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Antimicrobial Agents and Chemotherapy, December 2003, p. 3859-3866, Vol. 47, No. 12
0066-4804/03/$08.00+0 DOI: 10.1128/AAC.47.12.3859-3866.2003
Copyright © 2003, American
Society for
Microbiology. All Rights Reserved.
Molecular Biophysics Unit, Indian Institute of Science, Bangalore 560 012,1 Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bangalore 560 064, India2
Received 16 October 2002/ Returned for modification 25 November 2002/ Accepted 18 August 2003
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2,4,4'-Trichloro-2'-hydroxy-diphenyl ether, commonly referred to as triclosan, is a broad-spectrum hydrophobic antimicrobial agent. Because of its favorable safety profile, triclosan has been used for the past 2 decades in several dermatological preparations and oral hygiene products. Results of toxicology studies show that triclosan and its metabolites are well tolerated by a variety of species, including human beings (1, 5, 21, 37). Triclosan is not a carcinogen, mutagen, or teratogen and has been found to be safe in reproductive studies (5, 37). Though triclosan was suggested to have membranotropic effects, its recently discovered principal target is enoyl-acyl carrier protein (ACP) reductase, a key enzyme catalyzing the rate-determining step of the elongation cycle of the type II fatty acid biosynthesis pathway (14, 27, 39).
Fatty acids are essential components of phospholipids and sphingolipids that make up the plasma membrane and the membranes of intracellular organelles and are therefore indispensable to living systems. All organisms, therefore, have the ability to synthesize fatty acids from simple precursors, except the mycoplasmas, which scavenge them from their hosts. Fatty acid synthesis basically involves a succession of reduction and dehydration steps following the condensation of acetyl and malonyl moieties to build the fatty acid chain. This series of steps is brought about by distinct enzymes in the dissociative type of fatty acid synthase (FAS) or type II FAS (FASII) system present in bacteria and plastids of plants and algae but is brought about by a single multifunctional enzyme in the associative type of FAS (FASI) present in animal cells, yeasts, and fungi. These differences in the FAS systems of mammals, bacteria, and protozoans have given impetus to the development of the inhibitors of FASII as candidate drugs for treating infectious diseases (11, 25, 33). Among these inhibitors, none is as potent as triclosan (12, 33). The type I fatty acid biosynthesis pathway that operates in human beings is not inhibited by triclosan (33). The indispensability of fatty acid synthesis to life, coupled with the different systems of FAS operating in bacteria and its human hosts, makes triclosan a valuable antibacterial agent worthy of exploration for treating systemic bacterial infections.
The kinetics of inhibition of the bacterial enoyl-ACP reductases, as well as of the Plasmodium falciparum enoyl-ACP reductases by triclosan, has been well elucidated (10, 12, 13, 17, 30, 31, 32, 38). Moreover, in the span of the 2 decades of its use, there have been no reports of triclosan-resistant microbes in the wild, though Escherichia coli and Sphingosamine strains have been selected for resistance in vitro in the laboratory (9, 27). Though all these facts make triclosan a valuable antibiotic, its use has hitherto been limited to topical applications, principally due to problems of drug delivery. Toxicology studies performed with Sprague Dawley rats indicate that the oral, intravenous, and subcutaneous 50% lethal dose values for triclosan are approximately 4,000, 29, and 14,700 mg/kg of body weight, respectively (21), clearly ruling out intravenous delivery of triclosan. Here we report for the first time the efficacy of triclosan as an antibacterial agent in systemic bacterial infections. Our experiments demonstrate that triclosan, in a low-dose, galactosamine-sensitized mouse model of an acute E. coli O55:B5 infection, can increase the survival time by up to 48 h, compared to just 7 to 10 h for uninfected mice and 24 h with ampicillin and tetracycline. Our findings may have significant implications for treating systemic bacterial infections.
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Bacterial strain. The bacterial strain used for the study was E. coli O55:B5. The inoculum used, which contained 107 CFU in 0.4 ml of pyrogen-free saline, was prepared by growing a single colony of the bacterium overnight in Luria-Bertani (LB) broth and washing the cells with 0.9% saline made in endotoxin-free water.
Animals. BALB/c mice 6 to 9 weeks of age were used for the study. All animals were kept under pathogen-free conditions during the study.
Infection of animals. The animals were injected intraperitoneally with 0.4 ml of pyrogen-free saline containing 107 CFU of bacteria and D-galactosamine (300 mg/kg of body weight) (4, 8, 19).
