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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.2023.1270667</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>Sensor histidine kinases <italic>kdpD</italic> and <italic>aauS</italic> regulate biofilm and virulence in <italic>Pseudomonas aeruginosa</italic> PA14</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Sultan</surname>
<given-names>Maria</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2399389"/>
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<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Arya</surname>
<given-names>Rekha</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="author-notes" rid="fn001">
<sup>*</sup>
</xref>
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<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Chaurasia</surname>
<given-names>Akhilesh Kumar</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
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</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Kim</surname>
<given-names>Kyeong Kyu</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
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<aff id="aff1">
<sup>1</sup>
<institution>Department of Precision Medicine, Graduate School of Basic Medical Science, Institute for Antimicrobial Resistance Research and Therapeutics, Sungkyunkwan University School of Medicine</institution>, <addr-line>Suwon</addr-line>, <country>Republic of Korea</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Department of Orthopedic Surgery, University of Pittsburgh School of Medicine</institution>, <addr-line>Pittsburgh, PA</addr-line>, <country>United States</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Ahmed Sherif Attia, New Giza University, Egypt</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Karishma Bisht, Princeton University, United States; Reham Wasfi, Faculty of Pharmacy, MSA University, Egypt</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Kyeong Kyu Kim, <email xlink:href="mailto:kyeongkyu@skku.edu">kyeongkyu@skku.edu</email>; Rekha Arya, <email xlink:href="mailto:rekhuarya@gmail.com">rekhuarya@gmail.com</email>; Akhilesh Kumar Chaurasia, <email xlink:href="mailto:chaurasia.ak@gmail.com">chaurasia.ak@gmail.com</email>
</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>10</day>
<month>10</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="collection">
<year>2023</year>
</pub-date>
<volume>13</volume>
<elocation-id>1270667</elocation-id>
<history>
<date date-type="received">
<day>01</day>
<month>08</month>
<year>2023</year>
</date>
<date date-type="accepted">
<day>25</day>
<month>09</month>
<year>2023</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2023 Sultan, Arya, Chaurasia and Kim</copyright-statement>
<copyright-year>2023</copyright-year>
<copyright-holder>Sultan, Arya, Chaurasia and Kim</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>
<italic>Pseudomonas aeruginosa</italic> is a multidrug-resistant opportunistic human pathogen that utilizes two-component systems (TCSs) to sense pathophysiological signals and coordinate virulence. <italic>P. aeruginosa</italic> contains 64 sensor histidine kinases (HKs) and 72 response regulators (RRs) that play important roles in metabolism, bacterial physiology, and virulence. However, the role of some TCSs in virulence remains uncharacterized. In this study, we evaluated the virulence potential of some uncharacterized sensor HK and RR knockouts in <italic>P. aeruginosa</italic> using a <italic>Galleria mellonella</italic> infection model. Furthermore, we demonstrated that KdpD and AauS HKs regulate virulence by affecting <italic>P. aeruginosa</italic> biofilm formation and motility. Both &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> showed reduced biofilm and motility which were confirmed by restored phenotypes upon complementation. Moreover, &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> exhibited increased survival of HeLa cells and <italic>G. mellonella</italic> during <italic>in vivo</italic> infection. Altered expression of the transcriptional regulators <italic>anR</italic> and <italic>lasR</italic>, along with the virulence genes <italic>lasA, pelA, cupA, pqsA, pqsB, pqsC</italic>, and <italic>pqsD</italic> in the mutant strains elucidated the mechanism by which &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> affect virulence. These findings confirm that <italic>kdpD</italic> and <italic>aauS</italic> play important roles in <italic>P. aeruginosa</italic> pathogenesis by regulating biofilm formation and motility.</p>
</abstract>
<kwd-group>
<kwd>
<italic>Pseudomonas aeruginosa</italic>
</kwd>
<kwd>two-component system (TCS)</kwd>
<kwd>sensor histidine kinase</kwd>
<kwd>KdpD</kwd>
<kwd>AauS</kwd>
<kwd>quorum sensing (QS)</kwd>
<kwd>virulence</kwd>
</kwd-group>
<counts>
<fig-count count="6"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="84"/>
<page-count count="13"/>
<word-count count="7895"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Molecular Bacterial Pathogenesis</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<label>1</label>
<title>Introduction</title>
<p>Two-component systems (TCSs) play essential roles in the adaptation and survival of bacteria in various stressful environments, including pathophysiological conditions (<xref ref-type="bibr" rid="B52">Mitrophanov and Groisman, 2008</xref>; <xref ref-type="bibr" rid="B18">De Bentzmann and Pl&#xe9;siat, 2011</xref>). A TCS generally comprises a sensor histidine kinase (HK) and its cognate response regulator (RR). During pathogenesis, the HK responsible for sensing pathophysiological stimuli is phosphorylated and subsequently transfers or phosphorelays the signal to its cognate RR to activate the expression of virulence genes under its control (<xref ref-type="bibr" rid="B68">Stock et&#xa0;al., 2000</xref>). Bacterial virulence depends on virulence determinants, including biofilm formation, motility, lipopolysaccharides, capsules, alginate, pyoverdine, and pyocyanin. It also depends on the secretion of toxins, such as exotoxin A, phospholipases, and proteases, which play vital roles in disease progression caused by <italic>P. aeruginosa</italic> (<xref ref-type="bibr" rid="B46">Leit&#xe3;o, 2020</xref>; <xref ref-type="bibr" rid="B38">Jurado-Mart&#xed;n et&#xa0;al., 2021</xref>).</p>
<p>
<italic>P. aeruginosa</italic> is a Gram-negative, multidrug-resistant, opportunistic bacterium responsible for severe community and nosocomial infections in immunocompromised patients (<xref ref-type="bibr" rid="B18">De Bentzmann and Pl&#xe9;siat, 2011</xref>; <xref ref-type="bibr" rid="B80">Wu et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B27">Gale et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B55">Moradali et&#xa0;al., 2017</xref>). <italic>P. aeruginosa</italic> causes approximately 7.1&#x2013;7.3% of healthcare-associated infections (<xref ref-type="bibr" rid="B49">Magill et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B78">Weiner et&#xa0;al., 2016</xref>), and is the main cause of mortality and morbidity in patients with cystic fibrosis (CF) (<xref ref-type="bibr" rid="B54">Mogayzel et&#xa0;al., 2014</xref>). In a major multinational observational study of the point prevalence of infections in intensive care units, <italic>P. aeruginosa</italic> was reported to be responsible for 16.2% of patients&#x2019; infections and 23% of all ICU-acquired infections (<xref ref-type="bibr" rid="B76">Vincent et&#xa0;al., 2020</xref>). It is a life-threatening bacterium that was included in the priority pathogen list in 2017 (<xref ref-type="bibr" rid="B79">World Health Organization, 2017</xref>).</p>
<p>The <italic>P. aeruginosa</italic> genome contains many TCSs, including 64 sensor HKs and 72 RRs (<xref ref-type="bibr" rid="B23">Francis et&#xa0;al., 2017</xref>). These TCS-controlling networks are promising targets against antimicrobial resistance (AMR), pathogenesis, and biofilm (<xref ref-type="bibr" rid="B23">Francis et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B71">Tierney and Rather, 2019</xref>).</p>
<p>Biofilms are organized bacterial communities that act as buffers against external environmental stress (<xref ref-type="bibr" rid="B83">Yin et&#xa0;al., 2019</xref>). They may form colonies and persist long-term in patients by escaping the host immune system (<xref ref-type="bibr" rid="B43">Kostakioti et&#xa0;al., 2013</xref>). Moreover, extremely structured biofilms have been detected in patients with chronic lung and wound infections (<xref ref-type="bibr" rid="B63">R&#xf6;mling and Balsalobre, 2012</xref>). <italic>P. aeruginosa</italic> is a major biofilm-forming bacterium and the primary cause of 65&#x2013;80% of nosocomial infections (<xref ref-type="bibr" rid="B47">Li et&#xa0;al., 2023</xref>). Motility (swarming, swimming, and twitching) is another important virulence factor in pathogenesis, as it is crucial for mobilization, colonization in multiple environments, adherence, and biofilm formation (<xref ref-type="bibr" rid="B56">O'Toole and Kolter, 1998</xref>). Motility is involved in biofilm formation in many model bacterial pathogens (<xref ref-type="bibr" rid="B42">Korber et&#xa0;al., 1994</xref>; <xref ref-type="bibr" rid="B60">Pratt and Kolter, 1998</xref>).</p>
