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2016 ; 2
(7
): 478-88
Nephropedia Template TP
gab.com Text
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English Wikipedia
An "Unlikely" Pair: The Antimicrobial Synergy of Polymyxin B in Combination with
the Cystic Fibrosis Transmembrane Conductance Regulator Drugs KALYDECO and
ORKAMBI
#MMPMID27626100
Schneider EK
; Azad MA
; Han ML
; Tony Zhou Q
; Wang J
; Huang JX
; Cooper MA
; Doi Y
; Baker MA
; Bergen PJ
; Muller MT
; Li J
; Velkov T
ACS Infect Dis
2016[Jul]; 2
(7
): 478-88
PMID27626100
show ga
Novel combination therapies are desperately needed for combating lung infections
caused by bacterial "superbugs". This study aimed to investigate the synergistic
antibacterial activity of polymyxin B in combination with the cystic fibrosis
(CF) drugs KALYDECO (ivacaftor) and ORKAMBI (ivacaftor + lumacaftor) against
Gram-negative pathogens that commonly colonize the CF lung, in particular, the
problematic Pseudomonas aeruginosa. The in vitro synergistic activity of
polymyxin B combined with ivacaftor or lumacaftor was assessed using checkerboard
and static time-kill assays against a panel of polymyxin-susceptible and
polymyxin-resistant P. aeruginosa isolates from the lungs of CF patients.
Polymyxin B, ivacaftor, and lumacaftor were ineffective when used individually
against polymyxin-resistant (MIC ? 4 mg/L) isolates. However, when used together,
the combination of clinically relevant concentrations of polymyxin B (2 mg/L)
combined with ivacaftor (8 mg/L) or ivacaftor (8 mg/L) + lumacaftor (8 mg/L)
displayed synergistic killing activity against polymyxin-resistant P. aeruginosa
isolates as demonstrated by a 100-fold decrease in the bacterial count (CFU/mL)
even after 24 h. The combinations also displayed excellent antibacterial activity
against P. aeruginosa under CF relevant conditions in a sputum medium assay. The
combination of lumacaftor (alone) with polymyxin B showed additivity against P.
aeruginosa. The potential antimicrobial mode of action of the combinations
against P. aeruginosa was investigated using different methods. Treatment with
the combinations induced cytosolic GFP release from P. aeruginosa cells and
showed permeabilizing activity in the nitrocefin assay, indicating damage to both
the outer and inner Gram-negative cell membranes. Moreover, scanning and
transmission electron micrographs revealed that the combinations produce outer
membrane damage to P. aeruginosa cells that is distinct from the effect of each
compound per se. Ivacaftor was also shown to be a weak inhibitor of the bacterial
DNA gyrase and topoisomerase IV with no effect on either human type I or type II?
topoisomerases. Lumacaftor displayed the ability to increase the cellular
production of damaging reactive oxygen species. In summary, the combination of
polymyxin B with KALYDECO or ORKAMBI exhibited synergistic activity against
highly polymyxin-resistant P. aeruginosa CF isolates and can be potentially
useful for otherwise untreatable CF lung infections.