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1.
Eur J Med Chem ; 248: 115038, 2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36634458

RESUMO

Upregulation of mechanistic target of rapamycin (mTOR) signaling drives various types of cancers and neurological diseases. Rapamycin and its analogues (rapalogs) are first generation mTOR inhibitors, and selectively block mTOR complex 1 (TORC1) by an allosteric mechanism. In contrast, second generation ATP-binding site inhibitors of mTOR kinase (TORKi) target both TORC1 and TORC2. Here, we explore 3,6-dihydro-2H-pyran (DHP) and tetrahydro-2H-pyran (THP) as isosteres of the morpholine moiety to unlock a novel chemical space for TORKi generation. A library of DHP- and THP-substituted triazines was prepared, and molecular modelling provided a rational for a structure activity relationship study. Finally, compound 11b [5-(4-(3-oxa-8-azabicyclo[3.2.1]octan-8-yl)-6-(tetrahydro-2H-pyran-4-yl)-1,3,5-triazin-2-yl)-4-(difluoromethyl)pyridin-2-amine] was selected due its potency and selectivity for mTOR kinase over the structurally related class I phosphoinositide 3-kinases (PI3Ks) isoforms. 11b displayed high metabolic stability towards CYP1A1 degradation, which is of advantage in drug development. After oral administration to male Sprague Dawley rats, 11b reached high concentrations both in plasma and brain, revealing an excellent oral bioavailability. In a metabolic stability assay using human hepatocytes, 11b was more stable than PQR620, the first-in-class brain penetrant TORKi. Compound 11b also displayed dose-dependent anti-proliferative activity in splenic marginal zone lymphoma (SMZL) cell lines as single agent and when combined with BCL2 inhibition (venetoclax). Our results identify the THP-substituted triazine core as a novel scaffold for the development of metabolically stable TORKi for the treatment of chronic diseases and cancers driven by mTOR deregulation and requiring drug distribution also to the central nervous system.


Assuntos
Neoplasias , Serina-Treonina Quinases TOR , Ratos , Animais , Masculino , Humanos , Ratos Sprague-Dawley , Serina-Treonina Quinases TOR/metabolismo , Alvo Mecanístico do Complexo 1 de Rapamicina , Morfolinas/farmacologia , Morfolinas/química , Sirolimo/farmacologia , Sirolimo/uso terapêutico , Neoplasias/tratamento farmacológico , Piranos/uso terapêutico , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/uso terapêutico
2.
RSC Med Chem ; 12(4): 579-583, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-34041490

RESUMO

Highly selective mTOR inhibitors have been discovered through the exploration of the heteroaromatic ring engaging the binding affinity region in mTOR kinase. Compound 11 showed predicted BBB permeability in a MDCK-MDR1 permeability in vitro assay, being the first pyrimido-pyrrolo-oxazine with potential application in the treatment of neurological disorders.

3.
J Med Chem ; 63(22): 13595-13617, 2020 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-33166139

RESUMO

The mechanistic target of rapamycin (mTOR) pathway is hyperactivated in cancer and neurological disorders. Rapalogs and mTOR kinase inhibitors (TORKi) have recently been applied to alleviate epileptic seizures in tuberous sclerosis complex (TSC). Herein, we describe a pharmacophore exploration to identify a highly potent, selective, brain penetrant TORKi. An extensive investigation of the morpholine ring engaging the mTOR solvent exposed region led to the discovery of PQR626 (8). 8 displayed excellent brain penetration and was well-tolerated in mice. In mice with a conditionally inactivated Tsc1 gene in glia, 8 significantly reduced the loss of Tsc1-induced mortality at 50 mg/kg p.o. twice a day. 8 overcomes the metabolic liabilities of PQR620 (52), the first-in-class brain penetrant TORKi showing efficacy in a TSC mouse model. The improved stability in human hepatocytes, excellent brain penetration, and efficacy in Tsc1GFAPCKO mice qualify 8 as a potential therapeutic candidate for the treatment of neurological disorders.


