Exploring avibactam and relebactam inhibition of Klebsiella pneumoniae carbapenemase D179N variant: role of the Ω loop-held deacylation water.

Klebsiella pneumoniae carbapenemase-2 (KPC-2) presents a clinical threat as this ß-lactamase confers resistance to carbapenems. Recent variants of KPC-2 in clinical isolates contribute to concerning resistance phenotypes. Klebsiella pneumoniae expressing KPC-2 D179Y acquired resistance to the ceftazidime/avibactam combination affecting both the ß-lactam and the ß-lactamase inhibitor yet has lowered minimum inhibitory concentrations for all other ß-lactams tested. Furthermore, Klebsiella pneumoniae expressing the KPC-2 D179N variant also manifested resistance to ceftazidime/avibactam yet retained its ability to confer resistance to carbapenems although significantly reduced. This structural study focuses on the inhibition of KPC-2 D179N by avibactam and relebactam and expands our previous analysis that examined ceftazidime resistance conferred by D179N and D179Y variants. Crystal structures of KPC-2 D179N soaked with avibactam and co-crystallized with relebactam were determined. The complex with avibactam reveals avibactam making several hydrogen bonds, including with the deacylation water held in place by Ω loop. These results could explain why the KPC-2 D179Y variant, which has a disordered Ω loop, has a decreased affinity for avibactam. The relebactam KPC-2 D179N complex revealed a new orientation of the diazabicyclooctane (DBO) intermediate with the scaffold piperidine ring rotated ~150° from the standard DBO orientation. The density shows relebactam to be desulfated and present as an imine-hydrolysis intermediate not previously observed. The tetrahedral imine moiety of relebactam interacts with the deacylation water. The rotated relebactam orientation and deacylation water interaction could potentially contribute to KPC-mediated DBO fragmentation. These results elucidate important differences that could aid in the design of novel ß-lactamase inhibitors.

The best of both worlds: no apparent trade-off between immunity and reproduction in two group-living African mole-rat species.

Co-operatively breeding mammals often exhibit a female reproductive skew and suppression of the subordinate non-breeding group members. According to evolutionary theory and the immunity-fertility axis, an inverse relationship between reproductive investment and survival (through immunocompetence) is expected. As such, this study investigated if a trade-off between immunocompetence and reproduction arises in two co-operatively breeding African mole-rat species, namely the Damaraland mole-rat (Fukomys damarensis) and common mole-rat (Cryptomys hottentotus hottentotus), which possess female reproductive division of labour. This study also attempted to investigate the relationship between the immune and endocrine systems in Damaraland mole-rats. There was no trade-off between reproduction and immunocompetence in co-operatively breeding African mole-rat species, and in the case of the Damaraland mole-rats, breeding females (BFs) possessed increased immunocompetence compared with non-breeding females (NBFs). Furthermore, the increased levels of progesterone possessed by Damaraland mole-rat BFs compared with NBFs appear to be correlated to increased immunocompetence. In comparison, BF and NBF common mole-rats possess similar immunocompetence. The species-specific differences in the immunity-fertility axis may be due to variations in the strengths of reproductive suppression in each species. This article is part of the theme issue 'Evolutionary ecology of inequality'.

Structural Characterization of the D179N and D179Y Variants of KPC-2 ß-Lactamase: Ω-Loop Destabilization as a Mechanism of Resistance to Ceftazidime-Avibactam.

Klebsiella pneumoniae carbapenemases (KPC-2 and KPC-3) present a global clinical threat, as these ß-lactamases confer resistance to carbapenems and oxyimino-cephalosporins. Recent clinically identified KPC variants with substitutions at Ambler position D179, located in the Ω loop, are resistant to the ß-lactam/ß-lactamase inhibitor combination ceftazidime-avibactam, but susceptible to meropenem-vaborbactam. To gain insights into ceftazidime-avibactam resistance conferred by D179N/Y variants of KPC-2, crystal structures of these variants were determined. The D179N KPC-2 structure revealed that the change of the carboxyl to an amide moiety at position 179 disrupted the salt bridge with R164 present in wild-type KPC-2. Additional interactions were disrupted in the Ω loop, causing a decrease in the melting temperature. Shifts originating from N179 were also transmitted toward the active site, including ∼1-Å shifts of the deacylation water and interacting residue N170. The structure of the D179Y KPC-2 ß-lactamase revealed more drastic changes, as this variant exhibited disorder of the Ω loop, with other flanking regions also being disordered. We postulate that the KPC-2 variants can accommodate ceftazidime because the Ω loop is displaced in D179Y or can be more readily displaced in D179N KPC-2. To understand why the ß-lactamase inhibitor vaborbactam is less affected by the D179 variants than avibactam, we determined the crystal structure of D179N KPC-2 in complex with vaborbactam, which revealed wild-type KPC-2-like vaborbactam-active site interactions. Overall, the structural results regarding KPC-2 D179 variants revealed various degrees of destabilization of the Ω loop that contribute to ceftazidime-avibactam resistance, possible substrate-assisted catalysis of ceftazidime, and meropenem and meropenem-vaborbactam susceptibility.

