INTRODUCTION
Iron is an essential trace element for most life forms, occupying key positions in diverse metalloenzymes, spanning those involved in energy-yielding reactions to those critical for cellular defense (
1–3). In the context of infections, the iron requirement of pathogens has resulted in an evolutionary arms race between host and microbe to sequester and obtain iron, respectively (
4). The outcome of the infection depends on who wins this race: for example, iron can promote the formation of biofilms, complex microbial structures that are physiologically resistant to common antibiotics (
5–7). Iron commonly exists in one of two oxidation states: the oxidized form, ferric iron [Fe(III)]; or the reduced form, ferrous iron [Fe(II)]. Fe(III) predominates in oxic environments, whereas Fe(II) is more stable under hypoxic and/or reducing conditions, with its ionic form (Fe
2+) predominating at low pH and reduction potential (Eh) (
8). While Fe(III) uptake systems have been the focus of most mechanistically oriented studies, growing attention has been placed on the importance of Fe(II) sensing and uptake by pathogens. For example,
Pseudomonas aeruginosa, the opportunistic pathogen renowned for causing chronic pulmonary infections in CF patients, contains an Fe(II)-specific two-component system, BqsRS (
9);
Haemophilus influenzae, another respiratory tract pathogen, contains a different Fe(II)-responsive two-component system, FirRS (
10).
Recently, we reported average per patient micromolar concentrations of Fe(II) in the mucus-filled environment of the lungs of cystic fibrosis (CF) patients (
11). While the average value of sputum Fe(II) from patients at advanced stages of disease progression was ~40 µM, considerable variation existed between samples, with many presenting values greater than 100 µM and some over 200 µM. Fe(II), not Fe(III), correlated with severe lung function decline, with statistical significance comparable to or greater than that of other inflammatory indices (
12,
13). While the presence of high Fe(II) concentrations in the lung may seem paradoxical given it is the site for oxygen exchange into the bloodstream (
14), this finding is consistent with several studies that have found the CF mucus environment to contain hypoxic, if not anoxic, niches (
15,
16). It is perhaps not coincidental that BqsRS-containing members of the
Pseudomonadaceae are commonly found in soils and sediments (
17), where Fe(II) can reach low micromolar concentrations (
18). This environmental reservoir, together with the high Fe(II) concentrations found in sputum, may help contextualize why BqsRS is present in all sequenced strains of P. aeruginosa and why
bqsS transcripts were detected in the majority of CF sputum samples tested (
11).
With Fe(II) as a significant component of the CF lung environment and extracellular Fe(II) sensing predicted to be a conserved trait among diverse members of the
Pseudomonadaceae, it is important to understand how P. aeruginosa responds to Fe(II). Other members of the
Pseudomonadaceae (e.g.,
Azotobacter vinelandii) also contain BqsRS homologs, further motivating studies to better characterize this sensory system. P. aeruginosa has one of the largest regulatory networks of any bacterial species, which allows it to precisely control its response to a variety of environmental stimuli (
19). The two-component system BqsRS was originally discovered as an effector of biofilm dissolution and quorum sensing (
20); in a study using zebrafish embryos to screen two-component systems in P. aeruginosa for phenotypes, BqsS was shown to significantly impact the establishment of infection in the zebrafish host (
21). When the trace metal concentration in the medium was controlled by chelation, we showed that BqsRS responds specifically to extracellular Fe(II) at concentrations exceeding 10 µM (
9). However, while our previous study identified the
bqs operon and a small number of BqsR-regulated genes, it did not define the BqsR regulon.
Because bqsS transcripts are detectable in CF sputum from patients with chronic P. aeruginosa infections, we wondered whether the BqsRS regulon might control factors that affect its adaptation to the Fe(II)-replete environment of CF sputum. We are broadly interested in understanding how P. aeruginosa survives under conditions relevant to the microenvironment of chronic infections, including anoxia and antimicrobial stressors. Here, we sought to gain insight into how BqsS senses Fe(II) and how BqsR controls gene transcription. We identified the BqsRS regulon through bioinformatic, genetic, and biochemical approaches and tested predicted phenotypes. This study expands our knowledge of how P. aeruginosa responds to Fe(II) and suggests that a common mechanism helps protect the cell against Fe(II) and other cationic stressors, including certain clinically relevant antibiotics.
