The sphingolipids ceramide and inositol phosphorylceramide protect the Leishmania major membrane from sterol-specific toxins

  1. Chaitanya S. Haram
  2. Samrat Moitra
  3. Rilee Keane
  4. F. Matthew Kuhlmann
  5. Cheryl Frankfater
  6. Fong-Fu Hsu
  7. Stephen M. Beverley
  8. Kai Zhang
  9. Peter A. Keyel

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Abstract

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  1. Version published to 10.1016/j.jbc.2023.104745
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    Reply to the reviewers

    General Statements

    We thank the reviewers for their critical analysis of our manuscript. We have addressed all reviewer concerns and questions in our revised version. Along with other improvements requested by the reviewers, we added an MTT assay to validate our flow cytometry assays, normalized binding to surface area to better compare toxin binding between Leishmania and HeLa cells, and revised the discussion. We believe the revised contribution provides important novel insights into membrane integrity in a non-standard organism that will appeal to a broad audience.

    Reviewer comments below are in* italics.*

    Point-by-point description of the revisions

    Reviewer 1

    *Major Comments. The experimental work has been carried out carefully, including multiple biological replicates, convincing statistical analysis. Data presentation is extensive, including 6 supplementary figures. It is likely that the experiments could be reproduced by others, as the approaches do not seem to be especially difficult, and the methods are well documented. *

    We thank the reviewer for this assessment.

    *My major comment regarding revision is that this paper is quite long and extensive given the relatively restricted body of experiments and discrete conclusions. The principal discovery is that sphingolipids protect Leishmania parasites against somewhat artificial treatment with bacterial sterol-binding pore forming toxins, but they do not do so by obstructing toxin binding to sterols. A similar effect is seen for the antileishmanial drug amphotericin B, the most important agent studied. No further mechanistic insights are provided regarding the process whereby sphingolipids blunt toxicity of either the CDCs or amphotericin B. In addition, the experimental approach relies largely upon one methodology, dose-response curves. A report with such highly focused scope should be presentable with considerably more economy. In particular, the Discussion is long and diffuse, obscuring the presentation of the major conclusions. It could probably be cut in half and would in the process present the major deliverables of the paper with higher impact. *

    We have condensed the discussion as requested, and to address Reviewer 2’s concerns, we provided a summary articulating the significance.

    Significance

    *The most notable advance is the observation that sphingolipids protect Leishmania parasites from the cytotoxic activity of the first line antileishmanial drug amphotericin B that binds to the major sterol in the parasite plasma membrane, ergosterol, and induces pore formation. This discovery suggests that parallel treatments with agents that selectively reduce sphingolipid levels in the parasite might act synergistically with amphotericin B, potentially allowing treatment with lower doses of this inherently toxic drug. This work will likely be of most interest to those with a focus on pharmacology and drug development for this and related parasites, but it will also be of some interest to those working on the basic biochemistry of these organisms. The senior authors are major workers in sphingolipid biochemistry in Leishmania parasites and thus are well positioned to address the relevant background in the field, much of which has come out of their laboratories.

    The major limitation of this study is its relatively circumscribed scope, resulting in one principal conclusion: Leishmania sphingolipids blunt the potency of toxins or drugs that target sterols for pore formation, but they do not do so by impairing binding of these agents to sterols, as they do in mammalian cells. The work would be of higher impact if it addressed mechanistically how sphingolipids do decrease toxicity, e.g., do they prevent these agents from oligomerizing or from intercalating into the membrane to form pores. Such studies would require the application of an expanded repertoire of experimental methodologies going beyond the measurement of dose-response curves with various mutants and drugs.*

    We agree with the reviewer that next steps include determining if Leishmania sphingolipids interfere with oligomerization or pore-insertion. One challenge is that these tools need to first be validated in Leishmania.

    To address the reviewer concern about the limited range of experimental methodologies, we added an MTT assay (Supplementary Fig S2E) as validation of our flow cytometry assays. We have better summarized the significance and broad impact of our work in lines 466-476.