Analysis of the Structure and Function of FOX-4 Cephamycinase.

Class C ß-lactamases poorly hydrolyze cephamycins (e.g., cefoxitin, cefotetan, and moxalactam). In the past 2 decades, a new family of plasmid-based AmpC ß-lactamases conferring resistance to cefoxitin, the FOX family, has grown to include nine unique members descended from the Aeromonas caviae chromosomal AmpC. To understand the basis for the unique cephamycinase activity in the FOX family, we determined the first X-ray crystal structures of FOX-4, apo enzyme and the acyl-enzyme with its namesake compound, cefoxitin, using the Y150F deacylation-deficient variant. Notably, recombinant expression of N-terminally tagged FOX-4 also yielded an inactive adenylylated enzyme form not previously observed in ß-lactamases. The posttranslational modification (PTM), which occurs on the active site Ser64, would not seem to provide a selective advantage, yet might present an opportunity for the design of novel antibacterial drugs. Substantial ligand-induced changes in the enzyme are seen in the acyl-enzyme complex, particularly the R2 loop and helix H10 (P289 to N297), with movement of F293 by 10.3 Å. Taken together, this study provides the first picture of this highly proficient class C cephamycinase, uncovers a novel PTM, and suggests a possible cephamycin resistance mechanism involving repositioning of the substrate due to the presence of S153P, N289P, and N346I substitutions in the ligand binding pocket.

Stable transformation of Phaseolus vulgaris via electric-discharge mediated particle acceleration.

Transgenic Phaseolus vulgaris or common bean has been produced using electric-discharge particle acceleration. The method uses particle acceleration to introduce DNA into bean seed meristems. Multiple shoots are then generated and screened to recover transgenic plants at a rate of 0.03% germline transformed plants/shoot. We have been able to recover transgenic plants using both GUS and herbicide screening to introduce the gus, bar, and bean golden mosaic virus coat protein genes into the navy bean cultivar, Seafarer. The transgenic plants have been characterized over 5 generations of self-fertilization with no loss of introduced genes or expression. In addition, several families have been crossed with non-transgenic parents and these plants also show expected inheritance patterns. The introduced bar gene has been shown to confer strong resistance in transgenic beans to basta herbicide application in the greenhouse.

Swelling of multicellular spheroids induced by hyperthermia.

EMT6 multicellular spheroids invariably swell by 10 to 50 per cent after incubation at 43 to 45 degrees C for 1 h. Both scanning electron and optical microscopy reveal morphological alterations particularly in the outer region of the spheroids. While the control cells are contiguous to one another and tightly held to the spheroid body, the heated spheroids exhibit partially disrupted contacts among cells. Measurements of intercellular volume and water volume of spheroids with labelled water and inulin show that changes in the spheroid volume are not due to an increase in cell volume, but that they can be explained by a 60-100 per cent increase in the intercellular space within a spheroid. Continuous observation of individual spheroids heated to 43-45 degrees C shows loss of adhesion of cells in the outer region and even detachment of a few surface cells. This 'melting' of the spheroid surface appears to result from a disorder in the extracellular material. Treatment with cell swelling agents such as hypotonic solution, ouabain, excess extracellular potassium ions, or ionophore nigericin, K+/H+ exchanger, each separately causes the spheroids to swell at the control temperature. On the other hand, A23187, Ca2+ ionophore, causes shrinkage of the spheroids. Thus, under hyperthermia, the volume of spheroids increases due to the disruption in the cell organization in their outer region.

Use of silicone fluids in studies of cellular amino acids.

