1 Diversification of Antibiotic Scaffolds Spiramycin and Roxithromycin

Total Page:16

File Type:pdf, Size:1020Kb

1 Diversification of Antibiotic Scaffolds Spiramycin and Roxithromycin 1 Diversification of Antibiotic Scaffolds Spiramycin and Roxithromycin Through Carbenoid Functionalization A Thesis Presented to the Honors Tutorial College, Ohio University In Partial Fulfillment Of the Requirements for Graduation From the Honors Tutorial College With the degree of Bachelor of Science in Chemistry By: Andrea J. Oliver May 2019 2 This thesis is titled Diversification of Antibiotic Scaffolds Spiramycin and Roxithromycin Through Carbenoid Functionalization By: Andrea J. Oliver Has been approved by The Honors Tutorial College And the Department of Chemistry and Biochemistry Dr. Mark C. McMills Associate Professor, Thesis Advisor ______________________________ Dr. Lauren McMills Director of Studies, Chemistry ______________________________ Cary Roberts Frith Interim Dean, Honors Tutorial College ______________________________ 3 ABSTRACT OLIVER, ANDREA J., May 2019, Chemistry Diversification of Antibiotic Scaffolds Spiramycin and Roxithromycin Through Carbenoid Functionalization Thesis Advisor: Dr. Mark C. McMills Despite the constant development of new antibiotics, difficulties are encountered almost immediately through the development of antibiotic resistance. Researchers must constantly work to develop new antibiotics, while diversifying old antibiotic structures in order to avoid a global crisis caused by the generation of multidrug resistant organisms. This work described in this thesis attempts to diversify inexpensive, macrolide antibiotic scaffolds such as roxithromycin and spiramycin through the removal of sugar moieties, the functionalization of the existing ring and other structural changes. 4 ACKNOWLEDGEMENTS I would like to thank Dr. Mark McMills and Dr. Lauren McMills for their endless patience and guidance these last four years. I could not have made it this far without the support of two such caring individuals. Thank you for pushing me to try even when I was scared and getting me to the next step. I would like to thank the students in my 1510, 1500, and 1220 labs. It was such a privilege to get to be a part of your learning experience. Thank you for your enthusiasm and giving me opportunities to laugh every week. Thank you to Joe Tysko, you keep the oil changed in the vacuum pump, the N2 tanks filled, and the bin filled with dry ice. Thank you for only making fun of me a little when I ask you stupid questions. To my parents, and everyone else who has loved me along the way, thank you for keeping me sane and giving me the support I needed to keep plugging along. 5 TABLE OF CONTENTS Abstract……………………………………………………………………………………3 Acknowledgements………………………………………………………………………..4 List of Figures & Tables…………………………………………………………………..6 List of Schemes……………………………………………………………………………8 List of Abbreviations……………………………………………………………………...9 Chapter 1: Introduction…………………………………………………………………..10 Chapter 2: Introduction to Macrolides…………………………………………………...13 2.1 Spiramycin…………………………………………………………………...17 2.2 Roxithromycin……………………………………………………………….26 Chapter 3: Carbenoid Functionalization…………………………………………………30 3.1 Synthetic Strategy for the Preparation of Spiramycin Derivatives…………..36 3.2 Synthetic Strategy for the Preparation of Roxithromycin Derivatives………40 3.3 Experimental Determination…………………………………………………42 Chapter 4: General Experimental………………………………………………………...44 4.1 Spiramycin Experimental…………………………………………………….45 4.2 Roxithromycin Experimental………………………………………………...59 Chapter 5: Results………………………………………………………………………..66 Chapter 6: Discussion……………………………………………………………………74 6 List of Figures & Tables Figure 1: The Structure of Penicillin…………………………………………………….10 Figure 2: Tylosin, A 16-Membered Macrolide………………………………………….13 Figure 3: Azithromycin, A 15-Membered Macrolide…………………………………...13 Figure 4: Structure of Roxithromycin’s Aminosugar, which contributes to it’s basicity..14 Figure 5: Tacrolimus: A 23-Membered Macrolide……………………………………....15 Figure 6: Bafilomycin: A 16-Membered Macrolide……………………………………..15 Figure 7: Concanamycin: An 18-Membered Macrolide…………………………………15 Figure 8: Erythromycin: A 14-Membered Macrolide……………………………………16 Figure 9: 2D Structure of Spiramycin……………………………………………………17 Figure 10: Crystal Structure of Spiramycin (1KD1, Protein Data Base, RCSB.org)....... 