Assuntos
Encéfalo/metabolismo , Morfolinas/administração & dosagem , Morfolinas/metabolismo , Doenças do Sistema Nervoso/metabolismo , Serina-Treonina Quinases TOR/antagonistas & inibidores , Serina-Treonina Quinases TOR/metabolismo , Administração Oral , Animais , Encéfalo/efeitos dos fármacos , Cães , Feminino , Hepatócitos/efeitos dos fármacos , Hepatócitos/metabolismo , Humanos , Células Madin Darby de Rim Canino , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Nus , Morfolinas/química , Doenças do Sistema Nervoso/tratamento farmacológico , Ratos , Ratos Sprague-Dawley
4.
ACS Med Chem Lett ; 10(10): 1473-1479, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31620236

RESUMO

The phosphoinositide 3-kinase (PI3K)/mechanistic target of rapamycin (mTOR) pathway is a critical regulator of cell growth and is frequently hyperactivated in cancer. Therefore, PI3K inhibitors represent a valuable asset in cancer therapy. Herein we have developed a novel anticancer agent, the potent pan-PI3K inhibitor PQR514 (4), which is a follow-up compound for the phase-II clinical compound PQR309 (1). Compound 4 has an improved potency both in vitro and in cellular assays with respect to its predecessor compounds. It shows superiority in the suppression of cancer cell proliferation and demonstrates significant antitumor activity in an OVCAR-3 xenograft model at concentrations approximately eight times lower than PQR309 (1). The favorable pharmacokinetic profile and a minimal brain penetration promote PQR514 (4) as an optimized candidate for the treatment of systemic tumors.

5.
J Med Chem ; 62(18): 8609-8630, 2019 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-31465220

RESUMO

The mechanistic target of rapamycin (mTOR) plays a pivotal role in growth and tumor progression and is an attractive target for cancer treatment. ATP-competitive mTOR kinase inhibitors (TORKi) have the potential to overcome limitations of rapamycin derivatives in a wide range of malignancies. Herein, we exploit a conformational restriction approach to explore a novel chemical space for the generation of TORKi. Structure-activity relationship (SAR) studies led to the identification of compound 12b with a ∼450-fold selectivity for mTOR over class I PI3K isoforms. Pharmacokinetic studies in male Sprague Dawley rats highlighted a good exposure after oral dosing and a minimum brain penetration. CYP450 reactive phenotyping pointed out the high metabolic stability of 12b. These results identify the tricyclic pyrimido-pyrrolo-oxazine moiety as a novel scaffold for the development of highly selective mTOR inhibitors for cancer treatment.


Assuntos
Oxazinas/química , Inibidores de Proteínas Quinases/química , Pirimidinonas/química , Pirróis/química , Serina-Treonina Quinases TOR/antagonistas & inibidores , Trifosfato de Adenosina/química , Animais , Antineoplásicos/química , Antineoplásicos/farmacocinética , Cães , Desenho de Fármacos , Humanos , Concentração Inibidora 50 , Cinética , Masculino , Camundongos , Conformação Molecular , Neoplasias/tratamento farmacológico , Oxazinas/farmacocinética , Inibidores de Proteínas Quinases/farmacocinética , Pirimidinonas/farmacocinética , Pirróis/farmacocinética , Ratos , Ratos Sprague-Dawley , Relação Estrutura-Atividade , Serina-Treonina Quinases TOR/química
6.
J Med Chem ; 62(13): 6241-6261, 2019 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-31244112

