The use of ethionamide has been increasing in drug regiments due to greater incidence of multidrug resistance tuberculosis around the world. Ethionamide is metabolized into antimicrobial relevant compounds by different flavin-containing monooxygenase (FMO) enzymes including FMO1, FMO2, and FMO3. FMOs are found in various locations in the body including the intestine, kidney, liver, and lung. In humans, active functional FMO2*1 is found in approximately 50% of Sub-Saharan Africans and a truncated, inactive FMO2*2, is found in all Caucasians and Asians. Polymorphisms in human FMO2 were investigated by comparing differences in metabolism of ethionamide in wildtype mice relative to Fmo 1/2/4 null mice. All mice were capable of metabolizing ethionamide into ethionamide S-oxide and 2-ethyl-4-amidopyridine. Wildtype mice had higher plasma levels of metabolites than parent compound. In contrast, Fmo 1/2/4 null mice had higher plasma levels of parent compound than metabolites. In both mouse populations, maximum ethionamide concentration peaked at 2 hours post-exposure. Increased metabolism of ethionamide in wildtype mice may deplete glutathione pools and induce oxidative stress leading to greater toxicity and adverse drug effects. This murine model is used to demonstrate the polymorphic differences of FMO2 occurring in humans. Taking these differences into account, polymorphisms of drug metabolizing enzymes provide a basis for increasing specific and individualized drug treatment regiments in susceptible populations. / Graduation date: 2012

Les antibiotiques représentent à l’heure actuelle le seul moyen de lutte efficace contre la tuberculose. Parmi eux, l’éthionamide (ETH) est l’un des antituberculeux les plus efficaces. Il pose cependant des problèmes d’effets indésirables non négligeables ce qui relègue son utilisation en seconde ligne de traitement. Ces inconvénients aboutissent fréquemment à une inobservance au traitement, à l’origine du développement de souches résistantes.L’ETH, à l’instar d’autres composés antimycobactériens, est une pro-drogue nécessitant son activation métabolique par une enzyme produite par la mycobactérie elle-même. Il a été montré que cette bio-activation intra-bactérienne est exercée par la mono-oxygénase EthA dont la production est réprimée par le régulateur transcriptionnel EthR. Lors de travaux précédents, des inhibiteurs de EthR ont été développés dans le but de stimuler la bioactivation de l’ETH par EthA. Ces molécules de synthèse ont permis de potentialiser l’efficacité de l’ETH d’un facteur trois sur un modèle murin d’infection tuberculeuse. Toutefois, bien qu’actifs chez l’animal, cette première série de composés possède des propriétés pharmacocinétiques et pharmacodynamiques (PK/PD) insuffisantes pour une utilisation en clinique humaine. Le premier objectif de ce travail a donc été de définir un « profil minimum acceptable » nécessaire à la réalisation d’études pré-cliniques. L’évaluation systématique des performances de plus de 500 composés a mené à l’identification de leads compatibles avec le profil défini. Notre deuxième objectif a été d’évaluer l’intérêt de la stratégie de potentialisation de l’ETH dans la problématique de la prise en charge de la tuberculose multi-résistante (MDR-TB). Ainsi, dans 80% des cas, l’usage de nos inhibiteurs d’EthR a permis d’abaisser significativement la concentration minimale inhibitrice d’ETH.Parallèlement, tirant profit de la quantité importante de composés générés lors de ce programme d’optimisation, une étude fondamentale des interactions entre inhibiteurs et EthR a été menée. De cette manière, nous avons pu identifier une région restreinte de la poche d’interaction de EthR avec ses inhibiteurs/ligands, nécessaire et suffisante à la réorganisation spatiale menant à une forme inactive du répresseur. Pour la première fois dans cette famille de répresseur de type TetR, nous avons montré que la modification d’un seul acide aminé dans cette région de la protéine provoque les mêmes phénomènes allostériques que ceux induits par la fixation des inhibiteurs/ligands. De façon inattendue, le programme d’optimisation des inhibiteurs nous a mené à l’identification d’une nouvelle famille de molécules capables de potentialiser l’ETH alors qu’elles ont perdu leur capacité d’interagir avec EthR. Des expériences de transcriptomique et de RMN ont révélé que ces composés inhibent une voie de bio-activation de l’ETH indépendante de EthA. Cette voie ouvre des perspectives extraordinaires de traitement puisque ces inhibiteurs augmentent significativement l’efficacité de la prodrogue, non seulement sur les souches cliniques MDR-TB, mais également sur les souches cliniques résistantes à l’ETH. Notre dernier objectif a été de calquer cette stratégie de potentialisation à l’antituberculeux le plus utilisé dans le monde, l’isoniazide (INH). Tout comme l’ETH, l’INH est une pro-drogue. Sa bio-activation est tributaire de la catalase-peroxydase KatG dont le niveau d’expression est sous dépendance du régulateur transcriptionnel FurA. Notre objectif a donc été d’obtenir des inhibiteurs spécifiques de