Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/06—Antipsoriatics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/16—Otologicals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/04—Antibacterial agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

• Antibacterials kill or inhibit the growth of bacteria by interfering with major processes of cellular function that are essential for survival.
• the ⁇ -lactams penicillins and cephalosporins
• the glycopeptides vancomycin and teicoplanin
• Macrolides erythromycin, clarithromycin, and azithromycin
• clindamycin clindamycin
• chloramphenicol aminoglycosides
• streptomycin, gentamicin, and amikacin inhibit protein synthesis.
• Also inhibiting protein synthesis is the newest class of antibacterials to be approved (linezolid) are synthetic oxazolidinones.
• Rifampin inhibits RNA synthesis
• the fluoroquinolones such as ciproflox:acin
• Trimethoprim and the sulfonamides inhibit folate biosynthesis directly and DNA synthesis indirectly by depleting the pools of one of the required nucleotides (Chambers, H. F. and Sande, M. A. (1996) Antimicrobial Agents. Goodman & Gilman's The Pharmacological Basis of Therapeutics, McGraw-Hill, New York).
• the disclosure of this reference, and of all other patents, patent applications, and publications referred to herein, are incorporated by reference herein in their entirety.
• Resistance to antibacterials can occur when the target of a drag mutates so that it can still function, but is no longer inhibited by the drag (e.g., mutations in the quinolone resistance determining regions of bacterial gyrases and topisomerase enzymes that confer resistance to the fluoroquiniolones). Resistance may also be mediated by the over- expression or activation of efflux pumps that remove the drug from the cell interior (e.g. tetracycline efflux). Another common mechanism of resistance involves the production of enzymes that modify or degrade the drug so that it becomes inactive (e.g., ⁇ - lactamases, aminoglycoside modifying enzymes, etc.).
• Pseudomonic acid A also known as mupirocin, is a natural product synthesized by Pseudomonas fluorescens and is an inhibitor of isoleucyl-tRNA synthetases from Gram-positive infectious pathogens, including S. aureus, S. epidermidis, and S. saprophyticus and Gram-negative organisms, such as Haemophilus influenzae, Neisseria gonorrhoeae, and Neisseria meningitides.
• the bacterial isoleucyl tRNA synthetase enzyme has been successfully targeted by mupirocin or a pharmaceutically acceptable salt when formulated as an ointment or cream for the topical therapy of bacterial skin infections.
• Mupirocin and derivatives are mainly active against Gram-positive aerobes and some Gram-negative aerobes.
• Mupirocin free acid, its salts and esters are described in UK patent No. 1,395,907. These agents are found to be useful in treating skin, ear and eye disorders.
• Three commercial products contain mupirocin free acid or crystalline mupirocin calcium dihydrate as the active ingredients.
• Bactroban® Ointment Bactroban® Nasal and Bactroban® Cream, manufactured by GlaxoSmithKline.
• the first contains mupirocin, while the other two contain crystalline mupirocin calcium dihydrate.
• the formulation of Bactroban® Ointment is described in U.S. Pat. No. 4,524,075.
• the formulation of Bactroban® Nasal is described in U.S. Pat. No. 4,790,989.
• the cream base of Bactroban® Cream is described in WO 95/10999 and U.S. Pat. No. 6,025,389. Crystalline mupirocin calcium, its properties and methods of preparation are described in detail in U.S. Pat. No. 4,916,155.
• Mupirocin calcium amorphous has been described in U.S. Patent No. 6,489,358. Although mupirocin is a widely accepted and successful product, two types of resistance have been described: 1) Low level resistance with minimum inhibitory concentrations (MIC's) in the range of 8 - 256 ⁇ g/mL that is largely attributed to mutations in the chromosomally encoded isoleucyl tRNA synthetase protein, and 2) High level resistance (mupA) that is caused by a plasmid-encoded IRS enzyme and results in MICs > 512 ⁇ g/mL.
