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Antibiotics
Joel GoodmanSTARS Minisymposium
March 6, 2006
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Outline
• The spectrum of infectious agents and theglobal problem of human infections
• Classification of bacteria• Intro to antibiotic classes, drug targets and
resistance• Three antibiotics in detail
– Sulfonamides– Penicillin– Streptomycin
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Statement by
Dr. David L. HeymannExecutive Director for Communicable Diseases
World Health Organization
Before the
Committee on International RelationsU.S. House of Representatives
29 June 2000
“The Urgency of a Massive EffortAgainst Infectious Diseases”
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World Health Organization - CDS
Most deaths among young people
in developing countries are caused
by just a few illnessesAges 0 - 44 in South-East Asia and Africa
measles
ARI
maternal &
perinatal
conditions
malaria
AIDS
TB
diarrhoea
other
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World Health Organization - CDS
Leading Infectious KillersMillions of deaths, worldwide
All ages, 1998 estimate
0
0.5
1
1.5
2
2.5
3
3.5
4
ARI AIDS Diarrhoeal
diseases
TB Malaria Measles
Over age five
Under age five
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World Health Organization - CDS
Projected changes in life expectancy in selectedAfrican countries with high HIV prevalence
1995–2000
Projected changes in life expectancy in selected Africancountries with high HIV prevalence, 1995–2000
Source: United Nations Population Division, 1996
1955 1960 1965 1970 1975 1980 1985 1990 1995 2000
Average life expectancy at birth, in years65
60
55
50
45
40
35
Zimbabwe
ZambiaUganda
Botswana
Malawi
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World Health Organization - CDS
Frequent FlyersMost Popular Air Routes Between Countries, 1997
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World Health Organization - CDS
Emerging, re-emerginginfectious diseases
1996 to 2000
Cryptosporidiosis
Lyme Borreliosis
Reston virus
Venezuelan
Equine Encephalitis
Dengue
haemhorrhagic
feverCholera
E.coli O157
West Nile Fever
Typhoid
Diphtheria
E.coli O157
EchinococcosisLassa fever
Yellow fever
Ebola
haemorrhagic
fever
O’nyong-
nyong fever
Human
Monkeypox
Cholera 0139
Dengue
haemhorrhagic
fever
Influenza
A(H5N1)
Cholera
RVF/VHF
nvCJD
Ross River
virus
Equine
morbillivirus
Hendra virus
BSE
Multidrug resistant
Salmonella
E.coli non-O157
West Nile Virus
Malaria
Nipah Virus
Reston Virus
Legionnaire’s Disease
Buruli ulcer
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World Health Organization - CDS
Defending national bordersA strong defense must include protecting
the population from microbial invaders
150 million deathsFrom AIDS, TB and
malaria since 1945
23 million deathsMilitary and civilian
from war 1945 -1993
$15 billionEstimated global spending
for prevention and control
of AIDS, TB and malaria,
1995
$864 billionGlobal military spending,
1995
DISEASE WAR
DEATHS
PREVENTION
BUDGET
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World Health Organization - CDS
The Discovery and Loss of Penicillin in
treating Staphylococcus aureus
1928 Penicillin discovered
1942
Penicillin introduced
1945
Fleming warns of
possible resistance
in bacteria
1946
14% hospital
strains resistant
195059% hospital
strains resistant
1960 - 1970
Resistance spreads
in communities
1980 - 1990
Resistance exceeds 80% in community
strains, 95% in hospital strains
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“The highlyunnatural journeyof No. 534, from
calf to steak”
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New YorkTimesMagazine,March 31,2002, p51
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New YorkTimesMagazine,March 31,2002, p51
“Tylosin is amacrolide,bacteriostaticantibiotic. It is similarin structure,mechanism of action,and spectrum as thatof erythromycin”www.kuddlykorner4u.com
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Drug Resistance ca. 2006• Half the time, prescriptions for antibiotics are
inappropriate. Antibiotic use promotes outgrowth ofresistant organisms!
