CLINICAL NEED FOR NEW ANTI-TB DRUGS
Tuberculosis (TB) is one of the most common causes of human mortality in the world. The continual rise in the number of TB patients highlights the critical demand for new approaches to treat this important infectious disease. It is estimated that there are now 9.8 million new cases of TB each year, more than at any other time in history (
Dye and Williams, 2010). Our current inability to control this infectious disease stems from the loss of efficacy of vaccines and antibiotic pharmaceuticals that were once effective in the clinic. Replacement of old agents with new medicines required to treat drug resistant strains has been hampered by diminishing investment in antibiotic drug discovery and the lack of political desire to deliver therapies to those in most need (
Koul et al., 2011;
Lawn and Zumla, 2011). The complex lifecycle of
Mycobacterium tuberculosis, the pathogenic bacilli responsible for TB, also contributes to the bacteria’s extraordinary ability to evade antibiotic therapy (
Russell et al., 2010).
M. tuberculosis exists in both an active and latent state. Most antibiotics are effective against actively growing
Mycobacterium as they target metabolic processes required for the primary progressive stage of infection (
Baek et al., 2011;
Koul et al., 2011). Conversely, dormant bacilli are more difficult to treat as they have evolved complex mechanisms that assist them to evade both antibiotics and the patient’s immune system (
Joshi et al., 2006;
Ahmad, 2011). Hence, the bacteria can re-activate once antibiotic treatment has ceased or the immune system has been compromised, for example by co-infection with human immunodeficiency virus (HIV) (
Kwan and Ernst, 2011;
Lawn and Zumla, 2011). One novel strategy to treat TB is to pharmacologically target metabolic pathways essential in both the active and latent stages of
M. tuberculosis. The biotin biosynthesis pathway is potentially an example of such a pathway. Here we review recent studies into this metabolic pathway with a view to establishing its disruption as a strategy for antibiotic drug discovery.
BIOTIN IS AN ENZYME COFACTOR
Biotin (aka vitamin H or B7) is an essential cofactor for two important biotin-dependent enzymes in
M. tuberculosis, namely pyruvate carboxylase (PC) and acyl-CoA carboxylase (ACC). Here biotin is required for the transfer of a carboxyl anion onto a specific organic acid substrate. Pyruvate carboxylase plays an anapleurotic role in central carbon metabolism in many bacterial species by replenishing the TCA cycle with oxaloacetate (
Eisenreich et al., 2010). The role of pyruvate carboxylase has not been extensively investigated in
Mycobacterium compared with other bacteria, mainly due to the technical difficulties associated with studying metabolic pathways in an intracellular pathogen. Further work is needed to address our deficiencies in understanding in this area. Specifically, the mechanisms that permit the bacteria to survive and adapt to niche microenvironments inside host cells will need to be delineated (
Eisenreich et al., 2010). In contrast, ACC has been the subject of greater research focus primarily due to its potential as an antibiotic drug target (
Wright and Reynolds, 2007;
Chan and Vogel, 2010;
Parsons and Rock, 2011). ACC catalyses the carboxylation of various acyl CoA substrates, such as acetyl CoA, propionyl CoA and butyryl CoA (
Arabolaza et al., 2010;
Gago et al., 2011). The products of these reactions feed into the fatty acid synthesis and polyketide synthesis pathways, resulting in the production of mycolic acids and multimethyl-branched fatty acids present in the cell envelope (
Takayama et al., 2005;
Gago et al., 2011). These pathways are especially important in
Mycobacterium sp., as the cell envelope contains a complex lipid bi-layer composed primarily of mycolic acid. It has been estimated that 10% of the
Mtb genome is devoted to fatty acid biosynthesis (
Minnikin et al., 2002). The cell membrane greatly enhances the bacterium’s ability to resist chemical damage, survive in hostile environments, and limits its susceptibility to many antibiotics (
Niederweis et al., 2010). Therefore, the metabolic enzymes responsible for the synthesis of membrane lipids represent promising targets for the development of new anti-mycobacterial drugs. Clinical validation for this approach is provided by the anti-TB drug isoniazid that targets fatty acid biosynthesis (
Lu and Tonge, 2008). The important metabolic functions of both PC and ACC are critically dependent upon the availability of biotin as a coenzyme.