20 Figure 11: C5 Disaccharide Chain of Spiramycin……………………………………….21 Figure 12: C4-C7 Portion of Spiramycin’s Macrocyclic Lactone Ring (Sans Sugars).....22 Figure 13: Modification of Spiramycin through C5 Triazole Arm with Various R-groups. Derived from (Klich, et. al, 2016)……………………………………………………..…23 Figure 14: Roxithromycin (right) an Oxime Derivative of Erythromycin (left)………...26 Figure 15: Proximity of Roxithromycin groups to Peptidyl Proteins of the Peptidyl Transferase Center. Derived from (Schlunzen, et al., 2001)………………………….…27 Figure 16: Crystal Structure of Spiramycin (1KD1, Protein Data Base, RCSB.org)…....28 Figure 17: Carbene (left) and Metal Stabilized Carbene (right)…………………………31 Figure 18: The Structure of Cyclopropane……………………………………………....33 Figure 19: p-ABSA, a Diazo-Transfer Reagent. (Davies et. al, 1992)……………..…....34 Figure 20: Proposed Product Structure with C10 -C12 Alkene Intact…………………..…48 7 Figure 21: Methyl Malonyl Chloride (ChemDraw, 2019)……………………………….50 Figure 22: Structure of Roxithromycin…………………………………………………..66 Figure 23: Figure 23: H1 NMR of Roxithromycin…...…………………………………..67 Figure 24: H1 NMR of Spiramycin ………………………..…………………………….69 Figure 25: Structure of Roxithromycin w/o Cladinose…………………………………..70 Figure 26: H1 NMR of AO13-BF (Cladinose-Free Roxithromycin).……………………71 Figure 27: IR of AO13-BF (Cladinose-Free Roxithromycin)………………..………….72 Figure 28: Acetal Formation of Spiramycin’s C6 Aldehyde…………………………….73 Table 1: Establishing Solvent System for Spiramycin…………………………………..46 Table 2: Solvent System Determined for AO-06A……………………………………....51 Table 3: Establishing Solvent System for AO-06B……………………………...………52 Table 4: Establishing Solvent System for AO-07B Post Ethyl Acetate/Methanol (9:1) Column…………………………………………………………………………………...54 Table 5: Establishing Solvent System for AO-08 Crude………………………………...59 Table 6: Establishing Solvent System for AO-08C……………………………………...60 8 List of Schemes Scheme 1: Enzymatic Peptide Bond Formation, (forming peptide bond shown in red). Derived from (Berg et. al, 2015)…..…………………………………………………..…19 Scheme 2: Intramolecular Ketal Formation of Anhydroerythromycin in an Acidic Environment. (Al-Qattan, 2019)…………………………………………………………26 Scheme 3: Intermolecular Insertion into a Carbon-Hydrogen Bond. (Doyle, 1998)…….32 Scheme 4: Intermolecular Carbon Insertion into an Oxygen-Hydrogen Bond. (Doyle, 1998)……………………………………………………………………………………..32 Scheme 5: Cyclopropanation of an Alkene using Diazomethane and Palladium (II) Catalyst. (Doyle, 1998)…………………………………………………………………..34 Scheme 6: Mechanism of Diazo-Transfer Using p-ABSA. (Davies et. al, 1992)……….35 Scheme 7: A 1,3 dipolar cycloaddition. (McMills Group, 2019)………………………..36 Scheme 8: The Acylation of Unmodified Spiramycin using Ethyl Malonyl Chloride…..36 Scheme 9: Diazotization of β -Diester Derivative of Spiramycin……….………………37 Scheme 10: The Removal of Sugar, Mycarose from Spiramycin……………………….38 Scheme 11: The Acylation of Mycarose-Free Spiramycin using Methyl Malonyl Chloride…………………………………………………………………………………..39 Scheme 12: Diazotization of Acetylated Mycarose-Free Spiramycin Derivative……….39 Scheme 13: Tandem Ylide Formation/Cycloaddition Strategy………………………….40 Scheme 14: Removal of Cladinose from Roxithromycin………………………………..40 Scheme 15: Acylation of Cladinose-Free Roxithromycin Using Methyl Malonyl Chloride…………………………………………………………………………………..41 Scheme 16: Diazotization of Acetylated Cladinose-Free Roxithromycin