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Computational design of MmpL3 inhibitors for tuberculosis therapy. Mol Divers 2023; 27:357-369. [PMID: 35477825 DOI: 10.1007/s11030-022-10436-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/07/2022] [Indexed: 02/08/2023]
Abstract
Tuberculosis is a chronic communicable disease caused by Mycobacterium tuberculosis (Mtb) and spreads from lungs to lymphatic system. The cell wall of mycobacterium plays a prominent role in maintaining the virulence and pathogenicity and also acts as prime target for drug discovery. Hence, this study has put into emphasis with target MmpLs (Mycobacterial membrane proteins Large) which are significant for the growth and survival of Mycobacterium tuberculosis. MmpLs belongs to the resistance, nodulation and division (RND) protein superfamily. MmpL3 is the only MmpL deemed essential for the replication and viability of mycobacterial cells. For the study, we have selected SQ109 derivatives as Mmpl3 inhibitor, which holds non-covalent property. Structure-based pharmacophore model of MmpL3 target protein with SQ109 as co-crystallized ligand (PDB: 6AJG) was generated to screen the ligand database. Compounds with decent fitness score and pharmacophoric features were compared with standard drug and taken for molecular docking studies. Further prime molecular mechanics-Poisson-Boltzmann surface area (MM-GBSA) and induced fit calculations identified potential molecules for further drug-likeness screening. Overall computational calculations identified ZINC000000016638 and ZINC000000003594 as potential in silico MmpL3 inhibitors. Molecular dynamics simulations integrated with MM-PBSA free energy calculations identified that MmpL3-ZINC000000016638 complex was more stable. Study can be further extended for synthesis and biological evaluation, derivatization of active compound to identify potential and safe lead compounds for effective tuberculosis therapy.
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Bahraminia F, Zangiabadian M, Nasiri MJ, Fattahi M, Goudarzi M, Ranjbar R, Imani Fooladi AA. Rifampicin resistance in Mycobacterium tuberculosis in Iran: a two-centre study. New Microbes New Infect 2021; 42:100909. [PMID: 34336229 PMCID: PMC8313744 DOI: 10.1016/j.nmni.2021.100909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/30/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
Multidrug-resistant tuberculosis remains a challenge. In this study, we investigated the incidence of rifampicin (RIF) resistance in Mycobacterium tuberculosis in a large number of pulmonary specimens. A two-center study in Tehran, the capital of Iran, was performed with 6624 pulmonary samples of patients with tuberculosis (TB) who were subjected to detection of RIF-resistant TB by GeneXpert MTB/RIF assay between May 2014 and July 2018. Conventional drug susceptibility testing was performed to confirm the results. Xpert MTB/RIF identified a total of 96 positives for M. tuberculosis, of which 5 (5.3%) samples were found to be RIF-resistant TB. All RIF-resistant and sensitive isolates detected by GeneXpert were phenotypically confirmed by drug susceptibility testing. These results indicated that the Xpert MTB/RIF test can be used as a rapid diagnostic method and can potentially decrease the morbidity associated with diagnostic delay and mistreatment.
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Affiliation(s)
- F Bahraminia
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - M Zangiabadian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M J Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Fattahi
- Regional Tuberculosis Reference Laboratory, Tehran University of Medical Sciences, Tehran, Iran
| | - M Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Ranjbar
- Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - A A Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Arefzadeh S, Azimi T, Nasiri M, Nikpor Z, Dabiri H, Doustdar F, Goudarzi H, Allahyartorkaman M. High-resolution melt curve analysis for rapid detection of rifampicin resistance in Mycobacterium tuberculosis: a single-centre study in Iran. New Microbes New Infect 2020; 35:100665. [PMID: 32257224 PMCID: PMC7125345 DOI: 10.1016/j.nmni.2020.100665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/05/2020] [Indexed: 11/29/2022] Open
Abstract
This study aimed to compare the diagnostic accuracy of high-resolution melting (HRM) analysis in comparison with Xpert MTB/RIF as well as conventional drug susceptibility testing (DST) for the detection of rifampicin (RIF) resistance in Mycobacterium tuberculosis in Iran. A comparative cross-sectional study was carried out from April 2017 to September 2018. A total of 80 culture-positive clinical samples selected during the study period were analysed for detection of RIF-resistant TB by conventional DST, Xpert MTB/RIF, and sequencing. Sensitivity and specificity of the HRM calculated according to DST was our reference standard test in this study. The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HRM assay were found to be 100%, 89.33%, 38.46%, and 100% respectively. The analysis demonstrated that the diagnostic accuracy of HRM tests is insufficient to replace Xpert MTB/RIF and conventional DST. HRM tests have the advantage of time to result and may be used in combination with culture. Further work to improve molecular tests would benefit from standardized reference standards and the methodology.
