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Antimicrobial Agents and Chemotherapy, August 2003, p. 2526-2537, Vol. 47, No. 8
0066-4804/03/$08.00+0 DOI: 10.1128/AAC.47.8.2526-2537.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.
Paul J. Renick
,
Kelly M. Makin, David H. Ellis, Allison A. Kreiner, Min Li, Kirk J. Rupnik, Erica M. Kincaid,
Cynthia D. Wallace, Benoit Ledoussal, and Timothy W. Morris
*
Procter & Gamble Pharmaceuticals, Mason, Ohio 45040
Received 14 January 2003/ Returned for modification 26 February 2003/ Accepted 2 May 2003
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An improved definition of the quinolone binding pocket within the topoisomerase-DNA complex may facilitate the rational design of more potent analogs. Because a crystal structure of the quinolone-topoisomerase-DNA ternary complex has not been elucidated, researchers have relied on data for quinolone-resistant mutants to help define this interaction. Spontaneous resistance to quinolones most often arises through point mutations in the topoisomerase-encoding genes. These mutations cluster within a small (
40-amino-acid) region located in the amino-terminal portion of the GyrA (gyrase) and ParC (topoisomerase IV) subunits known as the quinolone resistance-determining region (QRDR) (15, 30). In Escherichia coli, the most common gyrase mutations occur at Ser-83 and Asp-87 of GyrA and generally lead to the largest increases in quinolone resistance. A crystal structure of the 59-kDa breakage-reunion fragment of GyrA (GyrA59) has revealed that these and other QRDR residues lie in the proposed DNA binding pocket and in close proximity to the active-site Tyr-122 residue (20). A small number of mutations in GyrB and ParE also contribute to quinolone resistance, and it has recently been proposed that the GyrB residues Lys-447 and Asp-426 form part of the quinolone binding pocket of DNA gyrase (13, 15, 31).
Although resistance to most quinolone drugs conforms to the pattern described above, recent reports have demonstrated that resistance to specific structural subfamilies can follow different patterns. For example, resistance to the nonfluorinated quinolones and other 8-methoxy quinolones can arise from mutations at a variety of previously unreported topoisomerase residues (16, 24). In this study, we have reinvestigated an early series of 5,6-bridged dioxinoquinolones originally reported to exhibit structure-activity relationships (SARs) that diverged from those of other quinolones (2). We demonstrate that these 5,6-bridged dioxinoquinolones target DNA gyrase in E. coli but that spontaneous resistance arises primarily through novel mutations in gyrA. In addition, we find that in vitro, these compounds inhibit the supercoiling activity of purified E. coli DNA gyrase but do not stimulate gyrase-dependent cleavable complex formation. We further demonstrate that the 5,6-bridged dioxinoquinolones antagonize ciprofloxacin-mediated cleavable complex formation, suggesting the presence of a binding site which overlaps that of conventional quinolones.
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TABLE 3. Antibacterial activities of 5,6-bridged dioxinoquinolones and comparator quinolones
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TABLE 1. Bacterial strains used in this study
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Red recombinase procedures described by Datsenko and Wanner (7) and Ellis et al. (9) was used. A 71-bp oligonucleotide designated S83W-T, which corresponds to the gyrA template strand from bases 283 to 213 but which contains a G-to-C mutation at base 248, was synthesized (Table 2). E. coli strain BW25113/pKD46 made competent as described previously was electroporated with 0.2 µg of S38W-T, and transformants were selected on 4 µg of nalidixic acid per ml (7). Electroporations with a control oligonucleotide corresponding to the wild-type gyrA sequence from bases 283 to 213 did not yield transformants. The GyrA S83W mutation was confirmed by DNA sequence analysis with primers gyrA-QF and gyrA-QR (Table 2). The S83W allele was then moved into DM200 by P1 transduction, which was confirmed by DNA sequencing, to create DM344. |
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TABLE 2. Oligonucleotides used in this study
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Selection of spontaneous E. coli mutants resistant to PGE-8367769. The agar MICs of PGE-8367769 and nalidixic acid were determined to be 0.5 and 1 µg/ml, respectively, for E. coli DM200. Four independent cultures of E. coli strain DM200 were grown in LB broth for approximately 8 h. Cultures were plated onto LB agar plates containing PGE-8367769 at 0.5 µg/ml (the MIC) and 1 µg/ml (two times the MIC). Three colonies were picked from each of the four cultures with each concentration of drug, for further analysis of a total of 24 mutants. As a control, 24 nalidixic acid-resistant mutants were isolated by a similar procedure with selection at 4 µg/ml (four times the MIC).
