Experimental characterization of salicylate-induced antibiotic resistance
To study the trade-off between drug toxicity and induced resistance, we first measured the effects of salicylate and two protein synthesis inhibitors, chloramphenicol and tetracycline, on cell growth. As expected, the effect of each drug alone is to slow cell growth as concentration increases. To quantitatively characterize this effect, we define growth cost as the reduction in growth rate of cells treated with one drug relative to the growth rate of untreated cells. In general, we find that cost functions are well-described by Hill functions with K
i, the concentration of drug i at which cost is half maximal, and n, the Hill coefficient (Figure a). This mathematical form is consistent with standard dose–response models [
10]. In the presence of a high concentration of chloramphenicol or tetracycline, however, we find that adding salicylate can increase growth (Figure b, Additional file
1: Figure S1). This effect was previously reported for a single concentration of salicylate [
26]; here we provide the entire non-monotonic dependence of this suppressive effect on concentration, allowing us to tease apart contributions of salicylate’s cost from its benefit (below). We also performed detailed quantitative measurements of another suppressive interaction between an antibiotic, chloramphenicol, but with a different inducer, sodium benzoate (Additional file
1: Figure S1).
Phenomenological cost-benefit model for MAR-induced drug resistance
To quantitatively model the interplay between inducer cost and benefit in a two-drug environment that includes an inducer, we assume that the effects of the two drugs, in the absence of MAR induction, are independent in the sense that the relative growth rate of cells in the presence of both drugs (g
SA) equals the product of individual relative growth rates of cells in the presence of each drug alone (g
SA
=

g
S g
A). This assumption, known as Bliss independence [
11], provides exact results for simple situations, such as a single enzymatic reaction disrupted by mutually non- exclusive inhibitors [
10], in which case the effects of the drugs are defined in terms of reaction fluxes. However, the assumption of Bliss independence often fails for more complex systems, and it is therefore primarily used as a phenomenological null model for the physiological effects of non-interacting drugs on cell proliferation or growth [
10,
14,
28-
30].
Here, we extend the concept of Bliss independence to include drug interactions mediated by the induction of the MAR system. Specifically, we assume that the presence of one drug (S) provides a fitness benefit by reducing the effective concentration of the second drug (A), thereby coupling the effects of the drugs. We incorporate this rescaling and re-write the model in terms of the combined growth cost, CSA (by definition 1- gSA) to arrive at
where f(A) and g(S) are the
growth costs of drugs alone (Figure a). Equation 1 expresses Bliss independence in terms of growth costs, and also generalizes it to include an S-dependent reduction of A to A
eff. Therefore, the approximate additivity of drug costs implied by Bliss independence is modified to an approximate additivity of
effective costs (Figure a). The model assumes that the presence of inducer reduces the effective concentration of drug A and adds an additional cost, but otherwise does not affect growth rate. This assumption considerably limits the spectrum of possible cellular responses to the drug pair, because drug S can only change the effective concentration of drug A, but will not change the shape of its cost function. The model can be readily extended to include two drugs which both act as inducers, in which case S is also changed to S
eff. However, because the antibiotics used are poor inducers of the MAR system (Additional file
1: Figure S7), we neglect their effects on the concentration S and limit this study to the directional model implied by Equation [1].
A simple model, which assumes that the concentration of antibiotic A is reduced by the induction of efflux pumps (Additional file 1), suggests a form for Aeff:
We call the function β(S) the
inducible benefit, and it contains all quantitative information about the resistance mechanisms induced by drug S. To estimate the inducible benefit, β(S), for the MAR system, we measured the activity of the
mar promoter as a function of S (Figure b; Additional file 1). MAR promoter activity could dictate the functional form for β(S) if, for example, we assume it is proportional to the number of efflux pumps produced in response to salicylate (Additional file 1). We scale this promoter activity by an adjustable parameter β
max, so that