• MIC's minimum inhibitory concentrations
• mupA High level resistance
• the present invention provides a pharmaceutical composition comprising an aminoacyl tRNA synthetase inhibitor and another antibacterial agent, including another aminoacyl tRNA synthetase inhibitor.
• Figure 1 shows selection of spontaneous resistant mutants from S. aureus ATCC 29213 following exposure to MRSi compound 2 and mupirocin alone and in combination.
• Figure 2 shows selection of spontaneous resistant mutants from S. aureus 31-1334 (low level mupirocin-resistant) following exposure to MRSi compound 2 and mupirocin alone and in combination.
• Figure 3 shows selection of spontaneous resistant mutants from seven staphylococcal isolates following exposure to MRSi compound 5 alone, mupirocin alone and MRSi compound 5/mupirocin combination.
• Figure 4 shows growth curves for low-level MRS-resistant strains of S. aureus
• One embodiment of the present invention is a therapeutic composition that, when administered to a host in an effective manner, is capable of protecting that human or animal from disease caused by bacteria.
• a protective compound refers to a compound that, when administered to a human or animal in an effective manner, is able to treat, ameliorate, and/or prevent disease caused by bacteria.
• the present disclosure describes therapeutic combination compositions containing at least one aminoacyl tRNA synthetase inhibitor, particularly a methionyl tRNA synthetase inhibitor, for use as antibacterial agents.
• the benefits of such combination therapy are not limited to topical uses but extend to oral and parenteral administration.
• the therapeutic compositions are useful for the prevention and/or treatment of infections caused by organisms that are resistant to mupirocin and other currently marketed antimicrobial agents.
• the invention contemplates formulations comprising at least one aminoacyl tRNA synthetase inhibitor in combination with at least one additional therapeutic agent, preferably an antibacterial or antibiotic agent, as active ingredients for the therapy of bacterial infections.
• the therapeutic composition contains a methionyl aminoacyl tRNA synthetase (MRS) inhibitor.
• MRS inhibitors are described in International Patent Application Publications WO 00/71524, WO 00/71522, WO 99/55677 and WO 00/21949; U.S. Patent No. 6,320,051; United States Patent Application Ser.
• the MRS inhibitors 1-8 may also be referred to, respectively, as 2-[3-(6,8-
• Mupirocin or Fusidic Acid may be used in their pharmaceutically acceptable salt or ester.
• the therapeutic composition may be in the form of MRS inhibitor mupirocinate (i.e. salt formed between MRS inhibitor and Mupirocin) or MRS inhibitor Fusidate (i.e. salt formed between MRS inhibitor and Fusidic acid).
• MRS inhibitor may be interchangeably referred to as MRSi for brevity.
• Suitable pharmaceutically acceptable salts of Mupirocin or Fusidic Acid are well known in the art and include alkali metal salts such as sodium and lithium and alkaline earth metal salts such as calcium, of which the calcium salt is desirable, in particular the crystalline dihydrate form thereof, as well as other metal salts, for instance silver and aluminium salts and ammonium substituted ammonium salts.
• the salts may be anhydrous or may be in the form of pharmaceutically acceptable solvates, for instance alcoholates and, especially, hydrates. Salts can include the calcium, silver and lithium salts, in particular the calcium salt.
• the calcium salt of mupirocin the crystalline salt, the crystalline hydrated calcium salt, or the crystalline dihydrate salt, is used.
• the MRSi mupirocinate salt or the MRSi Fusidate may be in the form of pharmaceutically acceptable solvates, for instance alcoholates and, especially, hydrates.
• the bacterial infections are topical bacterial infections including but not limited to impetigo, infected skin lesions, infected dermatitis (eczema, psoriasis, etc.), wound infections, burn infections, post-operative infections, dialysis site infections, and infections associated with colonization of the nasopharyrx by pathogenic organisms, sinusitis, including recurrences.
