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Unrecognized Potent Activities of Colistin Against Clinically Important mcr+ Enterobacteriaceae Revealed in Synergy with Host Immunity

Colistin (COL) is a cationic cyclic peptide that disrupts negatively-charged bacterial cell membranes and frequently serves as an antibiotic of last resort to combat multidrug-resistant Gram-negative bacterial infections. Emergence of the horizontally transferable plasmid-borne mobilized colistin re...

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Autores principales: Kumaraswamy, Monika, Riestra, Angelica, Flores, Anabel, Uchiyama, Satoshi, Dahesh, Samira, Bondsäter, Gunnar, Nilsson, Victoria, Chang, Melanie, Seo, Hideya, Sakoulas, George, Nizet, Victor
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cold Spring Harbor Laboratory 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10055327/
https://www.ncbi.nlm.nih.gov/pubmed/36993410
http://dx.doi.org/10.1101/2023.03.21.533661
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author Kumaraswamy, Monika
Riestra, Angelica
Flores, Anabel
Uchiyama, Satoshi
Dahesh, Samira
Bondsäter, Gunnar
Nilsson, Victoria
Chang, Melanie
Seo, Hideya
Sakoulas, George
Nizet, Victor
author_facet Kumaraswamy, Monika
Riestra, Angelica
Flores, Anabel
Uchiyama, Satoshi
Dahesh, Samira
Bondsäter, Gunnar
Nilsson, Victoria
Chang, Melanie
Seo, Hideya
Sakoulas, George
Nizet, Victor
author_sort Kumaraswamy, Monika
collection PubMed
description Colistin (COL) is a cationic cyclic peptide that disrupts negatively-charged bacterial cell membranes and frequently serves as an antibiotic of last resort to combat multidrug-resistant Gram-negative bacterial infections. Emergence of the horizontally transferable plasmid-borne mobilized colistin resistance (mcr) determinant and its spread to Gram-negative strains harboring extended-spectrum β-lactamase and carbapenemase resistance genes threatens futility of our chemotherapeutic arsenal. COL is widely regarded to have zero activity against mcr+ patients based on standard antimicrobial susceptibility testing (AST) performed in enriched bacteriological growth media; consequently, the drug is withheld from patients with mcr+ infections. However, these standard testing media poorly mimic in vivo physiology and omit host immune factors. Here we report previously unrecognized bactericidal activities of COL against mcr-1+ isolates of Escherichia coli (EC), Klebsiella pneumoniae (KP), and Salmonella enterica (SE) in standard tissue culture media containing the physiological buffer bicarbonate. Moreover, COL promoted serum complement deposition on the mcr-1+ Gram-negative bacterial surface and synergized potently with active human serum in pathogen killing. At COL concentrations readily achievable with standard dosing, the peptide antibiotic killed mcr-1+ EC, KP, and SE in freshly isolated human blood proved effective as monotherapy in a murine model of mcr-1+ EC bacteremia. Our results suggest that COL, currently ignored as a treatment option based on traditional AST, may in fact benefit patients with mcr-1+ Gram negative infections based on evaluations performed in a more physiologic context. These concepts warrant careful consideration in the clinical microbiology laboratory and for future clinical investigation of their merits in high risk patients with limited therapeutic options.
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spelling pubmed-100553272023-03-30 Unrecognized Potent Activities of Colistin Against Clinically Important mcr+ Enterobacteriaceae Revealed in Synergy with Host Immunity Kumaraswamy, Monika Riestra, Angelica Flores, Anabel Uchiyama, Satoshi Dahesh, Samira Bondsäter, Gunnar Nilsson, Victoria Chang, Melanie Seo, Hideya Sakoulas, George Nizet, Victor bioRxiv Article Colistin (COL) is a cationic cyclic peptide that disrupts negatively-charged bacterial cell membranes and frequently serves as an antibiotic of last resort to combat multidrug-resistant Gram-negative bacterial infections. Emergence of the horizontally transferable plasmid-borne mobilized colistin resistance (mcr) determinant and its spread to Gram-negative strains harboring extended-spectrum β-lactamase and carbapenemase resistance genes threatens futility of our chemotherapeutic arsenal. COL is widely regarded to have zero activity against mcr+ patients based on standard antimicrobial susceptibility testing (AST) performed in enriched bacteriological growth media; consequently, the drug is withheld from patients with mcr+ infections. However, these standard testing media poorly mimic in vivo physiology and omit host immune factors. Here we report previously unrecognized bactericidal activities of COL against mcr-1+ isolates of Escherichia coli (EC), Klebsiella pneumoniae (KP), and Salmonella enterica (SE) in standard tissue culture media containing the physiological buffer bicarbonate. Moreover, COL promoted serum complement deposition on the mcr-1+ Gram-negative bacterial surface and synergized potently with active human serum in pathogen killing. At COL concentrations readily achievable with standard dosing, the peptide antibiotic killed mcr-1+ EC, KP, and SE in freshly isolated human blood proved effective as monotherapy in a murine model of mcr-1+ EC bacteremia. Our results suggest that COL, currently ignored as a treatment option based on traditional AST, may in fact benefit patients with mcr-1+ Gram negative infections based on evaluations performed in a more physiologic context. These concepts warrant careful consideration in the clinical microbiology laboratory and for future clinical investigation of their merits in high risk patients with limited therapeutic options. Cold Spring Harbor Laboratory 2023-03-21 /pmc/articles/PMC10055327/ /pubmed/36993410 http://dx.doi.org/10.1101/2023.03.21.533661 Text en https://creativecommons.org/licenses/by-nd/4.0/This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nd/4.0/) , which allows reusers to copy and distribute the material in any medium or format in unadapted form only, and only so long as attribution is given to the creator. The license allows for commercial use.
spellingShingle Article
Kumaraswamy, Monika
Riestra, Angelica
Flores, Anabel
Uchiyama, Satoshi
Dahesh, Samira
Bondsäter, Gunnar
Nilsson, Victoria
Chang, Melanie
Seo, Hideya
Sakoulas, George
Nizet, Victor
Unrecognized Potent Activities of Colistin Against Clinically Important mcr+ Enterobacteriaceae Revealed in Synergy with Host Immunity
title Unrecognized Potent Activities of Colistin Against Clinically Important mcr+ Enterobacteriaceae Revealed in Synergy with Host Immunity
title_full Unrecognized Potent Activities of Colistin Against Clinically Important mcr+ Enterobacteriaceae Revealed in Synergy with Host Immunity
title_fullStr Unrecognized Potent Activities of Colistin Against Clinically Important mcr+ Enterobacteriaceae Revealed in Synergy with Host Immunity
title_full_unstemmed Unrecognized Potent Activities of Colistin Against Clinically Important mcr+ Enterobacteriaceae Revealed in Synergy with Host Immunity
title_short Unrecognized Potent Activities of Colistin Against Clinically Important mcr+ Enterobacteriaceae Revealed in Synergy with Host Immunity
title_sort unrecognized potent activities of colistin against clinically important mcr+ enterobacteriaceae revealed in synergy with host immunity
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10055327/
https://www.ncbi.nlm.nih.gov/pubmed/36993410
http://dx.doi.org/10.1101/2023.03.21.533661
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