• Antibiotics in cattle feeds account for ~ 50% of use;cross-resistance occurs. Antibiotics are ubiquitousin the environment.
• Until very recently, no classes of antimicrobial drugshave been developed since 1970. Big Pharma isreluctant to get involved! Resistance has developedto ALL these classes of antibiotics.
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Classes of Bacteria
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Classes of Bacteria• Gram stain distinguishes two classes
www.meddean.luc.edu/lumen/DeptWebs/microbio/med/gram/tech.htm
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Gram stain stains cell wall• Gram positive
bacteria haveexposed cell wall(peptidoglycan)
• Gram negativebacteria have anouter membranethat surrounds thecell wall http://pathmicro.med.sc.edu/fox/bact-mem.jpg
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Function of envelope
http://pathmicro.med.sc.edu/fox/bact-mem.jpg
http://textbookofbacteriology.net/structure.html
Maintains integrity of cytoplasmGenerates a proton gradient and ATP
Protects cells from toxic substancesKeeps important proteins concentrated in periplasm
OsmoprotectionMaintains cellshape
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Shapes of Bacteria
http://www.mansfield.ohio-state.edu/~sabedon/biol2010.htm
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StaphylococcusStreptococcus
B. anthracisListeria
N. gonorrheaeN. meningititis
E. coli, Klebsiella, Shigella,Salmonella, Proteus, V.choleriae
H. influenzae,P. aerugenosa
T. pallidumB. burgdorferi
Mycobacteria,Legionella
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How do you treat all thesebugs??
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Dawn of the Antibiotic Age
• 1870s - Robert Koch - discovered theanthrax bacterium.
• 1877 - Louis Pasteur - discovered thatcommon bacteria can prevent anthrax fromgrowing in culture.
• 1890s - Paul Ehrlich - chemicals can be“magic bullets”. Development of Salvarsan.
• 1908 - Paul Gelmo - textile azo dyes can killbacteria; led to sulfonamides in 1930s.
• 1928 - Alexander Fleming - discovery ofpenicillin. First patient cured in 1941.
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Sites of Drug Action (1)
Cell wall: Beta-lactams (Penicillins, Cephalosporins), Glycopeptides, Bacitracin
Plasma membrane: Daptomycin2
1
1 2
3 4 56
C1 transfer: Sulfonamides, Trimethoprim (Bactrim)3
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Sites of Action (2)
DNA synthesis: Fluoroquinolones (ex. Ciprofloxacin)
RNA synthesis: Rifampin, fluoroquinolones
Translation: Aminoglycosides (ex. streptomycin),Tetracyclines, Chloramphenicol, MLSK drugs, Linezolid,Streptogramins
6
5
4
0
1 2
3 4 56
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Sulfonamides
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~1940
http://www.us-israel.org/jsource/Holocaust/farben.html
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Prontosil
H2N N N
NH2
SO2NH2
GerhardDomagk
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Sulfanilamide, the active drug
H2N N N
NH2
SO2NH2
NH2 SO2NH2
H2N COOHPara-aminobenzoic acid(pABA)
Sulfanilamide
Prontosil
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Folic Acid
N
N
N
NH2N
OHHN
O
NH
COO-
CH2CH2COO-
pteridine
p-aminobenzoic acid glutamate
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Folic acid carries methyls for. .
• Purine biosynthesis– C2 and C8 carbons are delivered by THF
• Thymidylate synthesis– Catalyzed by thymidylate synthetase
• Amino acid synthesis– Serine (from glycine)– Methionine (from homocysteine)
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We can import folic acid.
Many bacteria cannot. . .They must synthesize it.
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Folate synthesis (bacteria)
H2
p
N COOH
ABA
dihydrofolate
glutamic acid
tetrahydrofolateDihydrofolate reductase (DHFR)
dihydropteridine- H COOH
dihydropteridine
N
Dihydropteroic Acid Synthase (DAS)
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Sulfonamides are CompetitiveInhibitors of DAS
H2N COOH
pABA
dihydropteridine-HN COOH
dihydrofolate
glutamic acid
tetrahydrofolate
dihydropteridine
Dihydrofolate reductase (DHFR)
Dihydropteroic Acid Synthase (DAS)
H2N SO2NHRSulfonamide
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Selective action of sulfa
• Mammals cannot make folic acid; theymust import it. We do not possessDAS, the drug target. Instead we havea folic acid transporter.