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Affiliation(s)
- S. Arefzadeh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - T. Azimi
- Department of Pathobiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - M.J. Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z. Nikpor
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H. Dabiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F. Doustdar
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H. Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M. Allahyartorkaman
- Regional Tuberculosis Reference laboratory, Tehran University of Medical Sciences, Tehran, Iran
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Amini S, Hoffner S, Allahyar Torkaman MR, Hamzehloo G, Nasiri MJ, Salehi M, Sami Kashkooli G, Shahraki MS, Mohsenpoor M, Soleimanpour S, Mir R. Direct drug susceptibility testing of Mycobacterium tuberculosis using the proportional method: A multicenter study. J Glob Antimicrob Resist 2019; 17:242-244. [PMID: 30630107 DOI: 10.1016/j.jgar.2018.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/10/2018] [Accepted: 12/30/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Conventional indirect drug susceptibility testing (DST) of Mycobacterium tuberculosis with solid media is inexpensive and reliable, but time-consuming. This study aimed to evaluate direct DST for testing sputum samples without culture to significantly reduce the time required to detect multidrug-resistant tuberculosis (MDR-TB). METHODS Direct and indirect DST of isoniazid (INH), rifampicin (RIF) and ethambutol (EMB) were performed on 334 sputum smear-positive specimens. RESULTS There was full agreement between the results obtained from direct testing and after isolation of the bacteria by culture. Thus, the sensitivity and specificity were observed to be 100% for all three tested drugs when compared with indirect DST. In comparison with indirect DST, none of the samples with the direct method took >25days to report the DST (between 15-25days with a mean detection time of 20 days). CONCLUSIONS Direct DST on solid media was shown to give reliable results at a much earlier stage than conventional phenotypic DST. The direct method was found to be more rapid, more accurate and simpler. In addition, it reduced the handling of pathogenic bacteria and thus reduced the bio hazards related to conventional DST.
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Affiliation(s)
- Sirus Amini
- Regional Tuberculosis Reference Laboratory, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sven Hoffner
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
| | | | - Gholamreza Hamzehloo
- Regional Tuberculosis Reference Laboratory, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Salehi
- Regional Tuberculosis Reference Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Golnar Sami Kashkooli
- Tuberculosis Reference Laboratory, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Sadegh Shahraki
- Regional Tuberculosis Reference Laboratory, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Maryam Mohsenpoor
- Tuberculosis Reference Laboratory, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saman Soleimanpour
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Raha Mir
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Monaco TJ, Hanania NA. Emerging inhaled long-acting beta-2 adrenoceptor agonists for the treatment of COPD. Expert Opin Emerg Drugs 2017; 22:285-299. [DOI: 10.1080/14728214.2017.1367382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Thomas J. Monaco
- Baylor College of Medicine, Section of Pulmonary and Critical Care Medicine, Houston, TX, USA
| | - Nicola A. Hanania
- Baylor College of Medicine, Section of Pulmonary and Critical Care Medicine, Houston, TX, USA
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New nitrofurans amenable by isocyanide multicomponent chemistry are active against multidrug-resistant and poly-resistant Mycobacterium tuberculosis. Bioorg Med Chem 2017; 25:1867-1874. [DOI: 10.1016/j.bmc.2017.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/23/2017] [Accepted: 02/01/2017] [Indexed: 02/03/2023]
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Resistance profile and risk factors of drug resistant tuberculosis in the Baltic countries. Tuberculosis (Edinb) 2015; 95:581-8. [PMID: 26164355 DOI: 10.1016/j.tube.2015.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 05/06/2015] [Accepted: 05/29/2015] [Indexed: 11/24/2022]
Abstract
The rates of multi- and extensively drug-resistant tuberculosis (X/MDRTB) in the Baltic countries are the highest within the European Union hampering recent achievements of national TB control programmes. We included all consecutive culture-confirmed X/MDRTB patients registered for treatment in 2009 in Latvia, Lithuania and Estonia into this multicenter case-control study. Cases were compared with randomly selected controls with non-MDRTB registered for treatment in the same year across these sites. Of 495 MDRTB patients, 243 (49.7%) showed resistance to at least one second-line drug, 206 (42.1%) had pre-XDRTB (i.e. MDRTB with additional resistance to a second-line injectable or fluoroquinolones) and 64 (13.1%) had XDRTB. Younger age, male gender and known contact with an MDRTB case were associated with increased risk of primary infection with X/MDRTB strains. Previous treatment and alcohol abuse were strong predictors for MDRTB acquisition; defaults and failures in the past triggered XDRTB development. All patients received appropriate therapy; less than half of the patients were fully adherent. An erroneous treatment strategy is unlikely to drive resistance development. Increasing patients' compliance, addressing issues of social support, rapid detection of drug resistance and improving infection control is crucial for prevention of further spread of X/MDRTB and achieving higher cure rates.
