Method of treatment
10875830 ยท 2020-12-29
Assignee
Inventors
Cpc classification
A61P31/00
HUMAN NECESSITIES
C07D207/44
CHEMISTRY; METALLURGY
A61K9/0073
HUMAN NECESSITIES
C07D207/333
CHEMISTRY; METALLURGY
A61K31/40
HUMAN NECESSITIES
International classification
A61K31/40
HUMAN NECESSITIES
C07D207/44
CHEMISTRY; METALLURGY
A61K31/4015
HUMAN NECESSITIES
C07D207/333
CHEMISTRY; METALLURGY
A61K9/00
HUMAN NECESSITIES
Abstract
Lactams for use in the treatment of respiratory tract infections, including chronic lung infections in patients having cystic fibrosis.
Claims
1. A method of treatment of cystic fibrosis in a subject comprising: administering to the subject an effective amount of a lactam of 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one.
Description
DETAILED DESCRIPTION
(1) The invention will now be described with reference to the following drawings in which: LB medium=Lysogeny broth ex. Sigma Aldrich UK. Lactam 131=4-phenyl-5-hydroxy-5-methyl-1H-pyrrol-2-one Lactam 258=4-(4-fluorophenyl)-5-hydroxy-5-methyl-1H-pyrrol-2-one Lactam 310=4-(4-fluorophenyl)-5-methylene-pyrrol-2-one Lactam 316=4-(4-bromophenyl)-5-hydroxy-5-methyl-1H-pyrrol-2-one Lactam 488=4-(4-chlorophenyl)-5-methylene-pyrrol-2-one Lactam 491=5-methylene-4-(p-tolyl)pyrrol-2-one
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PSEUDOMONAS AERUGINOSA
(16) Pseudomonas aeruginosa is a pathogen important in certain respiratory tract disorders and is associated with severe and often chronic infections in cystic fibrosis (CF) patients. There are a number of P. aeruginosa strains, including PA01, PA7, USBPP-PA14 and strain 2192. Except where indicated otherwise, a reference to P. aeruginosa is intended to refer to any and all strains.
(17) The methods described herein may be directed to treatment of respiratory tract infections in which P. aeruginosa is implicated. The P. aeruginosa may be a strain that produces AQs (alkylquinoline compounds). The P. aeruginosa may be a strain that produces one or both of PQS (Pseudomonas quinolone signal; 2-heptyl-3-hydroxy-4-(1H)-quinolone) and HHQ (4-hydroxy-2-heptylquinoline). The P. aeruginosa may be a strain belonging to one of the two major P. aeruginosa genomic groups (PAO1 and PA14).
(18) Cystic Fibrosis
(19) The methods described herein may be especially suitable for patients having cystic fibrosis. Accordingly, the method may be a method of treating a subject who has been diagnosed with cystic fibrosis. Cystic fibrosis is a genetic disorder inherited in an autosomal recessive manner. Sufferers have mutations in both copies of the CTFR gene (for the cystic fibrosis transmembrane conductance regulator (CFTR) protein) meaning that CFTR is not functional. The most common mutation is F508.
(20) As used herein, the terms cystic fibrosis sufferer and cystic fibrosis patient refer to a subject who has been medically diagnosed with cystic fibrosis and/or has mutations in copies of the CTFR gene.
(21) Quorum Sensing
(22) Quorum sensing (QS) is a mechanism whereby microorganisms, and in particular bacteria, communicate with each other and exhibit community-wide behaviour coordination through the secretion and detection of chemical signals called autoinducers (AIs). Quorum sensing has been demonstrated in a large number of bacteria species/strains and important in regulating bacterial virulence, drug resistance, expression of efflux transporters, and biofilm formation, and therefore is attracting attention in the antimicrobial field. (Frontiers in microbiology 6 (1036) September 2015).
(23) Quorum sensing is a cell-density based intercellular communication system to regulate collective behaviour, which plays a key role in regulation of bacterial virulence and biofilm formation. The process relies on the production, release and group-wide detection of signal molecules called autoinducing peptides (AlPs), which in gram-negative bacteria are typically homoserine lactones, (HSLs), especially N-acyl-homoserine lactones (AHLs). Other quorum sensing molecules are known, including epinephrine/norepinephrine.
(24) Biofilm formation enables the bacteria to resist antibiotics because once the bacteria sense that the outer layer of the biofilm is being destroyed, the inner layers will grow stronger to re-establish the community. The present invention is based on the inventors' investigation into the properties of certain lactams as described herein and their insight into the way in which said lactams influence QS in gram negative bacteria such as P. aeruginosa.
