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Dartois V, Dick T. Therapeutic developments for tuberculosis and nontuberculous mycobacterial lung disease. Nat Rev Drug Discov 2024; 23:381-403. [PMID: 38418662 PMCID: PMC11078618 DOI: 10.1038/s41573-024-00897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
Tuberculosis (TB) drug discovery and development has undergone nothing short of a revolution over the past 20 years. Successful public-private partnerships and sustained funding have delivered a much-improved understanding of mycobacterial disease biology and pharmacology and a healthy pipeline that can tolerate inevitable attrition. Preclinical and clinical development has evolved from decade-old concepts to adaptive designs that permit rapid evaluation of regimens that might greatly shorten treatment duration over the next decade. But the past 20 years also saw the rise of a fatal and difficult-to-cure lung disease caused by nontuberculous mycobacteria (NTM), for which the drug development pipeline is nearly empty. Here, we discuss the similarities and differences between TB and NTM lung diseases, compare the preclinical and clinical advances, and identify major knowledge gaps and areas of cross-fertilization. We argue that applying paradigms and networks that have proved successful for TB, from basic research to clinical trials, will help to populate the pipeline and accelerate curative regimen development for NTM disease.
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Affiliation(s)
- Véronique Dartois
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA.
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA.
| | - Thomas Dick
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Department of Microbiology and Immunology, Georgetown University, Washington, DC, USA
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2
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Meliefste HM, Mudde SE, Ammerman NC, de Steenwinkel JEM, Bax HI. A laboratory perspective on Mycobacterium abscessus biofilm culture, characterization and drug activity testing. Front Microbiol 2024; 15:1392606. [PMID: 38690364 PMCID: PMC11058659 DOI: 10.3389/fmicb.2024.1392606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Mycobacterium abscessus is an emerging opportunistic pathogen causing severe pulmonary infections in patients with underlying lung disease and cystic fibrosis in particular. The rising prevalence of M. abscessus infections poses an alarming threat, as the success rates of available treatment options are limited. Central to this challenge is the absence of preclinical in vitro models that accurately mimic in vivo conditions and that can reliably predict treatment outcomes in patients. M. abscessus is notorious for its association with biofilm formation within the lung. Bacteria in biofilms are more recalcitrant to antibiotic treatment compared to planktonic bacteria, which likely contributes to the lack of correlation between preclinical drug activity testing (typically performed on planktonic bacteria) and treatment outcome. In recent years, there has been a growing interest in M. abscessus biofilm research. However, the absence of standardized methods for biofilm culture, biofilm characterization and drug activity testing has led to a wide spectrum of, sometimes inconsistent, findings across various studies. Factors such as strain selection, culture medium, and incubation time hugely impact biofilm development, phenotypical characteristics and antibiotic susceptibility. Additionally, a broad range of techniques are used to study M. abscessus biofilms, including quantification of colony-forming units, crystal violet staining and fluorescence microscopy. Yet, limitations of these techniques and the selected readouts for analysis affect study outcomes. Currently, research on the activity of conventional antibiotics, such as clarithromycin and amikacin, against M. abscessus biofilms yield ambiguous results, underscoring the substantial impact of experimental conditions on drug activity assessment. Beyond traditional drug activity testing, the exploration of novel anti-biofilm compounds and the improvement of in vitro biofilm models are ongoing. In this review, we outline the laboratory models, experimental variables and techniques that are used to study M. abscessus biofilms. We elaborate on the current insights of M. abscessus biofilm characteristics and describe the present understanding of the activity of traditional antibiotics, as well as potential novel compounds, against M. abscessus biofilms. Ultimately, this work contributes to the advancement of fundamental knowledge and practical applications of accurate preclinical M. abscessus models, thereby facilitating progress towards improved therapies for M. abscessus infections.
