Modulation of Ferroptosis During Early Mycobacterium tuberculosis Infection Contributes to Beijing Lineage Strain SA161 Virulence

Although spread of internalized Mtb from the initial infected alveolar macrophages (AMs) is a crucial determinant of infection outcomes, the role of cell death in facilitating this spread, and how it is regulated by Mtb remains poorly understood. Ferroptosis, a lipid peroxidation-mediated form of necrotic cell death, contributes to pathology during later stages of infection. However, the role of ferroptosis in early AM cell death remains inadequately defined, and its induction during infection has been primarily studied with the laboratory strain, H37Rv. Using gene set variation analysis of single cell RNAseq data profiling Mtb-infected murine lungs, we found that the hypervirulent Beijing sublineage clinical strain SA161 is associated with an elevated pro-ferroptotic transcriptional response in AMs compared to H37Rv by 17 days post infection. Consistent with these transcriptional profiles, we found that SA161 induced increased lipid peroxidation in comparison to H37Rv during infection in vitro and in vivo. Administration of the lipid peroxidation inhibitor, ferrostatin-1 (Fer-1), reduces this Mtb-induced lipid peroxidation. Notably, we found that administration of Fer-1 to Mtb-infected mice significantly reduced bacterial burden for SA161 at 14 dpi while having no effect on H37Rv. Microscopic analysis of SA161-infected lung lesions at 14 dpi suggests that inhibition of ferroptosis-driving lipid peroxidation results in a greater proportion of AMs amongst infected cells and decreased neutrophil-associated IFN signaling. Collectively, these findings reveal that ferroptosis plays an important role during early infection with virulent clinical strains of Mtb by influencing bacterial spread and signaling of immune cell responders, potentially informing host-directed intervention strategies.