Macrophage Cholesterol Homeostasis Underpins the role of Sertraline as an Adjunctive Agent in Tuberculosis Therapy.

Cellular metabolism plays a deterministic role in the macrophage responses to intracellular pathogens such as Mycobacterium tuberculosis (Mtb) and infection control. Here, we demonstrate that the significant rewiring of the macrophage cholesterol metabolism by sertraline (SRT), an FDA-approved antidepressant, effectively enhances bacterial control. SRT, by virtue of its potent cationic amphiphilicity leads to the accumulation of lysosomal cholesterol in macrophages and activating the transcription factor SREBP2 and enhancing cholesterol biosynthesis. By specific gene silencing and biochemical inhibition assays, we further demonstrate that this metabolic reprogramming promotes lysosomal membrane permeabilization, mitochondrial reactive oxygen species (ROS) generation, heightened IL-1{beta} release, collectively enhancing macrophage bactericidal activity. Our results thus highlight a previously underappreciated link between cholesterol homeostasis and inflammasome activation, which contributes to improved Mtb clearance in the presence of adjunctive sertraline therapy. Statement of significanceTuberculosis remains a leading cause of global mortality, and treatment success is limited due to a long treatment regimen. This study identifies macrophage cholesterol homeostasis as a central pathway to enhance anti-tubercular therapy. We show that Sertraline, an FDA-approved antidepressant, a cationic amphiphilic drug (CAD), reprograms cholesterol trafficking through NPC1 inhibition. This drives the consequential processing of the master regulator SREBP2, accompanied by lysosomal membrane permeabilization. Collectively, these lead to mitochondrial ROS production and activation of NLRP3 signalling, boosting inflammasome-mediated bacterial clearance. By establishing cholesterol sequestration as the mechanistic basis of host-directed activity of sertraline and distinguishing it from ineffective CADs, our work provides a mechanistic framework for developing cholesterol-modulating host-directed adjuncts to improve TB treatment outcomes. Graphical abstract: SRT induced lysosomal cholesterol accumulation results in enhanced bacterial control via inflammasome activation O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=101 SRC="FIGDIR/small/665474v3_ufig1.gif" ALT="Figure 1"> View larger version (34K): org.highwire.dtl.DTLVardef@1019b4dorg.highwire.dtl.DTLVardef@7b0ae8org.highwire.dtl.DTLVardef@9297eorg.highwire.dtl.DTLVardef@1832bef_HPS_FORMAT_FIGEXP M_FIG C_FIG