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WO1999037667A1 - Inhibiteurs de pompe d'ecoulement - Google Patents

Inhibiteurs de pompe d'ecoulement Download PDF

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Publication number
WO1999037667A1
WO1999037667A1 PCT/US1999/001422 US9901422W WO9937667A1 WO 1999037667 A1 WO1999037667 A1 WO 1999037667A1 US 9901422 W US9901422 W US 9901422W WO 9937667 A1 WO9937667 A1 WO 9937667A1
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WO
WIPO (PCT)
Prior art keywords
substituted
alkyl
aryl
amino
thienyl
Prior art date
Application number
PCT/US1999/001422
Other languages
English (en)
Inventor
Suzanne Chamberland
May Lee
Ving J. Lee
Roger Leger
Thomas Renau
Miles She
Zhijia J. Zhang
Original Assignee
Microcide Pharmaceuticals, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US09/012,363 external-priority patent/US6114310A/en
Priority claimed from US09/020,001 external-priority patent/US6245746B1/en
Priority claimed from US09/089,734 external-priority patent/US6204279B1/en
Application filed by Microcide Pharmaceuticals, Inc. filed Critical Microcide Pharmaceuticals, Inc.
Priority to AU23375/99A priority Critical patent/AU2337599A/en
Publication of WO1999037667A1 publication Critical patent/WO1999037667A1/fr

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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K5/00—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof
    • C07K5/04—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof containing only normal peptide links
    • C07K5/06—Dipeptides
    • C07K5/06086—Dipeptides with the first amino acid being basic
    • C07K5/06095—Arg-amino acid
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K5/00—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof
    • C07K5/04—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof containing only normal peptide links
    • C07K5/06—Dipeptides
    • C07K5/06008—Dipeptides with the first amino acid being neutral
    • C07K5/06078—Dipeptides with the first amino acid being neutral and aromatic or cycloaliphatic
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K5/00—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof
    • C07K5/04—Peptides containing up to four amino acids in a fully defined sequence; Derivatives thereof containing only normal peptide links
    • C07K5/06—Dipeptides
    • C07K5/06086—Dipeptides with the first amino acid being basic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
    • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
    • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

  • This invention relates to the field of antimicrobial agents and to methods for identification and characterization of potential antimicrobial agents. More particularly, this invention relates to antimicrobial agents for which the mode of action involves cellular efflux pumps and the regulation of efflux pumps.
  • Antibiotics have been effective tools in the treatment of infectious diseases during the last half century. From the development of antibiotic therapy to the late 1980s there was almost complete control over bacterial infections in developed countries. The emergence of resistant bacteria, especially during the late 1980s and early 1990s, is changing this situation. The increase in antibiotic resistant strains has been particularly common in major hospitals and care centers. The consequences of the increase in resistant strains include higher morbidity and mortality, longer patient hospitalization, and an increase in treatment costs. (B. Murray, 1994, New Engl. J. Med. 330: 1229-1230.)
  • the constant use of antibiotics in the hospital environment has selected bacterial populations that are resistant to many antibiotics. These populations include opportunistic pathogens that may not be strongly virulent but that are intrinsically resistant to a number of antibiotics. Such bacteria often infect debilitated or immunocompromised patients.
  • the emerging resistant populations also include strains of bacterial species that are well known pathogens, which previously were susceptible to antibiotics. The newly acquired resistance is generally due to D ⁇ A mutations, or to resistance plasmids (R plasmids) or resistance-conferring transposons transferred from another organism. Infections by either type of bacterial population, naturally resistant opportunistic pathogens or antibiotic-resistant pathogenic bacteria, are difficult to treat 2 with current antibiotics. New antibiotic molecules which can override the mechanisms of resistance are needed.
  • Bacteria have developed several different mechanisms to overcome the action of antibiotics. These mechanisms of resistance can be specific for a molecule or a family of antibiotics, or can be non-specific and be involved in resistance to unrelated antibiotics. Several mechanisms of resistance can exist in a single bacterial strain, and those mechanisms may act independently or they may act synergistically to overcome the action of an antibiotic or a combination of antibiotics. Specific mechanisms include degradation of the drug, inactivation of the drug by enzymatic modification, and alteration of the drug target (B.G. Spratt, Science 264:388 (1994)).
  • antibiotic resistance due to low permeability is related to the structure of the bacterial membranes.
  • bacteria can be divided into two major groups based on the structure of the membranes surrounding the cytoplasm.
  • Gram- positive (G+) bacteria have one membrane, a cytoplasmic membrane.
  • Gram-negative (G-) bacteria have two membranes, a cytoplasmic membrane and an outer membrane. These bacterial membranes are lipid bilayers which contain proteins and may be associated with other molecules.
  • the permeability of bacterial membranes affects susceptibility/resistance to antibiotics because, while there are a few molecular targets of antibiotics, e.g., penicillin-binding proteins, that are accessible from the outer leaflet of the cytoplasmic membranes, the principal targets for antibiotics are in the cytoplasm or in the inner leaflet of the cytoplasmic membrane. Therefore for an antibiotic which has a target in the cytoplasmic membrane, in Gram-negative bacteria that antibiotic will first need to cross the outer membrane. For a target in the cytoplasm, an antibiotic will need to cross the cytoplasmic membrane in Gram-positive bacteria, 3 and both the outer and cytoplasmic membranes in Gram-negative bacteria. For both membranes, an antibiotic may diffuse through the membrane, or may cross using a membrane transport system.
  • antibiotics e.g., penicillin-binding proteins
  • the lipid composition of the outer membrane constitutes a significant permeability barrier.
  • the outer layer of this outer membrane contains a lipid, lipopolysaccharide (LPS), which is only found in the outer membrane of Gram-negative bacteria.
  • LPS lipopolysaccharide
  • the lipid layer of the outer membrane is highly organized in a quasi-crystalline fashion and has a very low fluidity. Because of the low fluidity of the lipid layer of the outer membrane, even lipophilic antibiotics will not diffuse rapidly through the lipid layer.
  • hydrophobic probe molecules have been shown to partition poorly into the hydrophobic portion of LPS and to permeate across the outer membrane bilayer at about one-fiftieth to one- hundredth the rate through the usual phospholipid bilayers (like the cytoplasmic membrane bilayer).
  • Some antibiotics may permeate through water- filled porin channels or through specific transport systems. Many of the porin channels, however, provide only narrow diameter channels which do not allow efficient diffusion of the larger antibiotic molecules. In addition, many porin channels are highly hydrophilic environments, and so do not efficiently allow the passage of hydrophobic molecules.
  • the outer membrane acts as a molecular sieve for small molecules. This explains, in part, why Gram-negative bacteria are generally less susceptible to antibiotics than Gram-positive bacteria, and why Gram-negative bacteria are generally more resistant to large antibiotics, such as glycopeptides, that cannot cross the outer membrane.
  • the cytoplasmic membrane also provides a diffusion barrier for some antibiotics.
  • drugs that show some lipophilicity will be able to permeate through the lipid layer.
  • Other drugs, such as phosphonomycin or D-cycloserine that have very low solubility in a lipophilic environment will cross the cytoplasmic membrane by using a transport system. In this case, though, if the transport system is not synthesized, the bacteria will become resistant to the drug (Peitz et al., 1967, Biochem. J. 6: 2561).
  • Different pumps can efflux specifically a drug or group of drugs, such as the NorA system that transports quinolones, or Tet A that transports tetracyclines, or they can efflux a large variety of molecules, such as certain efflux pumps of Pseudomonas aeruginosa.
  • efflux pumps have a cytoplasmic component and energy is required to transport molecules out of the cell.
  • Some efflux pumps have a second cytoplasmic membrane protein that extends into the periplasm.
  • At least some efflux pumps of P. aeruginosa have a third protein located in the outer membrane.
  • Efflux pumps are involved in antibiotic resistance since, in some cases, they can remove a significant fraction of the antibiotic molecules which manage to enter the cells, thereby maintaining a very low intracellular antibiotic concentration.
  • P. aeruginosa laboratory-derived mutant strain 799/61 which does not produce any measurable amounts of efflux pump is 8 to 10 fold more susceptible to tetracycline and ciprofloxacin than the parent strain P. aeruginosa 799, which synthesizes efflux pumps.
  • null mutants of mexA, the cytoplasmic component of a P. aeruginosa efflux pump are more susceptible to antibiotics than the wild type.
  • efflux pumps The physiological role of efflux pumps has not been clearly defined yet. They are involved in drug resistance but they also are involved in the normal physiology of the bacterial cell.
  • the efflux pump coded in the mexA operon of P. aeruginosa has been shown to be regulated by the iron content of the medium, and it is co-regulated with the synthesis of the receptors of siderophores.
  • Siderophores are molecules that are needed for bacterial growth under iron starvation conditions, such as during infection of an animal. They are synthesized in the cytoplasm and exported when the bacterial cell needs iron. Siderophores scavenge iron within the infected animal and return the iron to the microbe to be used for essential microbial processes. Since there is essentially no free iron in the bodies of animals, including the human body, the production of 5 siderophores by infecting bacteria is an important virulence factor for the progress of the infection.
  • This invention concerns particular compounds which are efflux pump inhibitors, and which are therfore compounds which inhibit cellular efflux pumps of bacteria or other microbes.
  • efflux pumps export substrate molecules from the cytoplasm in an energy-dependent manner, and the exported substrate molecules can include antibacterial agents or other antimicrobial agents.
  • efflux pump inhibitors are useful, for example, for treating microbial infections by reducing the export of a co- administered antimicrobial agent or by preventing the export of a compound synthesized by microbes (e.g., bacteria) to allow or improve their growth.
  • An example of reducing the export of such a compound is inhibiting iron availability for the microbe by reducing the export of siderophores.
