According
to the World Health Organization, antibiotic resistance
is a global health threat. Of particular importance are infections
caused by multidrug-resistant Gram-negative bacteria including Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa for which limited treatment
options exist. Multiple and simultaneously occurring resistance mechanisms
including outer membrane impermeability, overexpression of efflux
pumps, antibiotic-modifying enzymes, and modification of genes and
antibiotic targets have made antibiotic drug development more difficult
against these pathogens. One strategy to cope with these challenges
is the use of outer membrane permeabilizers that increase the intracellular
concentration of antibiotics when used in combination. In some circumstances,
this approach can rescue antibiotics from resistance or repurpose
currently marketed antibiotics. Tobramycin-based hybrid antibiotic
adjuvants that combine two outer membrane-active components have been
previously shown to potentiate antibiotics by facilitating transit
through the outer membrane, resulting in increased antibiotic accumulation
within the cell. Herein, we extended the concept of tobramycin-based
hybrid antibiotic adjuvants to tobramycin-based chimeras by engineering
up to three different membrane-active antibiotic warheads such as
tobramycin, 1-(1-naphthylmethyl)-piperazine, ciprofloxacin, and cyclam
into a central 1,3,5-triazine scaffold. Chimera 4 (TOB-TOB-CIP)
consistently synergized with ciprofloxacin, levofloxacin, and moxifloxacin
against wild-type and fluoroquinolone-resistant P.
aeruginosa. Moreover, the susceptibility breakpoints
of ceftazidime, aztreonam, and imipenem were reached using the triple
combination of chimera 4 with ceftazidime/avibactam,
aztreonam/avibactam, and imipenem/relebactam, respectively, against
β-lactamase-harboring P. aeruginosa. Our findings demonstrate that tobramycin-based chimeras form a
novel class of antibiotic potentiators capable of restoring the activity
of antibiotics against P. aeruginosa.