|
Memórias do Instituto Oswaldo Cruz
Fundação Oswaldo Cruz, Fiocruz
ISSN: 1678-8060 EISSN: 1678-8060
Vol. 104, Num. 4, 2009, pp. 580-582
|
Memórias do Instituto Oswaldo Cruz, Vol. 104, No. 4, July, 2009, pp. 580-582
ARTICLES
In
vitro synergic effect of β-lapachone
and isoniazid on the growth of Mycobacterium fortuitum and Mycobacterium
smegmatis
Joas L da Silva+;
Amanda RC Mesquita; Eulalia A Ximenes
Laboratório
de Bioquímica e Fisiologia de Microrganismos, Centro de Ciências
Biológicas, Departamento de Antibióticos, Universidade Federal
de Pernambuco, Rua Artur de Sá s/n, 50670-901 Recife, PE, Brasil
+
Corresponding author: joaslucas@gmail.com
Financial support: CAPES
Received 28 October
2008
Accepted 13 May 2009
Code Number: oc09133
ABSTRACT
Nontuberculous
mycobacteria are ubiquitous and saprophytic organisms that have been implicated
in a wide spectrum of diseases due to an increasing number of immunocompromised
patients. The natural resistance of atypical mycobacteria to classical antituberculous
drugs has encouraged research into new chemotherapeutic agents and drug combinations.
The aim of this study was to determine the in vitro antimycobacterial activities
of β-lapachone
alone and in combination with isoniazid against Mycobacterium fortuitum
and Mycobacterium smegmatis via the Time-Kill Curve method. A 2 log10
CFU/mL reduction in the M. smegmatis culture was observed 72 h after
adding β-lapachone
at its minimum inhibitory concentration. This drug sterilised the culture in
120 h. For M. fortuitum, a reduction of 1.55 log10 CFU/mL
occurred in 24 h, but regrowth was seen in contact with β-lapachone.
Both microorganisms were resistant to isoniazid. Regrowth of M. fortuitum
and M. smegmatis was observed at 48 h and 72 h, respectively. In combination,
these two drugs had a bactericidal effect and sterilised both cultures in 96
h. These results are valuable because antibiotic-resistant bacteria are a major
public health problem.
Key words:
β-lapachone
- nontuberculous mycobacteria - isoniazid - antimycobacterial activity
Nontuberculous
or atypical mycobacteria are opportunistic pathogens frequently found in water
sources, soil, dust, air and animals. These organisms are implicated in infections
of the skin, bones and soft tissues. Immunocompromised patients are the most
susceptible to disseminated infection caused by nontuberculous mycobacteria.
Furthermore, immunological status is important to the spread of the disease
(Dodiuk-Gad et al. 2007, Porat & Austin 2008, Prendiki et al. 2008).
The treatment of
infections caused by Mycobacterium species is difficult, lengthy and
often unsuccessful. This is a result of multi-drug regimens, long periods of
administration, a small selection of drugs, significant side effects and intrinsic
resistance to a wide range of medications (Nuermberguer & Grosset 2004).
These challenges have motivated the research of novel antimycobacterial agents
(Brendan et al. 2007).
Most atypical bacteria
are resistant to isonicotinic acid hydrazide (isoniazid), one of the most used
therapeutic agents for the treatment of tuberculosis. Isoniazid is a prodrug
that is activated by an endogenous mycobacterial catalase-peroxidase enzyme
using molecular oxygen (Zhang et al. 1992, Chung et al. 2006).
Some published
articles have demonstrated that quinones are active against Mycobacterium
tuberculosis, Mycobacterium smegmatis and Mycobacterium avium.
The mechanism of these compounds is still being investigated, although some
reports have suggested that quinones stimulate oxidative stress in biological
systems (Tran et al. 2004, Akhtar et al. 2006, Silva et al. 2008).
