Targeting Multidrug-Resistant Acinetobacter spp.: Sulbactam and the Diazabicyclooctenone β-Lactamase Inhibitor ETX2514 as a Novel Therapeutic Agent release_vjh4ly3xjzdsvmgrzv7qb62pfi

by Melissa D. Barnes, Vijay Kumar, Christopher R. Bethel, Samir H. Moussa, John O'Donnell, Joseph D. Rutter, Caryn E. Good, Kristine M. Hujer, Andrea M. Hujer, Steve H. Marshall, Barry N. Kreiswirth, Sandra S. Richter (+5 others)

Published in mBio by American Society for Microbiology.

2019   Volume 10, Issue 2


<jats:title>ABSTRACT</jats:title> Multidrug-resistant (MDR) <jats:italic>Acinetobacter</jats:italic> spp. poses a significant therapeutic challenge in part due to the presence of chromosomally encoded β-lactamases, including class C <jats:italic>Acinetobacter</jats:italic>-derived cephalosporinases (ADC) and class D oxacillinases (OXA), as well as plasmid-mediated class A β-lactamases. Importantly, OXA-like β-lactamases represent a gap in the spectrum of inhibition by recently approved β-lactamase inhibitors such as avibactam and vaborbactam. ETX2514 is a novel, rationally designed, diazabicyclooctenone inhibitor that effectively targets class A, C, and D β-lactamases. We show that addition of ETX2514 significantly increased the susceptibility of clinical <jats:named-content content-type="genus-species">Acinetobacter</jats:named-content><jats:named-content content-type="genus-species"> baumannii</jats:named-content> isolates to sulbactam. AdeB and AdeJ were identified to be key efflux constituents for ETX2514 in <jats:named-content content-type="genus-species">A. baumannii</jats:named-content>. The combination of sulbactam and ETX2514 was efficacious against <jats:named-content content-type="genus-species">A. baumannii</jats:named-content> carrying <jats:italic>bla</jats:italic><jats:sub>TEM-1</jats:sub>, <jats:italic>bla</jats:italic><jats:sub>ADC-82</jats:sub>, <jats:italic>bla</jats:italic><jats:sub>OXA-23</jats:sub>, and <jats:italic>bla</jats:italic><jats:sub>OXA-66</jats:sub> in a neutropenic murine thigh infection model. We also show that, <jats:italic>in vitro</jats:italic>, ETX2514 inhibited ADC-7 (<jats:italic>k</jats:italic><jats:sub>2</jats:sub>/<jats:italic>K<jats:sub>i</jats:sub></jats:italic> 1.0 ± 0.1 × 10<jats:sup>6</jats:sup> M<jats:sup>−1</jats:sup> s<jats:sup>−1</jats:sup>) and OXA-58 (<jats:italic>k</jats:italic><jats:sub>2</jats:sub>/<jats:italic>K<jats:sub>i</jats:sub></jats:italic> 2.5 ± 0.3 × 10<jats:sup>5</jats:sup> M<jats:sup>−1</jats:sup> s<jats:sup>−1</jats:sup>). Cocrystallization of ETX2514 with OXA-24/40 revealed hydrogen bonding interactions between ETX2514 and residues R261, S219, and S128 of OXA-24/40 in addition to a chloride ion occupied in the active site. Further, the C3 methyl group of ETX2514 shifts the position of M223. In conclusion, the sulbactam-ETX2514 combination possesses a broadened inhibitory range to include class D β-lactamases as well as class A and C β-lactamases and is a promising therapeutic candidate for infections caused by MDR <jats:italic>Acinetobacter</jats:italic> spp. <jats:bold>IMPORTANCE</jats:bold> The number and diversity of β-lactamases are steadily increasing. The emergence of β-lactamases that hydrolyze carbapenems poses a significant threat to our antibiotic armamentarium. The explosion of OXA enzymes that are carbapenem hydrolyzers is a major challenge (carbapenem-hydrolyzing class D [CHD]). An urgent need exists to discover β-lactamase inhibitors with class D activity. The sulbactam-ETX2514 combination demonstrates the potential to become a treatment regimen of choice for <jats:italic>Acinetobacter</jats:italic> spp. producing class D β-lactamases.
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