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Reply to the reviewers
We are very grateful for the positive feedback from all three reviewers. Below, we address each point in detail and outline proposed experiments and revision plans, with changes indicated by an underscore.
__Reviewer #1 (Evidence, reproducibility and clarity (Required)):
In this paper "Magnesium depletion unleashes two unusual modes of colistin resistance with different fitness costs," the authors examine how Pseudomonas aeruginosa evolves resistance to colistin, a last-resort antibiotic for multidrug-resistant Gram-negative infections. Although colistin resistance is a major clinical challenge, its underlying mechanisms, particularly under nutrient-limited conditions typical of infections, are not fully understood.
The study shows that under low magnesium (Mg²_⁺_) conditions-mimicking infection or biofilm stress-P. aeruginosa can develop colistin resistance via two distinct genetic pathways, each with unique fitness costs. The first involves mutations in genes such as htrB2 and lpxO2, granting strong resistance but compromising the outer membrane and increasing susceptibility to other antibiotics. The second involves regulatory mutations (e.g., in the oprH/phoP/phoQ promoter) that confer resistance with minimal membrane defects and generally lower fitness costs.
These resistance strategies lead to different trade-offs: membrane-compromising mutations reduce bacterial fitness without colistin, while regulatory mutations typically avoid these penalties, with context-dependent effects. The study underscores clinical relevance, noting that in infections-such as in cystic fibrosis-other microbes like Candida albicans may deplete magnesium, indirectly promoting resistance evolution.
Overall, this work offers important insights into antibiotic resistance in nutrient-stressed, polymicrobial environments, highlighting how magnesium availability shapes resistance evolution and fitness costs. The findings suggest new avenues for therapeutic intervention and call for a reevaluation of antibiotic strategies in nutrient-competitive infection settings.
Work is timely and important. Colistin resistance represents an urgent threat as colistin is a last-resort antibiotic used against multidrug-resistant Gram-negative pathogens. Insights into mechanisms evolving under nutrient limitation are highly relevant given the prevalence of such environmental conditions during infection and microbial biofilm growth.
The study reveals two previously uncharacterized pathways to colistin resistance in P. aeruginosa triggered by magnesium (Mg²_⁺_) depletion, each with distinct genetic signatures and trade-offs. This finding directly impacts the understanding of polymicrobial infection dynamics, especially where magnesium sequestration by fungi/ or other microbes may occur.
The identification of fitness costs and pleiotropic effects associated with specific resistance mutations provides crucial guidance for clinicians considering antibiotic stewardship and combination therapy strategies.
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We thank the reviewer for their summary of our study and its potential impact.
__Drawbacks
• Experimental scope: While the study is comprehensive for P. aeruginosa, the broader applicability to other Gram-negative pathogens is not directly tested.__
In our revision, we now explicitly point out that the magnesium limitation we have observed broadly applies to Gram-negative bacteria, as we demonstrated in our previous PLOS Biology paper. Therefore, we expect the same themes (and even genes, which are broadly conserved) to apply to Gram-negative bacteria in general. However, a full-fledged experimental study of other Gram-negative pathogens is outside the scope of our current study, which required a 90-day experimental evolution.
__Strengths
• Experimental evolution: This work uses laboratory evolution under controlled Mg²_⁺_-limited conditions to simulate selection pressures relevant to infection microenvironments.
• Genetics: Systematic identification and functional validation of key mutations-particularly in htrB2, lpxO2, and the oprH/phoP/phoQ promoter-give mechanistic depth to the findings.
• Two distinct resistance modes: Evidence for (i) one pathway leading to colistin resistance via htrB2 mutations, resulting in high resistance but significant membrane integrity loss and increased susceptibility to other antibiotics. (ii) a second pathway providing resistance without compromising membrane integrity, highlighting evolutionary flexibility and ecological implications.
• Fitness assessments: measurement of the costs associated with each resistance strategy, both in terms of membrane integrity and susceptibility to other agents.
• Relevance: Connection to natural scenarios, such as magnesium sequestration by fungi (e.g. Candida albicans) in polymicrobial environments, underscores the ecological and clinical significance.
• This manuscript is well written with clearly logical hypothesis testing__
We thank the reviewer for their appraisal, especially for recognizing the rigor and broader biological implications of our study.