DISCUSSION
Characterizing the environment that pathogens encounter within the human host can help us understand their behavior. This principle is illustrated by connecting the output of the BqsRS regulatory system to the chemical context of CF sputum. Our research suggests that Fe(II) is an important environmental variable that P. aeruginosa senses through BqsRS, leading to a response that helps it cope not only with elevated Fe(II) concentrations but multiple cationic stressors within the CF lung environment.
The ability of BqsRS to specifically respond to Fe(II) is an interesting example of metal selectivity (
9). Our results indicate that BqsS recognizes Fe(II) via the RExxE motif in its periplasmic domain, based on analogy to other Fe-sensing proteins. Although it is unusual for glutamates to prefer Fe(II) to Fe(III), the strongly positive arginine may tune the ligand environment to prefer the less positively charged Fe(II) over Fe(III). While PmrB from
S. typhimurium senses Fe(III) rather than Fe(II) through a similar motif (HExxE),
Pseudomonas PmrB does not bind Fe(III) (
43). The
Pseudomonas PmrB has a 32% amino acid similarity to
Salmonella, yet the Fe(III)-binding domain in
Salmonella strains is missing in P. aeruginosa's PmrB. The
Salmonella PmrB requires a distal serine in addition to the HExxE motif for Fe(III) binding (
24). This suggests that other, less proximal residues may contribute to Fe(II) recognition by BqsS, particularly as arginine replacement by histidine or alanine is insufficient to convert BqsS to an Fe(III) sensor. HbpS from Streptomyces reticuli contains 8 ExxE Fe(II) binding sites, each with a required adjacent Arg or Lys (single point mutations of the R/K resulted in reduced activity even with 7 other intact binding sites) (
53). This is consistent with the hypothesis that RExxE may directly bind Fe(II), and the R is a critical part of the Fe(II) binding event. The RExxE motif is just one strategy by which cells sense Fe(II): the FirRS system from H. influenzae utilizes a different motif, DYRED (
10). Upon activation, two-component sensors can act as a kinase or a phosphatase to their cognate response regulators (
54). BqsR prefers DNA binding sites that overlap RNA polymerase binding sites, suggesting that BqsR may help recruit RNA polymerase to promoter regions. As one of the few two-component systems for which the effector is known, BqsRS presents an attractive system for future biochemical studies to validate these predictions and explore the mechanisms of signal transduction.
Our primary goal in this study was to predict the biological response to extracellular Fe(II) mediated by BqsRS. Using iterative bioinformatic and experimental approaches to define BqsR regulon, we identified a set of approximately 100 genes potentially under BqsR control. Approximately a third of these genes encode proteins involved in stress tolerance, such as cation-binding, transport determinants, and lipopolysaccharide (LPS)-modulating proteins. Notably, several experimentally validated genes under BqsR control were annotated as playing a role in polyamine synthesis and transport. Polyamines, including spermidine, are present in all cells and environments (
55) and are known to stabilize DNA and RNA, enhance translation and transcription, control porin-mediated transport, and increase the stability of LPS (
41). A variety of metals are known to bind LPS (
56), and dipositive ions modulate polymyxin sensitivity through interactions with LPS (
57). Growing evidence has revealed that Fe(II) can be toxic under anaerobic conditions (
58–60).
Because Fe(II) is thought to enter the cell through outer membrane porins (
61,
62), that
bqs mutants are particularly sensitive to high levels of Fe(II) yet can be rescued by exogenous spermidine is not surprising. The
bqs mutants synthesize less spermidine than the WT, and while over 5 mM exogenous spermidine (a concentration higher than the reported intracellular spermidine concentration of 1 to 3 mM in bacteria [41]) is necessary to fully rescue these mutants, this can be rationalized by the fact that exogenous supplementation is different from endogenous production and that spermidine production is only one of several responses mediated by BqsRS that potentially helps confer resistance to Fe(II).