<p>Previous studies have demonstrated the roles of many TCSs in virulence (<xref ref-type="bibr" rid="B23">Francis et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B69">Sultan et&#xa0;al., 2021</xref>). The TCS GacS/GacA and HKs RetS and LadS act as switches between planktonic and biofilm lifestyles in <italic>P. aeruginosa</italic> (<xref ref-type="bibr" rid="B51">Mikkelsen et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B7">Chambonnier et&#xa0;al., 2016</xref>). BfiS/BfiR, MifS/MifR, and BfmS/BfmR TCSs contribute to biofilm development in a stage-specific manner and cause irreversible attachment, microcolony formation, and maturation, respectively (<xref ref-type="bibr" rid="B59">Petrova and Sauer, 2009</xref>). FleS/FleR, another TCS, regulates the expression of flagellar biosynthetic genes and alters swarming motility (<xref ref-type="bibr" rid="B17">Dasgupta et&#xa0;al., 2003</xref>). Similarly, CarS/CarR is a well-recognized calcium homeostasis TCS that regulates swarming motility and calcium-induced virulence factors (<xref ref-type="bibr" rid="B30">Guragain et&#xa0;al., 2016</xref>). However, the roles of some TCSs in virulence and biofilm formation in <italic>P. aeruginosa</italic> PA14 warrant further elucidation. Therefore, it is necessary to identify uncharacterized TCSs and establish their roles in virulence and biofilm formation to better understand <italic>P. aeruginosa</italic> pathogenesis.</p>
<p>The functional roles of <italic>kdpD, aauS, nasT</italic>, and <italic>cheB</italic> in <italic>P. aeruginosa</italic> virulence are not well characterized (<xref ref-type="bibr" rid="B23">Francis et&#xa0;al., 2017</xref>). Therefore, we monitored their potential for infection in a <italic>G. mellonella</italic> infection model using isogenic knockout strains to investigate their role in virulence. Based on the initial test, <italic>kdpD</italic> and <italic>aauS</italic> played a more substantial role in infection than <italic>nasT</italic> and <italic>cheB.</italic> These two HKs are involved in bacterial physiology. <italic>kdpD</italic> is an essential gene for potassium (K<sup>+</sup>) transport (<xref ref-type="bibr" rid="B24">Freeman et&#xa0;al., 2013</xref>), whereas <italic>aauS</italic> is involved in acidic amino acid utilization (<xref ref-type="bibr" rid="B67">Sonawane and Singh, 2006</xref>). However, their roles in <italic>P. aeruginosa</italic> virulence have not been well characterized. Recently, <xref ref-type="bibr" rid="B3">Badal et&#xa0;al. (2020)</xref> developed an <italic>in vitro</italic> approach to screen the role of 112 TCS of <italic>P. aeruginosa</italic> in biofilm on endotracheal tubes. Out of 112, 56 TCS were found to be involved in biofilm. Of these, 18 new TCSs including AauS and KdpD were identified to contribute in biofilm (<xref ref-type="bibr" rid="B3">Badal et&#xa0;al., 2020</xref>). However, the current study elucidated the role of KdpD and AauS in motility; and virulence by using HeLa cell line, and <italic>G. mellonella</italic> infection model. We further demonstrated the involvement of KdpD and AauS in biofilm using functional genomics and gene expression analyses of relevant genetic cascades to elucidate the mechanism by which <italic>kdpD</italic> and <italic>aauS</italic> affect the biofilm formation, motility, and pathogenesis of <italic>P. aeruginosa</italic> PA14.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<label>2</label>
<title>Materials and methods</title>
<sec id="s2_1">
<label>2.1</label>
<title>Growth and culture conditions of bacterial strains</title>
<p>Non-redundant transposon mutant libraries containing &#x394;<italic>nasT</italic>, &#x394;<italic>cheB</italic>, &#x394;<italic>kdpD</italic>, and &#x394;<italic>aauS</italic> that were developed using PA14 (PA14NR) (<xref ref-type="bibr" rid="B48">Liberati et&#xa0;al., 2006</xref>) were obtained from Harvard Medical School. All strains were grown on cetrimide agar (CA) (Sigma-Aldrich, St. Louis, MO, USA) plates for 16&#x2013;18 h at 37 &#xb0;C. Bacterial cultures were grown in Luria-Bertani (LB) medium (Becton Dickinson, Franklin Lakes, NJ, USA) under orbital shaking culture conditions at 200 rpm. Gentamicin (15 &#x3bc;g/mL) was used to grow the mutants, whereas 50 &#xb5;g/mL carbenicillin (Sigma-Aldrich) was used to grow the strains harboring empty pUCP18 or its derivative plasmids. The mutant complementation strains were grown in the presence of 15 &#x3bc;g/mL gentamicin and 50 &#x3bc;g/mL carbenicillin. Bacterial growth was monitored by measuring the optical density at 600 nm [OD<sub>600nm</sub> = 1.0 = 1.0 &#xd7; 10<sup>9</sup> colony-forming units (CFU/mL)] using a Gen 5 BioTek microplate reader (BioTek, Winooski, VT, USA). Bacterial cells were harvested using 4000 rpm (2701 &#xd7;<italic>g</italic>) centrifugation at 4 &#xb0;C. They were washed once using phosphate buffered saline (PBS, pH 7.2) in all experiments, unless otherwise stated. The strains and plasmids, as well as primers used in the study are listed in <xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Tables S1, S2</bold>
</xref>, respectively.</p>
</sec>
<sec id="s2_2">
<label>2.2</label>
<title>Complementation of &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> mutant strains</title>
<p>To complement the transposon mutants &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic>, the corresponding genes (<italic>kdpD</italic> and <italic>aauS</italic>) were PCR-amplified from <italic>P. aeruginosa</italic> PA14 genomic DNA using specific primers (<xref ref-type="supplementary-material" rid="SM1">
<bold>Table S2</bold>
</xref>). The column purified PCR-amplified DNA fragments, and the pUCP18 vector were restriction endonuclease digested with EcoRI and HindIII. The EcoRI/HindIII-digested <italic>kdpD</italic> and <italic>aauS</italic> genes and pUCP18 vector DNA were resolved on an agarose gel. This was followed by gel elution using a Cosmo Genentech gel elution kit (Seoul, Korea). The gel-eluted <italic>kdpD</italic> and <italic>aauS</italic> were cloned into EcoRI/HindIII sites of the pUCP18 vector to yield the recombinant plasmids pUCP18<italic>kdpD</italic> and pUCP18<italic>aauS</italic>, respectively. These plasmids were transformed into <italic>Escherichia coli</italic> DH5&#x3b1;, and clones were selected on LB agar plates containing 50 &#x3bc;g/mL carbenicillin. The plasmids were isolated using a Cosmo Genentech plasmid isolation kit and DNA was sequenced to verify the accuracy of the nucleotide sequences of the genes in pUCP18<italic>kdpD</italic> and pUCP18<italic>aauS</italic>. The empty control plasmid, pUCP18, was transformed into wild-type (WT), &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> of <italic>P. aeruginosa</italic> PA14. The WT strain possessing pUCP18 (WT::pUCP18) was selected on LB agar plates containing 50 &#x3bc;g/mL carbenicillin. Furthermore, the mutant strains (&#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic>) possessing the empty vector (&#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18) were selected on LB-agar plates containing 15 &#x3bc;g/mL gentamicin and 50 &#x3bc;g/mL carbenicillin. To obtain the knockout-complemented strains (&#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS)</italic>, the recombinant plasmids pUCP18<italic>kdpD and</italic> pUCP18<italic>aauS</italic> were transformed into &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> knockouts and selected on LB plates containing 50 &#x3bc;g/mL carbenicillin and 15 &#x3bc;g/mL gentamicin.</p>
</sec>
<sec id="s2_3">
<label>2.3</label>
<title>Quantification of biofilm formation using a crystal violet assay</title>
<p>Biofilm quantification through crystal violet (CV) staining was performed as previously described (<xref ref-type="bibr" rid="B12">Chen et&#xa0;al., 2018</xref>). Briefly, 16 h cultures of WT, mutant, and mutant-complemented strains were grown in Muller Hinton broth (MHB) (Becton Dickinson) at 37 &#xb0;C and diluted to OD<sub>600</sub> = 1 &#xd7; 10<sup>8</sup> CFU/mL in fresh MHB media. An aliquot of 100 &#x3bc;L bacterial suspension was added to a flat-bottom 96-well polystyrene microtiter plate. After 24 or 48 h incubation at 37 &#xb0;C, unattached cells were removed using two washes of PBS (pH 7.2). Next, 100 &#x3bc;L of 99% methanol was added to each well for 15 min, followed by methanol removal and drying of the plates at room temperature (25&#xb1;1 &#xb0;C) to perform biofilm fixation. Then, 100 &#x3bc;L of 0.04% CV was added for 20 min to stain the biofilm. Samples were washed with sterile PBS three consecutive times to remove additional colorants. Finally, 33% acetic acid was used to solubilize the biofilm-bound CV. Absorbance was measured at 630 nm using a Gen5 BioTek microplate reader (BioTek Instruments, Inc., Agilent Technologies, CA, USA). <italic>pqsA</italic> is an important biofilm producing gene so, &#x394;<italic>pqsA</italic> used as a negative control in the current experiment.</p>
</sec>
<sec id="s2_4">
<label>2.4</label>
<title>Confocal laser scanning microscopy</title>
<p>Bacteria cultures were grown in MHB at 37 &#xb0;C for 16&#x2013;18 h and diluted to OD<sub>600nm</sub> = 1 (1&#xd7;10<sup>8</sup> CFU/mL) in fresh MHB media. Then, 500 &#x3bc;L bacterial suspension was added into an 8-well chambered cover glass (Lab-Tek II 1.5 Borosilicate glass, Sigma-Aldrich) and incubated at 37 &#xb0;C under static culture conditions. The culture medium was changed after 24 h to remove non-attached bacterial cells. After 24 or 48 h of incubation, the biofilms were gently washed with saline [0.85% (w/v) sodium chloride (NaCl)]. Final concentrations of 30 &#x3bc;M propidium iodide (PI), and 5 &#x3bc;M SYTO9 (Sigma-Aldrich) were used for biofilm staining (<xref ref-type="bibr" rid="B11">Chaurasia et&#xa0;al., 2016</xref>). The chambered cover glass was incubated in the dark at room temperature for 20 min. The stained biofilms were washed with PBS prior to confocal microscopy. Biofilms were examined using confocal laser scanning microscopy (CLSM, Zeiss, Oberkochen, Germany) at 20&#xd7; or 63&#xd7; magnifications. Image stacks were collected from 20 random points on each biofilm to obtain accurate mean values for biofilm thickness measurement.</p>
