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=== Increased development of antimicrobial resistance (AMR) – a natural phenomenon strongly accelerated by human action === | === Increased development of antimicrobial resistance (AMR) – a natural phenomenon strongly accelerated by human action === | ||
<html><img src="http://s17531757.onlinehome-server.info/iGEM/img/problem-drugs.png" /></html> | <html><img src="http://s17531757.onlinehome-server.info/iGEM/img/problem-drugs.png" /></html> | ||
| - | ‘Inappropriate use of antimicrobials’ in humans is considered the ‘most important cause’ for AMR emergence by the WHO [8]. This includes both over and underuse. Every use of antimicrobials puts the human microbiome under selective pressure, enhancing selectively the proliferation of resistant strains. | + | ‘Inappropriate use of antimicrobials’ in humans is considered the ‘most important cause’ for AMR emergence by the WHO [8]. This includes both over- and underuse. Every use of antimicrobials puts the human microbiome under selective pressure, enhancing selectively the proliferation of resistant strains. |
Thus, over-prescription of antibiotics unnecessarily intensifies the selective pressure and promotes AMR development without benefit for the patient. <br/> | Thus, over-prescription of antibiotics unnecessarily intensifies the selective pressure and promotes AMR development without benefit for the patient. <br/> | ||
However, underuse in case of a bacterial infection is no less harmful. Intake of the right antibiotic for sufficient time and dosage is required to ensure complete elimination of the pathogenic bacteria. Non-lethal quantities of an antimicrobial drug enables pathogens to develop resistance and prolongs the infection, giving resistant organisms increased possibility to spread [9]. | However, underuse in case of a bacterial infection is no less harmful. Intake of the right antibiotic for sufficient time and dosage is required to ensure complete elimination of the pathogenic bacteria. Non-lethal quantities of an antimicrobial drug enables pathogens to develop resistance and prolongs the infection, giving resistant organisms increased possibility to spread [9]. | ||
<html><img src="http://s17531757.onlinehome-server.info/iGEM/img/problem-steak.png" /></html> | <html><img src="http://s17531757.onlinehome-server.info/iGEM/img/problem-steak.png" /></html> | ||
| - | Not only human health is achieved by use of antimicrobial compounds | + | Not only human health is achieved by use of antimicrobial compounds. Antibiotics are also applied on a large scale in animal husbandry for healing or preventively avoiding diseases. Moreover, their ability to promote animal growth and improve production performance makes them attractive feed additives especially for factory farming [10]. <br/> |
Such non-therapeutic antimicrobials have been shown to be associated with AMR development, promoting even multi-drug resistance to compounds that were not utilized as feed additives. Especially the low-dose, long-time application of antibiotics as feed additives selects strongly for resistant strains. Animal-to-human transfer of such strains may occur by direct contact or indirectly through the food chain [11]. | Such non-therapeutic antimicrobials have been shown to be associated with AMR development, promoting even multi-drug resistance to compounds that were not utilized as feed additives. Especially the low-dose, long-time application of antibiotics as feed additives selects strongly for resistant strains. Animal-to-human transfer of such strains may occur by direct contact or indirectly through the food chain [11]. | ||
Revision as of 19:23, 17 October 2014
What's the problem?
Antimicrobial resistance (AMR)
Life-threatening pneumonia, deadly wound infections - what sounds like a scenario from the 19th century is turning into an increasingly realistic future, as the weapons we have at command to fight such diseases are getting blunt.
Infectious diseases are caused by microorganisms like bacteria and were mostly impossible to cure a hundred years ago. The discovery of penicillin in the late 1920s gave rise to a completely new class of medicines, so called antimicrobials, which allowed for the first time selective targeting of microorganisms, in case of antibiotics specifically bacteria. In the following decades, development of a wide range of antimicrobials enabled successful treatment of formerly life-threatening diseases and significantly increased global health and life expectancy.
However, fighting microorganisms has never been a completed task but rather an always ongoing race between drug development and pathogen evolution, a race in which microorganisms are more and more taking the lead. Resistance of bacteria against all known antibiotics are no longer gloomy visions of the future but already detected in some of the most widespread genera [1, 2]. The World Health Organization (WHO) even warns of a post-antibiotic era, in which common infections once again become deadly threats, if no efficient countermeasures are taken within the next years [3].