• Bacteria cannot import folic acid (notransporter); they must synthesize it.
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Sulfa facts
• Usually administered as a combinationof sulfamethoxazole and trimethoprim(Bactrim)
• Broad spectrum, but bacteriostatic• Usually safe, but many suffer GI
distress or rashes• Commonly used for urinary tract
infections
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Beta-lactams
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History
• Flemingdiscoveredpenicillin (1928)
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History
• Fleming discovered penicillin (1928)• Florey, Chain and Abraham isolated it
and determined structure (1940)• First cure in human (1941)• Critically important on the field in WWII• Park & Strominger deduced
mechanism (1965)
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Ernst Chain1906-1979
Dorothy Hodgkin1910-1994
Howard Walter Florey1898-1968
The Oxford Group
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Goodman and Gilman, 2nd ed. (1955)
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The biosynthesisof cell wallpeptidoglycan,showing the sitesof action of fiveantibiotics(shaded bars;1 = fosfomycin,2 = cycloserine,3 = bacitracin,4 = vancomycin,5 = β-lactamantibiotics).Bactoprenol (BP)is the lipidmembranecarrier thattransportsbuilding blocksacross thecytoplasmicmembrane; M =N-acetylmuramicacid; Glc =glucose; NAcGlcor G = N-acetylglucosamine.
Katzung, 9th ed.
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Green - first strandYellow, second strand
Lee et al., (2001) :PNAS98:1427
Grooves in carboxypeptidase/transpeptidase, complexed with Cephalosporin I
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Penicillin Structure
S
COOH
CONH
NO
amide
Lactam = cyclic amide
αβ
Hence, β lactam
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Classes of β-lactams
PenGAmpicillinTicarcillinPipericillin
CephalothinCefaclorCeftriaxoneCefepime
Imipenem Aztreonam
Monobactams
NO
Carbapenems
NO
Penicillins
NO
S
NO
S
Cephalosporins
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Penicillin and other beta-lactams
• Very active against gram positive organisms(MICs as low as 0.01 µg/ml)
• Inhibits crosslinking of the peptidoglycan• Releases autolysins -> cell death• Side effects: ALLERGY!!• Resistance: bacteria make beta lactamases,
which destroy penicillin
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Ribosome Binders• 30S binders
– Aminoglycosides– Tetracyclines
• 50S binders– MLSK family
• Macrolides• Lincosamides• Streptogramins• Ketolides
– Chloramphenicol• Linezolid (binds both subunits)
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René Dubos
Selman Waksman
Aminoglycosides
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Binding of streptomycin to 30S
Figure 5 Interaction of streptomycin with the 30S ribosomal subunit. a, Difference Fourier maps showing the binding site ofstreptomycin. Mutations in ribosomal protein S12 that confer resistance are shown in red. b, Chemical structure ofstreptomycin, showing interactions of the various groups with specific residues of the ribosome. c, The streptomycin-bindingsite, showing its interaction with H27, the 530 loop (H18), H44 and ribosomal protein S12. d, A view of the 30S showingstreptomycin in a space-filling model, and the surrounding RNA and protein elements
Carter et al. (2000) Nature 407:340
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Aminoglycosides
• Used for serious gram negative infections• Binds to ribosomes, inhibits protein synthesis
and causes misreading of mRNA• Resistance: Bugs synthesize transferases
that inactivate drugs• Toxic effects: Ototoxicity (hearing and
balance loss) and nephrotoxicity
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Mechanisms of resistance
• Drug inactivation– Penicillins, aminoglycosides
• Alteration of target sites– Beta-lactams, fluoroquinolones
• Decrease in accessibility– Tetracyclines
• Increase in competing metabolites– Sulfonamides