Polymyxin antibiotics are relatively neurotoxic and nephrotoxic, so are usually used only as a last resort if modern antibiotics are ineffective or are contraindicated. Typical uses are for infections caused by strains of multiple drug-resistant Pseudomonas aeruginosa or carbapenemase-producing Enterobacteriaceae. Polymyxins have less effect on Gram-positive organisms, and are sometimes combined with other agents to broaden the effective spectrum. Polymyxins B are not absorbed from the gastrointestinal tract, so they are only administered orally if the goal is to disinfect the GI tract. Another route of administration is chosen for systemic treatment, e.g., parenteral or by inhalation. They are also used externally as a cream or drops to treat otitis externa , and as a component of triple antibiotic ointment to treat and prevent skin infections.
Mechanism of action
After binding to lipopolysaccharide in the outer membrane of Gram-negative bacteria, polymyxins disrupt both the outer and inner membranes. The hydrophobic tail is important in causing membrane damage, suggesting a detergent-like mode of action. Removal of the hydrophobic tail of polymyxin B yields polymyxin nonapeptide, which still binds to LPS, but no longer kills the bacterial cell. However, it still detectably increases the permeability of the bacterial cell wall to other antibiotics, indicating that it still causes some degree of membrane disorganization. Gram-negative bacteria can develop resistance to polymyxins through various modifications of the LPS structure that inhibit the binding of polymyxins to LPS. Antibiotic resistance to this drug has been increasing, especially in southern China. Recently the gene mcr-1, which confers the antibiotic resistance, has been isolated from bacterial plasmids in Enterobacteriaceae.
Chemistry
Polymyxins are a group of cyclic non-ribosomal polypeptide which are biosynthesized by bacteria belonging to the genus Bacillus, more specifically the subgenus Paenibacillus. Polymyxins consist of 10 amino acid residues, six of which are L-α,γ-diaminobutyric acid. The DAB residues cause polymyxins to have multiple positively charged groups at physiological pH. Seven amino acid residues form the main cyclic component, while the other three extend from one of the cyclic residues as a linear chain terminating in either 6-methyloctanoic acid or 6-methylheptanoic acid at the N-terminus. During cyclization, residue 10 is bound to the bridging residue 4. The amino acid residues and DAB monomers are generally in the L configuration, however certain strains such as P. polymyxa PKB1 have been observed to incorporate DAB with the D configuration at position 3 producing variations of polymyxin B. Polymyxin M is also known as "mattacin".
Biosynthesis
The polymyxins are produced by nonribosomal peptide synthetase systems in Gram-positive bacteria such as Paenibacillus polymyxa. Like other NRPs, polymyxins are assembled by synthetases with multiple modules, each containing a set of enzyme domains that sequentially operate on the growing chain by adding the next residue and extending the chain through peptide-bond formation and condensation reactions. The final steps involve a thioesterase domain at the C-terminal of the last module to cyclize the molecule and liberate the chain from the enzyme.
Research
Polymyxins are used to neutralize or absorb LPS contaminants in samples, for example in immunological experiments. Minimization of LPS contamination can be important because LPS can evoke strong reactions from immune cells, distorting experimental results. By increasing permeability of the bacterial membrane system, polymyxin is also used in clinical work to increase the release of secreted toxins, such as Shiga toxin, from Escherichia coli. The global problem of advancing antimicrobial resistance has led to a renewed interest in their use.
