In vitro activity of AST-120 that suppresses indole signaling in Escherichia coli, which attenuates drug tolerance and virulence

PLoS One. 2020 Apr 29;15(4):e0232461. doi: 10.1371/journal.pone.0232461. eCollection 2020.

Abstract

AST-120 (Kremezin) is used to treat progressive chronic kidney disease (CKD) by adsorbing uremic toxin precursors produced by gut microbiota, such as indole and phenols. In this study, we propose that AST-120 reduces indole level, consequently suppresses indole effects on induction of drug tolerance and virulence in Escherichia coli including enterohaemorrhagic strains. In experiments, AST-120 adsorbed both indole and tryptophan, a precursor of indole production, and led to decreased expression of acrD and mdtEF which encode drug efflux pumps, and elevated glpT, which encodes a transporter for fosfomycin uptake and increases susceptibility to aztreonam, rhodamine 6G, and fosfomycin. AST-120 also decreased the production of EspB, which contributes to pathogenicity of enterohaemorrhagic E. coli (EHEC). Aztreonam, ciprofloxacin, minocycline, trimethoprim, and sulfamethoxazole were also adsorbed by AST-120. However, fosfomycin, in addition to rifampicin, colistin and amikacin were not adsorbed, thus AST-120 can be used together with these drugs for therapy to treat infections. These results suggest another benefit of AST-120, i.e., that it assists antibacterial chemotherapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Carbon / pharmacology*
  • Drug Resistance, Bacterial / drug effects
  • Enterohemorrhagic Escherichia coli / drug effects
  • Enterohemorrhagic Escherichia coli / metabolism
  • Enterohemorrhagic Escherichia coli / pathogenicity
  • Escherichia coli / drug effects*
  • Escherichia coli / metabolism
  • Escherichia coli / pathogenicity
  • Escherichia coli Infections / drug therapy*
  • Escherichia coli Infections / microbiology
  • Humans
  • Indoles / metabolism*
  • Oxides / pharmacology*
  • Signal Transduction / drug effects*
  • Virulence / drug effects

Substances

  • Anti-Bacterial Agents
  • Indoles
  • Oxides
  • Carbon
  • AST 120

Grants and funding

The authors, Dr. Uchida and Dr. Nishijima belong to a commercial company, Kureha corp. They contributed to the study design, data interpretation and providing the AST-120 material in addition to financial support (20,000 dollars) to perform experiments and publish the results, but not salaries for authors as the funder. We believe that the financial support should be reasonable value, and I suggest that they did not directly participate in data collection. HH was supported by JSPS KAKENHI “Grant-in-Aid for Scientific Research (C) Grant Number 19K07533 (https://www.jsps.go.jp/) and HT was supported by Japan Agency for Medical Research and Development, AMED Grant Number 19fk0108061h0502 (https://www.amed.go.jp/en/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.