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Moro RN, Mehaffy C, De P, Phillips E, Borisov AS, Sterling TR, Dobos KM. Assessment for Antibodies to Rifapentine and Isoniazid in Persons Developing Flu-like Reactions During Treatment of Latent Tuberculosis Infection. J Infect Dis 2024:jiae180. [PMID: 38640958 DOI: 10.1093/infdis/jiae180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Flu-like reactions can occur after exposure to rifampin, rifapentine, or isoniazid. Prior studies have reported the presence of antibodies to rifampin, but associations with underlying pathogenesis are unclear. METHODS We evaluated PREVENT TB study participants who received weekly isoniazid + rifapentine for 3 months (3HP) or daily isoniazid for 9 months (9H) as treatment for M. tuberculosis infection. Flu-like reaction was defined as a grade ≥2 of any of flu-like symptoms. Controls (3HP or 9H) did not report flu-like reactions. We developed a competitive enzyme-linked immunosorbent assays (ELISA) to detect antibodies against rifapentine, isoniazid, rifampin, and rifapentine metabolite. RESULTS Among 128 participants, 69 received 3HP (22 with flu-like reactions; 47 controls) and 59 received 9H (12 with flu-like reactions; 47 controls). In participants receiving 3HP, anti-rifapentine IgG was identified in 2/22 (9%) participants with flu-like reactions and 6/47 (13%) controls (P = 0.7), anti-isoniazid IgG in 2/22 (9%) participants with flu-like reactions and 4/47 (9%) controls (P = 0.9), and anti-rifapentine metabolite IgG in 2/47 (4%) controls (P = 0.9). Among participants receiving 9H, IgG and IgM anti-isoniazid antibodies were each present in 4/47 (9%) controls, respectively, but none among participants with flu-like reactions; anti-rifapentine IgG antibodies were not present in any participants with flu-like reactions or controls. CONCLUSIONS We detected anti-rifapentine, anti-isoniazid, and anti-rifapentine metabolite antibodies, but the proportions of participants with antibodies were low, and did not differ between participants with flu-like reactions and those without such reactions. This suggests that flu-like reactions associated with 3HP and 9H were not antibody-mediated.
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Affiliation(s)
- Ruth N Moro
- Centers for Disease Control and Prevention, Atlanta, GA, U.S
| | - Carolina Mehaffy
- Department of Microbiology, Immunology and Pathology. Colorado State University, Fort Collins, CO, U.S
| | - Prithwiraj De
- Department of Microbiology, Immunology and Pathology. Colorado State University, Fort Collins, CO, U.S
| | | | | | | | - Karen M Dobos
- Department of Microbiology, Immunology and Pathology. Colorado State University, Fort Collins, CO, U.S
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Ahramiyanpour N, Mahmoudi Z, Nezhad NZ, Khazaeli P, Amiri R, Kasraee B. Topical isoniazid as a novel treatment for melasma: A randomized, double-blind, vehicle-controlled clinical trial. J Cosmet Dermatol 2024. [PMID: 38581222 DOI: 10.1111/jocd.16320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Melasma is a chronic hyperpigmentation disorder, and its treatment poses a challenge to dermatologists due to its chronicity and resistance to conventional therapies. Oral isoniazid is used for the treatment of tuberculosis. One of us had previously showed that topical isoniazid exerts a strong depigmenting action in animal models. In this clinical trial, we assessed the therapeutic effect of topical isoniazid on melasma. METHODS Twenty female patients suffering from epidermal melasma were enrolled and divided equally into two groups. The treatment group received topical isoniazid 10%, and the control group received the cold cream vehicle as the placebo. All participants were advised to avoid sunlight and used SPF 50 sunscreen. Patients applied topical agents once daily at night for 3 months. The melanin and erythema indices were measured by colorimetric evaluations at baseline and after 4, 8, and 12 weeks of treatment. At these time points, the (mMASI) score was also determined, as was the subjective evaluation through Melasma Quality of Life Scale (MELASQOL) scores. Blood tests were performed to evaluate CBC and the liver enzymes. RESULTS All patients completed the 12-week study. In the treatment group, a significant decrease in melanin index from 63.77 ± 6.27 at baseline to 55.92 ± 5.79 was recorded (p = 0.001). Very minimal clinical changes were also seen in the control group and melanin index was decreased from 62.65 ± 2.23 to 61.25 ± 2.34 (p = 0.004). Clinically significant differences were observed in the rate of changes between both groups. These findings indicate that topical isoniazid has significant depigmenting effects compared to the placebo (p = 0.001). The erythema index remained unchanged in both groups. In the treatment group, the mMASI score was 5.63 ± 3.28 at baseline and 2.13 ± 1.71 at the last follow-up, significantly reduced compared to the control group (p = 0.002). The MELASQOL score indicated a significant improvement in the quality of life in the treatment group. CONCLUSION This clinical trial shows for the first time that topical isoniazid is effective in treating melasma. Further clinical trials are necessary to confirm the efficacy and tolerability of topical isoniazid in comparison with other skin-depigmenting compounds.
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Affiliation(s)
- Najmeh Ahramiyanpour
- Department of Dermatology, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Zahra Mahmoudi
- Department of Dermatology, Afzalipour Faculty of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Payam Khazaeli
- School of Pharmacy, Kerman University of Medical sciences, Kerman, Iran
| | - Rezvan Amiri
- Department of Dermatology, Afzalipour Faculty of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Behrooz Kasraee
- Department of Dermatology, Geneva University Hospital, Geneva, Switzerland
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Li JM, Zhang RY, Yang GY, Cai QS, Lang YZ, Zhong FM, Huang JP, Chen YY, Qin Y, Fang LK, Ye B, Lin LH, Lin HH, Cai XJ, Xu K. Model-based precision dosing and remedial dosing recommendations for delayed or missed doses of isoniazid in Chinese patients with tuberculosis. Br J Clin Pharmacol 2024. [PMID: 38570184 DOI: 10.1111/bcp.16050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/04/2024] [Accepted: 01/20/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS Isoniazid (INH) has been used as a first-line drug to treat tuberculosis (TB) for more than 50 years. However, large interindividual variability was found in its pharmacokinetics, and effects of nonadherence to INH treatment and corresponding remedy regime remain unclear. This study aimed to develop a population pharmacokinetic (PPK) model of INH in Chinese patients with TB to provide model-informed precision dosing and explore appropriate remedial dosing regimens for nonadherent patients. METHODS In total, 1012 INH observations from 736 TB patients were included. A nonlinear mixed-effects modelling was used to analyse the PPK of INH. Using Monte Carlo simulations to determine optimal dosage regimens and design remedial dosing regimens. RESULTS A 2-compartmental model, including first-order absorption and elimination with allometric scaling, was found to best describe the PK characteristics of INH. A mixture model was used to characterize dual rates of INH elimination. Estimates of apparent clearance in fast and slow eliminators were 28.0 and 11.2 L/h, respectively. The proportion of fast eliminators in the population was estimated to be 40.5%. Monte Carlo simulations determined optimal dosage regimens for slow and fast eliminators with different body weight. For remedial dosing regimens, the missed dose should be taken as soon as possible when the delay does not exceed 12 h, and an additional dose is not needed. delay for an INH dose exceeds 12 h, the patient only needs to take the next single dose normally. CONCLUSION PPK modelling and simulation provide valid evidence on the precision dosing and remedial dosing regimen of INH.
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Affiliation(s)
- Jin-Meng Li
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Ruo-Ying Zhang
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Gao-Yi Yang
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Qing-Shan Cai
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Ya-Zhen Lang
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Fang-Ming Zhong
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Jin-Peng Huang
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yuan-Yuan Chen
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yao Qin
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Li-Kui Fang
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Bo Ye
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Li-Hua Lin
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Hui-Hong Lin
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Xin-Jun Cai
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Kan Xu
- Department of Pharmacy, Hangzhou Red Cross Hospital, Hangzhou, China
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Kashimura A, Nishikawa S, Ozawa Y, Hibino Y, Tateoka T, Mizukawa M, Nishina H, Sakairi T, Shiga T, Aihara N, Kamiie J. Combination of pathological, biochemical and behavioral evaluations for peripheral neurotoxicity assessment in isoniazid-treated rats. J Toxicol Pathol 2024; 37:69-82. [PMID: 38584972 PMCID: PMC10995436 DOI: 10.1293/tox.2023-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/08/2023] [Indexed: 04/09/2024] Open
Abstract
In drug development, assessment of non-clinical peripheral neurotoxicity is important to ensure human safety. Clarifying the pathological features and mechanisms of toxicity enables the management of safety risks in humans by estimating the degree of risk and proposing monitoring strategies. Published guidelines for peripheral neurotoxicity assessment do not provide detailed information on which endpoints should be monitored preferentially and how the results should be integrated and discussed. To identify an optimal assessment method for the characterization of peripheral neurotoxicity, we conducted pathological, biochemical (biomaterials contributing to mechanistic considerations and biomarkers), and behavioral evaluations of isoniazid-treated rats. We found a discrepancy between the days on which marked pathological changes were noted and those on which biochemical and behavioral changes were noted, suggesting the importance of combining these evaluations. Although pathological evaluation is essential for pathological characterization, the results of biochemical and behavioral assessments at the same time points as the pathological evaluation are also important for discussion. In this study, since the measurement of serum neurofilament light chain could detect changes earlier than pathological examination, it could be useful as a biomarker for peripheral neurotoxicity. Moreover, examination of semi-thin specimens and choline acetyltransferase immunostaining were useful for characterizing morphological neurotoxicity, and image analysis of semi-thin specimens enabled us to objectively show the pathological features.
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Affiliation(s)
- Akane Kashimura
- Safety Research Laboratories, Sohyaku, Innovative Research
Division, Mitsubishi Tanabe Pharma Corporation, Shonan Health Innovation Park, 2-26-1
Muraoka-Higashi, Fujisawa-shi, Kanagawa 251-8555, Japan
- Laboratory of Veterinary Pathology, School of Veterinary
Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201,
Japan
| | - Satomi Nishikawa
- Safety Research Laboratories, Sohyaku, Innovative Research
Division, Mitsubishi Tanabe Pharma Corporation, Shonan Health Innovation Park, 2-26-1
Muraoka-Higashi, Fujisawa-shi, Kanagawa 251-8555, Japan
| | - Yuhei Ozawa
- Safety Research Laboratories, Sohyaku, Innovative Research
Division, Mitsubishi Tanabe Pharma Corporation, Shonan Health Innovation Park, 2-26-1
Muraoka-Higashi, Fujisawa-shi, Kanagawa 251-8555, Japan
| | - Yui Hibino
- Safety Research Laboratories, Sohyaku, Innovative Research
Division, Mitsubishi Tanabe Pharma Corporation, Shonan Health Innovation Park, 2-26-1
Muraoka-Higashi, Fujisawa-shi, Kanagawa 251-8555, Japan
| | - Takashi Tateoka
- Safety Research Laboratories, Sohyaku, Innovative Research
Division, Mitsubishi Tanabe Pharma Corporation, Shonan Health Innovation Park, 2-26-1
Muraoka-Higashi, Fujisawa-shi, Kanagawa 251-8555, Japan
| | - Mao Mizukawa
- Safety Research Laboratories, Sohyaku, Innovative Research
Division, Mitsubishi Tanabe Pharma Corporation, Shonan Health Innovation Park, 2-26-1
Muraoka-Higashi, Fujisawa-shi, Kanagawa 251-8555, Japan
- Laboratory of Veterinary Pathology, School of Veterinary
Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201,
Japan
| | - Hironobu Nishina
- Safety Research Laboratories, Sohyaku, Innovative Research
Division, Mitsubishi Tanabe Pharma Corporation, Shonan Health Innovation Park, 2-26-1
Muraoka-Higashi, Fujisawa-shi, Kanagawa 251-8555, Japan
| | - Tetsuya Sakairi
- Safety Research Laboratories, Sohyaku, Innovative Research
Division, Mitsubishi Tanabe Pharma Corporation, Shonan Health Innovation Park, 2-26-1
Muraoka-Higashi, Fujisawa-shi, Kanagawa 251-8555, Japan
| | - Takanori Shiga
- Laboratory of Veterinary Pathology, School of Veterinary
Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201,
Japan
| | - Naoyuki Aihara
- Laboratory of Veterinary Pathology, School of Veterinary
Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201,
Japan
| | - Junichi Kamiie
- Laboratory of Veterinary Pathology, School of Veterinary
Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa 252-5201,
Japan
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Ulanova V, Kivrane A, Viksna A, Pahirko L, Freimane L, Sadovska D, Ozere I, Cirule A, Sevostjanovs E, Grinberga S, Bandere D, Ranka R. Effect of NAT2, GSTM1 and CYP2E1 genetic polymorphisms on plasma concentration of isoniazid and its metabolites in patients with tuberculosis, and the assessment of exposure-response relationships. Front Pharmacol 2024; 15:1332752. [PMID: 38584604 PMCID: PMC10995391 DOI: 10.3389/fphar.2024.1332752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
Objectives: Isoniazid is a key drug in the chemotherapy of tuberculosis (TB), however, interindividual variability in pharmacokinetic parameters and drug plasma levels may affect drug responses including drug induced hepatotoxicity. The current study investigated the relationships between isoniazid exposure and isoniazid metabolism-related genetic factors in the context of occurrence of drug induced hepatotoxicity and TB treatment outcomes. Methods: Demographic characteristics and clinical information were collected in a prospective TB cohort study in Latvia (N = 34). Time to sputum culture conversion (tSCC) was used as a treatment response marker. Blood plasma concentrations of isoniazid (INH) and its metabolites acetylisoniazid (AcINH) and isonicotinic acid (INA) were determined at three time points (pre-dose (0 h), 2 h and 6 h after drug intake) using liquid chromatography-tandem mass spectrometry. Genetic variations of three key INH-metabolizing enzymes (NAT2, CYP2E1, and GSTM1) were investigated by application PCR- and Next-generation sequencing-based methods. Depending on variables, group comparisons were performed by Student's t-test, one-way ANOVA, Mann-Whitney-Wilcoxon, and Kruskal-Wallis tests. Pearson correlation coefficient was calculated for the pairs of normally distributed variables; model with rank transformations were used for non-normally distributed variables. Time-to-event analysis was performed to analyze the tSCC data. The cumulative probability of tSCC was obtained using Kaplan-Meier estimators. Cox proportional hazards models were fitted to estimate hazard rate ratios of successful tSCC. Results: High TB treatment success rate (94.1%) was achieved despite the variability in INH exposure. Clinical and demographic factors were not associated with either tSCC, hepatotoxicity, or INH pharmacokinetics parameters. Correlations between plasma concentrations of INH and its metabolites were NAT2 phenotype-dependent, while GSTM1 genetic variants did not showed any effects. CYP2E1*6 (T > A) allelic variant was associated with INH pharmacokinetic parameters. Decreased level of AcINH was associated with hepatotoxicity, while decreased values of INA/INH and AcINH/INH were associated with month two sputum culture positivity. Conclusion: Our findings suggest that CYP2E1, but not GSTM1, significantly affects the INH pharmacokinetics along with NAT2. AcINH plasma level could serve as a biomarker for INH-related hepatotoxicity, and the inclusion of INH metabolite screening in TB therapeutic drug monitoring could be beneficial in clinical studies for determination of optimal dosing strategies.