, where K
ind
=

0.8 is the concentration of inducer that yields half maximal promoter activity (Figure b). The adjustable parameter β
max links
mar activity induced by drug S to a phenotypic response (resistance) to a second drug A. This parameter will be specific to drug A, and it provides a measure of the efficiency with which MAR induction eliminates A from the cell.
The cost-benefit theory assumes that the effects of the inducing drug and the antibiotic are independent, up to a reduction in the concentration of the antibiotic. The aim of our model is not to achieve a microscopic theoretical description of the system, but rather to provide a minimal phenomenological model that quantitatively captures the measured behavior. The success or failure of the model must therefore be determined experimentally. Specifically, our model does not attempt to elucidate the microscopic variables governing the multi-drug effects—which would require dozens, if not hundreds, of microscopic parameters—but rather posits that a simple relationship should exist between cell growth in the presence of one drug (which is a function of the cell’s internal state) and cell growth in the presence of two drugs (which is a function of an entirely different intracellular state). Specifically, the model requires equality between cell growth in the presence of A and cell growth in the presence of the combination S and A' (with A'>

A), once we account for the costs of drug S. To directly verify this hypothesis, we can rearrange equation 1 to express this concept as
The left hand side represents the "adjusted" multi-drug cost, once the toxic effects of S (cost) have been removed. The model implies that this adjusted cost of the drug combination, as a function of A
eff, is functionally equivalent to the cost function f(x) for a single drug. Hence, if one removes from the multi-drug costs (C
SA) the effects of g(S) according to the left-hand side of Equation 3 and then properly chooses the concentration reduction A→A
eff (determined by the single parameter β
max), all two-drug data from a given drug combination should collapse to the single curve determined by f(x). Note that because a Hill function describes costs for many individual drugs as well as slices through many drug combination effect surfaces[
10], collapsing the multi-drug cost curves from a given drug pair (Figure a) to a common Hill form can be simply achieved using independent parameters for each salicylate concentration. By contrast, equation 3 suggests that a non-trivial collapse of all curves for a given drug pair requires only a
single parameter β
max. Once this parameter is determined, the beneficial effects of different concentrations of salicylate are linked by the
mar promoter activity curve. We verified this constraint (Figure b) by fitting the single free parameter, β
max, using two-drug cost curves for salicylate and chloramphenicol (β
max
=

1.15 +/− 0.15) and salicylate and tetracycline (β
max
=

6.04 +/− 0.16). In all cases, the model provides an excellent fit to the data (R
2
=

0.98; see Additional file
1: Figure S2 for a direct comparison of growth rates from experiment and model). Interestingly, this analysis demonstrates that a superposition of cost and benefit functions quantitatively describes the combined effects of salicylate and an antibiotic. Surprisingly, we find that the benefit function depends only on the inducer concentration and is dictated by the
mar induction curve.
Transition from salicylate as toxic to salicylate as beneficial
Our results uncover an interesting range of cellular behavior that emerges from the trade-offs of salicylate toxicity and the simultaneous induction of multi-drug resistance. First, for each concentration of antibiotic, we find that growth is maximal at a single salicylate concentration S*. In addition, we see an apparent transition between two regimes—one where the presence of the inducing drug is harmful, and another where it is beneficial—as A eclipses a threshold A
crit (Figure a). That is, S* becomes non-zero as A crosses A
crit. In other words, the cell benefits from the presence of salicylate, but only when the antibiotic environment is sufficiently toxic to offset the inherent toxicity of the inducer. Interestingly, we find that
mar promoter activity saturates at S

≈

4

mM (Figure b), which is greater than S* for all concentrations of antibiotics used. Therefore, maximum suppression at S* results from a non-trivial interplay between MAR expression and inducer cost, not merely a maximum in MAR expression.
Contributions of inducer cost and benefit to apparent MIC’s of antibiotics
Given our characterization of salicylate-induced multi-drug resistance, it is straightforward to calculate the apparent MIC of an antibiotic in the presence of any concentration of salicylate. Here, we define the apparent MIC to be the minimum concentration of drug A at which relative growth is reduced to a value of δ. For small concentrations of salicylate, the apparent MIC’s of both tetracycline and chloramphenicol increase dramatically (Figure b). However, at higher concentrations, the toxicity of salicylate begins to overwhelm its potential benefits, eventually leading to a decrease in apparent MIC. It is therefore clear that MIC reflects contributions of both the cost and benefits of the inducing drug. By contrast, the interdependence of inducible resistance and mar promoter activity can be described using only a single parameter, βmax, which provides a quantitative measure of inducible benefit that is not masked by the effects of inducer cost.
Phase diagram for MAR-mediated drug interactions
The interactions between salicylate and tetracycline, salicylate and chloramphenicol, and sodium benzoate and tetracycline are all suppressive, but this class of models describes a range of interactions ranging from synergistic to suppressive, based on the interplay of induction benefit and drug toxicity. Using Equations 1 and 2, we quantitatively determine a phase diagram (Figure , Additional file
1: Figure S3) that specifies how a drug interaction depends on the trade-offs between inducible benefit (described by the parameters K
ind and β
max), the cost of inducer (K
S), and the steepness of the antibiotic dose-response curve (n). Specifically, the cellular response to the first drug (S) alone includes both the growth cost of the drug (characterized by K
S) and the induction of MAR system (characterized by K
ind). The dynamics of the efflux pumps and their specificity for drug A determine the concentration reduction (A to A
eff), which is governed by β
max. The phase diagram demonstrates that properties of the drugs alone (n, K
S, K
ind) determine the level of drug coupling, contained in β
max, required to achieve antagonism or suppression. Drugs that strongly induce growth benefit and have low associated cost (K
ind
<<K
S) are always suppressive. By contrast, high cost inducers (K
ind >>