  • this invention also provides compositions which include such efflux pump inhibitors and methods for treating microbial infections using those compositions. 6
  • P* carbonyl (CO), CONH, CO 2 , -CH 2 -, -CH(OH)- (R- or S-)configuration, SO t (t
  • A* carbonyl (CO), -CH(OH)CH 2 (R- or S-)configuration
  • R 2 H, alkyl (C,-C 4 ), branched alkyl (C 3 -C 6 ), fluoroalkyl (C,-C 4 ), perfluoroalkyl (C r C 4 ), aryl (C 6 -C 10 ), monosubstituted aryl (C 6 -C ]0 ) ⁇ optionally substituted with alkyl (C r C 4 ), alkoxy (C,-C 4 ), alkylthio (C,-C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C,-C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C,-C 4 )], or hydroxyl ⁇ , disubstituted aryl (C 6 -C 10 ) ⁇ any combination of alkyl (C r C 4 ), alkoxy (C r C 4
  • X aryl (C 6 -C 10 ), monosubstituted aryl (C 6 -C 10 ) ⁇ optionally substituted with alkyl (C,-C 4 ), alkoxy (C,-C 4 ), alkylthio (C r C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C,-C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C,-C 4 )], or hydroxyl ⁇ , disubstituted aryl (C 6 -C, 0 ) ⁇ any combination of alkyl (C r C 4 ), alkoxy (C r C 4 ), alkylthio (C C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino
  • alkyl (C,-C 4 ) [optionally substituted with alkyl (C,-C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C r C 4 )], or hydroxy ⁇ , 2-(or 3-)thienyl, 2- (or 3-)furyl, or 2-(3- or 4-)pyridyl, imidazolyl, mono- (or di-)substituted imidazolyl [optionally substituted with H, alkyl (C,-C 4 ), aryl (C 6 -C 10 ), arylalkyl (C 7 -C ⁇ ), aryloxy, arylthio, carboxy, alkoxycarbonyl, aryloxycarbonyl, arylalkoxycarbonyl, carboxamido, naphthyl-aminocarbonyl (1- or 2-position), substituted naphthylaminocarbonyl, quinolinylaminocarbonyl (2- to
  • the absolute stereochemistry can be either (R)- or (S)- configuration and any combination of configurations.
  • the efflux inhibitor compounds of this invention have a chemical structure desccribed by the sub-generic Type A structure as described below, namely:
  • R 2 H, alkyl (C,-C 4 ), branched alkyl (C 3 -C 6 ), fluoroalkyl (C,-C 4 ), perfluoroalkyl (C,-C 4 ), aryl (C 6 -C 10 ), monosubstituted aryl (C 6 -C 10 ) ⁇ optionally substituted with alkyl (C r C 4 ), alkoxy (C,-C 4 ), alkylthio (C r C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C,-C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C,-C 4 )], or hydroxyl ⁇ , disubstituted aryl (C 6 -C 10 ) ⁇ any combination of alkyl (C r C 4 ), alkoxy (C r C 4 ), al
  • X aryl (C 6 -C 10 ), monosubstituted aryl (C 6 -C 10 ) ⁇ optionally substituted with alkyl (C,-C 4 ), alkoxy (C,-C 4 ), alkylthio (C,-C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C,-C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C,-C 4 )], or hydroxyl ⁇ , disubstituted aryl (C 6 -C 10 ) ⁇ any combination of alkyl (C r C 4 ), alkoxy (C,-C 4 ), alkylthio (C,-C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C r C 4 )], disub
  • the absolute stereochemistry can be either (R)- or (S)- configuration and any combination of configuration.
  • R 2 H, alkyl (C,-C 4 ), branched alkyl (C 3 -C 6 ), fluoroalkyl (C,-C 4 ), perfluoroalkyl (C,-C 4 ), aryl (C 6 -C 10 ), monosubstituted aryl (C 6 -C ]0 ) ⁇ optionally substituted with alkyl (C,-C 4 ), alkoxy (C,-C 4 ), alkylthio (C,-C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C,-C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C r C 4 )], or hydroxyl ⁇ , disubstituted aryl (C 6 -C 10 ) ⁇ any combination of alkyl (C r C 4 ), alkoxy (C r C 4
  • R a (R b or R c ) H, alkyl (C,-C 4 ), phenyl, benzyl, cyano, hydroxy, or nitro.
  • R a +R b (or R b +R c ) (CH 2 ) 2.3 or -CHOH-.
  • X aryl (C 6 -C 10 ), monosubstituted aryl (C 6 -C 10 ) ⁇ optionally substituted with alkyl (C,-C 4 ), alkoxy (C r C 4 ), alkylthio (C C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C,-C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C r C 4 )], or hydroxyl ⁇ , disubstituted aryl (C 6 -C 10 ) ⁇ any combination of alkyl (C,-C 4 ), alkoxy (C,-C 4 ), alkylthio (C,-C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C,-C 4 )], disubstit
  • the absolute stereochemistry can be either (R)- or (S)- configuration and any combination of configuration.
  • R 2 H, alkyl (C,-C 4 ), branched alkyl (C 3 -C 6 ), fluoroalkyl (C,-C 4 ), perfluoroalkyl (C,-C 4 ), aryl (C 6 -C 10 ), monosubstituted aryl (C 6 -C 10 ) ⁇ optionally substituted with alkyl (C,-C 4 ), alkoxy (C,-C 4 ), alkylthio (C,-C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C C 4 )], or hydroxyl ⁇ , disubstituted aryl (C 6 -C 10 ) ⁇ any combination of alkyl (C r C 4 ), alkoxy (C,-C 4 ), alkylthio
  • N-tetrazolyl substituted azaheterocycles [e.g., 2-(or 3-) alkyl(C,-C 4 )morpholinyl, 2- (3- or 4-) alkyl (C,-C 4 ) ⁇ iperazinyl, 2-(or 3-)alkyl (C,-C 4 )pyrrolidinyl, 2-(or 3-)alkyl (C r C 4 )morpholinyl, 2-(or 3-)alkyl (C,-C 4 )pyrrolyl], hydroxy, alkoxy (C,-C 4 ), or alkylthio (C,-C 4 ).
  • substituted azaheterocycles e.g., 2-(or 3-) alkyl(C,-C 4 )morpholinyl, 2- (3- or 4-) alkyl (C,-C 4 ) ⁇ iperazinyl, 2-(or 3-)alkyl (C,-C 4 )pyrrolidinyl, 2-(or 3-)al
  • X aryl (C 6 -C 10 ), monosubstituted aryl (C 6 -C 10 ) ⁇ optionally substituted with alkyl (C,-C 4 ), alkoxy (C,-C 4 ), alkylthio (C,-C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C,-C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C,-C 4 )], or hydroxyl ⁇ , disubstituted aryl (C 6 -C 10 ) ⁇ any combination of alkyl (C,-C 4 ), alkoxy (C,-C 4 ), alkylthio (C r C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C r C 4 )], disub
  • the absolute stereochemistry can be either (R)- or (S)- configuration and any combination of configuration.
  • R 2 H, lower alkyl, branched alkyl
  • R 4 H, lower alkyl, branched alkyl
  • the absolute stereochemistry can be either (R)- or (S)- configuration and any combination of configuration.
  • R 2 H, lower alkyl, branched alkyl
  • R 5 H, lower alkyl, branched alkyl, halogen, aryl, arylalkyl, thienylalkyl, furylalkyl, alkoxyl, alkylthio, aryloxy, or arylthio;
  • R 6 H, lower alkyl, branched alkyl, halogen, aryl, arylalkyl, thienylalkyl, furylalkyl, alkoxyl, alkylthio, aryloxy, or arylthio;
  • T 6 ⁇ (or 6 pi)-annelated ring system or substituted 6p-annelated ring system (e.g. benzo, pyrido, pyrimido, pyrazino, thieno, furano, pyrrolo, pyrazolo, imidazolo, thiazolo, or oxazolo);
  • W amino, azaheterocycles, substituted azaheterocycles, hydroxyl, alkoxy, alkylthio, guanidino, or amidino.
  • the absolute stereochemistry can be either (R)- or (S)- configuration and any combination of configuration.
  • R H, lower alkyl, branched alkyl
  • X aryl (C 6 -C 10 ), monosubstituted aryl (C 6 -C 10 ) ⁇ optionally substituted with alkyl (C,-C 4 ), alkoxy (C,-C 4 ), alkylthio (C,-C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C r C 4 )], disubstituted amino [optionally substituted with any combination of alkyl (C,-C 4 )], or hydroxyl ⁇ , disubstituted aryl (C 6 -C 10 ) ⁇ any combination of alkyl (C r C 4 ), alkoxy (C,-C 4 ), alkylthio (C ⁇ C 4 ), halogen (Br, Cl, F or I), hydroxy, amino, monosubstituted amino [optionally substituted with alkyl (C,-C 4 )], disubsti
  • R 2 H, lower alkyl, branched alkyl
  • R 5 H, lower alkyl, branched alkyl, halogen, aryl, arylalkyl, thienylalkyl, furylalkyl, alkoxyl, alkylthio, aryloxy, or arylthio;
  • R 6 H, lower alkyl, branched alkyl, halogen, aryl, arylalkyl, thienylalkyl, furylalkyl, alkoxyl, alkylthio, aryloxy, or arylthio;
  • T ⁇ 6 ⁇ (or 6 pi)-annelated ring system or substituted 6p-annelated ring system e.g., benzo, pyrido, pyrimido, pyrazino, thieno, furano, pyrrolo, pyrazolo, imidazolo, thiazolo, or oxazolo
  • W amino, azaheterocycles, substituted azaheterocycles, hydroxyl, alkoxy, alkylthio, guanidino, or amidino.
  • the absolute stereochemistry can be either (R)- or (S)- configuration and any combination of configuration.
  • the number of atoms of a particular type in a substituent group is generally given as a range.
  • an alkyl group containing from 1 to 4 carbon atoms is indicated as alkyl (C,-C 4 ), or as (C M ) alkyl.
  • Such a range reference is intended to include specific references to groups having each of the integer number of atoms within the specified range.
  • C,-C 4 includes each of C l5 C 2 , C 3 and C 4 .
  • Other numbers of atoms and other types of atoms are indicated in a similar manner.
  • a range is indicated as a range of integer values, e.g., in the form 1-4, 1-5, 1-6, 4-10, etc. each integer in the range is specifically indicated, as well as subranges within the broader range.