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Affiliation(s)
- Viktorija Ulanova
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
| | - Agnija Kivrane
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
| | - Anda Viksna
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
- Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Upeslejas, Latvia
| | - Leonora Pahirko
- Faculty of Physics, Mathematics, and Optometry, University of Latvia, Riga, Latvia
| | - Lauma Freimane
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Darja Sadovska
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
| | - Iveta Ozere
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
- Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Upeslejas, Latvia
| | - Andra Cirule
- Centre of Tuberculosis and Lung Diseases, Riga East University Hospital, Upeslejas, Latvia
| | | | | | - Dace Bandere
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
| | - Renate Ranka
- Laboratory of Molecular Microbiology, Latvian Biomedical Research and Study Centre, Riga, Latvia
- Pharmacogenetics Laboratory, Department of Pharmaceutical Chemistry, Riga Stradins University, Riga, Latvia
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Gupta A, Hughes MD, Cruz JL, Avihingsanon A, Mwelase N, Severe P, Omoz-Oarhe A, Masheto G, Moran L, Benson CA, Chaisson RE, Swindells S. Adverse Pregnancy Outcomes Among Women with Human Immunodeficiency Virus Taking Isoniazid Preventive Therapy During the First Trimester. Clin Infect Dis 2024; 78:667-673. [PMID: 37768207 PMCID: PMC10954322 DOI: 10.1093/cid/ciad583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Isoniazid preventive therapy (IPT) is recommended for tuberculosis prevention yet data on the safety of first-trimester pregnancy exposure are limited. METHODS Planned secondary analysis in a TB prevention trial of adverse pregnancy outcomes among participants assigned to 9-month IPT who became pregnant during (IPT-exposed) or after (unexposed) IPT. Regression models compared binary outcomes of a composite adverse outcome (any non-live birth, excluding induced abortion); preterm delivery <37 weeks; and low birth weight <2500 g) among exposure groups. Models were adjusted for latent TB infection, maternal age, CD4 count, and antiretroviral therapy (ART). RESULTS In total, 128 participants had a known pregnancy outcome; 39 IPT-exposed and 89 unexposed. At pregnancy outcome, ART use was lower in IPT-exposed (79%) than unexposed women (98%). Overall, 29 pregnancies ended in a composite adverse outcome (25 spontaneous abortions, 2 stillbirths and 2 ectopic pregnancies), 15 preterm deliveries, and 10 infants with low birth weight. IPT was associated with the composite adverse outcome adjusting for covariates at enrollment (adjusted relative risk [aRR] 1.98; 95% confidence interval [CI] 1.15, 3.41), but the effect was attenuated when adjusted for covariates at pregnancy outcome (aRR 1.47; 95% CI .84, 2.55); IPT was not associated with preterm delivery (relative risk [RR] 0.87; 95% CI .32-2.42) or low birth weight (RR 1.01; 95% CI .29, 3.56). CONCLUSIONS First-trimester IPT exposure was associated with nearly two-fold increased risk of fetal demise, mostly spontaneous abortion, though the association was attenuated when adjusted for covariates proximal to pregnancy outcome including ART use. Further study is needed to inform TB prevention guidelines.
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Affiliation(s)
- Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael D Hughes
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Jorge Leon Cruz
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre and Center of Excellence in Tuberculosis, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand
| | - Noluthando Mwelase
- Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Patrice Severe
- Clinical Trials Unit, Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Ayotunde Omoz-Oarhe
- Botswana Harvard AIDS Institute Partnership, Clinical Trials Unit, Gaborone, Botswana
| | - Gaerolwe Masheto
- Botswana Harvard AIDS Institute Partnership, Clinical Trials Unit, Gaborone, Botswana
| | - Laura Moran
- Public Health and Scientific Research Unit, Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | - Constance A Benson
- Division of Infectious Diseases, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Richard E Chaisson
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Harrison GA, Wang ER, Cho K, Mreyoud Y, Sarkar S, Almqvist F, Patti GJ, Stallings CL. Inducing vulnerability to InhA inhibition restores isoniazid susceptibility in drug-resistant Mycobacterium tuberculosis. mBio 2024; 15:e0296823. [PMID: 38294237 PMCID: PMC10936210 DOI: 10.1128/mbio.02968-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
Of the approximately 10 million cases of Mycobacterium tuberculosis (Mtb) infections each year, over 10% are resistant to the frontline antibiotic isoniazid (INH). INH resistance is predominantly caused by mutations that decrease the activity of the bacterial enzyme KatG, which mediates the conversion of the pro-drug INH to its active form INH-NAD. We previously discovered an inhibitor of Mtb respiration, C10, that enhances the bactericidal activity of INH, prevents the emergence of INH-resistant mutants, and re-sensitizes a collection of INH-resistant mutants to INH through an unknown mechanism. To investigate the mechanism of action of C10, we exploited the toxicity of high concentrations of C10 to select for resistant mutants. We discovered two mutations that confer resistance to the disruption of energy metabolism and allow for the growth of Mtb in high C10 concentrations, indicating that growth inhibition by C10 is associated with inhibition of respiration. Using these mutants as well as direct inhibitors of the Mtb electron transport chain, we provide evidence that inhibition of energy metabolism by C10 is neither sufficient nor necessary to potentiate killing by INH. Instead, we find that C10 acts downstream of INH-NAD synthesis, causing Mtb to become particularly sensitive to inhibition of the INH-NAD target, InhA, without changing the concentration of INH-NAD or the activity of InhA, the two predominant mechanisms of potentiating INH. Our studies revealed that there exists a vulnerability in Mtb that can be exploited to render Mtb sensitive to otherwise subinhibitory concentrations of InhA inhibitor.IMPORTANCEIsoniazid (INH) is a critical frontline antibiotic to treat Mycobacterium tuberculosis (Mtb) infections. INH efficacy is limited by its suboptimal penetration of the Mtb-containing lesion and by the prevalence of clinical INH resistance. We previously discovered a compound, C10, that enhances the bactericidal activity of INH, prevents the emergence of INH-resistant mutants, and re-sensitizes a set of INH-resistant mutants to INH. Resistance is typically mediated by katG mutations that decrease the activation of INH, which is required for INH to inhibit the essential enzyme InhA. Our current work demonstrates that C10 re-sensitizes INH-resistant katG-hypomorphs without enhancing the activation of INH. We furthermore show that C10 causes Mtb to become particularly vulnerable to InhA inhibition without compromising InhA activity on its own. Therefore, C10 represents a novel strategy to curtail the development of INH resistance and to sensitize Mtb to sub-lethal doses of INH, such as those achieved at the infection site.
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Affiliation(s)
- Gregory A. Harrison
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erin R. Wang
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kevin Cho
- Department of Chemistry, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Center for Metabolomics and Isotope Tracing, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Yassin Mreyoud
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Souvik Sarkar
- Department of Chemistry, Umeå University, Umeå, Sweden
| | - Fredrik Almqvist
- Department of Chemistry, Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research, UCMR, Umeå University, Umeå, Sweden
| | - Gary J. Patti
- Department of Chemistry, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Center for Metabolomics and Isotope Tracing, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christina L. Stallings
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri, USA
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Mecha J, Escudero JN, Richardson BA, Maleche-Obimbo E, Matemo D, Kinuthia J, John-Stewart G, LaCourse SM. Maternal HIV Status and Risk of Infant Mycobacterium tuberculosis Infection as Measured by Tuberculin Skin Test. Pediatr Infect Dis J 2024; 43:250-256. [PMID: 37991383 PMCID: PMC10922277 DOI: 10.1097/inf.0000000000004190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND The effect of maternal HIV on infant Mycobacterium tuberculosis (Mtb) infection risk is not well-characterized. METHODS Pregnant women with/without HIV and their infants were enrolled in a longitudinal cohort in Kenya. Mothers had interferon gamma-release assays (QFT-Plus) and tuberculin skin tests (TST) at enrollment in pregnancy; children underwent TST at 12 and 24 months of age. We estimated the incidence and correlates of infant TST-positivity using Cox proportional hazards regression. RESULTS Among 322 infants, 170 (53%) were HIV-exposed and 152 (47%) were HIV-unexposed. Median enrollment age was 6.6 weeks [interquartile range (IQR): 6.1-10.0]; most received Bacillus Calmette-Guerin (320, 99%). Thirty-nine (12%) mothers were TST-positive; 102 (32%) were QFT-Plus-positive. Among HIV-exposed infants, 154 (95%) received antiretrovirals for HIV prevention and 141 (83%) of their mothers ever received isoniazid preventive therapy (IPT). Cumulative 24-month infant Mtb infection incidence was 3.6/100 person-years (PY) [95% confidence interval (CI): 2.4-5.5/100 PY]; 5.4/100 PY in HIV-exposed infants (10%, 17/170) versus 1.7/100 PY in HIV-unexposed infants (3.3%, 5/152) [hazard ratio (HR): 3.1 (95% CI: 1.2-8.5)]. More TST conversions occurred in the first versus second year of life [5.8 vs. 2.0/100 PY; HR: 2.9 (95% CI: 1.0-10.1)]. Infant TST-positivity was associated with maternal TST-positivity [HR: 2.9 (95% CI: 1.1-7.4)], but not QFT-Plus-positivity. Among HIV-exposed children, Mtb infection incidence was similar regardless of maternal IPT. CONCLUSIONS Mtb infection incidence (by TST) by 24 months of age was ~3-fold higher among HIV-exposed children, despite high maternal IPT uptake. Overall, more TST conversions occurred in the first 12 months compared to 12-24 months of age, similar in both HIV-exposed and HIV-unexposed children.
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Affiliation(s)
- Jerphason Mecha
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Barbra A. Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Elizabeth Maleche-Obimbo
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Daniel Matemo
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, USA
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Sylvia M. LaCourse
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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9
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Abdelgawad N, Chirehwa M, Schutz C, Barr D, Ward A, Janssen S, Burton R, Wilkinson RJ, Shey M, Wiesner L, McIlleron H, Maartens G, Meintjes G, Denti P. Pharmacokinetics of antitubercular drugs in patients hospitalized with HIV-associated tuberculosis: a population modeling analysis. Wellcome Open Res 2024; 7:72. [PMID: 37008250 PMCID: PMC10050909 DOI: 10.12688/wellcomeopenres.17660.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/05/2024] Open
Abstract
Background Early mortality among hospitalized HIV-associated tuberculosis (TB/HIV) patients is high despite treatment. The pharmacokinetics of rifampicin, isoniazid, and pyrazinamide were investigated in hospitalized TB/HIV patients and a cohort of outpatients with TB (with or without HIV) to determine whether drug exposures differed between groups. Methods Standard first-line TB treatment was given daily as per national guidelines, which consisted of oral 4-drug fixed-dose combination tablets containing 150 mg rifampicin, 75 mg isoniazid, 400 mg pyrazinamide, and 275 mg ethambutol. Plasma samples were drawn on the 3rd day of treatment over eight hours post-dose. Rifampicin, isoniazid, and pyrazinamide in plasma were quantified and NONMEM ® was used to analyze the data. Results Data from 60 hospitalized patients (11 of whom died within 12 weeks of starting treatment) and 48 outpatients were available. Median (range) weight and age were 56 (35 - 88) kg, and 37 (19 - 77) years, respectively. Bioavailability and clearance of the three drugs were similar between TB/HIV hospitalized and TB outpatients. However, rifampicin's absorption was slower in hospitalized patients than in outpatients; mean absorption time was 49.9% and 154% more in hospitalized survivors and hospitalized deaths, respectively, than in outpatients. Higher levels of conjugated bilirubin correlated with lower rifampicin clearance. Isoniazid's clearance estimates were 25.5 L/h for fast metabolizers and 9.76 L/h for slow metabolizers. Pyrazinamide's clearance was more variable among hospitalized patients. The variability in clearance among patients was 1.70 and 3.56 times more for hospitalized survivors and hospitalized deaths, respectively, than outpatients. Conclusions We showed that the pharmacokinetics of first-line TB drugs are not substantially different between hospitalized TB/HIV patients and TB (with or without HIV) outpatients. Hospitalized patients do not seem to be underexposed compared to their outpatient counterparts, as well as hospitalized patients who survived vs who died within 12 weeks of hospitalization.
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Affiliation(s)
- Noha Abdelgawad
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Maxwell Chirehwa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Charlotte Schutz
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - David Barr
- Wellcome Trust Liverpool Glasgow Centre for Global Health Research, University of Liverpool, Liverpool, L3 5QA, UK
| | - Amy Ward
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Saskia Janssen
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 19268, The Netherlands
| | - Rosie Burton
- Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
- Khayelitsha Hospital, Department of Medicine, Khayelitsha, 7784, South Africa
| | - Robert J. Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
- Department of Infectious Diseases, Imperial College London, London, W12 0NN, UK
- The Francis Crick Institute, London, NW1 1AT, UK
| | - Muki Shey
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Observatory, 7925, South Africa
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10
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Yang W, Yang W, Ma Y, Yan L, Ma X. A novel chromone Schiff base as Zn 2+ turn-on fluorescent chemosensor in a mixed solution. LUMINESCENCE 2024; 39:e4712. [PMID: 38481369 DOI: 10.1002/bio.4712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/04/2024] [Accepted: 02/16/2024] [Indexed: 03/22/2024]
Abstract
In this study, a novel fluorescent chemosensor 1 based on chromone-3-carboxaldehyde Schiff base was synthesized and featured through nuclear magnetic resonance (NMR) and mass spectra. Spectroscopic investigation indicated that the fluorescent sensor showed high selectivity toward Zn2+ over other metal ions and that the detection limit of 1 could reach 10-7 M. These indicated that 1 acted as a highly selective and sensitive fluorescence chemosensor for Zn2+ .
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Affiliation(s)
- Wensheng Yang
- School of Chemistry and Chemical Engineering, Yulin University, Yulin, China
| | - Wan Yang
- School of Chemistry and Chemical Engineering, Yulin University, Yulin, China
| | - Yajun Ma
- School of Chemistry and Chemical Engineering, Yulin University, Yulin, China
| | - Long Yan
- School of Chemistry and Chemical Engineering, Yulin University, Yulin, China
| | - Xiangrong Ma
- School of Chemistry and Chemical Engineering, Yulin University, Yulin, China
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11
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Teixeira LAA, Santos B, Correia MG, Valiquette C, Bastos ML, Menzies D, Trajman A. Long-term protective effect of tuberculosis preventive therapy in a medium/high TB incidence setting. Clin Infect Dis 2024:ciae101. [PMID: 38407417 DOI: 10.1093/cid/ciae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/05/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND The duration of the protective effect of TB preventive therapy (TPT) is controversial. Some studies have found that the protective effect of TPT is lost after cessation of therapy among people living with HIV in settings with very high tuberculosis incidence, but others have found long-term protection in low incidence settings. METHODS We estimated the incidence rate (IR) of new tuberculosis disease (TB) for up to 12 years after randomization to four months of rifampin or nine months of isoniazid, among 991 Brazilian participants in a TPT trial in the state of Rio de Janeiro, with incidence 68.6/100,000 population in 2022. Adjusted hazard ratios (aHR) of independent variables for incident TB were calculated. RESULTS Overall TB incidence rate (IR) was 1.7 (1.01; 2.7)/1,000 person years (PY). The TB IR among those who did not complete TPT was higher than in those who completed [2.9/1000 PY (95% CI: 1.3; 5.6) versus 1.1/1000 PY (95% CI: 0.4; 2.3), IR ratio (IRR)= 2.7 (95% CI: 1.0; 7.2)]. TB IR was higher within 28 months after randomization [IR: 3.5/1000 PY (1.6; 6.6) PY, compared to 1.1/1000 PY (95% CI: 0.5; 2.1) between 28 and 143 months, IRR= 3.1, 95% CI: 1.2-8.2]. Treatment non-completion was the only variable associated with incident TB [aHR= 3.2 (1.1; 9.7)]. CONCLUSION In a mostly HIV non-infected population, a complete course of TPT conferred long-term protection against tuberculosis.
