scholarly journals Concentration-Dependent Mycobacterium tuberculosis Killing and Prevention of Resistance by Rifampin

2007 ◽  
Vol 51 (11) ◽  
pp. 3781-3788 ◽  
Author(s):  
Tawanda Gumbo ◽  
Arnold Louie ◽  
Mark R. Deziel ◽  
Weiguo Liu ◽  
Linda M. Parsons ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Intermittent Therapy ◽  
Postantibiotic Effect ◽  
Phase Growth ◽  
Time Curve ◽  
Antituberculosis Therapy ◽  
Major Implication ◽  
Effect Duration ◽  
Kinetics Of

ABSTRACT Rifampin is a cornerstone of modern antituberculosis therapy. However, rifampin's half-life of 3 h is believed to limit its utility for intermittent therapy, so new congeners with long half-lives are being developed. Using an in vitro pharmacokinetic-pharmacodynamic model of tuberculosis, we examined the relationships between rifampin exposure, microbial killing of log-phase-growth Mycobacterium tuberculosis, and suppression of resistance. Rifampin's microbial killing was linked to the area under the concentration-time curve-to-MIC ratio. The suppression of resistance was associated with the free peak concentration (C max)-to-MIC ratio and not the duration that the rifampin concentration was above MIC. Rifampin prevented resistance to itself at a free C max/MIC ratio of ≥175. The postantibiotic effect duration was ≥5.2 days and was most closely related to the C max/MIC ratio (r 2 = 0.96). To explain rifampin's concentration-dependent effect, we examined the kinetics of rifampin entry into M. tuberculosis. Rifampin achieved concentration-dependent intracellular steady-state concentrations within 15 min. Our results suggest that doses of rifampin higher than those currently employed would optimize the effect of rifampin, if patients could tolerate them. Another major implication is that in the design of new rifampin congeners for intermittent therapy, the important properties may include (i) the efficient entry of the rifamycin into M. tuberculosis, (ii) the achievement of a free C max/MIC of >175 that can be tolerated by patients, and (iii) a long postantibiotic effect duration.

scholarly journals Relationships of the Area under the Curve/MIC Ratio to Different Integral Endpoints of the Antimicrobial Effect: Gemifloxacin Pharmacodynamics in an In Vitro Dynamic Model

2001 ◽  
Vol 45 (3) ◽  
pp. 927-931 ◽  
Author(s):  
Alexander A. Firsov ◽  
Irene Y. Lubenko ◽  
Yury A. Portnoy ◽  
Stephen H. Zinner ◽  
Sergey N. Vostrov
Keyword(s):  
Area Under The Curve ◽  
Antimicrobial Effect ◽  
Time Curve ◽  
Marginal Value ◽  
Actual Effect ◽  
Control Growth ◽  
Effect Duration ◽  
Kill Curve ◽  
Time Kill

ABSTRACT Most integral endpoints of the antimicrobial effect are determined over an arbitrarily chosen time period, such as the dosing interval (τ), regardless of the actual effect duration. Unlike the τ-related endpoints, the intensity of the antimicrobial effect (I E) does consider its duration—from time zero to the time when bacterial counts on the regrowth curve achieve the same maximal numbers as in the absence of the antimicrobial. To examine the possible impact of this fundamental difference on the relationships of the antimicrobial effect to the ratio of the area under the concentration-time curve (AUC) to the MIC, a clinical isolate ofStaphylococcus aureus was exposed to simulated gemifloxacin pharmacokinetics over a 40-fold range of AUC/MIC ratios, from 11 to 466 h. In each run, I E and four τ-related endpoints, including the area under the time-kill curve (AUBC), the area above the curve (AAC), the area between the control growth and time-kill curves (ABBC), and the ABBC related to the area under the control growth curve (AUGC), were calculated for τ = 24 h. Unlike the I E, which displayed pseudolinear relationships with the AUC/MIC ratio; each τ-related endpoint showed a distinct saturation at potentially therapeutic AUC/MIC ratios (116 to 466 h) when the antimicrobial effect persisted longer than τ. This saturation results from the underestimation of the true effect and may be eliminated if ABBC, AAC, and AUBC (but not AUGC) are modified and determined in the same manner as the I E to consider the actual effect duration. These data suggest a marginal value of the τ-related endpoints as indices of the total antimicrobial effect. Since all of them respond to AUC/MIC ratio changes less than theI E, the latter is preferable in comparative pharmacodynamic studies.

