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Environment and Colonisation Sequence Are Key Parameters Driving Cooperation and Competition between Pseudomonas aeruginosa Cystic Fibrosis Strains and Oral Commensal Streptococci

  • Robert A. Whiley,

    Affiliation Department of Clinical & Diagnostic Oral Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, United Kingdom, E1 2AT

  • Emily V. Fleming,

    Affiliation Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, United Kingdom, E1 2AT

  • Ridhima Makhija,

    Affiliation Department of Clinical & Diagnostic Oral Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, United Kingdom, E1 2AT

  • Richard D. Waite

    Affiliation Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, United Kingdom, E1 2AT

Environment and Colonisation Sequence Are Key Parameters Driving Cooperation and Competition between Pseudomonas aeruginosa Cystic Fibrosis Strains and Oral Commensal Streptococci

  • Robert A. Whiley, 
  • Emily V. Fleming, 
  • Ridhima Makhija, 
  • Richard D. Waite


Cystic fibrosis (CF) patient airways harbour diverse microbial consortia that, in addition to the recognized principal pathogen Pseudomonas aeruginosa, include other bacteria commonly regarded as commensals. The latter include the oral (viridans) streptococci, which recent evidence indicates play an active role during infection of this environmentally diverse niche. As the interactions between inhabitants of the CF airway can potentially alter disease progression, it is important to identify key cooperators/competitors and environmental influences if therapeutic intervention is to be improved and pulmonary decline arrested. Importantly, we recently showed that virulence of the P. aeruginosa Liverpool Epidemic Strain (LES) could be potentiated by the Anginosus-group of streptococci (AGS). In the present study we explored the relationships between other viridans streptococci (Streptococcus oralis, Streptococcus mitis, Streptococcus gordonii and Streptococcus sanguinis) and the LES and observed that co-culture outcome was dependent upon inoculation sequence and environment. All four streptococcal species were shown to potentiate LES virulence factor production in co-culture biofilms. However, in the case of S. oralis interactions were environmentally determined; in air cooperation within a high cell density co-culture biofilm occurred together with stimulation of LES virulence factor production, while in an atmosphere containing added CO2 this species became a competitor antagonising LES growth through hydrogen peroxide (H2O2) production, significantly altering biofilm population dynamics and appearance. Streptococcus mitis, S. gordonii and S. sanguinis were also capable of H2O2 mediated inhibition of P. aeruginosa growth, but this was only visible when inoculated as a primary coloniser prior to introduction of the LES. Therefore, these observations, which are made in conditions relevant to the biology of CF disease pathogenesis, show that the pathogenic and colonisation potential of P. aeruginosa isolates can be modulated positively and negatively by the presence of oral commensal streptococci.


The airways of cystic fibrosis (CF) patients harbour a diverse consortium of microorganisms associated with disease pathogenesis and decline in lung function. However, despite the wealth of information documenting recognised CF pathogens and a more recent awareness of a potential role for other CF associated bacteria in disease progression the interactions between community members of this lung microbiome and how they are environmentally influenced remain largely unknown. Understanding the key interactors and the relationships that drive the population dynamics within these complex microbial communities will prove important in identification of inhabitants associated with both clinical stability and pulmonary exacerbation, and thus the development of improved, targeted CF therapies [1,2].

Streptococci have been frequently isolated during deep sequencing, culture-dependent and culture-independent studies on CF and non-CF respiratory microbiome composition and the role of the Anginosus-group of oral commensal streptococci (also known as the Streptococcus milleri group) has recently been highlighted [3,4,5,6,7,8,9]. Importantly in-vivo longitudinal studies have observed the proliferation of AGS to a significant proportion of the total bacterial flora before onset and during acute exacerbation in CF patients, who responded best to antibiotic therapy targeting AGS rather than Pseudomonas aeruginosa the established principal pathogen in adult CF [6]. Unfortunately, these commensal streptococci are still regarded as oral contaminants during routine clinical screening of CF sputa, thus their contribution to disease progression is underestimated and a potentially important therapeutic target is often ignored.

