‘Nightmare bacteria:’ Michigan Engineers discuss how to combat antibiotic resistance Drug-resistant bugs are on the rise and new approaches are needed.

Health officials at the U.S. Centers for Disease Control and Prevention earlier this month said they are seeing rising cases of “nightmare bacteria” that show strong resistance to antibiotics. More than 200 cases were reported in the last year alone, and across every state in the U.S.

“Unusual resistance germs—which are resistant to all or most antibiotics tested and are uncommon or carry special resistance genes—are constantly developing and spreading,” the CDC said.

A particular concern is the number of cases that crop up in hospitals and nursing homes where IVs, catheters and medical implants—all particularly susceptible to infection—are common.

“Antibiotic resistance is one of the most important public health problems of the 21st century,” said Angela Violi, professor of mechanical engineering and chemical engineering at U-M.

Violi is one of many researchers at Michigan Engineering who are are tackling this issue from a variety of angles. Some are exploring new ways to combine antibiotics to stay one step ahead of the bugs. Others are looking beyond antibiotics—to nanoparticles.

Nicholas Kotov, the Joseph B. and Florence V. Celka professor of chemical engineering, is part of a team researching the use of nanoparticles as a new form of antibiotics. Nanoparticles can be shaped specifically to get past a bacterium’s defenses and shut down processes essential to its survival. Nanoparticles can also be used to coat medical implants in order to prevent infection from drug resistant bacteria.

“New methods of suppressing or otherwise diminishing the health impact of antibiotic resistant bacteria are needed,” Kotov said. “Molecular and nanoscale engineering of inorganic nanoparticles offers this opportunity by utilizing the latest experimental and computational tools targeting the bacteria where it does not expect.”

Violi helps identify the best pathways for utilizing nanoparticles to attack antibiotic resistant bacteria.

“Potentially, all it takes is a single mutated bacterium to render an antibiotic useless for that infection,” she said. “When that mutant cell replicates, it will pass on its resistant phenotype to its daughter cells, and so on.

“At that point part of the replicating bacteria will be drug resistant: the drug will kill only those cells that do not have the newly evolved drug-resistance capacity. Eventually, the entire bacterial population will become resistant to the prescribed antibiotic.

“It is only when antibiotics are used that drug-resistant phenotypes have a selective advantage and survive.

“Nano and chemical engineering approaches provide unparalleled flexibility to control the composition, size, shape, surface chemistry, and functionality of nanostructures that can be used to develop a new generation of modified materials or to coat existing solid surfaces to fight bacteria.”

Professor working on a computer in the lab
Sriram Chandrasekaran, an assistant professor of biomedical engineering, uses computer simulations to develop strategies for using current antibiotics in combination as well as roadmaps for creating new classes of antibiotics. Photo by Joseph Xu

Sriram Chandrasekaran, an assistant professor of biomedical engineering, approaches drug resistant bacteria from a different angle. He and his team study proteins and analyze their behaviors via computer simulations to develop strategies for using current antibiotics in combination as well as roadmaps for creating new classes of antibiotics.

“In addition to better stewardship of antibiotics, we also need to come up with smarter treatment strategies that can reduce the rise of resistance,” Chandrasekaran said.

“For example, our lab and others are designing combinations of antibiotics that are more effective in retarding the evolution of drug resistance compared to using drugs individually. Such combinations of FDA approved drugs can also reach the clinic faster than developing new drugs from scratch.

“We are also developing computer algorithms that can identify the most optimal combination of drugs for a specific strain of pathogen. Overall, what we can learn from this crisis is that we cannot take antibiotics for granted. We have to keep investing on new treatments as bacteria will always eventually evolve resistance to whatever new drug we throw at it.”

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Closest look yet at killer T-cell activity could yield new approach to tackling antibiotic resistance An in-depth look at the work of T-cells, the body's bacteria killers, could provide a roadmap to effective drug treatments.

In a study that could provide a roadmap for combatting the rising threat of drug-resistant pathogens, researchers have discovered the specific mechanism the body’s T-Cells use to kill bacteria.

University of Michigan researchers, in collaboration with colleagues at Harvard University, have discovered a key difference between the way immune cells attack bacteria and the way antibiotics do. Where drugs typically attack a single process within bacteria, T-Cells attack a host of processes at the same time.

On Thursday, the journal Cell published findings from a team headed by U-M’s Sriram Chandrasekaran and Harvard’s Judy Lieberman. It’s a study with potential implications for drug-resistant pathogens—a problem projected to kill as many as 10 million people annually across the globe by the year 2050.

“We have a huge crisis of antibiotic resistance right now in that most drugs that treat diseases like tuberculosis or listeria, or pathogens like E.coli, are not effective,” said Chandrasekaran, an assistant professor of biomedical engineering. “So there is a huge need for figuring out how the immune system does its work. We hope to design a drug that goes after bacteria in a similar way.”

We’ve reached a point where we take what antibiotics can do for granted, and we can’t do that anymore.Sriram Chandrasekaran

Killer T-Cells, formally known as cytotoxic lymphocytes, attack infected cells by producing the enzyme granzyme B. How this enzyme triggers death in bacteria has not been well understood, Chandrasekaran said.

Proteomics – a technique that measures protein levels in a cell—and computer modeling, allowed researchers to see granzyme B’s multi-pronged attack targeting multiple processes.

Chandrasekaran and his team monitored how T-Cells deal with three different threats: E. coli, listeria and tuberculosis.

“When exposed to granzyme B, the bacteria were unable to develop resistance to the multi-pronged attack, even after exposure over multiple generations,” Chandrasekaran said. “This enzyme breaks down multiple proteins that are essential for the bacteria to survive.

“It’s essentially killing several birds with one stone.”

The possible applications of the new findings on T-Cells run the gamut from the creation of new medications to the re-purposing of previously-approved drugs in combination to fight infections by mimicking granzyme B.

Chandrasekaran’s team is now looking at how bacteria hide to avoid T-Cell attacks.

And the need for a new approach in some form is dire. World Health Organization officials describe antibiotic resistance as “one of the biggest threats to global health, food security and development today.”

Sriram Chandrasekaran, Assistant Professor of Biomedical Engineering, shows a computer model of a pathway for a potential disease or infection. Photo: Joseph Xu

Each year, an estimated 700,000 deaths are linked to antibiotic-resistant bacteria, according to the World Health Organization. Projections show that number skyrocketing to 10 million by 2050.

England’s top health official, Sally Davies, recently said the lost effectiveness of antibiotics would mean “the end of modern medicine.”

“We really are facing—if we don’t take action now—a dreadful post-antibiotic apocalypse,” she was quoted saying earlier this month. “I don’t want to say to my children that I didn’t do my best to protect them and their children.”

Of particular concern is the fact that there are few new antibiotics in the pipeline. The heyday of new antibiotics occurred the 1940s through the 1960s, with releases eventually grinding almost to a halt by the end of the twentieth century.

“We’ve reached a point where we take what antibiotics can do for granted, and we can’t do that anymore,” Chandrasekaran said. “We’re taking inspiration from the human immune system, which has been fighting infections for thousands of years.”

The paper is titled, “Granzyme B disrupts central metabolism and protein synthesis in bacteria to promote an immune cell death program.” The research is funded by the National Institutes of Health, Harvard University and the University of Michigan.

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