scholarly journals Isoniazid Bactericidal Activity and Resistance Emergence: Integrating Pharmacodynamics and Pharmacogenomics To Predict Efficacy in Different Ethnic Populations

2007 ◽  
Vol 51 (7) ◽  
pp. 2329-2336 ◽  
Author(s):  
Tawanda Gumbo ◽  
Arnold Louie ◽  
Weiguo Liu ◽  
David Brown ◽  
Paul G. Ambrose ◽  
...  
Keyword(s):  
Bactericidal Activity ◽  
Standard Dose ◽  
Nucleotide Polymorphisms ◽  
Time Curve ◽  
Mutant Selection ◽  
Concentration Time ◽  
Antituberculosis Therapy ◽  
Selection Window ◽  
Emergence Of Resistance

ABSTRACT Isoniazid, administered as part of combination antituberculosis therapy, is responsible for most of the early bactericidal activity (EBA) of the regimen. However, the emergence of Mycobacterium tuberculosis resistance to isoniazid is a major problem. We examined the relationship between isoniazid exposure and M. tuberculosis microbial kill, as well as the emergence of resistance, in our in vitro pharmacodynamic model of tuberculosis. Since single-nucleotide polymorphisms of the N-acetyltransferase-2 gene lead to two different clearances of isoniazid from serum in patients, we simulated the isoniazid concentration-time profiles encountered in both slow and fast acetylators. Both microbial kill and the emergence of resistance during monotherapy were associated with the ratio of the area under the isoniazid concentration-time curve from 0 to 24 h (AUC0-24) to the isoniazid MIC. The time in mutant selection window hypothesis was rejected. Next, we utilized the in vitro relationship between the isoniazid AUC0-24/MIC ratio and microbial kill, the distributions of isoniazid clearance in populations with different percentages of slow and fast acetylators, and the distribution of isoniazid MICs for isonazid-susceptible M. tuberculosis clinical isolates in Monte Carlo simulations to calculate the EBA expected for ∼10,000 patients treated with 300 mg of isoniazid. For those patient populations in which the proportion of fast acetylators and the isoniazid MICs were high, the average EBA of the standard dose was ∼0.3 log10 CFU/ml/day and was thus suboptimal. Our approach, which utilizes preclinical pharmacodynamics and the genetically determined multimodal distributions of serum clearances, is a preclinical tool that may be able to predict the EBAs of various doses of new antituberculosis drugs.

scholarly journals Clinical Concentrations of Thioridazine Kill Intracellular Multidrug-Resistant Mycobacterium tuberculosis

2003 ◽  
Vol 47 (3) ◽  
pp. 917-922 ◽  
Author(s):  
Diane Ordway ◽  
Miguel Viveiros ◽  
Clara Leandro ◽  
Rosário Bettencourt ◽  
Josefina Almeida ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Side Effects ◽  
Chronic Administration ◽  
Multidrug Resistant ◽  
Human Macrophages ◽  
Antituberculosis Therapy ◽  
High Prevalence ◽  
Negative Side Effects ◽  
Cellular Immune

ABSTRACT The phenothiazines chlorpromazine (CPZ) and thioridazine (TZ) have equal in vitro activities against antibiotic-sensitive and -resistant Mycobacterium tuberculosis. These compounds have not been used as anti-M. tuberculosis agents because their in vitro activities take place at concentrations which are beyond those that are clinically achievable. In addition, chronic administration of CPZ produces frequent severe side effects. Because CPZ has been shown to enhance the killing of intracellular M. tuberculosis at concentrations in the medium that are clinically relevant, we have investigated whether TZ, a phenothiazine whose negative side effects are less frequent and serious than those associated with CPZ, kills M. tuberculosis organisms that have been phagocytosed by human macrophages, which have nominal killing activities against these bacteria. Both CPZ and TZ killed intracellular antibiotic-sensitive and -resistant M. tuberculosis organisms when they were used at concentrations in the medium well below those present in the plasma of patients treated with these agents. These concentrations in vitro were not toxic to the macrophage, nor did they affect in vitro cellular immune processes. TZ thus appears to be a serious candidate for the management of a freshly diagnosed infection of pulmonary tuberculosis or as an adjunct to conventional antituberculosis therapy if the patient originates from an area known to have a high prevalence of multidrug-resistant M. tuberculosis isolates. Nevertheless, we must await the outcomes of clinical trials to determine whether TZ itself may be safely and effectively used as an antituberculosis agent.

