17/04/24 ERA4TB – Evaluation of critical parameters in the hollow-fibre system for tuberculosis: A case study of moxifloxacin

Abstract: The hollow-fibre system for tuberculosis (HFS-TB) is a preclinical model qualified by the European Medicines Agency to underpin the anti-TB drug development process. It can mimic in vivo pharmacokinetic (PK)–pharmacodynamic (PD) attributes of selected antimicrobials, which could feed into in silico models to inform the design of clinical trials. However, historical data and published protocols are insufficient and omit key information to allow experiments to be reproducible. Therefore, in this work, we aim to optimize and standardize various HFS-TB operational procedures. First, we characterized bacterial growth dynamics with different types of hollow-fibre cartridges, Mycobacterium tuberculosis strains and media. Second, we mimicked a moxifloxacin PK profile within hollow-fibre cartridges, in order to check drug–fibres compatibility. Lastly, we mimicked the moxifloxacin total plasma PK profile in human after once daily oral dose of 400 mg to assess PK–PD after different sampling methods, strains, cartridge size and bacterial adaptation periods before drug infusion into the system. We found that final bacterial load inside the HFS-TB was contingent on the studied variables. Besides, we demonstrated that drug–fibres compatibility tests are critical preliminary HFS-TB assays, which need to be properly reported. Lastly, we uncovered that the sampling method and bacterial adaptation period before drug infusion significantly impact actual experimental conclusions. Our data contribute to the necessary standardization of HFS-TB experiments, draw attention to multiple aspects of this preclinical model that should be considered when reporting novel results and warn about critical parameters in the HFS-TB currently overlooked.

Authors: Aguilar-Ayala D. A., Sanz-García F., Rabodoarivelo M. S., Susanto B. O., Bailo R. Eveque-Mourroux M. R., Willand N., Simonsson U. S. H., Ramón-García S., Lucía A.

Source: British Journal of Clinical Pharmacology

DOI: https://doi.org/10.1111/bcp.16068