Introdução: As polimixinas são consideradas as opções terapêuticas de resgate para o tratamento das infecções de corrente sanguínea (ICS) por bacilos Gram-negativos (BGN) com resistência aos carbapenens (CR) e a combinação com outro antimicrobiano tem sido utilizada apesar da falta de evidência clínica para esta prática. Objetivo: Avaliar o uso de polimixina B intravenosa em monoterapia e em combinação com outro antimicrobiano para ICS por BGN CR. Pacientes e Métodos: Foi um estudo de coorte retrospectivo em um hospital terciário, incluindo 99 pacientes. A comparação dos tipos terapias foi através do propensity score. Resultados: A mortalidade global em 30 dias foi de 43,4%: 40,7% (24 de 59) e 47,5% (19 de 40), p=0,51, em pacientes que receberam combinação e monoterapia, respectivamente. A sepse grave/choque séptico no dia da ICS, alta pontuação do escore de bacteremia de Pitt e a presença de neoplasia como doença de base foram, independentemente, associados a maior mortalidade em 30 dias no modelo de regressão de Cox. A terapia combinada não foi significativamente associada a este resultado (hazard ratio, 0,70; intervalo de confiança de 95%, 0,36-1,36); p=0,29). Apesar de não ser significativa, houve uma tendência a um efeito benéfico da associação em pacientes com ICS por BGN CR da família Enterobacteriaceae. Não houve diferença no desenvolvimento de insuficiência renal aguda em pacientes que receberam terapia de combinação comparado com os que receberam monoterapia. Conclusão: Não houve diferença na mortalidade em 30 dias em pacientes com ICS por BGN CR tratados com polimixina B em combinação com outro antimicrobiano ou em monoterapia. A prática rotineira de combinar um segundo antibiótico em esquemas baseados em polimixinas, especialmente, se a bactéria apresenta resistência in vitro ao carbapenem, ainda necessita estudos clínicos adicionais. / Background: Polymyxins are usually the last resort therapy for carbapenem-resistant Gram-negative bacteria (CR GNB) bloodstream infections (BSIs), combination with another antimicrobial has been used despite the lack of clinical evidence supporting such practice. Objetive: We aimed to assess the use of intravenous polymyxin B in combination with another antimicrobial in comparison with polymyxin B as a single drug for CR GNB BSIs, adjusting for a propensity score for indication of combination therapy. Patient and methods: We compared combination versus monotherapy with polymyxin B for CR GNB BSIs, adjusting for a propensity score for indication of combination therapy. It was a retrospective cohort study at a tertiary-hospital including 99 patients. Results: The overall 30-day mortality was 43.4%: 40.7% (24 of 59) and 47.5% (19 of 40), P=0.51, in patients receiving combination and monotherapy, respectively. Severe sepsis/ septic shock at BSI onset higher Pitt bacteremia score and neoplasia were independently associated with higher 30-day mortality in a Cox-regression model. Combination therapy was not significantly associated with this outcome (Hazard Ratio, 0.70; 95% confidence interval, 0.36-1.36); P=0.29). Although not significant, there was a tendency to a beneficial effect of combination in patients with Enterobacteriaceae CR GNB BSIs. There was no difference in development of AKI in patients receiving combination therapy compared to those receiving monotherapy. Conclusions: There was no difference in 30-day mortality in patients with CR GNB BSIs treated with polymyxin B in combination with another antimicrobial compared with polymyxin B alone. The routine practice of combining a second antibiotic in polymyxins-based regimes, especially if the bacteria present in vitro resistance to the agent, still lacks support from clinical studies.

