Pharmacokinetics/pharmacodynamics of polymyxin B in patients with bloodstream infection caused by carbapenem-resistant Klebsiella pneumoniae

Introduction: Polymyxin B is a last-line therapy for carbapenem-resistant microorganisms. However, a lack of clinical pharmacokinetic/pharmacodynamic (PK/PD) data has substantially hindered dose optimization and breakpoint setting.Methods: A prospective, multi-center clinical trial was undertaken with polymyxin B [2.5 mg/kg loading dose (3-h infusion), 1.25 mg/kg/12 h maintenance dose (2-h infusion)] for treatment of carbapenem-resistant K. pneumoniae (CRKP) bloodstream infections (BSI). Safety, clinical and microbiological efficacy were evaluated. A validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was applied to determine the concentrations of polymyxin B in blood samples. Population pharmacokinetic (PK) modeling and Monte Carlo simulations were conducted to examine the susceptibility breakpoint for polymyxin B against BSI caused by CRKP.Results: Nine patients were enrolled and evaluated for safety. Neurotoxicity (5/9), nephrotoxicity (5/9), and hyperpigmentation (1/9) were recorded. Blood cultures were negative within 3 days of commencing therapy in all 8 patients evaluated for microbiological efficacy, and clinical cure or improvement occurred in 6 of 8 patients. Cmax and Cmin following the loading dose were 5.53 ± 1.80 and 1.62 ± 0.41 mg/L, respectively. With maintenance dosing, AUCss,24 h was 79.6 ± 25.0 mg h/L and Css,avg 3.35 ± 1.06 mg/L. Monte Carlo simulations indicated that a 1 mg/kg/12-hourly maintenance dose could achieve >90% probability of target attainment (PTA) for isolates with minimum inhibitory concentration (MIC) ≤1 mg/L. PTA dropped substantially for MICs ≥2 mg/L, even with a maximally recommended daily dose of 1.5 mg/kg/12-hourly.Conclusion: This is the first clinical PK/PD study evaluating polymyxin B for BSI. These results will assist to optimize polymyxin B therapy and establish its breakpoints for CRKP BSI

Plant perception of β-aminobutyric acid is mediated by an aspartyl-tRNA synthetase

Specific chemicals can prime the plant immune system for augmented defense. β-aminobutyric acid (BABA) is a priming agent that provides broad-spectrum disease protection. However, BABA also suppresses plant growth when applied in high doses, which has hampered its application as a crop defense activator. Here we describe a mutant of Arabidopsis thaliana that is impaired in BABA-induced disease immunity (ibi1) but is hypersensitive to BABA-induced growth repression. IBI1 encodes an aspartyl-tRNA synthetase. Enantiomer-specific binding of the R enantiomer of BABA to IBI1 primed the protein for noncanonical defense signaling in the cytoplasm after pathogen attack. This priming was associated with aspartic acid accumulation and tRNA-induced phosphorylation of translation initiation factor eIF2α. However, mutation of eIF2α-phosphorylating GCN2 kinase did not affect BABA-induced immunity but relieved BABA-induced growth repression. Hence, BABA-activated IBI1 controls plant immunity and growth via separate pathways. Our results open new opportunities to separate broad-spectrum disease resistance from the associated costs on plant growth

A synergistic ozone-climate control to address emerging ozone pollution challenges

Tropospheric ozone threatens human health and crop yields, exacerbates global warming, and fundamentally changes atmospheric chemistry. Evidence has pointed toward widespread ozone increases in the troposphere, and particularly surface ozone is chemically complex and difficult to abate. Despite past successes in some regions, a solution to new challenges of ozone pollution in a warming climate remains unexplored. In this perspective, by compiling surface measurements at ∼4,300 sites worldwide between 2014 and 2019, we show the emerging global challenge of ozone pollution, featuring the unintentional rise in ozone due to the uncoordinated emissions reduction and increasing climate penalty. On the basis of shared emission sources, interactive chemical mechanisms, and synergistic health effects between ozone pollution and climate warming, we propose a synergistic ozone-climate control strategy incorporating joint control of ozone and fine particulate matter. This new solution presents an opportunity to alleviate tropospheric ozone pollution in the forthcoming low-carbon transition.This study was supported by the Research Grants Council of Hong Kong Special Administrative Region via General Research Funds (HKBU 15219621 and PolyU 15212421) and a Theme-based Research Scheme (T24-504/17-N). The authors acknowledge the support of the Australia–China Centre on Air Quality Science and Management. R.S. acknowledges support from ANID/FONDAP/1522A0001. D.S. thanks the program of Coordination for the Improvement of Higher Education Personnel (CAPES) (436466/2018-0). X.X. acknowledges funding from the Natural Science Foundation of China (41330422) and the Chinese Academy of Meteorological Sciences (2020KJ003). K.L. is supported by the Natural Science Foundation of China (42205114), Jiangsu Carbon Peak and Neutrality Science and Technology Innovation fund (BK20220031), and the Startup Foundation for Introducing Talent of NUIST. We sincerely appreciate all the organizations and programs introduced in the section “experimental procedures” for freely providing ozone data. We thank Dr. Owen Cooper (University of Colorado, Boulder, and NOAA) for insightful guidance and discussion. No organization or program will be responsible for the results generated from their data.Peer reviewe

