结核病新抗生素靶标和抑制剂研发

随着结核病耐药现象越来越严重,迫切需要开发新型抗结核药物,而大部分的药物开发主要依赖于新型的抗生素靶标的发现。文中综述了2016年以来新出现的具有开发为抗结核药物潜力的新化合物,并重点阐述了这些新化合物所针对的抗生素靶标,将有助于针对这些靶标进一步开发新型抗结核药物。     

扩增子测序法筛选结核分枝杆菌的耐药突变

结核病是严重的公共健康问题之一,而耐药结核病的增加是控制结核病流行的难点之一。快速、准确的诊断是提高结核患者治愈率和降低死亡率的关键因素。本研究建立了基于二代测序技术的扩增子测序方法,对5种一线抗结核药物的17个耐药基因进行检测。在26个临床耐药结核菌株中共鉴定出65个突变,包括33个热点突变,9个稀有突变和23个新突变。对18个新发现的错义突变进行了蛋白质序列保守性和蛋白质局部结构的分析。结果表明,14个新的错义突变在9种分枝杆菌中显示出高度保守性,并且导致了该蛋白质局部结构的改变。根据本研究检测和分析结果,推测这些新发现的突变可能是潜在的耐药突变。在本研究中,构建了扩增子测序的检测方法,可同时检测10株临床结核菌株的17个耐药基因,是一种快速、准确并且全面的检测耐药结核分枝杆菌一线治疗药物耐药突变的方法,该方法不仅能检测热点突变和稀有突变,还能发现一些未报道过的新突变。该检测方法或可用于临床诊断和基础研究。     

结核分枝杆菌乙胺丁醇耐药机制的研究进展

耐多药结核病的出现和流行对结核病的防控造成了严重威胁。乙胺丁醇(Ethambutol, EMB)是一线抗结核药物,常与异烟肼、利福平等联合应用,还可用于耐药结核病的治疗。但近年来EMB耐药形势严峻,我国复治结核病患者中EMB耐药率已达17.2%,并呈上升趋势;耐多药结核病患者中,EMB耐药率约为51.3%~66.7%,情况不容乐观。明确EMB耐药的产生机制对于有效防控EMB耐药率的上升、充分发挥EMB的作用十分重要,因此本文对结核分枝杆菌EMB的耐药现状、EMB的作用机制及其耐药产生机制方面的研究进展进行了综述。     

分枝杆菌枝菌酸合成及其调控

结核病是危害人类健康的重要传染病,每年200多万人死于结核病。耐(多)药菌株的出现、与HIV共感染以及人口老龄化等原因与全球结核病的卷土重来密切相关。枝菌酸是存在于结核分枝杆菌、其他分枝杆菌和许多放线菌的细胞壁中的关键组分,与结核分枝杆菌的致病、毒力和免疫逃避都有关系。枝菌酸在抗结核研究中有着极其重要的地位。结核分枝杆菌枝菌酸的生物合成途径一直是很重要的抗结核药物靶标,异烟肼、乙胺丁醇等抗结核药物都是以此为靶标。深入研究枝菌酸的合成、调控有助于发现更多的药物靶标,为开发结核病控制新措施提供基础。本文综述了结核分枝杆菌枝菌酸的结构与分类、生物合成途径及其调控、作为抗结核药物靶标的前景与应用,以期对枝菌酸有更深入的了解并为新型抗结核药物靶标的发现提供基础。     

耐药结核病及其防治

目前结核病呈现出高发病、高感染、高耐药、高死亡的特点。耐药结核病则是结核病防治工作的重点和难点。为有效控制其发展,本文分析了其产生和流行的医源性和社会性原因,并从7个方面阐述了耐药结核病的防治措施。即广泛普及结核病防治的知识;加强对流动人口的管理和监测;提高对耐药结核病的诊治水平;开展中西医结合和其他辅助治疗;预防社区和医院感染;完善结核病的耐药监测;积极开展抗结核新药、新手段和新方法的研究。     

Multidrug resistant to extensively drug resistant tuberculosis: What is next?

