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(Ebook) New Developments in Medicinal Chemistry by Marta P. Ortega Irene C. Gil ISBN 9781617285462, 1617285463 Full Chapters Instanly

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New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
NEW DEVELOPMENTS IN
MEDICINAL CHEMISTRY

No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or
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Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
NEW DEVELOPMENTS IN
MEDICINAL CHEMISTRY

MARTA P. ORTEGA
AND
IRENE C. GIL
EDITORS
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

Nova Science Publishers, Inc.


New York

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
Copyright © 2009 by Nova Science Publishers, Inc.

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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

New developments in medicinal chemistry / [edited by] Marta P. Ortega and Irene C. Gil.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-61728-546-2 (E-Book)
1. Pharmaceutical chemistry. I. Ortega, Marta P. II. Gil, Irene C.
[DNLM: 1. Chemistry, Pharmaceutical. 2. Drug Design. QV 744 N5325 2009]
RS403.N48 2009
615'.19--dc22
2009006386

Published by Nova Science Publishers, Inc. Ô New York

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
CONTENTS

Preface vii
Chapter 1 Folate Biosynthesis – Reappraisal of Old and Novel Targets in the
Search for New Antimicrobials 1
James Swarbrick, Peter Iliades, Jamie S. Simpson and Ian
Macreadie
Chapter 2 Studies on Anti-Cancer Agents: Phenolic Compounds and Their
Pharmacological Activity 41
Maria Dolors Pujol and Isabel Sánchez
Chapter 3 Cytotoxic Anticancer Drugs from Medicinal Plants 65
Anh-Tho Nguyen and Pierre Duez
Chapter 4 Emerging Applications of Quantum Dots in Medicinal Chemistry
and Drug Development 81
Ian D. Tomlinson, Michael R. Warnement and Sandra J. Rosenthal
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

Chapter 5 Medicinal Chemistry of Copper and Vanadium Bioactive


Compounds 105
Susana B. Etcheverry and Patricia A.M. Williams
Chapter 6 Antimalarial Peroxides: From Artemisinin to Synthetic Peroxides 131
Jernej Iskra
Chapter 7 Chemical Ecology and Medicinal Chemistry of Marine NF-kB
Inhibitors 171
F. Folmer, M. Schumacher, M. Jaspars, M. Dicato and M.
Diederich
Chapter 8 Layered Double Hydroxides and their Intercalation Compounds in
Photo-chemistry and in Medicinal Chemistry 221
Umberto Costantino and Morena Nocchetti
Index 255

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
PREFACE

Medicinal or pharmaceutical chemistry is a scientific discipline at the intersection of


chemistry and pharmacology involved with designing, synthesizing and developing
pharmaceutical drugs. Medicinal chemistry involves the identification, synthesis and
development of new chemical entities suitable for therapeutic use. It also includes the study
of existing drugs, their biological properties, and their quantitative structure-activity
relationships (QSAR). Pharmaceutical chemistry is focused on quality aspects of medicines
and aims to assure fitness for the purpose of medicinal products. Medicinal chemistry is a
highly interdisciplinary science combining organic chemistry with biochemistry,
computational chemistry, pharmacology, pharmacognosy, molecular biology, statistics, and
physical chemistry. This new book presents leading research from around the world in this
frontal field.
Chapter 1 - Folate biosynthesis remains a key target for antimicrobial therapy. Folate is
an essential vitamin (vitamin B9) that is required for many one-carbon transfer reactions and
is a critical precursor for the biosynthesis of purines, pyrimidines, and amino acids. Unlike
higher eukaryotes that scavenge preformed folates, prokaryotic and lower eukaryotic
microorganisms are dependent on several enzymes for the de novo biosynthesis of folate. One
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

of these enzymes, dihydropteroate synthase (DHPS), is the target of the first chemically-
synthesized antimicrobial agents, the sulfadrugs, which date back to the 1940s. Others are
essential enzymes that remain to be explored as drug targets. Resistance to the sulfadrugs
rapidly emerges due to the ability of the microbe to alter its susceptibility to the drug by
various means. Recently a number of new structures of the enzymes in the pathway has
become available. We review the recent literature relating to these targets (the enzymes: 7,8-
dihydroneopterin aldolase (DHNA), 6-hydroxymethyl-7,8-dihydropterin pyrophosphokinase
(HPPK), dihydropteroate synthase (DHPS), dihydrofolate synthase (DHFS)), their mode of
action and how current drugs may modulate this on a structural level. Furthermore, these data
advance our understanding of the emergence of drug resistance and may aid efforts and play a
major role in the design of new, more effective compounds as antimicrobial agents. To this
end we also review the recent literature in the development of inhibitors of these enzymes.
Future progress in this key area has the potential to benefit the war against devastating
organisms such as drug-resistant Staphylococcus aureus and Plasmodium falciparum.
Chapter 2 - Polyphenols constitute the most abundant group of antioxidants of normal
human food (tea, red wine, grapes, olive oil, chocolate, broccoli, cherries, pomegranates,
peanuts, berries and other fruits or vegetables including Ginkgo biloba) that protect against

