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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cell. Infect. Microbiol.</journal-id>
<journal-title>Frontiers in Cellular and Infection Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cell. Infect. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">2235-2988</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fcimb.2023.1174510</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Cellular and Infection Microbiology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Interplays of mutations in <italic>waaA</italic>, <italic>cmk</italic>, and <italic>ail</italic> contribute to phage resistance in <italic>Yersinia pestis</italic>
</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Xiao</surname>
<given-names>Lisheng</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Qi</surname>
<given-names>Zhizhen</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Song</surname>
<given-names>Kai</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lv</surname>
<given-names>Ruichen</given-names>
</name>
<xref ref-type="aff" rid="aff6">
<sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chen</surname>
<given-names>Rong</given-names>
</name>
<xref ref-type="aff" rid="aff7">
<sup>7</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/400858"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhao</surname>
<given-names>Haihong</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wu</surname>
<given-names>Hailian</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Cunxiang</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Xin</surname>
<given-names>Youquan</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jin</surname>
<given-names>Yong</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Xiang</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Xu</surname>
<given-names>Xiaoqing</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tan</surname>
<given-names>Yafang</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Du</surname>
<given-names>Zongmin</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/337566"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cui</surname>
<given-names>Yujun</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/74848"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhang</surname>
<given-names>Xuefei</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yang</surname>
<given-names>Ruifu</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Zhao</surname>
<given-names>Xilin</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/415580"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Song</surname>
<given-names>Yajun</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/23573"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University</institution>, <addr-line>Xiamen</addr-line>, <country>China</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>School of Basic Medicine, Anhui Medical University</institution>, <addr-line>Hefei</addr-line>, <country>China</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS)</institution>, <addr-line>Beijing</addr-line>, <country>China</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Qinghai Institute for Endemic Disease Prevention and Control</institution>, <addr-line>Xining</addr-line>, <country>China</country>
</aff>
<aff id="aff5">
<sup>5</sup>
<institution>National Health Commission - Qinghai Co-construction Key Laboratory for Plague Control</institution>, <addr-line>Xining</addr-line>, <country>China</country>
</aff>
<aff id="aff6">
<sup>6</sup>
<institution>Hua Dong Research Institute for Medicine and Biotechniques</institution>, <addr-line>Nanjing</addr-line>, <country>China</country>
</aff>
<aff id="aff7">
<sup>7</sup>
<institution>Department of Laboratory Medicine, First Medical Center of Chinese People&#x2019;s Liberation Army (PLA) General Hospital</institution>, <addr-line>Beijing</addr-line>, <country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Xihui Shen, Northwest A&amp;F University, China</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Lotta Johanna Happonen, Lund University, Sweden; Chao Pan, Beijing Institute of Biotechnology, China; Bo Pang, National Institute for Communicable Disease Control and Prevention (China CDC), China</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Yajun Song, <email xlink:href="mailto:songyj@bmi.ac.cn">songyj@bmi.ac.cn</email>; Xilin Zhao, <email xlink:href="mailto:zhaox5@njms.rutgers.edu">zhaox5@njms.rutgers.edu</email>
</p>
</fn>
<fn fn-type="equal" id="fn003">
<p>&#x2020;These authors have contributed equally to this work and share first authorship</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>26</day>
<month>05</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="collection">
<year>2023</year>
</pub-date>
<volume>13</volume>
<elocation-id>1174510</elocation-id>
<history>
<date date-type="received">
<day>26</day>
<month>02</month>
<year>2023</year>
</date>
<date date-type="accepted">
<day>04</day>
<month>05</month>
<year>2023</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2023 Xiao, Qi, Song, Lv, Chen, Zhao, Wu, Li, Xin, Jin, Li, Xu, Tan, Du, Cui, Zhang, Yang, Zhao and Song</copyright-statement>
<copyright-year>2023</copyright-year>
<copyright-holder>Xiao, Qi, Song, Lv, Chen, Zhao, Wu, Li, Xin, Jin, Li, Xu, Tan, Du, Cui, Zhang, Yang, Zhao and Song</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>Plague caused by <italic>Yersinia pestis</italic> remains a public health threat worldwide. Because multidrug-resistant <italic>Y. pestis</italic> strains have been found in both humans and animals, phage therapy has attracted increasing attention as an alternative strategy against plague. However, phage resistance is a potential drawback of phage therapies, and the mechanism of phage resistance in <italic>Y. pestis</italic> is yet to be investigated. In this study, we obtained a bacteriophage-resistant strain of <italic>Y. pestis</italic> (S56) by continuously challenging <italic>Y. pestis</italic> 614F with the bacteriophage Yep-phi. Genome analysis identified three mutations in strain S56: <italic>waaA</italic>* (9-bp in-frame deletion <sub>249</sub>GTCATCGTG<sub>257</sub>), <italic>cmk*</italic> (10-bp frameshift deletion <sub>15</sub>CCGGTGATAA<sub>24</sub>), and <italic>ail*</italic> (1-bp frameshift deletion A<sub>538</sub>). WaaA (3-deoxy-D-manno-octulosonic acid transferase) is a key enzyme in lipopolysaccharide biosynthesis. The <italic>waaA*</italic> mutation leads to decreased phage adsorption because of the failure to synthesize the lipopolysaccharide core. The mutation in <italic>cmk</italic> (encoding cytidine monophosphate kinase) increased phage resistance, independent of phage adsorption, and caused <italic>in vitro</italic> growth defects in <italic>Y. pestis.</italic> The mutation in <italic>ail</italic> inhibited phage adsorption while restoring the growth of the <italic>waaA</italic> null mutant and accelerating the growth of the <italic>cmk</italic> null mutant. Our results confirmed that mutations in the WaaA&#x2013;Cmk&#x2013;Ail cascade in <italic>Y. pestis</italic> contribute to resistance against bacteriophage. Our findings help in understanding the interactions between <italic>Y. pestis</italic> and its phages.</p>
</abstract>
<kwd-group>
<kwd>
<italic>Yersinia pestis</italic>
</kwd>
<kwd>phage</kwd>
<kwd>phage resistance</kwd>
<kwd>fitness cost</kwd>
<kwd>
<italic>waaA</italic>
</kwd>
<kwd>
<italic>cmk</italic>
</kwd>
<kwd>
<italic>ail</italic>
</kwd>
</kwd-group>
<counts>
<fig-count count="7"/>
<table-count count="1"/>
<equation-count count="2"/>
<ref-count count="54"/>
<page-count count="13"/>
