UBR-1 deficiency leads to ivermectin resistance in C. elegans

Reviewer #1 (Public review):

Summary:

The drug Ivermectin is used to effectively treat a variety of worm parasites in the world, however resistance to Ivermectin poses a rising challenge for this treatment strategy. In this study, the authors found that loss of the E3 ubiquitin ligase UBR-1 in the worm C. elegans results in resistance to Ivermectin. In particular, the authors found that ubr-1 mutants are resistant to the effects of Ivermectin on worm viability, body size, pharyngeal pumping, and locomotion. The authors previously showed that loss of UBR-1 disrupts homeostasis of the amino acid and neurotransmitter glutamate resulting in increased levels of glutamate in C. elegans. Here, the authors found that the sensitivity of ubr-1 mutants to Ivermectin can be restored if glutamate levels are reduced using a variety of different methods. Conversely, treating worms with exogenous glutamate to increase glutamate levels also results in resistance to Ivermectin supporting the idea that increased glutamate promotes resistance to Ivermectin. The authors found that the primary known targets of Ivermectin, glutamate-gated chloride channels (GluCls), are downregulated in ubr-1 mutants providing a plausible mechanism for why ubr-1 mutants are resistant to Ivermectin. Although it is clear that loss of GluCls can lead to resistance to Ivermectin, this study suggests that one potential mechanism to decrease GluCl expression is via disruption of glutamate homeostasis that leads to increased glutamate. This study suggests that if parasitic worms become resistant to Ivermectin due to increased glutamate, their sensitivity to Ivermectin could be restored by reducing glutamate levels using drugs such as Ceftriaxone in a combination drug treatment strategy.

Strengths:

(1) The use of multiple independent assays (i.e., viability, body size, pharyngeal pumping, locomotion, and serotonin-stimulated pharyngeal muscle activity) to monitor the effects of Ivermectin

(2) The use of multiple independent approaches (got-1, eat-4, ceftriaxone drug, exogenous glutamate treatment) to alter glutamate levels to support the conclusion that increased glutamate in ubr-1 mutants contributes to Ivermectin resistance.

Weaknesses:

(1) The primary target of Ivermectin is GluCls so it is not surprising that alteration of GluCl expression or function would lead to Ivermectin resistance.

(2) It remains to be seen what percent of Ivermectin-resistant parasites in the wild have disrupted glutamate homeostasis as opposed to mutations that more directly decrease GluCl expression or function.

Reviewer #2 (Public review):

Summary:

The authors provide a very thorough investigation of the role of UBR-1 in anthelmintic resistance using the non-parasitic nematode, C. elegans. Anthelmintic resistance to macrocyclic lactones is a major problem in veterinary medicine and likely just a matter of time until resistance emerges in human parasites too. Therefore, this study providing novel insight into the mechanisms of ivermectin resistance is particularly important and significant.

Strengths:

The authors use very diverse technologies (behavior, genetics, pharmacology, genetically encoded reporters) to dissect the role of UBR-1 in ivermectin resistance. Deploying such a comprehensive suite of tools and approaches provides exceptional insight into the mechanism of how UBR-1 functions in terms of ivermectin resistance.

Weaknesses:

I do not see any major weaknesses in this study. My only concern is whether the observations made by the authors would translate to any of the important parasitic helminths in which resistance has naturally emerged in the field. This is always a concern when leveraging a non-parasitic nematode to shed light on a potential mechanism of resistance of parasitic nematodes, and I understand that it is likely beyond the scope of this paper to test some of their results in parasitic nematodes.

Reviewer #3 (Public review):

Summary:

Li et al propose to better understand the mechanisms of drug resistance in nematode parasites by studying mutants of the model roundworm C. elegans that are resistant to the deworming drug ivermectin. They provide compelling evidence that loss-of-function mutations in the E3 ubiquitin ligase encoded by the UBR-1 gene make worms resistant to the effects of ivermectin (and related compounds) on viability, body size, pharyngeal pumping rate, and locomotion and that these mutant phenotypes are rescued by a UBR-1 transgene. They propose that the mechanism is resistance is indirect, via the effects of UBR-1 on glutamate production. They show mutations (vesicular glutamate transporter eat-4, glutamate synthase got-1) and drugs (glutamate, glutamate uptake enhancer ceftriaxone) affecting glutamate metabolism/transport modulate sensitivity to ivermectin in wild-type and ubr-1 mutants. The data are generally consistent with greater glutamate tone equating to ivermectin resistance. Finally, they show that manipulations that are expected to increase glutamate tone appear to reduce expression of the targets of ivermectin, the glutamate-gated chloride channels, which is known to increase resistance.