Drug administration. A subcutaneous injection of triclosan (40 mg/kg) in sterile DMSO was given middorsally 2 h prior to bacterial infection and every 12 h after infection. Ampicillin (40 mg/kg), tetracycline (40 mg/kg), or pyrogen-free water alone was subcutaneously or intraperitoneally injected into other groups of mice. Each group consisted of six male mice, and the experiments were repeated at least three times. All drug stocks used were tested for their antibacterial efficacies by disk diffusion susceptibility tests before use in the animal experiments.
Histopathology. Mice were sacrificed by cervical dislocation and dissected, and their livers, lungs, kidneys, and hearts were removed for histopathological analysis. For blood analysis, animals were bled from the retro-orbital complex, and the serum of each mouse was analyzed for urea, glucose, creatinine, serum glutamic pyruvic transaminase (SGPT) (serum alanine aminotransferase), and serum glutamic oxaloacetic transaminase (SGOT).
Assay for detection of
TNF-
.
The tumor
necrosis factor alpha (TNF-
) level in the serum was determined
by a bioassay using the L2N2 macrophage cell line
(15). TNF-
levels of uninfected mice, uninfected mice administered triclosan,
uninfected mice administered 500 µg of lipopolysaccharide
(LPS), and infected mice administered triclosan, ampicillin, and
tetracycline were determined at 1, 2, and 3 h after infection
or sham injection.
Quantitative assessment of viable bacteria in infected and treated mice. Mice were subcutaneously injected with 40 mg of triclosan/kg in DMSO, plain DMSO, or 40 mg of ampicillin/kg, 3 h after which they were infected with 107 CFU bacteria injected intraperitoneally. Blood was drawn in heparin from the intraorbital vein at 3, 7, and 10 h after infection. The plasma was separated from the blood cells and plated at a dilution of 1:102 on LB agar. The number of colonies was assessed after overnight incubation at 37°C. The MICs and 50% inhibitory concentrations (IC50s) for these isolates were also determined by using the procedure outlined below.
Quantitation of triclosan in vivo after injection in mice. Blood was collected in heparin from 6- to 8-week-old BALB/c mice at different time points (3, 7, 10, 20, and 36 h). Triclosan was subcutaneously injected into the mice at 0, 12, 24, and 36 h. The plasma was separated, and up to 1 ml of plasma in an equal volume of 0.2 M sodium acetate-acetic acid (pH 5.0) was added. To this, ß-glucuronidase (100 U) was added, and the solution was mixed and incubated at 40°C for 10 to 15 h. Solid-phase extraction was done by using SEP-PAK columns (Millipore Waters). The columns were prepared by passing 3 ml of methanol and then 1 ml of water through them. After the sample was loaded, the column was rinsed with 1 ml of distilled water and dried under vacuum for 5 min. The samples were eluted with 700 µl of methanol. The eluate was diluted 1:1 in distilled water, loaded on a C18 reverse-phase column (4.6 mm by 25 cm), and eluted with an isocratic gradient of acetonitrile and 0.1% trifluoroacetic-acid-phosphate (60/40) by using FPLC-AKTA Basic (Amersham Pharmacia). The absorbance was measured at 230, 240, and 280 nm.
MIC and IC50 determinations. The MICs of triclosan, tetracycline, and ampicillin for the infecting strain of E. coli used, O55:B5, were determined by growing the bacteria in the presence of various concentrations of the compound of interest in LB broth at 37°C with shaking. The absorbance at 600 nm was read after 12 h and plotted versus the log concentration of the antimicrobial used. The MIC was read as the lowest concentration that resulted in no bacterial growth after 12 h, and the IC50 was determined as the concentration of the antimicrobial at which there was a 50% reduction of the absorbance at 600 nm.
Statistical test. The differences in the experimental values obtained for the different groups were tested for statistical significance by one-way analysis of variance (ANOVA). A P value less than 0.01 was considered significant.
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FIG. 1. Survival
times based on a a low-dose, galactosamine-sensitized mouse model of an
acute, systemic E. coli infection. The survival time of the
mice was 48 h (±5 h) upon triclosan treatment
compared to only 8 h (±1 h) for untreated and
28 h (±3 h) and 24 h (±2 h) for
ampicillin- and tetracycline-treated mice, respectively. Statistical
significance was tested by one-way ANOVA (P < 0.001,
n = 5). (Inset) Triclosan administration along with,
instead of prior to, infection as well as intraperitoneal
administration instead of subcutaneous administration also increased
the survival time to 48
h.
