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The present study was undertaken in order to understand more about the interaction occurring between  S. maltophilia  and  P. aeruginosa , which are frequently co-isolated from CF airways. For this purpose,  S. maltophilia  RR7 and  P. aeruginosa  RR8 strains, co-isolated from the lung of a chronically infected CF patient during a pulmonary exacerbation episode, were evaluated for reciprocal effect during planktonic growth, adhesion and biofilm formation onto both polystyrene and CF bronchial cell monolayer, motility, as well as for gene expression in mixed biofilms.  P. aeruginosa  significantly affected  S. maltophilia  growth in both planktonic and biofilm cultures, due to an inhibitory activity probably requiring direct contact. Conversely, no effect was observed on  P. aeruginosa  by  S. maltophilia . Compared with monocultures, the adhesiveness of  P. aeruginosa  on CFBE41o- cells was significantly reduced by  S. maltophilia , which probably acts by reducing  P. aeruginosa's  swimming motility. An opposite trend was observed for biofilm formation, confirming the findings obtained using polystyrene. When grown in mixed biofilm with  S. maltophilia, P. aeruginosa  significantly over-expressed  aprA , and  algD —codifying for protease and alginate, respectively—while the quorum sensing related  rhlR  and  lasI  genes were down-regulated. The induced alginate expression by  P. aeruginosa  might be responsible for the protection of  S. maltophilia  against tobramycin activity we observed in mixed biofilms. Taken together, our results suggest that the existence of reciprocal interference of  S. maltophilia  and  P. aeruginosa  in CF lung is plausible. In particular,  S. maltophilia  might confer some selective “fitness advantage” to  P. aeruginosa  under the specific conditions of chronic infection or, alternatively, increase the virulence of  P. aeruginosa  thus leading to pulmonary exacerbation.

Cooperative pathogenicity in cystic fibrosis: Stenotrophomonas maltophilia modulates Pseudomonas aeruginosa virulence in mixed biofilm