Abstract

People with the genetic disorder cystic fibrosis (CF) harbor lifelong respiratory infections, with morbidity and mortality frequently linked to chronic lung infections dominated by the opportunistically pathogenic bacterium Pseudomonas aeruginosa. During chronic CF lung infections, a single clone of P. aeruginosa can persist for decades and dominate end-stage CF lung disease due to its propensity to adaptively evolve to the respiratory environment, a process termed "pathoadaptation". Chronic rhinosinusitis (CRS), chronic inflammation and infection of the sinonasal space, is highly prevalent in CF and the sinuses may serve as the first site in the respiratory tract to become colonized by bacteria that then proceed to seed lung infections. We identified three evolutionary genetic routes by which P. aeruginosa evolves in the sinuses of people with CF, including through the evolution of mutator lineages and proliferative insertion sequences and culminating in early genomic signatures of host-restriction. Our findings raise the question of whether a significant portion of the pathoadaptive phenotypes previously thought to have evolved in response to selective pressures in the CF lungs may have first arisen in the sinuses and underscore the link between sinonasal and lung disease in CF. Graphical abstract and highlightsO_LIPseudomonas aeruginosa undergoes adaptive evolution in the sinuses of people with CF C_LIO_LIOver time, pathoadapted strains display early signatures of genome degradation consistent with recent host restriction C_LIO_LIMutations previously thought to occur in CF lungs may have first evolved in sinuses C_LI O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=200 SRC="FIGDIR/small/359844v1_ufig1.gif" ALT="Figure 1"> View larger version (50K): org.highwire.dtl.DTLVardef@13b36aborg.highwire.dtl.DTLVardef@8230e1org.highwire.dtl.DTLVardef@1570c3eorg.highwire.dtl.DTLVardef@1e4e530_HPS_FORMAT_FIGEXP M_FIG C_FIG