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Affiliation(s)
| | - Saskia Emily Mudde
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nicole Christine Ammerman
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Hannelore Iris Bax
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
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Nguyen TQ, Heo BE, Jeon S, Ash A, Lee H, Moon C, Jang J. Exploring antibiotic resistance mechanisms in Mycobacterium abscessus for enhanced therapeutic approaches. Front Microbiol 2024; 15:1331508. [PMID: 38380095 PMCID: PMC10877060 DOI: 10.3389/fmicb.2024.1331508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Mycobacterium abscessus, a leading cause of severe lung infections in immunocompromised individuals, poses significant challenges for current therapeutic strategies due to resistance mechanisms. Therefore, understanding the intrinsic and acquired antibiotic resistance of M. abscessus is crucial for effective treatment. This review highlights the mechanisms employed by M. abscessus to sustain antibiotic resistance, encompassing not only conventional drugs but also newly discovered drug candidates. This comprehensive analysis aims to identify novel entities capable of overcoming the notorious resistance exhibited by M. abscessus, providing insights for the development of more effective therapeutic interventions.
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Affiliation(s)
- Thanh Quang Nguyen
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Bo Eun Heo
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Seunghyeon Jeon
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Anwesha Ash
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Heehyun Lee
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Cheol Moon
- Department of Clinical Laboratory Science, Semyung University, Jecheon, Republic of Korea
| | - Jichan Jang
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, Republic of Korea
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Lang M, Ganapathy US, Mann L, Abdelaziz R, Seidel RW, Goddard R, Sequenzia I, Hoenke S, Schulze P, Aragaw WW, Csuk R, Dick T, Richter A. Synthesis and Characterization of Phenylalanine Amides Active against Mycobacterium abscessus and Other Mycobacteria. J Med Chem 2023; 66:5079-5098. [PMID: 37001025 PMCID: PMC10586324 DOI: 10.1021/acs.jmedchem.3c00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Nα-2-thiophenoyl-d-phenylalanine-2-morpholinoanilide [MMV688845, Pathogen Box; Medicines for Malaria Venture; IUPAC: (2R)-N-(1-((2-morpholinophenyl)amino)-1-oxo-3-phenylpropan-2-yl)thiophene-2-carboxamide)] is a hit compound, which shows activity against Mycobacterium abscessus (MIC90 6.25-12.5 μM) and other mycobacteria. This work describes derivatization of MMV688845 by introducing a thiomorpholine moiety and the preparation of the corresponding sulfones and sulfoxides. The molecular structures of three analogs are confirmed by X-ray crystallography. Conservation of the essential R configuration during synthesis is proven by chiral HPLC for an exemplary compound. All analogs were characterized in a MIC assay against M. abscessus, Mycobacterium intracellulare, Mycobacterium smegmatis, and Mycobacterium tuberculosis. The sulfone derivatives exhibit lower MIC90 values (M. abscessus: 0.78 μM), and the sulfoxides show higher aqueous solubility than the hit compound. The most potent derivatives possess bactericidal activity (99% inactivation of M. abscessus at 12.5 μM), while they are not cytotoxic against mammalian cell lines.
