Structure-Activity Relationship of the Aminomethylcyclines and the Discovery of Omadacycline

Abstract

ABSTRACTA series of novel tetracycline derivatives were synthesized with the goal of creating new antibiotics that would be unaffected by the known tetracycline resistance mechanisms. New C-9-position derivatives of minocycline (the aminomethylcyclines [AMCs]) were tested forin vitroactivity against Gram-positive strains containing known tetracycline resistance mechanisms of ribosomal protection (Tet M inStaphylococcus aureus,Enterococcus faecalis, andStreptococcus pneumoniae) and efflux (Tet K inS. aureusand Tet L inE. faecalis). A number of aminomethylcyclines with potentin vitroactivity (MIC range of ≤0.06 to 2.0 μg/ml) were identified. These novel tetracyclines were more active against one or more of the resistant strains than the reference antibiotics tested (MIC range, 16 to 64 μg/ml). The AMC derivatives were active against bacteria resistant to tetracycline by both efflux and ribosomal protection mechanisms. This study identified the AMCs as a novel class of antibiotics evolved from tetracycline that exhibit potent activityin vitroagainst tetracycline-resistant Gram-positive bacteria, including pathogenic strains of methicillin-resistantS. aureus(MRSA) and vancomycin-resistant enterococci (VRE). One derivative, 9-neopentylaminomethylminocycline (generic name omadacycline), was identified and is currently in human trials for acute bacterial skin and skin structure infections (ABSSSI) and community-acquired bacterial pneumonia (CABP).