RESUMO

The phosphoinositide 3-kinase (PI3K)/mechanistic target of rapamycin (mTOR) pathway is frequently overactivated in cancer, and drives cell growth, proliferation, survival, and metastasis. Here, we report a structure-activity relationship study, which led to the discovery of a drug-like adenosine 5'-triphosphate-site PI3K/mTOR kinase inhibitor: (S)-4-(difluoromethyl)-5-(4-(3-methylmorpholino)-6-morpholino-1,3,5-triazin-2-yl)pyridin-2-amine (PQR530, compound 6), which qualifies as a clinical candidate due to its potency and specificity for PI3K and mTOR kinases, and its pharmacokinetic properties, including brain penetration. Compound 6 showed excellent selectivity over a wide panel of kinases and an excellent selectivity against unrelated receptor enzymes and ion channels. Moreover, compound 6 prevented cell growth in a cancer cell line panel. The preclinical in vivo characterization of compound 6 in an OVCAR-3 xenograft model demonstrated good oral bioavailability, excellent brain penetration, and efficacy. Initial toxicity studies in rats and dogs qualify 6 for further development as a therapeutic agent in oncology.


Assuntos
Aminopiridinas/farmacologia , Antineoplásicos/farmacologia , Morfolinas/farmacologia , Fosfatidilinositol 3-Quinases/metabolismo , Inibidores de Fosfoinositídeo-3 Quinase/farmacologia , Piridinas/farmacologia , Serina-Treonina Quinases TOR/antagonistas & inibidores , Triazinas/farmacologia , Aminopiridinas/síntese química , Aminopiridinas/metabolismo , Animais , Antineoplásicos/síntese química , Antineoplásicos/metabolismo , Encéfalo/metabolismo , Linhagem Celular Tumoral , Cães , Feminino , Humanos , Masculino , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Microssomos Hepáticos/metabolismo , Simulação de Acoplamento Molecular , Estrutura Molecular , Morfolinas/síntese química , Morfolinas/metabolismo , Inibidores de Fosfoinositídeo-3 Quinase/síntese química , Inibidores de Fosfoinositídeo-3 Quinase/metabolismo , Ligação Proteica , Piridinas/síntese química , Piridinas/metabolismo , Ratos Wistar , Relação Estrutura-Atividade , Serina-Treonina Quinases TOR/metabolismo , Triazinas/síntese química , Triazinas/metabolismo , Ensaios Antitumorais Modelo de Xenoenxerto
7.
J Med Chem ; 61(22): 10084-10105, 2018 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-30359003

RESUMO

Mechanistic target of rapamycin (mTOR) promotes cell proliferation, growth, and survival and is overactivated in many tumors and central nervous system disorders. PQR620 (3) is a novel, potent, selective, and brain penetrable inhibitor of mTORC1/2 kinase. PQR620 (3) showed excellent selectivity for mTOR over PI3K and protein kinases and efficiently prevented cancer cell growth in a 66 cancer cell line panel. In C57BL/6J and Sprague-Dawley mice, maximum concentration ( Cmax) in plasma and brain was reached after 30 min, with a half-life ( t1/2) > 5 h. In an ovarian carcinoma mouse xenograft model (OVCAR-3), daily dosing of PQR620 (3) inhibited tumor growth significantly. Moreover, PQR620 (3) attenuated epileptic seizures in a tuberous sclerosis complex (TSC) mouse model. In conclusion, PQR620 (3) inhibits mTOR kinase potently and selectively, shows antitumor effects in vitro and in vivo, and promises advantages in CNS indications due to its brain/plasma distribution ratio.


Assuntos
Compostos Azabicíclicos/farmacologia , Alvo Mecanístico do Complexo 1 de Rapamicina/antagonistas & inibidores , Alvo Mecanístico do Complexo 2 de Rapamicina/antagonistas & inibidores , Piridinas/farmacologia , Convulsões/tratamento farmacológico , Triazinas/farmacologia , Animais , Compostos Azabicíclicos/metabolismo , Compostos Azabicíclicos/uso terapêutico , Barreira Hematoencefálica/metabolismo , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Humanos , Camundongos , Modelos Moleculares , Fosfatidilinositol 3-Quinases/química , Fosfatidilinositol 3-Quinases/metabolismo , Conformação Proteica , Piridinas/metabolismo , Piridinas/uso terapêutico , Ratos , Triazinas/metabolismo , Triazinas/uso terapêutico
8.
J Med Chem ; 60(17): 7524-7538, 2017 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-28829592