Derivative…...41 9 Scheme 17: Projected OH Insertion Products from Diazotized Roxithromycin………...42 Scheme 18: Acetal Formation of C6 Aldehyde Before Attempted Sugar Removal……..58 List of Abbreviations MIC: Minimum Inhibitory Concentration MPC: Mutant Prevention Concentration MSW: Mutant Selection Window PAMS: Periodic Antibiotic Monitoring and Supervision A Site: Amino Site P Site: Peptidyl Site E Site: Exit Site p-ABSA: para-aminobenzenesulfonyl azide HCl: Hydrochloric Acid NaOH: Sodium Hydroxide NaCl: Sodium Chloride TLC: Thin Layer Chromatography dd: Doublet of Doublets ddq: Doublet of Doublets of Quartets m: Multiplet s: Singlet CDCl3: Chloroform-D Et3N: Triethylamine NMR: Nuclear Magnetic Resonance 10 Chapter 1: Introduction H H R N S CH3 O N CH3 O OH O Figure 1: The Structure of Penicillin. Since the discovery of penicillin in 1928 by Alexander Fleming, antibiotics have become an indispensable tool of our healthcare system. Whether it is treating routine bacterial infections in the general population, helping immune-compromised cancer patients avoid infection, or keeping recently transplanted organs viable in the bodies of transplant patients who are often susceptible to bacterial infections, antibiotics are an essential part of today’s healthcare system.1 Fleming’s insight into the trajectory of antibiotic use is far beyond his serendipitous discovery. In his Nobel Peace Prize acceptance speech, he warned those who would listen, that antibiotics under constant use are quickly plagued by antibiotic resistance. Resistance is inevitable as bacteria thrive in the most adverse conditions due to their ability to evolve so quickly. Bacteria utilize methods such as horizontal gene transfer within and between species, as well as selective pressure for beneficial random mutation, to thrive at a rate that the immune system cannot always match. In order to preserve antibiotics as
Recommended publications
  • Small Molecule Modulators Reveal Mechanisms Regulating Cell Death
    Investigating neurodegenerative diseases with small molecule modulators Reka Rebecca Letso Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2011 ©2011 Reka Rebecca Letso All Rights Reserved Abstract Investigating neurodegenerative diseases with small molecule modulators Reka Rebecca Letso Elucidation of the mechanisms underlying cell death in neurodegenerative diseases has proven difficult, due to the complex and interconnected architecture of the nervous system as well as the often pleiotropic nature of these diseases. Cell culture models of neurodegenerative diseases, although seldom recapitulating all aspects of the disease phenotype, enable investigation of specific aspects of these disease states. Small molecule screening in these cell culture models is a powerful method for identifying novel small molecule modulators of these disease phenotypes. Mechanistic studies of these modulators can reveal vital insights into the cellular pathways altered in these disease states, identifying new mechanisms leading to cellular dysfunction, as well as novel therapeutic targets to combat these destructive diseases. Small molecule modulators of protein activity have proven invaluable in the study of protein function and regulation. While inhibitors of protein activity are relatively common, small molecules that can increase protein abundance are quite rare. Small molecule protein upregulators with targeted activities would be of great value in the study of the mechanisms underlying many loss of function diseases. We developed a high- throughput screening approach to identify small molecule upregulators of the Survival of Motor Neuron protein (SMN), whose decreased levels cause the neurodegenerative disease Spinal Muscular Atrophy (SMA). We screened 69,189 compounds for SMN upregulators and performed mechanistic studies on the most active compound, a bromobenzophenone analog designated cuspin-1.
