[Strategies for the development of new tuberculosis vaccines]

Tuberculosis remains a substantial global health problem causing 2 million deaths, and an estimated 8 to 10 million new infections a year. The efficacy of the Mycobacterium bovis Bacillus Calmette-Guérin (BCG), the only available antituberculosis vaccine, is variable (0-80%), especially in tuberculosis-endemic countries. Over the past decade there has been a resurgence of interest in the development of new tuberculosis vaccines and some of the most promising are now entering into early clinical trials, based on two different strategies. The first is to use whole mycobacteria to replace BCG (priming vaccines), either by developing a recombinant strain of BCG or an attenuated strain of Mycobacterium tuberculosis. To date, two recombinant strains of BCG, one overexpressing antigen 85B (rBCG-85B) and the other, a urease-deficient BCG mutant which expresses the listeriolysin O gene from Listeria monocytogenes (rBCG::DeltaureC-hly+), entered into clinical trials. The second approach is to develop subunit vaccines (recombinant proteins and viral vectors, and DNA vaccines) expressing immunodominant antigen/s from M. tuberculosis able to augmenting BCG protection (booster vaccines). At the moment, three major vaccines, namely a recombinant modified vaccinia virus Ankara expressing antigen 85A (MVA85A), a fusion protein of ESAT6 and 85B (Hybrid 1), and another fusion protein comprising the 32 and 39 Kda proteins (72f) entered into clinical trials.

Influence of high motor unit synchronization levels on non-linear and spectral variables of the surface EMG

The aim of this study was to investigate the influence of high degrees of motor unit synchronization on surface EMG variables extracted by linear and non-linear analysis techniques. For this purpose, spectral and recurrent quantification analysis (RQA) were applied to both simulated and experimental EMG signals. Synthetic surface EMG signals were generated with a model of volume conductor comprising muscle, fat, and skin tissues. The synchronization was quantified by the percent of discharges of each motor unit synchronized with discharges of other motor units. The simulated signals presented degrees of synchronization in the range 0-80% (10% increments) and three mean values of motor unit conduction velocity distribution (3, 4 and 5 m/s). Experimental signals were collected from the first dorsal interosseous muscle of five patients with Parkinson disease during 10s of rest and 10s of isometric voluntary contraction at 50% of the maximal force. Mean power spectral frequency (MNF) and percent of determinism (%DET) of the surface EMG were computed from the simulated and experimental signals. In the simulated signals, %DET was linearly related to the level of synchronization in the entire range considered while MNF was sensitive to changes in synchronization in a smaller range (0-20%), outside which it levelled off. The experimental results indicated that %DET was significantly higher in the resting condition (with presence of tremor; mean +/- S.E., 85.4 +/- 0.8%) than during the voluntary contraction (which partly suppressed tremor; 60.0 +/- 2.3%; P < 0.01). On the contrary, MNF did not depend on the condition (114.3 +/- 1.5 Hz and 118.0 +/- 0.8 Hz for the resting and voluntary contraction, respectively), confirming the simulation results. Overall, these results indicated that linear and non-linear analyses of the surface EMG may have different sensitivities to the underlying physiological mechanisms in specific conditions, thus their joint use provides a more complete view of the muscle status than spectral analysis only.

Monitoring the quality of laboratories and the prevalence of resistance to antituberculosis drugs: Italy, 1998-2000

In 1998 a network of 20 regional tuberculosis (TB) laboratories (the Italian Multicentre Study on Resistance to Antituberculosis drugs (SMIRA) network) was established in Italy to implement proficiency testing and to monitor the prevalence of drug resistance nationwide. The network managed 30% of all TB cases reported in Italy each year. The aim of the present report is to describe: 1) the accuracy of drug-susceptibility testing in the network; 2) the prevalence of drug resistance for the period 1998-2000. Data were collected from the network laboratories. Sensitivity to streptomycin and ethambutol increased from the first survey (1998-1999) to the second survey (2000) from 87.7 to 91.9%. Specificity, predictive values for resistance and susceptibility, efficiency and reproducibility were consistent in both surveys. In previously untreated cases, the prevalence of multidrug-resistance was the same in both surveys (1.2%), while a slight decrease from the first to the second survey was observed for monoresistance to rifampicin (from 0.8 to 0.4%) and isoniazid (from 2.9 to 2%). The significant association found between isoniazid resistance and immigration is a useful indicator for both clinicians managing individual tuberculosis cases and public health services planning control strategies.

