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Functional drug screening reveals anticonvulsants as enhancers of mTOR-independent autophagic killing of Mycobacterium tuberculosis through inositol depletion.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Schiebler, Mark 
Brown, Karen 
Hegyi, Krisztina 
Newton, Sandra M 
Renna, Maurizio 

Abstract

Mycobacterium tuberculosis (MTB) remains a major challenge to global health made worse by the spread of multidrug resistance. We therefore examined whether stimulating intracellular killing of mycobacteria through pharmacological enhancement of macroautophagy might provide a novel therapeutic strategy. Despite the resistance of MTB to killing by basal autophagy, cell-based screening of FDA-approved drugs revealed two anticonvulsants, carbamazepine and valproic acid, that were able to stimulate autophagic killing of intracellular M. tuberculosis within primary human macrophages at concentrations achievable in humans. Using a zebrafish model, we show that carbamazepine can stimulate autophagy in vivo and enhance clearance of M. marinum, while in mice infected with a highly virulent multidrug-resistant MTB strain, carbamazepine treatment reduced bacterial burden, improved lung pathology and stimulated adaptive immunity. We show that carbamazepine induces antimicrobial autophagy through a novel, evolutionarily conserved, mTOR-independent pathway controlled by cellular depletion of myo-inositol. While strain-specific differences in susceptibility to in vivo carbamazepine treatment may exist, autophagy enhancement by repurposed drugs provides an easily implementable potential therapy for the treatment of multidrug-resistant mycobacterial infection.

Description

Keywords

autophagy, multidrug‐resistant, myo‐inositol, tuberculosis, Animals, Anticonvulsants, Antitubercular Agents, Autophagy, Carbamazepine, Cell Line, Disease Models, Animal, Drug Evaluation, Preclinical, Female, Humans, Inositol, Macrophages, Mice, Mice, Inbred C57BL, Mycobacterium tuberculosis, TOR Serine-Threonine Kinases, Tuberculosis, Zebrafish

Journal Title

EMBO Mol Med

Conference Name

Journal ISSN

1757-4676
1757-4684

Volume Title

7

Publisher

Springer Science and Business Media LLC
Sponsorship
Wellcome Trust (100140/Z/12/Z)
Wellcome Trust (095317/Z/11/A)