16 17 18 19 20 21 Word count Abstract = 165 22 Word count Text = 1,914 23 24 Keywords: Mycobacterium ulcerans, antimicrobials, decontamination, 25 environmental. 1 26 Abstract 27 Mycobacterium ulcerans, a non-tuberculous mycobacterium responsible for Buruli 28 ulcer, is residing in poorly defined environmental niches in the vicinity of stagnant 29 water points where very few isolates have been confirmed. In the perspective of 30 culturing M. ulcerans from such contaminated environmental specimens, we tested 31 the in vitro susceptibility of M. ulcerans CU001 strain co-cultivated with XTC cells to 32 anti-infectious molecules registered in the French pharmacopoeia, using a 33 standardised concentration, to find-out molecules inactive against M. ulcerans which 34 could be incorporated in decontaminating solution. Of 116 tested molecules, 64 35 (55.1%] molecules including 34 (29.3%] antibiotics, 14 (12%] antivirals, 8 (6.8%] 36 antiparasitic and 8 (6.8%] antifungals were ineffective against M. ulcerans CU001; 37 leaving 52 molecules active against M. ulcerans CU001. Three such inactive 38 antimicrobial molecules (oxytetracycline, polymyxin E and voriconazole] were then39 selected to make a decontamination solution shown to respect M. ulcerans CU001 40 viability. These three antimicrobials could be incorporated into a decontamination 41 solution for the tentative isolation and culture of M. ulcerans from environmental 42 samples. 1 43 Introduction 44 Mycobacterium ulcerans is a nontuberculous mycobacterium responsible for Buruli 45 ulcer, an opportunistic neglected tropical disease that also affects some nonhuman 46 mammal species [1]. M. ulcerans was first isolated in Australia in 1948 after the 47 disease was initially described in 1897 in Uganda [2]. Phylogenetic analysis showed 48 that M. ulcerans evolved from a common ancestor with Mycobacterium marinum after 49 genomic reduction characterized by an accumulation of insertion sequences and 50 counterbalanced by the acquisition of a giant plasmid encoding for the nonribosomal 51 synthesis of mycolactones, exotoxins exhibiting ulcerative, analgesic, 52 immunosuppressive and anti-inflammatory properties [3-4]. M. ulcerans is an 53 environmental mycobacteria, and although DNA sequences specific to M. ulcerans 54 are routinely detected in aquatic ecosystems by PCR [5-6], its exact reservoir and 55 routes of transmission to humans remain unknown [7]. Indeed, PCR-based data do 56 not provide insight into the viability of these detected mycobacteria.
57The first environmental M. ulcerans isolate was reported in 2008 from an aquatic 58 insect [8], 60 years after it was first isolated from a patient [2]. The long delay 59 between isolation from environmental sources and clinical sources illustrates the 60 particular constraint isolating M. ulcerans from environmental sources, i.e., 61 contamination by fast-growing mycobacteria, bacteria and fungi [9-10-11]. Therefore, 62 an efficient decontamination protocol is key for the tentative isolation of 63 environmental M. ulceran...