    Reviewer 2

    *In the abstract the authors describe that the pore-forming toxins engage with ceramide and other lipids and while it's clear that the levels of sphingolipids are important for the effect of these toxins there is limited evidence to show they physically interact as the word engage suggests. *

    We agree with the reviewer that we do not show physical interaction. In the abstract, we are careful to only use the word “engage” in association with our proposed model. Our proposed model both explains our data, and uses those data to open new horizons by making falsifiable predictions that can be tested in the future. Direct engagement of toxins with lipids is one such prediction. For these reasons, we prefer to retain the word “engage” in the abstract.

    *The authors conclude that the ergosterol on the Leishmania cell membrane is less accessible to the CDCs as it does not bind as much CDCs as a HeLa cell. What is the relative abundance of sterols in the HeLa membrane in comparison to a Leishmania cell. A HeLa cell is much bigger than a Leishmania cell and will therefore be able to bind a lot more CDC, was the MFI normalised for cell size? This would be important to know as the difference in intensity may be purely related to the difference in cell size. *

    We thank the reviewer for this insight. We had not normalized MFI by cell surface area. We added MFI normalized to cell size (described on lines 573-577) and found that when area was accounted for, the promastigotes bound more toxin than HeLa cells. These data are now included as Supplementary Fig S1A, and discussed on lines 187-189.

    *The authors are keen to prosecute that ceramide is important for differences between PFO and SLO action as the inhibitor has a much greater effect on the PFO treatment of ipcs- cells than SLO, as ceramide will accumulate in these cells. But for the SLO analysis they stated that the treatment of spt2- with myriocin had no change on the LC50 as the target of myriocin was spt2 while they noted was there a drop in the LC50 with PFO. Based on this I think the importance of ceramide is being overstated here, as spt2- cells have little ceramide in them. Moreover the authors also suggest that changes to the lipid environment rather than a single species might be important. Are there alternative targets the myriocin might inhibit when there is no spt2-, it is intriguing that there is a decrease in LC50 for PFO on spt2- myriocin treated cells. *

    Clearly, IPC is very important for determining the cytotoxicity for the CDCs in Leishmania but I think the evidence for the role of ceramide and the sensing of it is less clear cut and the strength of the conclusions about this should be modified. In the results the authors conclude that the L3 loop is sensing ceramide and the data shows that the L3 loop is important but in the discussion they are more circumspect about the moieties L3 can detect. The authors should qualify these conclusions in the results a bit more.

    As requested by the reviewer, we have qualified our statements in the results, lines 282, 297, 315.

    *Minor comments *

    *It would be helpful for the review process to include line and page numbers to highlight areas that I have concerns about. *

    We agree with the reviewer and have added line numbers.

    *In the first paragraph of the results is there a reference for the spt2- cell line that was used here. *

    We have added the Zhang 2003 reference to the first paragraph of the results, line 161.

    *In the second paragraph there is a disconnect between the statements about the phenotype of the ipcs- cells and the reference/evidence for it. *

    We have added the reference to the earlier mention of the ipcs cells, and in the introduction, lines 118-120 and 167-169.

    *On many of the graphs the letters a, b, c are alongside many of the symbols but it was unclear what they represented. *

    The letters represent statistically distinct groups. These are used instead of stars and bars to reduce clutter on the figure. We have now explained the difference in the first figure legend in which they are used, lines 818-823.

    *The colour scheme for figure 4 was confusing - yellow diamonds in A/B are spt2-/+spt2 but in C/D are iscl-, this makes it hard to compare between them. *

    We have changed the color and symbols for the iscl- mutant in Fig 4 and Fig S6.

    *The methodology states that various tests were used to define whether differences were significant but it was not clear from the figures when these were being applied only a few graphs had '*' associated with them. *

    We have clarified this in the figure legends.

    *There is no overall conclusion to the study at the end of the discussion just a series of limitations of the study, which is good to acknowledge but feels an odd way to finish the manuscript. *

    We have revised the discussion in response to Reviewer 1, and included a summary to tie everything together, lines 466-476.

