Synergism in dual functionality of cryptdin-2 in conjunction with antibiotics against Salmonella.

BACKGROUND & OBJECTIVES: The emergence of multidrug-resistant Salmonella over the last two decades poses a major health risk. In this context, antimicrobial peptides have found a strategic place in the therapeutic armamentarium. Previously, we found that cryptdin-2 has the potential to augment the activity of conventional second- and third-generation anti-Salmonella antibiotics as evident by in vitro assays. In continuation to this, the present study was designed to evaluate the in vivo synergistic effects, if any, of cryptdin-2 in combination with ciprofloxacin and ceftriaxone against murine salmonellosis. METHODS: Scanning electron microscopy (SEM) studies along with in vivo synergistic studies were performed using cryptdin- 2 and antibiotic combinations. In addition, peroxidative liver damage, levels of nitric oxide (NO) and antioxidant enzymes along with tumour necrosis factor-alpha (TNF-α) levels were also measured. RESULTS: The SEM results revealed marked changes on the outer membrane of the bacterial cells treated with various combinations. Both the tested combinations demonstrated synergistic in vivo potency against S. Typhimurium as evident by reduction in the number of Salmonellae in the liver, spleen and intestine. Analysis of peroxidative liver damage, levels of NO and antioxidant enzymes along with TNF-α and nuclear factor-kappa B levels revealed that the tested combinations restored their levels to near normal. The most potent combination was found to be that of cryptdin-2 and ciprofloxacin in terms of direct killing and immunomodulatory potential. INTERPRETATION & CONCLUSIONS: These findings suggest that cryptdin-2 may act in conjunction with conventional antibiotics indicating the possibility of developing these combinations as additional therapeutic agents to combat Salmonella infections.

Nisin/ß-lactam adjunct therapy against Salmonella enterica serovar Typhimurium: a mechanistic approach.

OBJECTIVES: Multidrug resistance exhibited by Salmonella strains has proved to be a big hurdle in the development of an effective anti-Salmonella therapy. In this context, we had previously demonstrated strong synergism of nisin/ceftriaxone and nisin/cefotaxime combinations against Salmonella enterica serovar Typhimurium. However, the mechanism remained unexplored. The present study was therefore planned in order to evaluate the underlying mechanisms responsible for the synergistic effect of nisin in combination with these ß-lactam antibiotics against serovar Typhimurium. METHODS: A membrane permeabilization assay along with pulse labelling studies were performed to confirm the ability of the combinations to permeabilize the bacterial membrane and to verify their effects on macromolecule synthesis. Additionally, analysis of peroxidative liver damage was performed and levels of nitric oxide, antioxidant enzymes, tumour necrosis factor-α and nuclear factor-κB were also measured. RESULTS: 1-N-phenylnapthylamine (NPN) uptake assay results confirmed a permeabilization-dependent mechanism, as NPN was taken up by treated cells in a time- and concentration-dependent manner, indicating that the combination influenced membrane permeability. Likewise, dose- and time-dependent inhibition of DNA, RNA and protein synthesis in the presence of both the combinations was observed. Interestingly, synergistic results inferred from in vivo assays confirmed the immuno-modulatory effects of the combinations in the treated mice. CONCLUSIONS: Nisin/ceftriaxone and nisin/cefotaxime combinations exert their antibacterial activity against Salmonella by multiple modes of action that involve membrane permeabilization, inhibition of DNA, RNA and protein synthesis and direct immuno-modulatory activity.

Revisiting eukaryotic anti-infective biotherapeutics.

Emerging drug resistance has forced the scientific community to revisit the observational data documented in the folklore and come up with novel and effective alternatives. Candidates from eukaryotic origin including herbal products and antimicrobial peptides are finding a strategic place in the therapeutic armamentarium against infectious diseases. These agents have recently gained interest owing to their versatile applications. Present review encompasses the use of these alternative strategies in their native or designer form, alone or in conjunction with antibiotics, as possible remedial measures. Further to this, the limitations or the possible concerns associated with these options are also discussed at length.

