Mathematical modeling of pulmonary tuberculosis therapy: Insights from a prototype model with rifampin

• Published in: Journal of theoretical biology 2011-08, Vol.282 (1), p.80-92
• Main Authors: Goutelle, Sylvain, Bourguignon, Laurent, Jelliffe, Roger W., Conte, John E., Maire, Pascal
• Format: Article
• Language: English
• Subjects: Animals; antibacterial properties; Antitubercular Agents - pharmacokinetics; Antitubercular Agents - pharmacology; Antitubercular Agents - therapeutic use; bacteria; drugs; Life Sciences; lungs; Mathematical model; mathematical models; Mice; Models, Theoretical; Mycobacterium; Other; patients; Pharmacodynamics; Pharmacokinetics; Rifampin - pharmacokinetics; Rifampin - pharmacology; Rifampin - therapeutic use; Simulations; therapeutics; Tuberculosis; Tuberculosis, Pulmonary - drug therapy
• ISSN: 0022-5193; 1095-8541
• DOI: 10.1016/j.jtbi.2011.05.013

There is a critical need for improved and shorter tuberculosis (TB) treatment. Current in vitro models of TB, while valuable, are poor predictors of the antibacterial effect of drugs in vivo. Mathematical models may be useful to overcome the limitations of traditional approaches in TB research. The objective of this study was to set up a prototype mathematical model of TB treatment by rifampin, based on pharmacokinetic, pharmacodynamic and disease submodels. The full mathematical model can simulate the time-course of tuberculous disease from the first day of infection to the last day of therapy. Therapeutic simulations were performed with the full model to study the antibacterial effect of various dosage regimens of rifampin in lungs. The model reproduced some qualitative and quantitative properties of the bactericidal activity of rifampin observed in clinical data. The kill curves simulated with the model showed a typical biphasic decline in the number of extracellular bacteria consistent with observations in TB patients. Simulations performed with more simple pharmacokinetic/pharmacodynamic models indicated a possible role of a protected intracellular bacterial compartment in such a biphasic decline. This modeling effort strongly suggests that current dosage regimens of RIF may be further optimized. In addition, it suggests a new hypothesis for bacterial persistence during TB treatment. ► We present a mathematical model of pulmonary tuberculosis therapy by rifampin. ► The model is based on pharmacokinetic, pharmacodynamic and disease submodels. ► The model simulates the bacterial dynamics of TB from the first day of infection to the last day of therapy. ► The model reproduces some properties of the bactericidal activity of rifampin observed in clinical studies. ► The model suggests a new hypothesis for bacterial persistence during TB treatment.