  • alkyl refers to a branched or unbranched aliphatic hydrocarbon group, preferably having from 1 to 6 carbon atoms, and more preferably 1 to 4 carbon atoms. Preferably the hydrocarbon group is saturated.
  • the alkyl group may optionally be substituted, and some preferred subsituents include alkoxy, alkylthio, halogen, amino, monosubstituted amino, disubstituted amino, and carboxy groups.
  • lower alkyl refers to an aliphatic hydrocarbon having 1 to 6 carbons, and preferably 1 to 4 carbon atoms (i.e., 1, 2, 3, or 4 carbon atoms).
  • the lower alkyl group may be substituted; preferred substituents include alkoxy, alkylthio, halogen, amino, monosubstituted amino, disubstituted amino, and carboxy.
  • branched alkyl refers to a branched aliphatic hydrocarbon.
  • the branched alkyl group is preferably 3 to 10 (i.e., 3, 4, 5, 6, 7, 8, 9 or 10 carbon atoms) carbons, and most preferably 3 to 6 carbons (i.e., 3, 4, 5, or 6 carbon atoms).
  • the branched alkyl group may be substituted and some preferred substituents include alkoxy, alkylthio, halogen, amino, monosubstituted amino, disubstituted amino, and carboxy.
  • fluoroalkyl refers to a lower alkyl group which is substituted with a fluorine.
  • perfluoroalkyl refers to a lower alkyl group which is substituted with a fluorine atom in every available position except for where the lower alkyl group is attached to the main chain.
  • Carboxyalkyl refers to a chemical moiety with formula -(R)n- COOH, where R is an alkyl moiety, preferably a saturated alkyl, and where n is 0-5.
  • hydroxyalkyl refers to a chemical moiety with the formula -(R)n- OH, where R is an alkyl moiety and where n is 1-4, i.e., 1,2,3 or 4.
  • alkoxy refers to a chemical substituent of formula -OR, where R is a saturated or unsaturated lower alkyl moiety.
  • alkylthio refers to a chemical substituent of formula -SR, where R is hydrogen or a saturated or unsaturated lower alkyl moiety.
  • aryl refers to an aromatic group which has at least one ring having a conjugated pi ( ⁇ ) electron system and includes both carbocyclic aryl (e.g. phenyl) and heterocyclic aryl groups (e.g. pyridine).
  • the aryl group is preferably 6 to 14 carbons, more preferably 6 to 10 carbons.
  • Aryl moieties include monocyclic, bicyclic, and tricyclic rings, where each ring has preferably five or six members.
  • the aryl moiety may be optionally monosubstituted or disubstituted with lower alkyl, hydroxyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, and disubstituted amino.
  • the substituents are independently selected and may be the same or different.
  • the term "monosubstituted aryl” refers to an aryl group substituted with a group selected from alkyl, alkoxy, alkylthio, halogen, hydroxyl, amino, monosubstituted amino, or disubstituted amino.
  • aryloxy and arylthio refer to an aromatic group that is bonded through either oxygen or sulfur, respectively.
  • the aromatic group which has at least one ring having a conjugated pi-electron system and includes both carbocyclic aryl (e.g. phenyl) and heterocyclic aryl groups (e.g. pyridine).
  • the aryl group is preferably 6 to 14 carbons, more preferably 6 to 10 carbons.
  • Aryl moieties include monocyclic, bicyclic, and tricyclic rings, where each ring has preferably five or six members.
  • the aryl moiety may be optionally monosubstituted or disubstituted with lower alkyl, hydroxyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, and disubstituted amino.
  • Carbocyclic refers to a compound which contains one or more covalently closed ring structures, and that the atoms forming the backbone of the ring are all carbon atoms. The term thus distinguishes carbocyclic from heterocyclic rings in which the ring backbone contains carbon atoms and at least one atom which is different from carbon (e.g., N, O, P, S, Se, Si).
  • azaheterocycle refers to a heterocyclic group which includes at least one nitrogen atom in a ring.
  • the azaheterocyclic group is a N-morpholinyl, N-thiomorpholinyl, N-piperazinyl, N-pyrrolidinyl, N-imidazolyl,
  • N-pyrrolyl, N-pyrazolyl, N-triazolyl, and N-tetrazolyl group may also be substituted as recognized in the art, forming a substituted azaheterocycle, preferably a 2-(or 3-) lower alkylmorpholinyl, 2-(3- or 4-)lower alkylthiomorpholinyl, 2-(3- or 4-) lower alkylpiperazinyl, 2-(or 3-) lower alkylpyrrolidinyl, 2-(or 3-) lower alkylmorpholinyl, 2-(or 3-) lower alkylpyrrolyl group.
  • Halogen or “halo” refers to F, Br, Cl, or I, but is preferably F or Br, and more preferably is F.
  • amino means the group NRR, where R and R 1 may independently be alkyl or hydrogen or hydroxyl, but preferably are hydrogen.
  • monosubstituted amino refers to an amino group in which one of R or R' is alkyl.
  • disubstituted amino refers to an amino group in which R and R' are each independently alkyl or hydroxyl, and may be the same or different.
  • thienyl refers to a group which has the core ring structure shown immediately below.
  • the thienyl group may be attached to the rest of the molecule through position 2 or 3 on the ring and may be optionally independently substituted with one or more lower alkyl or alkenyl, hydroxy, alkoxy, alkylthio, mercapto, halogen, haloalkyl, amino, monosubstituted amino, or disubstituted amino.
  • furyl refers to a group which has the core ring structure shown immediately below.
  • the furyl group may be attached to the rest of the molecule through position 2 or 3 on the ring and may be optionally independently substituted with one or more lower alkyl or alkenyl, hydroxy, alkoxy, alkylthio, mercapto, halogen, haloalkyl, amino, monosubstituted amino, or disubstituted amino.
  • pyridyl refers to a group which has the core ring structure shown immediately below.
  • the pyridyl group may be attached to the rest of the molecule through position 2, 3, or 4 on the ring and may be optionally substituted independently with lower alkyl, or alkenly, hydroxy, alkoxy, alkylthio, mercapto, halogen, haloalkyl, amino, monosubstituted amino, or disubstituted amino.
  • quinolyl refers to a group having the core ring structure below.
  • the quinolyl group may be attached to the rest of the molecule through positions 2,3,4,5,6,7, or 8.
  • the group may optionally be independently substituted by one or more groups as indicated for the thienyl group above.
  • isoquinolyl refers to a group with core ring structure shown below.
  • the isoquinolyl group may be attached to the rest of the molecule through positions 1,3,4,5,6,7, or 8.
  • the group may optionally be substituted independently by one or 42 more groups as indicated for the thienyl group above.
  • the group may be attached to the rest of the molecule through positions 1 ,3,5,6,7, or 8.
  • the group may optionally be substituted independently by one or more groups as indicated for the thienyl group above.
  • arylalkyl refers to a lower alkyl group substituted with an aryl group.
  • An example of an arylalkyl group is benzyl where a methyl group is substituted with phenyl.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, hydroxy, amino, monosubstituted amino, or disubstituted amino.
  • the arylalkyl group may be aryl-substituted where the aryl group is optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, hydroxy, amino, monosubstituted amino, or disubstituted amino.
  • thienylalkyl refers to a lower alkyl group substituted with a thienyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the thienylalkyl group may be thienyl-substituted where the thienyl group is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • furylalkyl refers to a lower alkyl group substituted with a furyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, 43 alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the furylalkyl group may be furyl-substituted where the furyl group is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • pyridylalkyl refers to a lower alkyl group substituted with a pyridyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the pyridylalkyl group may be pyridyl-substituted where the pyridyl group is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • benzothienylalkyl refers to a lower alkyl group substituted with a benzothienyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the benzothienylalkyl group may be benzothienyl-substituted where the benzothienyl group is optionally substituted with a lower alkyl, hydoxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • indolyalkyl refers to a lower alkyl group substituted with an indole group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the indolyalkyl group may be indole-substituted where the indole group is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • ⁇ -amino acyl refers to a group RCH(NR 1 R 2 )C(O)-where NR'R 2 is an optionally substituted amino group and R is H or a saturated or unsaturated hydrocarbon, preferably of 1-6, more preferably 1-4 carbon atoms.
  • ⁇ -amino acyl refers to a group R-CH(NR'R 2 )CH 2 C(O)-, where the components are as just described.
  • (alpha-aminoacyl)amido refers to a group having an amide linkage and which is alpha-amino substituted.
  • the group is an amide-linked alpha- amino acid, which may optionally be substituted, for example, glycylamido,
  • quinolinylalkyl refers to a lower alkyl group substituted with an quinolinyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the quinolinylalkyl group may be quinolinyl- substituted where the quinolinyl group is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • isoquinolinylalkyl refers to a lower alkyl group substituted with an isoquinolinyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the isoquinolinylalkyl group may be isoquinolinyl-substituted where the quinolinyl group is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • quinoxalinylalkyl refers to a lower alkyl group substituted with an quinoxalinyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the quinoxalinylalkyl group may be quinoxalinyl-substituted where the quinolinyl group is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • quinazolinylalkyl refers to a lower alkyl group substituted with an quinazolinyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the quinazolinylalkyl group may be quinazolinyl-substituted where the quinazolinylgroup is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • benzimidazolylalkyl refers to a lower alkyl group substituted with an benzimidazolyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the benzimidazolylalkyl group may be benzimidazolyl-substituted where the quinazolinylgroup is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino. 45
  • benzothiazolylalkyl refers to a lower alkyl group substituted with an benzothiazolyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the benzothiazolylalkyl group may be benzothiazolyl-substituted where the quinazolinylgroup is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • benzoxazolylalkyl refers to a lower alkyl group substituted with an benzoxazolyl group.
  • the lower alkyl group may be optionally substituted with a lower alkyl, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • the benzoxazolylalkyl group may be benzoxazolyl-substituted where the benzoxazolyl group is optionally substituted with a lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • tetrahydronaphthyl refers to a group which has a core ring structure of a phenyl ring fused to a cyclohexyl ring, as shown in the structure below, where the attachment to the rest of the molecule can be on either the phenyl ring or on the cyclohexyl ring.