__Drawbacks
• Experimental scope: While the study is comprehensive for P. aeruginosa, the broader applicability to other Gram-negative pathogens is not directly tested.__
We agree with the reviewer's point about broader applicability in other Gram-negative bacteria, as many of the lipid A biosynthesis genes are conserved among diverse bacterial lineages. We will include this point in our revised Discussion to suggest relevance to other Gram-negative bacteria:
"We previously showed that magnesium sequestration by fungi applies not only to P. aeruginosa but to other Gram-negative bacteria as well (ref). Our current study lays a foundation for developing evolution-guided strategies to combat multidrug-resistant P. aeruginosa and other Gram-negative bacteria that can also acquire colistin resistance. Since many other antibiotic mechanisms are similarly dependent on metal ions (refs), our work suggests that nutritional competition for metal ions may alter initial antibiotic resistance in Gram-negative bacteria and potentiate new evolutionary pathways of antibiotic resistance."
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Mechanistic depth: Some inferred mechanisms (e.g., the precise molecular impact of late-occurring adaptive mutations) merit deeper biochemical analysis.__
We will emphasize in our Revision that the MS data of endpoint clones and triple mutants reveal that their lipid A structures are identical. This suggests that the role of other late-occurring mutations in enhancing resistance is likely through lipid A-independent pathways.
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Results Lines 414- 423: While correlation is most what makes sense for some drugs, causality is implied (membrane defects increase susceptibility), but could be strengthened by directly measuring antibiotic uptake (e.g., fluorescence) or membrane permeability for these 3 antibiotics.__
We thank the reviewer for highlighting the issue of causality. For the three antibiotics tested, the most direct way to measure their effect is by measuring their impact on bacterial growth directly, which is what we have done. Our membrane permeability assay using NpN uptake operates under the same conditions suggested by the reviewer and directly measures molecular uptake. Moreover, only fluorescently labeled vancomycin is commercially available among the three antibiotics tested. Since it binds to the cell wall, its utility to measure membrane defects is more limited than the NpN assay we have already used. However, in response to this comment, we will make clear in our revision that we infer that increased susceptibility to other antibiotics is due to their increased membrane permeability.
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o Effect is mild and mostly not significant. It is also not clear whether authors only tested a handful of mutants shown in Fig. 7B-D or whether other clones were also tested. The sample of endpoints (P2, P5, P8) covers well-characterized lineages, but additional evolved clones or a broader panel could boost generality about other antibiotics. The authors note "significantly lower MICs" statistical treatment is implied; explicit statistical values and replicate numbers should be given in the text or figures.__
We slightly disagree with the reviewer that the results are not significant. Even two-to-three-fold differences in MICs translate to large differences in microbial competition. These three endpoint clones are representative of all eight evolved strains after 90-day evolution experiments. Moreover, we will emphasize in the Revision that we have tested all the mutations found in the endpoint clones; we know what these are from whole genome sequencing of multiple endpoint clones. In addition, we will explicitly state the p-value in the legend of Figure 7.
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The structural or physiological nature of "mild" vs. "severe" membrane defects could be better defined/quantified.__
Although we agree with the reviewer's suggestion, the variability of the SEM assay makes the classification of membrane defects based on cell morphology hard to quantify. We therefore only use the SEM images as representative of the various defects observed. For a more quantitative assay of the membrane defects, we instead rely on the standard NpN uptake assay to quantify membrane permeability as a quantifiable readout for membrane defects.
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Quantitative limits: Authors should add in the discussion that statistical robustness could be strengthened-for example, by including longer-term evolutionary predictions.__
We are not sure what the reviewer means and so cannot address this point completely. We ask the reviewer to rephrase this point, and we will address it to the best of our abilities.
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in vivo relevance: While the ecological context is discussed, direct in vivo confirmation (e.g., in animal infection models) of the observed resistance trajectories would increase translational impact and relevance.__
We agree with the reviewer's point. However, it is not trivial to directly perform evolution experiments of microbes in animal models. There are only a handful of labs worldwide that have working CF-relevant animal models. However, the colistin resistance mutations we identified provide a tool to look deeper into how colistin-resistant P. aeruginosa can evolve in vivo.
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Some sections are repetitive or overly detailed; condense where possible (especially on mutation lists and background for each claim).__
We will condense our manuscript as the reviewer suggested in our revision. Adding a graphical summary as suggested will also allow us to be more succinct in our description.
