Impact of immunopathology on the antituberculous activity of pyrazinamide.

Journal:
The Journal of experimental medicine, Volume: 215, Issue: 8
Published:
August 6, 2018
PMID:
30018074
Authors:
Landry Blanc L, Jansy Passiflora Sarathy JP, Nadine Alvarez Cabrera N, Paul O'Brien P, Isabela Dias-Freedman I, Marizel Mina M, James Sacchettini J, Radojka M Savic RM, Martin Gengenbacher M, Brendan K Podell BK, Brendan Prideaux B, Thomas Ioerger T, Thomas Dick T, VĂ©ronique Dartois V
Abstract:

In the 1970s, inclusion of pyrazinamide (PZA) in the drug regimen of tuberculosis (TB) patients for the first 2 mo achieved a drastic reduction of therapy duration. Until now, however, the mechanisms underlying PZA’s unique contribution to efficacy have remained controversial, and animal efficacy data vary across species. To understand how PZA kills bacterial populations present in critical lung lesion compartments, we first characterized a rabbit model of active TB, showing striking similarities in lesion types and fates to nonhuman primate models deemed the most appropriate surrogates of human TB. We next employed this model with lesion-centric molecular and bacteriology readouts to demonstrate that PZA exhibits potent activity against residing in difficult-to-sterilize necrotic lesions. Our data also indicate that PZA is slow acting, suggesting that PZA administration beyond the first 2 mo may accelerate the cure. In conclusion, we provide a pharmacodynamic explanation for PZA’s treatment-shortening effect and deliver new tools to dissect the contribution of immune response versus drug at the lesion level.