• active ingredients of the therapeutic composition are aminoacyl tRNA synthetase inhibitors
• two or more inhibitors in combination in a therapeutic composition of the invention should show synergy or additivity since each inhibitor targets a component of the same biochemical process (charging of tRNAs with cognate amino acids or, more generally, protein synthesis).
• an antibacterial drug comprised of a combination of tRNA synthetase inhibitors would have a low propensity for the development of resistance since resistance in two enzymes would need to develop simultaneously to confer protection of bacteria against the drag.
• a combined product embodied in this invention will have the ability to circumvent both the low- and high- level mupirocin (mupA) resistance mechanisms that have arisen in clinical isolates. Such as combined product would also not suffer from the disadvantage of exposing the bacteria to low level dosages of drug substances that might increase the risk of the development of resistant bacteria in a formulation with a single drag substance.
• tRNA synthetase inhibitors useful in the present invention include but are not limited to borredidin, furanomycin, granaticin, indolmycin, ochratoxin A, cispentacin, 5'-O- glycylsulfamoyladenosine; proline-based t-RNA synthetase inhibitors described in U. S. Patent Application Publication 2003-0013724A1, and United States Patent Nos. 6,417,217 and 6,333,344; aminoacyl sulfamide-based t-RNA synthetase inhibitors described in U.S. Patent No.
• the therapeutic compositions of the present disclosure have antibacterial activity against clinically important Gram-positive pathogens including the staphylococci, streptococci and enterococci and particularly including isolates resistant to currently marketed agents.
• the therapeutic compositions of the present disclosure can also be used for the prevention and/or treatment of infections caused by organisms that are resistant to mupirocin and other currently marketed antimicrobial agents.
• the active ingredient(s) may be made up into a cream, lotion ointment, sprays or inhalants, lozenges, throat paints, dentifrices, powders, encapsulated in micelles or liposomes and drag release capsules including the active compounds incorporated within a biocompatible coating designed for slow-release, and mouthwashes and other washes.
• Formulations which may be used for the active ingredient are conventional formulations well known in the art, for example as described in standard textbooks of pharmaceutics such as the United States Pharmacopoeia (USP), British Pharmacopoeia, European Pharmacopoeia, Japanese Pharmacopoeia, and International Pharmacopoeia.
• the compositions of the present disclosure may be made up in any conventional carriers suitable for the topical administration of antibiotics, for example paraffins and alcohols. They may be presented, as, for instance, ointments, creams or lotions, eye and ear ointments, gels, skin patches, impregnated dressings and aerosols.
• compositions may also contain appropriate conventional additives, for example preservatives, solvents to assist drag penetration (e.g., DMSO), emollients, local anesthetics, preservatives and buffering agents.
• a suitable composition according to the present invention comprises about 0.01% to 99% by weight, preferably 0.1-40% by weight, of the active ingredient. If the compositions contain dosage units, each dosage unit preferably contains from 0.1-500 mg of the active material. For adult human treatment, the dosage employed preferably ranges from 1 mg to 5 g, per day, depending on the route and frequency of administration of each of the tRNA synthetase inhibitors.
• a suitable ointment base may conveniently comprise from 65 to 100% (preferably 75 to 96%) of white soft paraffin, from 0 to 15% of liquid paraffin, and from 0 to 7% (preferably 3 to 7%) of lanolin or a derivative of synthetic equivalent thereof.
• Another suitable ointment base may conveniently comprise a polyethylene - liquid paraffin matrix.
• a suitable cream base may conveniently comprise an emulsifying system, for example from 2 to 10% of polyoxyethylene alcohols (e.g.
• Suitable bases for creams include sorbitan monostearate, Polysorbate 60, cetyl palmitate, paraffin, cetylstearyl alcohol, benzyl alcohol, silica, triacetin, isopropyl monostearate, polyethylene glycol, glycerol monostearate, polyacrylic acid, sodium hydroxide, docusate sodium, dimethicone, triglycerides, octyldecanol and octyldodecanol.
