Carbohydrates are thought to comprise the principal carbon source for pathogenic bacteria in such diverse niches as the intestinal lumen
31, the host cell cytosol
32, and phagocyte vacuoles
33. In contrast, pathogenic mycobacteria isolated from the lungs of mice preferentially respire fatty acids rather than carbohydrates
6, and mycobacterial fatty acid metabolic genes are up-regulated in macrophages
34 and mice
16. A central role for fatty acid metabolism is further suggested by the extensive duplication of genes involved in lipid degradation in
M. tuberculosis13,14. Homologous gene pairs include
icl1 and
icl2 encoding isocitrate lyases of the glyoxylate cycle (). Previously, we reported that
icl1 is dispensable for acute-phase growth but essential for chronic-phase persistence in
M. tuberculosis-infected mice, and we proposed that
M. tuberculosis might switch to fatty acid catabolism at the transition from the acute to the chronic phase of infection
17. Here, we adduce evidence that
icl1 and
icl2 are jointly required for survival of
M. tuberculosis in macrophages and mice at early as well as late stages of infection, indicating that fatty acid catabolism has a more fundamental role during infection than we had previously thought. In future, the roles of ICL1 and ICL2 in chronic-phase persistence could be addressed using new technologies for conditional gene expression in mycobacteria
35,36. Our studies raise the possibility that drugs capable of inhibiting both ICL isoforms might have potent anti-mycobacterial activity. However, there are significant differences in TB pathology in mice and humans, and it is possible that the
in vivo metabolism of
M. tuberculosis might be influenced by these factors. Resolution of these issues will require studies on the role of the glyoxylate cycle in human disease.
Primacy of fatty acid metabolism and essentiality of the glyoxylate cycle do not rule out the possibility that
M. tuberculosis might also have access to carbohydrates
in vivo. During growth on all types of carbon substrates, bacteria must replenish intermediates of central metabolism that are siphoned off to biosynthetic pathways. Nutrient availability and growth rate determine which anaplerotic pathways are employed.
Escherichia coli uses PPC to synthesize oxaloacetate during rapid growth with excess glucose, but switches to the glyoxylate cycle during slow growth with limiting glucose
37. Similarly,
Corynebacterium glutamicum uses PPC or PCA to replenish oxaloacetate during growth on glucose
38 (), but switches to the glyoxylate cycle when growing on mixtures of glucose and fatty acids
26.
Adaptation of
M. tuberculosis to low concentrations of glycolytic substrates
in vivo could involve reduced flux of carbon through glycolysis in order to conserve glycolytic intermediates for essential biosynthetic processes. This idea is consistent with preliminary evidence that glucokinase and a putative carbohydrate transporter are essential for growth of
M. tuberculosis in mice, whereas the glycolytic steps catalyzed by triosephosphate isomerase, glyceraldehyde 3-phosphate dehydrogenase, and phosphoglycerate kinase are apparently dispensable
7. If correct, these observations suggest that during infection glycolysis is not the source of PEP, an essential biosynthetic precursor of aromatic amino acids and peptidoglycan. Instead, PEP could be generated by the sequential action of the glyoxylate cycle, which converts acetyl-CoA to oxaloacetate, and PCK, which decarboxylates oxaloacetate to PEP (). Consistent with this idea,
pckA (encoding PCK) is up-regulated in the lungs of
M. tuberculosis-infected mice
16 and is essential for virulence in
M. bovis9,10.
During infection,
M. tuberculosis could obtain fatty acids from the host cell by hydrolysis of cell membrane lipids
39; consistent with this possibility,
M. tuberculosis genes encoding exported phospholipases are jointly required for growth in the lungs of mice
40.
M. tuberculosis might also catabolize internal lipid reserves such as triacylglycerol, particularly during persistence
41. Beta-oxidation of odd-chain fatty acids generates both acetyl-CoA (C
2) and propionyl-CoA (C
3); the latter can be metabolized via the methylcitrate cycle (), which is required for propionate catabolism in fungi and eubacteria
42,43. The
M. tuberculosis genome encodes homologs of methylcitrate synthase (
prpC) and methylcitrate dehydratase (
prpD), which are up-regulated during infection of macrophages
34. Methylisocitrate lyase (
prpB) is apparently missing in
M. tuberculosis; however, ICLs show limited homology to methylisocitrate lyases and possess weak methylisocitrate lysase activity
44. These observations, and our finding that ICL1 and ICL2 are jointly required for growth of
M. tuberculosis on propionate (, ), raise the possibility that these enzymes might substitute for PrpB in the methylcitrate cycle.
Our studies demonstrate that the glyoxylate cycle is essential for
M. tuberculosis growth and persistence in macrophages and mice. We have presented structural and biological evidence indicating the feasibility of developing dual-specificity ICL1/ICL2 inhibitors as potential therapeutic agents for TB. Mutations in
icl1 and
icl2 could also be incorporated in the design of live attenuated vaccines that might be safe for use in immuno-suppressed individuals, such as individuals with HIV/AIDS. As a novel target for drug development, the glyoxylate cycle is attractive because it is apparently absent in mammalian cells
23 and is essential for virulence in other major pathogens, such as
Candida albicans19. There is an urgent need for new and better drugs to treat persistent infections like candidiasis and TB, which require lengthy treatment regimens with potentially toxic drugs, resulting in patient non-adherence, treatment failure, and drug resistance.