Search
Advanced Search
Metrics info
Average Rating (0 User Ratings)
    • Currently 0/5 Stars.
    See all categories
      • Currently 0/5 Stars.
      • Currently 0/5 Stars.
      • Currently 0/5 Stars.
    Rate This Article
Share this Article info
  • Bookmark: StumbleUpon Facebook Connotea CiteULike Bibliography

Open Access

Research Article

Staphylococcal Biofilm Exopolysaccharide Protects against Caenorhabditis elegans Immune Defenses

Author Summary<p>Biofilm is an agglomeration of microbes bound together by a slimy matrix composed of excreted proteins and polysaccharide polymers. Most bacteria in the environment reside in biofilms, as do 80% or more of those causing human infections, according to some estimates. During infection, biofilm matrix acts as a safe haven, protecting bacterial cells from antibiotics, immune cells, and antimicrobial factors. In this report, we demonstrate that the ability of <i>Staphylococcus epidermidis</i> to produce a lethal infection within the intestinal tract of the roundworm <i>Caenorhabditis elegans</i> depends on the <i>S. epidermidis</i> intercellular adhesion <i>(ica)</i> locus, which is responsible for the synthesis of the principal exopolysaccharide of staphylococcal biofilm, polysaccharide intercellular adhesin (PIA). Using a collection of bacterial and nematode mutants, we show that PIA promotes infection by working against protective immune factors controlled by the <i>C. elegans</i> SEK-1 PMK-1 p38 mitogen-activated protein kinase pathway. In addition to providing further evidence for the immunoprotective function of the biofilm polymer PIA, these results show that <i>C. elegans</i> can be used in a simple, live animal model for the study of host–pathogen interactions involving biofilm matrix.</p></sec></div> <span property="dc:date" content="2007-04-20" datatype="xsd:date" rel="dc:identifier" href="http://dx.doi.org/10.1371/journal.ppat.0030057"></span> <span property="dc:subject" content="Immunology"></span> <span property="dc:subject" content="Microbiology"></span> <form action=""> <input type="hidden" name="journalDisplayName" id="journalDisplayName" value="PLoS Pathogens" /> <input type="hidden" name="crossRefPageURL" id="crossRefPageURL" value="/article/crossref/info%3Adoi%2F10.1371%2Fjournal.ppat.0030057" /> <input type="hidden" name="metricsTabURL" id="metricsTabURL" value="/article/metrics/info%3Adoi%2F10.1371%2Fjournal.ppat.0030057" /> <input type="hidden" name="doi" id="doi" value="info:doi/10.1371/journal.ppat.0030057" /> <input type="hidden" name="articleTitleUnformatted" id="articleTitleUnformatted" value="Staphylococcal%20Biofilm%20Exopolysaccharide%20Protects%20against%20Caenorhabditis%20elegans%20Immune%20Defenses" /> <input type="hidden" name="articlePubDate" id="articlePubDate" value="1177052400000" /> </form> <div class="horizontalTabs" xpathLocation="noSelect"> <ul id="tabsContainer"> <li id="article" class="active"><a href="/article/info%3Adoi%2F10.1371%2Fjournal.ppat.0030057" class="tab" title="Article">Article</a></li> <li id="metrics"><a href="/article/metrics/info%3Adoi%2F10.1371%2Fjournal.ppat.0030057" class="tab" title="Metrics">Metrics</a></li> <li id="related"><a href="/article/related/info%3Adoi%2F10.1371%2Fjournal.ppat.0030057" class="tab" title="Related Content">Related Content</a></li> <li id="comments"><a href="/article/comments/info%3Adoi%2F10.1371%2Fjournal.ppat.0030057" class="tab" title="Comments">Comments: 0</a></li> </ul> </div> <div id="retractionHtmlId" class="retractionHtmlId" style="display:none;" xpathLocation="noSelect"> <div id="retractionlist"></div> </div> <div id="fch" class="fch" style="display:none;" xpathLocation="noSelect"> <p class="fch"><strong> Formal Correction:</strong> This article has been <em>formally corrected</em> to address the following errors.</p> <ol id="fclist" class="fclist"></ol> </div> <div id="articleMenu" xpathLocation="noSelect"> <div class="wrap"> <ul> <li class="annotation icon">To <strong>add a note</strong>, highlight some text. <a href="#" onclick="toggleAnnotation(this, 'public'); return false;" title="Click to turn notes on/off">Hide notes</a></li> <li class="discuss icon"> <a href="/user/secure/secureRedirect.action?goTo=%2Farticle%2Finfo%3Adoi%2F10.1371%2Fjournal.ppat.0030057">Make a general comment</a> </li> </ul> <div id="sectionNavTopBox" style="display:none;"> <p><strong>Jump to</strong></p> <div id="sectionNavTop" class="tools"></div> </div> </div> </div> <p xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" class="authors" xpathLocation="noSelect"><span property="dc:creator">Jakob Begun</span><sup><a href="#aff1">1</a></sup><sup>,</sup><sup><a href="#aff2">2</a></sup>, <span property="dc:creator">Jessica M. Gaiani</span><sup><a href="#aff3">3</a></sup>, <span property="dc:creator">Holger Rohde</span><sup><a href="#aff4">4</a></sup>, <span property="dc:creator">Dietrich Mack</span><sup><a href="#aff5">5</a></sup>, <span property="dc:creator">Stephen B. Calderwood</span><sup><a href="#aff6">6</a></sup><sup>,</sup><sup><a href="#aff7">7</a></sup>, <span property="dc:creator">Frederick M. Ausubel</span><sup><a href="#aff1">1</a></sup><sup>,</sup><sup><a href="#aff2">2</a></sup>, <span property="dc:creator">Costi D. Sifri</span><sup><a href="#aff3">3</a></sup><sup>,</sup><sup><a href="#aff6">6</a></sup><sup><a href="#cor1" class="fnoteref">*</a></sup></p><p xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" class="affiliations" xpathLocation="noSelect"><a name="aff1" id="aff1"></a><strong>1</strong> Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts, United States of America, <a name="aff2" id="aff2"></a><strong>2</strong> Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America, <a name="aff3" id="aff3"></a><strong>3</strong> Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, Virginia, United States of America, <a name="aff4" id="aff4"></a><strong>4</strong> Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany, <a name="aff5" id="aff5"></a><strong>5</strong> Medical Microbiology and Infectious Diseases, The School of Medicine, University of Wales Swansea, Swansea, United Kingdom, <a name="aff6" id="aff6"></a><strong>6</strong> Division of Infectious Diseases, Massachusetts General Hospital, Boston Massachusetts, United States of America, <a name="aff7" id="aff7"></a><strong>7</strong> Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts, United States of America</p><div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" class="abstract" xpathLocation="/article[1]/front[1]/article-meta[1]/abstract[1]"><a id="abstract0" name="abstract0" toc="abstract0" title="Abstract"></a><h2 xpathLocation="noSelect">Abstract <a href="#top">Top</a></h2><p xpathLocation="/article[1]/front[1]/article-meta[1]/abstract[1]/p[1]"><span class="genus-species">Staphylococcus epidermidis</span> and <span class="genus-species">Staphylococcus aureus</span> are leading causes of hospital-acquired infections that have become increasingly difficult to treat due to the prevalence of antibiotic resistance in these organisms. The ability of staphylococci to produce biofilm is an important virulence mechanism that allows bacteria both to adhere to living and artificial surfaces and to resist host immune factors and antibiotics. Here, we show that the <i>icaADBC</i> locus, which synthesizes the biofilm-associated polysaccharide intercellular adhesin (PIA) in staphylococci, is required for the formation of a lethal <span class="genus-species">S. epidermidis</span> infection in the intestine of the model nematode <span class="genus-species">Caenorhabditis elegans</span>. Susceptibility to <span class="genus-species">S. epidermidis</span> infection is influenced by mutation of the <span class="genus-species">C. elegans</span> PMK-1 p38 mitogen-activated protein (MAP) kinase or DAF-2 insulin-signaling pathways. Loss of PIA production abrogates nematocidal activity and leads to reduced bacterial accumulation in the <span class="genus-species">C. elegans</span> intestine, while overexpression of the <i>icaADBC</i> locus in <span class="genus-species">S. aureus</span> augments virulence towards nematodes. PIA-producing <span class="genus-species">S. epidermidis</span> has a significant survival advantage over <i>ica</i>-deficient <span class="genus-species">S. epidermidis</span> within the intestinal tract of wild-type <i>C. elegans,</i> but not in immunocompromised nematodes harboring a loss-of-function mutation in the p38 MAP kinase pathway gene <i>sek-1</i>. Moreover, <i>sek-1</i> and <i>pmk-1</i> mutants are equally sensitive to wild-type and <i>icaADBC</i>-deficient <span class="genus-species">S. epidermidis</span>. These results suggest that biofilm exopolysaccharide enhances virulence by playing an immunoprotective role during colonization of the <span class="genus-species">C. elegans</span> intestine. These studies demonstrate that <span class="genus-species">C. elegans</span> can serve as a simple animal model for studying host–pathogen interactions involving staphylococcal biofilm exopolysaccharide and suggest that the protective activity of biofilm matrix represents an ancient conserved function for resisting predation.</p> </div><div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" class="abstract" xpathLocation="/article[1]/front[1]/article-meta[1]/abstract[2]"><a id="abstract1" name="abstract1" toc="abstract1" title="Author Summary"></a> <h2 xpathLocation="noSelect">Author Summary <a href="#top">Top</a></h2> <p xpathLocation="/article[1]/front[1]/article-meta[1]/abstract[2]/sec[1]/p[1]">Biofilm is an agglomeration of microbes bound together by a slimy matrix composed of excreted proteins and polysaccharide polymers. Most bacteria in the environment reside in biofilms, as do 80% or more of those causing human infections, according to some estimates. During infection, biofilm matrix acts as a safe haven, protecting bacterial cells from antibiotics, immune cells, and antimicrobial factors. In this report, we demonstrate that the ability of <span class="genus-species">Staphylococcus epidermidis</span> to produce a lethal infection within the intestinal tract of the roundworm <span class="genus-species">Caenorhabditis elegans</span> depends on the <span class="genus-species">S. epidermidis</span> intercellular adhesion <i>(ica)</i> locus, which is responsible for the synthesis of the principal exopolysaccharide of staphylococcal biofilm, polysaccharide intercellular adhesin (PIA). Using a collection of bacterial and nematode mutants, we show that PIA promotes infection by working against protective immune factors controlled by the <span class="genus-species">C. elegans</span> SEK-1 PMK-1 p38 mitogen-activated protein kinase pathway. In addition to providing further evidence for the immunoprotective function of the biofilm polymer PIA, these results show that <i>C. elegans</i> can be used in a simple, live animal model for the study of host–pathogen interactions involving biofilm matrix.</p> </div> <div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" class="articleinfo" xpathLocation="noSelect"><p><strong>Citation: </strong>Begun J, Gaiani JM, Rohde H, Mack D, Calderwood SB, et al. (2007) Staphylococcal Biofilm Exopolysaccharide Protects against <span class="genus-species">Caenorhabditis elegans</span> Immune Defenses. PLoS Pathog 3(4): e57. doi:10.1371/journal.ppat.0030057</p><p><strong>Editor: </strong>David S. Schneider, Stanford University, United States of America</p><p></p><p><strong>Received:</strong> January 27, 2006; <strong>Accepted:</strong> March 5, 2007; <strong>Published:</strong> April 20, 2007</p><p><strong>Copyright:</strong> © 2007 Begun et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</p><p><strong>Funding:</strong> This work was supported by the National Insititutes of Health grants R01 AI064332 to FMA and K08 AI053677 to CDS, by a research grant from Aventis Pharmaceuticals to FMA and SBC, and by a University of Virginia Digestive Health Research Center Feasibilty Project grant to CDS. </p><p><strong>Competing interests:</strong> The authors have declared that no competing interests exist.</p><p><strong>Abbreviations: </strong>C.F.U., colony-forming unit; FITC, fluorescein isothiocyanate; <i>ica,</i>, intercellular adhesion locus; MAP, mitogen-activated protein; PIA, polysaccharide intercellular adhesin; PNAG, β-1,6-linked polymeric <i>N</i>-acetyl glucosamine; SEM, standard error of the mean; TS, tryptic soy; WGA, wheat germ agglutinin</p><p><a name="cor1"></a>* To whom correspondence should be addressed. E-mail: <a href="mailto:csifri@virginia.edu">csifri@virginia.edu</a></p></div> <div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" id="section1" xpathLocation="/article[1]/body[1]/sec[1]"><a id="s1" name="s1" toc="s1" title="Introduction"></a><h3 xpathLocation="noSelect">Introduction <a href="#top">Top</a></h3><p xpathLocation="/article[1]/body[1]/sec[1]/p[1]">Staphylococci are a predominant cause of hospital-acquired infections, particularly those associated with implanted medical devices and catheters. The ability of staphylococci, particularly <i>Staphylococcus epidermidis,</i> to form biofilm on biotic and abiotic surfaces appears to be critical for the establishment of these infections and to contribute to their persistence by protecting <span class="genus-species">S. epidermidis</span> from antibiotics and host defenses [<a href="#ppat-0030057-b001">1</a>,<a href="#ppat-0030057-b002">2</a>]. Bacterial biofilm is composed of multilayered cell clusters encased in an exopolysaccharide matrix. The biofilm matrix of <span class="genus-species">S. epidermidis</span> consists mainly of partially deacetylated β-1,6-linked polymeric <i>N</i>-acetyl glucosamine (PNAG), commonly referred to as polysaccharide intercellular adhesin (PIA) [<a href="#ppat-0030057-b003">3</a>]. PIA mediates intercellular adhesion essential for biofilm accumulation, and also has a role in primary attachment to certain hydrophilic abiotic polymer surfaces [<a href="#ppat-0030057-b003">3</a>–<a href="#ppat-0030057-b007">7</a>]. The <span class="genus-species">S. epidermidis</span> intercellular adhesion locus <i>(ica),</i> consisting of the biosynthetic operon <i>icaADBC</i> and the regulatory gene <i>icaR</i> [<a href="#ppat-0030057-b005">5</a>,<a href="#ppat-0030057-b008">8</a>,<a href="#ppat-0030057-b009">9</a>], is required for PIA biosynthesis as well as for biofilm formation in vitro and in several animal models of <span class="genus-species">S. epidermidis</span> infection [<a href="#ppat-0030057-b006">6</a>,<a href="#ppat-0030057-b010">10</a>,<a href="#ppat-0030057-b011">11</a>]. In addition to its role in surface and cell-to-cell adherence, biofilm also appears to provide an immunoprotective function, reducing the ability of phagocytes to engulf <span class="genus-species">S. epidermidis</span> and protecting <span class="genus-species">S. epidermidis</span> from antimicrobial peptides [<a href="#ppat-0030057-b012">12</a>,<a href="#ppat-0030057-b013">13</a>]. Epidemiologic studies have shown that the presence of the <i>ica</i> locus is associated with pathogenic strains of <span class="genus-species">S. epidermidis</span> [<a href="#ppat-0030057-b014">14</a>–<a href="#ppat-0030057-b016">16</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[1]/p[2]">In contrast to <i>S. epidermidis,</i> biofilm formation by <span class="genus-species">Staphylococcus aureus</span> appears to be more robust in vivo than in vitro, which may be a consequence of phenotypic switching or other regulatory differences [<a href="#ppat-0030057-b017">17</a>,<a href="#ppat-0030057-b018">18</a>]. Nevertheless, some <span class="genus-species">S. aureus</span> isolates produce biofilm on glucose- and/or sucrose-supplemented rich media or under anaerobic conditions, and most <span class="genus-species">S. aureus</span> strains contain the <i>icaADBC</i> operon [<a href="#ppat-0030057-b019">19</a>–<a href="#ppat-0030057-b023">23</a>]. Isolation of a spontaneous <span class="genus-species">S. aureus</span> mutant that produces copious amounts of biofilm in vitro, MN8m, led to the characterization of a 5-nucleotide regulatory sequence within the <i>icaADBC</i> promoter that normally acts to repress transcription [<a href="#ppat-0030057-b024">24</a>]. Deletion of this region, as in MN8m, results in increased <i>icaADBC</i> transcription and enhanced biofilm formation [<a href="#ppat-0030057-b024">24</a>]. Thus, the <i>icaADBC</i> operon may normally be repressed in <span class="genus-species">S. aureus</span> in vitro, which explains why relatively few <span class="genus-species">S. aureus</span> strains form biofilm under standard laboratory conditions. Nevertheless, the <i>ica</i> locus contributes to <span class="genus-species">S. aureus</span> virulence in several animal models of invasive <span class="genus-species">S. aureus</span> disease [<a href="#ppat-0030057-b025">25</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[1]/p[3]">While loss of the <i>icaADBC</i> operon generally leads to a reduction of pathogenicity and biofilm formation of <span class="genus-species">S. epidermidis</span> and <span class="genus-species">S. aureus</span> in vivo, complete loss of staphylococcal virulence is generally not observed [<a href="#ppat-0030057-b010">10</a>,<a href="#ppat-0030057-b025">25</a>,<a href="#ppat-0030057-b026">26</a>]. Moreover, the <i>ica</i> locus does not appear to contribute to <span class="genus-species">S. epidermidis</span> and <span class="genus-species">S. aureus</span> biofilm formation in guinea pig and mouse tissue cage infection models, perhaps due to the binding of staphylococci to host matrix molecules that coat the implanted cages [<a href="#ppat-0030057-b027">27</a>,<a href="#ppat-0030057-b028">28</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[1]/p[4]">Recently, the nematode <span class="genus-species">Caenorhabditis elegans</span> has proven to be a facile model for studying the interaction between microbial pathogens and host factors and examining the contribution of specific gene products to virulence and immunity [<a href="#ppat-0030057-b029">29</a>,<a href="#ppat-0030057-b030">30</a>]. A key feature of the <span class="genus-species">C. elegans</span> pathogenicity models is that many Gram-positive virulence factors previously identified to be important for mammalian pathogenesis have also been shown to play important roles in the infectious process in <span class="genus-species">C. elegans</span> [<a href="#ppat-0030057-b031">31</a>–<a href="#ppat-0030057-b034">34</a>]. Recently, biofilm formation has also been implicated as a virulence factor in <span class="genus-species">C. elegans</span> infection models for the Gram-negative pathogens <span class="genus-species">Yersinia pestis</span> and <i>Yersinia pseudotuberculosis,</i> which inhibit <span class="genus-species">C. elegans</span> growth by forming an obstructive mass over the pharyngeal opening of the nematode [<a href="#ppat-0030057-b035">35</a>,<a href="#ppat-0030057-b036">36</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[1]/p[5]">The <span class="genus-species">C. elegans</span> pathogenesis model system has also been used to study the nematode innate immune system [<a href="#ppat-0030057-b030">30</a>,<a href="#ppat-0030057-b037">37</a>]. In contrast to mammals and insects, the Toll signaling pathway may not play a significant role in <span class="genus-species">C. elegans</span> immune defenses. <span class="genus-species">C. elegans</span> lacks known MyD88 and Rel/NFκB homologs, and partial loss-of-function mutation of <i>tol-1,</i> the single Toll-like receptor (TLR) gene in <i>C. elegans,</i> does not alter susceptibility to several pathogens [<a href="#ppat-0030057-b038">38</a>]. However, three evolutionarily conserved signaling pathways have been found to impact nematode immunity to human pathogens: the DAF-2 insulin-signaling pathway [<a href="#ppat-0030057-b039">39</a>], the TGF-β pathway [<a href="#ppat-0030057-b040">40</a>,<a href="#ppat-0030057-b041">41</a>], and the p38 mitogen-activated protein (MAP) kinase pathway [<a href="#ppat-0030057-b042">42</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[1]/p[6]">The p38 MAP kinase pathway is composed of the MAP kinase kinase kinase NSY-1, the MAP kinase kinase SEK-1, and the MAP kinase PMK-1, which are homologous to the mammalian proteins ASK-1, MKK3/6, and p38 MAP kinase, respectively [<a href="#ppat-0030057-b042">42</a>]. <i>sek-1</i> and <i>nsy-1</i> mutants display enhanced susceptibility to a range of pathogens, including the Gram-positive bacteria <span class="genus-species">Enterococcus faecalis</span> and <span class="genus-species">S. aureus</span> [<a href="#ppat-0030057-b032">32</a>,<a href="#ppat-0030057-b042">42</a>]. Similar involvement of the p38 MAP kinase pathway in mammalian immune responses has led to the hypothesis that the pathway is an ancestral immune signal system that predates the development of TLR-dependent immune signaling pathways [<a href="#ppat-0030057-b030">30</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[1]/p[7]">Key components of the insulin-signaling pathway include the insulin receptor gene <i>daf-2</i> and the phosphatidylinositol 3-kinase catalytic subunit gene <i>age-1</i>. DAF-2 and AGE-1 act through PDK-1 kinase and AKT-family kinases to phosphorylate, and thereby impede, nuclear translocation of the forkhead transcription factor DAF-16/FOXO [<a href="#ppat-0030057-b043">43</a>–<a href="#ppat-0030057-b046">46</a>]. Loss-of-function mutation of <i>daf-2</i> or <i>age-1</i> increases lifespan, entry into dauer diapause, and resistance to oxidative stress and bacterial infection, all in a <i>daf-16</i>-dependent manner [<a href="#ppat-0030057-b039">39</a>,<a href="#ppat-0030057-b047">47</a>–<a href="#ppat-0030057-b049">49</a>]. Recent data suggest that the p38 MAP kinase pathway and the DAF-2 insulin-signaling pathway function in parallel in the innate immune response [<a href="#ppat-0030057-b050">50</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[1]/p[8]">Here, we use a <span class="genus-species">C. elegans</span>–<span class="genus-species">S. epidermidis</span> pathogenesis system to study the role of biofilm exopolysaccharide in bacterial pathogenesis. We show that <span class="genus-species">S. epidermidis</span> causes a lethal infection of the <span class="genus-species">C. elegans</span> intestinal tract and that disruption of the <i>icaADBC</i> locus prevents long-term bacterial colonization, reduces total bacterial accumulation, and greatly diminishes nematode killing. Furthermore, overexpression of the <i>S. aureus icaADBC</i> locus in <span class="genus-species">S. aureus</span> enhances virulence. An important experimental advantage of the <span class="genus-species">C. elegans</span> pathogenicity models is that genetic analysis can be carried out in both the pathogen and host simultaneously, a process we have termed “interactive genetic analysis” [<a href="#ppat-0030057-b029">29</a>]. Taking advantage of both pathogen and host mutants, we show here that wild-type and <i>ica</i>-deficient <span class="genus-species">S. epidermidis</span> strains kill at similar rates when they infect nematodes with defects in p38 MAP kinase signaling and accumulate to equivalent levels during infection of these immunocompromised hosts. These results demonstrate that the <i>C. elegans–S. epidermidis</i> pathogenesis system can be used as a live animal model for studying the role of biofilm exopolysaccharide in bacterial pathogenesis from the perspective of both the pathogen and the host.