Pathogenic Implication of a Fibrinogen-Binding Protein of Staphylococcus epidermidis in a Rat Model of Intravascular-Catheter-Associated Infection▿

The involvement of Fbe, a fibrinogen-binding protein of Staphylococcus epidermidis, in the pathogenesis of catheter-associated infection was investigated. An fbe (gene encoding Fbe protein) mutant was constructed by allelic replacement, wherein an erythromycin resistance gene replaced a portion of the A region of fbe. Meanwhile, a rat central venous catheter (CVC) infection model was established to assess the importance of Fbe in the pathogenesis of CVC-associated infection due to S. epidermidis. Fbe-positive S. epidermidis strain HB was significantly more likely to cause a CVC-associated infection resulting in bacteremia and metastatic disease than its isogenic Fbe-deficient mutant (100% versus 20%, P < 0.01). These results confirm the importance of adherence associated with Fbe in the pathogenesis of CVC-associated infection caused by S. epidermidis

Metal, iodine and oxidant-free electrosynthesis of substituted indoles from 1-(2-aminophenyl)alcohols

A green and straightforward electrosynthesis of substituted indoles has been developed through dehydration and intramolecular dehydrogenative C–N bond-forming radical cross-coupling from 1-(2-aminophenyl)alcohols under metal, iodine and oxidant-free conditions. This electrochemical indole synthesis strategy has an excellent functional group, water and air tolerance. And, a possible cyclization process was proposed based on the radical-trapping, intermediate verification, cyclic voltammetry, EPR and control experiments

Mechanistic studies leading to a new procedure for rapid microwave assisted generation of pyridine-3,5-dicarbonitrile libraries

Mechanistic investigations into the multi-component synthesis of pyridine-3,5-dicarbonitriles have established a defined reaction pathway, particularly clarifying the role of aerobic oxidation in conversion of the intermediate 1,4-dihydropyridines into the final products. Based on such improved understanding of the reaction mechanism, optimised conditions for the preparation of compound libraries based on this core structure have been developed and represent a significant improvement in yield over existing protocols. Particularly, microwave assisted synthesis was found to provide a procedure suitable for high-throughput synthesis of pyridine-3,5-dicarbonitrile libraries.Peer reviewe

Rapid and Simultaneous Quantitation of Amoxicillin and Clavulanic Acid in Human Plasma and Urine by Ultra-Performance Liquid Chromatography Tandem Mass Spectrometry and Its Application to a Pharmacokinetic Study

Rapid, accurate and sensitive ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) methods were developed and validated for the simultaneous quantitation of amoxicillin and clavulanic acid in human plasma and urine samples. Amoxicillin and clavulanic acid in both plasma and urine were extracted using a solid-phase extraction method. The compounds were separated on an Acquity UPLC HSS T3 column (2.1 × 100 mm, 1.8 μm). Ampicillin was used as the internal standard (IS) in plasma, while amoxicillin-d4 and sulbactam were used as ISs in urine. The lower limit of quantitation was 0.0500 and 0.0250 μg/mL for amoxicillin and clavulanic acid in plasma, and 0.0500 μg/mL for both analytes in urine. The established methods were validated in terms of selectivity, precision, accuracy, linearity, matrix effect, recovery, carryover, interaction, dilution integrity and stability, and successfully applied to a pharmacokinetic study of amoxicillin sodium and clavulanate potassium (10:1) injection in healthy volunteers