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Antimicrobial Agents and Chemotherapy, February 2007, p. 468-474, Vol. 51, No. 2
0066-4804/07/$08.00+0 doi:10.1128/AAC.01030-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
INRA Université de Bordeaux 2, UMR Génomique Développement Pouvoir Pathogène, 71 avenue Edouard Bourlaux, 33883 Villenave D'Ornon, France,1 Université de Rennes I, UMR CNRS 6026 Interactions Cellulaires et Moléculaires, Campus de Beaulieu, 35042 Rennes, France2
Received 17 August 2006/ Returned for modification 4 October 2006/ Accepted 3 November 2006
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This work focused on mycoplasmas (class Mollicutes), which include pathogens causing persistent and chronic respiratory, arthritic, and urogenital diseases in humans and many animal hosts (5, 15, 17). These minimalist bacteria (9) are characterized by the simplicity of their cell envelope, which lacks a cell wall and other components (lipopolysaccharide, outer membrane, and teichoic acids) found in gram-positive or gram-negative bacteria. This simplicity explains why mycoplasmas are attractive organisms for the study of antibiotics such as AMPs, which primarily target the plasma membrane. It also explains why the number of antibiotics that can be used for treating mycoplasmal infections is limited to tetracyclines, the macrolide-lincosamide-streptogramine-ketolide group, fluoroquinolones, and phenicols (2). The present work focuses on Mycoplasma pulmonis, which is the etiologic agent of respiratory mycoplasmosis in rodents. This pathogen is considered a very useful model for studying mycoplasmal respiratory infections, including those commonly caused by Mycoplasma pneumoniae in humans (17).
More specifically, we investigated (i) the influences of the antibiotic concentration, bacterial density, and incubation time on the antimycoplasmal activities of four AMPs (alamethicin, gramicidin S, globomycin, and surfactin) and (ii) the benefits of combining them with EFX, a fluoroquinolone widely used in veterinary medicine and having a potent activity against mycoplasmas (for a review, see reference 2). Among the four AMPs mentioned above, alamethicin is a 20-residue amphipathic peptide produced by the fungus Trichoderma viride and a member of the peptaibol family (for a review, see reference 25). Alamethicin helices form transmembrane voltage-dependent pores by aggregation in lipid bilayers (for a review, see references 12 and 18). The other AMPs are of bacterial origin and share a cyclic structure. While gramicidin S is a decapeptide (for a review, see reference 24) surfactin is a lipo-octapeptide acting as a surfactant on bacterial membranes (for a review, see reference 22), and globomycin is a lipopentapeptide that specifically inhibits bacterial signal peptidase II (11, 23, 26). These four AMPs were chosen for their structural diversity, for their known antimycoplasmal activities (4, 14), and because additive effects with EFX on mycoplasmas have already been observed in a tissue cell culture model system (20).
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Antimicrobial agents. Alamethicin, gramicidin S, surfactin, chloramphenicol, tylosine, mitomycin C, and tetracycline were of commercial origin (Sigma), whereas globomycin was a gift from S. Miyakoshi (Sankyo Co., Japan). Streptomycin and EFX were obtained from Laboratoires Diamant (Paris, France) and Bayer AG (Leverkusen, Germany), respectively.
Determination of the MICs and the MBCs.
The antimycoplasmal activities of antibiotics were determined as described previously (4, 14). Briefly, mycoplasmas at an initial concentration of 106 CFU/ml were grown in Hayflick medium containing 5% horse serum in 96-well plates in the presence of twofold serial dilutions of the antibiotics. The drug concentrations ranged from 0.4 to 100 µM. A change in the color of the phenol red added to the medium as a pH indicator was used to monitor bacterial growth. The MIC was defined as the lowest antibiotic concentration that completely inhibited the growth of mycoplasmas after 48 h. For minimal bactericidal concentration (MBC) determinations, cells were incubated in the presence of AMPs for 2 h and EFX for 24 h and then plated on solid culture medium. The plates were incubated at 37°C under anaerobic conditions and examined after 4 to 5 days for the appearance of colonies. The MBC was defined as the lowest antibiotic concentration that killed
99.9% of the cells. Experiments were performed in triplicate.
Checkerboard titration for antibiotic combination studies.
