ANTIBITOIC TREATMENT FOR TUBERCULOSIS INDUCES A PROFOUND DYSBIOSIS OF THE GUT MICROBIOME THAT PERSISTS LONG AFTER THERAPY IS COMPLETED A Thesis Presented to the Faculty of the Weill Cornell Graduate School of Medical Sciences in Partial Fulfillment of the Requirements for the Degree of Masters of Science by Matthew F. Wipperman May 2017 © 2017 Matthew F. Wipperman ABSTRACT Mycobacterium tuberculosis, the cause of Tuberculosis (TB), infects one third of the world’s population and causes substantial mortality worldwide. In its shortest format, treatment of drug sensitive TB requires six months of multidrug therapy with a mixture of broad spectrum and mycobacterial specific antibiotics, and treatment of multidrug resistant TB is much longer. The widespread use of this regimen worldwide makes this one the largest exposures of humans to antimicrobials, yet the effects of antimycobacterial agents on intestinal microbiome composition and long term stability are unknown. We compared the microbiome composition, assessed by both 16S rDNA and metagenomic DNA sequencing, of Haitian TB cases during antimycobacterial treatment and following cure by 6 months of TB therapy. TB treatment does not perturb overall diversity, but nonetheless dramatically depletes multiple immunologically significant commensal bacteria. The perturbation by TB therapy lasts at least 1.5 years after completion of treatment, indicating that the effects of TB treatment are long lasting and perhaps permanent. These results demonstrate that TB treatment has dramatic and durable effects on the intestinal microbiome and highlight unexpected extreme consequences of treatment for the world’s most common infection on human ecology. BIOGRAPHICAL SKETCH NAME POSITION TITLE Wipperman, Matthew Frederick Postdoctoral Researcher at eRA COMMONS USER NAME Memorial Sloan Kettering Cancer Center MFWIPPERMAN DEGREE INSTITUTION AND (if MM/YY FIELD OF STUDY LOCATION applicable) Franklin & Marshall College B.A. 2007 – 2011 Chemistry Lancaster, Pennsylvania Stony Brook University Chemistry and Chemical Ph.D. 2011 – 2015 Stony Brook, New York Biology Stony Brook Medicine Certificate 2013 – 2014 Biomedical science Stony Brook, New York Weill Cornell Medicine Clinical and translational M.Sc. 2015 – 2017 New York, New York research Memorial Sloan Kettering Cancer Center N/A 2015 – present Postdoctoral research New York, New York A. Personal Statement I am interested in using basic science to answer relevant questions in biomedical and translational scientific research. As an undergraduate I had the opportunity to work for four years under Dr. Phyllis Leber, who is a recognized expert in physical organic chemistry. My introduction to laboratory science during this time involved organic synthesis and physical chemistry techniques. I helped provide evidence that multicyclic vinylcyclobutanes rearrange to cyclohexenes via a diradical intermediate. Additionally, I helped characterize the properties of these diradical transition structures, helping to elucidate the mechanics of this class of pericyclic reactions. In graduate school, I worked under Dr. Nicole Sampson, a chemist and chemical biologist, which is where I learned techniques from classical biochemistry. I helped discover and characterize a new class of enzymes that make it possible for M. tuberculosis to metabolize steroids like cholesterol, synthesized chemical inhibitors that could target these enzymes, and helped to elucidate the steps of the cholesterol catabolic pathway. Additionally, I obtained a Certificate in iii Biomedical Science at Stony Brook Medicine, and pursued a translational research project involving the development of pediatric biomarkers for TB disease using cholesterol metabolism as an indicator. Under the guidance of my graduate school co-mentor Dr. Sharon Nachman, I traveled to South Africa and went though the process of obtaining clinical blood samples for my research. This experience helped to form my current interests in using scientific tools to answer questions related to human health. In my current postdoctoral position under Dr. Michael Glickman, a distinguished physician- scientist, I am involved with a large translational research project studying immune and microbiomic predictors of innate resistance to Tuberculosis (TB) infection. I study how the microbiome may affect other aspects of immune function, and how the various stages of TB infection and TB treatment alter microbiomic composition in the short and the long term. Additionally, I am investigating Mycobacterial RecA and how its regulation via phosphorylation affects DNA repair. The interplay between basic science and the clinic interests me greatly. I enjoy working with a multidisciplinary network of individuals to answer medical