Antibiotic resistance is a worldwide health threat, as bacteria continue to evade antibiotic treatment. In order to survive, bacteria utilize a number of resistance mechanisms, including efflux pumps, which efficiently export antibiotics outside of the cell to reduce intracellular damage. While such mechanisms are well known, there remains a significant gap in knowledge regarding how different environmental dynamics, such as the rate of antibiotic introduction or the diversity within a microbial community, play a role in resistance. In this work, we used the AcrAB-TolC efflux pump as a case study to explore how such complex dynamics promote antibiotic resistance and its evolution. First, through a combined effort using experiments and mathematical modeling, we discovered that the rate of antibiotic introduction impacts the fraction of resistant bacteria in a population. We then explored the impact of mixed populations on survival following antibiotic treatment. In mixed microcolonies, we found that resistant cells can harm their susceptible neighbors by exporting antibiotics to increase the local concentrations of these drugs. Next, we aimed to understand how these environmental effects may impact longer-term survival of an antibiotic treatment, focusing on the evolution of resistance over ~72 hours. Through a series of adaptive evolution experiments, we identified that near-MIC treatments were the most likely to promote antibiotic resistance, regardless of whether the strains contained the AcrAB-TolC pump at wild type or overexpressed levels, or whether the strains lacked the pump altogether. In studying antibiotic introduction rates on evolution, we found that slower introduction rates facilitated the evolution of high levels of resistance with a minimal fitness cost. Meanwhile, mixed populations demonstrated limited evolvability after rapid antibiotic introductions. This work provides important insights into the impacts of environmental factors, such as the rate of antibiotic introduction and the homogeneity of populations, on the promotion and evolution of antibiotic resistance. These lessons may help inform future policies on antibiotic use and mitigate the continued pattern of resistance evolution.

<p>Mycobacterium abscessus (Mab) is a non-tuberculous mycobacterium that is highly resistant to many antibiotics. Mab causes pulmonary infections in immunocompromised individuals. The presence of efflux pumps to pump out antibiotics and its ability to form biofilms makes Mab a virulent pathogen. Studies have been done on Mab antibiotic tolerance but there are still a lot of gaps in knowledge about the effects of efflux pump inhibitors (EPIs) on antibiotic resistance and lipid biosynthesis in this bacterium during biofilm formation. In this study, we investigated the effects of the EPIs chlorpromazine (CPZ), 1-(1-naphthylmethyl)-piperazine (NMP), thioridazine (TRZ), Phenylalanine-arginine β-naphthylamide (PBN) and plumbagin (PLU) on antibiotic resistance, efflux, biofilm formation and lipid biosynthesis associated with log-phase growth and biofilm formation in Mab. We used the resazurin assay to determine the minimum inhibitory concentration (MIC) of the EPIs. We investigated the effects of the EPIs during biofilm-forming growth conditions on the MICs of antibiotics such as clarithromycin, amikacin, cefoxitin, ciprofloxacin which are the frontline antibiotics used to treat non-tuberculous mycobacterial infections. We also assessed the effects of the EPIs on the accumulation and efflux activities of the Mab cells through ethidium bromide (EtBr) assay. Furthermore, we evaluated the effects of the EPIs at sub-MIC concentrations on Mab biofilm formation under normoxic and hypoxic conditions. We utilized metabolic radiolabeling methods using 14C-palmitic acid and 14C- acetic acid which are precursors of lipid biosynthesis and analyzed lipids by silica-thin layer chromatography and autoradiography. We observed that Mab cells developed higher tolerance to the EPIs in a biofilm-stimulating medium. Furthermore, a decrease in the MICs of antibiotics was observed in the presence of the EPIs. Also, in the presence of the EPIs, there was less efflux activity within the Mab cells. In addition, EPIs inhibited biofilm formation significantly. We also noticed that NMP and PBN inhibited 14C-palmitic acid and 14C- acetic acid incorporation into polar lipids such as glycopeptidolipids, trehalose monomycolate, phosphatidylethanolamine, phosphatidylglycerol/cardiolipin, phosphatidylinositol mannosides at specific tested conditions. Our findings suggest that the EPIs inhibited the activities of the efflux pumps associated with the efflux of the antibiotics and lipid biosynthesis involved in biofilm formation. In conclusion, the results from this study gives insights on possible therapeutic opportunities.</p>

Burkholderia pseudomallei est l’agent causal de la mélioïdose, une maladie tropicale endémique dans le Nord de l’Australie et en Asie du Sud-Est. Nous avons analysé le système d’efflux, mécanisme majoritairement impliqué la multi-résistance aux antibiotiques. Nous avons chercher à identifier des mutations dans les pompes d’efflux et des modulation de l’expression de ces dernières afin d’expliquer ces phénotypes de résistance. Les techniques de séquençage de l’ADN et de transcriptomique par RT-qPCR nous ont permis d’identifier deux mécanismes chez des souches cliniques. Un mécanisme transitoire responsable d'une résistance croisée du Cotrimoxazole, avec les quinolones, et le chloramphénicol, pour lequel nous suspectons une modulation de l’expression de l’efflux. Le second, impliqué dans la résistance au méropénème, par surexpression de l'efflux suite à une mutation dans le régulateur de la pompe AmrAB-OprA.Dans un second axe de recherche, nous avons également criblé plusieurs molécules afin d'identifier des candidats inhibiteurs de l'efflux, dérivant de la famille des phénothiazines et capables de restaurer une sensibilité aux antibiotiques. Nous avons analysé l’impact de ces molécules sur