</p> </div> <div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" id="section2" xpathLocation="/article[1]/body[1]/sec[2]"><a id="s2" name="s2" toc="s2" title="Results"></a><h3 xpathLocation="noSelect">Results <a href="#top">Top</a></h3> <h4 xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/title[1]"><span class="genus-species">S. epidermidis</span> Kills <span class="genus-species">C. elegans</span> through an Active Infectious Process</h4> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/p[1]">When feeding on their normal laboratory food source <span class="genus-species">Escherichia coli</span> strain OP50 or on other relatively benign bacteria such as <span class="genus-species">Bacillus subtilis</span> strain PY79, <span class="genus-species">C. elegans</span> has a lifespan of approximately 2 wk [<a href="#ppat-0030057-b039">39</a>,<a href="#ppat-0030057-b051">51</a>]. In contrast, <span class="genus-species">C. elegans</span> exhibit a considerably shorter lifespan when feeding on a variety of human pathogenic bacteria [<a href="#ppat-0030057-b029">29</a>,<a href="#ppat-0030057-b052">52</a>]. As is the case when <span class="genus-species">C. elegans</span> are fed several other pathogens, nematodes fed certain laboratory and clinical strains of <span class="genus-species">S. epidermidis</span> or other coagulase-negative staphylococci die over the course of 3–5 d (<a href="#ppat-0030057-g001">Figures 1</a>A and <a href="#ppat-0030057-sg001">S1</a>).</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[1]"><a name="ppat-0030057-g001" id="ppat-0030057-g001" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g001" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.g001&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[1]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g001" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[1]/label[1]">Figure 1. </span></a> <span xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[1]/caption[1]/title[1]"><span class="genus-species">S. epidermidis</span> Kills <span class="genus-species">C. elegans</span> and Causes Intestinal Distension</span></strong></p><p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[1]/caption[1]/p[1]">(A) <i>C. elegans</i> killing assays on lawns of live <span class="genus-species">S. epidermidis</span> 9142 (squares), heat-killed <span class="genus-species">S. epidermidis</span> 9142 (triangles), or <span class="genus-species">B. subtilis</span> strain RL2244 (diamonds).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[1]/caption[1]/p[2]">(B) Survival of <span class="genus-species">C. elegans</span> exposed to live <span class="genus-species">S. epidermidis</span> 9142 (squares), admixtures of live <span class="genus-species">S. epidermidis</span> 9142 and heat-killed <span class="genus-species">E. coli</span> OP50 at a ratio of 1:1 (circles) or 1:5 (diamonds), or heat-killed <span class="genus-species">E. coli</span> OP50 alone (triangles).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[1]/caption[1]/p[3]">(C) N2 <span class="genus-species">C. elegans</span> were exposed to <span class="genus-species">B. subtilis</span> RL2244 or <span class="genus-species">S. epidermidis</span> 9142 for 24 h and then visualized by Nomarski differential contrast microscopy. Arrows demarcate the intestinal tract lumen. Magnification, ×40.</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.g001</span><div class="clearer"></div></div><p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/p[2]">Several observations indicate that the <i>C. elegans–S. epidermidis</i> interaction involves an infectious process. First, heat-killed <span class="genus-species">S. epidermidis</span> does not kill <span class="genus-species">C. elegans</span> (<a href="#ppat-0030057-g001">Figure 1</a>A), and <span class="genus-species">S. epidermidis</span> culture supernatants do not lead to significant worm mortality (unpublished data). Furthermore, nematodes fed a mixture of live <span class="genus-species">S. epidermidis</span> and heat-killed OP50 (an innocuous food source to ensure adequate nutritional content) at an equal or 1:5 ratio, respectively, die within several days, although at a slightly reduced rate as compared to <span class="genus-species">S. epidermidis</span> alone (<a href="#ppat-0030057-g001">Figure 1</a>B). Taken together, the data in <a href="#ppat-0030057-g001">Figure 1</a>A and <a href="#ppat-0030057-g001">1</a>B demonstrate that the decreased lifespan requires live bacteria rather than stable secreted toxins and is not due simply to <span class="genus-species">S. epidermidis</span> being a poor source of nutrition.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/p[3]">The second line of evidence for an infectious process is that although <span class="genus-species">S. epidermidis</span>–mediated killing of <span class="genus-species">C. elegans</span> is accompanied by the matricidal hatching of eggs within the uterus of the hermaphrodite mother (similar to other pathogens that have been investigated [<a href="#ppat-0030057-b032">32</a>,<a href="#ppat-0030057-b053">53</a>]), this is not the main cause of death since <span class="genus-species">C. elegans</span> males, which do not produce embryos, are also killed by <span class="genus-species">S. epidermidis</span> (unpublished data).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/p[4]">Third, similar to other microbial pathogens that kill <i>C. elegans,</i> large numbers of intact <span class="genus-species">S. epidermidis</span> cocci accumulate within the intestinal tract of nematodes during the course of infection, leading to significant distension of the intestinal lumen compared to nematodes feeding on <span class="genus-species">B. subtilis</span> (<a href="#ppat-0030057-g001">Figure 1</a>C). It should be noted, however, that accumulation of bacteria within the nematode intestinal tract is not sufficient for killing: aerobically-cultured <span class="genus-species">Enterococcus faecium</span> accumulates to high titers within the digestive tract but is not appreciably harmful to wild-type nematodes [<a href="#ppat-0030057-b031">31</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/p[5]">A final reason to conclude that the <i>C. elegans–S. epidermidis</i> model involves an infectious process is that the altered susceptibility exhibited by <span class="genus-species">C. elegans</span> innate immunity-related mutants when fed <span class="genus-species">S. epidermidis</span> is comparable to the observed phenotypes of these mutants exposed to other pathogens that infect <span class="genus-species">C. elegans</span>. <i>nsy-1</i> and <i>sek-1</i> encode the MAPKKK and MAPKK, respectively, of a conserved p38 MAP kinase signaling pathway in <i>C. elegans,</i> and mutations in these genes result in enhanced susceptibility to a variety of pathogens, including <span class="genus-species">S. aureus</span> [<a href="#ppat-0030057-b032">32</a>]. When <i>nsy-1(ag3)</i> and <i>sek-1(ag1)</i> mutant nematodes are fed <i>S. epidermidis,</i> they display significantly enhanced susceptibility to infection, as shown in <a href="#ppat-0030057-g002">Figure 2</a>A (<i>p</i> < 0.0001).</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[2]"><a name="ppat-0030057-g002" id="ppat-0030057-g002" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g002" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.g002&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[2]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g002" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[2]/label[1]">Figure 2. </span></a> <span xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[2]/caption[1]/title[1]"><span class="genus-species">C. elegans</span> Mutants with Altered Immune Function Show Differential Sensitivity to <span class="genus-species">S. epidermidis</span></span></strong></p><p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[2]/caption[1]/p[1]">(A) Survival of wild-type N2 <span class="genus-species">C. elegans</span> (squares) compared to survival of the immunocompromised, p38 MAP kinase pathway mutants <i>sek-1(ag1)</i> (triangles, <i>p</i> < 0.0001) or <i>nsy-1(ag3)</i> (inverted triangles, <i>p</i> < 0.0001) when exposed to <span class="genus-species">S. epidermidis</span> 9142.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/fig[2]/caption[1]/p[2]">(B) Survival of N2 animals (squares) compared to survival of the pathogen-resistant, insulin signaling pathway mutants <i>age-1(hx546)</i> (diamonds, <i>p</i> < 0.0001) or <i>daf-2(e1370)</i> (circles, <i>p</i> < 0.0001) when exposed to <span class="genus-species">S. epidermidis</span> 9142. Survival of <i>daf-2(e1370);daf-16(mgDf47)</i> mutants (asterisks) demonstrates that <i>daf-16(mgDf47)</i> suppresses <i>daf-2(e1370)</i> enhanced pathogen resistance.</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.g002</span><div class="clearer"></div></div><p xpathLocation="/article[1]/body[1]/sec[2]/sec[1]/p[6]">Conversely, <span class="genus-species">C. elegans</span> genes <i>daf-2</i> and <i>age-1</i> encode components of an insulin-signaling pathway, and mutations in these genes increase nematode longevity on innocuous bacteria as well as greatly increase resistance to infection by Gram-positive pathogens [<a href="#ppat-0030057-b039">39</a>]. As shown in <a href="#ppat-0030057-g002">Figure 2</a>B, <i>daf-2(e1370)</i> and <i>age-1(hx546)</i> mutants are remarkably less susceptible to <span class="genus-species">S. epidermidis</span>–mediated killing (<i>p</i> < 0.0001). Similar to other pathogens that have been tested [<a href="#ppat-0030057-b039">39</a>], the extension of lifespan on <span class="genus-species">S. epidermidis</span> is disproportionate to that observed during exposure to innocuous bacteria. For example, <i>daf-2(e1370)</i> mutants exposed to <span class="genus-species">S. epidermidis</span> have a 10-fold extension in lifespan compared to wild-type nematodes (<a href="#ppat-0030057-g002">Figure 2</a>B), whereas the average lifespan of <i>daf-2(e1370)</i> mutants are, at most, doubled when exposed to the non-pathogens OP50 and PY79 [<a href="#ppat-0030057-b039">39</a>]. DAF-2 and AGE-1 negatively regulate the forkhead transcription factor DAF-16/FOXO, and, as expected, survival of <i>daf-2(e1370);daf16(mgDf47)</i> animals is comparable to wild-type N2 nematodes (<i>p ></i> 0.05), demonstrating that DAF-2–mediated pathogen resistance requires DAF-16 signaling (<a href="#ppat-0030057-g002">Figure 2</a>B). Survival of <i>daf-16(mgDf47)</i> mutants exposed to <span class="genus-species">S. epidermidis</span> is comparable to N2 nematodes (unpublished data), similar to results published previously for <span class="genus-species">S. aureus</span> [<a href="#ppat-0030057-b039">39</a>].</p> <h4 xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/title[1]"><i>S. epidermidis ica</i> Locus Is Required for Colonization and Killing of <span class="genus-species">C. elegans</span></h4> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/p[1]">Biofilm is a major virulence factor of <span class="genus-species">S. epidermidis</span> in mammalian pathogenesis that promotes adherence to artificial surfaces and protects <span class="genus-species">S. epidermidis</span> from antibiotics and immune effectors. To investigate the contribution of biofilm exopolysaccharide to <span class="genus-species">S. epidermidis</span>–mediated killing of <i>C. elegans,</i> nematodes were fed <span class="genus-species">S. epidermidis</span> strain 9142-M10, which produces no detectable PIA and is completely biofilm-deficient as a result of a Tn<i>917</i> insertion in the <i>icaA</i> gene [<a href="#ppat-0030057-b004">4</a>,<a href="#ppat-0030057-b026">26</a>,<a href="#ppat-0030057-b054">54</a>]. As shown in <a href="#ppat-0030057-g003">Figure 3</a>A, 9142-M10 exhibits significantly decreased virulence relative to the wild-type isogenic parental strain 9142 (<i>p</i> < 0.0001). To confirm that the reduced virulence of 9142-M10 was due to interruption of <i>icaA,</i> plasmid pTX<i>icaADBC,</i> which contains the <i>icaADBC</i> operon driven by the P<i>xylA</i> xylose-inducible promoter [<a href="#ppat-0030057-b055">55</a>,<a href="#ppat-0030057-b056">56</a>], was introduced into 9142-M10 (see <a href="#s4">Materials and Methods</a>). The complemented mutant, 9142-M10(pTX<i>ica</i>), was able to form as robust a biofilm on polystyrene as the wild-type parental strain under 2% xylose-inducing conditions, but was as biofilm-deficient as 9142-M10 when grown without xylose supplementation (<a href="#ppat-0030057-g003">Figure 3</a>B). Similarly, the nematocidal activity of 9142-M10(pTX<i>ica</i>) exceeded that of 9142 when grown in the presence of 2% xylose, but was as attenuated as 9142-M10 when grown without supplemental xylose. Survival of <span class="genus-species">C. elegans</span> grown on 9142 or 9142-M10 was not meaningfully changed with xylose supplementation (<a href="#ppat-0030057-g002">Figure 2</a>A and unpublished data).</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/fig[1]"><a name="ppat-0030057-g003" id="ppat-0030057-g003" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g003" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.g003&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/fig[1]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g003" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/fig[1]/label[1]">Figure 3. </span></a> <span xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/fig[1]/caption[1]/title[1]"><span class="genus-species">S. epidermidis</span> Virulence in the <span class="genus-species">C. elegans</span> Infection Model Depends on <i>icaADBC</i></span></strong></p><p xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/fig[1]/caption[1]/p[1]">(A) Survival of <span class="genus-species">C. elegans</span> infected with <span class="genus-species">S. epidermidis</span> strain 9142-M10 (circles), which contains a transposon insertion in the <i>icaA</i> gene, and the complemented strain 9142-M10(pTX<i>ica</i>) (triangles), which carries the <i>icaADBC</i> operon driven by the xylose-inducible P<i>xylA</i> promoter, compared to wild-type <span class="genus-species">S. epidermidis</span> 9142 (squares) and <span class="genus-species">B. subtilis</span> (asterisks). Survival assays were performed under standard conditions (closed symbols) or using plates supplemented with 2% xylose (xyl, open symbols).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/fig[1]/caption[1]/p[2]">(B) Biofilm formation of <span class="genus-species">S. epidermidis</span> 9142, 9142-M10, and 9142-M10(pTX<i>ica</i>) on polystyrene. Attachment to polystyrene 96-well flat bottom microtiter plate was performed as described in the Materials and Methods. Strains were grown in TS broth without supplementation (TSB) or supplemented with 2% xylose (TSB-xyl).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/fig[1]/caption[1]/p[3]">(C) Nomarski micrograph of <span class="genus-species">C. elegans</span> after feeding for 24 h on <span class="genus-species">S. epidermidis</span> 9142 or 9142-M10. Arrows demarcate the intestinal tract lumen. Magnification, ×40.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/fig[1]/caption[1]/p[4]">(D) Quantification of intestinal bacteria obtained by disruption of worms after 24 h of feeding on either <span class="genus-species">S. epidermidis</span> 9142 or 9142-M10. Values represent the mean of five samples with approximately eight worms per sample ± standard error of the mean (SEM). The asterisk indicates a significant difference (<i>p</i> < 0.001).</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.g003</span><div class="clearer"></div></div><p xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/p[2]">Previous work has shown that growth inhibition of <span class="genus-species">C. elegans</span> by <span class="genus-species">Y. pestis</span> and <span class="genus-species">Y. pseudotuberculosis</span> also depends on biofilm production, and specifically on the <i>hmsHFRS</i> locus, a homolog of <i>icaADBC</i> [<a href="#ppat-0030057-b035">35</a>]. In these infections, an obstructive biofilm plug forms over the mouth of the nematode, starving the animals. However, microscopic examination of nematodes feeding on <span class="genus-species">S. epidermidis</span> showed no sign of obstructive masses or bacterial adherence to the cuticle (unpublished data). To further test whether bacterial adhesion to the surface of nematodes was a factor in <span class="genus-species">S. epidermidis</span> infection of nematodes, we tested the susceptibility of a set of <span class="genus-species">C. elegans</span> mutants with altered cuticle structure. The <span class="genus-species">C. elegans</span> mutants <i>srf-2, srf-3,</i> and <i>srf-5</i> display wild-type sensitivity to <span class="genus-species">S. epidermidis</span> (unpublished data). In contrast, these mutants have been shown to be resistant to biofilm-mediated cuticle infection by <span class="genus-species">Y. pseudotuberculosis</span> [<a href="#ppat-0030057-b036">36</a>,<a href="#ppat-0030057-b057">57</a>]. These data suggest that <span class="genus-species">S. epidermidis</span> virulence does not depend on its ability to adhere to the external surfaces of worms.