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Blood infections caused by gram-negative bacteria are one of the major challenges facing modern medicine, despite treatment with the available conventional antibiotics (22). Mortality rates in the range of 20 to 80% for septicemia caused by gram-negative bacteria have been reported. Antibiotic treatment is often administered when the disease reaches an advanced stage, usually when symptoms appear, by which point insufficient time remains for the antibiotic to kill the pathogen before the onset of irreversible tissue damage. Moreover, in many cases the antibiotic is given before sensitivity tests have been performed to identify an effective treatment. The emergence of bacterial strains resistant to conventional antibiotics, the lack of a rapid means of diagnosing the infection, and the generally unknown antibiotic sensitivity pattern of the infecting bacteria are probably among the major causes of inefficient therapy and high mortality rates (26). Most of these blood infections are caused by opportunistic pathogens that are not usually capable of initiating bacteremia in otherwise healthy individuals. Host defense mechanisms of the innate, nonclonal immune system serve as the principal pathway for effective elimination of pathogens (11). Potent components of innate immunity are the macrophages and polymorphonuclear leukocytes (PMNs) that mediate the early clearance of bacteria by the phagocytic process (1, 23). Agents that enhance phagocytosis may promote clearance of the pathogen and termination of the infectious process. In some cases the phagocytotic process is mediated by adhesins expressed on the bacterial surface, in a process termed nonopsonic phagocytosis (18). However, the interaction of many bacteria with phagocytic cells is greatly facilitated by opsonins, which act as a bridge between the surfaces of these two types of cells (5, 8). The development of agents that can function as opsonins may provide a useful new approach to terminating the infectious process by enhancing bacterial attachment to phagocytic cells, followed by ingestion and digestion of the pathogen. For an agent to function as an opsonin, it must contain a moiety that recognizes a specific target molecule on the bacterial surface and another that recognizes specific receptors on phagocytic cells. Moreover, its toxicity must be relatively low, and most importantly, there should be little likelihood for the emergence of strains resistant to its action. In the present study, we describe the synthesis of antimicrobial peptide conjugates that act both as opsonins to enhance destruction by phagocytic cells and as agents that permeabilize the bacterial membrane to enhance eradication by hydrophobic antibiotics and other antimicrobial agents. The peptides are derived from polymyxin B (PMB) or polymyxin E (PME) covalently linked to a short chemotactic peptide. Early studies have established that although polymyxin-based antibiotics are relatively toxic, they can be rendered 10 to 15 times less toxic by cleaving the lipid moiety from the molecule (7, 10). These polymyxin-based peptides lack direct bactericidal activity but retain their ability to bind to lipopolysaccharides (LPSs) on the bacterial surface and to permeabilize the outer membrane (OM) to hydrophobic antibiotics that cannot otherwise penetrate the bacteria, as well as to other bactericidal agents, such as the complement (33). Since resistance to the parent polymyxins is rare (25), it is expected that resistance to these polymyxin-derived peptides will be rare as well. Indeed, we did not find strains resistant to the permeabilizing activity of a polymyxin B (PMB) nonapeptide (PMBN) among 59 PMB-sensitive strains tested (21). Moreover, administration of the nonapeptide in combination with erythromycin protected mice against a lethal dose of an erythromycin-resistant strain of Klebsiella pneumoniae (19). More recently, we showed that the polymyxin B nonapeptide binds to LPS, which is consistent with previous studies showing that the parent PMB and PME molecules bind to lipid A of LPS on bacterial surfaces (16, 25, 31). Encouraged by these results, we reasoned that conjugation of PMBN or PMEN to a moiety that recognizes specific receptors on phagocytic cells may confer opsonic activity on the molecule. We chose to use formyl methionine-leucine-phenylalanine (fMLF), a chemotactic peptide, as our conjugant because it has been studied extensively for its property of binding to specific receptors on phagocytic cells (17). It will be shown that conjugates consisting of polymyxin peptides covalently linked to fMLF enhance the bactericidal activities of conventional antibiotics, act as opsonins in promoting the phagocytic destruction of bacteria in vitro, and protect mice from lethal infections and bacteremia in vivo.