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Affiliation(s)
- Leidy Anne Alves Teixeira
- Instituto Nacional de Cardiologia (INC), Núcleo de Avaliação de Tecnologias em Saúde, Rio de Janeiro, Brasil
| | - Braulio Santos
- Instituto Nacional de Cardiologia (INC), Núcleo de Avaliação de Tecnologias em Saúde, Rio de Janeiro, Brasil
| | - Marcelo Goulart Correia
- Instituto Nacional de Cardiologia (INC), Núcleo de Avaliação de Tecnologias em Saúde, Rio de Janeiro, Brasil
| | - Chantal Valiquette
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, and McGill University, Montreal, Quebec, Canada
| | - Mayara Lisboa Bastos
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, and McGill University, Montreal, Quebec, Canada
- University of Manitoba, Family Medicine Department, Winnipeg, Canada
| | - Dick Menzies
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, and McGill University, Montreal, Quebec, Canada
| | - Anete Trajman
- Universidade Federal do Rio de Janeiro Departamento de Clínica Médica, Rio de Janeiro, Brasil and McGill International Tuberculosis Centre, McGill University, Montreal, Quebec, Canada
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12
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Nikolaev YA, Mukhina TN, Potapov VD, Kuznetsov BB, El'-Registan GI, Firstova VV, Shemyakin IG, Manzenyuk OY. Antibiotic Adjuvant 4-Hexylresorcinol Enhances the Efficiency of Antituberculosis Drugs. Bull Exp Biol Med 2024; 176:466-471. [PMID: 38488964 DOI: 10.1007/s10517-024-06048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Indexed: 03/17/2024]
Abstract
We studied the possibility of using 4-hexylresorcinol to increase the efficiency of anti-mycobacterial chemotherapy. In an in vitro experiment, 4-hexylresorcinol increased the efficiency of rifampicin, kanamycin, and isoniazid against Mycobacterium smegmatis by 3-5 times. Experiments in sanitation of BALB/c mice infected with M. smegmatis showed the best efficacy of the isoniazid and 4-hexylresorcinol combination in comparison with isoniazid monotherapy. The growth-inhibiting activity of the combination of antibiotic rifabutin with 4-hexylresorcinol was shown on 6 strains of M. tuberculosis. A 2-fold decrease in the minimum inhibitory concentration of this antibiotic in the presence of half-minimum inhibitory concentration of 4-hexylresorcinol was demonstrated for monoresistant strain M. tuberculosis 5360/42Hr. On the mouse model of experimental tuberculosis caused by M. tuberculosis H37Rv, a 5-fold decrease in lung contamination and more rapid complete cure were achieved in animals treated with the combination of rifabutin and 4-hexylresorcinol in comparison with rifabutin monotherapy.
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Affiliation(s)
- Yu A Nikolaev
- Federal Research Centre "Fundamentals of Biotechnology", Russian Academy of Sciences, Moscow, Russia
| | - T N Mukhina
- State Research Center for Applied Microbiology and Biotechnology, Federal Service of Consumer Right Surveillance and Human Welfare, Obolensk, Moscow Region, Russia
| | - V D Potapov
- State Research Center for Applied Microbiology and Biotechnology, Federal Service of Consumer Right Surveillance and Human Welfare, Obolensk, Moscow Region, Russia
| | - B B Kuznetsov
- Federal Research Centre "Fundamentals of Biotechnology", Russian Academy of Sciences, Moscow, Russia
| | - G I El'-Registan
- Federal Research Centre "Fundamentals of Biotechnology", Russian Academy of Sciences, Moscow, Russia
| | - V V Firstova
- State Research Center for Applied Microbiology and Biotechnology, Federal Service of Consumer Right Surveillance and Human Welfare, Obolensk, Moscow Region, Russia
| | - I G Shemyakin
- State Research Center for Applied Microbiology and Biotechnology, Federal Service of Consumer Right Surveillance and Human Welfare, Obolensk, Moscow Region, Russia
| | - O Yu Manzenyuk
- State Research Center for Applied Microbiology and Biotechnology, Federal Service of Consumer Right Surveillance and Human Welfare, Obolensk, Moscow Region, Russia.
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13
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Niesyto K, Keihankhadiv S, Mazur A, Mielańczyk A, Neugebauer D. Ionic Liquid-Based Polymer Matrices for Single and Dual Drug Delivery: Impact of Structural Topology on Characteristics and In Vitro Delivery Efficiency. Int J Mol Sci 2024; 25:1292. [PMID: 38279291 PMCID: PMC10816880 DOI: 10.3390/ijms25021292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
Previously reported amphiphilic linear and graft copolymers, derived from the ionic liquid [2-(methacryloyloxy)ethyl]trimethylammonium chloride (TMAMA_Cl‾), along with their conjugates obtained through modification either before or after polymerization with p-aminosalicylate anions (TMAMA_PAS‾), were employed as matrices in drug delivery systems (DDSs). Based on the counterion type in TMAMA units, they were categorized into single drug systems, manifesting as ionic polymers with chloride counterions and loaded isoniazid (ISO), and dual drug systems, featuring ISO loaded in self-assembled PAS conjugates. The amphiphilic nature of these copolymers was substantiated through the determination of the critical micelle concentration (CMC), revealing an increase in values post-ion exchange (from 0.011-0.063 mg/mL to 0.027-0.181 mg/mL). The self-assembling properties were favorable for ISO encapsulation, with drug loading content (DLC) ranging between 15 and 85% in both single and dual systems. In vitro studies indicated ISO release percentages between 16 and 61% and PAS release percentages between 20 and 98%. Basic cytotoxicity assessments using the 2,5-diphenyl-2H-tetrazolium bromide (MTT) test affirmed the non-toxicity of the studied systems toward human non-tumorigenic lung epithelial cell line (BEAS-2B) cell lines, particularly in the case of dual systems bearing both ISO and PAS simultaneously. These results confirmed the effectiveness of polymeric carriers in drug delivery, demonstrating their potential for co-delivery in combination therapy.
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Affiliation(s)
| | | | | | | | - Dorota Neugebauer
- Department of Physical Chemistry and Technology of Polymers, Faculty of Chemistry, Silesian University of Technology, 44-100 Gliwice, Poland; (K.N.); (S.K.); (A.M.); (A.M.)
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14
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Pandey S, Vilchèze C, Werngren J, Bainomugisa A, Mansjö M, Groenheit R, Miotto P, Cirillo DM, Coulter C, Baulard AR, Schön T, Jacobs WR, Djaout K, Köser CU. Loss-of-function mutations in ndh do not confer delamanid, ethionamide, isoniazid, or pretomanid resistance in Mycobacterium tuberculosis. Antimicrob Agents Chemother 2024; 68:e0109623. [PMID: 38038476 PMCID: PMC10777854 DOI: 10.1128/aac.01096-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Results from clinical strains and knockouts of the H37Rv and CDC1551 laboratory strains demonstrated that ndh (Rv1854c) is not a resistance-conferring gene for isoniazid, ethionamide, delamanid, or pretomanid in Mycobacterium tuberculosis. This difference in the susceptibility to NAD-adduct-forming drugs compared with other mycobacteria may be driven by differences in the absolute intrabacterial NADH concentration.
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Affiliation(s)
- Sushil Pandey
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Catherine Vilchèze
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Arnold Bainomugisa
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | | | | | - Paolo Miotto
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela M. Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christopher Coulter
- Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Brisbane, Queensland, Australia
| | - Alain R. Baulard
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR9017 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Thomas Schön
- Department of Infectious Diseases, Linköping University Hospital, Linköping, Sweden
- Division of Infection and Inflammation, Institute of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Infectious Diseases, Region Östergötland and Kalmar County Hospital, Linköping University, Linköping, Sweden
| | - William R. Jacobs
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kamel Djaout
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR9017 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Claudio U. Köser
- Department of Genetics, University of Cambridge, Cambridge, United Kingdom
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15
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Abouzid M, Kosicka-Noworzyń K, Karaźniewicz-Łada M, Rao P, Modi N, Xie YL, Heysell SK, Główka A, Kagan L. Development and Validation of a UPLC-MS/MS Method for Therapeutic Drug Monitoring, Pharmacokinetic and Stability Studies of First-Line Antituberculosis Drugs in Urine. Molecules 2024; 29:337. [PMID: 38257250 PMCID: PMC10818978 DOI: 10.3390/molecules29020337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Tuberculosis (TB) remains one of the leading global causes of mortality. Several methods have been established to detect anti-TB agents in human plasma and serum. However, there is a notable absence of studies analyzing TB drugs in urine. Thus, our objective was to validate a method for quantifying first-line anti-TB agents: isoniazid (INH), pyrazinamide (PZA), ethambutol (ETH), and rifampicin (RIF), along with its metabolite 25-desacetylrifampicin, and degradation products: rifampicin quinone and 3-formyl-rifampicin in 10 µL of urine. Chromatographic separation was achieved using a Kinetex Polar C18 analytical column with gradient elution (5 mM ammonium acetate and acetonitrile with 0.1% formic acid). Mass spectrometry detection was carried out using a triple-quadrupole tandem mass spectrometer operating in positive ion mode. The lower limit of quantification (LLOQ) was 0.5 µg/mL for INH, PZA, ETH, and RIF, and 0.1 µg/mL for RIF's metabolites and degradation products. The method was validated following FDA guidance criteria and successfully applied to the analysis of the studied compounds in urine of TB patients. Additionally, we conducted a stability study of the anti-TB agents under various pH and temperature conditions to mimic the urine collection process in different settings (peripheral clinics or central laboratories).
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Affiliation(s)
- Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 3 Rokietnicka Street, 60-806 Poznań, Poland; (M.A.); (K.K.-N.)
- Doctoral School, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812 Poznań, Poland
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
| | - Katarzyna Kosicka-Noworzyń
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 3 Rokietnicka Street, 60-806 Poznań, Poland; (M.A.); (K.K.-N.)
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
| | - Marta Karaźniewicz-Łada
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 3 Rokietnicka Street, 60-806 Poznań, Poland; (M.A.); (K.K.-N.)
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
| | - Prakruti Rao
- Division of Infectious Diseases and International Health, University of Virginia, 345 Crispell Drive, Charlottesville, VA 22903, USA; (P.R.); (S.K.H.)
| | - Nisha Modi
- Public Health Research Institute, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07013, USA; (N.M.); (Y.L.X.)
| | - Yingda L. Xie
- Public Health Research Institute, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07013, USA; (N.M.); (Y.L.X.)
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health, University of Virginia, 345 Crispell Drive, Charlottesville, VA 22903, USA; (P.R.); (S.K.H.)
| | - Anna Główka
- Department of Bromatology, Poznan University of Medical Sciences, 3 Rokietnicka Street, 60-806 Poznań, Poland;
| | - Leonid Kagan
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
- Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
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16
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Zhou M, Liu AM, Yang XB, Guan CP, Zhang YA, Wang MS, Chen YL. The efficacy and safety of high-dose isoniazid-containing therapy for multidrug-resistant tuberculosis: a systematic review and meta-analysis. Front Pharmacol 2024; 14:1331371. [PMID: 38259285 PMCID: PMC10800833 DOI: 10.3389/fphar.2023.1331371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Objectives: Accumulating evidence are available on the efficacy of high-dose isoniazid (INH) for multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to perform a systematic review and meta-analysis to compare clinical efficacy and safety outcomes of high-dose INH- containing therapy against other regimes. Methods: We searched the following databases PubMed, Embase, Scopus, Web of Science, CINAHL, the Cochrane Library, and ClinicalTrials.gov. We considered and included any studies comparing treatment success, treatment unsuccess, or adverse events in patients with MDR-TB treated with high-dose INH (>300 mg/day or >5 mg/kg/day). Results: Of a total of 3,749 citations screened, 19 studies were included, accounting for 5,103 subjects, the risk of bias was low in all studies. The pooled treatment success, death, and adverse events of high-dose INH-containing therapy was 76.5% (95% CI: 70.9%-81.8%; I2: 92.03%), 7.1% (95% CI: 5.3%-9.1%; I2: 73.75%), and 61.1% (95% CI: 43.0%-77.8%; I2: 98.23%), respectively. The high-dose INH administration is associated with significantly higher treatment success (RR: 1.13, 95% CI: 1.04-1.22; p < 0.01) and a lower risk of death (RR: 0.45, 95% CI: 0.32-0.63; p < 0.01). However, in terms of other outcomes (such as adverse events, and culture conversion rate), no difference was observed between high-dose INH and other treatment options (all p > 0.05). In addition, no publication bias was observed. Conclusion: In MDR-TB patients, high-dose INH administration is associated with a favorable outcome and acceptable adverse-event profile. Systematic review registration: identifier CRD42023438080.
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Affiliation(s)
- Ming Zhou
- Department of Laboratory Medicine, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Ai-Mei Liu
- Department of Infectious Diseases, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Xiao-Bing Yang
- Department of Laboratory Medicine, Chest Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, Guangxi, China
| | - Cui-Ping Guan
- Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, Shandong, China
| | - Yan-An Zhang
- Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, Shandong, China
- Department of Cardiovascular Surgery, Shandong Public Health Clinical Center, Shandong University, Jinan, Shandong, China
| | - Mao-Shui Wang
- Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, Shandong, China
| | - Ya-Li Chen
- Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, Shandong, China
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17
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Mendes LVP, Trajman A, Campos MR, Correa MCDV, Osorio-de-Castro CGS. The incorporation of the 3HP regimen for tuberculosis preventive treatment in the Brazilian health system: a secondary-database nationwide analysis. Front Med (Lausanne) 2024; 10:1289298. [PMID: 38249969 PMCID: PMC10796787 DOI: 10.3389/fmed.2023.1289298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction The recommendation of rifampin-based shorter - and safer - regimens for tuberculosis preventive treatment (TPT) is progressively replacing monotherapy with isoniazid by different countries. The Brazilian Ministry of Health (MoH) approved the incorporation of the Rifapentine + isoniazid regimen (3HP) at the end of 2020, with free distribution in the Brazilian Unified Health System (SUS) started from the last quarter of 2021. The objectives were to describe the implementation of the IL-TB System (Information System of TPT Notification) and uptake of Rifapentine + isoniazid (3HP) and Isoniazid (6H or 9H) in Brazil. Methods A quantitative observational and descriptive was performed using the IL-TB National System as the main data source, from January 2018 to December 2022. Results and discussion There was a steady increase of the number of TPT prescription quarterly throughout the period, which reflects the implementation of the system itself and the progressive adherence of the health system to the non-compulsory notification of new TPT. The substitution of isoniazid (6H or 9H) by 3HP is progressing. The 3HP regimen represented less than 4% of the total administered by the end of 2021, reaching around 30% in the second half of 2022 and 40% in the last quarters of 2022. The study points not only to the need to expand TPT in the country, but also to accelerate 3HP uptake and to encourage the municipalities to notify to the IL-TB system, since there is still a high level of underreporting.