Development gap
Two aspects mainly contribute to the worsening situation. On the one hand, emergence and spread of antimicrobial resistance speeds up, while on the other hand the development of new antimicrobial agents slows down. Reasons for both aspects are numerous and will be highlighted with focus on antibacterial compounds.
Lack of new antimicrobial drugs
Economic reasons: Drug development is economically unviable.
Newly introduced antibiotics are used only sparsely to prevent development of new resistance. They are likely to be kept as second or third-line drugs, in case conventional treatments fails. Thus, profit potential of such compounds is low [5, 6].
Scientific reasons: New classes of antibiotics are hard to discover.
Targets for antibacterial drugs have to fulfil a range of criteria like essentiality to the organism, conservation across bacterial species or ‘druggability’ by small molecules blocking the target’s function. Despite new technologies like the ‘-omics’, bioinformatics or high-throughput methods, researchers are struggling to find potential drug targets meeting these requirements and no significant scientific progress has been made in the field of antibiotics over the past 25 years [7].
Regulatory Reasons: Established antibiotics set high standards regarding toxicity.
High demands are placed on newly developed compounds in terms of toxicity, as known antibiotics generally show very few side effects. Thus, investors face the risk that their agent is withdrawn from the market when too many side-effects occur.
Increased development of antimicrobial resistance (AMR) – a natural phenomenon strongly accelerated by human action
‘Inappropriate use of antimicrobials’ in humans is considered the ‘most important cause’ for AMR emergence by the WHO [8]. This includes both over- and underuse. Every use of antimicrobials puts the human microbiome under selective pressure, enhancing selectively the proliferation of resistant strains.
Thus, over-prescription of antibiotics unnecessarily intensifies the selective pressure and promotes AMR development without benefit for the patient.
However, underuse in case of a bacterial infection is no less harmful. Intake of the right antibiotic for sufficient time and dosage is required to ensure complete elimination of the pathogenic bacteria. Non-lethal quantities of an antimicrobial drug enables pathogens to develop resistance and prolongs the infection, giving resistant organisms increased possibility to spread [9].
Not only human health is achieved by use of antimicrobial compounds. Antibiotics are also applied on a large scale in animal husbandry for healing or preventively avoiding diseases. Moreover, their ability to promote animal growth and improve production performance makes them attractive feed additives especially for factory farming [10].
Such non-therapeutic antimicrobials have been shown to be associated with AMR development, promoting even multi-drug resistance to compounds that were not utilized as feed additives. Especially the low-dose, long-time application of antibiotics as feed additives selects strongly for resistant strains. Animal-to-human transfer of such strains may occur by direct contact or indirectly through the food chain [11].
Global challenges regarding faster and wider spread of antimicrobial resistance
Global trade and travel have increased significantly in the last decades, while urbanization leads to higher population density in cities. Both factors enhance spreading of resistant microorganisms between individuals, communities and nations. Additional trends like the AIDS epidemic or ageing populations in industrial countries increase the number of immunocompromised and hospitalized people, two groups at particularly high risk of exposure and opportunistic infections [8].
Detailed knowledge about emerging resistance and its spread is crucial for correct risk assessment and appropriate countermeasures. Thus, surveillance of antimicrobial resistance is a basis for global health. It is, however, neither coordinated nor harmonized globally and often incomplete in many countries of the world. The lack of representative data hampers development and implementation of effective strategies against AMR [3].
A problem-solving approach
The BaKillus strategy
Increasing bacterial resistance to classical antibiotics is a serious threat to global health and urges the development of novel pathogen-killing strategies. To address this need, we, the iGEM 2014 team LMU-Munich, are developing BaKillus, a pathogen-hunting microbe. Our genetically modified Bacillus subtilis is able to detect pathogens by eavesdropping on their communication system which is based on quorum sensing (QS). This is a promising target, as many pathogens synchronize their pathogenicity using QS. In response to the sensing of the pathogen, BaKillus produces various killing factors such as peptide antibiotics or toxins to extinguish it. Additionally, BaKillus is able to adhere to the pathogen and after fulfilling its purpose, it drives itself into suicide by a delayed loss of immunity against its own killing factors.
How BaKillus decelerates the development of antimicrobial resistance
By operating via an innovative pathogen-killing strategy, Bakillus aims to decelerate the spread of bacterial resistance to antibiotics. With our strategy, we will be able to avoid one of the main reasons for antibiotic resistance, namely the mis-/overuse of antimicrobial agents. This is primarily accomplished through reduction of inappropriate use of antibiotics and a higher degree of treatment efficacy.
