Teicoplanin

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Teicoplanin
Teicoplanin core and major components.svg
Clinical data
Pronunciation /ˌtkˈplnɪn/
TY-koh-PLAY-nin
Trade names Targocid
AHFS/Drugs.com International Drug Names
Pregnancy
category
  • AU:B3
Routes of
administration
Intravenous, intramuscular
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only) [1]
  • UK: POM (Prescription only)
  • EU:Rx-only [2]
Pharmacokinetic data
Bioavailability 90% (given IM)
Protein binding 90% to 95%
Metabolism Nil
Elimination half-life 70 to 100 hours
Excretion Kidney (97% unchanged)
Identifiers
  • Ristomycin A 34-O-[2-(acetylamino)-2-deoxy-.beta.-D-glucopyranosyl]-22,31-dichloro-7-demethyl-64-O-demethyl-19-deoxy-56-O-[2-deoxy-2-[(8-methyl-1-oxononyl)amino]-.beta.-D-glucopyranosyl]-42-O-.alpha.-D-mannopyranosyl-
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
NIAID ChemDB
CompTox Dashboard (EPA)
Chemical and physical data
Formula Variable
Molar mass 1564.3 to 1907.7 g/mol
Melting point 260 °C (500 °F) (dec.)
  • InChI=1S/C89H99Cl2N9O33/c1-34(2)9-7-5-4-6-8-10-61(109)95-69-75(114)72(111)59(32-102)130-88(69)133-79-56-26-41-27-57(79)127-53-18-14-39(24-48(53)91)78(132-87-68(93-35(3)104)74(113)71(110)58(31-101)129-87)70-85(122)99-67(86(123)124)46-29-43(106)30-55(128-89-77(116)76(115)73(112)60(33-103)131-89)62(46)45-23-38(13-15-50(45)107)64(82(119)100-70)97-84(121)66(41)98-83(120)65-40-21-42(105)28-44(22-40)125-54-25-37(12-16-51(54)108)63(92)81(118)94-49(80(117)96-65)20-36-11-17-52(126-56)47(90)19-36/h11-19,21-30,34,49,58-60,63-78,87-89,101-103,105-108,110-116H,4-10,20,31-33,92H2,1-3H3,(H,93,104)(H,94,118)(H,95,109)(H,96,117)(H,97,121)(H,98,120)(H,99,122)(H,100,119)(H,123,124)/t49-,58-,59-,60-,63+,64-,65+,66-,67-,68-,69-,70+,71-,72-,73-,74-,75-,76+,77+,78-,87+,88+,89+/m1/s1 Yes check.svgY
  • Key:FHBQKTSCJKPYIO-OXIGXJDJSA-N Yes check.svgY
 X mark.svgNYes check.svgY  (what is this?)    (verify)

Teicoplanin is an semisynthetic glycopeptide antibiotic with a spectrum of activity similar to vancomycin. Its mechanism of action is to inhibit bacterial cell wall [3] peptidoglycan [4] synthesis. It is used in the prophylaxis and treatment of serious infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus and Enterococcus faecalis . [3]

Contents

Teicoplanin is marketed by Sanofi-Aventis under the trade name Targocid. Other trade names include Ticocin marketed by Cipla(India).

Oral teicoplanin has been demonstrated to be effective in the treatment of pseudomembranous colitis and Clostridioides difficile -associated diarrhoea, with comparable efficacy with vancomycin. [5]

Its strength is considered to be due to the length of the hydrocarbon chain. [6]

Teicoplanin is produced by the so-called "rare" actinobacterium Actinoplanes teichomyceticus ATCC 31121, [7] belonging to the Micromonosporaceae family. Biosynthetic pathway leading to teicoplanin, as well as the regulatory circuit governing the biosynthesis, were studied intensively in recent years allowing to construct an integrated model of the biosynthesis. [8]

Indications

Teicoplanin treats a wide range of infections with Gram-positive bacteria, including endocarditis, sepsis, soft tissue and skin infections, and venous catheter-associated infections. [9]

