Bacterial infections are becoming harder-to-treat with current antibiotics, due to antimicrobial resistance and biofilm-formation. Therefore, there is an urgent need for novel antibacterial agents and antimicrobial peptides (AMPs) may fulfill this role. Herein, three strategies were explored for optimization of our lead AMP SAAP-148 to combat bacterial infections: i) chemical lead-optimization, ii) combination therapy with other antimicrobial agents and iii) innovative AMP delivery systems. The latter strategy was also applied to another promising AMP, the snake cathelicidin Ab-Cath. First, we demonstrated that conjugation of short polyethylene glycol chains to SAAP-148 reduced the peptide’s cytotoxicity and remarkably improved its ability to modulate the immune system to a more pro-inflammatory subset. Second, it was shown that combinations of SAAP-148 and novel antibiotic halicin were more effective than single agent treatment against planktonic bacteria of specific resistant bacterial strains, also in clinically relevant cell models. Third, we demonstrated that hyaluronic acid-based nanogels allow for efficient encapsulation of SAAP-148 and Ab-Cath, thereby improving the selectivity index of both peptides by maintaining antimicrobial activities against resistant bacteria and reducing cytotoxic activities against mammalian cells. Thus, the findings described in this thesis contribute to the development of SAAP-148 and Ab-Cath as therapeutics to combat bacterial infections.The work presented in this thesis was financially supported by the Dutch Research Council (NWO), Novel Antibacterial Compounds and Therapies Antagonizing Resistance Program: grant number 16434.LUMC / Geneeskund