INTRODUÇÃO: O aumento da incidência de infecções causadas por bactérias resistentes a múltiplos antimicrobianos limita cada vez mais as opções terapêuticas, dificultando o tratamento e aumentando os índices de morbidade e mortalidade, além dos gastos em saúde. Ao longo dos últimos cinco anos, essa limitação tem levado ao reestabelecimento do uso de antimicrobianos consideradas ultrapassados, como as polimixinas. Este grupo passou a ser utilizado com cada vez mais frequência no tratamento de infecções causadas por microrganismos gram-negativos resistentes aos carbapenêmicos. As enterobactérias, em particular a espécie Klebsiella pneumoniae, tem apresentado frequentemente esse perfil, porém, a resistência à polimixinas têm sido relatada, eliminando essa importante alternativa terapêutica. Apesar da importância do tema, são escassas as publicações sobre frequência de resistência às polimixinas em K. pneumoniae e a relação clonal entre isolados resistentes à polimixina B no Brasil. OBJETIVOS: Avaliar a relação genética, perfil de sensibilidade antimicrobiana e mecanismos de resistência às polimixinas em K. pneumoniae. MATERIAIS E MÉTODOS: A execução deste trabalho dividiu-se em duas partes principais: (i) levantamento de dados de culturas positivas para K. pneumoniae da rotina de pacientes hospitalizados em instituições atendidas pelo serviço de análises clínicas do Fleury Medicina e Saúde; (ii) confirmação das concentrações inibitórias mínimas (CIM) para polimixina B, avaliação da relação clonal por eletroforese em campos pulsados (PFGE),e sequenciamento de múltiplos loci (MLST), avaliação da integridade do gene mgrB e da presença do gene mcr-1 por PCR entre isolados resistentes à polimixina B e aos carbapenêmicos (CPRKp). RESULTADOS e CONCLUSÕES: Na análise de 3.085 isolados de K. pneumoniae obtidos de pacientes internados em 11 hospitais da Grande São Paulo entre os anos de 2011 e 2015, foi evidenciado um aumento estatisticamente significativo na resistência aos carbapenêmicos de 6,8% em 2011 para 35,5% em 2015. Em 2015, KPC foi detectada em 96,2% dos isolados resistentes aos carbapenêmicos. A distribuição das concentrações inibitórias mínimas de polimixina B entre todos os isolados de K. pneumoniae evidenciou uma distribuição bimodal com a CIM de 2 mg/L como o valor de ponto de corte para a susceptibilidade à polimixina B; assim, 3,6% do número total de isolados sensíveis aos carbapenêmicos foram interpretados como resistentes enquanto essa proporção foi de 22,5% entre as resistentes aos carbapenêmicos (CRKp). Entre esses últimos isolados também houve um aumento estatisticamente significativo na tendência anual de resistência à polimixina B, de 0% em 2011 para 27,1% em 2015. Estas taxas variaram de 0,7% em 2011 para 3,9% até junho de 2014 entre os sensíveis aos carbapenêmicos. Entre os antimicrobianos alternativos, a amicacina e a tigeciclina foram os compostos mais ativos. A análise por PFGE de 60 isolados de CPRKp obtidos de pacientes distintos nos anos de 2014 e 2015 evidenciou dois grandes grupos clonais: CPRKp1 e CPRKp2, os quais segundo a análise por MLST pertencem, respectivamente, aos grupos ST11 e ST437, ambos do complexo clonal 258. Foi observado o mesmo grupo ST entre isolados obtidos dentro de um mesmo hospital e também entre diferentes hospitais, públicos e privados. O mecanismo de resistência mais comum entre os isolados de CPRKp foi a presença de sequências de inserção interrompendo o gene mgrB. O gene mcr-1 não foi detectado em nenhum dos isolados. / INTRODUCTION: The increasing incidence of infections caused by bacteria resistant to multiple antimicrobials increasingly limits therapeutic options, making treatment difficult and increasing the morbidity and mortality and health spending. Over the past five years, this limitation has led to the reestablishment of the use of antimicrobials deemed outdated, such as polymyxins. This group is now used with increasing frequency to treat infections caused by carbapenem-resistant gram-negative microorganisms. Enterobacteria, especially Klebsiella pneumoniae, have often presented this profile, however, resistance to polymyxins have been also reported, eliminating this important therapeutic alternative. Despite the importance of this issue, the publications are scarce on the polymyxins resistance frequency in K. pneumoniae and clonal relationship among isolates resistant to polymyxin B in Brazil. OBJECTIVES: To evaluate the genetic relationship, antimicrobial susceptibility profile and polymyxin B resistance mechanisms in K. pneumoniae. MATERIALS AND METHODS: The execution of this work was divided into two main parts: (i) survey data on routine cultures positive for K. pneumoniae from patients hospitalized in institutions attended by the clinical analysis service of Fleury Health and Medicine; (ii) confirmation of to polymyxin B minimum inhibitory concentrations (MIC), evaluation of clonal relationship by electrophoresis pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST), evaluation of the integrity of the mgrB gene and the presence of mcr-1 gene by PCR among isolates resistant to polymyxin B and carbapenems (CPRKp). RESULTS AND CONCLUSIONS: The analysis of 3,085 K. pneumoniae isolates obtained from inpatients from 11 hospitals in the São Paulo urban area between 2011 and 2015, has shown a statistically significant increase in carbapenem resistance from 6.8% in 2011 to 35.5% in 2015. In 2015, KPC was detected in 96.2% of isolates resistant to carbapenems. The polymyxin B MIC distribution of all Klebsiella pneumoniae showed a bimodal distribution with the MIC of 2 mg/L as the cutoff value for polymyxin B susceptibility; thus, 3.6% of the total number of isolates susceptible to carbapenems were interpreted as resistant while this proportion was 22.5% among carbapenem-resistant isolates (CRKp). Among these isolates there was also a statistically significant increase in the annual trend of polymyxin B resistance, from 0% in 2011 to 27.1% in 2015. These rates ranged from 0.7% in 2011 to 3.9% by June 2014 between carbapenem-susceptible isolates. Among alternative antimicrobials, amikacin and tigecycline were the most active compounds. The analysis by PFGE of 60 CPRKp isolates obtained from different patients in the years 2014 and 2015 showed two major clonal groups: CPRKp1 and CPRKp2, which according to the analysis by MLST belong respectively to ST11 and ST437 groups, both from clonal complex 258. We observed the same ST group of isolates obtained within a hospital and between different public and private hospitals. The most common mechanism of polymyxin B resistance among CPRKp isolates was the presence of insertion sequences interrupting the mgrB gene. The mcr-1 gene was not detected in any of the isolates.

