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      Protein-inspired antibiotics active against vancomycin- and daptomycin-resistant bacteria

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          Abstract

          The public health threat posed by a looming ‘post-antibiotic’ era necessitates new approaches to antibiotic discovery. Drug development has typically avoided exploitation of membrane-binding properties, in contrast to nature’s control of biological pathways via modulation of membrane-associated proteins and membrane lipid composition. Here, we describe the rejuvenation of the glycopeptide antibiotic vancomycin via selective targeting of bacterial membranes. Peptide libraries based on positively charged electrostatic effector sequences are ligated to N-terminal lipophilic membrane-insertive elements and then conjugated to vancomycin. These modified lipoglycopeptides, the ‘vancapticins’, possess enhanced membrane affinity and activity against methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive bacteria, and retain activity against glycopeptide-resistant strains. Optimised antibiotics show in vivo efficacy in multiple models of bacterial infection. This membrane-targeting strategy has potential to ‘revitalise’ antibiotics that have lost effectiveness against recalcitrant bacteria, or enhance the activity of other intravenous-administered drugs that target membrane-associated receptors.

          Abstract

          The antibiotic vancomycin inhibits bacterial cell wall synthesis by binding to a membrane-associated precursor. Here, Blaskovich et al. synthesize vancomycin derivatives containing lipophilic peptide moieties that enhance membrane affinity and in vivo activities against glycopeptide-resistant strains.

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          Physiological parameters in laboratory animals and humans.

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            The effect of plasma protein binding on in vivo efficacy: misconceptions in drug discovery.

            Data from in vitro plasma protein binding experiments that determine the fraction of protein-bound drug are frequently used in drug discovery to guide structure design and to prioritize compounds for in vivo studies. However, we consider that these practices are usually misleading, because in vivo efficacy is determined by the free (unbound) drug concentration surrounding the therapeutic target, not by the free drug fraction. These practices yield no enhancement of the in vivo free drug concentration. So, decisions based on free drug fraction could result in the wrong compounds being advanced through drug discovery programmes. This Perspective provides guidance on the application of plasma protein binding information in drug discovery.
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              Vancomycin Resistance in Staphylococcus aureus


              The evolution of Staphylococcus aureus during the modern antibiotic era has been delineated by distinct strain emergence events, many of which include acquisition of antibiotic resistance. The relative high burden of methicillin-resistant S. aureus (MRSA) in healthcare and community settings is a major concern worldwide. Vancomycin, a glycopeptide antibiotic that inhibits cell wall biosynthesis, remains a drug of choice for treatment of severe MRSA infections. S. aureus strains exhibiting increased resistance to vancomycin, known as vancomycin intermediate-resistant S. aureus (VISA) (MIC = 4-8 µg/mL), were discovered in the 1990s. The molecular basis of resistance in VISA is polygenic and involves stepwise mutations in genes encoding molecules predominantly involved in cell envelope biosynthesis. S. aureus isolates with complete resistance to vancomycin (MIC ≥ 16 µg/mL) are termed vancomycin-resistant S. aureus (VRSA)—they were first reported in the U.S. in 2002. Resistance in VRSA is conferred by the vanA gene and operon, which is present on a plasmid. Although treatment of VRSA infections is challenging, the total number of human VRSA infections to date is limited (14 in the U.S.). By comparison, the burden of VISA is relatively high and the molecular mechanisms of resistance are less well-defined. VISA are associated with persistent infections, vancomycin treatment failure, and poor clinical outcomes. Here, we review in brief progress made toward understanding the acquisition of antibiotic resistance in S. aureus, with an emphasis on the molecular mechanisms underlying vancomycin resistance.
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                Author and article information

                Contributors
                m.blaskovich@uq.edu.au
                m.cooper@uq.edu.au
                Journal
                Nat Commun
                Nat Commun
                Nature Communications
                Nature Publishing Group UK (London )
                2041-1723
                2 January 2018
                2 January 2018
                2018
                : 9
                : 22
                Affiliations
                [1 ]ISNI 0000 0000 9320 7537, GRID grid.1003.2, Institute for Molecular Bioscience, , The University of Queensland, ; St. Lucia, QLD 4072 Australia
                [2 ]ISNI 0000 0000 9320 7537, GRID grid.1003.2, UQ Centre for Clinical Research, , The University of Queensland, Royal Brisbane and Women’s Hospital Campus, ; Brisbane, QLD 4029 Australia
                [3 ]AdProTech Ltd, Chesterford Research Park, Saffron Walden, Essex CB10 1XL UK
                [4 ]ISNI 0000 0000 9320 7537, GRID grid.1003.2, School of Pharmacy, , The University of Queensland, ; Brisbane, QLD 4102 Australia
                [5 ]GRID grid.476060.3, Present Address: AC Immune SA, EPFL Innovation Park, ; CH-1015 Lausanne, Switzerland
                [6 ]GRID grid.480138.6, Present Address: Novasep (Dynamit Nobel Explosivstoff und Systemtechnik), ; Kalkstrasse 218, 51377 Leverkusen, Germany
                [7 ]GRID grid.434747.7, Present Address: Illumina Cambridge Ltd, Capital Park, Fulbourn, ; Cambridge, CB21 5XE UK
                [8 ]Present Address: Sterling Pharma Solutions, Sterling Place, Dudley, Cramlington, Northumberland NE23 7QG UK
                [9 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Present Address: School of Immunology and Microbial Science, , Kings College London, Guy’s Hospital, ; London, SE1 9RT UK
                Author information
                http://orcid.org/0000-0001-9447-2292
                http://orcid.org/0000-0003-2535-9071
                http://orcid.org/0000-0001-6689-4236
                http://orcid.org/0000-0002-9664-3101
                http://orcid.org/0000-0001-7540-434X
                http://orcid.org/0000-0001-6145-8363
                http://orcid.org/0000-0002-2983-0484
                http://orcid.org/0000-0001-6240-6020
                Article
                2123
                10.1038/s41467-017-02123-w
                5750218
                29295973
                01d48737-4403-409d-8503-395cf280d910
                © The Author(s) 2017

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 24 November 2016
                : 8 November 2017
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