Pharmacological and Molecular Mechanisms Behind the Sterilizing Activity of Pyrazinamide

Trends Pharmacol Sci. 2019 Dec;40(12):930-940. doi: 10.1016/ Epub 2019 Nov 6.


Inclusion of pyrazinamide (PZA) in the tuberculosis (TB) drug regimen during the 1970s enabled a reduction in treatment duration from 12 to 6 months. PZA has this remarkable effect in patients despite displaying poor potency against Mycobacterium tuberculosis (Mtb) in vitro. The pharmacological basis for the in vivo sterilizing activity of the drug has remained obscure and its bacterial target controversial. Recently it was shown that PZA penetrates necrotic caseous TB lung lesions and kills nongrowing, drug-tolerant bacilli. Furthermore, it was uncovered that PZA inhibits bacterial Coenzyme A biosynthesis. It may block this pathway by triggering degradation of its target, aspartate decarboxylase. The elucidation of the pharmacological and molecular mechanisms of PZA provides the basis for the rational discovery of the next-generation PZA with improved in vitro potency while maintaining attractive pharmacological properties.

Keywords: drug tolerance; lesion penetration; pyrazinamide; target degradation; tuberculosis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Antitubercular Agents / chemistry*
  • Antitubercular Agents / pharmacokinetics
  • Antitubercular Agents / pharmacology*
  • Humans
  • Mycobacterium tuberculosis / drug effects*
  • Pyrazinamide / chemistry*
  • Pyrazinamide / pharmacokinetics
  • Pyrazinamide / pharmacology*
  • Pyrazinamide / therapeutic use
  • Tuberculosis / drug therapy*
  • Tuberculosis / metabolism
  • Tuberculosis / microbiology


  • Antitubercular Agents
  • Pyrazinamide