La colistine, antibiotique appartenant à la famille des polymyxines, est un polypeptide cyclique, cationique, ciblant les membranes bactériennes. Elle est produite par Paenibacillus polymyxa via des complexes multi-enzymatiques appelés Non-Ribosomal Peptides Synthétases (NRPS). Dans le cas de la mucoviscidose, et malgré des effets secondaires importants, la colistine est utilisée comme ultime recours pour lutter contre les bactéries Gram-négatives multirésistantes responsables d’infections pulmonaires dont Pseudomonas aeruginosa. Jusqu’ici les systèmes génétiques à l’origine de la production de la colistine étaient peu connus. Au cours de cette étude, nous avons caractérisé par LC-MS haute résolution des molécules antimicrobiennes, dont des colistines, produites par un nouveau Paenibacillus. Afin d’identifier et de cloner le cluster de gène responsable de la production de ces antibiotiques, une banque d’ADN génomique a été construite et criblée par homologie de séquence avec des systèmes de production déjà connus. Ce criblage a permis de sélectionner quatre clones d’intérêt. L’étude in silico de leurs séquences a permis d’identifier les différents modules d’un nouveau cluster NRPS qui serait à l’origine de la synthèse de variants de la colistine. À terme, cette découverte pourrait permettre de mieux contrôler la production de la colistine et d’obtenir des composés plus actifs et/ou présentant des effets secondaires amoindris. En parallèle à ce premier travail, nous avons également recherché la présence de nouvelles NRPS chez une centaine de micro-organismes issus d’une station d’étude environnementale du laboratoire (vasière intertidale). Ce travail a permis de découvrir des nouvelles séquences et d’isoler un nouveau micro-organisme producteur d’antibiotique(s). / Colistin is a cationic cyclic polypeptide antibiotic belonging to the polymyxin family and targeting bacterial membranes. It is produced by Paenibacillus polymyxa through a Nonribosomal Peptide Synthetase (NRPS) mechanism. In the context of cystic fibrosis (CF), colistin is used for the treatment of lung infections caused by multiresistant Gram-negative bacteria including Pseudomonas aeruginosa. Unfortunately, this molecule is also known for its strong side effects. So far, genetic systems controlling the production of polymyxins were little known. In this study we characterized by High-resolution LC-MS the antimicrobial molecules, including colistins, of a new Paenibacillus. A genomic library of this strain was constructed and screened to identify genes involved in the production of these antibiotics. A degenerated PCR screening was performed and allowed to select four clones in the genomic library. In silico study allowed to identify a new NRPS gene cluster responsible for the biosynthesis of colistin variants. In the future, this work might allow the harnessing of the production of colistin derived structures, more active and/or showing fewer side effects. In parallel, a second investigation was performed in order to find new NRPS genes in a collection of one hundred intertidal mudflat bacterial isolates. This work has allowed the identification of new sequences and the characterization of a new antimicrobial producing strain.

L’émergence de nouvelles souches bactériennes résistantes a signé la fin de l’« âge d’or » des antibiotiques. L’organisation mondiale de la santé a reconnu l’imminence des problèmes associés à ces nouvelles bactéries, qui engendrent de nouveau une mortalité en augmentation. Afin de palier à ce problème, de nouvelles alternatives aux antibiotiques sont envisagées par les chercheurs à travers le monde. La thérapie photodynamique antimicrobienne est l’une de ces alternatives. Elle a su se démarquer grâce à son incapacité à induire la résistance bactérienne. Alors que les résultats furent initialement très prometteurs contre les bactéries Gram positif, une moins bonne sensibilité fut rapidement observée de la part des bactéries Gram négatif. Afin d’augmenter le potentiel antibactérien de cette technique, diverses stratégies furent élaborées comme l’utilisation de photosensibilisateurs cationiques, l’ajout d’un agent de ciblage, ou la présence d’un agent de perméabilisation membranaire. L’un de ces agents est la polymyxine B, un peptide antimicrobien qui arbore une très bonne affinité avec les bactéries Gram négatif. Dans cette étude, nous avons voulu associer chimiquement différents photosensibilisateurs avec des dérivés de polymyxines B de façon covalente, par l’intermédiaire d’un bras « spacer » ou d’une plateforme. L’association de ces deux familles de molécules a permis d’élaborer de nouveaux composés qui ont démontré une activité photobactéricide accrue contre un large spectre de bactérie. De plus, ces composés ont montré une affinité augmentée pour les bactéries, ce qui permettra de réduire les effets secondaires sur les cellules humaines. Cette étude confirme l’importance d’utiliser des peptides antimicrobiens afin d’améliorer la thérapie photodynamique. Ces travaux seront approfondis afin de permettre la création de nouveaux traitements dermatologiques basées sur cette nouvelle thérapie et efficaces contre un large spectre de souche bactérienne / Despite advances achieved over the last decade, infections caused by multi-drug resistant bacterial strains are increasingly important societal issues that need to be addressed. New approaches have already been developed in order to overcome this problem. Photodynamic antimicrobial chemotherapy (PACT) could provide an alternative to fight infectious bacteria. Interesting results have been obtained against Gram-positive bacteria, but it also appeared that Gram-negative strains were less sensitive to PACT. Enhanced efficacy against Gram-negative bacteria had been previously obtained following three differents strategies, which are respectively the use of cationic photosensitizers, photosensitizers bound to antimicrobial peptides, or a membrane disrupting agent. Polymyxin B is an antimicrobial peptide, known as the “last-line” treatment against Gram-negative resistant strains, which has already been used as a disrupting agent in order to improve PACT. In addition of this enhancement, this peptide is known for its strong interaction for Gram-negative bacteria. Thus, in this work, we designed differents coumpounds, consisting of a photosensitizer covalently attached to derivatives of polymyxin B, through a spacer or a chemical platform. These combinations have led to the creation of novel compounds which have shown highly photobactericidal activities against a wide spectrum of bacteria. Moreover, these compounds present enhanced affinity for bacteria, which should significantly reduce side effects on mammalian cells. This study confirmed the importance of using antimicrobial in order to target bacterial strains. Thus, such results may allow the creation of novels PACT-based dermatological treatments efficient against a wide spectrum of bacterial strains.

