Targeting InhA in drug-resistant Mycobacterium tuberculosis: potent antimycobacterial activity of diaryl ether...

Tuberculosis (TB) remains a major global threat, with 10 million new cases and 1.5 million deaths each year. In multidrug-resistant tuberculosis (MDR-TB), resistance is most commonly observed against isoniazid (INH) and rifampicin (RIF), the two frontline drugs. Isoniazid resistance is predominantly linked to mutations in the InhA gene, which encodes an enzyme involved in mycolic acid synthesis, a vital component of the mycobacterial cell wall. Mutations in InhA reduce drug binding, rendering INH ineffective. These morbidity and mortality figures, along with the fact that the rise and global spread of drug-resistant TB, underscores the need for the discovery of novel therapeutics. In this direction, we have previously synthesized, characterized, and screened a library of diaryl ether dehydrozingerone derivatives against mycobacteria and identified two best hits, 7 and 14, based on bacteriostatic activities. The present study aimed to thoroughly investigate the antituberculosis potential of these compounds, particularly regarding drug-resistant TB. Our findings revealed that both compounds exhibited tuberculocidal activity against the standard laboratory strain Mycobacterium tuberculosis (M. tb) H37Rv, with minimal bactericidal concentrations (MBC) of 4μg/ml for compound 7 and 8 μg/ml for compound 14. Next, concentration vs time-kill kinetics of both these compounds showed concentration-dependent bactericidal activities against M. tb and complete pathogen eradication from culture at just 16× MIC. Both compounds were found to be suitable for combination regimens as their interactions with isoniazid and rifampicin against M. tb were observed to be synergistic. Additionally, 7 and 14 exhibited minimal hemolysis against human RBCs and less cytotoxicity was observed against three human cell lines up to 1000 μM. Molecular docking revealed that these compounds bind more effectively to M. tb InhA, including its mutant forms where isoniazid binding is impaired, outperforming both isoniazid and triclosan in binding affinity. Importantly 7 and 14 showed potent activity against drug-susceptible clinical isolates and two isoniazid-resistant M. tb clinical isolates equivalent to that against M. tb H37Rv. The most interesting observation was that both compounds were found to be effective against three multi-drug resistant (MDR) strains of M. tb, thereby depicting their potential against drug-resistant TB. An ex vivo assay on RAW 264 cells infected with M. tb demonstrated a significant reduction in bacterial load at 8× MIC, revealing the fact that these compounds are highly effective against intracellular M. tb H37Rv. To the best of our knowledge, this is the first study that reports promising antimycobacterial potential of 7 and 14 against drug-susceptible, isoniazid-resistant, and MDR tuberculosis which warrants further exploration considering the need for new anti-TB medicine.