Correlation of trimethoprim and brodimoprim physicochemical and lipid membrane interaction properties with their accumulation in human neutrophils

Therapies in preclinical and in early clinical development for the treatment of urinary tract infections: from pathogens to therapies

INTRODUCTION

Urinary tract infections (UTIs) are a prevalent health challenge characterized by the invasion and multiplication of microorganisms in the urinary system. The continuous exploration of novel therapeutic interventions is imperative. Advances in research offer hope for revolutionizing the management of UTIs and improving the overall health outcomes for individuals affected by these infections.

AREAS COVERED

This review aimed to provide an overview of existing treatments for UTIs, highlighting their strengths and limitations. Moreover, we explored and analyzed the latest therapeutic modalities under clinical development. Finally, the review offered a picture into the potential implications of these therapies on the future landscape of UTIs treatment, discussing possible advancements and challenges for further research.

EXPERT OPINION

Comprehensions into the pathogenesis of UTIs have been gleaned from foundational basic science studies, laying the groundwork for the exploration of novel therapeutic interventions. The primary source of evidence originates predominantly from animal studies conducted on murine models. Nevertheless, the lack of clinical trials interferes the acquisition of robust evidence in humans. The challenges presented by the heterogeneity and virulence of uropathogens add an additional layer of complexity, posing an obstacle that scientists and clinicians are actively grappling with in their pursuit of effective solutions.

Direct toxicity of six antibiotics on soil bacterial communities affected by the addition of bio-adsorbents

Reducing the toxicity caused by antibiotics on bacterial communities in the soil is one of the great challenges of this century. For this, the effectiveness of amending the soil with different bioadsorbents such as crushed mussel shell (CMS), pine bark (PB) and biomass ash (BA), as well as combinations of them (CMS + PB and PB + BA) was studied at different doses (0 g kg^-1 to 48 g kg^-1). Soil samples were spiked, separately, with increasing doses (0-2000 mg kg^-1) of cefuroxime (CMX), amoxicillin (AMX), clarithromycin (CLA), azithromycin (AZI), ciprofloxacin (CIP) and trimethoprim (TMP). Their toxicity on bacterial growth was estimated using the tritium-labeled leucine (³H) incorporation method. Toxicity was observed to behave differently depending on the antibiotic family and bioadsorbent, although in different magnitude and at different doses. The toxicity of β-lactams (AMX and CXM) was reduced by up to 54% when the highest doses of bio-adsorbents were added due to the increase in pH (CMS and BA) and carbon (PB) contribution. Macrolides (CLA and AZI) showed slight toxicity in un-amended soil samples, which increased by up to 65% with the addition of the bio-adsorbents. The toxicity of CIP (a fluoroquinolone) increased with the dose of the bio-adsorbents, reaching up to 20% compared with the control. Finally, the toxicity of TMP (a diaminopyrimidine) slightly increased with the dose of bio-adsorbents. The by-products that increase soil pH are those that showed the highest increases of CLA, AZI, CIP and TMP toxicities. These results could help to prevent/reduce environmental pollution caused by different kinds of antibiotics, selecting the most appropriated bio-adsorbents and doses.

Glucose Incorporated Graphite Matrix for Electroanalysis of Trimethoprim

The antibiotic drug trimethoprim (TMP) is used to treat bacterial infections in humans and animals, and frequently TMP is used along with sulfonamides. However, a large portion of TMP is excreted in its active state, which poses a severe problem to humans and the environment. A sensitive, rapid, cost-effective analytical tool is required to monitor the TMP concentration in biological and environmental samples. Hence, this study proposed an analytical methodology to analyze TMP in clinical, biological and environmental samples. The investigations were carried out using a glucose-modified carbon paste electrode (G-CPE) employing voltammetric techniques. Electrochemical behavior was examined with 0.5 mM TMP solution at optimum pH 3.4 (Phosphate Buffer Solution, I = 0.2 M). The influence of scan rate on the electro-oxidation of TMP was studied within the range of 0.05 to 0.55 V/s. The effect of pH and scan rate variations revealed proton transfer during oxidation. Moreover, diffusion phenomena governed the irreversibility of the electrode reaction. A probable and suitable electrode interaction and reaction mechanism was proposed for the electrochemical oxidation of TMP. Further, the TMP was quantitatively estimated with the differential pulse voltammetry (DPV) technique in the concentration range from 9.0 × 10^-7 to 1.0 × 10^-4 M. The tablet, spiked water and urine analysis demonstrated that the selected method and developed electrode were rapid, simple, sensitive, and cost-effective.

