Patent application title: INOSITOL HEXAKISPHOSPHATE ANALOGS AND USES THEREOF
Tor C. Savidge (League City, TX, US)
Petri Urvil (Galveston, TX, US)
Dhamanjaya Nauduri (Galveston, TX, US)
Numan Oezguen (Galveston, TX, US)
Catherine Schein (Friendswood, TX, US)
Werner Braun (Friendswood, TX, US)
The Board of Regents of the University of Texas System
IPC8 Class: AC07F9117FI
Class name: Designated organic active ingredient containing (doai) phosphorus containing other than solely as part of an inorganic ion in an addition salt doai ester of (hx)p=x(xh)(xh) (x is chalcogen) (e.g., phosphate, etc.)
Publication date: 2012-10-11
Patent application number: 20120258936
Provided herein are analog and derivative compounds of inositol
hexakisphosphate effective to treat a Clostridium difficile infection and
to neutralize the bacterial toxins produced by the same. In addition,
methods of treating the C. difficile infection and for neutralizing its
toxins with the compounds are provided.
1. An inositol hexakisphosphate analog having a chemical structure of
Formula I: ##STR00003## wherein R1, R2, R3, R4,
R5, and R6 independently are --PO(OH)2, --PS(OH)2,
--PSe(OH)2, or --AsO3; at least one of R1, R2,
R3, R4, R5, and R6 is --PS(OH)2,
--PSe(OH)2, or --AsO3; and R1 and R3 are not both
--PS(OH)2 or --PSe(OH)2 when R2, R4, R5, and
R6 are --PO(OH).sub.2.
2. The analog of claim 1, wherein R1 and one of R2, R4, R5, or R6 are --PS(OH).sub.2.
3. The analog of claim 1, wherein R1, R2, and one of R3, R4, R5, or R6 are --PS(OH).sub.2.
4. The analog of claim 1, wherein R1, R4, and one of R2, R3, R5, or R6 are --PS(OH).sub.2.
5. The analog of claim 1, wherein R1, R5, and one of R2, R3, R4, or R6 is --PS(OH).sub.2.
6. The analog of claim 1, wherein R1, R6 and one of R2, R3, R4, or R5 are --PS(OH).sub.2.
7. The analog of claim 1, wherein R1, R2, R3, R4, R5, and R6 are --PS(OH).sub.2.
8. The analog of claim 7, wherein the inositol analog is a myo-inositol analog.
9. The analog of claim 1, wherein R1 and one of R2, R4, R5, or R6 are --PSe(OH).sub.2.
10. The analog of claim 1, wherein R1, R2, and one of R3, R4, R5, or R6 are --PSe(OH).sub.2.
11. The analog of claim 1, wherein R1, R4, and one of R2, R3, R5, or R6 are --PSe(OH).sub.2.
12. The analog of claim 1, wherein R1, R5, and one of R2, R3, R4, or R6 is --PSe(OH).sub.2.
13. The analog of claim 1, wherein R1, R6 and one of R2, R3, R4, or R5 are --PSe(OH).sub.2.
14. The analog of claim 1, wherein R1, R2, R3, R4, R5, and R6 are --PSe(OH).sub.2.
15. The analog of claim 14, wherein the inositol analog is a myo-inositol analog.
16. The analog of claim 1, wherein nitric oxide (NO) is bound to at least one of R1, R2, R3, R4, R5, and R.sub.6.
17. The analog of claim 16, wherein NO is bound to --PS(OH)2, or --PSe(OH).sub.2.
18. The analog of claim 16, wherein NO is covalently bound.
19. The analog of claim 16, wherein NO is ionically bound.
20. A pharmaceutical composition comprising the analog of claim 1 and a pharmaceutically acceptable carrier.
21. A method for neutralizing a Clostridium difficile bacterial toxin, comprising contacting the C. difficile bacterial toxin with the analog of claim 1.
22. The method of claim 21, wherein the Clostridium difficile bacterial toxin is TcdA, TcdB, or TcdA and TcdB.
23. A method for treating a subject having a Clostridium difficile infection, comprising: administering to the subject an effective dose of the analog of claim 1.
24. The method of claim 23, wherein the analog is administered orally.
25. An inositol hexakisphosphate analog having a chemical structure of Formula I: ##STR00004## wherein R1, R2, R3, R4, R5, and R6 independently are --PO(OH)2, or --PO(OH)2NO, and at least one of R1, R2, R3, R4, R5, and R6 is --PO(OH)2NO.
 This application claims priority to U.S. Provisional Patent Application Ser. No. 61/516,639 filed Apr. 6, 2011, which is incorporated herein by reference in its entirety.
 I. Field of the Invention
 The present invention relates generally to microbiology, pharmaceutical chemistry and antibiotic formulations. More specifically, the present invention relates to inositol hexakisphosphate analogs.
 II. Description of the Related Art
 Clostridium difficile is a Gram-positive, spore-forming anaerobic bacillus that is a common cause of nosocomial antibiotic-associated diarrhea and is the etiologic agent of pseudomembranous colitis. The disease ranges from mild diarrhea to life threatening fulminating colitis. Antibiotic use in patients results in a reduction of the commensal gut microflora. C. difficile is resistant to most antibiotics, which gives it a competitive advantage over normal bacterial flora resulting in its proliferation and toxin production.
 C. difficile enterotoxins (TcdA and TcdB) are the major cause of the disease since toxin-deficient strains are avirulent. Standard therapy depends on treatment with vancomycin or metronidazole, neither of which is fully effective. Moreover, up to 35% of patients infected with C. difficile relapse following treatment. The primary treatment option for recurrent C. difficile infection (CDI) is still metronidazole or vancomycin. C. difficile infection accounts for approximately 25% of cases of antibiotic-associated diarrhea and the incidence of infection is rising steadily in North America, with yearly costs in the U.S. estimated at $3.2 billion. Several recent hospital outbreaks of C. difficile infection associated with high morbidity and mortality rates have been attributed to the widespread use of broad-spectrum antibiotics. The emergence of new and more virulent C. difficile strains also contributes to the increased incidence and severity of the disease. Because of the steadily rising incidence and severity, C. difficile infection is an important emerging drug-resistance associated disease.