FurA. En l’absence de structure cristallographique de FurA nous empêchant une approche par chimie raisonnée sur cible, nous avons basé notre stratégie sur un criblage à haut débit de vastes chimiothèques. Les premiers hits et leur partielle optimisation sont discutés dans ce travail. / Antibiotics are currently the only effective means of control against tuberculosis. Among them, ethionamide (ETH) is one of the most effective. However it is responsible for significant side effects that relegate the ETH use to a second-line. These events often lead to non-compliance with treatment promoting many cases of multidrug resistant-tuberculosis (MDR-TB). Like other antimycobacterial compounds, ETH is a prodrug that requires bioactivation by an enzyme produced by the mycobacteria. It has been shown that the intrabacterial bioactivation of the prodrug by the monooxygenase EthA is controled by the mycobacterial repressor EthR. In previous studies, our group has developped EthR inhibitors shown to stimulate the bioactivation of ETH by EthA. These synthetic compounds led to boost the ETH efficacy three-fold in a M. tuberculosis-infected mice model. However, although active in animals, these compounds possess insufficient pharmacokinetic and pharmacodynamic (PK/PD) properties for envisaging human clinical evaluation. The first objective of this work was therefore to define a “minimum acceptable profile” required for initiating pre-clinical studies. Systematic evaluation of the performance of more than 500 compounds led to the identification of leads compatible with the defined profile. Our second objective was to evaluate the benefit of the ETH boosting strategy in the management of MDR-TB. In 80% of cases, the use of our EthR inhibitors drastically decreased the minimum inhibitory concentration of ETH.In parallel, we conducted a fundamental study on the interactions between inhibitors and EthR by exploiting the large amount of compounds generated during the optimization blueprint. This way, we have identified a narrow region of the binding pocket of EthR that interacts in all cases with its inhibitors/ligands. For the first time in this TetR family of repressors, we have shown that this portion of the ligand-binding site is necessary and sufficient for the structural reorganization of the repressor. As such, the modification of a single amino acid in this region of the protein caused the same allosteric phenomena as those induced by inhibitors/ligands, which led to the inactive form of EthR.Unexpectedly, the optimization blueprint of EthR inhibitors led to the identification of a new family of compounds able to boost ETH in spite of their loss of interaction with EthR. Transcriptomics and NMR experiments showed that these compounds inhibit the ETH bioactivation independently of EthA. This novel pathway opens up extraordinary opportunities for TB treatment since these compounds significantly increase the effectiveness of ETH, not only against clinical MDR-TB strains, but also against clinical isolates resistant to ETH.The last objective was to transpose this boosting strategy to isoniazid (INH), the most commonly used antituberculosis drug. As ETH, INH is a prodrug. Its bioactivation depends on the catalase-peroxidase KatG whose level of expression is controlled by the transcriptional regulator FurA. Our objective was therefore to obtain specific FurA inhibitors. Due to the absence of crystallographic structure of FurA, which preclude a target based approach, our strategy was based on high-throughput screening of large chemical libraries. The first hits and their partial optimization are discussed in this work.

La tuberculose est l'une des maladies infectieuses les plus meurtrières au monde. Malgré l'existence d'un traitement polychimiothérapeutique efficace, le nombre de cas de tuberculose incurable augmente sensiblement en raison de l'apparition de souches de Mycobacterium tuberculosis résistantes aux traitements de 1ère, 2ème et 3ème intentions actuellement disponibles. Parmi les antibiotiques spécifiques de la tuberculose, nous nous intéressons plus particulièrement, dans le cadre de cette thèse, aux pro-drogues isoniazide et éthionamide. Ces deux médicaments ciblent l'enzyme InhA du Mycobacterium tuberculosis, qui est impliquée dans la synthèse de la paroi bactérienne. Les principales résistances de Mycobacterium tuberculosis à ces pro-drogues résident en un défaut des enzymes responsables de l'activation de ces médicaments à l'intérieur du pathogène. Le but de cette thèse est, dans un premier temps, d'étudier différentes approches originales visant à contourner ces résistances. La première stratégie consiste à concevoir des pro-drogues hybrides d'isoniazide et d'éthionamide qui pourraient être activées indifféremment par KatG et EthA. KatG est la catalase-peroxydase responsable de l'activation de l'isoniazide, et EthA la mono-oxygénase à flavine qui active l'éthionamide. Les chances de bio-activation de ces nouvelles molécules seraient donc supérieures même si l'une des deux enzymes est mutée. La deuxième stratégie examinée consiste à synthétiser