    *Significance: *

    Overall this is a strong manuscript with a set of experiments that have a clear strategy and purpose that was well written. This paper outlines the importance of the lipid composition for the cytotoxicity of both sterol specific toxins and amphotericin B in Leishmania, which will have significant implications for their study for other pathogens but also for the development of combination therapies to enhance the potency of amphotericin B, as such I think this will be of interest to both researchers interested in drug discovery and those interested in lipid metabolism.

    We thank the reviewer for this assessment.

    Reviewer 3

    *Major comments:

    1. The idea that sphingolipids do not block toxin access relies on the work of CDC-based probes binding the accessible pool of cholesterol in mammalian membranes. The authors make the observation that ergosterol is not shielded by sphingolipids because the presence of them does not prevent CDC binding. Is it possible to show that Leishmania sphingolipids are able to actually sequester ergosterol or would it all be considered free and available to toxin binding?*

    Our interpretation of the binding data is that the Leishmania sphingolipids fail to sequester ergosterol from toxins, so ergosterol accessibility is independent of sphingolipids. Similar to mammalian cells, there could be an “essential” pool of ergosterol bound to other proteins/lipids that is inaccessible to toxins. However, detecting that pool is technically challenging.

    We have revised the manuscript to clarify this, lines 454-456.

    1. The statistical analysis applied to each experiment, while defined in the figure legends, are presented mostly using uncommon methods of presentation, making it difficult to determine if the correct analysis was applied.*

    We have clarified the statistics and use of letters. The letters represent statistically distinct groups. These are used instead of stars and bars to reduce clutter on the figure. We have now explained the difference in the first figure legend in which they are used, lines 818-823.

    1. The binding of these toxins to Leishmania cells appears to be independent of their lipid composition, but Figure 1A-D suggests that these toxins do not bind very well to Leishmania; a ~65 fold increase in toxin added only results in a maximal 3 fold change in amount of toxin bound. Therefore, the authors need to demonstrate that this increase in binding is not simply the result of adding more ug of each CDC. *

    Leishmania are smaller than HeLa cells, which accounts for the apparent reduced binding. We added Supplementary Fig S1A, which normalized MFI to estimated surface area. When normalized to surface area, Leishmania bound to toxin better than HeLa cells. We further note that the dose-dependent increase in cytotoxicity argues against non-specificity of increased toxin.

    1. The authors use HeLa cells to compare the ability of these toxins to bind to sterol containing membranes, but it is unclear how a mammalian cell line, which lacks ergosterol, can inform upon the differences in binding to Leishmania membranes when their data shows almost no cholesterol is found in the Leishmania membrane. The use of HeLa cells to compare the toxicity of these CDCs is simply a control experiment for the lytic activity of these proteins, and should not be used as a direct comparison of their LC50s, as a mammalian plasma membrane lipid composition is significantly different from that of Leishmania. If the authors want to use HeLa cells as a direct comparison to show that sphingolipids in mammalian cells also protect them from CDC pore formation, they must demonstrate the HeLa cells which have genetic defects in sphingolipid biology or which have been treated with sphingomyelinases are more sensitive to these CDCs. *

    We agree with the reviewer that to argue sphingolipids in mammalian cells are protective would require additional data beyond the scope of this manuscript. We are not making any statements about the role of sphingolipids in mammalian cells, which have a controversial role in CDC damage and membrane repair (see e.g. Schoenauer et al 2019. PMID: 29979630). Since the head group of sphingomyelin interacts with cholesterol (Endapally et al 2019), but the IPC head group is not expected to interact similarly with ergosterol, we choose to remain focused on Leishmania sphingolipids.

    Given our focus on Leishmania, why include HeLa cells at all? We think including HeLa cells provides an important and relevant point of reference because there are situations where both human cells and Leishmania promastigotes could encounter pore-forming toxins. This comparison provides insight to the following question: “In a mix of promastigotes and human cells (for example during a blood meal), which cells would die first from the bacterial PFT?” Comparing cytotoxicity to HeLa cells provides a point of reference in judging how cytotoxic CDCs are to Leishmania promastigotes, and how sensitive the spt- promastigotes become.