β-lapachone
(3,4-dihydro-2,2-dimethyl-2H-naphthol [1,2-b]pyran-5,6-dione)
is a natural quinone extracted from the bark of the Lapacho tree (Tabebuia
avellanedae) or synthesised from lapachol or lomatiol. β-lapachone
is known to have a variety of pharmacological effects, including trypanocidal,
moluscicidal, antifungal, antibacterial, antiviral and anticancer actions. Quinones
have been reported to stimulate isoniazid activity, most likely by increasing
intracellular superoxide production (Tran et al. 2004, Silva et al. 2008).
The present study
compares the in vitro antimycobacterial activities of β-lapachone
and the combination of isoniazid and β-lapachone
against Mycobacterium fortuitum and M. smegmatis. Currently, there
are no reports regarding the activity of β-lapachone
in combination with isoniazid against M. fortuitum and M. smegmatis.
MATERIALS AND
METHODS
Strains -
The M. fortuitum and M. smegmatis strains used in this study were
clinical isolates obtained from AIDS patients. They were scraped from Lowestein-Jensen
slants and recultured in Mueller-Hinton broth (Oxoid) containing 0.01% tween
80.
Drugs -
Isoniazid (LAFEPE) was dissolved in sterile distilled water. β-lapachone
was provided by the Departamento de Antibióticos-Universidade Federal
de Pernambuco and dissolved in a propyleneglicol/sterile distilled water solution
(1:9). All drug solutions were extemporaneously prepared. Appropriate solvent
controls were included in the test to exclude the possibility that the solvent
concentration used would have toxic effects on the microorganisms.
Determination
of viable counts - Samples of culture were collected and 10-fold dilutions
were made in sterile saline. Then, six 10-μL
aliquots from each tube were plated onto Mueller-Hinton agar. Colonies were
counted using a colony counter (Biomatic) after incubation at 37ºC for 72 h.
Minimum inhibitory
concentration (MIC) and Minimum Bactericide Concentration (MBC) determinations
- The MIC values for the two drugs were determined by a standard twofold
serial dilution method (NCCLS 1990) in Mueller-Hinton broth (Oxoid) containing
0.01% of tween 80. The inocula of M. fortuitum and M. smegmatis
were grown at 37ºC for 72 h. The microorganisms were then diluted into fresh
broth and adjusted to obtain final inocula of approximately 106 CFU/mL.
Finally, 4.5 mL of each culture was combined with 0.5 mL of the drug. The final
concentration of each drug ranged from 0.5-128 μg/mL.
The MIC was determined
to be the lowest concentration that prevented visible growth after incubation
at 37ºC for 72 h. Samples of 10 μL
were transferred from tubes, which had not grown microorganisms, to Mueller-Hinton
agar plates. Once on the plates, the samples were incubated for 72 h at 37ºC.
The MBC was determined to be the lowest drug concentration inhibiting >
99.9% of the bacterial population. All experiments were carried out in triplicate
on three different days.
Bactericidal
kinetic studies - The bactericidal activity of drugs was determined by the
Time-kill curve method (Krogstad & Moellering 1986). The log-phase inoculum
was prepared in a manner similar to the MIC and MBC. Tubes were prepared containing
the inoculum and single or combined drugs at MIC. A growth tube without drugs
was used as a control. The tubes were incubated at 37ºC and appropriate dilutions
were performed at 0, 24, 48, 72, 96, 120 and 144 h in order to determine the
number of viable bacteria (log10 CFU/mL). Time-kill curves for the
individual drugs and the combinations of drugs were constructed by plotting
log10 CFU/mL versus time. All experiments were carried out in triplicate
on three different days.
RESULTS
Determination
of MIC and MBC of β-lapachone
and isoniazid - For both microorganisms, the MIC and MBC values of β-lapachone
were 32 and 64 μg/mL,
respectively. For isoniazid, the MIC and MBC values were 8 and 16 μg/mL,
respectively.
Bactericidal
activity - For β-lapachone,
there was no significant reduction in the number of viable bacteria during the
144 h incubation. Compared to the control, isoniazid produced a 1.54-log CFU/mL
reduction in the count at 24 h. However, regrowth was observed after 48 h of
incubation. Unlike β-lapachone
or isoniazid alone, the combination of these drugs exhibited a bactericidal
effect on M. fortuitum at 96 h of incubation. Moreover, this combination
was able to prevent regrowth.
