肽偶联磷酰胺吗啉寡聚物抑制 MCR-1 恢复多黏菌素敏感性。

MCR-1 Inhibition with Peptide-Conjugated Phosphorodiamidate Morpholino Oligomers Restores Sensitivity to Polymyxin in .

机构信息

Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.

Department of Microbiology, Oregon State University, Corvallis, Oregon, USA.

出版信息

mBio. 2017 Nov 7;8(6):e01315-17. doi: 10.1128/mBio.01315-17.

Abstract

In late 2015, the first example of a transferrable polymyxin resistance mechanism in Gram-negative pathogens, MCR-1, was reported. Since that report, MCR-1 has been described to occur in many Gram-negative pathogens, and the mechanism of MCR-1-mediated resistance was rapidly determined: an ethanolamine is attached to lipid A phosphate groups, rendering the membrane more electropositive and repelling positively charged polymyxins. Acquisition of MCR-1 is clinically significant because polymyxins are frequently last-line antibiotics used to treat extensively resistant organisms, so acquisition of this mechanism might lead to pan-resistant strains. Therefore, the ability to inhibit MCR-1 and restore polymyxin sensitivity would be an important scientific advancement. Peptide-conjugated phosphorodiamidate morpholino oligomers (PPMOs) are antisense molecules that were designed to target mRNA, preventing translation. Peptide conjugation enhances cellular entry, but they are positively charged, so we tested our lead antibacterial PPMOs by targeting an essential gene, , and demonstrated that they were still effective in --positive strains. We then designed and synthesized two PPMOs targeted to mRNA. Five clinical -positive strains were resensitized to polymyxins by MCR-1 inhibition, reducing MICs 2- to 16-fold. Finally, therapeutic dosing of BALB/c mice with MCR-1 PPMO combined with colistin in a sepsis model reduced morbidity and bacterial burden in the spleen at 24 h and offered a survival advantage out to 5 days. This is the first example of a way to modulate colistin resistance with an antisense approach and may be a viable strategy to combat this globally emerging antibiotic resistance threat. Polymyxin use has been increasing as a last line of defense against Gram-negative pathogens with high-level resistance mechanisms, such as carbapenemases. The recently described MCR-1 is a plasmid-mediated mechanism of resistance to polymyxins. MCR-1 is currently found in Gram-negative organisms already possessing high-level resistance mechanisms, leaving clinicians few or no antibacterial options for infections caused by these strains. This study utilizes antisense molecules that target mRNA, preventing protein translation. Herein we describe antisense molecules that can be directly antibacterial because they target genes essential to bacterial growth or blockade of MCR-1, restoring polymyxin sensitivity. We also demonstrate that MCR-1 antisense molecules restore the efficacies of polymyxins in mouse models of septicemia. Considering all things together, we demonstrate that antisense molecules may be effective therapeutics either alone when they target an essential gene or combined with antibiotics when they target specific resistance mechanisms, such as those seen with MCR-1.

摘要

2015 年末,首次报道了革兰氏阴性病原体中可转移多粘菌素耐药机制 MCR-1。自该报告以来,MCR-1 已在许多革兰氏阴性病原体中被描述,并且 MCR-1 介导的耐药机制很快被确定:乙醇胺附着在脂质 A 磷酸盐基团上,使膜更带正电,并排斥带正电荷的多粘菌素。MCR-1 的获得在临床上具有重要意义,因为多粘菌素通常是用于治疗广泛耐药的最后一线抗生素,因此获得这种机制可能会导致泛耐药株。因此,抑制 MCR-1 并恢复多粘菌素敏感性将是一项重要的科学进展。肽偶联磷酰胺二胺吗啉寡聚物(PPMOs)是一种设计用于靶向 mRNA 以阻止翻译的反义分子。肽偶联增强了细胞进入,但它们带正电荷,因此我们通过靶向必需基因 来测试我们的先导抗菌 PPMO,并证明它们在 阳性 株中仍然有效。然后,我们设计并合成了两种针对 mRNA 的 PPMO。通过抑制 MCR-1,五种临床 阳性 多粘菌素耐药菌株对多粘菌素重新敏感,MIC 降低 2 至 16 倍。最后,在败血症模型中,用 MCR-1 PPMO 联合粘菌素对 BALB/c 小鼠进行治疗剂量给药,可在 24 小时内降低脾脏中的发病率和细菌负荷,并在 5 天内提供生存优势。这是首次通过反义方法调节粘菌素耐药性的方法,可能是对抗这种全球新兴抗生素耐药性威胁的可行策略。由于具有高水平耐药机制(如碳青霉烯酶)的革兰氏阴性病原体,多粘菌素的使用一直在增加,作为最后的防御手段。最近描述的 MCR-1 是一种对多粘菌素的质粒介导的耐药机制。MCR-1 目前存在于已经具有高水平耐药机制的革兰氏阴性生物中,这使得临床医生在治疗这些菌株引起的感染时几乎没有或没有抗菌选择。本研究利用靶向 mRNA 的反义分子,阻止蛋白质翻译。本文描述的反义分子可以直接具有抗菌作用,因为它们靶向细菌生长所必需的基因或阻断 MCR-1,恢复多粘菌素敏感性。我们还证明,MCR-1 反义分子在败血症的小鼠模型中恢复了多粘菌素的疗效。综合考虑所有因素,我们证明,当反义分子靶向必需基因时,它们本身可能是有效的治疗药物,或者当它们靶向特定的耐药机制(如 MCR-1 所见)时,它们与抗生素联合使用可能是有效的治疗药物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9700/5676038/7dd9d8de5bbf/mbo0051735740001.jpg

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