25Variation in the genome of Pseudomonas aeruginosa, an important pathogen, can have 26 dramatic impacts on the bacterium's ability to cause disease. We therefore asked whether it 27 was possible to predict the virulence of P. aeruginosa isolates based upon their genomic 54 Pseudomonas aeruginosa is a ubiquitous gram-negative opportunistic pathogen that can 55 infect a variety of hosts. Its ability to cause severe acute infections in susceptible patients and 56 chronic infections in individuals with cystic fibrosis, coupled with increasing rates of antimicrobial 57 resistance, make it an organism of particular concern to the medical community 1-3 . The P. 58 aeruginosa species, however, is not monolithic but rather shows a large amount of genomic 59 diversity both through polymorphisms and differences in gene content 4-6 . As routine whole 60 genome sequencing becomes increasingly feasible, understanding how these genomic 61 differences impact the pathogenicity of P. aeruginosa may allow clinicians to rapidly identify 62 high-risk infections and researchers to select the most high-yield strains for further study.
63As with other bacteria, the genome of P. aeruginosa can be divided into a core genome, 64 made up of sequences common to the species, and an accessory genome, made up of 65 sequences present in some strains but not others 6,7 . While only 10-15% of a typical strain's 66 genome is accessory, these sequences when combined from all strains comprise the vast 67 majority of the P. aeruginosa pangenome 4,7,8 . Variations in both the core and accessory 68 genomes play an important role in the virulence of any given P. aeruginosa strain. Core genome 69 mutations that accumulate in P. aeruginosa strains during chronic infection of cystic fibrosis 70 patients lead to decreased markers of in vitro virulence 9 , and these strains have attenuated 71 virulence in animal models of acute infection 10 . Genomic islands, major components of the 72 accessory genome, are enriched for predicted virulence factors 11 . Several genomic islands in P. 73 aeruginosa, including those containing the type III secretion system (T3SS) effector gene exoU, 74 have been shown to enhance pathogenicity in multiple infection models [12][13][14] . We recently mined 75 the accessory genome and identified multiple novel factors important in virulence in a mouse 76 model of bacteremia 15 . Conversely, a study using a Caenorhabditis elegans model identified 77 several P. aeruginosa accessory genes whose presence reduced virulence 16 . Further, the 78 presence of active CRISPR systems was associated with increased virulence 16 , supporting the 79 5 hypothesis that many horizontally transferred elements are genetic parasites with respect to the 80 host bacterium 17 . Because of its role in both increasing and decreasing the pathogenicity of 81 individual P. aeruginosa strains, the accessory genome may serve as a useful predictor of an 82 isolate's virulence. This is not necessarily as simple as detecting individual virulence or anti-83 virulence...