Iliades Peter, Meshnick Steven R, Macreadie Ian G
CSIRO Health Sciences and Nutrition, 343 Royal Parade, Parkville, Victoria 3052, Australia.
Antimicrob Agents Chemother. 2005 Feb;49(2):741-8. doi: 10.1128/AAC.49.2.741-748.2005.
Pneumocystis jirovecii is a major opportunistic pathogen that causes Pneumocystis pneumonia (PCP) and results in a high degree of mortality in immunocompromised individuals. The drug of choice for PCP is typically sulfamethoxazole (SMX) or dapsone in conjunction with trimethoprim. Drug treatment failure and sulfa drug resistance have been implicated epidemiologically with point mutations in dihydropteroate synthase (DHPS) of P. jirovecii. P. jirovecii cannot be cultured in vitro; however, heterologous complementation of the P. jirovecii trifunctional folic acid synthesis (PjFAS) genes with an E. coli DHPS-disrupted strain was recently achieved. This enabled the evaluation of SMX resistance conferred by DHPS mutations. In this study, we sought to determine whether DHPS mutations conferred sulfa drug cross-resistance to 15 commonly available sulfa drugs. It was established that the presence of amino acid substitutions (T(517)A or P(519)S) in the DHPS domain of PjFAS led to cross-resistance against most sulfa drugs evaluated. The presence of both mutations led to increased sulfa drug resistance, suggesting cooperativity and the incremental evolution of sulfa drug resistance. Two sulfa drugs (sulfachloropyridazine [SCP] and sulfamethoxypyridazine [SMP]) that had a higher inhibitory potential than SMX were identified. In addition, SCP, SMP, and sulfadiazine (SDZ) were found to be capable of inhibiting the clinically observed drug-resistant mutants. We propose that SCP, SMP, and SDZ should be considered for clinical evaluation against PCP or for future development of novel sulfa drug compounds.
耶氏肺孢子菌是一种主要的机会性病原体,可引起肺孢子菌肺炎(PCP),并导致免疫功能低下个体的高死亡率。PCP的首选药物通常是磺胺甲恶唑(SMX)或氨苯砜与甲氧苄啶联合使用。药物治疗失败和磺胺类药物耐药性在流行病学上与耶氏肺孢子菌二氢蝶酸合酶(DHPS)的点突变有关。耶氏肺孢子菌不能在体外培养;然而,最近实现了用大肠杆菌DHPS缺失菌株对耶氏肺孢子菌三功能叶酸合成(PjFAS)基因进行异源互补。这使得能够评估由DHPS突变赋予的SMX耐药性。在本研究中,我们试图确定DHPS突变是否赋予对15种常用磺胺类药物的磺胺类药物交叉耐药性。已确定PjFAS的DHPS结构域中存在氨基酸取代(T(517)A或P(519)S)会导致对大多数评估的磺胺类药物产生交叉耐药性。两种突变同时存在会导致磺胺类药物耐药性增加,表明存在协同作用和磺胺类药物耐药性的渐进演变。鉴定出两种比SMX具有更高抑制潜力的磺胺类药物(磺胺氯哒嗪[SCP]和磺胺甲氧哒嗪[SMP])。此外,发现SCP、SMP和磺胺嘧啶(SDZ)能够抑制临床观察到的耐药突变体。我们建议应考虑将SCP、SMP和SDZ用于针对PCP的临床评估或新型磺胺类药物化合物的未来开发。