title: Persister formation inStaphylococcus aureusis associated with ATP depletion.
abstract: Persisters are dormant phenotypic variants of bacterial cells that are tolerant to killing by antibiotics1. Persisters are associated with chronic infections and antibiotic treatment failure1-3. InEscherichia coli, toxin/antitoxin (TA) modules have been linked to persister formation4-6. The mechanism of persister formation in Gram-positive bacteria is unknown.Staphylococcus aureusis a major human pathogen, responsible for a variety of chronic and relapsing infections such as osteomyelitis, endocarditis and infections of implanted devices. Deleting TA modules inS. aureusdid not affect the level of persisters. Here we show thatS. aureuspersisters are produced due to a stochastic entrance into stationary phase accompanied by a drop in intracellular ATP. Cells expressing stationary state markers are present throughout the growth phase, increasing in frequency with cell density. Cell sorting revealed that expression of stationary markers is associated with a 100-1000 fold increase in the likelihood of survival to antibiotic challenge. The ATP level of the cell is predictive of bactericidal antibiotic efficacy and explains bacterial tolerance to antibiotics.
authors.affiliation: Antimicrobial Discovery Center, Department of Biology, Northeastern University, Massachusetts 02115.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Conlon
authors.affiliation: Antimicrobial Discovery Center, Department of Biology, Northeastern University, Massachusetts 02115; Synlogic, Cambridge, Massachusetts 02139.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Rowe
authors.affiliation: Antimicrobial Discovery Center, Department of Biology, Northeastern University, Massachusetts 02115.
authors.forename: Autumn Brown
authors.initials: AB
authors.lastname: Gandt
authors.affiliation: Antimicrobial Discovery Center, Department of Biology, Northeastern University, Massachusetts 02115.
authors.forename: Austin S
authors.initials: AS
authors.lastname: Nuxoll
authors.affiliation: Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, 03755.
authors.forename: Niles P
authors.initials: NP
authors.lastname: Donegan
authors.affiliation: Antimicrobial Discovery Center, Department of Biology, Northeastern University, Massachusetts 02115.
authors.forename: Eliza A
authors.initials: EA
authors.lastname: Zalis
authors.affiliation: Biological Sciences Division, Pacific Northwest National Laboratory, Richland, Washington 99352.
authors.forename: Geremy
authors.initials: G
authors.lastname: Clair
authors.affiliation: Biological Sciences Division, Pacific Northwest National Laboratory, Richland, Washington 99352.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Adkins
authors.affiliation: Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, 03755.
authors.forename: Ambrose L
authors.initials: AL
authors.lastname: Cheung
authors.affiliation: Antimicrobial Discovery Center, Department of Biology, Northeastern University, Massachusetts 02115.
authors.forename: Kim
authors.initials: K
authors.lastname: Lewis