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Clinically efficacious combination therapies capable of impeding resistance are widely sought for the treatment of mycobacterial infections. Here, we described structural modifications of the phenylalkylamine scaffold of verapamil to give an analog with more than 10-fold greater growth inhibitory activity than verapamil against , BCG, and The analog synergized with the FF-ATP synthase inhibitor bedaquiline in checkerboard assays and augmented the bactericidal properties of bedaquiline against BCG and . Using live cell bioorthogonal imaging techniques, biochemical and genetic assays, the bactericidal activity of the analog is attributed to the perturbation of membrane bioenergetics and disruption of mycobacterial respiration.

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Netupitant Exhibits Potent Activity on Persisters.

ACS Infect Dis

August 2025

Department of Microbiology, University of Washington, Seattle, Washington 98109, United States.

In (Mtb), persisters are genotypically drug-sensitive bacteria that nonetheless survive antibiotic treatment. Persisters contribute to prolonged TB treatment duration and relapse risk, highlighting the need for new therapeutic strategies to effectively eliminate these tolerant subpopulations. In this study, we screened 2,336 FDA-approved compounds to identify agents that enhance the sterilizing activity of standard anti-TB drugs and prevent the regrowth of persisters.

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Aims: BeBedaquiline (BDQ) is a first-in-class diarylquinoline (DARQ) and a potent anti-tuberculosis drug, vital in combating multi-drug resistant tuberculosis (TB). Understanding its lung pharmacokinetics (PK) across species is crucial for effective clinical translation. This study aimed to extrapolate BDQ's lung PK from preclinical species to humans, focusing on healthy and TB-infected lung tissue.

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(-)-Bedaquiline [(-)-BDQ] is considered to be one of the most promising new therapeutic agents for tuberculosis for over 50 years. However, there are limited general and highly stereocontrolled asymmetric synthetic methods available for (-)-BDQ and its analogues due to the challenge of forging their vicinal stereocenters. Herein, we report a concise and stereocontrolled synthetic route to (-)-BDQ in six steps with an overall yield of 34%, integrating a Rh-catalyzed dynamic kinetic resolution-asymmetric transfer hydrogenation (DKR-ATH) with TADDOL-mediated diastereoselective allylation.

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Although bedaquiline (BDQ) received conditional approval for multi-drug resistance tuberculosis (MDR-TB), a black box warning was added due to QT prolongation risk. WX-081, a promising second-in-class drug that finished phase II clinical trial, exhibited comparable anti-TB activity and better cardiac safety. The accumulation of its active metabolite WX-081-M3 leads to QT prolongation, whereas the relationships between dosage, exposure and response have not been established.

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