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WO 2016/123368 Al 4 August 2016 (04.08.2016) P O P C T

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WO 2016/123368 Al 4 August 2016 (04.08.2016) P O P C T (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2016/123368 Al 4 August 2016 (04.08.2016) P O P C T (51) International Patent Classification: AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, A61K 31/28 (2006.01) A61K 39/04 (2006.01) BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, A61K 31/70 (2006.01) A61P 31/04 (2006.01) DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, A61K 31/135 (2006.01) A61P 31/06 (2006.01) HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, (21) International Application Number: MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, PCT/US20 16/0 15409 PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC, (22) International Filing Date: SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, 28 January 2016 (28.01 .2016) TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (25) Filing Language: English (84) Designated States (unless otherwise indicated, for every kind of regional protection available): ARIPO (BW, GH, (26) Publication Language: English GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ, (30) Priority Data: TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, 62/109,447 29 January 2015 (29.01.2015) U S TJ, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, (71) Applicant: THE CALIFORNIA INSTITUTE FOR LV, MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK, BIOMEDICAL RESEARCH [US/US]; 11119 North SM, TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, Torrey Pines Road, Suite 100, La Jo11a, California 92037 GW, KM, ML, MR, NE, SN, TD, TG). (US). Declarations under Rule 4.17 : (72) Inventors: WANG, Feng; 615 1 Citracado Circle, Carls — as to applicant's entitlement to apply for and be granted a bad, California 92009 (US). HARBUT, Michael; 201 1 W . patent (Rule 4.1 7(H)) California St., San Diego, California 921 10 (US). SCHULTZ, Peter G.; 1650 La Jolla Rancho Road, La — as to the applicant's entitlement to claim the priority of the Jolla, California 92037 (US). earlier application (Rule 4.1 7(in)) (74) Agent: HARDT, Ingo H.; Wilson Sonsini Goodrich & Published: Rosati, 650 Page Mill Road, Palo Alto, California 94304 — with international search report (Art. 21(3)) (US). — before the expiration of the time limit for amending the (81) Designated States (unless otherwise indicated, for every claims and to be republished in the event of receipt of kind of national protection available): AE, AG, AL, AM, amendments (Rule 48.2(h)) (54) Title: METHODS OF ANTIBIOTIC TREATMENT WITH METAL-THIOLATE COMPLEXES 100- 75' . 2 0.12 g k 0 1 2 3 4 5 6 7 Days (57) Abstract: The present invention provides methods of treating bacterial infections with metal thiolate complexes, such as auran- ofin. Disclosed herein are methods of treating a bacterial infection in a subject, comprising administering a metal thiolate complex, wherein the metal thiolate complex is cytotoxic to a bacteria. The bacteria may be a gram-positive bacteria. The gram-positive bac teria may be of a Mycobacterium genus. The gram-positive bacteria may be of a Bacillus genus. The gram-positive bacteria may be of an Enterococcus genus. The gram-positive bacteria may be Mycobacterium tuberculosis. The gram-positive bacteria may be Ba cillus subtilis. The gram-positive bacteria may be selected from Enterococcusfaecium and Enterococcusfaecalis. The gram-positive bacteria may be Staphylococcus aureus. The Staphylococcus aureus may be resistant to a drug. The drug may be an antibiotic agent selected from vancomycin and linezolid. METHODS OF ANTIBIOTIC TREATMENT WITH METAL-THIOLATE COMPLEXES FEDERALLY SPONSORED RESEARCH [001] This invention was made in part during work supported by N H grant R01 AI097548 from the National Institutes of Health. The government may have certain rights to this invention. BACKGROUND OF THE INVENTION [002] The emergence and spread of antibiotic-resistant bacterial infections is an ongoing and growing public health concern, and has resulted in a growing urgency to identify new compounds with novel mechanisms of action that are active against antibiotic-resistant pathogenic bacteria. Drug-resistance has a profound clinical significance; including increased hospitalizations and excess healthcare costs and higher rates of mortality. Outbreaks of methicillin-resistant S. aureus (MRSA), previously confined to hospitals now have expanded due to community-associated spreading. For tuberculosis (TB), the lengthy course of drug treatment persisters has contributed to multidrug- resistant M tuberculosis (MDR-MTB). Costs for a drug course for multidrug-resistant TB (MDR- TB) can be thousands of times more than for regular treatment, and treatment success rates for individuals with extensively drug resistant TB are less than 50%. SUMMARY OF THE INVENTION [003] Disclosed herein are methods of treating a bacterial infection in a subject, comprising administering a metal thiolate complex, wherein the metal thiolate complex is cytotoxic to a