INTRODUCTION
The ability to adapt to environmental changes is critical to bacterial survival, including that of pathogens, which can face rapidly changing conditions and stresses during infection (
1–4). Sense-and-respond adaptation strategies often involve two-component systems (TCS) that consist of a sensor kinase and a cognate response regulator. In response to an activating signal, such as binding of a ligand or a change in pH, the sensor kinase autophosphorylates and activates the response regulator through transfer of the phosphoryl group (
5,
6). Response regulators have a wide range of functions, and many control transcription through direct binding of DNA. The resulting transcriptional changes contribute to adaptation of the bacterium to the environmental stimulus sensed by the sensor kinase. Bacteria can also adapt to stimuli via intracellular small molecules such as cyclic diguanylate (c-di-GMP) (
7,
8). The intracellular level of c-di-GMP is modulated by the opposing activities of diguanylate cyclases and phosphodiesterases that synthesize and degrade c-di-GMP, respectively; the production and function of these enzymes is controlled by environmental signals (
9,
10). C-di-GMP is then recognized by specific protein or RNA receptors (riboswitches) that mediate the adaptive response (
11–13).
In contrast, diversification of phenotypes in a bacterial population serves as a bet-hedging strategy to help ensure survival of the population as a whole. The development of phenotypically distinct variants, independent of environmental conditions, improves the odds that a subpopulation survives a sudden stress (
2,
14). Phase variation, a mechanism of generating phenotypic heterogeneity, occurs through reversible genetic changes that typically cause an ON/OFF phenotypic “switch” (
15,
16). Several mechanisms of phase variation have been described, including conservative site-specific recombination, in which a sequence-specific recombinase binds inverted repeats and mediates inversion of the intervening DNA (
15,
17). The invertible DNA element contains regulatory information, such as a promoter, that impacts the expression of adjacent genes. In a well-characterized example in
Escherichia coli, phase variation of fimbria production is mediated by the
fimS invertible element, which contains a promoter that drives transcription of the fimbrial genes when properly oriented (
18–20).
Clostridioides difficile is an intestinal pathogen and a leading cause of nosocomial infections in the United States.
C. difficile infection (CDI) can result in mild to severe diarrhea and potentially fatal complications such as pseudomembranous colitis, toxic megacolon, and sepsis. Recent work has shown that
C. difficile contains multiple invertible DNA elements flanked by inverted repeats, indicating a considerable capacity for phenotypic heterogeneity through phase variation (
21,
22). Four of these invertible elements have been demonstrated to regulate downstream genes and related phenotypes in a phase variable manner. The Cdi4 invertible element, also called the flagellar switch, modulates expression of the
flgB flagellar operon, resulting in phase variation of flagella (
23,
24). This operon encodes the sigma factor SigD, which promotes the transcription of flagellar genes as well as transcription of
tcdR, which encodes a direct activator of the
C. difficile toxin genes
tcdA and
tcdB (
25,
26). Accordingly, the production of these toxins is also phase variable (
23,
24,
27). The Cdi1 invertible element mediates phase variation of CwpV, which contributes to phage resistance (
28–31). The Cdi2 element, or
pdcB switch, modulates the production of a c-di-GMP phosphodiesterase and affects intracellular c-di-GMP and related phenotypes (
32,
33).
The Cdi6 invertible element, here called the “
cmr switch,” regulates the expression of
cmrRST in a phase-variable manner (
21,
34). The
cmrRST operon encodes a putative noncanonical TCS with two DNA-binding response regulators (CmrR and CmrT) and a sensor kinase (CmrS) (
34). Both CmrR and CmrT contain phosphoreceiver and DNA binding domains, suggesting that they function as transcriptional regulators. Phase variation of CmrRST allows
C. difficile to switch between rough and smooth colony morphologies that differ in several physiological characteristics. Through unknown mechanisms, CmrRST positively regulates type IV pilus-independent surface motility and cell elongation, and it negatively regulates swimming motility and biofilm formation. Furthermore, a
cmrR mutant strain is deficient for colonization and shows attenuated virulence in a hamster model of infection, indicating a role for this regulatory system in CDI.