BIOTIN BIOSYNTHETIC PATHWAY
Many micro-organisms, plants and fungi can synthesize biotin
de novo (
Cronan and Lin, 2011). In contrast, mammals are biotin auxotrophs that obtain the micronutrient from intestinal micro-flora, dietary sources and recycling (
Said, 2009). The absence of an analogous metabolic pathway in mammals makes biotin biosynthesis an attractive prospect for antibiotic discovery. The final four steps in the pathway are conserved amongst the biotin-producing organisms. The universal biosynthetic pathway, shown in Fig. 1, converts a pimeloyl-thioester to biotin through the activity of four enzymes, namely 7-keto-8-aminopelargonic acid synthase (KAPAS, encoded by
bioF), 7,8-diaminopelargonic acid synthase (DAPAS, encoded by
bioA), dethiobiotin synthetase (DTBS, encoded by
bioD), and biotin synthase (BS, encoded by
bioB) (reviewed (
Cronan and Lin, 2011)). Briefly, KAPAS converts a pimelate moiety to 7-keto-8-aminopelargonic acid (KAPA) using L-alanine as an amino donor. The KAPA is subsequently converted to 7, 8-diaminopelargonic acid (DAPA) by the activity of DAPAS requiring S-adenosylmethionine (SAM) as an amino donor. Next, the conversion of DAPA into dethiobiotin (DTB) is catalyzed by DTBS that requires CO
2 and ATP to close the ureido ring. Finally, the sulfur ring of biotin is closed by biotin synthase requiring one sulfur atom and two electrons transferred from flavodoxin, SAM and nicotinamide adenine dinucleotide phosphate (NADPH) (
Berkovitch et al., 2004). As will be discussed below, genetic studies that disrupt
bioF,
A,
D and
B assist in establishing the biotin biosynthesis pathway as a target for the development of new anti-TB agents.
Whilst the final four steps are highly conserved, precursors that feed into this pathway can be acquired through different means. New insights into the mechanisms employed by the model bacteria
Escherichia coli have come to light, and have been reviewed recently (
Cronan and Lin, 2011). Briefly, the 3-carbon chain present in malonyl CoA is extended by four additional carbon units by the fatty acid biosynthetic pathway (Fig. 1). The BioC methyltransferase is required to move the biotin precursor into the fatty acid synthesis pathway, whereas the esterase BioH facilitates escape of pimeloyl-thioester so BioF can use it as a substrate in the conserved pathway (
Lin et al., 2010). The identification of BioC and BioH homologues in available
Mycobacteria genomes suggests that this pathway is also employed by this species (
Yu et al., 2011). A recent study highlighted the importance of the biotin precursor pathway in
Mycobacteria. Deletion of Rv1882c, a putative short chain dehyrodogenase in the fatty acid biosynthesis pathway, yielded an
M. tuberculosis strain with attenuated growth on blood agar and in murine macrophages
in vitro. Supplementing the growth media with high concentrations of biotin (> 1 μmol/L) restored growth rates. Unlike wildtype
Mycobacterium marinum, a Rv1882c deletion mutant strain also failed to colonize the livers of zebrafish and were completely cleared from the fish two weeks post infection (
Yu et al., 2011). These data suggest that the intracellular supply of biotin is insufficient for
Mycobacterium survival, and the bacteria are critically dependent upon
de novo synthesis.
BIOTIN BIOSYNTHESIS IS REQUIRED IN INFECTION AND LATENCY
Genetic studies have played an important role in establishing the importance of biotin synthesis in
Mycobacterium at various stages of its life-cycle. Access to genome-wide, insertional mutagenic libraries of
Mycobacteria has facilitated phenotypic screening to identify key metabolic pathways required under a variety of conditions (
Sassetti et al., 2001,
2003). For example disruption of
bioA attenuated the growth of
M. smegmatis on carbon-depleted media, imitating the nutrient deprived state experienced by stationary phase bacteria during latency (
Keer et al., 2000). As the ability of
Mycobacteria to grow inside macrophages is related to its virulence and pathogenicity (
Russell, 2001), manipulation of
in vitro growth conditions can also imitate conditions experienced
in vivo. Non-stimulated macrophages model initial and latent infections, whereas macrophages stimulated with interferon gamma imitates an on-going immune response (
Rengarajan et al., 2005).
bioF and
bioB mutants were identified in a genetic screen investigating genes required for prolonged infection of primary murine macrophages (
Rengarajan et al., 2005). Both mutant strains showed attenuated growth in un-stimulated and stimulated macrophages, suggesting a critical role for
de novo biotin synthesis during and post infection.