Susceptible organisms

Teicoplanin has demonstrated in vitro efficacy against Gram-positive bacteria including staphylococci (including MRSA), streptococci, enterococci, and against anaerobic Gram-positive bacteria including Clostridium spp. Teicoplanin is ineffective against Gram-negative bacteria as the large, polar molecules of the compound are unable to pass through the external membrane of these organisms. [9] The following represents MIC susceptibility data for a few medically significant pathogens: [4]

Pharmacology

Teicoplanin exhibits a very long biological half-life of about 45-70h (sufficient plasma levels can thus be sustained with once-daily administration). Elimination is almost exclusively renal. It is mostly excreted unchanged. [9]

Adverse effects

Adverse effects of teicoplanin are usually limited to local effects or hypersensitivity reactions. While there is potential for nephrotoxicity and ototoxicity, the incidence of such organ toxicity is rare if recommended serum concentrations are successfully maintained. [9]

Considerations

Reduced renal function slows teicoplanin clearance, consequently increasing its elimination half-life. Elimination half-life is longer in the elderly due to the reduced renal function in this population. [9]

Chemistry

Teicoplanin (TARGOCID, marketed by Sanofi Aventis Ltd) is actually a mixture of several compounds, five major (named teicoplanin A2-1 through A2-5) and four minor (named teicoplanin RS-1 through RS-4). [10] [11] All teicoplanins share a same glycopeptide core, termed teicoplanin A3-1 — a fused ring structure to which two carbohydrates (mannose and N-acetylglucosamine) are attached. The major and minor components also contain a third carbohydrate moietyβ-D-glucosamine — and differ only by the length and conformation of a side-chain attached to it. Teicoplanin A2-4 and RS-3 have chiral side chains while all other side chains are achiral. Teicoplanin A3 lacks both the side chains as well as the β-D-glucosamine moiety.

The structures of the teicoplanin core and the side-chains that characterize the five major as well as four minor teicoplanin compounds are shown below.

Teicoplanin core (left, black) and side-chains that characterize teicoplanins A2-1 through A2-5 (middle) as well as related RS-1 through RS-4 (right). In blue: b-D-glucosamine. Teicoplanin core components.svg
Teicoplanin core (left, black) and side-chains that characterize teicoplanins A2-1 through A2-5 (middle) as well as related RS-1 through RS-4 (right). In blue: β-D-glucosamine.

Teicoplanin refers to a complex of related natural products isolated from the fermentation broth of a strain of Actinoplanes teichomyceticus , [12] consisting of a group of five structures. These structures possess a common aglycone, or core, consisting of seven amino acids bound by peptide and ether bonds to form a four-ring system. These five structures differ by the identity of the fatty acyl side-chain attached to the sugar. The origin of these seven amino acids in the biosynthesis of teicoplanin was studied by 1H and 13C nuclear magnetic resonance. [13] The studies indicate amino acids 4-Hpg, 3-Cl-Tyr, and 3-chloro-β-hydroxytyrosine are derived from tyrosine, and the amino acid 3,5-dihydroxyphenylglycine (3,5-Dpg) is derived from acetate. Teicoplanin contains 6 non-proteinogenic amino acids and three sugar moieties, N-acyl-β-D-glucosamine, N-acetyl-β-D-glucosamine, and D-mannose.

Gene cluster

The study of the genetic cluster encoding the biosynthesis of teicoplanin identified 49 putative open reading frames (ORFs) involved in the compound's biosynthesis, export, resistance, and regulation. Thirty-five of these ORFs are similar to those found in other glycopeptide gene clusters. The function of each of these genes is described by Li and co-workers. [14] A summary of the gene layout and purpose is shown below.

Gene layout. The genes are numbered. The letters L and R designate transcriptional direction. The presence of the * symbol means a gene is found after NRPs, which are represented by A, B, C, and D. Based on the figure from: Li, T-L.; Huang, F.; Haydock, S. F.; Mironenko, T.; Leadlay, P. F.; Spencer, J. B. Chemistry & Biology. 2004, 11, p. 109.