Polymyxin B nonapeptide (PMBN), a cationic cyclic peptide derived from the antibacterial peptide polymyxin B, is capable of specifically increasing the permeability of the outer membrane (OM) of Gram-negative bacteria toward hydrophobic antibiotics. In this study, we evaluated the contribution of the hydrophobic segment of PMBN (i.e., D-Phe(5)-Leu(6)) to this activity. Accordingly, we synthesized four analogs of PMBN by replacing D-Phe(5) with either with D-Trp or D-Tyr and Leu(6) with Phe or Ala and evaluated their ability to bind cell-free lipopolysaccharide (LPS) and increase bacterial OM permeability. Compared with PMBN, [D-Tyr(5)]PMBN and [Ala(6)]PMBN possessed reduced LPS affinity (IC(50) = 2.5, 25, and 12 microM, respectively) and significantly reduced OM permeability and LPS neutralization activity. [Phe(6)]PMBN exhibited rather similar affinity to cell-free LPS (IC(50) = 5 microM) and the same OM permeability capacity as PMBN. However, [D-Trp(5)]PMBN, despite its similar affinity to cell-free LPS (IC(50) = 4 microM), had moderately reduced OM permeability capacity. These results demonstrate the significant role of the PMBN hydrophobic segment in promoting biological activity.

Polymyxin B (PMB) is a potent antibacterial lipopeptide composed of a positively charged cyclic peptide ring and a fatty acid containing tail. Polymyxin B nonapeptide (PMBN), the deacylated amino derivative of polymyxin B, is much less bactericidal but able to permeabilize the outer membrane of Gram-negative bacteria and to neutralize the toxic effects of lipopolysaccharide (LPS). In this study, we synthesized and evaluated the antibacterial and LPS neutralizing activities of four PMBN analogs modified at their N-terminal. Our results suggest that oligoalanyl substitutions of PMBN do not effect most of PMBN activities. However, a hydrophobic aromatic substitution generated a PMB-like molecule with high antibacterial activity and significant reduced toxicity.

The Gram-negative bacterial endotoxin lipopolysaccharide (LPS) is a major inducer of sepsis. The natural cyclic peptide polymyxin B (PMB) is a potent antimicrobial agent, albeit highly toxic, by virtue of its capacity to neutralize the devastating effects of LPS. However, the exact mode of association between PMB and LPS is not clear. In this study, we have synthesized polymyxin B nonapeptide, the LPS-binding cyclic domain of PMB, and its enantiomeric analogue and studied several parameters related to their interaction with LPS and their capacity to sensitize Gram-negative bacteria toward hydrophobic antibiotics. The results suggest that whereas the binding of the two enantiomeric peptides to E. coli and to E. coli LPS is rather similar, functional association with the bacterial cell is stereospecific. Thus, the L-enantiomer is capable of synergism with the hydrophobic antimicrobial drugs novobiocin and erythromycin, whereas the D-enantiomer is devoid of such activity. The potential of understanding and consequently utilizing the PMB-LPS association for novel, nontoxic PMB-derived drugs is discussed.

Polymyxin B nonapeptide (PMBN), a cationic cyclic peptide derived by enzymatic processing from the naturally occurring peptide polymyxin B, is able to increase the permeability of the outer membrane of Gram-negative bacteria toward hydrophobic antibiotics probably by binding to the bacterial lipopolysaccharide (LPS). We have synthesized 11 cyclic analogues of PMBN and evaluated their activities compared to that of PMBN. The synthetic peptides were much less potent than PMBN in their capacity to sensitize Escherichia coli and Klebsiella pneumoniae toward novobiocin and to displace dansyl-PMBN from Escherichia coli LPS. Moreover, unlike PMBN, none of the analogues were able to inhibit the growth of Pseudomonas aeruginosa. The structural-functional features of PMBN were characterized and identified with regard to the ring size, the distance between positive charges and peptide backbone, the chirality of the DPhe-Leu domain, and the nature of the charged groups. Apparently, the structure of PMBN is highly specific for efficient perturbation of the outer membrane of Gram-negative bacteria as well as for LPS binding. The present study further increases our understanding of the complex PMBN-LPS and may, potentially, enable the design of compounds having enhanced permeabilization potency of the Gram-negative outer membrane.