A Physiologically-Based Pharmacokinetic Model of Trimethoprim for MATE1, OCT1, OCT2, and CYP2C8 Drug-Drug-Gene Interaction Predictions

Trimethoprim is a frequently-prescribed antibiotic and therefore likely to be co-administered with other medications, but it is also a potent inhibitor of multidrug and toxin extrusion protein (MATE) and a weak inhibitor of cytochrome P450 (CYP) 2C8. The aim of this work was to develop a physiologically-based pharmacokinetic (PBPK) model of trimethoprim to investigate and predict its drug–drug interactions (DDIs). The model was developed in PK-Sim^®, using a large number of clinical studies (66 plasma concentration–time profiles with 36 corresponding fractions excreted in urine) to describe the trimethoprim pharmacokinetics over the entire published dosing range (40 to 960 mg). The key features of the model include intestinal efflux via P-glycoprotein (P-gp), metabolism by CYP3A4, an unspecific hepatic clearance process, and a renal clearance consisting of glomerular filtration and tubular secretion. The DDI performance of this new model was demonstrated by prediction of DDIs and drug–drug–gene interactions (DDGIs) of trimethoprim with metformin, repaglinide, pioglitazone, and rifampicin, with all predicted DDI and DDGI AUC_last and C_max ratios within 1.5-fold of the clinically-observed values. The model will be freely available in the Open Systems Pharmacology model repository, to support DDI studies during drug development.

Pharmacokinetics and pharmacodynamics of sulfamethoxazole and trimethoprim in swimming crabs (Portunus trituberculatus) and in vitro antibacterial activity against Vibrio: PK/PD of SMZ-TMP in crabs and antibacterial activity against Vibrio

Serious bacterial pathogens have recently become a major cause of massive mortality in swimming crabs (Portunus trituberculatus). In this study, the antibacterial activity against Vibrio and the pharmacokinetics (PK) of sulfamethoxazole (SMZ)-trimethoprim (TMP) in crabs were estimated to explore the pharmacokinetics/pharmacodynamics (PK/PD) properties of the SMZ-TMP combination. The in vitro bacteriostatic activity and the anti-Vibrio infection activity of the SMZ-TMP combination at various ratios in crabs were studied. A degree of synergism was observed in the SMZ-TMP combination at ratios ranging from 50:1 to 1:5. The results showed that the MIC50 and MIC90 values for different SMZ-TMP combinations were in the ranges of 0.62-5 and 0.62-10μg/mL, respectively. The distribution of the MIC values of the SMZ-TMP combination at ratios of 1:1 and 5:1 were 0.31-5 and 0.31-10μg/mL, respectively. Crabs were then fed the SMZ-TMP combination (at ratios of 5:1 and 1:1) six successive times and then challenged with Vibrio parahaemolyticus at 1×10(5), 1×10(6), and 5×10(6) colony forming units (cfu) per crab. The results showed that the number of surviving crabs administered SMZ-TMP at a ratio of 1:1 was greater than that of the crabs given SMZ-TMP at a ratio of 5:1. In addition, the tissue distribution and absorption of SMZ-TMP (ratios of 5:1 and 1:1) in crabs were studied through high-performance liquid chromatography (HPLC). In the crabs fed SMZ-TMP at a ratio of 5:1, the CmaxSMZ/TMP values in the hemolymph, hepatopancreas, muscle and gill were 104:1. 0.57:1, 19:1 and 6:1, respectively. In contrast, the corresponding CmaxSMZ/TMP values in these tissues in the crabs fed SMZ-TMP at a ratio of 1:1 were 34:1, 0.14:1, 4:1 and 3:1, respectively. The results showed that TMP was better absorbed and eliminated in the crabs fed SMZ-TMP at a ratio of 1:1 than in the crabs fed this combination at a ratio of 5:1. In addition, TMP was absorbed and eliminated more rapidly in the hepatopancreas than in the gill, muscle and hemolymph. The distribution volume of TMP in the hepatopancreas exceeded that of SMZ observed in the experiments. The results indicated that the PK/PD effect of the SMZ-TMP at a ratio of 1:1 was greater than that of the combination at a ratio of 5:1. Our study suggests that a SMZ-TMP ratio of 1:1 may be used to control bacterial disease in aquatic animals.

