Transcriptional Reprogramming of Staphylococcus aureus in Chronic Rhinosinusitis Reveals a Persistence-Associated Phenotype

Chronic rhinosinusitis (CRS) is a persistent inflammatory condition frequently associated with Staphylococcus aureus. The bacterium’s ability to evade immune clearance and establish long-term infection complicates treatment. In our previous study, we demonstrated that S. aureus isolates obtained from patients with CRS (CRS-S. aureus isolates; CSS) exhibit reduced glycolytic activity and cytotoxicity, which is consistent with a persistence-associated phenotype. Here, we present transcriptomic evidence that supports this shift. Comparative RNA sequencing of CSS and control (S. aureus isolates from healthy carriers, MIN) isolates from healthy individuals revealed significantly lower expression of genes involved in canonical virulence pathways in CSS isolates, particularly during the early growth phase. These profiles suggest reduced acute virulence in favour of metabolic changes that aid survival in the chronically inflamed sinus. The distinct transcriptional state of CSS isolates might reflect the influence of the CRS host milieu in shaping bacterial behaviour. Host factors such as sustained inflammation or altered nutrient availability may select for persistence-associated phenotypes. Together, these findings advance our understanding of chronic S. aureus infection and may aid/guide the development of therapies aimed at disrupting persistence programmes or enhancing host resilience.