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Evidence that the fosfomycin target Cys115 in UDP-N-acetylglucosamine enolpyruvyl transferase (MurA) is essential for product release.

MurA (UDP-N-acetylglucosamine enolpyruvyl transferase, EC 2.5.1.7) is an essential enzyme in the biosynthesis of the peptidoglycan layer of the bacterial cell. It provides an attractive template for the design of novel antibiotic drugs and is the target of the naturally occurring antibiotic fosfomycin, which covalently attaches to Cys115 in the active site of the enzyme. Mutations of Cys115 to Asp exist in pathogens such as Mycobacteria or Chlamydia rendering these organisms resistant to fosfomycin. Thus, there is a need for the elucidation of the role of this cysteine in the MurA reaction. We determined the x-ray structure of the C115S mutant of Enterobacter cloacae MurA, which was crystallized in the presence of the substrates of MurA. The structure depicts the product state of the enzyme with enolpyruvyl-UDP-N-acetylglucosamine and inorganic phosphate trapped in the active site. Kinetic analysis revealed that the Cys-to-Ser mutation results in an enzyme that appears to perform a single turnover of the reaction. Opposing the common view of Cys115 as a key residue in the chemical reaction of enolpyruvyl transfer, we now conclude that the wild-type cysteine is essential for product release only. On the basis of a detailed comparison of the product state with the intermediate state and an unliganded state of MurA, we propose that dissociation of the products is an ordered event with inorganic phosphate leaving first. Phosphate departure appears to trigger a suite of conformational changes, which finally leads to opening of the two-domain structure of MurA and the release of the second product enolpyruvyl-UDP-N-acetylglucosamine.

Alkyl and Aryl Transferases↗

Variability of immune response induced by bacteria treated with subminimal inhibitory concentrations of fosfomycin.

Experiments were conducted to explore the possibility that bacterial strains treated with subminimal inhibitory concentrations (sub-MICs) of fosfomycin might induce immune responses different from those induced by intact, untreated bacteria. A preliminary study was done with a strain of Salmonella wien. The immune response in rabbits immunized with bacteria that had been exposed to either the sub-MIC or the minimal inhibitory concentration (MIC) of fosfomycin was compared with that in rabbits immunized with S. wien not exposed to the drug. The titers of antibody to S. wien in rabbits immunized with abnormal, sub-MIC-treated bacteria were higher than those in rabbits immunized with either MIC-treated or untreated S. wien. This difference was seen not only with the total antigen of Salmonella but also with somatic (O) and flagellar (H) antigens.

Agglutination Tests↗

Antimicrobial activity of fosfomycin in vitro.

Fosfomycin is a new bactericidal broad-spectrum antibiotic. In this study the minimum inhibiting concentration (MIC) was determined for 745 recent clinical isolates. Staphylococcus aureus and epidermidis, group A and B streptococci Streptococcus faecalis and pneumoniae as well as Escherichia coli, Proteus mirabilis, Serratia marcescens and Haemophilus influenzae were very sensitive to the new drug with essentially all strains inhibited at 64 mg/l or less. Klebsiella, Enterobacter, indole-positive proteus and Pseudomonas-aeruginosa were less sensitive with 96, 42, 66 and 58% inhibited at 64 mg/l of fosfomycin. Bacteroides fragilis was resistant.

Anti-Bacterial Agents↗

Treatment of severe staphylococcal infections with cefotaxime and fosfomycin in combination.

In a prospective study, 23 severe staphylococcal infections (9 meningitis, 10 bone and joint infections, 3 septicaemia, 1 superinfection of a congenital varicella) were treated with cefotaxime and fosfomycin in combination. There was a synergistic effect of the combination for 14 of the 17 strains tested. Three hours after the end of the infusion, mean CSF concentrations of cefotaxime and fosfomycin were respectively at day 2 3.2 mg/l and 31.4 mg/l, at day 4 2.9 mg/l and 33.9 mg/l. All the patients with meningitis or acute bone and joint infections recovered satisfactorily without relapses. Two superinfections were observed (one systemic candidosis and one septicaemia due to Pseudomonas aeruginosa). Clinical tolerance was good and treatment was discontinued for side effects in only three patients.

Adolescent↗

Fosfomycin tromethamine susceptibility of outpatient urine isolates of Escherichia coli and Enterococcus faecalis from ten North American medical centres by three methods.

One hundred percent of 1097 Escherichia coli and 97.5% of 157 Enterococcus faecalis isolates from outpatient urine specimens at ten North American medical centres were susceptible to fosfomycin tromethamine. The Etest MICs correlated well with those of agar dilution. Disc diffusion zone diameters correlated well with MICs and supported the previously proposed zone diameter breakpoints for fosfomycin.