des souches modèles de multi-résistance (Burkholderia thailandensis) et sur des souches cliniques et environnementales de B. pseudomallei. Ces molécules sont capables d’impacter l’expression de l’efflux, mais nous pensons que le mécanisme majeur d’inhibition de cette famille de molécules reste l’entrée en compétition avec les antibiotiques efflués. Nous avons identifié une molécule, AST17, capable de restaurer la sensibilité au Cotrimoxazole, ainsi qu'aux quinolones. / Burkholderia pseudomallei is thecausal agent of melioidosis, a tropical disease, endemic in Notrhern Australia and South-East Asia. We have analyzed efflux systeme, known to be one of the main mecanism implicated in antibiotic resistance phenotypes. We have looked for mutations in efflux pumps and for transient modulations of the efflux pumps expression, that could explain resistance phenotypes. Whole genome sequencing and a the targeted method of RT-qPCR allowed us to identified two mecanisms in clinical strains. A transient mecanism, responsible of a cross-resistance to Cotrimoxazole, quinolones and chloramphenicol, and we suspect an implication of modulation of efflux. The second one is implicated in meropenem resistance by an overexpression of the AmrAB-OprA efflux pumps, due to a mutation of its regulator. In a second time, we also have screened several compounds, all derivated from phenothiazines, in order to identify efflux pump inhibitors for a restoration of the antibiotic susceptibility. We have analyzed the impact of these molecules in multi-resistant strain models, and on several clinical and environnemental strains. These molecules are able to modulate efflux pumps expression, however, we think that the main inhibition mecanism of these derivatives is about a competition between the molecule and the antibiotics. We have identified one molecule, AST17, that is able to restore Cotrimoxazole and quinolones susceptibilities.

Implementation and analysis of mathematical models can serve as a powerful tool in understanding how intracellular processes in bacteria affect the bacterial phenotype. In this thesis I have implemented and analysed models of a number of different parts of the bacterium E. coli in order to understand these types of connections. I have also developed new tools for analysis of stochastic reaction-diffusion models. Resistance mutations in the E. coli ribosomes make the bacteria less susceptible to treatment with the antibiotic drug erythromycin compared to bacteria carrying wildtype ribosomes. The effect is dependent on efficient drug efflux pumps. In the absence of pumps for erythromycin, there is no difference in growth between wildtype and drug target resistant bacteria. I present a model explaining this unexpected phenotype, and also give the conditions for its occurrence. Stochastic fluctuations in gene expression in bacteria, such as E. coli, result in stochastic fluctuations in biosynthesis pathways. I have characterised the effect of stochastic fluctuations in the parallel biosynthesis pathways of amino acids. I show how the average protein synthesis rate decreases with an increasing number of fluctuating amino acid production pathways. I further show how the cell can remedy this problem by using sensitive feedback control of transcription, and by optimising its expression levels of amino acid biosynthetic enzymes. The pole-to-pole oscillations of the Min-proteins in E. coli are required for accurate mid-cell division. The phenotype of the Min-oscillations is altered in three different mutants: filamentous cells, round cells and cells with changed membrane lipid composition. I have shown that the wildtype and mutant phenotypes can be explained using a stochastic reaction-diffusion model. In E. coli, the transcription elongation rate on the ribosmal RNA operon increases with increasing transcription initiation rate. In addition, the polymerase density varies along the ribosomal RNA operons. I present a DNA sequence dependent model that explains the transcription elongation rate speed-up, and also the density variation along the ribosomal operons. Both phenomena are explained by the RNA polymerase backtracking on the DNA. / Felaktigt tryckt som Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Science and Technology 715

Tyrimų tikslas – išsiaiškinti DVAsiurblių aktyvumą dar neištirtose E. typographi bakterijose, esančiose žievėgraužio tipografo žarnyno mikrofloroje, jas veikiant eterinių aliejų sudedamąją dalimimircenu (MC). Tyrimai atlikti VDU Biochemijos katedroje vykdant potenciometrinius universalaus daugiavaisčio atsparumo siurblių substrato TPP+ jonų srautų per ląstelės apvalkalėlį matavimus.E. typographiląsteliųreakcijas į mirceną lyginome su šios medžiagos poveikiu gramneigiamosiomsE. coli ir S. enterica, ir gramteigiamosiomsS. aureus ir B. subtilis ląstelėms. MC poveikįE. typographiląstelėms stebėjome ir lyginome su pokyčiais, paveikus jas rezerpinu (RZ) ir RND šeimos siurblių slopikliufenilalanil-arginil-β-naftilamidu(PAβN).Tyrėme laukinio tipo ir mutantines E. coliirS. entericaląsteles, o taip pat ląsteles su pralaidinta išorine membrana bei pažeistais DVA siurbliais. Lygindami E. typographiląsteles su gramteigiamosiomis ląstelėmis, išsiaiškinome, kadPAβN panašiai slopina TPP+ kaupimąsi S. aureus, B. subtilis ir E. typographi ląstelėse, bet gramteigiamosioms ląstelėms reikia didesnės MC koncentracijos iki pilnos ląstelių plazminės membranos depoliarizacijos. Alkaloidas rezerpinas EDTA dorotose E. typographi ląstelėse skatino substrato TPP+ jonų sugertį, o ląstelėse su intaktine išorine membrana depoliarizavo plazminę membraną. / The aim of the study was to determine activity of MDR pumps in yet uninvestigated E. typography cells discovered in bark beetle gut microflora. The cells were exposed to myrcene anintegral part essential oils. The Investigations were carried out at department of Biochemistry of VMU using potentiometric analysis of a flow through the cell envelope of an universal substrate of multidrug resistant pumps substrate TPP+ions. Reactions of