<word-count count="6534"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Bacteria and Host</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>Phages have long been used in medicine to identify specific bacteria or as alternative treatment for treating bacterial diseases. Because of the global emergence of antibiotic resistance, phage treatment has attracted great attention as an alternative or complement to antibiotic therapy. <italic>Y. pestis</italic>, the causative agent of plague, is transmitted by fleabite or respiratory droplets (<xref ref-type="bibr" rid="B10">Gage and Kosoy, 2005</xref>; <xref ref-type="bibr" rid="B4">Cathelyn et&#xa0;al., 2006</xref>). Three plague pandemics have been recorded in history, resulting in approximately 200 million deaths (<xref ref-type="bibr" rid="B40">Sun and Singh, 2019</xref>). Although human plague cases have been well controlled in most countries, sporadic cases or outbreaks are occasionally reported in plague foci worldwide. In 2017, a pneumonic plague outbreak in Madagascar caused 209 deaths in 4 months (<xref ref-type="bibr" rid="B43">Tsuzuki et&#xa0;al., 2017</xref>). Antibiotics are generally effective in the treatment of plague, but several antibiotic-resistant strains of <italic>Y. pestis</italic> have been isolated from patients and rodents in recent years (<xref ref-type="bibr" rid="B3">Cabanel et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B39">Sebbane and Lemaitre, 2021</xref>). In this context, bacteriophage therapy has been suggested as an alternative, the efficacy of which depends on the administration route (e.g., oral, intramuscular, and aerosol spray) or the frequency of phage application (<xref ref-type="bibr" rid="B1">Anisimov and Amoako, 2006</xref>; <xref ref-type="bibr" rid="B39">Sebbane and Lemaitre, 2021</xref>; <xref ref-type="bibr" rid="B45">Vagima et&#xa0;al., 2022</xref>).</p>
<p>The use of phage therapy has many ethical considerations. For instance, discussing the known and unknown risks of phage therapy can be challenging for patients and physicians. Moreover, the development of phage therapy has been hindered by the lack of predefined regulatory pathways for phage production and concerns about intellectual property protection (<xref ref-type="bibr" rid="B20">Kingwell, 2015</xref>). However, the main limitation of phage therapy is phage resistance. In natural environments, bacteria are subjected to strong selective pressure by bacteriophages (<xref ref-type="bibr" rid="B46">Vlot et&#xa0;al., 2018</xref>). In response, bacteria have developed mechanisms to resist phages, including inhibition of DNA injection, restriction and modification, abortive infection, CRISPR&#x2013;Cas, and inhibition of adsorption via phase variation of cell surface receptors (<xref ref-type="bibr" rid="B18">Kim et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B41">Takeuchi et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B35">Reyes-Robles et&#xa0;al., 2018</xref>). Although the CRISPR&#x2013;Cas system has been studied for decades, unknown defense systems in bacteria remain to be discovered (<xref ref-type="bibr" rid="B25">Makarova et&#xa0;al., 2013</xref>). For example, Doron et&#xa0;al. have identified several unreported defense systems using microbial pangenome analysis (<xref ref-type="bibr" rid="B7">Doron et&#xa0;al., 2018</xref>). Notably, mutations in certain genes may render the host bacterium resistant to phage infection (<xref ref-type="bibr" rid="B22">Laanto et&#xa0;al., 2020</xref>).</p>
<p>In this study, we used <italic>in vitro</italic> culture assays to screen <italic>Y. pestis</italic> strains with varying degrees of phage resistance and obtained several strains with mild-to-complete resistance to bacteriophages. We examined heritable gene mutations in resistant strains and identified <italic>Y. pestis</italic> genes involved in resistance to phage lysis, such as <italic>waaA</italic>, <italic>cmk</italic>, and <italic>ail</italic>. <italic>waaA</italic> encodes 3-deoxy-D-manno-octulosonic acid transferase, which is involved in the synthesis of lipopolysaccharide (LPS) and serves as the phage receptor in <italic>Y. pestis</italic> (<xref ref-type="bibr" rid="B17">Kiljunen et&#xa0;al., 2011</xref>). <italic>cmk</italic> encodes cytidine monophosphate (CMP) kinase, which catalyzes the transfer of a phosphoryl group from ATP to CMP or dCMP and plays a crucial role in the biosynthesis of nucleoside precursors (<xref ref-type="bibr" rid="B48">Walker et&#xa0;al., 2012</xref>). <italic>Escherichia coli</italic> with the <italic>cmk</italic> mutation are less susceptible to T7 phage (<xref ref-type="bibr" rid="B34">Qimron et&#xa0;al., 2006</xref>). Our previous study indicated that Ail contributes to phage adsorption in <italic>Y. pestis</italic> by interacting with the phage tail fiber protein (<xref ref-type="bibr" rid="B53">Zhao et&#xa0;al., 2013</xref>). By deciphering the evolutionary processes of <italic>Y. pestis</italic> against phage lysis stress, we have provided insights into the physiological processes involved in receptor recognition, phage DNA replication, and host degradation resistance.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<title>Materials and methods</title>
<sec id="s2_1">
<title>Bacterial strains, plasmids, phage, and media</title>
<p>The <italic>Y</italic>. <italic>pestis</italic> strains used in this study are described in <xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>. Other bacterial strains and plasmids are described in <xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Table S1</bold>
</xref>, and the primers used in the study are described in <xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Table S2</bold>
</xref>. The phage Yep-phi used in this study can effectively lyse all tested Chinese isolates of <italic>Y. pestis</italic> but is unable to lyse other <italic>Yersinia</italic> species (<xref ref-type="bibr" rid="B54">Zhao et&#xa0;al., 2011</xref>). <italic>Y. pestis</italic> and Yep-phi cultures were incubated at 26&#xb0;C and <italic>E. coli</italic> at 37 &#xb0;C. Luria&#x2013;Bertani (LB) media were used for bacterial liquid cultures. A soft agar medium was prepared by adding 0.4% (wt/vol) agar to liquid media. Plates were supplemented with ampicillin (Amp, 100 &#x3bc;g/ml), kanamycin (Kan, 100 &#x3bc;g/ml), spectinomycin (Spe, 100 &#x3bc;g/ml), or chloramphenicol (Cm, 34 &#x3bc;g/ml) when required.</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>
<italic>Y</italic>. <italic>pestis</italic> strains used in this work.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" align="left">Strains</th>
<th valign="middle" align="left">Characteristics</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">614F</td>
<td valign="top" align="left">Antiqua biovar strain</td>
</tr>
<tr>
<td valign="top" align="left">S12</td>
<td valign="top" align="left">Partially phage-resistant strain after 12 passages of 614F with phage challenging, with <sub>249</sub>GTCATCGTG<sub>257</sub> deletion in <italic>waaA</italic> gene, accession numbers SAMN07501781</td>
</tr>
<tr>
<td valign="top" align="left">S38</td>
<td valign="top" align="left">Phage-resistant strain after 38 passages of 614F with phage challenging, with <sub>15</sub>CCGGTGATAA<sub>24</sub> deletion in <italic>cmk</italic>
</td>
</tr>
<tr>
<td valign="top" align="left">S56</td>
<td valign="top" align="left">Phage-resistant strain after 56 passages of 614F with phage challenging, with A<sub>538</sub> deletion in the <italic>ail</italic> gene on top of S38 accession numbers SAMN07488721</td>
</tr>
<tr>
<td valign="top" align="left">S88</td>
<td valign="top" align="left">Phage-sensitive strain after 56 passages of 614F without phage challenging, accession numbers SAMN07488727</td>
</tr>
<tr>
<td valign="top" align="left">201</td>
<td valign="top" align="left">Microtus biovar strain</td>
</tr>
<tr>
<td valign="top" align="left">&#x394;<italic>waaA</italic>
</td>
<td valign="top" align="left">
<italic>waaA</italic> was replaced by a Spe cassette in 201</td>
</tr>
<tr>
<td valign="top" align="left">&#x394;<italic>cmk</italic>
</td>
<td valign="top" align="left">
<italic>cmk</italic> was replaced by a Spe cassette in 201</td>
</tr>
<tr>
<td valign="top" align="left">&#x394;<italic>ail</italic>
</td>
<td valign="top" align="left">
<italic>ail</italic> was replaced by a Spe cassette in 201</td>
</tr>
<tr>
<td valign="top" align="left">
<italic>waaA</italic>*</td>
<td valign="top" align="left">
<italic>waaA</italic> (&#x394;<sub>249</sub>GTCATCGTG<sub>257</sub>), &#x394;<italic>waaA</italic> with Spe cassette replaced by the <italic>waaA</italic> of S56</td>
</tr>
<tr>
<td valign="top" align="left">
<italic>cmk</italic>*</td>
<td valign="top" align="left">
<italic>cmk</italic> (&#x394;<sub>15</sub>CCGGTGATAA<sub>24</sub>), &#x394;<italic>cmk</italic> with Spe cassette replaced by the <italic>cmk</italic> of S56</td>
</tr>
<tr>
<td valign="top" align="left">
<italic>ail</italic>*</td>
