Yang Xinxin, Yuan Tianao, Ma Rui, Chacko Kieran I, Smith Melissa, Deikus Gintaras, Sebra Robert, Kasarskis Andrew, van Bakel Harm, Franzblau Scott G, Sampson Nicole S
Department of Chemistry , Stony Brook University , 100 John S. Toll Drive , Stony Brook , New York 11794-3400 , United States.
Institute for Tuberculosis Research , University of Illinois at Chicago , 833 South Wood Street, 425 PHARM , Chicago , Illinois 60612-7231 , United States.
ACS Infect Dis. 2019 Jul 12;5(7):1239-1251. doi: 10.1021/acsinfecdis.9b00099. Epub 2019 May 3.
One-third of the world's population carries (), the infectious agent that causes tuberculosis (TB), and every 17 s someone dies of TB. After infection, can live dormant for decades in a granuloma structure arising from the host immune response, and cholesterol is important for this persistence of . Current treatments require long-duration drug regimens with many associated toxicities, which are compounded by the high doses required. We phenotypically screened 35 6-azasteroid analogues against and found that, at low micromolar concentrations, a subset of the analogues sensitized to multiple TB drugs. Two analogues were selected for further study to characterize the bactericidal activity of bedaquiline and isoniazid under normoxic and low-oxygen conditions. These two 6-azasteroids showed strong synergy with bedaquiline (fractional inhibitory concentration index = 0.21, bedaquiline minimal inhibitory concentration = 16 nM at 1 μM 6-azasteroid). The rate at which spontaneous resistance to one of the 6-azasteroids arose in the presence of bedaquiline was approximately 10, and the 6-azasteroid-resistant mutants retained their isoniazid and bedaquiline sensitivity. Genes in the cholesterol-regulated Mce3R regulon were required for 6-azasteroid activity, whereas genes in the cholesterol catabolism pathway were not. Expression of a subset of Mce3R genes was down-regulated upon 6-azasteroid treatment. The Mce3R regulon is implicated in stress resistance and is absent in saprophytic mycobacteria. This regulon encodes a cholesterol-regulated stress-resistance pathway that we conclude is important for pathogenesis and contributes to drug tolerance, and this pathway is vulnerable to small-molecule targeting in live mycobacteria.
全球三分之一的人口携带结核分枝杆菌(),这是一种导致结核病(TB)的病原体,每17秒就有一人死于结核病。感染后,结核分枝杆菌可在宿主免疫反应形成的肉芽肿结构中潜伏数十年,胆固醇对结核分枝杆菌的这种潜伏状态很重要。目前的治疗需要长期的药物方案,且有许多相关毒性,高剂量用药更是雪上加霜。我们对35种6-氮杂甾体类似物进行了表型筛选,发现其中一部分类似物在低微摩尔浓度下能使结核分枝杆菌对多种抗结核药物敏感。选择了两种类似物进行进一步研究,以表征在常氧和低氧条件下贝达喹啉和异烟肼的杀菌活性。这两种6-氮杂甾体与贝达喹啉表现出很强的协同作用(分数抑制浓度指数=0.21,在1μM 6-氮杂甾体存在下,贝达喹啉的最小抑菌浓度=16 nM)。在贝达喹啉存在的情况下,结核分枝杆菌对其中一种6-氮杂甾体自发产生耐药性的速率约为10,且对6-氮杂甾体耐药的突变体仍保持对异烟肼和贝达喹啉的敏感性。胆固醇调节的Mce3R调控子中的基因是6-氮杂甾体活性所必需的,而胆固醇分解代谢途径中的基因则不是。6-氮杂甾体处理后,Mce3R基因子集的表达下调。Mce3R调控子与抗逆性有关,在腐生分枝杆菌中不存在。该调控子编码一条胆固醇调节的抗逆途径,我们认为这条途径对发病机制很重要,并导致药物耐受性,而且这条途径在活的分枝杆菌中易受小分子靶向作用。