Tuberculosis remains one of humankind's greatest killers, and new therapeutic strategies are needed to combat the causative agent, Mycobacterium tuberculosis, which is rapidly developing resistance to conventional antibiotics. Using the highly demanding guinea pig model of pulmonary tuberculosis, we have investigated the feasibility of inhibiting M. tuberculosis glutamine synthetase (GS), an enzyme that plays a key role in both nitrogen metabolism and cell wall biosynthesis, as a novel antibiotic strategy. In guinea pigs challenged by aerosol with the highly virulent Erdman strain of M. tuberculosis, the GS inhibitor L-methionine-SR-sulfoximine (MSO) protected the animals against weight loss, a hallmark of tuberculosis, and against the growth of M. tuberculosis in the lungs and spleen; MSO reduced the CFU of M. tuberculosis at 10 weeks after challenge by ϳ0.7 log unit compared with that in control animals. MSO acted synergistically with isoniazid in protecting animals against weight loss and bacterial growth, reducing the CFU in the lungs and spleen by ϳ1.5 log units below the level seen with isoniazid alone. In the presence of ascorbate, which allows treatment with a higher dose, MSO was highly efficacious, reducing the CFU in the lungs and spleen by 2.5 log units compared with that in control animals. This study demonstrates that inhibition of M. tuberculosis GS is a feasible therapeutic strategy against this pathogen and supports the concept that M. tuberculosis enzymes involved in cell wall biosynthesis, including major secretory proteins, have potential as antibiotic targets.Tuberculosis remains one of the world's major health problems and the leading cause of death from a single infectious agent. Compounding the problem, strains of Mycobacterium tuberculosis, the primary causative agent of tuberculosis, that are resistant to the major drugs used to treat tuberculosis are rapidly emerging worldwide (3,14). The World Health Organization has declared tuberculosis a global emergency, the first disease so designated.New therapeutic strategies to combat M. tuberculosis are urgently needed. In previous studies in this laboratory, the enzyme glutamine synthetase (GS) (E.C. 6.3.1.2) was identified as a potential antibiotic target (6, 7). In addition to its wellcharacterized role in nitrogen metabolism, in pathogenic mycobacteria GS appears to play an important role in cell wall biosynthesis, specifically, the synthesis of a poly-L-glutamateglutamine cell wall component found exclusively in pathogenic mycobacteria. Treatment of M. tuberculosis with the GS inhibitor L-methionine-SR-sulfoximine (MSO) or with antisense oligodeoxyribonucleotides specific to M. tuberculosis GS mRNA inhibits the formation of the poly-L-glutamate-glutamine cell wall structure (6, 9). Paralleling this effect, these agents also inhibit bacterial growth, indicating that the enzyme plays an important role in bacterial homeostasis (6, 9). MSO selectively blocks the growth in broth cultures of pathogenic mycobacteria, including M. tuberculosis, ...