Distribution and Inhibition of Liposomes on Staphylococcus aureus and Pseudomonas aeruginosa Biofilm

BACKGROUND

Staphylococcus aureus and Pseudomonas aeruginosa are major pathogens in chronic rhinosinusitis (CRS) and their biofilms have been associated with poorer postsurgical outcomes. This study investigated the distribution and anti-biofilm effect of cationic (+) and anionic (-) phospholipid liposomes with different sizes (unilamellar and multilamellar vesicle, ULV and MLV respectively) on S. aureus and P. aeruginosa biofilms.

METHOD

Specific biofilm models for S. aureus ATCC 25923 and P. aeruginosa ATCC 15692 were established. Liposomal distribution was determined by observing SYTO9 stained biofilm exposed to DiI labeled liposomes using confocal scanning laser microscopy, followed by quantitative image analysis. The anti-biofilm efficacy study was carried out by using the alamarBlue assay to test the relative viability of biofilm treated with various liposomes for 24 hours and five minutes.

RESULTS

The smaller ULVs penetrated better than larger MLVs in both S. aureus and P. aeruginosa biofilm. Except that +ULV and -ULV displayed similar distribution in S. aureus biofilm, the cationic liposomes adhered better than their anionic counterparts. Biofilm growth was inhibited at 24-hour and five-minute exposure time, although the decrease of viability for P. aeruginosa biofilm after liposomal treatment did not reach statistical significance.

CONCLUSION

The distribution and anti-biofilm effects of cationic and anionic liposomes of different sizes differed in S. aureus and P. aeruginosa biofilms. Reducing the liposome size and formulating liposomes as positively charged enhanced the penetration and inhibition of S. aureus and P. aeruginosa biofilms.

Dihydrofolate reductase as a therapeutic target for infectious diseases: opportunities and challenges

Infectious diseases caused by parasites continue to take a massive toll on human health in the poor regions of the world. Filling the anti-infective drug-discovery pipeline has never been as challenging as it is now. The organisms responsible for these diseases have interesting biology with many potential biochemical targets. Inhibition of metabolic enzymes has been established as an attractive strategy for anti-infectious drug development. In this field, dihydrofolate reductase (DHFR) is an important enzyme in nucleic and amino acid synthesis and an extensively studied drug target over the past 50 years. The challenges for novel DHFR inhibition-based chemotherapeutics for the treatment of infectious diseases are now focused on overcoming the resistance problem as well as cost–effectiveness. Each year, the large number of literature citations attest the continued popularity of DHFR. It becomes truly the ‘enzyme of choice for all seasons and almost all reasons’. Herein, we summarize the opportunities and challenges in developing novel lead based on this target.

Liquid scintillation spectrometry of tritium in studying lysozyme behavior in aqueous/organic liquid systems. The influence of the organic phase

Liquid scintillation spectrometry of tritium in the application of the scintillation phase method was used for studying the adsorption of lysozyme at the liquid/liquid interface and its distribution in the bulk of the system. The goal of this research was to reveal the influence of the nature of the organic phase on the distribution and adsorption ability of the protein when it is placed in a system containing two immiscible liquids. Based on the radiochemical assay distribution coefficients and adsorption isotherms obtained for aqueous/octane, aqueous/p-xylene and aqueous/octanol systems, it was concluded that the interaction of the protein with the interface plays a dominant role in protein behavior in aqueous/organic liquid systems.

