21Mycobacterium tuberculosis (Mtb) spontaneously grows at the air-medium interface 22 forming pellicle biofilms, which harbor more drug tolerant persisters than planktonic 23 cultures. The underlying basis for increased persisters in Mtb biofilms is unknown. 24 Using a Tn-seq approach, we show here that multiple genes that are necessary for 25 fitness of Mtb cells within biofilms, but not in planktonic cultures, are also important for 26 their tolerance to a diverse set of stressors and antibiotics. Thus, development of Mtb 27 biofilms appears to be associated with population enrichment, in which endogenous 28 stresses presumably generated by challenging growth conditions within biofilm 29 architecture select for cells that maintain tolerance to exogenous stresses including 30 antibiotic exposure. We further observed that the intrinsic drug tolerance of constituent 31 cells of biofilms determines the frequency of persisters: morphologically 32 indistinguishable monoculture biofilms of a ΔpstC2A1 mutant hypersensitive to 33 rifampicin harbor ~20-fold fewer persisters than wild-type. These findings together allow 34 us to propose that the selection of elite cells during biofilm development significantly 35 contributes to the persister frequency. Furthermore, probing the possibility that the 36 population enrichment is an outcome of unique environment within biofilms, we 37 demonstrate biofilm-specific induction in the synthesis of isonitrile lipopeptides (INLP). 38 Mutation analysis indicates that INLP is necessary for the architecture development of 39 Mtb biofilms. In summary, the study offers an insight into persistence of Mtb biofilms 40 under antibiotic exposure, while identifying INLP as a biomarker for further investigation 41 of this phenomenon. 42 3 SIGNIFICANCE 43 The tuberculosis (TB) pathogen Mycobacterium tuberculosis (Mtb) is one of the 44 deadliest bacterial pathogens known to mankind, and TB treatment is inefficient. A 45 lengthy chemotherapy for TB is attributed to a small subpopulation of Mtb bacilli 46 exhibiting phenotypic tolerance to antibiotics. Drugs targeting these persisters are 47 55 Treatment of tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), entails a 56 multi-drug regimen administered for at least 6 months. A lengthy treatment is 57presumably necessitated by the persistence of a small subpopulation of bacilli, which 58 exhibit phenotypic tolerance to antibiotics (1, 2). Although the mechanism underlying the 59 development of Mtb persisters during infection is unclear, in vitro studies suggest that 60 these bacilli probably develop through both stochastic and induced mechanisms(3-6).
61The persistence of microbes against antibiotics has been closely linked to their 62 ability to grow as sessile, three-dimensionally organized, matrix encapsulated, 63 multicellular communities called biofilms (7-11). Biofilm-related antibiotic tolerance is 64 rendered particularly relevant by the fact that a majority of chronic microbial infections in 65 humans occur as biofi...