Antibiotic combinations were tested by the checkerboard titration method using 96-well microtiter plates. The drug concentrations ranged from 0.4 to 50 µM, 0.1 to 1.25 µM, 0.05 to 6.25 µM, 0.012 to 1.6 µM, and 0.006 to 0.8 µM for surfactin, alamethicin, gramicidin S, globomycin, and EFX, respectively. The fractional inhibitory concentration (FIC) index for combinations of two antimicrobials was calculated according to the following equation: FIC index = FICA + FICB = (A/MICA) + (B/MICB), where A and B are the MICs of drug A and drug B in the combination and MICA and MICB are the MICs of drug A and drug B alone. The FIC indexes were interpreted as follows:
0.5, synergy; >0.5 to 4, indifference; >4, antagonism (13). Experiments were performed in duplicate.
Time-kill assay. Aliquots of exponentially growing mycoplasmas (2.5 x 108 CFU/ml in Hayflick medium) were resuspended in fresh Hayflick broth at approximately 108, 106, and 104 CFU/ml and exposed to antimicrobial agents alone at 1x MIC for 1, 2, or 24 h at 37°C. Then, 0.1-ml samples were serially diluted in Hayflick medium and plated onto agar plates to obtain viable colonies. The control experiment consisted of plating cultures of MpUR1.1 without antibiotics. For combination studies, antimicrobial agents were used at their MIC or at concentrations equal to MIC/2 for EFX, MIC/4 for alamethicin, and MIC/16 for surfactin according to checkerboard titration results. Experiments were performed in duplicate.
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TABLE 1. MICs and MBCs of AMPs and enrofloxacin for M. pulmonis MpUR1.1a
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FIG. 1. Effects of variations in the M. pulmonis concentration on the MICs of AMPs and enrofloxacin. Various concentrations (104 to 108 CFU/ml) of exponential-phase growing cells of MpUR1.1 were incubated with twofold dilutions of antibiotics. Inhibitory concentrations of antibiotics were determined by monitoring changes of color of phenol red after 24 and 48 h. For each cellular concentration, the inhibitory-concentration/MIC ratio was calculated. At the standard concentration (106 CFU/ml), the ratio was equal to 1. The experiment was performed three times, and the results did not vary from one experiment to the next.
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FIG. 2. Effects of variations in the M. pulmonis concentration on the bactericidal activities of AMPs and EFX. Cultures of M. pulmonis at three different concentrations (104, 106, and 108 CFU/ml) were incubated with antibiotics (concentration equal to the MIC). Aliquots were withdrawn after 24 h and diluted to obtain a viable count expressed as a percentage of the viable count of the control culture (without antibiotic). Average values from two independent experiments are shown. The values did not vary significantly from one experiment to the next (at most, there was a 10% variation in the number of CFU/ml).
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FIG. 3. Rates of killing of M. pulmonis by AMPs and enrofloxacin. Log-phase bacteria (about 106 CFU/ml) were obtained in Hayflick medium, and concentrations equal to the MICs of antibiotics (Table 1) were added at time zero. Aliquots were withdrawn at the indicated times (1, 2, and 24 h) and diluted to count viable cells. The percentage of viable cells was equal to 100% for the control (i.e., MpUR1.1 without antibiotic). Average values from two independent experiments are shown. The values did not vary significantly from one experiment to the next (at most, there was a 6.4% variation in the number of CFU/ml).
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In the checkerboard method, the FIC indexes were equal to 0.56 for the EFX-surfactin association, 0.75 for EFX-alamethicin, and 1 for both EFX-globomycin and EFX-gramicidin S associations (Fig. 4). Actually, the FIC of the EFX-surfactin combination suggested a synergy of action of the two compounds, since it proved to be quite close to the threshold (FIC
0.5) defined by current international standards for synergistic action (21).
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FIG. 4. Effects of combinations of enrofloxacin and AMPs on M. pulmonis growth by the checkerboard system. A culture of M. pulmonis (106 CFU/ml) was incubated with twofold dilutions of antibiotic associations from 2x MIC to MIC/32. The inhibition of growth was monitored by the color change of Hayflick medium. FIC indexes were subsequently calculated (see Materials and Methods) for each of the combinations: EFX with alamethicin (A), with surfactin (B), with globomycin (C), and with gramicidin S (D). Experiments were performed in duplicate. No significant changes were observed from one experiment to another.