PHARMACEUTICS, PREFORMULATION ANDDRUG DELIVERY

The isolation and physicochemical characterization of four crystalline modifications of brodimoprim (5-[(4-bromo-3,5-dimethoxyphenyl)methyl]-2,4-pyrimidinediamine, hereinafter BMP), a structural analog of trimethoprim (TMP), are reported. These phases include an unsolvated form of BMP, a hemihydrate (BMP 0.5H(2)O), a 1:1 solvate containing isopropanol (BMP C(3)H(7)OH(iso)), and a hemichloroformate (BMP 0.5CHCl(3)). Unsolvated BMP was isolated both by recrystallization from a range of common solvents as well as by thermal decomposition of the above solvates and no evidence for polymorphism was found. PXRD data indicated that the three solvates crystallize in different arrangements. Data from thermal analysis (thermogravimetry (TGA), hot stage microscopy (HSM), differential scanning calorimetry (DSC)) of the solvates containing water and iso-propanol were interpreted on the basis of their single-crystal X-ray structures which revealed that the modes of solvent inclusion in BMP 0.5H(2)O and BMP C(3)H(7)OH(iso) may be described as 'isolated site' and 'lattice channel' type inclusions, respectively.

Adsorptive stripping voltammetry of trimethoprim: Mechanistic studies and application to the fast determination in pharmaceutical suspensions

The adsorptive stripping voltammetric behaviour of trimethoprim (TMP) was studied at pH 3.8 and 7.0 by linear-sweep (LS) and cyclic voltammetry at the hanging mercury drop electrode. The charges and surface concentrations of the protonated TMP species were determined at both pH values. Taking advantage of the adsorption features of TMP fast voltammetric techniques (LS and square-wave (SW) voltammetry) were applied to the determination of TMP at the 10(-7)mol dm(-3) concentration level (pH 3.8). For these concentrations the relative standard deviations were <2% (N=8) and the detection limit was 10nM (3 ng/mL) for the SW-AdCSV (3s; accumulation time 10s, frequency 100 Hz). The use of SW-adsorptive cathodic stripping voltammetry originated a very fast and sensitive method for the direct analysis of TMP in pharmaceutical suspensions without any matrix effects or interference from sulfamethoxazole. No sample pre-treatments or solvent extraction procedures were needed. The quantitative results were in agreement with the data supplied by the manufacturer.

Combining molecular modeling with experimental methodologies: mechanism of membrane permeation and accumulation of ofloxacin

The interaction between ofloxacin, as a model drug of the fluoroquinolone class, and biomembranes was examined as the possible initial step in a transmembrane diffusion process. Dipalmitoylphosphatidylcholine was used for the preparation of biomembrane models. The influence of environmental conditions and protonation on molecular physicochemical behavior, and hence on the membrane interaction, was investigated by differential scanning calorimetry (DSC). This technique has been shown to be very effective in the interpretation of interactions of drug microspeciations with biomembranes. These findings suggest that the interaction occurred owing to ionic and hydrophobic forces showing how the passage through the membrane is mainly favored in the pH interval 6-7.4. It was demonstrated that a pH gradient through model membranes may be responsible for a poorly homogeneous distribution of ofloxacin (or other related fluoroquinolones), which justifies the in vivo accumulation properties of this drug. DSC experiments, which are in agreement with computational data, also showed that the complexing capability of ofloxacin with regard to Mg(++) or Ca(++) may govern the drug entrance into bacterial cells before the DNA Girase inhibition and could ensure the formation of hydrophobic and more fluid phospholipid domains on the surface of the model membrane. These regions are more permeable with regard to various solutes, as well as ofloxacin, allowing a so-called 'self-promoted entrance pathway'. The combination of experimental methodologies with computational data allowed a further rationalization of the results and opened new perspectives into the mechanism of action of ofloxacin, namely its interaction with lipid bilayers and drug-divalent cation complex formation, which might be extended to the entire fluoroquinolone class. Ofloxacin accumulation within Escherichia coli ATCC 25922 was measured as a function of time. Also in this example, the environmental conditions influenced ofloxacin penetration and accumulation. The in vitro experiments, reported here, show that a suitable balance of hydrophilic and hydrophobic fluoroquinolone properties needs to occur for there to be increased drug permeation.