Drug resistant tuberculosis is a man made problem. While tuberculosis is hundred percent curable, multidrug resistant tuberculosis (MDR-TB) is difficult to treat. Inadequate and incomplete treatment and poor treatment adherence has led to a newer form of drug resistance known as extensively drug resistant tuberculosis (XDR-TB). XDR-TB is defined as tuberculosis caused by Mycobacterium tuberculosis strain, which is resistant to at least rifampicin and isoniazid among the first line anti tubercular drugs (MDR-TB) in addition to resistance to any fluroquinolones and at least one of three injectable second line anti tubercular drugs i.e. amikacin, kanamycin and/or capreomycin. Mismanagement of tuberculosis paves the way to drug resistant tuberculosis. Emergence of XDR-TB is reported world wide. Reported prevalence rates of XDR-TB of total MDR cases are; 6.6% overall worldwide, 6.5% in industrialized countries, 13.6% in Russia and Eastern Europe, 1.5% in Asia, 0.6% in Africa and Middle East and 15.4% in Republic of Korea. Better management and control of tuberculosis specially drug resistant TB by experienced and qualified doctors, access to standard microbiology laboratory, co-morbitidy of HIV and tuberculosis, new anti-TB drug regimens, better diagnostic tests, international standards for second line drugs (SLD)-susceptibility testing, invention of newer antitubercular molecules and vaccines and knowing the real magnitude of XDR-TB are some of the important issues to be addressed for effective prevention and management of XDR-TB.     

MTB新疆临床分离株MDR-TB和XDR-TB耐药情况初步调查

目的:分析新疆喀什地区结核分枝杆菌(MTB)临床分离株对4种一线和7种二线抗结核药物的耐药情况,初步探讨本地区耐多药结核病(MDR-TB)和广泛耐药结核病(XDR-TB)的流行情况。方法:收集2008.11.1~2009.10.31日期间新疆喀什地区结核病患者痰液标本,进行分离培养及菌种鉴定,并应用比例法对所分离得到的菌株进行耐药性检测。结果:102株分枝杆菌中,88株(86.3%)属于结核分枝杆菌复合群,7株(6.9%)属于牛型分枝杆菌,7株(6.9%)属于非结核分枝杆菌。对一种以上的抗结核药物具有耐药性的有20株,总耐药率为22.7%(20/88),耐多药率为6.8%(6/88),pre-XDR为33.3%(2/6),无XDR-TB病例。结论:新疆喀什地区结核病患者耐药率较高,在结核病治疗工作中应给予重视,尤其应加强对Pre-XDR的重视,以免发展成XDR-TB。     

Drug resistance in tuberculosis--a reinfection model

There is increasing recognition that reinfection is an important component of TB transmission. Moreover, it has been shown that partial immunity has significant epidemiological consequences, particularly in what concerns disease prevalence and effectiveness of control measures. We address the problem of drug resistance as a competition between two types of strains of Mycobacterium tuberculosis: those that are sensitive to anti-tuberculosis drugs and those that are resistant. Our objective is to characterise the role of reinfection in the transmission of drug-resistant tuberculosis. The long-term behaviour of our model reflects how reinfection modifies the conditions for coexistence of sensitive and resistant strains. This sets the scene for discussing how strain prevalence is affected by different control strategies. It is shown that intervention effectiveness is highly sensitive to the baseline epidemiological setting.     

抗结核药物及其耐药相关突变位点的研究进展

结核病是结核分枝杆菌复合物引起的传染性疾病,致死率、致残率高,在全球传染病中居第2位。近年来耐药结核病所占比例逐年升高,成为消灭结核病面临的巨大挑战之一。传统的耐药诊断方法基于培养,费时费力,所需技术要求高;而现有分子检测方法仅能检测少量抗结核药物的少数耐药基因。因此,更好地理解抗结核药物的耐药机制有助于全面耐药诊断。本文对临床中使用频率较高的11类一线和二线抗结核药物及其相应耐药相关基因、突变位点的研究进展进行总结,尤其是对环丝氨酸、利奈唑胺、氯法齐明等二线药物的近期研究做了系统描述,为全面耐药诊断、精准治疗指导、新药研发及耐药机制深入研究提供了前期工作基础。     

Nanoparticle delivery of anti-tuberculosis chemotherapy as a potential mediator against drug-resistant tuberculosis

Drug-resistant tuberculosis is quickly emerging as one of the largest threats to the global health community. Current chemotherapy for tuberculosis dates back to the 1950s and is arduous, lengthy, and remains extremely difficult to complete in many of the highest burdened areas. This causes inadequate or incomplete treatment, resulting in genetic selection of drug-resistant strains. With a dearth of novel anti-TB drug candidates in the development pipeline, nanoparticle technology allows us to take current chemotherapies and deliver them more efficaciously, reducing the frequency and duration of treatment and increasing bioavailability. This approach can improve patient adherence, reduce pill burden, and shorten time to completion, all which are at the heart of drug resistance. This review examines the multiple advantages of nanoparticle drug delivery of tuberculosis chemotherapy and summarizes the challenges in implementation.     