(25) The QS network of P. aeruginosa is organised in a multi-layered hierarchy consisting of at least four interconnected signalling mechanisms and demonstrates plasticity, in that it can respond to bacterial population changes and possibly also environmental stress cues. P. aeruginosa orchestrates biofilm formationand production of virulence factorsby reliance on two QS systems, both part of the Luxl/R signalling cascade, the Las and Rh1 systems.
(26) In Pseudomonas aeruginosa, the acyl-homoserine lactone (AHL) and alkyl quinolone (AQ) QS systems are important for virulence and biofilm formation. One acyl-HSL QS regulator is LasR. A non-AHL signalling molecule produced by P. aeruginosa is known as PQS (Pseudomonas quinolone signal), which is 2-heptyl-3-hydroxy-4-(1H)-quinolone.
(27) Biofilm
(28) The term biofilm as used herein refers to biological films that develop and persist at interfaces in aqueous environments, particularly in this case as foci of chronic infections and on medical implants used in the respiratory system. These biological films are composed of microorganisms embedded in organic gelatinous matrices composed of one or more matrix polymers that are secreted by the resident microorganisms. Biofilms can develop into macroscopic structures and are also capable of trapping nutrients and particulates that can contribute to their enhanced development and stability. Biofilms can also prevent penetration of antimicrobial agents, which may lead to persistent infections. Formation of biofilms provides bacteria with a protected environment such as within the lungs with can withstand various stresses, including many antibiotic treatments.
(29) Pharmaceutical Compositions
(30) The invention further provides pharmaceutical compositions comprising a lactam as described herein. It will be appreciated that the pharmaceutical composition will be formulated to be suitable for the intended route of administration. A pharmaceutical composition comprising a lactam of Formula I or II will typically include a pharmaceutically acceptable carrier and may optionally include other therapeutic ingredients.
(31) Typically, compositions as described herein may be ingested, inhaled or administered parenterally (via injection or infusion), although other administration routes including buccal, endosinusial, endotracheal, intrabronchial, and transtracheal are also envisaged. The compound may be administered locally or systemically.
(32) In some cases, the composition is formulated for oral administration and may be provided as a tablet, capsule, liquid or similar. In some cases, the composition is formulated for parenteral administration and may be presented in unit- or multi-dose containers such as sealed ampoules or vials, and/or may be stored in a lyophilized condition. In some cases, the composition is formulated for administration by insufflation and/or inhalation. For example, the composition may be provided via an inhaler or nebuliser, suitably a metered-dose inhaler or nebuliser. Accordingly, the composition may be formulated for administration as an aerosol, either a fine solid (for example micronized) particles or liquid droplets. A liquefied propellant may be used when the composition is presented as a suspension or solution formulation.
(33) Preferably the composition is formulated to provide an effective amount of the lactam. The term effective amount as used herein refers to an amount of the lactam at least sufficient to achieve a desired modulation of the activity or physiological property of a microbial population. The effective amount is determined, at least in part, upon the compound used, the microbial species present, the structure, system, or host, and the desired level of regulation. Modulating the activity or physiological property of the microbial population includes, but is not limited to, slowing, attenuating or inhibiting the growth of a microbial population and/or the colonization of a surface; causing a partial or total reduction in a microbial population; inhibiting the formation, development or growth of a biofilm, and partially or totally reducing the extent of a biofilm, and the like.
(34) For administration to human patients, it is expected that the daily dosage level of the lactams will be from 0.01 to 50 mg/kg, for example around 1 mg/kg. The physician in any event will determine the actual dosage most suitable for an individual patient, which will vary with the age, weight and response of the patient. The dose may be administered once, twice or three times per day, as appropriate.
(35) Methods of Treatment
(36) It will be appreciated that the term methods of treatment as used herein includes prophylaxis, treatment that hamper bacterial colony population growth, treatments that keep a bacterial colony population stable, and treatments that reduce or eradicate a bacterial population.
(37) The invention relates to methods of treatment for respiratory tract infections, in particular lower respiratory tract infections. These are commonly referred to as lung infections. The lactams described herein may be especially suitable for the treatment of chronic respiratory tract infections. These may also be referred to as lung disease. A chronic condition is characterised by long duration or frequent recurrence.
(38) Chronic bacterial respiratory tract infections present a particular problem in cystic fibrosis (CF) sufferers. Accordingly, the present invention is envisaged for the treatment of bacterial respiratory tract infections in patients that have been diagnosed with cystic fibrosis.
