Growth-state as a determinant of in vivo virulence of Mycoplasma pneumoniae

Mycoplasma pneumoniae is a leading cause of community acquired pneumonia and bronchitis in people, particularly children and young adults. Like many bacterial pathogens, M. pneumoniae can grow in biofilm towers on both biotic and abiotic surfaces. Current models indicate that planktonic M. pneumoniae are simply individual cells that are dispersed from biofilm towers due to physical shear forces, and do not represent a bona fide planktonic growth state. However recent data indicate that these fractions may be physiologically distinct and may differentially influence disease outcome. We observed that experimental infection of mice with inoculum containing both adherent and non-adherent fractions of M. pneumoniae produced more severe lung pathology than inoculum prepared from M. pneumoniae adherent biofilms alone. Direct comparison of experimental infection with titer matched non-adherent (P-Mp) and adherent (B-Mp) fractions revealed that P-Mp produces more severe lung pathology compared to infection with B-Mp. Furthermore, experimental infection with a lower dose of P-Mp resulted in similar lung pathology relative to B-Mp infected mice. This increase in pathology was not associated with differences in bacterial burden, bacterial dispersal during inoculum preparation, nor due to differences in the phenotype of host immune responses. Comparative proteomics revealed that certain known and putative virulence factors associated with immune evasion are upregulated in P-Mp, potentially explaining the difference in virulence between the two fractions. Furthermore, comparative proteomics revealed distinct metabolic phenotypes between the two fractions, consistent with distinct planktonic and biofilm growth states, indicating that P-Mp likely represents a bona fide planktonic growth state. Collectively, these data implicate the growth state of M. pneumoniae as a determinant of in vivo virulence for this atypical human pathogen.