Bleomycin

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Bleomycin
Bleomycin A2.svg
Bleomycin ball-and-stick.png
Bleomycin A2
Systematic (IUPAC) name
(3-{[(2'-{(5S,8S,9S,10R,13S)-15-{6-amino-2- [(1S)-3-amino-1-{[(2S)-2,3-diamino-3-oxopropyl]amino}-3-oxopropyl] -5-methylpyrimidin-4-yl}-13-[{[(2R,3S,4S,5S,6S)-3- {[(2R,3S,4S,5R,6R)-4-(carbamoyloxy)-3,5-dihydroxy-6- (hydroxymethyl)tetrahydro-2H-pyran-2-yl]oxy} -4,5-dihydroxy-6-(hydroxymethyl)tetrahydro-2H-pyran-2-yl]oxy} (1H-imidazol-5-yl)methyl]-9-hydroxy-5-[(1R)-1-hydroxyethyl]-8,10-dimethyl-4,7,12,15-tetraoxo-3,6,11,14-tetraazapentadec-1-yl}-2,4'-bi-1,3-thiazol-4-yl)carbonyl]amino}propyl)(dimethyl)sulfonium
Clinical data
Trade names Blenoxane
AHFS/Drugs.com monograph
MedlinePlus a682125
Pregnancy
category
  • US: D (Evidence of risk)
Legal status
Routes of
administration
intravenous, intramuscular, subcutaneous, intrapleural, intratumoral
Pharmacokinetic data
Bioavailability well absorbed
Metabolism ?
Biological half-life 2 hours
Excretion renal (60-70%)
Identifiers
CAS Registry Number 11056-06-7 YesY
ATC code L01DC01
PubChem CID: 456190
DrugBank DB00290 N
ChemSpider 401687 YesY
UNII 40S1VHN69B YesY
KEGG D07535 N
ChEBI CHEBI:22907 N
ChEMBL CHEMBL403664 N
Chemical data
Formula C55H84N17O21S3
Molecular mass 1415.551
 N (what is this?)  (verify)

Bleomycin is a medication used to treat cancer.[1] This includes Hodgkin's lymphoma, non-Hodgkin's lymphoma, testicular cancer, ovarian cancer, and cervical cancer among others. Typically used with other cancer medications, it can be given intravenously, by injection into a muscle or under the skin.[1] It may also be administered inside the chest to help prevent the recurrence of a fluid around the lung due to cancer; however talc is better for this.[1][2]

Common side effects include fever, weight loss, vomiting, and rash. A severe type of anaphylaxis may occur. It may also cause inflammation of the lungs that can result in lung scarring. Chest X-rays every couple of weeks are recommended to check for this. Bleomycin may cause harm to the baby if used during pregnancy. Believed to primarily work by preventing the making of DNA.[1]

Bleomycin was discovered in 1962.[3] It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[4] It is available as a generic medication.[1] The wholesale cost is between 14 USD and 78 USD a dose.[5] It is made from the bacterium Streptomyces verticillus.[1]

Medical uses[edit]

Cancer[edit]

Bleomycin is mostly used to treat cancer.[1] This includes Hodgkin's disease, non-Hodgkin's disease, testicular cancer, ovarian cancer, and cervical cancer.[1] It can be given intravenously, by injection into a muscle or under the skin.[1]

Other uses[edit]

It may also be put inside the chest to help prevent the recurrence of a pleural effusion due to cancer.[1] For scaring down the pleura talc however appears to be better.[2]

While potentially effective against bacterial infections, its toxicity prevents its use for this purpose.[1] It has been studied in the treatment of warts but is of unclear benefit.[6]

Side effects[edit]

The most serious complication of bleomycin is pulmonary fibrosis and impaired lung function. It has been suggested that bleomycin induces sensitivity to oxygen toxicity[7] and recent studies support the role of the proinflammatory cytokines IL-18 and IL-1beta in the mechanism of bleomycin-induced lung injury.[8] Past history of treatment with bleomycin should therefore always be disclosed to the anaesthetist prior to undergoing a procedure requiring general anaesthesia. Due to the oxygen sensitive nature of bleomycin, and the theorised increased likelihood of developing pulmonary fibrosis following supplemental oxygen therapy, it has been questioned whether patients should take part in scuba diving following treatment with the drug.[9]

Other side effects include fever, rash, dermatographism, hyperpigmentation, alopecia (hair loss) and Raynaud's phenomenon (discoloration of fingers and toes).

Mechanism of action[edit]

Bleomycin acts by induction of DNA strand breaks.[10] Some studies suggest bleomycin also inhibits incorporation of thymidine into DNA strands. DNA cleavage by bleomycin depends on oxygen and metal ions, at least in vitro. The exact mechanism of DNA strand scission is unresolved, but it has been suggested that bleomycin chelates metal ions (primarily iron), producing a pseudoenzyme that reacts with oxygen to produce superoxide and hydroxide free radicals that cleave DNA. An alternative hypothesis states that bleomycin may bind at specific sites in the DNA strand and induce scission by abstracting the hydrogen atom from the base, resulting in strand cleavage as the base undergoes a Criegee-type rearrangement, or forms an alkali-labile lesion.[11] In addition, these complexes also mediate lipid peroxidation and oxidation of other cellular molecules. Therefore bleomycin is used in combination with doxorubicin in Hodgkins lymphoma, as they have additive and complementary effects on the DNA, since doxorubicin acts by intercalating between DNA strands, and also acts on topoisomerase II enzyme thus relaxing the topoisomerase complexes.

