The uptake of avermectins in Caenorhabditis elegans is dependent on Intra-Flagellar Transport and other protein trafficking pathways

Parasitic nematodes are globally important and place a heavy disease burden on infected humans, crops and livestock, while commonly administered anthelmintics used for treatment are being rendered ineffective by increasing levels of resistance. Although the modes of action and resistance mechanisms caused by detoxification and target site insensitivity for these compounds is well documented, the mechanisms for uptake, which can also cause resistance, are still poorly defined. It has recently been shown in the model nematode Caenorhabditis elegans that the avermectins or macrocyclic lactones such as ivermectin and moxidectin gain entry though the sensory cilia of the amphid neurons. This study interrogated the molecular mechanisms involved in the uptake of avermectins using a combination of forward genetics and targeted resistance screening approaches along with visualising a BODIPY labelled ivermectin analog and confirmed the importance of intraflagellar transport in this process. This approach also identified the protein trafficking pathways used by the downstream effectors and the components of the ciliary basal body that are required for effector entry into these non-motile structures. Mutations in many of the genes under investigation also resulted in resistance to the unrelated anthelmintic drugs albendazole and levamisole, giving insights into the potential mechanisms of multidrug resistance observed in field isolates of the parasitic nematodes that are a scourge of ruminant livestock. In total 50 novel C. elegans anthelmintic survival associated genes were identified in this study, three of which ( daf-6 , rab-35 and inx-19 ) are associated with broad spectrum cross resistance. When combined with previously known resistance genes, there are now 53 resistance associated genes which are directly involved in amphid, cilia and IFT function. Author Summary Nematodes represent significant pathogens of man and domestic animals and control relies heavily on limited classes of Anthelminitic drugs. Single and multi-drug resistance is a growing problem however mechanisms of anthelmintic drug resistance and drug uptake by nematodes remain to be clearly elucidated. In Caenorhabditis elegans there has been an association between amphid and dye filling defects with resistance to avermectins however the effector and causal mechanisms remain elusive. This study uses a combination of fluorescently labelled anthelmintics and anthelmintic resistance screens to probe the uptake mechanisms for these drugs. The role of the sensory amphids in the uptake of avermectins was confirmed. The avermectins enter the distal segment of the cilia using an effector which is delivered by the UNC-119 and UNC-33/UNC-44 transport systems to the base of the cilia, followed by distal appendage dependent entry and transport along the cilia by the intraflagellar transport pathway. Of the genes investigated, three ( daf-6 , rab-35 and inx-19 ) were linked to cross resistance against all the anthelmintics tested (Ivermectin, Moxidectin, Albendazole and Levamisole). This study gives further insight into how important classes of anthelmintics enter nematodes and highlights the potential for this process to give rise to anthelmintic resistance. ### Competing Interest Statement The authors have declared no competing interest.