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Affiliation(s)
| | - Anete Trajman
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica Rodrigues Campos
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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18
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Pang S, An B, Miao Z, Li C, Wei N, Zhang Y. A near-infrared fluorescent probe for detecting hydrazine metabolized from isoniazid in living cells. LUMINESCENCE 2024; 39:e4676. [PMID: 38286600 DOI: 10.1002/bio.4676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/12/2023] [Accepted: 12/25/2023] [Indexed: 01/31/2024]
Abstract
Isoniazid is a drug for treating tuberculosis, but hydrazine (N2 H4 ), the major metabolite of isoniazid, can cause hepatotoxicity. Therefore, monitoring the content of N2 H4 in time is of great significance for studying the hepatotoxicity induced by isoniazid. In this study, a near-infrared fluorescent probe (BC-N) was designed and synthesized based on the specific reaction of acetyl ester with N2 H4 . BC-N exhibits excellent selectivity, sensitivity, and biocompatibility. In addition, BC-N is applied in the visualization of N2 H4 produced from isoniazid in living cells and is a potential tool for monitoring hepatotoxicity induced by isoniazid.
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Affiliation(s)
- Shude Pang
- Department of Pharmaceutical Analysis, School of Pharmacy, Qingdao University Medical College, Qingdao, China
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, Qingdao, China
| | - Baoshuai An
- Department of Pharmaceutical Analysis, School of Pharmacy, Qingdao University Medical College, Qingdao, China
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, Qingdao, China
| | - Zhuo Miao
- Department of Pharmaceutical Analysis, School of Pharmacy, Qingdao University Medical College, Qingdao, China
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, Qingdao, China
| | - Cheng Li
- Department of Pharmaceutical Analysis, School of Pharmacy, Qingdao University Medical College, Qingdao, China
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, Qingdao, China
| | - Ningning Wei
- Department of Pharmaceutical Analysis, School of Pharmacy, Qingdao University Medical College, Qingdao, China
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, Qingdao, China
| | - Yanru Zhang
- Department of Pharmaceutical Analysis, School of Pharmacy, Qingdao University Medical College, Qingdao, China
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, Qingdao, China
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19
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Rohit Singh T, Ezhilarasan D, Karthick M, Shree Harini K. Lagerstroemia speciosa Pers. (Lythraceae) Ethanolic Extract Attenuates Isoniazid-Induced Oxidative Stress and Hepatic Inflammation in Rats. Cureus 2024; 16:e51609. [PMID: 38313882 PMCID: PMC10837052 DOI: 10.7759/cureus.51609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Background Drug-induced liver injury is a common cause of acute liver failure. Isoniazid (INH) is used as a first-line treatment for tuberculosis. Clinical and experimental studies have reported abnormal liver function after INH therapy. Lagerstroemia speciosa Pers., commonly known as banaba, has been traditionally used to treat various ailments including diabetes and obesity due to its antioxidant and anti-inflammatory properties. Aim To investigate the hepatoprotective effect of ethanolic banaba leaf extract (EBLE) against INH-induced hepatotoxicity in rats. Materials and methods A total of 30 male Wistar albino rats (150 - 200 g) were divided into five groups (n = 6). Group I rats were served as a control and were administered dimethyl sulfoxide for the first 30 days and water for the next 30 consecutive days. Group II rats were administered INH (50 mg/kg, p.o.) once in the first 30 consecutive days and sacrificed at Day 30. Group III rats were administered INH for 30 consecutive days and left without treatment for the next 30 days. In Groups IV and V, rats were post-treated orally with EBLE 250 and 500 mg/kg, p.o. (0.3 ml/rat) for 30 days after INH administration. At the end of Day 60, the remaining group of animals were sacrificed. The blood and liver tissues were collected. The marker enzymes of hepatotoxicity, oxidative stress markers, inflammatory markers, and histopathology were analyzed. Results INH administration induced significant elevation of marker enzymes (aspartate transaminase, alanine transaminase, alkaline phosphatase, lactate dehydrogenase, bilirubin, gamma-glutamyl transpeptidase) of hepatotoxicity in the serum. This treatment also increased lipid peroxidation and proinflammatory marker expression (tumor necrosis factor-alpha, transforming growth factor-beta, and nuclear factor kappa B (NF-κB) except inhibitor of NF-κB) and decreased antioxidants such superoxide dismutase, catalase, and glutathione in the liver tissue. All these abnormalities were significantly mitigated after treatment with EBLE. Conclusion The results of this study suggest that EBLE can be used for INH-induced hepatotoxicity.
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Affiliation(s)
- T Rohit Singh
- Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Devaraj Ezhilarasan
- Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Munusamy Karthick
- Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Karthik Shree Harini
- Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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20
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Imakura T, Kakiuchi S, Kagawa H, Murakami N, Haku T. Two Cases of Mycobacterium shinjukuense Pulmonary Disease With a Long-Term Response to Treatment With Clarithromycin, Rifampicin, and Ethambutol. Cureus 2024; 16:e52888. [PMID: 38406085 PMCID: PMC10891419 DOI: 10.7759/cureus.52888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Mycobacterium shinjukuense is a nontuberculous mycobacterium, and standard treatment for the infection has not been established. We report two cases of M. shinjukuense pulmonary disease in which two patients were treated with clarithromycin (CAM), rifampicin (RFP), and ethambutol (EB). Based on computed tomography (CT) findings, the patients experienced improvement with treatment. Reports of multiple cases of M. shinjukuense pulmonary disease treated with clarithromycin, rifampicin, and ethambutol are valuable, and they suggest that this regimen may be a new treatment option.
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Affiliation(s)
- Takeshi Imakura
- Department of Respiratory Medicine, Tokushima Prefectural Central Hospital, Tokushima, JPN
| | - Soji Kakiuchi
- Department of Respiratory Medicine, Tokushima Prefectural Central Hospital, Tokushima, JPN
| | - Hitomi Kagawa
- Department of Respiratory Medicine, Tokushima Prefectural Central Hospital, Tokushima, JPN
| | - Naoya Murakami
- Department of Respiratory Medicine, Tokushima Prefectural Central Hospital, Tokushima, JPN
| | - Takashi Haku
- Department of Respiratory Medicine, Tokushima Prefectural Central Hospital, Tokushima, JPN
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21
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Cheng F, Qiu CC, Jiang XG, Wu T, Zhang Q, Chen X, Zheng SL, Liu SD, Ye XC, Shi JC. Relevance of NAT2 genotype and clinical factors to risk for antituberculosis drug-induced liver injury. Pharmacogenomics 2024; 25:21-28. [PMID: 38131213 DOI: 10.2217/pgs-2023-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
The study analyzes the risk factors associated with antituberculosis drug-induced liver injury (ATB-DILI), and the relationship between ATB-DILI and NAT2 gene polymorphisms. Out of the 324 included patients, 57 (17.59%) developed ATB-DILI. Age, history of liver disease, alcohol consumption and timing of antituberculosis (ATB) treatment were independent risk factors for ATB-DILI in the patients with tuberculosis (TB; p < 0.05). There was a significant difference in the distribution of NAT2 metabolic phenotypes between the study group and the control group (p < 0.05). The ATB drug treatment for pulmonary TB can cause a high incidence of ATB-DILI. Age, history of liver disease, alcohol consumption and timing of ATB treatment are independent risk factors for ATB-DILI in patients with TB.
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Affiliation(s)
- Fang Cheng
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
| | - Chao-Chao Qiu
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
| | - Xian-Gao Jiang
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
| | - Te Wu
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
| | - Qiang Zhang
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
| | - Xin Chen
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
| | - Shi-Lin Zheng
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
| | - Sai-Duo Liu
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
| | - Xin-Chun Ye
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
| | - Ji-Chan Shi
- Department of Infectious Disease of Wenzhou Central Hospital, Wenzhou Central Hospital,The Dingli Clinical College of Wenzhou Medical University,Wenzhou, 325000, China
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22
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Lin KY, Sun HY, Yang CJ, Lu PL, Lee YT, Lee NY, Liou BH, Tang HJ, Lee MH, Wang NC, Chen TC, Hii IM, Huang SH, Lin CY, Tsai CS, Cheng CY, Hung CC. Treatment responses to integrase strand-transfer inhibitor-containing antiretroviral regimens in combination with short-course rifapentine-based regimens for latent tuberculosis infection among people with HIV. Clin Infect Dis 2023:ciad730. [PMID: 38051646 DOI: 10.1093/cid/ciad730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/12/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Real-world experience with combinations of short-course rifapentine-based regimens and integrase strand-transfer inhibitor (InSTI)-containing antiretroviral therapy (ART) in management of latent tuberculous infection (LTBI) is limited among people with HIV (PWH). METHODS From August 2019 to October 2022, PWH receiving 3 months of weekly rifapentine plus isoniazid (3HP) or 1 month of daily rifapentine plus isoniazid (1HP) in combination with ART were included. The primary outcome was virologic response within 12 months after LTBI treatment, and the secondary outcomes included treatment completion rate and safety of LTBI regimens. RESULTS During the study period, 479 PWH (94.6% male; median age, 43 years) were included: 142 received 1HP and bictegravir (BIC)-containing regimens (1HP/BIC group), 46 1HP and dolutegravir (DTG)-containing regimens (1HP/DTG group), 38 3HP and BIC-containing regimens (3HP/BIC group), 214 3HP and DTG-containing regimens (3HP/DTG group), 17 1HP and other ART regimens (1HP/others group), and 22 3HP/other ART regimens (3HP/others group). In the intention-to-treat analysis, the proportions of PWH maintaining plasma HIV-1 RNA <200 copies/mL within 12 months after LTBI treatment completion were 96.5% (1HP/BIC), 100% (1HP/DTG), 100% (3HP/BIC), 95.8% (3HP/DTG), 100% (1HP/others), and 100% (3HP/others). The overall completion rates were >80% for all treatment groups, whereas >50% of the included PWH experienced any adverse event. LTBI regimens and ART combinations were not associated with virologic response and completion rate. CONCLUSION Combinations of short-course rifapentine-based regimens and InSTI-containing ART maintained viral suppression for most PWH within 12 months of LTBI treatment completion with low rates of grade 3 or higher adverse events.
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Affiliation(s)
- Kuan-Yin Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Ti Lee
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
| | - Bo-Huang Liou
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Mei-Hui Lee
- Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan
| | - Ning-Chi Wang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tun-Chieh Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Ing-Moi Hii
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Ying Lin
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Chin-Shiang Tsai
- Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, Yunlin, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- School of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
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23
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Van Schalkwyk M, Bekker A, Decloedt E, Wang J, Theron GB, Cotton MF, Eke AC, Cressey TR, Shapiro DE, Bacon K, Knowles K, George K, Browning R, Chakhtoura N, Rungruengthanakit K, Wiesner L, Capparelli EV, Stek AM, Mirochnick M, Best BM. Pharmacokinetics and safety of first-line tuberculosis drugs rifampin, isoniazid, ethambutol, and pyrazinamide during pregnancy and postpartum: results from IMPAACT P1026s. Antimicrob Agents Chemother 2023; 67:e0073723. [PMID: 37882552 PMCID: PMC10648924 DOI: 10.1128/aac.00737-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023] Open
Abstract
Physiological changes during pregnancy may alter the pharmacokinetics (PK) of antituberculosis drugs. The International Maternal Pediatric Adolescent AIDS Clinical Trials Network P1026s was a multicenter, phase IV, observational, prospective PK and safety study of antiretroviral and antituberculosis drugs administered as part of clinical care in pregnant persons living with and without HIV. We assessed the effects of pregnancy on rifampin, isoniazid, ethambutol, and pyrazinamide PK in pregnant and postpartum (PP) persons without HIV treated for drug-susceptible tuberculosis disease. Daily antituberculosis treatment was prescribed following World Health Organization-recommended weight-band dosing guidelines. Steady-state 12-hour PK profiles of rifampin, isoniazid, ethambutol, and pyrazinamide were performed during second trimester (2T), third trimester (3T), and 2-8 of weeks PP. PK parameters were characterized using noncompartmental analysis, and comparisons were made using geometric mean ratios (GMRs) with 90% confidence intervals (CI). Twenty-seven participants were included: 11 African, 9 Asian, 3 Hispanic, and 4 mixed descent. PK data were available for 17, 21, and 14 participants in 2T, 3T, and PP, respectively. Rifampin and pyrazinamide AUC0-24 and C max in pregnancy were comparable to PP with the GMR between 0.80 and 1.25. Compared to PP, isoniazid AUC0-24 was 25% lower and C max was 23% lower in 3T. Ethambutol AUC0-24 was 39% lower in 3T but limited by a low PP sample size. In summary, isoniazid and ethambutol concentrations were lower during pregnancy compared to PP concentrations, while rifampin and pyrazinamide concentrations were similar. However, the median AUC0-24 for rifampin, isoniazid, and pyrazinamide met the therapeutic targets. The clinical impact of lower isoniazid and ethambutol exposure during pregnancy needs to be determined.
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Affiliation(s)
- Marije Van Schalkwyk
- Division of Adult Infectious Diseases, Department of Medicine, Family Centre for Research with Ubuntu, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Adrie Bekker
- Department of Pediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Eric Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Jiajia Wang
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gerhard B. Theron
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
| | - Mark F. Cotton
- Department of Pediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ahizechukwu C. Eke
- Division of Maternal Fetal Medicine and Clinical Pharmacology, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tim R. Cressey
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - David E. Shapiro
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kira Bacon
- Frontier Science Foundation, Amherst, New York, USA
| | | | | | - Renee Browning
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Nahida Chakhtoura
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, Maryland, USA
| | | | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Edmund V. Capparelli
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
- Department of Pediatrics, School of Medicine, University of California, San Diego, California, USA
| | - Alice M. Stek
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California, USA
| | - Mark Mirochnick
- Division of Neonatology, Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Brookie M. Best
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
- Department of Pediatrics, School of Medicine, University of California, San Diego, California, USA
| | - on behalf of the IMPAACT P1026s Protocol Team
- Division of Adult Infectious Diseases, Department of Medicine, Family Centre for Research with Ubuntu, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- Department of Pediatrics and Child Health, Family Centre for Research with Ubuntu, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa
- Division of Maternal Fetal Medicine and Clinical Pharmacology, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- AMS-PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Frontier Science Foundation, Amherst, New York, USA
- FHI 360, Durham, North Carolina, USA
- Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, Maryland, USA
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
- Department of Pediatrics, School of Medicine, University of California, San Diego, California, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California, USA
- Division of Neonatology, Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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A Majed A, Al-Duhaidahawi D, A Omran H, Abbas S, S Abid D, Y Hmood A. Synthesis, molecular docking of new amide thiazolidine derived from isoniazid and studying their biological activity against cancer cells. J Biomol Struct Dyn 2023:1-12. [PMID: 37922154 DOI: 10.1080/07391102.2023.2276313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/07/2023] [Indexed: 11/05/2023]
Abstract
BCL2, an antiapoptotic protein, is overexpressed in many cancers, making it a good cancer treatment target. In 30 years, few BCL2 targeting agents have shown clinical significance. This work designed new amide thiazolidine derived from isoniazid targeting BCL2 and tested them on cancer cell lines, for binding affinities, the novel candidates were docked to the BCL2 target receptor. IC50 of compound A8 46.67 ± 0.9 and 57.14 ± 0.88 μg/ml against PC3 and HEPG2 respectively with docking score -7.6 Kcal/mol with 6GL8 make it the best compound in this series. Melting point, FT-IR, elemental microanalysis (CHN), 1HNMR, and 13CNMR confirmed chemical structures.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Ahmed A Majed
- College of Education, Department of Chemistry, Basrah University, Basrah, Iraq
- Education Directorate of Thi-Qar, Ministry of Education, Thi-Qar, Iraq
| | | | - Haider A Omran
- Education Directorate of Basrah, Ministry of Education, Basrah, Iraq
| | - Sabah Abbas
- College of Pharmacy, University of Kufa, AL-Najaf, Iraq
| | - Dawood S Abid
- College of Education for Pure Sciences, Department of Chemistry, Basrah University, Basrah, Iraq
| | - Ahmed Y Hmood
- Department of Marine Environmental Chemistry, Marine Science Center, University of Basrah, Basrah, Iraq
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25
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Eka Rani YD, Rahmadi M, Hariyadi DM. Characteristics and release of isoniazid from inhalable alginate/carrageenan microspheres. Ther Deliv 2023; 14:689-704. [PMID: 38084393 DOI: 10.4155/tde-2023-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Aim: Inhalable microspheres made of polymers as a targeted drug delivery system have been developed to overcome the limitation of current treatments in Tuberculosis. Materials & methods: Isoniazid inhalable microspheres were created using a gelation ionotropic method with sodium alginate, carrageenan and calcium chloride in four different formulations. Result: The particle morphology has smooth surfaces and round spherical shapes with sizes below 5 μm; good flowability. The drug loading and entrapment efficiency values ranged from 1.69 to 2.75% and 62.44 to 85.30%, respectively. The microspheres drug release followed the Korsmeyer-Peppas model, indicating Fickian diffusion. Conclusion: Isoniazid inhalable microspheres achieved as targeted lung delivery for tuberculosis treatment.