β-lapachone
alone was more active against M. smegmatis than isoniazid alone. β-lapachone
had a bactericidal effect at 120 h of incubation. Compared with the control,
isoniazid produced a 1.46-log CFU/mL reduction in the count at 48 h. However,
regrowth was observed with isoniazid after 48 h of incubation. The combination
of isoniazid and β-lapachone
showed a bactericidal effect against M. smegmatis at 96 h of incubation.
In the combination samples, regrowth was not observed.
DISCUSSION
The data in the
literature concerning the in vitro activity of quinones against atypical mycobacteria
is limited. However, the MIC values obtained in this work for β-lapachone
are in agreement with those obtained by D'albuquerque et al. (1972) against
M. smegmatis (MIC values ranging from 40-60 μg/mL).
Tran et al. (2004)
reported the in vitro antimycobacterial of quinone derivatives against M.
fortuitum and M. smegmatis. Plumbagin was the most potent synthesised
quinone against M. smegmatis and M. avium, exhibiting a MIC value
of 12.5 μg/mL.
Meanwhile, 2,3-dipropyl-1,4-naphthoquinone had a MIC value of 50 μg/mL
against M. fortuitum.
The high resistance
of nontuberculous mycobacteria to isoniazid has been attributed to (i) decreased
permeability of the cell wall; (ii) reduced conversion of isoniazid to its active
form and (iii) extrusion by efflux pumps. High levels of resistance may be acquired
with the loss of catalase-peroxidase activity and the overproduction of superoxide
dismutase (Mdluli et al. 1998, Bulatovic et al. 2002, Gupta et al. 2006).
The results obtained
using the killing curve method indicate that regrowth of M. fortuitum
and M. smegmatis occurs in the presence of isoniazid alone at MIC.
Some in vitro studies
have used only one drug to evaluate the efficacy of new antimicrobial agents.
However, the combination of two or more antibiotics is required to avoid an
increase in drug-resistant mycobacteria during therapy (Maheshwari 2007).
A combination of
β-lapachone
and isoniazid demonstrated bactericidal activity against both microorganisms.
Quinones generate reactive oxygen species that can damage lipids, proteins and
deoxyribonucleic acids. Published works have postulated that the activity of
β-lapachone
and other quinones against bacteria and Trypanosoma cruzi is due to superoxide
and hydrogen peroxide formation (Cruz et al. 1978, Bulatovic et al. 2002, Salas
et al. 2008).
The activation
of isoniazid also produces reactive oxygen species. These reactive by-products
are important in the action mechanism of isoniazid. Bulatovic et al. (2002)
described the synergistic activity of plumbagin (a naturally occurring naphthoquinone)
with isoniazid against M. tuberculosis and M. smegmatis. This
synergic effect was easily prevented by the overexpression of superoxide-dismutase.
Further studies
will focus on the possibility that β-lapachone
stimulated isoniazid activity by raising the amount of activated isoniazid and
increasing cell damage by oxidative stress.
The effectiveness
of the combination of β-lapachone
and isoniazid demonstrates that quinones and their derivatives may be useful
against resistant mycobacteria. The combination therapy prevented the selection
of resistant variants and consequently stopped the regrowth of resistant strains.
The data from this study are valuable because antibiotic-resistant bacteria
are currently a major public health problem.
REFERENCES
- Akhtar P, Srivastava
S, Srivastava A, Srivastava M, Srivastava BS, Srivastava R 2006. Rv3303c of
Mycobacterium tuberculosis protects tubercle bacilli against oxidative
stress in vivo and contributes to virulence in mice. Microbes Infect
8: 2855-2862.
- Brendan L, Wilkinson
LFB, Anthony DW, Houston TA, Sally-Ann P 2007. Anti-mycobacterial activity of
a bis-sulfonamide 2007. Bioorg Med Chem Letters 17: 1355-1357.
- Bulatovic VM, Wengenack
NL, Uhl JR, Hall L, Roberts GD, Cockerill FR, Rusnak F 2002. Oxidative stress
increases susceptibility of Mycobacterium tuberculosis to isoniazid. Antimicrob Agents Chemoter 46: 2765-2771.
