The emergence of
drug resistance in tuberculosis requires alternative strategies to
combat the resistance. To this end, we have synthesized zinc oxide
nanoparticles (ZnO NPs) of 11 nm diameter and evaluated its effect
against mycobacteria alone, as well as in combination with the first-line
anti-TB drug, rifampicin. These ZnO NPs themselves are not inhibitory
against the wild-type (WT) Mycobacterium smegmatis, up to a concentration as high as 256 μg/mL. However, a subinhibitory
concentration of only 32 μg/mL of ZnO NPs in combination with
rifampicin, showed a 4-fold reduction in the minimum inhibitory concentration
of rifampicin, against WT M. smegmatis. Thus, the
fractional inhibitory concentration index for the combination was
found to be 0.375, which proves the effect to be synergistic. This
is explained by high membrane permeability observed in presence of
the combination of ZnO NPs and rifampicin, which increased with time.
High membrane permeability, in turn, increased rifampicin uptake in
cells, which subsequently enhanced the bactericidal effect of the
drug. The resultant morphology of the bacteria, from Cryo-SEM, showed
membrane damage, following treatment with a combination of ZnO NPs
and rifampicin. However, this combination showed very less reactive
oxygen species (ROS) production, compared to ZnO NPs alone. Hence,
we can conclude that membrane damage is the dominant mechanism behind
synergism of the combination, rather than that of ROS generation.
This combination also proved to be successful against our laboratory-generated,
drug resistant strains of M. smegmatis, as well as
against vaccine strain- M. bovis BCG, which proves
the general applicability of this synergism for different strains.
We hence propose that our developed ZnO NPs and drug combination can
be promising for overcoming mycobacterial drug resistance.