Pyrazinoic acid, the active form of the first-line antituberculosis drug pyrazinamide, decreased the proton motive force and respiratory ATP synthesis rates in subcellular mycobacterial membrane assays. Pyrazinoic acid also significantly lowered cellular ATP levels in Mycobacterium bovis BCG. These results indicate that the predominant mechanism of killing by this drug may operate by depletion of cellular ATP reserves.Shortening tuberculosis treatment duration is a key objective in order to reduce noncompliance and to combat recently emerging multidrug-resistant strains of Mycobacterium tuberculosis (6,19,36). Pyrazinamide (PZA), an important first-line drug employed in tuberculosis chemotherapy, played a key role in shortening the duration of tuberculosis treatment from 9 months to 6 months (22). PZA is a sterilizing drug that efficiently kills populations of Mycobacterium tuberculosis residing in acidic environments, as found during active inflammation (1,7,10,11,20,21,28,32). Despite the importance of PZA, no cellular target proteins have been clearly identified (4,23,30,41), and its mechanism of action is probably the least understood among all first-and second-line antituberculosis drugs. A better understanding of PZA action may help in development of new drugs to further shorten tuberculosis treatment.PZA constitutes a prodrug that is hydrolyzed in the mycobacterial cell by pyrazinamidase to yield the active entity pyrazinoic acid (POA) (15,16). According to the hypothesis put forward by Zhang and colleagues, POA, a weak acid (pK a , 2.9), acts as an uncoupling agent by breaking down the bacterial membrane potential (39,40). POA in its unprotonated form can leave the cell by means of an unknown efflux system (37, 40), take up a proton in the acidic environment, and enter the mycobacterial cell again in its protonated, less polar form (39). The resultant decrease in proton motive force then blocks, among other processes, uptake of metabolites required for growth (40). However, it is not known whether the decreased membrane potential observed for PZA in whole mycobacterial cells (40) is due to the postulated uncoupling effect or indirectly caused by interference of PZA or POA with other cellular targets. Moreover, the impact of POA on respiratory ATP synthesis and on cellular ATP levels has not been investigated. In the present study, we used subcellular and cellular assays to address these open issues. We used M. bovis BCG, which is resistant to PZA due to mutations in pyrazinamidase (16,29,30) but is fully susceptible to POA (15, 31, 37), as a model system.POA directly interferes with the proton motive force. We isolated membrane vesicles from M. bovis BCG as previously reported (9). In this subcellular system, the cytosolic fraction is removed, allowing a more specific investigation of drug action directed to membrane components (8, 9). First we determined whether pyrazinoic acid (POA) directly interferes with the proton motive force. The proton motive force was monitored with the ACMA (9-amino-6-chloro-2...