ATP burst is the dominant driver of antibiotic lethality in Mycobacteria

Reviewer #1 (Public review):

Summary:

Lodhiya et al. demonstrate that antibiotics with distinct mechanisms of action, norfloxacin, and streptomycin, cause similar metabolic dysfunction in the model organism Mycobacterium smegmatis. This includes enhanced flux through the TCA cycle and respiration as well as a build-up of reactive oxygen species (ROS) and ATP. Genetic and/or pharmacologic depression of ROS or ATP levels protect M. smegmatis from norfloxacin and streptomycin killing. Because ATP depression is protective, but in some cases does not depress ROS, the authors surmise that excessive ATP is the primary mechanism by which norfloxacin and streptomycin kill M. smegmatis. In general, the experiments are carefully executed; alternative hypotheses are discussed and considered; the data are contextualized within the existing literature. Clarification of the effect of 1) ROS depression on ATP levels and 2) ADP vs. ATP on divalent metal chelation would strengthen the paper, as would discussion of points of difference with the existing literature. The authors might also consider removing Figures 9 and 10A-B as they distract from the main point of the paper and appear to be the beginning of a new story rather than the end of the current one. Finally, statistics need some attention.

Strengths:

The authors tackle a problem that is both biologically interesting and medically impactful, namely, the mechanism of antibiotic-induced cell death.

Experiments are carefully executed, for example, numerous dose- and time-dependency studies; multiple, orthogonal readouts for ROS; and several methods for pharmacological and genetic depletion of ATP.

There has been a lot of excitement and controversy in the field, and the authors do a nice job of situating their work in this larger context.

Inherent limitations to some of their approaches are acknowledged and discussed e.g., normalizing ATP levels to viable counts of bacteria.

Weaknesses:

The authors have shown that treatments that depress ATP do not necessarily repress ROS, and therefore conclude that ATP is the primary cause of norfloxacin and streptomycin lethality for M. smegmatis. Indeed, this is the most impactful claim of the paper. However, GSH and dipyridyl beautifully rescue viability. Do these and other ROS-repressing treatments impact ATP levels? If not, the authors should consider a more nuanced model and revise the title, abstract, and text accordingly.

Does ADP chelate divalent metal ions to the same extent as ATP? If so, it is difficult to understand how conversion of ADP to ATP by ATP synthase would alter metal sequestration without concomitant burst in ADP levels.

Some of the results in the paper diverge from what has been previously reported by some of the referenced literature. These discrepancies should be clarified.

Reviewer #2 (Public review):

Summary:

The authors are trying to test the hypothesis that ATP bursts are the predominant driver of antibiotic lethality of Mycobacteria.

Strengths:

This reviewer has not identified any significant strengths of the paper in its current form.

Weaknesses:

A major weakness is that M. smegmatis has a doubling time of three hours and the authors are trying to conclude that their data would reflect the physiology of M. tuberculossi which has a doubling time of 24 hours. Moreover, the authors try to compare OD measurements with CFU counts and thus observe great variabilities.

If the authors had evidence to support the conclusion that ATP burst is the predominant driver of antibiotic lethality in mycobacteria then this paper would be highly significant. However, with the way the paper is written, it is impossible to make this conclusion.

Author response:

Reviewer #1 (Public review):

Summary:

Lodhiya et al. demonstrate that antibiotics with distinct mechanisms of action, norfloxacin, and streptomycin, cause similar metabolic dysfunction in the model organism Mycobacterium smegmatis. This includes enhanced flux through the TCA cycle and respiration as well as a build-up of reactive oxygen species (ROS) and ATP. Genetic and/or pharmacologic depression of ROS or ATP levels protect M. smegmatis from norfloxacin and streptomycin killing. Because ATP depression is protective, but in some cases does not depress ROS, the authors surmise that excessive ATP is the primary mechanism by which norfloxacin and streptomycin kill M. smegmatis. In general, the experiments are carefully executed; alternative hypotheses are discussed and considered; the data are contextualized within the existing literature. Clarification of the effect of 1) ROS depression on ATP levels and 2) ADP vs. ATP on divalent metal chelation would strengthen the paper, as would discussion of points of difference with the existing literature. The authors might also consider removing Figures 9 and 10A-B as they distract from the main point of the paper and appear to be the beginning of a new story rather than the end of the current one. Finally, statistics need some attention.

Strengths:

The authors tackle a problem that is both biologically interesting and medically impactful, namely, the mechanism of antibiotic-induced cell death.