  • the group may optionally be substituted independently with one or more of lower alkyl or alkenyl, halogeno, hydoxy, alkyloxy, alkylthio, amino, monosubstituted amino, and disubstituted amino.
  • indanyl refers to a group which has the core bicyclic ring structure below.
  • the group may be attached to the rest of the molecule through either the phenyl ring or through the 5-membered ring.
  • benzofuranyl refers to a group which has the core ring structure 46 of Stracture A below.
  • the benzofuranyl group may be optionally substituted with lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • benzothienyl refers to a group which has the core ring structure of Stracture B below.
  • the benzothienyl group may be optionally substituted with lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • indolyl refers to a group which has the core ring structure of Structure C below.
  • the indolyl group may be optionally substituted with lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • benzimidazolyl refers to a group which has the core ring stracture of Stracture D below.
  • the benzimidazolyl group may be optionally substituted with lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • benzothiazolyl refers to a group which has the core ring stracture of Structure F below.
  • the benzothiazolyl group may be optionally substituted with lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • benzoxazolyl refers to a group which has the core ring stracture of Structure E below.
  • the benzoxazolyl group may be optionally substituted with lower alkyl, hydroxy, alkoxy, alkylthio, halogen, amino, monosubstituted amino, or disubstituted amino.
  • a particularly appropriate example of a microbe appropriate for the use of an efflux pump inhibitor is a pathogenic bacterial species, Pseudomonas aeruginosa, which is intrinsically resistant to many of the commonly used antibacterial agents. Exposing this bacterium to an efflux pump inhibitor can significantly slow the export of an antibacterial agent from the interior of the cell or the export of siderophores. Therefore, if another antibacterial agent is administered in conjunction with the efflux pump inhibitor, the antibacterial agent, which would otherwise be maintained at a very low intracellular concentration by the export process, can accumulate to a concentration which will inhibit the growth of the bacterial cells. This growth inhibition can be due to either bacteriostatic or bactericidal activity, depending on the specific antibacterial agent used. While P. aeruginosa is an example of an appropriate bacterium, other bacterial and microbial species may contain similar broad substrate pumps, which actively export a variety of antimicrobial agents, and thus can also be appropriate targets.
  • efflux pump inhibitors can decrease the virulence of the microbe, for example, by inhibiting the transport of factors important for pathogenicity.
  • inhibition of an efflux pump in this bacterium inhibits the uptake of iron, which is important for pathogenicity.
  • the mechanism of bacterial iron transport involves molecules called siderophores, which are synthesized and exported by bacterial cells via efflux pumps. These siderophores bind tightly to iron scavenged from the host, and are then taken up by the bacteria. In this way, the iron needed for bacterial metabolism is obtained, and an infection can be maintained. Therefore, illustrating the utility of efflux pump inhibitors, inhibiting the efflux pump of P. aeruginosa allows obtaining one or more of the following biological effects:
  • P. aeruginosa strains will become susceptible to antibiotics that could not be used for treatment of pseudomonad infections, or become more susceptible to antibiotics which do inhibit pseudomonal growth. 2. P. aeruginosa strains will become more susceptible to antibiotics currently used for treatment of pseudomonad infections.
  • the inhibition of the pump or of one of the components of the pump may be lethal or prevent growth.
  • microbes include, for example, bacteria, fungi, yeasts, and protozoa.
  • the bacterium to be inhibited through the use of an efflux pump inhibitor can be from other bacterial groups or species, such as one of the following: Pseudomonas aeruginosa, Pseudomonas fluorescens, Pseudomonas acidovorans, Pseudomonas alcaligenes, Pseudomonas putida, Stenotrophomonas maltophilia,
  • Salmonella enteritidis Shigella dysenteriae, Shigella flexneri, Shigella sonnei, Enterobacter cloacae, Enterobacter aerogenes, Klebsiella pneumoniae, Klebsiella oxytoca, Serratia marcescens, Francisella tularensis, Morganella morganii, Proteus mirabilis, Proteus vulgaris, Providencia alcalifaciens, Providencia rettgeri, Providencia stuartii, Acinetobacter calcoaceticus, Acinetobacter haemolyticus, Yersinia enter ocolitica, Yersiniapestis, Yersinia pseudotuberculosis, Yersinia intermedia, Bordetella pertussis, Bordetella parapertussis, Bordetella bronchiseptica, Haemophilus in ⁇ uenzae, Haemophilus parain ⁇ uenzae
  • the term "efflux pump” refers to a protein assembly which exports substrate molecules from the cytoplasm or periplasm of a cell, in an energy dependent fashion.
  • an efflux pump will typically be located in the cytoplasmic membrane of the cell (spanning the cytoplasmic membrane). In Gram-negative bacteria the pump may span the periplasmic space and there may also be portion of the efflux pump which spans the outer membrane.
  • Certain efflux pumps will include a polypeptide which has at least 50% amino acid sequence similarity with a polypeptide which is part of the Pseudomonas aeruginosa mexA/mexB/oprM efflux pump or the efflux pump overexpressed by P. aeruginosa Strain K385, or the efflux pump overexpressed by P. aeruginosa Strain PAO4098E. Due to the described sequence similarity of a component polypeptide of the efflux pump, such an efflux pump is termed a Pseudomonas aeruginosa-type efflux pump.
  • non-tetracycline-specific efflux pump refers to an efflux pump which is not highly specific for tetracycline (relative to other antibiotics) and thus is not a tetracycline (tetracycline-specific) efflux pump.
  • the term thus includes broad substrate pumps (efflux a number of compounds with varying structural characteristics) and pumps which are highly specific for compounds (including antibiotics) other than tetracyclines.
  • Tetracycline efflux pumps are involved in specific resistance to tetracycline in bacteria.
  • TetA- E tetracycline resistance determinants contain a structural gene, tet A, which is a tetracycline specific pump, and a repressor gene, tetR, that mediates inducible resistance to tetracyclines.
  • Tetracycline efflux pumps belonging to this group are designated tetA(A), tetA(B), tetA ), and tet-4(E), and are found in
  • TetK and TetL are pumps involved in tetracycline resistance in Gram-positive bacteria.
  • the genes are regulated via translational attenuation and are not homologous to tetA group.
  • an "efflux pump inhibitor” is a compound which specifically interferes with the ability of an efflux pump to export its normal substrate, or other compounds such as an antibiotic.
  • the inhibitor may have intrinsic antimicrobial (e.g., antibacterial) activity of its own, but at least a significant portion of the relevant activity is due to the efflux pump inhibiting activity.
  • compounds which inhibit the export or activity of efflux pumps which have a broad substrate range which includes antibacterial agents.
  • non-tetracycline- specific efflux pump inhibitor refers to an efflux pump inhibitor which inhibits a non-tetracycline-specific efflux pump.
  • Pseudomonas aeruginosa-type efflux pump inhibitor refers to an efflux pump inhibitor which inhibits a Pseudomonas aeruginosa-type efflux pump.
  • a 'Pseudomonas aeruginosa efflux pump inhibitor is an efflux pump inhibitor which inhibits the export activity of an efflux pump found in Pseudomonas aeruginosa.
  • comprising it is meant including, but not limited to, whatever follows the word “comprising”. Thus, use of the term “comprising” indicates that the listed elements are required or mandatory, but that other elements are optional and may or may not be present.
  • this invention provides a method for treating a microbial infection, e.g., a bacterial infection, in an animal by administering to an animal suffering from such an infection an efflux pump inhibitor as described above, e.g., by generic stracture descriptions of Structures 1, and Types A,B,C,D,E,F and G structures, in an amount sufficient to reduce efflux pump activity in a microbe involved in the infection.
  • a microbial infection e.g., a bacterial infection
  • a microbe is "involved" in an infection if the presence of the microbe causes the infection, at least in part, or contributes to the course of the infection, or causes or contributes to the symptoms or physiological effects caused in the host animal by the infection.
  • the microbe need not be the only or even principal microbe present at an infection site.
  • the inhibitor is one which decreases the pathogenicity of the microbe.
  • a decrease in pathogenicity can be obtained, for example, by interfering with bacterial iron acquisition by inhibiting the transport of siderophores.
  • the pathogenicity may also be reduced by reducing or eliminating the microbial products which cause tissue-damaging effects to the host. Other methods of reducing pathogenicity are, however, also within this aspect.
  • the animal may be, for example, chickens and turkeys, and in certain preferred embodiments is a mammal, e.g., a human.
  • the microbial infection may be due to bacteria, which may, for example, be any of the bacterial species indicated above, but specifically including Pseudomonas aeruginosa.
  • this invention provides a method of treating an animal suffering from a microbial infection by administering to the animal an efflux pump inhibitor as described above in an amount sufficient to reduce efflux pump activity.
  • the efflux pump inhibitor in one which reduces the in vivo viability of a microbe involved in the infection.
  • the infected animal can more readily clear its body of the infection, or the microbes may even be killed.
  • the animal is a mammal.
  • the microbe may be from one of a variety of pathogenic bacterial species, specifically including those listed above.
  • in vivo viability refers to the ability of a microbe, e.g., a bacterium, to survive or grow in a host, such as an animal. Therefore, an efflux pump inhibitor which reduces the in vivo viability of a microbe may stop the growth of the microbe and/or kill the microbe. Such efflux pump inhibitors , therefore are antimicrobial agents.
  • this invention includes a method for prophylactic treatment of an animal, e.g., a mammal.
  • an efflux pump inhibitor which reduces the pathogenicity of a microbe is administered to a mammal at risk of a microbial infection, e.g. , a bacterial infection.
  • the invention provides a method for treating a microbial infection in an animal, specifically including in a mammal, by treating an animal suffering from such an infection with an antimicrobial agent in conjunction with an efflux pump inhibitor which increase the susceptibility of the microbe for that antimicrobial agent.
  • an antimicrobial agent in conjunction with an efflux pump inhibitor which increase the susceptibility of the microbe for that antimicrobial agent.
  • a microbe involved in the infection can be treated using the antimicrobial agent in smaller quantities, or can be treated with an antimicrobial agent which is not therapeutically effective when used in the absence 53 of the efflux pump inhibitor.