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
viii Marta P. Ortega and Irene C. Gil

oxidative stress and their associated pathologies such as inflammation, cancer and coronary
heart diseases. [1] The presence of phenol functions in their structures confers stability
against oxidation. Also the biological properties are related to the phenol groups and their
disposition in the structure. These compounds that occurs naturally in various food and
beverages of plant origin, were also named Vitamin P (more than 1500 compounds) and their
main beneficial biological effects are: [2, 3] a) The diminution of reactive oxygen species
related with the inflammation process, with the immune system by the recruitment of
leucocytes and the blood homeostasis. b) Inhibition of growth of several tumors. Thus,
following the American Cancer Society dietary guidelines [4] of "five or more pieces of fresh
fruit and vegetables per day" to help prevent cancer and anti-inflammatory diseases. Also
fruit and vegetable juices or tea might provide substances that help prevent cancer. c)
Reduction of inflammatory effects such as coronary diseases related to the oxidation of LDL
(light density lipoprotein). d) Treatment of skin aging in humans (Figure 1).
Chapter 3 - Although there have been large improvements in cancer treatment over the
last twenty years, the lack of cancer chemotherapeutic drugs is still a major cause of death in
this century. Medicinal plants play an important role in the treatment of cancer by offering
unique active drugs or their templates for clinical uses, as exemplified by paclitaxel (Taxol®),
vinca alkaloids (vincristine, vinblastine), and flavopiridol. The strategies for developing
anticancer agents from medicinal plants have changed in the last decade for a number of
reasons, including advances in technology, changes in the plant selection mode and biological
activity testing. This review reflects and discusses the newest methods applied for searching
anticancer agents from medicinal plants including plant selection and extraction, the active
principle isolation, structure elucidation and biological testing. This review reflects and
discusses the newest methods applied for searching anticancer agents from medicinal plants
including plant selection and extraction, the active principle isolation, structure elucidation
and biological testing.
Chapter 4 - Quantum dots have increasingly been incorporated into a wide variety of
biological assays as improved fluorescent probes. Their photophysical properties permit the
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

investigation of cellular processes and biological phenomena with unprecedented spatial


resolution and temporal longevity. Consequently, quantum dots are poised to facilitate
advances in future drug development applications. Multiplexed detection in whole cell assay
format may ultimately provide added insight into the extremely complex biochemical
mechanisms involved in drug receptor interactions. This article provides a detailed discussion
of biological applications which have incorporated quantum dot detection, with a particular
emphasis on their possible integration into drug discovery and medicinal chemistry
applications.
Chapter 5 - Transition metals play a fundamental role in different living systems. In
particular, in aerobic organisms, the presence of copper is essential for the function of many
enzymes related to cellular respiration, iron homeostasis, neurotransmitter production, peptide
biogenesis, connective tissue biosynthesis, and antioxidant defense. Copper compounds are
reported to act as antioxidant, anti-inflammatory, antimicrobial, antiparasitic, anticonvulsant
and antitumoral agents. In addition, in vertebrates, copper deficiency causes skeletal
alterations. Vanadium, another transition metal, is present in trace amounts in higher animals.
Even though its essentiality has not yet been clearly established, experimental results both in
vivo and in vitro suggest that vanadium compounds may participate in important biological
functions acting as insulinmimetic, osteogenic and antitumoral compounds. Once absorbed,