Recently, it was discovered that virulence of P. aeruginosa strain PAO1 (originally a wound isolate) in infection models could be modulated by streptococci and other oropharyngeal flora (OF) [10,11]. Due to the enormous variation in the pathogenic potential and phenotypes of P. aeruginosa isolates from different habitats and clinical origins we expanded these studies to investigate the interactions between AGS and clinical P. aeruginosa isolates with phenotypes associated with CF airway disease (low, intermediate and over-production of the virulence factor pyocyanin) [12,13,14,15]. In addition we chose to use examples of the Liverpool epidemic strain (LES) which is a highly transmissible, CF lung adapted strain frequently isolated within the United Kingdom and now found in North America [12,16]. We showed that AGS survived at high cell densities in biofilm co-culture with P. aeruginosa, that coexistence of AGS with a low and an intermediate pyocyanin producer resulted in enhancement of virulence factor production (pyocyanin and elastase) and that LES/AGS partnerships were pathogenic in vivo in an insect acute infection model [15]. Given the widespread association of streptococci within CF patient lung microbiomes, the aim of this study was to examine population dynamics of other oropharyngeal commensal streptococci in combination with the LES. This study extends our investigations to another streptococcal species group that mainly consists of ubiquitous oral commensals, namely the Mitis Group. These streptococci are present in high numbers and colonise all surfaces of the mouth. They are presumed to have importance in the microbial ecology of the oral cavity and include opportunistic pathogens causing endocarditis in contrast to the AGS which are associated with intra- and extra-oral purulent infections. We show that potentiation of virulence of P. aeruginosa CF isolates is not exclusive to the AGS and that, importantly, environmentally influenced H2O2 production by Streptococcus oralis can profoundly alter biofilm development and climax population composition.

Materials and Methods

Bacterial strains and culture conditions

The bacterial strains used in this study are listed in Table 1. P. aeruginosa was routinely grown at 37°C on LB agar (Invitrogen, Paisley, United Kingdom) whilst streptococcal strains were grown on blood agar containing 6% defibrinated horse blood (BA; Oxoid, Hampshire, UK) in an anaerobic atmosphere (80% nitrogen, 10% hydrogen and 10% carbon dioxide, vol/vol). Liquid cultures used to inoculate biofilms were grown overnight at 37°C in Todd Hewitt broth (Oxoid) supplemented with 0.5% Yeast Extract (BBL, Becton Dickson & Co., USA) (THY); P. aeruginosa were incubated aerobically with agitation (200 rpm) and streptococci at 37°C anaerobically.

Biofilm modelling

Static biofilms were grown on 47 mm diameter nitrocellulose filters (Millipore) placed on THY agar as previously described [15]. Replicate filters were inoculated with approximately 7.0x104–1.0x105 colony-forming units (CFU) of a P. aeruginosa isolate either singly or in combination with 5–24 fold more streptococcal CFU (co-cultures). Aerobic incubation was at 37°C in either a 10% CO2 atmosphere or in the absence of added CO2. After 48 h incubation, filters were placed into 10 ml THY broth, vortexed for 2x30 seconds interspersed by scraping with a sterile loop, to recover the bacteria from the biofilms. For bacterial population quantitation, viable counts were performed using Pseudomonas Isolation Agar (PIA; Difco) incubated aerobically overnight (37°C) and TYC medium (Lab M, Heywood, Lancashire, UK) incubated anaerobically (37°C) for a minimum of 24 h to select for streptococci. To assess the effect of H2O2 decomposition on population dynamics in P. aeruginosa / S. oralis co-culture biofilms 500 units of catalase (from bovine liver, Sigma Aldrich) was incorporated into the inoculum before spreading onto the nitrocellulose filters.

Detection of P. aeruginosa virulence factor production

Virulence factor quantification was performed as described previously using supernatant generated from biofilms grown and disrupted as described above [15,17,18].

Hydrogen peroxide (H2O2) quantification

Triplicate filters were inoculated with approximately 5x105 CFU of a streptococcal strain and incubated at 37°C in either a 5% or 10% CO2 atmosphere or in the absence of added CO2. After 24 h incubation filters were placed into 2.5 ml sterile saline and bacterial cells removed as above. Resuspended biofilm cells were pelleted by centrifugation and H2O2 quantified in 50 μl aliquots of supernatant using a hydrogen peroxide colorimetric detection kit (Enzo Life Sciences Ltd., Exeter, UK.)

Pioneer / secondary coloniser competition assays

Antagonism of growth of competitors by pioneering streptococcal colonisers was assessed using a method adapted from a previously described protocol [19]. Briefly, 8 μl of streptococcal overnight cultures were inoculated onto THY agar and incubated at 37°C h in an aerobic (+10% CO2) or an anaerobic atmosphere. After 24 h, 8 μl of a P. aeruginosa CF2004 overnight culture (diluted 1000 fold) was inoculated next to the streptococcal colonies formed and agar plates were incubated for a further 24 h at 37°C h in an aerobic atmosphere (+10% CO2). Growth antagonism was revealed by the inhibition of growth of the side of the P. aeruginosa colony proximal to the streptococcal colony.

Statistical Analysis

Data were analysed using one-way analysis of variance (ANOVA) with Holm-Sidak post hoc test or the Student’s t-test (two independent samples assuming unequal variances). Differences were statistically significant at p<0.05*, p<0.01**, p<0.001***. The degree of spread of the data is shown as standard deviation.


Population densities and virulence factor production in co-culture biofilms

Streptococcal species belonging to the Mitis species group were selected for this study as these are amongst the most common taxa found both in the oropharyngeal flora and from the sputa of CF patients [20,21]. CF2004, the P. aeruginosa strain chosen is a low virulence factor producing variant of a common subtype of the LES, and we recently showed that its virulence could be potentiated by the presence of AGS [15].

