One Sentence Summary: Potent antimicrobial activity of human MAIT cells overcomes carbapenem-resistance in control of Escherichia coli Category of manuscript: Research Article. Abstract word count: 220 References: 69 Display items: 6 figures, 7 supplementary figures, 3 supplementary tables. Word count incl. main text, references, and figure legends: 10041. 3 Abstract Mucosa-associated invariant T (MAIT) cells are abundant antimicrobial T cells in humans, and recognize antigens derived from the microbial riboflavin biosynthetic pathway presented by the MHC-Ib-related protein (MR1). However, the mechanisms responsible for MAIT cell antimicrobial activity are not fully understood, and the efficacy of these mechanisms against antibiotic resistant bacteria has not been explored. Here, we show that MAIT cells mediate MR1restricted antimicrobial activity against E. coli clinical strains in a manner dependent on the activity of cytolytic proteins, but independent of production of pro-inflammatory cytokines or induction of apoptosis in infected cells. The combined action of the pore-forming antimicrobial protein granulysin and the serine protease granzyme B released in response to TCR-mediated recognition of MR1-presented antigen is essential to mediate control against both cell-associated and free-living E. coli. Furthermore, MAIT cell-mediated bacterial control extend to multidrugresistant E. coli primary clinical isolates additionally resistant to carbapenems, a class of last resort antibiotics. Notably, high levels of granulysin and granzyme B in the MAIT cell secretomes directly damage bacterial cells by increasing their permeability, rendering initially resistant E. coli susceptible to the bactericidal activity of carbapenems. These findings define the role of cytolytic effector proteins in MAIT cell-mediated antimicrobial activity, and indicate that granulysin and granzyme B synergize to restore carbapenem bactericidal activity and overcome carbapenem resistance in E. coli. 4 [Main Text: ] Introduction Mucosa-associated invariant T (MAIT) cells are innate-like T cells that are highly abundant in mucosal tissues, the liver, lungs and gastrotintestinal tract, and in peripheral blood [1]. MAIT cells are mostly CD8α + [2, 3], express a semi-invariant T cell receptor (TCR), and recognize antigens in complex with the MHC-Ib-related protein (MR1) [4]. MR1 displays an extraordinary level of evolutionary conservation among placental and marsupial mammals [5], strongly supporting the notion that MR1 and MAIT cells perform critical functions in the immune system. The MR1presented antigens recognized by MAIT cells are derivatives of intermediates in the microbial synthesis of vitamin B 2 (riboflavin) and are produced by many bacteria [6-8]. Riboflavin is a critical component in a wide variety of bacterial cellular processes [9]. MAIT cells are thus able to recognize and respond to a broad set of bacteria [10]. Following TCR-mediated recognition of MR1-presented bacterial riboflavin metabolite antigens, MAIT cells rapidly media...