Importance of Confirming Data on theIn VivoEfficacy of Novel Antibacterial Drug Regimens against Various Strains of Mycobacterium tuberculosis

Abstract

ABSTRACTIn preclinical testing of antituberculosis drugs, laboratory-adapted strains ofMycobacterium tuberculosisare usually used both forin vitroandin vivostudies. However, it is unknown whether the heterogeneity ofM. tuberculosisstocks used by various laboratories can result in different outcomes in tests of antituberculosis drug regimens in animal infection models. In head-to-head studies, we investigated whether bactericidal efficacy results in BALB/c mice infected by inhalation with the laboratory-adapted strains H37Rv and Erdman differ from each other and from those obtained with clinical tuberculosis strains. Treatment of mice consisted of dual and triple drug combinations of isoniazid (H), rifampin (R), and pyrazinamide (Z). The results showed that not all strains gave the samein vivoefficacy results for the drug combinations tested. Moreover, the ranking of HRZ and RZ efficacy results was not the same for the two H37Rv strains evaluated. The magnitude of this strain difference also varied between experiments, emphasizing the risk of drawing firm conclusions for human trials based on single animal studies. The results also confirmed that the antagonism seen within the standard HRZ regimen by some investigators appears to be anM. tuberculosisstrain-specific phenomenon. In conclusion, the specific identity ofM. tuberculosisstrain used was found to be an important variable that can change the apparent outcome ofin vivoefficacy studies in mice. We highly recommend confirmation of efficacy results in late preclinical testing against a differentM. tuberculosisstrain than the one used in the initial mouse efficacy study, thereby increasing confidence to advance potent drug regimens to clinical trials.