E. typography cells to myrcene were compared with effects of this compound on Gram-negative E. coli and S. entericaas well as Gram-positive S. aureus and B. subtiliscells. Effects of myrcene on E. typography cell were compared with the cell responses to alkaloid reserpine (RZ) and RND-type efflux pump inhibitor phenylalanyl – arginine – β – naphthylamide ( PAβN ). We investigated also wild type and mutant E. coli and S. enterica cells, including the cells with EDTA-permeabilized outer membrane. Comparing E. typographycells with Gram-positive bacteria we found that inhibition of S. aureus, B. subtilis and E. typography pumpsusing PAβN was similar, but Gram-positive bacteria required higher concentrations of MC to depolarize the cells. Alkaloid reserpine stimulated the accumulation of TPP+ions by EDTA-treated E. typographycells but in the case of cells with the intact outer membrane this inhibitor depolarized the cells.

A resistência aos antibióticos é um problema de saúde pública global com sérias consequências para o tratamento de várias infecções bacterianas. Os fatores de transcrição da família MarR têm sido descritos controlando resistência a antibióticos e vários outros processos em bactérias. Neste trabalho, estudamos mecanismos de resistência a antibióticos em Chromobacterium violaceum, uma bactéria Gram-negativa ambiental que pode atuar como um patógeno oportunista em humanos. A estratégia envolveu a varredura de um painel de treze linhagens mutantes de fatores de transcrição da família MarR de C. violaceum disponíveis, por testes de susceptibilidade a 24 antibióticos. Estes ensaios revelaram que apenas o mutante ?emrR apresentou resistência aumentada ao antibiótico ácido nalidíxico em relação à linhagem selvagem. Esta resistência aumentada do mutante ?emrR ao ácido nalidíxico foi revertida em uma linhagem complementada deste mutante, conforme verificado por ensaios de viabilidade, ensaios de difusão em disco e concentração inibitória mínima (MIC). O fenótipo de diminuída produção de violaceína deste mutante, observado em meio líquido, também foi complementado. Além disso, foi realizado o isolamento de mutantes espontâneos de C. violaceum resistentes a ácido nalidíxico com mutação pontual em emrR. Os ensaios de microarranjo de DNA mostraram que EmrR reprime algumas dezenas de genes, incluindo o operon emrCAB, o qual codifica a bomba de efluxo EmrCAB. Os ensaios de Northern blot confirmaram que o EmrR reprime o operon emrCAB, e que a expressão desta bomba é induzida por salicilato, mas não outros compostos, como ácido nalidíxico ou brometo de etídeo. Os ensaios de alteração de mobilidade eletroforética (EMSA) mostraram que a proteína EmrR purificada se liga diretamente às 8 regiões promotoras de emrR, emrCAB e vários outros genes do regulon EmrR, para exercer uma regulação negativa direta sobre esses genes. Um mutante nulo ?emrCAB foi obtido, mas a ausência desta bomba de efluxo não tornou C. violaceum mais susceptível ao ácido nalidíxico, sugerindo que ela é importante somente em condições nas quais é induzida. Estas condições indutoras talvez incluam estresse oxidativo, uma vez que enzimas antioxidantes são parte do regulon de EmrR e a proteína EmrR formou dímeros covalentes na presença de agentes oxidantes in vitro. Portanto, nossos dados revelam que mutações pontuais ou moléculas como salicilato abolem a atividade repressora do fator de transcrição EmrR sobre o operon emrCAB, levando a superexpressão da bomba de efluxo EmrCAB e aumentando a resistência ao ácido nalidíxico em C. violaceum. / Antibiotic resistance is a global public health problem with serious consequences for the treatment of various bacterial infections. MarR family transcription factors have been described controlling antibiotic resistance and several other processes in bacteria. In this work, we studied mechanisms of antibiotic resistance in Chromobacterium violaceum, an environmental Gramnegative bacterium that can act as a human opportunistic pathogen. The strategy involved a screening of an available collection of thirteen C. violaceum mutant strains of MarR family transcription factors, by susceptibility testing for 24 antibiotics. These assays revealed that only the ?emrR mutant showed increased resistance to the antibiotic nalidixic acid in relation to the wild-type strain. This increased resistance of the ?emrR mutant to nalidixic acid was reversed in a complemented strain of this mutant, as verified by viability, disk diffusion, and minimal inhibitory concentration (MIC) assays. The phenotype of decreased violacein production of this mutant, observed in a liquid medium, was also complemented. In addition, it was performed the isolation of spontaneous mutants of C. violaceum resistant to nalidixic acid with a point mutation in emrR. DNA microarray assays showed that EmrR represses a few dozen of genes, including the emrCAB operon, which encodes the EmrCAB efflux pump. Northern blot assays confirmed that EmrR represses the emrCAB operon and that the expression of this pump is induced by salicylate, but not other compounds, such as nalidixic acid or ethidium bromide. Electrophoretic mobility shift assays (EMSA) showed that the purified EmrR protein binds directly to the promoter regions of emrR, emrCAB and several other genes of the EmrR regulon, to exert a direct negative regulation of these genes. A ?emrCAB null mutant strain was obtained, but the absence of this efflux pump did not make C. violaceum more susceptible to nalidixic acid, suggesting that it is important only under conditions in which it is induced. These inducing conditions may include 10 oxidative stress since antioxidant enzymes are part of the EmrR regulon and the EmrR protein has formed covalent dimers in the presence of oxidizing agents in vitro. Therefore, our data reveal that point mutations or molecules such as salicylate abolish the repressive activity of the EmrR transcription factor on the emrCAB operon, causing overexpression of the EmrCAB efflux pump and increasing the resistance to nalidixic acid in C. violaceum.

