Browsing Pathways

Tigecycline is an intravenous antibiotic drug used to treat infections caused by a variety of gram-positive and gram-negative microorganisms including Mycoplasma pneumoniae, Pasteurella pestis, Escherichia coli, Haemophilus influenzae (respiratory infections), and Diplococcus pneumoniae. Tigecycline first clinically-available drug in the class of glycylcyclines antibiotics. Glycylcyclines are derived from tetracycline which are analogues are specifically designed to overcome tetracycline resistance mediated by acquired efflux pumps and/or ribosomal protection. In bacterial protein synthesis, transcription and translation occur in the cytoplasm. Tigecycline targets protein translation. Translation occurs using the bacterial 70S ribosome composed of a 50S and a 30S subunit. The ribosome has 3 binding sites, A (acceptor site), P (peptidyl site) and E (exit site). The charged tRNA with an amino acid attached (amino-acyl tRNA) binds to the A site. The P site binds to the tRNA holding the growing polypeptide chain and the E site binds to the uncharged tRNA.

Tigecycline is a glycylcycline, a class of antibiotics derived from tetracycline. Tigecycline has broad spectrum antibacterial abilities and is not susceptible to traditional tetracycline resistance mechanisms such as ribosomal protection and efflux by tetracycline-specific pumps. Tigecycline inhibits bacterial protein synthesis by binding to the A site of the 16s rRNA on the 30S ribosomal subunit. By binding to the A site, tigecycline prevents tRNA from docking onto the 16S rRNA with it’s codon ultimately halting the addition of amino acids to elongate peptide chains used in protein structures.

Ticlopidine is a platelet aggregation inhibitor also known as Ticlid, used to prevent strokes or transient ischemic attacks. It is administered orally as a prodrug that is metabolized into its active form, it then goes on to prevent the binding of ADP to the P2Y receptor. With ADP activation of the receptor inhibited this leads to impaired platelet aggregation and activation. Ticlopidine should be taken with a high fat meal, as it increases absorption of the drug and helps reduce any gastrointestinal irritation.

Ticlopidine, marketed as Ticlid, is an antiplatelet drug that targets the P2Y12 receptor of platelets. Ticlopidine is taken orally and is a prodrug that must be metabolically activated before it can be effective. It first enters the liver and enters the endoplasmic reticulum where it is metabolized to form the active metabolite. First, it is catalyzed by cytochromes P450 2C19, 2B6 and 1A2 into 2-oxoclopidogrel. Secondly, it is processed by cytochromes P450 2B6, 2C9, 2C19, 3A4, 3A5, and serum paraoxonase/arylesterase 1 into the active metabolite of clopidogrel. The active metabolite of clopidogrel then enters the blood stream, where it binds irreversibly to the P2Y purinoreceptor 12 on the surface of platelet cells, preventing ADP from binding to and activating it. Clopidogrel prevents the activation of the Gi protein associated with the P2Y12 receptor from inactivating adenylate cyclase in the platelet, leading to a buildup of cAMP. This cAMP then activates calcium efflux pumps, preventing calcium buildup in the platelet, which would cause activation, and later, aggregation.

Ticagrelor also known via brand names Brilinta or Brilique, is a platelet inhibitor used to prevent infarction, stroke or cardiovascular death. Once administered orally it travels to the bloodstream and acts on platelets' P2Y receptors which inhibits the formation of thromboses. An activated P2Y receptor couples with guanine nucleotide-binding protein subunit i2 that inhibits adenylyl cyclase. By inhibiting adenylyl cyclase, it stops the formation of cAMP, leading to a stop of calcium efflux causing platelet aggregation and activation. Grapefruit products should be avoided as it inhibits the CYP3A4 metabolism of ticagrelor and cause an increase in the drug which may lead to an overdose. Herbs and supplements with anticoagulant and antiplatelet activity should be avoided such as garlic, ginger, bilberry, danshen, piracetam and ginkgo biloba. St. John's Wort induces the CYP3A4 metabolism of the drug and will reduce its efficacy and concentration.