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
Preface ix

vanadium and copper are distributed among tissues and stored mainly in bone. In this chapter,
the behavior of these metal derivatives on bone-related cells in cultures is discussed in detail.
Two cellular lines, MC3T3E1 derived from mouse calvaria, and UMR106 from rat
osteosarcoma, have been used as a model for normal and tumoral bone processes. To expand
the studies on antineoplastic metal drug activity, experiments with copper and vanadium
compounds have been undertaken on two tumoral cell lines of human colon adenocarcinoma
(Caco-2 and TC7). Different copper complexes with pharmacologically active ligands such as
the antihypertensive drug losartan and a derivative of the antiparasitic santonin, santonic acid,
were synthesized and tested in vitro in the mentioned cell lines. Both complexes improve the
antitumoral effect of free copper ions. This behavior agreed with the morphological cellular
alterations. On the other hand, the biological effects of vanadyl(IV) complexes with the
flavonoids quercetin and hesperidin were discussed and compared with a vanadium(IV)
derivative of the structural related ligand, the disaccharide trehalose. In the tumoral cell lines
these compounds were deleterious. The effects on cellular differentiation (specific alkaline
phosphatase activity and collagen type I production) were also described for the osteosarcoma
cells. Moreover, for the complexes with quercetin and trehalose, the effect on the activation
of ERK (extracellular regulated kinase) cascade was investigated using specific antibodies in
order to identify one of the possible mechanisms of action. Altogether, these promising
results of a first stage in medicinal chemistry on metal-based drugs merit further investigation
in animal models.
Chapter 6 - Malaria remains on of the most prevalent and deadly of the insect-borne
communicable diseases. Since the parasite Plasmodium developed resistance to classical
drugs of quinine type, artemisinin-based peroxides have become the most important
antimalarial drugs. Various artemisinin derivatives have been developed to improve the
antimalarial performance, while insights into its mechanism of action reveal that the
pharmacophore unit in artemisinin is a peroxide group bound to the 1,2,4-trioxane skeleton.
However, it is not economical to synthesize artemisinin directly and currently, the global
demand for artemisinin cannot be met by the low yield obtained from the cultivation of herb
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

Artemisia annua. Therefore, current research focuses on the development of easily accessible,
cheap and effective antimalarial drugs based on synthetic peroxides. The main synthetic
analogues of artemisinin belong to a 1,2,4-trioxane type of organic peroxides, that together
with structurally related 1,2,4,5-tetraoxanes and 1,2,4-trioxolanes constitutes the core of
antimalarial synthetic peroxides, while various endoperoxides, cyclic and acyclic perketals
are also active antimalarial agents. Another interesting concept in antimalarial chemotherapy
are chimeric compounds or hybrids; these are composed of two different antimalarial agents
joined in one molecule. The following chapter discusses synthetic antimalarial peroxides with
an emphasis on the development of synthetic compounds from 2000 onwards.
Chapter 7 - NF-κB is an inducible transcription factor found in virtually all types of
vertebrate cells, as well as in some invertebrate cells. While normal activation of NF-κB is
required for cell survival and immunity, its deregulated expression is characteristic of cancer,
inflammation, and numerous other diseases. Hence, NF-κB has recently become one of the
major targets in drug discovery.
Several marine organisms use NF-κB (or analogues thereof), NF-κB inducers, or NF-κB
inhibitors as chemical defence mechanisms, for parasitic invasion, for symbiosis, or for larval
development. In particular, a wide range of marine natural products have been reported to

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
x Marta P. Ortega and Irene C. Gil

possess NF-κB inhibitory properties, and some of these marine metabolites are currently in
clinical trials as anticancer or anti-inflammatory drugs.
In the present review, we discuss the role of NF-κB inhibitors in marine chemical
ecology, as well as in biomedicine. We also describe synthetic modifications that have been
made to a range of highly promising marine NF-κB inhibitors, including the macrolide
bryostatin 1 isolated from the bryozoan Bugula neritina, the lactone-γ-lactam salinosporamide
A isolated from the actinomycete Salinispora tropica, the alkaloid hymenialdisine isolated
from various sponges, the sesquiterpenoid hydroquinone avarol isolated from the sponge
Dysidea avara, and the sesterterpene lactone cacospongonolide B isolated from the sponge
Fasciospongia cavernosa, to increase their bioactivity and bioavailability, to decrease their
level of toxicity or to lower the risk of other detrimental side-effects, and to increase the
sustainability of their pharmaceutical production by facilitating their chemical synthesis.
Chapter 8 - Many efforts have been made in the past few years to build up, into the
interlayer region of layered solids, supramolecular assemblies with special functionalities in
the field of photochemistry, electrochemistry, molecular recognition, chiral recognition and
catalysis.1-5 Furthermore, the interlayer region of layered solids is starting to be used as a
privileged reaction vessel to perform chemical reactions between the guest themselves
(polymerisation reactions) or between the guests and the host (topotactic and grafting
reactions).6 In addition, the interlayer region of a layered solid may be considered a micro-
container where guest species are stored, protected from oxidation or photolysis, and
withdrawn for use by a chemical signal, i. e., by a deintercalation process.4 Other interesting
reactions performed with layered solids are "exfoliation reactions", that consist of separating
the sheets of a layered compound into individual lamellae. This goal is reached with the aid of
specific intercalation or de-intercalation reactions and leads to colloidal dispersion of
lamellae. These dispersions can be used to obtain materials with a very high specific surface
area useful in catalysis or films and thin layers with applications ranging from optical coating
to microelectronics.7
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
In: New Developments in Medicinal Chemistry ISBN 978-1-60456-810-3
Editors: Marta P. Ortega and Irene C. Gil © 2009 Nova Science Publishers, Inc.