Introdução: Isolados clínicos de Pseudomonas aeruginosa multirresistentes estão associados a elevadas taxas de mortalidade. A resistência ao imipenem é uma urgência global, uma vez que é considerado o tratamento de escolha para infecções associadas a bactérias Gram negativas multirresistentes. Assim, elucidar os mecanismos de resistência é de vital importância para realizar um controle epidemiológico efetivo da disseminação deste tipo de isolado. Objetivos: Caracterizar os principais mecanismos de resistência ao imipenem em 76 isolados clínicos brasileiros de Pseudomonas aeruginosa, recuperados em 2004/2007, de 4 centros hospitalares do Estado de São Paulo. Material e métodos: Foram investigados: i) o perfil de resistência com determinação da CIM do imipenem; ii) a detecção de metalo-betalactamases (MBL) através de métodos fenotípicos e genotípicos; iii) a sensibilidade e especificidade do método de dupla difusão do disco na detecção de MBL; iv) a presença de genes codificadores de metilases 16S RNAr e sua associação com fenótipos aminoglicosídeo resistentes; v) alterações da permeabilidade por perda da porina OprD; vi) a presença ou ausência do gene oprD por PCR; vii) triagem fenotípica para expressão de bombas de efluxo através da determinação da CIM de quinolonas, cefalosporinas e carbapenêmicos na presença/ausência de inibidores específicos, realizando uma análise comparativa com o método de disco combinado; viii) os genes associados às bombas de efluxo mexA e mexE, através de PCR; ix) caracterizar a expressão das bombas de efluxo MexAB-OprM e MexEF-OprN, x) a clonalidade dos isolados por tipagem genotípica, através de ERIC-PCR, avaliando a relação genética (dendrograma) e sua associação com o predomínio de um determinado mecanismo de resistência. Resultados: Dentre os isolados de P. aeruginosa resistentes ao imipenem estudados (n=76, CIM50 e CIM90 = 32 &#181;g/mL e > 512 &#181;g/mL, respectivamente) 82% apresentaram um fenótipo de multirresistência. O principal mecanismo de resistência ao imipenem foi a produção de MBL, detectada em 74% dos isolados, e destes, 62% carregavam o gene blaSPM-1 e 12% carregavam o gene blaVIM-like. O método de dupla difusão do disco identificou a produção de MBL em 61% dos isolados. A combinação CAZ/MAA apresentou maior sensibilidade na detecção de MBL associada à SPM-1 (89%), mostrando uma especificidade de 86%. A presença do gene rmtD foi confirmada em 66% das amostras resistentes aos aminoglicosídeos, sendo que a presença concomitante do gene rmtD e do gene blaSPM-1 foi confirmada em 61% dos isolados. A deleção da porina OprD foi observada em 71% dos isolados. Dentre os isolados MBL positivos, 66% apresentaram ausência desta porina e, dentre as amostras MBL negativas, 85% não apresentaram OprD. Assim, para a resistência ao imipenem foi confirmada a contribuição de dois mecanismos, mediados pela presença de MBL e ausência de porina OprD. Em 13% (10/76) isolados, a deleção da porina OprD esteve associada à presença de seqüências de inserção (SI) em uma região anterior ao gene oprD. Por outro lado, a ausência de amplificação da região 736/1394 do gene oprD, em 11% (9/76) dos isolados, sugeriu a presença de polimorfismos. O gene mexA esteve presente em 92% dos isolados, enquanto que o gene mexE esteve presente em 82% dos isolados. A triagem de bombas de efluxo por disco combinado e análise da CIM na presença de reserpina, CCCP e PA&#946;N, utilizando levofloxacina, meropenem, aztreonam, imipenem ou levofloxacina, não teve correlação com a superexpressão dos sistemas MexAB-OprM e MexEF-OprN. Ambos os métodos careceram de especificidade e sensibilidade quando comparados ao PCR em tempo real. A superexpressão dos sistemas mexA e mexE foi confirmada em 35% (7/20) isolados MBL negativos, enquanto que 11% (6/56) isolados MBL positivos apresentaram superexpressão do gene mexA ou mexE, sendo que 7% (4/56) isolados MBL positivos superexpressaram ambos os genes. A superexpressão dos sistemas MexAB-OprM e MexEFOprN como único mecanismo de resistência ao meropenem e imipenem foi confirmada em 10% (2/20) dos isolados MBL negativos. Nos 76 isolados, a tipagem genotípica por ERIC-PCR, identificou a presença de 24 clusters (considerando 90% de similaridade na análise do dendrograma). Conclusão: A convergência