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A time course killing assay using EFX and AMPs at their MICs indicated that whatever the time of incubation (1, 2, or 24 h), the number of viable cells detected after the action of EFX-gramicidin S or EFX-globomycin combinations on M. pulmonis was similar to that obtained after the action of each of the AMPs alone (Fig. 5A). In contrast, for the EFX-surfactin combination, the number of viable cells dropped by almost 2 orders of magnitude (
90-fold) after 24 h compared to the action of surfactin alone (Fig. 5A). The EFX-alamethicin combination showed the highest efficacy, even after 1 hour (2.4% of viable cells versus 31% with the AMP alone). After 2 h of incubation, cell killing was close to 99.9%, meaning that the number of viable cells was 100 times lower than with the AMP alone (Fig. 5A).
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FIG. 5. Effects of the combination of enrofloxacin and AMPs on M. pulmonis growth by the viable-cell count technique. (A) Log-phase bacteria (about 106 CFU/ml) were obtained in Hayflick medium. The viable-cell count was assessed by incubating mycoplasma with each antibiotic alone or with a combination of concentrations of enrofloxacin with globomycin, gramicidin S, surfactin, and alamethicin equal to the MIC. Aliquots were withdrawn after 1, 2, and 24 h and diluted for a viable count. Average values from two independent experiments are shown. The values did not vary significantly from one experiment to the next (at most, there was a 6.2% variation). (B) The same combination experiments were performed using EFX at MIC/2, alamethicin at MIC/4, and surfactin at MIC/16. Viable-cell counts were performed after 2 and 24 h. Average values from two independent experiments are shown. The values did not vary significantly from one experiment to the next (at most, there was a 5% variation in the number of CFU/ml).
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This study was also aimed at identifying possible synergistic interactions between EFX and the four AMPs. The checkerboard method and the time course killing assay showed indifferent interactions between the fluoroquinolone EFX and globomycin or gramicidin S. In contrast, this method revealed that combining EFX with alamethicin or surfactin led to FIC indexes of <1, indicating possible additive effects between these molecules. These results were confirmed by the time course killing assay of the EFX-alamethicin and EFX-surfactin combinations. When, in these associations, the three molecules were used at their respective MICs, it was possible to kill virtually all the mycoplasma cells after 2 h with the EFX plus alamethicin combination and after 24 h with the EFX plus surfactin combination. Furthermore, the mycoplasma-killing activities of the two combinations enrofloxacin (MIC/2) plus alamethicin (MIC/4) and enrofloxacin (MIC/2) plus surfactin (MIC/16) were almost 2 orders of magnitude higher than those of the three molecules used separately. Consistent with the fact that the association of EFX with alamethicin was capable of curing a HeLa cell culture of Mycoplasma fermentans in 30 min and of Mycoplasma hyorhinis in 24 h (20), this result indicated synergistic effects between EFX and alamethicin or surfactin against M. pulmonis.
Hence, the two salient results of our study are that, in vitro, (i) AMPs retain the same level of activity over a large range of M. pulmonis concentrations and (ii) there is a synergistic action between the fluoroquinolone enrofloxacin and two AMPs (alamethicin and surfactin). Associating EFX with either of these two AMPs allowed lower concentrations of EFX and AMPs to be used than when each molecule was taken alone. This is important because, although AMPs are broad-spectrum antimicrobials displaying rapid bactericidal activity, from the perspective of therapeutic applications these advantages are counterbalanced by limited in vivo stability (notably for AMPs composed of L-
-amino acid residues) and possible toxicity toward mammalian cells (see reference 19 for a recent review of this subject). Toxicity remains a major concern, because the MICs of AMPs are usually 1 or 2 orders of magnitude higher than those of many conventional antibiotics. This was confirmed in this study when the MIC and MBC of EFX were compared with those of the AMPs (Table 1). Furthermore, the activities of AMPs can be hampered in vivo by different biological factors, such as enzymatic cleavage or absorption by serum lipoproteins. Fortunately, a better knowledge of the structure-activity relationships of AMPs makes it feasible to design molecules with a better therapeutic index. For example, Dartois et al. (10) have recently designed cationic cyclic peptides displaying a broad antimicrobial spectrum and a prolonged systemic activity in the mouse. Additionally, although the pharmaceutical usefulness of AMPs has still to be fully established, several molecules are presently under clinical development (1, 19, 27), and one may expect still better achievements in the future from the association of conventional antibiotics with engineered AMPs. We believe that this track should be explored in the case of mycoplasmas.
We thank Géraldine Gourgues for skilled technical help. We acknowledge the gift of globomycin from S. Miyakoshi (Sankyo Co., Japan).
Published ahead of print on 13 November 2006. ![]()
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