Functional drug screening reveals anticonvulsants as enhancers of mTOR-independent autophagic killing of Mycobacterium tuberculosis through inositol depletion.
Schiebler, Mark;
Brown, Karen;
Hegyi, Krisztina;
Newton, Sandra M;
Renna, Maurizio;
Hepburn, Lucy;
Klapholz, Catherine;
Coulter, Sarah;
Obregón-Henao, Andres;
Henao Tamayo, Marcela;
+12 more...Basaraba, Randall;
Kampmann, Beate;
Henry, Katherine M;
Burgon, Joseph;
Renshaw, Stephen A;
Fleming, Angeleen;
Kay, Robert R;
Anderson, Karen E;
Hawkins, Phillip T;
Ordway, Diane J;
Rubinsztein, David C;
Floto, Rodrigo Andres;
(2015)
Functional drug screening reveals anticonvulsants as enhancers of mTOR-independent autophagic killing of Mycobacterium tuberculosis through inositol depletion.
EMBO MOLECULAR MEDICINE, 7 (2).
pp. 127-139.
ISSN 1757-4676
DOI: https://doi.org/10.15252/emmm.201404137
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
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.