In numerous cellular studies, cells labeled with radioisotopes have been separated from the labeling medium by an aqueous solution in order to determine the quantity of internalized labels; however, the aqueous wash tends to remove significant labeling from the cells. Therefore, in order to preserve all of the internalized labels, non-aqueous medium such as silicone fluids may be used. The termination of the labeling is achieved in the silicone method when, upon centrifugation, the cells separate from the medium and enter the silicone fluid to sediment to the tube bottom. This sedimentation of cells placed above a layer of silicone fluid exhibits a critical dependence on the centrifugal force, and gives rise to an uncertainty of only 2 s in determining the time of separation of cells from the medium using General Electric F-50 silicone fluid and a modified Beckman J2-21 centrifuge. It is therefore possible to determine the kinetics of incorporation of labeled amino acids into intracellular pools and proteins. In particular, since this silicone wash method determines the size of the total pool and the aqueous wash method determines the size of the acid-extractable pool, the simultaneous measurements of the size of both pools leads to the determination of the kinetics of labeling of the free amino acid pool. Among many possible applications and extensions of these methods, the studies of formation of intracellular pools and relations among different pools of transported molecules, such as water and amino acids, appear promising.

Chronic radiation myelitis.

From March 1971 to September 1973, 200 patients with primary bronchogenic carcinoma received 4,000 rad (40 Gy) by means of split-course accelerated fractionation. Forty-five patients (22.5%) survived more than 11 months; and of these, 6 (13.3%) were found to have progressive myelitis. Recent reports indicate that rapid fractionation is preferred in some centers and may be undergoing a resurgence. The authors review their experience with this technique and the current understanding of the factors which affect the development of radiation myelitis.

Acute obstructive uric acid nephropathy after treatment of neoplastic adenopathy.

Patients with lymphoma and leukemia are at increased risk of therapy-related sudden increase in the serum uric acid level, with resultant precipitation and obstruction in the more acidic and concentrated distal nephron. Appropriate pretreatment measures can prevent intrarenal crystal formation. The acute obstruction responds well to treatment, and aggressive measures are indicated.

Radition therpay control of nine patients with malignant thymoma.

Malignant thymoma is a relatively rare condition and a review of the literature reveals approximately 100 reported cases. Only a small percentage of these have been treated with megavoltage radiation therapy; therefore, it is difficult to find the necessary information to establish a proper time-dose relationship for treatment. This report deals with the radiation therapy and survival data concerning nine patients treated for malignant thymoma during a ten year period at the Medical University of South Carolina. Megavoltage irradiation in the dose range of 3500-4800 rads was employed in all patients. All gross tumor was completely resected in only three patients, two had a biopsy only, and the remaining four had subtotal resections. Local tumor control has been 100% with the average follow-up being 5.5 years and a minimum of 30 months. Three patients are dead; one from intercurrent disease, one from myasthenia gravis, and one from radiation injury to the spinal cord. One patient is alive with metastatic disease controlled by chemotherapy. The technique of radiation therapy is outlined, as well as suggested treatment policy.

Preoperative radiation therapy for carcinoma of the esophagus.

From 1960 through 1973, 415 patients with carcinoma of the esophagus were treated with radiation therapy. Three hundred and thirty-two patients had planned preoperative irradiation to a dose of 4500 rads in 18 fractions, and 101 of these had subsequent resections with either colon or stomach replacement. The operative mortality in this group was 18% and the 2- and 5-year survivals were 22.8 and 13.6%, respectively. The dose of 4500 rads in 18 fractions produced tumor sterilization in 3% and reduction to in situ carcinoma in 10% of these 101 patients. The survival was considerably improved in this small group of patients. Those patients not amenable to exploration had a 3% 5-year and a 5.6% 2-year survival was 12.1%. The overall survival was 9% at 2 years and 6% at 5 years. The results in this series are compared with the most recent reports in the literature.

Megavoltage therapy in patients with aneurysmal bone cysts.

Three adolescent patients with similar destructive lesions involving the pelvis were found to have unresectable aneurysmal bone cysts. All 3 patients appear to have permanent control and good function from 2 to 7 years after megavoltage irradiation with 4,000 rads. No complications or late sequelae have occurred, and follow-up radiographs demonstrate reconstitution and calcification of the affected bone. A slightly lower dose may be just as effective in controlling such lesions.