Contribution of Pretomanid to Novel Regimens Containing Bedaquiline with either Linezolid or Moxifloxacin and Pyrazinamide in Murine Models of Tuberculosis.
Novel regimens combining bedaquiline and pretomanid with either linezolid (BPaL regimen) or moxifloxacin and pyrazinamide (BPaMZ regimen) shorten the treatment duration needed to cure tuberculosis (TB) in BALB/c mice compared to that of the first-line regimen and have yielded promising results in initial clinical trials. However, the independent contribution of the investigational new drug pretomanid to the efficacy of BPaMZ has not been examined, and its contribution to BPaL has been examined only over the first 2 months of treatment. In the present study, the addition of pretomanid to BL increased bactericidal activity, prevented emergence of bedaquiline resistance, and shortened the duration needed to prevent relapse with drug-susceptible isolates by at least 2 months in BALB/c mice. Addition of pretomanid to bedaquiline, moxifloxacin, and pyrazinamide (BMZ) resulted in a 1-log10 greater CFU reduction after 1 month of treatment and/or reduced the number of mice relapsing in each of 2 experiments in BALB/c mice and in immunocompromised nude mice. Bedaquiline-resistant isolates were found at relapse in only one BMZ-treated nude mouse. Treatment of infection with a pyrazinamide-resistant mutant in BALB/c mice with BPaMZ prevented selection of bedaquiline-resistant mutants and reduced the proportion of mice relapsing compared to that for BMZ treatment alone. Among severely ill C3HeB/FeJ mice with caseous pneumonia and cavitation, BPaMZ increased median survival (≥60 versus 21 days) and reduced median lung CFU by 2.4 log10 at 1 month compared to the level for BMZ. In conclusion, in 3 different mouse models, pretomanid contributed significantly to the efficacy of the BPaMZ and BPaL regimens, including restricting the selection of bedaquiline-resistant mutants.
['Xu|Jian|J|', 'Li|Si-Yang|SY|', 'Almeida|Deepak V|DV|', 'Tasneen|Rokeya|R|', 'Barnes-Boyle|Kala|K|', 'Converse|Paul J|PJ|', 'Upton|Anna M|AM|', 'Mdluli|Khisimuzi|K|', 'Fotouhi|Nader|N|', 'Nuermberger|Eric L|EL|']
D000818:Animals D000995:Antitubercular Agents D064687:Diarylquinolines D004195:Disease Models, Animal D005260:Female D000069349:Linezolid D051379:Mice D008807:Mice, Inbred BALB C D008819:Mice, Nude D000077266:Moxifloxacin D009593:Nitroimidazoles D011718:Pyrazinamide D012336:RNA, Ribosomal, 16S D014376:Tuberculosis
pretomanid bedaquiline linezolid moxifloxacin pyrazinamide murine model resistance