Imitation of β-lactam binding enables broad-spectrum metallo-β-lactamase inhibitors

Carbapenems are vital antibiotics, but their efficacy is increasingly compromised by metallo-beta-lactamases (MBLs). Here we report the discovery and optimization of potent broad-spectrum MBL inhibitors. A high-throughput screen for NDM-1 inhibitors identified indole-2-carboxylates (InCs) as potential beta-lactamase stable beta-lactam mimics. Subsequent structure-activity relationship studies revealed InCs as a new class of potent MBL inhibitor, active against all MBL classes of major clinical relevance. Crystallographic studies revealed a binding mode of the InCs to MBLs that, in some regards, mimics that predicted for intact carbapenems, including with respect to maintenance of the Zn(II)-bound hydroxyl, and in other regards mimics binding observed in MBL-carbapenem product complexes. InCs restore carbapenem activity against multiple drug-resistant Gram-negative bacteria and have a low frequency of resistance. InCs also have a good in vivo safety profile, and when combined with meropenem show a strong in vivo efficacy in peritonitis and thigh mouse infection models.Peer reviewe

In vitro efficacy of Imipenem-Relebactam and Cefepime-AAI101 against a global collection of ESBL-positive and carbapenemase-producing Enterobacteriaceae

Objectives: In vitro evaluation of the potential clinical efficacy of the novel β-lactam/β-lactamase-inhibitor combinations including imipenem-relebactam (IPM-REL) and cefepime-AAI101 (enmetazobactam) (FEP-AAI) against contemporary multidrug-resistant Enterobacteriaceae. Methods: Agar-based MIC screening against MDR-Enterobacteriaceae (n=264) was used to evaluate the in vitro efficacy of IPM-REL and FEP-AAI, to compare the results with established combinations, and to investigate alternative β-lactam partners for REL and AAI. The inhibition activities of REL, AAI and the comparators avibactam (AVI) and tazobactam, against isolated recombinant β-lactamases covering representatives from all four Ambler classes of β-lactamases were tested using a fluorescence-based assay. Results: Using recombinant proteins, all four inhibitors were highly active against the tested class A serine β-lactamases (SBLs); REL and AVI showed moderate activity against the Class C AmpC from P. aeruginosa and the Class D OXA-10/-48 SBLs, but outperformed tazobactam and AAI. All tested inhibitors lacked activity against Class B MBLs. In the presence of REL, IPM, but not AAI susceptibility increased against KPC-positive and OXA-48-positive isolates. Both aztreonam-AVI and ceftolozane-tazobactam were more efficacious than IPM-REL. In all the tested combinations, AAI was a more effective inhibitor of class A β-lactamases (ESBLs) than the established inhibitors. Conclusions: The results lead to the proposal of alternative combination therapies involving REL and AAI to potentiate the use of β-lactams against clinical Gram-negative isolates expressing a variety of β-lactamases. These results highlight the potential of novel combinations for combating strains not covered by existing therapies.</p

In vitro efficacy of Imipenem-Relebactam and Cefepime-AAI101 against a global collection of ESBL-positive and carbapenemase-producing Enterobacteriaceae

Objectives: In vitro evaluation of the potential clinical efficacy of the novel β-lactam/β-lactamase-inhibitor combinations including imipenem-relebactam (IPM-REL) and cefepime-AAI101 (enmetazobactam) (FEP-AAI) against contemporary multidrug-resistant Enterobacteriaceae. Methods: Agar-based MIC screening against MDR-Enterobacteriaceae (n=264) was used to evaluate the in vitro efficacy of IPM-REL and FEP-AAI, to compare the results with established combinations, and to investigate alternative β-lactam partners for REL and AAI. The inhibition activities of REL, AAI and the comparators avibactam (AVI) and tazobactam, against isolated recombinant β-lactamases covering representatives from all four Ambler classes of β-lactamases were tested using a fluorescence-based assay. Results: Using recombinant proteins, all four inhibitors were highly active against the tested class A serine β-lactamases (SBLs); REL and AVI showed moderate activity against the Class C AmpC from P. aeruginosa and the Class D OXA-10/-48 SBLs, but outperformed tazobactam and AAI. All tested inhibitors lacked activity against Class B MBLs. In the presence of REL, IPM, but not AAI susceptibility increased against KPC-positive and OXA-48-positive isolates. Both aztreonam-AVI and ceftolozane-tazobactam were more efficacious than IPM-REL. In all the tested combinations, AAI was a more effective inhibitor of class A β-lactamases (ESBLs) than the established inhibitors. Conclusions: The results lead to the proposal of alternative combination therapies involving REL and AAI to potentiate the use of β-lactams against clinical Gram-negative isolates expressing a variety of β-lactamases. These results highlight the potential of novel combinations for combating strains not covered by existing therapies

