An In Vitro Caseum Binding Assay that Predicts Drug Penetration in Tuberculosis Lesions

Summary

Here we describe a rapid equilibrium dialysis (RED) method to measure drug binding to caseum from pulmonary tuberculosis lesions and cavities. The protocol is also used with a foamy macrophage-derived matrix that is an effective surrogate to caseum.

Abstract

The eradication of tuberculosis disease requires drug regimens that can penetrate the multiple layers of complex pulmonary lesions. Drug distribution in the caseous cores of cavities and lesions is especially crucial because they harbor subpopulations of drug-tolerant bacteria also commonly referred to as persisters. Existing methods for the measurement of drug penetration in tuberculosis lesions involve costly and time-consuming in vivo pharmacokinetic studies coupled to bioanalytical or imaging techniques. The in vitro measurement of drug binding to caseum macromolecules was proposed as an alternative to such techniques since this binding hinders the passive diffusion of drug molecules through caseum. Rapid equilibrium dialysis is a fast and reliable system for performing plasma protein and tissue binding studies. In this protocol, we used a rapid equilibrium dialysis (RED) device to measure drug binding to homogenates of caseum that is excised from the lesions and cavities of tuberculosis-infected rabbits. The protocol also describes how to generate a surrogate matrix from lipid loaded THP-1 macrophages to use in place of caseum. This caseum/surrogate binding assay is an important tool in tuberculosis drug discovery and can be adapted to help study drug distribution in lesions or abscesses caused by other diseases.

Introduction

The treatment of pulmonary tuberculosis disease requires effective distribution of drugs into different types of lesions. Necrotic lesions and cavities contain caseous centers that harbor subpopulations of drug-tolerant or 'persistent' bacteria.^1,2 The cavitary disease is associated with inferior cure rates and poor prognosis.^3,4 Previous studies have shown, using quantitative and imaging techniques, that the ability to penetrate caseum varies significantly from one drug class to another.^5,6<....

Protocol

All animal studies were carried out in accordance with the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health with approval from the Institutional Animal Care and Use Committee of the NIAID (NIH), Bethesda, MD. All studies involving M. tuberculosis were performed in a laboratory with biosafety containment level 3 (BSL-3).

1. Rabbit Infection Model and Caseum Collection

1. Infect New Zealand white rabbits with M. tuberculosis using a nose-only aerosol exposure system as previously described.^12,13 Allow the infection to pro....

Results

Using this protocol, we have tested hundreds of tuberculosis drug development compounds for their predicted efficiency at penetrating caseum. Figure 1 visualizes the basic concepts of the RED assay. The dialysis membrane of the RED inserts allows for unbound small molecules to diffuse from the donor well to the receiver well, finally achieving an equilibrium between both compartments. Small molecules that are bound to macromolecules such as proteins or lipids are trapped .......

Discussion

Pulmonary necrotic lesions and cavities in tuberculosis-infected patients contain subpopulations of bacteria that are recalcitrant to drug treatment. The caseous cores of these structures are particularly responsible for harboring these persisters in an extracellular environment.¹⁶ Favorable distribution of anti-bacterial agents into these remote locations is believed to be an important determinant of tuberculosis drug efficacy. Prior to the validation of this protocol, there were no available

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
New Zealand White Rabbits	Covance	-
HN878 Mycobacterium tuberculosis	BEI Resources	NR-13647
Ketathesia (Ketamine) 100 mg/mL C3N	Henry Schein Animal Health	56344
Anased (Xylazine) 100 mg/mL	Henry Schein Animal Health	33198
Euthasol (pentobarbital sodium and phenytoin sodium) Solution	Virbac	710101
THP-1 monocytic cell line	ATCC	ATCC TIB-202
175 cm² TC-Treated Flask (T175)	Fisher Scientific	T-3400-175
RPMI 1640 media w/o glutamine	Fisher Scientific	MT-15-040-CV
Hyclone Fetal Bovine Serum, Gamma irradiated	Fisher Scientific	SH3091003IR
Hyclone L-glutamine, 200 mM	Fisher Scientific	SH3003401
Cellstar TC dish, 145 mm x 20 mm, vented	Fisher Scientific	T-2881-1
Phorbol 12-myristate 13-acetate (PMA)	Fisher Scientific	BP685-1
Ethylenediaminetetraacetic acid	Sigma	E6758
Oleic acid	Fisher Scientific	ICN15178101
Pierce RED Device Reusable Base Plate	Fisher Scientific	PI-89811
Pierce RED Device Inserts, 50/box	Fisher Scientific	PI-89809
Pierce RED insert removal tool	Fisher Scientific	89812
Adhesive plate seal	Fisher Scientific	08-408-240
PBS, pH 7.4, 10x 500 mL (Gibco)	Life Technologies	10010-049
DMSO	Sigma	472301
Acetonitrile	Sigma	34998
Methanol	Sigma	34860
Verapamil hydrochloride	Sigma	V4629
Diclofenac sodium salt	Sigma	93484
Trypan Blue Solution, 0.4%	Fisher Scientific	15-250-061
Ethanol, 200 proof	Fisher Scientific	04-355-451
2010 Geno/Grinder	SPEX SamplePrep	2010
Bead Mill Homogenizer Accessory, Metal Bulk Beads	Fisher Scientific	15-340-158
484R Cobalt 60 Irradiator	JL Shepard	7810-484-1
INCYTO C-Chip Disposable Hemacytometers	Fisher Scientific	22-600-100
Upright Light Microscope	Leica	DM1000
Binary Liquid Chromatography system	Agilent	1260	Multi-compenent
Mass spectrometer	AB Sciex	4000