</sec>
<sec id="s2_5">
<label>2.5</label>
<title>Swarming motility assay</title>
<p>Swarming motility was assessed as previously described, with slight modifications (<xref ref-type="bibr" rid="B31">Ha et&#xa0;al., 2014a</xref>). M8-supplemented swarming medium was used to prepare the swarm plates. Briefly, 6 g agar was added to 800 mL water (final concentration = 0.6%) and autoclaved to obtain a sterile, homogeneous agar suspension. A 5&#xd7; M8 solution was prepared using 30 g Na<sub>2</sub>HPO<sub>4</sub>, 15 g KH<sub>2</sub>PO<sub>4</sub>, and 2.5 g NaCl in water by adjusting the final volume to 1 L, autoclaving, and finally adding a 5&#xd7; M8 solution (200 mL) to the melted agar. Next, 20% glucose (final concentration = 0.2%), 20% casamino acids (final concentration = 0.5%), and 1 M MgSO<sub>4</sub> (final concentration = 1 mM) were added to molten agar. The agar medium was mixed gently and cooled before being poured into Petri dishes (~25 mL/plate) and solidified at room temperature. The center of each plate was inoculated with 2.5 &#x3bc;L of OD<sub>600nm</sub> 1 equivalent overnight bacterial culture. Plates were incubated upright at 37 &#xb0;C for 16&#x2013;24 h and observed for the swarming phenotype. The sensor kinase <italic>fleS</italic> of the <italic>fleSR</italic> TCS was used as a negative control in the current experiment, as &#x394;<italic>fleS</italic> alters swarming motility in <italic>P. aeruginosa</italic> PA14 (<xref ref-type="bibr" rid="B41">Kollaran et&#xa0;al., 2019</xref>).</p>
</sec>
<sec id="s2_6">
<label>2.6</label>
<title>Swimming motility assay</title>
<p>Swimming motility was assessed using 0.3% LB agar as previously described, with slight modifications (<xref ref-type="bibr" rid="B20">D&#xe9;ziel et&#xa0;al., 2001</xref>). First, 25 mL media plates were solidified at room temperature for 1.5 h. The cell number was adjusted based on the OD<sub>600nm</sub> value. Then, 100 &#x3bc;L of OD<sub>600nm</sub> 1 bacterial culture was transferred into a 1.5 mL microcentrifuge tube. To avoid the production of swarming and twitching phenotypes, a sterile toothpick was dipped into the OD<sub>600nm</sub> 1 equivalent culture and stabilized in the middle of the agar layer without touching the top or bottom of the Petri plate. The plates were incubated upright for 20 h at 30 &#xb0;C. The phenotype was observed, and the diameters of the swim zones were measured. The hook-associated gene, <italic>flgK</italic>, is essential for flagellar assembly. Additionally, its mutant showed reduced swimming motility (<xref ref-type="bibr" rid="B32">Ha et&#xa0;al., 2014b</xref>). Therefore, in the current experiment &#x394;<italic>flgK</italic> was used as a negative control for the no-swimming phenotypes.</p>
</sec>
<sec id="s2_7">
<label>2.7</label>
<title>Twitching motility assays</title>
<p>Twitching motility was tested as previously described (<xref ref-type="bibr" rid="B20">D&#xe9;ziel et&#xa0;al., 2001</xref>). Twitching motility was assessed on LB plates containing 1% (w/v) agar. A sterile toothpick was dipped into the OD<sub>600nm</sub> 1 equivalent bacterial culture. The toothpick touched the bottom of the Petri plate to move into the interstitial space between the basal surfaces of the agar. The plates were subsequently incubated at 37 &#xb0;C for 48 h. The agar was gently removed from the Petri plate using a spatula to measure the twitch zone. The twitch zone was stained with 2 mL 0.1% (w/v) CV in water for 10 min. The CV was removed, and the plates were washed with water and allowed to air-dry at room temperature. The twitch zone diameters were measured and recorded. As the role of the TCS PilS/PilR in the regulation of type IV pilus expression has been demonstrated (<xref ref-type="bibr" rid="B39">Kilmury and Burrows, 2018a</xref>), we used &#x394;<italic>pilR</italic> as a negative control.</p>
</sec>
<sec id="s2_8">
<label>2.8</label>
<title>Quantitative reverse-transcription polymerase chain reaction analysis</title>
<p>The WT, mutant, and complementation strains were grown in M9 minimal medium for 10 h at 37 &#xb0;C (<xref ref-type="bibr" rid="B21">Egli, 2015</xref>). For identification of biofilm genes bacteria was grown in 8-well chambered cover glass for 10, 24 and 48 h. Planktonic cells were discarded, and biofilm population was used for RNA isolation (<xref ref-type="bibr" rid="B4">Bisht et&#xa0;al., 2021</xref>). Total RNA was isolated using the Qiagen RNeasy kit (Hilden, Germany) according to the manufacturer&#x2019;s protocol. Total RNA (1 &#xb5;g) was treated with RNase-free DNase I (1 U) (amplification grade; Sigma-Aldrich) at room temperature for 15 min. The DNase I reaction was stopped using stop-buffer followed by inactivation of DNase at 70 &#xb0;C for 10 min. To prepare cDNA from the isolated DNA-free mRNA, a random hexamer premix (RNA-to-cDNA EcoDryTM premix; Takara Bio, Kusatsu, Japan) was used. The qRT-PCR was performed using 55 &#xb0;C annealing temperature and SYBR Green Supermix (Bio-Rad, Hercules, CA, USA). Here, <italic>rho</italic> was used as a housekeeping gene. The expression of <italic>kdpD</italic> and <italic>aauS</italic> was normalized to calculate the relative gene expression analyzed using the 2<sup>&#x2212;&#x394;&#x394;CT</sup> method (<xref ref-type="bibr" rid="B65">Schmittgen and Livak, 2008</xref>).</p>
</sec>
<sec id="s2_9">
<label>2.9</label>
<title>Invasion assay</title>
<p>To examine the roles of <italic>kdpD</italic> and <italic>aauS</italic> in <italic>P. aeruginosa</italic> virulence, we performed invasion assays as previously described (<xref ref-type="bibr" rid="B40">Kim et&#xa0;al., 2019</xref>). HeLa cells were grown in Dulbecco&#x2019;s modified Eagle&#x2019;s medium (DMEM) with 10% fetal bovine serum (FBS) in a 5% CO<sub>2</sub> humidified incubator at 37 &#xb0;C. The cells were seeded in 6-well plates (5.0&#xd7;10<sup>5</sup> cells/well) and incubated for 24 h. PBS-washed bacterial cells were placed in invasion medium (DMEM without FBS) for 2 h before infection. Then, WT and mutant strains at a multiplicity of infection <italic>(</italic>MOI<italic>)</italic> of 10 were used to infect HeLa cells for 120 min. Extracellular bacterial cells were killed through 60-min gentamicin (100 &#xb5;g/mL) treatment. Residual gentamicin was removed by washing the cells twice with PBS. The infected cells were treated with 0.1% Triton-X100 to lyse the HeLa cells and retrieve intracellular bacteria, which were then serially diluted in PBS to plate 100 &#xb5;L diluted cell suspension on cetrimide agar plates for CFU enumeration.</p>
</sec>
<sec id="s2_10">
<label>2.10</label>
<title>Live/dead assays</title>
<p>The live/dead assay was performed as previously described (<xref ref-type="bibr" rid="B53">Mittal et&#xa0;al., 2014</xref>). Briefly, DMEM with 10% FBS was used to grow HeLa cells in a 5% CO<sub>2</sub> humidified incubator at 37 &#xb0;C for 48 h. HeLa cells were seeded into 8-well chamber slides (5.0&#xd7;10<sup>5</sup> cells/well) and incubated for 24 h. After two PBS washes, HeLa cells were infected with bacteria at an MOI of 10 for 120 min. Uninfected cells were used as negative (untreated) controls. After incubation, the infected HeLa cells were washed with PBS and a live/dead viability kit was used for staining. Fluorescently stained bacterial cells were observed using CLSM (Zeiss, Oberkochen, Germany) and images were captured.</p>
</sec>
<sec id="s2_11">
<label>2.11</label>
<title>
<italic>G. mellonella</italic> infection model</title>
<p>The overnight grown cultures of <italic>P. aeruginosa</italic> strains were suspended in LB for 6 h. Bacterial cells were collected through 4000 rpm centrifugation (2701 &#xd7;g) at 4 &#xb0;C and washed with PBS (pH 7.2). The number of bacterial cells was maintained by adjusting the optical density (OD<sub>600 nm</sub> = 1) in PBS. <italic>G. mellonella</italic> larvae were stored for 24 h before infection (<xref ref-type="bibr" rid="B50">M&#xe9;nard et&#xa0;al., 2021</xref>). Then, the weight and length of each worm were measured. Ten waxworms of similar size (200 &#xb1; 2 mg, 2 &#xb1; 0.2 cm) were chosen for each group, including the carrier (PBS) control. Waxworms were injected with 10 bacterial cells (20 &#xb5;L) in the last posterior leg using a 0.3 mL syringe (Becton Dickinson) (<xref ref-type="bibr" rid="B19">Desbois and Coote, 2011</xref>; <xref ref-type="bibr" rid="B34">Hill et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B36">Imdad et&#xa0;al., 2018</xref>). Similarly, 20 &#xb5;L PBS was injected into the worms in the control group. After injection, worms were incubated at 27 &#xb0;C and observed at different time points. We applied a health scoring index wherein each worm was given a score based on movement, melaninization, cocoon formation, and survival compared to the untreated control group (<xref ref-type="bibr" rid="B10">Champion et&#xa0;al., 2018</xref>). The experiment was terminated after 72 h and CFUs were counted using CA plates.</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<label>3</label>