des molécules capables d'être activées par l'enzyme KatG mutée qui reste fonctionnelle. Nous avons alors préparé des molécules analogues de l'isoniazide qui pourraient être éventuellement reconnues et activées par une KatG mutée montrant une modification du potentiel d'oxydation ou de la structure protéique. La dernière stratégie étudiée consiste à synthétiser des molécules qui ne nécessitent pas d'être activées par une enzyme pour exercer leur action mais simplement par des agents oxydants endogènes. En se basant sur une molécule décrite dans la littérature par nos collaborateurs brésiliens, le complexe d'isoniazide-fer(II) ((isoniazide)pentacyanoferrate(II) de sodium), nous avons synthétisé différents analogues de ce complexe en faisant varier le ligand et avons évalué par RPE leur capacité à générer des radicaux. Cette étude de relation structure-réactivité a permis de mieux comprendre le mécanisme d'activation de ces complexes en présence de H2O2. La deuxième partie de cette thèse est consacrée au mécanisme d'activation des pro-drogues isoniazide et éthionamide. Même si ces molécules sont utilisées depuis plus de 50 ans dans le traitement de la tuberculose, leur mécanisme d'activation d'un point de vue chimique est très mal décrit. Dans la mycobactérie, ces pro-drogues, une fois activées, forment un adduit avec le cofacteur NAD(H) donnant ainsi l'inhibiteur ultime de l'enzyme InhA. Dans le cas de l'isoniazide, nous avons utilisé le système biomimétique mis en place dans l'équipe pour étudier son mécanisme d'activation d'un point de vue moléculaire. Dans le cas de l'éthionamide, nous avons développé un système chimique biomimétique qui, pour la première fois, a conduit à la formation de l'adduit éthionamide-NAD+ in vitro. Grâce au succès de cette approche et à la caractérisation des intermédiaires et métabolites formés, nous avons pu proposer un mécanisme d'oxydation moléculaire de l'éthionamide entièrement original, s'affranchissant de l'intermédiaire clé acide sulfinique évoqué jusque-là dans la littérature sans aucune preuve expérimentale. / Tuberculosis is one of the leading causes of death in the world among infectious diseases. Despite the existence of efficient multidrug treatment, the number of incurable cases of tuberculosis substantially increases due to the emergence of Mycobacterium tuberculosis strains resistant to available 1st-, 2nd- and 3rd-lines-treatments. Among the specific drugs currently employed to treat tuberculosis, we particularly focus on pro-drugs (isoniazid and ethionamide) for which resistances mainly result in a default of their activation enzymes inside the pathogen. The aim of this thesis is, firstly, to study various innovative approaches to overcome the resistance. The first strategy consists in designing hybrid pro-drugs, by combination of isoniazid and ethionamide moieties, which could be activated by two different enzymes, KatG and EthA. KatG is the mycobacterial catalase peroxidase enzyme which activates isoniazid, and EthA the flavin monooxygenase responsible of ethionamide activation. Probability of bio-activation of these new molecules would therefore be higher even if one of the two enzymes is mutated. The second strategy discussed herein is the synthesis of molecules able to be activated by mutated KatG enzyme, which remains functional. We synthesized isoniazid derivatives, which might be recognized and activated by a mutated KatG enzyme showing a modification of its oxidation potential or in the protein structure. The last strategy is founded on the development of molecules that do not need to be activated by an enzyme but by a simple chemical oxidation. Based on a molecule described in the literature by our brazilian collaborators, an isoniazid-iron (II) complex (sodium (isoniazid)pentacyanoferrate(II)), we synthesized various analogues of this complex by varying the ligand structure and evaluated by ESR their ability to generate radicals in the presence of H2O2. The structure-reactivity relationship analysis led to better understanding of the molecular activation mechanism of these complexes in the presence of H2O2. The second part of this thesis is dedicated to the activation mechanisms of pro-drugs isoniazid and ethionamide. Even though these molecules have been used for more than 50 years for the treatment of tuberculosis, their activation mechanism on a molecular point of view is poorly described. In the mycobacterium, once activated these pro-drugs form an adduct with the NAD(H) cofactor, leading to the active metabolite. For isoniazid, we used the biomimetic system developed previously by our team to clarify the molecular activation mechanism. For ethionamide, we have developed a biomimetic system which, for the first time, leads to the formation of the ethionamide-NAD+ adduct in vitro. We used this method to study the molecular oxidation mechanism of ethionamide and to characterize intermediates and metabolites. We finally proposed a completely original mechanism, not involving the sulfinic acid intermediate, which has been mentioned in the literature without any experimental evidence.

