INTRODUCTION
Innovative anti-infective agents are urgently needed to overcome the antibiotic resistance problem. Antimicrobial peptides (AMPs) are a large class of innate immunity effectors with a remarkable capacity to kill microorganisms, which are currently in the limelight as potential future anti-infective therapeutics (
1). Most AMPs strongly interact with bacterial membranes, leading to a lethal permeabilization of the microbial envelope (
2). However, some AMPs kill bacteria mainly by interfering with internal cellular functions and without significant perturbation of cell membranes at microbicidal concentrations (
3,
4).
The group of proline-rich peptides (PR-AMPs) is the best known example of these intracellular-acting peptides (
5,
6). Some of them have been identified in mammal neutrophils (
7), whereas others have been found in hemolymph of insects and crustaceans (
8). All of them invariably have a high number of proline and arginine residues, show similar spectra of activity, including several Gram-negative species, and have similar modes of action. Recently different PR-AMPs, both mammalian Bac7(1–35) and insect oncocin and apidaecins, were demonstrated to efficiently bind to different regions of prokaryote ribosomes (
9–11), leading to the inhibition of protein synthesis (
12).
PR-AMPs reach the ribosome after having crossed the cell membranes by means of SbmA/BacA, an inner membrane transporter present in several but not all proteobacteria. In
Escherichia coli, some PR-AMPs appeared to rely exclusively on the SbmA uptake system (
13), whereas others, including Bac7(1–35) and oncocin, are quite active also in SbmA-deleted strains (
14), likely because of the presence of a second bacterial transport system recently identified as the
yjiL-mdtM gene cluster (
13).
Pseudomonas aeruginosa is an emergent pathogen with high intrinsic antibiotic resistance and is among the most common hospital pathogens (
15). Serious
P. aeruginosa infections are often associated with compromised host defenses such as in neutropenia, severe burns, or cystic fibrosis (CF) (
16). These infections demonstrate high morbidity and mortality for the limited therapies, in particular due to the spread of antimicrobial-resistant strains (
17). For these reasons, finding alternative prevention and treatment strategies is an urgent priority (
18).
A number of
P. aeruginosa strains, including multidrug-resistant (MDR) strains, show considerable susceptibility to the PR-AMP Bac7(1–35), with MIC values ranging from 0.5 to 32 μM (
19). In addition, the artificial long proline-rich antimicrobial peptide dimer A3-APO, is active against strains of
P. aeruginosa (
20). Despite this clear anti-
Pseudomonas activity and different from other gammaproteobacteria,
P. aeruginosa lacks the inner membrane protein SbmA as well as the homologue of the
yjiL-mdtM cluster. Therefore, the mechanism used by this PR-AMP to cross the bacterial membranes and more in general the mechanism of bacterial killing are still puzzling.
In this study, we investigated the activity of Bac7(1–35) against P. aeruginosa strains and the mechanism by which the peptide kills these bacteria. We then evaluated the effect of the heterologous expression of the E. coli SbmA transporter on the susceptibility to PR-AMPs in this bacterial species, which naturally lacks this transporter. The results highlight a different mechanism of action for PR-AMPs from that previously described against other Gram-negative bacteria, which is also influenced by the expression of SbmA.
DISCUSSION
P. aeruginosa infections represent an urgent and worldwide health problem that needs to be addressed through the development of new therapeutic agents. PR-AMPs such as Bac7(1–35) and optimized apidaecins have been proved to be active against several strains of this opportunistic pathogen (
19,
25). Here we showed that it is active also against
P. aeruginosa strains isolated from CF patients, and it acts through a complex mechanism that involves membranolytic activity.
Hosts and pathogens can coexist in CF for years, leading to genotypes of the
P. aeruginosa strains present in CF infections that differ from those of wild-type
P. aeruginosa (
26). These strains are characterized by high mutation rates
in vivo that are linked to the evolution of antibiotic resistance (
27). It is worth noting that Bac7(1–35) possesses good antimicrobial activity against almost half of these CF strains that are resistant to at least three groups of antibiotics. Despite their genotypes not having been characterized yet, this result indicates that mutations that are responsible for the resistance to the currently used antibiotics could not lead to resistance to this peptide, suggesting it has a different mode of action.
The mechanism of action of PR-AMPs, such as Bac7 and other proline-rich peptides, has previously been well depicted in
E. coli and
Salmonella enterica serovar Typhimurium (
22,
28). PR-AMPs cross the plasma membrane, exploiting the inner membrane protein SbmA (
23,
29), and enter the cytoplasm, where they inhibit vital functions such as protein synthesis (
12). Bac7(1–35) and other PR-AMPs have also shown membranolytic activity in
E. coli and
S. Typhimurium, but only at much higher concentrations than their MIC values (16- to 64-fold); however, lytic effects due to PR-AMPs occur over longer times than those observed by most AMPs with lytic activity (
30). For this reason, membrane damage has been described as a secondary effect at killing concentrations (
30). No other species have been studied in details in relation to the killing mechanism.
Here we show that this peptide affects
P. aeruginosa strains by a different mechanism.
P. aeruginosa strains are susceptible to Bac7(1–35) at micromolar concentrations despite the fact they do not have a gene homologue to SbmA or other PR-AMPs' known transporters. This apparent discrepancy can be explained by the fact that killing mechanism of Bac7(1–35) against
P. aeruginosa relies mainly on membrane permeabilization occurring at the MIC and that this effect on membrane integrity is responsible for the bacterial cell death. Fifty percent of PAO1 cells are permeabilized within 30 min of incubation with the peptide, a value that is not so different from that observed for canonical lytic AMPs. On the contrary, less than 5% of
E. coli and
S. enterica serovar Typhimurium cells are permeabilized within the same time period with Bac7(1–35) used at near MICs (
22,
31). Moreover, the temporal correlation between membrane damage and cellular death here evidenced for Bac7(1–35) against PAO1 cells is a typical feature of the activity of membranolytic peptides.