Prevalence of resistance to anti-tuberculosis drugs: results of the 1998/99 national survey in Italy

OBJECTIVE

To determine the prevalence of resistance to the main anti-tuberculosis drugs in newly and previously treated tuberculosis patients in Italy and to evaluate the contribution of foreign-born and human immunodeficiency virus (HIV) positive cases to drug resistance.

METHODS

Methods and definitions were derived from the WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance. Univariate and multivariate analysis was used to study prevalence rates of drug resistance in risk groups.

RESULTS

In a national survey in Italy, 810 initial isolates of Mycobacterium tuberculosis (683 from new cases, 115 from retreatment cases and 12 from patients whose treatment history was unknown/dubious) were analysed. Low prevalence of drug and multidrug resistance was found in the new cases (isoniazid 2.9%; rifampicin 0.8%; multidrug resistance 1.2%; any drug resistance 12.3%). The prevalence of resistance to isoniazid and rifampicin was significantly higher in immigrants and HIV-positive subjects, respectively. A high prevalence of drug resistance was found in cases with previous treatment failure or default (isoniazid 5.2%; rifampicin 4.3%; multidrug resistance 36.5%; any drug resistance 61.7%).

RECOMMENDATIONS

Special efforts are necessary to monitor trends in drug resistance and to ensure favourable treatment outcomes among immigrants and HIV-positive tuberculosis cases.

Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study

OBJECTIVE

To test whether rhythmic formulas such as the rosary and yoga mantras can synchronise and reinforce inherent cardiovascular rhythms and modify baroreflex sensitivity.

DESIGN

Comparison of effects of recitation of the Ave Maria (in Latin) or of a mantra, during spontaneous and metronome controlled breathing, on breathing rate and on spontaneous oscillations in RR interval, and on blood pressure and cerebral circulation.

SETTING

Florence and Pavia, Italy.

PARTICIPANTS

23 healthy adults.

MAIN OUTCOME MEASURES

Breathing rate, regularity of breathing, baroreflex sensitivity, frequency of cardiovascular oscillations.

RESULTS

Both prayer and mantra caused striking, powerful, and synchronous increases in existing cardiovascular rhythms when recited six times a minute. Baroreflex sensitivity also increased significantly, from 9.5 (SD 4.6) to 11.5 (4.9) ms/mm Hg, P<0.05.

CONCLUSION

Rhythm formulas that involve breathing at six breaths per minute induce favourable psychological and possibly physiological effects.

Influence of Mycobacterium bovis bacillus Calmette Guérin on in vitro induction of CD1 molecules in human adherent mononuclear cells

Nonpeptide antigens (including glycolipids of microbial origin) can be presented to T cells by CD1 molecules expressed on monocyte-derived dendritic cells. These HLA unrestricted responses appear to play a role in host immunity against Mycobacterium tuberculosis and other pathogenic bacteria. It is known that vaccination with Mycobacterium bovis bacillus Calmette-Guérin (BCG) has limited efficacy in many clinical settings, although the reasons for its inadequacy remain unclear. Here we have investigated the influence of BCG on the induction of CD1b on human monocytes by granulocyte-macrophage colony-stimulating factor (GM-CSF), which is believed to be the principal inducer of this antigen-presenting molecule. Although BCG alone led to a slight induction of CD1b expression, this agent reduced markedly the ability of GM-CSF to induce high levels of CD1b that were typically observed in uninfected cells. Inhibition of CD1b expression in BCG-infected monocytes was apparent at both the mRNA transcript and CD1b protein levels. Down-regulation of CD1b expression by BCG was mediated, at least in part, by one or more soluble factors and could not be reversed with high concentrations of GM-CSF or a variety of other cytokines. The present results suggest that BCG could diminish the efficiency of CD1-restricted T-cell responses against nonpeptide mycobacterial antigens by reducing CD1 expression on antigen-presenting cells. These findings have potential implications for understanding the nature of the immune response elicited by BCG in humans and suggest potential strategies that could be important for the development of better vaccines for the prevention of tuberculosis.