Biotin biosynthesis in
Mycobacteria has also been investigated in mouse models of the infectious disease. Genome-wide genetic screens performed in mice, designed to isolate
M. tuberculosis genes required for
in vivo virulence, identified
bioF,
A and
B (
Sassetti and Rubin, 2003). These mutant strains showed dramatically reduced growth rates in the murine infection model. Particularly noteworthy was
bioF. An in-frame deletion of
bioF in
M. tuberculosis resulted in rapid clearance of the mutant strain in the early stages of infection, and showed poor survival in mouse lung and spleen (
Sassetti and Rubin, 2003). Interestingly, the genome sequence of
M. tuberculosis contains two
bioF genes (
bioF1, Rv1569 and
bioF2, Rv0032). However, only
bioF1 was identified in any of the above screens, suggesting no redundancy between the two alleles. This is supported by targeted gene knockout studies that showed deletion of
bioF1 has a bacteriocidal phenotype unless grown
in vitro on media supplemented with high concentrations of biotin (
Dey et al., 2010).
BIOTIN TRANSPORTER PROTEINS
Based on the studies above, the literature strongly suggests that
Mycobacteria’s primary source of biotin is via
de novo biosynthesis. In other words, the bacilli do not posses a biotin transport system to scavenge biotin from exogenous sources. Many other bacteria do possess this ability by utilizing a biotin transport protein. The most characterized example is BioY (
Rodionov et al., 2009). This transporter works with an energy coupling system to actively move biotin across the bacterial cell membrane in an ATP-dependent manner (
Hebbeln et al., 2007;
Rodionov et al., 2009). Genome annotation studies have failed to identify homologues of the
bioY gene in the
M. tuberculosis genome (
Rodionov et al., 2002;
Hebbeln et al., 2007). Supporting the observation that
Mycobacteria require
de novo biotin synthesis are reports that chemical inhibition of the biotin biosynthetic enzymes also impedes the growth of
Mycobacteria in vitro. This has been investigated using two natural compounds isolated from culture filtrates of
Streptomyces species, namely amiclenomycin and actithiazic acid (
Ogata et al., 1973;
Okami et al., 1974). The BioA inhibitor, amiclenomycin, is a narrow-spectrum antibiotic with activity against
Mycobacteria sp., but not other bacteria or fungi that can scavenge exogenous biotin (
Kitahara et al., 1975). Its anti-TB activity can be reversed by high concentrations of external biotin, above 0.01 μg/mL (
Sandmark et al., 2002;
Mann et al., 2005), which is at least 10-fold greater than the concentration found in normal human plasma (
Mock and Malik, 1992). This implies that the water-soluble biotin might enter through the bacilli membrane using mechanisms that are not yet identified, but only in supra-physiological concentrations of the nutrient. Similarly, the BioA inhibitor actithiazic acid also displays narrow spectrum activity against
Mycobacteria (
Ogata et al., 1973). Together, the restricted antibiotic spectrum is consistent with the genetic studies demonstrating
de novo biotin biosynthesis is essential in
Mycobacterium sp., but not other eubacteria.
FUTURE DIRECTIONS
In this review we have highlighted key studies that demonstrate biotin biosynthesis is an important metabolic process in
Mycobacteria. Why the bacilli have evolved such dependence upon their own synthesis, rather than scavenging from exogenous sources, is puzzling. This is especially so when one considers that biotin biosynthesis is an energetically expensive exercise requiring at least six enzymes and seven ATP equivalents to generate one biotin molecule (
Abdel-Hamid and Cronan, 2007). It is possible that the quantity of bioavailable biotin present inside mammalian host cells where the bacilli reside is so scarce that
de novo synthesis is a sound survival strategy. By applying genetics with modern research tools, such as proteomics and metabolomics, researchers can begin to dissect how metabolic enzymes and pathways are regulated in response to the niche microenvironments encountered inside host cells. In particular, this work will allow us to better understand the contribution of the biotin-dependent enzymes, pyruvate carboxylase and acyl CoA carboxylase, in metabolic adaptation. Additionally, the work highlighted in this review helps to establish the biotin biosynthesis pathway as a potential target for the development of new anti-TB agents. Especially important are studies that suggest this pathway is critical in the active growth phase as well as latency. Whilst the genetic validation studies are encouraging, the lack of pharmacological validation demands more work in this area. Towards this end, the recent availability of X-ray structures for BioA and BioD are likely to assist efforts in structure guided inhibitor design (
Dey et al., 2010).
Higher Education Press and Springer-Verlag Berlin Heidelberg 2011