Abstract Mucosa-associated biofilms are associated with many human disease states, but the mechanisms by which the host promotes biofilm biogenesis remain unclear. In chronic respiratory diseases like cystic fibrosis (CF), Pseudomonas aeruginosa establishes chronic infection through biofilm formation. P. aeruginosa can be attracted to interspecies biofilms through potassium currents emanating from the biofilms. We hypothesized that P. aeruginosa could, similarly, sense and respond to the potassium efflux from human airway epithelial cells (AECs) to promote biofilm biogenesis. Using respiratory epithelial co-culture biofilm imaging assays of P. aeruginosa grown in association with CF bronchial epithelial cells (CFBE41o - ), we found that P. aeruginosa biofilm biogenesis was increased by potassium efflux from AECs, as examined by potentiating large conductance potassium channel, BK Ca (NS19504) potassium efflux. This phenotype is driven by increased bacterial attachment and increased coalescence of bacteria into aggregates. Conversely, biofilm formation was reduced when AECs were treated with a BK Ca blocker (paxilline). Using an agar-based macroscopic chemotaxis assay, we determined that P. aeruginosa chemotaxes toward potassium and screened transposon mutants to discover that disruption of the high-sensitivity potassium transporter, KdpFABC, and the two-component potassium sensing system, KdpDE, reduces P. aeruginosa potassium chemotaxis. In respiratory epithelial co-culture biofilm imaging assays, a KdpFABCDE deficient P. aeruginosa strain demonstrated reduced biofilm growth in association with AECs while maintaining biofilm formation on abiotic surfaces. Collectively, these data suggest that P. aeruginosa biofilm formation can be increased by attracting bacteria to the mucosal surface via a potassium gradient and enhancing coalescence of single bacteria into microcolonies through aberrant AEC potassium efflux sensed through the bacterial KdpFABCDE system. These findings suggest that electrochemical signaling from the host can amplify biofilm biogenesis, a novel host-pathogen interaction, and that potassium flux could be a potential target for therapeutic intervention to prevent chronic bacterial infections in diseases with mucosa-associated biofilms, like CF. Author Summary Biofilm formation is important for Pseudomonas aeruginosa to cause chronic infections on epithelial surfaces during respiratory diseases, like cystic fibrosis (CF). The host factors that promote biofilm formation on host surfaces are not yet fully understood. Potassium signals from biofilms can attract P. aeruginosa , but it is unknown if potassium from the human cells can influence P. aeruginosa biofilm formation on a host surface. We found that P. aeruginosa biofilm formation on human airway cells can be increased by the potassium currents from airway cells, and determined bacterial genes related to potassium uptake and sensing that contribute to biofilm formation on airway cells. These findings suggest that P. aeruginosa can respond to host potassium signals by forming increased biofilm and that reducing chronic infections may be accomplished by reducing potassium coming from airway cells or blocking the bacterial proteins responsible for the biofilm enhancement by potassium currents.
