La colistine est un vieil antibiotique, utilisé à la fois en médecine humaine et vétérinaire. Cependant, l'arsenal antibiotique étant de plus en plus limité, la colistine apparait comme un des derniers remparts dans la lutte contre les bactéries multi-résistantes chez l'Homme. Afin de préserver l'efficacité de la colistine, deux problématiques ont été abordées dans cette thèse : (i) les risques de sélection de résistance à la colistine en lien avec la découverte fin 2015 d'un gène porté par un plasmide (mcr-1). Ainsi, l'impact de l'usage de colistine par voie orale en production porcine a été évalué in vivo et une absence de sélection a été observée dans nos conditions expérimentales. De façon similaire, l'usage (minoritaire) de colistine en médecine humaine comme prophylaxie de décontamination digestive sélective (SDD) a été étudié chez des rats hébergeant un microbiote intestinal humain. Les résultats préliminaires ne montrent pas non plus d'effet de sélection. (ii) le développement d'un modèle pharmacocinétique basé sur la physiologie (PBPK) chez le porc pour l'usage par voie systémique de la colistine et de sa prodrogue, le colistine méthanesulfonate (CMS). Ce modèle a permis d'explorer la distribution tissulaire du CMS et de la colistine, notamment au niveau rénal où la toxicité est la plus fréquente. Comme application de ce modèle, l'estimation des temps d'attente avant abattage lors d'usage de CMS chez le porc a été effectué. Enfin, la capacité des modèles PBPK à réaliser des extrapolations intra et inter-espèces a été utilisé pour adapter ce modèle chez l'adulte et l'enfant, afin de pouvoir prédire les concentrations plasmatiques de colistine lors d'un traitement. / Colistin is an old antibiotic used in human and veterinary medicine. However, as less and less antibiotics are discovered, colistin is considered as a last-line antibiotic to fight against multi-drug resistant bacteria in human. In order to preserve the efficacy of colistin, two issues were investigated in this thesis:(i) Risks of selection of bacteria resistant to colistin, in conjunction with the discovery by the end of 2015 of a plasmid-mediated resistance gene (mcr-1). Thus, the impact of oral use of colistin in pigs was assessed in vivo and no selection was observed in our experimental conditions. Similarly, the use of colistin in human medicine for selective digestive decontamination was studied thanks to human flora‐associated rats. Preliminary results were also neither in favour of a selective effect of colistin.(ii) development of a physiologically-based pharmacokinetic model (PBPK) in pigs for the systemic use of colistin and its prodrug, the colistimethate sodium (CMS). This model provided a further insight into CMS and colistin tissue distribution, especially in kidneys where toxic effects are frequent. As a model application, the withdrawal period after use of CMS in pigs was estimated. Then, we used the ability of PBPK models to carry out intra and inter-species extrapolations in order to adapt this model in adults and children and eventually predict the plasmatic concentrations of colistin during a treatment with CMS.

Polymyxins are potent antibiotics that bind to the outer membrane of Gram-negative bacteria, entering the cell and disrupting the inner membrane, resulting in cell death. They were traditionally used as antibiotics of last resort, but the recent surge of multidrug resistant pathogens has renewed interest in these antibiotics. The emergence of polymyxin resistance determinants such as the recently discovered plasmid-mediated phosphoethanolamine transferase MCR-1 may put a strain on the future effectiveness of this antibiotic. One method to combat the rise in antibiotic resistant bacteria is through the identification and development of antibiotic adjuvants. These are small molecules that are able to inhibit the resistance mechanism, allowing previously ineffective antibiotics to once again become effective at treating bacterial infections. In this work, a high throughput cell-based screen was conducted using an in-house library of Actinomycete-derived crude cell extracts in order to search for a natural product inhibitor of an E. coli strain expressing mcr-1. In addition, the development of a new enzyme assay was attempted using purified MCR-1 C-terminal catalytic domain and a chromogenic substrate to test enzymatic activity in vitro, in hopes of establishing a simple means of studying inhibition of MCR-1. The structure-function relationship of MCR-1 was also explored by generating amino acid substitutions and studying their effect on the ability of the enzyme to confer resistance to colistin, as well as the generation of MCR-1 transmembrane truncation mutants to determine if it was possible to generate a shorter variant of MCR-1 that retained its enzymatic activity. This work furthers our understanding of the biochemistry and enzymology of MCR-1, and outlines attempts to identify inhibitors of MCR-1 in order to re-sensitize resistant bacteria to polymyxins. / Thesis / Master of Science (MSc) / Polymyxins are potent antibiotics that are threatened by the spread of multi-drug resistant bacteria. Resistance to these antibiotics is relatively rare, although the recent discovery of a mobile polymyxin resistance enzyme, MCR-1, threatens the future use of this antibiotic for treating infections, as it can readily transfer to other bacteria. The goal of this work was to search for a natural product inhibitor of MCR-1 in order to reverse its ability to confer resistance to polymyxins. A color-changing assay was conducted with MCR-1 in hopes of establishing a method to study the inhibition of MCR-1 in vitro. Additionally, amino acid substitutions were generated in MCR-1 to better understand how key amino acids affect enzyme function, as well as transmembrane domain truncations to determine if it was possible to create a shorter functioning variant of MCR-1.