Novel treatment strategies for tuberculosis are urgently needed. Many different preclinical models assessing anti-tuberculosis drug activity are available, but it is yet unclear which combination of models is most predictive of clinical treatment efficacy. The aim of this study was to determine the role of our in vitro time kill-kinetics assay as an asset to a predictive preclinical modeling framework assessing anti-tuberculosis drug activity. The concentration- and time-dependent mycobacterial killing capacities of six anti-tuberculosis drugs were determined during exposure as single drugs or in dual, triple and quadruple combinations towards a Mycobacterium tuberculosis Beijing genotype strain and drug resistance was assessed. Streptomycin, rifampicin and isoniazid were most active against fast-growing M. tuberculosis. Isoniazid with rifampicin or high dose ethambutol were the only synergistic drug combinations. The addition of rifampicin or streptomycin to isoniazid prevented isoniazid resistance. In vitro ranking showed agreement with early bactericidal activity in tuberculosis patients for some but not all anti-tuberculosis drugs. The time-kill kinetics assay provides important information on the mycobacterial killing dynamics of anti-tuberculosis drugs during the early phase of drug exposure. As such, this assay is a valuable component of the preclinical modeling framework.

译文

:迫切需要新的结核病治疗策略。目前已有许多评估抗结核药物活性的临床前模型,但尚不清楚哪种模型组合最能预测临床治疗效果。这项研究的目的是确定我们在体外时间杀伤动力学测定中作为评估抗结核药物活性的预测性临床前建模框架的一项资产的作用。在暴露于结核分枝杆菌北京基因型菌株的单药或双重,三重和四重组合暴露期间,确定了六种抗结核药物的浓度和时间依赖性分枝杆菌杀伤能力,并评估了耐药性。链霉素,利福平和异烟肼对快速增长的结核分枝杆菌最为活跃。异烟肼与利福平或大剂量乙胺丁醇是唯一的协同药物组合。在异烟肼中添加利福平或链霉素可防止异烟肼耐药。在体外排名显示,对于某些但不是全部抗结核药物,结核病患者的早期杀菌活性与之一致。时间杀灭动力学测定法提供了有关药物暴露初期抗结核药物分枝杆菌杀灭动力学的重要信息。因此,该测定是临床前建模框架的重要组成部分。

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