The structure of 3-deoxy-d-arabino-heptulosonate 7-phosphate synthase from Mycobacterium tuberculosis reveals a common catalytic scaffold and ancestry for type I and type II enzymes

The shikimate pathway, responsible for the biosynthesis of aromatic compounds, is essential for the growth of Mycobacterium tuberculosis and is a potential target for the design of new anti-tuberculosis drugs. The first step of this pathway is catalyzed by 3-deoxy-d-arabino-heptulosonate 7-phosphate synthase (DAH7PS). The DAH7PSs have been classified into two apparently unrelated types and, whereas structural data have been obtained for the type I DAH7PSs, no structural information is available for their type II counterparts. The type II DAH7PS from M.tuberculosis has been expressed in Escherichia coli, purified, functionally characterized and crystallized. It is found to be metal ion-dependent and subject to feedback inhibition by phenylalanine, tryptophan, tyrosine and chorismate, with a significant synergistic effect when tryptophan is used in combination with phenylalanine. The crystal structure of M.tuberculosis DAH7PS has been determined by single-wavelength anomalous diffraction and refined at 2.3A in complex with substrate phosphoenolpyruvate and Mn(2+). The structure reveals a tightly associated dimer of (beta/alpha)(8) TIM barrels. The monomer fold, the arrangement of key residues in the active site, and the binding modes of PEP and Mn(2+), all match those of the type I enzymes, and indicate a common ancestry for the type I and type II DAH7PSs, despite their minimal sequence identity. In contrast, the structural elements that decorate the core (beta/alpha)(8) fold differ from those in the type I enzymes, consistent with their different regulatory and oligomeric properties.     

Extensively drug-resistant tuberculosis: current challenges and threats

Extensively drug-resistant tuberculosis (XDR-TB) is defined as tuberculosis caused by a Mycobacterium tuberculosis strain that is resistant to at least rifampicin and isoniazid among the first-line antitubercular drugs (multidrug-resistant tuberculosis; MDR-TB) in addition to resistance to any fluroquinolones and at least one of three injectable second-line drugs, namely amikacin, kanamycin and/or capreomycin. Recent studies have described XDR-TB strains from all continents. Worldwide prevalence of XDR-TB is estimated to be c. 6.6% in all the studied countries among multidrug-resistant M. tuberculosis strains. The emergence of XDR-TB strains is a reflection of poor tuberculosis management, and controlling its emergence constitutes an urgent global health reality and a challenge to tuberculosis control activities in all parts of the world, especially in developing countries and those lacking resources and as well as in countries with increasing prevalence of HIV/AIDS.     

猫爪草提取物对结核分枝杆菌临床分离株的可能作用靶标

利用双向电泳技术, 对猫爪草提取物作用前后的结核分枝杆菌临床分离株的全细胞蛋白表达图谱进行差异比较和分析, 发现其中22个蛋白质斑点的浓度具有差异,利用基质辅助激光解吸/电离飞行时间质谱技术, 对其中4个表达明显下调和1个明显上调的蛋白质斑点进行分析鉴定, 获得5个明确的肽质量指纹图谱.通过数据库检索, 确定这5个蛋白质分别为S-腺苷甲硫氨酸合成酶、吲哚-3-甘油磷酸合酶、烯酰-CoA水合酶、琥珀酰辅酶A合成酶和60 kD的分子伴侣2.其中前4个分子是首次报道参与结核分枝杆菌的重要生理活动.该结果有助于了解猫爪草提取物对结核分枝杆菌生理的影响, 为进一步确定中药猫爪草提取物对结核分枝杆菌的作用靶标和机理提供了基础.     

Investigating the role of the hydroxyl groups of substrate erythrose 4-phosphate in the reaction catalysed by the first enzyme of the shikimate pathway

3-Deoxy-D-arabino-heptulosonate 7-phosphate (DAH7P) synthase catalyses the first step of the shikimate pathway, which is responsible for the biosynthesis of aromatic amino acids in microorganisms and plants. This enzyme catalyses an aldol reaction between phosphoenolpyruvate and D-erythrose 4-phosphate to generate DAH7P. Both 2-deoxyerythrose 4-phosphate and 3-deoxyerythrose 4-phosphate were synthesised and tested as alternative substrates for the enzyme. Both compounds were found to be substrates for the DAH7P synthases from Escherichia coli, Pyrococcus furiosus and Mycobacterium tuberculosis, consistent with an acyclic mechanism for the enzyme for which neither C2 nor C3 hydroxyl groups are required for catalysis. The enzymes all showed greater tolerance for the loss of the C2 hydroxyl group than the C3 hydroxyl group.     

Estimates of tuberculosis progression rate of children in China

In this paper, a discrete mathematical model is formulated to describe tuberculosis (TB) progression from latent infection to active disease. The data of national TB epidemiology surveys in China are taken to estimate the TB progression rate for children aged 0–14 years. The progression rate obtained in this paper gives a detailed and better estimate of TB progression rate among children.     

