Colistin,
typically viewed as the antibiotic of last resort to
treat infections caused by multidrug-resistant (MDR) Gram-negative
bacteria, had fallen out of favor due to toxicity issues. The recent
increase in clinical usage of colistin has resulted in colistin-resistant
isolates becoming more common. To counter this threat, we have investigated
previously reported compounds, HSD07 and HSD17, and developed 13 compounds with more desirable drug-like properties
for colistin sensitization against 16 colistin-resistant bacterial
strains, three of which harbor the plasmid-borne mobile colistin resistance
(mcr-1). Lead compound HSD1624, which
has a lower LogDpH7.4 (2.46) compared to HSD07 (>5.58), reduces the minimum inhibitory concentration (MIC) of
colistin
against Pseudomonas aeruginosa strain
TRPA161 to 0.03 μg/mL from 1024 μg/mL (34,000-fold reduction).
Checkerboard assays revealed that HSD1624 and analogues
are also synergistic with colistin against colistin-resistant strains
of Escherichia coli, Acinetobacter baumannii, and Klebsiella
pneumoniae. Preliminary mechanism of action studies
indicate that HSD1624 exerts its action differently depending
on the bacterial species. Time-kill studies suggested that HSD1624 in combination with 0.5 μg/mL colistin was bactericidal to
extended-spectrum beta-lactamase (ESBL)-producing E.
coli, as well as to E. coli harboring mcr-1, while against P.
aeruginosa TRPA161, the combination was bacteriostatic.
Mechanistically, HSD1624 increased membrane permeability
in K. pneumoniae harboring a plasmid
containing the mcr-1 gene but did not increase radical
oxygen species (ROS), while a combination of 15 μM HSD1624 and 0.5 μg/mL colistin significantly increased ROS in P. aeruginosa TRPA161. HSD1624 was not
toxic to mammalian red blood cells (up to 226 μM).