1. Bacterial Physiology (Micr430) Lecture 10 Macromolecular Synthesis: Cell Wall (Text Chapter: 11)

2. Peptidoglycan Review Cell wall is composed of peptidoglycan. N-acetylmuramic acid is unique to bacterial cell wall; it cannot be found in any other cell types or organisms. Peptidoglycan is made of glycan strands of alternating residues of N- acetylmuramic acid and N- aetylglucosamine linked by  -1,4 bond.

3. Fig. 11.2

4. Peptidoglycan Review These glycan strands are cross-linked by amino acids. Attached to each N-acetylmuramic acid is a tetrapeptide in the following order: L-alanyl-D-glutamyl-  -L-R3-D-alanine. Peptidoglycan confers strength to the cell wall.

5. Fig. 11.3

6. Peptidoglycan Synthesis Peptidoglycan is made in four stages: Precursor formation (in cytoplasm) involving UDP derivatives of amino sugars Transfer through membrane. Polymerization on outer surface of membrane A transpeptidation reaction cross-links the peptidoglycan.

7. Fig. 11.4

8. Fig. 11.6

9. Fig. 11.7

10. phosphomycin cycloserine penicillins tunicamycin

11. Inhibitors of cell wall biosynthesis

12. Beta-Lactam Structure

13.  -Lactam Characteristics Same MOA: Inhibit cell wall synthesis Bactericidal (except against Enterococcus sp.); time-dependent killers Short elimination half-life Primarily renally eliminated (except nafcillin, oxacillin, ceftriaxone, cefoperazone) Cross-allergenicity - except aztreonam

14. ALL  -lactams Mechanism of Action z interfere with cell wall biosynthesis by binding to penicillin-binding proteins (PBPs) which are located in bacterial cell walls z inhibition of PBPs leads to inhibition of peptidoglycan synthesis z are bactericidal

15. Penicillins Natural Penicillins (penicillin G, penicillin VK) Penicillinase-Resistant Penicillins (nafcillin, oxacillin, methicillin) Developed to overcome the penicillinase enzyme of S. aureus which inactivated natural penicillins Aminopenicillins (ampicillin, amoxicillin) Developed to increase activity against gram-negative aerobes Carboxypenicillins (carbenicillin, ticarcillin) and Ureidopenicillins (piperacillin, azlocillin) Developed to further increase activity against resistant gram-negative aerobes  -Lactamase Inhibitor Combos (Unasyn, Augmentin, Timentin, Zosyn) Developed to gain or enhance activity against  - lactamase producing organisms

16. Cephalosporins Divided into 4 major groups called “Generations” based on z antimicrobial activity z resistance to beta-lactamase

17. Monobactams Spectrum of Activity Aztreonam bind preferentially to PBP 3 of gram-negative aerobes; has little to no activity against gram-positives or anaerobes Gram-negative E. coli, K. pneumoniae, P. mirabilis, S. marcescens H. influenzae, M. catarrhalis Enterobacter, Citrobacter, Providencia, Morganella Salmonella, Shigella Pseudomonas aeruginosa

18. Carbapenems Spectrum of Activity Most broad spectrum of activity of all antimicrobials Have activity against gram-positive and gram-negative aerobes and anaerobes Bacteria not covered by carbapenems include MRSA, VRE, coagulase-negative staph, C. difficile, S. maltophilia, Nocardia

19. Vancomycin Complex tricyclic glycopeptide produced by Nocardia orientalis, MW = 1500 Da Commercially-available since 1956 Current product has been extensively purified - decreased adverse effects Clinical use decreased with introduction of antistaphylococcal penicillins Today, use increasing due to emergence of resistant bacteria (MRSA)

20. Vancomycin Structure

21. Vancomycin Mechanism of Action Inhibits bacterial cell wall biosynthesis at a site different than beta-lactams Inhibits synthesis and assembly of the second stage of peptidoglycan polymers Binds firmly to D-alanyl-D-alanine portion of cell wall precursors Bactericidal (except for Enterococcus)

22. Vancomycin Spectrum of Activity Gram-positive bacteria Methicillin-Susceptible AND Methicillin-Resistant S. aureus and coagulase-negative staphylococci Streptococcus pneumoniae (including PRSP), viridans streptococcus, Group B streptococcus Enterococcus sp. Corynebacterium, Bacillus. Listeria, Actinomyces Clostridium sp. (including C. difficile), Peptococcus, Peptostreptococcus No activity against gram-negative aerobes or anaerobes