<title>Results</title>
<sec id="s3_1">
<label>3.1</label>
<title>Functional assessment of TCSs in virulence using the <italic>G. mellonella</italic> infection model</title>
<p>The relevance of <italic>kdpD</italic>, <italic>aauS</italic>, <italic>nasT</italic>, and <italic>cheB</italic> in <italic>P. aeruginosa</italic> virulence is yet to be well characterized (<xref ref-type="bibr" rid="B23">Francis et&#xa0;al., 2017</xref>). Therefore, we initially tested their roles in virulence using a <italic>G. mellonella</italic> infection model. The hemocytes present in <italic>G. mellonella</italic> larvae share functional similarities with mammalian phagocytic cells (<xref ref-type="bibr" rid="B6">Browne et&#xa0;al., 2013</xref>). Therefore, <italic>G. mellonella</italic> larval infection models have been used to identify virulence-related genes in various human pathogens (<xref ref-type="bibr" rid="B37">Jander et&#xa0;al., 2000</xref>; <xref ref-type="bibr" rid="B8">Champion et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B45">Lebreton et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B58">Peleg et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B9">Champion et&#xa0;al., 2010</xref>). <italic>rsmA</italic>, a virulence gene encoding the carbon storage and a pyocyanin production regulator, was used as a positive control to determine the potential roles of uncharacterized regulators. Mutant strains lacking <italic>rsmA, kdpD</italic>, <italic>aauS</italic>, <italic>nasT</italic>, <italic>cheB</italic>, or the WT were injected into the left posterior legs of <italic>G. mellonella</italic> larvae (n = 10) to assess their roles in the pathogenic potential of <italic>P. aeruginosa</italic> PA14. The results showed only 10% survival in WT strains 72 h post-infection, whereas the &#x394;<italic>rsmA</italic> showed 90% survival compared to the PBS control (100% survival) (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>; <xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S1</bold>
</xref>). However, a delay in mortality was observed for &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic>, with 60% and 30% survival, respectively. The comparative growth profile of &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> knockouts with the WT strain was monitored for physiological fitness to confirm that the difference in their infection potential was not due to their compromised growth proficiency. The growth of the WT, &#x394;<italic>kdpD</italic>, and &#x394;<italic>aauS</italic> strains was identical (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S2</bold>
</xref>). Furthermore, the &#x394;<italic>nasT</italic> and &#x394;<italic>cheB</italic> strains showed earlier mortality than the WT, with only 20% survival 72 h post-infection. These results demonstrate that <italic>kdpD</italic> and <italic>aauS</italic> contribute to virulence. Thus, we further investigated their relevance to the virulence potential of <italic>P. aeruginosa.</italic>
</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Screening of TCS genes relevant to virulence using a <italic>G. mellonella</italic> larvae infection model. The colony farming units (CFUs) (10 for each strain), namely the WT, &#x394;<italic>rsmA</italic>, &#x394;<italic>kdpD</italic>, &#x394;<italic>aauS</italic>, &#x394;<italic>nasT,</italic>or &#x394;<italic>cheB</italic>, were injected into waxworms (<italic>n</italic> =10), followed by incubation at 27 &#xb0;C to examine their survival up to 72 h post-infection. A delay in mortality was observed for &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic>, with 60% and 30% survival, respectively.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1270667-g001.tif"/>
</fig>
</sec>
<sec id="s3_2">
<label>3.2</label>
<title>Roles of <italic>kdpD</italic> and <italic>aauS</italic> in biofilm formation</title>
<p>KdpD/KdpE is an &#x2018;adaptive regulator&#x2019; TCS involved in the virulence and intracellular survival of various pathogenic bacteria (<xref ref-type="bibr" rid="B24">Freeman et&#xa0;al., 2013</xref>). To elucidate the roles of <italic>kdpD</italic> and <italic>aauS</italic> in biofilm formation, we used a CV staining assay, followed by CLSM confirmation and image analysis to determine the quantity and thickness of the biofilm, respectively. Firstly, strains &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> were tested against the WT (positive control) and &#x394;<italic>pqsA (</italic>negative control). After 24 and 48 h, &#x394;<italic>pqsA</italic> showed considerably poor biofilm formation compared to the WT. At 24 h, &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> showed 69.1% and 54.9% reduction in biofilm formation, respectively (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S3A</bold>
</xref>). Similarly, we observed 69.7% and 72.8% inhibition of biofilm formation after 48 h in &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic>, respectively (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S3B</bold>
</xref>). Furthermore, knockouts were complemented with their corresponding genes in the pUCP18 vector to confirm the roles of <italic>kdpD</italic> and <italic>aauS</italic> in biofilm formation. Empty plasmid controls (pUCP18) were used for WT strains and knockouts. At 24 h, knockout strains with the empty plasmids &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 showed 38.7% and 29.0% reduction in biofilm formation, respectively compared to WT::pUCP18 (<xref ref-type="fig" rid="f2">
<bold>Figures&#xa0;2A, B</bold>
</xref>). Similarly, &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 showed 62.7% and 58.7% biofilm reduction, respectively at 48 h. The complemented strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic>, and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> showed biofilm formation similar to that of WT::pUCP18 (<xref ref-type="fig" rid="f2">
<bold>Figures&#xa0;2C, D</bold>
</xref>). These results indicate that <italic>kdpD</italic> and <italic>aauS</italic> contribute to biofilm formation. Furthermore, we investigated biofilm formation in the WT, &#x394;<italic>kdpD</italic>, &#x394;<italic>aauS</italic>, and complementation strains through CLSM using empty plasmid controls. At 24 and 48 h, &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 showed reduced biofilm formation compared to WT::pUCP18, whereas their complemented strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> exhibited similar biofilm formation as WT::pUCP18 (<xref ref-type="fig" rid="f2">
<bold>Figures&#xa0;2E&#x2013;H</bold>
</xref>). Based on these results, we concluded that <italic>kdpD</italic> and <italic>aauS</italic> play vital roles in the biofilm formation of <italic>P. aeruginosa</italic>.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>The roles of <italic>kdpD</italic> and <italic>aauS</italic> in biofilm formation. Qualitative and quantitative analysis of biofilm formation by WT::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18, &#x394;<italic>aauS</italic>::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic>, and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> at 24 and 48 h, performed using 96-well polystyrene plates <bold>(A&#x2013;D)</bold> and 8-chambered covered glass slides <bold>(E&#x2013;H)</bold>. <bold>(A&#x2013;D)</bold> Microtiter wells showing the CV-stained biofilm phenotype at 24 h <bold>(A)</bold> and 48 h <bold>(C)</bold>, and their corresponding quantification at 24 h <bold>(B)</bold> and 48 h <bold>(D)</bold>. <bold>(E&#x2013;H)</bold> A SYTO9- and PI-labelled fluorescent photomicrograph showing biofilm phenotypes at 24 h <bold>(E)</bold> and 48 h <bold>(F)</bold> and their corresponding thickness, as measured through 3D images from CLSM using a 10&#xd7; objective lens at 24 h <bold>(G)</bold> and 48 h <bold>(H)</bold>. Mutant strains &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 showed considerably reduced biofilm formation compared to the WT::pUCP18 strain, as determined using CV staining and fluorescence microscopic analysis. Similar to WT::pUCP18, the complemented strains (&#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic>) restored the biofilm, confirming the role of <italic>kdpD</italic> and <italic>aauS</italic> in the biofilm phenotype of <italic>P. aeruginosa.</italic> All the experiments were performed in triplicates. The significance of the data was analyzed using Student&#x2019;s <italic>t</italic>-test. <italic>P</italic> &lt; 0.05 was considered statistically significant (ns, non significant; *<italic>p</italic> &lt; 0.05, **<italic>p</italic> &lt; 0.01, and ***<italic>p</italic> &lt; 0.005). The scale bar is 100 &#x3bc;m in confocal images.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1270667-g002.tif"/>
</fig>
</sec>
<sec id="s3_3">
<label>3.3</label>
<title>Roles of <italic>kdpD</italic> and <italic>aauS</italic> in motility</title>
<p>Bacterial motility is an important virulence factor in host-pathogen interactions. Therefore, we investigated the relevance of <italic>kdpD</italic> and <italic>aauS</italic> in motility by analyzing the comparative swarming phenotypes of the WT with &#x394;<italic>kdpD</italic>, &#x394;<italic>aauS</italic>, and mutant-complemented strains. Our data revealed markedly reduced swarming (69.7%) in &#x394;<italic>fleS</italic> compared to the WT (<xref ref-type="fig" rid="f3">
