SULFONAMIDES Chapter 19

Lead Compound Notes Prontosil - red dye Antibacterial activity in vivo (1935) Inactive in vitro Metabolised to active sulfonamide Acts as a prodrug Sulfanilamide - first synthetic antibacterial agent acting on a wide range of infections

Structure-Activity Relationships Aromatic para-Amino group Sulfonamide para-Amino group is essential (R1=H) para-Amido groups (R1=acyl) are allowed inactive in vitro, but active in vivo act as prodrugs Aromatic ring is essential para-Substitution is essential Sulfonamide group is essential Sulfonamide nitrogen must be primary or secondary R2 can be varied

Prodrugs of sulfonamides Enzyme Notes Amide group lowers the polarity of the sulfonamide Amide cannot ionise Alkyl group increases the hydrophobic character Crosses the gut wall more easily Metabolised by enzymes (e.g. peptidases) in vivo Metabolism generates the primary amine Primary amine ionizes and can form ionic interactions Ionised primary amine also acts as a strong HBD

Sulfanilamide analogues Notes R2 is variable Different aromatic and heteroaromatic rings are allowed Affects plasma protein binding Determines blood levels and lifetime of the drug Affects solubility Affects pharmacokinetics rather than pharmacodynamices

Sulfanilamides - applications Notes Antibacterial drugs of choice prior to penicillins (1930s) Superseded by penicillins Current uses Treatment of urinary tract infections Eye lotions Treatment of gut infections Treatment of mucous membrane infections

Mechanism of action para-Aminobenzoic acid Dihydropteroate synthetase Sulfonamides Reversible inhibition _ Dihydrofolate L-Glutamic acid Dihydrofolate reductase NADPH Tetrahydrofolate (coenzyme F) Trimethoprim _

Mechanism of action Target enzyme Dihydropteroate synthetase - bacterial enzyme Not present in human cells Important in the biosynthesis of the tetrahydrofolate cofactor Cofactor is crucial to pyrimidine and DNA biosynthesis Crucial to cell growth and division Sulfonamides Competitive enzyme inhibitors Bacteriostatic agents Not ideal for patients with weakened immune systems Mimic the enzyme substrate - para-aminobenzoic acid (PABA) Bind to the active site and block access to PABA Reversible inhibition Resistant strains produce more PABA

Mechanism of action Binding interactions Active site Active site O C H 2 N S O N R H 2 Ionic bond H-Bond van der Waals interactions

Mechanism of action Metabolic differences between bacterial and mammalian cells Dihydropteroate synthetase is present only in bacterial cells Transport protein for folic acid is only present in mammalian cells

Sulfonamides - Drug Metabolism Sulfathiazole Insoluble metabolite N-Acetylation Notes Sulfonamides are metabolised by N-acetylation N-Acetylation increases hydrophobic character Reduces aqueous solubility May lead to toxic side effects

Sulfonamides with reduced toxicity Sulfathiazole Sulfadiazine Notes Thiazole ring is replaced with a pyrimidine ring Pyrimidine ring is more electron-withdrawing Sulfonamide NH proton is more acidic and ionizable Sulfadiazine and its metabolite are more water soluble Reduced toxicity Silver sulfadiazine is used topically to prevent infection of burns

Examples of Sulfonamides Sulfadoxine Belongs to a new generation of sulfonamides Long lasting antibacterial agent Once weekly dosing regime Sulfadoxine + pyrimethamine = Fanisdar Used for the treatment of malaria Pyrimethamine

Examples of Sulfonamides Succinyl sulfathiazole Sulfathiazole Succinic acid Enzyme Notes Acts as a prodrug of sulfathiazole Ionized in the alkaline conditions of the intestine Too polar to cross the gut wall Concentrated in the gut Slowly hydrolysed by enzymes in the gut Used for gut infections

Examples of Sulfonamides Benzoyl prodrugs Benzoyl prodrug Sulfonamide Benzoic acid Too hydrophobic to cross gut wall Slowly hydrolyzed by enzymes in gut Used for gut infections

Examples of Sulfonamides Sulfamethoxazole Trimethoprim Sulfamethoxazole + trimethoprim = co-trimoxazole Agents inhibit different enzymes in same biosynthetic pathway Strategy of sequential blocking Allows lower, safer dose levels of each agent

Sulfones Thought to inhibit dihydropteroate synthetase Used in the treatment of leprosy