The first part our project, the detection of QS-molecules, enables a time-limited application, as antibiotics are only produced if the QS-molecule threshold is reached. In contrast, common antibiotic therapies are administered over a longer period of time.
Bacteria regulate and synchronize energy-consuming mechanisms like pathogenicity and biofilm formation via QS in dependence on a certain cell density. Thus, only bacteria on the cusp of pathogenicity are targeted. Commensals and probiotic microorganisms residing the human body or even providing benefits, can escape the killing factors. This forms a striking contrast to the administration of broad-spectrum antimicrobials, which do not distinguish between their targets when applied, and which may lead to undesirable side effects. Therefore, the QS-dependent detection is an excellent feature to reduce the misuse of antimicrobials.
The adhesion module of BaKillus also contributes to the reduction of inappropriate use of antimicrobial agents. Our BaKillus is able to adhere to the surface of a specific pathogen, which allows a precise and localized application of the killing factors. This shelters commensals and probiotics from the exposure to antibiotics.
Furthermore, the attachment to the surface of the pathogen leads to a higher treatment efficacy. A high dose of antimicrobials is released in close proximity to the target pathogen in order to efficiently kill it. In contrast, classical treatments lack this precision and pathogens can evade the drugs more easily. As adhesion happens regardless of the QS-threshold of the pathogens, this provides an excellent control strategy against opportunistic pathogens. If the cell density of the pathogen population increases and becomes pathogenic, BaKillus is already at the right spot of intervention.
Moreover, killing strategies used by BaKillus frequently have high target specificities and are only active against a certain pathogen, but spare other residents from harm. The specificity is further supported by the modularity of the systems, allowing the simple exchange of killing and sensing devices. This also helps to reduce the use of antibiotics, since it once more minimizes the exposure of antimicrobials to commensals. Another attribute of BaKillus is the usage of complementary combat strategies. Similar to classical therapies with combination products, BaKillus can produce more than one killing factor, which operate in a complementary fashion. Thereby, the concentration required for killing the pathogen is reduced for both agents. Furthermore, complementary substances, such as biofilm-degrading agents could be used as supplements to contribute to a higher efficacy of the treatment.
In conclusion, our BaKillus strategy increases the efficiency of antimicrobial treatments and strongly reduces the mis- and overuse of antibiotics, the main reason for increasing antimicrobial resistance. Thus, BaKillus is able to decelerate the development of this fast-growing, global threat.
Team LMU-Munich
igem@bio.lmu.de
AG Thorsten MascherGroßhaderner Str. 2
82152 Planegg (Martinsried)
Hi there!
Welcome to our Wiki! I'm BaKillus, the pathogen-hunting microbe, and I'll guide you on this tour through our project. If you want to learn more about a specific step, you can simply close the tour and come back to it anytime you like. So let's start!
What's the problem?
First of all, what am I doing here? The problem is, pathogenic bacteria all around the world are becoming more and more resistant against antimicrobial drugs. One major reason for the trend is the inappropriate use of drugs. With my BaKillus super powers, I want to reduce this misuse and thus do my part to save global health.
Sensing of pathogens
To combat the pathogenic bacteria, I simply eavesdrop on their communication. Bacteria talk with each other via quorum sensing systems, which I use to detect them and trigger my responses.
Adhesion
The more specific and effective I can use my powers, the lower the danger is of provoking new resistance development. So I catch pathogens whenever I get hold of them and stick to them until my work is done.
Killing
Talking about my work - killing pathogens is finally what I am made for. In response to quorum sensing molecules of the pathogens, I export a range of antimicrobial substances leading to dissipation of biofilms and the killing of the targeted bacteria.
Suicide switch
When the job is done and all the bad guys are finished, you don't need a super hero anymore. So after fulfilling my work I say goodbye to the world by activating my suicide switch.
Application
Of course I'm not only a fictional hero, but a very real one. In two different prototypes, I could be used for diagnosis or treatment of pathogen-caused diseases. However, there is still a whole lot of regulational and economical questions that have to be answered before.
See you!
So now you know my short story - and it is time for me to return to my fight for a safer world. Feel free to take a closer look on my super powers, the process of my development or the plans for a medical application.