bacteria. The bacteria may be a gram-positive bacteria. The gram-positive bacteria may be of a Mycobacterium genus. The gram-positive bacteria may be of a Bacillus genus. The gram-positive bacteria may be of an Enterococcus genus. The gram-positive bacteria may be Mycobacterium tuberculosis. The gram-positive bacteria may be Bacillus subtilis. The gram-positive bacteria may be selected from Enterococcusfaecium and Enterococcusfaecalis. The gram-positive bacteria may be Staphylococcus aureus. The Staphylococcus aureus may be resistant to a drug. The drug may be an antibiotic agent selected from vancomycin and linezolid. The drug may be methicillin. The bacteria may express a thioredoxin and a thioredoxin reductase. The bacteria may be Staphylococcus aureus and the thioredoxin may be TrxC. The bacteria may be Mycobacterium tuberculosis and the thioredoxin reductase may be TrxB2. The bacteria may not express a glutathione reductase. The bacteria may be a dormant bacteria. The metal thiolate complex may be a gold salt. The metal thiolate complex may be a gold complex. The metal thiolate complex may be an organogold compound. The metal thiolate complex may be selected from auranofin, aurothioglucose, disodium aurothiomalate, sodium aurothiosulfate, sodium aurothiomalate and pharmaceutically acceptable derivatives thereof. The metal thiolate complex may be selected from auranofin and pharmaceutically acceptable derivatives thereof. The method may further comprise administering an agent selected from paraquat, diamide, and a combination thereof. [004] Further disclosed herein are methods of inhibiting a thioredoxin reductase or substrate thereof in a bacteria comprising contacting the bacteria with a metal thiolate complex. The contacting may comprise administering the metal thiolate complex to a subject infected with the bacteria. The bacteria may not express a glutathione reductase. The metal thiolate complex may comprise a compound selected from auranofin and pharmaceutically acceptable derivatives thereof. The thioredoxin reductase may be a first enzyme and the method further comprises administering a therapeutic agent that inhibits at least one additional enzyme. The at least one additional enzyme may comprise an enzyme bearing a reactive cysteine residue. The at least one additional enzyme may be selected from a cysteine protease and a sulfurtransferase. The at least one additional enzyme may be an oxidoreductase. The oxidoreductase may be an NADPH-dependent oxidoreductase. The oxidoreductase may be a mycothione reductase. The bacteria may be a gram-positive bacteria. The gram-positive bacteria may be selected from Mycobacterium tuberculosis and Bacillus subtilis. The gram-positive bacteria may be a drug-resistant strain of bacteria. The drug-resistant strain of bacteria may be a strain of bacteria selected from Enterococcusfaecium and Enterococcusfaecalis. The drug-resistant strain of bacteria may be a strain of Staphylococcus aureus. The strain of Staphylococcus aureus may be resistant to an antibiotic agent selected from methicillin, vancomycin, and linezolid. The metal thiolate complex may be a gold salt. The metal thiolate complex may be a gold complex. The metal thiolate complex may be an organogold compound. The metal thiolate complex may be selected from auranofin, aurothioglucose, disodium aurothiomalate, sodium aurothiosulfate, sodium aurothiomalate and pharmaceutically acceptable derivatives thereof. The metal thiolate complex may be selected from auranofin and pharmaceutically acceptable derivatives thereof. [005] Further disclosed herein are methods for preventing a bacterial infection in a subject, comprising administering a metal thiolate complex. The bacterial infection may be an infection with a gram-positive bacterium. The bacterial infection may be an infection with a bacterium that expresses thioredoxin reductase and does not express glutathione reductase. The metal thiolate complex may be a gold salt. The metal thiolate complex may be a gold complex. The metal thiolate complex may be an organogold compound. The metal thiolate complex may be selected from auranofin, aurothioglucose, disodium aurothiomalate, sodium aurothiosulfate, sodium aurothiomalate and pharmaceutically acceptable derivatives thereof. The metal thiolate complex may be selected from auranofin and pharmaceutically acceptable derivatives thereof. The method may further comprise administering an agent selected from paraquat, diamide, and a combination thereof. [006] Further disclosed herein are methods of treating tuberculosis in a subject comprising administering a therapeutic agent to the subject, wherein the therapeutic agent modulates an activity of a thioredoxin reductase or a substrate thereof. The thioredoxin reductase may be TrxB2. The therapeutic agent may inhibit the activity of the thioredoxin reductase. [007] Further disclosed herein are methods of treating a Staphylococcus aureus infection in a subject comprising administering a therapeutic agent to the subject, wherein the therapeutic agent modulates a thioredoxin reductase or substrate thereof.
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