 The incidence of C. difficile carriage in healthy adults is around 3-5%. By contrast, in hospitalized adults taking antibiotics, the rate of colonization increases substantially to 20-40%, and is associated with a high disease burden. According to the U.S. Agency of Healthcare Research and Quality (AHRQ), the prevalence of hospital patients infected with C. difficile jumped 200% from 2000 to 2005, which follows a 74% increase from 1993 to 2000. This rapid increase in C. difficile infection cases is attributed to the use of broad-spectrum antibiotics and/or the emergence of new hypervirulent C. difficile strains, such as BI/NAP1/027.
 C. difficile infection is associated with a wide spectrum of clinical outcomes ranging from asymptomatic carriage to fulminant and fatal colitis. Severe C. difficile infection may also be associated with systemic manifestations including marked leukocytosis, hypotension, renal failure, respiratory failure, coagulopathy, and lactic acidosis. Refractory cases, not responding to vancomycin and/or metronidazole treatment is not uncommon. A recent study found that 22.1% of hospital in-patients with C. difficile infection had severe disease. The incidence of in-hospital deaths in the cohort of patients with C. difficile infection was 12.1%, and mortality caused primarily by C. difficile infection was 4.0%. Surgical intervention in the form of sub-total colectomy can be life-saving in severe, fulminant, or refractory C. difficile infection. However, patients with severe C. difficile infection are typically elderly, critically ill, and are at high risk for surgical and anesthetic complications.
 Several reports have described clinical improvement following use of passive antitoxin immunotherapy with normal pooled intravenous immunoglobulin to avoid surgery and prevent death. More recently, passive immunotherapy using human IgG monoclonal antitoxins was reported to be effective in preventing recurrent C. difficile infection. However, it did not confer protection against toxin activity, and the length of hospitalization was not significantly reduced. Other options, such as probiotics and anion-exchange resins, have limited efficacy and are potentially harmful. Complementary therapy is therefore urgently warranted to neutralize toxin activity. Experimental therapy currently under clinical development includes toxin-absorbing polymers and new antibiotics.
 There is a recognized need in the art for alternative therapies for Clostridium difficile infections. The present invention fulfills this long-standing need and desire in the art by providing inositol hexakisphosphate-based compounds effective to treat C. difficile infections and to neutralize its toxins.
 The present invention is directed to an inositol hexakisphosphate analog compound. In certain aspects, an inositol hexakisphosphate analog will be an allosteric activator or inhibitor of C. difficile exotoxin cleavage. In further aspects, the analog will be a degradation resistant (e.g., phytase resistant) allosteric activator of C. difficile exotoxin cleavage. In certain embodiments the derivative or analog compound has a chemical structure of Formula I
where R1-R6 independently are --PO(OH)2, --PS(OH)2, --PSe(OH)2, --AsO3, or NO associated with --PO(OH)2 (i.e., --PO(OH)2NO), whereby at least one of R1-R6 is --PS(OH)2, --PSe(OH)2, or NO associated with --PO(OH)2 (i.e., PO(OH)2NO). In certain aspects R1 and R3 are not both --PSe(OH)2 or --PS(OH)2 when R2, R4, R5, R6 are --PO(OH)2. In certain aspects, R1 is not --PS(OH)2 or --PSe(OH)2 if R2-R6 are --PO(OH)2. In further aspects, the analog can be a pharmacologically effective salt of the compounds described herein. In other aspects, the analog can be a derivative, such as the pyrophosphates IP7 and IP8.
 Certain embodiments are directed to inositol analogs having the chemical formula of Formula I. In certain embodiments the inositol analog is a myo-inositol analog. In further aspects, the inositol analog is a neo-inositol analog. In still further aspects, the inositol analog is a D-chiro-inositol analog. In further aspects, the inositol analog is a L-chiro-inositol analog. In certain aspects, the inositol analog is a muco-inositol analog. In still further aspects, the inositol analog is an allo-inositol analog. In still further aspects, the inositol analog is a scyllo-inositol analog. In yet further aspects, the inositol analog is an epi-inositol analog. In certain aspects, the inositol analog is a cis-inositol analog.
 As used herein, "analog" refers to a chemical compound that is structurally similar to a parent compound, but differs in composition (e.g., differs by appended functional groups or substitutions). The analog may or may not have different chemical or physical properties than the original compound and may or may not have improved biological and/or chemical activity. For example, the analog may be more hydrophilic or it may have altered reactivity as compared to the parent compound. The analog may mimic the chemical and/or biologically activity of the parent compound (i.e., it may have similar or identical activity), or, in some cases, may have increased or decreased activity.
 The present invention is directed to an inositol hexakisphosphate analog compound. The analog compound has a chemical structure of Formula I wherein R1 is --PSe(OH)2 and (i) R2-R6 (i.e., R2, R3, R4, R5, and R6) are --PO(OH)2 or (ii) R2-R6 are independently --PO(OH)2, --PS(OH)2, --PSe(OH)2, --AsO3, or PO(OH)2NO, but not all are --PO(OH)2. In certain aspects, R2 is --PSe(OH)2, and R1 and R3-R6 are --PO(OH)2. In further aspects, R4 is --PSe(OH)2, and R1-R3 and R5-R6 are --PO(OH)2. In still further aspects, R5 is --PSe(OH)2, and R1-R4 and R6 are --PO(OH)2. In certain aspects, R1-R4 are --PSe(OH)2 and R5-R6 are --PO(OH)2. In certain aspects, one or more of the --PO(OH)2 groups is further modified to a --PO(OH)2NO. The NO group can be covalently or non-covalently bound to the analog. In a further aspect, the compound is a pharmacologically effective salt or derivative of these compounds.
 In certain aspects, the derivative or analog compound has a chemical structure of Formula I where R1 is --PS(OH)2 and R2-R6 are --PO(OH)2. In further aspects, R2 is --PS(OH)2 and R1 and R3-R6 are --PO(OH)2. In still further aspects, R4 is --PS(OH)2 and R1-R3 and R5-R6 are --PO(OH)2. In certain aspects, R1, R5, and R3 are --PS(OH)2, and R2 and R4-R6 are --PO(OH)2. In further aspects, R5 is --PS(OH)2 and R1-R4 and R6 are --PO(OH)2. In still further aspects, R1-R4 are --PS(OH)2 and R5-R6 are --PO(OH)2. In certain aspects the analog is an inhibitor of exotoxin cleavage. In certain aspects, the compounds are pharmacologically effective salt or derivative of these compounds.
