DESCRIPTION (provided by applicant): Infection with Mycobacterium tuberculosis (Mtb) often results in a chronic tuberculosis (TB) infection. Of those infected, ~90% mount a successful immune response that sequesters the bacterium in a granuloma. The granuloma limits the spread and growth of the bacterium and results in a persistent infection. Under conditions that weaken the immune system Mtb can be released from the granuloma and establish an active, infectious disease state. Developing new therapies that target mechanisms required for Mtb to establish, maintain or exit a persistent state has the potential to shorten the course of current ~6-9 month Mtb drug regimens as well as combat the emergence of multidrug-resistant Mtb. Mtb alters its physiology in response to host immune pressures thus enabling the bacterium to remain viable in humans for decades. Mtb is an intracellular pathogen that resides within macrophages (M), a host immune cell that kills most other bacteria. Following infection, the M releases immune modulators that orchestrate the formation of a granuloma around the infected M. The granuloma limits the availability of nutrients and oxygen to the bacterium and drives Mtb to realign its gene expression and physiology to support a non-replicative, persistent (NRP) state. Transition into and maintenance of NRP is governed, in part, by the DosRST two component regulator system (TCS). DosR is a DNA binding response regulator that is phosphorylated by the sensor kinase DosT to induce expression of approximately 50 genes in response to cues such as hypoxia. One of the most strongly DosR induced genes is triacylglycerol synthase 1 (tgs1), which is responsible for the accumulation of intracellular triacylglycerol (TAG). In vitro growth conditions that induce DosR and NRP cause Mtb to accumulate inclusion bodies that are primarily composed of TAG. These TAG inclusion bodies are also observed during infections and in clinical sputum samples from infected humans, supporting a role for TAG accumulation in the progression of TB during chronic infection. We propose to exploit Mtb TAG metabolism pathways to develop high throughput screening (HTS) platforms that target Mtb persistence pathways. We will develop fluorescent reporter assays that measure TAG metabolism: i) directly by staining TAG inclusions with the fluorescent stains, or ii) indirectly by using a synthetic tgs1'::GFP reporter strain (Specific Aim 1). These HTS platforms will be optimized and validated in a 384 well format and the best performing platform will be used for a HTS of a 500,000 small compound library for inhibitors of TAG metabolism (Specific Aim 2). Hits identified in the screen will be validated, prioritized and the most promising compounds will undergo preclinical characterization including, mechanism of action, structure activity relationship studies, and efficacy in animal models of infection (Specific aim 3). The goa of this proposal is to identify a lead compound that is suitable for further optimization and that specifically targets the chronic stage of tuberculosis infection.

The spread of tuberculosis is a global health crisis leading to over one million deaths annually. The global burden of tuberculosis is a threat to the health of al Americans, and directly relevant to the mission of the National Institute of Allergy and Infectious Diseases, given the easy transmission of the disease through the air and the emergence of drug resistant strains that are difficult to treat. Moreover, there exists an increasing population of Americans with enhanced susceptibility to TB due to factors associated with compromised immune systems, including: HIV infection, the use of anti-rejection and anti-inflammatory drugs, as well as natural decreases in immunity associated with an aging population.