<p>Sepsis and septic shock are life-threating conditions, which resulted from a continuum of the body’s response to overwhelming infection. Elimination of bacteria through antibiotics is not sufficient, because the host is still left with a large amount of lipopolysaccharide (LPS) that prevents the host immune system from returning to normal homeostasis. Synthetic LPS antagonists that can bind to LPS via electrostatic and/or hydrophobic interactions cause systemic toxicities. Moreover, LPS elimination alone may not address already established complications of sepsis. To address these challenges, we propose to develop nanoparticle formulations of LPS antagonists (D-TZP) that can be delivered systemically. Specifically, cholecalciferol (vitamin D) was encapsulated in a self-assembly of tannic acid/Fe³⁺ coordination complex (pTA) capsule, forming a core that could be surface-modified with LPS adsorbents, such as low molecular weight succinylated chitosan (LMZWC) and polymyxin B (PMB). D-TZP suppressed pro-inflammatory effects of LPS on the engineered human monocytes with significantly less cytotoxicity than free PMB at the equivalent dose. D-TZP increased the maximum tolerated dose of PMB by both intraperitoneal and intravenous administration. In the LPS-induced mouse model of sepsis, systemic administration of D-TZP immediately after LPS challenge neutralized the lethal effect of LPS. D-TZP also reduced the mortality of mice when given 2 h after the LPS challenge. D-TZP inhibited the mortality in the cecal ligation and puncture (CLP)-induced bacteremia mouse model when given IV 2 h after the insult. In the CLP model, the D-TZP-treated animals also showed lower levels of both TNF-α and IL-10 cytokines as well as D-dimer levels, reflecting the attenuation of disseminated intravascular coagulation, compared to the vehicle-treated control group. Collectively, these results support that the D-TZP is a safe and effective systemic intervention of sepsis.<br></p>

Tesis por compendio / [ES] Esta tesis doctoral titulada "Nanopartículas de sílice mesoporosas funcionalizadas con puertas moleculares para aplicaciones biomédicas" está centrada en el diseño y la síntesis de nuevos nanosistemas sensores y terapéuticos con aplicaciones en el campo clínico y medioambiental. En la introducción de esta tesis (capítulo uno) se presenta una visión general de conceptos básicos de nanotecnología, química supramolecular, nanopartículas de sílice mesoporosa y de puertas moleculares. A continuación, se presentan los objetivos generales y específicos que se van a desarrollar en los capítulos experimentales siguientes. En el tercer capítulo se presenta el diseño, síntesis y caracterización de un nanodispositivo para la detección de endotoxina en medios acuosos. El nanodispositivo está basado en nanopartículas de sílice mesoporosa con los poros cargados con rodamina B y su superficie externa funcionalizada con grupos carboxilato. Los poros se bloquean, para evitar la liberación de la rodamina B, con polimixina B, un péptido con carga positiva. En presencia de la endotoxina, la polimixina B es desplazada de la superficie de las nanopartículas y se activa la liberación de la rodamina B del interior de los poros a la disolución. Esta liberación genera un aumento significativo de la fluorescencia en la disolución permitiendo la detección de la endotoxina. La respuesta obtenida con el nanodispositivo es muy selectiva ya que otras especies como el arabinogalactan, el ß-(1,3)-D-glucano, la pectina, el EDTA, la glucosa, el GTP y el polvo no son capaces de inducir la apertura de los poros y la liberación de la rodamina B. Además, el nanodispositivo presenta un límite de detección para la endotoxina en el rango picomolar. En el cuarto capítulo se describe un nanodispositivo, basado en nanopartículas de sílice mesoporosa cargadas con rodamina B y tapadas con curcumina, que se emplea para la detección selectiva de seroalbúmina humana (HSA) mediante medidas de fluorescencia. En este nanodispositivo, de nuevo, la presencia de HSA es capaz de desplazar la curcumina de la superficie de las nanopartículas permitiendo la liberación controlada de la rodamina B. El nanodispositivo preparado presentó una respuesta muy selectiva hacia la HSA con un límite de detección tan bajo como 0.1 mg/mL en PBS (pH 7.4)-acetonitrilo 95:5 v/v. El capítulo cinco está centrado en la preparación de un nanodispositivo para la liberación sinérgica del antibiótico linezolida en presencia de bacterias Gram negativas. Este nanomaterial está basado en el empleo de nanopartículas de sílice mesoporosa (como soporte inorgánico) con los poros cargados con linezolida y con la superficie externa funcionalizada con el antibiótico disruptor de membrana polimixina B (mediante interacciones electrostáticas). Cuando estas nanopartículas entran en contacto con bacterias Gram negativas el lipopolisacárido (LPS) de sus membrabas induce el desplazamiento de la polimixina B que actúa eficientemente como permeador y permite la liberación de la linezolida. La liberación simultánea de linezolida y la polimixina B en forma de nanoformulación inducen una reducción significativa de los valores del IC50 para bacterias cuando se compara con los valores