The repurposing of Tebipenem pivoxil as alternative therapy for severe gastrointestinal infections caused by extensively drug-resistant Shigella spp.
Creators: name: Fernández Álvaro, Elena
name: Voong Vinh, Phat
name: De Cozar, Cristina
name: Willé, David R
name: Urones, Beatriz
name: Cortés, Alvaro
name: Price, Alan
name: Tran Do Hoang, Nhu
name: Ha Thanh, Tuyen
name: McCloskey, Molly
name: Shaheen, Shareef
name: Dayao, Denise
name: De Mercado, Jaime
name: Castañeda, Pablo
name: García-Perez, Adolfo
name: Singa, Benson
name: Pavlinac, Patricia
name: Walson, Judd
name: Martínez-Martínez, Maria Santos
name: Arnold, Samuel LM
name: Saul, Tzipori
name: Ballell Pages, Lluis
name: Baker, Stephen
Publisher: name: Apollo - University of Cambridge Repository
Year: 2022
Subjects: Research Article
Epidemiology and Global Health
Microbiology and Infectious Disease
Shigella spp
drug discovery
multi-drug resistance
dysentery
diarrhoea
carbapenems
Other

description: Background: Diarrhoea remains one of the leading causes of childhood mortality globally. Recent epidemiological studies conducted in low-middle income countries (LMICs) identified Shigella spp. as the first and second most predominant agent of dysentery and moderate diarrhoea, respectively. Antimicrobial therapy is often necessary for Shigella infections; however, we are reaching a crisis point with efficacious antimicrobials. The rapid emergence of resistance against existing antimicrobials in Shigella spp. poses a serious global health problem. Methods: Aiming to identify alternative antimicrobial chemicals with activity against antimicrobial resistant Shigella, we initiated a collaborative academia-industry drug discovery project, applying high-throughput phenotypic screening across broad chemical diversity and followed a lead compound through in vitro and in vivo characterisation. Results: We identified several known antimicrobial compound classes with antibacterial activity against Shigella. These compounds included the oral carbapenem Tebipenem, which was found to be highly potent against broadly susceptible Shigella and contemporary MDR variants for which we perform detailed pre-clinical testing. Additional in vitro screening demonstrated that Tebipenem had activity against a wide range of other non-Shigella enteric bacteria. Cognisant of the risk for the development of resistance against monotherapy, we identified synergistic behaviour of two different drug combinations incorporating Tebipenem. We found the orally bioavailable prodrug (Tebipenem pivoxil) had ideal pharmacokinetic properties for treating enteric pathogens and was effective in clearing the gut of infecting organisms when administered to Shigella-infected mice and gnotobiotic piglets. Conclusions: Our data highlight the emerging antimicrobial resistance crisis and shows that Tebipenem pivoxil (licenced for paediatric respiratory tract infections in Japan) should be accelerated into human trials and could be repurposed as an effective treatment for severe diarrhoea caused by MDR Shigella and other enteric pathogens in LMICs. Funding: Tres Cantos Open Lab Foundation (projects TC239 and TC246), the Bill and Melinda Gates Foundation (grant OPP1172483) and Wellcome (215515/Z/19/Z).