de múltiplos mecanismos de resistência em P. aeruginosa parece ser um evento favorável para a seleção de clones endêmicos multirresistentes disseminados na região Sudeste do Brasil. / Introduction: Clinical isolates of Pseudomonas aeruginosa are associated with high mortality rates. Resistance to imipenem is a global concern, since it is a drug of choice for the treatment of infections produced by multidrug-resistant Gram-negative bacteria. Thus, research on resistance mechanisms is crucial to carry out an effective program for infection control and epidemiology of imipenem-resistant strains. Objective: to characterize the major mechanisms of imipenem resistance in 76 clinical isolates of P. aeruginosa recovered from clinical samples collected, from 2004 to 2007, in four hospitals in the State of São Paulo, Brazil. Material and methods: Isolates were screened for: i) resistance profile to antibacterial agents, determining the MIC of imipenem; ii) the detection of metallo-beta-lactamase (MBL) by phenotypic and genotypic methods, iii) MBL detection by using a double-disk diffusion test (D-test), determining the sensitivity and specificity of the assay; iv) the presence of genes encoding 16S rRNA methylases and their association with aminoglycoside-resistant phenotypes, v) changes in the bacterial permeability due to porin (OprD) loss; vi) the presence or absence of the oprD gene by using PCR; vii) phenotypic expression of efflux pumps by determining the MIC of quinolones, cephalosporins and carbapenems in the presence/absence of specific inhibitors, performing a comparative analysis with a combined-disk method, viii) genes encoding efflux pumps proteins (mexC and mexX) by PCR; ix) MexAB-OprM and MexEF efflux pumps expression; x) clonal relatedness, by ERIC-PCR genotyping, regarding the predominance of major resistance genotypes. Results: Among imipenem-resistant P. aeruginosa strains (n=76, MIC50 e MIC90 = 32 &#181;g/mL e > 512 &#181;g/mL, respectively) 82% showed a multidrug-resistant phenotype. The main mechanism of imipenem resistance was the MBL production detected in 74% strains, of which 62% harbored the blaSPM-1 gene, and 12% harbored the blaVIM-like gene. The D-test identified MBL production in 61% strains. In this regard, CAZ/MAA was the most sensitive combination for MBL detection associated to SPM-1 enzyme (89%), exhibiting 86% specificity. The presence of the rmtD 16S rRNA methylase gene was confirmed in 66% aminoglycoside-resistant strains. Moreover, presence of both rmtD and blaSPM-1 genes was identified in 61% strains. Loss of OprD porins was observed in 71% strains. In this regard, 66% MBL positive strains and 85% MBL negative strains showed OprD loss. Thus, MBL production and OprD loss contributed to imipenem resistance in P. aeruginosa. Most likely, in 13% (10/76) strains the porin loss was associated to insertion sequences (SI) inserted upstream of the oprD gene. On the other hand, in 11% (9/76) strains the absence of a PCR product targeting the 736/1394 region of the oprD gene, suggested the presence of polymorphisms. The mexA gene was identified in 92% strains, whereas the mexE gene was identified in 82% strains. Results obtained from efflux pump screening by using a combined-disk assay and MIC determination in the presence of reserpine, CCCP e PABN (using levofloxacin, meropenem, aztreonam or imipenem) was not correlated with results obtained from MexAB-OprM and MexEF-OprN overexpression analysis by RT-PCR. In this regard, both combined-disk and MIC assay showed lack of specificity and sensitivity in comparison to RT-PCR. Overexpression of mexA and mexE genes was confirmed in 35% (7/20) MBL-negative and 11% (6/56) MBL-positive strains, respectively, being 7% (4/56) MBL-positive strains overexpressed both genes. The overexpression of MexAB-OprM and MexEF-OprN efflux pumps, as only mechanism of resistance to meropenem and imipenem was observed in 10% (2/20) MBL-negative strains. ERICPCR typing revealed the presence of 24 clusters among 76 imipenem-resistant P. aeruginosa strains (&#8805; 90% similarity). Conclusion: The convergence of multiple mechanisms of resistance in Pseudomonas aeruginosa seems to be a favorable event for the selection of multiresistant clones endemic in the southeastern region of Brazil.