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Affiliation(s)
- Markus Lang
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany
| | - Uday S. Ganapathy
- Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, 07110 Nutley, New Jersey, USA
| | - Lea Mann
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany
| | - Rana Abdelaziz
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany
| | - Rüdiger W. Seidel
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany
| | - Richard Goddard
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470 Mülheim an der Ruhr, Germany
| | - Ilaria Sequenzia
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany
| | - Sophie Hoenke
- Institut für Chemie, Martin-Luther-Universität Halle-Wittenberg, Kurt-Mothes-Str. 2, 06120 Halle (Saale), Germany
| | - Philipp Schulze
- Max-Planck-Institut für Kohlenforschung, Kaiser-Wilhelm-Platz 1, 45470 Mülheim an der Ruhr, Germany
| | - Wassihun Wedajo Aragaw
- Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, 07110 Nutley, New Jersey, USA
| | - René Csuk
- Institut für Chemie, Martin-Luther-Universität Halle-Wittenberg, Kurt-Mothes-Str. 2, 06120 Halle (Saale), Germany
| | - Thomas Dick
- Center for Discovery and Innovation, Hackensack Meridian Health, 111 Ideation Way, 07110 Nutley, New Jersey, USA
- Department of Medical Sciences, Hackensack Meridian School of Medicine, 123 Metro Blvd, 07110 Nutley, New Jersey, USA
- Department of Microbiology and Immunology, Georgetown University, 3900 Reservoir Road, N.W., 20007 Washington DC, USA
| | - Adrian Richter
- Institut für Pharmazie, Martin-Luther-Universität Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120 Halle (Saale), Germany
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Lan T, Ganapathy US, Sharma S, Ahn Y, Zimmerman M, Molodtsov V, Hegde P, Gengenbacher M, Ebright RH, Dartois V, Freundlich JS, Dick T, Aldrich CC. Redesign of Rifamycin Antibiotics to Overcome ADP-Ribosylation-Mediated Resistance. Angew Chem Int Ed Engl 2022; 61:e202211498. [PMID: 36222275 PMCID: PMC9633546 DOI: 10.1002/anie.202211498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Indexed: 11/11/2022]
Abstract
Rifamycin antibiotics are a valuable class of antimicrobials for treating infections by mycobacteria and other persistent bacteria owing to their potent bactericidal activity against replicating and non-replicating pathogens. However, the clinical utility of rifamycins against Mycobacterium abscessus is seriously compromised by a novel resistance mechanism, namely, rifamycin inactivation by ADP-ribosylation. Using a structure-based approach, we rationally redesign rifamycins through strategic modification of the ansa-chain to block ADP-ribosylation while preserving on-target activity. Validated by a combination of biochemical, structural, and microbiological studies, the most potent analogs overcome ADP-ribosylation, restored their intrinsic low nanomolar activity and demonstrated significant in vivo antibacterial efficacy. Further optimization by tuning drug disposition properties afforded a preclinical candidate with remarkable potency and an outstanding pharmacokinetic profile.
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Affiliation(s)
- Tian Lan
- Department of Medicinal ChemistryCollege of PharmacyUniversity of Minnesota308 SE Harvard St SEMinneapolisMN 55455USA
| | - Uday S. Ganapathy
- Center for Discovery and InnovationHackensack Meridian Health & Department of Medical SciencesHackensack Meridian School of Medicine123 Metro BoulevardNutleyNJ 07110USA
| | - Sachin Sharma
- Department of Medicinal ChemistryCollege of PharmacyUniversity of Minnesota308 SE Harvard St SEMinneapolisMN 55455USA
| | - Yong‐Mo Ahn
- Department of Pharmacology and PhysiologyDepartment of MedicineCenter for Emerging and Reemerging PathogensRutgers University185 South Orange AvenueNewarkNJ 07103USA,National Center for Advancing Translational SciencesNational Institutes of HealthRockvilleMD 20850USA
| | - Matthew Zimmerman
- Center for Discovery and InnovationHackensack Meridian Health & Department of Medical SciencesHackensack Meridian School of Medicine123 Metro BoulevardNutleyNJ 07110USA
| | - Vadim Molodtsov
