Abstract

The continued rise of antibiotic resistance threatens to undermine the utility of the world’s current antibiotic arsenal. This problem is particularly troubling when it comes to Gram-negative pathogens for which there are inherently fewer antibiotics available. To address this challenge, recent attention has been focused on finding compounds capable of disrupting the Gram-negative outer membrane as a means of potentiating otherwise Gram-positive-specific antibiotics. In this regard, agents capable of binding to the lipopolysaccharide (LPS) present in the Gram-negative outer membrane are of particular interest as synergists. Recently, thrombin-derived C-terminal peptides (TCPs) were reported to exhibit unique LPS-binding properties. We here describe investigations establishing the capacity of TCPs to act as synergists with the antibiotics erythromycin, rifampicin, novobiocin, and vancomycin against multiple Gram-negative strains including polymyxin-resistant clinical isolates. We further assessed the structural features most important for the observed synergy and characterized the outer membrane permeabilizing activity of the most potent synergists. Our investigations highlight the potential for such peptides in expanding the therapeutic range of antibiotics typically only used to treat Gram-positive infections.

Highlights

  • The rising tide of antibiotic resistance presents a clear threat to global health

  • It is well established that compared to Gram-positive pathogens, Gram-negative bacteria are more difficult to kill with antibiotics due to the presence of an additional barrier: the outer membrane (OM) [4,5]

  • Common to all four is the core sequence previously reported to be responsible for LPS binding [26]

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Summary

Introduction

The rising tide of antibiotic resistance presents a clear threat to global health. This threat, coupled with the well-documented dearth of new antibiotics in the development pipeline, means that resistant pathogens are even more problematic [1]. The World Health Organization (WHO) predicts that infections due to resistant bacteria will be the leading cause of death globally by 2050 [2]. Gram-negative pathogens is concerning given the limited number of viable treatment options available [3]. It is well established that compared to Gram-positive pathogens, Gram-negative bacteria are more difficult to kill with antibiotics due to the presence of an additional barrier: the outer membrane (OM) [4,5]. The OM protects Gram-negative bacteria from a large number

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