P. aeruginosa e espécies de Acinetobacter são causas comuns de diversas infecções em pacientes hospitalizados, principalmente nos internados em centros de tratamento intensivo. Além disso, esses microrganismos se destacam por apresentarem resistência, intrínseca e adquirida, a várias classes de antibióticos, conferindo à bactéria fenótipos de multirresistência e panresistência. O objetivo deste estudo foi avaliar a participação de integrons (elementos genéticos que carreiam genes de resistência), de genes codificadores de metalo--lactamases, da perda de porinas (canais protéicos da membrana externa), e da atividade de efluxo aumentada, como determinantes do fenótipo de multirresistência e panresistência. Foram estudadas 147 P. aeruginosa e 57 Acinetobacter spp. isolados de pacientes hospitalizados no Hospital Universitário da Universidade Federal de Juiz de Fora, no período de 2003 a 2006. O perfil de sensibilidade destes isolados foi determinado por disco de difusão e utilizado para classificá-las como multirresistentes (MDR) e não multirresistentes (n-MDR). A variabilidade clonal dos isolados foi investigada por PFGE. Os isolados pertencentes aos grupos MDR e n-MDR foram investigados quanto a presença de integrons de classe 1, 2 e 3, por PCR e análise de RFLP. Os cassetes gênicos contidos nestes integrons, assim como genes codificadores de carbapenemases (ex. IMP, VIM e SPM), foram detectados por PCR e identificados por seqüenciamento. Avaliação da expressão gênica de bombas de efluxo (mexB, mexY, mexD e adeB) e de porina (OprD) foi conduzida por real-time RT-PCR. Os dados apresentados para os isolados do grupo MDR foram comparados àqueles do grupo n-MDR e a associação entre os determinantes de resistência e o fenótipo MDR foi calculada estatisticamente. Fenótipo de multiresistência foi observado em 42,2% e 84,2% das P. aeruginosa e Acinetobacter spp. estudadas. Nenhum isolado bacteriano apresentou fenótipo panresistente. Em 65 (44,2%) dos isolados de P. aeruginosa, foram detectados integrons de classe 1. Esses elementos apresentaram relação estatisticamente significativa com fenótipos MDR em P. aeruginosa. Entretanto, a maioria desses integrons não carreava nenhum cassete gênico (43/65) ou continham apenas cassetes gênicos de resistência a aminoglicosídeos (19/65). Entre os isolados de Acinetobacter spp., 11 (17,5%) apresentaram integrons de classe 1 e 30 (47,6%) integrons de classe 2. Apenas os últimos foram estatisticamente associados com fenótipos MDR. A pesquisa de metalo--lactamase (MBL) revelou a produção de enzimas SPM em 24 isolados de P. aeruginosa. Os estudos de expresão gênica demonstraram que, entre os sistemas de efluxo mais relatados para P. aeruginosa, MexXY-OprM foi o que mostrou maior diferença entre o nível de expressão dos grupos MDR e n-MDR, sugerindo que este sistema de efluxo desempenha importante papel no fenótipo MDR. Diminuição, em média de 66,4%, da produçãode OprD também foi um padrão encontrado nos isolados MDRem relação aos n-MDR. Dois grupos clonais de P. aeruginosa e dois de Acinetobacter spp. foram predominantes e tiveram relação com presença de integrons, produção de SPM-1 e com fenótipo MDR. Portanto, esse fenótipo pode ser consequência de acúmulo de determinantes de resistência em clones específicos. / The non-fermenting pathogenic bacteria Pseudomonas aeruginosa and Acinetobacter spp. are important causes of nosocomial infections. Theses species are often associated with a multidrug resistance (MDR) phenotype, due to intrinsic and acquired resistance genes. Some determinants of resistance, such as integrons, carbapenemases, overexpression of efflux systems and porins loss may be associated with the MDR phenotype. The aim of this study was to evaluate the association of non-MDR and MDR phenotypes in P. aeruginosa and Acinetobacter spp. to the presence of integrons and carbapenemases encoding genes, the overexpression of mexY, mexB, mexD and adeB genes and loss of the outer membrane protein, OprD. These resistance determinants were evaluated in 147 P. aeruginosa and 57 Acinetobacter spp., isolated from in-patients of University Hospital of UFJF. Isolates with different PFGE and non-susceptibility profiles were grouped according to MDR or non-MDR phenotypes. PCR and real-time RT-PCR were used to investigate the presence of class 1, 2 and 3 integrons and carbapenemase encoding genes and the expression of mexY, mexB, mexD and adeB efflux pumps and OprD porin, respectively. Class 1 integrons were one of the most common genetic elements present in MDR P. aeruginosa (44,2%), but the phenotype could not be attributed to these elements, since they showed empty (43/65) or only aminoglycoside gene cassettes (19/65). Class 2 integrons were the most common genetic elements in MDR Acinetobacter spp., and this association was statistically significant. SPM encoding gene was the only carbapenemase gene found in P. aeruginosa and, predominantly, in the PFGE cluster A. Expression of MexXY-OprM determined by real-time RT-PCR was the highest variable between MDR and non-MDR P. aeruginosa isolates (almost 10-fold). Reduction of 66.4% in OprD expression was observed in MDR P. aeruginosa, in comparison with non-MDR ones. It is concluded that the most important genetic determinants in the MDR phenotype of P. aeruginosa were SPM-1 production, followed by MexXY-OprM over expression and diminished production of OprD, while class 2 integrons was the most important genetic determinant of MDR phenotype in A. baumannii.