 In a further aspect, the derivative or analog compound has a chemical structure of Formula I where R1-R6 independently are --PO(OH)2 or --PO(OH)2NO (NO associated covalently or ionically with --PO(OH)2), whereby at least one of R1-R6 is NO associated with --PO(OH)2, or a pharmacologically effective salt or derivative thereof.
 In certain embodiments an inositol analog has a chemical structure of formula I where R1, R2, R3, R4, R5, and R6 are independently --PS(OH)2, --PSe(OH)2, --AsO3, or --PO(OH)NO. In certain aspects, R1, R2, R3, R4, R5, and R6 are --PS(OH)2. In certain aspects, R1, R2, R3, R4, R5, and R6 are --PSe(OH)2. In certain aspects, R1, R2, R3, R4, R5, and R6 are --AsO3. In certain aspects, R1, R2, R3, R4, R5, and R6 are --PO(OH)2NO. In certain aspects, R1, R2, and 1, 2, 3, or 4 of R3, R4, R5, and R6 are --PS(OH)2, --PSe(OH)2, --AsO3, or --PO(OH)2NO. In further aspects R1, R4, and 1, 2, 3, or 4 of R2, R3, R5, and R6 are --PS(OH)2, --PSe(OH)2, --AsO3, or --PO(OH)NO. In still further aspects, R1, R5, and 1, 2, 3, or 4 of R2, R3, R4, and R6 are --PS(OH)2, --PSe(OH)2, --AsO3, or --PO(OH)NO. In certain aspects, R1, R6, and 1, 2, 3, or 4 of R2, R3, R4, and R5 are --PS(OH)2, --PSe(OH)2, --AsO3, or --PO(OH)NO. In certain embodiments the inositol analog is a myo-inositol analog.
 The present invention also is directed to a method for neutralizing a pathogenic Clostridium difficile bacteria toxin. The method comprises contacting the C. difficile bacteria or toxin with the compounds described herein, where the compound potentiates or inhibits cysteine-dependent toxin self-cleavage, thereby neutralizing the same.
 The present invention is directed further to a method of treating a pathogenic Clostridium difficile infection in a subject. The method comprises administering to the subject a pharmacologically effective dose of the compounds described herein.
 As used herein, the term, "a" or "an" may mean one or more. As used herein in the claim(s), when used in conjunction with the word "comprising", the words "a" or "an" may mean one or more than one. As used herein "another" or "other" may mean at least a second or more of the same or different claim element or components thereof.
 As used herein, the term "or" in the claims refers to "and/or" unless explicitly indicated to refer to alternatives only or the alternatives are mutually exclusive, although the disclosure supports a definition that refers to only alternatives and "and/or".
 As used herein, the term "contacting" refers to any suitable method of bringing the analog and derivative compounds of inositol hexakisphosphate into contact with a Clostridium difficile toxin or the bacterial cell comprising the same. In vitro or ex vivo this is achieved by exposing the compound to the toxin and/or C. difficile bacteria in a suitable medium. For in vivo applications, any known method of administration is suitable as described herein.
 As used herein, the term "subject" refers to any recipient of the novel compounds or a pharmaceutical composition thereof provided herein that are effective as therapeutics or inhibitors against a Clostridium difficile infection.
 Other and further aspects, features, and advantages of the present invention will be apparent from the following description of the presently preferred embodiments of the invention. These embodiments are given for the purpose of disclosure.
DESCRIPTION OF THE DRAWINGS
 So that the matter in which the above-recited features, advantages and objects of the invention, as well as others which will become clear, are attained and can be understood in detail, more particular descriptions and certain embodiments of the invention briefly summarized above are illustrated in the appended drawings. These drawings form a part of the specification. It is to be noted, however, that the appended drawings illustrate preferred embodiments of the invention and therefore are not to be considered limiting in their scope.
 FIG. 1 shows CPD domain boundaries in TcdB.
 FIGS. 2A-2B shows the Toxin InsP6 sensor. FIG. 2A shows InsP6-induced toxin cleavage and the allosteric sensor activity of the glutamic acid (E743) residue. Enhanced InsP6-induced self-cleavage is evident in the toxin E743A mutant, whereas no cleavage is evident in the inactive catalytic cysteine (C698S) mutant. FIG. 2B shows that, using an N-terminus specific anti-TcdB antibody, it is demonstrated that toxin cleavage is approximately 2-orders of magnitude more sensitive following genetic disruption of the toxin allosteric-sensor mechanism (E743A).
 FIGS. 3A-3D show therapeutic allostery and examples of the assays to test designed compounds. FIG. 3A shows that InsP6-autocleaves (left) and inhibits toxin-induced cytotoxicity (right) in Caco-2 colonocytes (AC50 and IC50=10 μM). Toxin (TcdB) cleavage fragments are shown in FIG. 3B, and are absent in the presence of a CPD inhibitor. (FIGS. 3C-3D) Kaplan-Meier survival plots of infected mice. C57BL/6 mice were inoculated with 106 C. difficile. Oral InsP6 (but not inositol) therapy dose dependently protects mice from CDI (0.25 and 2.5 mg/kg/day delivered intragastrically; n=12/group, survival at day 6). The protective effect is statistically significant in the 2.5 mg/kg group, which is within the daily recommended dose for humans.
 FIGS. 4A-4B show Nitroso-InsP6 experimental UV spectra (FIG. 4A) and LC-MS for nitroso-InsP6 vs. InsP6 (FIG. 4B).
 FIGS. 5A-5B shows that Nitroso-InsP6 shows greater amelioration in experimental CDI. FIG. 5A shows antimicrobial activity of InsP6 vs. InsP6-NO against C. difficile. FIG. 5B demonstrates how mini-osmotic pumps (7 day pumps; n=10/group) were surgically implanted to deliver inositol derivatives at 12.5 mg/kg/day, starting 1 day prior to C. difficile inoculation (106 bacteria). In this set of experiments, vehicle treatment was associated with 100% mortality, vs. 40% and 10% for InsP6 and nitroso-InsP6 groups, respectively.
 FIG. 6 shows TcdB autocleavage in the presence of 10 μM InsP6 derivatives.
