Conspectus
“
Drug resistance is an unavoidable consequence of
the use of drugs; however, the emergence of multi-drug resistance
can be managed by accurate diagnosis and tailor-made regimens.
”
Antimicrobial resistance (AMR), is one of the most
paramount health
perils that has emerged in the 21st century. The global increase in
drug-resistant strains of various bacterial pathogens prompted the
World Health Organization (WHO) to develop a priority list of AMR
pathogens.
Mycobacterium tuberculosis
(
Mtb
), an acid-fast bacillus that causes tuberculosis (TB), merits being
one of the highest priority pathogens on this list since drug-resistant
TB (DR-TB) accounts for ∼29% of deaths attributable to AMR.
In recent years, funded collaborative efforts of researchers from
academia, not-for-profit virtual R&D organizations and industry
have resulted in the continuous growth of the TB drug discovery and
development pipeline. This has so far led to the accelerated regulatory
approval of bedaquiline and delamanid for the treatment of DR-TB.
However, despite the availability of drug regimes, the current cure
rate for multi-drug-resistant TB (MDR-TB) and extensively drug-resistant
TB (XDR-TB) treatment regimens is 50% and 30%, respectively. It is
to be noted that these regimens are administered over a long duration
and have a serious side effect profile. Coupled with poor patient
adherence, this has led to further acquisition of drug resistance
and treatment failure. There is therefore an urgent need to develop
new TB drugs with novel mechanism of actions (MoAs) and associated
regimens.
This Account recapitulates drug resistance in TB,
existing challenges
in addressing DR-TB, new drugs and regimens in development, and potential
ways to treat DR-TB. We highlight our research aimed at identifying
novel small molecule leads and associated targets against TB toward
contributing to the global TB drug discovery and development pipeline.
Our work mainly involves screening of various small molecule chemical
libraries in phenotypic whole-cell based assays to identify hits for
medicinal chemistry optimization, with attendant deconvolution of
the MoA. We discuss the identification of small molecule chemotypes
active against
Mtb
and subsequent structure–activity
relationships (SAR) and MoA deconvolution studies. This is followed
by a discussion on a chemical series identified by whole-cell cross-screening
against
Mtb
, for which MoA deconvolution studies
revealed a pathway that explained the lack of in vivo efficacy in
a mouse model of TB and reiterated the importance of selecting an
appropriate growth medium during phenotypic screening. We also discuss
our efforts on drug repositioning toward addressing DR-TB. In the
concluding section, we preview some promising future directions and
the challenges inherent in advancing the drug pipeline to address
DR-TB.