NEW DRUG FIGHTS BACTERIAL INFECTIONS IN NOVEL WAY.

Over the course of the 20th Century, doctors waged war against infectious bacterial illness with the best new weapon they had: antibiotics.

But the emergence of dangerous, multi-drug resistant strains of tuberculosis and other killer infections means that in the 21st century antibiotics are losing ground against bacterial disease.

Now, researchers from Weill Cornell Medical College in New York City say exciting new molecular targets -- so-called "virulence factors" that bacteria use to thrive once they are in the host -- present an alternative, potent means of stopping TB, leprosy and other bacterial illness.

"We have developed the first inhibitor of a key small molecule from /Mycobacterium tuberculosis/ and /Mycobacterium leprae/ (which causes leprosy) utilized to subvert human host's defenses and damage and invade human host's cells during infection," explains study senior author Dr. Luis Quadri, Associate Professor of Microbiology and Immunology at Weill Cornell.

"With this work, we now have proof of principle for the inhibition of this /virulence factor/ in bacteria cultured in the lab. Our next step is to explore whether this inhibitor can stop these pathogens from multiplying in a mouse host, curtailing infection," Dr. Quadri said.

The findings -- published online in /Chemistry and Biology/ and appearing in the journal's Jan. 26 print edition -- highlight what Dr. Quadri has called a "paradigm shift" in infectious disease research.

"We are moving beyond antimicrobials such as antibiotics, which kill the bacterium directly, to anti-infectives, that may have no effect against the pathogen in the test tube but which do compromise its ability to infect and spread in the host," he explains. "We believe that the expansion of the drug armamentarium to include such anti-infective drugs could help the fight against multi-drug resistant infection that has become such a challenge today."

According to World Health Organization data, TB remains one of the world's top-ten leading causes of death, killing nearly two million people each year. Multi-drug resistant strains of /M. tuberculosis/ -- as well as even more dangerous, extensive-drug-resistant (XDR) strains of the bug -- are emerging each year.

"Obviously, we are going to require more than the traditional antimicrobial approach to turn this situation around," Dr. Quadri said.

In this study, Dr. Quadri, along with co-lead researchers Drs. Julian Ferraras and Karen Stirrett, focused on particular small-molecule virulence factors called phenolic glycolipids (PGLs).

Various strains of /M. tuberculosis/ use PGLs to weaken our body defenses whereas /M. leprae/ uses PGLs to damage and invade our nerve cells during infection.

"Therefore, we hypothesize that drugs blocking PGL synthesis would reduce the adaptive fitness of PGL-producing /M. tuberculosis/ strains in the human host by eliminating PGL-dependent immunomodulatory effects. These drugs may also diminish the ability of /M. leprae/ to invade nerve cells and produce nerve function impairment," Dr. Quadri explains.

In complex work in the laboratory, the researchers investigated and then elucidated a crucial, early step in PGL biosynthesis. They also pinpointed a key enzyme, called FadD22, that is essential to that stage of the process.

"Based on that, we collaborated with Dr. Derek Tan's lab at Memorial Sloan-Kettering Cancer Center to synthesize a molecule that targets FadD22 and successfully inhibits that early step in PGL production," Dr. Quadri said.

Follow-up work using both enzyme assays and /M. tuberculosis/ assays confirmed that the new inhibitor does block the production of PGLs. Although it was technically not possible to test the inhibitor in /M. leprae/, that pathogen is very closely related to /M. tuberculosis/, so the researchers believe their agent would inhibit production of PGLs there, as well.

Work is already underway to come up with other, even more potent PGL biosynthesis inhibitors, Dr. Quadri said, with an eye to testing the best candidates in an animal model.

"We are not saying that anti-infectives will ever replace antibiotics, but with pathogens as deadly as /M. tuberculosis/ or as debilitating as /M. leprae/, you'd ideally like to have as many pharmaceutical weapons in your armamentarium as you can, to use either alone or in combination," Dr. Quadri said.

The new discoveries are highly encouraging, he adds.

"I believe that drugs targeting virulence factors are just one component of the paradigm shift in the antimicrobial drug discovery for the 21st century -- one that will offer patients more options in the fight against truly global killers," he said.

This research was funded by the U.S. National Institutes of Health, the Stavros S. Niarchos Foundation, NYSTAR Watson Investigator Program, William H. Goodwin and Alice Goodwin, the Commonwealth Foundation for Cancer Research and MSKCC Experimental Therapeutics Center.

Co-researchers include Xuequan Lu of Memorial Sloan-Kettering Cancer Center, New York City; Jae-Sang Ryu, now at Ewha Woman's University, Seoul, S. Korea; and Clifford E. Soll, Hunter College, New York City.

Weill Cornell Medical College*

Weill Cornell Medical College -- Cornell University's Medical School located in New York City -- is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, infectious disease, obesity, cancer, psychiatry and public health -- and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. The Medical College -- in its commitment to global health and education -- has a strong presence in such places as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. With the historic Weill Cornell Medical College in Qatar, the Medical School is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances -- from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial for gene therapy for Parkinson's disease, the first indication of bone marrow's critical role in tumor growth, and, most recently, the world's first successful use of deep brain stimulation to treat a minimally-conscious brain-injured patient.

For more information, visit http://www.med.cornell.edu or call 212/821.0560.