(39) The lungs of individuals with CF are colonized and infected by bacteria from an early age. In the initial stages, common bacteria such as Staphylococcus aureus and Haemophilus influenzae typically colonize and infect the lungs. Eventually, P. aeruginosa (and sometimes Burkholderia cepacia) dominates. By 18 years of age, it is estimated 80% of patients with classic CF harbor P. aeruginosa, and 3.5% harbor B. cepacia.
(40) These bacteria thrive in the altered mucus that is a symptom of CF, which collects in the small airways of the lungs, and adapt to the environment. P. aeruginosa in particular is known to form large colonies, known as mucoid P. aeruginosa, which are rarely seen in people that do not have CF. This includes biofilm formation. Over time, and with prolonged treatment, these colonies develop resistance to commonly used antibiotics, meaning that treatment regimens may need to be frequently altered. This problem is exacerbated as many people with CF are taking one or more antibiotics at all times (even when healthy to prophylactically suppress infection).
(41) Owing to their unusual biological profile, the lactams of Formula I and II may be useful in the long term treatment of respiratory tract infections associated with cystic fibrosis. This is because, owing to their selective interactions with the various bio-pathways of the bacteria, and in particular P. aeruginosa, the lactams may permit population control and reduction without triggering the mechanisms that are thought to lead to evolutionary resistance.
(42) In some cases, the bacterial infection is an infection in which Pseudomonas, (usually but not necessarily P. aeruginosa) is implicated.
(43) The methods described herein may be suitable for long term use. Accordingly, the methods may include regular administration of the lactam to a subject for a period of at least several weeks, several months, at least one year, at least two years, at least three years, at least 5 years, at least 8 years, or at least 10 years.
EXAMPLES
(44) To elucidate the mechanism of action of compounds described herein, the impact of each lactam on both N-acylhomoserine lactone (AHL) and 2-alkyl-4-quinolone-(AQ)-dependent quorum sensing (QS) in P. aeruginosa was explored.
(45) The expression of rhl and las AHL- and the pqsA AQ-synthase genes was evaluated using lux-based lasl (
(46) The P. aeruginosa PAO1-N tac::lux strain was used as a positive control biosensor as it constitutively expresses luxCDABE and hence light (
(47) The qualitative effect of compound 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) on pyocyanin production by PAO1-L was then investigated.
(48) Pyocyanin is a blue redox-active secondary metabolite and a putative signalling molecule in P. aeruginosa (Jayaseelan et al, 2014). The pyocyanin biosynthetic (phz) genes are regulated by QS and in part via the transcriptional regulator PqsR acting through PqsE (Rampioni et al 2011). Pyocyanin production was visually assessed after 8 h of incubation at 37 C. in P. aeruginosa strain PAO1-L in the presence and absence of compound 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488), which
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(50) The inhibition of pyocyanin production by lactam 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) was observed as the absence of green pigmentation in culture supernatant in vial 2 (
(51) The inhibitory properties of compounds of the invention on AQ-dependent QS in P. aeruginosa were then investigated.
(52) In P. aeruginosa, the pqsABCDE genes code for the biosynthetic pathway required for the synthesis and action of 2-alkyl-4(1H)-quinolones (AQs) (Heeb et al 2010). The transcriptional activator PqsR regulates the expression of the pqs biosynthetic pathway that in turn controls secondary metabolites such as elastase, pyocyanin and phospholipase as well as biofilm maturation and swarming motility. In this QS system, the primary AQ signal molecules are 4-hydroxy-2-heptylquinoline (HHQ) and 2-heptyl-3-hydroxy-4-quinolone (PQS) both of which act as co-inducers of PqsR (Heeb et al 2010; Ilangovan et al 2013).
(53) The results from the first screening experiments (
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(55) The mode of action on AQ-dependent QS was investigated.
(56) The major QS molecules in the pqs system are the AQs, PQS and its precursor HHQ (Williams & Camara 2009). Their biosynthesis requires the regulator PqsR and the biosynthetic proteins, PqsABCD and the mono-oxygenase, PqsH (Heeb et al 2010).
(57) The inhibitory action of 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) may involve inhibition of AQ biosynthesis or 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) may behave like an antagonist and block the PQS receptor, PqsR. These experiments do not discriminate between inhibition of PqsR activation and inhibition of AQ biosynthesis because the biosensor strain used maintains an intact AQ-dependent QS system. Experiments were therefore designed to determine the nature and degree of 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) inhibitory activity. Firstly, the possibility that 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) is an inhibitor of the response regulator protein, PqsR that is essential for expression of the pqsABCDE genes and hence AQ production was explored.