    [Show full text]
  • Protein Kinase C Activates an H' (Equivalent) Conductance in The
    Proc. Nati. Acad. Sci. USA Vol. 88, pp. 10816-10820, December 1991 Cell Biology Protein kinase C activates an H' (equivalent) conductance in the plasma membrane of human neutrophils (HI channels/pH regulation/leukocytes/H+-ATPase/bafllomycin) ARVIND NANDA AND SERGIO GRINSTEIN* Division of Cell Biology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada Communicated by Edward A. Adelberg, August 12, 1991 ABSTRACT The rate of metabolic acid generation by it can be calculated that pH1 would be expected to drop by neutrophils increases greatly when they are activated. Intra- over 5 units (to pH 1.6) if the metabolically generated H+ cellular acidification is prevented in part by Na+/H' ex- were to remain within the cell. However, cells stimulated in change, but a sizable component ofH+ extrusion persists in the the nominal absence of Na+ and HCO- maintain their pH1 nominal absence of Na' and HCO3 . In this report we deter- above 6.4, suggesting that alternative (Na+- and HCO3- mined the contribution to H+ extrusion of a putative HI independent) H+ extrusion mechanisms must exist in acti- conductive pathway and its mode ofactivation. In unstimulated vated neutrophils. Accordingly, accelerated extracellular cells, H+ conductance was found to be low and unaffected by acidification can be recorded under these conditions. depolarization. An experimental system was designed to min- The existence of H+-conducting channels has been docu- imize the metabolic acid generation and membrane potential mented in snail neurones (5) and axolotl oocytes (6). In these changes associated with neutrophil activation. By using this tissues, the channels are inactive at the resting plasma system, (3-phorbol esters were shown to increase the H+ membrane potential (Em) but open when the membrane (equivalent) permeability of the plasma membrane.
    [Show full text]
  • Early-Life Antibiotic Use and Risk of Asthma and Eczema: Results of a Discordant Twin Study
    Early View Original article Early-life antibiotic use and risk of asthma and eczema: results of a discordant twin study Elise M.A. Slob, Bronwyn K. Brew, Susanne J.H. Vijverberg, Chantal J.A.R. Kats, Cristina Longo, Mariëlle W. Pijnenburg, Toos C.E.M. van Beijsterveldt, Conor V. Dolan, Meike Bartels, Patrick Magnusson, Paul Lichtenstein, Tong Gong, Gerard H. Koppelman, Catarina Almqvist, Dorret I. Boomsma, Anke H. Maitland-van der Zee Please cite this article as: Slob EMA, Brew BK, Vijverberg SJH, et al. Early-life antibiotic use and risk of asthma and eczema: results of a discordant twin study. Eur Respir J 2020; in press (https://doi.org/10.1183/13993003.02021-2019). This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Copyright ©ERS 2020 Early-life antibiotic use and risk of asthma and eczema: results of a discordant twin study Elise M.A. Slob1,2 Bronwyn K. Brew3,4 Susanne J.H. Vijverberg1,2 Chantal J.A.R. Kats1 Cristina Longo1 Mariëlle W. Pijnenburg5 Toos C.E.M. van Beijsterveldt6 Conor V. Dolan6 Meike Bartels6 Patrick Magnusson3 Paul Lichtenstein3 Tong Gong3 Gerard H. Koppelman7,8 Catarina Almqvist3,9 Dorret I. Boomsma6 Anke H. Maitland-van der Zee1,2* 1. Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, P.O.
