First published October 24, 2019 - More info
Tuberculosis (TB) remains a major infectious disease worldwide. TB treatment displays a bi-phasic bacterial clearance, in which the majority of bacteria clear within the first month of treatment, but residual bacteria remains non-responsive to treatment and eventually may become resistant. Here, we have shown that Mycobacterium tuberculosis (M.tb) is taken up by mesenchymal stem cells (MSCs), where it established dormancy and became highly non-responsive to isoniazid, a major constituent of Directly Observed Treatment Short-course (DOTS). Dormant M.tb induced quiescence in MSCs and promoted their long-term survival. Unlike macrophages, where M.tb resides in early-phagosomal compartments, in MSCs the majority of bacilli were found in the cytosol, where they promoted rapid lipid-synthesis, hiding within lipid-droplets. Inhibition of lipid-synthesis prevented dormancy and sensitized the organisms to isoniazid. Thus, we have established that M.tb gains dormancy in MSCs, which thus serve as a long-term natural-reservoir of dormant M.tb. Interestingly, in the murine-model of TB, induction of autophagy eliminated M.tb from MSCs and consequently, the addition of rapamycin to an isoniazid treatment regimen successfully attained sterile clearance and prevented disease reactivation.