Acinetobacter phages use distinct strategies to breach the capsule barrier

Abstract

Acinetobacter baumannii is an opportunistic pathogen that is a growing threat in hospital settings due to its alarmingly high rates of antibiotic resistance. Alternative therapies are urgently needed to manage the growing burden of untreatable A. baumannii infections. Phage therapy is a promising avenue that has already seen some success in isolated compassionate-use cases, including the famous "Patterson case". A. baumannii capsule is highly diverse both in structure and composition, and provides the first immunity barrier against phages. Here, we perform a detailed molecular characterization of three recently isolated, distinct A. baumannii phages that breach the capsule via different mechanisms. Like many previously described A. baumannii phages, a specific capsule type is necessary and sufficient for StAb1 infection. We found that StAb2 and its relatives adsorb to either a specific capsule type or the conserved outer membrane protein CarO, a porin normally occluded by the capsule. Thus, this phage has a narrow host range amongst capsulated strains, but can broadly infect A. baumannii strains lacking capsule. We also show that an unclassified siphophage, StAb3, requires a conserved and uncharacterized glycan, likely containing ManNAc, that enables StAb3 to infect a broad range of A. baumannii strains without depolymerizing the capsule. We demonstrate how rationally combining phages with distinct capsule interactions reduces the rapid emergence of phage escape mutants, with potential applications for more effective phage therapy.