    [Show full text]
  • Autophagy Flux in Critical Illness, a Translational Approach
    www.nature.com/scientificreports OPEN Autophagy fux in critical illness, a translational approach Nicolas Tardif 1,2, Franck Polia2, Inga Tjäder1,2, Thomas Gustafsson3 & Olav Rooyackers1,2 Recent clinical trials suggest that early nutritional support might block the induction of autophagy in Received: 17 October 2018 critically ill patients leading to the development of organ failure. However, the regulation of autophagy, Accepted: 7 June 2019 especially by nutrients, in critical illness is largely unclear. The autophagy fux (AF) in relation to critical Published: xx xx xxxx illness and nutrition was investigated by using an in vitro model of human primary myotubes incubated with serum from critically ill patients (ICU). AF was calculated as the diference of p62 expression in the presence and absence of chloroquine (50 µM, 6 h), in primary myotubes incubated for 24 h with serum from healthy volunteers (n = 10) and ICU patients (n = 93). We observed 3 diferent phenotypes in AF, non-altered (ICU non-responder group), increased (ICU inducer group) or blocked (ICU blocker group). This block was not associate with a change in amino acids serum levels and was located at the accumulation of autophagosomes. The increase in the AF was associated with lower serum levels of non-essential amino acids. Thus, early nutrition during critical illness might not block autophagy but could attenuate the benefcial efect of starvation on reactivation of the autophagy process. This could be of clinical importance in the individual patients in whom this process is inhibited by the critical illness insult. Critically ill patients treated in an Intensive Care Unit (ICU) ofen have organ failure already at their admittance or will develop it early during their stay in the unit.
    [Show full text]
  • Chemoenzymatic Synthesis of Glycosylated Macrolactam Analogues of the Macrolide Antibiotic YC-17
    FULL PAPERS DOI:10.1002/adsc.201500250 Chemoenzymatic Synthesis of Glycosylated Macrolactam Analogues of the Macrolide Antibiotic YC-17 Pramod B. Shinde,a,e Hong-Se Oh,b Hyemin Choi,c Kris Rathwell,a Yeon Hee Ban,a Eun Ji Kim,a Inho Yang,a Dong Gun Lee,c David H. Sherman,d Han-Young Kang,b,*and YeoJoon Yoona,* a Department of Chemistry andNano Science,Ewha Womans University,Seoul 120-750, Republic of Korea Fax: (+82)-2-3277-3419;phone:(+ 82)-2-3277-4446;e-mail:[email protected] b Department of Chemistry,Chungbuk National University,Cheongju 361-763, Republic of Korea Fax: (+82)-43-267-2279;phone:(+ 82)-43-261-2305;e-mail:[email protected] c School of Life Sciences,BK21Plus KNU Creative BioResearch Group,College of Natural Sciences,Kyungpook National University,Daehak-ro 80, Buk-gu, Daegu 702-701,Republic of Korea d Department of Medicinal Chemistry,Life Science Institute,DepartmentofChemistry,and Department of Microbiology &Immunology, University of Michigan, Ann Arbor, Michigan 48109, USA e Present address:Institute of Bioinformatics and Biotechnology (IBB), Savitribai Phule Pune University (formerly University of Pune), Pune 411-007, India Received:March 12, 2015; Revised:June 15, 2015;Published online:August 19, 2015 Supporting information for this article is availableonthe WWW under http://dx.doi.org/10.1002/adsc.201500250. Abstract: YC-17 is a12-membered ring macrolide sugars for subsequent glycosylation. Some YC-17 antibiotic producedfrom Streptomyces venezuelae macrolactam analogues were active against erythro- ATCC 15439
    [Show full text]
  • Gabaergic Signaling Linked to Autophagy Enhances Host Protection Against Intracellular Bacterial Infections