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New tuberculosis diagnostics and rollout. Int J Infect Dis 2015; 32:81-6. [DOI: 10.1016/j.ijid.2015.01.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/09/2015] [Accepted: 01/14/2015] [Indexed: 11/23/2022] Open
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Anderson LF, Tamne S, Watson JP, Cohen T, Mitnick C, Brown T, Drobniewski F, Abubakar I. Treatment outcome of multi-drug resistant tuberculosis in the United Kingdom: retrospective-prospective cohort study from 2004 to 2007. ACTA ACUST UNITED AC 2013; 18. [PMID: 24128699 DOI: 10.2807/1560-7917.es2013.18.40.20601] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
United Kingdom (UK) guidelines recommend at least 18 months treatment for patients with multidrug-resistant tuberculosis (MDR-TB). Prior to 2008, data on treatment outcome were only available at 12 months and therefore the proportion completing treatment was unknown. This retrospective-prospective cohort study reports on treatment outcomes for MDR-TB patients notified between 2004 and 2007 and examines factors associated with successful outcomes. 70.6% (144/204) completed treatment in 24 months or more, 6.9% (14) stopped treatment, 6.9% (14) died, 7.8% (16) were lost to follow up, 0.5% (1) relapsed and 4.4% (9) were transferred overseas. Following adjustment for age, being non-UK born, non-compliance and having co-morbidities, treatment with a fluoroquinolone (OR 3.09; 95% CI 1.21-7.88; p<0.05) or bacteriostatic drug (OR 4.23; 95% CI 1.60-11.18; p<0.05) were independently associated with successful treatment outcome. Treatment completion for MDR-TB cases remains below the World Health Organization (WHO) target. Our findings support current WHO guidelines for MDR-TB treatment. The UK should consider adopting individualised regimens based on WHO recommended drugs, taking into account drug sensitivities. Improving treatment completion rates will be key to tackling further drug resistance and transmission from untreated infectious cases.
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Affiliation(s)
- L F Anderson
- Public Health England, Respiratory Diseases Department, TB Section, London, United Kingdom
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Paudel A, Kaneko K, Watanabe A, Shigeki M, Motomu K, Hamamoto H, Sekimizu K. Structure–activity relationship study of novel iminothiadiazolo-pyrimidinone antimicrobial agents. J Antibiot (Tokyo) 2013; 66:663-7. [DOI: 10.1038/ja.2013.69] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 11/09/2022]
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Pontali E, Matteelli A, D'Ambrosio L, Centis R, Migliori GB. Rediscovering high technology from the past: thoracic surgery is back on track for multidrug-resistant tuberculosis. Expert Rev Anti Infect Ther 2013. [PMID: 23199397 DOI: 10.1586/eri.12.108] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The global emergence of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB represents a core challenge for global tuberculosis control. MDR-TB and extensively drug-resistant TB are more difficult to treat and have a worse outcome compared with drug-susceptible disease. Surgery has proved to improve treatment success in MDR-TB patients. This study was designed to assess the impact of surgery in a cohort of MDR-TB patients. The authors evaluate one of the largest cohorts treated by a single center, demonstrating that specialized thoracic surgery centers may achieve excellent results with a low rate of complications after surgery, and proposing an effective model of teamwork based on pulmonologists and surgeons. A review of the evidence supporting the role of surgery in addition to chemotherapy to improve treatment outcomes in difficult-to-treat cases of TB is also performed.
