Repurposing a neurodegenerative disease drug to treat Gram-negative antibiotic-resistant bacterial sepsis

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De Oliveira, David MP
Bohlmann, Lisa
Conroy, Trent
Jen, Freda E-C
Everest-Dass, Arun
Hansford, Karl A
Bolisetti, Raghu
El-Deeb, Ibrahim M
Forde, Brian M
Minh-Duy, Phan
Lacey, Jake A
Tan, Aimee
Jennings, Michael P
von Itzstein, Mark
et al.
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2020
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Abstract

The emergence of polymyxin resistance in carbapenem-resistant and extended-spectrum β-lactamase (ESBL)- producing bacteria is a critical threat to human health, and alternative treatment strategies are urgently required. We investigated the ability of the hydroxyquinoline analog ionophore PBT2 to restore antibiotic sensitivity in polymyxin-resistant, ESBL-producing, carbapenem-resistant Gram-negative human pathogens. PBT2 resensitized Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa to last-resort polymyxin class antibiotics, including the less toxic next-generation polymyxin derivative FADDI-287, in vitro. We were unable to select for mutants resistant to PBT2 + FADDI-287 in polymyxin-resistant E. coli containing a plasmid-borne mcr-1 gene or K. pneumoniae carrying a chromosomal mgrB mutation. Using a highly invasive K. pneumoniae strain engineered for polymyxin resistance through mgrB mutation, we successfully demonstrated the efficacy of PBT2 + polymyxin (colistin or FADDI-287) for the treatment of Gram-negative sepsis in immunocompetent mice. In comparison to polymyxin alone, the combination of PBT2 + polymyxin improved survival and reduced bacterial dissemination to the lungs and spleen of infected mice. These data present a treatment modality to break antibiotic resistance in high-priority polymyxin-resistant Gram-negative pathogens.

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Science Translational Medicine

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12

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570

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Biological sciences

Microbiology

Biomedical and clinical sciences

Clinical sciences

Medical biotechnology

Biomedical engineering

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Life Sciences & Biomedicine

Cell Biology

Medicine, Research & Experimental

Research & Experimental Medicine

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De Oliveira, DMP; Bohlmann, L; Conroy, T; Jen, FE-C; Everest-Dass, A; Hansford, KA; Bolisetti, R; El-Deeb, IM; Forde, BM; Minh-Duy, P; Lacey, JA; Tan, A; Jennings, MP; von Itzstein, M; et al., Repurposing a neurodegenerative disease drug to treat Gram-negative antibiotic-resistant bacterial sepsis, Science Translational Medicine, 2020, 12 (570)

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