 FIG. 7 shows an increased phytase resistance of myo-inositol-hexaphosphorothioate (InsP6(S)).
 C. difficile infection is a toxin-mediated disease. Two exotoxins, toxin A (TcdA) and toxin B (TcdB), are the major virulence factors. C. difficile strains that lack both toxin genes are non-pathogenic. TcdA and TcdB are structurally similar to each other. Both toxins consist of at least three functional domains that are now well defined. The C-terminus receptor binding domain (RBD) has a a-solenoid structure and is involved in receptor binding. The middle part is involved in translocation of the toxins into the target cells, and the N-terminus is a catalytic glucosyltransferase (GT) domain. Interactions between the C-terminal receptor binding domain and host cell receptors initiate receptor-mediated endocytosis. Although the precise intracellular mode of action remains unclear, the toxins undergo a conformational change at the low pH of the endosomal compartment, leading to a membrane insertion and channel formation. An essential host-derived virulence cofactor inositol hexakisphosphate (InsP6) is then required to trigger an allosteric structural change that activates a cysteine protease domain to induce toxin self-cleavage, resulting in the release of the GT-effector domain into the cytosol. Once in the cytosol, the catalytic GT-domain mono-O glucosylates small GTPases of the Rho family, including RhoA, Rac1, and Cdc42. Glucosylation of Rho proteins inhibits their "molecular switch" function, thus blocking Rho GTPase-dependent signaling in intestinal epithelial cells, leading to alterations in the actin cytoskeleton, massive fluid secretion, acute inflammation and necrosis of the colonic mucosa.
 Cysteine-dependent cleavage is a crucial activation mechanism for TcdA and TcdB because it facilitates toxin entry into cells. Specific inhibition of this cleavage reaction significantly attenuates the toxin. This virulence mechanism is dependent on cellular InsP6 that activates the cysteine protease domain (CPD) to facilitate toxin self-cleavage. Cysteine protease domain crystal structures for TcdA and the closely aligned Vibrio cholerae RTX toxin demonstrate a well defined catalytic cleft separated from a positively charged InsP6-binding pocket abutting a flexible β-hairpin fold (β-flap).
 In one embodiment of the present invention there is provided an inositol hexakisphosphate analog or derivative compound having a chemical structure:
where R1-R6 independently are --PO(OH)2, --PS(OH)2, --PSe(OH)2, --AsO3, or NO associated with --PO(OH)2, whereby at least one of R1-R6 is --PS(OH)2, --PSe(OH)2, or NO associated with --PO(OH)2, and R1 and R3 are not both --PSe(OH)2; or a pharmacologically effective salt or derivative thereof. In certain aspects, R1 is --PS(OH)2 or --PSe(OH)2 when R2-R6 are not --PO(OH)2. In all embodiments and aspects the inositol hexakisphosphate analog or derivative compound may comprise a pharmaceutical composition with a pharmaceutically acceptable carrier.
 In one aspect R1 may be --PS(OH)2 and R2-R6 may be --PO(OH)2. In one aspect R1 may be --PS(OH)2 and one or more of R2-R6, but not all of R2-R6 is --PO(OH)2. In another aspect R2 may be --PS(OH)2, and R1 and R3-R6 may be --PO(OH)2. In yet another aspect R4 may be --PS(OH)2 and R1-R3 and R5-R6 may be --PO(OH)2. In yet another aspect of this embodiment R5 may be --PS(OH)2 and R1-R4 and R6 may be --PO(OH)2. In yet another aspect R1 and R3 may be PS(OH)2, and R2 and R4-R6 may be --PO(OH)2. In yet another aspect R1-R4 may be --PS(OH)2 and R5-R6 may be --PO(OH)2. In yet another aspect R1 may be --PSe(OH)2 and R2-R6 may be --PO(OH)2. In yet another aspect R1 may be --PSe(OH)2 and one or more, but not all, of R2-R6 may be --PO(OH)2. In yet another aspect R2 may be --PSe(OH)2, and R1 and R3-R6 may be --PO(OH)2. In yet another aspect R4 may be --PSe(OH)2 and R1-R3 and R5-R6 may be --PO(OH)2. In yet another aspect R5 may be --PSe(OH)2, and R1-R4 and R6 may be --PO(OH)2. In yet another aspect R1-R4 may be --PSe(OH)2 and R5-R6 may be --PO(OH)2. In yet another aspect of this embodiment the NO substituent may be associated covalently or ionically with --PO(OH)2.
 In a related embodiment, there is provided an inositol hexakisphosphate analog or derivative compound having a chemical structure as described supra where R1 is --PSe(OH)2 and R2-R6 are --PO(OH)2; R2 is --PSe(OH)2, and R1 and R3-R6 are --PO(OH)2; R4 is --PSe(OH)2 and R1-R3 and R5-R6 are --PO(OH)2; R5 is --PSe(OH)2 and R1-R4 and R6 are --PO(OH)2; or R1-R4 are --PSe(OH)2 and R5-R6 are --PO(OH)2; a pharmacologically effective salt or derivative thereof.
 In another related embodiment there is provided an inositol hexakisphosphate analog or derivative compound having a chemical structure as described supra where R1 is --PS(OH)2 and R2-R6 are --PO(OH)2; R2 is --PS(OH)2, and R1 and R3-R6 are --PO(OH)2; R4 is --PS(OH)2 and R1-R3 and R5-R6 are --PO(OH)2; R5 is --PS(OH)2, and R1-R4 and R6 are --PO(OH)2; R1 and R3 are --PS(OH)2, and R2 and R5-R6 are --PO(OH)2; R1-R4 are --PS(OH)2 and R5-R6 are --PO(OH)2 or a pharmacologically effective salt or derivative thereof.
 In another related embodiment there is provided an inositol hexakisphosphate analog or derivative compound having a chemical structure as described supra where R1-R6 independently are --PO(OH)2 or --PO(OH)NO (NO associated covalently or ionically with --PO(OH)2), whereby at least one of R1-R6 is --PO(OH)2NO; or a pharmacologically effective salt or derivative thereof.
 In another embodiment of the present invention there is provided a method for neutralizing a toxin in a pathogenic Clostridium difficile bacteria, comprising contacting the C. difficile bacteria with a compound as described supra, wherein said compound inhibits cysteine-dependent toxin self-cleavage, thereby neutralizing the same. In this embodiment the toxin may be one or both of TcdA or TcdB.