Tuberculosis (TB) remains the leading cause of death due to a single infectious agent with more than 1.5 million people killed each year. In 2018, the World Health Organization (WHO) estimated that one third of the world’s population was infected with Mycobacterium tuberculosis (Mtb), the pathogen responsible for the disease.In 2000, EthR, a mycobacterial transcriptional repressor, was identified as a key modulator of ethionamide (ETH) bioactivation. ETH is one of the main second-line drugs used to treat drug-resistant strains and it is a prodrug that is activated in Mtb by the mono-oxygenase EthA and then inhibits InhA, an enzyme involved in the mycolic acid biosynthesis. In 2009, it was demonstrated that co-administration of ETH with the drug-like inhibitors of EthR was able to boost ETH activity by a factor three in a mouse-model of TB-infection, thus validating EthR protein as a target for a new therapeutic strategy. The first part of this thesis deals with the validation and deep characterization of the solved EthR-ligand structures based on all analysis of how each ligand bind to the EthR. In this section, based on the study of both co-crystal structures and the physicochemical properties of the ligands, we have rationalized the information currently available and understood the interaction of all EthR inhibitors in order to lead to more effective inhibitor design.More recently, another mycobaterial repressor, denoted EthR2, was identified as a putative target that appears to be functionally comparable to EthR (then the locus has been termed EthA2/EthR2, due to its similarity to the EthA/EthR locus). Furthermore, a spiroisoxazoline family of small-molecules, generically denoted as SMARt, has been identified as effective ligand of EthR2. However, according to the data present in the literature, this spiroisoxazoline family can also bind to the former EthR. In order to investigate this proposition, I have solved these small molecules in complex with EthR and compared their binding interactions to the EthR2 protein as well. The opportunity for the design small-molecules is capable of targeting both repressors, thereby opening the way to a dual-target approach.Finally, the third part of this thesis is devoted to the mycobacterial transcriptional factor MabR (Rv2242). Several studies identified this protein as a regulatory transcription factor of the fatty acid synthase II operon, which is mainly responsible for the mycolic acid biosynthesis in Mtb. I therefore purified to homogeneity and characterized the MabR protein as well as I determined the crystal structure of its C-terminal part. Finally, the functional role of MabR is largely discussed, and the way on how to interfere with its DNA binding ability is commented with respect to our results. / Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie) / info:eu-repo/semantics/nonPublished

En 1993, l’Organisation Mondiale de la Santé déclarait que la tuberculose était « une urgence de santé publique mondiale ». Plus de 20 ans après, cette maladie infectieuse causée par Mycobacterium tuberculosis, reste toujours un problème à l’échelle de la planète. Malgré des progrès très importants enregistrés dans la lutte contre la tuberculose dans le monde, l’OMS estime que 9 millions de personnes ont contracté cette maladie en 2013 et que 1,5 million sont morts durant cette même année. De plus, l'émergence de la tuberculose multirésistante nécessite le développement de nouveaux outils et de nouvelles stratégies thérapeutiques. Récemment, deux nouveaux composés, bedaquiline et delamanid ont reçu une autorisation temporaire d’utilisation dans le but de renforcer l’arsenal thérapeutique. Néanmoins, il existe toujours la possibilité que la bactérie puisse rapidement développer des résistances liées au mécanisme d’action de ces nouveaux médicaments. C’est pour toutes ces raisons que l’arsenal thérapeutique doit être renforcé. Ce travail de thèse repose sur la découverte et l'optimisation de nouveaux composés antituberculeux selon des approches dont le point de départ commun est le criblage de petites molécules appelées fragments.La première partie de ce manuscrit présente la continuité d’un travail démarré au cours de la thèse de Baptiste Villemagne et qui a pour but de potentialiser l’activité de l'éthionamide, un médicament antituberculeux utilisé pour le traitement de seconde intention. Le répresseur transcriptionnel EthR a été validé comme élément clé dans la bioactivation de l’éthionamide. Les inhibiteurs de cette cible, développés selon une approche par fragments ont permis de potentialiser l'activité de l'éthionamide in vitro. Cependant, la faible stabilité microsomale de ces composés a limité leur utilisation in vivo. L’étude de la métabolisation du composé tête de série et la modification structurale de ce dernier a permis le développement des nouveaux inhibiteurs d’EthR présentant des propriétés pharmacocinétiques et physico-chimiques désormais acceptables pour la réalisation de tests in vivo.La deuxième partie de cette thèse s’est concentrée sur la synthèse d’inhibiteurs de MabA, une β-cétoacyl-ACP réductase mycobactérienne participant à la synthèse des acides gras à longue chaîne, précurseurs des acides mycoliques qui sont les constituants majeurs de la paroi mycobactérienne. Cette enzyme a été montrée comme étant indispensable à la survie de la bactérie mais aucun inhibiteur à ce jour n’a été identifié. Le criblage d’une chimiothèque de fragments sur MabA a été réalisé via deux tests différents (un test d’affinité pour la cible (TSA) et un test enzymatique). Les hits ainsi identifiés ont été resynthétisés et testés dans un test fonctionnel. Les étapes d’optimisation de l’activité des hits reconfirmés sont ainsi décrites. Ces résultats ont permis de développer des composés présentant des activités de l’ordre du micromolaire. Dans la troisième partie, un travail de conception et de synthèse de nouveaux fragments, visant à compléter