obtenidos empleando de forma individual ambas especies. El capítulo sexto está dedicado a la discusión de los resultados experimentales descritos en los capítulos tres, cuatro y cinco. Finalmente, el capítulo siete de esta tesis doctoral, presenta las conclusiones generales que se derivan del trabajo experimental realizado. También se presentan las perspectivas futuras en el campo de las aplicaciones biomédicas de las nanopartículas de sílice mesoporosa con puertas moleculares. Esperamos que los resultados que se presentan en esta tesis doctoral puedan abrir nuevas oportunidades de investigación en el desarrollo de nuevos nanodispositivos inteligentes que puedan actuar como agentes antimicrobianos. / [CAT] Aquesta tesi doctoral titulada "Nanopartícules de sílice mesoporoses funcionalitzades amb portes moleculars per a aplicacions biomèdiques" està centrada en el disseny i la síntesi de nous nanosistemes sensors i terapèutics amb aplicacions en el camp clínic i mediambientals. En la introducció d'aquesta tesi (capítol un) es presenta una visió general de conceptes bàsics de nanotecnologia, química supramolecular, nanopartícules de sílice mesoporosa i de portes moleculars. A continuació, es presenten els objectius generals i específics que es desenvoluparan en els capítols experimentals següents. En el tercer capítol es presenta el disseny, síntesi i caracterització d'un nanodispositiu per a la detecció d'endotoxina en mitjans aquosos. El nanodispositiu està basat en nanopartícules de sílice mesoporosa amb els porus carregats amb rodamina B i la seua superfície externa funcionalitzada amb grups carboxilat. Els porus es bloquegen, per a evitar l'alliberament de la rodamina B, amb polimixina B, un pèptid amb càrrega positiva. En presència de l'endotoxina, la polimixina B és desplaçada de la superfície de les nanopartícules i s'activa l'alliberament de la rodamina B de l'interior dels porus a la dissolució. Aquest alliberament genera un augment significatiu de la fluorescència en la dissolució permetent la detecció de l'endotoxina. La resposta obtinguda amb el nanodispositiu és molt selectiva ja que altres espècies com l'arabinogalactan, el ß-(1,3)-D-glucà, la pectina, l'EDTA, la glucosa, el GTP i la pols no són capaços d'induir l'obertura dels porus i l'alliberament de la rodamina B. A més, el nanodispositiu presenta un límit de detecció per a l'endotoxina en el rang picomolar. En el quart capítol es descriu un nanodispositiu, basat en nanopartícules de sílice mesoporosa carregades amb rodamina B i tapades amb curcumina, que s'empra per a la detecció selectiva de seroalbúmina humana (HSA) mitjançant mesures de fluorescència. En aquest nanodispositiu, de nou, la presència de HSA és capaç de desplaçar la curcumina de la superfície de les nanopartícules permetent l'alliberament controlat de la rodamina B. El nanodispositiu preparat va presentar una resposta molt selectiva cap a la HSA amb un límit de detecció tan baix com 0.1 mg/ml en PBS (pH 7.4)-acetonitril 95:5 v/v. El capítol cinc està centrat en la preparació d'un nanodispositiu per a l'alliberament sinèrgic de l'antibiòtic linezolida en presència de bacteris Gram negatives. Aquest nanomaterial està basat en l'ús de nanopartícules de sílice mesoporosa (com a suport inorgànic) amb els porus carregats amb linezolida i amb la superfície externa funcionalitzada amb l'antibiòtic disruptor de membrana polimixina B (mitjançant interaccions electroestàtiques). Quan aquestes nanopartícules entren en contacte amb bacteris Gram negatives el lipopolisacàrid (*LPS) de les seues membranes indueix el desplaçament de la polimixina B que actua eficientment com permeador i permet l'alliberament de la linezolida. L'alliberament simultani de linezolida i la polimixina B en forma de nanoformulació indueixen una reducció significativa dels valors de l'IC50 per a bacteris quan es compara amb els valors obtinguts emprant de manera individual totes dues espècies. El capítol sisé està dedicat a la discussió dels resultats experimentals descrits en els capítols tres, quatre i cinc. Finalment, el capítol set d'aquesta tesi doctoral, presenta les conclusions generals que es deriven del treball experimental realitzat. També es presenten les perspectives futures en el camp de les aplicacions biomèdiques de les nanopartícules de sílice mesoporosa amb portes moleculars. Esperem que els resultats que es presenten en aquesta tesi doctoral puguen obrir noves oportunitats d'investigació en el desenvolupament de nous nanodispositius intel·ligents que puguen actuar com a agents antimicrobians / [EN] This PhD thesis entitled "Gated mesoporous silica nanoparticles for biomedical applications" is focused on the design and synthesis of novel nanodevices for sensing and therapeutic applications in clinical and environmental fields. The first introductory chapter presented an overview of the different concepts related to nanotechnology, supramolecular chemistry, mesoporous silica nanoparticles (MSNs), and molecular gates. Next, the general and specific objectives of this PhD thesis, that are addressed in the different experimental chapters, are presented. The third chapter presented the design, synthesis, and characterization of a nanodevice for endotoxin