Chapter 1

FOLATE BIOSYNTHESIS – REAPPRAISAL OF OLD AND


NOVEL TARGETS IN THE SEARCH FOR NEW
ANTIMICROBIALS

James Swarbrick1∗, Peter Iliades2♦, Jamie S. Simpson1


and Ian Macreadie3•
1. Medicinal Chemistry and Drug Action,
Monash Institute of Pharmaceutical Sciences,
Monash University (Parkville Campus), Parkville, Victoria, Australia
2. The Walter and Eliza Hall Institute of Medical Research,
Parkville, Victoria, Australia
3. CSIRO Molecular and Health Technologies,
Parkville, Victoria, Australia
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

ABSTRACT
Folate biosynthesis remains a key target for antimicrobial therapy. Folate is an
essential vitamin (vitamin B9) that is required for many one-carbon transfer reactions and
is a critical precursor for the biosynthesis of purines, pyrimidines, and amino acids.
Unlike higher eukaryotes that scavenge preformed folates, prokaryotic and lower
eukaryotic microorganisms are dependent on several enzymes for the de novo
biosynthesis of folate. One of these enzymes, dihydropteroate synthase (DHPS), is the
target of the first chemically-synthesized antimicrobial agents, the sulfadrugs, which date
back to the 1940s. Others are essential enzymes that remain to be explored as drug
targets. Resistance to the sulfadrugs rapidly emerges due to the ability of the microbe to
alter its susceptibility to the drug by various means. Recently a number of new structures
of the enzymes in the pathway has become available. We review the recent literature
relating to these targets (the enzymes: 7,8-dihydroneopterin aldolase (DHNA), 6-

∗ 381 Royal Parade, Parkville, Victoria 3052, Australia.


♦ 1G Royal Parade, Parkville, Victoria 3050 Australia.
• 343 Royal Parade, Parkville, Victoria 3052 Australia.

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
2 James Swarbrick, Peter Iliades, Jamie S. Simpson et at.

hydroxymethyl-7,8-dihydropterin pyrophosphokinase (HPPK), dihydropteroate synthase


(DHPS), dihydrofolate synthase (DHFS)), their mode of action and how current drugs
may modulate this on a structural level. Furthermore, these data advance our
understanding of the emergence of drug resistance and may aid efforts and play a major
role in the design of new, more effective compounds as antimicrobial agents. To this end
we also review the recent literature in the development of inhibitors of these enzymes.
Future progress in this key area has the potential to benefit the war against devastating
organisms such as drug-resistant Staphylococcus aureus and Plasmodium falciparum.

ABBREVIATIONS
AMPCPP, ΑΒ-METHYLENEADENOSINE TRIPHOSPHATE;
DHNA, 7,8-DIHYDRONEOPTERIN ALDOLASE;
DHPS, DIHYDROPTEROATE SYNTHASE;
DHFR, DIHYDROFOLATE REDUCTASE;
DHFS, DIHYDROFOLATE SYNTHASE;
DHPP, 6-HYDROXYMETHYL-7,8-DIHYDROPTERIN-PYROPHOSPHATE;
FAS, FOLIC ACID SYNTHESIS;
FPGS, FOLYPOLYGLUTAMATE SYNTHASE;
GTP-CH, GTP CYCLOHYDROLASE;
HP, 6-HYDROXYMETHYL-7,8-DIHYDROPTERIN;
HPPK, 6-HYDROXYMETHYL-7,8-DIHYDROPTERIN PYROPHOSPHOKINASE;
PABA, P-AMINOBENZOIC ACID;
PCP, PNEUMOCYSTIS CARINII PNEUMONIA;
SMX, SULFAMETHOXAZOLE;
TMP, TRIMETHOPRIM;
TS, THYMIDYLATE SYNTHASE.
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

INTRODUCTION
Effective antimicrobials are essential for the maintenance of our 21st century lifestyle.
Without antimicrobials, death rates from simple and common infectious diseases would be
high, epidemics would be rampant and advances in surgery and immunosuppressive therapies
would amount to nil. Good targets for antimicrobials are essential enzymes (for the
microorganism) that are not present in the host organism. Furthermore, it is preferable that the
enzyme has a track record as a target for drugs and its properties are well documented. The
folate biosynthetic pathway fits the criteria of being an ideal target for antimicrobial therapy
and is the focus of this review.
Our review commences with a historical perspective of the clinical application of the
sulfadrugs that target folate synthesis to the inevitable rapid spread of antibiotic resistance in
several relevant pathogenic organisms. Understanding of resistance is explained at the
molecular and structural level of the folate biosynthesis pathway. An insight into the catalytic
mechanism and function is provided by virtue of a multitude of structures for all the relevant
enzymes often in many catalytic states. Therefore, we describe current strategies that tap into

