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

Brem, Jurgen; Panduwawala, Tharindi; Hansen, Jon Ulf; Hewitt, Joanne; Liepins, Edgars; Donets, Pawel; Espina, Laura; Farley, Alistair J. M.; Shubin, Kirill; Campillos, Gonzalo Gomez; Kiuru, Paula; Shishodia, Shifali; Krahn, Daniel; Lesniak, Robert K.; Schm

NATURE CHEMISTRY
2021
VL / 14 - BP / - EP /
abstract
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.

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