SUMMARY
Staphylococcus aureus is one of the leading causes of bacterial infections in the United States. Invasive S.
aureus infections (such as osteomyelitis, endocarditis, and bloodstream infections) are associated with relatively
high rates of morbidity and mortality even when treated with appropriate antibiotics. The ability to form biofilms,
microbially derived communities where cells grow attached to a surface or as a bacterial conglomerate
surrounded by a complex extracellular matrix, has been associated with persistent S. aureus infections. A
defining feature of bacterial biofilms, including S. aureus biofilms, is a high tolerance to antibiotics. Despite the
clinical significance of the antibiotic tolerance seen in biofilm-mediated infections, the mechanism by which this
occurs is poorly understood. Antibiotics have been shown to penetrate S. aureus biofilms, suggesting that there
are other mechanisms besides physical occlusion involved in tolerance. One possible explanation for the
increase in antibiotic tolerance is an enhanced ability to tolerate oxidative stress, which is seen in biofilm growth.
Given the growing body of literature suggesting a role for oxidative stress in antibiotic-mediated killing, we
hypothesize that changes in protein production that promote the bacterial oxidative stress response lead to the
antibiotic tolerance phenotype seen during biofilm-mediated S. aureus infections. Furthermore, given the
important role of the transition metals manganese and iron in S. aureus virulence and the oxidative stress
response, we anticipate that the ability to regulate the levels of these metals and their distribution within S. aureus
biofilms is integral to the antibiotic tolerance phenotype seen in S. aureus biofilms. In order to test this hypothesis,
we will (1) determine the impact of antibiotic exposure on metal regulation and the oxidative stress response in
S. aureus biofilms using a combination of fluorescence microscopy along with matrix-assisted laser
desorption/ionization imaging mass spectrometry (MALDI-IMS) and laser ablation inductively coupled plasma
mass spectrometry (LA-ICP-MS), (2) identify the staphylococcal genes responsible for antibiotic tolerance in
biofilm growth using transposon sequencing (TnSeq) and proteomic experiments, and (3) demonstrate the in
vivo significance of these findings using an animal model of osteomyelitis, a chronic biofilm-mediated S. aureus
infection. The sum of this work will result in not only a better understanding of what the elements are that are
responsible for antibiotic tolerance in S. aureus infections, but it will also provide new insight that will be useful
in developing therapeutics and treatments aimed at reducing the morbidity and mortality of infections due to S.
aureus.