PerSort facilitates characterization and elimination of persister subpopulation in mycobacteria

Mycobacterium tuberculosis (MTB) generates phenotypic diversity to persist and survive the harsh conditions encountered during infection. MTB avoids immune effectors and antibacterial killing by entering into distinct physiological states. The surviving cells, persisters, are a major barrier to the timely and relapse-free treatment of tuberculosis (TB). We present for the first time, PerSort, a method to isolate and characterize persisters in the absence of antibiotic, or other pressure. We demonstrate the value of PerSort to isolate translationally dormant cells that pre-exist in small numbers within Mycobacterium spp. cultures growing under optimal conditions, but which dramatically increased in proportion under stress conditions. The translationally dormant subpopulation exhibited multidrug tolerance and regrowth properties consistent with persister cells. Furthermore, PerSort enabled single-cell transcriptional profiling that provided evidence that the translationally dormant persisters were generated through a variety of mechanisms, including vapC30, mazF, and relA/spoT overexpression. Finally, we demonstrate that notwithstanding the varied mechanisms by which the persister cells were generated, they converge on a similar low oxygen metabolic state that was reversed through activation of respiration to rapidly eliminate persisters fostered under host-relevant stress conditions. We conclude that PerSort provides a new tool to study MTB persisters, enabling targeted strategies to improve and shorten the treatment of TB. SummaryWe have developed a novel method, PerSort, to isolate translationally dormant cells that pre-exist in small numbers within Mycobacterium spp. cultures growing under naive conditions (i.e., absence of antibiotic treatment), but dramatically increase in proportion under stress conditions. The translationally dormant cells have high tolerance to isoniazid and rifampicin, and can regenerate the parental population structure in standard media, albeit after a significantly longer lag phase, indicating they are persister cells. Single-cell expression profiling demonstrated that the translationally dormant persister subpopulation is a mixture of vapC30, mazF, and relA/spoT overexpressing cells, indicating there are multiple pathways to become a persister cell. Regardless of the mechanism by which they are generated, the persister cells have reduced oxidative metabolism, which is reversed upon addition of L-cysteine to effect complete clearance by INH and RIF under host-related stress.