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Machado D, Coelho TS, Perdigão J, Pereira C, Couto I, Portugal I, Maschmann RDA, Ramos DF, von Groll A, Rossetti MLR, Silva PA, Viveiros M. Interplay between Mutations and Efflux in Drug Resistant Clinical Isolates of Mycobacterium tuberculosis. Front Microbiol 2017; 8:711. [PMID: 28496433 PMCID: PMC5406451 DOI: 10.3389/fmicb.2017.00711] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/06/2017] [Indexed: 11/23/2022] Open
Abstract
Numerous studies show efflux as a universal bacterial mechanism contributing to antibiotic resistance and also that the activity of the antibiotics subject to efflux can be enhanced by the combined use of efflux inhibitors. Nevertheless, the contribution of efflux to the overall drug resistance levels of clinical isolates of Mycobacterium tuberculosis is poorly understood and still is ignored by many. Here, we evaluated the contribution of drug efflux plus target-gene mutations to the drug resistance levels in clinical isolates of M. tuberculosis. A panel of 17 M. tuberculosis clinical strains were characterized for drug resistance associated mutations and antibiotic profiles in the presence and absence of efflux inhibitors. The correlation between the effect of the efflux inhibitors and the resistance levels was assessed by quantitative drug susceptibility testing. The bacterial growth/survival vs. growth inhibition was analyzed through the comparison between the time of growth in the presence and absence of an inhibitor. For the same mutation conferring antibiotic resistance, different MICs were observed and the different resistance levels found could be reduced by efflux inhibitors. Although susceptibility was not restored, the results demonstrate the existence of a broad-spectrum synergistic interaction between antibiotics and efflux inhibitors. The existence of efflux activity was confirmed by real-time fluorometry. Moreover, the efflux pump genes mmr, mmpL7, Rv1258c, p55, and efpA were shown to be overexpressed in the presence of antibiotics, demonstrating the contribution of these efflux pumps to the overall resistance phenotype of the M. tuberculosis clinical isolates studied, independently of the genotype of the strains. These results showed that the drug resistance levels of multi- and extensively-drug resistant M. tuberculosis clinical strains are a combination between drug efflux and the presence of target-gene mutations, a reality that is often disregarded by the tuberculosis specialists in favor of the almost undisputed importance of antibiotic target-gene mutations for the resistance in M. tuberculosis.
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Affiliation(s)
- Diana Machado
- Unidade de Microbiologia Médica, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de LisboaLisboa, Portugal
| | - Tatiane S. Coelho
- Programa de Pós-Graduação em Biologia Celular e Molecular, Centro de Biotecnologia, Fundação Universidade Federal do Rio GrandePorto Alegre, Brazil
- Núcleo de Pesquisa em Microbiologia Médica, Faculdade de Medicina, Fundação Universidade Federal do Rio GrandePorto Alegre, Brazil
| | - João Perdigão
- iMed.ULisboa, Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de LisboaLisboa, Portugal
| | - Catarina Pereira
- iMed.ULisboa, Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de LisboaLisboa, Portugal
| | - Isabel Couto
- Unidade de Microbiologia Médica, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de LisboaLisboa, Portugal
| | - Isabel Portugal
- iMed.ULisboa, Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de LisboaLisboa, Portugal
| | - Raquel De Abreu Maschmann
- Programa de Pós-Graduação em Biologia Celular e Molecular, Centro de Biotecnologia, Fundação Universidade Federal do Rio GrandePorto Alegre, Brazil
- Fundação Estadual de Produção e Pesquisa em Saúde, Centro de Desenvolvimento Científico e TecnológicoPorto Alegre, Brazil
| | - Daniela F. Ramos
- Núcleo de Pesquisa em Microbiologia Médica, Faculdade de Medicina, Fundação Universidade Federal do Rio GrandePorto Alegre, Brazil
| | - Andrea von Groll
- Núcleo de Pesquisa em Microbiologia Médica, Faculdade de Medicina, Fundação Universidade Federal do Rio GrandePorto Alegre, Brazil
| | - Maria L. R. Rossetti
- Fundação Estadual de Produção e Pesquisa em Saúde, Centro de Desenvolvimento Científico e TecnológicoPorto Alegre, Brazil
- Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde, Universidade Luterana do BrasilCanoas, Brazil
| | - Pedro A. Silva
- Programa de Pós-Graduação em Biologia Celular e Molecular, Centro de Biotecnologia, Fundação Universidade Federal do Rio GrandePorto Alegre, Brazil
- Núcleo de Pesquisa em Microbiologia Médica, Faculdade de Medicina, Fundação Universidade Federal do Rio GrandePorto Alegre, Brazil
| | - Miguel Viveiros
- Unidade de Microbiologia Médica, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de LisboaLisboa, Portugal
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Bhavanam S, Rayat GR, Keelan M, Kunimoto D, Drews SJ. Understanding the pathophysiology of the human TB lung granuloma using in vitro granuloma models. Future Microbiol 2016; 11:1073-89. [PMID: 27501829 DOI: 10.2217/fmb-2016-0005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis remains a major human health threat that infects one in three individuals worldwide. Infection with Mycobacterium tuberculosis is a standoff between host and bacteria in the formation of a granuloma. This review will introduce a variety of bacterial and host factors that impact individual granuloma fates. The authors describe advances in the development of in vitro granuloma models, current evidence surrounding infection and granuloma development, and the applicability of existing in vitro models in the study of human disease. In vitro models of infection help improve our understanding of pathophysiology and allow for the discovery of other potential models of study.