DNA sequence analysis. Saturated cultures of E. coli strains were diluted 1:10 in TE buffer (10 mM Tris-HCl, 1 mM EDTA [pH 8]) and used as templates for PCR amplification by first heating the diluted cultures to 94°C for 5 min prior to the cycling reactions. The primers used for amplification of the gyrA QRDR were gyrA-QF and gyrA-QR (Table 2). The DNA sequences of both strands of the PCR products were determined with an Applied Biosystems automated DNA sequencer. For strains in which no mutation was found in the QRDR, overlapping fragments covering the entire gyrA gene were amplified, and both strands were sequenced. Primers covering the E. coli gyrA gene were as follows: gyrA-IF1, gyrA-IR1, gyrA-IF2, gyrA-IR2, gyrA-IF3, gyrA-IR3, gyrA-IF4, and gyrA-IR4 (Table 2).
Correlation of resistance phenotype and genotype by genetic mapping. To confirm the genetic linkage of resistance to gyrA, selected quinolone (nalidixic acid or PGE-8367769)-resistant strains were transduced to neomycin resistance (30 µg/ml) with a P1 lysate prepared on CAG12383 gyrA+ (zfa-3145::Tn10kan) to cross in a linked wild-type gyrA gene (25). Neomycin-resistant transductants were then scored for the loss of quinolone resistance.
Bactericidal kinetics. Log-phase cultures of E. coli strain DM200 (approximately 106 bacteria/ml) were incubated in cation-adjusted Mueller-Hinton broth at 37°C with shaking in the presence of test compounds at one-half, one, two, four, and eight times the MIC. At regular intervals, aliquots were removed and dilutions were prepared in 0.9% saline. The numbers of bacterial CFU were determined by the colony count method with a spiral plater (Spiral Biotech, Inc., Bethesda, Md.).
Topoisomerase catalytic and cleavable complex assays. (i) Gyrase supercoiling assays. All assays comparing the wild-type and quinolone-resistant enzymes were conducted in parallel with the same reagent stock solutions. Reaction mixtures (20 µl) containing 35 mM Tris-HCl (pH 7.5), 24 mM KCl, 4 mM MgCl2, 5 mM dithiothreitol, 1.8 mM spermidine, 0.36 µg of bovine serum albumin per ml, 6.5% glycerol, 0.14 mM EDTA, 1 mM ATP, 175 ng of relaxed pBR322 plasmid DNA, and 0.04 U of wild-type or quinolone-resistant E. coli DNA gyrase were incubated at 37°C for 30 min. The reactions were terminated with loading dye (G-2526; Sigma), and the products were separated on 1% agarose gels at 100 V in 1x TBE (89 mM Tris-borate, 2 mM EDTA [pH 8.3]). DNA was visualized after staining of the products with SYBR gold on a Kodak 440 CF image workstation. Supercoiled pBR322 bands were quantified with Kodak 1D analysis software, and 50% inhibitory concentrations (IC50s) were determined by use of a nonlinear regression curve fit on GraphPad Prism software.
(ii) Gyrase cleavable complex assays. Reaction mixtures (20 µl) containing 35 mM Tris-HCl (pH 7.5), 24 mM KCl, 4 mM MgCl2, 2 mM dithiothreitol, 1.8 mM spermidine, 100 µg of bovine serum albumin per ml, 6.5% glycerol, 9 µg of E. coli tRNA per ml, 2 mM ATP, 240 ng of relaxed pBR322 plasmid DNA, and 2.5 U of wild-type E. coli DNA gyrase were incubated at 37°C for 60 min. The reactions were stopped by the addition of 2 µl of 10% sodium dodecyl sulfate and 1 µl of 1.8 mg of proteinase K per ml was added. The reaction mixtures were incubated for 30 min at 37°C, the reactions were stopped with loading dye, and separation was done on 1% agarose gels containing 0.5 mg of ethidium bromide per ml. The cleaved complex (linear pBR322) was quantified, and the concentration of inhibitor that produced 50% of the maximum cleavage (CC50) was determined by use of a nonlinear regression curve fit.