Experiments are carefully executed, for example, numerous dose- and time-dependency studies; multiple, orthogonal readouts for ROS; and several methods for pharmacological and genetic depletion of ATP.

There has been a lot of excitement and controversy in the field, and the authors do a nice job of situating their work in this larger context.

Inherent limitations to some of their approaches are acknowledged and discussed e.g., normalizing ATP levels to viable counts of bacteria.

We sincerely thanks appreciate the reviewer’s encouraging feedback.

Weaknesses:

The authors have shown that treatments that depress ATP do not necessarily repress ROS, and therefore conclude that ATP is the primary cause of norfloxacin and streptomycin lethality for M. smegmatis. Indeed, this is the most impactful claim of the paper. However, GSH and dipyridyl beautifully rescue viability. Do these and other ROS-repressing treatments impact ATP levels? If not, the authors should consider a more nuanced model and revise the title, abstract, and text accordingly.

We thank the reviewer for asking this question. In the revised version of the manuscript, we will include data on the impact of the antioxidant GSH on ATP levels.

Does ADP chelate divalent metal ions to the same extent as ATP? If so, it is difficult to understand how conversion of ADP to ATP by ATP synthase would alter metal sequestration without concomitant burst in ADP levels.

We sincerely thank the reviewer for raising this insightful question. Indeed, ADP and AMP can also form complexes with divalent metal ions; however, these complexes tend to be less stable. According to the existing literature, ATP-metal ion complexes exhibit a higher formation constant compared to ADP or AMP complexes. This has been attributed to the polyphosphate chain of ATP, which acts as an active site, forming a highly stable tridentate structure (Khan et al., 1962; Distefano et al., 1953). An antibiotic-induced increase in ATP levels, irrespective of any changes in ADP levels, could still result in the formation of more stable complexes with metal ions, potentially leading to metal ion depletion. Although recent studies indicate that antibiotic treatment stimulates purine biosynthesis (Lobritz MA et al., 2022; Yang JH et al., 2019), thereby imposing energy demands and enhancing ATP production, the possibility of a corresponding increase in total purine nucleotide levels (ADP+ATP) exist (is mentioned in discussion section). However, this hypothesis requires further investigation.

Khan MMT, Martell AE. Metal Chelates of Adenosine Triphosphate. Journal of Physical Chemistry (US). 1962 Jan 1;Vol: 66(1):10–5

Distefano v, Neuman wf. Calcium complexes of adenosinetriphosphate and adenosinediphosphate and their significance in calcification in vitro. Journal of Biological Chemistry. 1953 Feb 1;200(2):759–63

Lobritz MA, Andrews IW, Braff D, Porter CBM, Gutierrez A, Furuta Y, et al. Increased energy demand from anabolic-catabolic processes drives β-lactam antibiotic lethality. Cell Chem Biol [Internet]. 2022 Feb 17.

Yang JH, Wright SN, Hamblin M, McCloskey D, Alcantar MA, Schrübbers L, et al. A White-Box Machine Learning Approach for Revealing Antibiotic Mechanisms of Action. Cell [Internet]. 2019 May 30

Some of the results in the paper diverge from what has been previously reported by some of the referenced literature. These discrepancies should be clarified.

We apologize for any confusion, but we are uncertain about the specific discrepancies the reviewer is referring. In the discussion section, we have addressed and analysed our results within the broader context of the existing literature, regardless of whether our findings align with or differ from previous studies.

Reviewer #2 (Public review):

Summary:

The authors are trying to test the hypothesis that ATP bursts are the predominant driver of antibiotic lethality of Mycobacteria.

Strengths:

This reviewer has not identified any significant strengths of the paper in its current form.

Weaknesses:

A major weakness is that M. smegmatis has a doubling time of three hours and the authors are trying to conclude that their data would reflect the physiology of M. tuberculosis which has a doubling time of 24 hours. Moreover, the authors try to compare OD measurements with CFU counts and thus observe great variabilities.

If the authors had evidence to support the conclusion that ATP burst is the predominant driver of antibiotic lethality in mycobacteria then this paper would be highly significant. However, with the way the paper is written, it is impossible to make this conclusion.

We have identified this new mechanism of antibiotic action in Mycobacterium smegmatis and have also mentioned that whether and how much of this mechanism is true in other organism needs to be tested as argued extensively in the discussion section of the manuscript.

We have always drawn inferences from the CFU counts as the OD600nm is never a reliable method as reported in all of our experiments.