• a cream preparation which comprises an oleaginous base selected from the group consisting of petrolatum and hard fat; stiffening agents that are selected from the group consisting of cetostearyl alcohol, cetyl alcohol and stearyl alcohol; humectants selected from a group consisting of castor oil and oleyl alcohol; surfactants selected from the group consisting of a surfactant with an HLB equal to or below 5, and other pharmaceutically accepted additives.
• a suitable gel base may conveniently comprise a semi-solid system in which a liquid phase is constrained within a three dimensional polymeric matrix with a high degree of cross-linking.
• the liquid phase may conveniently comprise water, together with from 0 to 20% of water-miscible additives, for example glycerol, polyethylene glycol, or propylene glycol, and from 0.1 to 10%, preferably from 0.5 to 2%, of a thickening agent, which may be a natural product, for example tragacanth, pectin, carrageen, agar and alginic acid, or a synthetic or semi-synthetic compound, for example methylcellulose and carboxypolymethylene (carbopol); together with one or more preservatives, for example from 0.1 to 2% of methyl 4-hydroxybenzoate (methyl paraben) or phenoxy ethanol.
• water-miscible additives for example glycerol, polyethylene glycol, or propylene glycol
• a thickening agent which may be a natural product, for example tragacanth, pectin, carrageen, agar and alginic acid, or a synthetic or semi-s
• Another suitable base may comprise from 70 to 90% of polyethylene glycol (for example, polyethylene glycol ointment containing 40% of polyethylene glycol 3350 and 60% of polyethylene glycol 400, prepared in accordance with the U.S. National Formulary (USNF)), from 5 to 20% of water, from 0.02 to 0.25% of an anti-oxidant (for example butylated hydroxytoluene), and from 0.005 to 0.1 % of a chelating agent (for example ethylenediamine tetraacetic acid (EDTA)).
• polyethylene glycol for example, polyethylene glycol ointment containing 40% of polyethylene glycol 3350 and 60% of polyethylene glycol 400, prepared in accordance with the U.S. National Formulary (USNF)
• an anti-oxidant for example butylated hydroxytoluene
• a chelating agent for example ethylenediamine tetraacetic acid (EDTA)
• lanolin substitutes include in particular synthetic or semisynthetic compounds and mixtures which are known and used in the pharmaceutical and cosmetic arts as alternatives to lanolin and may, for example, be referred to as lanolin substitutes.
• One suitable synthetic equivalent of lanolin that may be used is the material available under the SOFTISAN trade mark.
• the compositions of the disclosure may be produced by conventional pharmaceutical techniques. Thus the aforementioned composition, for example, may conveniently be prepared by mixing together at an elevated temperature, preferably 60- 70°C, the soft paraffin, liquid paraffin if present, and lanolin or derivative or synthetic equivalent thereof.
• an effective amount is an amount effective to either (1) reduce the symptoms of the disease sought to be treated or (2) induce a pharmacological change relevant to treating the disease sought to be treated.
• an effective amount includes an amount effective to: reduce or eliminate the bacterial population; slow the spread of infection; or increase the life expectancy of the affected human or animal.
• Therapeutically effective amounts of the therapeutic agents can be any amount or doses sufficient to bring about the desired effect and depend, in part, on the condition, type and location of the infection, the size and condition of the patient, as well as other factors readily known to those skilled in the art.
• the dosages can be given as a single dose, or as several doses, for example, divided over the course of several weeks.
• the present disclosure is also directed toward methods of treatment utilizing the therapeutic compositions of the present disclosure.
• the method comprises administering the therapeutic agent to a subject in need of such administration.
• Compositions may be applied topically both to the outer skin and to other parts of the human or animal body, for example the eyes and inside the nose.
• compositions may also be applied topically to areas in which the skin is missing or damaged, as found, for example, in burns and wounds.