P. aeruginosa e espécies de Acinetobacter são causas comuns de diversas infecções em pacientes hospitalizados, principalmente nos internados em centros de tratamento intensivo. Além disso, esses microrganismos se destacam por apresentarem resistência, intrínseca e adquirida, a várias classes de antibióticos, conferindo à bactéria fenótipos de multirresistência e panresistência. O objetivo deste estudo foi avaliar a participação de integrons (elementos genéticos que carreiam genes de resistência), de genes codificadores de metalo--lactamases, da perda de porinas (canais protéicos da membrana externa), e da atividade de efluxo aumentada, como determinantes do fenótipo de multirresistência e panresistência. Foram estudadas 147 P. aeruginosa e 57 Acinetobacter spp. isolados de pacientes hospitalizados no Hospital Universitário da Universidade Federal de Juiz de Fora, no período de 2003 a 2006. O perfil de sensibilidade destes isolados foi determinado por disco de difusão e utilizado para classificá-las como multirresistentes (MDR) e não multirresistentes (n-MDR). A variabilidade clonal dos isolados foi investigada por PFGE. Os isolados pertencentes aos grupos MDR e n-MDR foram investigados quanto a presença de integrons de classe 1, 2 e 3, por PCR e análise de RFLP. Os cassetes gênicos contidos nestes integrons, assim como genes codificadores de carbapenemases (ex. IMP, VIM e SPM), foram detectados por PCR e identificados por seqüenciamento. Avaliação da expressão gênica de bombas de efluxo (mexB, mexY, mexD e adeB) e de porina (OprD) foi conduzida por real-time RT-PCR. Os dados apresentados para os isolados do grupo MDR foram comparados àqueles do grupo n-MDR e a associação entre os determinantes de resistência e o fenótipo MDR foi calculada estatisticamente. Fenótipo de multiresistência foi observado em 42,2% e 84,2% das P. aeruginosa e Acinetobacter spp. estudadas. Nenhum isolado bacteriano apresentou fenótipo panresistente. Em 65 (44,2%) dos isolados de P. aeruginosa, foram detectados integrons de classe 1. Esses elementos apresentaram relação estatisticamente significativa com fenótipos MDR em P. aeruginosa. Entretanto, a maioria desses integrons não carreava nenhum cassete gênico (43/65) ou continham apenas cassetes gênicos de resistência a aminoglicosídeos (19/65). Entre os isolados de Acinetobacter spp., 11 (17,5%) apresentaram integrons de classe 1 e 30 (47,6%) integrons de classe 2. Apenas os últimos foram estatisticamente associados com fenótipos MDR. A pesquisa de metalo--lactamase (MBL) revelou a produção de enzimas SPM em 24 isolados de P. aeruginosa. Os estudos de expresão gênica demonstraram que, entre os sistemas de efluxo mais relatados para P. aeruginosa, MexXY-OprM foi o que mostrou maior diferença entre o nível de expressão dos grupos MDR e n-MDR, sugerindo que este sistema de efluxo desempenha importante papel no fenótipo MDR. Diminuição, em média de 66,4%, da produçãode OprD também foi um padrão encontrado nos isolados MDRem relação aos n-MDR. Dois grupos clonais de P. aeruginosa e dois de Acinetobacter spp. foram predominantes e tiveram relação com presença de integrons, produção de SPM-1 e com fenótipo MDR. Portanto, esse fenótipo pode ser consequência de acúmulo de determinantes de resistência em clones específicos. / The non-fermenting pathogenic bacteria Pseudomonas aeruginosa and Acinetobacter spp. are important causes of nosocomial infections. Theses species are often associated with a multidrug resistance (MDR) phenotype, due to intrinsic and acquired resistance genes. Some determinants of resistance, such as integrons, carbapenemases, overexpression of efflux systems and porins loss