Dartois Véronique, Lan Tian, Ganapathy Uday S, Wong Chui Fann, Sarathy Jickky P, Jimenez Diana C, Alshiraihi Ilham M, Lam Ha, Rodriguez Suyapa, Xie Min, Soto-Ojeda Maritza, Jackson Mary, Wheat William, Dillman Nathan C, Kostenkova Kateryna, Schmitt Jake, Mann Lea, Richter Adrian, Imming Peter, Sarathy Jansy, Kaya Firat, Paruchuri Sindhuja, Tatek Betelhem, Folvar Camilla, Proietto Julianna, Zimmerman Matthew, Gonzalez-Juarrero Mercedes, Aldrich Courtney C, Dick Thomas
Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110.
Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ 07110.
Proc Natl Acad Sci U S A. 2025 May 6;122(18):e2423842122. doi: 10.1073/pnas.2423842122. Epub 2025 May 1.
is a rapidly growing nontuberculous causing severe pulmonary infections, especially in immunocompromised individuals and patients with underlying lung conditions like cystic fibrosis (CF). While rifamycins are the pillar of tuberculosis treatment, their efficacy against lung disease is severely compromised by intrabacterial ADP-ribosylation. Additionally, rifamycins induce cytochrome P450 3A4 (CYP3A4), a major human drug-metabolizing enzyme, further limiting their use in patients with comorbidities that require treatment with CYP3A4 substrates such as CF and HIV coinfection. We chemically reengineered rifabutin to enhance its potency against by blocking intrabacterial inactivation and eliminate drug-drug interactions by removing induction of CYP3A4 gene expression. We have designed and profiled a series of C25-substituted derivatives resistant to intracellular inactivation and lacking CYP3A4 induction, while retaining excellent pharmacological properties. Against , devoid of ADP-ribosyltransferase, the frontrunners are equipotent to rifabutin, suggesting superior clinical utility since they no longer come with the drug interaction liability typical of rifamycins. Prioritized compounds demonstrated superior antibacterial activity against a panel of clinical isolates, were highly bactericidal against replicating and drug-tolerant nonreplicating bacteria in caseum surrogate and were active against intracellular bacteria. As single agents, these rifamycins were as effective as a standard-of-care four-drug combination in a murine model of lung infection.
是一种迅速增长的非结核分枝杆菌,可引起严重的肺部感染,尤其是在免疫功能低下的个体以及患有潜在肺部疾病(如囊性纤维化(CF))的患者中。虽然利福霉素是结核病治疗的支柱,但它们对肺部疾病的疗效因细菌内ADP-核糖基化而严重受损。此外,利福霉素会诱导细胞色素P450 3A4(CYP3A4),这是一种主要的人体药物代谢酶,进一步限制了它们在需要使用CYP3A4底物(如CF和HIV合并感染)进行治疗的合并症患者中的应用。我们对利福布汀进行了化学改造,通过阻断细菌内失活来增强其对的效力,并通过消除CYP3A4基因表达的诱导来消除药物相互作用。我们设计并分析了一系列C25取代的衍生物,它们对细胞内失活具有抗性且缺乏CYP3A4诱导,同时保留了优异的药理特性。对于缺乏ADP-核糖基转移酶的,领先者与利福布汀等效,这表明其具有更好的临床实用性,因为它们不再具有利福霉素典型的药物相互作用风险。优先选择的化合物对一组临床分离株表现出优异的抗菌活性,对酪蛋白替代物中复制的和耐药物的非复制细菌具有高度杀菌作用,并且对细胞内细菌有活性。作为单一药物,这些利福霉素在肺部感染的小鼠模型中与标准的四联药物组合一样有效。