scholarly journals Synergy between Circular Bacteriocin AS-48 and Ethambutol against Mycobacterium tuberculosis

2018 ◽  
Vol 62 (9) ◽  
Author(s):  
Clara Aguilar-Pérez ◽  
Begoña Gracia ◽  
Liliana Rodrigues ◽  
Asunción Vitoria ◽  
Rubén Cebrián ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Antimycobacterial Activity ◽  
Multidrug Resistant ◽  
Content Type ◽  
Gram Positive Bacteria ◽  
Antituberculosis Therapy ◽  
Circular Bacteriocin ◽  
Low Cytotoxicity

ABSTRACT The increasing incidence of multidrug-resistant Mycobacterium tuberculosis strains and the very few drugs available for treatment are promoting the discovery and development of new molecules that could help in the control of this disease. Bacteriocin AS-48 is an antibacterial peptide produced by Enterococcus faecalis and is active against several Gram-positive bacteria. We have found that AS-48 was active against Mycobacterium tuberculosis, including H37Rv and other reference and clinical strains, and also against some nontuberculous clinical mycobacterial species. The combination of AS-48 with either lysozyme or ethambutol (commonly used in the treatment of drug-susceptible tuberculosis) increased the antituberculosis action of AS-48, showing a synergic interaction. Under these conditions, AS-48 exhibits a MIC close to some MICs of the first-line antituberculosis agents. The inhibitory activity of AS-48 and its synergistic combination with ethambutol were also observed on M. tuberculosis-infected macrophages. Finally, AS-48 did not show any cytotoxicity against THP-1, MHS, and J774.2 macrophage cell lines at concentrations close to its MIC. In summary, bacteriocin AS-48 has interesting antimycobacterial activity in vitro and low cytotoxicity, so further studies in vivo will contribute to its development as a potential additional drug for antituberculosis therapy.

scholarly journals Inactivation of the ilvB1 gene in Mycobacterium tuberculosis leads to branched-chain amino acid auxotrophy and attenuation of virulence in mice

Microbiology ◽  
2009 ◽  
Vol 155 (9) ◽  
pp. 2978-2987 ◽  
Author(s):  
Disha Awasthy ◽  
Sheshagiri Gaonkar ◽  
R. K. Shandil ◽  
Reena Yadav ◽  
Sowmya Bharath ◽  
...  
Keyword(s):  
Amino Acids ◽  
Mycobacterium Tuberculosis ◽  
Amino Acid ◽  
Mutant Strain ◽  
Branched Chain Amino Acids ◽  
Branched Chain Amino Acid ◽  
Branched Chain ◽  
Kinetics Of

Acetohydroxyacid synthase (AHAS) is the first enzyme in the branched-chain amino acid biosynthesis pathway in bacteria. Bioinformatics analysis revealed that the Mycobacterium tuberculosis genome contains four genes (ilvB1, ilvB2, ilvG and ilvX) coding for the large catalytic subunit of AHAS, whereas only one gene (ilvN or ilvH) coding for the smaller regulatory subunit of this enzyme was found. In order to understand the physiological role of AHAS in survival of the organism in vitro and in vivo, we inactivated the ilvB1 gene of M. tuberculosis. The mutant strain was found to be auxotrophic for all of the three branched-chain amino acids (isoleucine, leucine and valine), when grown with either C6 or C2 carbon sources, suggesting that the ilvB1 gene product is the major AHAS in M. tuberculosis. Depletion of these branched chain amino acids in the medium led to loss of viability of the ΔilvB1 strain in vitro, resulting in a 4-log reduction in colony-forming units after 10 days. Survival kinetics of the mutant strain cultured in macrophages maintained with sub-optimal concentrations of the branched-chain amino acids did not show any loss of viability, indicating either that the intracellular environment was rich in these amino acids or that the other AHAS catalytic subunits were functional under these conditions. Furthermore, the growth kinetics of the ΔilvB1 strain in mice indicated that although this mutant strain showed defective growth in vivo, it could persist in the infected mice for a long time, and therefore could be a potential vaccine candidate.