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[2]/p[3]">To further examine the relationship between bacterial virulence and PIA production, nematodes feeding on wild-type and PIA-deficient <span class="genus-species">S. epidermidis</span> strains were examined microscopically. As shown in <a href="#ppat-0030057-g003">Figure 3</a>C, both wild-type <span class="genus-species">S. epidermidis</span> 9142 and the <i>ica</i> mutant 9142-M10 accumulate in the <span class="genus-species">C. elegans</span> intestine; however, worms feeding on 9142-M10 appear to have less intestinal distension. To determine if the reduced distension is a result of decreased colonization of the intestinal tract, the number of live intestinal bacteria was quantified. As shown in <a href="#ppat-0030057-g003">Figure 3</a>D, <span class="genus-species">C. elegans</span> feeding on 9142-M10 have significantly fewer colony-forming units (C.F.U.) in their intestines than worms feeding on wild-type bacteria (<i>p</i> < 0.001).</p> <h4 xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/title[1]">The <i>ica</i> Locus Confers a Competitive Survival Advantage to <span class="genus-species">S. epidermidis</span> during Infection of <span class="genus-species">C. elegans</span></h4> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/p[1]">To date, two distinct mechanisms of nematode killing associated with intestinal tract colonization have been described: transient infection and persistent infection [<a href="#ppat-0030057-b029">29</a>]. In the latter case, brief exposure to some pathogens, such as <span class="genus-species">E. faecalis</span> and <i>Salmonella enterica,</i> leads to lethal infection that is associated with bacterial retention and proliferation in the <span class="genus-species">C. elegans</span> intestinal tract [<a href="#ppat-0030057-b031">31</a>,<a href="#ppat-0030057-b058">58</a>]. In contrast, <i>S. aureus,</i> typical of those pathogens that cause a transient infection, is completely expelled from the intestinal tract within 2 h of nematodes being transferred to another food source [<a href="#ppat-0030057-b032">32</a>]. Consequently, continuous exposure to <span class="genus-species">S. aureus</span> is necessary to achieve maximal worm killing [<a href="#ppat-0030057-b032">32</a>]. Since both <span class="genus-species">S. epidermidis</span> and <span class="genus-species">S. aureus</span> colonize the nematode intestinal tract and kill worms, we examined whether the mechanism of worm killing by <span class="genus-species">S. epidermidis</span> was similar to that of <span class="genus-species">S. aureus</span>.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/p[2]">First, we evaluated the relative virulence of wild-type and PIA-deficient <span class="genus-species">S. epidermidis</span> by exposing nematodes to lawns of 9142 diluted in 9142-M10. As shown in <a href="#ppat-0030057-g004">Figure 4</a>A, significant nematode killing occurred with exposure to mixed lawns of 9142 and 9142-M10 in ratios as low as 1:10,000. That a relatively small amount of wild-type <span class="genus-species">S. epidermidis</span> has significant nematocidal activity suggests that PIA-producing <span class="genus-species">S. epidermidis</span> may preferentially colonize the <span class="genus-species">C. elegans</span> intestinal tract compared to <i>ica</i>-deficient 9142-M10. Alternatively, it could be hypothesized that killing by PIA-producing <span class="genus-species">S. epidermidis</span> is not bacterial density–dependent.</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/fig[1]"><a name="ppat-0030057-g004" id="ppat-0030057-g004" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g004" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.g004&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/fig[1]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g004" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/fig[1]/label[1]">Figure 4. </span></a> <span xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/fig[1]/caption[1]/title[1]">The Fitness of Intraluminal <span class="genus-species">S. epidermidis</span> during Colonization of <span class="genus-species">C. elegans</span> Is <i>icaADBC</i>-Dependent</span></strong></p><p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/fig[1]/caption[1]/p[1]">(A) Survival of nematodes feeding on mixed lawns of <span class="genus-species">S. epidermidis</span> 9142 and 9142-M10 in the ratios of 9142:9142-M10 indicated.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/fig[1]/caption[1]/p[2]">(B) <span class="genus-species">C. elegans</span> exposed to <span class="genus-species">S. epidermidis</span> 9142 for 12 h and then transferred to <span class="genus-species">S. epidermidis</span> 9142-M10 (triangles) die with similar kinetics to worms transferred from 9142 to 9142 (squares) or 9142-M10 to 9142 (diamonds) and much more rapidly than control worms transferred from 9142-M10 to 9142-M10 (circles).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/fig[1]/caption[1]/p[3]">(C) Intestinal proliferation of <span class="genus-species">S. epidermidis</span> 9142 over time in <span class="genus-species">C. elegans</span> feeding on 9142 for 12 h and transferred to 9142-M10. Values represent the mean of three samples with approximately ten worms per sample ± SEM.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/fig[1]/caption[1]/p[4]">(D) Nematodes exposed to <span class="genus-species">S. epidermidis</span> 9142 for 12 h and transferred either to 9142-M10 (squares) or a second <i>ica</i>-deficient <span class="genus-species">S. epidermidis</span> strain ATCC 12228 (circles) retain a high proportion of 9142 in their intestinal tracts, whereas those exposed first to the <i>ica</i>-deficient 9142-M10 and transferred to <i>ica</i>-deficient ATCC 12228 (triangles), or vice versa (diamonds), do not retain the initial bacteria in their digestive tracts. Fitness Index is defined as: (pulse <span class="genus-species">S. epidermidis</span> strain C.F.U.) / (pulse <span class="genus-species">S. epidermidis</span> strain C.F.U. + chase <span class="genus-species">S. epidermidis</span> strain C.F.U.). Values represent the mean of three samples with approximately ten worms per sample ± SEM.</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.g004</span><div class="clearer"></div></div><p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/p[3]">To further examine the mechanism of <span class="genus-species">S. epidermidis</span> infection, nematodes were fed wild-type <span class="genus-species">S. epidermidis</span> 9142 for 12 h and then transferred to plates containing <i>ica</i>-deficient 9142-M10. As shown in <a href="#ppat-0030057-g004">Figure 4</a>B, transferred nematodes die with similar kinetics as worms fed exclusively wild-type bacteria, suggesting that the <i>ica</i> mutant 9142-M10 was not capable of rescuing the worms and that durable colonization is established within 12 h of exposure to <i>S. epidermidis,</i> a time at which there is no observed nematode mortality. In contrast, 9142-M10 is capable of being an effective “rescue” food for worms that have been fed <i>S. aureus;</i> that is, when <i>S. aureus</i>–fed <span class="genus-species">C. elegans</span> were transferred to <span class="genus-species">S. epidermidis</span> 9142-M10, the worms survived significantly longer than worms that remained on the <span class="genus-species">S. aureus</span> plates (unpublished data).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/p[4]">Taken together, these data suggest that a small inoculum of or brief exposure to <span class="genus-species">S. epidermidis</span> may be sufficient to establish a long lasting, lethal infection. To verify this, nematodes were exposed to 9142 and then transferred to 9142-M10, as above, and intestinal bacteria were recovered by mechanical disruption and quantified at various time points. Recovered bacteria were serially diluted on tryptic soy (TS) agar containing Congo Red dye to distinguish wild-type and biofilm exopolysaccharide–negative colonies [<a href="#ppat-0030057-b016">16</a>]. As shown in <a href="#ppat-0030057-g004">Figure 4</a>C, wild-type <span class="genus-species">S. epidermidis</span> persists and accumulates over time within the intestinal tract of worms transferred to 9142-M10.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/p[5]">To determine whether <span class="genus-species">S. epidermidis</span> persists in the intestinal tract irrespective of the rescue food source, <span class="genus-species">S. epidermidis</span>–fed nematodes were transferred to <span class="genus-species">E. faecium</span> E007. As we have previously observed for <span class="genus-species">S. aureus</span>–fed nematodes [<a href="#ppat-0030057-b032">32</a>], <span class="genus-species">C. elegans</span> exposed to <span class="genus-species">S. epidermidis</span> 9142 were rescued from lethal infection when transferred to E007 (unpublished data). The fact that <span class="genus-species">E. faecium</span> was an effective rescue food for worms infected with <i>S. epidermidis,</i> whereas an <i>ica S. epidermidis</i> mutant did not rescue worms previously infected with wild-type <i>S. epidermidis,</i> led us to hypothesize that the competitive advantage exhibited by 9142 during mixed infections with 9142-M10 is the result of biofilm exopolysaccharide. To test this, we first exposed nematodes to wild-type <span class="genus-species">S. epidermidis</span> 9142 and then transferred them to either the 9142-M10 or to ATCC 12228 [<a href="#ppat-0030057-b059">59</a>], an <i>ica</i>-deficient <span class="genus-species">S. epidermidis</span> reference strain, which is not pathogenic to worms, as shown in <a href="#ppat-0030057-sg001">Figure S1</a>. Prior to transfer and 20 and 40 h after transfer, nematodes were collected and intestinal tract bacteria were quantified by serial dilution plating on TS agar plate containing Congo Red dye, as above [<a href="#ppat-0030057-b016">16</a>]. As shown in <a href="#ppat-0030057-g004">Figure 4</a>D, wild-type bacteria persist in the intestinal tract of worms transferred to lawns of PIA-deficient bacteria, becoming the vast majority of the population 40 h after transfer, despite the fact that the nematodes were feeding exclusively on biofilm exopolysaccharide–deficient strains. As was observed in <a href="#ppat-0030057-g004">Figure 4</a>C, the absolute number of wild-type <span class="genus-species">S. epidermidis</span> 9142 also increased during this period (unpublished data). As a control, nematodes were transferred from one PIA-deficient <span class="genus-species">S. epidermidis</span> strain to a second PIA-deficient strain. As shown in <a href="#ppat-0030057-g004">Figure 4</a>D, the second <i>ica</i>-deficient strain displaced the initial <i>ica</i>-deficient strain.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[3]/p[6]">Taken together, the data in this section demonstrate that <span class="genus-species">S. epidermidis</span> transiently colonizes the nematode intestinal tract when transferred to an unrelated, innocuous bacterial strain. However, <i>icaADBC</i>-containing <span class="genus-species">S. epidermidis</span> has a strong competitive survival and/or growth advantage over <i>ica</i>-deficient <span class="genus-species">S. epidermidis</span> within the intestinal tract, thereby allowing PIA-producing cells to initiate a durable and ultimately fatal infection.</p> <h4 xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/title[1]"><span class="genus-species">S. epidermidis</span> Biofilm Matrix in the Nematode Intestinal Tract</h4> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/p[1]">We used fluorescein isothiocyanate (FITC)–conjugated wheat germ agglutinin (WGA) lectin to determine whether biofilm-associated polymers are present in the intestine of <span class="genus-species">C. elegans</span> feeding on <i>S. epidermidis.</i> This lectin binds to <i>N-</i>acetyl glucosamine polymers and has previously been shown to bind to the exopolysaccharide of <span class="genus-species">S. epidermidis</span> and <span class="genus-species">Y. pseudotuberculosis</span> biofilm [<a href="#ppat-0030057-b060">60</a>,<a href="#ppat-0030057-b061">61</a>]. Wild-type <span class="genus-species">S. epidermidis</span> 9142, but not 9142-M10, is efficiently labeled by the WGA lectin when the bacteria are grown in vitro (unpublished data). <a href="#ppat-0030057-g005">Figure 5</a>A–<a href="#ppat-0030057-g005">5</a>D shows that when nematodes are fed lectin-labeled wild-type <i>S. epidermidis,</i> a strong green fluorescent signal is observed in the intestinal lumen. However, nematodes feeding on similarly labeled <span class="genus-species">S. epidermidis</span> 9142-M10 lawns do not accumulate any fluorescent signal, as shown in <a href="#ppat-0030057-g005">Figure 5</a>E–<a href="#ppat-0030057-g005">5</a>H. Fluorescence was also observed outside of the intestinal lumen. This signal, which can be differentiated from the FITC signal by its spread into the red spectrum, is due to autofluorescence of the intestinal cells and is often enhanced in worms feeding on pathogens [<a href="#ppat-0030057-b062">62</a>]. No fluorescent signal was observed in close approximation to the cuticle surface of the nematode. These results show that wild-type <span class="genus-species">S. epidermidis</span> 9142, but not 9142-M10, is able to produce biofilm-associated exopolysaccharide under the standard killing conditions, and that biofilm polymers are either effectively ingested by nematodes and/or that 9142 synthesizes the polymers in the <span class="genus-species">C. elegans</span> intestine.</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]"><a name="ppat-0030057-g005" id="ppat-0030057-g005" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g005" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.g005&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g005" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]/label[1]">Figure 5. </span></a> <span xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]/caption[1]/title[1]">Production of PIA by <span class="genus-species">S. epidermidis</span> within the <span class="genus-species">C. elegans</span> Intestinal Tract</span></strong></p><p xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]/caption[1]/p[1]">Confocal microscopy images of <span class="genus-species">C. elegans</span> feeding on <span class="genus-species">S. epidermidis</span> labeled with FITC-conjugated WGA lectin, which selectively labels the exopolysaccharide of the biofilm matrix.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]/caption[1]/p[2]">Nematodes feeding on labeled wild-type <span class="genus-species">S. epidermidis</span> 9142 (A–D) or 9142-M10 (E–H).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]/caption[1]/p[3]">(A and E) Nomarski differential interference contrast image of anterior portion of nematodes.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]/caption[1]/p[4]">(B and F) Green fluorescence due to FITC-labeled lectin adhering to <span class="genus-species">S. epidermidis</span> exopolysaccharide and <span class="genus-species">C. elegans</span> intestinal autofluorescence.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]/caption[1]/p[5]">(C and G) Red fluorescence resulting from intestinal autofluorescence.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[4]/fig[1]/caption[1]/p[6]">(D and H) Merged fluorescent images in which green demonstrates bound lectin and yellow demonstrates intestinal autofluorescence.</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.g005</span><div class="clearer"></div></div> <h4 xpathLocation="/article[1]/body[1]/sec[2]/sec[5]/title[1]">Overexpression of <i>icaADBC</i> Enhances <span class="genus-species">S. aureus</span> Virulence</h4> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[5]/p[1]">To further investigate the role of the <i>ica</i> locus as an independent virulence factor in staphylococci, the pathogenic behavior of <span class="genus-species">S. aureus</span> strains with altered levels of <i>icaADBC</i> expression were examined. First, we examined the behavior of the clinical strain MN8 and a spontaneously derived mutant, MN8m, which constitutively produces excess biofilm exopolysaccharide due to increased <i>icaADBC</i> transcription [<a href="#ppat-0030057-b017">17</a>]. MN8m produces visibly mucoid lawns on TS agar plates and, as shown in <a href="#ppat-0030057-g006">Figure 6</a>A, was dramatically more virulent towards nematodes than the parental MN8 strain (<i>p</i> < 0.0001). Despite the mucoid nature of the MN8m lawns, worms were still able to ingest the bacteria, which accumulated to high levels in the intestine similar to <span class="genus-species">S. epidermidis</span> 9142 (unpublished data).</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[2]/sec[5]/fig[1]"><a name="ppat-0030057-g006" id="ppat-0030057-g006" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g006" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.g006&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[2]/sec[5]/fig[1]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g006" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[2]/sec[5]/fig[1]/label[1]">Figure 6. </span></a> <span xpathLocation="/article[1]/body[1]/sec[2]/sec[5]/fig[1]/caption[1]/title[1]">Overexpression of <i>icaADBC</i> in <span class="genus-species">S. aureus</span> Enhances Virulence</span></strong></p><p xpathLocation="/article[1]/body[1]/sec[2]/sec[5]/fig[1]/caption[1]/p[1]">(A) Survival of <span class="genus-species">C. elegans</span> N2 infected by the <i>icaADBC</i>-overexpressing <span class="genus-species">S. aureus</span> strain MN8m (circles) compared to wild-type MN8 (squares) (<i>p</i> < 0.0001).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[5]/fig[1]/caption[1]/p[2]">(B) Survival of <span class="genus-species">C. elegans</span> N2 infected by <span class="genus-species">S. aureus</span> strain 10833 (squares), 10833 Δ<i>ica</i> (triangles, <i>p</i> > 0.05), and by strain 10833 Δ<i>ica</i>(pMUC) (circles, <i>p</i> < 0.0001).</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.g006</span><div class="clearer"></div></div><p xpathLocation="/article[1]/body[1]/sec[2]/sec[5]/p[2]">To confirm that overexpression of the <i>S. aureus icaADBC</i> locus is sufficient to increase virulence towards <i>C. elegans,</i> we tested the effect of <i>icaADBC</i> expression in a second <span class="genus-species">S. aureus</span> strain, the clumping factor–positive strain 10833 Δ<i>ica</i> harboring the plasmid pMUC, which carries the de-repressed <i>icaADBC</i> locus from MN8m [<a href="#ppat-0030057-b024">24</a>]. <span class="genus-species">S. aureus</span> 10833 Δ<i>ica</i>(pMUC) also produces a visibly mucoid lawn on nematode killing plates and, as shown in <a href="#ppat-0030057-g006">Figure 6</a>B, kills nematodes much more rapidly than the parental strain 10833 (<i>p</i> < 0.0001). Interestingly, deletion of the <i>icaADBC</i> operon in 10833 or MN8 does not significantly alter the killing kinetics compared with their parental strains (<a href="#ppat-0030057-g006">Figure 6</a>B and unpublished data), indicating that <i>S. aureus icaADBC</i> expression is likely low under the conditions used in this assay.</p> <h4 xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/title[1]">PIA Production May Protect <span class="genus-species">S. epidermidis</span> in the <span class="genus-species">C. elegans</span> Intestine</h4> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/p[1]">We hypothesized that staphylococcal PIA production may enhance virulence in the <span class="genus-species">C. elegans</span> model either by promoting bacterial adherence to intestinal cells and/or by increasing bacterial survival in the intestinal tract. To further investigate the mechanism by which biofilm matrix contributes to <span class="genus-species">S. epidermidis</span> virulence, a competition-based assay was performed. Wild-type N2 <span class="genus-species">C. elegans</span> were allowed to feed on lawns consisting of wild-type <span class="genus-species">S. epidermidis</span> 9142 and PIA-deficient 9142-M10 in a ratio of 1:100, respectively. Nematodes were harvested after 6 and 20 h of feeding, washed, and disrupted, and the intestinal bacterial loads of <span class="genus-species">S. epidermidis</span> 9142 and 9142-M10 quantified. As shown in <a href="#ppat-0030057-g007">Figure 7</a>A, after 6 h of feeding, the ratio of <span class="genus-species">S. epidermidis</span> 9142 to 9142-M10 in the intestine was approximately the same as that on the feeding plates. However, after 20 h of feeding, the ratio increased to 1:1, indicating significant enrichment of wild-type 9142 compared to PIA-deficient 9142-M10 within the <span class="genus-species">C. elegans</span> intestine.