Antibiotic Persistence Emerges from Cell-State-Driven Transcriptional Reprogramming

Abstract Antibiotic persistence allows a subpopulation of bacterial cells to survive antibiotic treatment without acquiring resistance mutations, often contributing to treatment failure. Although many genes have been linked to persistence, their deletion rarely abolishes the phenotype, highlighting redundancy in persistence mechanisms. Moreover, the transient and heterogeneous nature of persister formation has made it difficult to resolve its molecular basis using bulk analyses. Here, we use bacterial single-cell RNA sequencing and functional assays in Klebsiella pneumoniae to demonstrate how transcriptional heterogeneity and redundancy in stress responses shape persistence outcomes. Using growth phase as a biologically meaningful axis of transcriptional variation, we reveal that even within an isogenic population, distinct transcriptional responses can be induced and co-contribute to survival. These responses are shaped by the cell’s pre-treatment transcriptional state and the mechanism of antibiotic action. Genetic and environmental perturbations, such as rpoS deletion and nutrient supplementation, shift pre-treatment cell states and alter persistence frequencies. Our findings establish the biological significance of transcriptional heterogeneity shaped by pre-treatment cell states, providing a systems-level framework for understanding persistence and suggesting strategies to enhance antibiotic efficacy by modulating cell states.