1区 · 医学
Article
作者: Ballell, Lluis ; Remuiñán, Modesto J. ; Rullas, Joaquín ; Deprez, Benoit ; Tanina, Abdalkarim ; Frita, Rosangela ; de Mercado, Jaime ; Soetaert, Karine ; Jiménez, Elena ; Willand, Nicolas ; Djaout, Kamel ; Baulard, Alain R. ; Drewes, Gerard ; Casado, Patricia ; Flipo, Marion ; Gamallo, Pablo ; Porras-De Francisco, Esther ; Kiass, Mehdi ; Brodin, Priscille ; Megalizzi, Véronique ; Boesche, Markus ; Leroux, Florence ; Slupek, Stéphanie ; Gresham, Stephanie ; Antoine, Rudy ; Boyle, Gary W. ; Mendoza-Losana, Alfonso ; Moune, Martin ; Mathys, Vanessa ; Wintjens, René ; Delorme, Vincent ; Bourotte, Marilyne ; Ghidelli-Disse, Sonja ; Barros-Aguirre, David ; Kemmer, Christian ; Lociuro, Sergio ; Piveteau, Catherine ; Gitzinger, Marc ; Pérez-Herrán, Esther ; Derimanov, Geo ; Martínez-Martínez, María S.
The sensitivity of
Mycobacterium tuberculosis
, the pathogen that causes tuberculosis (TB), to antibiotic prodrugs is dependent on the efficacy of the activation process that transforms the prodrugs into their active antibacterial moieties. Various oxidases of
M. tuberculosis
have the potential to activate the prodrug ethionamide. Here, we used medicinal chemistry coupled with a phenotypic assay to select the N-acylated 4-phenylpiperidine compound series. The lead compound, SMARt751, interacted with the transcriptional regulator VirS of
M. tuberculosis
, which regulates the
mymA
operon encoding a monooxygenase that activates ethionamide. SMARt751 boosted the efficacy of ethionamide in vitro and in mouse models of acute and chronic TB. SMARt751 also restored full efficacy of ethionamide in mice infected with
M. tuberculosis
strains carrying mutations in the
ethA
gene, which cause ethionamide resistance in the clinic. SMARt751 was shown to be safe in tests conducted in vitro and in vivo. A model extrapolating animal pharmacokinetic and pharmacodynamic parameters to humans predicted that as little as 25 mg of SMARt751 daily would allow a fourfold reduction in the dose of ethionamide administered while retaining the same efficacy and reducing side effects.