</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/fig[1]"><a name="ppat-0030057-g007" id="ppat-0030057-g007" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g007" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.g007&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/fig[1]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g007" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/fig[1]/label[1]">Figure 7. </span></a> <span xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/fig[1]/caption[1]/title[1]">Intestinal and Fecal Ratios of Wild-Type and Biofilm-Deficient <span class="genus-species">S. epidermidis</span> in <span class="genus-species">C. elegans</span> when Fed Mixed Lawns</span></strong></p><p xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/fig[1]/caption[1]/p[1]">(A) Intestinal load of <span class="genus-species">S. epidermidis</span> 9142 (dark bars) and 9142-M10 (light bars) within wild-type N2 <span class="genus-species">C. elegans</span> feeding on mixed lawns in a ratio of 1:100. Bacterial loads were determined in triplicate from approximately ten disrupted worms. Data represent mean ± SEM.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/fig[1]/caption[1]/p[2]">(B) Ratio of <span class="genus-species">S. epidermidis</span> 9142 to 9142-M10 of excreted and intestinal bacteria. Colonized N2 <span class="genus-species">C. elegans</span> were allowed to feed on mixed lawns of 9142 and 9142-M10 (ratio 1:100) for 16 h, washed, and then transferred to M9 buffer, in which bacteria were freely excreted. Bacterial loads were determined in triplicate from the homogenates and expelled collections of approximately ten worms. Data represent mean ± SEM.</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.g007</span><div class="clearer"></div></div><p xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/p[2]">To distinguish between increased adherence and increased intestinal survival, nematodes were allowed to feed as above on a 1:100 mixed lawn for 16 h, washed, and transferred to M9 buffer, where they excreted intestinal bacteria into the media. We reasoned that if the ratio of 9142:9142-M10 was lower in the excrement than in the intestine, it would indicate that 9142 was preferentially retained compared to 9142-M10. Alternatively, if the 9142:9142-M10 ratio was equivalent in the excrement and the intestine, it would suggest that 9142 bacteria are better able to survive in the intestinal environment. As shown in <a href="#ppat-0030057-g007">Figure 7</a>B, there was not a significant decrease in the ratio of 9142:9142-M10 in the excrement, arguing against the hypothesis that wild-type <span class="genus-species">S. epidermidis</span> is preferentially retained in the <span class="genus-species">C. elegans</span> intestine compared to PIA-deficient 9142-M10.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[6]/p[3]">To determine whether PIA-producing 9142 formed focal collections of cells within the nematode intestinal tract, animals fed 9142:9142-M10 mixtures were labeled with FITC-conjugated WGA. Fluorescence appeared uniform throughout the intraluminal space, and discrete agglomerations of fluorescing cells surrounded by non-labeled bacteria were not observed. Nevertheless, we cannot exclude the possibility that such agglomerations exist in the intestinal tract and are difficult to recognize microscopically.</p> <h4 xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/title[1]">Interaction of the <span class="genus-species">C. elegans</span> Innate Immune System and <span class="genus-species">S. epidermidis</span> Biofilm Production</h4> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/p[1]">In mammals, biofilm formation by pathogens plays an important role in evading the host innate immune response. To test whether <span class="genus-species">S. epidermidis</span> biofilm exopolysaccharide protects the bacteria from <span class="genus-species">C. elegans</span> immune effectors, we examined the susceptibility of <span class="genus-species">C. elegans</span> mutants deficient in innate immune response to <span class="genus-species">S. epidermidis</span> infection. As shown in <a href="#ppat-0030057-g002">Figure 2</a>, <span class="genus-species">C. elegans</span> harboring missense mutations in the p38 MAP kinase pathway components <i>nsy-1</i> or <i>sek-1</i> were more susceptible to <i>S. epidermidis–</i>mediated killing. Similarly, the kinase domain deletion mutant <i>sek-1(km4)</i> was also more susceptible to killing by wild-type <span class="genus-species">S. epidermidis</span> (<a href="#ppat-0030057-g008">Figure 8</a>A). Interestingly, the <i>sek-1(km4)</i> mutant was also highly susceptible to killing by the PIA-deficient <span class="genus-species">S. epidermidis</span> 9142-M10 (<a href="#ppat-0030057-g008">Figure 8</a>A), unlike the wild-type nematode. Similarly, the <span class="genus-species">C. elegans</span> mutant <i>pmk-1(km25),</i> which contains a deletion in the gene encoding the p38-like MAP kinase downstream of SEK-1, was also highly and comparably susceptible to 9142 and 9142-M10 (unpublished data).</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/fig[1]"><a name="ppat-0030057-g008" id="ppat-0030057-g008" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g008" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.g008&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/fig[1]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.g008" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/fig[1]/label[1]">Figure 8. </span></a> <span xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/fig[1]/caption[1]/title[1]">Immunocompromised <span class="genus-species">C. elegans</span> Are Hypersusceptible to both Wild-Type and Biofilm-Deficient <span class="genus-species">S. epidermidis</span> and Accumulate both Strains Equally</span></strong></p><p xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/fig[1]/caption[1]/p[1]">(A) <i>sek-1(km4)</i> mutant worms (circles) are similarly susceptible to both <span class="genus-species">S. epidermidis</span> 9142 (closed symbols) and 9142-M10 (open symbols), whereas wild-type N2 nematodes (squares) are differentially resistant to 9142-M10 (<i>p</i> < 0.0001).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/fig[1]/caption[1]/p[2]">(B) <span class="genus-species">S. epidermidis</span> 9142 (solid bars) is better able to colonize N2 worms than 9142-M10 (open bars), but there is no difference between colonization rates in <i>sek-1(km4)</i> mutant nematodes after 16 h of feeding on <span class="genus-species">S. epidermidis</span>. Data represent mean ± SEM. The asterisk indicates a significant difference (<i>p</i> < 0.05).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/fig[1]/caption[1]/p[3]">(C) Intestinal load of <span class="genus-species">S. epidermidis</span> 9142 (dark bars) and 9142-M10 (light bars) within <i>sek-1(km4) C. elegans</i> feeding on mixed lawns in a ratio of 1:100. Bacterial loads were determined in triplicate from approximately ten disrupted worms. Data represent mean ± SEM.</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.g008</span><div class="clearer"></div></div><p xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/p[2]">To determine if the sensitivity of <i>sek-1(km4)</i> nematodes to <i>ica</i>-deficient <span class="genus-species">S. epidermidis</span>–mediated killing correlated with colonization levels, the bacterial load of <i>sek-1(km4)</i> nematodes feeding on <span class="genus-species">S. epidermidis</span> 9142 and 9142-M10 for 16 h were compared to that of wild-type worms, as shown in <a href="#ppat-0030057-g008">Figure 8</a>B. Interestingly, the bacterial load in <i>sek-1(km4)</i> nematodes is lower than in wild-type <span class="genus-species">C. elegans</span> when feeding on either 9142 or 9142-M10. However, <i>sek-1(km4)</i> animals accumulate equal intestinal loads of <span class="genus-species">S. epidermidis</span> 9142 and <i>ica</i>-deficient 9142-M10, whereas wild-type animals accumulate more 9142 than 9142-M10, as previously noted (<a href="#ppat-0030057-g003">Figure 3</a>). The decreased accumulation of bacteria in the immunocompromised <i>sek-1(km4)</i> mutants may be a reflection of overall worm health. Indeed, <i>sek-1(km4)</i> and other immunocompromised worms were observed to perform less foraging and move more slowly through the <span class="genus-species">S. epidermidis</span> lawns compared to wild-type worms. However, the equal accumulation of wild-type <span class="genus-species">S. epidermidis</span> and PIA-deficient 9142-M10 within the intestinal tract of <i>sek-1(km4)</i> mutants correlates with their comparable nematocidal activity (<a href="#ppat-0030057-g008">Figure 8</a>A).</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/p[3]">If PIA production enhances the ability of <span class="genus-species">S. epidermidis</span> to colonize wild-type N2 nematodes but not immunocompromised <i>sek-1</i> mutants, then 9142 should have a competitive advantage over 9142-M10 within the nematode intestinal tract of N2, but not within <i>sek-1</i> animals during mixed infection. To test this, <i>sek-1(km4)</i> mutants were exposed to mixed lawns of 9142 and 9142-M10 in a ratio of 1:100, respectively, as was performed for N2 nematodes (<a href="#ppat-0030057-g007">Figure 7</a>B). As shown in <a href="#ppat-0030057-g008">Figure 8</a>C, <i>sek-1(km4)</i> mutants maintained similar proportions of 9142 and 9142-M10 at both 6 and 20 h.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/p[4]">To investigate whether the production of PIA by <span class="genus-species">S. epidermidis</span> may mask antigens sensed by the <span class="genus-species">C. elegans</span> p38 MAP kinase signaling pathway, worms containing green fluorescent protein (GFP) under the control of promoters of two putative PMK-1 target genes (D. H. Kim, personal communication) were exposed to wild-type and <i>ica</i>-deficient <i>S. epidermidis,</i> and no difference in GFP expression was observed (unpublished data). Consequently, we have no evidence that PIA exopolysaccharide conceals staphylococcal antigens recognized by the p38 MAP kinase signaling system, although such a function cannot be conclusively ruled out.</p> <p xpathLocation="/article[1]/body[1]/sec[2]/sec[7]/p[5]">The data presented in this section demonstrate that, in contrast to wild-type nematodes, <span class="genus-species">C. elegans</span> with compromised innate immunity due to defective MAP kinase signaling are equally susceptible to killing by <i>S. epidermidis,</i> whether or not biofilm matrix is produced. These results support the hypothesis that biofilm exopolysaccharide in <span class="genus-species">S. epidermidis</span> protects bacteria in the <span class="genus-species">C. elegans</span> intestinal tract by modulating killing by the nematode innate immune system.</p> </div> <div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" id="section3" xpathLocation="/article[1]/body[1]/sec[3]"><a id="s3" name="s3" toc="s3" title="Discussion"></a><h3 xpathLocation="noSelect">Discussion <a href="#top">Top</a></h3><p xpathLocation="/article[1]/body[1]/sec[3]/p[1]">The best-characterized aspect of <span class="genus-species">S. epidermidis</span> virulence is its ability to form biofilm on solid surfaces, such as implanted medical devices and catheters. Indeed, the primary method for assessing <span class="genus-species">S. epidermidis</span> virulence is to measure persistence and accumulation on an implanted foreign body in a mammalian host [<a href="#ppat-0030057-b063">63</a>]. <span class="genus-species">S. epidermidis</span> biofilm formation is not only crucial for adherence to and accumulation on artificial surfaces, but also appears to serve protective functions against antibiotics and the immune system [<a href="#ppat-0030057-b005">5</a>,<a href="#ppat-0030057-b013">13</a>]. As a result, biofilm-associated <span class="genus-species">S. epidermidis</span> infections of bioprosthetic materials are usually difficult to eradicate, even with prolonged antibiotic therapy, and often require removal of the colonized material in order to achieve cure.</p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[2]">There is now a growing body of work demonstrating the utility of using <span class="genus-species">C. elegans</span> as a model organism to study host–pathogen interactions from both the standpoints of the pathogen and the host for a variety of microbial infections (for reviews see [<a href="#ppat-0030057-b029">29</a>] and [<a href="#ppat-0030057-b064">64</a>]). Compared to vertebrate models, <span class="genus-species">C. elegans</span>–based models are rapid, inexpensive, and technically straightforward. In previous work, we and others have shown that <span class="genus-species">S. aureus</span> infects and kills <span class="genus-species">C. elegans</span> by a process that requires many, but not all, of the same factors necessary for full virulence in mammalian models. For example, <span class="genus-species">S. aureus</span> virulence factors or traits important for disease in both vertebrates and nematodes include virulence regulators (<i>sarA, saeRS,</i> σ<sup>B</sup>), exotoxins (α-toxin, V8 protease), capsule, virulence-related metabolic factors, and phenotypic variants (small colony variants) [<a href="#ppat-0030057-b032">32</a>,<a href="#ppat-0030057-b034">34</a>,<a href="#ppat-0030057-b065">65</a>,<a href="#ppat-0030057-b066">66</a>]. In contrast, adhesins of the microbial surface components recognizing the adhesive matrix molecules (MSCRAMM) family are crucial for colonization and infection in mammals but are not required for infection of nematodes [<a href="#ppat-0030057-b066">66</a>]. Interestingly, the accessory gene regulator <i>(agr)</i> quorum-sensing system appears to contribute to <span class="genus-species">S. aureus</span> virulence in several but not all genetic backgrounds [<a href="#ppat-0030057-b032">32</a>,<a href="#ppat-0030057-b066">66</a>] (M. Cupp and C. Sifri, unpublished observations), which may reflect strain-dependent differences in <i>agr</i> gene regulation [<a href="#ppat-0030057-b067">67</a>]. Here we describe the use of the <span class="genus-species">C. elegans</span> model to study the role of biofilm exopolysaccharide in <span class="genus-species">S. epidermidis</span> and <span class="genus-species">S. aureus</span> pathogenesis and host defense responses.</p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[3]">In this study, we demonstrated that the biofilm-associated exopolysaccharide PIA is produced by <span class="genus-species">S. epidermidis</span> when it colonizes the nematode intestinal tract. Importantly, disruption of the <i>icaADBC</i> operon, which is required for PIA biosynthesis, not only greatly diminishes the ability of <span class="genus-species">S. epidermidis</span> to infect and kill <i>C. elegans,</i> but also reduces <span class="genus-species">S. epidermidis</span> fitness during intestinal colonization. Importantly, plasmid pTX<i>icaADBC</i> complemented both biofilm formation and nematocidal activity of the <i>ica</i> mutant under xylose-inducing conditions. It should be noted that while loss of PIA production in 9142-M10 greatly diminishes virulence towards nematodes, the strain is not avirulent, as has been observed in mammalian models of <span class="genus-species">S. epidermidis</span> disease [<a href="#ppat-0030057-b010">10</a>]. Presumably, other factors contribute to <span class="genus-species">S. epidermidis</span> virulence, a hypothesis that is supported by the high susceptibility of immunocompromised <i>sek-1</i> mutants to <i>ica</i>-deficient 9142-M10. Further experiments will be required to determine whether other putative <span class="genus-species">S. epidermidis</span> virulence factors, such as poly-γ-<small>DL</small>-glutamic acid, accumulation-associated protein, fibrinogen-binding protein, phenol-soluble modulins, hemolysins, extracellular proteases, or the <i>agr</i> quorum-sensing system contribute to disease in nematodes.</p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[4]">Biofilm formation has been previously found to play a role in <span class="genus-species">Y. pestis</span> and <i>Y. pseudotuberculosis</i>–mediated growth inhibition of <span class="genus-species">C. elegans</span> [<a href="#ppat-0030057-b035">35</a>,<a href="#ppat-0030057-b036">36</a>,<a href="#ppat-0030057-b061">61</a>]. In these cases, the mechanism of virulence involves the formation of an obstructive plug over the pharyngeal opening, preventing feeding and resulting in the nematodes starving to death. Disruption of the <i>Yersinia hmsHFRS</i> locus, which is homologous to the <i>S. epidermidis icaADBC</i> locus, results in a less virulent phenotype. However, formation of an obstructive pharyngeal plug is unlikely to play a role in <span class="genus-species">S. epidermidis</span> killing, because microscopic visualization did not reveal the presence of obstructive plugs, and nematodes were able to ingest bacteria. In addition, the <i>C. elegans srf-2, srf-3,</i> and <i>srf-5</i> mutants, which are resistant to <i>Yersinia</i> infection due to the inability of the bacteria to adhere to the altered nematode cuticle, are as sensitive as wild-type animals are to <span class="genus-species">S. epidermidis</span>. Therefore, the mechanism of biofilm-mediated virulence is more likely to be a consequence of effects within the nematode intestine rather than on the surface of the nematode.</p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[5]">Since genetic disruption of the <i>S. epidermidis ica</i> biosynthetic locus specifically blocks PIA production and biofilm formation, it is unlikely that the lesion causes a pleiotropic phenotype. However, the lack of biofilm formation could lead to altered gene regulation and decreased virulence, since the global gene expression patterns of planktonic and biofilm bacteria differ significantly for <span class="genus-species">S. aureus</span> and several other bacterial species [<a href="#ppat-0030057-b068">68</a>,<a href="#ppat-0030057-b069">69</a>]. Nevertheless, the observed reduction in virulence of <i>S. epidermidis ica</i> mutants is most likely a direct consequence of reduced PIA production. This conclusion is supported by the increase in virulence observed in <span class="genus-species">S. aureus</span> strains in which the transcription of <i>icaADBC</i> is increased, as well as by the restored virulence in the pTX<i>icaADBC</i>-complemented <i>S. epidermidis icaA</i> mutant under inducing but not non-inducing conditions. It is not likely that PIA itself is toxic to nematodes, since heat-killed bacteria and culture supernatants are not harmful to <i>C. elegans.</i></p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[6]">Importantly, our data suggest that wild-type <span class="genus-species">S. epidermidis</span> 9142 is better able to survive the host defense response within the <span class="genus-species">C. elegans</span> intestine than the isogenic PIA-deficient strain 9142-M10. This is reflected in the greater absolute number of bacteria recovered from worms feeding on wild-type 9142 compared to those feeding on 9142-M10, as well as in the enrichment of wild-type bacteria found within N2 <span class="genus-species">C. elegans</span> feeding on a mixed population of bacteria. In principle, this could result from greater intestinal retention of wild-type bacteria due to increased adherence (attachment hypothesis), or increased survival of wild-type bacteria in the intestinal milieu (survival hypothesis). Although we cannot definitively rule out the former possibility, we favor the survival hypothesis for the following reasons. First, nematodes feeding on mixed lawns of 9142 and 9142-M10, which are then transferred to buffer, do not excrete more PIA-deficient bacteria than wild-type bacteria. In fact, there were relatively more wild-type bacteria than PIA-deficient organisms in the expelled collections than the intestinal tract, although this difference did not reach statistical significance, suggesting that PIA-producing bacteria may have a survival advantage over PIA-deficient bacteria during transit through the digestive tract. Second, 9142 has a competitive advantage over 9142-M10 within the intestinal tract of N2 <span class="genus-species">C. elegans</span> feeding on a mixed population of 9142 and 9142-M10. By contrast, no enrichment of 9142 is observed in immunocompromised <i>sek-1</i> loss-of-function mutants feeding on a mixed population of the two strains. These results indicate that the selective advantage afforded by PIA production to 9142 during intestinal tract colonization is manifested only in animals with intact immune systems. Finally, immunocompromised <i>C. elegans pmk-1</i> and <i>sek-1</i> mutants are very sensitive to PIA-deficient <i>S. epidermidis,</i> and in <i>sek-1</i> mutants<i>,</i> in contrast to wild-type nematodes, there is no difference in bacterial titer following infection with PIA-producing and PIA-deficient <span class="genus-species">S. epidermidis</span> strains.