  • this method of treatment is especially appropriate for the treatment of infections involving microbial strains which are difficult to treat using an antimicrobial agent alone due to a need for high dosage levels (which can cause undesirable side effects), or due to lack of any clinically effective antimicrobial agents.
  • an antimicrobial agent is used
  • the antimicrobial agent and the efflux pump inhibitor can be administered to an animal jointly, or either can be administered before the other, but sufficiently closely in time so that the efflux pump inhibitor can inhibit a target efflux pump during a time period when the extracellular concentration of the antimicrobial agent is at or above the level required to inhibit a relevant microbe in the presence of efflux pump inhibition.
  • the antimicrobial agent and the efflux pump inibitor are administered such that the second compound administered is administered within 10% of the serum half-life of the first administered compound.
  • the antimicrobial agent is a compound which is effluxed by efflux pumps in microbes involved in the infection.
  • the microbe is a fungus, where the term fungus is as generally understood by those skilled in the art.
  • the microbe is a bacterium, which may, for example, be from any of the groups or species indicated above.
  • various antibacterial agents can be used. These include quinolones, 54 tetracyclines, glycopeptides, aminoglycosides, ⁇ -lactams, rifamycins, coumermycins, macrolides, oxazolidinones, and chloramphenicol.
  • an antibiotic of the above classes can be, for example, one of the following: ⁇ -Lactam Antibiotics imipenem, meropenem, biapenem, cefaclor, cefadroxil, cefamandole, cefatrizine, cefazedone, cefazolin, cefixime, cefmenoxime, cefodizime, cefonicid, cefoperazone, ceforanide, cefotaxime, cefotiam, cefpimizole, cefpiramide, cefpodoxime, cefsulodin, ceftazidime, cefteram, ceftezole, ceftibuten, ceftizoxime, ceftriaxone, cefuroxime, cefuzonam, cephaacetrile, cephalexin, cephaloglycin, cephaloridine, cephalothin, cephapirin, cephradine, cefmetazole, cefoxitin, ce
  • Tetracyclines chlortetracycline, demeclocycline, doxycycline, lymecycline, methacycline, minocycline, oxytetracycline, tetracycline Aminoglycosides amikacin, arbekacin, butirosin, dibekacin, fortimicins, gentamicin, kanamycin, meomycin, netilmicin, ribostamycin, sisomicin, spectinomycin, streptomycin, tobramycin, clindamycin, lincomycin Oxazolidinones Linezolid(U- 100766), eperezolide(U-l 00592).
  • this invention includes a method for prophylactic treatment of a mammal.
  • an antimicrobial agent and an efflux pump inhibitor is administered to a mammal at risk of a microbial infection, e.g., a bacterial infection or a fungal infection.
  • Preferred embodiments include those as described above, for example, embodiments including various bacteria and antimicrobial agents as described.
  • susceptibility refers to the sensitivity of the microbe for the presence of the antimicrobial agent. So, to increase the susceptibility means that the microbe will be inhibited by a lower concentration of the antimicrobial agent in the medium surrounding the microbial cells. This is equivalent to saying that the microbe is more sensitive to the antimicrobial agent. In most cases the minimum inhibitory concentration (MIC) of that antimicrobial agent will have been reduced.
  • MIC minimum inhibitory concentration
  • treating refers to administering a pharmaceutical composition for prophylactic and/or therapeutic purposes.
  • prophylactic treatment refers to treating a patient who is not yet infected, but who is susceptible to, or otherwise at risk of, a particular infection.
  • therapeutic treatment refers to administering treatment to a patient already suffering from an infection.
  • treating is the administration to a mammal (either for therapeutic or prophylactic purposes) of therapeutically effective amounts of a potentiator and an antibacterial (or antimicrobial) agent in combination (either simultaneously or serially).
  • a therapeutically effective amount or “pharmaceutically effective amount” is meant an amount of an efflux pump inhibitor, or amounts individually of an efflux pump inhibitor and an antimicrobial agent, as disclosed for this invention, which have a therapeutic effect, which generally refers to the inhibition to some extent of the normal metabolism of microbial cells causing or contributing to a microbial infection.
  • the doses of efflux pump inhibitor and antimicrobial agent which are useful in combination as a treatment are therapeutically effective amounts.
  • a therapeutically effective amount means those amounts of efflux pump inhibitor and antimicrobial agent which, when used in combination, produce the desired therapeutic effect as judged by clinical trial results and/or model animal infection studies.
  • the efflux pump inhibitor and antimicrobial agent are combined in pre-determined proportions and thus a therapeutically effective amount would be an amount of the combination.
  • This amount and the amount of the efflux pump inhibitor and antimicrobial agent individually can be routinely determined by one of skill in the art, and will vary, depending on several factors, such as the particular microbial strain involved and the particular efflux pump inhibitor and antimicrobial agent used. This amount can further depend upon the patient's height, weight, sex, age and medical history.
  • a therapeutically effective amount is that amount which would be effective if a microbial infection existed.
  • a therapeutic effect relieves, to some extent, one or more of the symptoms of the infection, and includes curing an infection. "Curing" means that the symptoms of active infection are eliminated, including the elimination of excessive members of viable microbe of those involved in the infection. However, certain long-term or permanent effects of the infection may exist even after a cure is obtained (such as extensive tissue damage).
  • microbial infection refers to the invasion of the host mammal by pathogenic microbes. This includes the excessive growth of microbes which are normally present in or on the body of a mammal. More generally, a microbial infection can be any situation in which the presence of a microbial population(s) is damaging to a host mammal. Thus, a mammal is "suffering" from a microbial infection when excessive numbers of a microbial population are present in or on a mammal's body, or when the effects of the presence of a microbial population(s) is damaging the cells or 57 other tissue of a mammal. Specifically, this description applies to a bacterial infection.
  • administration refers to a method of giving a dosage of an antimicrobial pharmaceutical composition to a mammal, where the method is, e.g., topical, oral, intravenous, intraperitoneal, or intramuscular.
  • the preferred method of administration can vary depending on various factors, e.g. , the components of the pharmaceutical composition, the site of the potential or actual bacterial infection, the microbe involved, and the severity of an actual microbial infection.
  • this invention also features a method of inhibiting a membrane channel in a cellular membrane, involving contacting the membrane channel with a membrane channel inhibitor, where the inhibitor reduces the effluxing capacity of the membrane channel.
  • a membrane channel inhibitor e.g., a polypeptide of the membrane channel has at least 50% amino acid sequence similarity with a polypeptide of the mexA/mexB/oprM efflux pump, or of the efflux pump overexpressed by Pseudomonas aeruginosa Strain K385.
  • membrane channel refers to a protein assembly located in the cellular membrane of a cell which allows the transport of one or more types of molecules across the membrane. Such transport may be either passive transport in response to concentration gradients, or may be active transport which depends upon a cellular energy source.
  • a “membrane channel inhibitor” then is, similar to an efflux pump inhibitor, a compound which slows or prevents the transport of molecules across the cellular membrane using the corresponding membrane channel.
  • This invention also features a method of enhancing the antimicrobial activity of an antimicrobial agent against a microbe, in which such a microbe is contacted with an efflux pump inhibitor, e.g., a non-tetracycline specific efflux pump inhibitor, to an efflux pump in the cell, and an antibacterial agent.
  • an efflux pump inhibitor e.g., a non-tetracycline specific efflux pump inhibitor
  • this method makes an antimicrobial agent more effective against a cell which expresses an efflux pump when the cell is treated with the combination of an antimicrobial agent and a non-tetracycline-specific efflux pump inhibitor.
  • the microbe is a bacterium or a fungus, such as 58 any of those indicated above; the antimicrobial agent is as described above; and an antibacterial agent is selected from a number of structural classes of antibiotics including, e.g., ⁇ -lactams, glycopeptides, aminoglycosides, quinolones, tetracyclines, rifamycins, coumermycins, macrolides, oxazolidinones, and chloramphenicol.
  • an antibiotic of the above classes can be a compound as stated above.
  • this invention provides pharmaceutical compositions effective for treatment of an infection of an animal, e.g., a mammal, by a microbe, such as a bacterium or a fungus.
  • the composition includes a pharmaceutically acceptable carrier and an efflux pump inhibitor as described above.
  • efflux pump inhibitors which are themselves effective antimicrobial agents, even in the absence of another antimicrobial agent (i.e., have intrinsic antimicrobial activity).
  • pharmaceutical compositions including such efflux pump inhibitors can be used either alone or in conjunction with another antimicrobial agent.
  • the efflux pump inhibitors in pharmaceutical compositions of this aspect are efflux pump inhibitors which enhance the effectiveness of an antimicrobial agent other than the efflux pump inhibitor, so such compositions would generally be used in combination with such other antimicrobial agent.
  • the invention also provides pharmaceutical compositions similarly effective for treatment of an infection of a mammal which include an efflux pump inhibitor and an antimicrobial agent, e.g., an antibacterial agent or an antifungal agent.
  • the invention provides antimicrobial formulations which include an antimicrobial agent, an efflux pump inhibitor, and a carrier.
  • the antimicrobial agent is an antimicrobial agent or an antibacterial agent as described above.
  • a “carrier” or “excipient” is a compound or material used to facilitate administration of the compound, for example, to increase the solubility of the compound.
  • Solid carriers include, e.g., starch, lactose, dicalcium phosphate, sucrose, and kaolin.
  • Liquid carriers include, e.g., sterile water, saline, buffers, non-ionic surfactants, and edible oils such as oil, peanut and sesame oils.
  • various adjuvants such as are commonly used in the art may be included.
  • the invention provides a method of suppressing growth of a microbe, e.g., a bacterium, expressing an efflux pump, e.g., a non-tetracycline- specific efflux pump.
  • a microbe e.g., a bacterium
  • an efflux pump e.g., a non-tetracycline- specific efflux pump.
  • the method involves contacting that bacterium with an efflux pump inhibitor as described above, e.g., a non-tetracycline-specific efflux pump inhibitor, in the presence of a concentration of antibacterial agent below the MIC of the bacterium (or other microbe).