 In yet another embodiment of the present invention, there is provided a method for treating a pathogenic Clostridium difficile infection in a subject, comprising administering to the subject a pharmacologically effective dose of the compound as described supra. In certain embodiment the compound may be comprised an oral formulation and/or administered orally.
 In yet another embodiment of the present invention there is provided a method for identifying an inositol hexakisphosphate analog or derivative compound effective to inhibit self-cleavage of a pathogenic Clostridium difficile toxin, comprising designing a 3D-pharmacophore, at least in part in silica, based on a crystal structure of inositol hexakisphosphate bound to the toxin; selecting a potential inhibitor compound; and analyzing a structure activity relationship of the potential inhibitor with the toxin 3D-pharmacophore to determine inhibitory activity of toxin self-cleavage, thereby identifying an inhibitory inositol hexakisphosphate analog or derivative compound. Further to this embodiment the method may comprise optimizing the structure of the inhibitory inositol hexakisphosphate analog or derivative compound.
 In a related embodiment, there is provided a 3D-pharmacophore based on the crystal structure of inositol hexakisphosphate bound to the C. difficile toxin as described supra.
 In another related embodiment, there is provided an inositol hexakisphosphate analog or derivative compound or a pharmaceutical composition thereof identified by the method described supra.
 Provided herein are analog and derivative compounds of inositol hexakisphosphate that demonstrate therapeutic activity against pathogenic Clostridium difficile and neutralize its toxins. In certain aspects the inositol-hexakisphosphate is myo-inositol (1R,2R,3S,4S,5R,6S)-cyclohexane-1,2,3,4,5,6-hexayl hexakis [dihydrogen (phosphate)] (myo-InsP6). Particularly, the derivative and analog compounds are effective to neutralize the toxins that are produced by pathogenic C. difficile. Preferably, the compounds described herein are effective to inhibit self-cleavage of a pathogenic Clostridium difficile toxin TcdA and TcdB. It is contemplated that the therapeutic effect is at least in part due to toxin neutralization.
 Generally, the novel derivative and analog compounds are substituted at one or more of the P1-P6 phosphate moieties substituted at C1-C6, respectively, comprising the cyclohexane ring. Particularly, P1, P2, P4, or P5; P1-P4; or P1 and P3 phosphates may contain a sulfur or P1, P2, P4, or P5; or P1-P4 may contain selenium or arsenic. Alternatively, at least one of P1-P6 may be associated with a nitroso moiety either covalently or ionically. The compounds presented herein may be synthesized by known and standard chemical synthetic methods, for example see Xu et al., Tetrahedron Letters 46:8311-14, 2005; Zhang et al., Bioorganic and Medicinal Chemistry Letters 18:762-66, 2008, both of which are incorporated herein by reference in their entirety.
 It is contemplated that potential inhibitor compounds may be designed utilizing a 3D-pharmacophore based on a crystal structure of a C. difficile toxin, for example, TcdA or TcdB, containing inositol hexakisphosphate or other similar compound bound therein using at least in part computer aided design as is known in the art. A potential inhibitor is selected and a structure activity relationship is analyzed by well-known and standard assays. Potential compounds may be derived from the derivative and analog compounds described herein, may be designed at least in part using known in silica methods, may be selected from a chemical library or may be derivative or analogs of the same, or may be synthesized de novo. A potential compound that is determined to potentiate or inhibit self-cleavage of a pathogenic Clostridium difficile toxin is suitable for the therapeutic and/or inhibitory methods provided. In addition, such recognized compounds may be further optimized structurally to increase therapeutic and inhibitory efficacy.
 Thus, the present invention provides methods for neutralizing a Clostridium difficile toxin either in vitro or in vivo. For example, the bacteria or the toxins may be contacted by one or more of the compounds described herein in vitro. Effectiveness may be determined by an assay to determine if the toxin cleavage product is present as is known in the art.
 As such, the present invention also provides methods for treating a Clostridium difficile infection in a subject. The derivative and analog compounds provided may be administered one or more times to a subject in need of such treatment. Dosage formulations of the inositol hexakisphosphate derivatives and analogs may comprise conventional non-toxic, physiologically or pharmaceutically acceptable carriers or vehicles suitable for the method of administration. These compounds or pharmaceutical compositions thereof may be administered independently one or more times to achieve, maintain or improve upon a pharmacologic or therapeutic effect derived from these compounds or other agents suitable for C. difficile infection being treated. It is well within the skill of an artisan to determine dosage or whether a suitable dosage comprises a single administered dose or multiple administered doses. An appropriate dosage depends on the subject's health, the progression or remission or at risk status of the infection, the route of administration and the formulation used. Preferably, these compounds may be administered in an oral formulation, although the scope of the invention does not limit administration to an oral route.
 The following examples as well as the figures are included to demonstrate preferred embodiments of the invention. It should be appreciated by those of skill in the art that the techniques disclosed in the examples or figures represent techniques discovered by the inventors to function well in the practice of the invention, and thus can be considered to constitute preferred modes for its practice. However, those of skill in the art should, in light of the present disclosure, appreciate that many changes can be made in the specific embodiments which are disclosed and still obtain a like or similar result without departing from the spirit and scope of the invention.
Allosteric Activation of TcdA and TcdB Autocleavage
 In order to better understand how InsP6 allosterically activates TcdA and TcdB autocleavage, cysteine protease domain homology models were generated that included the uncut N-terminus substrate cleavage fragment within the P1-substrate residue catalytic cleft (FIG. 1). These studies have identified a reaction mechanism in response to conformational-coupling by InsP6. Analysis of these N-terminus extended cysteine protease domain models demonstrated an extensive network of interconnecting hydrogen bonds within the catalytic active site. Because of the unusually large distances (>6 Å) between the catalytic cysteine and histidine in all of the microbial cysteine protease domain crystal structures, the histidine residue appears to play a role in substrate orientation within the P1 pocket rather than conferring nucleophilicity to the catalytic cysteine thiolate as conventionally happens in cysteine proteases. The aspartic acid may stabilize the histidine imidazolium ring, and hydrogen bonding between a novel glutamic acid residue and the catalytic cysteine modulates thiolate reactivity. Thus, this tetrad active site motif appears to have developed an allosteric sensor mechanism (achieved via hydrogen bonding between a highly conserved glutamic acid (Glu) and the catalytic cysteine) in order to restrict toxin self-cleavage to situational exposure to InsP6 cofactor. Applicants note that their analysis is not to be construed as a limitation on the claimed subject matter unless expressly included as a limitation.