Significant fluorescence quenching has been observed in the peptide-treated
P. aeruginosa strains, a feature that has never been observed previously in
E. coli or
S. enterica serovar Typhimurium cells (
22,
31), where the internalization of the peptide is very efficient. These data are consistent with an extracellular localization of the peptide, and this observation is strengthened also by the images obtained by confocal microscopy showing the localization of most of the peptide on the bacterial surface, possibly on the membranes. Again these results suggest that the killing of
P. aeruginosa cells is due to a membrane-related event rather than to inhibition of an internal target.
By cytometric analysis, we observed an intense fluorescence in peptide-treated
P. aeruginosa strains, with marked difference among the strains, but always higher than that detected on the susceptible
E. coli strains analyzed under the same conditions.
P. aeruginosa produces at least three exopolysaccharides, namely, alginate, Psl, and Pel (
32,
33), which could influence the binding of Bac7(1–35) to the surface of the cells. Alginate is produced by a subset of strains that are often isolated from lungs of chronically colonized CF patients, and its overproduction is responsible for the mucoid phenotype of
P. aeruginosa strains (
32). Psl and Pel are often associated with nonmucoid strains and are necessary for biofilm formation (
34). The anionic alginate could interact electrostatically with Bac7(1–35) enhancing the binding of the peptide, while the cationic Pel could repulse it (
35). In this respect, it has been shown that alginate in solution inhibits the antimicrobial activity of structurally different peptides, including Bac7(1–35) (
36). We do not know whether the strains analyzed in this study express one of these biopolymers; however, we found that the amount of peptide bound to each strain is nonpredictive of the antibacterial activity. It is worth noting that PA21 is the less susceptible strain and at the same time binds to Bac7(1–35) very efficiently (
Fig. 2G). On the contrary, PA35 showing the highest level of peptide-derived fluorescence is also the more susceptible to Bac7(1–35). Further studies will be necessary to understand this complex relationship between different binding ability and bacterial killing capacity.
When a copy of the E. colisbmA gene was introduced into the PAO1 cells, we found that the level of expression of the SbmA protein in P. aeruginosa was comparable to that in E. coli, allowing a direct comparison of the effects of SbmA expression on the susceptibility to the peptide. The presence of a functional SbmA transporter made P. aeruginosa cells more susceptible to different proline-rich peptides of both mammalian and insect origins. In addition, the decreased level of fluorescence quenching in the strain expressing SbmA and the confocal microscopy images are consistent with a more efficient SbmA-mediated internalization of Bac7(1–35).
Our results show that the
sbmA gene can be efficiently expressed in
P. aeruginosa, resulting in functional transport, and confirm that the SbmA protein is a stand-alone transporter that does not need other subunits to translocate proline-rich peptides across the membrane (
29).
Previously an heterologous expression of SbmA was achieved in
Sinorhizobium meliloti, an alphaproteobacterium symbiotic with leguminous plants, showing that SbmA is functionally interchangeable with its homolog BacA of
S. meliloti (
24). BacA is essential for bacteroid development (
37), and it has been proposed to protect bacteria from host-derived NCR peptides during the instauration of symbiosis (
38). BacA is thought to reduce the extent of cytoplasmic membrane damage due to nodule-specific cysteine-rich (NCR) peptides, possibly by mediating their uptake into the cytoplasm, thus reducing their local concentration at the membrane level. The BacA homolog SbmA could have a similar effect when expressed in
P. aeruginosa cells. That the percentage of PI-positive cells in bacteria expressing SbmA was significantly lower than that in the wild-type PAO1 cells suggests that expressed SbmA could decrease the amount of surface-bound Bac7(1–35) by mediating its internalization into the cytoplasm and reducing the damaging effect onto the bacterial cell membrane.
Overall, these results indicate that a peptide antibiotic such as Bac7(1–35) has a complex and variable mode of action, where membranolytic effects and intracellular activity may participate both in bacterial killing in different proportions according to the different bacterial species and also different strains. Otvos et al. also demonstrated that slight changes in amino acid composition of the nonlytic PR-AMP pyrrhocoricin resulted in derivatives with an altered mode of action. It was shown that the dimeric pyrrhocoricin derivative Pip-pyrr-MeArg (
39) and also the mixed pyrrhocoricin-drosocin dimer (
40) kill bacteria better than the native proline-rich peptide due to improved activity on bacterial membranes (
39).
In conclusion, we have shown that the proline-rich peptide Bac7(1–35) has the ability to kill P. aeruginosa CF clinical isolates switching from a mode of action mainly based on intracellular activity, as observed in E. coli and S. enterica, to a mechanism mainly based on membrane damage, as shown here against P. aeruginosa strains. Therefore, we showed that Bac7(1–35) and possibly other PR-AMPs are capable of inhibiting bacteria via a multimodal mechanism, which could be varied depending on the nature of the target bacteria, the composition of their cellular membrane, and the presence of suitable transmembrane transporters. In this respect, the presence of SbmA/BacA plays the role of a “switch” allowing or not the internalization of the peptide and hence changing the peptide effects. These features point out the potential of Bac7(1–35) as an antibiotic molecule, since its multimodal mode of action makes the development of resistance in bacteria a more difficult and slow process.