Mycobacterium tuberculosis Genes Needed for Intra-alveolar Resuscitation After Airborne Transmission

Mycobacterium tuberculosis (Mtb) must survive multiple changes in environment for aerosol transmission. Our genome-wide screen for rehydration of modeled aerosols in surrogate pulmonary alveolar lining fluid identified a survival-sustaining role for 22 genes not required for survival during earlier stages of transmission, 20 of which are non-essential in routine culture. Thirteen genes were also needed for Mtb to survive in alveolar macrophages after passing through the earlier stages of transmission. Nine 9 of the 13 were needed for full infectivity of aerosols in mice. Seven of the genes sustaining the intra-alveolar survival of aerosolized Mtb are likely to regulate Mtbs uptake, catabolism or synthesis of lipids as regulated by cAMP. Our results reveal a dynamic form of conditional essentiality that only emerges after bacteria experience a sequence of other pathophysiologically relevant conditions. These findings enlarge Mtbs candidate transmission survival genome with stage-specific genes encoding potential targets for blocking tuberculosis transmission.