Recent findings from multinational resistance surveys: are we 'PROTEKTed' from resistance?

Continual monitoring of antimicrobial resistance rates is essential. Several large surveillance programmes have been established, including the international, longitudinal, multi-centre study PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin). Initiated in 1999, PROTEKT monitors the antibacterial susceptibility of common respiratory tract pathogens. This article reviews the findings from PROTEKT to date and anticipates future trends in antimicrobial resistance. Data from PROTEKT indicate that resistance patterns for Streptococcus pneumoniae and Haemophilus influenzae are changing, with an increasing prevalence of multi-drug resistant genotypes. Resistance to the ketolide telithromycin is very rare, with rates of S. pneumoniae susceptibility remaining >99%. The in vitro activity of telithromycin remains at a high level irrespective of pathogen genotype or phenotype.     

Mutation and evolution of antibiotic resistance: antibiotics as promoters of antibiotic resistance?

Antibiotic resistance appearance and spread have been classically considered the result of a process of natural selection, directed by the use of antibiotics. Bacteria, that have to face the antibiotic challenge, evolve to acquire resistance and, under this strong selective pressure, only the fittest survive, leading to the spread of resistance mechanisms and resistant clones. Horizontal transference of resistance mechanisms seems to be the main way of antibiotic resistance acquisition. Nevertheless, recent findings on hypermutability and antibiotic-induced hypermutation in bacteria have modified the landscape. Here, we present a review of the last data on molecular mechanisms of hypermutability in bacteria and their relationship with the acquisition of antibiotic resistance. Finally, we discuss the possibility that antibiotics may act not only as selectors for antibiotic resistant bacteria but also as resistance promoters.     

Do antibiotics maintain antibiotic resistance?

Important human pathogens resistant to antibiotics result from the human use of antibiotics. Does this imply that reducing their usage or removing antibiotics from medicine and agriculture will restore the effectiveness of these drugs? The authors argue that resistance evolution and susceptibility evolution are not, in a sense, just different sides of the same coin. Resistance genes acquire new functions and the initial costs of resistance can evolve into advantages. Decreasing drug use might not replace a fundamental change in drug design to avoid the evolution of resistant, and encourage the evolution of susceptible, microorganisms.     

α 2-adrenoceptors in rat resistance vessels

Summary In pithed rats increases in blood pressure were induced by i.v. injections of the ₁-agonist methoxamine and the ₂-agonists clonidine, oxymetazoline and B-HT 920. The pressor responses were further analyzed by repeated measurements of cardiac output with the thermodilution technique and by calculation of total peripheral vascular resistance. During the pressor phase both vascular resistance and cardiac output were found to be elevated. This indicates that increases in both haemodynamic variables contributed to the pressure rise. Under the assumption that elevated vascular resistance reflected constriction of arterioles and elevated cardiac output constriction of capacitance vessels via increased venous return to the heart, and considering that the magnitude of the increase of both haemodynamic parameters was similar for all three agonists, the results suggest the existence of both ₁- and ₂-adrenoceptors in resistance as well as in capaticance vessels of rats. For ₂-adrenoceptors in resistance vessels this conclusion was supported by the finding that the calcium antagonists verapamil and/or tiapamil virtually abolished the increases of blood pressure and vascular resistance in response to clonidine, oxymetazoline or B-HT 920, but not to methoxamine. The calcium antagonists did not affect the increases in cardiac output, irrespective of which type of -agonist was administered. While the present results support the existence of ₂-adrenoceptors in resistance vessels of the rat, they do not allow a firm conclusion as to their occurrence in rat capacitance vessels.     

Can light-based approaches overcome antimicrobial resistance?

The relentless rise of antibiotic resistance is considered one of the most serious problems facing mankind. This mini-review will cover three cutting-edge approaches that use light-based techniques to kill antibiotic-resistant microbial species, and treat localized infections. First, we will discuss antimicrobial photodynamic inactivation using rationally designed photosensitizes combined with visible light, with the added possibility of strong potentiation by inorganic salts such as potassium iodide. Second, the use of blue and violet light alone that activates endogenous photoactive porphyrins within the microbial cells. Third, it is used for “safe UVC” at wavelengths between 200 nm and 230 nm that can kill microbial cells without damaging host mammalian cells. We have gained evidence that all these approaches can kill multidrug resistant bacteria in vitro, and they do not induce themselves any resistance, and moreover can treat animal models of localized infections caused by resistant species that can be monitored by noninvasive bioluminescence imaging. Light-based antimicrobial approaches are becoming a growing translational part of anti-infective treatments in the current age of resistance.     

Glucocorticoid resistance - what is known?

It has become apparent in recent years that the glucocorticoid receptor is not a simple on/off switch, but instead orchestrates subtle and complex interactions between large numbers of proteins. This more sophisticated understanding awaits a unifying concept that will explain mechanisms of glucocorticoid resistance and allow new approaches to enhancing sensitivity.     