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Affiliation(s)
- Yotomi Desia Eka Rani
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Airlangga, Campus C Mulyorejo, Surabaya, 60115, Indonesia
| | - Mahardian Rahmadi
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Campus C Jl. Mulyorejo, Surabaya, 60115, Indonesia
| | - Dewi Melani Hariyadi
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Airlangga, Campus C Mulyorejo, Surabaya, 60115, Indonesia
- Nanotechnology & Drug Delivery System Research Group, Faculty of Pharmacy, Universitas Airlangga, Campus C Mulyorejo, Surabaya, 60115, Indonesia
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van Staden D, Haynes RK, Van der Kooy F, Viljoen JM. Development of a HPLC Method for Analysis of a Combination of Clofazimine, Isoniazid, Pyrazinamide, and Rifampicin Incorporated into a Dermal Self-Double-Emulsifying Drug Delivery System. Methods Protoc 2023; 6:104. [PMID: 37987351 PMCID: PMC10660689 DOI: 10.3390/mps6060104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
We describe the development and validation of a new high performance liquid chromatography (HPLC) method for analysis of a combination of the first-line anti-tubercular drugs isoniazid, pyrazinamide, and rifampicin together with clofazimine. This is a unique challenge since clofazimine and rifampicin are relatively highly lipophilic drugs, whereas isoniazid and pyrazinamide are considerably more hydrophilic. Thus, clear separation of peaks and quantification of four individual drugs can present difficulties during the development of an analytical method. Detection was established at two wavelengths-254 nm for isoniazid and pyrazinamide and 320 nm for clofazimine and rifampicin. Gradient elution was employed using 0.1% aqueous formic acid (A) and acetonitrile (B); clear separation of the four drugs was achieved within 10 min. A linear relationship was indicated by a correlation coefficient (r2) of 0.9999 for each anti-tubercular drug, respectively. The limit of detection (LOD) for the individual drugs was 0.70 µg/mL (isoniazid), 0.30 µg/mL (pyrazinamide), 0.20 µg/mL (rifampicin) and 0.20 µg/mL (clofazimine). Precision experiments rendered a mean recovery percentage of 101.25% (isoniazid), 98.70% (pyrazinamide), 99.68% (rifampicin) and 97.14% (clofazimine). This HPLC method was validated and is reliable, repeatable, and accurate for the purpose of conducting simultaneous HPLC analyses of the four anti-tubercular drugs.
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Affiliation(s)
- Daniélle van Staden
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); or (R.K.H.); (F.V.d.K.)
| | - Richard K. Haynes
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); or (R.K.H.); (F.V.d.K.)
- Rural Health Research Institute, Charles Sturt University, 346 Leeds Parade, Orange, NSW 2800, Australia
| | - Frank Van der Kooy
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); or (R.K.H.); (F.V.d.K.)
| | - Joe M. Viljoen
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); or (R.K.H.); (F.V.d.K.)
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Rivera JGB, Albério CAA, Vieira JLF. Influence of sex on the exposure to isoniazid in patients with pulmonary tuberculosis. Rev Inst Med Trop Sao Paulo 2023; 65:e56. [PMID: 37878973 PMCID: PMC10588987 DOI: 10.1590/s1678-9946202365056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/30/2023] [Indexed: 10/27/2023] Open
Abstract
Isoniazid is a key component of tuberculosis treatment. Adequate exposure is a determinant for therapeutic success; however, considerable inter- and intraindividual variations in drug plasma levels can lead to unfavorable outcomes. While some predictors of isoniazid levels are well-known, others, such as sex, yield controversial results, requiring further investigation to optimize exposure. This study investigates whether the sex of patients influences the dose administered and the concentrations of isoniazid in plasma. Levels of isoniazid were associated with the N-acetyltransferase 2 phenotypes. A total of 76 male and 58 female patients were included. Isoniazid was measured by high-performance liquid chromatography, and N-acetyltransferase 2 phenotypes were assessed using molecular techniques. The results show that the dose administered, expressed in mg/kg, was higher in females, but the plasma levels were similar between both sexes. Among patients, 46.2%, 38.8%, and 15% were slow, intermediate, and fast acetylators, respectively. As expected, isoniazid levels were associated with the acetylation phenotypes, with higher concentrations in the slow acetylators. Thus, sex-related difference in isoniazid levels is due to the body weight of patients, and the optimized dose regimen based on patient weight and acetylator phenotypes can improve the treatment outcomes.
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Cheng L, Luo M, Guo Y, Fan Y, Wang P, Zhou G, Qin S, Weng B, Li P, Liu Z, Liu S. Correlations among the plasma concentrations of first-line anti-tuberculosis drugs and the physiological parameters influencing concentrations. Front Pharmacol 2023; 14:1248331. [PMID: 37869746 PMCID: PMC10587680 DOI: 10.3389/fphar.2023.1248331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Background: The plasma concentrations of the four most commonly used first-line anti-tuberculosis (TB) drugs, isoniazid (INH), rifampicin (RMP), ethambutol (EMB), and pyrazinamide (PZA), are often not within the therapeutic range. Insufficient drug exposure could lead to drug resistance and treatment failure, while excessive drug levels may lead to adverse reactions. The purpose of this study was to identify the physiological parameters influencing anti-TB drug concentrations. Methods: A retrospective cohort study was conducted. The 2-h plasma concentrations of the four drugs were measured by using the high-performance liquid chromatography-tandem mass spectrometry method. Results: A total of 317 patients were included in the study. The proportions of patients with INH, RMP, EMB, and PZA concentrations within the therapeutic range were 24.3%, 31.5%, 27.8%, and 18.6%, respectively. There were positive associations between the concentrations of INH and PZA and RMP and EMB, but negative associations were observed between the concentrations of INH and RMP, INH and EMB, RMP and PZA, and EMB and PZA. In the multivariate analysis, the influencing factors of the INH concentration were the PZA concentration, total bile acid (TBA), serum potassium, dose, direct bilirubin, prealbumin (PA), and albumin; those of the RMP concentration were PZA and EMB concentrations, weight, α-l-fucosidase (AFU), drinking, and dose; those of the EMB concentration were the RMP and PZA concentrations, creatinine, TBA and indirect bilirubin; and those of the PZA concentration were INH, RMP and EMB concentrations, sex, weight, uric acid and drinking. Conclusion: The complex correlations between the concentrations of the four first-line anti-TB drugs lead to a major challenge in dose adjustment to maintain all drugs within the therapeutic window. Levels of TBA, PA, AFU, and serum potassium should also be considered when adjusting the dose of the four drugs.
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Affiliation(s)
- Lin Cheng
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Ming Luo
- Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing, China
| | - Yan Guo
- Department of Infectious Diseases, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Yunfan Fan
- Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing, China
| | - Pengsen Wang
- Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing, China
| | - Gang Zhou
- Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing, China
| | - Shiwei Qin
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Bangbi Weng
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Peibo Li
- Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing, China
| | - Zhirui Liu
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Songtao Liu
- Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing, China
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Zhu W, Su H, Wei Y, Huang Y, Chen S, Shi Y, Long Y, Qiu Y, Wei J. Asiatic acid ameliorates rifampicin- and isoniazid-induced liver injury in vivo by regulating sphingolipid metabolism and mitogen-activated protein kinase signalling pathways. Basic Clin Pharmacol Toxicol 2023; 133:402-417. [PMID: 37272388 DOI: 10.1111/bcpt.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
In this study, we aimed to determine whether asiatic acid (AA) exerts any therapeutic effects on rifampicin (RFP)- and isoniazid (INH)-induced liver injury and elucidate the underlying mechanisms. Briefly, liver injury in mice was induced via RFP and INH administration. We investigated the effects and potential action mechanisms of AA on liver injury using transcriptomics, metabolomics and various examinations. We found that AA significantly ameliorated the pathological changes in liver tissues and decreased the transaminase activity, inflammation and oxidative stress damage. Transcriptomics revealed 147 differentially expressed genes (DEGs) between the AA and model groups that were enriched in metabolic and mitogen-activated protein kinase (MAPK) signalling pathways. Metabolomics revealed 778 differentially expressed metabolites between the AA and model groups. Furthermore, integrated transcriptomics and metabolomics analyses revealed strong correlations between DEGs and differentially expressed metabolites and indicated that AA regulates the sphingolipid metabolism by inhibiting the expression of delta 4-desaturase, sphingolipid 1. Experimental results confirmed that AA inhibited the MAPK signalling pathway. In summary, AA inhibits inflammation and oxidative stress damage by regulating the sphingolipid metabolism pathway and blocking the MAPK signalling pathway, thereby relieving the RFP/INH-induced liver injury.
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Affiliation(s)
- Wuchang Zhu
- Pharmaceutical College, Guangxi Medical University, Nanning, China
- Pharmacy Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hongmei Su
- Pharmaceutical College, Guangxi Medical University, Nanning, China
| | - Yuanyuan Wei
- Pharmaceutical College, Guangxi Medical University, Nanning, China
| | - Yushen Huang
- Pharmaceutical College, Guangxi Medical University, Nanning, China
| | - Siyun Chen
- Pharmacy Department, The People's Hospital of Hezhou, Hezhou, China
| | - Yanxia Shi
- Pharmaceutical College, Guangxi Medical University, Nanning, China
| | - Yan Long
- Pharmaceutical College, Guangxi Medical University, Nanning, China
| | - Yue Qiu
- Pharmaceutical College, Guangxi Medical University, Nanning, China
| | - Jinbin Wei
- Pharmaceutical College, Guangxi Medical University, Nanning, China
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van Staden D, Haynes RK, Viljoen JM. The Development of Dermal Self-Double-Emulsifying Drug Delivery Systems: Preformulation Studies as the Keys to Success. Pharmaceuticals (Basel) 2023; 16:1348. [PMID: 37895819 PMCID: PMC10610238 DOI: 10.3390/ph16101348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Self-emulsifying drug delivery systems (SEDDSs) are lipid-based systems that are superior to other lipid-based oral drug delivery systems in terms of providing drug protection against the gastrointestinal (GI) environment, inhibition of drug efflux as mediated by P-glycoprotein, enhanced lymphatic drug uptake, improved control over plasma concentration profiles of drugs, enhanced stability, and drug loading efficiency. Interest in dermal spontaneous emulsions has increased, given that systems have been reported to deliver drugs across mucus membranes, as well as the outermost layer of the skin into the underlying layers. The background and development of a double spontaneous emulsion incorporating four anti-tubercular drugs, clofazimine (CFZ), isoniazid (INH), pyrazinamide (PZY), and rifampicin (RIF), are described here. Our methods involved examination of oil miscibility, the construction of pseudoternary phase diagrams, the determination of self-emulsification performance and the emulsion stability index of primary emulsions (PEs), solubility, and isothermal micro calorimetry compatibility and examination of emulsions via microscopy. Overall, the potential of self-double-emulsifying drug delivery systems (SDEDDSs) as a dermal drug delivery vehicle is now demonstrated. The key to success here is the conduct of preformulation studies to enable the development of dermal SDEDDSs. To our knowledge, this work represents the first successful example of the production of SDEDDSs capable of incorporating four individual drugs.
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Affiliation(s)
- Daniélle van Staden
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); (R.K.H.)
| | - Richard K. Haynes
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); (R.K.H.)
- Rural Health Research Institute, Charles Sturt University, 346 Leeds Parade, Orange, NSW 2800, Australia
| | - Joe M. Viljoen
- Faculty of Health Sciences, Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), Building G16, North-West University, 11 Hoffman Street, Potchefstroom 2520, South Africa; (D.v.S.); (R.K.H.)
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Verma R, da Silva KE, Rockwood N, Wasmann RE, Yende N, Song T, Kim E, Denti P, Wilkinson RJ, Andrews JR. A Nanopore sequencing-based pharmacogenomic panel to personalize tuberculosis drug dosing. medRxiv 2023:2023.09.08.23295248. [PMID: 37732197 PMCID: PMC10508808 DOI: 10.1101/2023.09.08.23295248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Rationale Standardized dosing of anti-tubercular (TB) drugs leads to variable plasma drug levels, which are associated with adverse drug reactions, delayed treatment response, and relapse. Mutations in genes affecting drug metabolism explain considerable interindividual pharmacokinetic variability; however, pharmacogenomic (PGx) assays that predict metabolism of anti-TB drugs have been lacking. Objectives To develop a Nanopore sequencing panel and validate its performance in active TB patients to personalize treatment dosing. Measurements and Main Results We developed a Nanopore sequencing panel targeting 15 single nucleotide polymorphisms (SNP) in 5 genes affecting the metabolism of isoniazid (INH), rifampin (RIF), linezolid and bedaquiline. For validation, we sequenced DNA samples (n=48) from the 1000 genomes project and compared variant calling accuracy with Illumina genome sequencing. We then sequenced DNA samples from patients with active TB (n=100) from South Africa on a MinION Mk1C and evaluated the relationship between genotypes and pharmacokinetic parameters for INH and RIF. Results The PGx panel achieved 100% concordance with Illumina sequencing in variant identification for the samples from the 1000 Genomes Project. In the clinical cohort, coverage was >100x for 1498/1500 (99.8%) amplicons across the 100 samples. One third (33%) of participants were identified as slow, 47% were intermediate and 20% were rapid isoniazid acetylators. Isoniazid clearance was significantly impacted by acetylator status (p<0.0001) with median (IQR) clearances of 11.2 L/h (9.3-13.4), 27.2 L/h (22.0-31.7), and 45.1 L/h (34.1-51.1) in slow, intermediate, and rapid acetylators. Rifampin clearance was 17.3% (2.50-29.9) lower in individuals with homozygous AADAC rs1803155 G>A substitutions (p=0.0015). Conclusion Targeted sequencing can enable detection of polymorphisms influencing TB drug metabolism on a low-cost, portable instrument to personalize dosing for TB treatment or prevention.