    We have rephrased the manuscript (lines 208-209) to better clarify that HeLa cells are a reference point so readers can evaluate the relative sensitivity of sphingolipid-deficient promastigotes.

    1. The authors need to demonstrate that the mutant cholesterol recognition motif (CRM) and the glycan binding mutant proteins can still bind to both Leishmania and Hela cell membranes to serve as controls for their lack of lytic activities. Without this, they cannot conclude that "Leishmania membranes engage the same binding determinants used by CDCs to target mammalian cells". *

    The glycan binding and ΔCRM mutants are unable to bind to HeLa cells. These toxin mutations were previously characterized (Mozola & Caparon, 2015 and Farrand et al 2010), showing that their defect lies in binding to cells, but not oligomerization or pore-formation. Since their defect lies solely in binding, if these toxins were able to bind to spt2- cells, they would kill the spt2- cells. This enables us to use these toxin mutants to ask if the CRM or glycan-binding is essential for toxin binding to Leishmania. Since the only defect in these mutant toxins is binding (either to glycans or cholesterol), the failure of these mutants to kill allows us to conclude that both of these binding surfaces on the toxin are essential for cytotoxicity in L. major.

    We have clarified the manuscript, lines 236-240. *

    Minor comments:

    1. Multiple figures lack adequately defined axes. Examples include, but are not limited to: Figure 1A-D where the X-axis is plotted as logarithmic based 2 but this is not defined. Figure 2 the Y axis is plotted as logarithmic based 10 but is not defined. *

    We have updated the figure legends to indicate where log axes are used.

    7) The authors state that "Promastigotes with inactivated de novo sphingomyelin synthesis has a significant increase in total sterols" in reference to Figure 1E. Not only is there no significance indicated for the spt2-/-, the authors only indicate a significance point for the Myr (not yet defined) + WT sample in "Other sterols".

    We have rephrased this to indicate a trend, line 181.

    8) The authors use increases in membrane permeability as a read out for specific lysis using PI uptake, however, they then refer to this read out as killing of Leishmania, without measuring the viability of these cells. Therefore, the authors should provide additional experiments that demonstrate the death of the different Leishmania strains treated with the cytolysins.

    As requested, we have now provided an additional experiment to validate Leishmania death. We have now added MTT assay as Fig S2E, and discussed in the results, lines 202-205.

    9) It is not clear how the authors calculated their LC50 values in Figure 2. According to the figure legends, the authors used HU/ml ranges that would be sub lethal or not completely lysed within this range to most of the Leishmania strains tested. The data presented in Figure are not clear that the correct LC50 calculations were used as none of the Specific Lysis curves do not reach saturation with the concentrations presented, and one does not even reach 50% Lysis.

    We thank the reviewer for catching this discrepancy. The legend in Fig 2 did not include the correct ranges of toxin dose used for PFO. We have corrected the legend to indicate the toxin range used. To calculate LC50, we used linear regression on the linear portion of the death curve to determine the concentration at 50% lysis. This gives us a way to determine LC50 even without the use of very large (and costly) amounts of toxin to get extensive saturation on the kill curve.

    1. Figure 4 and Figure S6 are very difficult to interpret. Figure S6 would benefit by breaking up each graph into multiple graphs that would allow the reader to see more of the curves individually. Additionally, there are multiple conditions were it appears that a different number of experiments (2-4 totals) were preformed but statistical analysis was applied to these data. *

    We updated the labels on Fig 4 for improved readability. We broke Fig S6 up into multiple graphs. We have removed unpaired data (eg the n of 4 noted by the reviewer), and re-checked our stats. This change did not alter our conclusions. The apparent n of 2 was overlap of data points due to poor jittering of the datapoints. We have increased the jitter on the data points to make all three reps more distinct.

