Decade-long use of the antimicrobial peptide combination tyrothricin does not pose a major risk of acquired resistance with gram-positive bacteria and Candida spp.

Tyrothricin, an antimicrobial peptide combination produced by Bacillus brevis consisting of gramicidins and tyrocidins commands broad antimicrobial activity against gram-positive bacteria and some yeasts in vitro. The polypeptide and its components have been used therapeutically for about 60 years in the local treatment of infected skin and infected oro-pharyngeal mucous membranes. Though older studies suggest that resistance development of originally susceptible microorganisms towards tyrothricin is a rare event, data concerning recent state of resistance are lacking. In the present in vitro study the susceptibility to tyrothricin of clinical isolates of bacterial and yeast origin from superficial swabs of the skin and mucous membranes of outpatients and inpatients obtained from clinical material in the second half of the year 2003 was determined. Using a microdilution assay, the minimum inhibitory concentration (MIC and MIC90, defined as the concentration that inhibits at least 90 percent of the tested strains) of 20 strains each of Staphylococcus aureus of the variety MSSA (susceptible to methicillin), Staphylococcus aureus of the variety MRSA (methicillin resistant), Staphylococcus haemolyticus, Streptococcus pyogenes, Enterococcus faecalis, Corynebacterium spec., Candida albicans and Candida parapsilosis was determined. All of the tested gram-positive bacteria turned out to be highly susceptible to tyrothricin with MICs ≤ 4mg/l. The tested yeast strains were susceptible to the polypeptide antibiotic as well, but (with MICs of 16 mg/l and 32 mg/l, respectively) to a lesser extent. No acquired resistance of the tested strains was determined, indicating that the risk of resistance development against topically applied tyrothricin is only marginal, if there is any at all. Thus, long-term-, i.e. decade-long use of topically applied tyrothricin and its components in the local treatment of infected skin does not pose a major risk with respect to acquired resistance of originally susceptible gram-positive bacteria and yeasts, not even in the case of Staphylococcus aureus, both with MSSA and MRSA strains. The broad anti-bacterial and anti-fungal activity of tyrothricin combined with its lacking risk for resistance development make the antimicrobial peptide a valuable addition to our therapeutic armamentarium in the treatment of infected skin.

Efficacy of a tyrothricin-containing wound gel in an abrasive wound model for superficial wounds.

BACKGROUND: Topical preparations are a common treatment for superficial acute wounds, which at the least do not interfere with healing and ideally result in enhanced wound healing irrespective of microbial colonization. OBJECTIVE: To examine the effects of a topical antimicrobial gel and its vehicle on the wound healing of standardized, superficial abrasions. METHODS: Thirty-three healthy volunteers were enrolled in a double-blinded, randomized, intraindividual comparison study. Three standardized, superficial abrasions were induced on their forearms. A tyrothricin 0.1% gel (Tyrosur® gel; Engelhard Arzneimittel GmbH & Co. KG, Niederdorfelden, Germany) and its vehicle were randomly applied to two of the test areas, and one lesion remained untreated. RESULTS: A significant improvement of wound healing was seen with both tyrothricin 0.1% gel and its corresponding vehicle in the clinical assessment. The mean area under the curve (AUC) of wound healing scores was the same for both preparations and the mean reepithelization scores were comparable at all test points over the entire 12 days. A lower mean AUC representing less reepithelization was found for the untreated test fields. CONCLUSION: The use of tyrothricin 0.1% gel and its corresponding vehicle resulted in statistically significant improved wound healing with an earlier onset of healing in particular. Based on these results obtained using an abrasive wound model, it can be concluded that the addition of tyrothricin 0.1% to the gel vehicle did not interfere with the improved wound healing seen with the vehicle alone.

Antimicrobial peptides and skin: a paradigm of translational medicine.