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Affiliation(s)
- Renu Verma
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, California, USA
- Institute of Bioinformatics, International Tech Park, Bangalore, India
- Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Kesia Esther da Silva
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, California, USA
| | - Neesha Rockwood
- Center for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Dept. Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Infectious Diseases, Imperial College, London, W12 0NN, United Kingdom
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Roeland E. Wasmann
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nombuso Yende
- Department of Pathology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
| | - Taeksun Song
- Department of Pathology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
| | - Eugene Kim
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, California, USA
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Robert. J. Wilkinson
- Center for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine and Dept. Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Infectious Diseases, Imperial College, London, W12 0NN, United Kingdom
- Francis Crick Institute, London NW1 1AT, United Kingdom
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, California, USA
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Arvidsson Å, Lafta G, Sönnerbrandt M, Sundelin K, Paues J. The cascade of care for pregnant women with latent tuberculosis infection in a high-income country. Infect Dis (Lond) 2023; 55:635-645. [PMID: 37389825 DOI: 10.1080/23744235.2023.2228406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Pregnant women have an increased risk of developing active tuberculosis (TB). The Public Health Agency of Sweden recommends screening of active TB and latent tuberculosis infection (LTBI) among pregnant women from countries with high TB incidence at Maternal Health Care (MHC) clinics. In Östergötland County, Sweden, a screening program has been active since 2013. The aim of this study was to evaluate this screening program and the cascade of care for LTBI among pregnant women in Östergötland county. METHODS Data were obtained from pregnant women screened for TB at MHC clinics and subsequently referred to the pulmonary medicine clinic or the clinic of infectious diseases in Östergötland County between 2013 and 2018. The Public Health Agency of Sweden's national database for active TB was used to analyse if any women developed active TB up to two years after the screening process. RESULTS A total of 439 women were included. Nine cases of active TB were discovered during the screening process and two developed active TB afterward. 177 women were recommended LTBI treatment and variables significantly associated with a decreased likelihood of being recommended treatment were increasing age, time in Sweden, and parity. 137 women received and 112 (82%) completed treatment. 14 women discontinued treatment due to adverse effects. CONCLUSION Screening of pregnant women from countries with high TB incidence at MHC clinics led to the discovery of several cases of active TB. The completion rate of LTBI treatment was high and few discontinued due to adverse effects.
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Affiliation(s)
- Åsa Arvidsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Gihan Lafta
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Karin Sundelin
- Department for Infectious Diseases, Region Östergötland, Linköping, Sweden
| | - Jakob Paues
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department for Infectious Diseases, Region Östergötland, Linköping, Sweden
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Scheepers MC, Lemmerer A. The synthesis and characterization of a series of cocrystals of an isoniazid derivative with butan-2-one and propan-2-one. Acta Crystallogr C Struct Chem 2023; 79:365-373. [PMID: 37610289 PMCID: PMC10561595 DOI: 10.1107/s2053229623007179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023] Open
Abstract
Four cocrystals containing N'-(butan-2-ylidene)pyridine-4-carbohydrazide (izbt) and one cocrystal containing N'-isopropylideneisonicotinohydrazide (izact) were synthesized by reacting isoniazid with either butan-2-one (for the former) or acetone (for the latter). The coformers used to synthesize the izbt cocrystals were 2,4-dihydroxybenzoic acid, 2,5-dihydroxybenzoic acid, 2-chloro-4-nitrobenzoic acid and 1-naphthoic acid. 1-Naphthoic acid was also used with izact to form a cocrystal. The 1:1 cocrystals are: N'-(butan-2-ylidene)pyridine-4-carbohydrazide-1-naphthoic acid (izbt-1nta), C10H13N3O·C11H8O2, N'-(butan-2-ylidene)pyridine-4-carbohydrazide-2,4-dihydroxybenzoic acid (izbt-2,4-dhba), C10H13N3O·C7H6O4, N'-(propan-2-ylidene)pyridine-4-carbohydrazide-1-naphthoic acid (izact-1nta), C9H11N3O·C11H8O2, N'-(butan-2-ylidene)pyridine-4-carbohydrazide-2-chloro-4-nitrobenzoic acid (izbt-2c4n), C10H13N3O·C7H4ClNO4, and N'-(butan-2-ylidene)pyridine-4-carbohydrazide-2,5-dihydroxybenzoic acid (izbt-2,5-dhba), C10H13N3O·C7H6O4. The cocrystals containing izbt were compared to those containing the same (or similar) coformers with izact that have been reported either here or in the Cambridge Structural Database (CSD). Most of the cocrystals showed different packing despite having the same hydrogen-bonding motifs. The cocrystals were characterized by single-crystal X-ray diffraction (SC-XRD), powder X-ray diffraction (PXRD) and differential scanning calorimetry (DSC).
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Affiliation(s)
- Matthew Clarke Scheepers
- Molecular Sciences Institute, School of Chemistry, University of the Witwatersrand, Private Bag 3, Johannesburg, Gauteng 2050, South Africa
| | - Andreas Lemmerer
- Molecular Sciences Institute, School of Chemistry, University of the Witwatersrand, Private Bag 3, Johannesburg, Gauteng 2050, South Africa
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Xia X. Horizontal Gene Transfer and Drug Resistance Involving Mycobacterium tuberculosis. Antibiotics (Basel) 2023; 12:1367. [PMID: 37760664 PMCID: PMC10526031 DOI: 10.3390/antibiotics12091367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Mycobacterium tuberculosis (Mtb) acquires drug resistance at a rate comparable to that of bacterial pathogens that replicate much faster and have a higher mutation rate. One explanation for this rapid acquisition of drug resistance in Mtb is that drug resistance may evolve in other fast-replicating mycobacteria and then be transferred to Mtb through horizontal gene transfer (HGT). This paper aims to address three questions. First, does HGT occur between Mtb and other mycobacterial species? Second, what genes after HGT tend to survive in the recipient genome? Third, does HGT contribute to antibiotic resistance in Mtb? I present a conceptual framework for detecting HGT and analyze 39 ribosomal protein genes, 23S and 16S ribosomal RNA genes, as well as several genes targeted by antibiotics against Mtb, from 43 genomes representing all major groups within Mycobacterium. I also included mgtC and the insertion sequence IS6110 that were previously reported to be involved in HGT. The insertion sequence IS6110 shows clearly that the Mtb complex participates in HGT. However, the horizontal transferability of genes depends on gene function, as was previously hypothesized. HGT is not observed in functionally important genes such as ribosomal protein genes, rRNA genes, and other genes chosen as drug targets. This pattern can be explained by differential selection against functionally important and unimportant genes after HGT. Functionally unimportant genes such as IS6110 are not strongly selected against, so HGT events involving such genes are visible. For functionally important genes, a horizontally transferred diverged homologue from a different species may not work as well as the native counterpart, so the HGT event involving such genes is strongly selected against and eliminated, rendering them invisible to us. In short, while HGT involving the Mtb complex occurs, antibiotic resistance in the Mtb complex arose from mutations in those drug-targeted genes within the Mtb complex and was not gained through HGT.
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Affiliation(s)
- Xuhua Xia
- Department of Biology, University of Ottawa, Ottawa, ON K1N 9A7, Canada; ; Tel.: +1-613-562-5718
- Ottawa Institute of Systems Biology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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Ahalwat S, Bhatt DC, Rohilla S, Jogpal V, Sharma K, Virmani T, Kumar G, Alhalmi A, Alqahtani AS, Noman OM, Almoiliqy M. Mannose-Functionalized Isoniazid-Loaded Nanostructured Lipid Carriers for Pulmonary Delivery: In Vitro Prospects and In Vivo Therapeutic Efficacy Assessment. Pharmaceuticals (Basel) 2023; 16:1108. [PMID: 37631023 PMCID: PMC10458796 DOI: 10.3390/ph16081108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Resistance to isoniazid (INH) is common and increases the possibility of acquiring multidrug-resistant tuberculosis. For this study, isoniazid-loaded nanostructured lipid carriers (INH-NLCs) were developed and effectively functionalized with mannose (Man) to enhance the residence time of the drug within the lungs via specific delivery and increase the therapeutic efficacy of the formulation. The mannose-functionalized isoniazid-loaded nanostructured lipid carrier (Man-INH-NLC) formulation was evaluated with respect to various formulation parameters, namely, encapsulation efficiency (EE), drug loading (DL), average particle size (PS), zeta potential (ZP), polydispersity index (PDI), in vitro drug release (DR), and release kinetics. The in vitro inhalation behavior of the developed formulation after nebulization was investigated using an Andersen cascade impactor via the estimation of the mass median aerosolized diameter (MMAD) and geometric aerodynamic diameter (GAD) and subsequently found to be suitable for effective lung delivery. An in vivo pharmacokinetic study was carried out in a guinea pig animal model, and it was demonstrated that Man-INH-NLC has a longer residence time in the lungs with improved pharmacokinetics when compared with unfunctionalized INH-NLC, indicating the enhanced therapeutic efficacy of the Man-INH-NLC formulation. Histopathological analysis led us to determine that the extent of tissue damage was more severe in the case of the pure drug solution of isoniazid compared to the Man-INH-NLC formulation after nebulization. Thus, the nebulization of Man-INH-NLC was found to be safe, forming a sound basis for enhancing the therapeutic efficacy of the drug for improved management in the treatment of pulmonary tuberculosis.
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Affiliation(s)
- Shaveta Ahalwat
- School of Medical and Allied Sciences, G. D. Goenka University, Gurugram 122103, India; (V.J.); (K.S.)
| | - Dinesh Chandra Bhatt
- Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science and Technology, Hisar 125001, India;
| | - Surbhi Rohilla
- Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science and Technology, Hisar 125001, India;
| | - Vikas Jogpal
- School of Medical and Allied Sciences, G. D. Goenka University, Gurugram 122103, India; (V.J.); (K.S.)
| | - Kirti Sharma
- School of Medical and Allied Sciences, G. D. Goenka University, Gurugram 122103, India; (V.J.); (K.S.)
| | - Tarun Virmani
- School of Pharmaceutical Sciences, MVN University, Palwal 121105, India; (T.V.); (G.K.)
| | - Girish Kumar
- School of Pharmaceutical Sciences, MVN University, Palwal 121105, India; (T.V.); (G.K.)
| | - Abdulsalam Alhalmi
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India;
| | - Ali S. Alqahtani
- Department of Pharmacognosy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia; (A.S.A.); (O.M.N.)
| | - Omar M. Noman
- Department of Pharmacognosy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia; (A.S.A.); (O.M.N.)
| | - Marwan Almoiliqy
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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Agyemang N, Scarsi KK, Baker P, Smeaton LM, Podany AT, Olefsky M, Woolley E, Barr E, Pham M, Mawlana S, Supparatpinyo K, Gatechompol S, Jalil EM, Gadama L, Badal-Faesen S, Van Schalkwyk M, Kayama C, Belaunzaran-Zamudio PF, Godfrey C, Cohn SE, Mngqibisa R, Haas DW. Pharmacogenetic interactions of efavirenz or rifampin and isoniazid with levonorgestrel emergency contraception during treatment of HIV or tuberculosis. Pharmacogenet Genomics 2023; 33:126-135. [PMID: 37306344 PMCID: PMC10309098 DOI: 10.1097/fpc.0000000000000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE In AIDS Clinical Trials Group study A5375, a pharmacokinetic trial of levonorgestrel emergency contraception, double-dose levonorgestrel (3 mg, versus standard dose 1.5 mg) offset the induction effects of efavirenz or rifampin on plasma levonorgestrel exposure over 8 h post-dose (AUC 0-8h ). We characterized the pharmacogenetics of these interactions. METHODS Cisgender women receiving efavirenz- or dolutegravir-based HIV therapy, or on isoniazid-rifampin for tuberculosis, were followed after a single oral dose of levonorgestrel. Linear regression models, adjusted for BMI and age, characterized associations of CYP2B6 and NAT2 genotypes (which affect plasma efavirenz and isoniazid exposure, respectively) with levonorgestrel pharmacokinetic parameters. RESULTS Of 118 evaluable participants, 17 received efavirenz/levonorgestrel 1.5 mg, 35 efavirenz/levonorgestrel 3 mg, 34 isoniazid-rifampin/levonorgestrel 3 mg, and 32 (control group) dolutegravir/levonorgestrel 1.5 mg. There were 73 Black and 33 Asian participants. Regardless of genotype, women on efavirenz and isoniazid-rifampin had higher levonorgestrel clearance. In the efavirenz/levonorgestrel 3 mg group, CYP2B6 normal/intermediate metabolizers had levonorgestrel AUC 0-8h values similar to controls, while CYP2B6 poor metabolizers had AUC 0-8h values of 40% lower than controls. In the isoniazid-rifampin group, NAT2 rapid/intermediate acetylators had levonorgestrel AUC 0-8h values similar to controls, while NAT2 slow acetylators had AUC 0-8h values 36% higher than controls. CONCLUSION CYP2B6 poor metabolizer genotypes exacerbate the efavirenz-levonorgestrel interaction, likely by increased CYP3A induction with higher efavirenz exposure, making the interaction more difficult to overcome. NAT2 slow acetylator genotypes attenuate the rifampin-levonorgestrel interaction, likely by increased CYP3A inhibition with higher isoniazid exposure.
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Affiliation(s)
- Nana Agyemang
- Tufts University School of Medicine, Boston, Massachusetts
| | - Kimberly K. Scarsi
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paxton Baker
- Vanderbilt Technologies for Advanced Genomics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura M. Smeaton
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, Massachusetts
| | - Anthony T. Podany
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Maxine Olefsky
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, Massachusetts
| | | | - Elizabeth Barr
- Office of Research on Women’s Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Michelle Pham
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sajeeda Mawlana
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
| | | | | | - Emilia M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Luis Gadama
- Johns Hopkins Research Project, Blantyre, Malawi
| | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg
| | - Marije Van Schalkwyk
- Family Center for Research with Ubuntu, Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Cecelia Kayama
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Catherine Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington, DC
| | - Susan E. Cohn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rosie Mngqibisa
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
| | - David W. Haas
- Department of Medicine, Vanderbilt University School of Medicine
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
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Tamez-Torres KM, Mongua-Rodríguez N, Ferreyra-Reyes L, Torres-Gonzalez P, Delgado-Sánchez G, Martínez-Hernández M, Bobadilla-del-Valle M, Jasso-Sosa VY, López-Castillo PDS, Ferreira-Guerrero E, Cruz-Hervert LP, Sifuentes-Osornio J, Aguilar-Salinas CA, García-García L, Ponce-de-Leon A. Safety and Tolerability of Six Months of Isoniazid Plus Pyridoxine or Three Months of Rifampicin for Tuberculosis among Subjects with Diabetes Mellitus: A Randomized Trial. Microorganisms 2023; 11:1917. [PMID: 37630477 PMCID: PMC10459081 DOI: 10.3390/microorganisms11081917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Tuberculosis (TB) associated with diabetes mellitus (DM) is a growing problem, particularly in low- and medium-resource countries. We conducted an open-label, parallel-group, randomized, and controlled trial in a tertiary care center in Mexico City to assess TB preventive treatment (TPT) with isoniazid (INH) or rifampicin (RIF) in people with type 2 DM. Participants were assigned six months of INH 300 mg/day plus pyridoxine 75 mg or three months of RIF 600 mg/day. The primary outcomes were adverse events resulting in permanent treatment cessation and considered possibly or probably related to study drugs. We included 130 subjects, 68 randomized to INH and 62 to RIF. We prematurely halted the study based on recommendations of the Adverse Event Safety Panel. There was no difference between arms in the overall frequency of adverse events. However, the INH group had significantly more permanent treatment interruptions due to grade 2 recurrent or grade 3 or 4 hepatoxicity. In comparison, the RIF arm had more treatment interruptions due to grade 3 or 4 gastrointestinal intolerance. TPT using INH or RIF is not safe enough to be considered a universal indication to patients with type 2 DM and TB infection. These results underline the need to search for alternative TB preventions with better safety profiles for type 2 DM patients.