C-di-GMP riboswitches are widespread in the
C. difficile genome and appear to be the primary mechanism of c-di-GMP regulation in this species (
11,
12,
35,
36). Upstream of the
cmr switch lies a class II c-di-GMP riboswitch that positively regulates
cmrRST transcription in response to c-di-GMP (
Fig. 1A) (
35,
36). Increasing c-di-GMP levels results in the formation of the rough colony morphology, consistent with increased
cmrRST expression (
34). The relative contributions of the c-di-GMP riboswitch and the
cmr switch to controlling expression of
cmrRST, and therefore to the phenotypes controlled by this system, are unknown.
One challenge to the study of phase variation is its stochastic nature, which adds uncontrolled variation into an otherwise controlled experiment. Phase-locked strains in which the invertible element is prevented from inverting can be a useful tool with which to study phase-variable systems (
23,
37). Our previous work on CmrRST relied primarily on characterization of wild-type (WT)
C. difficile rough and smooth colony isolates, which have a strong bias for the ON and OFF
cmr switch orientations, respectively, but remain capable of switch inversion and phenotypic switching (
34). We aimed to characterize
cmrRST regulation through the interplay of c-di-GMP and the
cmr switch by generating phase-locked
cmr-OFF and
cmr-ON mutants. The results of this study indicate that
cmrRST expression is subject to complex regulation by both sense-and-respond mechanisms and phase variation, highlighting the potential importance of this system to
C. difficile physiology through the variety of activating signals.
DISCUSSION
In this study, we demonstrate that multiple regulatory mechanisms control the transcription of cmrRST. Our results support a model in which, under basal c-di-GMP conditions, the orientation of the cmr switch determines the expression level of cmrRST. This phase variation mechanism involves the reversible inversion of a promoter within the cmr switch sequence. Increasing intracellular c-di-GMP augments cmrRST expression independent of cmr switch orientation. Our data also show that expression of cmrRST is also subject to autoregulation by CmrR, which occurs at an additional promoter downstream of the cmr switch and is enhanced by the orientation of the cmr switch. Therefore, multiple environmental signals may impact cmrRST expression through c-di-GMP signaling, phase variation, and the activation of the response regulator CmrR. CmrRST has important roles in C. difficile cell and colony morphology, motility, biofilm formation, and virulence, suggesting multiple contexts in which distinct environmental stimuli and selective pressures must be integrated to appropriately control cmrRST expression at the single-cell and population levels. This work represents the first account of a unique intersection of regulatory mechanisms controlling the expression of a signal transduction system that broadly impacts C. difficile physiology and disease development.
Phenotypic analysis of phase-locked R20291 mutants (
cmr-Δ3 ON and
cmr-Δ3 OFF) showed that they behave similarly to WT rough and smooth populations, respectively. Expression of
cmrRST in the locked-ON mutant was equivalent to that of WT rough isolates, while expression in the
cmr-Δ3 OFF mutant was similar to that of WT smooth isolates. Consistent with these results,
cmr-Δ3 ON yielded rough colonies, increased surface motility, and decreased swimming motility and biofilm formation compared to WT smooth isolates, the
cmr-OFF mutant, and the Δ
cmrR Δ
cmrT mutant. Interestingly, while
cmr-Δ3 ON forms rough colonies, they are not identical to those formed in WT populations, and there is still some heterogeneity of colony morphology. This observation may reflect differences in activity of CmrR or CmrT or that other factors contribute to colony morphology. Other work has suggested heterogeneity in c-di-GMP levels among individual
C. difficile cells (
23,
44), so c-di-GMP may also result in colony morphology differences via modulation of
cmrRST expression.
By artificially manipulating intracellular c-di-GMP levels in the
cmr locked mutants, we found that c-di-GMP promotes
cmrRST expression regardless of the orientation of the
cmr switch. These findings are consistent with observed phenotypes; the
cmr-Δ3 OFF mutant exhibited surface motility intermediate between that of the WT and the Δ
cmrR Δ
cmrT mutant. In the
cmr-Δ3 OFF mutant,
cmrRST could still be expressed from the TSS1 promoter upstream of the invertible element if c-di-GMP levels are sufficiently high. Intracellular c-di-GMP levels have been shown to increase in
C. difficile with growth on a surface (
41), which is consistent with c-di-GMP serving as a signal to enhance CmrRST-mediated surface motility regardless of
cmr switch orientation.