K
S) can never be suppressive because the cost of induction is too high (Figure c).
The inducible benefit parameter (β
max
=

1.15) characterizing the salicylate and chloramphenicol combination in wild type cells is far above the suppressive-antagonistic boundary (β
max >

>

2K
ind/(K
1n)

=

0.45), and the interaction is clearly suppressive for all concentrations of salicylate. To explore different regions of the phase diagram experimentally, we measured the effects of two different mutations on the suppressive drug interaction between salicylate and chloramphenicol. The first mutant, ΔtolC [
31], lacks the protein TolC required for efflux pumping [
32]. While we expect that the ΔtolC deletion will partially suppress the benefit induced by salicylate, we cannot predict how the costs of the drugs and, therefore, the precise nature of the drug interaction, will be altered. Experimentally, this mutant showed decreased resistance to chloramphenicol (Figure a, b), corresponding to a rescaling of the single drug cost (i.e. K
A smaller than in wild type), but the cost of salicylate remains unchanged (K
S approximately same as wild type). β
max was measured to be −0.15 +/− 0.01. According to the phase diagram (Figure ), the interaction should therefore be weakly synergistic, and in fact the contours of constant growth appear slightly concave (lower inset). The suppressive drug interaction has been eliminated because the benefit associated with salicylate has been decreased while its cost remains unchanged, resulting in significantly less antagonistic interaction.
Since the suppressive interaction between salicylate and chloramphenicol is partially associated with the synthesis of AcrAB-TolC efflux pumps, we also hypothesized that cells with constitutive
mar promoter activity would disrupt the cost-benefit interplay required for drug suppression. We selected such a mutant, here-called a
tet mutant, by growing cells in 1

μg/mL tetracycline for 48 hours. We observed that the MAR system is a common target for mutations that confer resistance to tetracycline (see also [
23]) (Additional file
1: Figure S6). In terms of our cost-benefit analysis, these cells synthesize resistance systems (benefit) without the associated cost of an inducing drug. To verify the molecular basis of resistance in the tet mutant, we sequenced the full genome and found only a single point mutation in the α5 region of the MAR repressor marR, which is linked to dimer formation and subsequent binding to the
mar promoter [
33]. In the salicylate-chloramphenicol combination, the tet mutant showed increased resistance to chloramphenicol (K
A is larger than in wild-type) and a near-additive drug interaction (β
max
=

0.19 +/− 0.03) between salicylate and chloramphenicol (Figure ). Because the cost of salicylate is unchanged, the elimination of suppression suggests that the mutation has blocked the inducible benefit of salicylate (see also Additional file
1: Figure S5 for similar results with a different drug pair). Biologically, the inactivation of the MarR repressor no longer requires the presence of salicylate, and therefore the cost of the drug exceeds its associated inducible benefit. Interestingly, we also found that the
mar activity in the mutant is higher in the absence of salicylate than the maximum
mar activity induced by even high concentrations of salicylate in the wild type strain. However, adding salicylate further increases
mar activity in the mutant (Additional file
1: Figure S7A). Moreover, the functional dependence of the induction on salicylate is similar to that of the wild-type (Additional file
1: Figure S7A, inset). This result is not intuitive because the beneficial effects of salicylate on the growth of the mutant in the presence of chloramphenicol are quite small (β
max is approximately 17% of that of the wild type, and the antagonism between the drugs is markedly decreased).