Adaptation of Burkholderia cenocepacia to low oxygen drives changes consistent with adaptation to chronic infection

Cystic fibrosis (CF) is characterised by chronic respiratory infections, involving opportunistic pathogens, including Burkholderia cenocepacia. The CF lung comprises hypoxic niches that drives bacterial adaptation, and the adaptability of pathogens to this environment is key to their successful colonisation. We previously identified several proteins encoded on a low-oxygen activated (Lxa) locus that were significantly increased in abundance in late chronic infection B. cenocepacia isolates. However, the impact of long-term hypoxia exposure on B. cenocepacia adaptation remains unclear. To investigate the role of hypoxia in driving traits associated with chronic infection, we exposed an early infection B. cenocepacia isolate to low (6% O₂) or atmospheric oxygen (21% O₂) over 22 days. By day 22, 364 proteins were significantly increased in abundance in hypoxia-adapted cultures relative to the early infection isolate (Day 0). Overall, 1066 individual proteins were significantly increased in abundance in the hypoxia-adapted cultures relative to normoxia-adapted cultures, across four different timepoints from day 1 to day 22. Comparative proteome analysis identified 81 proteins with consistent changes in abundance both in hypoxia-adapted cultures and the respective late infection isolate relative to the early infection isolate, including lxa-encoded proteins and the FixK transcriptional regulator. Proteins associated with shikimate pathways were also significantly changed in abundance. Importantly, hypoxia-adapted cultures showed increased survival in CF macrophages, increased attachment to CF lung cells, elevated protease activity, greater resistance to ceftazidime and ciprofloxacin, all of which are consistent with adaptations observed in late chronic infection isolates. Hypoxia-adapted cultures also displayed enhanced virulence in Galleria mellonella larvae, as did the late infection isolate. The changes in phenotype and proteome of B. cenocepacia observed after long-term hypoxia suggest that hypoxia may drive the adaptation to chronic infection, promoting survival in macrophages, host-cell attachment, antibiotic resistance and protease activity. Therapeutic strategies that modulate oxygen availability or target hypoxia-sensing may hold promise in preventing or mitigating chronic infection in CF.