Rana Harvesh Kumar, Singh Amit Kumar, Kumar Ramesh, Pandey Abhay K
Department of Biochemistry, University of Allahabad, Prayagraj (Allahabad), 211002, India.
Department of Zoology, Feroze Gandhi College, Raebareli, 229001, India.
Naunyn Schmiedebergs Arch Pharmacol. 2024 Mar;397(3):1251-1273. doi: 10.1007/s00210-023-02679-z. Epub 2023 Sep 4.
Mycobacterium tuberculosis (Mtb) is a pathogenic bacterium which causes tuberculosis (TB). TB control programmes are facing threats from drug resistance. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Mtb strains need longer and more expensive treatment with many medications resulting in more adverse effects and decreased chances of treatment outcomes. The World Health Organization (WHO) has emphasised the development of not just new individual anti-TB drugs, but also novel medication regimens as an alternative treatment option for the drug-resistant Mtb strains. Many plants, as well as marine creatures (sponge; Haliclona sp.) and fungi, have been continuously used to treat TB in various traditional treatment systems around the world, providing an almost limitless supply of active components. Natural products, in addition to their anti-mycobacterial action, can be used as adjuvant therapy to increase the efficacy of conventional anti-mycobacterial medications, reduce their side effects, and reverse MDR Mtb strain due to Mycobacterium's genetic flexibility and environmental adaptation. Several natural compounds such as quercetin, ursolic acid, berberine, thymoquinone, curcumin, phloretin, and propolis have shown potential anti-mycobacterial efficacy and are still being explored in preclinical and clinical investigations for confirmation of their efficacy and safety as anti-TB medication. However, more high-level randomized clinical trials are desperately required. The current review provides an overview of drug-resistant TB along with the latest anti-TB medications, drug-induced hepatotoxicity and oxidative stress. Further, the role and mechanisms of action of first and second-line anti-TB drugs and new drugs have been highlighted. Finally, the role of natural compounds as anti-TB medication and hepatoprotectants have been described and their mechanisms discussed.
结核分枝杆菌（Mtb）是一种导致结核病（TB）的致病细菌。结核病控制项目正面临耐药性的威胁。耐多药（MDR）和广泛耐药（XDR）的结核分枝杆菌菌株需要使用多种药物进行更长时间且更昂贵的治疗，这会导致更多不良反应以及治疗结果的成功率降低。世界卫生组织（WHO）强调不仅要研发新的单一抗结核药物，还要研发新的药物治疗方案，作为耐药结核分枝杆菌菌株的替代治疗选择。在世界各地的各种传统治疗体系中，许多植物以及海洋生物（海绵；Haliclona属）和真菌一直被用于治疗结核病，提供了几乎无限的活性成分供应。天然产物除了具有抗分枝杆菌作用外，还可用作辅助治疗，以提高传统抗分枝杆菌药物的疗效，减少其副作用，并因分枝杆菌的遗传灵活性和环境适应性而逆转耐多药结核分枝杆菌菌株。几种天然化合物，如槲皮素、熊果酸、黄连素、百里醌、姜黄素、根皮素和蜂胶，已显示出潜在的抗分枝杆菌疗效，目前仍在进行临床前和临床研究，以确认其作为抗结核药物的疗效和安全性。然而，迫切需要更多高水平的随机临床试验。本综述概述了耐药结核病以及最新的抗结核药物、药物性肝毒性和氧化应激。此外，还强调了一线和二线抗结核药物及新药的作用和作用机制。最后，描述了天然化合物作为抗结核药物和肝保护剂的作用，并讨论了其作用机制。
