The repurposing of Tebipenem pivoxil as alternative therapy for severe gastrointestinal infections caused by extensively drug-resistant Shigella spp.
Authors
Voong Vinh, Phat
de Cozar, Cristina
Willé, David R
Urones, Beatriz
Cortés, Alvaro
Price, Alan
Tran Do Hoang, Nhu
Ha Thanh, Tuyen
McCloskey, Molly
Shaheen, Shareef
Dayao, Denise
de Mercado, Jaime
Castañeda, Pablo
García-Perez, Adolfo
Singa, Benson
Pavlinac, Patricia
Walson, Judd
Martínez-Martínez, Maria Santos
Arnold, Samuel LM
Saul, Tzipori
Ballell Pages, Lluis
Publication Date
2022-03-15Journal Title
Elife
ISSN
2050-084X
Publisher
eLife Sciences Publications, Ltd
Volume
11
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Fernández Álvaro, E., Voong Vinh, P., de Cozar, C., Willé, D. R., Urones, B., Cortés, A., Price, A., et al. (2022). The repurposing of Tebipenem pivoxil as alternative therapy for severe gastrointestinal infections caused by extensively drug-resistant Shigella spp.. Elife, 11 https://doi.org/10.7554/eLife.69798
Abstract
Background: Diarrhoea remains one of the leading causes of childhood mortality globally. Recent epidemiological studies conducted in low-middle income countries (LMICs) identified Shigella spp. as the first and second most predominant agent of dysentery and moderate diarrhoea, respectively. Antimicrobial therapy is often necessary for Shigella infections; however, we are reaching a crisis point with efficacious antimicrobials. The rapid emergence of resistance against existing antimicrobials in Shigella spp. poses a serious global health problem. Methods: Aiming to identify alternative antimicrobial chemicals with activity against antimicrobial resistant Shigella, we initiated a collaborative academia-industry drug discovery project, applying high-throughput phenotypic screening across broad chemical diversity and followed a lead compound through in vitro and in vivo characterisation. Results: We identified several known antimicrobial compound classes with antibacterial activity against Shigella. These compounds included the oral carbapenem Tebipenem, which was found to be highly potent against broadly susceptible Shigella and contemporary MDR variants for which we perform detailed pre-clinical testing. Additional in vitro screening demonstrated that Tebipenem had activity against a wide range of other non-Shigella enteric bacteria. Cognisant of the risk for the development of resistance against monotherapy, we identified synergistic behaviour of two different drug combinations incorporating Tebipenem. We found the orally bioavailable prodrug (Tebipenem pivoxil) had ideal pharmacokinetic properties for treating enteric pathogens and was effective in clearing the gut of infecting organisms when administered to Shigella-infected mice and gnotobiotic piglets. Conclusions: Our data highlight the emerging antimicrobial resistance crisis and shows that Tebipenem pivoxil (licenced for paediatric respiratory tract infections in Japan) should be accelerated into human trials and could be repurposed as an effective treatment for severe diarrhoea caused by MDR Shigella and other enteric pathogens in LMICs. Funding: Tres Cantos Open Lab Foundation (projects TC239 and TC246), the Bill and Melinda Gates Foundation (grant OPP1172483) and Wellcome (215515/Z/19/Z).
Keywords
Research Article, Epidemiology and Global Health, Microbiology and Infectious Disease, Shigella spp, drug discovery, multi-drug resistance, dysentery, diarrhoea, carbapenems, Other
Sponsorship
GSK Open Lab Foundation (TC239 and TC246)
Bill and Melinda Gates Foundation (OPP1172483)
Wellcome Trust (215515/Z/19/Z)
Identifiers
69798
External DOI: https://doi.org/10.7554/eLife.69798
This record's URL: https://www.repository.cam.ac.uk/handle/1810/335465
Rights
Licence:
http://creativecommons.org/licenses/by/4.0/
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