title: Mutations in the Pneumocystis jirovecii DHPS gene confer cross-resistance to sulfa drugs.
abstract: Pneumocystis jirovecii is a major opportunistic pathogen that causes Pneumocystis pneumonia (PCP) and results in a high degree of mortality in immunocompromised individuals. The drug of choice for PCP is typically sulfamethoxazole (SMX) or dapsone in conjunction with trimethoprim. Drug treatment failure and sulfa drug resistance have been implicated epidemiologically with point mutations in dihydropteroate synthase (DHPS) of P. jirovecii. P. jirovecii cannot be cultured in vitro; however, heterologous complementation of the P. jirovecii trifunctional folic acid synthesis (PjFAS) genes with an E. coli DHPS-disrupted strain was recently achieved. This enabled the evaluation of SMX resistance conferred by DHPS mutations. In this study, we sought to determine whether DHPS mutations conferred sulfa drug cross-resistance to 15 commonly available sulfa drugs. It was established that the presence of amino acid substitutions (T(517)A or P(519)S) in the DHPS domain of PjFAS led to cross-resistance against most sulfa drugs evaluated. The presence of both mutations led to increased sulfa drug resistance, suggesting cooperativity and the incremental evolution of sulfa drug resistance. Two sulfa drugs (sulfachloropyridazine [SCP] and sulfamethoxypyridazine [SMP]) that had a higher inhibitory potential than SMX were identified. In addition, SCP, SMP, and sulfadiazine (SDZ) were found to be capable of inhibiting the clinically observed drug-resistant mutants. We propose that SCP, SMP, and SDZ should be considered for clinical evaluation against PCP or for future development of novel sulfa drug compounds.
authors.affiliation: CSIRO Health Sciences and Nutrition, 343 Royal Parade, Parkville, Victoria 3052, Australia. peter.iliades@csiro.au
authors.forename: Peter
authors.initials: P
authors.lastname: Iliades
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
authors.forename: Ian G
authors.initials: IG
authors.lastname: Macreadie
mesh_terms: D019943:Amino Acid Substitution; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003470:Culture Media; D004094:Dihydropteroate Synthase / Q000037:antagonists & inhibitors / Q000235:genetics*; D024881:Drug Resistance, Bacterial; D004791:Enzyme Inhibitors / Q000494:pharmacology; D004926:Escherichia coli / Q000235:genetics; D005822:Genetic Vectors; D008826:Microbial Sensitivity Tests; D009154:Mutation / Q000235:genetics*; D011010:Pneumocystis / Q000235:genetics*; D011014:Pneumonia / Q000188:drug therapy / Q000382:microbiology; D013449:Sulfonamides / Q000494:pharmacology*; D014169:Transformation, Bacterial
chemical_list: D000900:Anti-Bacterial Agents; D003470:Culture Media; D004791:Enzyme Inhibitors; D013449:Sulfonamides; D004094:Dihydropteroate Synthase