Synergistic antibacterial activity of tetrandrine combined with colistin against MCR-mediated colistin-resistant Salmonella.

It has been recognized that colistin resistance is a growing problem that seriously impairs the clinical efficacy of colistin against bacterial infections. One strategy that has been proven to have therapeutic effect is to overcome the widespread emergence of antibiotic-resistant pathogens by combining existing antibiotics with promising non-antibiotic agents. In this work, antibiotic susceptibility testing, checkerboard assays and time-kill curves were used to investigate the antibacterial activity of the individual drugs and the potential synergistic activity of the combination. The molecular mechanisms of tetrandrine in combination with colistin were analyzed using fluorometric assay and Real-time PCR. To predict possible interactions between tetrandrine and MCR-1, molecular docking assay was taken. Finally, we evaluated the in vivo efficacy of tetrandrine in combination with colistin against MCR-positive Salmonella. Overall, the combination of tetrandrine and colistin showed significant synergistic activity. In-depth mechanistic analysis showed that the combination of tetrandrine with colistin enhances the membrane-damaging ability of colistin, undermines the functions of proton motive force (PMF) and efflux pumps in MCR-positive bacteria. The results of molecular docking and RT-PCR analyses showed that tetrandrine not only affects the expression of mcr -1 but is also an effective MCR-1 inhibitor. Compared with colistin monotherapy, the combination of tetrandrine with colistin significantly reduced the bacterial load in vivo. Our findings demonstrated that tetrandrine serves as a potential colistin adjuvant against MCR-positive Salmonella. • In our study, the combination of tetrandrine and colistin drastically enhanced colistin bactericidal activity compared with monotreatment. • In-depth mechanistic analysis showed that tetrandrine potentiated colistin activity through enhancing the membrane-damaging ability of colistin. • Tetrandrine dramatically undermines the function of PMF and result in decreased intracellular ATP levels. In addition, the activity of efflux pump was significantly inhibited by the addition of tetrandrine in both single or combination treatments. • Tetrandrine not only affects the expression of mcr -1 but also as an effective MCR-1 inhibitor. • The discovery of tetrandrine as a potential adjuvant for colistin therapy in combination therapy for severe infections caused by MCR-1 positive Salmonella. [ABSTRACT FROM AUTHOR]