• the present disclosure provides a method of treating skin disorders in human or domestic mammals, which method comprises applying topically to a human or domestic mammal in need thereof the composition.
• the present invention in some embodiments, also provides for the use of a tRNA synthetase inhibitor with another antibiotic including another tRNA synthetase inhibitor such as mupirocin or a pharmaceutically acceptable ester or salt thereof in the manufacture of a medicament for the prophylactic treatment of infections including, but not limited to, surgical site infections, catheter-associated infections, burns and sinusitis, including recurrent infections.
• Such treatment may be prophylactic treatment; that is treatment that includes not only complete elimination of the bacterial infection, but also a partial elimination of thereof, that is a reduction in the number of acute episodes. It is believed that the successful treatment of bacterial infections, such as recurrent otitis media and recurrent sinusitis, is associated with the elimination or reduction of nasal carriage of pathogenic bacteria such as S. aureus, H influenzae, S. pneumoniae and ML. catarrhalis, in particular colonization of the nasospharynx by such organisms.
• the present invention provides for the use of tRNA synthetase inhibitor with another antibiotic including another tRNA synthetase inhibitor such as mupirocin or a pharmaceutically acceptable ester or salt thereof in the manufacture of a medicament for reducing or eliminating the nasal carriage of pathogenic organisms associated with recurrent otitis media, which medicament is adapted for nasal administration, in particular, focused delivery to the nasopharynx.
• another antibiotic including another tRNA synthetase inhibitor such as mupirocin or a pharmaceutically acceptable ester or salt thereof in the manufacture of a medicament for reducing or eliminating the nasal carriage of pathogenic organisms associated with recurrent otitis media, which medicament is adapted for nasal administration, in particular, focused delivery to the nasopharynx.
• EXAMPLE 1 GENERAL METHOD FOR MUPIROCINATE SALT FORMATION To 1.0 meq of a methanolic Psuedomonic acid A solution was added 1.0 meq of an MRSi. The mixture is warmed to 50 °C and gently agitated for 10 minutes. After the mixture returns to ambient temperature it is filtered through a 1 ⁇ m glass fiber syringe filter. The flask and filter are rinsed with methanol and the combined filtrates diluted with water. The solution was then concentrated using a centrifugal concentrator followed by drying in a vacuum oven at ambient temperature to give an off-white amorphous solid.
• EXAMPLE 2 GENERAL METHOD FOR FUSIDATE FORMATION To 1.0 meq of a methanolic Fusidic acid solution was added 1.0 meq of an MRSi. The mixture is warmed to 50 °C and gently agitated for 10 minutes. After the mixture returns to ambient temperature it is filtered through a 1 ⁇ m glass fiber syringe filter. The flask and filter are rinsed with methanol and the combined filtrates diluted with water.
• MRSi compound 3 was prepared as described in Example 71 of United States Patent 6,320,051 which is incorporated by reference herein.
• MUPIROCINATE a) Diphenyl(l-fluorovinyl)methylsilane. In a flame-dried 1 L 3 -neck round bottom under an anhydrous atmosphere, 65 mL (309 mmol) of diphenylmethylchlorosilane was added to 4.3 g (618 mmol) of lithium wire in 650 mL of anhydrous THF. The mixture was stirred at ambient temperature for 20 hours. The mixture was then cooled to -78 °C and the atmosphere replaced with 1,1-difluoroethylene (excess) such that the temperature of the reaction mixture remained below -55 °C. Difluoroethylene addition was stopped when the reaction temperature remained at or below -70 °C.
• the reaction was stirred at ⁇ -70 °C until it turned a clear light yellow ( ⁇ 2 hr.) and was then allowed to warm to ambient temperature. The remaining lithium wire was removed and the mixture treated with portions of Na 2 SO -10H 2 O until no gas evolved upon addition. The mixture was then dried over Na 2 SO 4 , filtered through a silica pad and the pad rinsed with ether. The combined filtrates were dried under vacuum, the resulting residue suspended/dissolved in hexanes and filtered through another silica pad. The pad was rinsed with hexanes, the filtrates combined and the solvent removed under reduced pressure to give a light yellowish liquid with some white crystalline material present.