detection in aqueous environments. The prepared nanodevice is based on mesoporous silica nanoparticles loaded rhodamine B and with its external surface functionalized with carboxylates. Pores are finally capped upon addition of cationic polymyxin B peptide. In the presence of endotoxin, polymyxin B is detached from the surface of the nanoparticles with subsequent rhodamine B release from the inner of the pores to the solution. This release generated a marked emission enhancement in solution which allow endotoxin detection. The obtained response was highly selective to endotoxin because other interfering agents such as arabinogalactan, ß-(1,3)-D-glucan, pectin, EDTA, glucose, GTP and dust were unable to induce pore opening and rhodamine B release. Besides, the system detects endotoxin with a limit of detection in the picomolar range. The fourth chapter presented a nanodevice, based on mesoporous silica nanoparticles loaded with rhodamine B and capped with anionic curcumin, which is used for the selective and sensitive fluorogenic detection of human serum albumin (HSA). Again, in the presence of HSA, curcumin was detached from nanoparticles surface allowing rhodamine B release. Prepared nanodevice showed a highly selective response toward HSA with a limit of detection for HSA as low as 0.1 mg/mL in PBS (pH 7.4)-acetonitrile 95:5 v/v. Chapter five focus on the design and synthesis of a nanodevice for the synergic release of linezolid antibiotic in the presence of Gram-negative bacteria. This nanodevice is based on the use of mesoporous silica nanoparticles (as inorganic support) with the pores loaded with linezolid and capped with the membrane disruptor polymyxin B through electrostatic interactions. When these particles enter in contact with Gram-negative bacterium, lipopolysaccharide (LPS) present in the cell membrane induces the detachment of polymyxin B, which acts as membrane permeator, from the nanodevice allowing linezolid release. Simultaneous release of linezolid and polymyxin B as a nanoformulation induced a marked reduction in the IC50 values for bacteria when compared to the values obtained using free linezolid and polymyxin B alone. The sixth chapter is devoted to the discussion of the experimental results described in the previous chapters. Finally, the seventh chapter of this PhD thesis, presented the main conclusions, derived from the experimental work, and future perspectives in the field of gated mesoporous silica nanoparticles for biomedical applications. We hope that the results achieved in this PhD thesis will open new research opportunities to develop advanced smart nanodevices as antimicrobial drugs / Otri, I. (2023). Gated Mesoporous Silica Nanoparticles for Biomedical Applications [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/194710 / Compendio

Au laboratoire, une famille de tyrosine kinases propres aux bactéries et ne présentant aucune ressemblance structurale avec les protéine-kinases d’origine eucaryote a été identifiée. Ces enzymes, appelées BY-kinases, sont notamment impliquées dans la biosynthèse des polysaccharides extracellulaires, mais leurs rôles précis ainsi que leurs mécanismes catalytiques sont encore peu compris.Dans la première partie de ce travail, nous avons caractérisé le rôle physiologique de la phosphorylation sur la tyrosine de la protéine Ugd, une UDP-glucose déshydrogénase, par les BY-kinases Wzc et Etk d’E. coli. Nous avons démontré que la phosphorylation d’Ugd sur un site commun à Wzc et Etk augmente son activité. Nous avons également établi que la phosphorylation d’Ugd par Wzc participe à la régulation de la quantité d’acide colanique produit, tandis que la phosphorylation d’Ugd par Etk influence la résistance de la bactérie à la polymyxine.Nous avons également effectué une analyse structure-fonction du domaine cytoplasmique de deux BY-kinases, CapA1/CapB2 de S. aureus et Wzc d’E. coli. Nous avons montré que ces deux protéines s’associent en octamère, grâce au motif EX2RX2R et qu’elle s’autophosphoryle selon un mécanisme intermoléculaire. Nous avons, de plus, identifié le mécanisme d’activation de ces protéines et révélé l’importance d’un domaine particulier dans l’autophosphorylation de Wzc et la biosynthèse de l’acide colanique.La caractérisation structurale et fonctionnelle des BY-kinases représente une approche prometteuse et originale en vue de l’élaboration de molécules inhibant spécifiquement leur activité et pouvant affecter le pouvoir virulent des bactéries pathogènes. / A new class of bacterial enzymes, named BY-kinases, has been shown to catalyze protein-tyrosine phosphorylation. These enzymes share no structural and functional similarities with their eukaryotic counterparts. Evidence of their involvement in extracellular polysaccharide biosynthesis has been provided, but their accurate functions and their catalytic mechanism remain largely unknown.First, we characterized the physiological role of tyrosine phosphorylation of Ugd, a UDP-glucose dehydrogenase, by the BY-kinases Wzc and Etk of E. coli. We demonstrated that Ugd phosphorylation by Wzc or Etk occurs on the same site and increases its activity. We also established that Wzc-mediated phosphorylation of Ugd participates in the regulation