may be associated with the MDR phenotype. The aim of this study was to evaluate the association of non-MDR and MDR phenotypes in P. aeruginosa and Acinetobacter spp. to the presence of integrons and carbapenemases encoding genes, the overexpression of mexY, mexB, mexD and adeB genes and loss of the outer membrane protein, OprD. These resistance determinants were evaluated in 147 P. aeruginosa and 57 Acinetobacter spp., isolated from in-patients of University Hospital of UFJF. Isolates with different PFGE and non-susceptibility profiles were grouped according to MDR or non-MDR phenotypes. PCR and real-time RT-PCR were used to investigate the presence of class 1, 2 and 3 integrons and carbapenemase encoding genes and the expression of mexY, mexB, mexD and adeB efflux pumps and OprD porin, respectively. Class 1 integrons were one of the most common genetic elements present in MDR P. aeruginosa (44,2%), but the phenotype could not be attributed to these elements, since they showed empty (43/65) or only aminoglycoside gene cassettes (19/65). Class 2 integrons were the most common genetic elements in MDR Acinetobacter spp., and this association was statistically significant. SPM encoding gene was the only carbapenemase gene found in P. aeruginosa and, predominantly, in the PFGE cluster A. Expression of MexXY-OprM determined by real-time RT-PCR was the highest variable between MDR and non-MDR P. aeruginosa isolates (almost 10-fold). Reduction of 66.4% in OprD expression was observed in MDR P. aeruginosa, in comparison with non-MDR ones. It is concluded that the most important genetic determinants in the MDR phenotype of P. aeruginosa were SPM-1 production, followed by MexXY-OprM over expression and diminished production of OprD, while class 2 integrons was the most important genetic determinant of MDR phenotype in A. baumannii.

L'utilisation d'antibiotiques pour lutter contre les infections bactériennes a favorisé l'émergence de souches résistantes. Comprendre les mécanismes de résistance est crucial pour lutter contre ces pathogènes. Cette thèse propose une étude structurale d'une pompe à efflux multidrogues de Pseudomonas aeruginosa qui se compose d'un transporteur MexB, d'une protéine canal OprM et d'une protéine adaptateur MexA. Les partenaires du complexe tripartite stabilisés en nanodisques ont permis la formation du complexe in vitro. L'optimisation des conditions de production du complexe a permis de cribler les différents paramètres régissant son assemblage. L'étude structurale par cryo-ME révèle un complexe de 30 nm de long en conformation de repos. L'étude de la stabilisation des protéines membranaires par nanodisques a conduit au développement d'un système minimal, débarrassé des lipides. Ce système minimal a révélé la nécessité d'une phase lipidique autour de MexB pour l'assemblage du complexe. / Antibiotics use against bacterial infections has led to the emergence of resistance. Understanding the mechanisms underlying resistance to antibiotics is critical to fight against these pathogens. This thesis presents a structural study of a multidrug efflux pump in Pseudomonas aeruginosa, composed of a transporter MexB, an exit duct OprM and an adaptor protein MexA. The proteins reconstituted in nanodiscs allowed tripartite complex formation in vitro. Optimization of yield led to the identification of key parameters governing complex assembly. Structural cryo-EM study revealed a 30 nm long complex in a resting state. The study of membrane protein stabilization by nanodisks led to the development of a minimal system devoid of lipids. This system showed a lipid phase around MexB is required for complex formation.

