Penetration of beta-lactamase inhibitors into the periplasm of gram-negative bacteria.

The effectiveness of a beta-lactamase inhibitor/beta-lactam combination against Gram-negative pathogens depends on many interplaying factors, one of which is the penetration of the inhibitor across the outer membrane. In this work we have measured the relative penetrations of clavulanic acid, sulbactam, tazobactam and BRL 42715 into two strains of Escherichia coli producing TEM-1 beta-lactamase, two strains of Klebsiella pneumoniae producing either TEM-1 or K-1, and two strains of Enterobacter cloacae each producing a Class C beta-lactamase. It was shown that clavulanic acid penetrated the outer membranes of all these strains more readily than the other beta-lactamase inhibitors. For the strains of E. coli and K. pneumoniae clavulanic acid penetrated approximately 6 to 19 times more effectively than tazobactam, 2 to 9 times more effectively than sulbactam and 4 to 25 times more effectively than BRL 42715. The superior penetration of clavulanic acid observed in this study is likely to contribute to the efficacy of clavulanic acid/beta-lactam combinations in combating beta-lactam resistant bacterial pathogens.

Biochemical and Enzyme Kinetic Applications for the Characterization of ßLactamases.

For the last 20 yr thin-layer polyacrylamide isoelectric focusing (IEF) has played a major role in the identification and characterization of ß-lactamases. IEF is able to distinguish enzymes that focus only 0.05 pI apart (1), but the exponential increase rin the numbers of ß-lactamases discovered over the last 10 yr has meant that this method no longer provides sufficient resolution to distinguish the majority of ß-lactamases. Today the pI of a ß-lactamase is still an essential determinant that must be used in combination with a variety of other data. Moreover, the IEF of ß-lactamases is now entering a new era as this technique can be adapted to provide important biochemical information on ß-lactamases other than simply their pI values. These approaches are discussed in Subheading 3.1.

Inhibition of metallo-beta-lactamases by a series of mercaptoacetic acid thiol ester derivatives.

A series of mercaptoacetic acid thiol esters have been identified as metallo-beta-lactamase inhibitors. Electrospray mass spectrometry (ESMS) has shown that irreversible inhibition of the Bacillus cereus II metallo-beta-lactamase by SB214751, SB214752, and SB213079 was concomitant with a 90-Da increase in mass of the enzyme. Tryptic digestion of the B. cereus II inhibited with SB214751 illustrated that the peptide fragment, containing the only cysteine of the enzyme, had undergone a mass increment of 90 Da. It was further demonstrated that B. cereus II hydrolyzed this type of compound across the thiol ester bond to yield mercaptoacetic acid. Mercaptoacetic acid is the only molecular fragment common to SB214751, SB214752, and SB213079, and free mercaptoacetic acid does not bind covalently to B. cereus II. Therefore, it is concluded that these compounds inhibit B. cereus II by the mechanism-based delivery of mercaptoacetic acid, forming a disulfide linkage with the active sites cysteine (predicted mass shift = +90 Da) under the aerobic conditions of the assay. The different thiol esters examined had a broad range of potencies against the metallo-beta-lactamases tested. For example SB214751, SB214752, and SB213079 all had 50% inhibitory concentrations of < 10 and > 1,000 microM for the Stenotrophomonas maltophilia L-1 and Bacteroides fragilis CfiA enzymes, respectively. SB216968 was particularly active against the Aeromonas hydrophila CphA metallo-beta-lactamase and was found to be an uncompetitive inhibitor of this enzyme (Ki = 3.9 microM), whereas it exhibited irreversible inhibition of the L-1 enzyme. These observations with this series of compounds have revealed subtle differences between the active sites of different metallo-beta-lactamases. Finally, a novel application for isothermal titration calorimetry for assessing the zinc chelating activity of candidate inhibitors is also presented.

Acromial arch shape: assessment with MR imaging.

PURPOSE: To test the hypothesis that acromial shape is comparable on supraspinatus outlet view radiographs and parasagittal magnetic resonance (MR) images. MATERIALS AND METHODS: Supraspinatus outlet view radiographs of a dried scapula were obtained in the neutral position and with various degrees of caudal, cranial, anterior, and posterior angulation. Sagittal MR images of 41 asymptomatic and 39 symptomatic shoulders were reviewed and compared with outlet view radiographs from the 39 symptomatic cases. Acromial shape was assessed with published classification schemes. RESULTS: Minor variations in angulation produced changes in apparent acromial shape and thickness on the radiographs. MR imaging from a lateral to a more medial section changed the shape or thickness grade in 39 of 41 asymptomatic shoulders. There was poor correlation between findings at radiographic and MR assessment of acromial shape in the symptomatic group. CONCLUSION: Apparent acromial shape is sensitive to minor changes in radiographic technique and MR section viewed.

Kinetic and physical studies of beta-lactamase inhibition by a novel penem, BRL 42715.

The interactions of Staphylococcus aureus, Bacillus cereus I, TEM, Klebsiella pneumoniae K1 and Enterobacter cloacae P99 beta-lactamases with the novel penem inhibitor BRL 42715 were investigated kinetically and, in some cases, by electrospray mass spectrometry (e.s.m.s.). All the beta-lactamases were rapidly inactivated by BRL 42715, with second-order rate constants ranging from 0.17 to 6.4 microM-1.s-1. The initial stoichiometry of beta-lactamase inhibition was essentially 1:1, with the exception of the K1 enzyme. In this instance about 20 molecules of BRL 42715 were hydrolysed before the enzyme was completely inhibited. Inhibited beta-lactamases did not readily regain activity in the absence of BRL 42715, the half-lives for regeneration of free enzyme ranging from 5 min for the K1 beta-lactamase to over 2 days for the staphylococcal enzyme. Recovery of activity was incomplete for TEM-1, K1 and P99 beta-lactamases, suggesting partitioning of the inhibited enzymes to give a permanently (or at least very stable) inactivated species. Examination of the interactions of the penem with TEM, B. cereus I and P99 beta-lactamases by e.s.m.s. also showed rapid and stoichiometric binding of the inhibitor. In all cases a mass increase of 264 Da over the native enzyme was observed, corresponding to the molecular mass of BRL 42715, showing that no fragmentation of the penem occurred on reaction with the beta-lactamases.

