Bedaquiline reprograms central metabolism to reveal glycolytic vulnerability in Mycobacterium tuberculosis

Nat Commun. 2020 Nov 30;11(1):6092. doi: 10.1038/s41467-020-19959-4.

Abstract

The approval of bedaquiline (BDQ) for the treatment of tuberculosis has generated substantial interest in inhibiting energy metabolism as a therapeutic paradigm. However, it is not known precisely how BDQ triggers cell death in Mycobacterium tuberculosis (Mtb). Using 13C isotopomer analysis, we show that BDQ-treated Mtb redirects central carbon metabolism to induce a metabolically vulnerable state susceptible to genetic disruption of glycolysis and gluconeogenesis. Metabolic flux profiles indicate that BDQ-treated Mtb is dependent on glycolysis for ATP production, operates a bifurcated TCA cycle by increasing flux through the glyoxylate shunt, and requires enzymes of the anaplerotic node and methylcitrate cycle. Targeting oxidative phosphorylation (OXPHOS) with BDQ and simultaneously inhibiting substrate level phosphorylation via genetic disruption of glycolysis leads to rapid sterilization. Our findings provide insight into the metabolic mechanism of BDQ-induced cell death and establish a paradigm for the development of combination therapies that target OXPHOS and glycolysis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Antitubercular Agents / pharmacology
  • Bacterial Proteins / metabolism
  • Carbon Cycle / drug effects
  • Citric Acid Cycle / drug effects
  • Diarylquinolines / pharmacology*
  • Energy Metabolism / drug effects
  • Glycolysis / drug effects*
  • Glyoxylates
  • Mycobacterium tuberculosis / drug effects*
  • Mycobacterium tuberculosis / genetics
  • Mycobacterium tuberculosis / metabolism*
  • Oxidative Phosphorylation
  • Tuberculosis / microbiology

Substances

  • Anti-Bacterial Agents
  • Antitubercular Agents
  • Bacterial Proteins
  • Diarylquinolines
  • Glyoxylates
  • bedaquiline
  • glyoxylic acid