RESUMO

Phosphoinositide 3-kinase (PI3K) is deregulated in a wide variety of human tumors and triggers activation of protein kinase B (PKB/Akt) and mammalian target of rapamycin (mTOR). Here we describe the preclinical characterization of compound 1 (PQR309, bimiralisib), a potent 4,6-dimorpholino-1,3,5-triazine-based pan-class I PI3K inhibitor, which targets mTOR kinase in a balanced fashion at higher concentrations. No off-target interactions were detected for 1 in a wide panel of protein kinase, enzyme, and receptor ligand assays. Moreover, 1 did not bind tubulin, which was observed for the structurally related 4 (BKM120, buparlisib). Compound 1 is orally available, crosses the blood-brain barrier, and displayed favorable pharmacokinetic parameters in mice, rats, and dogs. Compound 1 demonstrated efficiency in inhibiting proliferation in tumor cell lines and a rat xenograft model. This, together with the compound's safety profile, identifies 1 as a clinical candidate with a broad application range in oncology, including treatment of brain tumors or CNS metastasis. Compound 1 is currently in phase II clinical trials for advanced solid tumors and refractory lymphoma.


Assuntos
Aminopiridinas/uso terapêutico , Antineoplásicos/uso terapêutico , Morfolinas/uso terapêutico , Neoplasias/tratamento farmacológico , Inibidores de Fosfoinositídeo-3 Quinase , Inibidores de Proteínas Quinases/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores , Administração Oral , Aminopiridinas/administração & dosagem , Aminopiridinas/farmacocinética , Animais , Antineoplásicos/administração & dosagem , Antineoplásicos/farmacocinética , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Proliferação de Células/efeitos dos fármacos , Cães , Humanos , Camundongos , Modelos Moleculares , Morfolinas/administração & dosagem , Morfolinas/farmacocinética , Neoplasias/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/farmacocinética , Ratos , Ratos Nus , Transdução de Sinais/efeitos dos fármacos , Serina-Treonina Quinases TOR/metabolismo
9.
J Med Chem ; 56(24): 9874-96, 2013 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-24175572

RESUMO

We identified 6-alkoxy-5-aryl-3-pyridinecarboxamides as potent CB1 receptor antagonists with high selectivity over CB2 receptors. The series was optimized to reduce lipophilicity compared to rimonabant to achieve peripherally active molecules with minimal central effects. Several compounds that showed high plasma exposures in rats were evaluated in vivo to probe the contribution of central vs peripheral CB1 agonism to metabolic improvement. Both rimonabant and 14g, a potent brain penetrant CB1 receptor antagonist, significantly reduced the rate of body weight gain. However, 14h, a molecule with markedly reduced brain exposure, had no significant effect on body weight. PK studies confirmed similarly high exposure of both 14h and 14g in the periphery but 10-fold lower exposure in the brain for 14h. On the basis of these data, which are consistent with reported effects in tissue-specific CB1 receptor KO mice, we conclude that the metabolic benefits of CB1 receptor antagonists are primarily centrally mediated as originally believed.


Assuntos
Amidas/farmacologia , Piridinas/farmacologia , Receptor CB1 de Canabinoide/antagonistas & inibidores , Amidas/síntese química , Amidas/química , Animais , Células CHO , Células Cultivadas , Cricetulus , Relação Dose-Resposta a Droga , Humanos , Masculino , Estrutura Molecular , Piridinas/síntese química , Piridinas/química , Ratos , Ratos Sprague-Dawley , Relação Estrutura-Atividade
11.
J Med Chem ; 54(7): 2207-24, 2011 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-21388139

