Tetracycline; protein synthesis of bacteria

体外活性：Omadacycline 是一种新型氨甲基四环素抗生素，正在开发用于口服和静脉 (IV) 给药，用于治疗社区获得性细菌感染，例如急性细菌性皮肤和皮肤结构感染 (ABSSSI)、社区获得性细菌性肺炎 (CABP)和尿路感染（UTI）。在体外，omadacycline 对革兰氏阳性和革兰氏阴性需氧菌、厌氧菌和非典型病原体（包括军团菌和衣原体属）具有活性。奥马达环素提供每日一次的口服和静脉注射给药方式，其临床耐受性和安全性与当前用于治疗严重社区获得性感染的抗生素相比具有优势，而在这些感染中，耐药性已大大降低了有效性。在针对复杂皮肤和皮肤结构感染（包括 MRSA 感染患者）的研究中，omadacycline 表现出与利奈唑胺相当的疗效和耐受性。正在进行和计划中的临床研究正在评估 omadacycline 作为治疗严重社区获得性细菌感染的单一疗法，包括急性细菌性皮肤和皮肤结构感染 (ABSSSI) 和社区获得性细菌性肺炎 (CABP)。本综述概述了奥马环素的发现、微生物学、非临床数据以及可用的临床安全性和有效性数据，并参考了其他当代四环素衍生抗生素。细胞测定：omadacycline 对 MRSA、VRE 和 β-溶血性链球菌的 MIC90 分别为 1.0 μg/mL、0.25 μg/mL 和 0.5 μg/mL，omadacycline 对 PRSP 和流感嗜血杆菌的 MIC90 为 0.25 μg/ml分别为2.0μg/mL和2.0μg/mL。 Omadacycline 对生物体具有活性，表现出两种主要的耐药机制：核糖体保护和活性四环素外排[1]。 Omadacycline 抑制蛋白质合成，但对 RNA、DNA 和肽聚糖合成无明显影响。此外，omadacycline 与细菌核糖体 30S 亚基上的四环素结合位点结合，基于额外的分子相互作用，其结合增强，类似于替加环素。

使用小鼠腹膜内感染模型证明了omadacycline的体内功效。单次静脉注射剂量的 omadacycline 对肺炎链球菌、大肠杆菌和金黄色葡萄球菌（包括含有 tet (M) 和 tet (K) 外排的菌株和 MRSA 菌株）具有疗效。获得的肺炎链球菌的50%有效剂量（ED50）范围为0.45 mg/kg至3.39 mg/kg，获得的金黄色葡萄球菌的ED50范围为0.30 mg/kg至1.74 mg/kg，大肠杆菌的ED50为2.02毫克/公斤。

奥马环素的体外稳定性及药物相互作用潜力[6]
测定了4.8 μM和48 μM的奥马环素在人微粒体和肝细胞中的稳定性。奥马大环素在人微粒体中孵育30分钟后，>90%的奥马环素被完整地回收。同样，奥马环素在人肝细胞中孵育24小时后，>86%的细胞恢复完好。这些结果表明，奥马环素没有代谢到任何显著程度。使用混合人肝微粒体制剂、S9、肝细胞质或重组黄素单加氧酶(FMO1、FMO3、FMO5)评估与奥马环素药物相互作用的可能性。在原代人肝细胞中，用1-100 μM的奥马环素和底物探针孵育24和48小时，评估CYP450同工酶的诱导作用。在浓度为1-50 μM的奥马环素和浓度近似于每个底物Km的同工酶特异性底物的混合人微粒体中，评估CYP450同工酶的抑制作用。评估的同工酶包括CYP 1A1、1A2、1B1、2A6、2B6、2C8、2C9、2C19、2D6、2E1、2J2和3A4/5。奥马环素没有诱导CYP同工酶，并且没有或很少(<40%的最大阳性对照反应)诱导它们的mrna。奥马达环素对CYP同工酶活性无明显抑制作用。此外，奥马环素及其可能的代谢物对CYP1A2 2C9、2D6或3A4/5没有时间依赖性的抑制作用。