 This catalytic tetrad function is demonstrated experimentally by site-directed mutagenesis in TcdB, where there was generated (i) a catalytically dead Cys698Ser mutation; (ii) a highly attenuated toxin His655Ala mutation (104 fold inhibition), and (iii) an enhancing Glu743Ala mutation, which sensitizes toxin self-cleavage into the nM InsP6 range (a concentration that is readily achieved in the gut lumen by dietary InsP6) (FIGS. 2A-2B). Further, this regulatory glutamic acid is located on the flexible cysteine protease domain 13-flap, a structure likely to be regulated by InsP6. However, because of the instability of the cysteine protease domain in the absence of InsP6 cofactor, it has not been possible to generate crystal structures of the native unbound configuration to elucidate this β-flap mechanism. Therefore, in order to better understand the structural basis for the InsP6 allostery, molecular dynamics (MD) structural simulations of InsP6 binding to the cysteine protease domain of TcdA, TcdB, and V. cholerae RTX toxin were performed.
 InsP6 binds to a highly conserved positively charged binding pocket that conforms to the edge of the flexible allosteric 13-flap. The molecular dynamics-simulation models consistently showed that allosteric InsP6 binding facilitates substrate access to the active site cysteine in the catalytic groove by inducing conformational changes that leverage the flexible β-flap away from catalytic cleft. Moreover, InsP6 re-orientates the glutamic acid side chain relative to the catalytic cysteine. Thus, InsP6 allostery appears to facilitate toxin self-cleavage by promoting accessibility and reactivity of the active site cysteine thiolate for the cleavage substrate.
 Extracellular InsP6 concentrations in blood and plasma are generally too low (<1 nM) to facilitate autocleavage of the C. difficile toxins. However, in the gut lumen InsP6 can reach much higher concentrations from dietary sources, although it seems unlikely that sufficiently high levels are achieved to neutralize the toxins because gut-associated enzymes rapidly degrade InsP6 to inactive myo-inositol ((1R,2R,3S,4S,5R,6S)-cyclohexane-1,2,3,4,5,6-hexol)) and inorganic phosphate. Phytic acid (InsP6) is the principle storage form of phosphorous in many plant tissues, especially in the fiber of bran and seeds. Because InsP6 is currently regarded as the main chemoprotective agent in dietary fiber due to its potent anti-oxidant and metal ion chelator properties, it is available to the public as a nutritional supplement. The enzyme meso-inositol hexaphosphate phosphohydrolase (phytase) actively degrades InsP6 into lower inositol phosphate derivatives, rapidly reducing its bioavailability in the colon.
 Three classes of phytase enzymes exist which initiate dephosphorylation of InsP6 at different positions on the inositol ring, and provide different isomers of lower inositol phosphates. These phytase families have pronounced stereospecificity targeting the P3, P5, and/or P4/6 positions, and have a strong preference for equatorial over axial phosphate groups. Because the lower inositol phosphate products are poor allosteric activators of the toxin cysteine protease, the present invention generates non-hydrolysable phytase-resistant InsP6 analogs that remain potent toxin inhibitors in the colon. Echelon Biosciences has generated stable racemic P1/3 phosphoroselenium and phosphorothiolate InsP6 derivatives that are resistant to the P3 family of microbial phytases, which represents the major enzyme class in the human colon. Computational 3D-pharmacophores and structure activity relationship analysis of the toxin allosteric binding site will aid in the optimization of these phytase-resistant InsP6 derivatives for therapy.
 C. difficile, newly emerged in its present drug resistant hyper-virulent form, causes serious and potentially fatal inflammation of the colon. Currently, there is an urgent need to find alternative therapy for CDI as C. difficile is rapidly developing resistance to antibiotic treatment. Although an antitoxin vaccine program is in clinical trials, the efficacy of this approach remains highly uncertain and problematic since patients with severe CDI typically tend to be the elderly and the critically ill. Passive systemic antitoxin immunotherapy has been reported to be effective in preventing disease recurrence in CDI patients, but failed to confer significant clinical benefits or reduce the length of hospitalization. Oral adaptation of passive immunotherapy is not feasible or economical. Probiotics and anion-exchange resins remain unproven treatment options for CDI with limited efficacy. Thus, in CDI, there is an urgent need to develop therapeutics not subject to antimicrobial resistance. A goal of the present invention is to address these critical issues by developing antimicrobial inositol phosphate-based therapy that also neutralizes toxin activity in the colon.
 Cysteine proteases degrade polypeptides via a common catalytic mechanism that normally involves a nucleophilic cysteine thiol in a catalytic triad. This important enzyme class regulates many cellular activities in eukaryotic cells and in infectious pathogens, including C. difficile. Thus, various strategies are being explored to combat infectious disease by specific inhibition of microbial cysteine proteases. Proof-of-concept for such an approach has been provided by demonstrating that wide-spectrum cysteine protease inhibitors suppress both viral and parasitic disease. Vinyl sulfone-based peptides are efficient inhibitors of microbial cysteine proteases, such as cruzain and falcipains, by forming irreversible covalent bonds with the thiolate of the catalytic cysteine.
 Although such irreversible inhibitors are quite potent, with IC50 values in the nanomolar range, the poor selectivity for parasitic over human cysteine proteases remains a significant concern. Also, it is desirable to design non-peptide based reversible inhibitors to minimize the potential toxicity that can be observed with irreversible inhibitors.