P. aeruginosa CF2004 was grown in monoculture and in co-culture with Streptococcus mitis NCTC 12261T, Streptococcus gordonii NCTC 7865T, Streptococcus sanguinis NCTC 7863T and S. oralis ATCC 35037T under the same environmental conditions used in our previous study -37°C, aerobically with a 10% CO2 atmosphere (+10% CO2) [15] (Fig. 1A). As for previous observations with AGS, S. mitis, S. gordonii and S. sanguinis all survived at high cell density in biofilm co-culture achieving populations of 8.5x108–4.6x109 CFU / filter after 48 h (20–440 fold higher than in monoculture, p<0.001), with CF2004 always the numerically dominant partner (8.8x1010–1.2x1011 CFU filter) (Fig. 1B). Again as with AGS, when in co-culture with S. mitis, CF2004 clearly displayed a more uniform and intense distribution of blue-green pigmentation than in monoculture biofilms, which was reflected in a significantly increased measurement of the virulence factor pyocyanin (Fig. 1A and 1C, F(4,19) = 8.634; p<0.001). In addition, elastase production was also significantly enhanced in CF2004 / S. mitis co-culture biofilms (F(4,14) = 26.226; p<0.001) and in combinations containing S. gordonii (p<0.001) and S. sanguinis, (p<0.05) (Fig. 1D).

Fig 1. Population dynamics and virulence factor production in co-culture biofilms.

Bacterial strains—Pa, P. aeruginosa CF2004; Sm, S. mitis NCTC 12261T; Sg, S. gordonii NCTC 7865T; Ss, S. sanguinis NCTC 7863T; So, S. oralis ATCC 35037T and So spxB, S. oralis ATCC 35037T spxB mutant. Inoculation ratios for Pa:Sm, Pa:Sg, Pa:Ss, Pa:So and Pa:So spxB were 1:6, 1:18, 1:24, 1:6 and 1:5 respectively. (A) Biofilms formed on nitrocellulose filters after 48 h (37°C, 10% CO2). (B) Quantitative bacteriology (CFU / filter) of monoculture and co-culture biofilms sampled after 48 h (at 37°C, 10% CO2); shaded bars P. aeruginosa CF2004 population, unshaded bars streptococcal population; significant differences between cfu in monocultures and co-cultures (p<0.001***) using two-tailed t-test were observed for all streptococci with the exception of the S.oralis spxB mutant. (C) Pyocyanin and (D) elastase activity per P. aeruginosa cfu. Fold increase in co-culture biofilms compared with mono-culture control displayed. Biofilms sampled after 48 h (at 37°C); standard deviation of triplicate or quadruplicate cultures shown. Results significantly different from control using ANOVA with Holm Sidak post hoc test are denoted with an asterisk (*p<0.05, ***p<0.001). A significant fold-increase in pyocyanin was also observed between the Pa+Sm / Pa+Ss pairing (p<0.001) and for elastase production significant increases were observed for the following pairings; Pa+Sm / Pa+Ss, Pa+Sm / Pa+So spxB (p<0.001), Pa+Sm / Pa+Sg (p<0.01) and Pa+Sg / Pa+Ss (p<0.05).

The co-culture biofilm that showed the most striking difference, was the CF2004 / S. oralis combination. For these biofilms P. aeruginosa colonies grew mostly around the periphery of the filter with small S. oralis colonies just visible to the naked eye covering the remaining surface (Fig. 1A). As S. oralis is a known producer of H2O2 we hypothesised that this was the antimicrobial factor responsible for the prevention of development of a confluent biofilm with P. aeruginosa as the principal component. This was confirmed when monoculture biofilm levels of P. aeruginosa population were recovered when CF2004 was grown in combination with a S. oralis mutant deficient in H2O2 production (S. oralis ATCC 35037 spxB deletion mutant) (Fig. 1A and 1B). Interestingly, biofilm co-culture with the spxB deletion mutant led to observations similar to those obtained in combination with the other wild type streptococcal species examined; high streptococcal cell density (4.2x108 CFU / filter) and enhanced pyocyanin and elastase levels (p<0.001) (Fig. 1B, 1C and 1D). Similarly, we also observed catalase-mediated protection of the CF2004 population when grown in the presence of wild type S. oralis (Fig. 2A and 2B). In addition, S. oralis was found to survive at significantly higher cell densities in catalase protected monocultures and co-cultures (7–615 fold and 240–2220 fold higher CFU / sample, respectively) suggesting a role for H2O2 in growth limitation (Fig. 2B).

Fig 2. Catalase-mediated protection of the CF2004 population when grown in biofilm co-culture with S. oralis.