(58) By using the AQ-non producing P. aeruginosa strain PAO1-L pqsA, pqsA::lux, the EC.sub.50 value for the native PqsR agonist, PQS was calculated as 2 M (Ilangovan et al. 2013). In the presence of a fixed concentration of lactam 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) and a range of PQS concentrations, the EC.sub.50 value increased 15 fold to 31 M (
(59) The experiment shown in
(60) These data demonstrate the selective binding and competitive antagonist activity of 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488).
(61) A PAO1-L pqsA pqsA::lux biosensor-based assay was performed to determine whether lactam 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) exhibits any partial agonist activity at higher concentrations. A partial agonist is a molecule that can bind to and activate a receptor resulting in a non-complete response compared with a full agonist. Graphically, an antagonist that is also a partial agonist exhibits agonist activity at high concentrations.
(62) PQS is capable of weakly activating pqsA in the absence of PqsR via a mechanism that is not fully understood but appears to depend on the iron chelating properties of PQS. The aim of this experiment was to clarify whether lactam 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) is also inhibitory for pqsA expression via the PqsR independent pathway. As previously described, the pqsA::lux biosensor based on the triple mutant PAO1-N pqsAHR cannot produce AQs and lacks pqsR but still responds to exogenous PQS. This response is however much weaker that the PqsR-dependent response.
(63) Indeed for 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) the PQS pathway is the dominant inhibitory route. Taking into account the role of quorum sensing in toxicity and virulence of pseudomonas, then this technology is most effective against those strains capable of quorum sensing.
(64) To investigate the inhibitory effect of 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) on P. aeruginosa PA14, a pqsA::lux fusion was introduced onto the chromosome. Comparable inhibitory effects with those previously described for strain PAO1 were observed. The IC.sub.50 extrapolated from the inhibition curve in
(65) To determine whether 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) is capable of inhibiting the enzymes (PqsABCD) involved in AQ biosynthesis, the P. aeruginosa PAO1-N pqsAHR was exploited. This mutant cannot produce AQs because the genes coding for the key biosynthetic enzymes (PqsA and PqsH) and regulation (PqsR) have been deleted. To restore AQ production in a PqsR-independent manner in PAO1-N pqsA, the pqsABCD genes were introduced on a plasmid (pBBR pqsABCD; Niewerth et al. 2011). P. aeruginosa PAO1-N pqsAHR and P. aeruginosa PAO1-N pqsAHR pBBR pqsABCD were both incubated overnight in LB with and without 4-(4-chlorophenyl)-5-methylene-pyrrol-2-one (Ref. 488) (200 M), resuspended to an OD.sub.600 1.0. The cultures were extracted with acidified ethyl acetate, the organic phase removed, dried and resuspended in methanol subjected to thin layer chromatography (TLC).
(66) TABLE-US-00001 TABLE 1 1 PQS, 10 mM + HHQ, 10 mM, 2 l 2 488 10 mM, 5 l 3 PAO1-N pqsAHR organic extract, 10 l 4 PAO1-N pqsAHR + 488 200 M organic extract, 10 l 5 PAO1-N pqsAHR pBBR-pqsABCD organic extract, 10 l 6 PAO1-N pqsAHR pBBR-pqsABCD + 488 200 M organic extract, 10 l
(67) After chromatography using a dichloromethane-methanol mobile phase, the TLC plates were overlaid with a thin agar layer containing the AQ biosensor strain PAO1-L pqsA CTX::pqsA-luxCDABE (Fletcher et al. 2007) incubated and examined for reporter output (
(68) The biosensor revealed the presence of HHQ both in the samples of PAO1-N pqsAHR pBBR-pqsABCD without (
(69) Sources of Bacterial Strains
(70) The bacterial strains were obtained or made as follows:
(71) TABLE-US-00002 TABLE 2 Strain Antibiotic Source or reference Escherichia Coli: S17-1 pMiniCTX- Gentamycin 25 g/ml Diggle et al., 2007 pqsA::lux DH5 pBBRMCS- Gentamycin 25 g/ml Niewerth et al., 2011 5::pqsABCD Pseudomonas aeruginosa: PAO1-L Halloway collection PAO1-N Halloway collection PAO1-L pqsA This study PAO1-L pqsA, Gentamycin 25 g/ml This study pqsA::lux PAO1-N pqsA Aendekerk et al., 2005 PAO1-N pqsA, Tetracyclin 125 g/ml Diggle et al., 2007 pqsA::lux PAO1-N pqsAH Diggle et al., 2007 PAO1-N pqsAH, Gentamycin 25 g/ml Diggle et al., 2007 pqsA::lux PAO1-N pqsAHR Ilangovan at al., 2013 PAO1-N pqsAHR, Gentamycin 25 g/ml By applicant pqsA::lux PAO1-L pqsAHR, Gentamycin 25 g/ml By applicant pqsABCD PAO1-L rhll Dr. Matthew Fletcher PAO1-L lasl Dr. Matthew Fletcher PAO1-L pqsA::lux Gentamycin 25 g/ml By applicant PAO1-L las::lux Gentamycin 25 g/ml James Lazenby. Unpublished PAO1-L rhll::lux Gentamycin 25 g/ml James Lazenby. Unpublished PAO1-N tac::lux Tetracyclin 125 g/ml By applicant PA ATCC 15442 Unilever* PA ATCC 15442, Gentamycin 25 g/ml By applicant pqsA::lux PA14 Rahme et al., 1995 PA14, pqsA::lux Gentamycin 25 g/ml By applicant *accession no. AYUC00000000 on DDBJ/EMBL/GenBank
(72) Summary of Biological Activity
(73) The examples demonstrate that compounds of the invention have been shown to: inhibit alkylquinolone (AQ) dependent quorum sensing (QS) in P. aeruginosa. inhibit PqsR in representative strains belonging to the major P. aeruginosa genomic groups (PAO1 and PA14 respectively). interact antagonistically with the LysR-type regulator PqsR (in a competitive manner without partial-agonist activity). do not appear to directly inhibit AQ biosynthesis but block AQ synthesis by acting as a PqsR antagonist. potentially interact with the co-inducer binding domain of PqsR (PqsR.sup.CBD) acting an allosteric inhibitors.
(74) This provides an unusual biological profile that may enable compounds of the invention to be useful in the treatment of chronic respiratory tract disorders stemming from bacterial infection. In particular, the biological profile of the compounds of the invention offer utility in the treatment of chronic respiratory tract disorders experienced by cystic fibrosis patients. This is because the compounds of the invention have a biological activity profile that controls multiplication and biofilm formation, but does not trigger the bio-pathways that are associated with developing antibacterial resistance.
REFERENCES
(75) The references cited herein are incorporated by reference in their entirety for all purposes: Aendekerk S, Diggle S P, Song Z, Hiby N, Cornelis P, Williams P, Cmara M. The MexGHI-OpmD multidrug efflux pump controls growth, antibiotic susceptibility and virulence in Pseudomonas aeruginosa via 4-quinolone-dependent cell-to-cell communication. (2005) Microbiology 151(4) 1113-25. Barr H L, Halliday N, Cmara M, Barrett D A, Williams P, Forrester D L, Simms R, Smyth A R, Honeybourne D, Whitehouse J L, Nash E F, Dewar J, Clayton A, Knox A J, Fogarty A W. (2015) Pseudomonas aeruginosa quorum sensing molecules correlate with clinical status in cystic fibrosis. European Respiratory Journal 46 (4) 1046-1054. Fletcher M P, Diggle S P, Cmara M & Williams, P. (2007) Biosensor-based assays for PQS, HHQ and related 2-alkyl-4-quinolone quorum sensing signal molecules. Nature Protocols, 2, 1254-1262 doi:10.1038/nprot.2007.158. Fletcher M P, Diggle S P, Cmara M. and Williams P. (2007) Biosensor-based assays for PQS, HHQ and related 2-alkyl-4-quinolone quorum sensing signal molecules. Nature protocols, 2, 1254-62. Freschi et al. (2015) Clinical utilization of genomics data produced by the international Pseudomonas aeruginosa consortium. Frontiers in microbiology 6, Article 1036. Ilangovan A, Fletcher M, Ramioni G, Pustelny C, Rumbaugh K, Heeb S, Cmara M, Truman A, Chhabra S R, Emsley J & Williams P. (2013) Structural basis for native agonist and synthetic inhibitor recognition by the Pseudomonas aeruginosa quorum sensing regulator PqsR (MvfR). PLOS Pathogens 9(7):e1003508. Niewerth H, Bergander K, Chhabra S, Williams P, and Fetzner S. (2011) Synthesis and biotransformation of 2-alkyl-4(1H)-quinolones by recombinant Pseudomonas putida KT2440, Applied Microbiology and Biotechnology, 91, 1399-1408. Rahme L G, Stevens E J, Wolfort S F, Shao J, Tompkins R G, et al. (1995) Common virulence factors for bacterial pathogenicity in plants and animals. Science, 268: 1899-1902.