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Potentiation of Aminoglycoside Activity in Pseudomonas aeruginosa by Targeting the AmgRS Envelope Stress-Responsive
Keith Poole1, Christie Gilmour2, Maya A Farha3
1Department of Biomedical and Molecular Sciences, Botterell Hall, Queen's University, Kingston, Ontario, Canada poolek@queensu.ca.
Abstract:
A screen for agents that potentiated the activity of paromomycin (PAR), a 4,5-linked aminoglycoside (AG), against wild-type Pseudomonas aeruginosa identified the RNA polymerase inhibitor rifampin (RIF). RIF potentiated additional 4,5-linked AGs, such as neomycin and ribostamycin, but not the clinically important 4,6-linked AGs amikacin and gentamicin. Potentiation was absent in a mutant lacking the AmgRS envelope stress response two-component system (TCS), which protects the organism from AG-generated membrane-damaging aberrant polypeptides and, thus, promotes AG resistance, an indication that RIF was acting via this TCS in potentiating 4,5-linked AG activity. Potentiation was also absent in a RIF-resistant RNA polymerase mutant, consistent with its potentiation of AG activity being dependent on RNA polymerase perturbation. PAR-inducible expression of the AmgRS-dependent genes htpX and yccA was reduced by RIF, suggesting that AG activation of this TCS was compromised by this agent. Still, RIF did not compromise the membrane-protective activity of AmgRS, an indication that it impacted some other function of this TCS. RIF potentiated the activities of 4,5-linked AGs against several AG-resistant clinical isolates, in two cases also potentiating the activity of the 4,6-linked AGs. These cases were, in one instance, explained by an observed AmgRS-dependent expression of the MexXY multidrug efflux system, which accommodates a range of AGs, with RIF targeting of AmgRS undermining mexXY expression and its promotion of resistance to 4,5- and 4,6-linked AGs. Given this link between AmgRS, MexXY expression, and pan-AG resistance in P. aeruginosa, RIF might be a useful adjuvant in the AG treatment of P. aeruginosa infections.
Insights
Rifampin potentiates specific aminoglycosides against Pseudomonas aeruginosa by targeting the AmgRS system, offering potential for combination therapies against resistant infections.
Area of Science:
- Microbiology
- Pharmacology
- Molecular Biology
Background:
- Aminoglycosides (AGs) are crucial antibiotics, but resistance in Pseudomonas aeruginosa is a growing concern.
- The AmgRS two-component system (TCS) is vital for P. aeruginosa to resist AGs by mitigating membrane damage.
- Understanding mechanisms to overcome AG resistance is critical for effective treatment strategies.
Purpose of the Study:
- To identify agents that enhance the activity of paromomycin (PAR), a 4,5-linked AG, against P. aeruginosa.
- To elucidate the mechanism by which rifampin (RIF) potentiates AG activity.
- To explore the potential of RIF as an adjuvant therapy for AG-resistant P. aeruginosa infections.
Main Methods:
- Conducted a screen to identify agents potentiating PAR activity.
- Tested RIF's potentiation of various AGs in wild-type and mutant P. aeruginosa strains.
- Investigated the role of the AmgRS TCS and RNA polymerase in RIF's potentiation effect.
- Assessed RIF's impact on AmgRS-dependent gene expression and MexXY efflux system activity.
Main Results:
- Rifampin (RIF) potentiated 4,5-linked AGs (e.g., paromomycin, neomycin) but not 4,6-linked AGs (e.g., amikacin, gentamicin).
- Potentiation was dependent on the AmgRS TCS and functional RNA polymerase.
- RIF reduced the expression of some AmgRS-dependent genes but did not impair membrane protection.
- RIF reversed AG resistance in clinical isolates, partly by downregulating the MexXY efflux system.
Conclusions:
- RIF potentiates specific AGs by interfering with the AmgRS TCS and RNA polymerase function in P. aeruginosa.
- RIF's ability to overcome AmgRS-mediated resistance, including MexXY efflux, highlights its potential as an adjuvant.
- Combination therapy with RIF and AGs may offer a strategy to treat challenging P. aeruginosa infections.
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