Impact of immunopathology on the antituberculous activity of pyrazinamide

Landry Blanc, Jansy Passiflora Sarathy, Nadine Alvarez Cabrera, Paul O’Brien, Isabela Dias‑Freedman, Marizel Mina, James Sacchettini, Radojka M. Savic, Martin Gengenbacher, Brendan K. Podell, Brendan Prideaux, Thomas Ioerger, Thomas Dick, Véronique Dartois

Research output: Contribution to journalArticle

11 Scopus citations

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 Mycobacterium tuberculosis 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.

Original languageEnglish (US)
Pages (from-to)1975-1986
Number of pages12
JournalJournal of Experimental Medicine
Volume215
Issue number8
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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    Blanc, L., Sarathy, J. P., Cabrera, N. A., O’Brien, P., Dias‑Freedman, I., Mina, M., Sacchettini, J., Savic, R. M., Gengenbacher, M., Podell, B. K., Prideaux, B., Ioerger, T., Dick, T., & Dartois, V. (2018). Impact of immunopathology on the antituberculous activity of pyrazinamide. Journal of Experimental Medicine, 215(8), 1975-1986. https://doi.org/10.1084/jem.20180518