New therapeutic strategies for pulmonary diseases - untapping the mycolic acid pathway.

Introduction: Treatment options against infections are very limited. New compounds are needed to cure pulmonary diseases. While the mycolic acid biosynthetic pathway has been largely exploited for the treatment of tuberculosis, this metabolic process has been overlooked in , although it offers many potential drug targets for the treatment of this opportunistic pathogen.

Areas Covered: Herein, the authors review the role of the MmpL3 membrane protein and the enoyl-ACP reductase InhA involved in the transport and synthesis of mycolic acids, respectively. They discuss their importance as two major vulnerable drug targets in and report the activity of MmpL3 and InhA inhibitors. In particular, they focus on NITD-916, a direct InhA inhibitor against , particularly warranted in the context of multidrug resistance.

Expert Opinion: There is an increasing body of evidence validating the mycolic acid pathway as an attractive drug target to be further exploited for lung disease treatments. The NITD-916 studies provide a proof-of-concept that direct inhibitors of InhA are efficient in vitro, in macrophages and in zebrafish. Future work is now required to improve the activity and pharmacological properties of these inhibitors and their evaluation in pre-clinical models.