ABSTRACT
          
            The objective of this study was to investigate the risk of attenuated efficacy due to adaptive resistance for the siderophore-conjugated monocarbam SMC-3176 in
            Pseudomonas aeruginosa
            by using a pharmacokinetic/pharmacodynamic (PK/PD) approach. MICs were determined in cation-adjusted Mueller-Hinton broth (MHB) and in Chelex-treated, dialyzed MHB (CDMHB). Spontaneous resistance was assessed at 2× to 16× the MIC and the resulting mutants sequenced. Efficacy was evaluated in a neutropenic mouse thigh model at 3.13 to 400 mg/kg of body weight every 3 h for 24 h and analyzed for association with free time above the MIC (
            fT
            >MIC). To closer emulate the conditions of the
            in vivo
            model, we developed a novel assay testing activity mouse whole blood (WB). All mutations were found in genes related to iron uptake:
            piuA
            ,
            piuC
            ,
            pirR
            ,
            fecI
            , and
            pvdS
            . Against four
            P. aeruginosa
            isolates, SMC-3176 displayed predictable efficacy corresponding to the
            fT
            >MIC using the MIC in CDMHB (
            R
            2
            = 0.968 to 0.985), with stasis to 2-log kill achieved at 59.4 to 81.1%. Efficacy did not translate for
            P. aeruginosa
            isolate JJ 4-36, as the
            in vivo
            responses were inconsistent with
            fT
            >MIC exposures and implied a threshold concentration that was greater than the MIC. The results of the mouse WB assay indicated that efficacy was not predictable using the MIC for JJ 4-36 and four additional isolates, against which
            in vivo
            failures of another siderophore-conjugated β-lactam were previously reported. SMC-3176 carries a risk of attenuated efficacy in
            P. aeruginosa
            due to rapid adaptive resistance preventing entry via the siderophore-mediated iron uptake systems. Substantial
            in vivo
            testing is warranted for compounds using the siderophore approach to thoroughly screen for this
            in vitro-in vivo
            disconnect in
            P. aeruginosa
            .
          
 
                                    摘要
          
            本研究的目的是调查苷元结合单卡巴姆 SMC-3176 在
铜绿假单胞菌中的适应性抗药性导致药效减弱的风险。
            
铜绿假单胞菌
            采用药代动力学/药效学(PK/PD)方法。在阳离子调整的穆勒-希顿肉汤(
MHB)和经 Chelex 处理的透析 
MHB(C
DMHB)中测定了 MIC。在 MIC 为 2 倍至 16 倍时对自发耐药性进行评估,并对由此产生的突变体进行测序。在嗜中性粒细胞病小鼠大腿模型中,以每公斤体重 3.13 至 400 毫克的剂量,每 3 小时注射一次,连续注射 24 小时,对药效进行了评估,并分析了药效与高于 MIC 的自由时间(fT)的关系。
            fT
            MIC)的相关性进行分析。为了更接近
            体内
            模型的条件,我们开发了一种检测小鼠全血(WB)活性的新型检测方法。所有突变都发生在与
铁吸收有关的
基因中:
            piuA
            ,
            piuC
            ,
            pirR
            ,
            fecI
            和
            pvdS
            .针对四种
            
铜绿假单胞菌
            分离物,SMC-3176 显示出与
            fT
            >MIC(使用 C
DMHB 中的 MIC (
            R
            2
            = 0.968 到 0.985),59.4% 到 81.1%的杀灭率达到 2-log。对于
            绿脓杆菌
            分离物 JJ 4-36 的疗效没有转化为
            体内
            反应与
            fT
            >MIC 暴露不一致,这意味着阈值浓度高于 MIC。小鼠 WB 检测结果表明,使用 JJ 4-36 和另外四种分离物的 MIC 无法预测药效。
            体内
            此前曾有报道称,另一种苷元结合的 β-内酰胺类药物对这四种分离物的体内疗效不佳。SMC-3176 对
铜绿假单胞菌的疗效可能会减弱。
            
铜绿假单胞菌
            SMC-3176 在
铜绿假单胞菌中的疗效可能会减弱,因为快速的适应性抗药性会阻止其通过嗜苷
铁元素介导的
铁吸收系统进入体内。在
            体内
            测试,以彻底筛查这种 "体外-体内 "试验。
            体外-体内
            
铜绿假单胞菌
            
铜绿假单胞菌
            .