1. Drug-Driven Phenotypic Convergence Supports Rational Treatment Strategies of Chronic Infections.
- Author
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Imamovic L, Ellabaan MMH, Dantas Machado AM, Citterio L, Wulff T, Molin S, Krogh Johansen H, and Sommer MOA
- Subjects
- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Bacterial Proteins genetics, Cystic Fibrosis complications, DNA-Binding Proteins genetics, Humans, Male, Middle Aged, Mutation, Pseudomonas Infections complications, Pseudomonas Infections microbiology, Pseudomonas aeruginosa drug effects, Pseudomonas aeruginosa pathogenicity, Selection, Genetic, Transcription Factors genetics, Cystic Fibrosis microbiology, Drug Resistance, Bacterial, Evolution, Molecular, Phenotype, Pseudomonas Infections drug therapy, Pseudomonas aeruginosa genetics
- Abstract
Chronic Pseudomonas aeruginosa infections evade antibiotic therapy and are associated with mortality in cystic fibrosis (CF) patients. We find that in vitro resistance evolution of P. aeruginosa toward clinically relevant antibiotics leads to phenotypic convergence toward distinct states. These states are associated with collateral sensitivity toward several antibiotic classes and encoded by mutations in antibiotic resistance genes, including transcriptional regulator nfxB. Longitudinal analysis of isolates from CF patients reveals similar and defined phenotypic states, which are associated with extinction of specific sub-lineages in patients. In-depth investigation of chronic P. aeruginosa populations in a CF patient during antibiotic therapy revealed dramatic genotypic and phenotypic convergence. Notably, fluoroquinolone-resistant subpopulations harboring nfxB mutations were eradicated by antibiotic therapy as predicted by our in vitro data. This study supports the hypothesis that antibiotic treatment of chronic infections can be optimized by targeting phenotypic states associated with specific mutations to improve treatment success in chronic infections., (Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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