Use of polymyxin B in patients with renal impairment: A retrospective examination of 5 cases

Enhanced protective efficacy of an OprF/PcrV bivalent DNA vaccine against Pseudomonas aeruginosa using a hydrogel delivery system

Pseudomonas aeruginosa (PA) is one of the leading pathogens responsible for hospital-acquired infections. With the increasing antibiotic resistance of PA, clinical treatment has become increasingly challenging. DNA vaccines represent a promising approach for combating PA infection. However, the immune response induced by a single antigen is limited, and combination vaccines hold greater therapeutic potential. The highly conserved OprF and PcrV genes are attractive candidate antigens for vaccine development, but the poor delivery of such vaccines has limited their clinical application. In this study, we constructed an OprF/PcrV bivalent DNA vaccine, and a polyaspartamide/polyethylene glycol di-aldehyde (PSIH/PEG DA) hydrogel was formulated to improve DNA delivery. The OprF/PcrV DNA vaccine formulated with the PSIH/PEG DA hydrogel was carefully characterized in vitro and in vivo and showed suitable compatibility. The PSIH/PEG DA hydrogel formulation induced a mixed Th1/Th2/Th17 immune response in mice, leading to a significant increase in antibody titers, lymphocyte proliferation rates, and cytokine levels compared to those in mice treated with single or combined vaccines. The PSIH/PEG DA hydrogel delivery system significantly enhanced the immune protection of the DNA vaccine in a murine pneumonia model, as revealed by the reduced bacterial burden and inflammation in the mouse lungs and increased survival rate. In conclusion, the PSIH/PEG DA hydrogel delivery system can further enhance the immune efficacy of the combination OprF/PcrV DNA vaccine. This research provides a novel optimized strategy for the prevention and treatment of PA infection using DNA vaccines.

Ferroptosis is involved in polymyxin B-induced acute kidney injury via activation of p53

Polymyxin B (PMB) is one of the most effective drugs for the treatment of multi-resistant and pan-resistant gram-negative infections. However, it can induce acute kidney injury (AKI), the mechanism of which has not yet been fully elucidated. In this study, RNA sequencing and in vitro and in vivo experiments demonstrated that PMB induced AKI by promoting ferroptosis. Moreover, the metallothionein-1 (MT-1) level was significantly increased in the AKI group and clinical cases revealed that iron and MT-1 levels in urine were significantly higher in patients with AKI than in those without AKI. To explore the mechanism of PMB induced ferroptosis, we silenced p53 in human kidney-2 (HK2) cells according to RNA sequencing, which showed that p53 was obviously enhanced in the PMB treated group. While PMB significantly enhanced Fe²⁺, lipid peroxidation, malondialdehyde (MDA), transferrin receptor protein 1 (TFR1), and arachidonate 12-lpoxygenase (ALOX12), decreased the survival rate, solute carrier family 7 member 11 (SLC7A11), glutathione peroxidase 4 (GPX4), and glutathione (GSH), downregulation of p53 reversed these effects, suggesting PMB induced ferroptosis by activating p53. Studies have shown p53 can promote ferroptosis by regulating the downstream factors SLC7A11 or TFR1. Further, we verified that silencing TFR1 expression as well as overexpression of SLC7A11 inhibited ferroptosis and significantly increased the survival rate of HK2 cells. Overall, PMB induces ferroptosis in renal tubular cells by activating p53 to reduce SLC7A11 expression and elevate TFR1, leading to AKI; MT-1 and iron levels in urine were significantly increased when PMB induced ferroptosis.

A novel decoy strategy for polymyxin resistance in Acinetobacter baumannii

Modification of the outer membrane charge by a polymyxin B (PMB)-induced PmrAB two-component system appears to be a dominant phenomenon in PMB-resistant Acinetobacter baumannii. PMB-resistant variants and many clinical isolates also appeared to produce outer membrane vesicles (OMVs). Genomic, transcriptomic, and proteomic analyses revealed that upregulation of the pmr operon and decreased membrane-linkage proteins (OmpA, OmpW, and BamE) are linked to overproduction of OMVs, which also promoted enhanced biofilm formation. The addition of OMVs from PMB-resistant variants into the cultures of PMB-susceptible A. baumannii and the clinical isolates protected these susceptible bacteria from PMB. Taxonomic profiling of in vitro human gut microbiomes under anaerobic conditions demonstrated that OMVs completely protected the microbial community against PMB treatment. A Galleria mellonella-infection model with PMB treatment showed that OMVs increased the mortality rate of larvae by protecting A. baumannii from PMB. Taken together, OMVs released from A. baumannii functioned as decoys against PMB.

Wrapped in a thick, protective outer membrane, Acinetobacter baumannii bacteria can sometimes cause serious infections when they find their way into human lungs and urinary tracts. Antibiotics are increasingly ineffective against this threat, which forces physicians to resort to polymyxin B, an old, positively-charged drug that ‘sticks’ to the negatively-charged proteins and fatty components at the surface of A. baumannii.

Scientists have noticed that when bacteria are exposed to lethal drugs, they often react by releasing vesicles, small ‘sacs’ made of pieces of the outer membranes which can contain DNA or enzymes. How this strategy protects the cells against antibiotics such as polymyxin B remains poorly understood.

To investigate this question, Park et al. examined different strains of A. baumannii, showing that bacteria resistant to polymyxin B had lower levels of outer membrane proteins but would release more vesicles. Adding vesicles from resistant strains to non-resistant A. baumannii cultures helped cells to survive the drugs. In fact, this protective effect extended to other species, shielding whole communities of bacteria against polymyxin B. In vivo, the vesicles protected bacteria in moth larvae infected with A. baumannii, leading to a higher death rate in the animals. Experiments showed that the negatively-charged vesicles worked as decoys, trapping the positively-charged polymyxin B away from its target.

Taken together, the findings by Park et al. highlight a new strategy that allows certain strains of bacteria to protect themselves from antibiotics, while also benefitting the rest of the microbial community.