__Other comments
• Authors should provide clarification on how the Mg²_⁺_ concentrations used in vitro compare to those found in clinically relevant infection settings. This would be helpful to enhance significance.__
We thank the reviewer for raising this good point. Based on our previous work, we know the Mg2+ levels in our model (0.3-0.45mM) are within the physiological range of Mg2+ in infection settings (0.1-0.8mM). We will highlight this point in the introduction.
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Authors should explicitly report statistical methods (e.g., types of tests, adjustments for multiple comparisons) in figure legends for reproducibility.__
We will include the details of our statistical tests in each panel of figures both in the main text and the supplement.
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Nomenclature for key mutations and their position within the genetic context (e.g., htrB2 mutation specifics) could be more detailed in figures or supplemental materials.__
We will name each of the particular mutations tested to be specific about the nature of all the evolved mutations in our figure legends.
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The manuscript could benefit from a graphical summary illustrating the two distinct evolutionary pathways and their respective fitness landscapes.__
We thank the reviewer for this suggestion to enhance the clarity of our work. We will make a new graphical summary highlighting two different evolutionary pathways as a new figure.
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A brief discussion of therapeutic implications-such as combining colistin with agents that target membrane integrity-would help bridge the gap from mechanism to clinical management.__
In our discussion, we have suggested that collateral sensitivity (line 446-453) and PhoPQ kinase inhibitors (line 512-515) could be exploited to combat colistin resistance. To make this point more clearly, we will slightly expand our Discussion to include the therapeutic implications of our study.
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Additional discussion on whether the fitness costs are reversible or can be compensated by further adaptation would be valuable for long-term dynamics.__
We thank the reviewer for raising this interesting point. The evolution trajectory of P8 suggests that fitness costs can be compensated by later-occurring mutations during evolution. We will further discuss this point to highlight the importance of understanding the mutational dynamics of antibiotic resistance evolution.
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It would be valuable for the authors to comment on, or further analyze, whether there is a direct association between specific fitness costs and sensitivity to other antibiotics. Such information could inform on evolutionary constraints and possible trade-offs relevant to clinical settings.__
We will include a supplemental figure showing the correlation between fitness costs and antibiotic susceptibility for P2, P5, and P8.
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Main figures and support for claims
The main and supplementary figures comprehensively illustrate the evolutionary trajectories, genetic bases, and phenotypic outcomes associated with colistin resistance under magnesium depletion in P. aeruginosa. The figures effectively detail:
• Genetic pathways involved including the experimental evolution design (colistin selection under Mg²_⁺_ depletion), whole-genome sequencing results, and timelines of observed mutations (e.g., in htrB2, lpxO2, oprH/phoP/phoQ promoter, PA4824).
• Phenotypes and biochemical analyses such as lipid A structure (via mass spectrometry), minimum inhibitory concentration (MIC) assays, and epistasis analyses between mutations are depicted.
• Fitness trade-offs are demonstrated using bacterial survival, membrane integrity (e.g., scanning electron microscopy images), membrane permeability assays (NPN uptake), and competitive fitness assays.
• Mechanistic claims about the necessity of early mutations, the requirement of the PhoPQ pathway at different evolutionary stages, and the fitness cost imposed by certain resistance mutations.
To further enhance the rigor and clarity of the manuscript, the authors should implement the following improvements:
• Labelling consistency: In some instances, figure legends could provide more granular detail about specific mutations (e.g., positions of amino acid changes).
• Graphical summary: A schematic summary figure that visually integrates the three main evolutionary resistance trajectories, the mutational order, corresponding lipid A changes, and fitness costs, would enhance readability.
• Replicates: Plots should more thoroughly indicate the number of replicates and show individual data points (not just means {plus minus} SD), add number of replicates in each experiment.
• Supplementary: figures referenced in the text (e.g., lipid A structures or mutation reversion outcomes) should be made more prominent or better cross-referenced from the main results section. Authors should highlight when supplementary data provide critical functional confirmation (e.g., confirming mutation function or fitness reversal).__
We thank the reviewer for their appreciation of our work and constructive feedback.