  • an efflux pump inhibitor as described above, e.g., a non-tetracycline-specific efflux pump inhibitor
  • This method is useful, for example, to prevent or cure contamination of a cell culture by a bacterium possessing an efflux pump.
  • the invention provides a method for reducing a population of a microbial, e.g., a bacterial strain, involving contacting the population with an efflux pump inhibitor which inhibits a component of an efflux pump expressed in the microbe in that population, which is essential for the growth of the microbe expressing that efflux pump.
  • an efflux pump inhibitor which inhibits a component of an efflux pump expressed in the microbe in that population, which is essential for the growth of the microbe expressing that efflux pump.
  • that component is a cytoplasmic membrane component.
  • efflux pump inhibitors may act in various ways, including, but not limited to, acting directly on the essential component, or acting to inhibit the expression of that component.
  • the microbe or bacterium is as described above.
  • an "essential component" of an efflux pump is one which is essential to the in vivo survival of the microbe, i.e., the survival in a host.
  • this invention provides a method for enhancing growth of an animal by administering an efflux pump inhibitor to the animal, which inhibits an efflux pump expressed in a bacterial strain in the animal, and which inhibits the growth of that bacterial strain.
  • an efflux pump inhibitor to the animal, which inhibits an efflux pump expressed in a bacterial strain in the animal, and which inhibits the growth of that bacterial strain.
  • Such a growth enhancing effect may result from the reduced 60 energy consumption by the bacteria, which increases the food energy available to the animal.
  • This method is appropriate, for example, for use with cattle, swine, and fowl such as chickens and turkeys.
  • the invention provides novel compounds having efflux pump activity. These compounds have chemical structures as described above.
  • the screening method based on inhibition of microbial growth in the presence of a subinhibitory concentration of an antibacterial agent which is normally effluxed by the test microbe and a concentration of a test compound was used for indentifying some of the active compounds disclosed herein.
  • inhibition of growth of the microbe is indicative that export of the antibacterial agent is inhibited by the test compound, and that the test compound is therefore an efflux pump inhibitor.
  • the mode of action of the test compound so identified can then be comfirmed as inhibiting active efflux.
  • other screening methods for detecting efflux pump inhibitors can also be used, specifically including the additional methods described in the above references.
  • the test organism used is Pseudomonas aeruginosa PAM1001.
  • the compounds of this invention demonstrate pump inhibitory activity against a broad range of P. aeruginosa over-producing singular efflux pumps (MexAB, MexCD, and MexEF) and clinical strains containing multiple efflux pumps, not limited to the Mex classification.
  • the compounds tabulated below are representative of the described invention.
  • Stock solution can be 62 stored at -80°C. Quinolones are solubilized according to the instructions of the manufacturers, at a concentration of 1 mg/ml. They are then further diluted in MHB. Stock solution can be stored at -80°C.
  • the checkerboard assay is performed in microtiter plates. Levofloxacin is diluted in the x axis, each column containing a single concentration of levofloxacin. The EPI is diluted in the y axis, each row containing an equal concentration of EPI. The result of these manipulations is that each well of the microtiter plate contains a unique combination of concentrations of the two agents. Each of the EPIs are tested independently. The assay is performed in MHB with a final bacterial inoculum of 5 x 10 s
  • Microtiter plates are incubated during 20 h at 35°C and are read using a microtiterplate reader (Molecular Devices) at 650 nm as well as visual observation using a microtiterplate reading minor.
  • the MIC is defined as the lowest concentration of quinolone, within the combination, at which the visible growth of the organism is completely inhibited.
  • EPI Cone Compound EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone.
  • EPI Cone Compound EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone.
  • EPI Cone Compound EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone.
  • EPI Cone Compound EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone.
  • EPI Cone EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. 0 ⁇ g/ml 0.625 ⁇ g/ml 1.25 ⁇ g/ml 2.5 ⁇ g/ml 5 ⁇ g/ml 10 ⁇ g/ml 20 ⁇ g/ml 40 ⁇ g/ml
  • EPI Cone Compound EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone.
  • EPI Cone EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. 0 ⁇ g/ml 0.625 ⁇ g/ml 1.25 ⁇ g/ml 2.5 ⁇ g/ml 5 ⁇ g/ml 10 ⁇ g/ml 20 ⁇ g/ml 40 ⁇ g/ml
  • EPI Cone EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone. EPI Cone.
  • Inhibitors of the bacterial efflux pumps are generally initially characterized in vitro. Those which show effective inhibition of the pump(s) and which show synergistic activity with antibiotics are selected for evaluation in vivo. Efficacy testing can be done using standard procedures. Primary efficacy evaluation may be done using the murine septicemia model (M.G. Bergeron, 1978, Scand. J. Infect. Dis. Suppl. 14:189-206; S.D. Davis, 1975, Antimicrob. Agents Chemother. 8:50-53). In this model a supra-lethal dose of bacteria is used to challenge the rodents. Treatment is initiated, varying either or both time(s) of treatment and dose of antibiotic. In these experiments both the antibiotic and the efflux pump inhibitor doses are varied. A positive result is indicated by significant increase in protection from the lethal infection by the combination of the potentiator (the efflux pump inhibitor) and the antibiotic versus the antibiotic alone.
  • the efflux pump inhibitor the efflux pump inhibitor
  • mice are infected with an appropriate titer of bacteria in the muscle of the hind thigh.
  • Mice are either neutropenic (cyclophosphamide treated at 125 mg/kg on days -4,-2, and 0) or immunocompetent.
  • the infecting dose is commonly lO O 6 colony forming units per animal. Treatment with the combination of the efflux pump inhibitor and/or antibiotics follows infection, or can occur before infection.
  • the proliferation (or death) of the bacteria within the thigh muscle is monitored over time. Effective combinations show greater activity than the antibiotic alone. Activity is defined as reduction in growth rate of the test bacteria in the murine tissue.
  • Another model useful for assessing the effectiveness of the efflux pump inhibitors is the diffusion chamber model (Malouin et al., 1990, Infect. Immun. 58:1247-1253; Day et al., J. Infect. 2:39-51; Kelly et al., 1989, Infect. Immun. 57:344-350).
  • rodents have a diffusion chamber surgically placed in their peritoneal cavity.
  • the chamber can consist of a polypropylene cylinder with semipermeable membranes covering the cylinder ends.
  • Diffusion of peritoneal fluid into and out of the chamber provides nutrients for the microbes.
  • the proliferation of the bacteria in the presence and absence of the antibiotic/efflux pump inhibitor is compared to the antibiotic alone. Dose ranging of the combination and the antibiotic alone are done to assess effectiveness of the antimicrobial and combinations.
  • a tertiary model useful as a stringent test of the efflux pump inhibitor/antibiotic combination is the endocarditis model (J. Santoro and M.E. Levinson, 1978, Infect. Immun. 19:915-918). Either rats or rabbits are effectively used in this model. The effectiveness of combinations of efflux inhibitor and antibiotic are compared to antibiotic alone. The end point is usually viable cells remaining in the cardiac vegetations at the end of treatment.
  • infection models are not limiting. As understood by those skilled in the art, other models can be utilized as appropriate for a specific infecting microbe. In particular, cell-based infection models may be used in some circumstances instead of animal models.
  • the particular compound that is an efflux pump inhibitor can be administered to a patient either by itself, or in combination with an antimicrobial, e.g., antibacterial, agent, or in pharmaceutical compositions where it is mixed with suitable carriers or excipient(s).
  • a combination of an efflux pump inhibitor with an antimicrobial agent can be of at least two different types. In one, a quantity of an efflux pump inhibitor is combined with a quantity of an antimicrobial agent in a mixture, e.g. , in a solution or powder mixture. In such mixtures, the relative quantities of the inhibitor and the antimicrobial agent may be varied as appropriate for the specific combination and expected treatment.
  • an inhibitor and an antimicrobial agent can be covalently linked in such manner that the linked molecule can be cleaved within the cell.
  • the term "in combination” can also refer to other possibilities, including serial administration of an inhibitor and another antimicrobial agent.
  • an efflux pump inhibitor and/or another antimicrobial agent may be administered in pro-drug forms, i.e. the compound is administered in a form which is modified within the cell to produce the functional form.
  • a therapeutically effective amount of an agent or agents such as these is administered.
  • a therapeutically effective dose refers to that amount of the compound(s) that results in amelioration of symptoms or a prolongation of survival in a patient, and may include elimination of a microbial infection. Toxicity and therapeutic efficacy of such compounds can be determined by standard pharmaceutical procedures in cell cultures or experimental animals, e.g., for determining the LD 50 (the dose lethal to 50% of the population) and the ED 50 (the dose therapeutically effective in 50% of the population). The dose ratio between toxic and therapeutic effects is the therapeutic index and it can be expressed as the ratio LD 50 /ED 50 . Compounds which exhibit large therapeutic indices are preferred. The data obtained from these cell culture assays and animal studies can be used in formulating a range of dosage for use in human.
  • the dosage of such compounds lies preferably within a range of circulating concentrations that include the ED 50 with little or no toxicity.
  • the dosage may vary within this range depending upon the dosage form employed and the route of administration utilized.
  • the therapeutic serum concentration of an efflux pump inhibitor should be in the range of 0.1-100 ⁇ g/ml., more preferably 0.1-50 ⁇ g/ml.; 0.1-20 ⁇ g/ml.; 1.0-50 ⁇ g/ml.; or 1.0-20 ⁇ g/ml.
  • the therapeutically effective dose can be estimated initially from cell culture assays.
  • a dose can be formulated in animal models to achieve a circulating plasma concentration range that includes the IC 50 as determined in cell culture. Such information can be used to more accurately determine useful doses in humans. Levels in plasma may be measured, for example, by HPLC.
  • the efflux inhibitor in a pharmaceutical composition has a structure as shown by the generic structures described above.