<td valign="top" align="left">
<italic>ail</italic>* (&#x394;A<sub>538</sub>), &#x394;<italic>ail</italic> with Spe cassette replaced by the <italic>ail</italic> of S56</td>
</tr>
<tr>
<td valign="top" align="left">
<italic>waaA</italic>*/<italic>cmk</italic>*</td>
<td valign="top" align="left">
<italic>cmk</italic>*/&#x394;<italic>waaA</italic> with Spe cassette replaced by the <italic>waaA</italic> of S56</td>
</tr>
<tr>
<td valign="top" align="left">
<italic>waaA</italic>*/<italic>ail</italic>*</td>
<td valign="top" align="left">
<italic>ail</italic>*/&#x394;<italic>waaA</italic> with Spe cassette replaced by the <italic>waaA</italic> of S56</td>
</tr>
<tr>
<td valign="top" align="left">
<italic>cmk</italic>*/<italic>ail</italic>*</td>
<td valign="top" align="left">
<italic>ail</italic>*/&#x394;<italic>cmk</italic> with Spe cassette replaced by the <italic>cmk</italic> of S56</td>
</tr>
<tr>
<td valign="top" align="left">
<italic>waaA</italic>*/<italic>cmk</italic>*/ail*</td>
<td valign="top" align="left">
<italic>cmk</italic>*/ail* with the <italic>waaA</italic> in 201 replaced by the <italic>waaA</italic> of S56</td>
</tr>
<tr>
<td valign="top" align="left">C_<italic>waaA</italic>*</td>
<td valign="top" align="left">Complemented with <italic>waaA</italic> of 201 on pACYA184</td>
</tr>
<tr>
<td valign="top" align="left">C_<italic>cmk</italic>*</td>
<td valign="top" align="left">
<italic>cmk</italic>* with overexpressed <italic>cmk</italic> on pBAD33</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s2_2">
<title>Identification of phage-resistant <italic>Y. pestis</italic> 614F derivates</title>
<p>Different titers (from 1.5 &#xd7; 10<sup>8</sup> plaque-forming unit [PFU] to 1.5 &#xd7; 10<sup>4</sup> PFU) of 0.5&#xa0;ml strain 614F (10<sup>9</sup> CFU/ml) and 5&#xa0;ml Yep-phi were mixed and incubated at 26&#xb0;C for 24h. The serial mixtures were separately plated on LB agar and incubated at 26&#xb0;C for 24h. Colonies on plates were resistant to the corresponding titer of phage and were selected for passages. Bacterial stocks of every passage were stored for future analysis. Coculture passages were performed to obtain a fully resistant Yep-phi derivate of 614F (phage titer 1.5 &#xd7; 10<sup>8</sup> PFU). The genomes of resistant and wild-type 614F strains were sequenced and compared. The identified mutations were screened with mismatch&#x2013;polymerase chain reaction (PCR) in all passage stocks to determine when these mutations occurred during the entire passage process (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Table S2</bold>
</xref>) (<xref ref-type="bibr" rid="B49">Wangkumhang et&#xa0;al., 2007</xref>).</p>
</sec>
<sec id="s2_3">
<title>Mutant construction</title>
<p>Scarless genome editing was used to generate gene knockouts and point mutants in <italic>Y. pestis</italic> (<xref ref-type="bibr" rid="B19">Kim et&#xa0;al., 2014</xref>). In brief, selection cassettes containing Spe-resistant genes, flanked by FRT, I-SceI sites, and 120-bp homologous arms, were electroporated into 201/pREDTKI, which encodes meganuclease I-SceI under the control of the an hydrotetracycline-induced <italic>tetA</italic> promoter and &#x3bb;-Red recombinase genes under the control of the arabinose-inducible <italic>araB</italic> promoter as well as a temperature-sensitive replication origin. The knockout strains were confirmed via PCR and sequencing. Using the primers listed in <xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Table S2</bold>
</xref>, the PCR fragment containing the SacI/HindIII site of mutant gene S56 was amplified and cloned into the donor plasmid pKSI-1, which with I-SceI recognition sites was digested with SacI and HindIII to produce pKSI-1_<italic>waaA</italic>*, pKSI-1_<italic>cmk</italic>*, and pKSI-1<sub>_</sub>
<italic>ail</italic>*. The donor plasmid was electroporated into knockout strains; transformants were restruck onto LB plates containing Kan, Spe, and Amp and grown overnight at 26&#xb0;C. Restruck colonies were suspended in LB containing Kan, Spe, and Amp and grown overnight at 26&#xb0;C. The colonies were repatched twice onto LB supplemented with 10 mmol L-arabinose for inducing lambda red recombinase and 20 mmol IPTG for inducing I-SceI expression to loop out the selection cassette and donor plasmid at 26&#xb0;C. To verify the loss of the selection cassette, isolates were tested for growth on LB plates with or without Spe and Amp. The sensitive isolates were screened via PCR and sequencing to confirm mutagenesis. Successive passage was performed at 37&#xb0;C to remove pREDTKI from the strain. The <italic>waaA</italic>*/<italic>cmk</italic>*/<italic>ail</italic>* mutant was constructed via suicide plasmid-mediated genome editing (<xref ref-type="bibr" rid="B33">Philippe et&#xa0;al., 2004</xref>). Homologous upstream and downstream fragments flanking the <italic>waaA</italic>* mutation were amplified from S56 using PCR. The fragments were cloned into the suicide plasmid pDS132, which was digested with SacI and SalI, and replicated in S17-1 &#x3bb;pir. The recombinant plasmids were purified and introduced in <italic>cmk</italic>*/<italic>ail</italic>* via conjugation. Plates containing Cm were screened after incubation at 37&#xb0;C overnight. The clone was selected on a plate containing 7% sucrose following growth at 26&#xb0;C for 4 days. We selected transformants that grew on plates but not on Cm plates. The strain containing <italic>waaA</italic>*/<italic>cmk</italic>*/<italic>ail</italic>* was detected via PCR and confirmed via sequencing.</p>
</sec>
<sec id="s2_4">
<title>Growth curves</title>
<p>The overnight grown strains were cultured to OD<sub>620</sub> of approximately 1.0, diluted 1:100 into 20&#xa0;ml of LB, and cultured at 26&#xb0;C and 200 rpm. OD<sub>620</sub> was determined every 2h using 300 &#x3bc;l of bacterial culture. The OD<sub>620</sub> values were used to draw growth curves. Data were obtained in triplicate, and experiments were repeated twice. Area under the curve analysis was used to quantify the differences in growth (<xref ref-type="bibr" rid="B47">Vornhagen et&#xa0;al., 2019</xref>).</p>
</sec>
<sec id="s2_5">
<title>Phage infection assay</title>
<p>The lysis activity of each phage strain was examined using a spot test on <italic>Y. pestis</italic> (<xref ref-type="bibr" rid="B32">Paul et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B53">Zhao et&#xa0;al., 2013</xref>). In brief, 100&#xa0;ml of bacteria cultured to exponential phase (OD<sub>620</sub>~1.0) were concentrated 10-fold via centrifugation and mixed with 3&#xa0;ml of liquefied soft agar medium. The mixture was plated on LB plates to create double-layer agar plates. When the medium solidified, 3 &#x3bc;l of serial dilutions of Yep-phi were spotted on the plates. Plates were incubated at room temperature for 10 h and then examined and photographed.</p>
</sec>
<sec id="s2_6">
<title>Phage adsorption assay</title>
<p>For phage adsorption, approximately 8 &#xd7; 10<sup>5</sup> PFU of Yep-phi in 100 &#x3bc;l was mixed with 500 &#x3bc;l bacteria (OD<sub>620</sub>~1.0). LB was used as a nonadsorbing control in each assay, and the phage titer in the control supernatant was set to 100%. The mixture was incubated at room temperature for 5&#xa0;min and centrifuged at 16,000 &#xd7; <italic>g</italic> for 3&#xa0;min. Residual PFU percentage was calculated as described in a previous study (<xref ref-type="bibr" rid="B17">Kiljunen et&#xa0;al., 2011</xref>).</p>
<disp-formula>
<mml:math display="block" id="M1">
<mml:mrow>
<mml:mtext>Residual&#xa0;PFU&#xa0;</mml:mtext>
<mml:mo>=</mml:mo>
<mml:mtext>&#xa0;</mml:mtext>
<mml:mfrac>
<mml:mrow>
<mml:mtext>number&#xa0;of&#xa0;PFU&#xa0;in&#xa0;mixture</mml:mtext>
</mml:mrow>
<mml:mrow>
<mml:mtext>number&#xa0;of&#xa0;PFU&#xa0;in&#xa0;LB</mml:mtext>
</mml:mrow>
</mml:mfrac>
<mml:mtext>&#xa0;</mml:mtext>
<mml:mo>&#xd7;</mml:mo>
<mml:mtext>&#xa0;</mml:mtext>
<mml:mn>100</mml:mn>
<mml:mo>%</mml:mo>
</mml:mrow>
</mml:math>
</disp-formula>
<p>Statistical differences were determined using one-way analysis of variance (ANOVA) with three independent data sets. To reveal the temporal phage adsorption kinetics of all strains, residual PFU percentage was tested at different time points (2, 5, 10, and 15&#xa0;min). Each assay was performed in triplicate and repeated twice. Statistical differences were determined using two-way RM ANOVA with Dunnett&#x2019;s multiple comparisons to wild-type groups.</p>