__Statistics
The authors have appropriately incorporated statistical analyses throughout the figures. To enhance the robustness and credibility of their findings, authors should also cross-check
• Tests in legends: Every figure and supplementary figure should clearly state the type of statistical test used, how many biological replicates, and any corrections for multiple comparisons.__
As mentioned above, we will provide more details about the statistical tests of each panel.
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Effect sizes: Where appropriate, reporting effect sizes-rather than just p values-would contextualize the biological impact.__
We agree with the reviewer; we will mention the magnitude of MIC changes in the corresponding figure legends.
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Raw data accessibility: For full transparency, consider sharing underlying raw data and analysis scripts.
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We will provide the raw data of each panel.
__Overall, the main and supplementary figures effectively illustrate and substantiate the key claims-particularly the alternative molecular pathways, phenotypic trade-offs, and the role of environmental magnesium in mediating colistin resistance. Statistical analysis is generally robust and appropriately presented throughout, though improvements could include more explicit reporting, additional controls, and accessible raw data. The visual and quantitative data in the figures provide support for the authors' conclusions about the evolution of antibiotic resistance under nutrient limitation in microbial environments. Understanding these alternative pathways is important for designing better treatment strategies and for predicting how resistance might evolve under varying clinical and environmental conditions.
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We thank the reviewer for their positive assessment.
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Reviewer #1 (Significance (Required)):
Overall, this work offers important insights into antibiotic resistance in nutrient-stressed, polymicrobial environments, highlighting how magnesium availability shapes resistance evolution and fitness costs. The findings suggest new avenues for therapeutic intervention and call for a reevaluation of antibiotic strategies in nutrient-competitive infection settings.__
We sincerely thank the reviewer for constructive and thoughtful feedback and the acknowledgement of our figure presentation and experimental design. We feel very encouraged by the reviewer's perspective that our study provides unique insights into resistance evolution in polymicrobial environments and may inform therapeutic strategies.
__My expertise:
Gut microbiome, gut microbiota resilience, ecology, and evolution in microbial communities, antimicrobial resistance, high-throughput drug-bacteria interactions
Reviewer #2 (Evidence, reproducibility and clarity (Required)):
Summary: The paper by Hsieh and colleagues unravels the molecular basis of colistin resistance in Pseudomonas aeruginosa under low magnesium (Mg2+) conditions. Colistin is a last resort antibiotic that compromises bacterial cell wall integrity. Bacteria can respond (phenotypically and genotypically) to colistin by modifying membrane-anchored lipopolysaccharides. Mg2+ depletion can trigger similar responses. In their study, Hsieh et al. find that Mg2+ depletion (induced by a co-infecting fungal pathogen, Candida albicans) leads to evolutionary trajectories and resistance mechanisms that differ from those observed under Mg-rich conditions. The authors conducted a series of detailed genetic, chemical and fitness-based experiments to elucidate the molecular, physiological and evolutionary basis of these new resistance mechanisms.__
We thank the reviewer for their summary of our study.__
Major comments:
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1. The authors reconstituted key mutations observed during experimental evolution in the ancestral background. Moreover, they took clones from the final stage of the evolution experiment and restored the ancestral state of the mutated genes. This dual approach is extremely strong and allows to decipher the causal effects of colistin resistance. I like to applaud the authors for this rigorous approach.
We thank the reviewer's appreciation about the rigor and comprehensive analyses of our study.
2. I understand that this work focusses on evolved mutants isolated from a previous experiment. The focus is on Mg2+ limitation. However, it would still have been nice to include a characterised colistin resistent strain featuring more standard resistance mechanisms. How different would such a strain be in the analyses shown in Fig. 3? Would morphological changes (Fig. 5A), fitness trade-offs (Fig. 6) and collateral sensitivity (Fig. 7) also occur in such a mutant. I do not regard it as imperative to include data from such a strain. But putting the new data into context (at least in the discussion) would clearly increase the overall impact of this work.
We thank the reviewer for raising this fascinating and vital point. We will address the point in our Revision using the monoculture (high Mg2+) evolved strains, which acquired many known mutations for colistin resistance, as our reference. We will provide a supplemental figure about the membrane permeability, fitness costs, and collateral sensitivity of monoculture evolved strains. We will also contrast their difference from co-culture evolved strains in the revised Discussion.__
- I recommend to discuss the findings in the context of the work conducted by Jochumsen et al. 2016 Nature Communications https://doi.org/10.1038/ncomms13002. To me, this is one of the most insightful papers on the genetic basis and epistasis of colistin resistance.__
We thank the reviewer for pointing out this important reference. We will include this reference and its findings in the Discussion.