Development of TGF-β resistance during malignant progression

Transforming growth factor-beta (TGF-beta) is the prototypical multifunctional cytokine, participating in the regulation of vital cellular activities such as proliferation and differentiation as well as a number of basic physiological functions. The effects of TGF-beta are critically dependent on the expression and distribution of a family of TGF-beta receptors, the TGF-beta types I, II, and III. It is now known that a wide variety of human pathology can be caused by aberrant expression and function of these receptors. The coding sequence of the type II receptor (RII) appears to render it uniquely susceptible to DNA replication errors in the course of normal cell division. By virtue of its key role in the regulation of cell proliferation, TGF-beta RII should be considered as a tumor suppressor gene. High levels of mutation in the TGF-beta RII gene have been observed in a wide range of primarily epithelial malignancies, including colon and gastric cancer. It appears likely that mutation of the TGF-beta RII gene may be a very critical step in the pathway of carcinogenesis.     

The 4′-O-benzylated doxorubicin analog WP744 overcomes resistance mediated by P-glycoprotein,multidrug resistance protein and breast cancer resistance protein in cell lines and acute myeloid leukemia cells

Summary Background: The synthetic 4’-O-benzylated doxorubicin analog WP744 was designed to abrogate transport by the multidrug resistance (MDR)-associated ATP-binding cassette (ABC) proteins P-glycoprotein (Pgp) and multidrug resistance protein (MRP-1). We compared its uptake and cytotoxicity with those of doxorubicin and daunorubicin in cell lines overexpressing Pgp, MRP-1 or breast cancer resistance protein (BCRP) and in acute myeloid leukemia (AML) cells. Methods: Cellular uptake was studied by flow cytometry and cytotoxicity in 96-h 96-well cultures in cell lines overexpressing Pgp, MRP-1 or wild type (BCRP^R482) or mutant (BCRP^R482T, BCRP^R482G) BCRP and in pre-treatment AML marrow cells. Results: Uptake and cytotoxicity of WP744 were consistently greater than those of doxorubicin and daunorubicin at equimolar concentrations in all cell lines studied and in AML cells. Conclusion: WP744 overcomes transport by Pgp, MRP-1 and BCRP in cell lines and AML cells and is a promising agent for clinical development in AML and other malignancies with broad-spectrum multidrug resistance.     

Antimicrobial resistance in foodborne pathogens--a cause for concern?

The widespread use of antibiotics in food animal production systems has resulted in the emergence of antibiotic resistant zoonotic bacteria that can be transmitted to humans through the food chain. Infection with antibiotic resistant bacteria negatively impacts on public health, due to an increased incidence of treatment failure and severity of disease. Development of resistant bacteria in food animals can result from chromosomal mutations but is more commonly associated with the horizontal transfer of resistance determinants borne on mobile genetic elements. Food may represent a dynamic environment for the continuing transfer of antibiotic resistance determinants between bacteria. Current food preservation systems that use a combination of environmental stresses to reduce growth of bacteria, may serve to escalate development and dissemination of antibiotic resistance among food related pathogens. The increasing reliance on biocides for pathogen control in food production and processing, heightens the risk of selection of biocide-resistant strains. Of particular concern is the potential for sublethal exposure to biocides to select for bacteria with enhanced multi-drug efflux pump activity capable of providing both resistance to biocides and cross-resistance to multiple antibiotics. Although present evidence suggests that biocide resistance is associated with a physiological cost, the possibility of the development of adaptive mutations conferring increased fitness cannot be ruled-out. Strategies aimed at inhibiting efflux pumps and eliminating plasmids could help to restore therapeutic efficacy to antibiotics and reduce the spread of antibiotic resistant foodborne pathogens through the food chain.     

Does omethoate have the potential to cause insulin resistance?

Persistent organic pollutant exposure is strongly associated with the development of diabetes. The development of diabetes or alteration in blood glucose levels is associated with insulin resistance that precedes diabetes for many years. Omethoate is a commonly used insecticide in most developing countries. The present study was designed to elucidate the potent role of omethoate in developing insulin resistance in rats. Male Wistar rats were exposed to omethoate at the concentration of 1.5 mg/kg body weight (1/40 LD₅₀), 3 mg/kg body weight (1/20 LD₅₀) and 6 mg/kg body weight (1/10 LD₅₀) through gastric injection for 60 days; control group rats received PBS through gastric injection. The results showed that the levels of MDA, TNF-α and IL-6 were increased and the activities of SOD and GSH-Px were decreased in the right thigh muscles of rats exposed to omethoate. However, JNK, p38 MAPK and NF-κB in right thigh muscles of rats exposed to omethoate were activated. This study suggested that omethoate had a potential to cause insulin resistance.     

Horizontal gene transfer—emerging multidrug resistance in hospital bacteria

The frequency and spectrum of antibiotic resistant infections have increased worldwide during the past few decades. This increase has been attributed to a combination of microbial characteristics, the selective pressure of antimicrobial use, and social and technical changes that enhance the transmission of resistant organisms. The resistance is acquired by mutational change or by the acquisition of resistance-encoding genetic material which is transfered from another bacteria. The spread of antibiotic resistance genes may be causally related to the overuse of antibiotics in human health care and in animal feeds, increased use of invasive devices and procedures, a greater number of susceptible hosts, and lapses in infection control practices leading to increased transmission of resistant organisms. The resistance gene sequences are integrated by recombination into several classes of naturally occurring gene expression cassettes and disseminated within the microbial population by horizontal gene transfer