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Affiliation(s)
- Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
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12
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Giehl C, Lange C, Duarte R, Bothamley G, Gerlach C, Cirillo DM, Wagner D, Kampmann B, Goletti D, Juers T, Sester M. TBNET - Collaborative research on tuberculosis in Europe. Eur J Microbiol Immunol (Bp) 2012; 2:264-74. [PMID: 24265908 DOI: 10.1556/eujmi.2.2012.4.4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 09/10/2012] [Indexed: 02/04/2023] Open
Abstract
Networking is a key feature of scientific success. The Tuberculosis Network European Trialsgroup (TBNET) was founded in 2006 as a non-profit, non-governmental peer-initiated scientific organization to collaboratively address research priorities in the area of tuberculosis in Europe. Today, TBNET is the largest tuberculosis research organization in Europe with nearly 500 members from 22 EU countries and 49 countries worldwide (www.tb-net.org). Apart from small multicenter basic research studies, a particular strength of TBNET is the performance of large collaborative projects, pan-European multicenter studies and database projects. In recent years, research from TBNET has substantially contributed to the understanding of the management, risk and prognosis of patients with multidrug (MDR) and extensively drug-resistant (XDR) tuberculosis and led to a better understanding of the clinical value of novel tests for the identification of adults and children with tuberculosis and latent infection with Mycobacterium tuberculosis. In 2009, two branches of TBNET were founded to specifically address tuberculosis in the pediatric population (ptbnet) and non-tuberculous mycobacterial diseases (NTM-NET). In addition to the research activities, TBNET is developing expert consensus documents for clinical management and provides training and capacity building especially for members from Eastern European countries, where tuberculosis is still a prevalent health problem.
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Cazzola M, Rogliani P, Segreti A, Matera MG. An update on bronchodilators in Phase I and II clinical trials. Expert Opin Investig Drugs 2012; 21:1489-501. [PMID: 22916733 DOI: 10.1517/13543784.2012.710602] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Inhaled bronchodilators are the mainstay of the current management of COPD at all stages of the disease, and are critical in the symptomatic management of asthma. Therefore, there is still considerable interest in finding novel classes of broncholytic drugs or, at least, in improving the existing classes of bronchodilator. AREAS COVERED This review paper mainly focuses on bronchodilators that are in Phase I and II clinical trials. EXPERT OPINION To date, finding new classes of bronchodilators has proved difficult. Consequently, many research groups have sought to improve the existing classes of bronchodytic drugs. The majority of programs in development for novel bronchodilators are focused on developing new ligands that interact with β(2)-adrenoceptors and/or muscarinic acetylcholine receptors in a manner that enhances their bronchodilator effectiveness and duration of action, which allows only one administration per day, although the twice-daily dosing of bronchodilators is still considered a useful approach to the symptomatic treatment of COPD, and improving their safety profiles. Moreover, the current opinion is that it is advantageous to develop inhalers containing combinations of long-acting bronchodilator drugs in an attempt to simplify treatment regimes as much as possible. Another goal is to develop novel combinations of one or two classes of long-acting bronchodilators along with inhaled corticosteroids.
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Affiliation(s)
- Mario Cazzola
- University of Rome Tor Vergata, Department of System Medicine, Rome, Italy.