    1. The authors state "In contrast to myriocin-treated ipcs- L. major, which contain low levels of ceramide, myriocin treated iscl- L. major contain low levels of IPC" but do not provide a reference or point to data to support this claim. *

    We have qualified these statements to say ‘are expected to’ on lines 306-307.

    1. Figure 5 E would benefit in presentation by being broken up into 4 separate graphs based on the toxin used, as it is difficult to determine which data points are being compared. *

    We compare by toxin used in Fig 5A-D. The purpose of Fig 5E is to compare between toxins. We included all of the data points (including resistant control strains) for completeness. The main focus is the spt2- and ipcs- parts of Fig 5E.

    1. The authors state that "myriocin did not inhibit growth more than 25% promastigotes at 10 μM" but this data is not presented. *

    We have now added these data as Fig 6A.

    14) Multiple graphs lack legends or have axis that are not defined.

    In order to improve readability and avoid cluttering the figures, where the legends and axes are the same across multiple graphs, they are included only once for a given row and/or column.*

    Significance:

    Overall, the experiments presented were conducted to analyze each question, but many of the results are observational, without considering the impact of altered lipid species on the findings. The data suggests an existence of a protective mechanism for the parasite from CDCs, but it unclear how these finding inform upon the CDC or Leishmania fields. CDCs have been known to target sterols within membranes and that altered local membrane environments can have substantial impacts on CDC binding. This work suggests that the altered lipid species of Leishmania membranes, compared to a mammalian membrane, could dramatically effect the sequestering power of sphingolipids or other lipids, and thus change how CDCs bind to them. This work advances is likely to have specialized audience of Leishmania researchers looking at the dynamics of their membranes.*

    We believe this work will be valuable to a broad audience because it will be of interest to researchers studying membranes in general, pathogenic eukaryotes and pore-forming toxins. Most membrane biology work is done either in opisthokonts or in model liposomes, so there are few studies on biomembranes in other taxonomic groups, including many different human pathogens. We provide a blueprint for examining the membranes of non-standard organisms, establish *L. major *as a pathogenically relevant model system, and report on key differences in sterol sequestration compared to mammalian cells. These findings provide important perspectives for the generalization of biomembranes, especially when compared to prior work in opisthokonts.

    We have clarified our significance in lines 466-476.

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    Referee #3

    Evidence, reproducibility and clarity

    Haram & Moitra et al. report a mechanism by which the lipid environment of the Leishmania membrane determines the effects of two different pore forming toxins. They demonstrate that sphingolipids protect Leishmania from toxin-induced cytotoxicity without effecting the proteins ability to bind to the membrane. They further demonstrate that ceramide can reduce the cytotoxicity of the toxins through the sensing of the local lipids, and that this composition can protect Leishmania from first line antibiotics. The manuscript follows a model for explaining this protection, but several important questions and controls remain and need to be addressed.

    Major comments:

    1. The idea that sphingolipids do not block toxin access relies on the work of CDC-based probes binding the accessible pool of cholesterol in mammalian membranes. The authors make the observation that ergosterol is not shielded by sphingolipids because the presence of them does not prevent CDC binding. Is it possible to show that Leishmania sphingolipids are able to actually sequester ergosterol or would it all be considered free and available to toxin binding?
    2. The statistical analysis applied to each experiment, while defined in the figure legends, are presented mostly using uncommon methods of presentation, making it difficult to determine if the correct analysis was applied.
    3. The binding of these toxins to Leishmania cells appears to be independent of their lipid composition, but Figure 1A-D suggests that these toxins do not bind very well to Leishmania; a ~65 fold increase in toxin added only results in a maximal 3 fold change in amount of toxin bound. Therefore, the authors need to demonstrate that this increase in binding is not simply the result of adding more ug of each CDC.
    4. The authors use HeLa cells to compare the ability of these toxins to bind to sterol containing membranes, but it is unclear how a mammalian cell line, which lacks ergosterol, can inform upon the differences in binding to Leishmania membranes when their data shows almost no cholesterol is found in the Leishmania membrane. The use of HeLa cells to compare the toxicity of these CDCs is simply a control experiment for the lytic activity of these proteins, and should not be used as a direct comparison of their LC50s, as a mammalian plasma membrane lipid composition is significantly different from that of Leishmania. If the authors want to use HeLa cells as a direct comparison to show that sphingolipids in mammalian cells also protect them from CDC pore formation, they must demonstrate the HeLa cells which have genetic defects in sphingolipid biology or which have been treated with sphingomyelinases are more sensitive to these CDCs.
    5. The authors need to demonstrate that the mutant cholesterol recognition motif (CRM) and the glycan binding mutant proteins can still bind to both Leishmania and Hela cell membranes to serve as controls for their lack of lytic activities. Without this, they cannot conclude that "Leishmania membranes engage the same binding determinants used by CDCs to target mammalian cells".