Biochemical basis of mupirocin resistance in strains of Staphylococcus aureus.

Twenty one strains of Staphylococcus aureus, of varying resistance to mupirocin, were examined in order to determine the mechanism of resistance to this antibiotic; six of these strains were mupirocin sensitive (MIC 0.12-1.0 mg/L) nine moderately resistant strains (MIC 8-256 mg/L) and six highly resistant strains (MIC > 2048 mg/L). Mupirocin showed a time-dependent inhibition of the target enzyme, isoleucyl-tRNA synthetase (IRS); incubation of the antibiotic with this enzyme before adding the substrates markedly increased inhibition in sensitive strains. The IRS I50 values (the antibiotic concentrations which cause a 50% decrease in enzyme activity) correlated well with the MIC values for each strain (P < 0.01). The mean I50 value for sensitive strains was 3.3 x 10(-2) mg/L, in moderately resistant strains it was 1.3 x 10(-1) mg/L and in highly resistant strains it was 7.5 mg/L. No degradation of mupirocin could be detected during extended incubation of the antibiotic with cell free extracts from four resistant S. aureus strains. We conclude that the production of a modified IRS enzyme is the major cause of mupirocin resistance in the strains studied.

Maximizing contrast to noise with inductively coupled implanted coils.

Magnetic resonance (MR) microscopy with inductively coupled implanted coils has been used previously to follow loss and return of intra-medullary contrast as a result of nephrotoxic acute tubular necrosis with 117 microns resolution over a 2000 microns thick slice. The purpose of the current study was to further investigate the capabilities of in vivo MR microscopy by combining the implanted coil imaging technique with spin echo pulse sequence optimization done through signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) modeling. These models included consideration of the effects of T2* and sampling time on signal-to-noise and contrast-to-noise ratios. They were initially tested with GdCl3 and agar gel phantoms constructed to the relaxation time and spin density specifications of the intra-medullary junction which bridges the outer and inner stripe of the outer medulla. In vivo microscopy was performed using single turn radiofrequency (RF) coils that were surgically implanted around the left kidney of two rats and inductively coupled to an external "birdcage" body coil. The models revealed maximum CNR per unit imaging time at a TR of 800 msec. A TE of 16 msec proved to be the best compromise between loss of transverse magnetization and decreased bandwidth. These CNR predictions were supported by the gel phantom and in vivo data. Maximizing the CNR in the current study enabled us to improve the resolution of in vivo MR microscopy to 78 microns over a 1000 microns slice with an SNR of 40 and a CNR of eight in a total imaging time of 54 minutes.

Implanted coil MR microscopy of renal pathology.

Inductively coupled implanted coils have been shown to provide up to a 10-fold increase in signal-to-noise ratio when compared to whole-body imaging of small animals. The current study was designed to extend the implanted coil imaging technique to a rodent model of renal pathology. Resonant radiofrequency (RF) coils were implanted around the left kidney of four rats and inductively coupled from within a birdcage body coil. All images were acquired at 2 T using a T1-weighted spin-echo sequence with TR = 500 ms and TE = 20 ms. In vivo MR microscopy with voxels of 117 x 117 x 2000 microns demonstrated cortex, inner and outer medulla, and major vascular structures on baseline images. Mercuric chloride-induced nephrotoxic acute tubular necrosis (ATN) diminished cortico-medullary contrast at 24 h after dosing with pathologic evaluation demonstrating nephrotoxic changes in the inner cortex. The kidney regained a baseline MR appearance 360 h after dosing and resolution of the damage was confirmed with histology. T1 data were gathered on excised kidneys as an adjunct to the images to help correlate the loss and return of cortico-medullary contrast with the pathology and pathophysiology of nephrotoxic ATN. With implanted RF coils we were able to demonstrate renal pathology and follow its subsequent resolution. Specifically, loss and return of cortico-medullary contrast as a result of nephrotoxic ATN were serially documented in four rats. Such serial in vivo studies performed on single animals should further the use of MR microscopy by minimizing the number of animals required for adequate biostatistics.

The effects of clavulanic acid and sulbactam on beta-lactamase biosynthesis.

Clavulanic acid and sulbactam were tested as inducers of beta-lactamase in 21 strains of Gram-negative bacteria. beta-Lactamase synthesis was inducible in all these strains, as demonstrated by the increased enzyme activities obtained when cells were grown in the presence of 10 mg/l of cefoxitin, the increase varying from 11- to 734-fold However, at the same concentration, neither inhibitor induced significant amounts of beta-lactamase, except in one strain of Providencia rettgeri, where both were potent inducers. When steps were taken to overcome the inhibitory effects of clavulanic acid and sulbactam, they were still found to be ineffective inducers. We conclude that, at therapeutic concentrations, clavulanic acid and sulbactam are generally poor inducers of beta-lactamase. Amoxycillin and ampicillin induced more beta-lactamase than the inhibitors, but were much less effective than cefoxitin, except for the strain of Prov. rettgeri.