Combination chemotherapy with the nitroimidazopyran PA-824 and first-line drugs in a murine model of tuberculosis

Antimicrob Agents Chemother. 2006 Aug;50(8):2621-5. doi: 10.1128/AAC.00451-06.

Abstract

The creation of new chemotherapeutic regimens that permit shortening the duration of treatment is a major priority for antituberculosis drug development. In this study, we used the murine model of experimental tuberculosis therapy to determine whether incorporation of the investigational new nitroimidazopyran PA-824 into the standard first-line regimen has the potential to shorten the 6-month duration of treatment. As demonstrated previously, PA-824 alone had significant bactericidal activity over the first 2 months of treatment. Moreover, the substitution of PA-824 for isoniazid led to significantly lower lung CFU counts after 2 months of treatment and to more rapid culture-negative conversion compared to the standard regimen of rifampin, isoniazid, and pyrazinamide. Despite this, there was no difference in the proportion of mice relapsing after completing 6 months of therapy (2 of 19 mice treated with PA-824 in place of isoniazid relapsed versus 0 of 46 mice treated with the standard regimen). Meanwhile, no other PA-824-containing regimen tested was superior to the standard regimen on any assessment. Thus, we were unable to establish a clear role for PA-824 in a treatment-shortening regimen that includes two or more of the current first-line drugs. Future preclinical studies should include the evaluation of novel combinations of PA-824 with new drug candidates in addition to existing antituberculosis drugs for their potential to substantially improve the treatment of both drug-susceptible and multidrug-resistant tuberculosis.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antibiotics, Antitubercular / administration & dosage
  • Antibiotics, Antitubercular / pharmacology
  • Antitubercular Agents / administration & dosage*
  • Antitubercular Agents / pharmacology
  • Disease Models, Animal
  • Drug Therapy, Combination
  • Ethambutol / administration & dosage
  • Ethambutol / pharmacology
  • Female
  • Isoniazid / administration & dosage
  • Isoniazid / pharmacology
  • Mice
  • Mice, Inbred BALB C
  • Mycobacterium tuberculosis / drug effects*
  • Mycobacterium tuberculosis / growth & development*
  • Mycobacterium tuberculosis / isolation & purification
  • Nitroimidazoles / administration & dosage*
  • Nitroimidazoles / pharmacology
  • Pyrazinamide / administration & dosage
  • Pyrazinamide / pharmacology
  • Rifampin / administration & dosage
  • Rifampin / pharmacology
  • Secondary Prevention
  • Time Factors
  • Tuberculosis, Pulmonary / drug therapy*
  • Tuberculosis, Pulmonary / microbiology

Substances

  • Antibiotics, Antitubercular
  • Antitubercular Agents
  • Nitroimidazoles
  • pretomanid
  • Pyrazinamide
  • Ethambutol
  • Isoniazid
  • Rifampin