Alpibectir functions through a unique mechanism that targets bacterial transcriptional regulators, activating novel bioactivation pathways for ethionamide (Eto). Eto is an older, well-known anti-TB drug, but its use at high concentrations is limited due to significant side effects. By enhancing Eto’s efficacy, alpibectir enables its use at lower, non-toxic concentrations, potentially improving its safety profile while maintaining therapeutic effectiveness. Alpibectir is in phase II. Primary patents on alpibectir have been filed in many LMICs and are expected to expire in 2038.