• EXAMPLE 10 N-(lH-IMIDAZ ⁇ r4.5-i?lPYRIDI ⁇ -2-YL N , -(3.4.6-TRIC ⁇ LORO- lH-INDOL-2-YLMETHYL) -PROPANE-1.3-DIAMINE MUPIROCINATE. a) N-(3,4,6-Trichloro-lH-indoI-2-yImethyl)-N-(lH-imidazo[4,5-b]pyridin-2- yl)-propane-l,3-diamine.
• MRSi compound 2 demonstrated equivalent activity (MICs ranging from 0.06-0.25 ⁇ g/mL) against all strains tested including those with low and high-level resistance to mupirocin.
• the MRS inhibitor 4 alone and in combination with mupirocin were tested against a collection of Gram-positive pathogens.
• the results in Table 2 show that both the mupirocin salt of MRSi compound 4 and MRSi compound 4/mupirocm 1 : 1 combination demonstrated equivalent activity against all the organisms tested.
• the combination products demonstrated potent activity against mupirocin-resistant S. aureus and S. epidermidis.
• MRS inhibitor 4 Antibacterial activity MRS inhibitor 4 alone and in combination with mupirocin
• the MRS inhibitor 8 was also prepared as a fusidate and mupirocinate salt and tested for antibacterial activity against Gram-positive bacteria (Table 3).
• the mupirocinate and fusidate salts demonstrated equivalent antibacterial activities against all the organisms tested.
• MRSi compound 8 alone and the fusidate and mupirocin salts were active against mupirocin-resistant S. aureus and S. epidermidis and organisms such as E. faecalis that are not susceptible to mupirocin.
• Table 3 Activity of the acetate, fusidate and mupirocinate salts of the MRS inhibitor 8 against Gram-positive bacteria
• MRS inhibitor 5 acetate and mupirocin salts were tested against a collection of Gram-positive bacteria.
• MRSi compound 5 alone and in combination with mupirocin demonstrated potent activity against all pathogens including mupirocin and oxacillin (methicillin) resistant S. aureus as shown in Table 4.
• Table 4 Activity of the acetate and mupirocin salts of the MRS inhibitor 5 against Gram-positive bacteria
• MRSi compound 5 (acetate and mupirocin salts) were further challenged against 62 recent clinical isolates of S. aureus and Table 5 shows potent activity against both oxacillin-susceptible and resistant organisms.
• Table 5 Activity of MRSi compound 5 and MRSi compound 5/Mupirocin (1:1 Combination) against oxacillin-susceptible and -resistant S. aureus
• EXAMPLE 13 ACTIVITY OF MRSI COMPOUND 5 AND MRSI COMPOUND 5 /MUPIROCIN AGAINST MUPIROCIN-RESISTANT S. AUREUS
• the acetate and mupirocin salts of the MRS inhibitor compound 5 were tested against a collection of both low and high-level mupirocin resistant clinical isolates of S. aureus (Table 6). The results show that MRSi compound 5 alone and in combination with mupirocin (mupirocin salt) have potent activity against both low and high-level mupirocin-reistant S. aureus.
• Table 6 Activity of MRSi compound 5 and MRSi compound 5/mupirocin against mupirocm-resistant S. aureus
• S. pyogenes is also a significant skin pathogen and 48 recent clinical isolates were tested for their susceptibility to MRSi compound 5 alone (acetate) and in combination (1:1) with mupirocin (mupirocinate). Both MRSi compound 5 alone and in 1 :1 combination showed potent activity against S. pyogenes (Table 11).