[11-L] [10-L] [9-R] [8-R] [7-R] [6-R] [5-R] [4-L][3-L] [2-L] [1-R] [A-R] [B-R] [C-R] [D-R] [1*-R] [2*-R] [3*-R] [4*-R] [5*-R] [6*-R] [7*-R] [8*-R] [9*-R] [10*-R] [11*-R] [12*-R] [13*-R] [14*-R] [15*-R] [16*-R] [17*-R] [18*-R] [19*-R] [20*-R] [21*-R] [22*-R] [23*-R] [24*-R] [25*-L] [26*-L] [27*-R] [28*-R] [29*-R] [30*-R][31*-R] [32*-L] [33*-L] [34*-R]

Enzyme produced by gene sequenceRegulatory proteinsOther enzymesResistant enzymesΒ-hydroxy-tyrosine and 4-hydroxy-phenylglycin biosynthetic enzymesGlycosyl transferasesPeptide synthetasesP450 oxygenasesHalogenase3,5-dihydroxy phenylglycin biosynthetic enzymes
Genes11, 10, 3, 2, 15*, 16*, 31*9, 8, 1*, 2*, 4*, 11*, 13*, 21*, 26*, 27*, 30*, 32*, 33*, 34*7, 6, 54, 12*, 14*, 22*, 23*, 24*, 25*, 28*, 29*1, 3*, 10*A, B, C, D5*, 6*, 7*, 9*8*17*, 18*, 19*, 20*, 23*

Heptapeptide backbone synthesis

The heptapeptide backbone of teicoplanin is assembled by the nonribosomal peptide synthetases (NRPSs) TeiA, TeiB, TeiC and TeiD. Together these comprise seven modules, each containing a number of domains, with each module responsible for the incorporation of a single amino acid. Modules 1, 4, and 5 activate L-4-Hpg as the aminoacyl-AMP, modules 2 and 6 activate L-Tyr, and modules 3 and 7 activate L-3,5-Dpg. The activated amino acids are covalently bound to the NRPS as thioesters by a phosphopantetheine cofactor, which is attached to the peptidyl carrier protein (PCP) domain. The enzyme bound amino acids are then joined by amide bonds by the action of the condensation (C) domain.

The heptapetide of teicoplanin contains 4 D-amino acids, formed by epimerization of the activated L-amino acids. Modules 2, 4 and 5 each contain an epimerization (E) domain which catalyzes this change. Module 1 does not contain an E domain, and epimerization is proposed to be catalysed by the C domain. [15] In all, six of the seven total amino acids of the teicoplanin backbone are composed of nonproteinogenic or modified amino acids. Eleven enzymes are coordinatively induced to produce these six required residues. [16] Teicoplanin contains two chlorinated positions, 2 (3-Cl-Tyr) and 6 (3-Cl-β-Hty). The halogenase Tei8* has been acts to catalyze the halogenation of both tyrosine residues. Chlorination occurs at the amino acyl-PCP level during the biosynthesis, prior to phenolic oxidative coupling, with the possibility of tyrosine or β-hydroxytyrosine being the substrate of chlorination. [17] Hydroxylation of the tyrosine residue of module 6 also occurs in trans during the assembly of the heptapeptide backbone.

Modification after heptapeptide backbone formation

Once the heptapeptide backbone has been formed, the linear enzyme-bound intermediate is cyclized. [16] Gene disruption studies indicate cytochrome P450 oxygenases as the enzymes that performs the coupling reactions. The X-domain in the final NRPS module is required to recruit the oxygenase enzymes. [18] OxyB forms the first ring by coupling residues 4 and 6, and OxyE then couples residues 1 and 3. OxyA couples residues 2 and 4, followed by the formation of a C-C bond between residues 5 and 7 by OxyC. [19] The regioselectivity and atropisomer selectivity of these probable one-electron coupling reactions has been suggested to be due to the folding and orientation requirements of the partially crossed-linked substrates in the enzyme active site. [16] The coupling reactions are shown below.

Oxidative cross-linkings steps during teicoplanin biosynthesis, catalysed by cytochrome P450 oxidases OxyB, E, A and C. Teicoplanin P450 Oxidations.png
Oxidative cross-linkings steps during teicoplanin biosynthesis, catalysed by cytochrome P450 oxidases OxyB, E, A and C.