scholarly journals Effect of Administration of Moxifloxacin plus Rifampin against Mycobacterium tuberculosis for 7 of 7 Days versus 5 of 7 Days in an In Vitro Pharmacodynamic System

mBio ◽  
2011 ◽  
Vol 2 (4) ◽  
Author(s):  
G. L. Drusano ◽  
N. Sgambati ◽  
A. Eichas ◽  
D. Brown ◽  
R. Kulawy ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Drug Holiday ◽  
Directly Observed Therapy ◽  
Time Curve ◽  
Content Type ◽  
Days Of Therapy ◽  
The Mean ◽  
Low Exposure ◽  
Emergence Of Resistance

ABSTRACT Some trials administered antituberculosis agents for 5 of 7 days (5/7-day regimen) to optimize adherence. Since moxifloxacin has a longer half-life than rifampin, rifampin concentrations are <1% of the maximum concentration in serum (C max) on day 6 and nondetectable on day 7, while concentrations of moxifloxacin remain and are able to induce error-prone replication. We determined if functional moxifloxacin monotherapy for 24 h/week caused resistance. In in vitro pharmacodynamic experiments, Mycobacterium tuberculosis was treated with mean area under the concentration-time curve (AUC) exposures for moxifloxacin and rifampin of 400 and 600 mg/kg/day and exposures equal to 1 standard deviation (SD) above and below the mean values. The drugs were administered on schedules of 7/7 days and 5/7 days. Over the 28-day experiments, bacteria were plated onto antibiotic-free agar to determine the effects of exposure and schedule on the total population. MICs were checked for emergence of resistance. At days 7 and 14, there was a 0.56- to 1.22-log10-CFU/ml greater cell kill with the 7/7-day regimen versus the 5/7-day regimen (low exposure). This difference was not seen for the larger exposures at day 21. At day 23, the low-exposure 5/7-day arm had breakthrough resistance, with the total count increasing to >2 log10 CFU/ml above the low-exposure 7/7-day arm. Pharmacokinetic mismatching of drugs in the therapy of tuberculosis may result in emergence of resistance when a drug holiday is imposed during which there is functional monotherapy and where the remaining agent induces error-prone replication. This is particularly true for the portion of the population where the clearance is higher (1 SD above the mean). IMPORTANCE Directly observed therapy is a cornerstone of treatment of Mycobacterium tuberculosis. Patients are often given a drug holiday to facilitate the direct observation of therapy. With rifampin and moxifloxacin, there is a discordance between the half-lives of these agents (1.9 versus 6.5 h when employed in combination). In addition, moxifloxacin induces error-prone replication in Mycobacterium tuberculosis. In this experiment, we demonstrate that the drug holiday (5 of 7 days of therapy [5/7-day regimen]) allows the emergence of resistance to moxifloxacin, which was not seen with 7/7-day therapy. If drug holidays are used, it is imperative to better match pharmacokinetics to minimize the risk of emergence of resistance.

scholarly journals Alteration of postantibiotic effect during one dosing interval of tobramycin, simulated in an in vitro pharmacokinetic model.

