Dual role of hypoxia-inducible factor 1 α in experimental pulmonary tuberculosis: its implication as a new therapeutic target

Aim: Investigate the role of hypoxia-inducible factor-1 alpha (HIF-1 alpha) in pulmonary tuberculosis (TB). Methods & results: A model of progressive pulmonary TB in BALB/c mice, immunohistochemistry and digital pathology were used. High HIF-1 alpha expression was observed during early TB in activated macrophages. During late TB, even higher HIF-1 alpha expression was observed in foamy macrophages, which are resistant to apoptosis. Blocking HIF-1 alpha during early infection with 2-methoxyestradiol worsened the disease, while during late TB, it induced macrophage apoptosis and decreased bacillary loads. Conclusion: HIF-1 alpha has a dual role in experimental TB. This finding could have therapeutic implications because combined treatment with 2-methoxyestradiol and antibiotics appeared to eliminate mycobacteria more efficiently than conventional chemotherapy during advanced disease.