__Minor comments:
- First section of results and Fig. 1. It is unclear what parts are repetition from the ref. 37 and what is new. Please clarify.__
We thank the reviewer for this suggestion. Figures 1A and 1B summarize the previous paper; all other panels are new data. We will make this clear in the revised text and figure legend.
5. MIC-data (e.g. Fig. 2) come in discrete categories (based on the underlying dilution series). This comes with some challenges for statistical analysis. First, linear models like ANOVAs are based on normally distributed residuals. This is violated with discrete data distributions. Second, there is often no within-treatment variation (e.g., Fig. 2B), which makes statistical analyses obsolete. These points need to be addressed. Moreover, how is it possible to have subtle variations in MIC (e.g., Fig. 2A, P2 endpoint clone) with classic dilution series (as indicated on the y-axis, 128, 256, 512)? Please explain.
We agree with the reviewer that statistical analysis of MIC data is not straightforward. ANOVAs are not well-suited for this type of discrete data, and the lack of variation within replicates reduces the power of non-parametric tests such as the Mann-Whitney U test. To improve the statistical reporting of MIC data, we will apply non-parametric tests and include effect size measurements, as recommended by Reviewer 1.
Moreover, the design of dilution series may underestimate the true nature of antibiotic susceptibility. To address these issues, we have also performed survival assays to assess colistin resistance in both the endpoint and reversion strains; we will also include statistics to assess the significance of their different survival frequencies.
We thank the reviewer for highlighting the point about subtle variations in a classical dilution series. Our endpoint strains grew robustly in media containing 192 μg/mL colistin-the highest concentration used in our evolution experiment. To more accurately determine and compare their maximum MICs, we expanded the colistin concentration range using finer fold increases (1.5×, 2×, 2.5×, 3×, 3.5×, and 4×) from 192 to 768 μg/mL. We will update these details in the Materials & Methods.
__ Lines 264-269. This analysis focusses on enzyme impairment. However, mutations could also change enzyme activity. Could any of these mutations have such an effect?__
The answer is "yes". As evolved strains with lpxA mutation still have lipid A, we suspect this mutation does not altogether abolish lipid A synthesis. However, this mutation could affect the amount of lipid A or change enzyme specificity. These are interesting ideas for further investigation, but they fall beyond the scope of our current study. We will, however, include the requested detail in the discussion.
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Figure 5A. Some arrows seem to be out of place and point at void spaces. Please check.__
We thank the reviewer for pointing out this error, which we will correct.
8. The use of polymyxin B is not well justified (Fig. 5 and Fig. S13). Did the authors aim to test whether there is cross-resistance to other antimicrobial peptides?
We will more clearly justify our choice of using polymyxin B for directly assaying binding of polymyxin antibiotics to bacterial cells using fluorescence-labeled polymyxins, since no such reagents exist for colistin and since previous studies (including ours) have shown similarity of susceptibility to colistin and polymyxin B:
"Although P2 and P5 endpoint clones have more permeable membranes, they exhibited greater resistance to polymyxin antibiotics, including colistin (polymyxin E) (Fig. 5D), and polymyxin B (Fig. S13A) than WT cells. To investigate how membrane-compromised cells gain increased resistance to antibiotics that target the outer membrane, we used dansyl-labeled polymyxin B [51] to quantify the binding of polymyxins to P. aeruginosa; dansyl-labeled polymyxin fluoresces upon binding the hydrophobic portion of bacterial membranes. We used polymyxin B binding as a surrogate for how bacterial cells bind to all polymyxin antibiotics, including colistin."
__ Line 564. Please indicate the dilution factor used.__
Thank you for pointing out this inadvertent omission. We will update our Materials & Methods accordingly, as in response to the Reviewer 2's comment 5.
__Reviewer #2 (Significance (Required)):
This is a very strong and well designed study. It provides novel and relevant insights into the resistance mechanisms against an important last resort antibiotic.__
We sincerely thank the reviewer for their thoughtful summary and generous evaluation of our work.
