Metabolite-Enabled Eradication of Bacterial Persisters by Aminoglycosides

Bacterial persistence is a state in which a sub-population of dormant cells (persisters) tolerates antibiotic treatment(1-4). Bacterial persisters have been implicated in biofilms and chronic and recurrent infections(5-7). Despite this clinical relevance, there are currently no viable means for eradicating persisters. Here we show that specific metabolic stimuli enable aminoglycoside killing of both Gram-negative (Escherichia coli) and Gram-positive (Staphylococcus aureus) persisters. This potentiation is aminoglycoside-specific, does not rely on growth resumption, is effective in both aerobic and anaerobic conditions, and proceeds by generation of proton-motive force (PMF) which facilitates aminoglycoside uptake. Our results demonstrate that persisters, though dormant, are primed for metabolite uptake, central metabolism, and respiration. We show that aminoglycosides in combination with specific metabolites can be used to treat E. coli and S. aureus biofilms. Further, we demonstrate that this approach can improve treatment of chronic infection in a mouse urinary tract infection model. This work establishes a metabolic-based strategy for eradicating bacterial persisters and highlights the critical importance of metabolic environment to antibiotic treatment.