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Cazzola M, Page CP, Calzetta L, Matera MG. Pharmacology and therapeutics of bronchodilators. Pharmacol Rev 2012; 64:450-504. [PMID: 22611179 DOI: 10.1124/pr.111.004580] [Citation(s) in RCA: 307] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Bronchodilators are central in the treatment of of airways disorders. They are the mainstay of the current management of chronic obstructive pulmonary disease (COPD) and are critical in the symptomatic management of asthma, although controversies around the use of these drugs remain. Bronchodilators work through their direct relaxation effect on airway smooth muscle cells. at present, three major classes of bronchodilators, β(2)-adrenoceptor (AR) agonists, muscarinic receptor antagonists, and xanthines are available and can be used individually or in combination. The use of the inhaled route is currently preferred to minimize systemic effects. Fast- and short-acting agents are best used for rescue of symptoms, whereas long-acting agents are best used for maintenance therapy. It has proven difficult to discover novel classes of bronchodilator drugs, although potential new targets are emerging. Consequently, the logical approach has been to improve the existing bronchodilators, although several novel broncholytic classes are under development. An important step in simplifying asthma and COPD management and improving adherence with prescribed therapy is to reduce the dose frequency to the minimum necessary to maintain disease control. Therefore, the incorporation of once-daily dose administration is an important strategy to improve adherence. Several once-daily β(2)-AR agonists or ultra-long-acting β(2)-AR-agonists (LABAs), such as indacaterol, olodaterol, and vilanterol, are already in the market or under development for the treatment of COPD and asthma, but current recommendations suggest the use of LABAs only in combination with an inhaled corticosteroid. In addition, some new potentially long-acting antimuscarinic agents, such as glycopyrronium bromide (NVA-237), aclidinium bromide, and umeclidinium bromide (GSK573719), are under development, as well as combinations of several classes of long-acting bronchodilator drugs, in an attempt to simplify treatment regimens as much as possible. This review will describe the pharmacology and therapeutics of old, new, and emerging classes of bronchodilator.
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Affiliation(s)
- Mario Cazzola
- Università di Roma Tor Vergata, Dipartimento di Medicina Interna, Via Montpellier 1, 00133 Roma, Italy.
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Abstract
The global emergence and spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis has led to the re-examination of surgery as a possible adjunctive treatment. We present the case of a 26-year-old HIV-seronegative patient with XDR pulmonary tuberculosis refractory to medical therapy. Surgical resection of the patient's solitary cavitary lesion was done as adjunctive treatment, and a successful outcome with a combination of surgery and drug therapy was achieved. We review the history of surgical therapy for tuberculosis and reports of its role in treatment of MDR and XDR tuberculosis. 26 case series and cohort studies were included, and together showed that surgical resection is beneficial in the treatment of drug-resistant tuberculosis. However, the results might not be applicable in all settings because investigations were observational and typically included patients with less severe disease, and all surgeries were done at specialised thoracic-surgery centres. Well designed studies are needed to establish the efficacy of surgery in treatment of drug-resistant tuberculosis.
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Balabanova Y, Nikolayevskyy V, Ignatyeva O, Kontsevaya I, Rutterford CM, Shakhmistova A, Malomanova N, Chinkova Y, Mironova S, Fedorin I, Drobniewski FA. Survival of civilian and prisoner drug-sensitive, multi- and extensive drug- resistant tuberculosis cohorts prospectively followed in Russia. PLoS One 2011; 6:e20531. [PMID: 21695213 PMCID: PMC3112205 DOI: 10.1371/journal.pone.0020531] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/04/2011] [Indexed: 11/18/2022] Open
Abstract
Objective and Methods A long-term observational study was conducted in Samara, Russia to assess the survival and risk factors for death of a cohort of non-multidrug resistant tuberculosis (non-MDRTB) and multidrug resistant tuberculosis (MDRTB) civilian and prison patients and a civilian extensive drug-resistant tuberculosis (XDRTB) cohort. Results MDRTB and XDRTB rates of 54.8% and 11.1% were identified in the region. Half (50%) of MDRTB patients and the majority of non-MDRTB patients (71%) were still alive at 5 years. Over half (58%) of the patients died within two years of establishing a diagnosis of XDRTB. In the multivariate analysis, retreatment (HR = 1.61, 95%CI 1.04, 2.49) and MDRTB (HR = 1.67, 95%CI 1.17, 2.39) were significantly associated with death within the non-MDR/MDRTB cohort. The effect of age on survival was relatively small (HR = 1.01, 95%CI 1.00, 1.02). No specific factor affected survival of XDRTB patients although median survival time for HIV-infected versus HIV-negative patients from this group was shorter (185 versus 496 days). The majority of MDRTB and XDRTB strains (84% and 92% respectively) strains belonged to the Beijing family. Mutations in the rpoB (codon 531 in 81/92; 88.8%), katG (mutation S315T in 91/92, 98.9%) and inhA genes accounted for most rifampin and isoniazid resistance respectively, mutations in the QRDR region of gyrA for most fluroquinolone resistance (68/92; 73.5%). Conclusions Alarmingly high rates of XDRTB exist. Previous TB treatment cycles and MDR were significant risk factors for mortality. XDRTB patients' survival is short especially for HIV-infected patients. Beijing family strains comprise the majority of drug-resistant strains.
