2 The opportunistic pathogen Pseudomonas aeruginosa is a leading cause of airway infection in 3 cystic fibrosis (CF) patients. P. aeruginosa employs several hierarchically arranged and 4 interconnected quorum sensing (QS) regulatory circuits to produce a battery of virulence factors 5 such as elastase, phenazines, and rhamnolipids. The QS transcription factor LasR sits atop this 6 hierarchy, and activates the transcription of dozens of genes, including that encoding the QS 7 regulator RhlR. Paradoxically, inactivating lasR mutations are frequently observed in isolates from 8 CF patients with chronic P. aeruginosa infections. In contrast, mutations in rhlR are rare. We have 9 recently shown that in CF isolates, the QS circuitry is often "rewired" such that RhlR acts in a 10 LasR-independent manner. To begin understanding how QS activity differs in this "rewired" 11 background, we characterized QS activation and RhlR-regulated gene expression in P.12 aeruginosa E90, a LasR-null, RhlR-active chronic infection isolate. In this isolate, RhlR activates 13 the expression of 53 genes in response to increasing cell density. The genes regulated by RhlR 14 include several that encode virulence factors. Some, but not all, of these genes are present in the 15 QS regulon described in the well-studied laboratory strain PAO1. We also demonstrate that E90 16 produces virulence factors at similar concentrations to that of PAO1. Unlike PAO1, cytotoxicity by 17 E90 in a three-dimensional lung epithelium cell model is also RhlR-regulated. These data 18 illuminate a "rewired" LasR-independent RhlR regulon in chronic infection isolates and suggest 19 that RhlR may be a target for therapeutic development in chronic infections. 2 20 AUTHOR SUMMARY 21 Pseudomonas aeruginosa is a prominent cystic fibrosis (CF) pathogen that uses quorum sensing 22 (QS) to regulate virulence. In laboratory strains, the key QS regulator is LasR. Some isolates from 23 patients with chronic CF infections appear to use an alternate QS circuitry in which another 24 transcriptional regulator, RhlR, mediates QS. We show that a LasR-null CF clinical isolate 25 engages in QS through RhlR and remains capable of inducing cell death in an in vivo-like lung 26 epithelium cell model. Our findings support the notion that LasR-null clinical isolates can engage 27 in RhlR QS and highlight the centrality of RhlR gene regulation in chronic P. aeruginosa infections. 3 28 INTRODUCTION 29 Many species of bacteria are able to sense and communicate with each other via quorum sensing 30 (QS), a cell-density dependent gene regulation mechanism[1]. In Proteobacteria, acyl-31 homoserine lactones (HSL) are used as QS signals. Commonly, signals are produced by acyl-32 HSL synthases of the luxI family and are recognized by their cognate receptors, transcription 33 factors of the luxR family[2].34 35 Pseudomonas aeruginosa, a leading cause of airway infection in cystic fibrosis (CF) patients, 36 uses QS to regulate the production of a wide array of virulence factors including phenazines, 3...