26Bacterial pathogens encounter a variety of nutritional environments in the human host, 27 including nutrient metal restriction and overload. Uptake of manganese (Mn) is essential for 28 Enterococcus faecalis growth and virulence; however, it is not known how this organism 29 prevents Mn toxicity. In this study, we examine the role of the highly conserved MntE 30 transporter in E. faecalis Mn homeostasis and virulence. We show that inactivation of mntE 31 results in growth restriction in the presence of excess Mn, but not other metals, demonstrating 32 its specific role in Mn detoxification. Upon growth in the presence of excess Mn, an mntE 33 mutant accumulates intracellular Mn, iron (Fe), and magnesium (Mg), supporting a role for 34 MntE in Mn and Fe export, and a role for Mg in offsetting Mn toxicity. Growth of the mntE 35 mutant in excess Fe also results in increased levels of intracellular Fe, but not Mn or Mg, 36 providing further support for MntE in Fe efflux. Inactivation of mntE in the presence of 37 excess iron also results in the upregulation of glycerol catabolic genes and enhanced biofilm 38 growth, and addition of glycerol is sufficient to augment biofilm growth for both the mntE 39 mutant and its wild type parental strain, demonstrating that glycerol availability significantly 40 enhances biofilm formation. Finally, we show that mntE contributes to infection of the 41 antibiotic-treated mouse gastrointestinal (GI) tract, suggesting that E. faecalis encounters 42 excess Mn in this niche. Collectively, these findings demonstrate that the manganese exporter 43 MntE plays a crucial role in E. faecalis metal homeostasis and virulence. 44 45 nutritional immunity (1, 4-6). To counteract these host-mediated defences, many bacterial 51 pathogens including Enterococci encode dedicated systems to acquire Mn. 52 53Bacteria encode conserved ABC and NRAMP-family transporters for manganese uptake (1, 54 2). In Enterococcus faecalis, three manganese uptake systems have been described: the ABC-55 type transporter encoded by efaCBA and two NRAMP transporters encoded by mntH1 and 56 mntH2 (7). These three Mn transport systems are functionally redundant since deletion of all 57 three transporter systems (efaCBA, mntH1, mntH2) is required to abrogate intracellular Mn 58 accumulation, rendering the triple mutant severely impaired in growth (7). Furthermore, 59 deletion of both efaCBA and mntH2, or all three transporters together results in attenuated 60 colonization in rabbit endocarditis and mouse catheter-associated urinary tract infection 61 (CAUTI) models (7). Together these observations demonstrate that the ability to acquire Mn 62 is essential for E. faecalis virulence.
64In contrast to Mn influx mechanisms that have been characterized in E. faecalis, Mn export 65 pathways have not been described. The contribution of Mn export to bacterial pathogenesis 66 and virulence has been demonstrated for some bacterial species (8-15) and is dependent on 67 two widely characterized classes of exporters -MntE, a cat...