la chimiothèque actuelle a été effectué. Les fragments originaux contenant un motif isoxazoline ont été synthétisés à partir d’alcènes et d’aldoximes utilisés en tant que synthons de départ, selon une réaction de cycloaddition 1,3-dipolaire. L’analyse conformationnelle de ces fragments a permis de montrer que ces structures venaient enrichir l’espace de la diversité, notamment par l’introduction d'un motif permettant le déploiement des substituants dans les trois dimensions de l’espace. La solubilité expérimentale de ces fragments a été également mesurée et nous avons pu montrer que ces molécules étaient adaptées au criblage. / In 1993, the World Health Organization (WHO) declared Tuberculosis (TB) as a global public health emergency. Over 20 years later, this infectious disease caused by Mycobacterium tuberculosis, remains a major public health problem. Despite the significant progress in the fight against TB worldwide, WHO estimates that 9 million people contracted the disease in 2013 and 1.5 million died in that year. In addition, the emergence of multidrug-resistant tuberculosis (MDR-TB) requires the development of new tools and new therapeutic strategies. Recently, two new compounds, bedaquiline and delamanid were approved in MDR-TB treatment in order to strengthen the actual MDR-TB chemotherapy. Nevertheless, there is always the possibility that the tubercle bacillus can quickly develop resistance related to the mechanism of action of these new drugs. Therefore, the actual therapeutic arsenal must be strengthened. This thesis is based on the discovery and optimization of new anti-TB compounds starting from the screening of small molecules called fragments.The first part of this thesis is the continuation of the research project which was started during the thesis of Baptiste Villemagne. This work aims to develop compounds that can boost the activity of ethionamide, a second-line drug used to treat MDR-TB. The transcriptional repressor EthR has been validated as a key element in the bioactivation of ethionamide. EthR inhibitors were identified using a fragment-based approach and were optimized to potentiate the activity of ethionamide in vitro. However, the low microsomal stability of the lead compound has limited its use in vivo. The metabolism study of the lead compound and key structural modifications allowed a development of new potent EthR inhibitors having acceptable pharmacokinetic and physico-chemical properties for in vivo testing.The second part of this thesis focused on the synthesis of MabA inhibitors. MabA is a mycobacterial β-ketoacyl-ACP reductase involved in the synthesis of long-chain fatty acids, precursors of mycolic acids, which are major constituents of the mycobacterial cell wall. This enzyme has been shown to be essential for the survival of the bacteria but until now no inhibitor has been identified. Screening of a library of fragment molecules on MabA was performed via two different assays (affinity assay using TSA and an enzymatic assay). The identified hits were re-synthesized and tested in a functionnal assay. The optimization steps to improve the activity of the hits are also described. Compounds with activity in the micromolar range were discovered.In the third part, a design and synthesis of new fragments is described. The aim of this project is to build a collection of original fragments showing a 3D-structure scaffold amenable for rapid derivatization. The fragments that contain an original isoxazoline motif were synthesized from alkenes and aldoxime as starting building-blocks by using 1,3-dipolar cycloaddition. The conformational analysis of these structures has shown that they were, as expected, able to deploy substituents in the 3D space. The experimental solubility of these fragments was also measured and the results demonstrated that these molecules are suitable for the screening against new biological targets to help kick-start hit discovery program.

Magister Pharmaceuticae - Mpharm / Many studies have investigated the pharmacokinetics (PK) of anti-tuberculosis drugs in tuberculosis patients. However, currently in South Africa, no studies have been done on ethionamide (ETH) PK in adult MDR-TB patients that are infected with HIV and those without HIV infection. Therefore, the objective of this current study was firstly, to find out ethionamide plasma concentration using the LC-MS method; secondly, to evaluate and compare the pharmacokinetics of ethionamide in MDR-TB patients infected with and without HIV infection; thirdly, to examine the effects of ARVs and kidney impairment on the PK of ethionamide and fourthly, to find out the consequence of sex and age on ETH PK parameters.

Made available in DSpace on 2016-07-01T11:59:26Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 1.pdf: 7298045 bytes, checksum: 81f5fe7a39c309b83b7b15679d38d8b6 (MD5) Previous issue date: 2014 / Made available in DSpace on 2016-07-21T14:39:33Z (GMT). No. of bitstreams: 2 1.pdf: 7298045 bytes, checksum: 81f5fe7a39c309b83b7b15679d38d8b6 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Instituto de Tecnologia em Fármacos/Farmanguinhos. Rio de Janeiro, RJ, Brasil. / A Etionamida (ETA) é um fármaco usado no tratamento da tuberculose pulmonar e extrapulmonar, junto com outros tuberculostáticos, nos casos de falência de tratamentos, resistência ou intolerância a outros fármacos, ou abandono de tratamento. A ETA está descrita na literatura como praticamente insolúvel em água e possui rápida absorção por via oral, o que sugere ser um fármaco de classe II do sistema de classificação biofarmacêutica (SCB), ou seja, baixa solubilidade e alta permeabilidade. Para estes fármacos, é importante o conhecimento dos fatores físicos que influenciam na sua dissolução a partir do produto final, além de se investigar condições para ensaios de perfis de dissolução que possam discriminá-los, isoladamente ou em formulações, com o objetivo de se obter um produto final elegível