 With the recent discovery that C. difficile toxins require cysteine protease activity for virulence, specific targeting of this enzyme class represents an important therapeutic strategy in combating CDI. The present invention designs small molecule therapeutics to combat CDI that mimics the cytosolic allosteric cofactor, inositol hexakisphosphate (InsP6) of these toxins. As the exotoxin cysteine protease active site self-processes the toxin to an active state, is normally inaccessible to inhibitors. In certain embodiments the InsP6 analog is designed to trigger the accessible and highly conserved allosteric site, inducing autolytic cleavage and preventing the toxins from entering mammalian cells. This approach has been validated by showing that high levels of dietary InsP6 can mitigate CDI in an animal model. However, oral InsP6 therapy may be limited due to enzymatic degradation by gut phytases. Thus, the present invention develops new degradation resistant or phytase-resistant inositol analogs that bind to the allosteric site and rapidly trigger the autolysis while the toxin is still in the extracellular milieu. Computational modeling of the toxin-InsP6 allosteric mechanism and structure-based design of the allosteric binding site assist in the design and selection of inhibitors. Data for structure-activity relationship analysis is generated for phosphoroseleno-, phosphorothiolate-, and antimicrobial nitroso-derivatives of InsP6. Thus, the present invention exploits the reliance of the C. difficile toxins on InsP6 as a virulence factor to develop inositol phosphate based-therapy for CDI.
 Optimization of phytase-resistant InsP6 analogues for CDI therapy. Aspects of the present invention provide compositions and methods of neutralizing C. difficile exotoxins in the extracellular gut environment. C. difficile toxins are autocleaved by InsP6 in the μM range (IC50=10 μM; FIGS. 3A-3B). When this autocleavage occurs outside of the cell (by means of InsP6 supplementation), this renders the toxin inactive as the effector domain does not enter the cytosol. The present invention demonstrates that oral InsP6 supplementation is protective in a murine CDI model that closely resembles the human disease. C57BL/6 mice were administered antibiotics and then orally inoculated with 104-to-106 C. difficile (strain VPI 10463). Disease outcome measures included evidence of inflammation and fluid secretion in the caecum and colon of severely afflicted animals, and of characteristic pseudomembraneous histopathologic lesions in the colonic mucosa. Surviving mice developed diarrhea for 5 days post infection and weight loss lasted for 3 to 4 days. Mice continued to shed C. difficile bacteria in the stool for up to 13 days post challenge, at which time the experiments were terminated. The highest bacterial dose (106 CFU) was used to test for InsP6 efficacy given intra-gastrically (0.25-to-2.5 mg/kg/day; range is within the recommended oral daily dose for humans (1,020 mg/day)). These studies demonstrated dose-dependent protective effects of InsP6 that were not evident with inactive myo-inositol (FIGS. 3C-3D).
 Phytases are gut-associated acid phosphatases that degrade dietary InsP6 into myo-inositol and inorganic phosphorous. Toxin models indicate that the highly conserved InsP6 binding pocket is readily accessible to inhibitors. The present invention provides an analysis of the allosteric site, tests new small molecule derivatives for toxin cleavage activity, and designs--pharmacophores for use in developing novel phytase-resistant InsP6 derivatives that will not degrade in the intestine. The present invention discloses structural predictions of chemical modifications that optimize toxin cleavage activity for the synthesis of therapeutic InsP6 analogs. This involves targeted synthesis of P1/3 modifications, followed by targeted polymodifications, and finally combinatorial mono-modifications.
 Modeling of the toxin allosteric binding site. As described above, the present invention used homology modeling and MD simulations to determine the likely structure of the CPD in the absence of allosteric InsP6. The flexible β-flap must move to open the InsP6 binding site and block access to the 1a protease active site in the InsP6 free toxin. Thus, a series of conformations are chosen from the molecular dynamics-simulations that reflect different degrees of opening and solvent exposure of the β-flap. A series of InsP6-derivatives are then docked to these conformations, and select the conformation that is most consistent with the experimentally derived activities of these compounds. This conformation is then used for designing 3D-pharmacophores.
 To demonstrate feasibility, InsP6 (12 rotatable bonds) was docked to a conformer of TcdA. Of 2aa Autodock poses for InsP6 binding to the open β-flap (inactive) TcdA conformation, 139 clustered together at the lowest binding energy. Their position was confirmed as the InsP6 binding site in the TcdA crystal structure. Probably due to the symmetry of the molecule, the InsP6 in the docking positions was rotated by 60° clockwise about the ring axis and tilted about 50°.
 Designing 3D-pharmacophores specific for the C. difficile toxins. Design begins with analysis of the toxin homology models and the bound conformation of InsP6 and the analogs of known activity. A 3D-pharmacophore based on the crystal structure of the bound InsP6 is designed that can be used to optimize the design of phytase-stable InsP6 derivatives. In addition, structure activity relationship analysis of InsP6 derivatives are used with activities determined in toxin cleavage and binding assays. Alternative conformations of the modeled InsP6 binding site, taken from the molecular dynamics simulations, may be used in the structure activity relationship to refine the binding model. Structurally related compounds from the ZINC database in toxin autocleavage assays are examined. Preliminary studies have demonstrated that the inositolhexakissulfate (InS6) analog is an active compound, as are InsP7 derivatives. Of interest, InsP7 derivatives demonstrate enhanced toxin cleavage activity vs. InsP6, indicating that autocleavage efficacy can be achieved in the IC50 nM range by optimizing the design for synthesis of the phytase-resistant inositol phosphate derivatives.
 Development of antimicrobial nitroso InsP6 derivatives for CDI therapy. As described above, stable phytase-resistant InsP6 derivatives that inactive the C. difficile toxins are synthesized. As described below, combinatorial antimicrobial activity can be imparted to these derivatives. Because C. difficile is highly susceptible to nitric oxide (NO) signals and this has been suggested as an antimicrobial strategy for CDI, NO-derivatives of InsP6 that exert both antimicrobial and antitoxin activity were generated. A 5 molar excess of ethylnitrite was added to InsP6 and incubated at room temperature in the dark for three days. The reaction mixture was dried to completion under nitrogen gas. Dried nitroso-InsP6 was dissolved in water and a UV spectrum analysis was performed. Equilibrium geometries at global minimum energy were calculated using Spartan '08 for windows (See URL wavefun.com on the world wide web), density functional theory (DFT, 6-31G*) level in vacuum phase. The experimental UV spectrum for nitroso-InsP6 is in close agreement with the predicted spectrum for mono-nitrosylated InsP6 with a λ-max at 300 nm (FIG. 4A). Further, calculated energies of InsP6 and InsP6-NO (18.4 kcal/mole) suggested similar stability. Aqueous nitroso-InsP6 was stable at ambient temperature over a period of two weeks.