    ARTICLE DOI: 10.1038/s41467-018-06487-5 OPEN GABAergic signaling linked to autophagy enhances host protection against intracellular bacterial infections Jin Kyung Kim1,2,3, Yi Sak Kim1,2,3, Hye-Mi Lee1,3, Hyo Sun Jin4, Chiranjivi Neupane 2,5, Sup Kim1,2,3, Sang-Hee Lee6, Jung-Joon Min7, Miwa Sasai8, Jae-Ho Jeong 9,10, Seong-Kyu Choe11, Jin-Man Kim12, Masahiro Yamamoto8, Hyon E. Choy 9,10, Jin Bong Park 2,5 & Eun-Kyeong Jo1,2,3 1234567890():,; Gamma-aminobutyric acid (GABA) is the principal inhibitory neurotransmitter in the brain; however, the roles of GABA in antimicrobial host defenses are largely unknown. Here we demonstrate that GABAergic activation enhances antimicrobial responses against intracel- lular bacterial infection. Intracellular bacterial infection decreases GABA levels in vitro in macrophages and in vivo in sera. Treatment of macrophages with GABA or GABAergic drugs promotes autophagy activation, enhances phagosomal maturation and antimicrobial responses against mycobacterial infection. In macrophages, the GABAergic defense is mediated via macrophage type A GABA receptor (GABAAR), intracellular calcium release, and the GABA type A receptor-associated protein-like 1 (GABARAPL1; an Atg8 homolog). Finally, GABAergic inhibition increases bacterial loads in mice and zebrafish in vivo, sug- gesting that the GABAergic defense plays an essential function in metazoan host defenses. Our study identified a previously unappreciated role for GABAergic signaling in linking antibacterial autophagy to enhance host innate defense against intracellular bacterial infection. 1 Department of Microbiology, Chungnam National University School of Medicine, Daejeon 35015, Korea. 2 Department of Medical Science, Chungnam National University School of Medicine, Daejeon 35015, Korea.
    [Show full text]
  • An Effort to Address Antibiotic Resistance
    Desmethyl Analogs of Telithromycin: An Effort to Address Antibiotic Resistance A Dissertation Submitted to the Temple University Graduate Board in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy By Venkata Velvadapu August, 2011 Examining Committee Members: Dr. Rodrigo B. Andrade, Research Advisor, Chemistry Dr. Franklin A. Davis, Committee Chair, Chemistry Dr. William M. Wuest, Committee Member, Chemistry Dr. Kevin C. Cannon, External Committee Member, Chemistry i © by Venkata Velvadapu 2011 All Rights Reserved ii ABSTRACT The development of antibiotic resistance has been an inevitable problem leading to an increased demand for novel antibacterial drugs. To address this need, we initiated a structure-based drug design program wherein desmethyl analogues (i.e., CH 3H) of the 3rd -generation macrolide antibiotic telithromycin were prepared via chemical synthesis. Our approach will determine the biological functions of the methyl groups present at the C-4, C-8 and C-10 position of the ketolide. These structural modifications were proposed based on the structural data interpreted by Steitz and co-workers after obtaining crystal structures of macrolides erythromycin and telithromycin bound to the 50S ribosomal subunits of H.marismortui. Steitz argued that in bacteria, A2058G mutations confer resistance due to a steric clash of the amino group of guanine 2058 with the C-4 methyl group. In turn, we hypothesize that our desmethyl analogs are predicted to address antibiotic resistance arising from this mutation by relieving the steric clash. To readily access the analogs, we proposed to synthesize, 4,8,10-tridesmethyl telithromycin, 4,10-didesmethyl telithromycin, 4,8-didesmethyl telithromycin and 4- desmethyl telithromycin as four targeted desmethyl analogs of telithromycin.