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
Folate Biosynthesis – Reappraisal of Old and Novel Targets… 3

this structural data resource and review structural biology combined with medicinal
chemistry, assay technologies, modern structure-based approaches and methods for inhibitor
design. The folate biosynthesis pathway is shown to have considerable untapped potential to
be exploited for the rational design of new antibiotics that can slow the onset of resistance and
combat current resistance isolates that are threatening epidemics across the world.

HISTORICAL ASPECTS LEADING TO RESISTANCE


Drug pressure on the folate biosynthetic pathway to date has only occurred on DHPS so it
is not surprising that mutations in DHPS, DHPS gene duplication and the confounding effects
of DHPS metabolites, pABA or environmentally acquired folates, are the only clinically-
verified resistance modalities reported. From the very beginning, sulfonamides were used to
treat diverse infections and consequently, resistance has been observed in all circumstances.
Sulfanilamide (the active component of Prontosil – an azo sulfonamide dye) was
developed in 1932. Domagk demonstrated that it was capable of protecting mice from lethal
streptococcal infections, rabbits from staphlylococcal infections, and in one case, cured an
infant from a life-threatening infection. This work led to Domagk being awarded a Nobel
prize in 1939. Prontosil was successfully trialled for the treatment of malaria in 1937 (Hill
and Goodwin 1937) and thousands of sulfonamides / sulfones compounds, collectively called
sulfadrugs, have been synthesised and tested since.
The use of sulfonamide and sulfones as antifolates predates the demonstration of their
mode of action. As early as 1940 however, pABA was found to antagonize the bacteriostatic
action of sulfonamides (Woods 1940). Enzymes involved in bacterial folate biosynthesis were
identified in the 1960s as were the first resistance mechanisms. It was determined that
increased pABA and folic acid synthesis could lead to sulfonamide resistance in
Staphylococci (White and Woods 1965a, b).
Sulfonamides were found to act on the folate biosynthetic pathway as competitive (with
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

pABA) inhibitors of DHPS. Furthermore, the sulfonamides tested were more inhibitory in
cell-free enzymatic systems than as inhibitors of cell growth indicating limited cell
permeability (Brown 1962). One year later, E. coli mutants were selected that had mutant
enzymes that changed the cell’s permeability to sulfonamides (Pato and Brown 1963).
In the 1950s it became evident that the combination of sulfonamides and the 2,4
diaminopyrimidine class of compounds (later shown to be DHFR inhibitors) were more
effective than either drug alone to treat malaria patients infected with P. falciparum
(Greenberg and Richeson 1950; Hurly 1959). The use of sulfonamides as a monotherapy to
treat malaria infections was discontinued due to the low efficacy and high toxicity (Michel
1968; Rieckmann et al. 1968; Sheehy et al. 1967). In various studies in the 1960s,
combination therapy proved more efficacious than the traditional anti-malarial (chloroquine)
which they replaced owing to emerging parasite resistance (Chin et al. 1966; Chulay et al.
1984; Degowin and Powell 1964; Harinasuta et al. 1967; McGregor et al. 1963). However,
antifolate resistance to SP (Sulfadoxine / Pyrimethamine) emerged almost immediately
following its introduction in 1967 in Thailand (Peters 1987).
The dogma until recently was that sulfonamides exerted all their effects by competing
with pABA to deplete the intracellular folate-cofactor pool, thus starving the cell. The sulfa-

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
4 James Swarbrick, Peter Iliades, Jamie S. Simpson et at.

pterin analog diffused out of the cell and was no consequence to the growth of bacteria
exposed to it (Roland et al. 1979). However, later work by Patel and colleagues showed that
in Saccharomyces cerevisiae, the sulfa-containing folate analogs were growth inhibitory
(Patel et al. 2003b).