<bold>Figures&#xa0;3A, B</bold>
</xref>). Contrastingly, &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> showed 37.5% and 35.8% reduction in swarming motility, respectively compared to the WT (<xref ref-type="fig" rid="f3">
<bold>Figures&#xa0;3A, B</bold>
</xref>). These results indicate that <italic>kdpD</italic> and <italic>aauS</italic> contribute to swarming motility.</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Assessment of the roles of <italic>kdpD</italic> and <italic>aauS</italic> in motility. Comparative qualitative and quantitative analysis of the motility phenotypes of &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> mutant strains with the WT, including <bold>(A, B)</bold> swarming <bold>(A)</bold> and its quantification <bold>(B)</bold>; <bold>(C, D)</bold> swimming <bold>(C)</bold> and its quantification <bold>(D)</bold>; and <bold>(E, F)</bold> twitching <bold>(E)</bold> and its quantification <bold>(F)</bold>. The &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> mutants with empty vectors (&#x394;<italic>kdpD</italic>::pUCP18, &#x394;<italic>aauS</italic>::pUCP18) were both complemented (&#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic>). The complemented strains showed a restoration of swarming <bold>(G)</bold>, swimming <bold>(H)</bold>, and <bold>(I)</bold> twitching motility similar to that of the WT <italic>P. aeruginosa</italic> containing an empty vector (WT::pUCP18<italic>).</italic> All the mobility assay experiments were conducted three times. The significance of the data was analyzed using Student&#x2019;s <italic>t</italic>-test. <italic>P</italic> &lt; 0.05 was considered statistically significant (ns, non significant; **<italic>p</italic> &lt; 0.01, and ***<italic>p</italic> &lt; 0.005). The scale bar is 10 mm in motility plates.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1270667-g003.tif"/>
</fig>
<p>The swimming phenotype is also important for flagellar motility, which plays an important role in infection by various pathogenic bacteria (<xref ref-type="bibr" rid="B35">Horstmann et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B15">Corral et&#xa0;al., 2020</xref>). Therefore, the involvement of <italic>kdpD</italic> and <italic>aauS</italic> was investigated to assess their roles in swimming motility. Here, &#x394;<italic>flgK</italic> showed a reduction of 62.9% in swimming compared to WT, whereas &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> did not (<xref ref-type="fig" rid="f3">
<bold>Figures&#xa0;3C, D</bold>
</xref>). These findings suggest that these two genes are not involved in swimming motility in <italic>P. aeruginosa</italic>. Furthermore, we compared the twitching phenotypes of &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> knockouts with those of the WT strain. We observed 62.9% and 26.5% reductions in twitching activity in &#x394;<italic>pilR</italic> and &#x394;<italic>kdpD</italic> compared to the WT. However, no reduction was observed in the twitching phenotype of the &#x394;<italic>aauS</italic> mutant strain (<xref ref-type="fig" rid="f3">
<bold>Figures&#xa0;3E, F</bold>
</xref>).</p>
<p>We confirmed these results by investigating the motility of WT::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18, &#x394;<italic>aauS</italic>::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic>, and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS.</italic> In this study, &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 showed reduced swarming compared to the empty vector control (WT::pUCP18). In contrast, their corresponding mutant-complemented strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> exhibited a swarming phenotype similar to that of WT::pUCP18 (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3G</bold>
</xref>). These results indicate that <italic>kdpD</italic> and <italic>aauS</italic> contributory roles into the swarming mobility of <italic>P. aeruginosa</italic>. Complementation of the sensor kinases <italic>aauS</italic> and <italic>kdpD</italic> further confirmed that these genes have no role in swimming motility (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3H</bold>
</xref>). <italic>aauS</italic> displayed no role in twitching, whereas <italic>kdpD</italic> played a considerable role in twitching mobility. Similarly, &#x394;<italic>kdpD</italic>::pUCP18 showed reduced twitching, and &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> restored the phenotype to WT::pUCP18 (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3I</bold>
</xref>). These results indicate that <italic>kdpD</italic> contributes to swarming and twitching motility, whereas <italic>aauS</italic> only affects the swarming motility of <italic>P. aeruginosa.</italic>
</p>
</sec>
<sec id="s3_4">
<label>3.4</label>
<title>The roles of <italic>kdpD</italic> and <italic>aauS</italic> in the inhibition of genes involved in biofilm and motility</title>
<p>Well-known genes were initially considered to assess the relative gene expression in &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> knockouts with the empty plasmids to elucidate the role of <italic>kdpD</italic> and <italic>aauS</italic> in biofilm formation, swarming, and twitching mobility. Many genes play important roles in <italic>P. aeruginosa</italic> biofilm formation. For example, <italic>lasA</italic> plays a key role in biofilm development (<xref ref-type="bibr" rid="B70">Thi et&#xa0;al., 2020</xref>) while the <italic>pelA</italic> markedly contributes to the pellicle matrix formation of biofilm in <italic>P. aeruginosa</italic> (<xref ref-type="bibr" rid="B25">Friedman and Kolter, 2004</xref>; <xref ref-type="bibr" rid="B64">Sakuragi and Kolter, 2007</xref>; <xref ref-type="bibr" rid="B14">Colvin et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B77">Wei and Ma, 2013</xref>). Additionally, <italic>cupA</italic> is a crucial fimbria gene that contributes to biofilm formation <italic>via</italic> adhesion (<xref ref-type="bibr" rid="B73">Vallet et&#xa0;al., 2001</xref>; <xref ref-type="bibr" rid="B74">Vallet-Gely et&#xa0;al., 2007</xref>). Therefore, <italic>lasA, pelA</italic>, and <italic>cupA</italic> expression was investigated in the WT with empty plasmids and knockout with the empty plasmid strains. We found reduction in <italic>lasA</italic> expression at 10 h by 62.5% and 39.1% in &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18, respectively (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4A</bold>
</xref>). Complemented strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> restored expression levels to the level of of WT::pUCP18 (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4A</bold>
</xref>). Furthermore, <italic>lasA</italic> expression was also found to be reduced at 24 and 48 h time points by 25.9% and 19.1% in &#x394;<italic>kdpD</italic>::pUCP18; and 22.0% and 26.0% in case of &#x394;<italic>aauS</italic>::pUCP18, respectively (<xref ref-type="fig" rid="f4">
<bold>Figures&#xa0;4B, C</bold>
</xref>). These results demonstrate that <italic>kdpD</italic> and <italic>aauS</italic> contribute to initial biofilm formation by controlling <italic>lasA</italic> expression. We found no significant reduction in <italic>pelA</italic> and <italic>cupA</italic> in both the &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 strains at 10 and 24 h (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figures S4A&#x2013;D</bold>
</xref>). However, at 48 h <italic>pelA</italic> showed slightly reduced expression of 13.0% and 31.0% in the &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 strains, respectively (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4D</bold>
</xref>). Furthermore, <italic>cupA</italic> also showed reduced expression of 21.9% and 15.3% at 48 h in the &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 strains, respectively (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4E</bold>
</xref>). Complemented strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> restored expression levels to the level of WT::pUCP18 (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4E</bold>
</xref>). Overall, these results indicate that <italic>kdpD</italic> and <italic>aauS</italic> contribute to biofilm formation by modulating the expression of <italic>lasA</italic>, <italic>pelA</italic> and <italic>cupA</italic> genes.</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>Quantitative-RT PCR analysis of the transcription factors (TFs) and their downstream genes in <italic>kdpD</italic> and <italic>aauS</italic> knockouts affecting biofilm formation, motility, and pathogenic potentials. <bold>(A&#x2013;C)</bold> Relative expression of biofilm-regulated <italic>lasA</italic> in <italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 mutants compared to WT::pUCP18 and their complemented &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> strains at 10, 24 and 48 h; <bold>(D)</bold> Relative expression of <italic>pelA</italic> in <italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 mutants compared to WT::pUCP18 and their complemented &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> strains at 48 h; <bold>(E)</bold> Relative expression of <italic>cupA</italic> in <italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 mutants compared to WT::pUCP18 and their complemented &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> strains at 48 h; <bold>(F)</bold> Relative gene expression of various transcription regulators (<italic>algR</italic>, <italic>cpxR</italic>, <italic>fuR, rpoD, rpoN, rpoS, lasR, algU, anR, narL</italic>, and <italic>ntbR</italic> in the <italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 mutants) compared to the WT::pUCP18 strain; and <bold>(G)</bold> Relative gene expression of the PQS operon (<italic>pqsA, pqsB pqsC</italic> and <italic>pqsD)</italic> in &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 mutants compared to the WT::pUCP18 strain and their complimented strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS.</italic> All the experiments were performed in triplicates. The significance of the data was analyzed using Student&#x2019;s <italic>t</italic>-test. <italic>P</italic> &lt; 0.05 was considered statistically significant (*<italic>p</italic> &lt; 0.05, **<italic>p</italic> &lt; 0.01, and ***<italic>p</italic> &lt; 0.005, ****<italic>p</italic> &lt; 0.0001).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1270667-g004.tif"/>