The Implementation of Corporate Governance Principles in an Emerging Economy: a critique of the situation in Cyprus

When the Cyprus economy was booming in the 1990s, key issues emanating from sound corporate governance, such as accountability, transparency and effective independent boards were not deemed important. However, largely as a result of the Cyprus stock exchange collapse of 2000, this view changed. In September 2002, due to the collapse, the Cyprus Stock Exchange implemented a Corporate Governance Code predicated largely on Anglo-Saxon principles of corporate governance. Copyright (c) 2006 The Authors; Journal compilation (c) 2006 Blackwell Publishing Ltd.

In vitro efficacy of Imipenem-Relebactam and Cefepime-AAI101 against a global collection of ESBL-positive and carbapenemase-producing Enterobacteriaceae

Objectives: In vitro evaluation of the potential clinical efficacy of the novel β-lactam/β-lactamase-inhibitor combinations including imipenem-relebactam (IPM-REL) and cefepime-AAI101 (enmetazobactam) (FEP-AAI) against contemporary multidrug-resistant Enterobacteriaceae. Methods: Agar-based MIC screening against MDR-Enterobacteriaceae (n=264) was used to evaluate the in vitro efficacy of IPM-REL and FEP-AAI, to compare the results with established combinations, and to investigate alternative β-lactam partners for REL and AAI. The inhibition activities of REL, AAI and the comparators avibactam (AVI) and tazobactam, against isolated recombinant β-lactamases covering representatives from all four Ambler classes of β-lactamases were tested using a fluorescence-based assay. Results: Using recombinant proteins, all four inhibitors were highly active against the tested class A serine β-lactamases (SBLs); REL and AVI showed moderate activity against the Class C AmpC from P. aeruginosa and the Class D OXA-10/-48 SBLs, but outperformed tazobactam and AAI. All tested inhibitors lacked activity against Class B MBLs. In the presence of REL, IPM, but not AAI susceptibility increased against KPC-positive and OXA-48-positive isolates. Both aztreonam-AVI and ceftolozane-tazobactam were more efficacious than IPM-REL. In all the tested combinations, AAI was a more effective inhibitor of class A β-lactamases (ESBLs) than the established inhibitors. Conclusions: The results lead to the proposal of alternative combination therapies involving REL and AAI to potentiate the use of β-lactams against clinical Gram-negative isolates expressing a variety of β-lactamases. These results highlight the potential of novel combinations for combating strains not covered by existing therapies.</p

Wild rice growing at Camp A-Z in Chuckfee Bay, photo 1

The bicyclic boronate VNRX-5133 (taniborbactam) is a new type of β-lactamase inhibitor in clinical development. We report that VNRX-5133 inhibits serine-β-lactamases (SBLs) and some clinically important metallo-β-lactamases (MBLs), including NDM-1 and VIM-1/2. VNRX-5133 activity against IMP-1 and tested B2/B3 MBLs was lower/not observed. Crystallography reveals how VNRX-5133 binds to the class D SBL OXA-10 and MBL NDM-1. The crystallographic results highlight the ability of bicyclic boronates to inhibit SBLs and MBLs via binding of a tetrahedral (sp3) boron species. The structures imply conserved binding of the bicyclic core with SBLs/MBLs. With NDM-1, by crystallography, we observed an unanticipated VNRX-5133 binding mode involving cyclization of its acylamino oxygen onto the boron of the bicyclic core. Different side-chain binding modes for bicyclic boronates for SBLs and MBLs imply scope for side-chain optimization. The results further support the "high-energy-intermediate" analogue approach for broad-spectrum β-lactamase inhibitor development and highlight the ability of boron inhibitors to interchange between different hybridization states/binding modes