Omadacycline 对 MRSA、VRE 和 β 溶血性链球菌的 MIC90 分别为 1.0 μg/mL、0.25 μg/mL 和 0.5 μg/mL。对于 PRSP 和流感嗜血杆菌，相应的 omadacycline MIC90 为 0.25 μg/ml 和 2.0 μg/mL。 Omadacycline 对具有核糖体保护和活性四环素外排（两种主要耐药机制）的生物体具有功效[1]。奥马达环素对DNA、RNA或肽聚糖的合成影响不大，但会抑制蛋白质的合成。此外，由于额外的分子相互作用，omadacycline 与细菌核糖体 30S 亚基上的四环素结合位点的结合力与替加环素相当。

Systemic i.p. challenge model. Six-week-old, specific-pathogen-free, male CD-1 mice, weighing 18 to 30 g were used for all experiments. At 1 h postinfection (p.i.), mice were dosed intravenously (i.v.) with omadacycline or comparator compounds of interest, dissolved in sterile saline for injection at a volume of 10 ml/kg. All drug doses were formulated fresh immediately prior to administration and adjusted to account for percent activity. A minimum of four dose levels were tested per experiment with 5 mice/group. The typical doses tested ranged from 0.11 to 18 mg/kg of body weight, with exceptions for comparators that required significantly higher or lower doses to achieve 50% efficacy (dose range minimum-maximum, 0.08 to 54 mg/kg). Each study also included an untreated control group. Mice were housed in filter-topped cages in an isolated room and monitored for morbidity at least every 24 h for 7 days. Efficacy was determined by calculating the 50% effective dose (ED50) for all drugs tested. The ED50 is defined as the dose required to achieve 50% survival at 7 days p.i. and was estimated when possible using the formula y = 1/[1 + 10(log(k)-log(x)× 4.2)], where k = 0.5, by nonlinear regression analysis with Prism, version 3.0 software. [2]

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0.45 mg/kg to 3.39 mg/kg; i.p.

Mice

The pharmacokinetics of omadacycline are best described by a linear, three-compartment model following a zero-order intravenous infusion or first-order oral administration with transit compartments to account for delayed absorption. Omadacycline has a volume of distribution (Vd) ranging from 190 to 204 L, a terminal elimination half-life (t½) of 13.5-17.1 h, total clearance (CLT) of 8.8-10.6 L/h, and protein binding of 21.3% in healthy subjects. Oral bioavailability of omadacycline is estimated to be 34.5%. A single oral dose of 300 mg (bioequivalent to 100 mg IV) of omadacycline administered to fasted subjects achieved a maximum plasma concentration (Cmax) of 0.5-0.6 mg/L and an area under the plasma concentration-time curve from 0 to infinity (AUC0-∞) of 9.6-11.9 mg h/L. The free plasma area under concentration-time curve divided by the minimum inhibitory concentration (i.e., fAUC24h/MIC), has been established as the pharmacodynamic parameter predictive of omadacycline antibacterial efficacy. Several animal models including neutropenic murine lung infection, thigh infection, and intraperitoneal challenge model have documented the in vivo antibacterial efficacy of omadacycline. A phase II clinical trial on complicated skin and skin structure infection (cSSSI) and three phase III clinical trials on ABSSSI and CABP demonstrated the safety and efficacy of omadacycline. The phase III trials, OASIS-1 (ABSSSI), OASIS-2 (ABSSSI), and OPTIC (CABP), established non-inferiority of omadacycline to linezolid (OASIS-1, OASIS-2) and moxifloxacin (OPTIC), respectively. Omadacycline is currently approved by the FDA for use in treatment of ABSSSI and CABP. Phase II clinical trials involving patients with acute cystitis and acute pyelonephritis are in progress. Mild, transient gastrointestinal events are the predominant adverse effects associated with use of omadacycline. Based on clinical trial data to date, the adverse effect profile of omadacycline is similar to studied comparators, linezolid and moxifloxacin. Unlike tigecycline and eravacycline, omadacycline has an oral formulation that allows for step-down therapy from the intravenous formulation, potentially facilitating earlier hospital discharge, outpatient therapy, and cost savings. Omadacycline has a potential role as part of an antimicrobial stewardship program in the treatment of patients with infections caused by antibiotic-resistant and multidrug-resistant Gram-positive [including methicillin-resistant Staphylococcus aureus (MRSA)] and Gram-negative pathogens. [https://pubmed.ncbi.nlm.nih.gov/31970713/]

Effects During Pregnancy and Lactation
◉ Summary of Use during Lactation
No information is available on the use of omadacycline during breastfeeding. It is unknown how much omadacycline is excreted into breastmilk, but the drug is only about 35% absorbed orally under optimal circumstances, and is probably less from milk because of its calcium content. The manufacturer states that breastfeeding is not recommended during treatment and for 4 days after the last dose. If an infant is breastfed, monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis. As a theoretical precaution, avoid prolonged or repeat courses during nursing.
◉ Effects in Breastfed Infants
Relevant published information was not found as of the revision date.
◉ Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.