__Reviewer #3 (Evidence, reproducibility and clarity (Required)):
This manuscript reports on biologically interesting and clinically-relevant findings, that upon passaging in the presence of spent media from C. albicans, P. aeruginosa develops resistance to colistin through lipid A modifications. The authors thoroughly characterize novel lipid A structures seen in their resistant mutants, and test a variety of genetically constructed mutants to determine the contributions of specific mutant alleles to resistance.__
We thank the reviewer for the appreciation of our experimental design and comprehensive genetic and biochemical analyses of our evolved strains.
However, additional experiments are needed to demonstrate the specific role and necessity of the lipid modifications for colistin resistance.
We are also grateful for the reviewer's feedback and constructive criticisms to improve the clarity and impact of our manuscript. We have listed detailed responses to the reviewer below.
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Evidence that the lipid A mutations are causal for colistin resistance is sparse:
- Both the htrB2 mutations (in P2 and P5) are posited to be loss-of-function alleles. However, the phenotypes of the individual alleles are different (shown in Fig 2A and 2B). While the mutation in P2 shows a ~2x increase in resistance, the mutation in P5 does not. Thus it is not clear that the specific lipid A modifications seen in the htrB2 mutants are sufficient to confer colistin resistance. Can the authors test a clean deletion mutant of htrB2?
Further, reversion of the htrB2 mutation in P2 has only a mild effect on colistin resistance, while reversion in P5 leads to a ~3-4x reduction in colistin resistance (Fig. S3), once again making it hard to parse out the exact effect of the lipid A modifications seen in the htrB2 mutants.
- Similarly, a single lpxO2 mutation does not have any effect on colistin resistance (in P5), indicating that the modifications seen in this mutant are not sufficient to lead to resistance.__
We thank the reviewer for making this suggestion. The reviewer is correct that a clean deletion will directly assess the effects of htrB2 mutations. We will make htrB2 deletion in WT and the triple mutants and endpoint clones of P2 and P5 to check the effect of htrB2 deletion on colistin resistance.
Additionally, as Reviewer 2 pointed out, both mutation reconstruction and reversion experiments are required for understanding the roles of each mutation and interactions among different mutations in contributing to resistance. Combining all the results of htrB2 and lpxO2 mutations in these two orthogonal genetic experiments, it is the synergistic interactions among these mutations that lead to enhanced resistance after evolution. This explains why we saw genetic background effects of htrB2 mutation (P2 vs P5) and why each single mutation is required for resistance but doesn't contribute to resistance significantly by itself.
- In P8, the effect of a single lpxA mutation is not tested. Further, the resistance of a P-oprH + lpxA mutant is the same as that of just the P-oprH mutant, indicating that the lpxA mutation likely does not directly alter colistin resistance. It is possible that mutations in lpxA were selected to compensate for fitness defects resulting from the other mutations, or for adaptation to some other component of the media conditions.
This is an excellent suggestion. We will assess the MIC and fitness of reconstructed strains with the lpxA mutation to update the role of this mutation.
- While reversion of the htrB2 and lpxO2 mutations do lead to ~3-4x reduced resistance in P5 indicating some contribution of these mutations, it is specific to this population, and thus not clear whether it is due to the specific lipid A modifications (some of which are seen in the other populations too). A specific combination of lipid A modifications may confer colistin resistance, but this needs to be demonstrated by generating just those clean deletion mutants and showing an effect on resistance.
In response to this comment and comment 1, we will make lpxO2 deletions in WT, the triple mutant and the endpoint clone of P5 to test colistin resistance. However, our results of reverting single htrB2 or lpxO2 mutation to WT are robust and use two independent assays, including the standard MIC test and colistin survival assay. So, we are confident that each mutation is necessary for enhancing colistin resistance.
__ Overall, given the high levels of colistin resistance still exhibited by single mutant revertants (Fig. S3) and the absence of double or triple revertants, it is hard to come to any conclusions regarding causality. This is especially the case for P8 but also true of P2 and P5. What are the other mutations in these populations, and what role do they play in colistin resistance?__
We respectfully disagree with the reviewer on this point. One point that we have made and will re-emphasize in our Revision is that we have assayed all the mutations in these populations; this is one of the advantages of our experimental evolution and genome sequencing strategy. All the mutations that could play a role in colistin resistance have therefore been tested. Furthermore, due to genetic epistasis of mutations in different evolutionary lineages, we do not necessarily expect that a single revertant would altogether abolish colistin resistance, as has been demonstrated in several previous studies. As Reviewer 2 pointed out, combining mutation reconstruction and reversion is the best way to establish causality, and we have done so. Therefore, it is not correct to say that we cannot come to 'any conclusions regarding causality'.
