Olson Joshua, Khetarpal Anuj K, Jankeel Allen, Lorenzana Arianna, Nizet Victor, Sakoulas George, Ulloa Erlinda R
Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA.
Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, California, USA.
Open Forum Infect Dis. 2025 May 13;12(6):ofaf291. doi: 10.1093/ofid/ofaf291. eCollection 2025 Jun.
BACKGROUND: The emergence of antibiotic-tolerant staphylococcal strains, such as vancomycin-intermediate (VISA), poses a significant healthcare challenge and complicates treatment regimens. VISA often exhibits mutations in Krebs cycle enzymes, promoting anaerobic metabolism under physiological conditions and reducing susceptibility to antibiotics and innate immune defenses-factors not typically captured in standard susceptibility testing. Building on these findings, we investigated ethylenediaminetetraacetic acid (EDTA), a chelator that enhances reactive oxygen species (ROS) production, as an adjunct to vancomycin for combating VISA infections. METHODS: RNA sequencing analysis compared gene expression of a well-characterized VISA strain (D712) under physiological versus nutrient-rich conditions. Hydrogen peroxide (HO) killing assays were conducted with and without the hydroxyl radical quencher thiourea, while neutrophil killing assays used ROS scavenger butylated hydroxyanisole (BHA). A murine bacteremia model assessed the effects of vancomycin, EDTA, or their combination on VISA. RESULTS: VISA exhibited downregulation of Krebs cycle enzymes and other genes associated with resistance to iron and ROS-mediated killing under physiological conditions. EDTA, alone or with vancomycin, improved HO-mediated killing compared to vancomycin alone, a response counteracted by thiourea. The combination of EDTA and vancomycin enhanced neutrophil killing of VISA more effectively than either treatment alone, an effect negated by BHA. In vivo, EDTA enhanced vancomycin activity against VISA. CONCLUSIONS: EDTA potentiates vancomycin efficacy against VISA in vivo and enhances susceptibility to HO and neutrophil killing. Reduced expression of Krebs cycle enzymes in VISA suggests that EDTA promotes ROS-mediated bacterial killing, targeting a key mechanism by which persistent staphylococci evade host defenses.
背景:耐抗生素葡萄球菌菌株的出现,如万古霉素中介金黄色葡萄球菌(VISA),给医疗保健带来了重大挑战,并使治疗方案复杂化。VISA通常在三羧酸循环酶中表现出突变,在生理条件下促进无氧代谢,并降低对抗生素和先天免疫防御的敏感性,而这些因素在标准药敏试验中通常未被捕捉到。基于这些发现,我们研究了乙二胺四乙酸(EDTA),一种能增强活性氧(ROS)生成的螯合剂,作为万古霉素的辅助药物来对抗VISA感染。
方法:RNA测序分析比较了一株特征明确的VISA菌株(D712)在生理条件与营养丰富条件下的基因表达。在有和没有羟基自由基淬灭剂硫脲的情况下进行过氧化氢(H₂O₂)杀菌试验,而中性粒细胞杀菌试验使用ROS清除剂丁基羟基茴香醚(BHA)。一个小鼠菌血症模型评估了万古霉素、EDTA或它们的组合对VISA的影响。
结果:VISA在生理条件下表现出三羧酸循环酶以及其他与铁抗性和ROS介导的杀伤相关基因的下调。与单独使用万古霉素相比,EDTA单独使用或与万古霉素联合使用时,增强了H₂O₂介导的杀伤作用,硫脲可抵消这种反应。EDTA和万古霉素的组合比单独使用任何一种治疗更有效地增强了中性粒细胞对VISA的杀伤作用,BHA可消除这种作用。在体内,EDTA增强了万古霉素对VISA的活性。
结论:EDTA在体内增强了万古霉素对VISA的疗效,并增强了对H₂O₂和中性粒细胞杀伤的敏感性。VISA中三羧酸循环酶表达的降低表明,EDTA促进了ROS介导的细菌杀伤,针对的是持续性葡萄球菌逃避宿主防御的关键机制。
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