Bacterial strains—Pa, P. aeruginosa CF2004; So, S. oralis ATCC 35037T. A) Biofilms grown on nitrocellulose filters for 48 h (37°C, 10% CO2) in the presence and absence of catalase (500 units). (B) Quantitative bacteriology (CFU / filter) of samples taken from central regions of biofilms (+ or - catalase) after 24 and 48 h at 37°C (+10% CO2); shaded bars 24 h population, unshaded bars 48 h population. Detection limit; 1.0x103 CFU/ sample.

Quantification of H2O2 levels demonstrate S. oralis ATCC 35037T to be a high producer in mono-culture biofilms

Mono-culture biofilms were grown aerobically (+10% CO2) for 24 h for all four species of streptococci and the S. oralis spxB deletion mutant, their populations determined and the amount of H2O2 produced quantified. Variable populations were observed between species (population densities: S. oralis spxB > S. gordonii > S. sanguinis > S. oralis > S. mitis) with S. mitis (2.8 x 106 CFU / filter) the least populated biofilm and the S. oralis ATCC 35037 spxB deletion mutant biofilm (5.3 x 108 CFU / filter) >16 fold higher in cell density than its parent population (Fig. 3A, F(4,10) = 71.11; p<0.001). When H2O2 was quantified, it was found to be released in monoculture biofilms of all species and despite producing the second lowest biofilm biomass S. oralis was by the far the highest producer (H2O2 production: S. oralis > S. sanguinis > S. gordonii > S. oralis spxB > S. mitis, all pairwise comparisons significantly different—F(4,10) = 376.2; p<0.001) generating almost twice the amount of the next highest producer S. sanguinis (Fig. 3B). Unsurprisingly S. oralis was still the highest producer when H2O2 / CFU was determined and this analysis clearly showed that H2O2 is produced in the low cell density S. mitis biofilms (H2O2 / million CFU: S. oralis > S. mitis > S. sanguinis > S.gordonii > S. oralis spxB) (S1 Fig.).

Fig 3. Quantitative bacteriology and H2O2 production in streptococcal mono-culture biofilms.

A) Quantitative bacteriology and B) H2O2 production in monoculture biofilms sampled after 24 h incubation at 37°C in the indicated atmosphere. p values using ANOVA and Holm-Sidak post hoc test for pairwise comparisons of the quantitative bacteriology data and H2O2 production are shown in accompanying matrices (Aii, Aiii, Bii and Biii). C) Quantitative bacteriology of Streptococcus oralis monoculture biofilms with and without catalase. Significant difference (p<0.001***) using the two-tailed t-test shown.

We also evaluated biofilm cell densities and the amount of H2O2 produced by S. oralis under two other atmospheric conditions; aerobic (air) or aerobic + 5% CO2 (37°C) (Fig. 3A and 3B). Although the average S. oralis biomass halved in aerobic (+ 5% CO2) conditions the amount of H2O2 produced was still higher than that of all other streptococcal species when grown in aerobic (+ 10% CO2) conditions. In air however, further reductions in biofilm cell density (F(2,6) = 5.434; p = 0.045) and production of H2O2 (F(2,6) = 627.761; p<0.001) (>8 and >12 fold reduced, compared to + 10% CO2 conditions respectively) were observed.

These data explain why S. oralis is able to shape the bacterial composition of co-culture biofilms so dramatically to its advantage when grown in the presence of added CO2 (Fig. 1A and S1 Fig.) and show that reducing the CO2 concentration progressively to atmospheric levels reduces biofilm cell density and thus the amount of H2O2 produced (Fig. 3A and 3B). Interestingly, we also showed that catalase protected S. oralis biofilms had a cell density that was 6 fold higher than the parental control (Fig. 3C, p<0.001). This is in agreement with the higher cell density observation made with the spxB mutant (Fig. 3A) and in catalase protected S. oralis biofilm samples (Fig. 2B) and demonstrates that H2O2 production is a mechanism for self-limitation of S. oralis biofilm development.

Inoculation sequence influences P. aeruginosa antagonism

In addition to determining population dynamics after co-inoculation in a biofilm model, we also explored whether H2O2 production by these four species of streptococci when grown as a pioneer coloniser could antagonize growth of P. aeruginosa. Streptococci were deposited on the surface of THY agar and grown for 24 h in both an aerobic (+10% CO2) and an anaerobic atmosphere. The compact high cellular density colonies were then challenged with P. aeruginosa CF2004 and after a further 24 h (aerobic, +10% CO2) growth inhibition determined visually. Interestingly the lowest H2O2 producer in the biofilm model—S. mitis, strongly inhibited growth of P. aeruginosa CF2004 (Fig. 4A and 4B). H2O2 mediated antagonism of P. aeruginosa CF2004 growth was also observed for S. sanguinis and S. gordonii, but was clearly weaker than that observed for the other two species. Similar results were obtained for both streptococcal colonising incubation conditions (aerobic +10% CO2 and anaerobic atmospheres). H2O2 was confirmed as the inhibiting substance through incorporation of catalase into the inoculum of the pioneer coloniser and the use of the spxB mutant (Fig. 4A, 4B, 4C and 4D).