结核免疫应答相关白细胞介素的作用机制研究进展

白细胞介素(简称白介素)能够调控免疫细胞的分化、增殖及效应功能。结核抗原特异性诱导的白介素的表达水平能够表征结核杆菌感染后的机体状态。在机体的抗结核免疫应答中,白介素可以直接调控吞噬细胞对胞内感染结核杆菌的杀菌活性;也能够调控效应性T细胞的增殖,并进一步激活吞噬细胞的杀菌功能。目前,部分白介素已被证明有望用于结核病的免疫辅助治疗,正在进行相关临床实验。本文对白介素调控免疫细胞抗结核免疫应答的研究进展进行综述,以期为制定结核病的白介素免疫辅助治疗方案提供指导。     

Improved understanding of pathogenesis from protein interactions in Mycobacterium tuberculosis

Comprehensive mapping and analysis of protein–protein interactions provide not only systematic approaches for dissecting the infection and survival mechanisms of pathogens but also clues for discovering new antibacterial drug targets. Protein interaction data on Mycobacterium tuberculosis have rapidly accumulated over the past several years. This review summarizes the current progress of protein interaction studies on M. tuberculosis, the causative agent of tuberculosis. These efforts improve our knowledge on the stress response, signaling regulation, protein secretion and drug resistance of the bacteria. M. tuberculosis–host protein interaction studies, although still limited, have recently opened a new door for investigating the pathogenesis of the bacteria. Finally, this review discusses the importance of protein interaction data on identifying and screening new anti-tuberculosis targets and drugs, respectively.     

抗结核活性化合物HY-152E的作用靶点分析

抗结核活性化合物HY-152E是本实验室前期获得的具有良好抗结核活性并拥有授权专利（ZL201210088290.0）的小分子化合物（最低抑菌浓度≤0.09 μg/mL）。为深入探索HY-152E的抗结核机制,本研究利用药物亲和反应靶标稳定性（drug affinity responsive target stability,DARTS）技术并结合蛋白质谱技术,分析可能与HY-152E相互作用的结核分枝杆菌潜在靶标蛋白。将结核分枝杆菌H37Ra的菌体蛋白裂解液与HY-152E共同孵育互作,用不同浓度的链霉菌蛋白酶消化30、45、60 min后,十二烷基硫酸钠-聚丙烯酰胺凝胶电泳（sodium dodecyl sulfate-polyacrylamide gel electrophoresis,SDS-PAGE）分离并比较与HY-152E互作前后菌体蛋白耐受蛋白酶消化的差异条带,分别在相对分子质量70 000和45 000~55 000处观察到差异蛋白条带。利用蛋白质谱技术分析差异条带的蛋白信息,共获得86个蛋白信息。结合结核分枝杆菌数据库及蛋白功能信息,最终筛选到9个蛋白可能是HY-152E的抗结核作用潜在靶标。这些潜在靶点的确定,为后续研究HY-152E的抗结核分子机制奠定了基础。     

Database Searching for Thymidine and Thymidylate Kinase Inhibitors Using Three-dimensional Structure-based Methods

Structure-based drug design methods were used to search for novel inhibitors of herpes simplex virus type 1 (HSV-1) thymidine kinase and Mycobacterium tuberculosis thymidylate kinase. The method involved the use of crystal structure complexes to guide database searching for potential inhibitors. A number of weak inhibitors of HSV-2 were identified, one of which was found to inhibit HSV-1 TK and HSV-1 TK-deficient viral strains. Each compound tested against M. tuberculosis thymidylate kinase was found to have some activity. The best of these compounds was only 4.6-fold less potent than 3′-azido-3′-deoxythymidine-5′-monophosphate (AZTMP). This study demonstrates the utility of structure-based drug design methods in the search for novel enzyme inhibitors.     

CD14 gene promoter polymorphism in different clinical forms of tuberculosis

Mycobacterium tuberculosis interacts with monocyte-macrophages through cell surface molecules including CD14. A soluble form of CD14 (sCD14) exists in human serum, and higher amounts of it are found in tuberculosis. A polymorphism on CD14 gene promoter was associated with increased sCD14 levels in some diseases. To evaluate whether this polymorphism associates with tuberculosis, its clinical forms, and increased sCD14, genotype/allele frequencies in tuberculosis patients were compared with the controls. Results confirmed increased levels of sCD14 in patients with tuberculosis, and those with miliary tuberculosis had the highest levels. sCD14 decreased to normal levels after anti-tuberculosis treatment. No association was found between the CD14 polymorphism and tuberculosis or sCD14 levels. Results suggest that sCD14 may be involved in anti-tuberculosis immune response, but its increase is a consequence of infection rather than a predisposed genetic trait. Measuring sCD14 in tuberculosis may help monitor anti-tuberculosis treatment.