Multiple TSS were identified upstream of
cmrRST using 5′ RACE (
Fig. S3). TSS1 mapped upstream of the c-di-GMP riboswitch sequence and is preceded by –10 and –35 sites. TSS2 was identified within the
cmr switch in
cmr-ON
C. difficile. The TSS2 region showed transcriptional activity using the alkaline phosphatase reporter, and TSS2 is preceded by potential –10 and –35 sites. TSS3 was detected within the
cmr switch in
cmr-OFF bacteria; while qRT-PCR analysis suggested low-level transcription and potential responsiveness to
cmrR overexpression, the TSS3 region lacked detectable transcriptional activity using the
phoZ reporter assay, and no –10/–35 sites were identifiable. TSS4 was found between the
cmr switch and the translational start of
cmrR in both
cmr-ON and
cmr-OFF strains; the TSS4 region showed transcriptional activity when
cmrR was overexpressed. A longer region containing both TSS2 and TSS4 showed maximal reporter activity, and the contributions of the TSS2 and TSS4 promoters to transcription appeared additive. Furthermore, only the reporters containing TSS4 exhibited CmrR-mediated autoactivation. Together, these results support a model (
Fig. 7) in which the TSS1 promoter (P1) acts independently of the downstream promoters and yields an mRNA with a c-di-GMP riboswitch that enhances transcription readthrough when the c-di-GMP ligand is bound. The
cmr switch in the ON state contains a promoter (P2) corresponding to TSS2, while the inverse orientation of the
cmr switch lacks an active promoter. An additional promoter (P4) downstream of the
cmr switch is activated by CmrR and autoactivates
cmrRST. These regulatory elements are poised to modulate
cmrRST expression in response to distinct environmental stimuli. Interestingly, CmrT does not regulate the expression of
cmrRST, suggesting that CmrR and CmrT have different DNA specificities and, accordingly, distinct regulons. Future work will identify the genes directly and indirectly regulated by CmrR, CmrT, or both as well as determine their consensus DNA binding sites, which will elucidate the functions of these coexpressed response regulators.
In other bacteria, the reversible inversion of a promoter via site-specific DNA recombination is a common mechanism of phase-variable expression of adjacent genes (
15,
45). Two additional mechanisms have been described in
C. difficile. Phase variation of the cell wall protein CwpV in
C. difficile occurs as a result of site-specific recombination of a sequence mapping to the 5′ untranslated region of
cwpV. In one orientation, the invertible DNA sequence results in the formation of an intrinsic terminator in the mRNA, preventing expression of the downstream gene
cwpV; the intrinsic terminator does not form in the mRNA with the sequence in the inverse orientation, allowing
cwpV transcription to occur (
28). Flagellar phase variation in
C. difficile also occurs through an mRNA-mediated mechanism, where one orientation of the invertible sequence yields an mRNA permissive for transcriptional readthrough, while the other orientation results in Rho-mediated transcription termination (
23,
24,
27,
44). Notably, the region upstream of the
flgB operon has a similar arrangement to that of
cmrRST, with a c-di-GMP riboswitch preceding the switch that undergoes site-specific recombination (
23,
25,
36). However, the riboswitch upstream of
flgB negatively regulates transcriptional readthrough, so binding of c-di-GMP by the riboswitch leads to transcription termination precluding synthesis of longer transcripts containing the flagellar switch regardless of its orientation. Thus, phase variation and c-di-GMP regulation of flagellar gene expression are linked, in contrast to the
cmrRST system in which c-di-GMP and the
cmr switch independently modulate expression.
In summary, this work demonstrates that cmrRST expression is subject to multilayered regulation with multiple potential inputs from environmental signals. The complexity of this regulatory network suggests that cmrRST expression, and therefore its transcriptional targets, requires careful control. Further work that defines the signals which promote cmrRST expression will provide important insights into the role of this TCS in C. difficile physiology and pathogenesis.