Auranofin exerts broad-spectrum bactericidal activities by targeting thiol-redox homeostasis

Significance The identification of new antibiotics with novel mechanisms of action has become a pressing need considering the growing threat of drug-resistant infections. We have identified auranofin, an FDA-approved drug, as having potent bactericidal activity against Gram-positive pathogenic bacteria. Auranofin inhibits an enzyme, thioredoxin reductase, not targeted by other antibiotics, and thus retains efficacy against many clinically relevant drug-resistant strains, including in a mouse model of infection. Because auranofin is an approved drug, its route to the clinic may be expedited with reduced cost. Our work suggests that auranofin is a candidate for drug repurposing in antibacterial therapy. Infections caused by antibiotic-resistant bacteria are a rising public health threat and make the identification of new antibiotics a priority. From a cell-based screen for bactericidal compounds against Mycobacterium tuberculosis under nutrient-deprivation conditions we identified auranofin, an orally bioavailable FDA-approved antirheumatic drug, as having potent bactericidal activities against both replicating and nonreplicating M. tuberculosis. We also found that auranofin is active against other Gram-positive bacteria, including Bacillus subtilis and Enterococcus faecalis, and drug-sensitive and drug-resistant strains of Enterococcus faecium and Staphylococcus aureus. Our biochemical studies showed that auranofin inhibits the bacterial thioredoxin reductase, a protein essential in many Gram-positive bacteria for maintaining the thiol-redox balance and protecting against reactive oxidative species. Auranofin decreases the reducing capacity of target bacteria, thereby sensitizing them to oxidative stress. Finally, auranofin was efficacious in a murine model of methicillin-resistant S. aureus infection. These results suggest that the thioredoxin-mediated redox cascade of Gram-positive pathogens is a valid target for the development of antibacterial drugs, and that the existing clinical agent auranofin may be repurposed to aid in the treatment of several important antibiotic-resistant pathogens.