23Antibiotic-tolerant persister bacteria involve frequent treatment failures, relapsing infections and the need 24 for extended antibiotic treatment. Taking persisters into account in susceptibility assays is thus an essential 25 success factor in antibacterial drug discovery. The virulence of the obligate intracellular bacterium 26Chlamydia pneumoniae is tightly linked to its propensity for persistence, but current susceptibility 27 screening on this gram-negative respiratory pathogen relies on permissive epithelial cells. To establish an 28 improved antichlamydial susceptibility assay allowing the analysis of both actively growing and persister 29 bacteria, we studied C. pneumoniae clinical isolate CV-6 infection kinetics in THP-1 macrophages by qPCR 30 and quantitative culture. Indicated by the steady increase of chlamydial genome copy numbers and 31 infectious progeny as well as the failure of azithromycin to eradicate the intracellular forms of the 32 bacterium, the macrophages were found to harbor a subpopulation of persister C. pneumoniae cells. The 33 potential of the assay for the discovery of anti-persister molecules against intracellular bacteria was 34 demonstrated by the identification of the differential effects of two dibenzocyclooctadiene lignans on C. 35 pneumoniae infection. While schisandrin reverted C. pneumoniae persistence and promoted productive 36 infection, schisandrin C was superior to azithromycin in eradicating the C. pneumoniae infection. The 37 phenotypic switch was associated with the suppression of cellular glutathione pools, implying that targeting 38 glutathione homeostasis may provide a novel means for intracellular bacteria resuscitation. In conclusion, 39 these data highlight the value of macrophages over permissive cell lines in anti-persister agent discovery on 40 intracellular bacteria and targeting host cell redox status to fight persistent infections. 41 42 43 Keywords: persistent infection, antibiotic persistence, dormancy, phenotypic switch, glutathione, 44 antibacterial agent 45 46 47 48 49 50 51 52Owing to redundant mechanisms, these phenotypical variants are able to survive under antibiotic pressure 58 and revert back to metabolically more active phenotype when stressful conditions are cleared off. 59In clinical settings, bacterial dormancy is associated with hard-to-treat infections via two mechanistically 60 overlapping phenomena, persistent infections evading host immune responses and antibiotic persistence 61 defined based on the presence of drug-tolerant subpopulations of bacteria. Both of these features are 62 typical to infections caused by Chlamydia pneumoniae, a gram-negative obligate intracellular human 63 pathogen that causes respiratory infections from dry cough to pneumonia. While a majority of C. 64 pneumoniae infections are subclinical, nearly everyone getting infected during their lifetime, the bacterium 65 is also responsible for 5-10% of community-acquired pneumonia cases worldwide 3, 4 . C. pneumoniae has a 66 unique biphasic development cycle, whe...