Lower ototoxicity and absence of hidden hearing loss point to gentamicin C1a and apramycin as promising antibiotics for clinical use

Trabajo presentado en el 42nd Annual MidWinter Meeting of the Association of Otorhinolaryngology, celebrado en Baltimore (Estados Unidos) del 9 al 13 de febrero de 2019.[Background]: Spread of antimicrobial resistance and shortage of novel antibiotics have led to an urgent need for new antibacterials (Maura et al. 2016, Curr Opin Microbiol 33: 41-46; Tacconelli et al. 2018, Lancet Infect Dis 18: 318-327). Although aminoglycoside antibiotics (AGs) exhibit potent antimicrobial activity, their use has been largely restricted due to serious sideeffects, mainly nephrotoxicity and ototoxicity (Forge and Schacht 2000, Audiol Neurootol 5: 3-22; Huth et al. 2011, Int J Otolaryngol 2011: 937861). It is therefore of great importance to identify AGs of strong antibacterial activity that lack their most harmful side effects.[Methods]: A large number of AGs were tested against a series of multidrug-resistant clinical isolates of the ESKAPE panel; of these, five AGs showing strong antibacterial activity were selected to evaluate their ototoxicity. A stepwise approach was followed, aiming at setting up a protocol that could be used in future high-throughput screenings. In vitro tests were initially conducted by assessing the viability of two established otic cell lines following AG treatment, and subsequently on murine cochlear organotypic cultures, by analysing hair cell survival. In vivo work was then carried out on a guinea pig model, following local round window application of the AGs.[Results]: Commercial gentamicin mixture (GM), the GM congener gentamicin C1a (GM C1a), apramycin (Apra), paromomycin (Paro) and neomycin (Neo) were selected for ototoxicity testing. In vitro analyses confirmed GM and Neo as the most toxic of the tested AGs, and Apra and Paro as those with the lowest toxicity; interestingly, GM C1a appeared to be less toxic than GM. Regarding the in vivo work, a dose-dependent effect of AGs on outer hair cell (OHC) survival and compound action potentials (CAPs) showed that GM C1a and Apra were the least toxic. Strikingly, although no changes were observed in CAP thresholds and OHC survival following treatment with low concentrations of Neo, GM and Paro, the number of inner hair cell (IHC) synaptic ribbons and the CAP amplitudes were reduced. This indication of hidden hearing loss was not observed with GM C1a or Apra at such concentrations.[Conclusion]: These findings have: (a) validated our screening approach, approach that will now be used for high-throughput testing of newly isolated AG congeners, (b) revealed the IHCs as the inner ear’;s most vulnerable element to AG treatment, and (c) identified GM C1a and Apra as promising bases for the development of clinically useful antibiotics

Acetyl-4'-phosphopantetheine is stable in serum and prevents phenotypes induced by pantothenate kinase deficiency

CITATION: Di Meo, I., et al. 2017. Acetyl-4′-phosphopantetheine is stable in serum and prevents phenotypes induced by pantothenate kinase deficiency. Scientific Reports, 7:11260, doi:10.1038/s41598-017-11564-8.The original publication is available at https://www.nature.comCoenzyme A is an essential metabolite known for its central role in over one hundred cellular metabolic reactions. In cells, Coenzyme A is synthesized de novo in five enzymatic steps with vitamin B5 as the starting metabolite, phosphorylated by pantothenate kinase. Mutations in the pantothenate kinase 2 gene cause a severe form of neurodegeneration for which no treatment is available. One therapeutic strategy is to generate Coenzyme A precursors downstream of the defective step in the pathway. Here we describe the synthesis, characteristics and in vivo rescue potential of the acetyl-Coenzyme A precursor S-acetyl-4′-phosphopantetheine as a possible treatment for neurodegeneration associated with pantothenate kinase deficiency.https://www.nature.com/articles/s41598-017-11564-8Publisher's versio

Stable pantetheine derivatives for the treatment of pantothenate kinase associated neurodegeneration (PKAN) and methods for the synthesis of such compounds

The invention relates to (S)-acyl-4'-phosphopantetheine derivatives, methods of their synthesis, and related medical uses of such compounds. Preferred medical uses relate to the treatment of neurodegenerative diseases, such as PKAN

Stable pantetheine derivatives for the treatment of pantothenate kinase associated neurodegeneration (PKAN) and methods for the synthesis of such compounds

The invention relates to (S)-acyl-4'-phosphopantetheine derivatives, methods of their synthesis, and related medical uses of such compounds. Preferred medical uses relate to the treatment of neurodegenerative diseases, such as PKAN

Lower ototoxicity and absence of hidden hearing loss point to gentamicin C1a and apramycin as promising antibiotics for clinical use

Spread of antimicrobial resistance and shortage of novel antibiotics have led to an urgent need for new antibacterials. Although aminoglycoside antibiotics (AGs) are very potent anti-infectives, their use is largely restricted due to serious side-effects, mainly nephrotoxicity and ototoxicity. We evaluated the ototoxicity of various AGs selected from a larger set of AGs on the basis of their strong antibacterial activities against multidrug-resistant clinical isolates of the ESKAPE panel: gentamicin, gentamicin C1a, apramycin, paromomycin and neomycin. Following local round window application, dose-dependent effects of AGs on outer hair cell survival and compound action potentials showed gentamicin C1a and apramycin as the least toxic. Strikingly, although no changes were observed in compound action potential thresholds and outer hair cell survival following treatment with low concentrations of neomycin, gentamicin and paromomycin, the number of inner hair cell synaptic ribbons and the compound action potential amplitudes were reduced. This indication of hidden hearing loss was not observed with gentamicin C1a or apramycin at such concentrations. These findings identify the inner hair cells as the most vulnerable element to AG treatment, indicating that gentamicin C1a and apramycin are promising bases for the development of clinically useful antibiotics.This study was supported by TRIH grants/Action on Hearing Loss (Grant No. Project No. T3_Petkovic), the Deutsche Forschungsgemeinschaft SPP 1608 RU 316/12-1; SPP1608 KN 316/12-1. Dr Marta Fernández-Martínez and Dr Luis Martínez-Martínez are supported by Plan Nacional de I + D + i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0007 and RD16/0016/0008, respectively), and co-financed by the European Development Regional Fund “A way to achieve Europe”, Operative Program Intelligent Growth 2014–2020.Peer reviewe