Transport processes in reversed-field-pinch plasmas: inconsistency with the self-organized-criticality paradigm

A statistical analysis of the anomalous particle flux in the edge region of the RFX experiment has revealed that laminar times between bursts, which account for more than 50% of the losses, have a power law distribution and that flux fluctuations are not self-similar. These properties are found in contrast with a wide class of self-organized-criticality models so that it is concluded that there is no experimental evidence of avalanchelike process occurrence in the plasma of RFX.

Infection of human macrophages and dendritic cells with Mycobacterium tuberculosis induces a differential cytokine gene expression that modulates T cell response

Macrophages and dendritic cells (DC) play an essential role in the initiation and maintenance of immune response to pathogens. To analyze early interactions between Mycobacterium tuberculosis (Mtb) and immune cells, human peripheral blood monocyte-derived macrophages (MDM) and monocyte-derived dendritic cells (MDDC) were infected with Mtb. Both cells were found to internalize the mycobacteria, resulting in the activation of MDM and maturation of MDDC as reflected by enhanced expression of several surface Ags. After Mtb infection, the proinflammatory cytokines TNF-alpha, IL-1, and IL-6 were secreted mainly by MDM. As regards the production of IFN-gamma-inducing cytokines, IL-12 and IFN-alpha, was seen almost exclusively from infected MDDC, while IL-18 was secreted preferentially by macrophages. Moreover, Mtb-infected MDM also produce the immunosuppressive cytokine IL-10. Because IL-10 is a potent inhibitor of IL-12 synthesis from activated human mononuclear cells, we assessed the inhibitory potential of this cytokine using soluble IL-10R. Neutralization of IL-10 restored IL-12 secretion from Mtb-infected MDM. In line with these findings, supernatants from Mtb-infected MDDC induced IFN-gamma production by T cells and enhanced IL-18R expression, whereas supernatants from MDM failed to do that. Neutralization of IFN-alpha, IL-12, and IL-18 activity in Mtb-infected MDDC supernatants by specific Abs suggested that IL-12 and, to a lesser extent, IFN-alpha and IL-18 play a significant role in enhancing IFN-gamma synthesis by T cells. During Mtb infection, macrophages and DC may have different roles: macrophages secrete proinflammatory cytokines and induce granulomatous inflammatory response, whereas DC are primarily involved in inducing antimycobacterial T cell immune response.

Search of self-organized criticality processes in magnetically confined plasmas: hints from the reversed field pinch configuration

In order to test the self-organized criticality (SOC) paradigm in transport processes, a novel technique has been applied for the first time to plasmas confined in reversed field pinch configuration. This technique consists of an analysis of the probability distribution function of the times between bursts in density fluctuations measured by microwave reflectometry and electrostatic probes. The same analysis has also been applied to intermittent events sorted out from the Gaussian background. In both cases, the experimental results disagree with the predictions for a SOC system.

Linear and non-linear analysis of surface electromyograms in weightlifters

The present research was aimed at investigating the peculiarities of surface electromyogram (sEMG) signals in 12 weightlifting athletes (WLA) and 9 control subjects (control group, CG) The sEMG signals were recorded from both vastus lateralis muscles during 20 s isometric contractions made at 30% and 60% of the maximal voluntary contraction (MVC). Ground reaction force (vertical component) was recorded using a force plate. The sEMG was analysed in the frequency domain and the median frequency (MDF) was computed over successive 1 s epochs. A non-linear technique, recurrence quantification analysis was also applied to assess the presence and time course of deterministic structures in sEMG. The percentage of determinism (%DET) was used as a synthetic parameter to quantify the amount of regularly repeating sEMG waves within the signal itself (bursts). In 5 WLA the sEMG displayed a clear burst activity centred at 11 Hz. These bursts were correlated with force output oscillations and were evident both at 30% and 60% MVC. The MDF decay with time was more evident in WLA than in CG subjects. The %DET increased in WLA, this increase being more evident during 60% MVC contractions. Our results seemed to suggest a special disposition among WLA for the development of long-term changes in firing probability during sub-maximal isometric exercise. The MDF and %DET data provided indications of a greater involvement of fast twitch muscle fibres in WLA than in CG.

