Breaking antimicrobial resistance by disrupting extracytoplasmic protein folding

Data availability: All data generated during this study that support the findings are included in the manuscript or in the Supplementary Information.Copyright © 2022, Furniss et al. Antimicrobial resistance in Gram-negative bacteria is one of the greatest threats to global health. New antibacterial strategies are urgently needed, and the development of antibiotic adjuvants that either neutralize resistance proteins or compromise the integrity of the cell envelope is of ever-growing interest. Most available adjuvants are only effective against specific resistance proteins. Here we demonstrate that disruption of cell envelope protein homeostasis simultaneously compromises several classes of resistance determinants. In particular, we find that impairing DsbA-mediated disulfide bond formation incapacitates diverse β-lactamases and destabilizes mobile colistin resistance enzymes. Furthermore, we show that chemical inhibition of DsbA sensitizes multidrug-resistant clinical isolates to existing antibiotics and that the absence of DsbA, in combination with antibiotic treatment, substantially increases the survival of Galleria mellonella larvae infected with multidrug-resistant Pseudomonas aeruginosa. This work lays the foundation for the development of novel antibiotic adjuvants that function as broad-acting resistance breakers.MRC Career Development Award MR/M009505/1 (to D.A.I.M.); the institutional BBSRC-DTP studentships BB/M011178/1 (to N.K.) and BB/M01116X/1 (to H.L.P.); the BBSRC David Philips Fellowship BB/M02623X/1 (to J.M.A.B.); the ISSF Wellcome Trust grant 105603/Z/14/Z (to G.L.-M.); the Brunel Research Innovation and Enterprise Fund, Innovate UK and British Society for Antimicrobial Chemotherapy grants 2018-11143, 37800 and BSAC-2018-0095, respectively (to R.R.MC); the Swiss National Science Foundation Postdoc Mobility and Ambizione Fellowships P300PA_167703 and PZ00P3_180142, respectively (to D.G.)