Francisella tularensis is a highly infectious Gram-negative intracellular pathogen that causes tularemia. Because of its potential as a bioterrorism agent, there is a need for new therapeutic agents. We therefore developed a whole animal Caenorhabditis elegans-F. tularensis pathosystem for high throughput screening to identify and characterize potential therapeutic compounds. We found that the C. elegans p38 MAP kinase cascade is involved in the immune response to F. tularensis and we developed a robust F. tularensis-mediated C. elegans killing assay with a Z'-factor consistently >0.5, which was then utilized to screen a library of FDA approved compounds that included 1,760 small molecules. In addition to clinically used antibiotics, 5 FDA-approved drugs were also identified as potential hits, including the anti-inflammatory drug diflunisal that showed anti-F. tularensis activity in vitro. Moreover, the NSAID diflunisal, at 4X MIC, blocked the replication of a F. tularensis live vaccine strain (LVS) in primary human macrophages and non-phagocytic cells. Diflunisal was non-toxic to human erythrocytes and HepG2 human liver cells at concentrations ≥32-μg/ml. Finally, diflunisal exhibited synergetic activity with the antibiotic ciprofloxacin in both a checkerboard assay and a macrophage infection assay. In conclusion, the liquid C. elegans — F. tularensis LVS assay described here allows screening for anti-F. tularensis compounds and suggests that diflunisal could potentially be repurposed for the management of tularemia.
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