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We also investigated the effects of various other substitutions to the 5,6-bridged dioxinoquinolone backbone. Consistent with established quinolone SAR trends (1), substitution at the C-2 position completely abolished the activities of the 5,6-bridged series (Table 3, PGE-6116542). A methyl substitution at the C-8 position (PGE-7872411) resulted in increased activities against S. pneumoniae and S. pyogenes relative to those of PGE-8367769 but decreased activities against S. aureus as well as the gram-negative organisms E. coli and K. pneumoniae. A C-7 methoxy substitution (PGE-878935) had little effect on activities against gram-positive bacteria but resulted in significantly diminished activity against gram-negative bacteria relative to the activities of PGE-8367769.
Contribution of outer membrane permeability and efflux to intrinsic resistance of E. coli to 5,6-bridged dioxinoquinolones. Although spontaneous resistance to quinolones in E. coli most often arises through mutation of the topoisomerase-encoding genes, low-level quinolone resistance may also occur via non-target-site mutations. Mutations leading to the increased expression of the AcrAB-TolC efflux pump or mutations at the mar (multiple antibiotic resistance) locus have been identified in quinolone-resistant isolates (17, 18). It has also been observed that mutations in lpxC, a gene involved in lipid A synthesis, cause increased sensitivity to the quinolones (32, 33). To examine the contribution of efflux and permeability to the intrinsic resistance of E. coli to the 5,6-bridged dioxinoquinolones, we constructed a set of isogenic strains containing mutations at the lpxC or tolC locus and determined the MICs of PGE-8367769, nalidixic acid, and ciprofloxacin. As demonstrated in Table 4, the lpxC101 allele conferred fourfold increased sensitivities to both PGE-8367769 and nalidixic acid, and the tolC6::mini-Tn10 allele conferred eightfold increased sensitivities to these quinolones. When the lpxC and tolC mutations were combined, the sensitivities increased twofold compared to that of the tolC single mutant. Sensitivities to ciprofloxacin were only marginally affected by single mutations (twofold), whereas the sensitivities increased significantly (greater than eightfold) in the lpxC tolC double mutant. Similar results were also observed for other 5,6-bridged dioxinoquinolones and benchmark quinolones (data not shown). These results demonstrate that the outer membrane permeability barrier and active efflux both contribute to the intrinsic resistance of E. coli to classical quinolones as well as the 5,6-bridged dioxinoquinolones.
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TABLE 4. Activities of quinolones against hyperpermeable E. coli strains
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To determine the identities of the resistance-conferring mutations, we sequenced the QRDR of gyrA from each of the PGE-8367769- and nalidixic acid-resistant mutants. For strains that did not contain mutations in this region, the entire gyrA gene was sequenced. The results of the DNA sequence analysis are summarized in Fig. 1A and B. Selection for nalidixic acid resistance produced typical GyrA QRDR hotspot mutations, including S83L, D87G, D87Y, and G81C (Fig. 1A). The mutation pattern for PGE-8367769 was strikingly different (Fig. 1B). Twenty-three of the 24 strains harbored mutations in GyrA, but the mutations were located inside the traditional QRDR (between residues 67 and 106) in only 7 strains. These included V70A, A84V, D87G, and I89L mutations. To our knowledge, the V70A and I89L mutations have not been previously implicated in quinolone resistance in E. coli, and A84V represents a novel amino acid substitution at position 84 (30). Notably, no mutations were observed at Ser-83, a residue known to play a critical role in quinolone resistance development. Several novel mutations were identified outside of the traditional QRDR. These included E16V, G31V, R38L, G40A, Y50D, V70A, M135T, G173S, T180I, F217C, P218T, and F513C. A single PGE-8367769-resistant strain did not contain a mutation in either gyrA or gyrB. Analysis of the tolC locus from this strain revealed that a perfect excision of the tolC6::mini-Tn10 insertion had occurred, producing a functional wild-type tolC gene and confirming the role of efflux in the intrinsic susceptibility of E. coli to PGE-8367769 (Fig. 1B, tolC+).
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FIG. 1. Characterization of spontaneous quinolone-resistant E. coli mutants. A total of 24 nalidixic acid-resistant (A) or 24 PGE-8367769-resistant (B) E. coli isolates were selected, and the gyrA gene was sequenced as described in Materials and Methods. The QRDR, spanning from residue 66 to residue 106, is delineated by dashed line; tolC+, perfect excision of the mini::Tn10 element regenerating the wild-type tolC gene (see text). The fold change in the nalidixic acid MICs (C) and the PGE-8367769 MICs (D) for quinolone-resistant GyrA and GyrB mutants relative to those for the DM200 parental strain are also shown.
