18While considered solely an extracellular pathogen, increasing evidence indicates that 19 Pseudomonas aeruginosa encounters intracellular environment in diverse mammalian cell 20 types, including macrophages. In the present study, we have deciphered the intramacrophage 21 fate of wild-type P. aeruginosa PAO1 strain by live and electron microscopy. P. aeruginosa 22 first resided in phagosomal vacuoles and subsequently could be detected in the cytoplasm, 23 indicating phagosomal escape of the pathogen, a finding also supported by vacuolar rupture 24 assay. The intracellular bacteria could eventually induce cell lysis. Two bacterial factors, 25 MgtC and OprF, recently identified to be important for survival of P. aeruginosa in 26 macrophages, were found to be involved in bacterial escape from the phagosome as well as 27 cell lysis caused by intracellular bacteria. Strikingly, type III secretion system (T3SS) genes 28 of P. aeruginosa were down-regulated within macrophages in both mgtC and oprF mutants.
29Concordantly, cyclic di-GMP (c-di-GMP) level was increased in both mutants, providing a 30 clue for negative regulation of T3SS inside macrophages. Consistent with the phenotypes and 31 gene expression pattern of mgtC and oprF mutants, a T3SS mutant (pscN) exhibited defect 32 in phagosomal escape and macrophage lysis driven by internalized bacteria. Importantly, 33 these effects appeared to be largely dependent on the ExoS effector, in contrast with the 34 known T3SS-dependent, but ExoS independent, cytotoxicity caused by extracellular P. 35 aeruginosa towards macrophages. Hence, our work highlights T3SS and ExoS, whose 36 expression is modulated by MgtC and OprF, as key players in the intramacrophage life of P. 37 aeruginosa, allowing internalized bacteria to evade macrophages.38 3 40Author summary 41 The ability of professional phagocytes to ingest and kill microorganisms is central to 42 host defense and Pseudomonas aeruginosa has developed mechanisms to avoid being killed 43 by phagocytes. While considered an extracellular pathogen, P. aeruginosa has been reported 44 to be engulfed by macrophages in animal models. Here, we visualized the fate of P. 45 aeruginosa within cultured macrophages, revealing macrophage lysis driven by intracellular 46 P. aeruginosa. Two bacterial factors, MgtC and OprF, recently discovered to be involved in 47 the intramacrophage survival of P. aeruginosa, appeared to play role in this cytotoxicity 48 caused by intracellular bacteria. We provided evidence that type III secretion system (T3SS) 49 gene expression is lowered intracellularly in mgtC and oprF mutants. We further showed that 50 intramacrophage P. aeruginosa uses its T3SS, specifically the ExoS effector, to promote 51 phagosomal escape and cell lysis. We thus describe a transient intramacrophage stage of P. 52 aeruginosa that could contribute to bacterial dissemination. 53 54 4 56 Introduction 57 58 Pathogenic bacteria are commonly classified as intracellular or extracellular pathogens 59 [1]. Intracellu...