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Chen HC, Pan YL, Chen Y, Yang TH, Hsu ET, Huang YT, Chiang MH. Monoclonal Antibodies as a Therapeutic Strategy against Multidrug-Resistant Bacterial Infections in a Post-COVID-19 Era. Life (Basel) 2024; 14:246. [PMID: 38398755 PMCID: PMC10890110 DOI: 10.3390/life14020246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
The development of severe multidrug-resistant bacterial infections has recently intensified because of the COVID-19 pandemic. According to the guidelines issued by the World Health Organization (WHO), routine antibiotic administration is not recommended for patients with supposed or confirmed mild SARS-CoV-2 infection or pneumonia, unless bacterial infection is clinically suspected. However, recent studies have pointed out that the proportion of non-essential antibiotic use in patients infected with SARS-CoV-2 remains high. Therefore, the silent pandemic of antibiotic resistance remains a pressing issue regardless of the present threats presented by the COVID-19 pandemic. To prevent or delay entry into the postulated post-antibiotic era, the long-term advocacy for the rational use of antibiotics, the optimization of infection control procedures, and the development of new antibacterial agents and vaccines should be underscored as vital practices of the antibacterial toolbox. Recently, the development of vaccines and monoclonal antibodies has gradually received attention following the advancement of biotechnology as well as enhanced drug discovery and development in cancer research. Although decent progress has been made in laboratory-based research and promising results have been obtained following clinical trials of some of these products, challenges still exist in their widespread clinical applications. This article describes the current advantages of antibacterial monoclonal antibodies, the development of associated clinical trials, and some perceived future perspectives and challenges. Further, we anticipate the development of more therapeutic agents to combat drug-resistant bacterial infections as well as to increase the resilience of current or novel agents/strategies.
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Affiliation(s)
- Hsiao-Chun Chen
- Department and Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Yu-Ling Pan
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei City 11490, Taiwan; (Y.-L.P.); (Y.C.)
| | - Ying Chen
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei City 11490, Taiwan; (Y.-L.P.); (Y.C.)
| | - Tsung-Hsuan Yang
- School of Nursing, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Erh-Tung Hsu
- School of Medicine, National Defense Medical Center, Taipei City 11490, Taiwan; (E.-T.H.); (Y.-T.H.)
| | - Yu-Ting Huang
- School of Medicine, National Defense Medical Center, Taipei City 11490, Taiwan; (E.-T.H.); (Y.-T.H.)
| | - Ming-Hsien Chiang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei City 11490, Taiwan; (Y.-L.P.); (Y.C.)
- mProbe Taiwan Inc., Taipei City 105037, Taiwan
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Yang YS, Chen HJ, Chen XC, Tang HJ, Chang FJ, Huang YL, Pan YL, Kesavan DK, Chen HY, Shang HS, Kuo SC, Chen TL, Chiang MH. Elizabethkingia anophelis outer membrane vesicles as a novel vaccine candidate against infection: insights into immune response and potential for passive immunity. mSphere 2023; 8:e0040023. [PMID: 38014949 PMCID: PMC10732079 DOI: 10.1128/msphere.00400-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE Elizabethkingia anophelis, a Gram-negative pathogen, causes infections such as bacteraemia, pneumonia, and neonatal meningitis. The pathogen resists most antimicrobial classes, making novel approaches urgently needed. In natural settings, Gram-negative bacteria secrete outer membrane vesicles (OMVs) that carry important molecules in the bacterial life cycle. These OMVs are enriched with proteins involved in virulence, survival, and carbohydrate metabolism, making them a promising source for vaccine development against the pathogen. This study investigated the efficacy of imipenem-induced OMVs (iOMVs) as a vaccine candidate against E. anophelis infection in a mouse pneumonia model. Mice immunized with iOMVs were completely protected during lethal-dose challenges. Passive immunization with hyperimmune sera and splenocytes conferred protection against lethal pneumonia. Further investigation is needed to understand the mechanisms underlying the protective effects of iOMV-induced passive immunity, such as the action on specific antibody subclasses or T cell subsets.