 LC-MS was used to separate InsP6 and nitroso-InsP6 derivatives. The mass spectrum showed four peaks. The first peak matched the InsP6 standard, and later peaks showed a mass spectrum that corresponded to a mixture of nitroso-InsP6(NO)4-6 derivatives, with approximate yields ranging from 2-28% (FIG. 4B). Further, the nitroso-InsP6 derivatives demonstrated significant antimicrobial activity towards C. difficile and showed enhanced disease amelioration in experimental CDI (FIGS. 5A-5B), without altering toxin cleavage efficiency (FIG. 6).
 Characterization and preparation of optimal nitroso InsP6 derivatives. The LC conditions are refined to separate out the different NO-derivatives in sufficient quantities of pure material so as to test them individually in antimicrobial and toxin assays, and phytase-enzymatic assays. MS is used to determine the size of each adduct, and as an approximate indicator of purity. With a reasonably pure, active molecule, the structure can be determined in more detail, using a combination of 31P- and Proton NMR. Initially, these studies determine whether the NO is covalently linked or remains as a free radical adduct. In the latter case, the distinctive proton resonances for the hydrogens should allow one to discriminate which position on the InsP6 has been modified. If the bond is indeed covalent, the synthesis is repeated, incorporating 15NO. In an effort to isolate and quantify nitroso-InsP6, a Q-Trap 2000 (Hybrid MS) is used, combination of trap [identification of unknown InsP6-(NO)x by mass spectral fragmentation] and triplequad mass spectrometry. Finally, synthesis conditions (variations in time, temperature, molar excess of ethylnitrite and other NO donors) are optimized to increase the yield of the various active nitroso-InsP6 derivatives.
 In vitro testing of nitroso-InsP6 derivatives. In vitro testing and measurement of binding affinities of compounds are performed using toxin cleavage assays, and by radioligand or BIACORE-toxin binding studies, respectively. For medium throughput toxin cleavage assays, autocleavage of 1 μg TcdA and TcdB holotoxins is performed in 25 μL 20 mM Tris-HCI, 150 mM NaCI (pH 7.4) with and without InsP6 for 10-60 min at 37° C. (FIG. 6). Cleavage reactions are then stopped with SDS-PAGE loading buffer and boiling at 96° C. for 5 min. Samples are then run under reducing conditions on 4-20% gradient gels and cleavage products stained with GelcodeBiue® for 1 hr and cleared in water overnight. AC50 and IC50 concentrations are calculated by measuring the relative absorbance of cleavage fragments relative to intact toxin using a LiCor Odyssey infrared scanner (λ=680 nm). Cleavage is plotted against ligand concentration using four-parameter logistic curve fitting on SigmaPlot 11.0 software. If the toxin cleavage efficiency remains unaltered in purified nitroso-InsP6 fractions, then toxin Rac1 glucosylation and cell rounding assays are initiated to evaluate cytoprotection in cell culture systems. Antimicrobial activity is then recorded as shown in FIGS. 5A-5B. Finally, if a covalent modification is formed with NO, it is contemplated that this shows phytase-resistance. Thus, enzymatic digestions of nitroso-InsP6 derivatives are carried out with EC 188.8.131.52 (type 3 phytase); EC 184.108.40.206 (type 5 phytase), and EC 220.127.116.11 (type 4/6 phytase) to test whether the NO-modifications are nonhydrolysable (e.g., FIG. 7).
TABLE-US-00001 TABLE 1 Representative AC50 (concentration that provides half the maximum activity) for representative inositol analogs. AC50 Compound (μM) myo-inositol-(1,3,4,5-tetrakisphosphate) Myo-InsP4(2,6) >1000 myo-inositol-(1,2,3,5-tetrakisphosphate) Myo-InsP4(4,6) >1000 myo-inositol-(2,3,4,5,6-pentakisphosphate) Myo-InsP5(1) 8.67 myo-inositol-(1,3,4,5,6-pentakisphosphate) Myo-InsP5(2) 10.47 myo-inositol-(1,2,4,5,6-pentakisphosphate) Myo-InsP5(3) 95.56 myo-inositol-(1,2,3,5,6-pentakisphosphate) Myo-InsP5(4) >1000 myo-inositol-hexakisphosphate Myo-InsP6 14.79 myo-inositol-(1,2,3,4,5,6-phosphorothioate) Myo-InsP6(S) 1.99 (1/3)-phospho-myo-inositol Myo-InsP7(1/3) 3.04 hexaakisphosphate
 It is proposed that an NO adduct is capable of forming with InsP6 which confers antimicrobial activity towards C. difficile (without significantly altering the toxin autocleavage efficiency). Studies in an experimental CDI model demonstrate that intra-colonic targeting of nitroso-InsP6 enhances the efficacy of InsP6 to 90% survival rates following administration of the antimicrobial derivatives. Because of the current uncertainty of the nitroso-InsP6 chemistry, there may be potential limitations to oral nitroso-InsP6 delivery as this molecule may show poor colonic bioavailability due to degradation and absorption in the small intestine.
 Any patents or publications mentioned in this specification are indicative of the levels of those skilled in the art to which the invention pertains. Further, these patents and publications are incorporated by reference herein to the same extent as if each individual publication was specifically and individually incorporated by reference.
 The present invention is well adapted to attain the ends and advantages mentioned as well as those that are inherent therein. The particular embodiments disclosed above are illustrative only, as the present invention may be modified and practiced in different but equivalent manners apparent to those skilled in the art having the benefit of the teachings herein. Furthermore, no limitations are intended to the details of construction or design herein shown, other than as described in the claims below. It is therefore evident that the particular illustrative embodiments disclosed above may be altered or modified and all such variations are considered within the scope and spirit of the present invention.
Patent applications by Catherine Schein, Friendswood, TX US
Patent applications by Numan Oezguen, Galveston, TX US
Patent applications by Tor C. Savidge, League City, TX US
Patent applications by Werner Braun, Friendswood, TX US
Patent applications by The Board of Regents of the University of Texas System
Patent applications in class Ester of (HX)P=X(XH)(XH) (X is chalcogen) (e.g., phosphate, etc.)
Patent applications in all subclasses Ester of (HX)P=X(XH)(XH) (X is chalcogen) (e.g., phosphate, etc.)