    Minor comments:

    1. Multiple figures lack adequately defined axes. Examples include, but are not limited to: Figure 1A-D where the X-axis is plotted as logarithmic based 2 but this is not defined. Figure 2 the Y axis is plotted as logarithmic based 10 but is not defined.
    2. The authors state that "Promastigotes with inactivated de novo sphingomyelin synthesis has a significant increase in total sterols" in reference to Figure 1E. Not only is there no significance indicated for the spt2-/-, the authors only indicate a significance point for the Myr (not yet defined) + WT sample in "Other sterols".
    3. The authors use increases in membrane permeability as a read out for specific lysis using PI uptake, however, they then refer to this read out as killing of Leishmania, without measuring the viability of these cells. Therefore, the authors should provide additional experiments that demonstrate the death of the different Leishmania strains treated with the cytolysins.
    4. It is not clear how the authors calculated their LC50 values in Figure 2. According to the figure legends, the authors used HU/ml ranges that would be sub lethal or not completely lysed within this range to most of the Leishmania strains tested. The data presented in Figure are not clear that the correct LC50 calculations were used as none of the Specific Lysis curves do not reach saturation with the concentrations presented, and one does not even reach 50% Lysis.
    5. Figure 4 and Figure S6 are very difficult to interpret. Figure S6 would benefit by breaking up each graph into multiple graphs that would allow the reader to see more of the curves individually. Additionally, there are multiple conditions were it appears that a different number of experiments (2-4 totals) were preformed but statistical analysis was applied to these data.
    6. The authors state "In contrast to myriocin-treated ipcs- L. major, which contain low levels of ceramide, myriocin treated iscl- L. major contain low levels of IPC" but do not provide a reference or point to data to support this claim.
    7. Figure 5 E would benefit in presentation by being broken up into 4 separate graphs based on the toxin used, as it is difficult to determine which data points are being compared.
    8. The authors state that "myriocin did not inhibit growth more than 25% promastigotes at 10 μM" but this data is not presented.
    9. Multiple graphs lack legends or have axis that are not defined.

    Significance

    Overall, the experiments presented were conducted to analyze each question, but many of the results are observational, without considering the impact of altered lipid species on the findings. The data suggests an existence of a protective mechanism for the parasite from CDCs, but it unclear how these finding inform upon the CDC or Leishmania fields. CDCs have been known to target sterols within membranes and that altered local membrane environments can have substantial impacts on CDC binding.

    This work suggests that the altered lipid species of Leishmania membranes, compared to a mammalian membrane, could dramatically effect the sequestering power of sphingolipids or other lipids, and thus change how CDCs bind to them.

    This work advances is likely to have specialized audience of Leishmania researchers looking at the dynamics of their membranes.

    Expertise: I study host-pathogen interactions with a focus on plasma membrane lipids and cholesterol.

