Targeting Mycolic Acid Biosynthesis - Towards New TB Drugs

The Department of Biology and Chemistry at Birkbeck recently hosted as a seminar speaker Dr Geoff Coxon, from the University of Strathclyde, Glasgow. Dr Coxon described a series of compounds that his group had synthesised, some of which are promising candidate drugs against tuberculosis. These are inhibitors of the enzyme beta-ketoacyl-ACP synthase (otherwise known as FabH) with a novel chemical scaffold.

Mycobacterium tuberculosis now infects over a third of the world's population, and tuberculosis kills two million people a year. The threat of tuberculosis is growing largely because of two reasons: a synergy between HIV and TB infections, and the growth of drug resistant strains of the bacterium. Multi-drug resistant (MDR) TB is defined as TB that is resistant to the two most commonly used anti-TB drugs, and extensively drug resistant (XDR) TB as TB that is resistant to four drugs including a fluoroquinolone. The latter is particularly hard to treat. More information on this is available from the TB Alliance.

In order to combat drug resistance it is essential to keep introducing new drugs, and preferably drugs with novel targets and mechanisms. Ideally, a drug should be active against active, replicating TB and persistent TB, which can resist treatment by remaining dormant in macrophages. Much work in anti-TB drug development has focused on enzymes involved in synthesising the very complex cell wall of the bacteria.

The genome sequence of M. tuberculosis (Camus et al., 2002, and material in PPS section 6) revealed a number of enzymes involved in cell wall synthesis. Coxon's group is focusing on the synthesis of one cell wall component, mycolic acids. These are long chain, 2-alkyl 3-hydroxyl fatty acids with between 60 and 80 atoms in their hydrocarbon chains. Two enzyme systems are involved in their synthesis: FAS-1 synthesises the main chain and FAS-2 adds the alpha branch. FAS-2 is found only in plants and mycobacteria.

The FAS-2 system includes a large number of enzymes, all involved in the complex, cyclic process of synthesising a long lipid chain. Inhibiting any of these enzymes will prevent the synthesis of the mature long chain mycolic acids. Coxon's group has been targeting one key enzyme in this process, known as FabH, which connects the FAS-1 and FAS-2 systems. The reaction it catalyses is an extension of the lipid chain by two carbon units.

This enzyme is a homodimer with a tunnel-shaped active site; the chain extension takes place after the substrate has moved into the tunnel. Its structure was first solved in 2001 by Scarsdale and co-workers (PDB code 1HZP). Coxon and his co-workers started their search for a specific inhibitor of this enzyme from the natural antibiotic, thiolactomycin (TLM). This, however, is a relatively weak inhibitor and a chiral compound that is extremely challenging to synthesise. He used fragment-based chemical libraries to develop a range of likely inhibitors with similar skeletons but that would be simpler to synthesise.

Some of the first compounds investigated were better inhibitors of the enzyme but not active against the whole FAS-2 system or M. tuberculosis itself. It appeared that another enzyme, known as KasA, may sometimes take the place of FabH if that is inhibited. They have now produced a series of compounds based on a 2-aminothiazole-4-carboxylate scaffold that includes some very active ones. However, the compounds in this series that are the most potent inhibitors of the enzyme are not the most active against the intact bacterium, and vice versa - there are complex interactions going on that are not yet entirely understood. It is likely, even, that FabH is not their most important protein target.

A good medicine against tuberculosis must be active against both resistant and dormant forms of the bacterium, with few side effects and few interactions with other drugs, and preferably orally available, and it must be cheap, and therefore easy, to synthesise. These 2-aminothiazole-4-carboxylates are easily synthesised and some are effective against M. tuberculosis in vivo, but much more work is needed to determine whether they will fulfil the other criteria.

See Al-Balas, Q. et al. (2009) PLoS ONE 4(5) (open access) for more information about this work.

Dr Coxon also works in TB Drug Discovery UK, an alliance of scientists involved in developing new treatments for tuberculosis.