Les bactéries pathogènes opportunistes de l'Homme (bpo) sont retrouvées dans le milieu hospitalier où elles sont responsables d'infections nosocomiales ainsi que dans les milieux naturels terrestres et aquatiques. Elles présentent souvent des résistances intrinsèques aux antibiotiques élevées. En milieu clinique, l'usage intensif d'antibiotiques peut conduire à l'émergence de souches dites « Multi Drug Resistant ». L'anthropisation des milieux naturels peut également influencer la prévalence et les propriétés de résistance des bpo. Mes travaux ont porté sur l'impact de l'épandage d'amendements organiques sur la prévalence de bpo dans les sols, leur diversité génétique et leurs propriétés de résistance aux antibiotiques. Une étude des espèces Stenotrophomonas maltophilia, Pseudomonas aeruginosa et Burkholderia du « cepacia complexe » (Bcc) réalisée sur des sites du Burkina-Faso amendés ou non en déchets urbains bruts a mis en évidence des différences dans les propriétés de résistance des 3 modèles. S. maltophila présente fréquemment des phénotypes MDR contrairement à P. aeruginosa et aux Bcc. Une approche de génomique comparative entre souches de S. maltophilia d'origine environnementale ou clinique et de phénotypes sensibles à MDR a été réalisée afin d'élucider l'origine génétique de l'hétérogénéité des phénotypes de résistance. Une variation dans le contenu en pompes à efflux et la présence de pompes souche spécifique chez des souches environnementales ont été observées. L'étude de l'expression d'une de ces pompes confirme son implication dans la résistance aux antibiotiques et dans l'adaptation à des paramètres environnementaux tels que la température / Opportunistic bacterial pathogens (obp) of Man are found in hospital setting where they are responsible for nosocomial infections as well as in terrestrial and aquatic natural environments. Obp often show high intrinsic antibiotic resistance level. Moreover, the intensive use of antibiotics in clinical settings can lead to the emergence of "Multi Drug Resistant" strains. The anthropisation of the natural environment leads to modifications in bacterial diversity of these environments and can affect the prevalence and the antibiotic resistance properties of obp. My research focused on the impact of organic amendments on the prevalence, genetic diversity and antibiotic resistance properties of obp. A study on the species Stenotrophomonas maltophilia, Pseudomonas aeruginosa and the “Burkholderia cepacia complex" (Bcc) was conducted on sites in Burkina Faso amended or not with raw urban wastes. This study showed differences in antibiotic resistance properties between the 3 models. S. maltophila frequently showed MDR phenotypes unlike P. aeruginosa and Bcc. A comparative genomics study between S. maltophilia strains from environmental or clinical origin showing sensitive or MDR phenotypes was performed to elucidate the genetic origins of heterogeneity in the resistance phenotypes. A variation in the efflux pumps content was observed between strains. The expression of an efflux pump specific to an environmental MDR strain was then evaluated and confirmed its likely involvement in antibiotic resistance and adaptation to environmental parameters such as temperature

Introdução: Isolados clínicos de Pseudomonas aeruginosa multirresistentes estão associados a elevadas taxas de mortalidade. A resistência ao imipenem é uma urgência global, uma vez que é considerado o tratamento de escolha para infecções associadas a bactérias Gram negativas multirresistentes. Assim, elucidar os mecanismos de resistência é de vital importância para realizar um controle epidemiológico efetivo da disseminação deste tipo de isolado. Objetivos: Caracterizar os principais mecanismos de resistência ao imipenem em 76 isolados clínicos brasileiros de Pseudomonas aeruginosa, recuperados em 2004/2007, de 4 centros hospitalares do Estado de São Paulo. Material e métodos: Foram investigados: i) o perfil de resistência com determinação da CIM do imipenem; ii) a detecção de metalo-betalactamases (MBL) através de métodos fenotípicos e genotípicos; iii) a sensibilidade e especificidade do método de dupla difusão do disco na detecção de MBL; iv) a presença de genes codificadores de metilases 16S RNAr e sua associação com fenótipos aminoglicosídeo resistentes; v) alterações da permeabilidade por perda da porina OprD; vi) a presença ou ausência do gene oprD por PCR; vii) triagem fenotípica para expressão de bombas de efluxo através da determinação da CIM de quinolonas, cefalosporinas e carbapenêmicos na presença/ausência de inibidores específicos, realizando uma análise comparativa com o método de disco combinado; viii) os genes associados às bombas de efluxo mexA e mexE, através de PCR; ix) caracterizar a expressão das bombas de efluxo MexAB-OprM e MexEF-OprN, x) a clonalidade dos isolados por tipagem genotípica, através de ERIC-PCR, avaliando a relação genética (dendrograma) e sua associação com o predomínio de um determinado mecanismo de resistência. Resultados: Dentre os isolados de P. aeruginosa resistentes ao imipenem estudados (n=76, CIM50 e CIM90 = 32 &#181;g/mL e > 512 &#181;g/mL, respectivamente) 82% apresentaram um fenótipo de multirresistência. O principal mecanismo de resistência ao imipenem foi a produção de MBL, detectada em 74% dos isolados, e destes, 62% carregavam o gene blaSPM-1 e 12% carregavam o gene blaVIM-like. O método de dupla difusão do disco identificou a produção de MBL em 61% dos isolados. A combinação CAZ/MAA apresentou maior sensibilidade na detecção de MBL associada à SPM-1 (89%), mostrando uma especificidade de 86%. A presença do gene rmtD foi confirmada em 66% das amostras resistentes aos aminoglicosídeos, sendo que a presença concomitante do gene rmtD e do gene blaSPM-1 foi confirmada em 61% dos isolados. A deleção da porina OprD foi observada em 71% dos isolados. Dentre os isolados MBL