__ Figure 4 is titled "The PhoPQ pathway synergizes with early-arising mutations to confer colistin resistance.", but instead what this figure shows is that the mutation upstream of oprH increases PhoP activity. I'm not sure what the synergy here is. The same is true for the section starting on line 276.
Further, the first sentence of that section states "We next investigated why the mutations conferring robust colistin resistance in low Mg2+ conditions are not observed in Mg2+ replete conditions.". However, there are no experiments there testing whether the mutations conferred resistance in Mg2+ conditions, instead the authors just test whether the mutations they are studying increase PhoP activity, and require PhoPQ to confer resistance.__
We thank the reviewer for raising this point. We apologize for the unclear writing. We will use this opportunity to improve the clarity of this section by rewriting it to focus on two points: 1. Evolved resistance is PhoPQ-dependent, instead of PmrAB-dependent. 2. Two lineages evolved enhanced resistance by boosting PhoPQ activity in both high and low Mg2+ conditions. We will also remove the statement highlighted by the reviewer from this section that obfuscates the motivation of this section. We feel this approach will more clearly show how lipid A-related mutations contribute to resistance in low Mg2+.
__ The authors claim that the identified mutations did not appear in the high magnesium conditions because they had a fitness cost under those conditions, but figure 6A shows that the evolved strains have fitness costs in low magnesium conditions as well.
Further, the authors suggest that because the studied mutations act via increased PhoPQ activity, they do not lead to resistance under high magnesium conditions (lines 376-379). However, the increased PhoPQ activity is mediated by the P-oprH mutation in the isolates which likely increases PhoPQ activity even in high magnesium conditions.
Overall, it is not clear why the mutations in the low magnesium condition were not selected for under high magnesium conditions.__
The reviewer is correct about the fitness cost in high Mg2+ and low Mg2+ conditions. These fitness experiments were carried out in the absence of colistin, which explains the finding that there are fitness defects in both conditions. As is well known, evolution for antibiotic resistance will ultimately select for resistant mutants, despite their fitness costs. In contrast, colistin MIC of these endpoint strains in high Mg2+ conditions was still much lower than the colistin concentration we applied during evolution (Fig. S15), indicating it is much less likely for these mutations to be selected for in high Mg2+. We will clarify this point in our revised Results and Discussion.
We agree with the reviewer about the P-oprH mutations (PhoPQ expression) and will note that, unlike the other mutations, it is not clear why these emerge only in the low Mg2+ condition.
__ The authors used C. albicans spent BHI media as their low magnesium condition, but this condition has a lot of other C. albicans metabolites that may be affecting the results. It is possible that what the authors are observing is not related to magnesium at all, and the authors should test the phenotypes in normal BHI medium depleted for magnesium or some defined medium where magnesium levels can be controlled.__
We thank the reviewer for mentioning this important point. In our prior PLOS Biology paper (https://doi.org/10.1371/journal.pbio.3002694.g005), we demonstrated that supplementing Mg2+ in evolved co-culture populations reduces colistin resistance, suggesting this evolved resistance is Mg2+ dependent. We also know that the MIC of our endpoint strains in C. albicans-spent BHI with supplemented Mg2+ (MIC of all three endpoint clones is less than 48 mg/mL colistin) is much lower than in C. albicans-spent BHI. We will mention this detail in the paper and include the data in our revision if the reviewer and editor require it.
Other comments:
- The authors use MIC assays as well as % survival to measure resistance against colistin, and sometimes use both in the same figure (e.g. Figure 2). This makes direct comparisons difficult. It would be better to consistently use one assay, preferably the MIC, at least in all the main figures. If the survival data needs to be included, it could go in the supplementary figures.
We thank the reviewer for this suggestion. We will move the MIC data of mutation-reversion strains to the main Fig. 2D-F.
- While the mutations seen in the low and high magnesium conditions were shown in the previous manuscript, given the extensive dissection here, it would be useful for readers if the authors gave some details about the serial passaging and evolution experiment, identification of mutations, and some mention of what mutations were seen in high Mg populations.
We will add these details in the introduction.
