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Antimicrobial Agents and Chemotherapy, September 2007, p. 3416-3419, Vol. 51, No. 9
0066-4804/07/$08.00+0 doi:10.1128/AAC.00196-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.
Histatin-Derived Monomeric and Dimeric Synthetic Peptides Show Strong Bactericidal Activity towards Multidrug-Resistant Staphylococcus aureus In Vivo
Mick M. Welling,1*
Carlo P. J. M. Brouwer,2
Wim van 't Hof,3
Enno C. I. Veerman,3 and
Arie V. Nieuw Amerongen3
Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center (LUMC), Leiden, the Netherlands,1
R&D, AM-Pharma, Bunnik, the Netherlands,2
Academic Centre for Dentistry Amsterdam (ACTA), Department of Oral Biochemistry, Amsterdam, the Netherlands3
Received 9 February 2007/
Returned for modification 4 April 2007/
Accepted 27 June 2007

ABSTRACT
Homodimerization of histatin-derived peptides generally led
to improved bactericidal activity against
Staphylococcus aureus in vitro. In vivo, monomers and dimers were equally active in
killing bacteria in mice with a soft tissue infection. Altogether,
these peptides are promising compounds for the development of
novel therapeutics against infections with drug-resistant bacteria.

TEXT
The rapid emergence of microbial resistance makes the development
of novel antibiotic agents urgent. Antimicrobial peptides, characterized
by a positive charge and amphipathic structure, are considered
promising candidates, as they display high therapeutic indices
in vitro (
16). One putative active domain of histatin 5 (Dh5:
residues 11 to 24) was used as scaffold for the design of peptides
Dhvar4 (increased amphipathicity) and Dhvar5 (reduced amphipathicity)
with improved potency in vitro and improved resistance to proteolytic
degradation (
14,
5,
10,
4). P-113 (residues 4 to 15 of histatin
5) is active against several clinically important pathogens
in vitro and in vivo in animals (
7,
9,
2,
3).
In this study we examined the effect of dimerization of Dh5, Dhvar4, Dhvar5, and P-113 on the antimicrobial potency in vitro and in mice with Staphylococcus aureus infections. The rationale behind using homodimers of antimicrobial peptides is that multiple peptides line up together in a dose-dependent fashion so that dimerization would lead to an increase in reaction rates and thus to a significant potentiation (11). Peptides and their homodimers were synthesized as described previously (12, 15) and are listed in Table 1. S. aureus ATCC 25923 was obtained from the American Type Culture Collection (Rockville, MD). S. aureus strain 2141 (multidrug-resistant S. aureus [MRSA]) is a multidrug-resistant clinical isolate (1). In the in vitro assay, 1 x 106/ml S. aureus organisms in phosphate buffer supplemented with 1% (wt/vol) tryptic soybean broth (Difco, Becton Dickinson Microbiology Systems, Sparks, MD) were exposed to various amounts of peptides for 2 h at 37°C, and the number of viable microorganisms was assessed microbiologically using DST plates as described by Welling et al. (18). Data are expressed as 50% lethal concentrations (LC50), i.e., in vitro as the concentration required reducing the viable bacteria by 50% compared to incubations without peptide. Histatin 5, Dh5, P-113, Dhvar4, and Dhvar5 killed both S. aureus and MRSA. Histatin 5 and Dhvar4 were the most potent peptides (Table 2). The dimers of Dh5, Dhvar4, and Dhvar5 were 4, 11, and 128 times as potent as the respective monomers against S. aureus and 14, 8, and 43 times as potent against MRSA. For P-113, dimerization led to a decrease in bactericidal potency.
Binding of equal amounts of
99mTc-labeled peptides to bacteria
was assessed at 4°C as described previously (
18). In short,
labeled peptide was incubated with 2
x 10
7 viable bacteria for
1 h, and the radioactivity bound to the bacterial pellet was
determined. Data are expressed as the percentage of total added
99mTc activity/2
x 10
7 CFU. With exception of Dhvar5, the dimers
of all peptides showed significantly (
P < 0.01) higher binding
than their respective monomers (Fig.
1). Notably, for this peptide
the effect of dimerization on the bactericidal effect was the
most pronounced. In the in vivo studies, performed in compliance
with the Dutch laws related to the conduct of animal experiments,
pathogen-free male Swiss mice (22 to 30 g; Broekman Institute,