ANTIFOLATE DRUG RESISTANCE MECHANISMS


Numerous antifolate resistance mechanisms have been reported. Numerous reports have
described multiple amino acid mutations, amino acid insertions/duplications in DHPS that
confer drug resistance to sulfonamides from many organisms and some organism-specific
examples will be reviewed. In some cases, these mutant DHPS forms have been detected in
organisms where resistance has been acquired by horizontal transfer of resistance plasmids
(Fermer et al. 1995). Furthermore, DHPS resistance elements have remained long-lived even
when sulfonamide pressure has been withdrawn owing to drug pressure exerted by other
drugs (Enne et al. 2001). Gene amplification was demonstrated as a potential sulfonamide
drug resistance mechanism in model systems (Iliades et al. 2003; Nichols and Guay 1989)
and recently shown to be a clinically valid resistance mechanism by following chromosomal
amplification of genetic elements encoding DHPS in S. agalactieae (Brochet et al. 2007). The
competing effect of increased levels of the DHPS substrate pABA was shown to confound the
effects of sulfonamides (Woods 1940) both clinically and in model systems (Castelli et al.
2001) as was the acquisition of environmental folates (Carter et al. 2005; van Hensbroek et
al. 1995). Drug resistance mutations have long been known to confer a fitness compromise. It
has been shown in both model systems (Bouma and Lenski 1988; Iliades et al. 2004a; Schrag
et al. 1997) and clinically (Fermer et al. 1997) that compensatory mutations or adaptation
mechanisms are capable of facilitating enzymatic improvements or altered regulation of
metabolic pathways to counter the fitness compromise.
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

DISEASES TARGETED BY ANTIFOLATES


Sulfonamides have been used to treat a large number of fungal, bacterial and parasitic
infections including; Pneumocystis pneumonia, malaria, Pneumococcal pneumonia, urinary
tract infections, candidiasis, tuberculosis, leprosy, meningitis, toxoplasmosis and many
others. As with most antibiotics which function as anti-metabolites, resistance evolved rapidly
making these compounds of limited utility and consequently reducing man’s armoury of
effective antibiotic countermeasures.

Fungal Pathogens

Pneumocystis Jiroveci (Formerly Carinii)


Pneumocystis jiroveci is a major opportunistic pathogen that results in Pneumocystis
pneumonia (PCP) of AIDS patients and immunocompromised individuals. It accounts for
40% of all AIDS-defining conditions and is the major cause of mortality of children with

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
Folate Biosynthesis – Reappraisal of Old and Novel Targets… 5

AIDS in Africa (Ansari et al. 2003; Armstrong et al. 2000). Clinically, PCP has been treated
with antifolates including combination therapy with sulfamethoxazole (SMX) and
trimethoprim (TMP) as the preferred first-line treatment (Kovacs et al. 2001). In P. jiroveci,
however, there is some evidence to suggest that TMP is ineffective and that such treatment is
actually sulfamethoxazole monotherapy (Meshnick 1999; Walzer et al. 1992).
The widespread use of sulfamethoxazole-trimethoprim (SMX-TMP for prophylaxis
against P. jiroveci pneumonitis in HIV-infected patients) has been implicated as the cause of
the increase in SMX-TMP –resistant bacteria (Martin et al. 1999). Several studies have
demonstrated point mutations in the P. jiroveci DHPS gene and have found an association
between the use of sulfonamide or sulfone drugs for P. carinii prophylaxis and DHPS
mutations (Kazanjian et al. 1998; Mei et al. 1998) but not in the DHFR gene (Ma et al. 1999).
The failure of prophylaxis and treatment of PCP patients has been associated with
mutations in DHPS (similar to those that confer sulfa resistance in other organisms by a large
number of epidemiological studies) (Ansari et al. 2003; Armstrong et al. 2000; Demanche et
al. 2002; Helweg-Larsen et al. 1999; Kazanjian et al. 1998; Kovacs et al. 2001; Lane et al.
1997; Ma et al. 2002; Mei et al. 1998; Navin et al. 2001; Takahashi et al. 2000; Visconti et
al. 2001). However more direct evidence demonstrating that such mutations confer resistance
in P. jiroveci only recently emerged (Iliades et al. 2005a, b) using models systems.
In fungi, mutations involved in resistance to sulfonamides are shown in Table 1. It was
demonstrated that (i) mutants having the single amino acid substitution T557A were more
sensitive than the WT, (ii) mutants having two amino acid substitutions, T557A and P559S,
had increased sulfadrug resistance relative to the wild type (WT), and (iii) there was
cooperativity between individual mutations that led to the increased sulfadrug resistance of
the double mutants.
Importantly, in the model studies of P. jiroveci DHPS mutations, it was observed that mutants
having two amino acid substitutions were initially compromised for growth due to an
increased requirement for pABA. Prototrophs that could grow in the absence of pABA could
be isolated via continual passage on low pABA medium. These double mutants were found to
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

be capable of improved growth vigor and consequently increased sulfadrug resistance


indicating an adaptive response to the initial growth compromise presumably conferred by the
DHPS mutations. This suggested that the DHPS mutations resulted in decreased enzyme
activity thus reducing folate synthesis. The observed adaptation to low pABA medium
implicated pABA up-regulation with sulfamethoxazole resistance mutations. Thus increased
pABA synthesis probably reflects an adaptive response that compensates for the reduced
pABA binding affinity by the double amino acid substitutions at the catalytic site of DHPS.
Such an observation was similar to observations made by Schrag and Perrot who noted an
adaptive response that resulted in secondary mutations to compensate for the fitness
compromise conferred by the primary mutations that led to drug resistance (Schrag et al.
1997).