Biosynthesis[edit]

Bleomycin is a nonribosomal peptide that is a hybrid peptide-polyketide natural product. The peptide/polyketide/peptide backbone of the bleomycin aglycon is assembled by the bleomycin megasynthetase, which is made of both nonribosomal peptide synthetase (NRPS) and polyketide synthase (PKS) modules. Nonribosomal peptides and polyketides are synthesized from amino acids and short carboxylic acids by NRPSs and PKSs, respectively. These NRPSs and PKSs use similar strategies for the assembly of these two distinct classes of natural products. Both NRPs and type I PKSs are organized into modules. The structural variations of the resulting peptide and polyketide products are determined by the number and order of modules on each NRPS and PKS protein.

The biosynthesis of the bleomycin aglycon can be visualized in three stages:

  1. NRPS-mediated formation of P-3A from Ser, Asn, His, and Ala
  2. PKS-mediated elongation of P-3A by malonyl CoA and AdoMet to yield P-4
  3. NRPS-mediated elongation of P-4 by Thr to P-5 that is further elongated by β-Ala, Cys, and Cys to get P-6m.

On the basis of the bleomycin structure and the deduced functions of individual NRPS and PKS domains and modules, a linear model for the bleomycin megasynthetase-templated assembly of the bleomycin peptide/polyketide/peptide aglycon was proposed from nine amino acids and one acetate.

History[edit]

Bleomycin was first discovered in 1966 when the Japanese scientist Hamao Umezawa found anticancer activity while screening culture filtrates of S. verticillus. Umezawa published his discovery in 1966.[12] The drug was launched in Japan by Nippon Kayaku in 1969. In the US, bleomycin gained FDA approval in July 1973. It was initially marketed in the US by the Bristol-Myers Squibb precursor, Bristol Laboratories, under the brand name Blenoxane.

See also[edit]

References[edit]

  1. ^ a b c d e f g h i j k "Bleomycin Sulfate". The American Society of Health-System Pharmacists. Retrieved Aug 1, 2015. 
  2. ^ a b Shaw, P; Agarwal, R (2004). "Pleurodesis for malignant pleural effusions.". The Cochrane database of systematic reviews (1): CD002916. PMID 14973997. 
  3. ^ Sneader, Walter (2005). Drug discovery : a history (Rev. and updated ed.). Chichester: Wiley. p. 312. ISBN 9780471899792. 
  4. ^ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014. 
  5. ^ "Bleomycin". International Drug Price Indicator Guide. Retrieved 26 August 2015. 
  6. ^ Kwok, CS; Gibbs, S; Bennett, C; Holland, R; Abbott, R (12 September 2012). "Topical treatments for cutaneous warts.". The Cochrane database of systematic reviews 9: CD001781. PMID 22972052. 
  7. ^ Dr Malcom Thompson (2003-07-25). "Bleomycin and Anaesthesia" (PDF). Retrieved 2008-04-10. 
  8. ^ Hoshino T, Okamoto M, Sakazaki Y, Kato S, Young HA, Aizawa H (March 2009). "Role of Proinflammatory Cytokine IL-18 and IL-1{beta} in Bleomycin-induced Lung Injury in Humans and Mice". Am. J. Respir. Cell Mol. Biol. 41 (6): 661–70. doi:10.1165/rcmb.2008-0182OC. PMID 19265174. 
  9. ^ "Bleomycin and scuba diving: to dive or not to dive? [Neth J Med. 2003] - PubMed - NCBI". Ncbi.nlm.nih.gov. 2012-05-24. Retrieved 2012-10-29. 
  10. ^ Takimoto CH, Calvo E. "Principles of Oncologic Pharmacotherapy" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
  11. ^ Hecht, SM (2000). "Bleomycin: new perspectives on the mechanism of action". J. Nat. Prod. 63: 158–168. doi:10.1021/np990549f. PMID 10650103. 
  12. ^ Umenzawa, H. et al. J. Antibiot. (Tokyo) Ser. A 1966, 19, 200.

Further reading[edit]

  • Claussen, C.A.; Long, E.C. (1999). "Nucleic Acid Recognition by Metal Complexes of Bleomycin". Chem. Rev. 99 (9): 2797–2816. doi:10.1021/cr980449z. PMID 11749501. 
  • Shen, B.; Du, L.C.; Sanchez, C.; Edwards, D.J.; Chen, M.; Murrell, J.M. (2001). "The biosynthetic gene cluster for the anticancer drug bleomycin from Streptomyces verticillus ATCC15003 as a model for hybrid peptide-polyketide natural product biosynthesis". Journal of Industrial Microbiology & Biotechnology 27 (6): 378–385. doi:10.1038/sj.jim.7000194. PMID 11774003.