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Grants
- 109-2320-B-016-002-MY2, 110-2320-B-016-014, 111-2320-B-016-015, 112-2314-B-016-023, 112-2314-B-016-039, 112-2314-B-016-024-MY2 Ministry of Science and Technology, Taiwan (MOST)
- TSGH-E-111244, TSGH-E-112253 Tri-Service General Hospital (TSGH)
- CMNDMC11108, CMNDMC11206 Chi Mei Medical Center
- MND-MAB-110-049, MND-MAB-D-111072, MND-MAB-D-112115, MND-MAB-D-113078 MOD | Medical Affairs Bureau (MAB)
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Affiliation(s)
- Ya-Sung Yang
- Department of Internal Medicine, Division of Infectious Diseases and Tropical Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Jui Chen
- Department of Infectious Diseases, Chi Mei Medical Center, Tainan, Taiwan
| | - Xiao-Chun Chen
- Department and Graduate institute of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Jen Tang
- Department of Infectious Diseases, Chi Mei Medical Center, Tainan, Taiwan
| | - Fang-Ju Chang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Yun-Ling Huang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ling Pan
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Dinesh Kumar Kesavan
- School of Material Science, Nanyang Technological University, Singapore, Singapore
| | - Huan-Yuan Chen
- Inflammation Core Facility, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Hung-Sheng Shang
- Department of Pathology, Division of Clinical Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Hsien Chiang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
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Abdel Halim RM, Saber SM, Fahim NAE. Evaluation of synergistic activity of antibiotic combinations in extensive drug-resistant Acinetobacter species using checkerboard assay. J Med Microbiol 2023; 72. [PMID: 36762530 DOI: 10.1099/jmm.0.001639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Introduction. Acinetobacter is one of the challenging drug-resistant organisms that can endanger patients' lives if not treated properly.Aim. This study was designed to investigate the activity of three synergistic antimicrobial combinations against extensive drug-resistant Acinetobacter isolates; ampicillin/sulbactam plus amikacin, ampicillin/sulbactam plus ciprofloxacin, and meropenem plus amikacin.Methodology. Minimum inhibitory concentrations of 100 XDR-Acinetobacter isolates were determined using the Vitek2 system. The broth micro-dilution method was performed to determine tigecycline MIC. Checkerboard assay was used to evaluate in vitro activity of the three antibiotic combinations.Results. MIC results by the Vitek 2C system revealed that all Acinetobacter isolates were resistant to all tested antibiotics except for colistin against which no resistance was reported. As for tigecycline, all isolates were susceptible. Regarding MIC results of each antibiotic, all isolates were resistant to meropenem and ciprofloxacin. While 95 % of isolates were resistant to both ampicillin/sulbactam and amikacin. The activities of antibiotic combinations by checkerboard assay were as follows: ampicillin/sulbactam plus amikacin was synergic in 52 %, additive 40 % and indifferent in 8 % of isolates, ampicillin/sulbactam plus ciprofloxacin was synergic in 40 %, additive 46 % and indifferent in 14 % of isolates, meropenem/amikacin combination was synergic in 22 %, additive in 49 % of isolates and indifferent in 29 % of isolates. No antagonistic activity was detected against any of the tested antibiotic combinations.Conclusion. Ampicillin/sulbactam plus amikacin showed the highest synergistic activity followed by ampicillin/sulbactam plus ciprofloxacin. This reflects the value of adding aminoglycosides to either of a β-lactam or quinolone. The tested antibiotic combinations are promising treatment options for XDR-Acinetobacter.
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Affiliation(s)
- Rania M Abdel Halim
- Clinical Pathology Department, Faculty of Medicine Ain Shams University, Cairo, Egypt
| | - Sally M Saber
- Clinical Pathology Department, Faculty of Medicine Ain Shams University, Cairo, Egypt
| | - Noha Alaa Eldin Fahim
- Clinical Pathology Department, Faculty of Medicine Ain Shams University, Cairo, Egypt
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Chiang MH, Chang FJ, Kesavan DK, Vasudevan A, Xu H, Lan KL, Huang SW, Shang HS, Chuang YP, Yang YS, Chen TL. Proteomic Network of Antibiotic-Induced Outer Membrane Vesicles Released by Extensively Drug-Resistant Elizabethkingia anophelis. Microbiol Spectr 2022; 10:e0026222. [PMID: 35852325 PMCID: PMC9431301 DOI: 10.1128/spectrum.00262-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Abstract
Elizabethkingia anophelis, a nonfermenting Gram-negative bacterium, causes life-threatening health care-associated infections. E. anophelis harbors multidrug resistance (MDR) genes and is intrinsically resistant to various classes of antibiotics. Outer membrane vesicles (OMVs) are secreted by Gram-negative bacteria and contain materials involved in bacterial survival and pathogenesis. OMVs specialize and tailor their functions by carrying different components to challenging environments and allowing communication with other microorganisms or hosts. In this study, we sought to understand the characteristics of E. anophelis OMVs under different antibiotic stress conditions. An extensively drug-resistant clinical isolate, E. anophelis C08, was exposed to multiple antibiotics in vitro, and its OMVs were characterized using nanoparticle tracking analysis, transmission electron microscopy, and proteomic analysis. Protein functionality analysis showed that the OMVs were predominantly involved in metabolism, survival, defense, and antibiotic resistance processes, such as the Rag/Sus family, the chaperonin GroEL, prenyltransferase, and an HmuY family protein. Additionally, a protein-protein interaction network demonstrated that OMVs from imipenem-treated E. anophelis showed significant enrichments in the outer membrane, adenyl nucleotide binding, serine-type peptidase activity, the glycosyl compound metabolic process, and cation binding proteins. Collectively, the OMV proteome expression profile indicates that the role of OMVs is immunologically relevant and related to bacterial survival in antibiotic stress environments rather than representing a resistance point. IMPORTANCE Elizabethkingia anophelis is a bacterium often associated with nosocomial infection. This study demonstrated that imipenem-induced E. anophelis outer membrane vesicles (OMVs) are immunologically relevant and crucial for bacterial survival under antibiotic stress conditions rather than being a source of antibiotic resistance. Furthermore, this is the first study to discuss the protein-protein interaction network of the OMVs released by E. anophelis, especially under antibiotic stress. Our findings provide important insights into clinical antibiotic stewardship.
