Drug Discovery for TB: Frontiers and Perspectives

Despite advances in the treatment of tuberculosis (TB) and increased effort to discover new anti-TB drugs, 8.6 million people were affected by Mycobacterium tuberculosis infection, leading to 1.3 million deaths in 2013. Tuberculosis is a substantial threat to public health because of co-infection with HIV and the emergence of resistant strains (MDR and XDR). The main obstacles for the discovery of new drugs against TB include high cost, lack of investment by large pharmaceutical companies and lack of infrastructure in the countries affected by this disease. The global effort to eliminate tuberculosis includes contributions by the Global Alliance for TB Drug Development (TB Alliance), several research groups, regulatory agencies, and institutions such as the NIH (National Institutes of Health) and Bill and Melinda Gates Foundation. This chapter discusses factors that impede anti-TB drug discovery, which include the development of bacterial drug resistance, role of bacterial efflux pumps, cross-resistance, drug interactions with antiretrovirals and lack of investment by pharmaceutical industries; furthermore, new drugs that are being tested for the treatment of TB are discussed.

Keywords: Drug discovery, drug interactions, drug resistance, efflux pumps, HIV, isoniazid, investments, mycobacteria, rifampicin, tuberculosis.