Interactions of metal ions with a 2,4-diaminopyrimidine derivative (trimethoprim). Antibacterial studies

The interaction of copper (II), zinc(II) and cadmium(II) with Trimethoprim (2,4-diamino-5-(3',4',5'-trimethoxybenzyl) pyrimidine) has been studied. The crystal structures of [Zn(Trim)2Cl2] (2) and [Cd(Trim)Cl2(CH3OH)]n (4) are reported. Compound (2) exhibits a distorted tetrahedral environment around the metal center and crystallizes in the triclinic space group P1 with a=10.2397(6), b=10.4500(6), c=16.3336(16) A, alpha=96.141(8), beta=106.085(5), gamma=96.551(5) degrees and Z=2. In complex (4), the Cd(II) centers are bridged sequentially by two chlorine ions to form infinite chains and present a six-coordinated environment; the compound crystallizes in the monoclinic P2(1)/C space group with a=13.958(5), b=7.532(2), c=18.390(2) A, alpha=90, beta=97.32(5), gamma=90 degrees and Z=4. In both structures the Trimethoprim acts as a monodentate ligand through the pyrimidinic nitrogen N(1) atom. The characterization of the Cu(Trim)2(CH3O)(ClO4) complex through EPR and magnetic measurements suggests a binuclear or polinuclear nature, with bridging methoxo groups. The complexes were screened for their activity against several bacteria, showing activity similar to that of trimethoprim.

Ofloxacin-loaded liposomes: in vitro activity and drug accumulation in bacteria

Different ofloxacin-loaded unilamellar vesicles were prepared by the extrusion technique, and their antimicrobial activities were determined in comparison to those of the free drug by means of MIC determinations with both American Type Culture Collection standards and wild-type bacterial strains (six strains of Enterococcus faecalis, seven strains of Escherichia coli, six strains of Staphylococcus aureus, and six strains of Pseudomonas aeruginosa). The accumulation of ofloxacin and liposome-ofloxacin was measured by determining the amount of the drug inside the bacteria as a function of time. Encapsulated fluoroquinolone yielded MICs which were at least twofold lower than those obtained with the free drug. In particular, liposomes made up of dimyristoylphosphatidylcholine-cholesterol-dipalmitoylphosphatidylser ine and dimyristoylphosphatidylcholine-cholesterol-dihexadecylphosphate (4:3:4 molar ratio) provided the best improvement in antimicrobial activity against the various bacterial strains investigated. The liposome formulation produced higher intracellular fluoroquinolone concentrations than those achieved simultaneously with the free drug in both E. coli and P. aeruginosa.

Characterization and in-vivo ocular absorption of liposome-encapsulated acyclovir

The potential of liposomes as an in-vivo ophthalmic drug delivery system for acyclovir was investigated. The drug-membrane interaction was evaluated by means of differential scanning calorimetry analysis. These experiments showed that acyclovir is able to interact with both positively and negatively charged membranes via electrostatic or hydrogen bonds. No interaction was observed with neutral membranes made up of dipalmitoylphosphatidylcholine. Different liposome preparation procedures were carried out to encapsulate acyclovir. The drug encapsulation mainly depends on the amount of water which the liposome system is able to entrap. In the case of multilamellar vesicles, charged systems showed the highest encapsulation efficiency. No particular difference in the encapsulation efficiency was observed for oligolamellar vesicles prepared with the reverse-phase evaporation technique. Oligolamellar liposomes showed the highest acyclovir encapsulation parameters and had release profiles similar to those of multilamellar liposomes. In-vivo experiments using male New Zealand albino rabbits were carried out to evaluate the aqueous humour concentration of acyclovir bioavailability. The most suitable ophthalmic drug delivery system was oligolamellar systems made up of dipalmitoylphosphatidylcholine-cholesterol-dimethyldioctadecyl glycerole bromide (7:4:1 molar ratio), which presented the highest encapsulation capacity and were able to deliver greater amounts of the drug into the aqueous humour than a saline acyclovir solution or a physical liposome/drug blend.