Antimicrobial peptides (AMPs) are small, cationic, amphiphilic peptides with broad-spectrum microbicidal activity against both bacteria and fungi. In mammals, AMPs form the first line of host defense against infections and generally play an important role as effector agents of the innate immune system. The AMP era was born more than 6 decades ago when the first cationic cyclic peptide antibiotics, namely polymyxins and tyrothricin, found their way into clinical use. Due to the good clinical experience in the treatment of, for example, infections of mucus membranes as well as the subsequent understanding of mode of action, AMPs are now considered for treatment of inflammatory skin diseases and for improving healing of infected wounds. Based on the preclinical findings, including pathobiochemistry and molecular medicine, targeted therapy strategies are developed and first results indicate that AMPs influence processes of diseased skin. Importantly, in contrast to other antibiotics, AMPs do not seem to propagate the development of antibiotic-resistant micro-organisms. Therefore, AMPs should be tested in clinical trials for their efficacy and tolerability in inflammatory skin diseases and chronic wounds. Apart from possible fields of application, these peptides appear suited as an example of the paradigm of translational medicine for skin diseases which is today seen as a 'two-way road' - from bench to bedside and backwards from bedside to bench.

Observational study on the tolerability and safety of film-coated tablets containing ivy extract (Prospan® Cough Tablets) in the treatment of colds accompanied by coughing.

The only saponin drug currently prescribed in any significant amount in monotherapy medicines is ivy. This post-marketing surveillance study (PMSS) aimed at investigating the tolerability and safety of film-coated tablets containing ivy leaves dry extract (extracting medium: ethanol 30%, DER 5-7.5:1 [Prospan® Cough Tablets]) under practice conditions. Adults and children aged 11-85 years of both genders were included. A total of 330 patients suffering from colds accompanied by coughing or from chronic, inflammatory bronchial diseases were scheduled to undergo treatment for a period of at least seven days. The tolerability of the tablets was rated by means of questionnaires. The results of this PMSS reflect the good to very good tolerability of the tablets in the global assessment by both, the practitioner (98.5%) and by the patient (96.4%). This is one of the reasons for the high acceptance and compliance (rated as 'good' in 98.8% of all cases). The safety not only regarding the administration form but also regarding the active substance is thus underlined once again.

Approaches to determining membrane protein structures to high resolution: do selections of subpopulations occur?

Three different methods are currently used for the study of high-resolution structures of membrane proteins: X-ray crystallography, electron crystallography, and nuclear magnetic resonance (NMR) spectroscopy. Thus far, all methods combined have yielded a rather modest number of crystal structures that have been solved at the atomic level. It is hypothesized here that different methods may select different populations of proteins on the basis of various properties. Thus, protein stability may be a significant factor in the formation of three-dimensional (3D) crystals from detergent solutions, since exposure of hydrophobic protein zones to water may cause structural perturbation or denaturation in conformationally labile proteins. This is different in the formation of two-dimensional (2D) crystals where a protein remains protected in its native membrane environment. A biological selection mechanism may therefore be operative in that highly ordered lattices may form only if strong protein-protein interactions are relevant in vivo, thereby limiting the number of proteins that are amenable to electron crystallography. Keeping a protein in a bilayer environment throughout 3D crystallization maintains the lateral pressure existing in native membranes. This can be accomplished by using lipidic cubic phases. Alternatively, the hydrophobic interface of a membrane protein may be spared from contact with water by crystallization from organic solvents where the polar caps are protected in reverse micelles by using appropriate detergents. Some of the criteria that are useful in optimizing the various approaches are given. While the usefulness of complementary methods seems obvious, the results presented may be particularly critical in recognizing key problems in other structural approaches.

Solubilized cytochrome c oxidase from Paracoccus denitrificans is a monomer.

Cytochrome c oxidase purified from the bacterium Paracoccus denitrificans was analyzed by analytical ultracentrifugation. In the detergent octyltetra/pentaoxyethylene (C8E45), the isolated enzyme exhibits a molecular weight of 79,000 to 84,000. The detergent-solubilized enzyme is thus a monomer which contains one copy of each of the two subunits.