Anti-Bacterial Agents↗

Role of K22 and R120 in the covalent binding of the antibiotic fosfomycin and the substrate-induced conformational change in UDP-N-acetylglucosamine enolpyruvyl transferase.

UDP-N-acetylglucosamine enolpyruvyl transferase (MurA), catalyzes the first step in the biosynthesis of peptidoglycan, involving the transfer of the intact enolpyruvyl moiety from phosphoenolpyruvate to the 3'-hydroxyl group of UDP-N-acetylglucosamine (UDPNAG). The enzyme is irreversibly inhibited by the antibiotic fosfomycin. The inactivation is caused by alkylation of a highly conserved cysteine residue (C115) that participates in the binding of phosphoenolpyruvate. The three-dimensional structure of the enzyme suggests that two residues may play a decisive role in fosfomycin binding: K22 and R120. To investigate the role of these residues, we have generated the K22V, K22E, K22R and R120K single mutant proteins as well as the K22V/R120K and K22V/R120V double mutant proteins. We demonstrated that the K22R mutant protein behaves similarly to wild-type enzyme, whereas the K22E mutant protein failed to form the covalent adduct. On the other hand, the K22V mutant protein requires the presence of UDPNAG for the formation of the adduct indicating that UDPNAG plays a crucial role in the organization of productive interactions in the active site. This model receives strong support from heat capacity changes observed for the K22V/R120K and R120K mutant proteins: in both mutant proteins, the heat capacity changes are markedly reduced indicating that their ability to form a closed protein conformation is impeded due to the R120K exchange.

Alkyl and Aryl Transferases↗

In vitro activities of teichomycin, fusidic acid, flucloxacillin, fosfomycin, and vancomycin against methicillin-resistant Staphylococcus aureus.

Flucloxacillin, fosfomycin, fusidic acid, teichomycin, and vancomycin were tested against 50 clinical isolates of methicillin-resistant Staphylococcus aureus by a broth macrodilution technique. Teichomycin had a narrow range of activity, similar to that of vancomycin (0.5 to 2.0 micrograms/ml). Fusidic acid had the lowest range of inhibitory activity, with 50 and 90% MICs of 0.19 and 0.35 micrograms/ml, respectively. Flucloxacillin and fosfomycin showed less activity, with MICs up to 32 micrograms/ml.

Anti-Bacterial Agents↗

Efficacy of pefloxacin-fosfomycin in experimental endocarditis caused by methicillin-resistant Staphylococcus aureus.

The efficacies of pefloxacin, fosfomycin, and both of these agents in combination against methicillin-resistant Staphylococcus aureus were assessed in a rat endocarditis model. The combination prevented emergence of the fosfomycin and pefloxacin resistance seen in 36 and 4%, respectively, of animals receiving either agent alone and was more effective than either agent in sterilizing cardiac vegetations.

Animals↗

Immunomodulating effect of fosfomycin on gut-derived sepsis caused by Pseudomonas aeruginosa in mice.

We evaluated the protective effect of fosfomycin (FOM) and an enantiomer of fosfomycin [FOM (+); an isomer of FOM with no bactericidal activity] on murine gut-derived sepsis caused by Pseudomonas aeruginosa. Endogenous bacteremia was induced by administering cyclophosphamide (CY) and ampicillin to specific-pathogen-free mice fed P. aeruginosa. Treatment of mice with FOM at 250 mg/kg of body weight per day twice a day after the second CY administration significantly increased the survival rate compared to that for control mice treated with saline. Treatment with FOM (+) at 20 and 100 mg/kg also significantly increased the survival rate (from 30% for control mice to 80% for treated mice). The bacterial counts in the liver and blood were both significantly lower in FOM(+)-treated mice in comparison with those in liver and blood of saline-treated control mice. FOM(+) administration affected neither the bacterial colonization in the intestinal tract nor the leukocyte counts in the peripheral blood of the mice. After intravascular inoculation of P. aeruginosa, treatment of mice with FOM (+) did not enhance bacterial clearance from the blood of mice pretreated or not enhance bacterial clearance from the blood of mice pretreated or not pretreated with CY, FOM(+) significantly suppressed tumor necrosis factor alpha, interleukin-1 beta, and interleukin-6 levels in the serum of mice after gut-derived sepsis. These results indicate that both FOM and FOM(+) have protective effects against P. aeruginosa bacteremia, despite a lack of specific activity of FOM(+), and suggest that FOM may possess immunomodulating activity and that it induces a protective effect. The protective mechanism is speculated to be that FOM modulates the vivo production of inflammatory cytokines.

Adjuvants, Immunologic↗

Penetration of fosfomycin into inflammatory lesions in patients with cellulitis or diabetic foot syndrome.