1996 ◽  
Vol 40 (3) ◽  
pp. 784-786 ◽  
Author(s):  
J G den Hollander ◽  
J W Mouton ◽  
M P van Goor ◽  
F P Vleggaar ◽  
H A Verbrugh
Keyword(s):  
Pharmacokinetic Model ◽  
Test Organism ◽  
Human Pharmacokinetics ◽  
Enzymatic Method ◽  
Postantibiotic Effect ◽  
Dosing Interval ◽  
Optimal Dosing ◽  
Aminoglycoside Therapy ◽  
Kinetics Of

The kinetics of the postantibiotic effect (PAE) during one dosing interval of tobramycin against Staphylococcus aureus and Pseudomonas aeruginosa was investigated. We determined the PAE at different time points during this dosing interval of 12 h in an in vitro pharmacokinetic model simulating human pharmacokinetics in which the half-life of tobramycin was adjusted to 2.4 +/- 0.2 h. Using an enzymatic method to inactivate tobramycin, we determined PAEs in samples extracted from the model at 1, 5, 8, and 12 h, corresponding with tobramycin concentrations of 20, 5, 2, and 1 times the MIC for the test organism. The PAE decreased significantly from 2.5 h at 1 h to 0 h at 12 h. No change in MIC was observed for the strains during the experiments. We conclude that the PAE decreases with decreasing tobramycin concentrations during a 12-h dosing interval and completely disappears after the concentration has reached the MIC for the test organism. On the basis of these observations, the emphasis that is placed on the PAE in discussions about the optimal dosing interval in aminoglycoside therapy is questionable.

scholarly journals Antimycobacterial, Enzyme Inhibition, and Molecular Interaction Studies of Psoromic Acid in Mycobacterium tuberculosis: Efficacy and Safety Investigations

2018 ◽  
Vol 7 (8) ◽  
pp. 226 ◽  
Author(s):  
Sherif Hassan ◽  
Miroslava Šudomová ◽  
Kateřina Berchová-Bímová ◽  
Shanmugaraj Gowrishankar ◽  
Kannan Rengasamy
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Drug Targets ◽  
Active Sites ◽  
In Silico Analysis ◽  
Inhibitory Effect ◽  
In Vitro Assays ◽  
Standard Drug ◽  
Antituberculosis Therapy ◽  
Ic50 Value

The current study explores the antimycobacterial efficacy of lichen-derived psoromic acid (PA) against clinical strains of Mycobacterium tuberculosis (M.tb). Additionally, the inhibitory efficacy of PA against two critical enzymes associated with M.tb, namely, UDP-galactopyranose mutase (UGM) and arylamine-N-acetyltransferase (TBNAT), as drug targets for antituberculosis therapy were determined. PA showed a profound inhibitory effect towards all the M.tb strains tested, with minimum inhibitory concentrations (MICs) ranging between 3.2 and 4.1 µM, and selectivity indices (SIs) ranging between 18.3 and 23.4. On the other hand, the standard drug isoniazid (INH) displayed comparably high MIC values (varying from 5.4 to 5.8 µM) as well as low SI values (13.0–13.9). Interestingly, PA did not exhibit any cytotoxic effects on a human liver hepatocellular carcinoma cell line even at the highest concentration tested (75 µM). PA demonstrated remarkable suppressing propensity against UGM compared to standard uridine-5'-diphosphate (UDP), with 85.8 and 99.3% of inhibition, respectively. In addition, PA also exerted phenomenal inhibitory efficacy (half maximal inhibitory concentration (IC50) value = 8.7 µM, and 77.4% inhibition) against TBNAT compared with standard INH (IC50 value = 6.2 µM and 96.3% inhibition). Furthermore, in silico analysis validated the outcomes of in vitro assays, as the molecular interactions of PA with the active sites of UGM and TBNAT were unveiled using molecular docking and structure–activity relationship studies. Concomitantly, our findings present PA as an effective and safe natural drug plausible for use in controlling tuberculosis infections.

scholarly journals Pharmacokinetics-Pharmacodynamics of Pyrazinamide in a Novel In Vitro Model of Tuberculosis for Sterilizing Effect: a Paradigm for Faster Assessment of New Antituberculosis Drugs

2009 ◽  
Vol 53 (8) ◽  
pp. 3197-3204 ◽  
Author(s):  
Tawanda Gumbo ◽  
Chandima S. W. Siyambalapitiyage Dona ◽  
Claudia Meek ◽  
Richard Leff
Keyword(s):  
Monte Carlo ◽  
Monte Carlo Simulations ◽  
Pharmacokinetic Parameters ◽  
Maximal Effect ◽  
Time Curve ◽  
Time Profiles ◽  
Concentration Time ◽  
Antituberculosis Therapy ◽  
Vitro Model

