Enhancing renal tuberculosis treatment: lysozyme-mediated targeted drug delivery approaches

Renal tuberculosis (TB) is an extrapulmonary form of TB, and is becoming more common and challenging to treat. This is because many anti-tubercular drugs have nephrotoxicity and have poor drug penetration into renal tissues. These problems highlight the urgent need for safer, kidney-targeted treatment regimes, particularly in patients with compromised kidney function. Thus, this study investigates lysozyme, which is a low-molecular-weight protein and has natural kidney-affinity, as a potential carrier for targeted renal drug delivery. Here, a comprehensive in silico approach has been utilized to identify non-nephrotoxic anti-TB drugs and evaluate their suitability for lysozyme-mediated renal-targeted delivery. For this study, a total of 21 clinically important anti-TB drugs, including first-line, second-line, and newly developed agents, were screened for nephrotoxicity using the SA-Predictor and ProTox 3.0 tools. Of these, eight drugs were predicted to be non-nephrotoxic and were used for molecular docking studies with hen egg-white lysozyme (HEWL). The non-nephrotoxic anti-TB drugs which showed better binding with HEWL, were subjected to 100 ns molecular dynamics simulations to examine protein-drug complex stability and were assessed using RMSD, RMSF, hydrogen-bond occupancy, and radius of gyration. Our study showed that ethambutol, pretomanid, and terizidone demonstrated the most stable interactions with HEWL. This work establishes a systematic computational pipeline that integrates nephrotoxicity profiling, molecular docking, and MD simulations to identify safe anti-TB drugs suitable for renal-targeted delivery. Additionally, in vitro and in vivo validation will be essential for advancing these findings toward clinical application.

The online version contains supplementary material available at 10.1007/s40203-026-00691-8.