Someren, The Netherlands) were infected with 0.1 ml saline containing
0.5 to 2.0
x 10
7 CFU (
18). After 18 h, animals were given intravenous
injections of various amounts of peptide. The animals were kept
for another 24 h and sacrificed, and the number of viable bacteria
was determined microbiologically (
1). Histatin 5, Dh5, P-113,
Dhvar4, and Dhvar5 killed both strains of bacteria, but the
range of bactericidal potencies was less pronounced than that
determined in vitro. Histatin 5 and Dhvar4 stood out as more
potent than the other peptides. In contrast with the in vitro
experiments, dimerization had little if any effect on the bactericidal
activity in vivo (Table
2). The high in vivo activity is surprising.
In a pilot experiment in vitro using phosphate-buffered saline
instead of a low-phosphate buffer to better simulate physiological
conditions, we found that the activities of all peptides were
virtually abolished at higher ionic strengths. Furthermore,
in vivo these bacteria exist as multicellular complexes (biofilms),
in which form they are far more resistant to antimicrobial peptides
than the cultured monocellular planktonic bacteria used in the
in vitro assays (
8). A possible explanation is that the activity
of this kind of peptide in vivo is not a reflection of their
cytolytic activity expressed in vitro but the result of their
immunomodulatory properties (
17,
13,
6). Apparently, these are
not influenced by dimerization.
Scintigraphic imaging after intravenous injection of mice with
technetium-99m-radiolabeled peptides (2 to 5 MBq) revealed that
the peptides were rapidly removed (biological half-life between
9 to 39 min) from the circulation (
19,
18). Most of the radioactivity
accumulated initially in the kidneys, after which it collected
in the urinary bladder (Table
3). It was observed at later intervals
that radioactivity that had accumulated in the liver and spleen
also rapidly decreased (data not shown). Only a small amount
(0.5 to 0.9% of the injected dose) accumulated at the infected
thigh muscles.
The accumulation of peptides varied, with ratios of accumulation
in infected thigh muscle (target [T]) to accumulation in the
contralateral noninfected thigh muscle (nontarget [NT]) between
1.6 and 4.4 for mice infected with
S. aureus (Fig.
2). The highest
T/NT ratios were calculated for monomeric (3.5 ± 0.4)
and dimeric (4.4 ± 0.4) peptides of Dh5. For mice infected
with MRSA, T/NT ratios for all peptides ranged between 1.8 and
2.4 (Fig.
2). We do not have a conclusive explanation for the
differences in T/NT ratios observed for radiolabeled Dh5 and
its dimer between
S. aureus and MRSA.
Apparently, there is no clear correlation between bacterial
binding, ionic strength sensitivity, and bactericidal activity
in vitro on the one hand and biodistribution data, clearance
kinetics, and bactericidal activity in vivo on the other. It
is evident that extrapolation of in vitro findings to the observations
in animals is extremely difficult. Peptide properties determined
in vitro, such as pore-forming and membrane-disrupting properties,
secondary structure, and state of aggregation, may be different
in vivo. The presence of many potentially synergistic compounds
and an active immune system in live animals is another complicating
factor. Considering that potentially antimicrobial peptides
act in vivo through other molecular mechanisms than in vitro,
we think that a critical reappraisal of the predictive value
of data obtained in vitro for actual activity in vivo may be
imperative. Despite the uncertainty as to how these peptides
exert their potent antimicrobial activity in vivo, our data
clearly show that they may be considered as promising new therapeutics
to fight infections with resistant bacteria.

FOOTNOTES
* Corresponding author. Mailing address: Section Nuclear Medicine, Division of Radiology, Leiden University Medical Center, Room C4-R-77, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Phone: 31 71 5261880. Fax: 31 71 5266751. E-mail:
m.m.welling{at}lumc.nl 
Published ahead of print on 9 July 2007. 

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Antimicrobial Agents and Chemotherapy, September 2007, p. 3416-3419, Vol. 51, No. 9
0066-4804/07/$08.00+0 doi:10.1128/AAC.00196-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.