Chez P. aeruginosa, la surproduction constitutive du système MexXY/OprM s'accompagne d'une augmentation de larésistance aux aminosides, fluoroquinolones et à certaines (3-lactamines. La caractérisation des mécanismes génétiquesconduisant à la surproduction de cette pompe parmi une collection de 57 isolats cliniques non redondants a permisd'identifier 3 types de mutations affectant, soit le gène mexZ dont le produit réprime l'opéron mexXY (mutants agrZ,77,2%), soit les gènes parRS codant pour un système à deux composants (mutants agrWl, 8,8%) ou d'autres cibles dontl'inactivation perturbe la synthèse protéique et entraîne la surexpression du gène PA5471 dont le produit, ArmZ, est unanti-répresseur de MexZ (mutants agrWl,\4%). Si certaines populations de P. aeruginosa tendent à devenir plusrésistantes aux aminosides en surproduisant le système MexXY/OprM, d'autres évoluent paradoxalement vers unehypersensibilité aux p-lactamines sous l'effet de mutations inactivant MexAB-OprM (MexAB-). L'analyse d'unecollection de 275 souches isolées de 36 patients CF nous a permis d'identifier des souches MexAB- hypersensibles à laticarcilline (37%) et des souches MexAB- non hypersensibles en raison d'une surproduction de la B-lactamase AmpC(16%). Au total, 53% des isolats sont apparus déficients dans le système MexAB-OprM. L'étude de l'activité ou de laproduction de divers facteurs de virulence a indiqué que la perte de fonction de MexAB-OprM n'était pas associée àcelle de caractères de virulence. Au final, notre travail apporte un éclairage nouveau sur la capacité de P. aeruginosa àmoduler l'activité de ses pompes d'efflux pour s'adapter à diverses situations cliniques. / Pseudomonas aeruginosa is a nosocomial pathogen naturally resistant to many antibiotics thanks to numerous resistantmechanisms. Among them, overproduction of the MexXY/OprM efflux System leads to decrease significantly thesusceptibility of P. aeruginosa to aminoglycosides, fluoroquinolones and some p-lactams. Characterization of geneticmechanisms leading to overproduction of this pump from a collection of 57 non-redundant clinical isolates enable toidentified three types of mutations affecting either the gene mexZ whose product represses mexXY operon (agrZmutants, «=77. 2%), or genes parRS encoding a two component System (agrW2 mutants, w=8.8%) or other targetswhose inactivation disturbs protein synthesis and results in overexpression of the gene PA547I, whose product ArmZ isan anti-repressor of MexZ protein (agrWl mutants, n= 14%). If some populations of A aeruginosa are becoming moreresistant to aminoglycosides by overproducing MexXY/OprM system, others develop an hypersensitivity to P-lactamsas a resuit of mutations inactivating MexAB-OprM efflux system (MexAB-). The analysis of 275 strains isolated from36 CF patients allowed us to identify MexAB- strains hypersensitive to ticarcillin (37%) and non-MexABhypersensitive strains due to an overproduction of the p-lactamase AmpC (16%). In fine, 53% of the isolates appeareddeficient in MexAB-OprM. The study of various virulence factors indicated that the loss of function of MexAB-OprMin P. aeruginosa was not associated with virulence of the strains. To conclude, our work highlight on the ability ofP. aeruginosa to modulate the activity of its efflux pumps in order to adapt to various clinical environments

L'apparition croissante de bactéries pathogènes multi-résistantes à la plupart des antibiotiques disponibles apparaît comme un problème mondial de santé publique. Malheureusement, un usage excessif à la fois en médecine humaine et animale a conduit à l’apparition de souches multi-résistantes à la plupart des antibiotiques disponibles sur le marché. Il est donc urgent de mieux comprendre les mécanismes mis en place par les bactéries pour résister aux antibiotiques afin de trouver des solutions pour combattre les souches multi-résistances.Dans ce contexte, le projet de la thèse vise à mieux comprendre les bases moléculaires de l’efflux actif de drogues chez Pseudomonas aeruginosa, qui est un des plus importants mécanismes utilisés par la bactérie pour lutter contre l’action de plusieurs antibiotiques. Les systèmes d’efflux forment des complexes protéiques situés dans la paroi de la bactérie et expulsent de manière active les antibiotiques avant même qu’ils aient pu atteindre leur cible intracellulaire, les rendant ainsi inactif.L’étude structurale se focalise sur le système RND (Resistance-Nodulation and cell Division) MexA-MexB-OprM qui est constitutivement exprimé chez la bactérie sauvage et est surexprimé chez les souches résistantes. Ce complexe tripartite est composé d'un transporteur inséré dans la membrane interne, d'une protéine canal insérée dans la membrane externe et d’une protéine adaptatrice périplasmique qui relie les deux autres protéines pour former un conduit étanche traversant le périplasme. En l’absence de la connaissance de la structure du complexe tripartite, l’objectif de la thèse a été de développer une stratégie originale pour reconstituer in vitro le complexe entier dans un environnement lipidique à partir des trois composants natifs produits séparément.L’assemblage du complexe tripartite est réalisé en mélangeant MexB et OprM en Nanodisque avec MexA mimant les deux bicouches lipidiques. La structure de ce complexe tripartite