Evidence map›Paper›PMID 41666210›Full record

ArticlePloS one2026

Identifying optimal combination regimens for therapy of Mycobacterium tuberculosis with an algorithmic approach: prospective predictions and validations.

Arnold Louie, Michael Neely, Sarah Kim, Charles A Scanga, JoAnne L Flynn, Charles A Peloquin, Brendan Prideaux, Stephan Schmidt, Mohammed Almoslem, Walter Yamada and 1 more

Abstract read
In one paragraph

Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Arnold LouieInstitute for Therapeutic Innovation, University of Florida College of Medicine Orlando, Florida, United States of America.
Michael NeelyLaboratory of Applied Pharmacokinetics and Bioinformatics, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America.
Sarah KimInstitute for Therapeutic Innovation, University of Florida College of Medicine Orlando, Florida, United States of America.ORCID https://orcid.org/0000-0002-9179-0735
Charles A ScangaDepartment of Microbiology and Molecular Genetics and Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
JoAnne L FlynnDepartment of Microbiology and Molecular Genetics and Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
Charles A PeloquinPharmacotherapy & Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, United States of America.ORCID https://orcid.org/0000-0001-9002-7052
Brendan PrideauxDepartment of Neurobiology, The University of Texas Medical Branch Galveston, Galveston, Texas, United States of America.
Stephan SchmidtDepartment of Pharmaceutics, Center for Pharmacometrics and System Pharmacology, College of Pharmacy, University of Florida, Orlando, Florida, United States of America].
Mohammed AlmoslemDepartment of Pharmaceutics, Center for Pharmacometrics and System Pharmacology, College of Pharmacy, University of Florida, Orlando, Florida, United States of America].
Walter YamadaLaboratory of Applied Pharmacokinetics and Bioinformatics, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America.ORCID https://orcid.org/0000-0003-3512-9202
George DrusanoInstitute for Therapeutic Innovation, University of Florida College of Medicine Orlando, Florida, United States of America.ORCID https://orcid.org/0000-0001-9162-7332

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMycobacterium tuberculosis resistance to standard-of-care agents is increasing. It is imperative to identify new combinations that increase the rate and depth of bacterial kill, shorten therapy and also suppress resistance. There has been little prior effort to identify combination regimens that employ new or repurposed drugs in a rational way. METHODS AND

findingsOur group developed a pathway to combine agents to achieve this end. This pathway starts with standard baseline evaluations (e.g., MIC), leverages information from in vitro assessments (hollow fiber infection model), then analyzes 2-agent combinations in a 96 well quantitative culture checkerboard format (Greco URSA model with simulation). Finally, development of a high dimensional mathematical model allowed evaluation of 2- and 3-drug regimens in multiple metabolic states to draw inferences regarding combination therapies. We prospectively evaluated these regimens in animal models. We showed that a prospectively chosen regimen of pretomanid, moxifloxacin plus bedaquiline performed as predicted. In the BALB/c murine model, this regimen produced sterilization in a cohort that was held for 12 weeks after therapy cessation, as it did in the C3HeB/FeJ ("Kramnik") murine model. Finally, this and other regimens were evaluated in a cynomolgus macaque model. The decrement of the 18F-deoxyglucose signal in Positron emission tomography (PET)- computed tomography (CT) evaluations was best with this regimen. Other endpoints such as necropsy score and colony counts in lung and lymph nodes also demonstrated that this regimen behaved as predicted from our pathway/algorithm.

conclusionsWe conclude that this provides a way forward for the future to identify the most promising regimens to shorten therapy for tuberculosis and suppress emergence of resistance.

Indexed as

AlgorithmsAntitubercular AgentsMycobacterium tuberculosisTuberculosisAnimalsDiarylquinolinesDrug Therapy, CombinationFemaleMiceMice, Inbred BALB CMicrobial Sensitivity TestsMoxifloxacinNitroimidazolesProspective StudiesAntitubercular AgentsbedaquilineDiarylquinolinesMoxifloxacinNitroimidazolespretomanid

Identifiers

PMID41666210
PMCPMC12890097

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.