positivos, 66% apresentaram ausência desta porina e, dentre as amostras MBL negativas, 85% não apresentaram OprD. Assim, para a resistência ao imipenem foi confirmada a contribuição de dois mecanismos, mediados pela presença de MBL e ausência de porina OprD. Em 13% (10/76) isolados, a deleção da porina OprD esteve associada à presença de seqüências de inserção (SI) em uma região anterior ao gene oprD. Por outro lado, a ausência de amplificação da região 736/1394 do gene oprD, em 11% (9/76) dos isolados, sugeriu a presença de polimorfismos. O gene mexA esteve presente em 92% dos isolados, enquanto que o gene mexE esteve presente em 82% dos isolados. A triagem de bombas de efluxo por disco combinado e análise da CIM na presença de reserpina, CCCP e PA&#946;N, utilizando levofloxacina, meropenem, aztreonam, imipenem ou levofloxacina, não teve correlação com a superexpressão dos sistemas MexAB-OprM e MexEF-OprN. Ambos os métodos careceram de especificidade e sensibilidade quando comparados ao PCR em tempo real. A superexpressão dos sistemas mexA e mexE foi confirmada em 35% (7/20) isolados MBL negativos, enquanto que 11% (6/56) isolados MBL positivos apresentaram superexpressão do gene mexA ou mexE, sendo que 7% (4/56) isolados MBL positivos superexpressaram ambos os genes. A superexpressão dos sistemas MexAB-OprM e MexEFOprN como único mecanismo de resistência ao meropenem e imipenem foi confirmada em 10% (2/20) dos isolados MBL negativos. Nos 76 isolados, a tipagem genotípica por ERIC-PCR, identificou a presença de 24 clusters (considerando 90% de similaridade na análise do dendrograma). Conclusão: A convergência de múltiplos mecanismos de resistência em P. aeruginosa parece ser um evento favorável para a seleção de clones endêmicos multirresistentes disseminados na região Sudeste do Brasil. / Introduction: Clinical isolates of Pseudomonas aeruginosa are associated with high mortality rates. Resistance to imipenem is a global concern, since it is a drug of choice for the treatment of infections produced by multidrug-resistant Gram-negative bacteria. Thus, research on resistance mechanisms is crucial to carry out an effective program for infection control and epidemiology of imipenem-resistant strains. Objective: to characterize the major mechanisms of imipenem resistance in 76 clinical isolates of P. aeruginosa recovered from clinical samples collected, from 2004 to 2007, in four hospitals in the State of São Paulo, Brazil. Material and methods: Isolates were screened for: i) resistance profile to antibacterial agents, determining the MIC of imipenem; ii) the detection of metallo-beta-lactamase (MBL) by phenotypic and genotypic methods, iii) MBL detection by using a double-disk diffusion test (D-test), determining the sensitivity and specificity of the assay; iv) the presence of genes encoding 16S rRNA methylases and their association with aminoglycoside-resistant phenotypes, v) changes in the bacterial permeability due to porin (OprD) loss; vi) the presence or absence of the oprD gene by using PCR; vii) phenotypic expression of efflux pumps by determining the MIC of quinolones, cephalosporins and carbapenems in the presence/absence of specific inhibitors, performing a comparative analysis with a combined-disk method, viii) genes encoding efflux pumps proteins (mexC and mexX) by PCR; ix) MexAB-OprM and MexEF efflux pumps expression; x) clonal relatedness, by ERIC-PCR genotyping, regarding the predominance of major resistance genotypes. Results: Among imipenem-resistant P. aeruginosa strains (n=76, MIC50 e MIC90 = 32 &#181;g/mL e > 512 &#181;g/mL, respectively) 82% showed a multidrug-resistant phenotype. The main mechanism of imipenem resistance was the MBL production detected in 74% strains, of which 62% harbored the blaSPM-1 gene, and 12% harbored the blaVIM-like gene. The D-test identified MBL production in 61% strains. In this regard, CAZ/MAA was the most sensitive combination for MBL detection associated to SPM-1 enzyme (89%), exhibiting 86% specificity. The presence of the rmtD 16S rRNA methylase gene was confirmed in 66% aminoglycoside-resistant strains. Moreover, presence of both rmtD and blaSPM-1 genes was identified in 61% strains. Loss of OprD porins was observed in 71% strains. In this regard, 66% MBL positive strains and 85% MBL negative strains showed OprD loss. Thus, MBL production and OprD loss contributed to imipenem resistance in P. aeruginosa. Most likely, in 13% (10/76) strains the porin loss was associated to insertion sequences (SI) inserted upstream of the oprD gene. On the other hand, in 11% (9/76) strains the absence of a PCR product targeting the 736/1394 region of the oprD gene, suggested the presence of polymorphisms. The mexA gene was identified in 92% strains, whereas the mexE gene was identified in 82% strains. Results obtained from efflux pump screening by using a combined-disk assay and MIC determination in the presence of reserpine, CCCP e PABN (using levofloxacin, meropenem, aztreonam or imipenem) was not correlated with results obtained from MexAB-OprM and MexEF-OprN overexpression analysis by RT-PCR. In this regard, both combined-disk and MIC assay showed lack of specificity and sensitivity in comparison to RT-PCR. Overexpression of mexA and mexE genes was confirmed in 35% (7/20) MBL-negative and 11% (6/56) MBL-positive strains, respectively, being 7% (4/56) MBL-positive strains overexpressed both genes. The overexpression of MexAB-OprM and MexEF-OprN efflux pumps, as only mechanism of resistance to meropenem and imipenem was observed in 10% (2/20) MBL-negative strains. ERICPCR typing revealed the presence of 24 clusters among 76 imipenem-resistant P. aeruginosa strains (&#8805; 90% similarity). Conclusion: The convergence of multiple mechanisms of resistance in Pseudomonas aeruginosa seems to be a favorable event for the selection of multiresistant clones endemic in the southeastern region of Brazil.