a été obtenu en combinant la cryo microscopie électronique et à l’approche dite ‘des particules isolées’. La structure tridimensionnelle du complexe calculée à une résolution inférieure à 4 Å a permis de construire un modèle atomique du complexe tripartite assemblé entre deux Nanodisques.Le complexe tripartite est composé d’un trimère d’OprM, d’un trimère de MexB et d’un hexamère de MexA entourant MexB et en interaction avec OprM. Ces données ont permis de résoudre la structure complète de MexA dans le complexe dont la partie N-terminale jusqu’alors inconnue car trop flexible et décrivent pour la première fois l’ancrage de MexA dans une membrane lipidique. Les changements conformationnels sont observés sur OprM et MexB lorsqu’ils sont engagés dans le complexe avec l’ouverture de l’extrémité périplasmique d’OprM et le basculement d’une boucle de MexB permettant d’établir un contact supplémentaire avec MexA.Pour replacer cette structure tripartite dans le cycle d’efflux de l’antibiotique, celle-ci décrit un état qui s’apparente probablement à un état au repos, sachant qu’aucun ligand spécifique n’a été ajouté au cours de l’assemblage. De plus, le complexe forme un canal ouvert à son extrémité extracellulaire, fournissant le conduit pour évacuer les drogues transportées par MexB qui utilise la force protomotrice comme source d’énergie.Ce travail ouvre la perspective à des études structurales d’autres états conformationnels du système d’efflux en condition « énergisé » pour compléter la compréhension du mécanisme du cycle d’efflux. Par ailleurs, la connaissance de cette première structure du complexe natif tripartite constitue le premier pas vers le développement de molécules capables de bloquer l’assemblage du complexe à des fins thérapeutiques. En effet, de telles molécules inhiberaient l’efflux actif et restauraient l’efficacité perdue des antibiotiques actuels. / The increasing appearance of multi-drug-resistant pathogenic bacteria to most available antibiotics is emerging as a global public health problem. Unfortunately, excessive use in both human and animal medicine has led to the emergence of multi-drug-resistant strains for most antibiotics available on the market. It is therefore urgent to better understand the underlying mechanisms by which bacteria resist to antibiotics to combat multi-resistance strains. In this context, this work aims at better understanding the molecular basis of active drug efflux in Pseudomonas aeruginosa, which is one of the most important mechanisms used by the bacterium to resist to several antibiotics. Efflux systems form protein complexes in the bacterial wall and actively expel antibiotics even before they reach their intracellular target, rendering them inactive. The structural study focuses on the MexA-MexB-OprM RND (Resistance-Nodulation and cell Division) system that is constitutively expressed in wild-type bacteria and is over-expressed in resistant strains. This tripartite complex is composed of a transporter inserted into the inner membrane, a channel protein inserted in the outer membrane and a periplasmic adapter protein that connects the other two proteins to form a sealed conduit through the periplasm. In the absence of knowledge of the structure of the tripartite complex, the aim of the thesis was to develop an original strategy to reconstitute the whole complex in vitro in a lipid environment from the three native components produced separately.The assembly of the tripartite complex is made by mixing MexA with MexB and OprM in Nanodisc mimicking the two lipid bilayers. The structure of this tripartite complex was obtained by combining cryo electron microscopy and the so-called 'isolated particles' approach. The three-dimensional structure of the complex, calculated at a resolution of less than 4 Å, was used to build an atomic model of the tripartite complex assembled between two Nanodiscs. The tripartite complex is composed of an OprM trimer, a MexB trimer and a MexA hexamer surrounding MexB and interacting with OprM. We solve the complete structure of MexA whose N-terminal part hitherto unknown because of a high flexibility and describe for the first time the anchoring of MexA in a lipid membrane. The conformational changes are observed on OprM and MexB when they are assembled in the complex with the opening of the periplasmic end of OprM and the spatial re-orientation of a MexB loop to establish additional contact with MexA.To integrate this tripartite structure into the antibiotic efflux cycle, it describes a state that is probably a resting state, knowing that no specific ligand was added during assembly. In addition, the complex forms an open channel at its extracellular end, providing the conduit to evacuate the drugs carried by MexB that uses the proton motive force as a source of energy. This work opens new perspective for structural studies of other conformational states of the efflux system in "energized" conditions to fulfill our understanding of the efflux cycle mechanism. Moreover, the knowledge of this first tripartite native complex structure constitutes the first step towards the development of molecules capable of blocking the assembly of the complex for therapeutic uses. Indeed, such molecules would inhibit active efflux and restore the lost efficiency of current antibiotics.