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      Assessment of carbapenems in a mouse model of Mycobacterium tuberculosis infection

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          Abstract

          We present further study of a subset of carbapenems, arising from a previously reported machine learning approach, with regard to their mouse pharmacokinetic profiling and subsequent study in a mouse model of sub-acute Mycobacterium tuberculosis infection. Pharmacokinetic metrics for such small molecules were compared to those for meropenem and biapenem, resulting in the selection of two carbapenems to be assessed for their ability to reduce M. tuberculosis bacterial loads in the lungs of infected mice. The original syntheses of these two carbapenems were optimized to provide multigram quantities of each compound. One of the two experimental carbapenems, JSF-2204, exhibited efficacy equivalent to that of meropenem, while both were inferior to rifampin. The lessons learned in this study point toward the need to further enhance the pharmacokinetic profiles of experimental carbapenems to positively impact in vivo efficacy performance.

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          Most cited references20

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          New agents for the treatment of drug-resistant Mycobacterium tuberculosis.

          Inadequate dosing and incomplete treatment regimens, coupled with the ability of the tuberculosis bacilli to cause latent infections that are tolerant of currently used drugs, have fueled the rise of multidrug-resistant tuberculosis (MDR-TB). Treatment of MDR-TB infections is a major clinical challenge that has few viable or effective solutions; therefore patients face a poor prognosis and years of treatment. This review focuses on emerging drug classes that have the potential for treating MDR-TB and highlights their particular strengths as leads including their mode of action, in vivo efficacy, and key medicinal chemistry properties. Examples include the newly approved drugs bedaquiline and delaminid, and other agents in clinical and late preclinical development pipeline for the treatment of MDR-TB. Herein, we discuss the challenges to developing drugs to treat tuberculosis and how the field has adapted to these difficulties, with an emphasis on drug discovery approaches that might produce more effective agents and treatment regimens.
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            Systematic review of mutations associated with resistance to the new and repurposed Mycobacterium tuberculosis drugs bedaquiline, clofazimine, linezolid, delamanid and pretomanid

            Improved genetic understanding of Mycobacterium tuberculosis (MTB) resistance to novel and repurposed anti-tubercular agents can aid the development of rapid molecular diagnostics. Adhering to PRISMA guidelines, in March 2018, we performed a systematic review of studies implicating mutations in resistance through sequencing and phenotyping before and/or after spontaneous resistance evolution, as well as allelic exchange experiments. We focused on the novel drugs bedaquiline, delamanid, pretomanid and the repurposed drugs clofazimine and linezolid. A database of 1373 diverse control MTB whole genomes, isolated from patients not exposed to these drugs, was used to further assess genotype–phenotype associations. Of 2112 papers, 54 met the inclusion criteria. These studies characterized 277 mutations in the genes atpE, mmpR, pepQ, Rv1979c, fgd1, fbiABC and ddn and their association with resistance to one or more of the five drugs. The most frequent mutations for bedaquiline, clofazimine, linezolid, delamanid and pretomanid resistance were atpE A63P, mmpR frameshifts at nucleotides 192–198, rplC C154R, ddn W88* and ddn S11*, respectively. Frameshifts in the mmpR homopolymer region nucleotides 192–198 were identified in 52/1373 (4%) of the control isolates without prior exposure to bedaquiline or clofazimine. Of isolates resistant to one or more of the five drugs, 59/519 (11%) lacked a mutation explaining phenotypic resistance. This systematic review supports the use of molecular methods for linezolid resistance detection. Resistance mechanisms involving non-essential genes show a diversity of mutations that will challenge molecular diagnosis of bedaquiline and nitroimidazole resistance. Combined phenotypic and genotypic surveillance is needed for these drugs in the short term.
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              Bedaquiline Resistance: Its Emergence, Mechanism, and Prevention

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                Author and article information

                Contributors
                Role: InvestigationRole: MethodologyRole: Writing – original draft
                Role: InvestigationRole: Methodology
                Role: Formal analysisRole: InvestigationRole: Methodology
                Role: InvestigationRole: MethodologyRole: Writing – original draft
                Role: InvestigationRole: Methodology
                Role: InvestigationRole: Methodology
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                3 May 2021
                2021
                : 16
                : 5
                : e0249841
                Affiliations
                [1 ] Department of Pharmacology, Physiology, and Neuroscience, Rutgers University–New Jersey Medical School, Newark, New Jersey, United States of America
                [2 ] Center for Tuberculosis Research and Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
                [3 ] Division of Infectious Disease, Department of Medicine and the Ruy V. Lourenço Center for the Study of Emerging and Re-emerging Pathogens, Rutgers University—New Jersey Medical School, Newark, New Jersey, United States of America
                Newcastle University, UK, UNITED KINGDOM
                Author notes

                Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: the authors declare that a United States patent (US10,695,322) has been granted, including J.S.F., G.L., and A.K. as inventors, relevant to the carbapenems disclosed herein. Novel Inhibitors of Bacterial Growth, U.S. Patent 10,695,322, issued June 30, 2020, Assignees: The Johns Hopkins University (Baltimore, MD), Rutgers, The State University of New Jersey (New Brunswick, NJ), Inventors: Gyanu Lamichhane (Towson, MD), Craig A. Townsend (Baltimore, MD), Evan Lloyd (Bunker Hill, WV), Amit Kaushik (Baltimore, MD), Pankaj Kumar (Baltimore, MD), Joel Freundlich (Princeton, NJ), Shaogang Li (Newark, NJ), Sean Ekins (Fuquay Varina, NC), Nicole Parrish (Bunker Hilol, WV. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                [¤]

                Current address: R. J.–Piramal Pharma Solutions; R.G.M.–Institute for Therapeutics Discovery and Development, University of Minnesota, Minneapolis, Minnesota, United States of America

                Author information
                https://orcid.org/0000-0002-3411-3455
                Article
                PONE-D-20-37167
                10.1371/journal.pone.0249841
                8092647
                33939697
                cd7ca9b2-5c1e-4b3d-9810-c9d052a478a4
                © 2021 Jadhav et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 25 November 2020
                : 25 March 2021
                Page count
                Figures: 4, Tables: 1, Pages: 11
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000009, Foundation for the National Institutes of Health;
                Award ID: R33AI111739
                Award Recipient :
                G.L., J.S.F., and E.L.N. acknowledge support from award number R33AI111739 “Development of oral carbapenem drugs for treatment of drug resistant TB” from the National Institutes of Health and National Institute of Allergy and Infectious Diseases. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Organisms
                Bacteria
                Actinobacteria
                Mycobacterium Tuberculosis
                Research and Analysis Methods
                Animal Studies
                Experimental Organism Systems
                Model Organisms
                Mouse Models
                Research and Analysis Methods
                Model Organisms
                Mouse Models
                Research and Analysis Methods
                Animal Studies
                Experimental Organism Systems
                Animal Models
                Mouse Models
                Physical Sciences
                Chemistry
                Chemical Reactions
                Organic Reactions
                Hydrogenation
                Physical Sciences
                Chemistry
                Organic Chemistry
                Organic Reactions
                Hydrogenation
                Research and Analysis Methods
                Chemical Synthesis
                Research and Analysis Methods
                Animal Studies
                Animal Models of Disease
                Animal Models of Infection
                Biology and Life Sciences
                Microbiology
                Animal Models of Infection
                Medicine and Health Sciences
                Pharmacology
                Pharmacokinetics
                Physical Sciences
                Chemistry
                Chemical Elements
                Sodium
                Physical Sciences
                Chemistry
                Chemical Compounds
                Bicarbonates
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

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