β-Lactamase Inhibitors To Restore the Efficacy of Antibiotics against Superbugs

J Med Chem. 2020 Mar 12;63(5):1859-1881. doi: 10.1021/acs.jmedchem.9b01279. Epub 2019 Nov 13.

Abstract

Infections caused by resistant bacteria are nowadays too common, and some pathogens have even become resistant to multiple types of antibiotics, in which case few or even no treatments are available. In recent years, the most successful strategy in anti-infective drug discovery for the treatment of such problematic infections is the combination therapy "antibiotic + inhibitor of resistance". These inhibitors allow the repurposing of antibiotics that have already proven to be safe and effective for clinical use. Three main types of compounds have been developed to block the principal bacterial resistance mechanisms: (i) β-lactamase inhibitors; (ii) outer membrane permeabilizers; (iii) efflux pump inhibitors. This Perspective is focused on β-lactamase inhibitors that disable the most prevalent cause of antibiotic resistance in Gram-negative bacteria, i.e., the deactivation of the most widely used antibiotics, β-lactams (penicillins, cephalosporines, carbapenems, and monobactams), by the production of β-lactamases. An overview of the most recently identified β-lactamase inhibitors and of combination therapy is provided. The article also covers the mechanism of action of the different types of β-lactamase enzymes as a basis for inhibitor design and target inactivation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Anti-Bacterial Agents / metabolism*
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Infections / drug therapy*
  • Bacterial Infections / metabolism
  • Drug Resistance, Microbial / drug effects*
  • Drug Resistance, Microbial / physiology
  • Humans
  • Protein Structure, Secondary
  • Protein Structure, Tertiary
  • Treatment Outcome
  • beta-Lactamase Inhibitors / chemistry
  • beta-Lactamase Inhibitors / metabolism*
  • beta-Lactamase Inhibitors / therapeutic use
  • beta-Lactamases / metabolism*

Substances

  • Anti-Bacterial Agents
  • beta-Lactamase Inhibitors
  • beta-Lactamases