Efficacy of cryptdin-2 as an adjunct to antibiotics from various generations against salmonella.

Emerging drug resistance in Salmonella coupled with the recent poor success rate of antibiotic discovery programs of the pharmaceutical industry is a cause for significant concern. It has forced the scientific community to look for alternative new classes of antimicrobial compounds. In this context, combinations of antimicrobial peptides (AMPs) and conventional antibiotics have gained interest owing to their versatile applications. The present study was therefore planned to evaluate the synergistic effects, if any, of cryptdin-2, a mouse Paneth cell alpha-defensin, in combination with four different antibiotics i.e. ciprofloxacin, ceftriaxone, cefotaxime and chloramphenicol, which are conventionally used against Salmonella. Minimum bactericidal concentrations of the selected antimicrobial agents were determined by micro and macro broth dilution assays. In-vitro synergy between the agents was evaluated by fractional bactericidal concentration index (checkerboard test) and time-kill assay. Cryptdin-2-ciprofloxacin, cryptdin-2-ceftriaxone and cryptdin-2-cefotaxime combinations were found synergistic as evident by in vitro assays. This synergism provides an additional therapeutic choice by allowing the use of conventional antibiotics in conjunction with AMPs against MDR Salmonella.

Dural arteriovenous fistula embolisation with venous remodelling following venous sinus stenting.

We report a case of the formation of a dural arteriovenous fistula (dAVF) of the transverse-sigmoid sinus following venous sinus stenting (VSS), treated with trans-arterial embolisation and venous remodelling. An obese woman in her 30s presented with persistent daily headaches after undergoing endoscopic repair of a skull base cerebrospinal fluid leak. Angiography demonstrated a focal right transverse-sigmoid sinus stenosis, and she underwent VSS of the right transverse sinus. She developed progressive pulsatile tinnitus within 3 months, and angiography demonstrated the formation of a Borden type 1 dAVF along the stent. Trans-arterial embolisation of the dAVF was performed with venous remodelling using a Copernic RC balloon. While VSS has become a promising treatment for venous sinus stenosis and idiopathic intracranial hypertension, dAVF formation is a rare but significant potential complication. Embolisation with venous remodelling can be performed to treat these lesions.

Value addition in the efficacy of conventional antibiotics by Nisin against Salmonella.

Frequent and indiscriminate use of existing battery of antibiotics has led to the development of multi drug resistant (MDR) strains of pathogens. As decreasing the concentration of the antibiotic required to treat Salmonellosis might help in combating the development of resistant strains, the present study was designed to assess the synergistic effects, if any, of nisin, in combination with conventional anti-Salmonella antibiotics against Salmonella enterica serovar Typhimurium. Minimum inhibitory concentrations (MICs) of the selected antimicrobial agents were determined by micro and macro broth dilution assays. In-vitro synergy between the agents was evaluated by radial diffusion assay, fractional inhibitory concentration (FIC) index (checkerboard test) and time-kill assay. Scanning electron microscopy (SEM) was also performed to substantiate the effect of the combinations. In-vivo synergistic efficacy of the combinations selected on the basis of in-vitro results was also evaluated in the murine model, in terms of reduction in the number of Salmonellae in liver, spleen and intestine. Nisin-ampicillin and nisin-EDTA combinations were observed to have additive effects, whereas the combinations of nisin-ceftriaxone and nisin-cefotaxime were found to be highly synergistic against serovar Typhimurium as evident by checkerboard test and time-kill assay. SEM results revealed marked changes on the outer membrane of the bacterial cells treated with various combinations. In-vivo synergy was evident from the larger log unit decreases in all the target organs of mice treated with the combinations than in those treated with drugs alone. This study thus highlights that nisin has the potential to act in conjunction with conventional antibiotics at much lower MICs. These observations seem to be significant, as reducing the therapeutic concentrations of antibiotics may be a valuable strategy for avoiding/reducing the development of emerging antibiotic resistance. Value added potential of nisin in the efficacy of conventional antibiotics may thus be exploited not only against Salmonella but against other Gram-negative infections as well.