion using colony PCR (49).
Antimicrobial susceptibility testing.
The antimicrobial susceptibilities of the various P. aeruginosa strains were assessed in microtiter plates by a twofold serial dilution technique (24). In some experiments, MgCl2 was included in the growth medium (5 mM) since this appears to enhance MexXY-mediated antimicrobial resistance (28).

RESULTS
Involvement of PA5471 in MexXY-mediated antimicrobial resistance.
Inducible (by antibiotics) (
23,
30) and mutational (
23,
58,
64) up-regulation of MexXY is associated with resistance to
multiple antimicrobials in
P. aeruginosa, although the details
of MexXY expression in each instance remain obscure. A recent
paper, however, highlights the significance of drug-ribosome
interactions in ultimately stimulating
mexXY expression (
23),
a finding consistent with earlier observations that while MexXY
accommodates and thus provides resistance to a variety of antimicrobials
(
30,
31), only those targeting the ribosome (e.g., aminoglycosides)
actually induce
mexXY expression (
23). To gain some insights
into the details of drug-inducible
mexXY expression, including
the identity of any additional gene(s) needed for this, a
P. aeruginosa clinical strain in which MexXY is expressed and implicated
in antimicrobial resistance (i.e., K2162) (
58) was subjected
to random transposon insertion mutagenesis (with mini-Tn
5-
tet)
and screened for a loss of resistance to representative MexXY
antimicrobial substrates. A library of mini-Tn
5-
tet mutants
of K2162 was thus constructed, and mutants initially showing
enhanced susceptibility to the aminoglycosides paromomycin and
streptomycin (good MexXY substrates [
58]) were selected. Subsequent
screening for increased susceptibilities to the aminoglycosides
spectinomycin and gentamicin, but not to antimicrobials known
not to be MexXY substrates (e.g., carbenicillin and imipenem),
identified seven mutants with generalized increased susceptibilities
to aminoglycosides. Of these, only two (K2435 and K2436; see
Table
3, for susceptibility data) lacked mini-Tn
5-
tet insertions
in
mexXY. Cloning and sequencing of the disrupted genes in each
instance revealed that the mini-Tn
5-
tet element had inserted
in the putative promoter region of (K2435) or within (K2436)
an opening reading frame dubbed PA5471 by the Pseudomonas Genome
Project (
http://www.pseudomonas.com). PA5471 encodes a predicted
product of 43,508 Da identified as a conserved hypothetical
protein and a member of the UPF0027 uncharacterized protein
family (Protein Families Database of Alignments and HMMS accession
number pfam01139 [
http://www.sanger.ac.uk/cgi-bin/Pfam/getacc?PF01139]),
which has numerous members broadly distributed among bacteria
(gram-positive and gram-negative) and archaea.
The creation of an in-frame deletion of PA5471 in K2162 also
compromised resistance to a variety of aminoglycosides, but
not to MexXY antimicrobial substrates known not to induce this
efflux system (e.g., cefotaxime and carbenicillin; see strain
K2418 in Table
3), confirming the contribution of this gene
to pan-aminoglycoside resistance. The elimination of PA5471
in wild-type PAO1 strain K767 also increased the susceptibilities
to aminoglycosides as well as other ribosome-targeting agents,
such as erythromycin and tetracycline (see strain K2413 in Table
3), reminiscent of the impact of a
mexXY deletion on resistance
in this strain (see strain K1525 in Table
3). These data suggested
that PA5471 plays a role in MexXY-mediated antimicrobial resistance,
and consistent with this, deletion of PA5471 in strains already
lacking MexXY had no impact on antimicrobial resistance (Table
3, compare K2414 with K1525). As expected, the cloned PA5471
gene (on plasmid pYM010) restored antimicrobial resistance in
the PA5471 deletion strain K2413 (Table
3).
Requirement for PA5471 for drug-inducible mexXY expression.