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    Referee #2

    Evidence, reproducibility and clarity

    Summary

    One of the major treatments of the parasitic disease Leishmaniasis is the drug amphotericin B, which targets ergosterol and a route to increasing its potency would be to increase the accessibility ergosterol on the surface of the parasite. With that in mind the authors investigated sterol-binding ability of two cytotoxic toxins PFO and SLO. The authors clearly show that these toxins are readily able to bind to the surface of the parasite regardless of the levels of sphingolipids present, yet the presence of inositol phosphorylceramide and to a lesser extent ceramide affect overall cytotoxicity. The L3 loop of the toxin was shown to be important for the sensitivity of the different toxins to the lipid composition of the membrane.

    Major comments

    In the abstract the authors describe that the pore-forming toxins engage with ceramide and other lipids and while it's clear that the levels of sphingolipids are important for the effect of these toxins there is limited evidence to show they physically interact as the word engage suggests.

    The authors conclude that the ergosterol on the Leishmania cell membrane is less accessible to the CDCs as it does not bind as much CDCs as a HeLa cell. What is the relative abundance of sterols in the HeLa membrane in comparison to a Leishmania cell. A HeLa cell is much bigger than a Leishmania cell and will therefore be able to bind a lot more CDC, was the MFI normalised for cell size? This would be important to know as the difference in intensity may be purely related to the difference in cell size.

    The authors are keen to prosecute that ceramide is important for differences between PFO and SLO action as the inhibitor has a much greater effect on the PFO treatment of ipcs- cells than SLO, as ceramide will accumulate in these cells. But for the SLO analysis they stated that the treatment of spt2- with myriocin had no change on the LC50 as the target of myriocin was spt2 while they noted was there a drop in the LC50 with PFO. Based on this I think the importance of ceramide is being overstated here, as spt2- cells have little ceramide in them. Moreover the authors also suggest that changes to the lipid environment rather than a single species might be important. Are there alternative targets the myriocin might inhibit when there is no spt2-, it is intriguing that there is a decrease in LC50 for PFO on spt2- myriocin treated cells.

    Clearly, IPC is very important for determining the cytotoxicity for the CDCs in Leishmania but I think the evidence for the role of ceramide and the sensing of it is less clear cut and the strength of the conclusions about this should be modified. In the results the authors conclude that the L3 loop is sensing ceramide and the data shows that the L3 loop is important but in the discussion they are more circumspect about the moieties L3 can detect. The authors should qualify these conclusions in the results a bit more.

    Minor comments

    It would be helpful for the review process to include line and page numbers to highlight areas that I have concerns about.

    In the first paragraph of the results is there a reference for the spt2- cell line that was used here.

    In the second paragraph there is a disconnect between the statements about the phenotype of the ipcs- cells and the reference/evidence for it.

    On many of the graphs the letters a, b, c are alongside many of the symbols but it was unclear what they represented.

    The colour scheme for figure 4 was confusing - yellow diamonds in A/B are spt2-/+spt2 but in C/D are iscl-, this makes it hard to compare between them.

    The methodology states that various tests were used to define whether differences were significant but it was not clear from the figures when these were being applied only a few graphs had '*' associated with them.

    There is no overall conclusion to the study at the end of the discussion just a series of limitations of the study, which is good to acknowledge but feels an odd way to finish the manuscript.

    Significance

    Overall this is a strong manuscript with a set of experiments that have a clear strategy and purpose that was well written. This paper outlines the importance of the lipid composition for the cytotoxicity of both sterol specific toxins and amphotericin B in Leishmania, which will have significant implications for their study for other pathogens but also for the development of combination therapies to enhance the potency of amphotericin B, as such I think this will be of interest to both researchers interested in drug discovery and those interested in lipid metabolism.

    Expertise in the molecular cell biology of trypanosomes and leishmania.

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    Referee #1

    Evidence, reproducibility and clarity

    Summary.

