Will genomics revolutionize antimicrobial drug discovery?

Are outer-membrane targets the solution for MDR Gram-negative bacteria?

The outer membrane (OM) of Gram-negative bacteria confers a significant barrier to many antibacterial agents targeting periplasmic and cytosolic functions. 'Synergist' approaches to disrupt the OM have been hampered by poor specificity and accompanying toxicities. The OM contains proteins required for optimal growth and pathogenesis, including lipopolysaccharide (LPS) and capsular polysaccharide (CPS) transport, porins for uptake of macromolecules, and transporters for essential elements (such as iron). Does the external proximity of these proteins offer an enhanced potential to identify effective therapies? Here, we review recent experiences in exploiting Gram-negative OM proteins (OMPs) to address the calamity of exploding antimicrobial resistance. Teaser: Multidrug-resistant (MDR) Gram-negative bacteria are a growing crisis. Few new antimicrobial chemotypes or targets have been identified after decades of screening. Are OMP targets a solution to MDR Gram-negative bacteria?

Appropriate Targets for Antibacterial Drugs

Successful small-molecule antibacterial agents must meet a variety of criteria. Foremost is the need for selectivity and safety: It is easy to kill bacteria with chemicals, but difficult to do it without harming the patient. Other requirements are possession of a useful antibacterial spectrum, no cross-resistance with existing therapeutics, low propensity for rapid resistance selection, and pharmacological properties that allow effective systemic dosing. Choosing molecular targets for new antibiotics does seem a good basis for achieving these criteria, but this could be misleading. Although the presence of the target is necessary to insure the desired spectrum, it is not sufficient, as the permeability and efflux properties of various species, especially Gram-negatives, are critical determinants of antibacterial activity. Further, although essentiality (at least in vitro), lack of close human homologs, lack of target-based cross-resistance, and presence in important pathogens can be predicted based on the target, the choice of a single enzyme as a target may increase the likelihood of rapid resistance selection. In fact, it is likely that the low output of antibacterial target-based discovery is because of difficulty of endowing lead enzyme inhibitors with whole-cell activity and to the propensity for such inhibitors (if they can gain entry) to select rapidly for resistance. These potential problems must be reckoned with for success of novel target-based discovery.

Cell-type-specific transcriptional profiles of the dimorphic pathogen Penicillium marneffei reflect distinct reproductive, morphological, and environmental demands

Penicillium marneffei is an opportunistic human pathogen endemic to Southeast Asia. At 25° P. marneffei grows in a filamentous hyphal form and can undergo asexual development (conidiation) to produce spores (conidia), the infectious agent. At 37° P. marneffei grows in the pathogenic yeast cell form that replicates by fission. Switching between these growth forms, known as dimorphic switching, is dependent on temperature. To understand the process of dimorphic switching and the physiological capacity of the different cell types, two microarray-based profiling experiments covering approximately 42% of the genome were performed. The first experiment compared cells from the hyphal, yeast, and conidiation phases to identify "phase or cell-state-specific" gene expression. The second experiment examined gene expression during the dimorphic switch from one morphological state to another. The data identified a variety of differentially expressed genes that have been organized into metabolic clusters based on predicted function and expression patterns. In particular, C-14 sterol reductase-encoding gene ergM of the ergosterol biosynthesis pathway showed high-level expression throughout yeast morphogenesis compared to hyphal. Deletion of ergM resulted in severe growth defects with increased sensitivity to azole-type antifungal agents but not amphotericin B. The data defined gene classes based on spatio-temporal expression such as those expressed early in the dimorphic switch but not in the terminal cell types and those expressed late. Such classifications have been helpful in linking a given gene of interest to its expression pattern throughout the P. marneffei dimorphic life cycle and its likely role in pathogenicity.