One way in which PA5471 could contribute to MexXY-mediated antimicrobial resistance is via involvement in the process of drug induction of mexXY expression. Indeed, the observation that expression of the cloned mexXY genes from a vector-borne promoter on plasmid pYM004 was sufficient to reverse the drug susceptibility of the PA5471 deletion in strain K2413 (Table 3) is consistent with PA5471 being required only for the expression of mexXY. To assess a contribution of PA5471 to drug-inducible expression of mexXY, the impact of PA5471 loss on mexX (as a measure of mexXY) gene expression was examined. As expected, agents that target the ribosome, including chloramphenicol, tetracycline, erythromycin, and kanamycin, induced the expression of mexXY in log-phase cells of P. aeruginosa strain K767 (Fig. 1A, cf. lanes 4 to 7 and lane 1), while those that do not (e.g., norfloxacin and cefotaxime, a fluoroquinolone and a ß-lactam, respectively) did not (Fig. 1A, lanes 2 and 3). Elimination of PA5471 in K767, however, severely compromised drug-inducible mexXY expression (Fig. 1B, lanes 4 to 7; compare with Fig. 1A, lanes 4 to 7). The mexXY message was still detectable in these mutants (Fig. 1B, lower panel), at levels comparable to or minimally above that seen in cells not exposed to antibiotics (Fig. 1A and B, lanes 1), consistent with PA5471 having a specific involvement in drug induction of mexXY expression. The fact that the PA5471 mutant K2413 still expressed some mexXY was also consistent with observations that it was more resistant to some MexXY antimicrobials than was the
mexXY knockout K1525 (Table 3). As expected, given its involvement in drug induction of mexXY expression, the expression of PA5471 was stimulated in log-phase cells of K767 (Fig. 1C, cf. lanes 4 to 7 and lane 1) by the same ribosome-targeting antimicrobials that induce mexXY, but not by agents that do not induce mexXY expression (Fig. 1C, lanes 2 and 3).
PA5471, but not PA5470, is required for mexXY expression.
Examination of the
P. aeruginosa genome reveals that PA5471
occurs upstream of and in a possible operon with an open reading
frame dubbed PA5470. PA5470 is predicted to encode a peptide
chain release factor of 22,282 Da (
http://www.pseudomonas.com).
RT-PCR confirmed both the drug inducibility of PA5470 and its
expression from a polycistronic message that also contains PA5471
(Fig.
1D, lanes 4 to 7). Still, the observation that resistance
to MexXY antimicrobial substrates was restored with the cloned
PA5471 gene alone (on plasmid pYM010) in a PA5471-PA5470 double
deletion mutant (K2417) (Table
3) suggested that PA5471 alone
was needed for drug-inducible
mexXY expression. Moreover, expression
of the cloned PA5471 gene from a vector-borne promoter on plasmid
pYM010 (Fig.
2A, lane 2) stimulated
mexXY expression in strain
K767 in the absence of antibiotic (Fig.
2B, cf. lane 2 and lane
1), indicating that drug induction of
mexXY is a consequence,
directly or indirectly, of PA5471 upregulation in response to
antibiotic exposure. The cloned PA5471 gene also promoted resistance
to norfloxacin, a noninducing MexXY substrate (Fig.
1A, lane
2), in MexXY
+ (i.e., YM34) but not MexXY
(i.e., YM44)
P. aeruginosa (Table
4), consistent with PA5471 positively affecting
mexXY expression.
PA5471 acts via the MexZ repressor in mediating drug-inducible mexXY expression.
The gene
mexZ occurs upstream of
mexXY and encodes a repressor
of
mexXY expression (
3,
32). While MexZ does not directly mediate
the drug inducibility of
mexXY (i.e., antibiotics do not bind
to MexZ and modulate its repressor activity [
32]), it may
respond to PA5471 or the activity of this protein in ultimately
effecting drug-inducible
mexXY expression. To address this possibility,
the impact of PA5471 loss on antimicrobial resistance and
mexXY expression in a strain carrying a
mexZ deletion was assessed.
If PA5471 should act, directly or indirectly, to modulate MexZ
repressor activity, such that PA5471 expression in response
to antimicrobials leads to derepression of
mexXY, then the loss
of PA5471 in a mutant already lacking
mexZ should have no adverse
impact on
mexXY expression or resistance. Conversely, and in
light of previous observations that
mexZ knockouts do not demonstrate
maximal
mexXY expression (
23), if drug-inducible/PA5471-dependent
mexXY expression is independent of MexZ, then the loss of PA5471
would compromise drug-inducible
mexXY expression and thus resistance,
even in a
mexZ mutant expected to already demonstrate an increase
in
mexXY expression and resistance relative to its MexZ
+ counterpart
(i.e., increased
mexXY expression in a
mexZ knockout would not
mask an additional contribution of PA5471 and thus a negative
impact of PA5471 loss on
mexXY expression and resistance). As
expected, the loss of
mexZ (in K767 derivative K2415) increased
the resistance to multiple antimicrobials, though only modestly
(Table
5), consistent with the increase in
mexXY expression
seen in this mutant even without antibiotic (e.g., chloramphenicol)
induction (Fig.
3A, cf. lane 5 and lane 1). Indeed, without
drug exposure, the
mexZ deletion mutant K2415 expressed this
efflux system at levels comparable to that seen for the drug-exposed
MexZ
+ parental strain K767 (Fig.
3A, compare lanes 2 and 5).
