Drug
resistant pathogens are on the rise, and new treatments are
needed for bacterial infections. Efforts toward antimicrobial discovery
typically identify compounds that prevent bacterial growth in microbiological
media. However, the microenvironments to which pathogens are exposed
during infection differ from rich media and alter the biology of the
pathogen. We and others have therefore developed screening platforms
that identify compounds that disrupt pathogen growth within cultured
mammalian cells. Our platform focuses on Gram-negative bacterial pathogens,
which are of particular clinical concern. We screened a panel of 707
drugs to identify those with efficacy against Salmonella enterica Typhimurium growth within macrophages. One of the drugs identified,
clofazimine (CFZ), is an antibiotic used to treat mycobacterial infections
that is not recognized for potency against Gram-negative bacteria.
We demonstrated that in macrophages CFZ enabled the killing of S. Typhimurium at single digit micromolar concentrations,
and in mice, CFZ reduced tissue colonization. We confirmed that CFZ
does not inhibit the growth of S. Typhimurium
and E. coli in standard microbiological media.
However, CFZ prevents bacterial replication under conditions consistent
with the microenvironment of macrophage phagosomes, in which S. Typhimurium resides during infection: low pH, low
magnesium and phosphate, and the presence of certain cationic antimicrobial
peptides. These observations suggest that in macrophages and mice
the efficacy of CFZ against S. Typhimurium is
facilitated by multiple aspects of soluble innate immunity. Thus,
systematic screens of existing drugs for infection-based potency are
likely to identify unexpected opportunities for repurposing drugs
to treat difficult pathogens.