  • the exact formulation, route of administration and dosage can be chosen by the individual physician in view of the patient's condition. (See e.g. Fingl et al., in THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, 1975, Ch. 1 p.l). It should be noted that the attending physician would know how to and when to terminate, interrupt, or adjust administration due to toxicity, or to organ dysfunctions. Conversely, the attending physician would also know to adjust treatment to higher levels if the clinical response were not adequate (precluding toxicity). The severity of the condition may, for example, be evaluated, in part, by standard prognostic evaluation methods. Further, the dose and perhaps dose frequency, will also vary according to the age, body weight, and response of the individual patient. A program comparable to that discussed above may be used in veterinary medicine.
  • Suitable routes may include oral, rectal, transdermal, vaginal, transmucosal, or intestinal administration; parenteral delivery, including intramuscular, subcutaneous, intramedullary injections, as well as intrathecal, direct intraventricular, intravenous, intraperitoneal, intranasal, or intraocular injections, just to name a few.
  • the agents of the invention may be formulated in aqueous solutions, preferably in physiologically compatible buffers such as Hanks's solution, Ringer's solution, or physiological saline buffer.
  • physiologically compatible buffers such as Hanks's solution, Ringer's solution, or physiological saline buffer.
  • penetrants appropriate to the barrier to be permeated are used in the formulation.
  • penetrants are generally known in the art.
  • Use of pharmaceutically acceptable carriers to formulate the compounds herein disclosed for the practice of the invention into dosages suitable for systemic administration is within the scope of the invention.
  • the compositions of the present invention in particular, those formulated as solutions, may be administered parenterally, such as by intravenous injection.
  • the compounds can be formulated readily using pharmaceutically acceptable carriers well known in the art, into dosages suitable for oral administration.
  • Such carriers enable the compounds of the invention to be formulated as tablets, pills, capsules, liquids, gels, syrups, slurries, suspensions and the like, for oral ingestion by a patient to be treated.
  • Pharmaceutical compositions suitable for use in the present invention include compositions wherein the active ingredients are contained in an effective amount to achieve its intended purpose. Determination of the effective amounts is well within the capability of those skilled in the art, especially in light of the detailed disclosure provided herein.
  • these pharmaceutical compositions may contain suitable pharmaceutically acceptable carriers including excipients and auxiliaries which facilitate processing of the active compounds into preparations which can be used pharmaceutically.
  • the preparations formulated for oral administration may be in the form of tablets, dragees, capsules, or solutions.
  • the pharmaceutical compositions of the present invention may be manufactured in a manner that is itself known, e.g., by means of conventional mixing, dissolving, granulating, dragee-making, levitating, emulsifying, encapsulating, entrapping or lyophilizing processes.
  • Pharmaceutical formulations for parenteral administration include aqueous solutions of the active compounds in water-soluble form. Additionally, suspensions of the active compounds may be prepared as appropriate oily injection suspensions.
  • Suitable lipophilic solvents or vehicles include fatty oils such as sesame oil, or synthetic fatty acid esters, such as ethyl oleate or triglycerides, or liposomes.
  • Aqueous injection suspensions may contain substances which increase the viscosity of the suspension, such as sodium carboxymethyl cellulose, sorbitol, or dextran.
  • the suspension may also contain suitable stabilizers or agents which increase the solubility of the compounds to allow for the preparation of highly concentrated solutions.
  • Pharmaceutical preparations for oral use can be obtained by combining the active compounds with solid excipient, optionally grinding a resulting mixture, and processing the mixture of granules, after adding suitable auxiliaries, if desired, to obtain tablets or dragee cores.
  • Suitable excipients are, in particular, fillers such as sugars, including lactose, sucrose, mannitol, or sorbitol; cellulose preparations such as, for example, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methyl cellulose, hydroxypropylmethyl-cellulose, sodium carboxymethylcellulose, and/or polyvinylpyrrolidone (PNP).
  • disintegrating agents may be added, such as the cross-linked polyvinyl pyrrolidone, agar, or alginic acid or a salt thereof such as sodium alginate.
  • Dragee cores are provided with suitable coatings.
  • concentrated sugar solutions may be used, which may optionally contain gum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, and/or titanium dioxide, lacquer solutions, and suitable organic solvents or solvent mixeries.
  • Dyestuffs or pigments may be added to the tablets or dragee coatings for identification or to characterize different combinations of active compound doses.
  • compositions which can be used orally include push-fit capsules made of gelatin, as well as soft, sealed capsules made of gelatin and a plasticizer, such as glycerol or sorbitol.
  • the push-fit capsules can contain the active ingredients in admixture with filler such as lactose, binders such as starches, and/or lubricants such as talc or magnesium stearate and, optionally, stabilizers.
  • the active compounds may be dissolved or suspended in suitable liquids, such as fatty oils, liquid paraffin, or liquid polyethylene glycols.
  • stabilizers may be added.
  • the compounds of the present invention may be readily prepared in accordance with the following synthesis schemes, as illustrated in the specific examples provided. However, those skilled in the art will recognize that other synthetic pathways for forming the compounds of this invention can be utilized, and that the following is provided merely by way of example, and is not limiting to the present invention. It will be further recognized that various protecting and deprotecting strategies will be employed which are standard in the art (see, e.g., "Protective Groups in Organic Synthesis” by Greene and Wuts). Those skilled in the arts will recognize that the selection of any particular protecting group (e.g., amine and carboxyl protecting groups) will depend on the stability of the protected moiety with regard to the subsequent reaction conditions and will understand the appropriate selections. Further illustrating the knowledge of those skilled in the art is the following sampling of the extensive chemical literature:
  • the starting material (10 mg) is dissolved in trifluoroacetic acid (1 ml) and stirred 1 hr, and then concentrated in vacuo.
  • the crude material is loaded onto a reverse phase preparative HPLC.
  • Typical HPLC conditions 1 cm X 22 cm Amberchrom; 2 ml /min flow.
  • the fractions are concentrated to remove acetonitrile, then lyophilized.
  • Example 1 Alanyl-Phenylalanyl-Arginine 2-Naphthylamide Trifluoroacetate
  • Phe- Arg ⁇ -naphthylamide dihydrochloride 25 mg
  • dusopropylethylamine 8 ⁇ l
  • Boc-alanine N-hydroxysuccinimide ester 14 mg
  • dimethylacet- amide 0.5 ml
  • N-Boc-phenylalanine N-hydroxysuccinimide ester (1.3 g, 3.6 mmol) was dissolved in dimethylformamide (15 mL) and N ⁇ -Boc-ornithine (0.88 g, 3.8 mmol) was added in one portion. The solution was kept at 70 °C for 1 hr, cooled to 25°C, filtered to clarify and concentrated in vacuo. The residue was dissolved in ethyl acetate and washed with water.
  • the organic layer was washed with water (2 x 20 mL), IN hydrochloric acid (2 x 10 mL), saturated sodium bicarbonate (2 x 10 mL) and brine.
  • the organic layer was dried over anhydrous sodium sulfate, filtered and the filtrate adsorbed onto 100 mg of silica gel and applied to a column prepacked with silica gel.
  • Example 5 - ⁇ -N-(Phenethyl)alanine Methyl Ester
  • a mixture of methyl acrylate (2.0 g), phenethylamine (3.1 g), anhydrous methanol (100 ml), and glacial acetic acid (100 mg) was stirred at 25°C for 14 hr, concentrated in vacuo and the resultant oil adsorbed onto silica gel (5 g) and applied to a column prepacked with silica gel.
  • Example 11 - ⁇ -N-(Cyclopropylmethyl)alanine Methyl Ester This was similarly prepared, as described in Example 5, except the starting materials are methyl acrylate and cyclopropylmethylamine.
  • Example 19 D-Ornithyl- ⁇ -N-(Cyclohexyl-methyl)alanine 2-Naphthylamide Trifluoroacetate This was similarly prepared, as described in Example 13, except the starting materials were ethyl ⁇ -N-(cyclohexylmethyl)alaninate, 2-aminonaphthalene, and N ⁇ ,N ⁇ -bis-Boc-D-ornithine.
  • Example 20 I A ⁇ yl- ⁇ -N-(is»-ButyI)alanme Quinoline-2-amide Trifluoroacetate
  • Example 25 D-Lysyl- ⁇ -N-(Ethylthioethyl)alanine 2-Naphthylamide Trifluoroacetate This was similarly prepared, as described in Example 13, except starting materials were methyl ⁇ -N-(ethylthioethyl)alaninate, 2-aminonaphalene and N ⁇ ,N ⁇ -bis-Boc-D- lysine, 100
  • Example 28 D-Ornithyl- ⁇ -N-(Cyclopropylmethyl)alanine Quinoline-2-amide Trifluoroacetate This was similarly prepared, as described in Example 13, except the starting materials were methyl ⁇ -N-(cyclopropylmethyl)alaninate, 2-aminoquinoline, and N ⁇ ,N-bis-Boc-D-ornithine,.
  • Example 31 Oraifl ⁇ yl- ⁇ -N-(3-Pheny-propyI)alanine 2-Naphthylamide Trifluoroacetate This was similarly prepared, as described in Example 13, except starting materials were methyl ⁇ -N-(3-phenylpropyl)alaninate, 2-aminonaphthalene, and N ⁇ ,N ⁇ -bis- 101
  • Example 32 Lysyl- ⁇ -N-(3,3-Dimethylbutyl)alanine Quinoline-3-amide Trifluoroacetate This was similarly prepared, as described in Example 13, except starting materials were methyl ⁇ -N-(3,3-dimethylbutyl)alaninate, 3-aminoquinoline, and N ⁇ ,N ⁇ -bis- Boc-lysine.

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Abstract

L'invention concerne des composés présentant une activité d'inhibiteur de pompe d'écoulement. L'invention concerne également des méthodes d'utilisation de ces composés inhibiteurs et des compositions pharmaceutiques renfermant de tels composés.