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FIG. 2. Liver
histopathology (methylene blue and eosin yellow staining) indicates
normal biliary parenchyma in control (a) and triclosan-administered (b)
mice. Liver sections of infected mice (c) show hydropic and fatty
changes with areas of hemorrhage, indicative of severe liver damage,
which is considerably reduced in infected mice administered triclosan
(d).
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View this table: [in a new window] |
TABLE 1. Analysis
of blood samples of all four groups of micea
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levels.
A bioassay to mark
the presence of serum TNF-
demonstrated that TNF-
levels were not detectable in the control group or in uninfected mice
receiving triclosan; however, the serum TNF-
level was
elevated in mice with acute bacterial infection. It reached a maximum
at around 1 h after infection and declined during the next
2 h. Significantly, TNF-
was substantially reduced
1 h after infection in mice treated with triclosan prior to
infection and was undetectable by 3 h after infection (Fig.
3). The antibiotics ampicillin and tetracycline also modulated
TNF-
levels in a similar manner (Fig.
3). Triclosan did not
lower TNF-
levels in mice administered 500 µg of LPS
alone, suggesting that triclosan exerts its effects on TNF-
production by virtue of its antibacterial effect
only.
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FIG. 3. The
serum TNF- level, undetectable in the untreated mice, was
elevated in mice with bacterial infection. Triclosan, ampicillin, or
tetracycline administration prior to infection resulted in a
significantly lower level of TNF- . Animals not infected with
bacteria but treated with triclosan showed no TNF- in their
sera. Animals treated with 500 µg of LPS/kg had TNF-
levels of 5.2, 6.0, and 4.6 at 1, 2, and 3 h,
respectively.
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levels gave an idea of the efficacy of the triclosan
treatment, in order to assess the antibacterial effect of triclosan, a
more direct method was required. Therefore, we assessed the effect of
triclosan by assessing bacteremia after infection with and without
treatment. Counts of viable bacteria present in the blood after
infection with and without treatment with triclosan showed that while
the bacteremia in the control mice increased rapidly from around 5
x 104 CFU at 3 h up to 3 x
105 CFU at 10 h after infection, the counts of
viable bacteria in the ampicillin- and triclosan-treated mice were much
lower. In the triclosan-treated mice, the bacteremia steadily decreased
to less than 5 x 104 CFU at 10 h after
infection but reached around 3 x 105 CFU at
45 h. In the ampicillin-treated mice, the viable-cell counts
decreased to less than 5 x 104 CFU at 7 h
after infection but rose to around 1.5 x 105 CFU at
10 h after infection (Fig.
4). Neither the IC50s nor the MICs of ampicillin and triclosan
were altered for the bacterial strains isolated at 10 and 45
h, respectively, from the ampicillin- and triclosan-treated
mice.
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FIG. 4. Counts
of viable bacteria in the blood of infected control mice (bars labeled
"1"), ampicillin-treated mice (bars labeled
"2"), or triclosan-treated mice (bars labeled
"3") after 3 h (open bars), 7 h
(hatched bars), 10 h (checkerboard bars), and 45 h
(solid bar). Triclosan or ampicillin administration resulted in lower
bacteremia.
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MICs of triclosan, ampicillin, and tetracycline. The MICs of triclosan, ampicillin, and tetracycline were determined by standard techniques as described above (Fig. 6). The results confirmed that the strain of E. coli which we used for the experiments, O55:B5, was indeed sensitive to triclosan, ampicillin, and tetracycline. The MICs of triclosan, ampicillin, and tetracycline were 600 nM (i.e., 172 ng/ml), 8 µM (i.e., 2,971 ng/ml), and 5 µM (i.e., 2,222 ng/ml), respectively (the range of MIC breakpoints of ampicillin and tetracycline for E. coli-susceptible strains are 5.4 to 21.5 µM, i.e., 2,005 to 7,985 ng/ml, and 2.25 to 9 µM, i.e., 1,000 to 4,000 ng/ml, respectively).
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FIG. 6. Inhibition
curves of ampicillin (MIC, 8 µM) (a), tetracycline (MIC, 5
µM) (b), and triclosan (MIC, 600 nM) (c). The IC50
of triclosan was found to be around 150 nM, and the MIC was 600 nM.
OD600, optical density at 600
nm.