RESUMO

The DNA gyrase inhibitor cyclothialidine had been shown to be a valuable lead structure for the discovery of new antibacterial classes able to overcome bacterial resistance to clinically used drugs. Bicyclic lactone derivatives containing in their 12-14-membered ring a thioamide functionality were reported previously to exhibit potent antibacterial activity against gram-positive bacteria. Moderate in vivo efficacy, however, was demonstrated only for derivatives bearing hydrophilic substituents, which were found to have a favorable impact on pharmcokinetics, and to reduce metabolic degradation, in particular glucuronidation. The incorporation of an additional amide unit into the 14-membered monolactam-lactone scaffold of cyclothialidine analogues provided a new "dilactam" subclass of DNA gyrase inhibitors of inherently higher polarity. After adjusting their lipophilicity by methyl-halogen exchange at the benzene ring, compounds of this series did not require the thioamide functionality to exert a decent antibacterial potency and consequently exhibited improved pharmacokinetic properties resulting in a pronounced in vivo efficacy in a mouse septicaemia infection model.


Assuntos
Lactamas/química , Lactonas/química , Peptídeos Cíclicos/química , Peptídeos Cíclicos/farmacologia , Inibidores da Topoisomerase II , Animais , Antibacterianos/síntese química , Antibacterianos/química , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , DNA Girase/química , Inibidores Enzimáticos/síntese química , Inibidores Enzimáticos/química , Inibidores Enzimáticos/farmacologia , Camundongos , Testes de Sensibilidade Microbiana , Modelos Moleculares , Peptídeos Cíclicos/síntese química , Conformação Proteica
12.
Org Biomol Chem ; 8(4): 758-60, 2010 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-20135030

RESUMO

A desymmetrization protocol has been used to develop a palladium catalyzed enantioselective carbonylation process. Achiral cyclic bis-alkenyltriflates are converted to their corresponding monoester derivatives with selectivities of up to 96% ee.


Assuntos
Compostos Alílicos/síntese química , Paládio/química , Polienos/síntese química , Carbono/química , Catálise , Modelos Químicos , Estereoisomerismo
13.
Bioorg Med Chem Lett ; 20(2): 594-9, 2010 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-19969452

RESUMO

Sulfonylureido thiazoles were identified from a HTS campaign and optimized through a combination of structure-activity studies, X-ray crystallography and molecular modeling to yield potent inhibitors of fructose-1,6-bisphosphatase. Compound 12 showed favorable ADME properties, for example, F=70%, and a robust 32% glucose reduction in the acute db/db mouse model for Type-2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Frutose-Bifosfatase/antagonistas & inibidores , Hipoglicemiantes/química , Compostos de Sulfonilureia/química , Tiazóis/química , Animais , Sítios de Ligação , Cristalografia por Raios X , Modelos Animais de Doenças , Frutose-Bifosfatase/metabolismo , Ensaios de Triagem em Larga Escala , Humanos , Hipoglicemiantes/síntese química , Hipoglicemiantes/farmacocinética , Camundongos , Relação Estrutura-Atividade , Compostos de Sulfonilureia/síntese química , Compostos de Sulfonilureia/farmacocinética , Tiazóis/síntese química , Tiazóis/farmacocinética , Tiazóis/farmacologia
14.
Bioorg Med Chem Lett ; 18(16): 4708-12, 2008 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-18650089

RESUMO

Human fructose-1,6-bisphosphatase (FBPase, EC 3.1.3.11) is a key gluconeogenic enzyme, responsible for the hydrolysis of fructose-1,6-bisphosphate to fructose-6-phosphate, and thus presents an opportunity for the development of novel therapeutics focused on lowering the hepatic glucose production in type 2 diabetics. In its active form FBPase exists as a homotetramer and is allosterically regulated by AMP. In an HTS campaign aromatic sulfonylureas have been identified as FBPase inhibitors mimicking AMP. By bridging two adjacent allosteric binding sites using two aromatic sulfonylureas as anchor units and covalently linking them, it was possible to obtain dual binding AMP site inhibitors that exhibit a strong inhibitory effect.