</p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[7]">How SEK-1 PMK-1 p38 MAP kinase signaling promotes immunity to infection by <span class="genus-species">S. epidermidis</span> or related bacteria has yet to be determined. However, Troemel et al. recently described how the p38 MAP kinase pathway controls defense responses to <span class="genus-species">Pseudomonas aeruginosa</span> infection in <span class="genus-species">C. elegans</span> [<a href="#ppat-0030057-b050">50</a>]. Microarray and genetic analysis show that the SEK-1 PMK-1 pathway directs a specific, inducible response to <span class="genus-species">P. aeruginosa</span> infection, characterized by activation of known or putative immune effector genes, including C-type lectins, lysozymes, neuropeptide-like proteins, homologs of ShK toxins, and proteins with CUB-like domains. If the SEK-1 PMK-1 pathway similarly regulates a specific immune response to staphylococcal infection, then the reduced production of immune effector molecules in immunocompromised <i>sek-1</i> or <i>pmk-1</i> mutants could abrogate the protective advantage of <span class="genus-species">S. epidermidis</span> biofilm exopolysaccharide. This hypothesis is consistent with the observed protection that biofilm formation confers against antibacterial peptides in vitro [<a href="#ppat-0030057-b070">70</a>], which are believed to be among the main immune effectors utilized by <span class="genus-species">C. elegans</span> [<a href="#ppat-0030057-b071">71</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[8]">Alternatively, the SEK-1 PMK-1 pathway may regulate a nonspecific response that promotes resistance to <span class="genus-species">S. epidermidis</span> infection, and reduced stress resistance in p38 MAP kinase mutants could similarly negate the protective advantage of <span class="genus-species">S. epidermidis</span> biofilm exopolysaccharide. Furthermore, it is conceivable that disruption of the p38 MAP kinase pathway could modify the intestinal epithelium in a manner that leads to altered bacterial adherence, or that a small quantity of PIA-producing bacteria could adhere to intestinal cells, repress immune signaling, and thereby facilitate long-term colonization and increased sensitivity to killing by <span class="genus-species">S. epidermidis</span>.</p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[9]">If biofilm exopolysaccharide acts to impede immunological molecules as it encases an agglomeration of bacteria, then biofilm could be predicted to protect both PIA-producing bacteria and bystander bacteria. Unexpectedly, the immunoprotective action of PIA production by <span class="genus-species">S. epidermidis</span> appears to be cell autonomous within the <span class="genus-species">C. elegans</span> intestine, since wild-type <span class="genus-species">S. epidermidis</span> out-competed <i>icaADBC</i>-deficient mutants in mixed lawn feeding experiments. This result indicates that a more complex mechanism may be at play. One possibility is that the polysaccharide matrix must be modified in order to be immunoprotective and that this modification occurs in a cell-autonomous fashion. Recently, Vuong et al. showed that the <i>icaB</i> gene encodes a surface-bound enzyme, which partially deacetylates the PIA precursor. Notably, they demonstrated that deacetylation is required for resistance to the human cationic antimicrobial peptides human-β-defensin 3 and LL37 [<a href="#ppat-0030057-b072">72</a>]. The cell autonomy of IcaB activity within the nematode intestinal tract was not investigated in this study and remains unknown.</p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[10]">It is interesting to speculate that the protective function of PIA represents an evolutionarily conserved activity that originated in bacteria to withstand grazing by bacterivorous nematodes and other predators. Indeed, homologs of the <i>ica</i> locus are present in a diverse array of environmental Gram-negative bacteria, including <i>Pseudomonas fluorescens, Xanthomonas axonopodis,</i> and <span class="genus-species">Ralstonia solanacearum</span> [<a href="#ppat-0030057-b073">73</a>]. Likewise, biofilm formation has been postulated to protect environmental bacteria against predatory protozoa [<a href="#ppat-0030057-b074">74</a>,<a href="#ppat-0030057-b075">75</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[3]/p[11]">Using an interactive genetic approach, our results establish a novel in vivo experimental system for investigating the interface between staphylococcal biofilm matrix and the innate immune system. Although previous studies have investigated the contribution of biofilm production to the colonization of foreign bodies in vivo, and the immunoprotective activity of biofilm formation in vitro, we are not aware of any reports directly demonstrating the immunoprotective activity of biofilm polysaccharide in a live animal model per se. The ease of manipulation and transparency of the model system, as well as the array of genetic tools available for use in <span class="genus-species">C. elegans</span> and staphylococcal research, make the <span class="genus-species">C. elegans</span>–<i>Staphylococcus</i> infection model an attractive system for studying the interaction of biofilm formation and host defense mechanisms.</p> </div> <div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" id="section4" xpathLocation="/article[1]/body[1]/sec[4]"><a id="s4" name="s4" toc="s4" title="Materials and Methods"></a><h3 xpathLocation="noSelect">Materials and Methods <a href="#top">Top</a></h3> <h4 xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/title[1]">Strains and growth conditions.</h4> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/p[1]">The bacterial strains used in this study are listed in <a href="#ppat-0030057-t001">Table 1</a>. All strains were maintained at −75 °C in TS or Luria-Bertani (LB) medium containing 15% glycerol. <span class="genus-species">S. aureus</span> strains MN8, MN8m, NCTC 10833 (herein 10833), 10833 <i>Δica,</i> and 10833 <i>Δica</i>(pMUC) were obtained from G. Pier (Channing Laboratory, Harvard Medical School, Boston, Massachusetts, United States). The sporulation-deficient <span class="genus-species">B. subtilis</span> strain RL2244 was obtained from R. Losick (Harvard University, Cambridge, Massachusetts, United States).</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/table-wrap[1]"><a name="ppat-0030057-t001" id="ppat-0030057-t001" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.t001" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.t001&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/table-wrap[1]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.t001" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/table-wrap[1]/label[1]">Table 1. </span></a></strong></p><p xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/table-wrap[1]/caption[1]/p[1]">Bacterial Strains and Plasmids Used in This Study</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.t001</span><div class="clearer"></div></div><p xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/p[2]">The <span class="genus-species">C. elegans</span> strains used in this study are listed in <a href="#ppat-0030057-t002">Table 2</a>. <span class="genus-species">C. elegans</span> strains Bristol N2, <i>age-1(hx546), daf-2(e1370), daf-16(mgDf47), srf-2(yj262), srf-3(yj10),</i> and <i>srf-5(ct115)</i> were obtained from the <i>Caenorhabditis</i> Genetics Center (<a href="http://www.cbs.umn.edu/CGC">http://www.cbs.umn.edu/CGC</a>). Strain <i>daf-2(e1370);daf-16(mgDf47)</i> was obtained from D. Garsin (University of Texas, Houston, Texas, United States). Strains <i>sek-1(ag1), nsy-1(ag3), sek-1(km4),</i> and <i>pmk-1(km25)</i> have previously been described [<a href="#ppat-0030057-b042">42</a>,<a href="#ppat-0030057-b076">76</a>,<a href="#ppat-0030057-b077">77</a>]. <span class="genus-species">C. elegans</span> strains were maintained at 15 °C on nematode growth medium (NGM) plates spread with <span class="genus-species">E. coli</span> strain OP50 as a food source [<a href="#ppat-0030057-b078">78</a>,<a href="#ppat-0030057-b079">79</a>], and were manipulated using established techniques [<a href="#ppat-0030057-b078">78</a>].</p> <div class="figure" xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/table-wrap[2]"><a name="ppat-0030057-t002" id="ppat-0030057-t002" title="Click for larger image " href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.t002" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><img xpathLocation="noSelect" border="1" src="/article/fetchObject.action?uri=info:doi/10.1371/journal.ppat.0030057.t002&representation=PNG_S" align="left" alt="thumbnail" class="thumbnail"></a><p><strong xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/table-wrap[2]/label[1]"><a href="/article/slideshow.action?uri=info:doi/10.1371/journal.ppat.0030057&imageURI=info:doi/10.1371/journal.ppat.0030057.t002" onclick="window.open(this.href,'plosSlideshow','directories=no,location=no,menubar=no,resizable=yes,status=no,scrollbars=yes,toolbar=no,height=600,width=850');return false;"><span xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/table-wrap[2]/label[1]">Table 2. </span></a></strong></p><p xpathLocation="/article[1]/body[1]/sec[4]/sec[1]/table-wrap[2]/caption[1]/p[1]"><span class="genus-species">C. elegans</span> Strains Used in This Study</p> <span xpathLocation="noSelect">doi:10.1371/journal.ppat.0030057.t002</span><div class="clearer"></div></div> <h4 xpathLocation="/article[1]/body[1]/sec[4]/sec[2]/title[1]">Complementation of the <i>ica</i> mutant strain.</h4> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[2]/p[1]">Phage transduction of plasmid pTX<i>icaADBC</i> from <span class="genus-species">S. epidermidis</span> 9142 [<a href="#ppat-0030057-b055">55</a>] into the <i>icaA</i>::Tn<i>917</i> mutant 9142-M10 was carried out as previously described with minor modifications [<a href="#ppat-0030057-b056">56</a>]. In brief, phage 48, provided by V. T. Rosdahl (Staten Serum Institut, Copenhagen, Denmark), was propagated on <span class="genus-species">S. epidermidis</span> 9142(pTX<i>ica</i>), provided by F. Götz (Universität Tübingen, Tübingen, Germany), and the resulting phage lysate was used to transduce the plasmid into 9142-M10. Transductants were selected on brain heart infusion medium containing 20 μg/ml erythromycin and 20 μg/ml tetracycline.</p> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[2]/p[2]">Previous work has shown that the <i>icaA</i>::Tn<i>917</i> mutation in 9142-M10 abolishes PIA production and attachment to polystyrene [<a href="#ppat-0030057-b004">4</a>,<a href="#ppat-0030057-b008">8</a>]. To assess production of functional PIA, polystyrene flat bottom microtiter well adherence assays were performed as previously described using the complemented mutant <span class="genus-species">S. epidermidis</span> 9142-M10(pTX<i>ica</i>) and comparator strains grown in TS medium with or without supplemental xylose (2% wt/vol) [<a href="#ppat-0030057-b056">56</a>].</p> <h4 xpathLocation="/article[1]/body[1]/sec[4]/sec[3]/title[1]">Nematode killing assays.</h4> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[3]/p[1]"><span class="genus-species">C. elegans</span> killing assays were performed as previously described for <span class="genus-species">S. aureus</span> [<a href="#ppat-0030057-b032">32</a>] with the following modifications. Staphylococcal strains were grown overnight at 30 °C or 37 °C with aeration in TS broth that was supplemented with 5 μg/ml nalidixic acid (Sigma, <a href="http://www.sigmaaldrich.com">http://www.sigmaaldrich.com</a>), 5 μg/ml tetracycline (Sigma), 10 μg/ml erythromycin (Sigma), or 5 μg/ml chloramphenicol (Sigma), as appropriate. <span class="genus-species">B. subtilis</span> was grown in LB broth containing 10 μg/ml tetracycline at 30 °C with aeration. Petri plates (3.5 cm) containing TS agar supplemented with 5 μg/ml nalidixic acid (Sigma) for staphylococcal strains were spread with 10 μl of culture and incubated at 30 °C for 6 h. These plates were allowed to equilibrate to room temperature and then were seeded with nematodes using standard techniques.</p> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[3]/p[2]">Heat-killed plates were prepared using the spotted lawn method as previously described [<a href="#ppat-0030057-b034">34</a>], with minor modifications. Briefly, heat-killed <span class="genus-species">E. coli</span> OP50 or <span class="genus-species">S. epidermidis</span> 9142 was prepared by heating a 3-ml overnight culture to 65 °C for 30 or 60 min, respectively. Samples were streaked onto drug-free plates to ensure that the organisms were dead. The culture was pelleted by centrifugation, decanted of the supernatant, and resuspended in 300 μl of TS medium. One-hundred microliters of the concentrated heat-killed bacteria were then spotted onto TS agar plates supplemented with nalidixic acid. Plates containing live <span class="genus-species">S. epidermidis</span> and heat-killed <span class="genus-species">E. coli</span> were similarly prepared at a ratio of 1:1 or 1:5 (vol:vol).</p> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[3]/p[3]">Approximately 30 hermaphrodite nematodes in the fourth larval stage (L4) were transferred to killing plates, and their survival was monitored over time at 25 °C. Experiments were conducted in triplicate and repeated at least three times. For groups in which most nematodes survived longer than 5 d, the animals were transferred to fresh plates every 3–5 d in order to separate subjects from progeny. For experiments with live <span class="genus-species">S. epidermidis</span> heat-killed <span class="genus-species">E. coli</span> mixtures, worms were transferred to freshly prepared plates daily to ensure that heat-killed <span class="genus-species">E. coli</span> OP50 was not preferentially consumed to exhaustion during the course of the experiment. Nematodes were considered dead when they failed to respond to touch. Worms that died as a result of crawling off the plate were censored from the analysis. Nematode survival was calculated by the Kaplan–Meier method, and survival differences were tested for significance using the log-rank test (GraphPad Prism, version 4.0; GraphPad, <a href="http://www.graphpad.com">http://www.graphpad.com</a>). <i>p</i>-Values < 0.05 were considered statistically significant.</p> <h4 xpathLocation="/article[1]/body[1]/sec[4]/sec[4]/title[1]">Microscopic visualization of nematode intestinal tract.</h4> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[4]/p[1]">Bacterial colonization of the nematode digestive tract was observed by differential interference contrast imaging with Nomarski optics using an Axioplan2 microscope (Zeiss, <a href="http://www.zeiss.com">http://www.zeiss.com</a>) [<a href="#ppat-0030057-b032">32</a>].</p> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[4]/p[2]">FITC-conjugated <span class="genus-species">Triticum vulgare</span> lectin from WGA was obtained from EY Laboratories (<a href="http://www.eylabs.com">http://www.eylabs.com</a>) and used to fluorescently label <span class="genus-species">S. epidermidis</span> exopolysaccharide using the protocol of Tan and Darby [<a href="#ppat-0030057-b061">61</a>] with the following modifications. <span class="genus-species">S. epidermidis</span> 9142 or 9142-M10 lawns grown for 24 h on TSA plates were scraped into 1 ml of PBS, resuspended and sonicated (three 60-second pulses of 50% duration, power level 3, on a Branson Sonifier 450) to homogenize the suspension, and washed twice with PBS to remove cell debris, with centrifugation at 16,000<i>g</i> for 3 min between washes. The cell pellet was resuspended in 1 ml of PBS containing WGA-FITC at 25 μg/ml, incubated for 60 min at room temperature with agitation, and washed three times with PBS to remove unbound WGA-FITC. Next, 50 μl aliquots of the labeled bacterial suspension were transferred to fresh Petri plates, allowed to dry, and then seeded with ten nematodes (L4) per plate. After 16 h of feeding, nematodes were examined using a Leica TCS NT confocal microscope with spectrophotometric detection by established methodologies [<a href="#ppat-0030057-b080">80</a>].</p> <h4 xpathLocation="/article[1]/body[1]/sec[4]/sec[5]/title[1]">Quantification of nematode colonization and excretion.</h4> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[5]/p[1]">For quantification of bacterial colonization of <span class="genus-species">C. elegans</span> and rates of differential excretion, nematodes were allowed to feed on <span class="genus-species">S. epidermidis</span> strain 9142, 9142-M10, or a mixture of both under standard killing conditions. Approximately 30 nematodes were transferred manually from the killing plates into a 250-μl drop of M9 buffer, divided into three pools, and washed three times with 200 μl of M9 buffer containing 1 mM sodium azide by serial transfer in a 96-well micro titer plate using a Pasteur pipette. Nematodes were then transferred into 2-ml conical tubes, and the volume was increased to 250 μl with fresh M9 buffer without added sodium azide. Worms were homogenized by adding approximately 200 μl of sodium carbide beads (BioSpec Products, <a href="http://www.biospec.com">http://www.biospec.com</a>) and vortexing for 1 min. Serial dilutions of the supernatant were made to determine the number of viable bacteria.</p> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[5]/p[2]">To evaluate persistent bacterial colonization of <i>C. elegans,</i> nematodes were allowed to feed on <span class="genus-species">S. epidermidis</span> strain 9142, 9142-M10, or ATCC 12228 under standard conditions. After 12 h of feeding on the initial (pulse) <span class="genus-species">S. epidermidis</span> strain, worms were transferred to a second (chase) <span class="genus-species">S. epidermidis</span> strain. Prior to and 20 and 40 h after transfer, approximately 30 nematodes were transferred, washed, homogenized, and plated as described above. Serial dilutions of the homogenates of nematodes transferred from <span class="genus-species">S. epidermidis</span> 9142 to 9142-M10 or ATCC 12228 were plated on TS agar plates containing 0.2% Congo Red and 0.25% additional glucose (CRA<sub>TS</sub>), and the plates were incubated overnight at 37 °C. Under these conditions, wild-type <span class="genus-species">S. epidermidis</span> 9142 appeared black, whereas the <i>ica</i> mutant strain 9142-M10 and the <i>ica</i>-deficient strain ATCC 12228 appeared red [<a href="#ppat-0030057-b016">16</a>]. Similarly, serial dilutions of the homogenates of nematodes transferred from 9142-M10 (erythromycin resistant) to ATCC 12228 (erythromycin sensitive), or vice versa, were replica plated on TS agar plates with and without 10 μg/ml erythromycin for enumeration. The Fitness Index is calculated as follows: (pulse <span class="genus-species">S. epidermidis</span> strain C.F.U) / (pulse <span class="genus-species">S. epidermidis</span> strain C.F.U. + chase <span class="genus-species">S. epidermidis</span> strain C.F.U), where the pulse strain is the initial <span class="genus-species">S. epidermidis</span> strain, and the chase strain is the second <span class="genus-species">S. epidermidis</span> strain.</p> <p xpathLocation="/article[1]/body[1]/sec[4]/sec[5]/p[3]">To determine excretion rates, three groups of ten nematodes each were transferred to 1.5-ml tubes containing 500 μl of M9 buffer without sodium azide. After 2 h, the number of C.F.U. were determined from aliquots of the solution and worm homogenates by plating serial dilutions on CRA<sub>TS</sub>. Differences in quantified intestinal tract and/or excreted bacteria were compared for statistical significance using a standard two-tailed <i>t</i>-test (GraphPad Prism, version 4.0). <i>p</i>-Values < 0.05 were considered statistically significant.