    In this manuscript the authors demonstrate that sphingolipids protect Leishmania major promastigotes from the toxic effects of two bacterial cholesterol-binding cytolysins (CDCs), polypeptide toxins that first bind to sterols in cellular membranes and then oligomerize to form pores. More significantly for Leishmania biology, sphingolipids also protect the parasites against similar pore forming activity by the first line antileishmanial drug amphotericin B, suggesting that treatments that reduced the levels of sphingolipids, especially ceramide and inositol-phosphoceramide (IPC), might enhance selective potency of amphotericin for the parasite and thus allow lower doses of this inherently toxic drug to be applied. The experimental work is based largely on dose-response curves of wild type, spt2- mutants (fail to make sphingolipids), ipcs- mutants (do not synthesize IPC and build up the precursor ceramide), and the respective add-back lines with and without treatment with myriocin that inhibits the SPR enzyme and thus blocks sphingolipid biosynthesis. These bacterial toxins, although not directly relevant to Leishmania biology, are used as a model to investigate sensitivity to sterol-binding pore forming agents, and sensitivity to the antileishmanial drug amphotericin B, which parallels the bacterial toxins in binding to ergosterol and forming membrane pores, is also found to be enhanced when sphingolipid levels are reduced. Notably, sphingolipids do not reduce the binding of CDCs to ergosterol in the parasite membrane, as they do in mammalian cells, but rather act downstream of sterol binding, possibly by reducing pore forming activity by some unknown mechanism.

    Major Comments.

    The experimental work has been carried out carefully, including multiple biological replicates, convincing statistical analysis. Data presentation is extensive, including 6 supplementary figures. It is likely that the experiments could be reproduced by others, as the approaches do not seem to be especially difficult, and the methods are well documented.

    My major comment regarding revision is that this paper is quite long and extensive given the relatively restricted body of experiments and discrete conclusions. The principal discovery is that sphingolipids protect Leishmania parasites against somewhat artificial treatment with bacterial sterol-binding pore forming toxins, but they do not do so by obstructing toxin binding to sterols. A similar effect is seen for the antileishmanial drug amphotericin B, the most important agent studied. No further mechanistic insights are provided regarding the process whereby sphingolipids blunt toxicity of either the CDCs or amphotericin B. In addition, the experimental approach relies largely upon one methodology, dose-response curves. A report with such highly focused scope should be presentable with considerably more economy. In particular, the Discussion is long and diffuse, obscuring the presentation of the major conclusions. It could probably be cut in half and would in the process present the major deliverables of the paper with higher impact.

    Minor Comments:

    Except for my comment about the length of the manuscript (which I consider to be a major comment for this paper), I have no further suggestions on this topic.

    Significance

    The most notable advance is the observation that sphingolipids protect Leishmania parasites from the cytotoxic activity of the first line antileishmanial drug amphotericin B that binds to the major sterol in the parasite plasma membrane, ergosterol, and induces pore formation. This discovery suggests that parallel treatments with agents that selectively reduce sphingolipid levels in the parasite might act synergistically with amphotericin B, potentially allowing treatment with lower doses of this inherently toxic drug. This work will likely be of most interest to those with a focus on pharmacology and drug development for this and related parasites, but it will also be of some interest to those working on the basic biochemistry of these organisms. The senior authors are major workers in sphingolipid biochemistry in Leishmania parasites and thus are well positioned to address the relevant background in the field, much of which has come out of their laboratories.

    The major limitation of this study is its relatively circumscribed scope, resulting in one principal conclusion: Leishmania sphingolipids blunt the potency of toxins or drugs that target sterols for pore formation, but they do not do so by impairing binding of these agents to sterols, as they do in mammalian cells. The work would be of higher impact if it addressed mechanistically how sphingolipids do decrease toxicity, e.g., do they prevent these agents from oligomerizing or from intercalating into the membrane to form pores. Such studies would require the application of an expanded repertoire of experimental methodologies going beyond the measurement of dose-response curves with various mutants and drugs.

    Reviewer's areas of expertise: Biochemistry, cell, and molecular biology of parasitic protozoa.

  6. Version published to 10.1101/2022.06.15.496300v3 on bioRxiv
  7. Version published to 10.1101/2022.06.15.496300v2 on bioRxiv
  8. Version published to 10.1101/2022.06.15.496300v1 on bioRxiv