Bacillus Calmette-Guerin down-regulates CD1b induction by granulocyte-macrophage colony stimulating factor in human peripheral blood monocytes

Non-peptide antigens (e.g. glycolipids of microbial origin) presented by monocyte-associated CD1 molecules to T cells appear to play an important role in host immunity against tuberculosis and other pathogenic bacteria. Since vaccination with Bacillus Calmette-Guerin (BCG) has limited efficacy, the influence of viable BCG organisms on the induction of CD1b antigen by granulocyte macrophage-colony stimulating factor (GM-CSF) has been tested in adherent mononuclear cells obtained from peripheral blood of healthy donors. The results indicate that the vaccine reduces substantially CD1b induction by GM-CSF. On the other hand, BCG was found to promote a slight increase in the expression of this molecule on target cells not exposed to GM-CSF. Attempts to reverse the antagonistic effects of BCG on GM-CSF with high concentrations of GM-CSF, alone, or associated with IL-4, were unsuccessful. Moreover, mycobacteria suppression by 10 microg/ml of rifampin, did not affect BCG influence on CD1b induction. The present results suggest that mycobacterium-induced impairment of the CD1 system could play a role in the unsatisfactory results obtained with BCG vaccination.

Surveillance of anti-tuberculosis drug resistance: results of the 1998/1999 proficiency testing in Italy. SMIRA (Italian Multicentre Study on Antituberculosis Drug Resistance) Study Group

OBJECTIVE

To determine the accuracy of drug-susceptibility testing (DST) for isoniazid, rifampicin, ethambutol and streptomycin in a provisional network of 22 regional laboratories in Italy.

METHODS

Methods, definitions and reference Mycobacterium tuberculosis strains were derived from the WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance. The laboratories were selected based on technical skills required by the project, the number of DST performed annually and geographic localisation. The results (sensitive/resistant strain) were compared with the gold standard (global project results). Sensitivity (ability to detect true resistance), specificity (ability to detect true susceptibility), positive predictive values for resistance and susceptibility, efficiency and reproducibility were calculated in two rounds.

RESULTS

Eighteen of 22 laboratories completed the first round of proficiency testing for the four drugs. Sensitivity was 76.6%, specificity 97.2%, predictive value of a resistant test 89.8% and of a susceptible test 86.8%, efficiency 87.8% and reproducibility 92.8%. A second round was performed by all those laboratories that did not achieve > or = 90% agreement with the results of the Global Project. Overall, after the second round, all the parameters except specificity improved, exceeding 90%.

CONCLUSIONS

A network of 15 regional laboratories that fulfil the quality criteria for determining the susceptibility of M. tuberculosis to the four primary antituberculosis drugs was established in Italy.

Activity of 16 antimicrobial agents against drug-resistant strains of Mycobacterium tuberculosis

The in vitro activity of 16 antimicrobial agents against 46 drug-resistant strains of Mycobacterium tuberculosis recently isolated from Italian patients was determined. As for first-line antituberculosis drugs, while isoniazid was ineffective against all the strains tested, resistance to streptomycin, rifampicin, pyrazinamide, and ethambutol was 80.4%, 71.7%, 39.1%, and 8.7%, respectively. Among second-line antituberculous drugs, resistance to ciprofloxacin, ofloxacin, and sparfloxacin and to amikacin and kanamycin was around 20%. About 10% of the strains were resistant to capreomycin and cycloserine and 4.3% were resistant to ethionamide; no strain was found to be resistant to thiacetazone, para-aminosalicylic acid, and viomycin. Although all strains displayed a rather continuous distribution of minimal inhibitory concentrations (MICs), a bimodal distribution was observed for rifampicin, amikacin, and kanamicin, with very high MIC values for resistant strains; relatively low MICs were found for fluoroquinolone-resistant strains. Among the small number of strains resistant to second-line agents, low resistant levels were observed. Restriction fragment length polymorphism analysis showed few strain clusters with resistance to first-line antituberculous drugs and aminoglycosides, fluoroquinolones, or both. Altogether, these results showed that second-line agents were still active against the isoniazid-resistant and multiply first-line resistant strains tested, with none or low resistance levels; these observations can be of importance for the treatment of multidrug-resistant tuberculosis in Italy.