</sec>
<sec id="s2_7">
<title>Phage efficiency of plating assay</title>
<p>To determine the efficiency of plating (EOP) of Yep-phi on different strains, 300 &#x3bc;l of wild-type and mutant <italic>Y. pestis</italic>&#x2013;cultured bacteria (OD<sub>620</sub>~1.0) were mixed with 100 &#x3bc;l of Yep-phi in 3&#xa0;ml of 0.4% soft agar and poured onto LB plates. The number of PFUs was counted after 24h&#x2013;48h. Each strain was verified in triplicate. EOP was calculated as described (<xref ref-type="bibr" rid="B13">Hyman and Abedon, 2010</xref>).</p>
<disp-formula>
<mml:math display="block" id="M2">
<mml:mrow>
<mml:mtext>EOP&#xa0;</mml:mtext>
<mml:mo>=</mml:mo>
<mml:mtext>&#xa0;</mml:mtext>
<mml:mfrac>
<mml:mrow>
<mml:mtext>number&#xa0;of&#xa0;PFU&#xa0;on&#xa0;mutant&#xa0;strain</mml:mtext>
</mml:mrow>
<mml:mrow>
<mml:mtext>number&#xa0;of&#xa0;PFU&#xa0;on&#xa0;wild</mml:mtext>
<mml:mo>&#x2212;</mml:mo>
<mml:mtext>type</mml:mtext>
</mml:mrow>
</mml:mfrac>
<mml:mtext>&#xa0;</mml:mtext>
<mml:mo>&#xd7;</mml:mo>
<mml:mtext>&#xa0;</mml:mtext>
<mml:mn>100</mml:mn>
<mml:mo>%</mml:mo>
</mml:mrow>
</mml:math>
</disp-formula>
</sec>
<sec id="s2_8">
<title>Isolation and analysis of LPS</title>
<p>LPS isolation was performed using the phenol&#x2013;water extraction method (<xref ref-type="bibr" rid="B51">Zhang and Skurnik, 1994</xref>). In brief, 9&#xa0;ml overnight bacterial cultures were collected via centrifugation and resuspended in 1.5&#xa0;ml distilled water. The bacterial suspensions were incubated at 70&#xb0;C for 1h and then mixed with water-saturated phenol (pH 4.0) reheated to 70&#xb0;C for 10&#xa0;min and then transferred to ice for cooling (&lt; 10&#xb0;C). Then, the cells were centrifuged at 2,000 &#xd7; <italic>g</italic> for 20&#xa0;min. The uppermost aqueous layer obtained was transferred to a new Eppendorf tube and 2 volumes of acetone were added to precipitate LPS. The LPS pellet was dissolved in 150 &#x3bc;l of water, of which 5 &#x3bc;l of LPS was analyzed via 15% sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver staining (<xref ref-type="bibr" rid="B51">Zhang and Skurnik, 1994</xref>).</p>
</sec>
<sec id="s2_9">
<title>Protein expression and purification</title>
<p>The PCR-generated DNA fragment comprising <italic>waaA</italic> and <italic>waaA</italic>* was cloned into the BamHI/HindIII site of the pET32a vector. The plasmid was introduced into DH5&#x3b1; cells, and its DNA sequence was confirmed. The plasmid was extracted and introduced into <italic>E. coli</italic> BL21(DE3) cells. To induce the expression of WaaA and WaaA* in <italic>E. coli</italic> BL21(DE3) cells, 1 mM IPTG was added when the culture reached the mid-exponential growth phase at an OD<sub>600</sub> of approximately 0.8. The bacterial cells were cultured at 37&#xb0;C for 4h and collected. WaaA and WaaA* were purified via immobilized metal affinity chromatography on a nickel cephalosporin HP column. The proteins were desalted with PBS (pH 7.2) and 20% glycerol and concentrated using a protein concentration column (<xref ref-type="bibr" rid="B26">Mamat et&#xa0;al., 2009</xref>). Protein concentrations were determined using a BCA protein assay kit.</p>
</sec>
<sec id="s2_10">
<title>Circular dichroism spectroscopy</title>
<p>To compare the circular dichroism (CD) spectra of wild-type WaaA and WaaA*, a Jasco J-815 spectropolarimeter (<xref ref-type="bibr" rid="B11">Greenfield, 1999</xref>; <xref ref-type="bibr" rid="B15">Kelly et&#xa0;al., 2005</xref>) was used. Protein solutions (0.1&#x2013;0.35 mg/ml) were quantified at 200&#x2013;260 nm. Spectra were obtained with a scan speed of 50 nm/min and 0.5-nm data pitch. The percentage of secondary structure was estimated using online software connected to Jasco J-815.</p>
</sec>
<sec id="s2_11">
<title>Protein structure analysis</title>
<p>Protein Data Bank (PDB) was used to conduct homology search (<xref ref-type="bibr" rid="B37">Rose et&#xa0;al., 2015</xref>). For WaaA, the structure of membrane-embedded monofunctional glycosyltransferase WaaA from <italic>Aquifex aeolicus</italic> (PDB code: 2XCI.A) was used as the template based on the quality of models produced. Multiple sequence alignment was performed using Clustal Omega from UniProt (<xref ref-type="bibr" rid="B50">Yip et&#xa0;al., 2008</xref>). The ESPript server was used to predict the secondary structure of WaaA (<xref ref-type="bibr" rid="B36">Robert and Gouet, 2014</xref>). The Alphafold v2.3.1 monomer_casp14 model was used to predict the structures of WaaA and WaaA* (<xref ref-type="bibr" rid="B14">Jumper et&#xa0;al., 2021</xref>). The biological and functional insights derived from the predicted models were verified by matching the models with the protein function database.</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<title>Results</title>
<sec id="s3_1">
<title>Continuous phage challenge produced phage-resistant derivates of strain 614F</title>
<p>Yep-phi is routinely used as a diagnostic phage for identifying <italic>Y. pestis</italic>, and no natural Yep-phi phage-resistant <italic>Y. pestis</italic> isolate has been reported (<xref ref-type="bibr" rid="B54">Zhao et&#xa0;al., 2011</xref>). In this study, we exposed cultures of <italic>Y. pestis</italic> 614F to serially diluted phage Yep-phi. The surviving clones were selected and amplified continuously. <xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1A</bold>
</xref> illustrates how resistant mutants were identified by rounds of progressive challenges with different phage titers. Phage spotting assays revealed that after 12 rounds of phage challenge, the derivate of 614F (strain S12) showed decreased phage susceptibility (resistant to phage titer 10<sup>5</sup> PFU), whereas later derivates (S38 and S56, with 38 and 56 rounds of challenges, respectively) were fully resistant to phage titer 10<sup>8</sup> PFU <bold>(</bold>
<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1B</bold>
</xref>
<bold>)</bold>. The EOP assay showed a similar result; the EOP value for S12 was 3.2 &#xd7; 10<sup>&#x2212;6</sup>, whereas the EOP values for S38 and S56 were&lt;1.68 &#xd7; 10<sup>&#x2212;9</sup> (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1C</bold>
</xref>). Our results confirmed that the 614F strain gradually developed full resistance to phage Yep-phi under continuous stress. Residual PFU percentages were used to evaluate the adsorption capability of 614F and its derivates S12, S38, and S56. All derivate strains lost their ability to adsorb phages (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1D</bold>
</xref>), which was confirmed through the temporal kinetics of adsorption assays (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1E</bold>
</xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Screening and characterization of phage-resistant mutants of strain 614F. <bold>(A)</bold> Screening procedures. <bold>(B)</bold> Ten-fold dilution of lysates of Yep-phi applied to bacterial lawns of 614F wild-type and phage-resistant strains. The maximum titer of bacteriophage is 10<sup>8</sup> PFU. <bold>(C)</bold> The efficiency of plating (EOP) of Yep-phi phage on various strains. EOP = (number of PFUs on mutant strain)/(number of PFUs on wild-type strain). The titer of bacteriophage is 1.68 &#xd7; 10<sup>9</sup> PFU. <bold>(D)</bold> Adsorption of Yep-phi on strain 614F and its derivates. The <italic>Y</italic>-axis represents percentage of residual plaque-forming unit (PFU). Error bars show standard deviations of the mean of three biological replicates. Significance was determined by one-way ANOVA followed by Dunnett&#x2019;s multiple comparison test. <sup>#</sup>
<italic>P&lt;</italic> 0.0001. <bold>(E)</bold> Adsorption kinetics of Yep-phi to strain 614F and its derivates. ***<italic>P&lt;</italic> 0.001 (two-way RM ANOVA with Dunnett&#x2019;s multiple comparison test). Error bars indicate standard deviations in triplicate samples.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1174510-g001.tif"/>
</fig>
</sec>
<sec id="s3_2">
<title>Genomic analysis revealed mutations in phage-resistant strain S56</title>