of colanic acid production whereas Ugd phosphorylation by Etk influences resistance to polymyxin.In addition, we performed a structure-function analysis of the cytoplasmic domain of two BY-kinases, namely CapA1/CapB2 from S. aureus and Wzc from E. coli. We showed that these two proteins associate in a ring-shaped octamer in which the motif EX2RX2R plays a crucial role. In addition, we showed that BY-kinases autophosphorylate using an intermolecular mechanism. We also identified the activation mechanism of BY-kinases and we revealed the role of a particular domain, found specifically in BY-kinases from proteobacteria, in Wzc autophosphorylation and colanic acid biosynthesis.Structural and functional characterization of BY-kinases represents an original and promising approach in order to develop new molecules inhibiting specifically these enzymes and to affect the virulence of bacterial pathogens.

Endotoxin or Lipopolysaccharide (LPS) is the invariant structural component of gram negative bacterial outer membranes and is the chief causative factor of Sepsis or endotoxic shock. Sepsis is a syndrome that has very high mortality rates even in this age of excellent therapeutics and critical patient care. The treatment for sepsis till date remains nonspecific and supportive due to lack of effective anti-endotoxic drugs. Sepsis is initiated when the circulating bacteria shed LPS from their cell envelopes. Shed LPS aggregates are recognized by LPS binding proteins and receptors, which activate the host's immune system. Uncontrolled and excessive stimulation of the host's immune system precipitates endotoxic shock which in advanced cases involving multiple system organ failure inevitably lead to patient's death. Many strategies have been tested out to combat this deadly affliction. One of the attractive clinical modalities in sepsis treatment is the use of peptides as LPS sequestering anti-endotoxic drugs. A classical peptide antibiotic of this class is Polymyxin B (PMB) a cyclic cationic acylated molecule, that recognizes LPS with a very high affinity. This thesis describes kinetics and thermodynamics of PMB-LPS interactions and applies these parameters over a framework of different models so as to gain insights into the structure-function relationships that govern the interactions of this peptide with endotoxin(s). Classical biophysical techniques like fluorescence, circular dichroism spectroscopy, stopped flow kinetics, titration calorirnetry (ITC) and the relatively new technique of Surface Plasmon Resonance (SPR) have been employed to dissect out the mechanism of the range of non-covalent forces that are involved in peptide-endotoxin recognition. Certain proteins that exhibit LPS binding activity have also been studied to gains insight about their mode of action. Implications of these studies for designing peptides that have better anti-endotoxic properties are also highlighted. The first chapter introduces and highlights the clinical features of sepsis. It also attempts to shed light on the LPS mediated signal transduction pathway that leads to endotoxic shock. This chapter also briefly explains the roles of many LPS receptors that are present in the human system and their specific roles in the signal transduction pathways. The second part of this chapter deals with the role of cationic peptides as anti-endotoxic drugs. Certain key functional aspects of these peptides, which impart in them, the desirable property of LPS recognition have also been discussed The second chapter describes the kinetic studies undertaken to unravel the exact mechanism of LPS-PMB interaction. The studies reveal that PMB recognizes LPS in a biphasic manner, with the second, unimolecular isomerization step of the reaction being the rate-limiting step. The initial reaction is shown to be influenced by the presence of salt in the reaction medium. The dissociation phase of this interaction also shows a biphasic pattern. These data allow us to speculate upon the exact mechanism by which PMB is able to recognize LPS. The studies also shed light on some structural aspects that govern and confer such high LPS binding activity to PMB. Based on these a model has been proposed to explain this recognition (C.J. Thomas et al, 1998). The second chapter discuses the mode of action of various PMB analogs. These analogs have been chosen in terms of their mode of action as well as their structural similarly to PMB. The affinities of these analogs to LPS and lipid A were quantified using the Surface plasmon resonance (SPR) method. SPR, a technique that relies on the quantification of change in mass during a binary binding process occurring between an immobilized entity and a flowing ligand, is a rapid and sensitive method to measure biologically relevant interactions. SPR studies provide us with the binding constants and thermodynamic parameters that allow evaluation of the affinities of these peptides towards LPS (C.J.Thomas and A.Surolia, 1999). The third chapter discusses a hitherto unknown mode by which PMB acts on a LPS lamellae. The results of this study wherein the binding affinities of PMB and its analogs were performed on monolayers and tethered liposomes, show that PMB is able to remove