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
6 James Swarbrick, Peter Iliades, Jamie S. Simpson et at.

Table 1. Changes in P. jiroveci and S. cerevisiae DHPS that are associated with
sulfonamide resistance.

Allele name Amino acid position in DHNA-HPPK-DHPS


#557 in S. cerevisiae; #559 in S. cerevisiae;
#517 in P. jiroveci #519 in P. jiroveci
Wild Type T P
VRS V S
ARS A S
TRS T S
ARP A P
Numbering is from the first methionine of the primary translation product

Conclusive evidence that the DHPS mutations resulted in sulfadrug resistance emerged
following the cloning of the trifunctional P. jiroveci DHNA-HPPK-DHPS (Iliades et al.
2004b) genes and their heterologous complementation in a DHPS-disrupted E. coli host strain
(Iliades et al. 2004a). Site-directed mutagenesis of the P. jiroveci trifunctional DHNA-HPPK-
DHPS genes (Iliades et al. 2005b) to reverse engineer the mutations suspected by
epidemiological data to cause drug resistance provided an assay method that permitted a
direct assessment of sulfadrug resistance. Thus the mutations observed clinically (T517A and
P519S) in the PjFAS genes were found to result in a threefold increase in sulfamethoxazole
resistance relative to the wild type clone and furthermore conferred significant cross
resistance to a range of sulfadrugs.

Parasitic (Protozoan) Pathogens

Plasmodium Falciparum
Malaria is one of the primary causes of infant mortality in the developing world and is
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

caused largely by the protozoan parasite Plasmodium falciparum. It accounts for 80% of
malaria infections and 90% of deaths estimated to be between 1-3 million per year of the 500
million infections worldwide (Snow et al. 2005). The largest mortality and morbidity burden
is suffered in sub-Saharan Africa and in particular by infants. To date, malaria has been
targeted therapeutically and preventatively with numerous antimalarials including
chloroquine (quinines), artemisinin, atovaquone, doxycline and antifolates. All have led to
resistance and multiple drug resistance is common in many parts of the world where malaria
is endemic.
P. falciparum drug resistance has spread very rapidly after the introduction of
antimalarial therapeutic and prophylaxis measures in Asia, South America and Africa.
Mutations that cause antifolate resistance have been found in DNA sequences of DHPS
associated with resistance to sulfadoxine (Brooks et al. 1994; Reeder et al. 1996; Triglia et al.
1997; Wang et al. 1995; Wang et al. 1997). In DHPS the acquisition of multiple point
mutations (Table 2) has been shown to increase sulfonamide resistance (Berglez et al. 2004;
Triglia et al. 1997). The relative contribution of the mutations has been shown to be
predictive of treatment failure in particular combinations (Dorsey et al. 2004). For example,

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
Folate Biosynthesis – Reappraisal of Old and Novel Targets… 7

E540 was a strong predictor of treatment failure as was DHFR mutant R59 in combination
with DHPS E540.

Table 2. Changes in P. falciparum DHPS that are associated with sulfodoxine (SDX)
resistance. Numbering is from the first methionine of the primary translation product

Isolate SDX response Amino acid position


436 437 540 581 613
Wild-type Sensitive S A K A A
3D7 Resistant G G
TN-1 Resistant G G E
K1 Resistant G G G
W2 Resistant F G S
V1/S Resistant F G T

Alignments of P. falciparum DHPS with other DHPS enzymes indicate that changes that
result in sulfadrug resistance lie in regions that are close to the site of catalysis. It would
appear that changes involved in DHPS associated with sulfadrug resistance lead to reduced
affinity of the sulfadrug for DHPS.
Resistance to antifolates by eukaryotes can be further achieved via acquisition of
environmental (exogenous) folates via active folate-specific transporters (Wang et al. 2007;
Zhang et al. 1992). It has been demonstrated that antimalarial therapy using antifolates can be
significantly compromised by the concomitant dietary supplementation of folic acid (Carter et
al. 2005; van Hensbroek et al. 1995). In addition, increased expression levels of DHPS
increase or decrease sulfadrug resistance depending on whether pABA is high or low,
respectively (Iliades et al. 2003; Iliades et al. 2004a). pABA overexpression as a potential
mode alleviating the inhibitory action of sulfonamides has been demonstrated in vivo using a
S. cerevisiae model (Castelli et al. 2001). Drug resistant mutants to DHFR inhibitors (Pyr)
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

were found to be selected when the in vivo concentration fell below the effective therapeutic
concentration (Nzila et al. 2000; Watkins and Mosobo 1993).