    [Show full text]
  • Nature Nurtures the Design of New Semi-Synthetic Macrolide Antibiotics
    The Journal of Antibiotics (2017) 70, 527–533 OPEN Official journal of the Japan Antibiotics Research Association www.nature.com/ja REVIEW ARTICLE Nature nurtures the design of new semi-synthetic macrolide antibiotics Prabhavathi Fernandes, Evan Martens and David Pereira Erythromycin and its analogs are used to treat respiratory tract and other infections. The broad use of these antibiotics during the last 5 decades has led to resistance that can range from 20% to over 70% in certain parts of the world. Efforts to find macrolides that were active against macrolide-resistant strains led to the development of erythromycin analogs with alkyl-aryl side chains that mimicked the sugar side chain of 16-membered macrolides, such as tylosin. Further modifications were made to improve the potency of these molecules by removal of the cladinose sugar to obtain a smaller molecule, a modification that was learned from an older macrolide, pikromycin. A keto group was introduced after removal of the cladinose sugar to make the new ketolide subclass. Only one ketolide, telithromycin, received marketing authorization but because of severe adverse events, it is no longer widely used. Failure to identify the structure-relationship responsible for this clinical toxicity led to discontinuation of many ketolides that were in development. One that did complete clinical development, cethromycin, did not meet clinical efficacy criteria and therefore did not receive marketing approval. Work on developing new macrolides was re-initiated after showing that inhibition of nicotinic acetylcholine receptors by the imidazolyl-pyridine moiety on the side chain of telithromycin was likely responsible for the severe adverse events.
    [Show full text]
  • APO-Roxithromycin Roxithromycin Consumer Medicine Information
    APO-Roxithromycin Roxithromycin Consumer Medicine Information For a copy of a large print leaflet, Ph: 1800 195 055 What is in this leaflet · acute pharyngitis (sore throat and Before you take it discomfort when swallowing) This leaflet answers some common · tonsillitis When you must not take it questions about roxithromycin. It · sinusitis does not contain all the available Do not take this medicine if you information. It does not take the · acute bronchitis (infection of the have an allergy to: bronchi causing coughing) place of talking to your doctor or · roxithromycin pharmacist. · worsening of chronic bronchitis · any other macrolide antibiotics All medicines have risks and · pneumonia (lung infection (e.g. azithromycin, clarithromycin benefits. Your doctor has weighed characterised by fever, malaise, or erythromycin) the risks of you using this medicine headache) · any of the ingredients listed at the against the benefits they expect it · skin and soft tissue infections end of this leaflet will have for you. · non gonococcal urethritis Some of the symptoms of an allergic Ask your doctor or pharmacist: · impetigo (bacterial infection reaction may include: · if there is anything you do not causing sores on the skin) · shortness of breath understand in this leaflet, · wheezing or difficulty breathing · if you are worried about taking How it works your medicine, or · swelling of the face, lips, tongue, Roxithromycin is an antibiotic that throat or other parts of the body · to obtain the most up-to-date belongs to a group of medicines · rash, itching or hives on the skin information. called macrolides. You can also download the most up These antibiotics work by killing or Do not take this medicine if you to date leaflet from stopping the growth of the bacteria have severe liver problems.
    [Show full text]
  • Astrocytes: a Driving Force in Brain Signaling and Encephalopathies Aleksandar Jeremic Iowa State University
    Iowa State University Capstones, Theses and Retrospective Theses and Dissertations Dissertations 2001 Astrocytes: a driving force in brain signaling and encephalopathies Aleksandar Jeremic Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/rtd Part of the Neuroscience and Neurobiology Commons, and the Neurosciences Commons Recommended Citation Jeremic, Aleksandar, "Astrocytes: a driving force in brain signaling and encephalopathies " (2001). Retrospective Theses and Dissertations. 648. https://lib.dr.iastate.edu/rtd/648 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Retrospective Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand comer and continuing from left to right in equal sections with small overlaps.
