25 26 suggesting coccoid viability. Using single-cell live microscopy, we observed that shape 42 conversion is associated with cell division interference. Oxidative stress represses antitoxin 43 promoter activity and enhances processing of its transcript leading to an imbalanced ratio in 44 favor of AapA1 toxin expression. 45Our data are in favor of viable coccoids with characteristics of dormant bacteria that might 46 be important in H. pylori infections refractory to treatment. 47
Significance Statement 49Helicobacter pylori, a gastric pathogen responsible for 800,000 deaths in the world every 50year, is encountered, both in vitro and in patients, as spiral-shaped bacteria and as round cells 51 named coccoids. We discovered that the toxin from a chromosomal type I toxin-antitoxin 52 system is targeting H. pylori membrane and acting as an effector of the morphological 53 conversion of H. pylori to coccoids. We showed that these round cells maintain their 54 membrane integrity and metabolism, strongly suggesting that they are viable dormant bacteria. 55Oxidative stress was identified as a signal inducing toxin expression. Our findings reveal new 56 insights into a form of dormancy of this bacterium that might be associated with H. pylori 57 infections refractory to treatment. 58 59 60 (10) and it was more generally found that decreased intracellular ATP concentration is a 79 landmark of persister formation (11). 80In the present work, we explored the role of TA systems in Helicobacter pylori, a 81 bacterium that colonizes the stomach of half of the human population worldwide and causes 82 the development of gastritis. In some cases, gastritis evolves into peptic ulcer disease or 83 gastric carcinoma that causes about 800,000 deaths in the world every year (12, 13). This 84 microaerophilic bacterium is unique in its capacity to persistently colonize the stomach 85 despite its extreme acidity and intense immune response (13). The molecular mechanisms at 86 both translation inhibition of the AapA1 active message and leading to rapid degradation of 104 the duplex by RNase III has been recently published (20). The H. pylori type I toxins are 105 typically small hydrophobic peptides of 30-40 amino acids predicted to form alpha-helices. 106No clues on the mode of action or the physiological role of these systems have been reported. 107Here we show that the AapA1 toxin induces a rapid and massive morphological 108 transformation of H. pylori from spirals to coccoids by targeting the inner membrane and 109 interfering with cell division, and that oxidative stress triggers imbalanced expression of the 110 TA components in favor of toxin production. 111
Results 112IsoA1 or pA1*. In contrast, addition of the inducer causes a rapid and immediate growth 129 arrest of H. pylori with pA1 indicating a toxic effect of AapA1 expression (Fig. 1B). The 130 growth arrest was accompanied by loss of culturability of more than 10 4 -fold 8h after 131 induction. 132In parallel to growth, we investigated the consequences of AapA1 expressio...