Specific glycosylation has been shown to occur after the formation of the heptpeptide aglycone. [20] Three separate glycosyl transferases are required for the glycosylation of the teicoplanin aglycone. Tei10* catalyses the addition of GlcNAc to residue 4, followed by deacetylation by Tei2*. The acyl chain (produced by the action of Tei30* and Tei13*) is then added by Tei11*. Tei1 then adds a second GlcNAc to the β-hydroxyl group of residue 6, followed by mannosylation of residue 7 catalysed by Tei3*. [21]

Related Research Articles

Peptidoglycan or murein is a unique large macromolecule, a polysaccharide, consisting of sugars and amino acids that forms a mesh-like layer (sacculus) that surrounds the bacterial cytoplasmic membrane. The sugar component consists of alternating residues of β-(1,4) linked N-acetylglucosamine (NAG) and N-acetylmuramic acid (NAM). Attached to the N-acetylmuramic acid is an oligopeptide chain made of three to five amino acids. The peptide chain can be cross-linked to the peptide chain of another strand forming the 3D mesh-like layer. Peptidoglycan serves a structural role in the bacterial cell wall, giving structural strength, as well as counteracting the osmotic pressure of the cytoplasm. This repetitive linking results in a dense peptidoglycan layer which is critical for maintaining cell form and withstanding high osmotic pressures, and it is regularly replaced by peptidoglycan production. Peptidoglycan hydrolysis and synthesis are two processes that must occur in order for cells to grow and multiply, a technique carried out in three stages: clipping of current material, insertion of new material, and re-crosslinking of existing material to new material.

<span class="mw-page-title-main">Vancomycin</span> Antibiotic medication

Vancomycin is a glycopeptide antibiotic medication used to treat certain bacterial infections. It is administered intravenously to treat complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant Staphylococcus aureus. Blood levels may be measured to determine the correct dose. Vancomycin is also taken orally to treat severe Clostridioides difficile infection. Taken orally, it is poorly absorbed.

<span class="mw-page-title-main">Alamethicin</span> Chemical compound

Alamethicin is a channel-forming peptide antibiotic, produced by the fungus Trichoderma viride. It belongs to peptaibol peptides which contain the non-proteinogenic amino acid residue Aib. This residue strongly induces formation of alpha-helical structure. The peptide sequence is

<span class="mw-page-title-main">Polymyxin</span> Group of antibiotics

Polymyxins are antibiotics. Polymyxins B and E are used in the treatment of Gram-negative bacterial infections. They work mostly by breaking up the bacterial cell membrane. They are part of a broader class of molecules called nonribosomal peptides.

<small>DD</small>-Transpeptidase Bacterial enzyme

DD-Transpeptidase is a bacterial enzyme that catalyzes the transfer of the R-L-αα-D-alanyl moiety of R-L-αα-D-alanyl-D-alanine carbonyl donors to the γ-OH of their active-site serine and from this to a final acceptor. It is involved in bacterial cell wall biosynthesis, namely, the transpeptidation that crosslinks the peptide side chains of peptidoglycan strands.

Nonribosomal peptides (NRP) are a class of peptide secondary metabolites, usually produced by microorganisms like bacteria and fungi. Nonribosomal peptides are also found in higher organisms, such as nudibranchs, but are thought to be made by bacteria inside these organisms. While there exist a wide range of peptides that are not synthesized by ribosomes, the term nonribosomal peptide typically refers to a very specific set of these as discussed in this article.

<span class="mw-page-title-main">Glycopeptide antibiotic</span> Class of antibiotic drugs

Glycopeptide antibiotics are a class of drugs of microbial origin that are composed of glycosylated cyclic or polycyclic nonribosomal peptides. Significant glycopeptide antibiotics include the anti-infective antibiotics vancomycin, teicoplanin, telavancin, ramoplanin and decaplanin, corbomycin, complestatin and the antitumor antibiotic bleomycin. Vancomycin is used if infection with methicillin-resistant Staphylococcus aureus (MRSA) is suspected.

<span class="mw-page-title-main">Daptomycin</span> Antibiotic

Daptomycin, sold under the brand name Cubicin among others, is a lipopeptide antibiotic used in the treatment of systemic and life-threatening infections caused by Gram-positive organisms.