    [Show full text]
  • Cisplatin-Induced Apoptosis Inhibits Autophagy, Which Acts As a Pro-Survival Mechanism in Human Melanoma Cells
    Cisplatin-Induced Apoptosis Inhibits Autophagy, Which Acts as a Pro-Survival Mechanism in Human Melanoma Cells Barbara Del Bello, Marzia Toscano, Daniele Moretti, Emilia Maellaro* Department of Pathophysiology, Experimental Medicine and Public Health, Istituto Toscano Tumori, University of Siena, Siena, Italy Abstract The interplay between a non-lethal autophagic response and apoptotic cell death is still a matter of debate in cancer cell biology. In the present study performed on human melanoma cells, we investigate the role of basal or stimulated autophagy in cisplatin-induced cytotoxicity, as well as the contribution of cisplatin-induced activation of caspases 3/7 and conventional calpains. The results show that, while down-regulating Beclin-1, Atg14 and LC3-II, cisplatin treatment inhibits the basal autophagic response, impairing a physiological pro-survival response. Consistently, exogenously stimulated autophagy, obtained with trehalose or calpains inhibitors (MDL-28170 and calpeptin), protects from cisplatin-induced apoptosis, and such a protection is reverted by inhibiting autophagy with 3-methyladenine or ATG5 silencing. In addition, during trehalose-stimulated autophagy, the cisplatin-induced activation of calpains is abrogated, suggesting the existence of a feedback loop between the autophagic process and calpains. On the whole, our results demonstrate that in human melanoma cells autophagy may function as a beneficial stress response, hindered by cisplatin-induced death mechanisms. In a therapeutic perspective, these findings suggest that the efficacy of cisplatin-based polychemotherapies for melanoma could be potentiated by inhibitors of autophagy. Citation: Del Bello B, Toscano M, Moretti D, Maellaro E (2013) Cisplatin-Induced Apoptosis Inhibits Autophagy, Which Acts as a Pro-Survival Mechanism in Human Melanoma Cells.
    [Show full text]
  • Danmap 2006.Pmd
    DANMAP 2006 DANMAP 2006 DANMAP 2006 - Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, foods and humans in Denmark Statens Serum Institut Danish Veterinary and Food Administration Danish Medicines Agency National Veterinary Institute, Technical University of Denmark National Food Institute, Technical University of Denmark Editors: Hanne-Dorthe Emborg Danish Zoonosis Centre National Food Institute, Technical University of Denmark Mørkhøj Bygade 19 Contents DK - 2860 Søborg Anette M. Hammerum National Center for Antimicrobials and Contributors to the 2006 Infection Control DANMAP Report 4 Statens Serum Institut Artillerivej 5 DK - 2300 Copenhagen Introduction 6 DANMAP board: National Food Institute, Acknowledgements 6 Technical University of Denmark: Ole E. Heuer Frank Aarestrup List of abbreviations 7 National Veterinary Institute, Tecnical University of Denmark: Sammendrag 9 Flemming Bager Danish Veterinary and Food Administration: Summary 12 Justin C. Ajufo Annette Cleveland Nielsen Statens Serum Institut: Demographic data 15 Dominique L. Monnet Niels Frimodt-Møller Anette M. Hammerum Antimicrobial consumption 17 Danish Medicines Agency: Consumption in animals 17 Jan Poulsen Consumption in humans 24 Layout: Susanne Carlsson Danish Zoonosis Centre Resistance in zoonotic bacteria 33 Printing: Schultz Grafisk A/S DANMAP 2006 - September 2007 Salmonella 33 ISSN 1600-2032 Campylobacter 43 Text and tables may be cited and reprinted only with reference to this report. Resistance in indicator bacteria 47 Reprints can be ordered from: Enterococci 47 National Food Institute Escherichia coli 58 Danish Zoonosis Centre Tecnical University of Denmark Mørkhøj Bygade 19 DK - 2860 Søborg Resistance in bacteria from Phone: +45 7234 - 7084 diagnostic submissions 65 Fax: +45 7234 - 7028 E.
    [Show full text]