We investigated the distribution of the broad-spectrum antibiotic fosfomycin in infected soft tissue of patients with uncomplicated cellulitis of the lower extremities or diabetic foot infection using in vivo microdialysis. Our findings suggest that fosfomycin exhibits good and similar penetration into the fluid in the interstitial space in inflamed and noninflamed soft tissue in patients.

Area Under Curve↗

In vitro activity of fosfomycin against extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: comparison of susceptibility testing procedures.

The agar dilution, broth microdilution, and disk diffusion methods were compared to determine the in vitro susceptibility of 428 extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae to fosfomycin. Fosfomycin showed very high activity against all ESBL-producing strains. Excellent agreement between the three susceptibility methods was found for E. coli, whereas marked discrepancies were observed for K. pneumoniae.

Anti-Bacterial Agents↗

FosB, a cysteine-dependent fosfomycin resistance protein under the control of sigma(W), an extracytoplasmic-function sigma factor in Bacillus subtilis.

We demonstrate that the Bacillus subtilis fosB(yndN) gene encodes a fosfomycin resistance protein. Expression of fosB requires sigma(W), and both fosB and sigW mutants are fosfomycin sensitive. FosB is a metallothiol transferase related to the FosA class of Mn(2+)-dependent glutathione transferases but with a preference for Mg(2+) and L-cysteine as cofactors.

Amino Acid Sequence↗

Fosfomycin and rifampin disk diffusion tests for detection of Escherichia coli mutator strains.

A simple method, using commercial disks to detect Escherichia coli mutator strains, is proposed. The breakpoint for detecting strains with a mutation frequency >/=5 x 10(-7) was established at >/=70 and >/=20 colonies in the inhibition zone of fosfomycin and rifampin disks, respectively, after seeding 100 microl of an overnight culture. Strains with <30 and <10 colonies in fosfomycin and rifampin inhibition zones are presumptively non-mutators.

Anti-Bacterial Agents↗

Fosfomycin tromethamine in uncomplicated urinary tract infections: a clinical study.

The aim of our study was to verify if the empiric therapy with a single dose of 3 g fosfomycin tromethamine in patients with uncomplicated urinary tract infections (UTIs) was able to clinically resolveand to microbiologically eradicate the infection. A total of 387 out of the 400 patients (274 cases with acute and 113 cases with recurrent uncomplicated UTIs) were enrolled in the clinical study. Clinical and microbiological assessments were performed before and at 8-10 days after the administration. At follow-up high clinical recovery (88.9%) and bacteriological (94.9%) eradication rates were achieved. Gastrointestinal side effects were found in only 4.3% of patients. In conclusion, a single-dose administration regimen of fosfomycin tromethamine should be encouraged as a first choice of drug therapy for uncomplicated UTIs.

Adolescent↗

Fosfomycin: Laboratory studies.

Fosfomycin, a nontoxic broad-spectrum antibiotic, different in structure from all previously described antibiotics, acts selectively by inhibiting cell wall formation. It was overlooked during many years of screening because of antagonism by culture medium ingredients and frequent occurrence of resistant mutants. It is effective in many because the neutralizing substances are not present and resistant mutants of most species are avirulent. Fosfomycin has favorable pharmacologic characteristics. It is not cross resistant, does not show antagonism, and has been used successfully in combinations. An insoluble calcium salt is used in oral formulation and a sodium salt for parenteral administration. Overall success rates of 86% were reported with 1,000 patients in Spain and 79% in Japan.

Animals↗

Susceptibility to fosfomycin of hospital strains isolated in Nantes (France). Frequency of mutation to resistance.

Susceptibility of 760 bacterial isolates to fosfomycin has been determined by the agar dilution method. The MICs of 364 strains have been determined by comparison of agar alone and agar plus glucose-6-phosphate. This later enhances the activity of fosfomycin. Lastly, we studied frequency of mutation toward resistance for 109 susceptible strains. We obtained 88 stable mutants.

Anti-Bacterial Agents↗

In vitro sensitivity of anaerobic bacteria to fosfomycin.

The minimum inhibitory concentrations were determined in 98 strains of anaerobic bacteria that came from clinical samples against fosfomycin, penicillin, cephalothin, tetracycline, chloramphenicol, clindamycin and lincomycin. The results obtained indicate that fosfomycin is usually inactive against Bacteroides sp. and is active up to 32 mug/ml or less against 85% of Peptococcus and 95% of Peptostreptococcus, being consequently comparatively less active than the rest of the antibiotics that were tested against Bacteroides, sp., while against Peptococcus and Peptostreptococcus it is less active than penicillin, cephalothin, clindamycin and lincomycin, and somewhat more active than chloramphenicol and tetracycline.

Anti-Bacterial Agents↗