<span class="mw-page-title-main">Tyrocidine</span> Chemical compound

Tyrocidine is a mixture of cyclic decapeptides produced by the bacteria Brevibacillus brevis found in soil. It can be composed of 4 different amino acid sequences, giving tyrocidine A–D. Tyrocidine is the major constituent of tyrothricin, which also contains gramicidin. Tyrocidine was the first commercially available antibiotic, but has been found to be toxic toward human blood and reproductive cells. The function of tyrocidine within its host B. brevis is thought to be regulation of sporulation.

<span class="mw-page-title-main">Long-chain-fatty-acid—CoA ligase</span> Class of enzymes

The long chain fatty acyl-CoA ligase is an enzyme of the ligase family that activates the oxidation of complex fatty acids. Long chain fatty acyl-CoA synthetase catalyzes the formation of fatty acyl-CoA by a two-step process proceeding through an adenylated intermediate. The enzyme catalyzes the following reaction,

<span class="mw-page-title-main">Dihydroxyphenylglycine</span> Chemical compound

(S)-3,5-Dihydroxyphenylglycine or DHPG is a potent agonist of group I metabotropic glutamate receptors (mGluRs) mGluR1 and mGluR5.

<span class="mw-page-title-main">Ramoplanin</span> Antibiotic chemical

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Streptogramin B is a subgroup of the streptogramin antibiotics family. These natural products are cyclic hexa- or hepta depsipeptides produced by various members of the genus of bacteria Streptomyces. Many of the members of the streptogramins reported in the literature have the same structure and different names; for example, pristinamycin IA = vernamycin Bα = mikamycin B = osteogrycin B.

In molecular biology, VanY are protein domains found in enzymes named metallopeptidases. They are vital to bacterial cell wall synthesis and antibiotic resistance.

<span class="mw-page-title-main">Non-proteinogenic amino acids</span> Are not naturally encoded in the genome

In biochemistry, non-coded or non-proteinogenic amino acids are distinct from the 22 proteinogenic amino acids, which are naturally encoded in the genome of organisms for the assembly of proteins. However, over 140 non-proteinogenic amino acids occur naturally in proteins and thousands more may occur in nature or be synthesized in the laboratory. Chemically synthesized amino acids can be called unnatural amino acids. Unnatural amino acids can be synthetically prepared from their native analogs via modifications such as amine alkylation, side chain substitution, structural bond extension cyclization, and isosteric replacements within the amino acid backbone. Many non-proteinogenic amino acids are important:

<span class="mw-page-title-main">Bottromycin</span> Chemical compound

Bottromycin is a macrocyclic peptide with antibiotic activity. It was first discovered in 1957 as a natural product isolated from Streptomyces bottropensis. It has been shown to inhibit methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) among other Gram-positive bacteria and mycoplasma. Bottromycin is structurally distinct from both vancomycin, a glycopeptide antibiotic, and methicillin, a beta-lactam antibiotic.

<span class="mw-page-title-main">4-Hydroxyphenylglycine</span> Chemical compound

4-Hydroxyphenylglycine (HPG) is a non-proteogenic amino acid found in vancomycin and related glycopeptides. HPG is synthesized from the shikimic acid pathway and requires four enzymes to synthesize: Both L- and D-HPG are used in the vancomycin class of antibiotics. Tyrosine, a similar amino acid, differs by a methylene group (CH2) between the aromatic ring and the alpha carbon.

<span class="mw-page-title-main">Chloroeremomycin</span> Chemical compound

Chloroeremomycin is a member of the glycopeptide family of antibiotics, such as vancomycin. The molecule is a non-ribosomal polypeptide that has been glycosylated. It is composed of seven amino acids and three saccharide units. Although chloroeremomycin has never been used in human medicine, oritavancin, a semi-synthetic derivative of chloroeremomycin, has full FDA approval.

Andrimid is an antibiotic natural product that is produced by the marine bacterium Vibrio coralliilyticus. Andrimid is an inhibitor of fatty acid biosynthesis by blocking the carboxyl transfer reaction of acetyl-CoA carboxylase (ACC).

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