ABSTRACT There are currently renewed efforts to develop drugs that could shorten the duration of antituberculosis therapy. This is best achieved by optimizing the sterilizing effect. However, the current pathway for the development of new molecules with the potential to have a sterilizing effect is inefficient. We designed an in vitro pharmacokinetic-pharmacodynamic model in which Mycobacterium tuberculosis replicating slowly at pH 5.8 was exposed to pyrazinamide by use of the concentration-time profiles encountered in patients. The sterilizing effect rates and the time to the emergence of drug resistance were examined. Daily pyrazinamide dosing for 28 days accurately achieved (i) the pyrazinamide pharmacokinetic parameters, (ii) the lack of early bactericidal activity, (iii) a sterilizing effect rate of 0.10 log10 CFU/ml per day starting on day 6 of therapy, and (iv) a time to the emergence of resistance of the from 2 to 3 weeks of monotherapy encountered in patients with tuberculosis. Next, dose-scheduling studies were performed. The sterilizing effect was linked to the pyrazinamide ratio of the area under the concentration-time curve from 0 to 24 h (AUC0-24) to the MIC (r 2 = 0.80 to 0.90), with 90% of the maximal effect being achieved by an AUC0-24/MIC of 209.08. Resistance suppression was associated with the percentage of time that the concentration persisted above the MIC (r 2 = 0.73 to 0.91). Monte Carlo simulations of 10,000 patients demonstrated that the currently recommended pyrazinamide doses (15 to 30 mg/kg of body weight/day) achieved the AUC0-24/MIC of 209.08 in the epithelial lining fluid of only 15.1 to 53.3% of patients. Doses of >60 mg/kg per day performed better. Our vitro model for the sterilizing effect, together with Monte Carlo simulations, can be used for the faster identification of the clinical doses that are needed to achieve a sterilizing effect and that can then be studied in clinical trials.

scholarly journals High Glucose Concentrations Impair the Processing and Presentation of Mycobacterium tuberculosis Antigens In Vitro

Biomolecules ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 1763
Author(s):  
Guadalupe Monroy-Mérida ◽  
Silvia Guzmán-Beltrán ◽  
Fernando Hernández ◽  
Teresa Santos-Mendoza ◽  
Karen Bobadilla
Keyword(s):  
Mycobacterium Tuberculosis ◽  
T Cell ◽  
T Cell Activation ◽  
High Glucose ◽  
Cathepsin D ◽  
Antigen Processing ◽  
Cell Activation ◽  
Hla Dr ◽  
Kinetics Of

Type 2 diabetes is an established risk factor for tuberculosis, but the underlying mechanisms are largely unknown. We established an in vitro model to analyze the effect of high glucose concentrations in antigen processing and presentation in antigen-presenting cells. Human monocyte-derived macrophages (MDMs) were exposed to high (11 mM and 30 mM) and low (5.5 mM) glucose concentrations and infected with Mycobacterium tuberculosis (Mtb). Flow cytometry was used to analyze the effect of high glucose concentrations in histocompatibility complex (MHC) class II molecules (HLA-DR) and co-stimulatory molecules (CD80 and CD86), indispensable for an adequate antigenic presentation and CD4+ T cell activation. HLA-DR and CD86 were significantly decreased by high glucose concentrations compared with low glucose concentrations. Confocal microscopy was used to detect Rab 5 and Lamp-1, proteins involved in the kinetics of antigen processing as early markers, and Rab 7 and cathepsin D as late markers. We observed a delay in the dynamics of the acquisition of Rab 7 and cathepsin D in high glucose concentrations. Moreover, the kinetics of the formation M. tuberculosis peptide–MHC II complexes in MDMs was decreased under high glucose concentrations, reducing their capacity for T cell activation. These findings suggest that high glucose concentrations directly affect antigenic processing, and therefore antigenic presentation.

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