<p>To examine the genetic variations responsible for phage resistance, we sequenced the genomes of strain S56 and its ancestor strain 614F. A control strain S88 (56 passages without phage challenges) was sequenced to rule out unrelated mutations. We identified three mutations in S56 (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S1</bold>
</xref>): a 9-bp in-frame deletion (<sub>249</sub>GTCATCGTG<sub>257</sub>) in <italic>waaA</italic> (gene ID: YPO0055), a 10-bp frame shift deletion (<sub>15</sub>CCGGTGATAA<sub>24</sub>) in <italic>cmk</italic> (gene ID: YPO1391), and a 1-bp frame shift deletion (A<sub>538</sub>) in <italic>ail</italic> (gene ID: YPO2905), which are annotated according to <italic>Y. pestis</italic> CO92. The mutations were named <italic>waaA</italic>*, <italic>cmk*</italic>, and <italic>ail*</italic>, respectively, and mismatch-PCR was used to screen their presence in passage stocks. The findings revealed that <italic>waaA</italic>* occurred in passage 12 (strain S12), <italic>cmk*</italic> occurred in passage 38 (strain S38) in addition to <italic>waaA</italic>*, and <italic>ail*</italic> occurred in passage 56 (strain S56) in addition to <italic>waaA</italic>*/<italic>cmk*</italic>.</p>
</sec>
<sec id="s3_3">
<title>
<italic>waaA</italic>*/<italic>cmk</italic>*/<italic>ail</italic>* mutations reproduced phage resistance phenotypes in strain 201</title>
<p>To determine whether a similar phage-resistant profile can be reproduced and the roles of mutations in <italic>waaA</italic> (9-bp deletions), <italic>cmk</italic> (10-bp deletions), and <italic>ail</italic> (1-bp deletion), we constructed single, double, or triple mutants derived from strain 201. Strain <italic>waaA</italic>* was partially resistant to phage Yep-phi (resistant to 3.15 &#xd7; 10<sup>3</sup> PFU, <xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2A</bold>
</xref>), with an EOP value of 5.4 &#xd7; 10<sup>&#x2212;6</sup> (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2B</bold>
</xref>, phage titer 1.05 &#xd7; 10<sup>10</sup> PFU). Moreover, <italic>waaA</italic>*/<italic>cmk</italic>* and <italic>waaA</italic>*/<italic>cmk</italic>*/<italic>ail</italic>* were fully resistant to phages with EOP&lt; 1.05 &#xd7; 10<sup>&#x2212;10</sup>, which is much lower than that for <italic>waaA*</italic> (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2B</bold>
</xref>). Adsorption assays indicated that all mutants had a significantly lower ability to adsorb phage Yep-phi, and the residual PFU percentages among the three mutants were indistinguishable (<xref ref-type="fig" rid="f2">
<bold>Figures&#xa0;2C, D</bold>
</xref>). These results suggest that the <italic>waaA</italic>* mutation affects the binding between <italic>Y. pestis</italic> and its phage.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Reproduction of phage resistance induced by <italic>waaA</italic>, <italic>cmk</italic>, and <italic>ail</italic> mutations in strain 201. <bold>(A)</bold> Ten-fold dilution of Yep-phi lysates applied to lawns of 201 wild-type and mutant bacterial strains. The maximum titer of bacteriophage is 3.15 &#xd7; 10<sup>7</sup> PFU. <bold>(B)</bold> Efficiency of plating (EOP) for different strains. The titer of bacteriophage is 1.05 &#xd7; 10<sup>10</sup> PFU. <bold>(C)</bold> Adsorption of 8 &#xd7; 10<sup>5</sup> PFU Yep-phi to <italic>Y. pestis</italic> 201 WT and its single-, double-, or triple-gene mutants shown as residual PFU percentages. Significance was determined by one-way ANOVA. <sup>#</sup>
<italic>P&lt;</italic> 0.0001. <bold>(D)</bold> Adsorption kinetics of Yep-phi to wild-type <italic>Y. pestis</italic> 201 and its mutants (ca. 2 &#xd7; 10<sup>6</sup> PFU/10<sup>8</sup> CFU). **<italic>P&lt;</italic> 0.01 (Dunnett&#x2019;s multiple comparison test of two-way RM ANOVA).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1174510-g002.tif"/>
</fig>
</sec>
<sec id="s3_4">
<title>The <italic>waaA</italic>* mutation inhibits phage adsorption by truncating LPS</title>
<p>Phage adsorption defects were found in strain <italic>waaA</italic>* and strain 614F carrying the <italic>waaA</italic>* mutation. The <italic>waaA*</italic> mutant and the <italic>waaA</italic> null mutant &#x394;<italic>waaA</italic> displayed similarly decreased phage susceptibility (resistant to 4.35 &#xd7; 10<sup>3</sup> PFU phage), with decreased EOP (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3A</bold>
</xref>). In the complementation test, the phage susceptibility of <italic>waaA</italic>* supplemented with plasmid pACYC184_<italic>waaA</italic> was restored and comparable to that of wild-type strain 201 (<xref ref-type="fig" rid="f3">
<bold>Figures&#xa0;3A, B</bold>
</xref>). In the adsorption kinetics assays, the phage adsorption ability of <italic>waaA</italic>* was similar to that of &#x394;<italic>waaA</italic>, and <italic>waaA</italic>* mutant complemented with plasmid pACYC184_<italic>waaA</italic> showed similar phage adsorption ability to the wild-type strain, confirming the anti-adsorption effect of the <italic>waaA</italic>* mutation (<xref ref-type="fig" rid="f3">
<bold>Figures&#xa0;3C, D</bold>
</xref>).</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>The <italic>waaA</italic> mutation inhibits phage adsorption by disrupting LPS. <bold>(A)</bold> Ten-fold dilution of Yep-phi lysates applied to bacterial lawns of wild-type and mutant <italic>Y. pestis</italic> strains. The maximum titer of bacteriophage is 4.35 &#xd7; 10<sup>7</sup> PFU. <bold>(B)</bold> Efficiency of plating (EOP) of 2 &#xd7; 10<sup>2</sup> PFU phage for different strains. <bold>(C)</bold> Adsorption of Yep-phi to <italic>Y. pestis</italic> 201 and <italic>waaA</italic> mutant strains, expressed as a percentage of residual PFU. Significance was determined by one-way ANOVA; **<italic>P&lt;</italic> 0.01. ns, non-significant. <bold>(D)</bold> Adsorption kinetics of Yep-phi to <italic>Y. pestis</italic> and <italic>waaA</italic> mutant strains expressed as percentages of residual PFU. Two-way RM ANOVA was used to determine significance between the mutant and wild-type groups; ** <italic>P&lt;</italic> 0.01. <bold>(E)</bold> Analysis of isolated LPS fractions from <italic>Y. pestis</italic> 201 and waaA mutants using SDS/PAGE. The gel was silver stained for visualization. <bold>(F)</bold> CD spectra of WaaA and WaaA*. <bold>(G)</bold> The build-in software of the spectropolarimeter predicted the conformations ratio between WaaA and WaaA* of <italic>Y. pestis</italic> 201.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1174510-g003.tif"/>
</fig>
<p>Because the <italic>waaA</italic> gene, encoding 3-deoxy-D-mannooctulosonic acid (KDO) transferase, is involved in LPS synthesis (<xref ref-type="bibr" rid="B5">Chung and Raetz, 2010</xref>), we hypothesize that the mutation in <italic>waaA</italic>* affects the adsorption of Yep-phi phage because of failure to synthesize LPS, which is the phage adsorption receptor. At 26&#xb0;C, <italic>Y. pestis</italic> expresses rough LPS, which does not contain the <italic>O</italic>-polysaccharide that is considered the phage receptor (<xref ref-type="bibr" rid="B17">Kiljunen et&#xa0;al., 2011</xref>). Rough LPS was expressed in 201 WT but was not stained on the gel by silver (a characteristic of a core-lacking LPS) in either &#x394;<italic>waaA</italic> or <italic>waaA</italic>* (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3E</bold>
</xref>), which confirmed the failure of complete LPS core synthesis in the two mutants (<xref ref-type="bibr" rid="B29">Meredith et&#xa0;al., 2006</xref>; <xref ref-type="bibr" rid="B6">Dentovskaya et&#xa0;al., 2011</xref>). CD spectra assays demonstrated that wild-type WaaA has two negative absorption bands at 209 and 222 nm, which are characteristic of &#x3b1;-helical proteins, and the CD spectrum of WaaA* protein is slightly different from that of wild-type strain (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3F</bold>
</xref>). Meanwhile, the build-in software of the spectropolarimeter predicted decreased &#x3b1;-helix and increased &#x3b2;-sheet in WaaA* protein comparing with the wild-type WaaA (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3G</bold>
</xref>).</p>