Use of DNA microarray technology and gene expression profiles to investigate the pathogenesis, cell biology, antifungal susceptibility and diagnosis of Candida albicans

The use of DNA microarrays is becoming the method of choice for assaying gene expression, particularly as costs and complexity are being reduced as the technology becomes more widespread and better standardized. A DNA array is nothing but a collection of probes fixed on a solid support. The probes can be PCR products of ORFs or short intragenic oligonucleotides deposited or synthesized in situ by photolithographic methods. To date, sequencing projects for fungal genomes have yielded 10 complete genomes and 21 whole shotgun sequences, including Candida albicans strain SC5314. Sequencing of the C. albicans genome has led to the construction of whole-genome DNA microarrays for in vitro transcription profiling by several universities and companies. The use of microarray or DNA chip techniques for Candida research has started recently but the number of studies using this technology is increasing rapidly, in order to address important remaining questions about pathogenesis, cell biology, antifungal susceptibility, and diagnosis.

The future challenges facing the development of new antimicrobial drugs

The emergence of resistance to antibacterial agents is a pressing concern for human health. New drugs to combat this problem are therefore in great demand, but as past experience indicates, the time for resistance to new drugs to develop is often short. Conventionally, antibacterial drugs have been developed on the basis of their ability to inhibit bacterial multiplication, and this remains at the core of most approaches to discover new antibacterial drugs. Here, we focus primarily on an alternative novel strategy for antibacterial drug development that could potentially alleviate the current situation of drug resistance--targeting non-multiplying latent bacteria, which prolong the duration of antimicrobial chemotherapy and so might increase the rate of development of resistance.

Identifying essential genes in fungal pathogens of humans

Opportunistic fungal pathogens are an important cause of fatal invasive diseases and one of the many threats facing immunocompromised patients. Because of the limitations of the antifungal therapies currently available such as their toxicity, their narrow spectrum and the emergence of resistant pathogens, there is a significant demand for a broader antifungal arsenal. The characterization of genes essential for fungal growth will be an important step in the identification and development of novel antifungal drugs. Original strategies and new technologies including in vivo or in vitro transposon mutagenesis and post-transcriptional gene silencing are being developed for genome-scale identification of essential genes in fungal species that are pathogenic to humans.

Evaluating and managing open skin wounds: colonization versus infection

Open skin wounds are colonized with bacteria, and optimal wound care is required to prevent progression to infection. Intact skin normally provides protection from external environmental assaults. Disruption of the skin or tissue creating an open skin wound can result in infection, dehydration, hypothermia, scarring, compromised immunity, and changes in body image. Biofilms and bacterial genomics are areas of intense scientific investigation in the face of the emerging threat of bacterial resistance. Optimal wound care to prevent progression from colonization to infection remains the foundation of good clinical practice. On the basis of wound conditions, cleansing, debridement, measures to increase oxygenation and perfusion, adequate nutrition, and appropriate use of topical agents and antibiotics, when indicated, are the keys to managing open skin wounds. This article provides a targeted review of normal skin flora, wound healing, prevention of skin infection, colonization versus infection, biofilms, genomics and infectious disease, and management of open skin wounds.

Virulence as a target for antimicrobial chemotherapy

Bacterial resistance to present day antibiotics has become a dangerous threat to public health. Consequently, the pharmaceutical industry must provide new agents and novel classes to combat bacterial disease and to stay a step ahead of the rapid evolution of bacterial resistance mechanisms. The need for novel antibacterials has resulted in a search for previously unexplored targets for chemotherapy, utilising the new techniques of genomics to identify them. Several targets currently under investigation are involved in the process of bacterial virulence. These targets are unique in that their inhibition, by definition, should interfere with the process of infection rather than with bacterial viability. If successful, virulence inhibition may represent a 'kinder, gentler' approach to chemotherapy in which the pathogen is disarmed rather than killed outright.

Combating Gram-positive pathogens: emerging techniques to identify relevant virulence targets

Recent progress in microbial genome sequencing, along with functional genomics technologies based on gene expression, proteomics and genetics have facilitated the identification of significant numbers of Gram-positive virulence genes. These genes represent a novel and heterogeneous class of targets for antimicrobial drug development. This review will concentrate of the contribution of two functional genomics technologies, in vivo expression technology (IVET) based on gene expression and signature-tagged mutagenesis (STM), a genetics based technology to the identification of virulence genes in Gram-positive pathogens.