2014
DOI: 10.1038/nrmicro3232
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Targeting virulence: can we make evolution-proof drugs?

Abstract: Antivirulence drugs are a new type of therapeutic drug that target virulence factors, potentially revitalising the drug-development pipeline with new targets. As antivirulence drugs disarm the pathogen, rather than kill or halt pathogen growth, it has been hypothesized that they will generate much weaker selection for resistance than traditional antibiotics. However, recent studies have shown that mechanisms of resistance to antivirulence drugs exist, seemingly damaging the 'evolution-proof' claim. In this Opi… Show more

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Cited by 451 publications
(446 citation statements)
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References 103 publications
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“…Potential conflicts with the host‐associated lysogenic phages might lead to unexpected treatment outcomes, and care should be taken to select lytic phage species that do not favor virulent QS‐signaling strains. Furthermore, if phage resistance is positively correlated with functional QS systems, phage therapy could be potentially combined with antivirulence strategies that impair bacterial QS (Allen, Popat, Diggle, & Brown, 2014). Lastly, our results suggest that phage selection might indirectly affect the evolution of social interactions with bacteria by potentially changing the relative benefit of cooperation and cheating.…”
Section: Discussionmentioning
confidence: 99%
“…Potential conflicts with the host‐associated lysogenic phages might lead to unexpected treatment outcomes, and care should be taken to select lytic phage species that do not favor virulent QS‐signaling strains. Furthermore, if phage resistance is positively correlated with functional QS systems, phage therapy could be potentially combined with antivirulence strategies that impair bacterial QS (Allen, Popat, Diggle, & Brown, 2014). Lastly, our results suggest that phage selection might indirectly affect the evolution of social interactions with bacteria by potentially changing the relative benefit of cooperation and cheating.…”
Section: Discussionmentioning
confidence: 99%
“…A worldwide increase in microbial drug resistance, coupled with stagnant growth in the discovery of new antibiotics, underscores the need for novel therapeutic approaches to directly target pathogenesis (35)(36)(37). The IpaH family, with its high conservation across numerous pathogenic Gram-negative bacteria, is an attractive candidate for the development of mechanism-based inhibitors with possibly broad applicability (18).…”
Section: Discussionmentioning
confidence: 99%
“…Critically, variation in disease that is due to G parasite  G parasite may be more amenable to intervention than variation caused by host genotypic differences. Capitalizing on within-host selection is a major tenet of Hamiltonian medicine [106] and understanding how parasite traits influence parasite fitness across spatial scales is crucial to predicting when novel therapies, such as targeting virulence factors, will be successful [107,108].…”
Section: Implications Of Within-host Competition To Host Healthmentioning
confidence: 99%