TY - JOUR
T1 - Dynamic imaging in patients with tuberculosis reveals heterogeneous drug exposures in pulmonary lesions
AU - Ordonez, Alvaro A.
AU - Wang, Hechuan
AU - Magombedze, Gesham
AU - Ruiz-Bedoya, Camilo A.
AU - Srivastava, Shashikant
AU - Chen, Allen
AU - Tucker, Elizabeth W.
AU - Urbanowski, Michael E.
AU - Pieterse, Lisa
AU - Fabian Cardozo, E.
AU - Lodge, Martin A.
AU - Shah, Maunank R.
AU - Holt, Daniel P.
AU - Mathews, William B.
AU - Dannals, Robert F.
AU - Gobburu, Jogarao V.S.
AU - Peloquin, Charles A.
AU - Rowe, Steven P.
AU - Gumbo, Tawanda
AU - Ivaturi, Vijay D.
AU - Jain, Sanjay K.
N1 - Funding Information:
We thank all the patients who participated in the study. Additionally, we thank the Maryland Department of Health and Mental Hygiene for recruiting patients with TB; R. Abdallah, C. Voicu, J. Sanchez-Bautista, S. Frey and L. Shinehouse (Johns Hopkins Hospitals) for coordinating the human imaging studies; and M. Klunk for helping with the animal experiments. This work was funded by the US National Institutes of Health (grant R01-HL131829), Director’s Transformative Research Award (grant R01-EB020539) and R56-AI145435 to S.K.J.
Publisher Copyright:
© 2020, The Author(s), under exclusive licence to Springer Nature America, Inc.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Tuberculosis (TB) is the leading cause of death from a single infectious agent, requiring at least 6 months of multidrug treatment to achieve cure1. However, the lack of reliable data on antimicrobial pharmacokinetics (PK) at infection sites hinders efforts to optimize antimicrobial dosing and shorten TB treatments2. In this study, we applied a new tool to perform unbiased, noninvasive and multicompartment measurements of antimicrobial concentration–time profiles in humans3. Newly identified patients with rifampin-susceptible pulmonary TB were enrolled in a first-in-human study4 using dynamic [11C]rifampin (administered as a microdose) positron emission tomography (PET) and computed tomography (CT). [11C]rifampin PET–CT was safe and demonstrated spatially compartmentalized rifampin exposures in pathologically distinct TB lesions within the same patients, with low cavity wall rifampin exposures. Repeat PET–CT measurements demonstrated independent temporal evolution of rifampin exposure trajectories in different lesions within the same patients. Similar findings were recapitulated by PET–CT in experimentally infected rabbits with cavitary TB and confirmed using postmortem mass spectrometry. Integrated modeling of the PET-captured concentration–time profiles in hollow-fiber bacterial kill curve experiments provided estimates on the rifampin dosing required to achieve cure in 4 months. These data, capturing the spatial and temporal heterogeneity of intralesional drug PK, have major implications for antimicrobial drug development.
AB - Tuberculosis (TB) is the leading cause of death from a single infectious agent, requiring at least 6 months of multidrug treatment to achieve cure1. However, the lack of reliable data on antimicrobial pharmacokinetics (PK) at infection sites hinders efforts to optimize antimicrobial dosing and shorten TB treatments2. In this study, we applied a new tool to perform unbiased, noninvasive and multicompartment measurements of antimicrobial concentration–time profiles in humans3. Newly identified patients with rifampin-susceptible pulmonary TB were enrolled in a first-in-human study4 using dynamic [11C]rifampin (administered as a microdose) positron emission tomography (PET) and computed tomography (CT). [11C]rifampin PET–CT was safe and demonstrated spatially compartmentalized rifampin exposures in pathologically distinct TB lesions within the same patients, with low cavity wall rifampin exposures. Repeat PET–CT measurements demonstrated independent temporal evolution of rifampin exposure trajectories in different lesions within the same patients. Similar findings were recapitulated by PET–CT in experimentally infected rabbits with cavitary TB and confirmed using postmortem mass spectrometry. Integrated modeling of the PET-captured concentration–time profiles in hollow-fiber bacterial kill curve experiments provided estimates on the rifampin dosing required to achieve cure in 4 months. These data, capturing the spatial and temporal heterogeneity of intralesional drug PK, have major implications for antimicrobial drug development.
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U2 - 10.1038/s41591-020-0770-2
DO - 10.1038/s41591-020-0770-2
M3 - Article
C2 - 32066976
AN - SCOPUS:85079804690
SN - 1078-8956
VL - 26
SP - 529
EP - 534
JO - Nature medicine
JF - Nature medicine
IS - 4
ER -