para um estudo de bioequivalência frente ao medicamento de referência. Foi realizado estudo de solubilidade em HCl 0,1 N, tampão acetato pH 4,5 e tampão fosfato pH 6,8, com amostra de ETA obtida no mercado. Estes estudos demonstraram que a ETA possui alta solubilidade em HCl 0,1 N e baixa solubilidade em tampão acetato pH 4,5 e tampão fosfato pH 6,8, considerando-se o critério de solubilidade do SCB, sugerindo que estes últimos meios seriam mais discriminativos para estudos de perfil de dissolução. O tamanho de partícula da ETA foi reduzido utilizando-se os processos de moagem (ETA-MOÍDA) e micronização (ETA-MICRO). As amostras de ETA, ETA-MOÍDA e ETA-MICRO, foram avaliadas quanto suas características de dissolução (molhabilidade, dispersão e intrínseca), físicas (distribuição granulométrica, microscopia, fluidez, DSC, TGA, DRXP, FTIR e FTNIR) e físico-químicas (teor, pH, umidade e substâncias relacionadas), além de serem utilizadas em formulações de núcleos de comprimidos revestidos produzidos pelos processos de compressão direta e granulação úmida. Os processos de moagem e micronização impactaram em alterações na distribuição granulométrica, morfologia dos cristais, fluidez e dissolução da ETA, porém não resultaram em alterações físico-químicas e de arranjo cristalino interno (polimofismo). As formulações fabricadas por granulação úmida apresentaram melhores características de fluidez, quando comparados os valores do índice de compressibilidade, razão de Hausner e fluxo por orifícios. Entretanto, as formulações fabricadas por compressão direta não apresentaram variação de peso durante o processo de compressão que indicasse fluidez inapropriada, com exceção daquela que utilizou ETAMICRO. Foram avaliados os perfis de dissolução das formulações frente ao medicamento de referência Trecator®, sendo evidenciado que a condição descrita nos compêndios oficiais, HCl 0,1 N, não foi suficiente para discriminá-las, sendo os perfis de dissolução considerados semelhantes quando calculados os fatores diferença (F1) e semelhança (F2). Quando alterado o meio de dissolução para tampão acetato pH 4,5 e tampão fosfato pH 6,8, foi possível evidenciar diferença entre as formulações, tendo aquelas que utilizaram ETA-MOÍDA maior semelhança frente ao Trecator®. Portanto, pôde-se concluir que para obtenção de formulações futuramente elegíveis a um estudo de bioequivalência, é necessário tamanho de partícula específico para a ETA, sugerindo-se d90 ~ 113,26 µm e d50 ~ 32,32 µm, sendo obtidas duas formulações candidatas a continuidade do desenvolvimento, não finalizado neste trabalho, uma fabricada por compressão direta e outra fabricada por granulação úmida. / The Ethionamide (ETA) is a drug used to treatment of pulmonary and extrapulmonary tuberculosis, together with other antituberculosis drugs in cases of failure of treatment, resistance or intolerance to other drugs, and abandonment of treatment. ETA is described as practically insoluble in water and has rapid oral absorption, which suggests that it a drug class II in the biopharmaceutical classification system (BCS), low solubility and high permeability. For these drugs, it is important to know the physical factors that influence in dissolution from the final product, and investigate conditions for the dissolution profiles that could discriminate them, alone or in formulations, with the goal of obtaining one product eligible for the bioequivalence study, compared to the reference product. Solubility studies were performed in 0.1 N HCl, acetate buffer pH 4.5 and phosphate buffer pH 6.8, with a sample of ETA obtained on the market. These studies have shown that the ETA has a high solubility in 0.1 N HCl and low solubility in acetate buffer pH 4.5 and phosphate buffer pH 6.8, considering the criteria of solubility of BCS, suggesting that these last mediums will be more discriminative for studies of the dissolution profile. The particle size of the ETA was reduced using the process of milling (ETA-MILLED) and micronization (ETA-MICRO). Samples of ETA, ETA-MILLED, and ETA-MICRO were evaluated for their dissolution characteristics (wetting, dispersing dissolution and intrinsic dissolution), physical properties (particle size distribution, microscopy, flow, DSC, TGA, XRPD, FTIR and FTNIR) and physicochemical characteristics (assay, pH, moisture and related substances), besides being used in formulations of cores coated tablets produced by direct compression and wet granulation. The processes of milling and micronization resulted in changes in particle size distribution, crystal morphology, flowability and dissolution of ETA, but did not result in physicochemical and internal crystalline arrangement (polymorphism) changes. The formulations manufactured by wet granulation showed better flow characteristics, when comparing the values of the compressibility index, Hausner ratio and flow through holes. However the formulations manufactured by direct compression did not show weight variation during the compression process to indicate inappropriate flowability, except that they used ETA-MICRO. The dissolution profiles front reference product (Trecator®) were evaluated and shown that the condition described in official compendium, 0.1 N HCl, was not enough to discriminate against them, and the dissolution profiles were similar when calculated factors difference (F1) and similarity (F2), for all formulations. When the dissolution medium was changed (acetate buffer pH 4.5 or phosphate buffer pH 6.8) was possible to identify differences between formulations and those used ETAMILLED resulted in a greater similarity to the front Trecator®. Therefore, we concluded that to obtain future formulations eligible to a bioequivalence study would require specific particle size for the ETA (d90 ~ d50 ~ 113.26 µm and 32.32 µm), and were obtained two formulations candidates to continue the development, one manufactured by direct compression and other manufactured by wet granulation.