</p> </div> <div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" id="section5" xpathLocation="/article[1]/body[1]/sec[5]"><a id="s5" name="s5" toc="s5" title="Supporting Information"></a><h3 xpathLocation="noSelect">Supporting Information <a href="#top">Top</a></h3><a name="ppat-0030057-sg001" id="ppat-0030057-sg001"></a><p><strong xPathLocation="noSelect"><a href="/article/fetchSingleRepresentation.action?uri=info:doi/10.1371/journal.ppat.0030057.sg001">Figure S1. </a>Coagulase-Negative Staphylococcal Species other than <span class="genus-species">S. epidermidis</span> Kill <span class="genus-species">C. elegans</span></strong></p><p xpathLocation="/article[1]/body[1]/sec[5]/supplementary-material[1]/caption[1]/p[1]">Survival of N2 <span class="genus-species">C. elegans</span> on strains F13532 (<span class="genus-species">Staphylococcus hominis</span> spp. <i>novobiosepticus,</i> squares), F16942 (<i>Staphylococcus haemolyticus,</i> triangles), and M3291 (<i>Staphylococcus lugdunensis,</i> diamonds) compared to ATCC 12228 (biofilm-deficient nonpathogenic <span class="genus-species">S. epidermidis</span> reference strain, circles).</p> <p xpathLocation="/article[1]/body[1]/sec[5]/supplementary-material[1]/caption[1]/p[2]">(1.5 MB PDF)</p> </div> <div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" xpathLocation="noSelect"><a id="ack" name="ack" toc="ack" title="Acknowledgments"></a><h3 xpathLocation="noSelect">Acknowledgments <a href="#top">Top</a></h3> <p xpathLocation="/article[1]/back[1]/ack[1]/p[1]">We thank Gerald Pier, Kimberley Jefferson, Friedrich Götz, Vibeke Thamdrup Rosdahl, Joseph John, Richard Losick, Dennis Kim, Emily Troemel, and Danielle Garsin for generously providing strains, reagents, and/or advice. Several <span class="genus-species">C. elegans</span> strains were originally obtained from the <i>Caenorhabditis</i> Genetics Center, which is supported by the National Institutes of Health National Center of Research Resources.</p> </div><div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" class="contributions"><a id="authcontrib" name="authcontrib" toc="authcontrib" title="Author Contributions"></a><h3 xpathLocation="noSelect">Author Contributions <a href="#top">Top</a></h3><p xpathLocation="noSelect"><span class="capture-id">B, FMA, and CDS conceived and designed experiments. HR and DM provided necessary reagents, constructed the complemented strain 9142-M10(pTX<i>ica</i>), and performed polystyrene microtiter plate adherence assays. JMG carried out nematode quantification and pathogenesis experiments for some pulse-chase and <i>sek-1</i> experiments. JB and CDS performed all other experiments. JB, FMA, SBC, and CDS analyzed the results and wrote the paper.</span></p></div><div xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:aml="http://topazproject.org/aml/" xpathLocation="noSelect"><a id="references" name="references" toc="references" title="References"></a><h3 xpathLocation="noSelect">References <a href="#top">Top</a></h3><ol class="references" xpathLocation="noSelect"><li xpathLocation="noSelect"><a name="ppat-0030057-b001" id="ppat-0030057-b001"></a><span class="authors">Costerton JW, Stewart PS, Greenberg EP</span> (1999) Bacterial biofilms: A common cause of persistent infections. Science 284: 1318–1322. <a class="find" href="/article/findArticle.action?author=Costerton&title=Bacterial biofilms: A common cause of persistent infections."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b002" id="ppat-0030057-b002"></a><span class="authors">Mah TF, O'Toole GA</span> (2001) Mechanisms of biofilm resistance to antimicrobial agents. Trends Microbiol 9: 34–39. <a class="find" href="/article/findArticle.action?author=Mah&title=Mechanisms of biofilm resistance to antimicrobial agents."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b003" id="ppat-0030057-b003"></a><span class="authors">Mack D, Fischer W, Krokotsch A, Leopold K, Hartmann R, et al. </span> (1996) The intercellular adhesin involved in biofilm accumulation of <span class="genus-species">Staphylococcus epidermidis</span> is a linear β-1,6-linked glucosaminoglycan: Purification and structural analysis. J Bacteriol 178: 175–183. <a class="find" href="/article/findArticle.action?author=Mack&title=The intercellular adhesin involved in biofilm accumulation of Staphylococcus epidermidis is a linear %CE%B2-1,6-linked glucosaminoglycan: Purification and structural analysis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b004" id="ppat-0030057-b004"></a><span class="authors">Mack D, Nedelmann M, Krokotsch A, Schwarzkopf A, Heesemann J, et al. </span> (1994) Characterization of transposon mutants of biofilm-producing <span class="genus-species">Staphylococcus epidermidis</span> impaired in the accumulative phase of biofilm production: Genetic identification of a hexosamine-containing polysaccharide intercellular adhesin. Infect Immun 62: 3244–3253. <a class="find" href="/article/findArticle.action?author=Mack&title=Characterization of transposon mutants of biofilm-producing Staphylococcus epidermidis impaired in the accumulative phase of biofilm production: Genetic identification of a hexosamine-containing polysaccharide intercellular adhesin."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b005" id="ppat-0030057-b005"></a><span class="authors">Götz F</span> (2002) <i>Staphylococcus</i> and biofilms. Mol Microbiol 43: 1367–1378. <a class="find" href="/article/findArticle.action?author=G%C3%B6tz&title=Staphylococcus and biofilms."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b006" id="ppat-0030057-b006"></a><span class="authors">Maira-Litrán T, Kropec A, Goldmann D, Pier GB</span> (2004) Biologic properties and vaccine potential of the staphylococcal poly-<i>N</i>-acetyl glucosamine surface polysaccharide. Vaccine 22: 872–879. <a class="find" href="/article/findArticle.action?author=Maira-Litr%C3%A1n&title=Biologic properties and vaccine potential of the staphylococcal poly-N-acetyl glucosamine surface polysaccharide."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b007" id="ppat-0030057-b007"></a><span class="authors">Mack D, Rohde H, Harris LG, Davies AP, Horstkotte MA, et al. </span> (2006) Biofilm formation in medical device-related infection. Int J Artif Organs 29: 343–359. <a class="find" href="/article/findArticle.action?author=Mack&title=Biofilm formation in medical device-related infection."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b008" id="ppat-0030057-b008"></a><span class="authors">Heilmann C, Gerke C, Perdreau-Remington F, Götz F</span> (1996) Characterization of Tn<i>917</i> insertion mutants of <span class="genus-species">Staphylococcus epidermidis</span> affected in biofilm formation. Infect Immun 64: 277–282. <a class="find" href="/article/findArticle.action?author=Heilmann&title=Characterization of Tn917 insertion mutants of Staphylococcus epidermidis affected in biofilm formation."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b009" id="ppat-0030057-b009"></a><span class="authors">Conlon KM, Humphreys H, O'Gara JP</span> (2002) <i>icaR</i> encodes a transcriptional repressor involved in environmental regulation of <i>ica</i> operon expression and biofilm formation in <span class="genus-species">Staphylococcus epidermidis</span>. J Bacteriol 184: 4400–4408. <a class="find" href="/article/findArticle.action?author=Conlon&title=icaR encodes a transcriptional repressor involved in environmental regulation of ica operon expression and biofilm formation in Staphylococcus epidermidis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b010" id="ppat-0030057-b010"></a><span class="authors">Rupp ME, Ulphani JS, Fey PD, Bartscht K, Mack D</span> (1999) Characterization of the importance of polysaccharide intercellular adhesin/hemagglutinin of <span class="genus-species">Staphylococcus epidermidis</span> in the pathogenesis of biomaterial-based infection in a mouse foreign body infection model. Infect Immun 67: 2627–2632. <a class="find" href="/article/findArticle.action?author=Rupp&title=Characterization of the importance of polysaccharide intercellular adhesin/hemagglutinin of Staphylococcus epidermidis in the pathogenesis of biomaterial-based infection in a mouse foreign body infection model."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b011" id="ppat-0030057-b011"></a><span class="authors">Shiro H, Muller E, Gutierrez N, Boisot S, Grout M, et al. </span> (1994) Transposon mutants of <span class="genus-species">Staphylococcus epidermidis</span> deficient in elaboration of capsular polysaccharide/adhesin and slime are avirulent in a rabbit model of endocarditis. J Infect Dis 169: 1042–1049. <a class="find" href="/article/findArticle.action?author=Shiro&title=Transposon mutants of Staphylococcus epidermidis deficient in elaboration of capsular polysaccharide/adhesin and slime are avirulent in a rabbit model of endocarditis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b012" id="ppat-0030057-b012"></a><span class="authors">Johnson GM, Lee DA, Regelmann WE, Gray ED, Peters G, et al. </span> (1986) Interference with granulocyte function by <span class="genus-species">Staphylococcus epidermidis</span> slime. Infect Immun 54: 13–20. <a class="find" href="/article/findArticle.action?author=Johnson&title=Interference with granulocyte function by Staphylococcus epidermidis slime."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b013" id="ppat-0030057-b013"></a><span class="authors">Vuong C, Voyich JM, Fischer ER, Braughton KR, Whitney AR, et al. </span> (2004) Polysaccharide intercellular adhesin (PIA) protects <span class="genus-species">Staphylococcus epidermidis</span> against major components of the human innate immune system. Cell Microbiol 6: 269–275. <a class="find" href="/article/findArticle.action?author=Vuong&title=Polysaccharide intercellular adhesin (PIA) protects Staphylococcus epidermidis against major components of the human innate immune system."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b014" id="ppat-0030057-b014"></a><span class="authors">Galdbart JO, Allignet J, Tung HS, Ryden C, El Solh N</span> (2000) Screening for <span class="genus-species">Staphylococcus epidermidis</span> markers discriminating between skin-flora strains and those responsible for infections of joint prostheses. J Infect Dis 182: 351–355. <a class="find" href="/article/findArticle.action?author=Galdbart&title=Screening for Staphylococcus epidermidis markers discriminating between skin-flora strains and those responsible for infections of joint prostheses."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b015" id="ppat-0030057-b015"></a><span class="authors">Frebourg NB, Lefebvre S, Baert S, Lemeland JF</span> (2000) PCR-Based assay for discrimination between invasive and contaminating <span class="genus-species">Staphylococcus epidermidis</span> strains. J Clin Microbiol 38: 877–880. <a class="find" href="/article/findArticle.action?author=Frebourg&title=PCR-Based assay for discrimination between invasive and contaminating Staphylococcus epidermidis strains."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b016" id="ppat-0030057-b016"></a><span class="authors">Ziebuhr W, Heilmann C, Götz F, Meyer P, Wilms K, et al. </span> (1997) Detection of the intercellular adhesion gene cluster (<i>ica</i>) and phase variation in <span class="genus-species">Staphylococcus epidermidis</span> blood culture strains and mucosal isolates. Infect Immun 65: 890–896. <a class="find" href="/article/findArticle.action?author=Ziebuhr&title=Detection of the intercellular adhesion gene cluster (ica) and phase variation in Staphylococcus epidermidis blood culture strains and mucosal isolates."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b017" id="ppat-0030057-b017"></a><span class="authors">McKenney D, Pouliot KL, Wang Y, Murthy V, Ulrich M, et al. </span> (1999) Broadly protective vaccine for <span class="genus-species">Staphylococcus aureus</span> based on an in vivo-expressed antigen. Science 284: 1523–1527. <a class="find" href="/article/findArticle.action?author=McKenney&title=Broadly protective vaccine for Staphylococcus aureus based on an in vivo-expressed antigen."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b018" id="ppat-0030057-b018"></a><span class="authors">Fluckiger U, Ulrich M, Steinhuber A, Doring G, Mack D, et al. </span> (2005) Biofilm formation, <i>icaADBC</i> transcription, and polysaccharide intercellular adhesin synthesis by staphylococci in a device-related infection model. Infect Immun 73: 1811–1819. <a class="find" href="/article/findArticle.action?author=Fluckiger&title=Biofilm formation, icaADBC transcription, and polysaccharide intercellular adhesin synthesis by staphylococci in a device-related infection model."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b019" id="ppat-0030057-b019"></a><span class="authors">Knobloch JK, Horstkotte MA, Rohde H, Mack D</span> (2002) Evaluation of different detection methods of biofilm formation in <span class="genus-species">Staphylococcus aureus</span>. Med Microbiol Immunol (Berl) 191: 101–106. <a class="find" href="/article/findArticle.action?author=Knobloch&title=Evaluation of different detection methods of biofilm formation in Staphylococcus aureus."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b020" id="ppat-0030057-b020"></a><span class="authors">Cramton SE, Ulrich M, Götz F, Doring G</span> (2001) Anaerobic conditions induce expression of polysaccharide intercellular adhesin in <span class="genus-species">Staphylococcus aureus</span> and <span class="genus-species">Staphylococcus epidermidis</span>. Infect Immun 69: 4079–4085. <a class="find" href="/article/findArticle.action?author=Cramton&title=Anaerobic conditions induce expression of polysaccharide intercellular adhesin in Staphylococcus aureus and Staphylococcus epidermidis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b021" id="ppat-0030057-b021"></a><span class="authors">Cramton SE, Gerke C, Schnell NF, Nichols WW, Götz F</span> (1999) The intercellular adhesion (<i>ica</i>) locus is present in <span class="genus-species">Staphylococcus aureus</span> and is required for biofilm formation. Infect Immun 67: 5427–5433. <a class="find" href="/article/findArticle.action?author=Cramton&title=The intercellular adhesion (ica) locus is present in Staphylococcus aureus and is required for biofilm formation."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b022" id="ppat-0030057-b022"></a><span class="authors">Martín-López JV, Pérez-Roth E, Claverie-Martin F, Díez Gil O, Batista N, et al. </span> (2002) Detection of <span class="genus-species">Staphylococcus aureus</span> clinical isolates harboring the <i>ica</i> gene cluster needed for biofilm establishment. J Clin Microbiol 40: 1569–1570. <a class="find" href="/article/findArticle.action?author=Mart%C3%ADn-L%C3%B3pez&title=Detection of Staphylococcus aureus clinical isolates harboring the ica gene cluster needed for biofilm establishment."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b023" id="ppat-0030057-b023"></a><span class="authors">Peacock SJ, Moore CE, Justice A, Kantzanou M, Story L, et al. </span> (2002) Virulent combinations of adhesin and toxin genes in natural populations of <span class="genus-species">Staphylococcus aureus</span>. Infect Immun 70: 4987–4996. <a class="find" href="/article/findArticle.action?author=Peacock&title=Virulent combinations of adhesin and toxin genes in natural populations of Staphylococcus aureus."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b024" id="ppat-0030057-b024"></a><span class="authors">Jefferson KK, Cramton SE, Götz F, Pier GB</span> (2003) Identification of a 5-nucleotide sequence that controls expression of the <i>ica</i> locus in <span class="genus-species">Staphylococcus aureus</span> and characterization of the DNA-binding properties of IcaR. Mol Microbiol 48: 889–899. <a class="find" href="/article/findArticle.action?author=Jefferson&title=Identification of a 5-nucleotide sequence that controls expression of the ica locus in Staphylococcus aureus and characterization of the DNA-binding properties of IcaR."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b025" id="ppat-0030057-b025"></a><span class="authors">Kropec A, Maira-Litrán T, Jefferson KK, Grout M, Cramton SE, et al. </span> (2005) Poly-<i>N</i>-acetylglucosamine production in <span class="genus-species">Staphylococcus aureus</span> is essential for virulence in murine models of systemic infection. Infect Immun 73: 6868–6876. <a class="find" href="/article/findArticle.action?author=Kropec&title=Poly-N-acetylglucosamine production in Staphylococcus aureus is essential for virulence in murine models of systemic infection."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b026" id="ppat-0030057-b026"></a><span class="authors">Rupp ME, Fey PD, Heilmann C, Götz F</span> (2001) Characterization of the importance of <span class="genus-species">Staphylococcus epidermidis</span> autolysin and polysaccharide intercellular adhesin in the pathogenesis of intravascular catheter-associated infection in a rat model. J Infect Dis 183: 1038–1042. <a class="find" href="/article/findArticle.action?author=Rupp&title=Characterization of the importance of Staphylococcus epidermidis autolysin and polysaccharide intercellular adhesin in the pathogenesis of intravascular catheter-associated infection in a rat model."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b027" id="ppat-0030057-b027"></a><span class="authors">Francois P, Tu Quoc PH, Bisognano C, Kelley WL, Lew DP, et al. </span> (2003) Lack of biofilm contribution to bacterial colonisation in an experimental model of foreign body infection by <span class="genus-species">Staphylococcus aureus</span> and <span class="genus-species">Staphylococcus epidermidis</span>. FEMS Immunol Med Microbiol 35: 135–140. <a class="find" href="/article/findArticle.action?author=Francois&title=Lack of biofilm contribution to bacterial colonisation in an experimental model of foreign body infection by Staphylococcus aureus and Staphylococcus epidermidis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b028" id="ppat-0030057-b028"></a><span class="authors">Kristian SA, Golda T, Ferracin F, Cramton SE, Neumeister B, et al. </span> (2004) The ability of biofilm formation does not influence virulence of <span class="genus-species">Staphylococcus aureus</span> and host response in a mouse tissue cage infection model. Microb Pathog 36: 237–245. <a class="find" href="/article/findArticle.action?author=Kristian&title=The ability of biofilm formation does not influence virulence of Staphylococcus aureus and host response in a mouse tissue cage infection model."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b029" id="ppat-0030057-b029"></a><span class="authors">Sifri CD, Begun J, Ausubel FM</span> (2005) The worm has turned—Microbial virulence modeled in <span class="genus-species">Caenorhabditis elegans</span>. Trends Microbiol 13: 119–127. <a class="find" href="/article/findArticle.action?author=Sifri&title=The worm has turned%E2%80%94Microbial virulence modeled in Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b030" id="ppat-0030057-b030"></a><span class="authors">Kim DH, Ausubel FM</span> (2005) Evolutionary perspectives on innate immunity from the study of <span class="genus-species">Caenorhabditis elegans</span>. Curr Opin Immunol 17: 4–10. <a class="find" href="/article/findArticle.action?author=Kim&title=Evolutionary perspectives on innate immunity from the study of Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b031" id="ppat-0030057-b031"></a><span class="authors">Garsin DA, Sifri CD, Mylonakis E, Qin X, Singh KV, et al. </span> (2001) A simple model host for identifying Gram-positive virulence factors. Proc Natl Acad Sci U S A 98: 10892–10897. <a class="find" href="/article/findArticle.action?author=Garsin&title=A simple model host for identifying Gram-positive virulence factors."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b032" id="ppat-0030057-b032"></a><span class="authors">Sifri CD, Begun J, Ausubel FM, Calderwood SB</span> (2003) <span class="genus-species">Caenorhabditis elegans</span> as a model host for <span class="genus-species">Staphylococcus aureus</span> pathogenesis. Infect Immun 71: 2208–2217. <a class="find" href="/article/findArticle.action?author=Sifri&title=Caenorhabditis elegans as a model host for Staphylococcus aureus pathogenesis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b033" id="ppat-0030057-b033"></a><span class="authors">Sifri CD, Mylonakis E, Singh KV, Qin X, Garsin DA, et al. </span> (2002) Virulence effect of <span class="genus-species">Enterococcus faecalis</span> protease genes and the quorum-sensing locus <i>fsr</i> in <span class="genus-species">Caenorhabditis elegans</span> and mice. Infect Immun 70: 5647–5650. <a class="find" href="/article/findArticle.action?author=Sifri&title=Virulence effect of Enterococcus faecalis protease genes and the quorum-sensing locus fsr in Caenorhabditis elegans and mice."