In contrast to the adverse impact of a PA5471 deletion on the
resistance of otherwise wild-type cells (Table
3), however,
the loss of PA5471 in the
mexZ deletion strain K2415 had no
effect on resistance (Table
5, compare strains K2416 and K2415).
Consistent with this,
mexXY expression in the
mexZ mutant strain
was not adversely impacted by the loss of PA5471 (Fig.
3A, cf.
lane 7 and lane 5).
Intriguingly, drug (chloramphenicol)-exposed K2415 (K767
mexZ)
still showed some increase in
mexXY expression (Fig.
3A, cf.
lane 6 and lane 5), and this drug inducibility of
mexXY in the
absence of
mexZ was also not compromised by a subsequent loss
of PA5471 (Fig.
3A, cf. lane 8 and lane 7). Clearly, then, PA5471
is required for drug-inducible
mexXY expression only in strains
expressing MexZ, consistent with it functioning to directly
or indirectly modulate the activity of this repressor. In agreement
with this, too, antibiotics or PA5471 did not adversely impact
mexZ expression (data not shown), i.e., did not increase
mexXY expression via a negative influence on
mexZ expression, and
thus must act at the level of MexZ activity.
mexZ expression
was, in fact, antibiotic (e.g., chloramphenicol) inducible (Fig.
3B, cf. lane 2 and lane 1), and this was dependent on PA5471
(Fig.
3B, lane 4), exactly mirroring the antibiotic and PA5471
dependence of
mexXY expression. This is consistent with
mexZ being subject to autoregulation, as for repressors of other
multidrug efflux systems (
41,
44), and given the low levels
of
mexZ mRNA detected (it took a minimum of 40 cycles to detect
mexZ using RT-PCR), it is not inconsistent with antibiotics
and/or PA5471 positively impacting
mexXY expression via modulation
of MexZ repressor activity.
PA5471-dependent MexXY operates independently of trans-translation.
Aminoglycosides and other ribosome-targeting agents promote mistranslation and stop codon readthrough, the latter of which results in ribosome stalling at the 3' ends of mRNAs and thus in the depletion of free tRNAs and ribosomes needed for translation (2, 19, 61, 62). Stalled ribosomes are rescued in bacteria by a process known as trans-translation that requires a specialized RNA species termed tmRNA (which functions as both a tRNA and an mRNA) and a small accessory protein, SmpB (17, 65). To assess, then, whether MexXY functions as part of a trans-translation process in P. aeruginosa that serves to counter the adverse effects of ribosome-targeting antimicrobials, homologues of the tmRNA (i.e., ssrA, or PA0826.2) and smpB (PA4768) genes were disrupted in MexXY+ (K767) and MexXY (K1525) strains, and the impact on antimicrobial resistance was assessed. The loss of ssrA or smpB had a modest (twofold decrease) but reproducible impact on resistance to aminoglycosides (amikacin, gentamicin, kanamycin, neomycin, paromomycin, and spectinomycin) and chloramphenicol in the MexXY+ K767 derivatives K2437 and K2438, respectively, and this was seen even in the absence of MexXY (in strains K2439 and K2440) (data not shown), consistent with tmRNA/SmpB and PA5471/MexXY operating independently of one another in promoting resistance to these agents. The observation, too, that the loss of ssrA or smpB in K767 did not adversely impact resistance to erythromycin (data not shown), while the loss of mexXY clearly did (Table 3, K1525), further supports these systems operating independently in P. aeruginosa, with PA5471/MexXY apparently playing no role in the process of trans-translation.

DISCUSSION
PA5471 is a member of a family of proteins (UPF0027) that are
broadly conserved in bacteria and archaea, consistent with it
playing a basic, housekeeping function in
P. aeruginosa. Interestingly,
however, a linkage of PA5471-like genes to a putative release
factor gene is seen in a more limited number of organisms that
include a variety of enterobacteria (
Erwinia carotovora subsp.
atroseptica SCRI1043,
Salmonella enterica serovar Typhi,
Salmonella enterica serovar Paratyphi,
Salmonella enterica serovar Choleraesuis,
Escherichia coli CFT073,
Escherichia coli K-12, and
Shigella flexneri 2a) and only three pseudomonads (
Pseudomonas fluorescens Pf-5,
Ralstonia solanacearum, and
Burkholderia cepacia R18154).
Whether this reflects a specific and unique function of PA5471
in these organisms or simply a lack of linkage of PA5470/PA5471
homologues in most bacteria harboring PA5471-like genes is unclear.
Interestingly, a homologue of PA5471 from
E. coli,
ykfJ (b0235;
GenBank accession numbers NP_414770 and CAH19161), was also
shown to be inducible by an agent, 4-azaleucine, known to interfere
with translation (
50), and it too is linked to a putative peptide
release factor gene (GenBank accession numbers NP_414771 and
CAH19162).
