The pathobiology of Mycobacterium abscessus revealed through phenogenomic analysis

The medical and scientific response to emerging pathogens is often severely hampered by ignorance of the genetic determinants of virulence, drug resistance, and clinical outcomes that could be used to identify therapeutic drug targets and forecast patient trajectories 1-5. Taking the newly emergent multidrug-resistant bacteria Mycobacterium abscessus as an example 6, we show that combining high dimensional phenotyping with whole genome sequencing in a phenogenomic analysis can rapidly reveal actionable systems-level insights into bacterial pathobiology. Using in vitro and in vivo phenotyping, we discovered three distinct clusters of isolates, each associated with a different clinical outcome. We combined genome-wide association studies (GWAS) with proteome-wide computational structural modelling 7 to define likely causal variants, and employed direct coupling analysis (DCA) 8 to identify co-evolving, and therefore potentially epistatic, gene networks. We then used in vivo CRISPR-based silencing to validate our findings, defining a novel secretion system controlling virulence in M. abscessus, and illustrating how phenogenomics can reveal critical pathways within emerging pathogenic bacteria.