Clofazimine targets essential nucleoid associated protein, mycobacterial integration host factor (mIHF), in Mycobacterium tuberculosis

Clofazimine (CFZ) is a phenazine derivative used for treatment of leprosy, MDR-TB and XDR-TB. There is recent interest in understanding how CFZ works following the demonstration of its unique ability to shorten the treatment of MDR-TB. However, the target of CFZ in mycobacteria has remained elusive. Here, we show that CFZ binds to mycobacterial integration host factor (mIHF), which is an essential nucleoid associated protein in mycobacteria involved in DNA protection, chromosome organization and global gene regulation. We demonstrate that CFZ inhibits mIHF binding to DNA and interferes with mycobacterial gene expression. This mode of action is unique among all antibiotics including antimycibacterial agents and may help to explain its unusual action against Mycobacterium tuberculosis. Our study provides new insight about the mechanism of action of this intriguing drug and has implications for developing more effective treatment of TB.