</fig>    <p>Many genes and transcription regulators involved in flagellar biosynthesis, assembly and regulation are relevant to motility (<xref ref-type="bibr" rid="B17">Dasgupta et&#xa0;al., 2003</xref>). For example, <italic>fleQ</italic> is an important transcription regulator in <italic>P. aeruginosa</italic>, contributing to transcription of many flagellar genes (<xref ref-type="bibr" rid="B2">Arora et&#xa0;al., 1997</xref>). Similarly, FleS/FleR is a crucial TCS that modulates flagellar motility and adhesion (<xref ref-type="bibr" rid="B62">Ritchings et&#xa0;al., 1995</xref>). FleN is an anti-activator of FleQ, which plays a vital role in retaining a single flagellum (<xref ref-type="bibr" rid="B16">Dasgupta et&#xa0;al., 2000</xref>). In addition, sigma factor &#x3c3;54 encoded by <italic>rpoN</italic> contributes to the regulation of flagellar expression (<xref ref-type="bibr" rid="B72">Totten et&#xa0;al., 1990</xref>). Furthermore, <italic>flgM</italic> is an important flagellar gene whose interactions with the sigma factor <italic>fliA</italic> contribute to flagellar biogenesis (<xref ref-type="bibr" rid="B26">Frisk et&#xa0;al., 2002</xref>). We analyzed the expression of several flagellar genes and transcription regulators in &#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> strains to investigate <italic>kdpD</italic> and <italic>aauS</italic> contribution to motility. There were no significant differences in the expression levels of the major motility-regulated genes <italic>fleS</italic>, <italic>fleR</italic>, <italic>fleQ</italic>, <italic>flgK</italic>, <italic>fliC</italic>, <italic>fliD</italic>, <italic>flgD</italic>, and <italic>flgE</italic> (<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Figure S5</bold>
</xref>). Therefore, a top-down approach was applied to comprehensively elucidate the mechanistic roles of <italic>kdpD</italic> and <italic>aauS</italic> in biofilm, motility, and pathogenesis. The expression of known transcription factors (TF) in &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 compared to WT::pUCP18 was examined using q-RT-PCR. Accordingly, the transcriptional regulators (<italic>algR</italic>, <italic>cpxR</italic>, <italic>furR</italic>, <italic>rpoD</italic>, <italic>rpoN</italic>, <italic>rpoS</italic>, <italic>lasR</italic>, <italic>algU</italic>, <italic>anR</italic>, <italic>narL</italic>, and <italic>nbtR</italic>) that are directly or indirectly involved in biofilm formation, motility, and virulence gene expression have been assessed (<xref ref-type="bibr" rid="B61">Pusic et&#xa0;al., 2021</xref>). In this study, the expression levels of <italic>lasR</italic> was enhanced by 190% and 110% in &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18, respectively, compared to WT::pUCP18 (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4F</bold>
</xref>). Secondly, the <italic>anR</italic> expression was increased by 130% and 306% in &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18, respectively; compared to WT::pUCP18 (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4F</bold>
</xref>). <italic>anR</italic> and <italic>lasR</italic> contribute to biofilm formation and motility by controlling the <italic>Pseudomonas</italic> quinolone signal (PQS) quorum sensing (QS) system (<xref ref-type="bibr" rid="B61">Pusic et&#xa0;al., 2021</xref>). The <italic>las</italic>-QS system is essential for PQS-stimulated biofilm formation in <italic>P. aeruginosa</italic> PA14 (<xref ref-type="bibr" rid="B13">Christiaen et&#xa0;al., 2014</xref>). These results partially demonstrate that <italic>kdpD</italic> and <italic>aauS</italic> contribute to biofilm formation by controlling <italic>lasA</italic> expression through the <italic>lasR</italic> TF. PQS suppresses swarming motility in <italic>P. aeruginosa</italic> PA14 (<xref ref-type="bibr" rid="B29">Guo et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B28">Garc&#xed;a-Reyes et&#xa0;al., 2021</xref>). Therefore, we confirmed the expression levels of <italic>pqs</italic> in &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18. Our results showed increased <italic>pqsA</italic>, <italic>pqsB</italic>, <italic>pqsC</italic>, and <italic>pqsD</italic> expression (141%, 208%, 115% and 230%) in &#x394;<italic>kdpD</italic>::pUCP18, and (169%, 228%, 107% and 127%) in &#x394;<italic>aauS</italic>::pUCP18 strains (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4G</bold>
</xref>). Their expression was restored to that observed in WT::pUCP18 in the complemented (&#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic>) strains. Overall, these results indicate that <italic>kdpD</italic> and <italic>aauS</italic> contribute to swarming motility by altering the expression of the PQS quorum sensing system controlled by <italic>anR</italic> and <italic>lasR</italic> transcriptional regulators.</p>
</sec>
<sec id="s3_5">
<label>3.5</label>
<title>&#x394;<italic>kdpD</italic> and &#x394;<italic>aauS</italic> attenuate HeLa cell invasion and increased host cell survival</title>
<p>
<italic>P. aeruginosa</italic> mainly invades mammalian epithelial cells via the type III secretion system (T3S) (<xref ref-type="bibr" rid="B33">Hern&#xe1;ndez-Padilla et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B44">Kroken et&#xa0;al., 2018</xref>). Therefore, we investigated the invasive activity of mutant strains with empty plasmids to evaluate the roles of <italic>kdpD</italic> and <italic>aauS</italic> in cell invasion. HeLa cells were infected with bacteria at an MOI of 10 for 120 min, and the number of intracellular bacterial cells was measured through CFU enumeration. Strains &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 showed reduced invasion activity, with intracellular CFUs difference of 2.0<italic>&#xd7;</italic>10<sup>3</sup> and 2.3&#xd7;10<sup>3</sup> CFU/mL, respectively compared to WT::pUCP18. In contrast, the intracellular CFU of the WT::pUCP18 strain was 3.7&#xd7;10<sup>3</sup> CFU/mL (<xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5A</bold>
</xref>). Moreover, the complemented strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> restored the intracellular CFU count to that of WT::pUCP18.</p>
<fig id="f5" position="float">
<label>Figure&#xa0;5</label>
<caption>
<p>Role of <italic>kdpD</italic> and <italic>aauS</italic> in host cell survival in mammalian cell culture conditions. <bold>(A)</bold> Assessment of role of <italic>kdpD</italic> and <italic>aauS</italic> the internalization potential of using GPA. HeLa cells were infected with bacteria at an MOI of 10 for 120 min in a 5% CO<sub>2</sub> environment at 37 <bold>&#xb0;</bold>C. Extracellular bacteria were killed through gentamycin treatment, and internalized bacterial cells were assessed through CFU determination. <bold>(B)</bold> Assessment of the <italic>in vitro</italic> pathogenic potential of various strains using live/dead staining of the host-pathogen complex after infection, wherein HeLa cells were infected with WT::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18, &#x394;<italic>aauS</italic>::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic>, and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> at an <italic>MOI</italic> of 10. Untreated cells were used as negative controls. After 2 h infection, the cells were stained with PI (red fluorescence) and fluorescein diacetate (green fluorescence) and visualized using CLSM. Green represents live cells, whereas red represents dead cells. Knockout strains of <italic>kdpD</italic> and <italic>aauS</italic> with empty vectors (&#x394;<italic>kdpD</italic>::pUCP18, &#x394;<italic>aauS</italic>::pUCP18) were the least toxic to host cells compared to the wild-type with empty vectors (WT::pUCP18) and complemented strains (&#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic>). The experiments were performed in triplicates. The significance of the data was analyzed using Student&#x2019;s <italic>t</italic>-test. <italic>P</italic> &lt; 0.05 was considered statistically significant (ns, non significant; ***<italic>p</italic> &lt; 0.005, ****<italic>p</italic> &lt; 0.0001). The scale bar is 20 &#x3bc;m in live dead images.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1270667-g005.tif"/>
</fig>
<p>The host-pathogen complex was stained with live/dead (green/red) reagents to further evaluate the roles of <italic>kdpD</italic> and <italic>aauS</italic> in HeLa cell infection. Uninfected HeLa cells mostly retained green fluorophores (Untreated, <xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5B</bold>