<p>The 9-bp (<sub>249</sub>GTCATCGTG<sub>257</sub>) in-frame deletion in <italic>waaA</italic> resulted in the <sub>84</sub>TMT<sub>86</sub> deletion in WaaA. To further determine the consequence of the <sub>84</sub>TMT<sub>86</sub> deletion in WaaA, we compared the predicted structures of wild-type WaaA and mutated WaaA*. Sequence alignment of WaaA and WaaA* showed the presence of charged residue matching the monofunctional glycosyltransferase WaaA of <italic>A. aeolicus</italic> (PDB code: 2XCI.A) (<xref ref-type="bibr" rid="B38">Schmidt et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B37">Rose et&#xa0;al., 2015</xref>). In <italic>A. aeolicus</italic>, residues S54 and R56 of WaaA had been proven vital for its KDO transferase activity, and these two residues together with S28 and E31 provide necessary hydrogen bonds to bind tetraacyl-4'-phosphate lipid A during KOD transferring process as part of the receptor-substance binding site of WaaA (<xref ref-type="bibr" rid="B38">Schmidt et&#xa0;al., 2012</xref>). Secondary structure predictions of WaaA and WaaA* indicated that the <sub>84</sub>TMT<sub>86</sub> deletion occurred in the junction of &#x3b2;-sheet 2 (&#x3b2;2) and &#x3b1;-helix3 (&#x3b1;3), right next to residues S54 and R56 of <italic>A</italic>. <italic>aeolicus</italic> WaaA (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S2</bold>
</xref>). Sequence alignment of multiple bacterial WaaA showed that the <sub>84</sub>TMT<sub>86</sub> region is conserved among multiple bacterial species (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S3</bold>
</xref>). Additionally, Alphafold analysis of WaaA and WaaA* proteins demonstrated that their predicted structures are slightly different from each other (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figures S4A&#x2013;C</bold>
</xref>). The <sub>84</sub>TMT<sub>86</sub> is located at an &#x3b1; helix-loop-&#x3b2; turn connection in WaaA protein, and the deletion of <sub>84</sub>TMT<sub>86</sub> of resulted in a shorter length of the &#x3b1; helix, followed by a shift of approximately 2.7 &#xc5; in the loop and a 6.8&#xb0; deflection of the in the &#x3b2; turn (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S4D</bold>
</xref>).</p>
<p>Our results suggest that the <sub>84</sub>TMT<sub>86</sub> deletion in WaaA hinders its binding to the precursor of lipid A, and causes the loss of its glycosyltransferase function. The three amino acids in-frame deletion in <italic>waaA</italic>* resulted in a core-lacking LPS of <italic>Y. pestis</italic>, leading to phage resistance similar to &#x394;<italic>waaA</italic>.</p>
</sec>
<sec id="s3_5">
<title>
<italic>cmk</italic>*-related phage resistance is independent of adsorption</title>
<p>
<italic>cmk</italic> encodes a cytidylate kinase that catalyzes phosphoryl transfer from ATP to (d)CMP (<xref ref-type="bibr" rid="B42">Tsao et&#xa0;al., 2015</xref>). Mutant <italic>waaA</italic>*/<italic>cmk</italic>* was more resistant to phage lysis than <italic>waaA</italic>*. However, the role of the <italic>cmk</italic> mutation against phage lysis remains unknown. To address this, we constructed <italic>cmk*</italic>, which contains a frameshift mutation (<sub>15</sub>CCGGTGATAA<sub>24</sub> deletion). We performed infection assays using <italic>cmk*</italic>, C<italic>_cmk*</italic> (a complementary strain), and &#x394;<italic>cmk</italic> (<italic>cmk</italic> null mutant) simultaneously and found that <italic>cmk</italic>* and &#x394;<italic>cmk</italic> were resistant to a high phage titer (3.15 &#xd7; 10<sup>7</sup> PFU) (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4A</bold>
</xref>), with EOP values of 5.8 &#xd7; 10<sup>&#x2212;5</sup> and 4.5 &#xd7; 10<sup>&#x2212;5</sup>, respectively (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4B</bold>
</xref>). C<italic>_cmk*</italic> restored susceptibility, comparable with wild-type 201. Notably, <italic>cmk</italic>* and &#x394;<italic>cmk</italic> have similar adsorption capacity compared with WT 201 (<xref ref-type="fig" rid="f4">
<bold>Figures&#xa0;4C, D</bold>
</xref>), suggesting that <italic>cmk*</italic>-mediated phage resistance is irrelevant for the adsorption of <italic>Y. pestis</italic> and phage particles. The 10-bp (<sub>15</sub>CCGGTGATAA<sub>24</sub>) deletion of <italic>cmk</italic> led to premature termination of Cmk translation. The mechanism of Cmk-related phage resistance needs further investigation.</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>
<italic>cmk</italic>* resists phage lysis without impacting phage adsorption. <bold>(A)</bold> Ten-fold dilution of Yep-phi lysates applied to bacterial lawns of wild-type and <italic>cmk</italic> mutant <italic>Y. pestis</italic> strains. The maximum titer of bacteriophage is 4.35 &#xd7; 10<sup>7</sup> PFU. <bold>(B)</bold> Efficiency of plating (EOP) for different strains. <bold>(C)</bold> Adsorption of Yep-phi to <italic>Y. pestis</italic> 201 and its <italic>cmk</italic> mutant strains expressed as a percentage of residual PFU. ns, non-significant (one-way ANOVA). <bold>(D)</bold> Adsorption kinetics of Yep-phi to <italic>Y. pestis</italic> and <italic>cmk</italic> mutant strains, expressed as percentages of residual PFU. ns, non-significant (Dunnett&#x2019;s multiple comparison test of two-way RM ANOVA).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1174510-g004.tif"/>
</fig>
</sec>
<sec id="s3_6">
<title>The <italic>ail*</italic> mutation affects the phage adsorption ability of <italic>Y. pestis</italic>
</title>
<p>In <italic>Y. pestis</italic>, Ail is an outer membrane protein that contains 182 amino acids. Our previous study revealed that Ail interacts with the phage tail fiber protein and contributes to phage adsorption in <italic>Y. pestis</italic> (<xref ref-type="bibr" rid="B53">Zhao et&#xa0;al., 2013</xref>). In this study, we identified the A<sub>538</sub> deletion in <italic>ail</italic> in strain S56 (<italic>ail</italic>*, <xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>), which is at the very end of the <italic>ail</italic> coding region. <italic>ail</italic>* or &#x394;<italic>ail</italic> was as susceptible to phages as wild-type 201, with comparable EOP values (<xref ref-type="fig" rid="f5">
<bold>Figures&#xa0;5A, B</bold>
</xref>). Moreover, the <italic>ail</italic>* mutant showed similar phage adsorption defects as the null mutant &#x394;<italic>ail</italic> (<xref ref-type="fig" rid="f5">
<bold>Figures&#xa0;5C, D</bold>
</xref>). The addition of <italic>waaA</italic>* or <italic>cmk</italic>* to <italic>ail</italic>* did not make a difference in phage adsorption (<xref ref-type="fig" rid="f5">
<bold>Figures&#xa0;5C, D</bold>
</xref>
<bold>)</bold>; however, it significantly increased resistance to phage compared with the <italic>ail</italic>* null strain <bold>(</bold>
<xref ref-type="fig" rid="f4">
<bold>Figures&#xa0;4B</bold>
</xref>, <xref ref-type="fig" rid="f5">
<bold>5B</bold>
</xref>
<bold>).</bold> Our results indicate that <italic>ail</italic>* (1-bp deletion at A<sub>538</sub>) exhibited phage adsorption resistance, consistent with the effects of disrupting phage adsorption in &#x394;<italic>ail</italic>.</p>
<fig id="f5" position="float">
<label>Figure&#xa0;5</label>
<caption>
<p>The <italic>ail</italic> mutation confers resistance to phages in <italic>Y. pestis</italic>. <bold>(A)</bold> Ten-fold dilution of Yep-phi lysates applied to bacterial lawns of wild-type and mutant strains. The maximum titer of bacteriophage is 4.35 &#xd7; 10<sup>7</sup> PFU. <bold>(B)</bold> Efficiency of plating (EOP) for different strains. <bold>(C, D)</bold> Yep-phi adsorption and adsorption kinetics to <italic>Y. pestis</italic> 201 and its mutant strains. <sup>#</sup>
<italic>P&lt;</italic> 0.0001. ns, non-significant.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1174510-g005.tif"/>
</fig>
</sec>
<sec id="s3_7">
<title>Interplays of <italic>waaA</italic>*/<italic>cmk</italic>*/<italic>ail</italic>* mutations restore the growth of the mutants</title>
<p>The <italic>waaA*/cmk</italic>* mutant is resistant to high-titer phage attacks (<xref ref-type="fig" rid="f2">
<bold>Figures&#xa0;2A, B</bold>
</xref>
