The risk of developing tuberculosis (TB) is estimated to be 26 to 31 times greater in people living with Human
Immunodeficiency Virus (HIV-1). The arduous treatment regimen for TB (minimum of six months on a cocktail
of antibiotics with dose-limiting side-effects) has remained essentially unchanged for decades. Reducing the
global TB burden has focused primarily on new antibiotics and vaccines with little focus on macrophage targeted
drug delivery methods that activate the immune system to increase microbial eradication. To address this unmet
need, we developed a targeted macrophage therapy with broad applications for HIV and TB. Our formulation
delivers a model rifamycin drug, rifampin, loaded into β-glucan and chitosan coated poly(lactic-co-glycolic) acid
(GLU-CS-PLGA) nanoparticles. Our pharmacokinetic studies found that after a single nanoparticle
administration via oropharyngeal aspiration to healthy mice, rifampin was detected in the cellular fraction of the
bronchoalveolar lavage up to 10 days post-dosing. Furthermore, we found a time course of release of TNFα that
returns to baseline at 24 hr post administration. All nanoparticles stimulated the release of TNFα in the range
of 500 to 2000 pg/ml, similar to TNFα concentrations in a TB mouse model after drug treatment. While we have
demonstrated sustained delivery of rifampin to alveolar macrophage in mice using our nanoparticles, we have
yet to learn how this nanoparticle functions in the setting of virulent mycobacterium tuberculosis in the
lung. Furthermore, we have yet to discover how this nanoformulation affects a TB granuloma in the absence
or presence of HIV viral proteins. To address this, we are taking a two-pronged approach with independent
aims. Aim 1, “Determine the GLU-CS-PLGA nanoparticles in an in vitro TB granuloma model in the absence or
presence of HIV proteins”, will analyze the bactericidal efficacy elicited by GLU-CS-PLGA nanoparticles in this
model. We also have included an exploratory experiment to investigate the effects of HIV-1 proteins on
GLU-CS-PLGA nanoparticle efficacy. Aim 2, “Determine the in vivo efficacy of GLU-CS-PLGA nanoparticles in
the BALB/c TB mouse model”, will determine the bactericidal efficacy in situ in the lungs following
oropharyngeal aspiration with GLU-CS-PLGA in the BALB/c TB mouse model. Therefore, this nanoplatform is
broadly relevant to disorders that affect macrophage, including TB and HIV (HIV macrophage reservoirs).
Determining the efficacious nature of this nanoformulation is essential to decide whether (1) we should abandon
this therapeutic approach or (2) we should move forward to test it in an advanced mouse TB model that develops
highly organized encapsulated necrotic lesions, i.e., granulomas, that contain large numbers of extracellular
bacilli that more closely resembled human lesions and, in an HIV-TB co-infection model. This innovative
proposal advances the conceptual and mechanistic knowledge of stimulation of the immune system to treat
infectious diseases and this novel immune-stimulating drug delivery nanoparticle platform. By incorporating
GLU onto the nanoparticle's surface, the resulting immune stimulation is independent of its therapeutic cargo.