Bacterial Pathogens

Escherichia Coli
Multi-drug resistance has eventuated as a particular problem for the treatment of urinary
tract infections. 25-80% of such infections were characterised as being multi-drug resistant by
1975 (Wise and Abou-Donia 1975). These resistant isolates showed sulfonamide resistance
with Minimum Inhibitory Concentration (MICs) 100-1000 fold higher than sensitive strains.
The resistance can be chromosomally encoded and include a single F28L mutation (Dallas et
al. 1992) or can be carried on horizontally transmissible R plasmids SulA, B, C, D (DHPS,
DHFS, GTP-CH and HPPK respectively]. These resistance plasmids have persisted
undiminished despite the prolonged withdrawal of selection pressure following formal
introduction of prescribing restrictions on co-trimoxazole, (Bean et al. 2005; Grape et al.
2003).

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
8 James Swarbrick, Peter Iliades, Jamie S. Simpson et at.

Neisseria Meningitidis
Neisseria meningitidis is a gram-negative diplococcal bacterium that infects and inflames
the protective membranes covering the central nervous system resulting in the rapid
progression from fever, headache and neck stiffness to coma and death in 10% of patients or
higher if left untreated.
The massive use of sulfonamides for both prevention and treatment of meningococcal
disease (Feldman 1986; Peltola 1983) led to the isolation of resistant strains of Neisseria
meningitidis as early as 1937 (Feldman 1966), only a couple of years after the discovery of
this class of drugs. Resistance has been shown to be mediated by altered forms of the
chromosomal dhps gene (Fermer et al. 1995; Raadstroem et al. 1992). As a result the World
Health Organisation now states “Although oral cotrimoxazole (trimethoprim sulfamethoxa-
zole) is inexpensive and has good CSF penetration, sulfa resistant strains have become
common and sulfadrugs are not recommended unless sulfa sensitivity testing has been done.
In unfavourable conditions, the drug of choice is oily chloramphenicol” (World Health
Organization and Control 2003).
Two DHPS mutations F31L and G194C were shown by MIC determinations to effect
resistance (Fermer et al. 1997) as well as Km and the Ki. A third mutation (P84S) did not
have any obvious effect on the resistance phenotype, however analysis of its enzyme kinetics
showed altered Km thus acting as a compensatory mutation for the first two mutations which
mediate sulfonamide resistance.

Streptococcus Pneumoniae
Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-haemolytic
diplococcus bacterium and is a significant human pathogen recognized as a major cause of
pneumonia worldwide. S. pneumoniae is the most common cause of acute respiratory
infections in adults and children which infects an estimated 2.6 million children under five
years of age annually. Pneumococcus causes over 1 million of these deaths, most of which
occur in developing countries, where pneumococcus is probably the most important pathogen
Copyright © 2009. Nova Science Publishers, Incorporated. All rights reserved.

of early infancy (World Health Organization 2003). Antifolates are no longer used, due to
resistance conferred by R plasmids encoding (i) plasmid borne SulA where a 2 amino acid
duplication in DHPS confers drug resistance (Akiba et al. 1960; Skold 1976; Swedberg and
Skoeld 1980; Watkins and Mosobo 1993) and (ii) plasmid borne TMP resistance (Fleming et
al. 1972; Pattishall et al. 1977; Then 1993).

Summary of Sulfadrug Resistance

Numerous drug resistance mechanisms have emerged in all cases where sulfonamides
have been used, and as is the case for all antibiotics this is not a new phenomenon. Resistance
has emerged due to overprescribing, ineffective use of synergistic compounds, poor patient
compliance with drug regime and the use of the drugs in the animal industry. Antifolates
however have proved to be successful (until the emergence of resistance) in treating a broad
range of infection thus validating the pathway as a source of important target. The folate
biosynthetic pathway has multiple unique enzymes to prokaryotes and lower eukaryotes that
recognize pterin-like molecules and as a result there could be potential for cross reactive

New Developments in Medicinal Chemistry, Nova Science Publishers, Incorporated, 2009. ProQuest Ebook Central,
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