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2016 ; 60
(9
): 5322-30
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Repurposing the Nonsteroidal Anti-inflammatory Drug Diflunisal as an
Osteoprotective, Antivirulence Therapy for Staphylococcus aureus Osteomyelitis
#MMPMID27324764
Hendrix AS
; Spoonmore TJ
; Wilde AD
; Putnam NE
; Hammer ND
; Snyder DJ
; Guelcher SA
; Skaar EP
; Cassat JE
Antimicrob Agents Chemother
2016[Sep]; 60
(9
): 5322-30
PMID27324764
show ga
Staphylococcus aureus osteomyelitis is a common and debilitating invasive
infection of bone. Treatment of osteomyelitis is confounded by widespread
antimicrobial resistance and the propensity of bacteria to trigger pathological
changes in bone remodeling that limit antimicrobial penetration to the infectious
focus. Adjunctive therapies that limit pathogen-induced bone destruction could
therefore limit morbidity and enhance traditional antimicrobial therapies. In
this study, we evaluate the efficacy of the U.S. Food and Drug
Administration-approved, nonsteroidal anti-inflammatory (NSAID) compound
diflunisal in limiting S. aureus cytotoxicity toward skeletal cells and in
preventing bone destruction during staphylococcal osteomyelitis. Diflunisal is
known to inhibit S. aureus virulence factor production by the accessory gene
regulator (agr) locus, and we have previously demonstrated that the Agr system
plays a substantial role in pathological bone remodeling during staphylococcal
osteomyelitis. Consistent with these observations, we find that diflunisal
potently inhibits osteoblast cytotoxicity caused by S. aureus secreted toxins
independently of effects on bacterial growth. Compared to commonly used NSAIDs,
diflunisal is uniquely potent in the inhibition of skeletal cell death in vitro
Moreover, local delivery of diflunisal by means of a drug-eluting, bioresorbable
foam significantly limits bone destruction during S. aureus osteomyelitis in vivo
Collectively, these data demonstrate that diflunisal potently inhibits skeletal
cell death and bone destruction associated with S. aureus infection and may
therefore be a useful adjunctive therapy for osteomyelitis.