Fig 4. Antagonism of P. aeruginosa growth by pioneering streptococcal colonisers.

Bacterial strains—Pa, P. aeruginosa CF2004; Sm, S. mitis NCTC 12261T; Sg, S. gordonii NCTC 7865T; Ss, S. sanguinis NCTC 7863T; So, S. oralis ATCC 35037T, and So spxB, S. oralis ATCC 35037T spxB mutant. Streptococcal spp were inoculated onto the agar surface as pioneer colonisers and incubated for 24 h at 37°C h in an A and C) aerobic (+10% CO2) and B and D) anaerobic atmosphere before CF2004 cultures were adjacently inoculated as secondary colonisers and grown for a further 24 h at 37°C h in an aerobic atmosphere (+10% CO2).

S. oralis is again the dominant partner when challenged with other commonly isolated phenotypes associated with CF respiratory infection

Three other variants of P. aeruginosa (768, H129 and DWW2) with different phenotypes to CF2004 were challenged with S. oralis in co-culture (aerobic +10% CO2); DWW2, which is a mucoid CF isolate and LES variants 768 (highly pigmented due to overproduction of pyocyanin) and H129 (intermediate pyocyanin producer) [15,22]. All P. aeruginosa variants were able to form confluent biofilms when grown alone but colonies were either absent (768) or observed only at the perimeter of the filter (H129, DWW2) when cultured together with S. oralis (Fig. 5A). Again S. oralis colonies just visible to the naked eye covered the majority of the surface of the filter and their dominance (5.0 x 102–4.2 x 103 per sample) and absence of P. aeruginosa (below detection limit of 1 x 103 per sample) in these regions was confirmed through quantitative bacteriology (Fig. 5B).

Fig 5. S. oralis also inhibits growth of other common P. aeruginosa CF phenotypes.

Bacterial strains—768, P. aeruginosa 768; H129, P. aeruginosa H129; DWW2, P. aeruginosa DWW2; So, S. oralis ATCC 35037T. (A) Biofilms formed on nitrocellulose filters after 48 h (37°C, 10% CO2). (B) Quantitative bacteriology (CFU / filter) of samples taken from central regions of monoculture and co-culture biofilms after 24 and 48 h at 37°C (+10% CO2); shaded bars 24 h population, unshaded bars 48 h population. Detection limit; 1.0x103 CFU/ Sample. Standard deviation shown for duplicate or triplicate samples.

Cooperation is observed between P. aeruginosa CF2004 and S. oralis ATCC 35037 grown together under aerobic conditions

As S. oralis grew poorly in air compared to atmospheres containing CO2 and produced significantly less H2O2, we postulated that it could form a cooperative partnership with P. aeruginosa in this environment. Mono and co-culture biofilms were grown at 37°C in air. In combination S. oralis and CF2004 formed a highly pigmented confluent biofilm (Fig. 6A), a striking contrast to the patchy biofilm this combination formed in the presence of 10% CO2 (Fig. 1A). As demonstrated with the other species of streptococci grown in combination in a 10% CO2 atmosphere, we observed comparable P. aeruginosa populations in CF2004 monoculture / co-culture biofilms (4.7–5.0x1010 CFU / filter), high S. oralis cell density in co-culture (2.0x108 CFU / filter, 15 fold greater than in monoculture) and significantly enhanced pyocyanin levels in co-culture (Fig. 6B, p<0.01; 6C, p<0.05).

Fig 6. Enhancement of P. aeruginosa CF2004 virulence factor by S. oralis in biofilms incubated without added CO2.

Bacterial strains—Pa, P. aeruginosa CF2004; So, S. oralis ATCC 35037T. Biofilms were grown aerobically on nitrocellulose filters for 48 h at 37°C. A) photographs and (B) quantitative bacteriology (CFU / filter) of monoculture and co-culture biofilms; shaded bars P. aeruginosa CF2004 population, unshaded bars streptococcal population. (C) Pyocyanin and (D) elastase activity in biofilms. Standard deviation of triplicate or quadruplicate cultures shown. Results significantly different from control using the two-tailed t-test are denoted with asterisks (*p<0.05, ** p<0.01).