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Unique gyrA mutations selected with PGE-8367769 confer resistance to 5,6-bridged dioxinoquinolones but not typical quinolones. To measure the effect of each GyrA mutation on the antibacterial activities of PGE-8367769, we determined the MICs for a representative strain containing each unique mutation, as well as for other gyrA and gyrB mutant strains (D. R. Macinga, unpublished data, 2002). Figure 1D and Table 5 illustrate that the novel gyrA mutations conferred four- to eightfold increased resistance to PGE-8367769 relative to the resistance of isogenic parent DM200. Although Ser-83 mutations were not isolated with PGE-8367769 (Fig. 1B), isogenic S83L and S83W mutations each conferred 16-fold increased resistance to PGE-8367769. With the exception of G81C and D87Y, other GyrA QRDR mutations led to fourfold increases in PGE-8367769 resistance; G81C and D87Y produced nonsignificant changes. GyrB D426N, G429V, and E466D mutants, which were isolated with other topoisomerase inhibitors, were fourfold more resistant to PGE-8367769 than the parent strain, DM200 (Macinga, unpublished data). Unexpectedly, a strain harboring a novel GyrB G429V mutation was hypersusceptible (16-fold) to PGE-8367769. As a control, we determined the nalidixic acid MICs for the same strains (Fig. 1C). Common QRDR mutations at Ser-83, Asp-87, and Gly-81 conferred 32- to 128-fold-increased nalidixic acid resistance, and GyrB mutations conferred four- to eight-fold-increased nalidixic acid resistance. In contrast, the novel GyrA mutations did not confer significant changes in sensitivity to nalidixic acid. We also tested the potencies of a number of other 5,6-bridged and control quinolones against the same panel of gyrA and gyrB mutants (Table 5). All of the 5,6-bridged quinolones were found to be four- to eightfold less potent against strains containing novel PGE-8367769-selected GyrA mutations. In contrast, the potencies of the unsubstituted compounds PGE-5215205 and PGE-9604297, as well as those of the benchmark quinolones nalidixic acid, ciprofloxacin, and clinafloxacin, were not significantly affected by these novel GyrA mutations.
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TABLE 5. Fold changes in MICs of quinolones for GyrA and GyrB mutants relative to MICs for DM200 parental strain
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FIG. 2. Bactericidal kinetics of PGE-8367769, nalidixic acid, and ciprofloxacin against E. coli DM200. The results obtained with two times the MIC (A) and four times the MIC (B) are shown. The MICs of the drugs for DM200 are shown in Table 5. PGE, PGE-8367768; NAL, nalidixic acid; CFX, ciprofloxacin. Datum points below the detection limit of the assay (20 CFU/ml) are plotted as 101 CFU/ml.
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TABLE 6. Inhibition of E. coli DNA gyrase supercoiling by 5,6-bridged dioxinoquinolones and comparator quinolones
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5,6-Bridged dioxinoquinolones do not stimulate DNA gyrase-dependent cleavable complex formation.
We have used an in vitro assay to measure the cleavable complex-stimulating activities of both benchmark quinolones and 5,6-bridged dioxinoquinolones using relaxed pBR322 as a DNA template (see Materials and Methods). As demonstrated in Fig. 3A and B, respectively, ciprofloxacin and nalidixic acid stimulated gyrase-dependent cleavable complex formation in a dose-dependent manner. Ciprofloxacin stimulated a maximum conversion of 79% of the template into the linear product (cleaved complex), and the CC50 was 0.69 µg/ml. Nalidixic acid stimulated 47% conversion of the template to the linear product, with a CC50 of 13.9 µg/ml. It is also evident from the gels that ciprofloxacin and nalidixic acid inhibited gyrase supercoiling activity under the cleavage reaction conditions. In contrast, PGE-8367769 and PGE-6596491 did not stimulate the cleavable complex above the background level at concentrations as high as 500 µg/ml (Fig. 3C and D, respectively). Strikingly, the corresponding unsubstituted analogs, PGE-5215205 and PGE-9604297, respectively, were able to stimulate cleavable complex formation (Fig. 3E and F, respectively). The absolute levels of cleavage were considerably lower than those produced by benchmark compounds, with PGE-5215205 and PGE-9604297 producing only 13 and 27% maximum cleavage, respectively. Moreover, none of the 5,6-bridged dioxinoquinolones stimulated cleavable complex formation when they were tested with purified human DNA topoisomerase II
(unpublished data), and PGE-8367769 induced no micronucleus formation when it was tested for genetic toxicity with Chinese hamster ovary cells (6), suggesting that the activities of the present compounds are relatively selective toward bacterial topoisomerases.