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Affiliation(s)
- Sudha Bhavanam
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Surgical-Medical Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Provincial Laboratory for Public Health, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Gina R Rayat
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Surgical-Medical Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Provincial Laboratory for Public Health, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Monika Keelan
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Surgical-Medical Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Provincial Laboratory for Public Health, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Dennis Kunimoto
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Surgical-Medical Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Provincial Laboratory for Public Health, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Steven J Drews
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Surgery, Surgical-Medical Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Provincial Laboratory for Public Health, Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
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Parumasivam T, Chan JGY, Pang A, Quan DH, Triccas JA, Britton WJ, Chan HK. In vitro evaluation of novel inhalable dry powders consisting of thioridazine and rifapentine for rapid tuberculosis treatment. Eur J Pharm Biopharm 2016; 107:205-14. [PMID: 27422209 DOI: 10.1016/j.ejpb.2016.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 02/03/2023]
Abstract
Thioridazine is an orally administered antipsychotic drug with potential for treatment of drug-resistant tuberculosis (TB). However, drug-induced adverse cardiac effects have been reported when thioridazine was used at an efficacious oral dose of 200mg/day to treat TB. Pulmonary delivery of thioridazine could be a rational approach to reduce dose-related side effects while enabling high drug concentrations at the primary site of infection. The present study compares in vitro aerosol performance, storage stability, and in vitro antimicrobial activity and cytotoxicity of two inhalable powders composed of thioridazine and a first-line anti-TB drug, rifapentine. Formulation 1 is a combination of amorphous thioridazine and crystalline rifapentine, while Formulation 2 consisted of both drugs as amorphous forms. Both thioridazine-rifapentine formulations were found suitable for inhalation with a total fine particle fraction (<5μm) of 68-76%. The two powders had similar MIC90 to rifapentine alone, being 0.000625μg/mL and 0.005μg/ml against Mycobacterium tuberculosis H37Ra and M. tuberculosis H37Rv, respectively. In contrast, thioridazine alone had a MIC90 of 12.5μg/mL and 500μg/mL, against M. tuberculosis H37Ra and M. tuberculosis H37Rv, respectively, demonstrating no synergistic anti-TB activity. However, thioridazine and rifapentine in a ratio of 1:3 enhanced the killing of M. tuberculosis H37Ra within the human monocyte-derived macrophages (THP-1) compared to the single drug treatments. Both powders showed an acceptable half maximal inhibitory concentration (IC50) of 31.25μg/mL on both THP-1 and human lung epithelial (A549) cells. However, Formulation 1 showed greater chemical stability than Formulation 2 after three months of storage under low humidity (vacuum) at 20±3°C. In conclusion, we have demonstrated a novel inhalable powder consisted of amorphous thioridazine and crystalline rifapentine (Formulation 1) with a good aerosol performance, potent anti-TB activity and storage stability, which deserves further in vivo investigations.
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Affiliation(s)
- T Parumasivam
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, 2006 NSW, Australia
| | - J G Y Chan
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, 2006 NSW, Australia; JHL Biotech, Inc., Hsinchu County, Taiwan
| | - A Pang
- Tuberculosis Research Program, Centenary Institute, and The University of Sydney, Sydney 2042, NSW, Australia
| | - D H Quan
- Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, 2006 NSW, Australia
| | - J A Triccas
- Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, 2006 NSW, Australia
| | - W J Britton
- Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, 2006 NSW, Australia; Tuberculosis Research Program, Centenary Institute, and The University of Sydney, Sydney 2042, NSW, Australia
| | - H K Chan
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, 2006 NSW, Australia.
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