NOS2-deficient mice with hypoxic necrotizing lung lesions predict outcomes of tuberculosis chemotherapy in humans

Martin Gengenbacher, Maria A. Duque-Correa, Peggy Kaiser, Stefanie Schuerer, Doris Lazar, Ulrike Zedler, Stephen T. Reece, Amit Nayyar, Stewart T. Cole, Vadim Makarov, Clifton E. Barry, Véronique Dartois, Stefan H.E. Kaufmann

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Abstract

During active TB in humans a spectrum of pulmonary granulomas with central necrosis and hypoxia exists. BALB/c mice, predominantly used in TB drug development, do not reproduce this complex pathology thereby inaccurately predicting clinical outcome. We found that Nos2 -/- mice incapable of NO-production in immune cells as microbial defence uniformly develop hypoxic necrotizing lung lesions, widely observed in human TB. To study the impact of hypoxic necrosis on the efficacy of antimycobacterials and drug candidates, we subjected Nos2 -/- mice with TB to monotherapy before or after establishment of human-like pathology. Isoniazid induced a drug-tolerant persister population only when necrotic lesions were present. Rifapentine was more potent than rifampin prior to development of human-like pathology and equally potent thereafter, in agreement with recent clinical trials. Pretomanid, delamanid and the pre-clinical candidate BTZ043 were bactericidal independent of pulmonary pathology. Linezolid was bacteriostatic in TB-infected Nos2 -/- mice but significantly improved lung pathology. Hypoxic necrotizing lesions rendered moxifloxacin less active. In conclusion, Nos2 -/- mice are a predictive TB drug development tool owing to their consistent development of human-like pathology.

Original languageEnglish (US)
Article number8853
JournalScientific reports
Volume7
Issue number1
DOIs
StatePublished - Dec 1 2017

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Tuberculosis
Pathology
Drug Therapy
Lung
Linezolid
rifapentine
Human Development
Pharmaceutical Preparations
Necrosis
Isoniazid
Rifampin
Granuloma
Clinical Trials
Population

All Science Journal Classification (ASJC) codes

  • General

Cite this

Gengenbacher, M., Duque-Correa, M. A., Kaiser, P., Schuerer, S., Lazar, D., Zedler, U., ... Kaufmann, S. H. E. (2017). NOS2-deficient mice with hypoxic necrotizing lung lesions predict outcomes of tuberculosis chemotherapy in humans. Scientific reports, 7(1), [8853]. https://doi.org/10.1038/s41598-017-09177-2
Gengenbacher, Martin ; Duque-Correa, Maria A. ; Kaiser, Peggy ; Schuerer, Stefanie ; Lazar, Doris ; Zedler, Ulrike ; Reece, Stephen T. ; Nayyar, Amit ; Cole, Stewart T. ; Makarov, Vadim ; Barry, Clifton E. ; Dartois, Véronique ; Kaufmann, Stefan H.E. / NOS2-deficient mice with hypoxic necrotizing lung lesions predict outcomes of tuberculosis chemotherapy in humans. In: Scientific reports. 2017 ; Vol. 7, No. 1.
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abstract = "During active TB in humans a spectrum of pulmonary granulomas with central necrosis and hypoxia exists. BALB/c mice, predominantly used in TB drug development, do not reproduce this complex pathology thereby inaccurately predicting clinical outcome. We found that Nos2 -/- mice incapable of NO-production in immune cells as microbial defence uniformly develop hypoxic necrotizing lung lesions, widely observed in human TB. To study the impact of hypoxic necrosis on the efficacy of antimycobacterials and drug candidates, we subjected Nos2 -/- mice with TB to monotherapy before or after establishment of human-like pathology. Isoniazid induced a drug-tolerant persister population only when necrotic lesions were present. Rifapentine was more potent than rifampin prior to development of human-like pathology and equally potent thereafter, in agreement with recent clinical trials. Pretomanid, delamanid and the pre-clinical candidate BTZ043 were bactericidal independent of pulmonary pathology. Linezolid was bacteriostatic in TB-infected Nos2 -/- mice but significantly improved lung pathology. Hypoxic necrotizing lesions rendered moxifloxacin less active. In conclusion, Nos2 -/- mice are a predictive TB drug development tool owing to their consistent development of human-like pathology.",
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Gengenbacher, M, Duque-Correa, MA, Kaiser, P, Schuerer, S, Lazar, D, Zedler, U, Reece, ST, Nayyar, A, Cole, ST, Makarov, V, Barry, CE, Dartois, V & Kaufmann, SHE 2017, 'NOS2-deficient mice with hypoxic necrotizing lung lesions predict outcomes of tuberculosis chemotherapy in humans', Scientific reports, vol. 7, no. 1, 8853. https://doi.org/10.1038/s41598-017-09177-2