</xref>). A high number of dead host cells was observed when WT::pUCP18 was added (<xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5B</bold>
</xref>). Moreover, a markedly increased number of live cells was observed when host cells were infected with &#x394;<italic>kdpD</italic>::pUCP18 or &#x394;<italic>aauS</italic>::pUCP18 (<xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5B</bold>
</xref>). Contrastingly, a considerable number of dead host cells was observed when the complemented strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> were used to infect HeLa cells. These results demonstrate the involvement of <italic>kdpD</italic> and <italic>aauS</italic> in host cell invasion and infection.</p>
</sec>
<sec id="s3_6">
<label>3.6</label>
<title>
<italic>kdpD</italic> and <italic>aauS</italic> play critical roles in <italic>G. mellonella</italic> infection</title>
<p>
<italic>G. mellonella</italic> larvae were challenged with WT::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18, &#x394;<italic>aauS</italic>::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic>, and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> at 10 CFU/larvae to further analyze the roles of <italic>kdpD</italic> and <italic>aauS</italic> in virulence. The WT::pUCP18 bacterial load was designed to allow 10% survival 72 h post-infection. Then, survival percentages of the larvae and their health indices were recorded. Our results indicated delayed mortality, with increased survival in &#x394;<italic>kdpD</italic>::pUCP18 (60%) and &#x394;<italic>aauS</italic>::pUCP18 (40%) compared to WT::pUCP18, after 72 h. This is consistent with the results obtained in the initial screening (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>). We further investigated the infection properties of complemented &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> strains. The results showed a survival comparable to that of WT::pUCP18 cells (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6A</bold>
</xref>). We also recorded the health index of each strain based on movement, cocoon formation, melaninization, and survival. Our results showed greater movement, full cocoon formation with less melaninization, and increased survival in larvae infected with &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 than in those infected with WT::pUCP18. However, larvae infected with &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic>showed less movement, greater melaninization, less cocoon formation, and decreased survival 72 h post-infection, demonstrating results similar to those of WT::pUCP18 (<xref ref-type="fig" rid="f6">
<bold>Figures&#xa0;6B, C</bold>
</xref>). Next, we determined the bacterial burden in the worms by measuring the number of bacteria in the infected larvae. Larvae infected with &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 showed 1.7<italic>&#xd7;</italic>10<sup>5</sup> and 3.4<italic>&#xd7;</italic>10<sup>5</sup>CFU/mL, respectively. These were lower than the 9.3<italic>&#xd7;</italic>10<sup>5</sup> CFU/mL observed in the WT::pUCP18 strain (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6D</bold>
</xref>). However, strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> showed no significant reduction in CFU compared to WT::pUCP18 (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6D</bold>
</xref>). These results were consistent with the survival and health index results, indicating that <italic>kdpD</italic> and <italic>aauS</italic> play important roles in <italic>G. mellonella</italic> infection.</p>
<fig id="f6" position="float">
<label>Figure&#xa0;6</label>
<caption>
<p>Confirming the roles of <italic>kdpD</italic> and <italic>aauS</italic> in the virulence potential of <italic>P. aeruginosa</italic> using the <italic>G. mellonella</italic> infection model. <bold>(A)</bold> Survival of <italic>G. mellonella</italic> larvae infected with 10 CFU of WT::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18, &#x394;<italic>aauS</italic>::pUCP18, &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic>, and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic> strains. The number of larvae in each group was 10 (n =10). The larvae were injected with 20 &#xb5;L bacterial solution, and their survival was examined for 72 (h) The control group received 20 &#xb5;L PBS. <bold>(B)</bold> The health index of larvae is plotted as an average of each group at multiple time points based on the health scoring index (movement, melaninization, cocoon formation, and survival). <bold>(C)</bold> An image showing the differential melaninization and death of waxworms infected with different bacterial strains; and <bold>(D)</bold> Assessment of CFUs recovered on selective media CA after 72 h of infection. The experiments were performed in triplicates. The significance of the data was analyzed using Student&#x2019;s <italic>t</italic>-test. <italic>P</italic> &lt; 0.05 was considered statistically significant (ns, non significant; **<italic>p</italic> &lt; 0.01, and ***<italic>p</italic> &lt; 0.005).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1270667-g006.tif"/>
</fig>
</sec>
</sec>
<sec id="s4" sec-type="discussion">
<label>4</label>
<title>Discussion</title>
<p>
<italic>P. aeruginosa</italic> is a gram-negative environmental MDR pathogen responsible for acute and chronic diseases, owing to its extensive biofilm formation. Protease, elastase, and phospholipase (<xref ref-type="bibr" rid="B75">Vasil, 1986</xref>) determine <italic>P. aeruginosa</italic> biofilm production, motility, pigment secretion, and pathogenic potential. These virulence determinants play important roles in bacterial colonization and host tissue invasion, which may lead to life-threatening infections. Chronic infections caused by biofilm formation include chronic pneumonia in patients with CF, colonization of ventilators and urinary catheters, and infected burn wounds (<xref ref-type="bibr" rid="B5">Bjarnsholt, 2013</xref>). Moreover, pseudomonad biofilm is a major cause of antimicrobial therapy failure because the biofilm enhances antimicrobial resistance by 2&#x2013;3 log values (<xref ref-type="bibr" rid="B82">Yin et&#xa0;al., 2022</xref>).</p>
<p>
<italic>P. aeruginosa</italic> uses TCSs to sense signals and coordinate bacterial virulence. The sensor HKs and RRs considerably contribute to <italic>P. aeruginosa</italic> metabolism and pathophysiology. However, only a few of these TCSs have been studied to investigate their role in virulence. Therefore, we screened a few <italic>P. aeruginosa</italic> TCSs whose functions in virulence are not clearly understood. We assessed the virulence potential of their mutant strains and identified two HKs that are involved in <italic>P. aeruginosa</italic> virulence. Furthermore, we investigated and confirmed the roles of these TCSs in the biofilm formation and motility of <italic>P. aeruginosa</italic>.</p>
<p>KdpD senses environmental signals to activate the expression of the K<sup>+</sup> transport system in <italic>E. coli</italic> (<xref ref-type="bibr" rid="B22">Epstein, 2016</xref>). Previous studies have emphasized its role in the virulence of other bacteria (<xref ref-type="bibr" rid="B84">Zhao et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B81">Xue et&#xa0;al., 2020</xref>). KdpD/KdpE is responsible for the virulence and motility of avian pathogenic <italic>E. coli</italic> (<xref ref-type="bibr" rid="B81">Xue et&#xa0;al., 2020</xref>). This TCS regulates the transcription of the flagellar-associated genes <italic>fliR</italic> and <italic>fliP</italic>. The deletion of KdpD/KdpE modulates the expression of several genes, including <italic>cap</italic> (synthesis of capsule), <italic>hla</italic> (alpha-toxin), <italic>spa</italic> (surface protein), <italic>geh</italic> (lipase gene), and <italic>hlgB</italic> (gamma-hemolysin), in <italic>S. aureus</italic> (<xref ref-type="bibr" rid="B84">Zhao et&#xa0;al., 2010</xref>). The AauS/AauR TCS is involved in acidic amino acid utilization in <italic>Pseudomonas putida</italic> (<xref ref-type="bibr" rid="B67">Sonawane and Singh, 2006</xref>). In <italic>P. putida</italic>, &#x394;<italic>aauS</italic> and &#x394;<italic>aauR</italic> cannot consume glutamate, aspartate, or glutamine as the sole nitrogen and carbon sources (<xref ref-type="bibr" rid="B67">Sonawane and Singh, 2006</xref>). Additionally, KdpD/KdpE regulation responds to virulence-related conditions, including phagocytosis, exposure to microbicides, host hormones, and quorum sensing (QS) signals (<xref ref-type="bibr" rid="B24">Freeman et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B1">Ali et&#xa0;al., 2017</xref>). However, the role of <italic>aauS</italic> in the virulence of other bacteria, including <italic>P</italic>. <italic>aeruginosa</italic> has not been intensively investigated until now. Therefore, our results provide clear evidence of <italic>kdpD</italic> and <italic>aauS</italic>-mediated <italic>P. aeruginosa</italic> virulence.</p>
