A sterilizing tuberculosis treatment regimen is associated with faster clearance of bacteria in cavitary lesions in marmosets

Laura E. Via, Kathleen England, Danielle M. Weiner, Daniel Schimel, Matthew D. Zimmerman, Emmanuel Dayao, Ray Y. Chen, Lori E. Dodd, Mike Richardson, Katherine K. Robbins, Ying Cai, Dima Hammoud, Peter Herscovitch, Véronique Dartois, Jo Anne L. Flynn, Clifton E. Barry

Research output: Contribution to journalArticlepeer-review

Abstract

Shortening the lengthy treatment duration for tuberculosis patients is a major goal of current drug development efforts. The common marmoset develops human-like disease pathology and offers an attractive model to better understand the basis for relapse and test regimens for effective shorter duration therapy. We treated Mycobacterium tuberculosis-infected marmosets with two drug regimens known to differ in their relapse rates in human clinical trials: the standard four-drug combination of isoniazid, rifampin, pyrazinamide, and ethambutol (HRZE) that has very low relapse rates and the combination of isoniazid and streptomycin that is associated with higher relapse rates. As early as 2 weeks, the more sterilizing regimen significantly reduced the volume of lung disease by computed tomography (P = 0.035) and also significantly reduced uptake of [18 F]-2-fluoro-2-deoxyglucose by positron emission tomography (P = 0.049). After 6 weeks of therapy, both treatments caused similar reductions in granuloma bacterial load, but the more sterilizing, four-drug regimen caused greater reduction in bacterial load in cavitary lesions (P = 0.009). These findings, combined with the association in humans between cavitary disease and relapse, suggest that the basis for improved sterilizing activity of the four-drug combination is both its faster disease volume resolution and its stronger sterilizing effect on cavitary lesions. Definitive data from relapse experiments are needed to support this observation.

Original languageEnglish (US)
Pages (from-to)4181-4189
Number of pages9
JournalAntimicrobial agents and chemotherapy
Volume59
Issue number7
DOIs
StatePublished - Jul 1 2015

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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