NOS2-deficient mice with hypoxic necrotizing lung lesions predict outcomes of tuberculosis chemotherapy in humans. / Gengenbacher, Martin; Duque-Correa, Maria A.; Kaiser, Peggy; Schuerer, Stefanie; Lazar, Doris; Zedler, Ulrike; Reece, Stephen T.; Nayyar, Amit; Cole, Stewart T.; Makarov, Vadim; Barry, Clifton E.; Dartois, Véronique; Kaufmann, Stefan H.E.

In: Scientific reports, Vol. 7, No. 1, 8853, 01.12.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - NOS2-deficient mice with hypoxic necrotizing lung lesions predict outcomes of tuberculosis chemotherapy in humans

AU - Gengenbacher, Martin

AU - Duque-Correa, Maria A.

AU - Kaiser, Peggy

AU - Schuerer, Stefanie

AU - Lazar, Doris

AU - Zedler, Ulrike

AU - Reece, Stephen T.

AU - Nayyar, Amit

AU - Cole, Stewart T.

AU - Makarov, Vadim

AU - Barry, Clifton E.

AU - Dartois, Véronique

AU - Kaufmann, Stefan H.E.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - During active TB in humans a spectrum of pulmonary granulomas with central necrosis and hypoxia exists. BALB/c mice, predominantly used in TB drug development, do not reproduce this complex pathology thereby inaccurately predicting clinical outcome. We found that Nos2 -/- mice incapable of NO-production in immune cells as microbial defence uniformly develop hypoxic necrotizing lung lesions, widely observed in human TB. To study the impact of hypoxic necrosis on the efficacy of antimycobacterials and drug candidates, we subjected Nos2 -/- mice with TB to monotherapy before or after establishment of human-like pathology. Isoniazid induced a drug-tolerant persister population only when necrotic lesions were present. Rifapentine was more potent than rifampin prior to development of human-like pathology and equally potent thereafter, in agreement with recent clinical trials. Pretomanid, delamanid and the pre-clinical candidate BTZ043 were bactericidal independent of pulmonary pathology. Linezolid was bacteriostatic in TB-infected Nos2 -/- mice but significantly improved lung pathology. Hypoxic necrotizing lesions rendered moxifloxacin less active. In conclusion, Nos2 -/- mice are a predictive TB drug development tool owing to their consistent development of human-like pathology.

AB - During active TB in humans a spectrum of pulmonary granulomas with central necrosis and hypoxia exists. BALB/c mice, predominantly used in TB drug development, do not reproduce this complex pathology thereby inaccurately predicting clinical outcome. We found that Nos2 -/- mice incapable of NO-production in immune cells as microbial defence uniformly develop hypoxic necrotizing lung lesions, widely observed in human TB. To study the impact of hypoxic necrosis on the efficacy of antimycobacterials and drug candidates, we subjected Nos2 -/- mice with TB to monotherapy before or after establishment of human-like pathology. Isoniazid induced a drug-tolerant persister population only when necrotic lesions were present. Rifapentine was more potent than rifampin prior to development of human-like pathology and equally potent thereafter, in agreement with recent clinical trials. Pretomanid, delamanid and the pre-clinical candidate BTZ043 were bactericidal independent of pulmonary pathology. Linezolid was bacteriostatic in TB-infected Nos2 -/- mice but significantly improved lung pathology. Hypoxic necrotizing lesions rendered moxifloxacin less active. In conclusion, Nos2 -/- mice are a predictive TB drug development tool owing to their consistent development of human-like pathology.

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