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Affiliation(s)
- Karla M. Tamez-Torres
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Norma Mongua-Rodríguez
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Leticia Ferreyra-Reyes
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Pedro Torres-Gonzalez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Guadalupe Delgado-Sánchez
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Maribel Martínez-Hernández
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
| | - Velma Y. Jasso-Sosa
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Priscila del S. López-Castillo
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
| | - Elizabeth Ferreira-Guerrero
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Luis Pablo Cruz-Hervert
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
- División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Jose Sifuentes-Osornio
- Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
| | - Carlos A. Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico;
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Lourdes García-García
- Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (N.M.-R.); (L.F.-R.); (G.D.-S.); (M.M.-H.); (E.F.-G.); (L.P.C.-H.)
| | - Alfredo Ponce-de-Leon
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (K.M.T.-T.); (P.T.-G.); (V.Y.J.-S.); (P.d.S.L.-C.)
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Arnab P, Croxford R, Scott J, Perumal S, Mohammed Z, Wiesner L, Cohen K, Wasserman S. Severe efavirenz associated neurotoxicity: A retrospective cohort study. S Afr J Infect Dis 2023; 38:522. [PMID: 37780199 PMCID: PMC10397354 DOI: 10.4102/sajid.v38i1.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/09/2023] [Indexed: 10/03/2023] Open
Abstract
Background Efavirenz (EFV) is associated with neuropsychiatric symptoms. Severe neurotoxicity has been reported but the clinical phenotype and risk factors are poorly defined. Objectives To characterise clinical presentations, risk factors and outcomes to help clinicians recognise severe neurotoxicity earlier. Method The authors retrospectively identified adults with supratherapeutic EFV concentrations (> 4 mg/L) obtained during routine clinical care in Cape Town, South Africa. Clinical and laboratory data at the time of EFV quantification were extracted from medical records. Logistic regression was performed to identify associations with neuropsychiatric symptoms, and with severe neurotoxicity. Results Eighty one patients were included; 62 with neuropsychiatric manifestations (most frequently ataxia [n = 20] and psychomotor slowing [n = 24]); and 19 with hepatotoxicity. Overall, 28 (34.6%) were male, 49 (60.5%) had concomitant isoniazid exposure, and median EFV concentration was 12.1 mg/L (interquartile range [IQR]: 6.6-20.0). Neuropsychiatric symptoms were associated with longer duration of EFV therapy, adjusted odds ratio (aOR) 1.3/180-day increment (95% confidence interval [CI]: 1.0-1.7); higher EFV concentrations, aOR 1.2/1 mg/L increase (95% CI: 1.0-1.4) and isoniazid exposure, aOR 8.2 (95% CI: 2.5-26.7). Severe neuropsychiatric symptoms occurred in 47 (75%) patients at a median of 5.9 months (IQR: 2.1-40.8) after EFV initiation. Severe symptoms odds were 1.2-fold higher (95% CI: 1.1-1.4) per 1 mg/L increase in EFV concentration. Symptoms resolved completely within 1 month in 25 (76%) patients with severe neurotoxicity who discontinued EFV. Conclusion A concentration-effect relationship for severe neurotoxicity exists, which occurred late and resolved in most patients after EFV discontinuation. Contribution The authors highlighted clinical heterogeneity and morbidity of EFV-associated neurotoxicity.
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Affiliation(s)
- Priyadarshini Arnab
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Roland Croxford
- Department of Health, DP Marais Hospital, Western Cape Government, Cape Town, South Africa
| | - Janet Scott
- Department of Health, DP Marais Hospital, Western Cape Government, Cape Town, South Africa
| | - Sameshan Perumal
- Department of Statistics, Faculty of Sciences, University of Cape Town, Cape Town, South Africa
| | - Zahraa Mohammed
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sean Wasserman
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Carlos Silveira Machado A, Figueiredo C, Teixeira T, Azevedo C, Fragoso J, Nunes S, Coutinho D, Malheiro L. Adverse Events of Latent Tuberculosis Treatment With Isoniazid in People Living With HIV: A Case-Control Study in a Resource-Rich Setting. Cureus 2023; 15:e41647. [PMID: 37575717 PMCID: PMC10412740 DOI: 10.7759/cureus.41647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Multiple risk factors, such as human immunodeficiency virus (HIV) infection and immunosuppressive therapies, increase the odds of latent tuberculosis infection (LTBI) reactivation and progression to active tuberculosis. A six-to-nine-month preventive treatment with isoniazid (INH) decreases the risk of LTBI reactivation, but its effectiveness can be limited by its long duration and adverse events (AEs), including liver toxicity. Due to comorbidities and polypharmacy, people living with HIV (PLHIV) may be at increased risk of INH-associated AEs. Our study aimed to assess the prevalence of AEs among patients receiving INH treatment for LTBI, to identify risk factors for their occurrence, and to evaluate whether PLHIV have higher odds of developing INH-associated AEs. Methods We conducted a single-center retrospective case-control study, including 130 outpatients with LTBI treated with INH between July 2019 and March 2022. Participants who developed AE (cases) were compared to controls, and a subgroup of PLHIV was compared to HIV-negative participants. Demographics, socioeconomic variables, comorbidities, and clinical variables were compared between study groups. Patient data were obtained from institutional electronic medical records, and outcomes were measured at regularly scheduled appointments. Results We included 130 participants, of which 54 were PLHIV. The PLHIV subgroup was significantly younger (p = 0.01) and demonstrated significantly higher prevalences of chronic liver disease, previous viral hepatitis, daily alcohol consumption, and intravenous drug use (IDU). One-third of the participants had an AE (45 cases, 34.6%), with liver toxicity being the most common (22.3%). Participants who developed AEs were significantly older (p = 0.030) and had a higher prevalence of economic hardship (p = 0.037), as well as higher scores of the Charlson comorbidity index (p = 0.002) than the controls. INH withdrawal occurred in 17 participants (13.1%) and was mainly associated with liver toxicity (p < 0.01) and gastrointestinal symptoms (p = 0.022). In the adjusted effect model, an age ≥ 65 years, economic hardship, and excessive alcohol consumption were significantly associated with higher odds of AEs, while HIV infection decreased the odds by 68.4% (p = 0.033). Conclusions In our study, INH-associated AEs were common, with liver toxicity being the most frequent. Older age, economic hardship, and excessive alcohol consumption increased the odds of INH-associated AEs, while PLHIV had lower odds of developing INH-associated AEs, even when adjusting for other variables in the multivariate analysis. Further studies should be conducted to assess if these results are replicable in a larger population and in different settings.
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Affiliation(s)
| | - Cristóvão Figueiredo
- Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, PRT
| | - Tiago Teixeira
- Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, PRT
| | - Carlos Azevedo
- Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, PRT
| | - Joana Fragoso
- Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, PRT
| | - Sofia Nunes
- Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, PRT
| | - Daniel Coutinho
- Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, PRT
| | - Luís Malheiro
- Infectious Diseases, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, PRT
- Medicine, Porto Academic and Clinical Centre, Porto, PRT
- Medicine, Faculty of Medicine - University of Porto, Porto, PRT
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Setshedi IB, Lemmerer A, Smith MG. Co-crystallization of N'-benzyl-idene-pyridine-4-carbohydrazide and benzoic acid via autoxidation of benzaldehyde. Acta Crystallogr E Crystallogr Commun 2023; 79:682-685. [PMID: 37601390 PMCID: PMC10439410 DOI: 10.1107/s2056989023005698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023]
Abstract
The 1:1 co-crystal N'-[(2-methyl-phen-yl)methyl-idene]pyridine-4-carbohydrazide-benzoic acid (1/1), C13H11N3O·C7H6O2, formed unexpectedly after autoxidation of benzaldehyde during the slow evaporation process of a solution of isoniazid in benzaldehyde. The original intent of the synthesis was to modify isoniazid with benzaldehyde and crystallize the product in order to improve efficacy against Mycobacteria species, but benzoic acid formed spontaneously and co-crystallized with the intended product, N'-benzyl-idene-pyridine-4-carbohydrazide.
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Affiliation(s)
- Itumeleng B. Setshedi
- University of South Africa, Department of Life Science, Unisa Science Campus, 28 Pioneer Avenue, Florida, Roodepoort, Gauteng, South Africa
| | - Andreas Lemmerer
- Molecular Sciences Institute, School of Chemistry, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Mark G. Smith
- University of South Africa, Chemistry Department, Unisa Science Campus, 28 Pioneer Avenue, Florida, Roodepoort, Gauteng, South Africa
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Sharma S, Anand A, Verma N, Sharma V, Bhatia A, Patil AN, Banerjee D. Pharmacokinetic Assessment of Isoniazid and Acetylisoniazid in Carbon Tetrachloride-Induced Liver Injury Model in Wistar Rats. J Pharm Bioallied Sci 2023; 15:139-145. [PMID: 37705856 PMCID: PMC10496850 DOI: 10.4103/jpbs.jpbs_320_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 09/12/2023] Open
Abstract
Background N-acetyl transferase 2 (NAT2) polymorphism testing could not see the light of success as a biomarker tool in tuberculosis management. Additionally, the antitubercular treatment (ATT) drug's reintroduction regimen variations exist because of the scarcity of robust preclinical evidence on ATT drug metabolism. Objective The experiment was planned to understand the pharmacokinetic (PK) behavior of isoniazid and acetylisoniazid (AcINH) in a Wistar rat model of acute liver injury induced by carbon tetrachloride (CCl4) and preclinical drug-induced liver injury (DILI) model induced with CCl4 + anti-Tuberculosis (TB) drugs together. Materials and Methods Thirty rats were used for the experiment and were divided into five groups. All rats were administered a single 0.5 ml/kg CCl4 intraperitoneal injection on day 0 to induce an animal model of DILI. Group I rats received CCl4 alone. Groups II-V were started on additional gavage feedings of isoniazid (H) alone, H plus rifampicin (R), H plus pyrazinamide (Z), and H, R, and Z together, respectively, daily for 21 days subsequently. Isoniazid and AcINH PK assessment was accomplished on day 20 of continuous once-daily dosing. Liver function test (LFT) monitoring was done at baseline on days 1, 7, and 21. On the last day of experiments, all experimental rats were sacrificed. Results Three-week ATT administration sustained the CCl4-induced LFT changes. Area under the curve (AUC) values for isoniazid and AcINH were found to be 2.24 and 1.69 times higher in the H + R group compared with the CCl4 + H group, respectively (P < 0.05). Isoniazid and AcINH maximum concentration (Cmax) reached the highest, while isoniazid clearance reached the lowest in the H + R group. AcINH AUC increased by double in the CCl4 + Isoniazid+Rifampicin+Pyrazinamide (HRZ) group compared with the CCl4 + H group (P < 0.05). Biochemical, histological, and antioxidant changes were consistent with the new liver injury model's development. Conclusion Rifampicin almost doubles up the isoniazid and AcINH exposure, in presence if DILI.
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Affiliation(s)
- Swati Sharma
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aishwarya Anand
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Alka Bhatia
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amol N. Patil
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dibyajyoti Banerjee
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Canarutto D, Oltolini C, Barzaghi F, Calbi V, Migliavacca M, Tucci F, Gallo V, Consiglieri G, Ferrua F, Recupero S, Cervi MC, Al-Mousa H, Pituch-Noworolska A, Tassan Din C, Scarpellini P, Silvani P, Fossati C, Casiraghi M, Cirillo DM, Castagna A, Bernardo ME, Aiuti A, Cicalese MP. Outcome of BCG Vaccination in ADA-SCID Patients: A 12-Patient Series. Biomedicines 2023; 11:1809. [PMID: 37509449 PMCID: PMC10376767 DOI: 10.3390/biomedicines11071809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Vaccination with Bacillus Calmette-Guérin (BCG) can be harmful to patients with combined primary immunodeficiencies. We report the outcome of BCG vaccination in a series of twelve patients affected by adenosine deaminase deficiency (ADA-SCID). BCG vaccination resulted in a very high incidence of complications due to uncontrolled replication of the mycobacterium. All patients who developed BCG-related disease were treated successfully and remained free from recurrence of disease. We recommend the prompt initiation of enzyme replacement therapy and secondary prophylaxis to reduce the risk of BCG-related complications in ADA-SCID patients.
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Affiliation(s)
- Daniele Canarutto
- Faculty of Medicine and Surgery, Vita-Salute S. Raffaele University, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Chiara Oltolini
- Clinic of Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Valeria Calbi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Francesca Tucci
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Vera Gallo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giulia Consiglieri
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Francesca Ferrua
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Salvatore Recupero
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Maria Celia Cervi
- Pediatric Infectious Diseases Division, Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo 05508-000, Brazil
| | - Hamoud Al-Mousa
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia
| | | | - Chiara Tassan Din
- Clinic of Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Paolo Scarpellini
- Clinic of Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Paolo Silvani
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Claudia Fossati
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Miriam Casiraghi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Antonella Castagna
- Faculty of Medicine and Surgery, Vita-Salute S. Raffaele University, 20132 Milan, Italy
- Clinic of Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Maria Ester Bernardo
- Faculty of Medicine and Surgery, Vita-Salute S. Raffaele University, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandro Aiuti
- Faculty of Medicine and Surgery, Vita-Salute S. Raffaele University, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Maria Pia Cicalese
- Faculty of Medicine and Surgery, Vita-Salute S. Raffaele University, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Galiyeva A, Daribay A, Zhumagaliyeva T, Zhaparova L, Sadyrbekov D, Tazhbayev Y. Human Serum Albumin Nanoparticles: Synthesis, Optimization and Immobilization with Antituberculosis Drugs. Polymers (Basel) 2023; 15:2774. [PMID: 37447420 PMCID: PMC10347201 DOI: 10.3390/polym15132774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
The aim of this study was to create nanoparticles of human serum albumin immobilized with anti-TB drugs (rifampicin, isoniazid) using the desolvation method. Central Composite Design (CCD) was applied to study the effect of albumin, urea, L-cysteine, rifampicin and isoniazid concentration on particle size, polydispersity and loading degree of the drugs. The optimized nanoparticles were spherical in shape with an average particle size of 216.7 ± 3.7 nm and polydispersity of 0.286 ± 4.9. The loading degree of rifampicin and isoniazid in the optimized nanoparticles were 44% and 27%, respectively. The obtained nanoparticles were examined by Fourier-transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC); the results showed the absence of drug-polymer interactions. The drug release from the polymer matrix was studied using dialysis membranes.