• Table 11 Activity of MRSi compound 5 and MRSi compound 5/Mupirocin (1:1 Combination) against clinical isolates of S. pyogenes
• Table 12 Activity of mupirocin in combination with MRSi compound 2 (MRS inhibitor) against mupirocin-susceptible and resistant S. aureus
• EXAMPLE 18 STUDY TO DETERMINE THE ABILITY OF AN MRS INHIBITOR (MRSI COMPOUND 2) IN COMBINATION WITH MUPIROCIN TO SELECT FOR SPONTANEOUS RESISTANT MUTANTS OF S. AUREUS.
• Many antimicrobial agents have been shown to be capable of selecting for spontaneous resistant mutants.
• the objective of this study was to examine the ability of mupirocin and the MRS inhibitor alone and in combination to select for spontaneous resistant mutants of S. aureus.
• Approximately, 10 9 bacteria were plated onto Mueller-Hinton agar supplemented with 10% horse blood and containing various concentrations of the test compounds alone
• Table 13 Selection of tRNA synthetase inhibitor resistant mutants from S. aureus ATCC 29213 and 31-1334
• Spontaneous resistant mutants were selected by plating S. aureus strains ATCC 29213 and 31-1334 onto medium containing mupirocin or MRSi compound 2 at 2, 4 and 8-fold MIC of each compound. No resistant colonies were detected on plates containing both compounds at 2, 4 and 8 their respective MICs.
• MRSi compound 5 (acetate salt, 1 ⁇ g/mL), mupirocin (1 ⁇ g/mL) and a 1:1 MRSi compound 5/mupirocin combination (each component at 1 ⁇ g/mL) were tested for their ability to select for spontaneous resistant mutants from seven different staphylococcal isolates. 10 9 colony forming units (CFU) of each organism were incubated on media containing one of the single agents or the combination. The results in Figure 3 show that both MRSi compound 5 and mupirocin had low propensity for the selection of spontaneous resistant mutants from staphylococci after incubation for 48 hours (resistance frequencies ranging from 3.3 x 10 "9 to 1.35 x 10 "7 ). In contrast, no resistant colonies could be detected on media containing MRSi compound 5/mupirocin (1:1 combination) for any of the seven staphylococcal isolates tested after incubation for 48 hours.
• EXAMPLE 20 SUSCEPTIBILITY OF MRS-RESISTANT MUTANTS OF S. AUREUS TO MUPIROCIN AND 1:1 MRSI COMPOUND 5/MUPIROCIN COMBINATION
• MRS -resistant mutants generated in vitro in either serial passage or spontaneous resistance development studies were evaluated for susceptibility to mupirocin alone and in a 1 :1 combination with MRSi compound 5. All mutants were characterized to identify key mutations in metS (Table 15). All the MRS -resistant mutants retained susceptibility to mupirocin and 1:1 MRSi compound 5/mupirocin with MICs ranging from 0.12 to 1
• MUTANTS MRS-resistant mutants S. aureus SP-1A2 and S. aureus SP-1B5 were evaluated in a growth curve study along with the parent wild type strain (S. aureus ATCC 29213). Growth of all three strains was determined by monitoring optical density (600 nm) over eight hours. The results in Figure 4 show that both the resistant mutants have slower rates of growth when compared with the wild type parent strain. It is possible that the A247E and I57N mutations appear to be responsible for low-level resistance to MRSi compound 5 and may also be associated with a fitness burden cost to the cell.
• EXAMPLE 22 MODE OF ACTION CONFIRMATION STUDIES
• MRSi compound 5 was tested against a strain of S. aureus in which the metRS gene was placed under the control of a xyl/tet promoter on a S. aureus compatible plasmid.
• the strain expresses high levels of MRS upon the addition of O.Ol ⁇ g/mL of anyhdrotetracycline.
• Table 16 show that over-expression of MRS leads to an 8-fold increase in MIC for MRSi compound 5 but not for mupirocin or the other control compounds tested.

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