specifically LPS or lipid A from monolayers or bilayer assemblies such as tethered liposomes. The exact mode of action of PMB is deciphered in the light of these new studies, which allow us to posit on the observed efficacy of PMB in neutralizing the endotoxin as compared to peptides with nearly similar affinities for LPS (C.J Thomas et al 1999). In the fourth chapter a series of 23 residue peptides, based on the sequence corresponding to the anti-sense strand of magainin gene have been synthesized. Magainin an amphiphilic helical peptide obtained from frog skins plays a vital role in the innate immune defense mechanisms of these organisms. It also exhibits LPS binding activity that makes it an attractive target as an anti-endotoxic drug. Biochemical and biophysical characterization of these peptides reveal that they have the tendency to perturb both the inner and the outer membranes of E.coli. The peptides are amphiphilic and have helical structure in a membrane bound environment. Three of the peptides tested have high affinities for lipid A that approach the values shown by PMB. The kinetic parameters obtained by stopped flow and SPR studies in conjunction with the therrnodynamic parameters obtained using ITC studies allow us to highlight the key structural features that need to be exhibited by peptides that are designed to be LPS recognizers. The studies also project the fact that ionic forces play an important role in the initial recognition of LPS by these peptides. Fortification of the might of these ionic charges increases affinity for LPS where as the hydrophobic residues that interact at the next phase of binding are more amenable to disruptions in contiguity. These factors are discussed using the helical wheel diagram that shows the clear amphiphilicity displayed by these peptides. (C.J Thomas et al Manuscript under preparation, 2000) Chapter six discusses the mode of action of certain LPS binding proteins. Limulus anti endotoxic factor (LALF) plays a vital role in the innate immune based defense systems of the horseshoe crab. Galectin-3 is a metal ion independent, galactosc binding Icctin of human origin with unknown functions. Both these phylogcntically-unrclatcd proteins exhibit LPS/lipid A recognizing properties. ITC and SPR studies have been used to determine the binding constants displayed by these proteins for lipid A. LALF bind to lipid A with very high affinity than compared to Galectin-3 and is also able to take away selectively lipid A from both monolayers and tethered liposomes. Galectin-3 does not show this property of LALF, which might account for its lowered affinities. Also structurally LALF has amphiphilic nature that confers high lipid A binding activity, which is clearly lacking in Galectin-3. These studies in conjunction with the knowledge gained from the study of LPS-PMB interaction stress on the importance of amphiphilicity in LPS recognition. (C.J Thomas et al Manuscript under preparation, 2000). The final chapter is a general discussion that attempts to collate all these kinetic and thermodynamic observations in the pursuit of designing small easily manipulatable peptides that exhibit high LPS binding activity. These studies are aimed to act as rough guidelines to the design of LPS sequestering peptides that might have better therapeutic and pharmacokinetic properties. The appendix to the main body of work presented in thesis are two pieces of work pertaining to the elucidation the kinetics and mechanism of sugar lectin interactions, when sugars are presented as glycolipids in monolayers or bilaycrs liposomes. Mode of the presentation of sugars at cell-surfaces in the form of glycolipids as ligands influence their recognition by macromolecular receptors like lectins. Appendix 1 is a study of the mode of action of Ulex europeus I lectin binding to H-fucolipid containing tethered liposomes, by SPR. Fucosylated sugars are often used as key markers in histochemical analysis of malignant cancerous tissues. Ulex lectin plays a vital role as a marker for identification of these tissues. The kinetics and thermodynamic parameters that are obtained in this study throw some light on the mode of recognition of glycolipid receptor by Ulex europeus I lectin (C.J Thomas and A. Surolia 2000). Appendix 2 is a study, that attempts to quantify the initial kinetic parameters that correlate the recognition of glycolipid receptors with their inclination at the membrane surface and the influence of charge on them by soyabean agglutinin (SBA), Abrus agglutinin I and II. Studies on the soyabean agglutinin-globoside interaction highlights the divalent cation mediated reorientation of these receptors on their accessibility and recognition to the agglutinin. The divalent cations are speculated to orient the oligosaccharide head groups in a spatial geometry that allows a heightened kinetics of their interaction by SBA. These studies reveal that the reorganization of the binding pocket of a lectin can also have a profound influence on ihc rates of recognition of a glycospingolipid ligand by a lectin as exemplified by Abrus agglutinin II- GM1 interactions (C.J Thomas ct al, Manuscript under preparation).

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