Tuberculosis affects millions of people worldwide every year. The current treatment for TB is divided into a regimen of both first- and second-line drugs, where first-line treatments are more tolerated and require shorter treatment lengths. With rising levels of resistance, alternative treatment regimes are urgently needed to fight this disease. Ethionamide, a second-line drug is administered as a prodrug which is activated in vivo by the enzyme EthA, which is in turn regulated by EthR. The disruption of the action of EthR could lead to novel therapeutics which could enhance the efficacy of ethionamide, and raise it to a first-line treatment. The work reported in this thesis examines the elaboration of three chemical scaffolds using fragment-based approaches to develop novel inhibitors capable of disrupting the EthR-DNA interaction. The first scaffold, 5-(furan-2-yl)isoxazole was investigated by fragment-merging approaches and produced compounds with the best of these having a KD of 7.4 uM. The second scaffold, an aryl sulfone was elaborated using fragment-merging strategies. This led to several modifications of the fragment, leading to several variants with KDs around 20 uM. With both of these series the affinity could not be improved below 10 uM and due to the synthetic complexity a further scaffold was prioritised. The third scaffold was explored was a 4-(4-(trifluoromethyl)phenyl)piperazine using fragmentgrowing from the NH of the piperazine to probe deeper into the EthR binding pocket. In addition to this, SAR around the 4-(trifluoromethyl)phenyl group was assessed to explore the interactions with EthR. These modifications led to compounds with nanomolar IC50s. A range of compounds were then screened by REMAssay to determine the boosting effect on ethionamide, and this identified compounds with up to 30 times boosting in the ethionamide MIC. The final chapter examines a concept where compounds were designed to exploit the dimeric nature of EthR by linking two chemical warheads with a flexible linker. These compounds are examined using mass spectrometry to investigate the stoichiometry of the interaction to provide insight into the binding of these extended compounds and exploring an alternative strategy to inhibit EthR. The work in this thesis demonstrated the successful use of fragment-based approaches for development of novel EthR inhibitors which showed significant ethionamide boosting effects.

Avec plus d’un million et demi de morts chaque année, la tuberculose reste aujourd’hui la seconde cause de mortalité liée à un agent infectieux. De plus l’organisation mondiale de la santé (OMS) a estimé en 2011 qu’un tiers de la population mondiale était porteuse du bacille Mycobacterium tuberculosis responsable de la maladie. Depuis la fin des années 1980, une recrudescence du nombre de cas de tuberculose est observée à l’échelle mondiale. Cette recrudescence est due à la fois à l’apparition de souches résistantes, mais également à l’épidémie de VIH qui est un facteur de prédisposition au déclenchement de la maladie.En 2000, le répresseur transcriptionnel mycobactérien EthR a été identifié comme étant un régulateur clé dans la bioactivation de l’éthionamide (ETH), un antituberculeux utilisé pour le traitement de seconde intention. En 2009, l’inhibition de ce répresseur par le développement de molécules « drug-like » a permis de potentialiser l’activité de l’éthionamide d’un facteur 3 chez la souris infectée et a permis de valider cette cible pour une future approche thérapeutique.Ce travail repose sur la découverte et l’optimisation de nouveaux inhibiteurs de ce répresseur transcriptionnel mycobactérien, à partir d’une petite molécule appelée « fragment » qui a été cocristallisée avec la protéine. Par la combinaison d’un criblage in silico, d’un criblage in vitro des touches identifiées, de l’étude des structures radiocristallographiques des complexes ligands/protéines et de la chimie médicinale, le développement de trois approches complémentaires dites « fragmentgrowing », « fragment-merging » et « fragment-linking » a permis de développer des composés présentant de fortes activités. Ces résultats permettront très prochainement de sélectionner une nouvelle molécule issue de ce travail dans la perspective de nouveaux essais sur le modèle murin. / Tuberculosis (TB) remains the leading cause of death due to a single infective agent with more than 1.5 million people killed each year. In 2011, the world health organization (WHO) estimated that one third of the world’s population is infected with Mycobacterium tuberculosis, the pathogen responsible for the disease. This phenomenon may be due to an explosive escalation of TB incidence that occurred in the 1980s due to the emergence of both resistant strains and HIV epidemic.In 2000, EthR, a mycobacterial transcriptional repressor, was identified as a key modulator of ethionamide (ETH) bioactivation. ETH is one of the main second-line drugs used to treat drug resistant strains. In 2009, it was shown that co-administration of ETH and drug-like inhibitors of EthR was able to boost ETH activity threefold in a mouse-model of TB-infection, thus validating the target for a new therapeutic strategy.This work deals with the discovery and optimisation of new EthR inhibitors, based on a small molecule, called a “fragment”, co-crystallized with the protein. We combined in silico screening, in vitro evaluation of the hit compounds, study of co-crystal structures and medicinal chemistry to develop three complementary approaches called “fragment growing”, “fragment merging” and “fragment linking” that led to the discovery of very potent inhibitors. Based on these results, we are currently selecting a potential candidate for new in vivo experiments.