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FIG. 3. Comparison of quinolone-stimulated cleavable complex formation by E. coli DNA gyrase. (A to F) Cleavable complex assays were performed as described in the Materials and Methods and contained the quinolones at the indicated concentrations. Gel images have been inverted for easier visualization of the DNA species. Lane a, relaxed pBR322 DNA; N, nicked DNA; L, linear DNA; SC, supercoiled DNA; R, relaxed DNA.
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FIG. 4. Antagonism of ciprofloxacin-stimulated cleavable complex formation by PGE-8367769. Cleavable complex assays containing ciprofloxacin at 2 µg/ml (A) or 0.5 µg/ml (B) and PGE-8367769 at the indicated concentrations were performed as described in the Materials and Methods. Gel images have been inverted for easier visualization of the DNA species. Lane a, relaxed pBR322 DNA; lane b, control reaction with no ciprofloxacin; N, nicked DNA; L, linear DNA; SC, supercoiled DNA; R, relaxed DNA. (C) Ciprofloxacin dose-response curves in the presence of constant concentrations of PGE-8367769. (D) Ciprofloxacin CC50 versus the concentration of PGE-8367769 included in the reaction.
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The 5,6-bridged dioxinoquinolones PGE-8367769 and PGE-6596491 failed to stimulate gyrase-dependent cleavable complex formation at concentrations as high as 500 µg/ml. Because PGE-8367769 was approximately twofold more potent than nalidixic acid at gyrase supercoiling inhibition and because nalidixic acid stimulated the cleavable complex with a CC50 of 13.9 µg/ml, it is highly unlikely that higher concentrations of PGE-8367769 would have led to cleavable complex formation. The 5,6-bridged quinolones may function as gyrase supercoiling inhibitors without stimulating cleavable complex formation by inhibiting the enzyme prior to DNA cleavage. This mechanism would be in contrast to that of typical quinolones such as ciprofloxacin, which are thought to stimulate cleavage and inhibit religation (8). Stabilization of the cleavable complex by quinolones is thought to be a prerequisite for double-stranded DNA break formation and bacterial death. We have found PGE-8367769 to be significantly less effective at killing E. coli than nalidixic acid and ciprofloxacin. This decreased killing may be directly related to the inability of PGE-8367769 to stabilize the cleavable complex in the bacterium. Further experiments will need to be conducted to determine whether PGE-8367769 fails to block DNA synthesis or to produce double-stranded DNA breaks in vivo. Such experiments may provide insights into the mechanisms of bacterial killing by quinolones.
PGE-8367769 was shown to antagonize ciprofloxacin-mediated cleavable complex formation, suggesting competition between PGE-8367769 and ciprofloxacin for binding to the gyrase-DNA complex. The coumarin antibacterial novobiocin, a potent inhibitor of GyrB ATPase activity, also inhibits gyrase supercoiling activity without simulating cleavable complex formation (4). Novobiocin did not antagonize ciprofloxacin-mediated cleavable complex formation, demonstrating that inhibition of gyrase supercoiling activity is not sufficient to block this effect. In dose-response experiments with ciprofloxacin (Fig. 4C), the inclusion of increasing PGE-8367769 concentrations caused a corresponding increase in the apparent ciprofloxacin CC50s, whereas the maximum level of cleavage stimulated by ciprofloxacin remained unchanged. From Fig. 4D, the affinity of ciprofloxacin for the gyrase-DNA complex was estimated to be approximately 300-fold greater than that of PGE-8367769. Overall, these results demonstrate that binding of ciprofloxacin and PGE-8367769 to DNA gyrase are mutually exclusive and strongly suggest that both compounds compete for a common, overlapping binding site within the gyrase-DNA complex.