<bold>)</bold>, and the <italic>ail*</italic> mutant is somewhat sensitive to phages even though it adsorbs phages less effectively. We wondered whether the evolution of phage resistance due to the <italic>waaA</italic>*/<italic>cmk</italic>* mutations was a liability that was compensated by the <italic>ail</italic> mutation or why the weakly lysis-resistant <italic>ail</italic>* mutation occurred in <italic>Y. pestis</italic> when the <italic>waaA</italic>*/<italic>cmk</italic>* mutation already renders the strain completely phage resistance. The 614F derivate S12 grows slower in LB than 614F. The growth of S38 is even slower than that of S12, which suggests the great fitness costs accompanying the phage resistance phenotype of these two derivates. Interestingly, S56 grew much better than S38, and its growth recovered to the level of 614F (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6A</bold>
</xref> and <xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S5A</bold>
</xref>). Because <italic>waaA</italic>*/<italic>cmk</italic>*/<italic>ail</italic>* mutations occurred sequentially in S12, S38, and S56, we assumed that <italic>waaA</italic>* and <italic>cmk</italic>* mutations influence the growth of the mutants in addition to conferring phage resistance onto them. Growth curves showed a deceleration of bacterial growth for <italic>cmk</italic>*, especially for <italic>waaA</italic>*, while the subsequent <italic>ail</italic>* mutation restored the mutant growth, as measured by calculating area under the curve (<xref ref-type="fig" rid="f6">
<bold>Figures&#xa0;6B, C</bold>
</xref>
<bold>;</bold> <xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figures S5B, C</bold>
</xref>). Our results indicate that the growth deficiency in <italic>waaA</italic>*/<italic>cmk</italic>* mutants can be compensated by the A<sub>538</sub> deletion of <italic>ail.</italic>
</p>
<fig id="f6" position="float">
<label>Figure&#xa0;6</label>
<caption>
<p>Growth attenuation caused by <italic>waaA</italic>* and/or <italic>cmk</italic>* mutations can be restored by <italic>ail</italic>* in <italic>Y. pestis</italic>. <bold>(A)</bold> Growth curve of <italic>Y. pestis</italic> 614F and its derivates. <bold>(B)</bold> <italic>ail*</italic> restored growth of <italic>waaA</italic>*. <bold>(C)</bold> <italic>ail*</italic> restored growth of <italic>cmk</italic>*. Data represent the average of three biological replicates; error bars indicate SEM.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1174510-g006.tif"/>
</fig>
</sec>
</sec>
<sec id="s4" sec-type="discussion">
<title>Discussion</title>
<p>In this study, we obtained phage-resistant <italic>Y. pestis</italic> mutants by continuously challenging strain 614F with the Yep-phi phage. Characterization of these mutants identified successive mutations in <italic>waaA</italic>, <italic>cmk</italic>, and <italic>ail</italic>.</p>
<p>The <italic>waaA</italic> null mutant not only demonstrated resistance to eight types of phages but was also greatly attenuated in mice (<xref ref-type="bibr" rid="B9">Filippov et&#xa0;al., 2011</xref>). Our previous study revealed that the <italic>waaA</italic> null mutant lost most of its phage-binding activity in an adsorption assay while remaining sensitive to high titers of Yep-phi (<xref ref-type="bibr" rid="B53">Zhao et&#xa0;al., 2013</xref>). Crystal structure analysis of WaaA from <italic>A. aeolicus</italic> suggested that the N-terminal domain functions as the acceptor&#x2013;substrate binding&#xa0;site for the lipid A precursor (<xref ref-type="bibr" rid="B38">Schmidt et&#xa0;al., 2012</xref>). In contrast, the <italic>waaA*</italic> mutant harbors a 9-bp in-frame deletion (<sub>249</sub>GTCATCGTG<sub>257</sub>, resulting in the <sub>84</sub>TMT<sub>86</sub> deletion in WaaA) that is located at the junction of the N-terminal &#x3b2;2 sheet and &#x3b1;2 helix (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S2</bold>
</xref>). Basic amino acids on the N-terminal &#x3b1;2 helix have been shown to be crucial for facilitating the entry of the lipid A precursor into the acceptor&#x2013;substrate binding site of WaaA (<xref ref-type="bibr" rid="B38">Schmidt et&#xa0;al., 2012</xref>). Here, we found that the phage-induced 9-bp in-frame deletion in <italic>waaA</italic> had similar effects to the <italic>waaA</italic> null mutation in <italic>Y. pestis</italic> regarding truncated LPS and phage resistance.</p>
<p>Previous research has revealed that <italic>Yersinia pseudotuberculosis</italic> with the <italic>cmk</italic> null mutation has a growth defect and is highly attenuated in mice (<xref ref-type="bibr" rid="B48">Walker et&#xa0;al., 2012</xref>). Our data indicate that the phage-induced <italic>cmk</italic>* mutation (with a <sub>15</sub>CCGGTGATAA<sub>24</sub> frameshift deletion leading to the failure of Cmk translation) displays a similar phage-resistant phenotype as &#x394;<italic>cmk</italic>. However, how defects in <italic>cmk</italic> confer phage resistance to <italic>Y. pestis</italic> is unclear. Because T7-like phages depend on the nucleoside monophosphate kinase of the host (<xref ref-type="bibr" rid="B34">Qimron et&#xa0;al., 2006</xref>), we propose that the loss of Cmk impacts nucleoside synthesis pathways and hinders the replication of phages in the host. In this study, other genes encoding nucleoside monophosphate kinases, such as <italic>adk</italic>, <italic>tmk</italic>, <italic>gmk</italic>, and <italic>pyrH</italic> (<xref ref-type="bibr" rid="B34">Qimron et&#xa0;al., 2006</xref>), were found to be unaffected in the phage-resistant S56 strain, likely due to the high fitness costs associated with mutations in these essential genes. Notably, <italic>cmk*</italic> showed growth deficiency in addition to phage resistance, similar to <italic>waaA</italic>*. This finding suggests that bacterial resistance to lytic phages comes at a cost to growth fitness.</p>
<p>Previous research has demonstrated that laboratory passages of <italic>Y. pestis</italic> may result in the disruption or premature truncation of Ail expression (<xref ref-type="bibr" rid="B24">Leiser et&#xa0;al., 2015</xref>). Ail is a critical virulence factor of <italic>Y. pestis</italic>, playing a central role in promoting immune resistance to human host defense (<xref ref-type="bibr" rid="B52">Zhang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B16">Kent et&#xa0;al., 2021</xref>). We have reported that <italic>ail*</italic> with a frameshift mutation in <italic>ail</italic> (A<sub>538</sub> deletion) and &#x394;<italic>ail</italic> have similar phenotypes, indicating that the A<sub>538</sub> deletion affects the functional integrity of Ail. Both <italic>waaA</italic>* and <italic>ail</italic>* attenuated phage adsorption, and the phage resistance of <italic>waaA</italic>*/<italic>ail</italic>* was additive compared with that of <italic>ail</italic>* or <italic>waaA</italic>* alone. Thus, we speculate that the phage primarily relies on LPS as an adsorption receptor, whereas <italic>ail</italic> is a secondary receptor, thereby affecting the reduction in viral progeny through different loadings onto host bacteria (<xref ref-type="bibr" rid="B53">Zhao et&#xa0;al., 2013</xref>).</p>
<p>The <italic>ail</italic>* mutation, which was observed only in S56 (the final passage), plays a minor role in phage resistance. However, the mutation in <italic>ail</italic> restores the growth of <italic>Y. pestis</italic> that was disrupted by a single mutation in <italic>waaA</italic> or <italic>cmk.</italic> In the phospholipid biosynthesis pathway, CTP and dCTP are downstream products of Cmk and may affect outer membrane lipids (<xref ref-type="bibr" rid="B23">Langley and Kennedy, 1978</xref>). In addition, the mutation in <italic>waaA</italic> can result in the accumulation of tetraacylated precursor lipid IV A (<xref ref-type="bibr" rid="B44">Tzeng et&#xa0;al., 2002</xref>). In contrast, the deletion of <italic>ail</italic> has been reported to cause an abnormal flow of phospholipids into the outer leaflet of the outer membrane (<xref ref-type="bibr" rid="B21">Kolodziejek et&#xa0;al., 2021</xref>), which might counterbalance the detrimental effects of accumulating mutations in <italic>waaA</italic> and <italic>cmk</italic>. One plausible explanation is that the <italic>ail</italic> mutation rebalances the changes in lipid content of the outer membrane caused by <italic>waaA</italic> and <italic>cmk</italic> mutations, thereby modifying cell shape and accelerating growth. Our data suggest that mutations in <italic>waaA</italic>* and <italic>cmk</italic>* may be advantageous to <italic>Y. pestis</italic> in the presence of phages but come at the cost of growth defects when phages are absent. Notably, <italic>waaA<sup>*</sup>