Activities of eighteen antimicrobial regimens against Mycobacterium avium infection in beige mice

The therapeutic effect of 18 anti-Mycobacterium avium regimens was examined in beige mice after 91 days of infection. Treatments included monotherapy with clarithromycin (CLA), ethambutol (EMB), amikacin (AMI), rifabutin (RFB), ciprofloxacin (CIP), clofazimine (CLO), and combinations of CLA, CLA-EMB, or CLA-AMI with one of the other drugs. After monotherapy, only AMI and CLA displayed bacteriostatic and/or moderate bactericidal effects in spleens and lungs, while CIP and RFB were totally inactive and CLO and EMB showed intermediate effects against the isolate tested. Resistant mutants were isolated in spleens of mice treated with EMB, CIP, RFB, and CLO-Among two-drug combinations, CLA-RFB, CLA-CIP, and CLA-CLO were significantly more active than RFB, CIP, CLO, respectively, but not more active than CLA alone, in both organs; CLA-AMI and CLA-EMB were bactericidal in spleens and lungs, respectively. Although activity of CLA-EMB was significantly potentiated by RFB and CLO in spleens and lungs, that of CLA-AMI was significantly increased by RFB and CLO only in lungs. The most active regimen in spleens and lungs on day 91 was the combination of all three, namely CLA-AMI-EMB, which reduced the CFU numbers of 2.7 and 7.5 log10, in comparison with day 1 and day 91 counts in untreated control mice, respectively.

Upregulation of p75 tumor necrosis factor alpha receptor in Mycobacterium avium-infected mice: evidence for a functional role

The bacterial growth and the production of tumor necrosis factor alpha (TNF-alpha) and TNF receptors (TNF-Rs) in the spleen and blood of BALB/c mice challenged with Mycobacterium avium complex (MAC) were monitored. Infection developed in two phases: the first, up to day 21, was associated with rapid MAC multiplication in the spleen and a drop in the mycobacteremia, and the second was associated with control of the infection in both compartments. In the spleen, TNF-alpha and TNF-RII mRNA levels peaked on day 21 and then slowly decreased; however, no increase in the level of TNF-RI mRNA was observed throughout these experiments. The level of circulating soluble TNF-RII (sTNF-RII) was transiently increased after day 21. In a model in which overproduction of bioactive TNF-alpha was triggered in response to a second infection with MAC, an increased production of sTNF-RII by cultured splenocytes was also observed. Administration of an antagonist anti-TNF-RII monoclonal antibody (MAb 6G1) to infected mice inhibited the bacterial growth in the spleen, suggesting that the TNF-RII and/or sTNF-RII was functionally involved in the mechanisms that control the infection. Overall, these observations suggest that upregulation of TNF-RII or sTNF-RII contributes to modulation of the TNF-alpha antibacterial activity in MAC infections.

Autonomic control of the cerebral circulation during normal and impaired peripheral circulatory control

OBJECTIVE

To determine whether oscillations in the cerebrovascular circulation undergo autonomic modulation in the same way as cardiovascular oscillations.

DESIGN

Cardiovascular and cerebrovascular oscillations were monitored at rest and during sympathetic stimulation (head up tilt). The association with and transmission of the oscillations in the sympathetic (low frequency, LF) and respiratory (high frequency, HF) bands was assessed.

SUBJECTS

13 healthy volunteers, 10 subjects with vasovagal syncope, and 12 patients with complicated non-insulin dependent diabetes mellitus.

MAIN OUTCOME MEASURES

Power spectrum analysis of cerebral blood flow velocity, arterial blood pressure, and heart rate. Coherence analysis was used to study the association between each pair of oscillations. Phase analysis showed the delay of the oscillations in the cardiovascular signals with respect to the cerebrovascular signals.

RESULTS

The power in the sympathetic (LF) components in all the oscillations increased during head up tilt (p < 0.01) in the controls and in the subjects with vasovagal syncope, but not in patients with diabetes. Significant coherence (> 0.5) in the LF band was present between cerebrovascular and cardiovascular oscillations in most of the controls and in subjects with vasovagal syncope, but not in the diabetic patients (< 50% of the patients). In the LF band, cerebrovascular oscillations preceded the cardiovascular oscillations (p < 0.05) at rest in all groups: the phase shifts were reduced (p < 0.05) during head up tilt for all cardiovascular signals in healthy and syncopal subjects, but only for heart rate in diabetic patients.

CONCLUSIONS

The cerebrovascular resistance vessels are subject to autonomic modulation; low frequency oscillations in cerebral blood flow velocity precede the resulting fluctuations in other cardiovascular signals. Autonomic neuropathy and microvascular stiffness in diabetic patients reduces this modulation.