Ribosome-targeting antibiotics, including those shown here to induce PA5471-PA5470 and mexXY expression, typically cause mistranslation and/or stop codon readthrough, leading to an accumulation of aberrant polypeptides or stalling of ribosomes at the 3' ends of mRNAs (e.g., aminoglycosides and chloramphenicol [2, 19]), dissociation of incomplete peptidyl-tRNAs from the ribosome (e.g., macrolides [20]), or an accumulation of truncated peptidyl-tRNAs and ribosome stalling (e.g., tetracycline and chloramphenicol [61]). Stalled ribosomes pose a serious problem in that they deplete pools of free tRNAs and ribosomes, and the accumulation of peptidyl-tRNAs is toxic to cells (33). While genes for a trans-translation system implicated in the alleviation of drug-induced ribosome stalling were identified in P. aeruginosa and were shown here to contribute, albeit modestly, to aminoglycoside and chloramphenicol resistance, as for other organisms (e.g., E. coli [2] and Synechocystis sp. [11]), MexXY clearly does not participate in this process.
The PA5470 gene is present on a polycistronic message that also encodes PA5471, which is annotated as a peptide chain release factor and carries signature sequences of peptidyl-tRNA hydrolases (http://www.tigr.org/tigr-scripts/CMR2/GenePage.spl?db=ntpa03&locus=PA5470). Intriguingly, a peptidyl-tRNA hydrolase (Pth) in E. coli is responsible for recycling of peptidyl-tRNAs formed, for example, as a result of antibiotic action (57). One possibility, then, is that PA5470 participates in the release of aberrant peptides from peptidyl-tRNAs that accumulate in response to drug treatment. Still, this gene is dispensable with regards to MexXY recruitment and MexXY-mediated antibiotic resistance, arguing that while PA5470 and PA5471 (and thus MexXY) may function in a common process that is initiated by ribosome disruption, antibiotic resistance promoted by PA5471/MexXY is independent of this common function. Should PA5470 function in the release of aberrant peptides, PA5471 and MexXY (and possibly others) may play a role in downstream processing of these peptides or the recruitment of components responsible for this. In such a scenario, MexXY may play an intended role in export of these anomalous peptides or processed products thereof and, given the anticipated variation in amino acid sequence and composition of these components (drugs will be targeting ribosomes translating a myriad of different mRNAs and disrupting them at various stages of translation, producing a very heterogeneous mixture of aberrant peptidyl-tRNAs), may need to be flexible with regards to substrate recognition. Such flexibility might then explain the ability of MexXY-OprM to accommodate a diverse array of unintended antimicrobial substrates. Certainly, the observations that substantial mexXY expression has only a modest positive impact on antimicrobial resistance (Tables 4 and 5) and that the loss of this efflux mechanism only modestly increases susceptibilities to many antimicrobials (Table 3) suggest that antimicrobials are not the intended or preferred substrates. Consistent with this, too, a recent DNA array study demonstrated that both PA5471 and PA5470 are inducible (two- to threefold) under anaerobic conditions, in parallel with several ribosome-related genes, possibly due to some adverse impact of anaerobiosis on ribosome function (15; unpublished data).
While there are as yet no definitive clues to the function of PA5471 in P. aeruginosa or how it effects mexXY upregulation, directly or indirectly, it does not impact mexZ expression and thus clearly works to modulate the activity of the MexZ repressor of mexXY expressionthe loss of PA5471 only compromises drug-inducible mexXY expression in MexZ+ and not MexZ strains. The observation that antibiotics still enhance mexXY expression in a mexZ knockout mirrors previous results (23) and is consistent with the presence of additional pathways in P. aeruginosa by which mexXY can be unregulated in response to antibiotics. Mutations in a gene(s) other than mexZ (as yet unidentified) are, in fact, also associated with mexXY upregulation (63), although whether these play a role in drug-inducible mexXY expression independent of MexZ is unknown. In any case, these additional pathways must be masked by MexZ repressor activity, inasmuch as drug-inducible mexXY expression is not observed in MexZ+ PA5471 deletion mutants.

ACKNOWLEDGMENTS
This work was supported by a grant from the Canadian Cystic
Fibrosis Foundation. M.L.S. was supported by a studentship from
the Natural Sciences and Engineering Research Council (Canada).

FOOTNOTES
* Corresponding author. Mailing address: Department of Microbiology and Immunology, Queen's University, Kingston, Ontario, Canada K7L 3N6. Phone: (613) 533-6677. Fax: (613) 533-6796. E-mail:
poolek{at}post.queensu.ca.


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