Previously we observed that the AGS could enhance production of elastase and pyocyanin, virulence factors associated with CF lung pathogenesis and thus disease progression when in co-culture with the LES variants CF2004 (low pyocyanin producer variant) and H129 (intermediate pyocyanin / high elastase producer) [15]. Here we show that four other streptococcal species (S. oralis, S. mitis, S. gordonii and S. sanguinis) can also survive in co-culture biofilm with P. aeruginosa CF2004 and the observed stimulation of virulence factor production show that the AGS are not the only streptococci able to potentiate the pathogenicity of P. aeruginosa CF isolates. Interestingly, contrasting observations were made for S. oralis when incubated in co-culture under two different environmental conditions; in the presence of added CO2 it is a lethal competitor producing enough H2O2 to reshape the dynamics of the partnership whilst in air it is a cooperator coexisting at high cell density and stimulating P. aeruginosa virulence factor production. Together, these data show that the nature of these interactions can be driven by the local environment. CF airways provide a highly variable habitat with diverse predisposing micro-environmental conditions and regional differences in microflora [23,24,25]. Whilst it is now well known that the thick dehydrated mucus that coats the CF airway has hypoxic regions, and as alveolar hypoventilation and severe hypercapnia are frequently observed in critically ill adult CF patients, it is highly likely that CO2 levels are also variable and in excess of that occurring in the healthy lung [23,26,27]. Therefore S. oralis has a capacity to influence CF community dynamics, both through the facilitation of lung damage by P. aeruginosa or alternatively by prevention of its colonization, that is environmentally dependent.

H2O2 is known to shape the colonization process in other ecosystems. For instance, oral commensal streptococci can produce competitive amounts of H2O2 that are involved in immigration selection during oral biofilm development and species composition has a direct impact on disease progression [28]. Similarly, interspecies interference by Streptococcus pneumoniae towards Staphylococcus aureus has been shown to be H2O2 mediated [29]. Data generated from H2O2 quantification in streptococcal monoculture biofilms (aerobic, + CO2) support our co-culture biofilm observations, showing S. oralis to be the highest producer of the four species examined (Fig. 3B). The lower levels of H2O2 produced by S. gordonii and S. sanguinis (Fig. 3B) could be due to repression in the biofilm mode of growth, as previously observed [30]. Interestingly, we also showed H2O2 to reduce biofilm formation in S. oralis monoculture biofilms, as a significantly higher cell density was obtained for the spxB deletion mutant and catalase protected biofilms. Thus this is compelling evidence that H2O2 production is also a mechanism for self-limitation of biofilm development and/or for the release of matrix components such as eDNA as observed previously for other Mitis group streptococci [28,31]. In addition we observed that S. oralis grows poorly in monoculture in air (Fig. 3A), but survives at high cell density in co-culture under this condition (Fig. 6B). There could be a number of interrelated reasons for increased S. oralis growth, including; the increased surface area created by the P. aeruginosa biofilm matrix, mutually beneficial metabolic interactions between co-colonisers and P. aeruginosa mediated detoxification of H2O2. In support of the latter, we observed that the S. oralis population can be enhanced in catalase protected co-culture biofilms when compared with unprotected controls, although a different incubation environment (aerobically +10% CO2) was used in that analysis (Fig. 2B). In addition the biofilm populations for the S. oralis spxB mutant are similar in mono and co-culture (Fig. 1B). Survival of P. aeruginosa in air co-cultures can be attributed to neutralization of any H2O2 present by catalase produced during its more rapid growth and by its numerically dominant population.

The observation that antagonism towards growth of P. aeruginosa is only visible after S. mitis, and to a lesser extent S. gordonii and S. sanguinis, are grown as pioneer colonisers shows that the inoculation sequence and the relative populations of these competing microbes has a major influence on community composition. Our laboratory observations showing antagonism by all four streptococcal species may presage the situation in-vivo in the CF lung when considered from a temporal perspective; it has been shown that streptococci of the Mitis species group that includes the species studied here, are one of the predominant groups of bacteria in the respiratory microbiome of infant CF patients, being detectable in relatively high numbers in the first month of life [32]. This mirrors the colonization pattern of the oropharynx in healthy neonates studied by Könönen and colleagues where the same group of streptococci were detectable at the earliest time point sampled after birth at 2 months [33]. Therefore, relatively early establishment of these commensal species in the oral cavity and CF lung may well be a significant factor in dictating community member acquisition, establishment and the subsequent interactions as the CF lung microbiome develops thereby delaying or promoting disease progression.

It is now accepted that the airway of a CF patient is a highly diverse and dynamic environment populated by a complex infecting microflora. It is also acknowledged that an understanding of these microbial communities, their dynamics and effects on the physiology of the infected CF lung will not only help us to identify members associated with a less pathogenic state but also to optimise therapeutic strategies for this disease [25]. The results of this study provide a window on the complexity of potential interactions between some members of the CF microbiota and the interpecies, environmental, spatial and temporal factors influencing them. Given the heterogeneity of sites within a single CF lung and between patients both in terms of environmental factors and microbial composition [24,34] it is clear that a deeper knowledge of the nature of interactive behaviour within the communities is required if we are to understand CF microbial community dynamics and evolution associated with health and disease progression.

Supporting Information

S1 Fig. H2O2 production per million streptococcal mono-culture biofilm CFU.

Values displayed calculated from data presented in Fig. 3A and 3B).


