Combinations of β-lactam or aminoglycoside antibiotics with plectasin are synergistic against methicillin-sensitive and methicillin-resistant Staphylococcus aureus

PLoS One. 2015 Feb 18;10(2):e0117664. doi: 10.1371/journal.pone.0117664. eCollection 2015.

Abstract

Bacterial infections remain the leading killer worldwide which is worsened by the continuous emergence of antibiotic resistance. In particular, methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) are prevalent and the latter can be difficult to treat. The traditional strategy of novel therapeutic drug development inevitably leads to emergence of resistant strains, rendering the new drugs ineffective. Therefore, rejuvenating the therapeutic potentials of existing antibiotics offers an attractive novel strategy. Plectasin, a defensin antimicrobial peptide, potentiates the activities of other antibiotics such as β-lactams, aminoglycosides and glycopeptides against MSSA and MRSA. We performed in vitro and in vivo investigations to test against genetically diverse clinical isolates of MSSA (n = 101) and MRSA (n = 115). Minimum inhibitory concentrations (MIC) were determined by the broth microdilution method. The effects of combining plectasin with β-lactams, aminoglycosides and glycopeptides were examined using the chequerboard method and time kill curves. A murine neutropenic thigh model and a murine peritoneal infection model were used to test the effect of combination in vivo. Determined by factional inhibitory concentration index (FICI), plectasin in combination with aminoglycosides (gentamicin, neomycin or amikacin) displayed synergistic effects in 76-78% of MSSA and MRSA. A similar synergistic response was observed when plectasin was combined with β-lactams (penicillin, amoxicillin or flucloxacillin) in 87-89% of MSSA and MRSA. Interestingly, no such interaction was observed when plectasin was paired with vancomycin. Time kill analysis also demonstrated significant synergistic activities when plectasin was combined with amoxicillin, gentamicin or neomycin. In the murine models, plectasin at doses as low as 8 mg/kg augmented the activities of amoxicillin and gentamicin in successful treatment of MSSA and MRSA infections. We demonstrated that plectasin strongly rejuvenates the therapeutic potencies of existing antibiotics in vitro and in vivo. This is a novel strategy that can have major clinical implications in our fight against bacterial infections.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aminoglycosides / pharmacology
  • Aminoglycosides / therapeutic use*
  • Amoxicillin / pharmacology
  • Amoxicillin / therapeutic use
  • Animals
  • Female
  • Gentamicins / pharmacology
  • Gentamicins / therapeutic use
  • Methicillin-Resistant Staphylococcus aureus / drug effects*
  • Methicillin-Resistant Staphylococcus aureus / pathogenicity
  • Mice
  • Microbial Sensitivity Tests
  • Penicillins / pharmacology
  • Penicillins / therapeutic use
  • Peptides / pharmacology*
  • Peptides / therapeutic use*
  • Staphylococcal Infections / drug therapy*
  • Staphylococcus aureus / drug effects*
  • Staphylococcus aureus / pathogenicity
  • beta-Lactams / pharmacology*
  • beta-Lactams / therapeutic use*

Substances

  • Aminoglycosides
  • Gentamicins
  • Penicillins
  • Peptides
  • beta-Lactams
  • plectasin
  • Amoxicillin

Grants and funding

This work was funded with support from the European Commission under grant agreement no: 278998, BacAttack. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein. The authors are also grateful for financial support from Helperby Therapeutics Group Ltd. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.