- Chung MJ, Lee KS,
Koh WJ, Kim TS, Kang EY, Kim SM, Kwon OJ, Kim S 2006. Drug-sensitive tuberculosis,
multidrug-resistant tuberculosis and nontuberculous mycobacterial pulmonary
disease in non AIDS adults: comparisons of thin-section CT findings. Eur
Radiol 16: 1934-1931.
- Cruz FS, Docampo
R, Boveris A 1978. Generation of superoxide anions and hydrogen peroxide from β-lapachone
in bacteria. Antimicrob Agents Chemother 14: 630-633.
- D'albuquerque IL,
Maciel MCN, Schuler ARP, Araujo MCM, Maciel GM, Cavalcanti MSB, Martins DG,
Lacerda AL 1972. Preparação e primeiras observações
sobre as propriedades antibióticas e antineoplásicas das naftoquinonas
homólogos inferiores na série da 2-hidróxi-3-(3-metil-2-2-butenil)-1,4-naftoquinona(lapachol). Rev Inst Ant 12: 31-40.
- Gupta AK, Chauhan
DS, Srivastava K, Das R, Batra S, Mittal M, Goswami P, Singhal N, Sharma VD,
Venkatesan K, Hasnain SE, Katoch VM 2006. Estimation of efflux mediated multi-drug
resistance and its correlation with expression levels of two major efflux pumps
in mycobacteria. J Commun Dis 38: 246-254.
- Krogstad DJ, Moellering
RC 1986. Antimicrobial combinations. In V Lorian, Antibiotics in laboratory
medicine, 2nd ed., Williams & Wilkins, Baltimore, p. 537-557.
- Maheshwari R 2007.
Combating antibiotic resistance in bacteria by combination drug therapy. Cur
Science 92: 1478.
- Mdluli K, Swanson
J, Fischer E, Lee RE, Barry CE 3rd 1998. Mechanisms involved in the intrinsic
isoniazid resistance of Mycobacterium avium. Mol Microbiol 27:
1223-1233.
- NCCLS - National
Committee for Clinical Laboratory Standards 1990. Methods for dilution antimicrobial
susceptibility tests for bacteria that grow aerobically, 2nd ed., Approved
Standard, Villanova, M7- A2.
- Nuermberger E,
Grosset J 2004. Pharmacokinetic and pharmacodynamic issues in the treatment
of mycobacterial infections. Eur J Clin Microbiol Infect Dis 23: 243-255.
- Porat MD, Austin
MS 2008. Bilateral knee periprosthetic infection with Mycobacterium fortuitum. J Arthroplasty 23: 787-789.
- Prendki V, Germaud
P, Bemer P, Masseau A, Hamidou M 2008. Les infectious a mycobactéries
non tuberculeuses. La Revue de Médicine Interne 29: 370-379.
- Salas C, Tapia
RA, Ciudad K, Armstrong V, Orellana M, Kemmerling U, Ferreira J, Maya JD, Morello
2008. Trypanosoma cruzi: activities of lapachol and α-
and β-lapachona
derivatives against epimastigote and trypomastigote forms. Bioorg Med Chem
16: 668-674.
- Silva Junior EN,
Souza MCBV, Fernandes MC, Menna-Barreto RFS, Pinto MCFR, Lopes FA, Simone CA,
Andrade CKZ, Pinto AV, Ferreira VF, Castro SL 2008. Synthesis and anti-Trypanosoma
cruzi activity of derivatives from nor-lapachones and lapachones. Bioorg
Med Chem 16: 5030-5038.
- Tran T, Saheba
E, Arcerio AV, Chavez V, Li Q, Martinez LE, Prim TP 2004. Quinones as antimycobacterial
agents. Bioorg Med Chem 12: 4809-4813.
- Zhang Y, Heym B,
Allem B, Young D, Cole ST 1992. The catalase-peroxidase gene and isoniazid resistance
of Mycobacterium tuberculosis. Nature 358: 591-593.
Copyright 2009 - Instituto Oswaldo Cruz - Fiocruz
|