Current Challenges in Antimicrobial Chemotherapy

The use of the three classical β-lactamase inhibitors (clavulanic acid, tazobactam and sulbactam) in combination with β-lactam antibacterials is currently the most successful strategy to combat β-lactamase-mediated resistance. However, these inhibitors are efficient in inactivating only class A β-lactamases and the efficiency of the inhibitor/antibacterial combination can be compromised by several mechanisms, such as the production of naturally resistant class B or class D enzymes, the hyperproduction of AmpC or even the production of evolved inhibitor-resistant class A enzymes. Thus, there is an urgent need for the development of novel inhibitors. For serine active enzymes (classes A, C and D), derivatives of the β-lactam ring such as 6-β-halogenopenicillanates, β-lactam sulfones, penems and oxapenems, monobactams or trinems seem to be potential starting points to design efficient molecules (such as AM-112 and LK-157). Moreover, a promising non-β-lactam molecule, NXL-104, is now under clinical development. In contrast, an ideal inhibitor of metallo-β-lactamases (class B) remains to be found, despite the huge number of potential molecules already described (biphenyl tetrazoles, cysteinyl peptides, mercaptocarboxylates, succinic acid derivatives, etc.). The search for such an inhibitor is complicated by the absence of a covalent intermediate in their catalytic mechanisms and the fact that β-lactam derivatives often behave as substrates rather than as inhibitors. Currently, the most promising broad-spectrum inhibitors of class B enzymes are molecules presenting chelating groups (thiols, carboxylates, etc.) combined with an aromatic group. This review describes all the types of molecules already tested as potential β-lactamase inhibitors and thus constitutes an update of the current status in β-lactamase inhibitor discovery.