Autonomic control of heart rate variability in vasovagal syncope: a study of the nighttime period in 24-hour recordings

Patients experiencing vasovagal syncope have been claimed to show reduced vagal tone over 24-hour electrocardiography recordings. Assessment of sympathovagal balance in the absence of external stimuli, i.e., nighttime electrocardiography monitoring, might help to clarify if increased sympathetic activity is present in these patients. Heart rate variability was examined at nighttime in 40 patients with recurrent episodes of vasovagal syncope within the last 2 years (22 men; mean age, 37 years) and 20 comparable healthy volunteers. Time domain parameters (pNN50 [proportion of successive RR intervals difference >50 ms in %] and rMSSD [root-mean-square successive difference of RR intervals in ms]), indexes of vagal tone, and frequency domain parameters, expressing the overall heart rate variability, vagal (high frequency [HF]) and sympathetic (low frequency [LF]) activity, and autonomic balance (LF/HF ratio) were compared between groups by Mann-Whitney test. Significant (p<0.05) reduction of heart rate variability and vagal tone (pNN50 and rMSSD) were found for patients with vasovagal syncope, together with increased sympathetic activity (increased LF/HF ratio). These findings could open new insights in the pathogenesis of vasovagal syncope because of the shift of the autonomic balance toward sympathetic activation near the syncopal episode.

Spatial and temporal distribution enhancement of movement-related brain macropotentials

Conventional brain maps suffer from severe limitations due to both the spatial blur of potential distributions and the dependence on electrical reference. The surface Laplacian (SL) has been used to deblur movement-related brain macropotentials (MRBM) since it acts as a high-pass spatial filter that reduces the head volume conductor effects. Moreover, the method usually employed to improve the signal-to-noise ratio (SNR) is the well-known synchronized average. However, this method is no longer valid when the object of the study is the sweep-by-sweep variability. In this case, the SNR of original and Laplacian-transformed single-sweep MRBM can be improved by autoregressive with exogenous input (ARX) filtering. In our study, isolated or combined ARX and SL are applied to enhance the spatial distributions of single-sweep MRBM associated with unilateral voluntary self-paced finger movements in humans. It shows that single-sweep brain mappings are more coherent to physiological findings when ARX is first used followed by SL.

rpoB mutations in multidrug-resistant strains of Mycobacterium tuberculosis isolated in Italy

Mutations of rpoB associated with rifampin resistance were studied in 37 multidrug-resistant (MDR) clinical strains of Mycobacterium tuberculosis isolated in Italy. At least one mutated codon was found in each MDR strain. It was always a single-base substitution leading to an amino acid change. Nine different rpoB alleles, three of which had not been reported before, were found. The relative frequencies of specific mutations in this sample were different from those previously reported from different geographical areas, since 22 strains (59.5%) carried the mutated codon TTG in position 531 (Ser-->Leu) and 11 (29.7%) had GAC in position 526 (His-->Asp).

Age-related changes of cardiac parasympathetic modulation after vasovagal syncope

The time-domain analysis of 24-hour electrocardiographic recordings showed that vagal modulation of heart rate is reduced within 48 hours from vasovagal syncope. However, patients with recent vasovagal syncope can be differentiated from healthy subjects only up to the age of 40 years with this analysis, because this parasympathetic modulation physiologically decreases with increasing age.

Typing of human Mycobacterium avium isolates in Italy by IS1245-based restriction fragment length polymorphism analysis

All but 2 of 63 Mycobacterium avium isolates from distinct geographic areas of Italy exhibited markedly polymorphic, multibanded IS1245 restriction fragment length polymorphism (RFLP) patterns; 2 isolates showed the low-number banding pattern typical of bird isolates. By computer analysis, 41 distinct IS1245 patterns and 10 clusters of essentially identical strains were detected; 40% of the 63 isolates showed genetic relatedness, suggesting the existence of a predominant AIDS-associated IS1245 RFLP pattern.

Activities of isoniazid alone and in combination with other drugs against Mycobacterium avium infection in beige mice

Monotherapy with isoniazid or amikacin or clarithromycin or combinations of two of these drugs showed nil to modest therapeutic activity in beige mice infected with Mycobacterium avium. However, the combination of all three, isoniazid-amikacin-clarithromycin, markedly reduced CFUs in both spleens and lungs after 91 days of infection.