Strategies for potentiation of ethionamide and folate antagonists against Mycobacterium tuberculosis

Expert Rev Anti Infect Ther. 2012 Sep;10(9):971-81. doi: 10.1586/eri.12.87.

Abstract

Antifolates inhibit de novo folate biosynthesis, whereas ethionamide targets the mycolate synthetic pathway in Mycobacterium tuberculosis. These antibiotics are effective against M. tuberculosis but their use has been hampered by concerns over toxicity and low therapeutic indexes. With the increasing spread of drug-resistant forms, interest in using old drugs for tuberculosis treatment has been renewed. Specific inhibitors targeting resistance mechanisms could sensitize M. tuberculosis to these available, clinically approved drugs. This review discusses recently developed strategies to boost the antituberculous activity of ethionamide and antifolates. These approaches might help broaden the currently limited chemotherapeutic options of not only drug-resistant but also drug-susceptible tuberculosis, which still remains one of the most common infectious diseases in the developing world.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Drug Design
  • Drug Resistance, Bacterial / drug effects
  • Drug Resistance, Bacterial / genetics
  • Drug Synergism
  • Drug Therapy, Combination / methods
  • Drug Therapy, Combination / trends
  • Ethionamide / chemistry
  • Ethionamide / pharmacology*
  • Ethionamide / therapeutic use
  • Folic Acid Antagonists / chemistry
  • Folic Acid Antagonists / pharmacology*
  • Folic Acid Antagonists / therapeutic use
  • Humans
  • Mycobacterium tuberculosis / drug effects*
  • Mycobacterium tuberculosis / genetics
  • Sulfonamides / chemistry
  • Sulfonamides / pharmacology*
  • Sulfonamides / therapeutic use
  • Tuberculosis, Multidrug-Resistant / drug therapy

Substances

  • Folic Acid Antagonists
  • Sulfonamides
  • Ethionamide