There is a need for genetic markers of ivermectin resistance in livestock parasites that can be used to better track resistance and to tailor drug treatment. The discovery of UBR-1 as a resistance gene in C. elegans will provide a candidate marker that can be followed up in parasites. The data suggest Ceftriaxone would be a candidate compound to reverse resistance.

Strengths:

The strength of the study is the thoroughness of the analysis and the quality of the data. There can be little doubt that ubr-1 mutations do indeed confer ivermectin resistance. The use of both rescue constructs and RNAi to validate mutant phenotypes is notable. Further, the variety of manipulations they use to affect glutamate metabolism/transport makes a compelling argument for some kind of role for glutamate in resistance.

Weaknesses:

The proposed mechanism of ubr-1 resistance i.e.: UBR-1 E3 ligase regulates glutamate tone which regulates ivermectin receptor expression, is broadly consistent with the data but somewhat difficult to reconcile with the specific functions of the genes regulating glutamatergic tone. Ceftriaxone and eat-4 mutants reduce extracellular/synaptic glutamate concentrations by sequestering available glutamate in neurons, suggesting that it is extracellular glutamate that is important. But then why does rescuing ubr-1 specifically in the pharyngeal muscle have such a strong effect on ivermectin sensitivity? Is glutamate leaking out of the pharyngeal muscle into the extracellular space/synapse? Is it possible that UBR-1 acts directly on the avr-15 subunit, both of which are expressed in the muscle, perhaps as part of a glutamate sensing/homeostasis mechanism?

The use of single ivermectin dose assays can be misleading. A response change at a single dose shows that the dose-response curve has shifted, but the response is not linear with dose, so the degree of that shift may be difficult to discern and may result from a change in slope but not EC50.

Similarly, in Figure 3C, the reader is meant to understand that eat-4 mutant is epistatic to ubr-1 because the double mutant has a wild-type response to ivermectin. But eat-4 alone is more sensitive, so (eyeballing it and interpolating) the shift in EC50 caused by the ubr-1 mutant in a wild type background appears to be the same as in an eat-4 background, so arguably you are seeing an additive effect, not epistasis. For the above reasons, it would be desirable to have results for rescuing constructs in a wild-type background, in addition to the mutant background.

The added value of the pumping data in Figure 5 (using calcium imaging) over the pump counts (from video) in Figure 1G, Figure 2E, F, K, & Figure 3D, H is not clearly explained. It may have to do with the use of "dissected" pharynxes, the nature/advantage of which is not sufficiently documented in the Methods/Results.

Author response:

We would like to express our sincere gratitude to both of you, and the reviewers, for the time and effort you have invested in reviewing our manuscript. We greatly appreciate the constructive feedback provided and are committed to addressing the suggested revisions.

In response to the public reviews, we would like to outline the following plan of action:

(1) Addressing Weaknesses in the Manuscript: We have carefully considered the comments regarding the weaknesses identified in the manuscript. Specifically, we will:

- Provide further clarification on the mechanism of IVM resistance in our study.

- Expand our discussion of the limitations and future directions of the research, addressing the concerns related to the potential translation of our findings to parasitic nematodes.

(2) Additional Experiments: We are currently conducting additional experiments to address the reviewers' suggestions, which include:

- Testing whether the overexpression of a relevant GluCl, such as AVR-15, can restore Ivermectin sensitivity in ubr-1 mutants.

- Examining the impact of Ceftriaxone treatment on the Ivermectin resistance in worms lacking key GluCls, such as avr-15, avr-14, and glc-1.

- Incorporating an analysis of major human parasitic nematodes in the phylogeny and discussing the conservation of relevant mechanisms across species.

- Double-checking the Dye filling (Dyf) phenotype in ubr-1 mutants, as suggested.

(3) Point-by-Point response: We will respond to both sets of comments (public reviews and editorial recommendations) in a comprehensive point-by-point manner in the revised manuscript.

(4) Timely Revisions: We aim to complete all revisions within a single round, ensuring that we address all comments thoroughly while maintaining the integrity of the data.