questions using basic science and technology. I have a history as a highly motivated and self-sufficient researcher who communicates and works well both independently and with others. B. Positions and Honors Experience and Professional Memberships 2010 – Member, American Chemical Society Honors 2012 Best Communicated Research (STEM) Award, Postdoctoral Research Symposium, Stony Brook University 2013 Scholarship, Scholars in the Biomedical Sciences at Stony Brook University C. Contributions to Science 1. Tuberculosis continues to plague humanity as the number one killer of an infectious disease, and although much is known about what risk factors contribute to TB pathogenesis, virtually nothing is known about how the gut microbiome contributes to this risk. I integrated the research fields of TB and the microbiome using clinical samples from cross sectional and cohort studies to demonstrate microbiomic differences between different groups of people. I demonstrated how TB antibiotics affect the microbiome during and post treatment, and have correlated this to immunological health using RNAseq and immunophenotyping. • Matthew F. Wipperman, Dan Fitzgerald, Ying Taur, Sivaranjani Namasivayam, Alan Sher, James M. Bean, Vanni Bucci, Michael S. iv Glickman. Antibiotic treatment for Tuberculosis induces a profound dysbiosis of the microbiome that persists long after completion of therapy. Scientific Reviews, 2017, submitted. • Sivaranjani Namasivayam, Mamoudou Maiga, Wuxing Yuan, Vishal Thovarai, Diego L. Costa, Lara R. Mittereder, Matthew F. Wipperman, Michael S. Glickman, Amiran Dzutsev, Giorgio, Trinchieri, Alan Sher. Longitudinal profiling reveals a persistent intestinal dysbiosis triggered by conventional antituberculosis therapy. Microbiome. 2017, 5:71. doi: 10.1186/s40168-017-0286-2. 2. The bacterial catabolism of steroids like cholesterol has been described for more than a century, however only recently has this process been implicated in disease pathogenesis, specifically of M. tuberculosis. I discovered and characterized a new class of acyl-CoA dehydrogenase enzymes using biochemical and bioinformatics techniques, and demonstrated their evolutionary distribution. I additionally synthesized an azasteroid inhibitor scaffold of these enzymes. • Matthew F. Wipperman, Meng Yang, Suzanne T. Thomas, and Nicole S. Sampson. Shrinking the FadE proteome of Mycobacterium tuberculosis: Insights into cholesterol metabolism through identification of an a2b2 heterotetrameric acyl coenzyme A dehydrogenase family. Journal of Bacteriology. 2013. J. Bacteriol. 195, 4331–4341. doi: 10.1128/JB.00502-13; PMCID: PMC3807453. • Commentary: Journal of Bacteriology: Voskuil, M. I. Mycobacterium tuberculosis cholesterol catabolism requires a new class of acyl coenzyme A dehydrogenase. 2013. J. Bacteriol. 195, 4319–4321. doi: 10.1128/JB.00867-13; PMCID: PMC3807469 • Highlighted on the cover of the Journal of Bacteriology for the October, 2013 edition. http://jb.asm.org/content/195/19.cover- expansion • Matthew F. Wipperman, Nicole S. Sampson, and Suzanne T. Thomas. Pathogen roid rage: Cholesterol utilization by Mycobacterium tuberculosis. Critical Reviews in Biochemistry anD Molecular Biology. July/August 2014, 49 (4), 269-293. doi:10.3109/10409238.2014.895700; PMCID: PMC4255906 • Meng Yang, Rui Lui, Kip E, Guja, Matthew F. Wipperman, Johnna R. St. Clair, Amber C. Bonds, Miguel Garcia-Diaz, Nicole S. Sampson. Unraveling Cholesterol Catabolism in Mycobacterium tuberculosis: ChsE4-ChsE5 a2b2 Acyl-CoA Dehydrogenase Initiates v β-Oxidation of 3-Oxo-cholest-4-en-26-oyl CoA. ACS Infectious Disease. 2015. doi: 10.1021/id500033m; PMCID: PMC4489319 3. Understanding the fundamental ways in which carbon-carbon bonds are made and broken has vast implications in our basic understanding of how organic reactions happen. I synthesized bicyclic and tricyclic vinylcyclobutanes, and studied [1,3] sigmatropic rearrangements of these molecules. I demonstrated the fundamental nature of diradical intermediates in this reaction process, and confirmed a theoretical prediction about the electron donating effects of the cyclopropylcarbinyl functionality. • Phyllis A. Leber, George R. Mann, III, William Hancock-Cerutti, Matthew F. Wipperman, Sylvia Zohrabian, Ryan M. Bell, and John E. Baldwin. Thermal Isomerizations of cis,anti,cis- Tricyclo[7.4.0.02,8]triDec-10-ene. The Journal of Organic Chemistry. 2012 77 (7), 3468-3474. doi: 10.1021/jo300082a • Phyllis A. Leber, Anthony J. Nocket, Matthew F. Wipperman, Sylvia Zohrabian, Christopher Y. Bemis, and Munsha K. Sidhu. Experimental Evidence of a Cyclopropylbarbinyl Conjugative Electronic Effect. Organic anD Biomolecular Chemistry. 2013. 11, 5994–5997. doi: 10.1039/C3OB41365A vi TABLE OF CONTENTS Biographical sketch iii List