Assuntos
Monofosfato de Adenosina/química , Química Farmacêutica/métodos , Frutose-Bifosfatase/antagonistas & inibidores , Frutose-Bifosfatase/química , Administração Oral , Sítio Alostérico , Sítios de Ligação , Desenho de Fármacos , Glucose/metabolismo , Humanos , Cinética , Fígado/metabolismo , Modelos Químicos , Conformação Molecular , Estrutura Molecular , Compostos de Sulfonilureia/química
15.
J Med Chem ; 47(6): 1487-513, 2004 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-14998336

RESUMO

Cyclothialidine (1, Ro 09-1437) is a potent DNA gyrase inhibitor that was isolated from Streptomyces filipinensis NR0484 and is a member of a new family of natural products. It acts by competitively inhibiting the ATPase activity exerted by the B subunit of DNA gyrase but barely exhibits any growth inhibitory activity against intact bacterial cells, presumably due to insufficient permeation of the cytoplasmic membrane. To explore the antibacterial potential of 1, we developed a flexible synthetic route allowing for the systematic modification of its structure. From a first set of analogues, structure-activity relationships (SAR) were established for different substitution patterns, and the 14-hydroxylated, bicyclic core (X) of 1 seemed to be the structural prerequisite for DNA gyrase inhibitory activity. The variation of the lactone ring size, however, revealed that activity can be found among 11- to 16-membered lactones, and even seco-analogues were shown to maintain some enzyme inhibitory properties, thereby reducing the minimal structural requirements to a rather simple, hydroxylated benzyl sulfide (XI). On the basis of these "minimal structures" a modification program afforded a number of inhibitors that showed in vitro activity against Gram-positive bacteria. The best activities were displayed by 14-membered lactones, and representatives of this subclass exhibit excellent and broad in vitro antibacterial activity against Gram-positive pathogens, including Staphylococcus aureus, Streptococcus pyogenes, and Enterococcus faecalis, and overcome resistance against clinically used drugs. By improving the pharmacokinetic properties of the most active compounds (94, 97), in particular by lowering their lipophilic properties, we were able to identify congeners of cyclothialidine (1) that showed efficacy in vivo.


Assuntos
Antibacterianos/síntese química , Lactamas/síntese química , Lactonas/síntese química , Oxidiazóis/síntese química , Peptídeos Cíclicos/síntese química , Inibidores da Topoisomerase II , Animais , Antibacterianos/química , Antibacterianos/farmacologia , DNA Girase/química , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Positivas/efeitos dos fármacos , Células HeLa , Humanos , Lactamas/química , Lactamas/farmacologia , Lactonas/química , Lactonas/farmacologia , Camundongos , Testes de Sensibilidade Microbiana , Modelos Moleculares , Oxidiazóis/química , Oxidiazóis/farmacologia , Peptídeos Cíclicos/química , Peptídeos Cíclicos/farmacologia , Subunidades Proteicas/antagonistas & inibidores , Infecções Estafilocócicas/tratamento farmacológico , Estereoisomerismo , Relação Estrutura-Atividade , Testes de Toxicidade
16.
J Antibiot (Tokyo) ; 55(8): 722-57, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12374386

RESUMO

Discovery of novel antimicrobial agents effective against infections caused by drug-resistant pathogens is an important objective. In order to find a new parenteral carbapenem antibiotic, which has potent antibacterial activity especially against methicillin-resistant staphylococci, vancomycin-resistant enterococci and penicillin-resistant Streptococcus pneumoniae, a series of 1beta-methylcarbapenems with thiazol-2-ylthio groups at the C-2 position have been synthesized. Structure-activity relationships were investigated which led to SM-197436 (27), SM-232721 (44) and SM-232724 (41), being selected for further evaluation.


Assuntos
Antibacterianos , Carbapenêmicos , Enterococcus/efeitos dos fármacos , Resistência a Meticilina , Staphylococcus aureus/efeitos dos fármacos , Resistência a Vancomicina , Antibacterianos/síntese química , Antibacterianos/química , Antibacterianos/farmacologia , Carbapenêmicos/síntese química , Carbapenêmicos/química , Carbapenêmicos/farmacologia , Humanos , Testes de Sensibilidade Microbiana/métodos , Resistência às Penicilinas , Streptococcus pneumoniae/efeitos dos fármacos , Relação Estrutura-Atividade
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