PCT/US1999/001422 1998-01-23 1999-01-22 Inhibiteurs de pompe d'ecoulement WO1999037667A1 (fr)

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US09/012,363 1998-01-23
US09/012,363 US6114310A (en) 1998-01-23 1998-01-23 Efflux pump inhibitors
US09/020,001 1998-02-04
US09/020,001 US6245746B1 (en) 1998-01-23 1998-02-04 Efflux pump inhibitors
US09/089,734 1998-06-03
US09/089,734 US6204279B1 (en) 1998-06-03 1998-06-03 Peptidomimetic efflux pump inhibitors

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Cited By (24)

* Cited by examiner, † Cited by third party
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US6346391B1 (en) 1999-07-22 2002-02-12 Trustees Of Tufts College Methods of reducing microbial resistance to drugs
WO2001098362A3 (fr) * 2000-06-16 2002-12-05 Hercules Inc Peptides modifies chimiquement, compositions et leur procede de production et d'utilisation
EP1227084A4 (fr) * 1999-10-28 2003-08-20 Essential Therapeutics Inc Inhibiteurs de la pompe par liberation de medicaments
WO2004062674A3 (fr) * 2003-01-07 2005-01-20 Paratek Pharm Innc Polyamines substituees inhibant les pompes a efflux des bacteries
WO2005113579A1 (fr) * 2004-05-21 2005-12-01 Mpex Pharmaceuticals, Inc. Inhibiteurs de pompe a ecoulement bacterien et procedes pour traiter des infections bacteriennes
US7056917B2 (en) * 2001-04-26 2006-06-06 Daiichi Pharmaceutical Co., Ltd. Drug efflux pump inhibitor
JP2006257090A (ja) * 2002-03-12 2006-09-28 Merck & Co Inc 置換アミド類
WO2005089738A3 (fr) * 2004-03-17 2007-08-23 Mpex Pharmaceuticals Inc Utilisation et administration d'inhibiteurs de pompe d'efflux de bacteries
WO2008019292A3 (fr) * 2006-08-04 2008-08-14 Univ Boston Compositions et procédés visant à potentialiser une activité antibiotique
EP1389463A4 (fr) * 2001-04-26 2008-09-17 Daiichi Seiyaku Co Medicament permettant d'inhiber une pompe d'elimination de medicament
US7585517B2 (en) 2003-09-18 2009-09-08 Macusight, Inc. Transscleral delivery
US7879795B2 (en) * 2004-05-21 2011-02-01 Mpex Pharmaceuticals, Inc. Enhancement of tigecycline potency using efflux pump inhibitors
US7994225B2 (en) 2004-03-17 2011-08-09 Rempex Pharmaceuticals, Inc. Bacterial efflux pump inhibitors for the treatment of ophthalmic and otic infections
US8163726B2 (en) 2002-09-18 2012-04-24 University Of Pennsylvania Method of inhibiting choroidal neovascularization
US8178490B2 (en) 2007-05-11 2012-05-15 Rempex Pharmaceuticals, Inc. Polybasic bacterial efflux pump inhibitors and therapeutic uses thereof
US8486960B2 (en) 2006-03-23 2013-07-16 Santen Pharmaceutical Co., Ltd. Formulations and methods for vascular permeability-related diseases or conditions
US8658667B2 (en) 2006-02-09 2014-02-25 Santen Pharmaceutical Co., Ltd. Stable formulations, and methods of their preparation and use
US8927005B2 (en) 2005-02-09 2015-01-06 Santen Pharmaceutical Co., Ltd. Liquid formulations for treatment of diseases or conditions
WO2015002230A1 (fr) 2013-07-03 2015-01-08 武田薬品工業株式会社 Composé amide
US9834520B2 (en) 2013-03-14 2017-12-05 Takeda Pharmaceutical Company Limited Heterocyclic compound
US10053468B2 (en) 2013-07-03 2018-08-21 Takeda Pharmaceutical Company Limited Heterocyclic compound
CN110511213A (zh) * 2018-05-22 2019-11-29 成都先导药物开发股份有限公司 一种免疫调节剂
EP3592736A1 (fr) * 2017-03-10 2020-01-15 Rutgers, the State University of New Jersey Dérivés d'indole utilisés en tant qu'inhibiteurs de pompe d'efflux
WO2021027722A1 (fr) * 2019-08-09 2021-02-18 成都先导药物开发股份有限公司 Immunomodulateur

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EP0078703A2 (fr) * 1981-11-02 1983-05-11 University Of Miami Dérivés marqués de pyroglu-l-phe-l-arg, substrates et méthodes d'essai pour kallikrein
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US7026136B2 (en) 1999-07-22 2006-04-11 Trustees Of Tufts College Methods of reducing microbial resistance to drugs
US6677133B2 (en) 1999-07-22 2004-01-13 Trustees Of Tufts College Methods of reducing microbial resistance to drugs
US6346391B1 (en) 1999-07-22 2002-02-12 Trustees Of Tufts College Methods of reducing microbial resistance to drugs
EP1227084A4 (fr) * 1999-10-28 2003-08-20 Essential Therapeutics Inc Inhibiteurs de la pompe par liberation de medicaments
EP1652839A3 (fr) * 1999-10-28 2006-07-05 Daiichi Pharmaceutical Co., Ltd. Inhibiteurs de la pompe par liberation de medicaments
WO2001098362A3 (fr) * 2000-06-16 2002-12-05 Hercules Inc Peptides modifies chimiquement, compositions et leur procede de production et d'utilisation
US6858581B2 (en) 2000-06-16 2005-02-22 Arizona State University Chemically-modified peptides, compositions, and methods of production and use
US7056917B2 (en) * 2001-04-26 2006-06-06 Daiichi Pharmaceutical Co., Ltd. Drug efflux pump inhibitor
EP1389463A4 (fr) * 2001-04-26 2008-09-17 Daiichi Seiyaku Co Medicament permettant d'inhiber une pompe d'elimination de medicament
JP2006257090A (ja) * 2002-03-12 2006-09-28 Merck & Co Inc 置換アミド類
US7550489B2 (en) 2002-03-12 2009-06-23 Merck & Co., Inc. Substituted pyridyoxy amides
US7816534B2 (en) 2002-03-12 2010-10-19 Merck Sharp & Dohme Corp. Substituted amides
US8618088B2 (en) 2002-09-18 2013-12-31 University Of Pennsylvania Methods of inhibiting choroidal neovascularization
US8163726B2 (en) 2002-09-18 2012-04-24 University Of Pennsylvania Method of inhibiting choroidal neovascularization
US7829543B2 (en) 2003-01-07 2010-11-09 Paratek Pharmaceuticals, Inc. Substituted polyamines as inhibitors of bacterial efflux pumps
WO2004062674A3 (fr) * 2003-01-07 2005-01-20 Paratek Pharm Innc Polyamines substituees inhibant les pompes a efflux des bacteries
US7585517B2 (en) 2003-09-18 2009-09-08 Macusight, Inc. Transscleral delivery
US7947741B2 (en) 2004-03-17 2011-05-24 Mpex Pharmaceuticals, Inc. Use and administration of bacterial efflux pump inhibitors
US7994225B2 (en) 2004-03-17 2011-08-09 Rempex Pharmaceuticals, Inc. Bacterial efflux pump inhibitors for the treatment of ophthalmic and otic infections
WO2005089738A3 (fr) * 2004-03-17 2007-08-23 Mpex Pharmaceuticals Inc Utilisation et administration d'inhibiteurs de pompe d'efflux de bacteries
WO2005113579A1 (fr) * 2004-05-21 2005-12-01 Mpex Pharmaceuticals, Inc. Inhibiteurs de pompe a ecoulement bacterien et procedes pour traiter des infections bacteriennes
US7893020B2 (en) 2004-05-21 2011-02-22 Mpex Pharmaceuticals, Inc. Bacterial efflux pump inhibitors and methods of treating bacterial infections
US7879795B2 (en) * 2004-05-21 2011-02-01 Mpex Pharmaceuticals, Inc. Enhancement of tigecycline potency using efflux pump inhibitors
US8927005B2 (en) 2005-02-09 2015-01-06 Santen Pharmaceutical Co., Ltd. Liquid formulations for treatment of diseases or conditions
US9381153B2 (en) 2005-02-09 2016-07-05 Santen Pharmaceutical Co., Ltd. Liquid formulations for treatment of diseases or conditions
US9387165B2 (en) 2005-02-09 2016-07-12 Santen Pharmaceutical Co., Ltd. Rapamycin formulations and methods of their use
US8658667B2 (en) 2006-02-09 2014-02-25 Santen Pharmaceutical Co., Ltd. Stable formulations, and methods of their preparation and use
US8486960B2 (en) 2006-03-23 2013-07-16 Santen Pharmaceutical Co., Ltd. Formulations and methods for vascular permeability-related diseases or conditions
US9452156B2 (en) 2006-03-23 2016-09-27 Santen Pharmaceutical Co., Ltd. Formulations and methods for vascular permeability-related diseases or conditions
WO2008019292A3 (fr) * 2006-08-04 2008-08-14 Univ Boston Compositions et procédés visant à potentialiser une activité antibiotique
US8178490B2 (en) 2007-05-11 2012-05-15 Rempex Pharmaceuticals, Inc. Polybasic bacterial efflux pump inhibitors and therapeutic uses thereof
US9834520B2 (en) 2013-03-14 2017-12-05 Takeda Pharmaceutical Company Limited Heterocyclic compound
WO2015002230A1 (fr) 2013-07-03 2015-01-08 武田薬品工業株式会社 Composé amide
US10053468B2 (en) 2013-07-03 2018-08-21 Takeda Pharmaceutical Company Limited Heterocyclic compound
US10472376B2 (en) 2013-07-03 2019-11-12 Takeda Pharmaceutical Company Limited Amide compound
US11053262B2 (en) 2013-07-03 2021-07-06 Takeda Pharmaceutical Company Limited Heterocyclic amide compounds having RORyT inhibitory action
US11851449B2 (en) 2013-07-03 2023-12-26 Takeda Pharmaceutical Company Limited Heterocyclic amide compounds having an RORvt inhibitory action
EP3592736A1 (fr) * 2017-03-10 2020-01-15 Rutgers, the State University of New Jersey Dérivés d'indole utilisés en tant qu'inhibiteurs de pompe d'efflux
CN110511213A (zh) * 2018-05-22 2019-11-29 成都先导药物开发股份有限公司 一种免疫调节剂
WO2021027722A1 (fr) * 2019-08-09 2021-02-18 成都先导药物开发股份有限公司 Immunomodulateur

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