- Given that oprH is present in an operon, it would be more accurate to call that mutation as being in the promoter of the oprH-phoP-phoQ operon rather than it being an oprH mutation (at least in the text, e.g. lines 127-129).
We agree. We will change this as the reviewer requested.
- Unlike what is stated on lines 287-290, deletion of oprH in P2 leads to a greater than 2x reduction in colistin MIC, suggesting that OprH is playing a role (albeit a smaller role than phoP)
- Line 50 has a typo, remove "160".
- Line 122: Specify which Pa and Ca strain backgrounds were used.
- Line 132: Were representative isolates derived from terminal passages? This should be defined.
We will change these points according to the reviewer's suggestions; we thank them for these suggestions.
- Line 215-219: It is interesting that Pa WT grown in spent medium additionally results in lipid A that is hexa-acylated. Is this sufficient to alter colistin resistance on its own?
We find that WT PAO1 in low Mg2+ conditions has PagP-mediated acylation, which can slightly increase colistin resistance, but not to the extent of resistance as our evolved strains.
- It would be useful to see a PCA plot for the samples shown in figures S6 and S7.
We will include such a plot in Figures S6 and S7
- Fig. S11: What are the colistin MICs of pmrA and phoP deletions in the WT background?
MIC of pmrA and phoP deletions in WT is 1.5ug/mL. We will include these data in the Revision.
- Instead of qualitative data, can the authors quantify cell length and perhaps some measure of cell shape (instead of just showing images in Fig. 5A and S12).
We thank the reviewer for raising this point. A similar comment was raised by Reviewer 1. As it's challenging to quantify membrane changes from the morphological data obtained through SEM (a point which we will now clarify in our Revision), we used a quantifiable NpN uptake assay to quantify membrane defects of our evolved strains.
- What is the WT MIC in high magnesium conditions? Please show that in Fig. S15.
We will include this detail in Fig. S15
- I am not an expert in lipid modifications and structures, but in figure S5, P2 and P4 show high peaks with lower m/z that seem specific to low magnesium conditions, but they are not labeled or discussed. What are these peaks?
We thank the reviewer for bringing up this concern. The unlabeled lipids in these spectra are cardiolipin, not lipid A. These peaks are present in all the samples, and the reason they appear larger in the P1 and P4 low magnesium conditions is that both spectra are scaled to the relative intensity of one another. It is important to note that MALDI-TOF MS is not a quantitative technique, and the relative intensity of the peak heights between two samples should not be used to compare the amounts of lipids in one sample versus another. Therefore, we cannot say that these lipids are present in greater quantities in low magnesium conditions versus high magnesium conditions.
- Lines 357-358 state that "mutant cells minimally bind polymyxin B (Fig. S13B)", but the figure shows increased binding compared to the WT. The legend of the figure also says something similar. Are the phoP pmrA mutants expected to bind more polymyxin B because they can't modify lipid A?
We thank the reviewer for pointing out this substantial error. We will change 'minimally bind' to 'demonstrate increased binding'.
- Given the fitness defects in just regular medium, is the data shown in Figure 7 specific collateral sensitivity to the antibiotics tested? Are there other conditions where P2 and P5 do not show increased sensitivity?
These are all the antibiotics we have tested. It is conceivable that P2 and P5 might not show increased sensitivity to other antibiotics that use the same mode of action as colistin or polymyxin B.
__Reviewer #3 (Significance (Required)):
This study aims to dissect novel mechanisms of colistin resistance in P. aeruginosa that arise upon passaging in C. albicans spent media. While the authors identify novel lipid A modifications associated with the evolved strains, the significance of the modifications for resistance, and the mechanisms for why these evolutionary trajectories were not selected for in high magnesium are not clear from the data presented.__
We thank the reviewer for recognizing the integrity of our work and for the constructive feedback on improving the clarity of our writing. We understand that some concerns may stem from a lack of clarity in our original submission, but that additional genetic experiments are necessary. We have already identified all mutations that arose independently across different lineages and characterized their contributions to resistance, which we believe supports a robust inference of causality. To strengthen our conclusions, we will incorporate additional experiments, including htrB2 deletion, lpxO2 deletion, and lpxA mutation, to better dissect the roles of these genes and mutations in colistin resistance. We hope this revision plan will ameliorate the reviewer's concerns.