- Waksman InstituteRutgers University190 Frelinghuysen RoadPiscatawayNJ 08854USA
| | - Pooja Hegde
- Department of Medicinal ChemistryCollege of PharmacyUniversity of Minnesota308 SE Harvard St SEMinneapolisMN 55455USA
| | - Martin Gengenbacher
- Center for Discovery and InnovationHackensack Meridian Health & Department of Medical SciencesHackensack Meridian School of Medicine123 Metro BoulevardNutleyNJ 07110USA
| | - Richard H. Ebright
- Waksman InstituteRutgers University190 Frelinghuysen RoadPiscatawayNJ 08854USA
| | - Véronique Dartois
- Center for Discovery and InnovationHackensack Meridian Health & Department of Medical SciencesHackensack Meridian School of Medicine123 Metro BoulevardNutleyNJ 07110USA
| | - Joel S. Freundlich
- Department of Pharmacology and PhysiologyDepartment of MedicineCenter for Emerging and Reemerging PathogensRutgers University185 South Orange AvenueNewarkNJ 07103USA
| | - Thomas Dick
- Center for Discovery and InnovationHackensack Meridian Health & Department of Medical SciencesHackensack Meridian School of Medicine123 Metro BoulevardNutleyNJ 07110USA,Department of Microbiology and ImmunologyGeorgetown University3900 Reservoir Road NWWashingtonDC 20007USA
| | - Courtney C. Aldrich
- Department of Medicinal ChemistryCollege of PharmacyUniversity of Minnesota308 SE Harvard St SEMinneapolisMN 55455USA
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Lan T, Ganapathy US, Sharma S, Ahn Y, Zimmerman M, Molodtsov V, Hegde P, Gengenbacher M, Ebright RH, Dartois V, Freundlich JS, Dick T, Aldrich CC. Redesign of Rifamycin Antibiotics to Overcome ADP‐Ribosylation‐Mediated Resistance. Angew Chem Int Ed Engl 2022. [DOI: 10.1002/ange.202211498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tian Lan
- Department of Medicinal Chemistry College of Pharmacy University of Minnesota 308 SE Harvard St SE Minneapolis MN 55455 USA
| | - Uday S. Ganapathy
- Center for Discovery and Innovation Hackensack Meridian Health & Department of Medical Sciences Hackensack Meridian School of Medicine 123 Metro Boulevard Nutley NJ 07110 USA
| | - Sachin Sharma
- Department of Medicinal Chemistry College of Pharmacy University of Minnesota 308 SE Harvard St SE Minneapolis MN 55455 USA
| | - Yong‐Mo Ahn
- Department of Pharmacology and Physiology Department of Medicine Center for Emerging and Reemerging Pathogens Rutgers University 185 South Orange Avenue Newark NJ 07103 USA
- National Center for Advancing Translational Sciences National Institutes of Health Rockville MD 20850 USA
| | - Matthew Zimmerman
- Center for Discovery and Innovation Hackensack Meridian Health & Department of Medical Sciences Hackensack Meridian School of Medicine 123 Metro Boulevard Nutley NJ 07110 USA
| | - Vadim Molodtsov
- Waksman Institute Rutgers University 190 Frelinghuysen Road Piscataway NJ 08854 USA
| | - Pooja Hegde
- Department of Medicinal Chemistry College of Pharmacy University of Minnesota 308 SE Harvard St SE Minneapolis MN 55455 USA
| | - Martin Gengenbacher
- Center for Discovery and Innovation Hackensack Meridian Health & Department of Medical Sciences Hackensack Meridian School of Medicine 123 Metro Boulevard Nutley NJ 07110 USA
| | - Richard H. Ebright
- Waksman Institute Rutgers University 190 Frelinghuysen Road Piscataway NJ 08854 USA
| | - Véronique Dartois
- Center for Discovery and Innovation Hackensack Meridian Health & Department of Medical Sciences Hackensack Meridian School of Medicine 123 Metro Boulevard Nutley NJ 07110 USA
| | - Joel S. Freundlich
- Department of Pharmacology and Physiology Department of Medicine Center for Emerging and Reemerging Pathogens Rutgers University 185 South Orange Avenue Newark NJ 07103 USA
| | - Thomas Dick
- Center for Discovery and Innovation Hackensack Meridian Health & Department of Medical Sciences Hackensack Meridian School of Medicine 123 Metro Boulevard Nutley NJ 07110 USA
- Department of Microbiology and Immunology Georgetown University 3900 Reservoir Road NW Washington DC 20007 USA
| | - Courtney C. Aldrich
- Department of Medicinal Chemistry College of Pharmacy University of Minnesota 308 SE Harvard St SE Minneapolis MN 55455 USA
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