The analysis of spontaneous mutants resistant to PGE-8367769 identified DNA gyrase as the primary antibacterial target in E. coli. However, the GyrA residues implicated in resistance development were dramatically different from those conferring resistance to typical quinolones. Of the 15 different mutations identified, only the D87G mutation has been described previously. Several isolates were found to harbor a conservative alanine-to-valine change at position 84 (A84V), which differs from a previously described A84P mutation (30). According to the GyrA59 fragment crystal structure, Ala-84 is located in
helix 4 and is situated between the key residues in quinolone resistance development, Ser-83 and Asp-87 (20). The A84P mutation is thought to confer resistance to quinolones by disrupting
helix 4 and perturbing the quinolone binding site (8), whereas the conservative A84V mutation would be expected to have a more subtle effect on the structure of
helix 4. The A84V mutation as well as a second conservative
helix 4 mutation, I89L, conferred resistance only to the 5,6-bridged quinolones. A previously described
helix 4 mutation, G81C (30), conferred resistance to nalidixic acid, ciprofloxacin, and clinafloxacin. In contrast, G81C did not confer resistance to the 5,6-bridged quinolones and led to significant hypersusceptibility to PGE-7872411 and PGE-878935 (Table 5). These data provide strong genetic evidence that the 5,6-dioxinoquinolones interact with DNA gyrase at a site similar to that at which typical quinolones interact, but do so in a qualitatively unique manner.
The majority of the mutations conferring PGE-8367769 resistance arose at residues outside of the QRDR and have not been previously reported. Like the A84V and I89L mutations, these conferred resistance only to the 5,6-bridged quinolones. The GyrA59 crystal structure demonstrates that the key residues involved in quinolone resistance development (Ser-83 and Asp-87) are located in close proximity to the active-site tyrosines (Tyr-122) at the dimer interface (20). A model with double-stranded DNA bound to this domain places Ser-83 and Asp-87 at the point where distortion of the DNA is predicted to occur. We speculate that the non-QRDR mutations may cause long-range conformational changes that alter the binding site of the 5,6-bridged quinolones. These conformational changes may also alter the distortion of the double-stranded DNA bound to the enzyme. The observation that these mutations confer resistance only to the 5,6-bridged dioxinoquinolones suggests that the dioxino moiety contributes directly to the binding of the drugs to the gyrase-DNA complex. This view is further supported by the data showing that unsubstituted analogs of the 5,6-bridged dioxinoquinolones are much less potent, as measured by both antibacterial activity and gyrase supercoiling inhibition. Alternatively, the 5,6-dioxino moiety may cause indirect inhibition of gyrase by instead promoting drug binding to the DNA substrate (rather than binding to the gyrase-DNA complex, as occurs for classical quinolones). However, this interpretation seems unlikely because these compounds did not show a significant affinity for DNA when they were tested in parallel experiments for direct binding to calf thymus DNA (data not shown).
In summary, the 5,6-bridged dioxinoquinolones were found to target DNA gyrase in E. coli but differed significantly in their interaction with this target relative to those of conventional quinolones, as determined by (i) SARs, (ii) resistance development, (iii) bactericidal kinetics, and (iv) cleavable complex stabilization. The results of this study demonstrate that modifications of the quinolone backbone can lead to qualitative differences in drug-target interactions and suggest that compounds can be designed to circumvent existing topoisomerase-mediated resistance. Although the compounds investigated in this study were considerably less potent than present therapeutic fluoroquinolones, it should be noted that their substitution patterns were rather simple. Because the initial compound, PGE-8367769, did not stimulate enzyme-mediated cleavable complex formation with E. coli gyrase or human topoisomerase II
and showed no genetic toxicity against Chinese hamster ovary cells, this series of 5,6-bridged quinolones may represent an opportunity to design new analogs with improved selectivities and safety profiles in humans. Although the existing knowledge of the SARs of this series is limited, further investigation of well-known substituents at the N-1, C-7, and C-8 positions may yield new derivatives with significantly improved potencies, spectra, and/or selectivities. At a minimum, even the present limited SARs for these unique compounds strongly suggests that there is still significant unexploited chemical and biological space for the invention of new antibacterials based on modifications of the traditional quinolone scaffold.
Present address: GOJO Industries, Akron, Ohio. ![]()
Present address: Cumbre, Inc., Dallas, Tex. ![]()
Present address: Division of Experimental Hematology, Cincinnati Children's Hospital, Cincinnati, Ohio. ![]()
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