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Affiliation(s)
- Ming-Hsien Chiang
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Fang-Ju Chang
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Dinesh Kumar Kesavan
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Aparna Vasudevan
- International Genomics Research Centre (IGRC), Jiangsu University, Zhenjiang, China
- Department of Immunology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Huaxi Xu
- International Genomics Research Centre (IGRC), Jiangsu University, Zhenjiang, China
- Department of Immunology, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Kuo-Lun Lan
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Wei Huang
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hung-Sheng Shang
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Ping Chuang
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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Ma C, Chen W. Where are we and how far is there to go in the development of an Acinetobacter vaccine? Expert Rev Vaccines 2021; 20:281-295. [PMID: 33554671 DOI: 10.1080/14760584.2021.1887735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Healthcare-associated infections caused by multidrug-resistant Acinetobacter baumannii are becoming alarming worldwide. However, the pipeline of new antibiotics is very limited. Vaccination is one of the most cost effective and promising strategies to prevent infections and can play an important role in combat multidrug resistance A. baumannii and prevent the development of new drug resistance. AREA COVERED This review gives an overview of the research and development of A. baumannii vaccines during the past five years (2015-2020), discusses the key progresses and current challenges of the field, and speculates on the future of A. baumannii vaccine development. EXPERT OPINION Moderate progresses have been made in the research and development of A. baumannii vaccine in the last five years, in particular in the areas of identification of new protein targets, development of multicomponent vaccines, and use of vaccines and antibodies as adjuncts for antibiotics therapies. However, substantial scientific and logistic challenges, such as selection of lead vaccine candidates and formulation, vaccine clinical trials and targeted population, and financial incentives, remain. Thus, innovative strategies will be needed before an A. baumannii vaccine candidate can be brought into late stage of preclinical development in next five years.
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Affiliation(s)
- Crystal Ma
- Human Health Therapeutics Research Center (HHT), National Research Council Canada, Ottawa, Ontario Canada
| | - Wangxue Chen
- Human Health Therapeutics Research Center (HHT), National Research Council Canada, Ottawa, Ontario Canada.,Department of Biology, Brock University, St. Catharines, Ontario Canada
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Swain BM, Guo D, Singh H, Rawlins PB, McAlister M, van Veen HW. Complexities of a protonatable substrate in measurements of Hoechst 33342 transport by multidrug transporter LmrP. Sci Rep 2020; 10:20026. [PMID: 33208856 PMCID: PMC7674423 DOI: 10.1038/s41598-020-76943-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
Multidrug transporters can confer drug resistance on cells by extruding structurally unrelated compounds from the cellular interior. In transport assays, Hoechst 33342 (referred to as Hoechst) is a commonly used substrate, the fluorescence of which changes in the transport process. With three basic nitrogen atoms that can be protonated, Hoechst can exist as cationic and neutral species that have different fluorescence emissions and different abilities to diffuse across cell envelopes and interact with lipids and intracellular nucleic acids. Due to this complexity, the mechanism of Hoechst transport by multidrug transporters is poorly characterised. We investigated Hoechst transport by the bacterial major facilitator superfamily multidrug-proton antiporter LmrP in Lactococcus lactis and developed a novel assay for the direct quantitation of cell-associated Hoechst. We observe that changes in Hoechst fluorescence in cells do not always correlate with changes in the amount of Hoechst. Our data indicate that chemical proton gradient-dependent efflux by LmrP in cells converts populations of highly fluorescent, membrane-intercalated Hoechst in the alkaline interior into populations of less fluorescent, cell surface-bound Hoechst in the acidic exterior. Our methods and findings are directly relevant for the transport of many amphiphilic antibiotics, antineoplastic agents and cytotoxic compounds that are differentially protonated within the physiological pH range.
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Affiliation(s)
- Brendan M Swain
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK
| | - Dawei Guo
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK
| | - Himansha Singh
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK
| | - Philip B Rawlins
- Structure, Biophysics and Fragment-Based Lead Generation, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, CB4 0WG, UK
| | - Mark McAlister
- Structure, Biophysics and Fragment-Based Lead Generation, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, CB4 0WG, UK
| | - Hendrik W van Veen
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK.
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