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Affiliation(s)
- Yanina Balabanova
- Queen Mary College, Barts and the London School of Medicine, University of London, London, United Kingdom.
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Marriner GA, Nayyar A, Uh E, Wong SY, Mukherjee T, Via LE, Carroll M, Edwards RL, Gruber TD, Choi I, Lee J, Arora K, England KD, Boshoff HIM, Barry CE. The Medicinal Chemistry of Tuberculosis Chemotherapy. TOPICS IN MEDICINAL CHEMISTRY 2011. [DOI: 10.1007/7355_2011_13] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Brienza NS, Amor-Carro O, Ramos-Barbón D. An update on the use of indacaterol in patients with COPD. Ther Adv Respir Dis 2010; 5:29-40. [PMID: 21059700 DOI: 10.1177/1753465810387810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Current guidelines for the management of chronic obstructive pulmonary disease (COPD) establish that bronchodilator medications are central to the symptomatic treatment of the disease. Regular treatment with long-acting bronchodilators is recommended as more effective and convenient than short-acting bronchodilators, because the long-acting agents provide greater bronchodilator efficacy and symptomatic relief, increased tolerance to exercise, and improved rate of exacerbations and quality of life test scores. Dosing regimens requiring less frequent dosing also provide improved treatment compliance. Indacaterol is a novel once-daily ultra-long-acting β(2)-agonist bronchodilator now approved in the European Union for maintenance bronchodilator treatment of airflow obstruction in adult patients with COPD, to be administered as 150 or 300 microg once-daily dose by means of a single-dose dry powder inhaler. This review focuses on providing a clinical practice-oriented synopsis of the data generated from the randomized trials during the clinical development of indacaterol, published as of the time of writing. Indacaterol has been shown to provide effective 24-h bronchodilation and a fast onset of action, with an efficacy at least comparable or superior to current bronchodilator therapy standards and with a favourable safety and tolerability profile within the β(2)-agonist drug class.
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Affiliation(s)
- Nadia S Brienza
- Respiratory Research Unit, Complexo Hospitalario Universitario & Instituto de Investigación Biomédica de A Coruña (INIBIC), Spain
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Park JK, Koh WJ, Kim DK, Kim EK, Kim YI, Kim HJ, Kim TH, Kim JY, Park MS, Park IN, Park JS, Lee KM, Song SH, Lee JH, Lee SH, Lee HP, Yim JJ, Lim J, Jegal YJ, Jung KH, Huh JW, Choi JC, Shim TS. Treatment Outcomes and Prognostic Factors in Patients with Multidrug-Resistant Tuberculosis in Korean Private Hospitals. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.2.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jin Kyeong Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Deog Kyeom Kim
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Eun Kyung Kim
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Yu Il Kim
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Hee Jin Kim
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Tae-Hyung Kim
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Jae Yeol Kim
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Moo Suk Park
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - I-Nae Park
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Jae Seuk Park
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Ki Man Lee
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Sook Hee Song
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Jin Hwa Lee
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
- Department of Pulmonary and Critical Care Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seung Heon Lee
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Hyuk Pyo Lee
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Jae-Joon Yim
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Jaemin Lim
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Yang Jin Jegal
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Ki Hwan Jung
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Jin Won Huh
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Jae Chol Choi
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Korean TB Study Group, Korean Academy of Tuberculosis and Respiratory Diseases, Seoul, Korea
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Migliori GB, D' Arcy Richardson M, Sotgiu G, Lange C. Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis in the West. Europe and United States: Epidemiology, Surveillance, and Control. Clin Chest Med 2009; 30:637-65, vii. [DOI: 10.1016/j.ccm.2009.08.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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