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Affiliation(s)
- Aldana Galiyeva
- Institute of Chemical Problems, Karagandy University of the Name of Academician E.A. Buketov, Karaganda City 100028, Kazakhstan; (A.D.); (T.Z.); (L.Z.); (D.S.)
| | | | | | | | | | - Yerkeblan Tazhbayev
- Institute of Chemical Problems, Karagandy University of the Name of Academician E.A. Buketov, Karaganda City 100028, Kazakhstan; (A.D.); (T.Z.); (L.Z.); (D.S.)
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Eady M, Caison J, Jinnah M, Jenkins D. A Rapid Qualitative Screening Method for Isoniazid Tablets Using Handheld NIR Spectrometers in Two Countries. Molecules 2023; 28:4758. [PMID: 37375311 DOI: 10.3390/molecules28124758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Isoniazid is a leading tuberculosis treating medication. Global supply chains provide essential medicines such as isoniazid to resource-limited areas. Ensuring the safety and efficaciousness of these medicines is essential to public health programs. Handheld spectrometers are becoming increasingly approachable in cost and usability. As supply chains expand, quality compliance screening of essential medications is necessary in site-specific locations. Here, a brand-specific qualitative discrimination analysis of isoniazid is approached by collecting data from two handheld spectrometers in two countries with the intent to build a multi-location quality compliance screening method for a brand of isoniazid. METHODS Two handheld spectrometers (900-1700 nm) were used to collect spectra from five manufacturing sources (N = 482) in Durham, North Carolina, USA, and Centurion, South Africa. A qualitative brand differentiation method was established from both locations by applying a Mahalanobis distance thresholding method as a measure of assessing similarity. RESULTS Combining data from both locations resulted in a 100% classification accuracy, at both locations, for brand 'A' and resulted in the four other brands classifying as dissimilar. Bias was found between sensors in terms of resulting Mahalanobis distances, but the classification method proved to be robust enough to accommodate. Several spectral peaks found in isoniazid references appear within the 900-1700 nm range, as well as variation in the excipients per manufacturer. CONCLUSIONS Results show promise for compliance screening isoniazid as well as other tablets in multiple geographic locations using handheld spectrometers.
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Affiliation(s)
- Matthew Eady
- FHI 360-Product Quality Compliance Department, Durham, NC 27713, USA
| | - Jonelle Caison
- FHI 360-Product Quality Compliance Department, Durham, NC 27713, USA
- Department of Pharmaceutical Sciences, Campbell University, Buies Creek, NC 27506, USA
| | - Mohammed Jinnah
- FHI 360-Product Quality Compliance Department, Centurion 0157, South Africa
| | - David Jenkins
- FHI 360-Product Quality Compliance Department, Durham, NC 27713, USA
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Beraldi-Magalhaes F, Parker SL, Sanches C, Garcia LS, Souza Carvalho BK, Costa AA, Fachi MM, de Liz MV, de Souza AB, Safe IP, Pontarolo R, Wallis S, Lipman J, Roberts JA, Cordeiro-Santos M. Is the Pharmacokinetics of First-Line Anti-TB Drugs a Cause of High Mortality Rates in TB Patients Admitted to the ICU? A Non-Compartmental Pharmacokinetic Analysis. Trop Med Infect Dis 2023; 8:312. [PMID: 37368730 DOI: 10.3390/tropicalmed8060312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Patients with tuberculosis (TB) may develop multi-organ failure and require admission to intensive care. In these cases, the mortality rates are as high as 78% and may be caused by suboptimal serum concentrations of first-line TB drugs. This study aims to compare the pharmacokinetics of oral rifampin, isoniazid, pyrazinamide and ethambutol patients in intensive care units (ICU) to outpatients and to evaluate drug serum concentrations as a potential cause of mortality. METHODS A prospective pharmacokinetic (PK) study was performed in Amazonas State, Brazil. The primary PK parameters of outpatients who achieved clinical and microbiological cure were used as a comparative target in a non-compartmental analysis. RESULTS Thirteen ICU and twenty outpatients were recruited. The clearance and volume of distribution were lower for rifampin, isoniazid, pyrazinamide and ethambutol. ICU thirty-day mortality was 77% versus a cure rate of 89% in outpatients. CONCLUSIONS ICU patients had a lower clearance and volume of distribution for rifampin, isoniazid, pyrazinamide and ethambutol compared to the outpatient group. These may reflect changes to organ function, impeded absorption and distribution to the site of infection in ICU patients and have the potential to impact clinical outcomes.
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Affiliation(s)
- Francisco Beraldi-Magalhaes
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Secretaria de Estado da Saúde do Paraná, Curitiba 80010-130, Brazil
- School of Medicine, Faculdades Pequeno Príncipe, Curitiba 80230-020, Brazil
| | - Suzanne L Parker
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Cristina Sanches
- Department of Pharmacy, Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Divinopolis 35501-296, Brazil
| | - Leandro Sousa Garcia
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Brenda Karoline Souza Carvalho
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Amanda Araujo Costa
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Mariana Millan Fachi
- Department of Pharmacy, Campus Jardim Botânico, Universidade Federal do Paraná, Curitiba 80210-170, Brazil
| | - Marcus Vinicius de Liz
- Department of Chemistry & Biology, Campus Curitiba, Universidade Tecnológica Federal do Paraná, Curitiba 81280-340, Brazil
| | - Alexandra Brito de Souza
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Izabella Picinin Safe
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Roberto Pontarolo
- Department of Pharmacy, Campus Jardim Botânico, Universidade Federal do Paraná, Curitiba 80210-170, Brazil
| | - Steven Wallis
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Jeffrey Lipman
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30900 Nimes, France
| | - Jason A Roberts
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30900 Nimes, France
- Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
| | - Marcelo Cordeiro-Santos
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus 69040-000, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil
- School of Medicine, Universidade Nilton Lins, Manaus 69058-040, Brazil
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Yong GKW, Hoe RHM, Choong CV. A Case of Isoniazid-Induced Cerebellar Syndrome. Mov Disord Clin Pract 2023; 10:1027-1028. [PMID: 37332643 PMCID: PMC10272889 DOI: 10.1002/mdc3.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/03/2023] [Accepted: 04/19/2023] [Indexed: 06/20/2023] Open
Affiliation(s)
| | - Rebecca Hui Min Hoe
- Department of NeurologyNational Neuroscience Institute (Tan Tock Seng Hospital)Singapore
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Abstract
Tuberculosis (TB) remains a major global health burden. Antitubercular drugs (ATDs) such as isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and ethambutol are used as first-line therapy in TB patients. Drug-induced liver injury is one of the common side effects that leads to the discontinuation of ATDs in TB patients. Therefore, this review discusses the molecular pathogenesis of ATDs induced liver injury. The biotransformation of INH, RIF, and PZA in the liver liberates several reactive intermediates, leading to peroxidation of the hepatocellular membrane and oxidative stress. INH + RIF administration decreased the expression of bile acid transporters such as the bile salt export pump and multidrug resistance-associated protein 2 and induced liver injury by sirtuin 1 and farnesoid X receptor pathway. INH inhibits the nuclear translocation of Nrf2 by interfering with its nuclear importer, karyopherin β1, thereby inducing apoptosis. INF + RIF treatments alter Bcl-2 and Bax homeostasis, mitochondrial membrane potential, and cytochrome c release, thereby triggering apoptosis. RIF administration enhances the expression of genes involved in fatty acid synthesis and hepatocyte fatty acid uptake (CD36). RIF induces the expression of peroxisome proliferator-activated receptor -γ and its downstream proteins and perilipin-2 by activating the pregnane X receptor in the liver to increase fatty infiltration into the liver. ATDs administration induces oxidative stress, inflammation, apoptosis, cholestasis, and lipid accumulation in the liver. However, ATDs toxic potentials are not elaborately studied at the molecular level in clinical samples. Therefore, future studies are warranted to explore ATDs induced liver injuries at the molecular level in clinical samples whenever possible.
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Affiliation(s)
- Devaraj Ezhilarasan
- Department of Pharmacology, Molecular Medicine and Toxicology Lab, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Cao B, Mijiti X, Deng LL, Wang Q, Yu JJ, Anwaierjiang A, Qian C, Li M, Fang DA, Jiang Y, Zhao LL, Zhao X, Wan K, Liu H, Li G, Yuan X. Genetic Characterization Conferred Co-Resistance to Isoniazid and Ethionamide in Mycobacterium tuberculosis Isolates from Southern Xinjiang, China. Infect Drug Resist 2023; 16:3117-3135. [PMID: 37228658 PMCID: PMC10204763 DOI: 10.2147/idr.s407525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
Background Ethionamide (ETH), a structural analogue of isoniazid (INH), is used for treating multidrug-resistant tuberculosis (MDR-TB). Due to the common target InhA, INH and ETH showed cross-resistance in M. tuberculosis. This study aimed to explore the INH and ETH resistant profiles and genetic mutations conferring independent INH- or ETH-resistance and INH-ETH cross-resistance in M. tuberculosis circulating in south of Xinjiang, China. Methods From Sep 2017 to Dec 2018, 312 isolates were included using drug susceptibility testing (DST), spoligotyping, and whole genome sequencing (WGS) to analyze the resistance characteristics for INH and/or ETH. Results Among the 312 isolates, 185 (58.3%) and 127 (40.7%) belonged to the Beijing family and non-Beijing family, respectively; 90 (28.9%) were INH-resistant (INHR) with mutation rates of 74.4% in katG, 13.3% in inhA and its promoter, 11.1% in ahpC and its upstream region, 2.2% in ndh, 0.0% in mshA, whilst 34 (10.9%) were ETH-resistant (ETHR) with mutation rates of 38.2% in ethA, 26.2% in inhA and its promoter, and 5.9% in ndh, 0.0% in ethR or mshA; and 25 (8.0%) were INH-ETH co-resistant (INHRETHR) with mutation rates of 40.0% in inhA and its promoter, and 8% in ndh. katG mutants tended to display high-level resistant to INH; and more inhA and its promoter mutants showed low-level of INH and ETH resistance. The optimal gene combinations by WGS for the prediction of INHR, ETHR, and INHRETHR were, respectively, katG+inhA and its promoter (sensitivity: 81.11%, specificity: 90.54%), ethA+inhA and its promoter+ndh (sensitivity: 61.76%, specificity: 76.62%), and inhA and its promoter+ndh (sensitivity: 48.00%, specificity: 97.65%). Conclusion This study revealed the high diversity of genetic mutations conferring INH and/or ETH resistance among M. tuberculosis isolates, which would facilitate the study on INHR and/or ETHR mechanisms and provide clues for choosing ETH for MDR treatment and molecular DST methods in south of Xinjiang, China.
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Affiliation(s)
- Bin Cao
- School of Public Health, University of South China, Hengyang, 421001, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Xiaokaiti Mijiti
- The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, People’s Republic of China
| | - Le-Le Deng
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Quan Wang
- The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, People’s Republic of China
| | - Jin-Jie Yu
- School of Public Health, University of South China, Hengyang, 421001, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | | | - Chengyu Qian
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, People’s Republic of China
| | - Machao Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Dan-Ang Fang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, China, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, People’s Republic of China
| | - Yi Jiang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Li-Li Zhao
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Xiuqin Zhao
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Kanglin Wan
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Haican Liu
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Guilian Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People’s Republic of China
| | - Xiuqin Yuan
- School of Public Health, University of South China, Hengyang, 421001, People’s Republic of China
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49
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Yimcharoen M, Saikaew S, Wattananandkul U, Phunpae P, Intorasoot S, Tayapiwatana C, Butr-Indr B. Mycobacterium tuberculosis Adaptation in Response to Isoniazid Treatment in a Multi-Stress System That Mimics the Host Environment. Antibiotics (Basel) 2023; 12:antibiotics12050852. [PMID: 37237755 DOI: 10.3390/antibiotics12050852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Isoniazid (INH) is an antibiotic that is widely used to treat tuberculosis (TB). Adaptation to environmental stress is a survival strategy for Mycobacterium tuberculosis and is associated with antibiotic resistance development. Here, mycobacterial adaptation following INH treatment was studied using a multi-stress system (MS), which mimics host-derived stress. Mtb H37Rv (drug-susceptible), mono-isoniazid resistant (INH-R), mono-rifampicin resistant (RIF-R), and multidrug-resistant (MDR) strains were cultivated in the MS with or without INH. The expression of stress-response genes (hspX, tgs1, icl1, and sigE) and lipoarabinomannan (LAM)-related genes (pimB, mptA, mptC, dprE1, dprE2, and embC), which play important roles in the host-pathogen interaction, were measured using real-time PCR. The different adaptations of the drug-resistant (DR) and drug-susceptible (DS) strains were presented in this work. icl1 and dprE1 were up-regulated in the DR strains in the MS, implying their roles as markers of virulence and potential drug targets. In the presence of INH, hspX, tgs1, and sigE were up-regulated in the INH-R and RIF-R strains, while icl1 and LAM-related genes were up-regulated in the H37Rv strain. This study demonstrates the complexity of mycobacterial adaptation through stress response regulation and LAM expression in response to INH under the MS, which could potentially be applied for TB treatment and monitoring in the future.
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Affiliation(s)
- Manita Yimcharoen
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sukanya Saikaew
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Usanee Wattananandkul
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ponrut Phunpae
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sorasak Intorasoot
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chatchai Tayapiwatana
- Division of Clinical Immunology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Bordin Butr-Indr
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
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50
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Adhikari YR, Bhattarai M, Baral B, Jha S, Subedi P, Karki R, Baral A, Sharma P, Kharel A, Paudel BS. Drug reaction with eosinophilia and systemic symptoms syndrome secondary to isoniazid and ethambutol: a case report and literature review. Ann Med Surg (Lond) 2023; 85:2180-2185. [PMID: 37228920 PMCID: PMC10205389 DOI: 10.1097/ms9.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/02/2023] [Indexed: 05/27/2023] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening condition precipitated by reaction of therapeutic drugs. The prevalence of potential antitubercular therapy (ATT)-induced DRESS is 1.2%. Case presentation A 71-year-old female patient after 5 weeks of starting ATT complaints of fever, vomiting, dizziness, and generalized itchy maculopapular rash over the body. It was associated with marked eosinophilia (absolute eosinophil count 3094 cell/mm3, 36% in peripheral blood smear). Discussion Fever, rash, lymphadenopathy, and internal organ involvement with marked eosinophilia constitute the major clinical manifestations of DRESS. RegiSCAR scoring system is usually used to diagnose DRESS. Identification of the culprit drug is based on the temporal correlation of symptoms with drug exposure and rechallenge test, patch test and lymphocytic transformation tests may be valuable adjunctive tools. Treatment includes withdrawal of offending agent and use of topical or systemic corticosteroids, antihistamines, cyclosporin or JAK inhibitor with clinical judgement. Conclusion Clinicians from the tuberculosis burden region must be aware of DRESS associated with ATT and they must counsel the patient properly before prescription and manage them without delay if DRESS ensues.
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Affiliation(s)
| | | | - Bikash Baral
- Tribhuvan University, Institute of Medicine, Maharajgunj
| | - Supriya Jha
- Tribhuvan University, Institute of Medicine, Maharajgunj
| | | | - Ruchi Karki
- Kist Medical College and Teaching Hospital, Lalitpur
| | | | - Prakash Sharma
- Tribhuvan University, Institute of Medicine, Maharajgunj
| | - Arun Kharel
- Tribhuvan University, Institute of Medicine, Maharajgunj
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