<p>Several TCSs contribute to biofilm formation in <italic>P. aeruginosa</italic> by sensing signals, eventually causing the bacteria to enter the sessile phase (<xref ref-type="bibr" rid="B51">Mikkelsen et&#xa0;al., 2011</xref>). GacS/GacA acts along with RetS and LadS to regulate the switch between planktonic and biofilm lifestyles (<xref ref-type="bibr" rid="B51">Mikkelsen et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B7">Chambonnier et&#xa0;al., 2016</xref>). Biofilm formation occurs at different stages, with BfiS/BfiR, MifS/MifR, and BfmS/BfmR playing essential roles in irreversible attachment, microcolony formation, and maturation of biofilm (<xref ref-type="bibr" rid="B59">Petrova and Sauer, 2009</xref>). Furthermore, microarray analysis and promoter fusion confirmed the role of FleSR in biofilm formation (<xref ref-type="bibr" rid="B17">Dasgupta et&#xa0;al., 2003</xref>). Our quantitative biofilm results and confocal microscopy data showed <italic>kdpD</italic> and <italic>aauS</italic> involvement in the regulation of biofilm formation (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2</bold>
</xref>). Therefore, in addition to known biofilm-associated TCSs, we propose that KdpD/KdpE and AauR/AauS are responsible for biofilm formation. In <italic>P. aeruginosa</italic>, QS systems play vital roles in biofilm formation (<xref ref-type="bibr" rid="B66">Solano et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B70">Thi et&#xa0;al., 2020</xref>). Therefore, the HK KdpD sensor could activate its cognate RR to express the genes involved in biofilm formation. Our gene expression results showed reduced expression of <italic>pelA</italic>, <italic>cupA</italic>, increased <italic>lasR</italic> TF expression and reduced expression of the downstream gene <italic>lasA</italic> in &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18, confirming that <italic>kdpD</italic> and <italic>aauS</italic> involvement in biofilm formation occurs via the <italic>pelA</italic>, <italic>cupA</italic> and <italic>las</italic>-QS system (<xref ref-type="fig" rid="f4">
<bold>Figures&#xa0;4A&#x2013;E</bold>
</xref>). The role of KdpD and AauS in <italic>P. aeruginosa</italic> biofilm is consistent with study of <xref ref-type="bibr" rid="B3">Badal et&#xa0;al. (2020)</xref> wherein KdpD and AauS was identified to involve in biofilm formation of <italic>P. aeruginosa</italic> on endotracheal tubes (<xref ref-type="bibr" rid="B3">Badal et&#xa0;al., 2020</xref>).</p>
<p>The pathogenesis of <italic>P. aeruginosa</italic> depends on motility, which modulates its mobilization and colonization during biofilm formation (<xref ref-type="bibr" rid="B56">O'Toole and Kolter, 1998</xref>), as demonstrated in studies investigating <italic>P. fluorescens</italic> and <italic>E. coli</italic> (<xref ref-type="bibr" rid="B42">Korber et&#xa0;al., 1994</xref>; <xref ref-type="bibr" rid="B60">Pratt and Kolter, 1998</xref>). Many TCSs and genes are associated with swarming, swimming, and twitching motility (<xref ref-type="bibr" rid="B69">Sultan et&#xa0;al., 2021</xref>). For example, FleS/FleR regulates the expression of flagellar biosynthetic genes and alters swarming motility. Similarly, CarS/CarR senses and modulates Ca<sup>2+</sup> homeostasis. This crucial TCS further contributes to swarming motility via <italic>carP</italic> (<xref ref-type="bibr" rid="B30">Guragain et&#xa0;al., 2016</xref>). PilS/PilR is another important TCS responsible for twitching and flagellum-dependent swimming motility (<xref ref-type="bibr" rid="B39">Kilmury and Burrows, 2018a</xref>). As we did not observe any changes in <italic>pilS</italic>, <italic>pilR</italic>, <italic>carS</italic>, or <italic>carR</italic> in the <italic>kdpD</italic> or <italic>aauS</italic> knockout strains, their contribution to motility seemed to be independent of PilS/PilR or CarS/CarR involvement. Similarly, we did not observe any mechanistic role of <italic>kdpD</italic> and <italic>aauS</italic> in motility by FleS/FleR, as there were no significant differences in the expression of flagellar genes. The metabolic regulator <italic>anR</italic> and quorum-sensing regulator <italic>lasR</italic> control the PQS system to regulate biofilm formation and motility (<xref ref-type="bibr" rid="B61">Pusic et&#xa0;al., 2021</xref>). PQS suppresses swarming motility in <italic>P. aeruginosa</italic> PA14 (<xref ref-type="bibr" rid="B29">Guo et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B28">Garc&#xed;a-Reyes et&#xa0;al., 2021</xref>). In this study, <italic>anR</italic> and <italic>lasR</italic> expression was increased in <italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 knockouts, confirming the roles of <italic>kdpD</italic> and <italic>aauS</italic> in swarming motility, which is conferred by these transcription regulators. The expression of PQS genes increases when <italic>anR</italic> and <italic>lasR</italic> expression is upregulated (<xref ref-type="bibr" rid="B61">Pusic et&#xa0;al., 2021</xref>). In our study, <italic>pqsA, pqsB, pqsC</italic>, and <italic>pqsD</italic> expression was also increased in &#x394;<italic>kdpD</italic>::pUCP18 and &#x394;<italic>aauS</italic>::pUCP18 knockouts (<xref ref-type="fig" rid="f4">
<bold>Figure&#xa0;4G</bold>
</xref>). This expression was restored to the level of WT::pUCP18 in the complement strains &#x394;<italic>kdpD</italic>::pUCP18<italic>kdpD</italic> and &#x394;<italic>aauS</italic>::pUCP18<italic>aauS</italic>. Overall, these results confirmed that <italic>kdpD</italic> plays a role in swarming motility by altering the expression of PQS quorum sensing system controlled by <italic>anR</italic> and <italic>lasR</italic> transcription regulators.</p>
<p>Several swarming-deficient mutants of <italic>P. aeruginosa</italic> showed poor biofilm formation, suggesting a strong relationship between swarming and biofilm formation (<xref ref-type="bibr" rid="B57">Overhage et&#xa0;al., 2007</xref>). Consistent with this finding, <italic>kdpD</italic> and <italic>aauS</italic> were associated with the swarming phenotype and biofilm formation in our study. However, twitching activity was not altered by <italic>aauS</italic> but was affected by <italic>kdpD.</italic> Furthermore, <italic>kdpD</italic> and <italic>aauS</italic> exhibited no roles in swimming motility. These results suggest that KdpD and AauS sensor HKs contribute to <italic>P. aeruginosa</italic> virulence through swarming motility.</p>
<p>In this study, we identified the roles of <italic>kdpD</italic> and <italic>aauS</italic> in the biofilm formation and motility of <italic>P. aeruginosa via</italic> several key genes involved in these virulence phenotypes. These roles were validated through cell invasion (<xref ref-type="fig" rid="f5">
<bold>Figure&#xa0;5</bold>
</xref>) and a <italic>G. mellonella</italic> infection model (<xref ref-type="fig" rid="f6">
<bold>Figure&#xa0;6</bold>
</xref>). The effects of <italic>kdpD</italic> and <italic>aauS</italic> were minimal on phenotype reduction in their knockout strains compared with the genes used as controls, such as <italic>pqsA</italic> for biofilm formation and <italic>fleS, flgK</italic>, and <italic>pilR</italic> for motility. However, our results clearly demonstrate the contributions of <italic>kdpD</italic> and <italic>aauS</italic> to the virulence phenotype. This was confirmed by the reduced infection activity of the knockout strain in the infection model and reduced expression of genes that control virulence. Therefore, we propose that <italic>kdpD</italic> and <italic>aauS</italic> are virulence-controlling TCSs. This study represents a milestone in the development of methods for identifying and validating key genes involved in bacterial virulence. Furthermore, our findings provide a molecular basis for understanding the virulence of <italic>P. aeruginosa</italic> and contribute to the design of inhibitors that target TCSs to overcome biofilm-mediated AMR.</p>
</sec>
<sec id="s5" sec-type="data-availability">
<title>Data availability statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="supplementary-material" rid="s11">
<bold>Supplementary material</bold>
</xref>. Further inquiries can be directed to the corresponding authors.</p>
</sec>
<sec id="s6" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>Ethical approval was not required for the study involving animals in accordance with the local legislation and institutional requirements because We do not use animals for experiments.</p>
</sec>
<sec id="s7" sec-type="author-contributions">
<title>Author contributions</title>
<p>MS: Writing &#x2013; original draft, Writing &#x2013; review &amp; editing, Data curation, Investigation, Methodology. RA: Writing &#x2013; review &amp; editing, Conceptualization, Supervision. AC: Conceptualization, Supervision, Writing &#x2013; review &amp; editing, Investigation, Writing &#x2013; original draft. KK: Conceptualization, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing, Funding acquisition.</p>
</sec>
</body>
<back>
<sec id="s8" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Research Foundation (NRF) of Korea grant to KKK (2017M3A9E4078553 and 2021M3A9I2080487). The funders had no role in the study design, data collection, analysis, interpretation, or the decision to submit this work for publication.</p>
</sec>
<sec id="s9" 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="s10" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s11" sec-type="supplementary-material">
<title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fcimb.2023.1270667/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fcimb.2023.1270667/full#supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="DataSheet_1.pdf" id="SM1" mimetype="application/pdf"/>
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