[1]. Omadacycline: A Newly Approved Antibacterial from the Class of Tetracyclines. Pharmaceuticals (Basel). 2019 Apr 21;12(2):63.

[2]. In vitro and in vivo antibacterial activities of omadacycline, a novel aminomethylcycline. Antimicrob Agents Chemother. 2014;58(2):1127-35.

[3]. Omadacycline: A Novel Oral and Intravenous Aminomethylcycline Antibiotic Agent. Drugs. 2020 Feb;80(3):285-313.

[4]. Omadacycline: First Global Approval. Drugs. 2018 Dec;78(18):1931-1937.

[5]. In Vitro and In Vivo Assessments of Cardiovascular Effects with Omadacycline. Antimicrob Agents Chemother. 2016 Aug 22;60(9):5247-53.

[6]. Bioorg Med Chem.2016 Dec 15;24(24):6409-6419.

See also: Omadacycline (annotation moved to); Omadacycline Tosylate (annotation moved to).

C36H48N4O10S

728.86

728.309

C, 59.33; H, 6.64; N, 7.69; O, 21.95; S, 4.40

1075240-43-5

Omadacycline;389139-89-3;Omadacycline hydrochloride;1196800-39-1;Omadacycline-d9;2272886-41-4;Omadacycline mesylate;1196800-40-4

54746485

White to yellow solid powder

4.736

239.41

7

13

8

51

1350

4

S(C1C([H])=C([H])C(C([H])([H])[H])=C([H])C=1[H])(=O)(=O)O[H].O([H])[C@@]12C(=C(C(N([H])[H])=O)C([C@]([H])([C@]1([H])C([H])([H])[C@]1([H])C([H])([H])C3=C(C([H])=C(C([H])([H])N([H])C([H])([H])C(C([H])([H])[H])(C([H])([H])[H])C([H])([H])[H])C(=C3C(=C1C2=O)O[H])O[H])N(C([H])([H])[H])C([H])([H])[H])N(C([H])([H])[H])C([H])([H])[H])=O)O[H]

SETFNHZTVGTBHC-XGLFQKEBSA-N

InChI=1S/C29H40N4O7.C7H8O3S/c1-28(2,3)12-31-11-14-10-17(32(4)5)15-8-13-9-16-21(33(6)7)24(36)20(27(30)39)26(38)29(16,40)25(37)18(13)23(35)19(15)22(14)34;1-6-2-4-7(5-3-6)11(8,9)10/h10,13,16,21,31,34,36-37,40H,8-9,11-12H2,1-7H3,(H2,30,39);2-5H,1H3,(H,8,9,10)/t13-,16-,21-,29-;/m0./s1

(4S,4aS,5aR,12aS)-4,7-bis(dimethylamino)-3,10,12,12a-tetrahydroxy-9-((neopentylamino)methyl)-1,11-dioxo-1,4,4a,5,5a,6,11,12a-octahydrotetracene-2-carboxamide 4-methylbenzenesulfonate

PTK 0796 tosylate; PTK-0796; PTK0796; Omadacycline (tosylate); Omadacycline tosylate [USAN]; Omadacycline tosilate; Amadacyclintosylate

2934.99.9001

Powder      -20°C    3 years

                     4°C     2 years

In solvent   -80°C    6 months

                  -20°C    1 month

注意： 请将本产品存放在密封且受保护的环境中（例如氮气保护），避免吸湿/受潮和光照。

Room temperature (This product is stable at ambient temperature for a few days during ordinary shipping and time spent in Customs)

DMSO : 12.5 100 mg/mL ( 137.2 mM )
Water : 100 mg/mL
Ethanol : 100 mg/mL

配方 1 中的溶解度: 50 mg/mL (68.60 mM) in PBS (这些助溶剂从左到右依次添加，逐一添加), 澄清溶液; 超声助溶。

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请根据您的实验动物和给药方式选择适当的溶解配方/方案：
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