Infections arising from multidrug-resistant pathogenic bacteria are spreading rapidly throughout the world and threaten to become untreatable. The origins of resistance are numerous and complex, but one underlying factor is the capacity of bacteria to rapidly export drugs through the intrinsic activity of efflux pumps. In this work, a summary is provided of our current understanding of the structures and molecular mechanisms of multidrug efflux pumps in bacteria (Chapter 1). The emerging picture of the structure, function and regulation of efflux pumps suggests opportunities for countering their activities. Although this thesis primarily explores structure and function, it also elucidates the hidden regulatory mechanism (post-translational) behind the association of a small protein called AcrZ with the tripartite complex AcrAB/TolC, in connection with the lipid environment, and the resulting changes in the latter's functionality (Chapter 2). A regulatory role of the native membrane lipid environment as well as of small proteins for efflux pump activity have previously been hypothesised. I present the first example of a function-regulating role of the lipid cardiolipin in combination with a small protein binding partner (AcrZ) for the substrate selectivity and transport activity of an efflux pump protein (AcrB). This regulation happens through induced structural changes which have remained unseen so far. Alongside with these results, a nanodisc reconstitution method was experimentally adapted for a structure-function investigation of an efflux pump (complex) using cryo-EM (Chapter 2). Beyond some fundamental regulatory insights, hidden intrinsic transport mechanisms for some transporters have also remained to be explored and studied. The discovery of a mechanism for active influx by a prominent efflux pump model system (Chapter 3) provides hope that this phenomenon is more common amongst multidrug transporters and that it could be utilised for drug discovery purposes. This novel feature explains the contradictory findings on this transporter in the past and raises new questions about the little-known physiological role and evolution of efflux pumps. The development and evolution of antimicrobial resistance has frequently shown to be a multifactorial and fast-moving process. One of these factors is the evolution of pumps itself towards an altered functionality (e.g. towards a broader or altered substrate spectrum or higher efflux rates). Against this background, the role of key carboxylate residues for efflux-energising proton trafficking was investigated for a prominent study model of a secondary-active transporter (Chapter 4). The re-allocation and/or addition of acidic residues was demonstrated to result in the preservation of wild type activity or the generation of hyper-efflux activity, respectively. These findings suggest that rapid emergence of antimicrobial resistance could be enhanced by the 'plasticity' in the location of key carboxylate residues with a role in proton coupling. It also demonstrates the necessity of antimicrobial drug design programmes to anticipate possible trajectories of an adaptive evolution of efflux pump. The 'cryo-EM revolution' has boosted the pace at which new structural and functional insights into multidrug efflux pumps are gained. Nevertheless, in order to derive the structure of individual pump components or of a full assembly, it is sometimes necessary to identify and characterise homologues and mutants, which would allow the application of cryo-EM for obtaining near-atomic maps. Functional analyses presented in this work helped to characterise a homologue and mutants of the MacAB/TolC tripartite complex to justify the obtained protein structures and strategies for further functional characterisation (Chapter 5). Given (1) the unusual stoichiometry of a MacB dimer in complex with a hexameric membrane-fusion protein (MacA), which leads to a seeming leakiness of the assembly, and (2) the fact that substrate has to pass through a narrow aperture in the membrane-fusion protein for extrusion, it is rather surprising that MacB was previously shown to transport an entire toxin. An experimental approach was developed that could enable the structure determination of a toxin-bound full assembly of MacAB/TolC (Chapter 5). Finally, the role of multidrug efflux pumps for the evolution of multidrug resistance is yet to be studied and better explored. For instance, evolutionary trajectories of pump overexpression, as compared to those of regular expression or no expression, are unknown yet could have the potential to reveal useful insights for spread prevention and drug design. The outline of an experimental design with some preliminary validating data is presented in Chapter 6.