P. aeruginosa possesses two different spermidine synthesis operons:
speDE (bacterial in origin) and PA14_63110/PA14_63120 (archaeal in origin). The bacterial
S-adenosylmethonine decarboxylase,
speD, requires a dipositive cation (most commonly Mg
2+) for activity, whereas the archaeal homolog to PA14_63110 does not require a cation for activity (63). Because other metals may substitute for Mg
2+ with reduced enzymatic activity (
63,
64), we speculate that high Fe(II) perturbs intracellular metal homeostasis enough to reduce SpeD activity, accounting for the lower spermidine concentrations in the Δ
bqsR and Δ
bqsS mutants. At high Fe(II), BqsR induction of PA14_63110/PA14_63120 may compensate for SpeD's reduced activity, increasing the concentration of spermidine to homeostatic levels.
Given the plausible electrostatic mechanism underpinning polyamine-mediated resistance to Fe(II), we reasoned that BqsRS might also influence resistance to diverse cationic antibiotics but not anionic stressors. Previous studies have established that polyamines can mediate antibiotic resistance to cationic peptides, aminoglycosides, quinolones, and oxidative stress (
42,
50,
65,
66). We show that
bqs mutants exhibit increased sensitivity to tobramycin compared to the WT when stressed by high Fe(II) concentrations. In addition to the genes involved in spermidine production and transport, BqsRS upregulates other genes known to be involved in polymyxin resistance, such as
arnB and
oprH. Moreover, BqsRS activates
pmrAB and
phoP, which mediate polymyxin resistance in response to other environmental signals (limiting Mg
2+/Ca
2+ and phosphate starvation, respectively [
50,
67]). The polymyxin B killing curve demonstrates that the Δ
bqsR strain is more sensitive than the WT in high Fe(II) conditions. Thus, BqsRS may be a master regulator under anoxic, Fe(II)-replete conditions, exerting indirect effects via modulating the expression of other regulatory systems. That BqsRS mediates a specific response to cationic stressors in the presence of high Fe(II) concentrations is supported by its lack of an effect on resistance to the negatively charged stressors cefsulodin, arsenate, and chromate.
Beyond mediating resistance to cationic antibiotics, BqsRS elicits a cellular response that is broadly relevant to survival in an environment where Fe(II) is a dominant parameter. Fe(II) is stable in a well-defined subset of environmental conditions spanning a range of acidic and reducing conditions (
68). It is well known that such microhabitats are present in soil environments, which are also replete with diverse natural products that have antibiotic activities (
69). While the evolutionary history of the BqsRS system is unknown, we note that pseudomonads (including P. aeruginosa isolates) are commonly found in soil environments (
17). Sensing Fe(II) as proxy for these conditions may allow the cell to modulate its behavior accordingly. Consistent with this hypothesis, the BqsR regulon includes genes that protect the cell against pH and redox stress. For example, BqsRS upregulates
dsbB, which helps control disulfide bond formation in the periplasm (
70) and carbonic anhydrase, which promotes acid tolerance (
71). Intriguingly, the most upregulated gene in the BqsR regulon, PA14_04180 (upregulated ~4,000-fold), is a predicted periplasmic bacterial oligonucleotide/oligosaccharide-binding (OB-fold) protein that likely binds positively charged molecules. This suggests that the cell may perceive a significant proportion of the Fe(II) pool in cationic form, consistent with the dominance of this species at low pH and Eh.
In summary, the connection between Fe(II) sensing and a response that broadly protects the cell against diverse cationic molecules—including clinically relevant antibiotics—reminds us of the importance of considering environmental chemistry when exploring mechanisms of microbial survival in habitats that include the human body. Typically, CF patients are first treated with aminoglycosides, beta-lactams, or fluoroquinolones. As lung function declines, polymyxins are employed as a last line of defense due to their harmful side effects (
72). It is worth exploring whether a combination of aminoglycosides and polymyxins in conjunction with Fe(II) chelators or novel molecules targeting BqsRS could potentially be administered at lower concentrations, reducing side effects and increasing drug efficacy.