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48 h) compared to that of mice administered
ampicillin or tetracycline (
24 to 30 h). The longer
survival time achieved with triclosan clearly indicates the superiority
of triclosan as an antibacterial agent for systemic infections compared
to ampicillin and tetracycline
(20,
22,
29,
40,
43). Moreover, at the
dosage of 40 mg/kg, the concentration of triclosan used during this
study, the levels of triclosan in the blood were around 3 to 9
µM (864 to 2,592 ng/ml) (as determined by FPLC), which is
greater than the MIC of triclosan. This explains why triclosan at this
dosage is effective at reducing the bacteremia and increasing the
survival time of the mice. Assuming a total volume in the blood of 3 ml
per mouse (average weight,
20 g), the effective amount of
triclosan in the blood coming from a dosage of 40 mg/kg, i.e., 800
µg/mouse, is 3 µg, which is therapeutic and yet comes
from a dosage below the level at which no effects were
observed. Histopathology studies using sections of kidney, spleen, heart, and lung revealed no significant changes, whereas sections of the liver mirrored the pathological state of the mice (Fig. 2). A normal pattern of biliary parenchyma was seen in sections of liver from uninfected mice as well as those from infected mice administered only triclosan, demonstrating the excellent safety profile of triclosan. Sections of liver from infected mice were, however, punctuated by fatty and hydropic changes as well as by regions of hemorrhages, indicative of severe liver damage. The finding of considerably fewer areas of congestion and fatty changes in sections of liver from triclosan-administered infected mice clearly reiterates its efficacy as a systemic antibacterial agent. Thus, these histopathological studies confirm the safety of triclosan injected subcutaneously or intraperitoneally and also highlight its profound antibacterial effect.
Triclosan by itself did not alter any of the blood parameters (Table 1). However, its administration to infected mice brought most of these parameters closer to the values observed for the uninfected mice. These results thus highlight the potency of triclosan as a curative agent in systemic bacterial infections.
TNF-
, a polyfunctional, proinflammatory
cytokine, is known to exhibit characteristic kinetics of appearance in
the serum following infection with gram-negative bacteria and plays the
role of a central mediator of the shock which develops in the course of
bacterial infections
(34). The elevated level
of TNF-
, a hallmark of bacterial infections, is reduced by
treatment with several antibiotics
(22,
29). Tetracyclines, for
instance, have been reported to significantly reduce the serum
interleukin-1
and TNF-
levels at the times of peak
production, i.e., around 4 and 2 h, respectively, after LPS
challenge, and to maintain this effect even 12 h afterwards
(22). In our study, the
serum TNF-
level in mice infected with E. coli did
shoot up rapidly within the first hour of infection and subsequently
decreased to undetectable levels, as expected. Strikingly, however, the
initial high level of TNF-
in infected mice was substantially
lowered on administration of triclosan prior to infection, as it also
was by administration of ampicillin and tetracycline (Fig.
3). Production of
TNF-
was not seen in the sham-infected control mice or in the
uninfected mice treated with triclosan. Triclosan had no effect on
TNF-
levels of mice treated with LPS alone, ruling out any
direct link between the production of the cytokine and the
hydroxydiphenyl ether. This finding that triclosan, in fact, modulates
serum TNF-
levels in the infected mice alone adds credence to
our other results, confirming the efficacy of triclosan as a systemic
antibacterial agent in the acute-bacterial-challenge mouse
model.
We have also demonstrated that the effects seen in the experiments are antimicrobial in nature by quantitative assessment of viable bacteria in treated and control mice, again ruling out the theory that the effect is entirely due to triclosan-blocking cytokine effects, improving survival as a biological response modifier (Fig. 3 and 4). Moreover, the levels of triclosan in blood reached clinical levels during the time that the counts of viable bacteria in the blood were reduced in the triclosan-treated mice compared to counts in the controls, thus confirming the antimicrobial effect of triclosan (Fig. 4 and 5).
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FIG. 5. FPLC
detection of triclosan levels in blood with a C18
reverse-phase column by monitoring absorbance at 230, 240, and 280 nm.
Triclosan levels in blood were detectable by 3 h after
intraperitoneal injection. Triclosan levels were detected at 3, 7, 10,
20, and 36 h after infection. Additional dosages of triclosan
were given at 12, 24, and 36 h,
respectively.
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* Mailing address for Namita Surolia: Molecular Biology and Genetics
Unit, Jawaharlal Nehru Centre for Advanced Scientific Research,
Bangalore 560 064, India. Phone: 91-80-8462750. Fax: 91-80-8462766.
E-mail: surolia{at}jncasr.ac.in. ![]()
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