S1 File. Tables A, B, C, D and E.

Raw data for Figs. 1, 2, 3, 5 and 6 respectively.



Thanks to Nobuo Okahashi (Osaka University, Japan) for supplying the S. oralis ATCC 35037 spxB mutant and its isogenic parent.

Author Contributions

Conceived and designed the experiments: RAW RDW. Performed the experiments: RAW RDW EVF RM. Analyzed the data: RAW RDW. Contributed reagents/materials/analysis tools: RAW RDW EVF RM. Wrote the paper: RAW RDW.


  1. 1. Harrison F (2007) Microbial ecology of the cystic fibrosis lung. Microbiology 153: 917–923. pmid:17379702
  2. 2. Segal LN, Rom WN, Weiden MD (2014) Lung Microbiome for Clinicians. New Discoveries about Bugs in Healthy and Diseased Lungs. Ann Am Thorac Soc 11: 108–116. pmid:24460444
  3. 3. Guss AM, Roeselers G, Newton IL, Young CR, Klepac-Ceraj V, et al. (2011) Phylogenetic and metabolic diversity of bacteria associated with cystic fibrosis. ISME J 5: 20–29. pmid:20631810
  4. 4. Filkins LM, Hampton TH, Gifford AH, Gross MJ, Hogan DA, et al. (2012) Prevalence of streptococci and increased polymicrobial diversity associated with cystic fibrosis patient stability. J Bacteriol 194: 4709–4717. pmid:22753064
  5. 5. Rogers GB, Carroll MP, Serisier DJ, Hockey PM, Jones G, et al. (2004) characterization of bacterial community diversity in cystic fibrosis lung infections by use of 16s ribosomal DNA terminal restriction fragment length polymorphism profiling. J Clin Microbiol 42: 5176–5183. pmid:15528712
  6. 6. Sibley CD, Parkins MD, Rabin HR, Duan K, Norgaard JC, et al. (2008) A polymicrobial perspective of pulmonary infections exposes an enigmatic pathogen in cystic fibrosis patients. Proc Natl Acad Sci U S A 105: 15070–15075. pmid:18812504
  7. 7. van der Gast CJ, Walker AW, Stressmann FA, Rogers GB, Scott P, et al. (2011) Partitioning core and satellite taxa from within cystic fibrosis lung bacterial communities. ISME J 5: 780–791. pmid:21151003
  8. 8. Waite RD, Wareham DW, Gardiner S, Whiley RA (2012) A simple, semiselective medium for anaerobic isolation of anginosus group streptococci from patients with chronic lung disease. J Clin Microbiol 50: 1430–1432. pmid:22238446
  9. 9. Purcell P, Jary H, Perry A, Perry JD, Stewart CJ, et al. (2014) Polymicrobial airway bacterial communities in adult bronchiectasis patients. BMC Microbiol 14: 130. pmid:24886473
  10. 10. Duan K, Dammel C, Stein J, Rabin H, Surette MG (2003) Modulation of Pseudomonas aeruginosa gene expression by host microflora through interspecies communication. Mol Microbiol 50: 1477–1491. pmid:14651632
  11. 11. Sibley CD, Duan K, Fischer C, Parkins MD, Storey DG, et al. (2008) Discerning the complexity of community interactions using a Drosophila model of polymicrobial infections. PLoS Pathog 4: e1000184. pmid:18949036
  12. 12. Fothergill JL, Walshaw MJ, Winstanley C (2012) Transmissible strains of Pseudomonas aeruginosa in cystic fibrosis lung infections. Eur Respir J 40: 227–238. pmid:22323572
  13. 13. Fothergill JL, Mowat E, Ledson MJ, Walshaw MJ, Winstanley C (2010) Fluctuations in phenotypes and genotypes within populations of Pseudomonas aeruginosa in the cystic fibrosis lung during pulmonary exacerbations. J Med Microbiol 59: 472–481. pmid:20019149
  14. 14. Fothergill JL, Panagea S, Hart CA, Walshaw MJ, Pitt TL, et al. (2007) Widespread pyocyanin over-production among isolates of a cystic fibrosis epidemic strain. BMC Microbiol 7: 45. pmid:17521417
  15. 15. Whiley RA, Sheikh NP, Mushtaq N, Hagi-Pavli E, Personne Y, et al. (2014) Differential potentiation of the virulence of the Pseudomonas aeruginosa cystic fibrosis liverpool epidemic strain by oral commensal Streptococci. J Infect Dis 209: 769–780. pmid:24158959
  16. 16. Aaron SD, Vandemheen KL, Ramotar K, Giesbrecht-Lewis T, Tullis E, et al. (2010) Infection with transmissible strains of Pseudomonas aeruginosa and clinical outcomes in adults with cystic fibrosis. JAMA 304: 2145–2153. pmid:21081727