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b034" id="ppat-0030057-b034"></a><span class="authors">Sifri CD, Baresch-Bernal A, Calderwood SB, von Eiff C</span> (2006) Virulence of <span class="genus-species">Staphylococcus aureus</span> small colony variants in the <span class="genus-species">Caenorhabditis elegans</span> infection model. Infect Immun 74: 1091–1096. <a class="find" href="/article/findArticle.action?author=Sifri&title=Virulence of Staphylococcus aureus small colony variants in the Caenorhabditis elegans infection model."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b035" id="ppat-0030057-b035"></a><span class="authors">Darby C, Hsu JW, Ghori N, Falkow S</span> (2002) <i>Caenorhabditis elegans:</i> Plague bacteria biofilm blocks food intake. Nature 417: 243–244. <a class="find" href="/article/findArticle.action?author=Darby&title=Caenorhabditis elegans: Plague bacteria biofilm blocks food intake."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b036" id="ppat-0030057-b036"></a><span class="authors">Joshua GW, Karlyshev AV, Smith MP, Isherwood KE, Titball RW, et al. </span> (2003) A <span class="genus-species">Caenorhabditis elegans</span> model of <i>Yersinia</i> infection: Biofilm formation on a biotic surface. Microbiology 149: 3221–3229. <a class="find" href="/article/findArticle.action?author=Joshua&title=A Caenorhabditis elegans model of Yersinia infection: Biofilm formation on a biotic surface."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b037" id="ppat-0030057-b037"></a><span class="authors">Kurz CL, Ewbank JJ</span> (2003) <i>Caenorhabditis elegans:</i> An emerging genetic model for the study of innate immunity. Nat Rev Genet 4: 380–390. <a class="find" href="/article/findArticle.action?author=Kurz&title=Caenorhabditis elegans: An emerging genetic model for the study of innate immunity."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b038" id="ppat-0030057-b038"></a><span class="authors">Pujol N, Link EM, Liu LX, Kurz CL, Alloing G, et al. </span> (2001) A reverse genetic analysis of components of the Toll signaling pathway in <span class="genus-species">Caenorhabditis elegans</span>. Curr Biol 11: 809–821. <a class="find" href="/article/findArticle.action?author=Pujol&title=A reverse genetic analysis of components of the Toll signaling pathway in Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b039" id="ppat-0030057-b039"></a><span class="authors">Garsin DA, Villanueva JM, Begun J, Kim DH, Sifri CD, et al. </span> (2003) Long-lived <i>C. elegans daf-2</i> mutants are resistant to bacterial pathogens. Science 300: 1921. <a class="find" href="/article/findArticle.action?author=Garsin&title=Long-lived C. elegans daf-2 mutants are resistant to bacterial pathogens."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b040" id="ppat-0030057-b040"></a><span class="authors">Mallo GV, Kurz CL, Couillault C, Pujol N, Granjeaud S, et al. </span> (2002) Inducible antibacterial defense system in <span class="genus-species">C. elegans</span>. Curr Biol 12: 1209–1214. <a class="find" href="/article/findArticle.action?author=Mallo&title=Inducible antibacterial defense system in C. elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b041" id="ppat-0030057-b041"></a><span class="authors">Tan MW</span> (2001) Genetic and genomic dissection of host-pathogen interactions using a <i>P. aeruginosa–C. elegans</i> pathogenesis model. Pediatr Pulmonol 32: 96–97. <a class="find" href="/article/findArticle.action?author=Tan&title=Genetic and genomic dissection of host-pathogen interactions using a P. aeruginosa%E2%80%93C. elegans pathogenesis model."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b042" id="ppat-0030057-b042"></a><span class="authors">Kim DH, Feinbaum R, Alloing G, Emerson FE, Garsin DA, et al. </span> (2002) A conserved p38 MAP kinase pathway in <span class="genus-species">Caenorhabditis elegans</span> innate immunity. Science 297: 623–626. <a class="find" href="/article/findArticle.action?author=Kim&title=A conserved p38 MAP kinase pathway in Caenorhabditis elegans innate immunity."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b043" id="ppat-0030057-b043"></a><span class="authors">Lin K, Dorman JB, Rodan A, Kenyon C</span> (1997) daf-16: An HNF-3/forkhead family member that can function to double the life-span of <span class="genus-species">Caenorhabditis elegans</span>. Science 278: 1319–1322. <a class="find" href="/article/findArticle.action?author=Lin&title=daf-16: An HNF-3/forkhead family member that can function to double the life-span of Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b044" id="ppat-0030057-b044"></a><span class="authors">Ogg S, Paradis S, Gottlieb S, Patterson GI, Lee L, et al. </span> (1997) The Fork head transcription factor DAF-16 transduces insulin-like metabolic and longevity signals in <span class="genus-species">C. elegans</span>. Nature 389: 994–999. <a class="find" href="/article/findArticle.action?author=Ogg&title=The Fork head transcription factor DAF-16 transduces insulin-like metabolic and longevity signals in C. elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b045" id="ppat-0030057-b045"></a><span class="authors">Paradis S, Ailion M, Toker A, Thomas JH, Ruvkun G</span> (1999) A PDK1 homolog is necessary and sufficient to transduce AGE-1 PI3 kinase signals that regulate diapause in <span class="genus-species">Caenorhabditis elegans</span>. Genes Dev 13: 1438–1452. <a class="find" href="/article/findArticle.action?author=Paradis&title=A PDK1 homolog is necessary and sufficient to transduce AGE-1 PI3 kinase signals that regulate diapause in Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b046" id="ppat-0030057-b046"></a><span class="authors">Lin K, Hsin H, Libina N, Kenyon C</span> (2001) Regulation of the <span class="genus-species">Caenorhabditis elegans</span> longevity protein DAF-16 by insulin/IGF-1 and germline signaling. Nat Genet 28: 139–145. <a class="find" href="/article/findArticle.action?author=Lin&title=Regulation of the Caenorhabditis elegans longevity protein DAF-16 by insulin/IGF-1 and germline signaling."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b047" id="ppat-0030057-b047"></a><span class="authors">Kenyon C, Chang J, Gensch E, Rudner A, Tabtiang R</span> (1993) A <i>C. elegans</i> mutant that lives twice as long as wild type. Nature 366: 461–464. <a class="find" href="/article/findArticle.action?author=Kenyon&title=A C. elegans mutant that lives twice as long as wild type."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b048" id="ppat-0030057-b048"></a><span class="authors">Wolkow CA, Kimura KD, Lee MS, Ruvkun G</span> (2000) Regulation of <span class="genus-species">C. elegans</span> life-span by insulinlike signaling in the nervous system. Science 290: 147–150. <a class="find" href="/article/findArticle.action?author=Wolkow&title=Regulation of C. elegans life-span by insulinlike signaling in the nervous system."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b049" id="ppat-0030057-b049"></a><span class="authors">Honda Y, Honda S</span> (1999) The daf-2 gene network for longevity regulates oxidative stress resistance and Mn-superoxide dismutase gene expression in <span class="genus-species">Caenorhabditis elegans</span>. FASEB J 13: 1385–1393. <a class="find" href="/article/findArticle.action?author=Honda&title=The daf-2 gene network for longevity regulates oxidative stress resistance and Mn-superoxide dismutase gene expression in Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b050" id="ppat-0030057-b050"></a><span class="authors">Troemel ER, Chu SW, Reinke V, Lee SS, Ausubel FM, et al. </span> (2006) p38 MAPK regulates expression of immune response genes and contributes to longevity in <span class="genus-species">C. elegans</span>. PLoS Genet 2: e183. doi:<a href="http://dx.doi.org/10.1371/journal.pgen.0020183">10.1371/journal.pgen.0020183</a>. </li><li xpathLocation="noSelect"><a name="ppat-0030057-b051" id="ppat-0030057-b051"></a><span class="authors">Riddle DL, Blumenthal T, Meyer BJ, Priess JR</span> (1997) Introduction to <span class="genus-species">C. elegans</span>. In: Riddle DL, Blumenthal T, Meyer BJ, Priess JR, editors. C elegans II. Plainview (New York): Cold Spring Harbor Laboratory Press. pp. 1–22. </li><li xpathLocation="noSelect"><a name="ppat-0030057-b052" id="ppat-0030057-b052"></a><span class="authors">Alegado RA, Campbell MC, Chen WC, Slutz SS, Tan MW</span> (2003) Characterization of mediators of microbial virulence and innate immunity using the <span class="genus-species">Caenorhabditis elegans</span> host-pathogen model. Cell Microbiol 5: 435–444. <a class="find" href="/article/findArticle.action?author=Alegado&title=Characterization of mediators of microbial virulence and innate immunity using the Caenorhabditis elegans host-pathogen model."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b053" id="ppat-0030057-b053"></a><span class="authors">Tan MW, Mahajan-Miklos S, Ausubel FM</span> (1999) Killing of <span class="genus-species">Caenorhabditis elegans</span> by <span class="genus-species">Pseudomonas aeruginosa</span> used to model mammalian bacterial pathogenesis. Proc Natl Acad Sci U S A 96: 715–720. <a class="find" href="/article/findArticle.action?author=Tan&title=Killing of Caenorhabditis elegans by Pseudomonas aeruginosa used to model mammalian bacterial pathogenesis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b054" id="ppat-0030057-b054"></a><span class="authors">Mack D, Riedewald J, Rohde H, Magnus T, Feucht HH, et al. </span> (1999) Essential functional role of the polysaccharide intercellular adhesin of <span class="genus-species">Staphylococcus epidermidis</span> in hemagglutination. Infect Immun 67: 1004–1008. <a class="find" href="/article/findArticle.action?author=Mack&title=Essential functional role of the polysaccharide intercellular adhesin of Staphylococcus epidermidis in hemagglutination."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b055" id="ppat-0030057-b055"></a><span class="authors">Gerke C, Kraft A, Süßmuth R, Schweitzer O, Götz F</span> (1998) Characterization of the <i>N</i>-acetylglucosaminyltransferase activity involved in the biosynthesis of the <span class="genus-species">Staphylococcus epidermidis</span> polysaccharide intercellular adhesin. J Biol Chem 273: 18586–18593. <a class="find" href="/article/findArticle.action?author=Gerke&title=Characterization of the N-acetylglucosaminyltransferase activity involved in the biosynthesis of the Staphylococcus epidermidis polysaccharide intercellular adhesin."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b056" id="ppat-0030057-b056"></a><span class="authors">Mack D, Bartscht K, Fischer C, Rohde H, de Grahl C, et al. </span> (2001) Genetic and biochemical analysis of <span class="genus-species">Staphylococcus epidermidis</span> biofilm accumulation. Methods Enzymol 336: 215–239. <a class="find" href="/article/findArticle.action?author=Mack&title=Genetic and biochemical analysis of Staphylococcus epidermidis biofilm accumulation."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b057" id="ppat-0030057-b057"></a><span class="authors">Höflich J, Berninsone P, Göbel C, Gravato-Nobre MJ, Libby BJ, et al. </span> (2004) Loss of <i>srf-3</i>-encoded nucleotide sugar transporter activity in <span class="genus-species">Caenorhabditis elegans</span> alters surface antigenicity and prevents bacterial adherence. J Biol Chem 279: 30440–30448. <a class="find" href="/article/findArticle.action?author=H%C3%B6flich&title=Loss of srf-3-encoded nucleotide sugar transporter activity in Caenorhabditis elegans alters surface antigenicity and prevents bacterial adherence."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b058" id="ppat-0030057-b058"></a><span class="authors">Aballay A, Yorgey P, Ausubel FM</span> (2000) <span class="genus-species">Salmonella typhimurium</span> proliferates and establishes a persistent infection in the intestine of <span class="genus-species">Caenorhabditis elegans</span>. Curr Biol 10: 1539–1542. <a class="find" href="/article/findArticle.action?author=Aballay&title=Salmonella typhimurium proliferates and establishes a persistent infection in the intestine of Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b059" id="ppat-0030057-b059"></a><span class="authors">Zhang YQ, Ren SX, Li HL, Wang YX, Fu G, et al. </span> (2003) Genome-based analysis of virulence genes in a non-biofilm-forming <span class="genus-species">Staphylococcus epidermidis</span> strain (ATCC 12228). Mol Microbiol 49: 1577–1593. <a class="find" href="/article/findArticle.action?author=Zhang&title=Genome-based analysis of virulence genes in a non-biofilm-forming Staphylococcus epidermidis strain (ATCC 12228)."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b060" id="ppat-0030057-b060"></a><span class="authors">Thomas VL, Sanford BA, Moreno R, Ramsay MA</span> (1997) Enzyme-linked lectinsorbent assay measures <i>N</i>-acetyl-D-glucosamine in matrix of biofilm produced by <span class="genus-species">Staphylococcus epidermidis</span>. Curr Microbiol 35: 249–254. <a class="find" href="/article/findArticle.action?author=Thomas&title=Enzyme-linked lectinsorbent assay measures N-acetyl-D-glucosamine in matrix of biofilm produced by Staphylococcus epidermidis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b061" id="ppat-0030057-b061"></a><span class="authors">Tan L, Darby C</span> (2004) A movable surface: Formation of <span class="genus-species">Yersinia</span> sp. biofilms on motile <span class="genus-species">Caenorhabditis elegans</span>. J Bacteriol 186: 5087–5092. <a class="find" href="/article/findArticle.action?author=Tan&title=A movable surface: Formation of Yersinia sp. biofilms on motile Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b062" id="ppat-0030057-b062"></a><span class="authors">Miller DM, Shakes DC</span> (1995) Immunofluorescence microscopy. Methods Cell Biol 48: 365–394. <a class="find" href="/article/findArticle.action?author=Miller&title=Immunofluorescence microscopy."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b063" id="ppat-0030057-b063"></a><span class="authors">Rupp ME, Fey PD</span> (2001) In vivo models to evaluate adhesion and biofilm formation by <span class="genus-species">Staphylococcus epidermidis</span>. Methods Enzymol 336: 206–215. <a class="find" href="/article/findArticle.action?author=Rupp&title=In vivo models to evaluate adhesion and biofilm formation by Staphylococcus epidermidis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b064" id="ppat-0030057-b064"></a><span class="authors">Millet AC, Ewbank JJ</span> (2004) Immunity in <span class="genus-species">Caenorhabditis elegans</span>. Curr Opin Immunol 16: 4–9. <a class="find" href="/article/findArticle.action?author=Millet&title=Immunity in Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b065" id="ppat-0030057-b065"></a><span class="authors">Begun J, Sifri CD, Goldman S, Calderwood SB, Ausubel FM</span> (2005) <span class="genus-species">Staphylococcus aureus</span> virulence factors identified by using a high-throughput Caenorhabditis elegans-killing model. Infect Immun 73: 872–877. <a class="find" href="/article/findArticle.action?author=Begun&title=Staphylococcus aureus virulence factors identified by using a high-throughput Caenorhabditis elegans-killing model."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b066" id="ppat-0030057-b066"></a><span class="authors">Bae T, Banger AK, Wallace A, Glass EM, Aslund F, et al. </span> (2004) <span class="genus-species">Staphylococcus aureus</span> virulence genes identified by <i>bursa aurealis</i> mutagenesis and nematode killing. Proc Natl Acad Sci U S A 101: 12312–12317. <a class="find" href="/article/findArticle.action?author=Bae&title=Staphylococcus aureus virulence genes identified by bursa aurealis mutagenesis and nematode killing."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b067" id="ppat-0030057-b067"></a><span class="authors">Blevins JS, Beenken KE, Elasri MO, Hurlburt BK, Smeltzer MS</span> (2002) Strain-dependent differences in the regulatory roles of <i>sarA</i> and <i>agr</i> in <span class="genus-species">Staphylococcus aureus</span>. Infect Immun 70: 470–480. <a class="find" href="/article/findArticle.action?author=Blevins&title=Strain-dependent differences in the regulatory roles of sarA and agr in Staphylococcus aureus."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b068" id="ppat-0030057-b068"></a><span class="authors">Beenken KE, Dunman PM, McAleese F, Macapagal D, Murphy E, et al. </span> (2004) Global gene expression in <span class="genus-species">Staphylococcus aureus</span> biofilms. J Bacteriol 186: 4665–4684. <a class="find" href="/article/findArticle.action?author=Beenken&title=Global gene expression in Staphylococcus aureus biofilms."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b069" id="ppat-0030057-b069"></a><span class="authors">Lazazzera BA</span> (2005) Lessons from DNA microarray analysis: The gene expression profile of biofilms. Curr Opin Microbiol 8: 222–227. <a class="find" href="/article/findArticle.action?author=Lazazzera&title=Lessons from DNA microarray analysis: The gene expression profile of biofilms."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b070" id="ppat-0030057-b070"></a><span class="authors">Vuong C, Kocianova S, Yao Y, Carmody AB, Otto M</span> (2004) Increased colonization of indwelling medical devices by quorum-sensing mutants of <i>Staphylococcus epidermidis in vivo</i>. J Infect Dis 190: 1498–1505. <a class="find" href="/article/findArticle.action?author=Vuong&title=Increased colonization of indwelling medical devices by quorum-sensing mutants of Staphylococcus epidermidis in vivo."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b071" id="ppat-0030057-b071"></a><span class="authors">Schulenburg H, Kurz CL, Ewbank JJ</span> (2004) Evolution of the innate immune system: The worm perspective. Immunol Rev 198: 36–58. <a class="find" href="/article/findArticle.action?author=Schulenburg&title=Evolution of the innate immune system: The worm perspective."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b072" id="ppat-0030057-b072"></a><span class="authors">Vuong C, Kocianova S, Voyich JM, Yao Y, Fischer ER, et al. </span> (2004) A crucial role for exopolysaccharide modification in bacterial biofilm formation, immune evasion, and virulence. J Biol Chem 279: 54881–54886. <a class="find" href="/article/findArticle.action?author=Vuong&title=A crucial role for exopolysaccharide modification in bacterial biofilm formation, immune evasion, and virulence."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b073" id="ppat-0030057-b073"></a><span class="authors">Wang X, Preston JF 3rd, Romeo T</span> (2004) The <i>pgaABCD</i> locus of <span class="genus-species">Escherichia coli</span> promotes the synthesis of a polysaccharide adhesin required for biofilm formation. J Bacteriol 186: 2724–2734. <a class="find" href="/article/findArticle.action?author=Wang&title=The pgaABCD locus of Escherichia coli promotes the synthesis of a polysaccharide adhesin required for biofilm formation."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b074" id="ppat-0030057-b074"></a><span class="authors">Matz C, Kjelleberg S</span> (2005) Off the hook—How bacteria survive protozoan grazing. Trends Microbiol 13: 302–307. <a class="find" href="/article/findArticle.action?author=Matz&title=Off the hook%E2%80%94How bacteria survive protozoan grazing."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b075" id="ppat-0030057-b075"></a><span class="authors">Matz C, McDougald D, Moreno AM, Yung PY, Yildiz FH, et al. </span> (2005) Biofilm formation and phenotypic variation enhance predation-driven persistence of <span class="genus-species">Vibrio cholerae</span>. Proc Natl Acad Sci U S A 102: 16819–16824. <a class="find" href="/article/findArticle.action?author=Matz&title=Biofilm formation and phenotypic variation enhance predation-driven persistence of Vibrio cholerae."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b076" id="ppat-0030057-b076"></a><span class="authors">Tanaka-Hino M, Sagasti A, Hisamoto N, Kawasaki M, Nakano S, et al. </span> (2002) SEK-1 MAPKK mediates Ca2+ signaling to determine neuronal asymmetric development in <span class="genus-species">Caenorhabditis elegans</span>. EMBO Rep 3: 56–62. <a class="find" href="/article/findArticle.action?author=Tanaka-Hino&title=SEK-1 MAPKK mediates Ca2+ signaling to determine neuronal asymmetric development in Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b077" id="ppat-0030057-b077"></a><span class="authors">Mizuno T, Hisamoto N, Terada T, Kondo T, Adachi M, et al. </span> (2004) The <span class="genus-species">Caenorhabditis elegans</span> MAPK phosphatase VHP-1 mediates a novel JNK-like signaling pathway in stress response. EMBO J 23: 2226–2234. <a class="find" href="/article/findArticle.action?author=Mizuno&title=The Caenorhabditis elegans MAPK phosphatase VHP-1 mediates a novel JNK-like signaling pathway in stress response."