Amixicile is a promising derivative of nitazoxanide (an antiparasitic therapeutic) developed to treat systemic infections caused by anaerobic bacteria, anaerobic parasites, and members of the Epsilonproteobacteria (Campylobacter and Helicobacter). Amixicile selectively inhibits pyruvate-ferredoxin oxidoreductase (PFOR) and related enzymes by inhibiting the function of the vitamin B 1 cofactor (thiamine pyrophosphate) by a novel mechanism. Here, we interrogate the amixicile scaffold, guided by docking simulations, direct PFOR inhibition assays, and MIC tests against Clostridium difficile, Campylobacter jejuni, and Helicobacter pylori. Docking simulations revealed that the nitro group present in nitazoxanide interacts with the protonated N4=-aminopyrimidine of thiamine pyrophosphate (TPP). The ortho-propylamine on the benzene ring formed an electrostatic interaction with an aspartic acid moiety (B456) of PFOR that correlated with improved PFOR-inhibitory activity and potency by MIC tests. Aryl substitution with electron-withdrawing groups and substitutions of the propylamine with other alkyl amines or nitrogen-containing heterocycles both improved PFOR inhibition and, in many cases, biological activity against C. difficile. Docking simulation results correlate well with mechanistic enzymology and nuclear magnetic resonance (NMR) studies that show members of this class of antimicrobials to be specific inhibitors of vitamin B 1 function by proton abstraction, which is both novel and likely to limit mutation-based drug resistance.
Infectious diseases are a leading cause of death worldwide, and antibiotics developed to combat these infections are being lost to the rapid emergence of drug resistance. For most antibiotics that are derivatives of natural products, resistance mechanisms often precede clinical usage, and these resistance genes over time tend to accumulate in pathogens via lateral transfer of genetic elements (1-3). In contrast, synthetic antimicrobials developed against new drug targets where no natural-product inhibitor exists are prone to mutation-based drug resistance (4, 5). Strategies employing empirical approaches to target identification and high-throughput screening of chemical libraries have also failed to deliver new therapeutics to the clinic (1, 2, 6, 7). Several studies have suggested that the number of druggable targets in microbial pathogens is quite small when essentiality, selectivity, catalytic mechanism, and chemical space are factored in (7,8). Thus, identifying new druggable targets is one of the major challenges for the development of next-generation antimicrobials. One potential target not found in humans or mitochondria but common in many human pathogens is pyruvate-ferredoxin oxidoreductase (PFOR) (EC 1.2.7.1) (9). We discovered that nitazoxanide (NTZ), a synthetic antiparasitic nitrothiazolide therapeutic (Fig. 1), inhibits this enzyme by a novel mechanism that does not involve nitroreduction (10,11).NTZ completely inhibits the production of acetyl-coenzyme A (CoA) and CO 2 from p...