  17. 17. Essar DW, Eberly L, Hadero A, Crawford IP (1990) Identification and characterization of genes for a second anthranilate synthase in Pseudomonas aeruginosa: interchangeability of the two anthranilate synthases and evolutionary implications. J Bacteriol 172: 884–900. pmid:2153661
  18. 18. Waite RD, Rose RS, Rangarajan M, Aduse-Opoku J, Hashim A, et al. (2012) Pseudomonas aeruginosa possesses two putative type I signal peptidases, LepB and PA1303, each with distinct roles in physiology and virulence. J Bacteriol 194: 4521–4536. pmid:22730125
  19. 19. Kreth J, Zhang Y, Herzberg MC (2008) Streptococcal antagonism in oral biofilms: Streptococcus sanguinis and Streptococcus gordonii interference with Streptococcus mutans. J Bacteriol 190: 4632–4640. pmid:18441055
  20. 20. Peterson SN, Snesrud E, Liu J, Ong AC, Kilian M, et al. (2013) The dental plaque microbiome in health and disease. PLoS One 8: e58487. pmid:23520516
  21. 21. Maeda Y, Elborn JS, Parkins MD, Reihill J, Goldsmith CE, et al. (2011) Population structure and characterization of viridans group streptococci (VGS) including Streptococcus pneumoniae isolated from adult patients with cystic fibrosis (CF). J Cyst Fibros 10: 133–139. pmid:21145793
  22. 22. Kenna DT, Doherty CJ, Foweraker J, Macaskill L, Barcus VA, et al. (2007) Hypermutability in environmental Pseudomonas aeruginosa and in populations causing pulmonary infection in individuals with cystic fibrosis. Microbiology 153: 1852–1859. pmid:17526842
  23. 23. Worlitzsch D, Tarran R, Ulrich M, Schwab U, Cekici A, et al. (2002) Effects of reduced mucus oxygen concentration in airway Pseudomonas infections of cystic fibrosis patients. J Clin Invest 109: 317–325. pmid:11827991
  24. 24. Willner D, Haynes MR, Furlan M, Schmieder R, Lim YW, et al. (2012) Spatial distribution of microbial communities in the cystic fibrosis lung. ISME J 6: 471–474. pmid:21796216
  25. 25. Conrad D, Haynes M, Salamon P, Rainey PB, Youle M, et al. (2013) Cystic fibrosis therapy: a community ecology perspective. Am J Respir Cell Mol Biol 48: 150–156. pmid:23103995
  26. 26. Corkill JE, Deveney J, Pratt J, Shears P, Smyth A, et al. (1994) Effect of pH and CO2 on in vitro susceptibility of Pseudomonas cepacia to beta-lactams. Pediatr Res 35: 299–302. pmid:7514780
  27. 27. Fauroux B (2011) Why, when and how to propose noninvasive ventilation in cystic fibrosis? Minerva Anestesiol 77: 1108–1114. pmid:21602746
  28. 28. Zhu L, Kreth J (2012) The role of hydrogen peroxide in environmental adaptation of oral microbial communities. Oxid Med Cell Longev 2012: 717843. pmid:22848782
  29. 29. Regev-Yochay G, Trzcinski K, Thompson CM, Malley R, Lipsitch M (2006) Interference between Streptococcus pneumoniae and Staphylococcus aureus: In vitro hydrogen peroxide-mediated killing by Streptococcus pneumoniae. J Bacteriol 188: 4996–5001. pmid:16788209
  30. 30. Nguyen PT, Abranches J, Phan TN, Marquis RE (2002) Repressed respiration of oral streptococci grown in biofilms. Curr Microbiol 44: 262–266. pmid:11910496
  31. 31. Xu Y, Kreth J (2013) Role of LytF and AtlS in eDNA release by Streptococcus gordonii. PLoS One 8: e62339. pmid:23638042
  32. 32. Madan JC, Koestler DC, Stanton BA, Davidson L, Moulton LA, et al. (2012) Serial analysis of the gut and respiratory microbiome in cystic fibrosis in infancy: interaction between intestinal and respiratory tracts and impact of nutritional exposures. MBio 3.
  33. 33. Kononen E, Jousimies-Somer H, Bryk A, Kilp T, Kilian M (2002) Establishment of streptococci in the upper respiratory tract: longitudinal changes in the mouth and nasopharynx up to 2 years of age. J Med Microbiol 51: 723–730. pmid:12358062
  34. 34. Quinn RA, Lim YW, Maughan H, Conrad D, Rohwer F, et al. (2014) Biogeochemical forces shape the composition and physiology of polymicrobial communities in the cystic fibrosis lung. MBio 5: e00956–00913. pmid:24667707
  35. 35. Okahashi N, Nakata M, Sumitomo T, Terao Y, Kawabata S (2013) Hydrogen peroxide produced by oral Streptococci induces macrophage cell death. PLoS One 8: e62563. pmid:23658745