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b078" id="ppat-0030057-b078"></a><span class="authors">Lewis JA, Fleming JT</span> (1995) Basic culture methods. Methods Cell Biol 48: 3–29. <a class="find" href="/article/findArticle.action?author=Lewis&title=Basic culture methods."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b079" id="ppat-0030057-b079"></a><span class="authors">Brenner S</span> (1974) The genetics of <span class="genus-species">Caenorhabditis elegans</span>. Genetics 77: 71–94. <a class="find" href="/article/findArticle.action?author=Brenner&title=The genetics of Caenorhabditis elegans."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b080" id="ppat-0030057-b080"></a><span class="authors">Sulston J, Hodgkin J</span> (1988) Methods. In: Wood WB, editor. The nematode Caenorhabditis elegans. Cold Spring Harbor (New York): Cold Spring Harbor Laboratory. pp. 587–606. </li><li xpathLocation="noSelect"><a name="ppat-0030057-b081" id="ppat-0030057-b081"></a><span class="authors">Mack D, Siemssen N, Laufs R</span> (1992) Parallel induction by glucose of adherence and a polysaccharide antigen specific for plastic-adherent <i>Staphylococcus epidermidis:</i> Evidence for functional relation to intercellular adhesion. Infect Immun 60: 2048–2057. <a class="find" href="/article/findArticle.action?author=Mack&title=Parallel induction by glucose of adherence and a polysaccharide antigen specific for plastic-adherent Staphylococcus epidermidis: Evidence for functional relation to intercellular adhesion."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b082" id="ppat-0030057-b082"></a><span class="authors">Kreiswirth BN, Lofdahl S, Betley MJ, O'Reilly M, Schlievert PM, et al. </span> (1983) The toxic shock syndrome exotoxin structural gene is not detectably transmitted by a prophage. Nature 305: 709–712. <a class="find" href="/article/findArticle.action?author=Kreiswirth&title=The toxic shock syndrome exotoxin structural gene is not detectably transmitted by a prophage."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b083" id="ppat-0030057-b083"></a><span class="authors">Hawiger J, Niewiarowski S, Gurewich V, Thomas DP</span> (1970) Measurement of fibrinogen and fibrin degradation products in serum by staphylococcal clumping test. J Lab Clin Med 75: 93–108. <a class="find" href="/article/findArticle.action?author=Hawiger&title=Measurement of fibrinogen and fibrin degradation products in serum by staphylococcal clumping test."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b084" id="ppat-0030057-b084"></a><span class="authors">Fawcett P, Eichenberger P, Losick R, Youngman P</span> (2000) The transcriptional profile of early to middle sporulation in <span class="genus-species">Bacillus subtilis</span>. Proc Natl Acad Sci U S A 97: 8063–8068. <a class="find" href="/article/findArticle.action?author=Fawcett&title=The transcriptional profile of early to middle sporulation in Bacillus subtilis."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b085" id="ppat-0030057-b085"></a><span class="authors">Kim DH, Liberati NT, Mizuno T, Inoue H, Hisamoto N, et al. </span> (2004) Integration of <span class="genus-species">Caenorhabditis elegans</span> MAPK pathways mediating immunity and stress resistance by MEK-1 MAPK kinase and VHP-1 MAPK phosphatase. Proc Natl Acad Sci U S A 101: 10990–10994. <a class="find" href="/article/findArticle.action?author=Kim&title=Integration of Caenorhabditis elegans MAPK pathways mediating immunity and stress resistance by MEK-1 MAPK kinase and VHP-1 MAPK phosphatase."> Find this article online </a></li><li xpathLocation="noSelect"><a name="ppat-0030057-b086" id="ppat-0030057-b086"></a><span class="authors">Hodgkin J, Kuwabara PE, Corneliussen B</span> (2000) A novel bacterial pathogen, <i>Microbacterium nematophilum,</i> induces morphological change in the nematode <span class="genus-species">C. elegans</span>. Curr Biol 10: 1615–1618. <a class="find" href="/article/findArticle.action?author=Hodgkin&title=A novel bacterial pathogen, Microbacterium nematophilum, induces morphological change in the nematode C. elegans."> Find this article online </a></li></ol></div> </div> </div> <div style="display:none"> <div dojoType="ambra.widget.RegionalDialog" id="AnnotationDialog" style="padding:0;margin:0;"> <div class="dialog annotate"> <div class="tipu" id="dTipu"></div> <div class="comment"> <h5><span class="commentPrivate">Add Your Note (For Private Viewing)</span><span class="commentPublic">Post Your Note (For Public Viewing)</span></h5> <div class="posting pane"> <form name="createAnnotation" id="createAnnotation" method="post" action=""> <input type="hidden" name="target" value="info:doi/10.1371/journal.ppat.0030057" /> <input type="hidden" name="startPath" value="" /> <input type="hidden" name="startOffset" value="" /> <input type="hidden" name="endPath" value="" /> <input type="hidden" name="endOffset" value="" /> <input type="hidden" name="commentTitle" id="commentTitle" value="" /> <input type="hidden" name="comment" id="commentArea" value="" /> <input type="hidden" name="ciStatement" id="statementArea" value="" /> <input type="hidden" name="isCompetingInterest" id="isCompetingInterest" value="false" /> <input type="hidden" name="noteType" id="noteType" value="" /> <fieldset> <legend>Compose Your Note</legend> <span id="submitMsg" class="error" style="display:none;"></span> <table class="layout"> <tr> <td> <label for="cNoteType">This is a </label><select name="cNoteType" id="cNoteType"><option value="note">note</option><option value="correction">correction</option></select> <span id="cdls" style="visibility:hidden;margin-left:0.3em; white-space:nowrap;"><a href="/static/commentGuidelines.action?target=info%3Adoi%2F10.1371%2Fjournal.ppat.0030057#corrections">What are corrections?</a></span> <label for="cTitle" class="commentPublic"><span class="none">Enter your note title</span><!-- error message text <em>A title is required for all public notes</em>--></label> <input type="text" name="cTitle" id="cTitle" value="Enter your note title..." class="title commentPublic" alt="Enter your note title..." /> <label for="cArea"><span class="none">Enter your note</span><!-- error message text <em>Please enter your note</em>--></label> <textarea name="cArea" id="cArea" value="Enter your note..." alt="Enter your note...">Enter your note...</textarea> <input type="hidden" name="isPublic" value="true" /> </td> <td> </td> <td class="coi"> <fieldset> <legend>Declare any competing interests.</legend> <ul> <li><label><input id="isCompetingInterestNo" type="radio" checked="checked" name="competingInterest" value="false" /> No, I don't have any competing interests to declare.</label></li> <li><label><input id="isCompetingInterestYes" type="radio" name="competingInterest" value="true" /> Yes, I have competing interests to declare (enter below):</label></li> </ul> <textarea name="ciStatementArea" id="ciStatementArea" disabled value="Enter your competing interests..." alt="Enter your competing interests...">Enter your competing interests...</textarea> </fieldset> </td> </tr> <tr> <td colspan="3" class="buttons"> <input type="button" value="Cancel" title="Click to close and cancel" id="btn_cancel"/> <input type="button" value="Submit" title="Click to post your note publicly" id="btn_post" class="primary"/> </td> </tr> </table> </fieldset> </form> </div> </div> <div class="tip" id="dTip"></div> </div> </div><div dojoType="ambra.widget.ContextAction" id="ContextActionDialog" class="contextActionDialog"> <div class="dialog context"> <div class="tipu" id="caTipu"></div> <div class="contextActionContent"> <h5><img src="/images/tooltip_addannotation.gif" /> Add a note to this text.</h5> Please follow our <a href="/static/commentGuidelines.action">guidelines for notes and comments</a> and review our <a href="/static/competing.action">competing interests policy</a>. Comments that do not conform to our guidelines will be promptly removed and the user account disabled. The following must be avoided: <ul> <li>Remarks that could be interpreted as allegations of misconduct</li> <li>Unsupported assertions or statements</li> <li>Inflammatory or insulting language</li> </ul> <form name="contextActionForm" id="contextActionForm" class="clearfix buttons" method="post" action=""> <input type="button" name="Continue" value="Continue" id="ContextActionDialogContinueButton" onmouseup="ambra.displayAnnotationContext.startComment(event);" title="Add a note to this text" class="primary"/> <input type="button" name="Cancel" value="Cancel" id="ContextActionDialogCancelButton" onclick="return false;" onmouseup="ambra.displayAnnotationContext.cancelContext(event);" title="Close this Window"/> </form> </div> <div class="tip" id="caTip"></div> </div> </div> <div dojoType="ambra.widget.ContextAction" id="ContextActionDialogNotLogged" class="contextActionDialog"> <div class="dialog context"> <div class="tipu" id="canlTipu"></div> <div class="contextActionContent"> <h5><img src="/images/tooltip_addannotation.gif" /> Add a note to this text.</h5> You must be logged in to add a note to an article. You may log in by <a onmousedown="ambra.displayAnnotationContext.disconnect(event);" href="/user/secure/secureRedirect.action?goTo=%2Farticle%2Finfo%3Adoi%2F10.1371%2Fjournal.ppat.0030057">clicking here</a> or <a href="#" onclick="return false;" onmouseup="ambra.displayAnnotationContext.cancelContext(event);">cancel this note</a>. </div> <div class="tip" id="canlTip"></div> </div> </div> <div dojoType="ambra.widget.ContextAction" id="ContextActionDialogBadSelection" class="contextActionDialog"> <div class="dialog context"> <div class="tipu" id="canBDTipu"></div> <div class="contextActionContent"> <h5 class="annotation icon"><img src="/images/tooltip_addannotation.gif" /> Add a note to this text.</h5> You cannot annotate this area of the document. <a href="#" onclick="return false;" onmouseup="ambra.displayAnnotationContext.cancelContext(event);">Close</a> </div> <div class="tip" id="canBDTip"></div> </div> </div> <div dojoType="ambra.widget.ContextAction" id="ContextActionDialogBadRangeSelection" class="contextActionDialog"> <div class="dialog context"> <div class="tipu" id="canbrTipu"></div> <div class="contextActionContent"> <h5><img src="/images/tooltip_addannotation.gif" /> Add a note to this text.</h5> You cannot create an annotation that spans different sections of the document; please adjust your selection.<br/> <a href="#" onclick="return false;" onmouseup="ambra.displayAnnotationContext.cancelContext(event);">Close</a> </div> <div class="tip" id="canbrTip"></div> </div> </div> <div dojoType="ambra.widget.RegionalDialog" id="CommentDialog" style="padding:0;margin:0;"> <div class="dialog preview"> <div class="tipu" id="cTipu"></div> <div class="btn close" id="btn_close" title="Click to close"><a title="Click to close">Close</a></div> <div id="cmtContainer" class="comment"> <h6 id="viewCmtTitle"></h6> <div class="detail" id="viewCmtDetail"></div> <div class="contentwrap" id="viewComment"></div> <div class="contentwrap" id="viewCIStatement"></div> <div class="detail" id="viewLink"> <!--<a href="#" class="commentary icon" title="Click to view full thread and respond">View all responses</a> <a href="#" class="respond tooltip" title="Click to respond to this posting">Respond to this</a>--> </div> </div> <div class="tip" id="cTip"></div> </div> </div> <div dojoType="ambra.widget.RegionalDialog" id="CommentDialogMultiple" style="padding:0;margin:0;"> <div class="dialog multiple preview"> <div class="tipu" id="mTipu"></div> <div class="btn close" id="btn_close_multi" title="Click to close"><a title="Click to close">Close</a></div> <ol id="multilist"></ol> <br/> <div id="multidetail"></div> <div class="tip" id="mTip"></div> </div> </div> <div dojoType="dijit.Dialog" id="Rating"> <div class="dialog annotate"> <div class="tipu" id="dTipu"></div> <div class="comment"> <h5><span class="commentPublic">Rate This Article</span></h5> <div class="instructions">Please follow our <a href="/static/ratingGuidelines.action">guidelines for rating</a> and review our <a href="/static/competing.action">competing interests policy</a>. Comments that do not conform to our guidelines will be promptly removed and the user account disabled. The following must be avoided: <ol> <li>Remarks that could be interpreted as allegations of misconduct</li> <li>Unsupported assertions or statements</li> <li>Inflammatory or insulting language</li> </ol> </div> <div class="posting pane"> <form name="ratingForm" id="ratingForm" method="post" action=""> <input type="hidden" name="articleURI" value="info:doi/10.1371/journal.ppat.0030057" /> <input type="hidden" name="commentTitle" id="commentTitle" value="" /> <input type="hidden" name="comment" id="commentArea" value="" /> <input type="hidden" name="ciStatement" id="statementArea" value="" /> <input type="hidden" name="isCompetingInterest" id="isCompetingInterest" value="" /> <fieldset> <legend>Compose Your Annotation</legend> <span id="submitRatingMsg" class="error" style="display:none;"></span> <table class="layout"> <tr> <td rowspan="2"> <label for="insight">Insight</label> <ul class="star-rating rating edit" title="Rate insight" id="rateInsight"> <li class="current-rating pct0"></li> <li><a href="javascript:void(0);" title="Bland" class="one-star" onclick="ambra.rating.setRatingCategory(this, 'insight', 1);">1</a></li> <li><a href="javascript:void(0);" title="" class="two-stars" onclick="ambra.rating.setRatingCategory(this, 'insight', 2);">2</a></li> <li><a href="javascript:void(0);" title="" class="three-stars" onclick="ambra.rating.setRatingCategory(this, 'insight', 3);">3</a></li> <li><a href="javascript:void(0);" title="" class="four-stars" onclick="ambra.rating.setRatingCategory(this, 'insight', 4);">4</a></li> <li><a href="javascript:void(0);" title="Profound" class="five-stars" onclick="ambra.rating.setRatingCategory(this, 'insight', 5);">5</a></li> </ul> <input type="hidden" name="insight" title="insight" value="" /> <label for="reliability">Reliability</label> <ul class="star-rating rating edit" title="Rate reliability" id="rateReliability"> <li class="current-rating pct0"></li> <li><a href="javascript:void(0);" title="Tenuous" class="one-star" onclick="ambra.rating.setRatingCategory(this, 'reliability', 1);">1</a></li> <li><a href="javascript:void(0);" title="" class="two-stars" onclick="ambra.rating.setRatingCategory(this, 'reliability', 2);">2</a></li> <li><a href="javascript:void(0);" title="" class="three-stars" onclick="ambra.rating.setRatingCategory(this, 'reliability', 3);">3</a></li> <li><a href="javascript:void(0);" title="" class="four-stars" onclick="ambra.rating.setRatingCategory(this, 'reliability', 4);">4</a></li> <li><a href="javascript:void(0);" title="Unassailable" class="five-stars" onclick="ambra.rating.setRatingCategory(this, 'reliability', 5);">5</a></li> </ul> <input type="hidden" name="reliability" title="reliability" value="" /> <label for="style">Style</label> <ul class="star-rating rating edit" title="Rate style" id="rateStyle"> <li class="current-rating pct0"></li> <li><a href="javascript:void(0);" title="Crude" class="one-star" onclick="ambra.rating.setRatingCategory(this, 'style', 1);">1</a></li> <li><a href="javascript:void(0);" title="" class="two-stars" onclick="ambra.rating.setRatingCategory(this, 'style', 2);">2</a></li> <li><a href="javascript:void(0);" title="" class="three-stars" onclick="ambra.rating.setRatingCategory(this, 'style', 3);">3</a></li> <li><a href="javascript:void(0);" title="" class="four-stars" onclick="ambra.rating.setRatingCategory(this, 'style', 4);">4</a></li> <li><a href="javascript:void(0);" title="Elegant" class="five-stars" onclick="ambra.rating.setRatingCategory(this, 'style', 5);">5</a></li> </ul> <input type="hidden" name="style" title="style" value="" /> <label for="cTitle" class="commentPublic"><span class="none">Enter your comment title</span><!-- error message text <em>A title is required for all public annotations</em>--></label> <input type="text" name="cTitle" id="cTitle" value="Enter your comment title..." class="title commentPublic" alt="Enter your comment title..." /> <label for="cArea"><span class="none">Enter your comment</span><!-- error message text <em>Please enter your annotation</em>--></label> <textarea name="cArea" id="cArea" value="Enter your comment..." alt="Enter your comment...">Enter your comment...</textarea> </td> <td rowspan="2"> </td> <td class="coi"> <fieldset> <legend>Declare any competing interests.</legend> <ul> <li><label><input id="isCompetingInterestNo" type="radio" name="competingInterest" value="false" /> No, I don't have any competing interests to declare.</label></li> <li><label><input id="isCompetingInterestYes" type="radio" name="competingInterest" value="true" /> Yes, I have competing interests to declare (enter below):</label></li> </ul> <textarea name="ciStatementArea" id="ciStatementArea" disabled value="Enter your competing interests..." title="Enter your competing interests...">Enter your competing interests...</textarea> </fieldset> </td> </tr> <tr> <td class="buttons"> <input type="button" value="Cancel" title="Click to close and cancel" id="btn_cancel_rating"/> <input type="button" value="Submit" title="Click to post your annotation publicly" id="btn_post_rating" class="primary"/> </td> </tr> </table> </fieldset> </form> </div> </div> </div> </div> <div dojoType="ambra.widget.LoadingCycle" id="LoadingCycle" class="loadingCycler"> <img src="/images/loading.gif" width="58" height="58" title="Loading..." /> </div> </div> </div> <!-- end : main contents --> </div> <!-- end : container --> <!-- begin : footer --> <div id="ftr"> <p><span>All site content, except where otherwise noted, is licensed under a <a href="http://creativecommons.org/licenses/by/2.5/" title="Creative Commons Attribution License 2.5" tabindex="200">Creative Commons Attribution License</a>.</span></p> <ul> <li><a href="/static/privacy.action" title="PLoS Privacy Statement" tabindex="501">Privacy Statement</a></li> <li><a href="/static/terms.action" title="PLoS Terms of Use" tabindex="502">Terms of Use</a></li> <li><a href="http://www.plos.org/advertise/" title="Advertise With PLoS" tabindex="503">Advertise</a></li> <li><a href="http://www.plos.org/journals/embargopolicy.html" title="PLoS Embargo Policy" tabindex="504">Media Inquiries</a></li> <li><a href="http://www.plos.org/journals/print.html" title="PLoS in Print" tabindex="505">PLoS in Print</a></li> <li><a href="/static/sitemap.action" title="Site Map" tabindex="506">Site Map</a></li> <li><a href="http://www.plos.org" title="PLoS.org" tabindex="507">PLoS.org</a></li> </ul> <div class="powered"> <ul> <li><a href="/static/releaseNotes.action" title="Ambra | Release Notes">Ambra 0.9.4 beta</a></li> <li>Managed Colocation provided by <a href="http://www.unitedlayer.com/" title="UnitedLayer: Built on IP Services">UnitedLayer</a>.</li> </ul> </div> </div> <!-- end : footer --> <script type="text/javascript"> var _namespace=""; var loggedIn = false; var almHost = "http://alm.plos.org"; // Safari v3.1.1 "console.debug" issue (http://trac.dojotoolkit.org/ticket/6849) workaround if (/3[\.0-9]+ Safari/.test(navigator.appVersion)) { window.console = { origConsole: window.console, log: function(s){ this.origConsole.log(s); }, info: function(s){ this.origConsole.info(s); }, error: function(s){ this.origConsole.error(s); }, warn: function(s){ this.origConsole.warn(s); } }; } var djConfig = { // don't debug for IE - as dojo's firebug lite module is error prone in IE isDebug: false, parseOnLoad: true }; </script> <script type="text/javascript" src="/javascript/dojo/dojo/dojo.js"></script> <script type="text/javascript" src="/javascript/dojo/dojo/ambra.js"></script> <script type="text/javascript" src="/javascript/init_global.js"></script> <script type="text/javascript" src="/javascript/init_article.js"></script> <script type="text/javascript" src="/javascript/init_ratings.js"></script> <script type="text/javascript" src="/javascript/init_article_body.js"></script> <script type="text/javascript" src="/javascript/init_article_rhc.js"></script> <script type="text/javascript" src="/javascript/alm.js"></script> <script type="text/javascript" src="/javascript/reporting/articleViewsCumulative.js"></script> <script type="text/javascript"> var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); </script> <script type="text/javascript"> var pageTracker = _gat._getTracker("UA-338393-1"); pageTracker._trackPageview(); pageTracker._setDomainName("www.plospathogens.org"); </script> </body> </html>