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No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Bruno_Regis_Lyrio_Ferraz.PDF: 3015137 bytes, checksum: d479e9335e2f200939b52075f9b84382 (MD5) Previous issue date: 2016 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / Funda??o de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG) / RESUMO Etionamida e pirazinamida s?o antibi?ticos ?teis no tratamento da tuberculose multirresistente. O presente trabalho descreve o desenvolvimento e valida??o de metodologias eletroanal?ticas para determina??o de etionamida e pirazinamida em formula??es farmac?uticas e em urina humana empregando um eletrodo de diamante dopado com boro e um eletrodo de carbono v?treo modificado comum filme de poli glicina. Durante o desenvolvimento de ambas as metodologias, a voltametria c?clica foi empregada para verificar a influ?ncia do pH, da velocidade de varredura e do eletr?lito suporte no comportamento eletroqu?mico de ambos os analitos, bem como foram calculados os n?meros de pr?tons e el?trons envolvidos em cada uma das rea??es eletroqu?micas. A voltametria de onda quadrada com os par?metros otimizados foi utilizada para construir curvas anal?ticas para a ETO e PZA. Para a ETO foi obtido um intervalo linear de 1,0 a 80,0 ?mol L?1, com LOD e LOQ iguais a 0,294 e 0,980 ?mol L?1, respectivamente. Para a PZA foi obtido um intervalo linear de 0,47 a 6,16 ?mol L?1, com LOD e LOQ iguais a 0,035 e 0,12 ?mol L?1, respectivamente. A precis?o foi avaliada pelo registro de voltamogramas no mesmo dia e em dias diferentes, obtendo-se desvios padr?es relativos, inferiores a 5,0% em ambos os m?todos. Os resultados dos estudos de interferentes mostraram que nenhuma das subst?ncias testadas interferiu de maneira significativa na determina??o de ambos os f?rmacos. Os m?todos desenvolvidos foram comparados estatisticamente com os protocolos oficiais da farmacopeia atrav?s do teste-t e do teste-F, e os resultados mostraram que os valores de t e F calculados foram menores do que os valores de t e F cr?ticos, indicando que n?o houve diferen?a estat?stica entre as m?dias. A exatid?o de ambos os m?todos foi avaliada tamb?m por estudos de adi??o e recupera??o, obtendo-se como resultados percentuais de recupera??o pr?ximos a 100% para ambos os m?todos. A valida??o das metodologias desenvolvidas foi realizada pela avalia??o dos par?metros anal?ticos como sensibilidade, seletividade, limite de detec??o, limite de quantifica??o, faixa linear, exatid?o e precis?o e os resultados obtidos foram satisfat?rios. Portanto, os m?todos desenvolvidos podem ser aplicados com sucesso na determina??o dos f?rmacos ETO e PZA em medicamentos e urina humana. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ci?ncias Farmac?uticas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / ABSTRACT Ethionamide and pyrazinamide antibiotics are useful in the treatment of multidrugresistant tuberculosis. This work describes the development and validation of electroanalytical methodologies for determination of ethionamide and pyrazinamide in pharmaceutical formulation and human urine using boron-doped diamond electrode and poly glycine modified glassy carbon electrode, respectively. During the development of both methodologies, cyclic voltammetry was used to investigate the influence of pH, scan rate and the supporting electrolyte on the electrochemical behavior of both analytes, as well as the numbers of protons and electrons involved in each of the electrochemical reactions were calculated. Square wave voltammetry with optimized parameters were used to construct standard curves for ETO and PZA. For ETO a linear range from 1.0 to 80.0 ?mol L?1 was obtained with LOD and LOQ equal to 0.294 and 0.980 ?mol L?1, respectively. For PZA a linear range from 0.47 to 6.16 ?mol L?1was obtained with LOD and LOQ equal to 0.035 and 0.12 ?mol L?1, respectively. The precision was evaluated by voltammograms record on the same day and on different days, obtaining relative standard deviation less than 5.0% in both methods. The results of interfering studies showed that none of the tested substance interferes significantly in the determination of both drugs. The developed methods were statistically compared with the pharmacopoeia official protocols through the t-test and F-test, and the results showed that the calculated t and F values were lower than the critical t and F values indicating that there was no statistical difference between the averages. The accuracy of both methods was also evaluated by addition and recovery studies, obtaining results as percentage recovery close to 100% for both methods. The validation of the developed methodologies was carried out by the evaluation of analytical parameters such as sensitivity, selectivity, detection limit, quantification limit, linear range, accuracy and precision and the obtained results were satisfactory. Therefore, the developed methods can be applied successfully in the determination of ETO and PZA drugs in pharmaceuticals and human urine.