Clioquinol inactivates thiamine pyrophosphate by increasing cellular oxidative stress

Clioquinol (CQ), a prescribed oral antibiotic, was withdrawn from use following its association with the incidence of subacute myelo-optic neuropathy (SMON) in Japan. The neurotoxicity associated with CQ may be linked to thiamine deficiency. However, their relationship and underlying mechanisms remain unclear. In this study, we identified thiamine pyrophosphate (TPP) as a key metabolite affected by CQ via metabolomics analysis. Analysis of related thiamine transport, TPP synthesis, and oxidative stress pathways revealed that CQ promoted TPP inactivation through oxidative modification. The Seahorse metabolic analyzer data showed that CQ-induced TPP deficiency led to diminished mitochondrial oxidative phosphorylation, accompanied by enhanced glycolysis. Morphological examination of mitochondria further indicated that CQ elicited mitochondrial damage in a TPP-dependent manner. In an Alzheimer's disease murine model, CQ administration similarly provoked oxidative stress, decreased cerebral TPP concentrations, and induced neuronal injury. Notably, supplementation with TPP or N-acetylcysteine (NAC) mitigated CQ-associated neurotoxicity and potentiated CQ-mediated clearance of amyloid plaques. Our findings elucidate that CQ is involved in mitochondrial dysfunction and metabolic reprogramming by inactivating TPP, providing valuable insights into the neurotoxicity of CQ.