</italic> and <italic>cmk</italic>
<sup>*</sup> could recover their fitness through the <italic>ail</italic> mutation.</p>
<p>In this study, we identified successive mutations in <italic>waaA</italic>, <italic>cmk</italic>, and <italic>ail</italic> of <italic>Y. pestis</italic> that were induced by continuous phage challenges. Although these genes have individually been shown to be related to phage resistance in <italic>Y. pestis</italic> and other bacteria, they have not been observed simultaneously in one strain. Based on our findings, we propose a scenario in which <italic>Y</italic>. <italic>pestis</italic> developed a phage-resistant phenotype through mutations in <italic>waaA</italic>, <italic>cmk</italic>, and <italic>ail</italic> under continuous phage pressure. Initially, when phage stress was imposed on <italic>Y. pestis</italic>, the cells prevented phage adsorption through the <italic>waaA</italic> mutation, which truncates LPS. As phage pressure persisted, <italic>waaA</italic>*/cmk* mediated stronger phage resistance reinforced by the <italic>cmk</italic> mutation, which enhances resistance to phage lysis but leads to growth defects. Finally, the growth of <italic>waaA</italic>*/cmk* was restored by the <italic>ail</italic> mutation, and <italic>waaA</italic>*/cmk*/<italic>ail</italic>* prevented phage attachment because the Ail receptor was damaged. The interplay between mutations in the WaaA&#x2013;Cmk&#x2013;Ail cascade illustrates a tradeoff strategy during the development of phage-resistant phenotypes in <italic>Y. pestis</italic> (<xref ref-type="fig" rid="f7">
<bold>Figure&#xa0;7</bold>
</xref>).</p>
<fig id="f7" position="float">
<label>Figure&#xa0;7</label>
<caption>
<p>Proposed scenario of interplay between mutations in <italic>Y. pestis</italic> leading to resistance to Yep-phi phage infection. <bold>(A)</bold> Inhibition of phage adsorption to the surface of bacterial cells due to alterations in the surface receptor LPS by <italic>waaA</italic>* and <italic>ail</italic>*. <bold>(B)</bold> Inhibition of phage replication through secondary bacterial metabolites by <italic>cmk</italic>*. <bold>(C)</bold> Restoration of growth by <italic>ail</italic>*.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1174510-g007.tif"/>
</fig>
<p>All three genes responsible for phage resistance in <italic>Y</italic>. <italic>pestis</italic> discussed in this study are known to be virulence-related factors for pathogenic <italic>Yersinia</italic>. In the case of CO92, the <italic>waaA</italic> null mutant exhibited an LD50 nearly 4 million times lower than that of its wild-type counterpart (<xref ref-type="bibr" rid="B9">Filippov et&#xa0;al., 2011</xref>). In mice, the KIM5 <italic>ail</italic> null mutant showed &gt; 3,000-fold increase in LD<sub>50</sub> (<xref ref-type="bibr" rid="B8">Felek et&#xa0;al., 2010</xref>). The <italic>cmk</italic> null mutant in <italic>Y. pseudotuberculosis</italic> was &gt; 400 times attenuated in the mice model (<xref ref-type="bibr" rid="B48">Walker et&#xa0;al., 2012</xref>). These findings suggest that phage pressure may have an impact on virulence and fitness in other niches of <italic>Y. pestis</italic>, which could partially explain the scarcity of natural phage-resistant isolates of <italic>Y. pestis</italic>.</p>
<p>A caveat to consider is whether these mutations are involved in antibiotic resistance in <italic>Y</italic>. <italic>pestis</italic>. Studies have suggested that LPS regulated by WaaA plays a role in polymyxin resistance, and an Ail-like protein imparts ceftriaxone resistance to <italic>Salmonella enterica</italic> (<xref ref-type="bibr" rid="B12">Hu et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B30">Moffatt et&#xa0;al., 2019</xref>). In <italic>Y. pestis</italic>, the minimal inhibitory concentration of polymyxin B for the <italic>waaA</italic> null mutant is 250 times lower than that of its wild-type counterpart, possibly due to the less efficient incorporation of 4-amino-4-deoxyarabinose into lipid A (<xref ref-type="bibr" rid="B6">Dentovskaya et&#xa0;al., 2011</xref>). Furthermore, reduced Cmk activity may increase the tolerance of <italic>Staphylococcus aureus</italic> to vancomycin through effects on cell wall biosynthesis (<xref ref-type="bibr" rid="B28">Matsuo et&#xa0;al., 2013</xref>). Notably, all these antibiotics target the bacterial membrane, which suggests that phage resistance likely relies on changes in membrane characteristics. Fortunately, there is no evidence linking the WaaA&#x2013;Cmk&#x2013;Ail cascade to resistance against first-line antibiotics used to treat plague (<xref ref-type="bibr" rid="B2">Barbieri et&#xa0;al., 2020</xref>). Studies using animal models and clinical studies have identified tradeoffs between resistance and virulence. These findings bode well for improving treatment effectiveness despite the development of phage resistance (<xref ref-type="bibr" rid="B31">Oechslin, 2018</xref>; <xref ref-type="bibr" rid="B27">Mangalea and Duerkop, 2020</xref>).</p>
<p>In this study, we examined the microevolutionary processes of <italic>Y. pestis</italic> under phage stress and found that phage exposure resulted in complex changes in <italic>Y. pestis</italic>, particularly perturbations of the cell membrane. The findings of the present study provide valuable insights into the molecular mechanisms underlying <italic>Y. pestis</italic> resistance to bacteriophage and may aid ongoing investigations into phage therapies for plague. Notably, as a facultative intracellular pathogen with a complex life cycle, <italic>Y. pestis</italic> is likely to develop phage resistance through different pathways under different conditions, such as in natural environments, fleas, and hosts if exposed to phage pressure. We acknowledge that these three genes (<italic>waaA</italic>, <italic>cmk</italic>, and <italic>ail</italic>) were identified through continuous <italic>in vitro</italic> selection with phage pressure and caution against using our data to predict or interpret what may happen in human or rodent hosts. Investigating the relationship between phage resistance and virulence characteristics of <italic>Y. pestis</italic> during long-term phage therapies will be valuable, although ethical and technical obstacles need to be addressed. Additional genetic factors related to phage resistance in <italic>Y. pestis</italic> should be discovered through parallel passages under phage pressure. Moreover, conditions more closely resembling the host environment may help identify pathways of phage resistance in <italic>Y. pestis</italic>.</p>
</sec>
<sec id="s5" sec-type="data-availability">
<title>Data availability statement</title>
<p>The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Material</bold>
</xref>.</p>
</sec>
<sec id="s6" sec-type="author-contributions">
<title>Author contributions</title>
<p>LX, ZQ, and KS conducted the experiments, analyzed the data, and authored the paper. The phage adsorption experiments were carried out by KS and RL. HZ, HW, CL, and YX took part in the screening of phage-resistant strains. YJ, XL, XX, and XuZ contributed to the development curve of the 614F strain. RC, YT, ZD, and YC contributed to the interpretation of the data. RY, XiZ, and YS designed the experiments and contributed to the production and revision of the text. All authors contributed to the article and approved the submitted version.</p>
</sec>
</body>
<back>
<sec id="s7" sec-type="funding-information">
<title>Funding</title>
<p>This research was supported by the National Natural Science Foundation of China (81660349, U22A20526), and the National Health Commission (2019PT310004). The funders had no role in study design, data collection, and interpretation, or the decision to submit the work for publication.</p>
</sec>
<ack>
<title>Acknowledgments</title>
<p>The authors are grateful to Dr. Guoqiang Li for AlphaFold analysis of WaaA and WaaA* proteins. We are also grateful to Medelite Corp. for language polishing.</p>
</ack>
<sec id="s8" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s9" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
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