结核分枝杆菌的耐药基因及其相关分子机制

结核分枝杆菌原发性和继发性耐药是当前控帝】和治疗结核病面临的重要问题,随着分子遗传学的发展,已经阐明了结核分枝杆菌耐药的分子基础是染色体的突变,影响了药靶本身或激活了药物前体的细菌酶,造成MTB的耐药。本文主要就MTB对其常用药物的耐药机制展开讨论,以便正确认识MTB对不同药物的耐药机制,建立快速检测耐药结核分枝杆菌基因型的分子生物学方法。     

耐药性结核分枝杆菌研究近况

结核分枝杆菌(简称结核杆菌,MTB)是结核痛的病原体.随着耐药性结核杆菌菌株的产生和播散,尤其是耐多药结核(MDR-TB)和广泛抗性结核菌株(XDR-TB)的出现,结核病的威胁在急速增长.现对结核杆菌的分子生物学、分型、耐药机制、致病机制、疫苗等方面作一概述.     

结核分枝杆菌对异烟肼耐药的分子机制

抗结核一线药物异烟肼是应用最广泛的抗结核药物之一,自1952年应用于临床以来,异烟肼就成了治疗结核和潜在感染的基础药物.有报道,我国异烟肼耐药已排在首位.结核分枝杆菌对异烟肼耐药的分子机制十分复杂,涉及katG、inhA、kasA、ndh、axyR等多种基因,本研究仅就此方面的研究作一综述.     

耐药结核分枝杆菌的适应性代价与补偿性进化

结核病耐药率的攀升是目前全球结核病防控面临的重大挑战。结核分枝杆菌主要通过其基因组中耐药相关基因发生点突变而获得耐药性。由于耐药相关基因通常具有重要的生理功能,其突变往往会导致结核分枝杆菌自身适应性下降,即产生“适应性代价”。然而,耐药结核分枝杆菌可通过进一步积累其他特定突变来回复其适应性,这种能使其适应性上升的突变称为“补偿性突变”。耐药结核分枝杆菌的补偿性进化被认为是耐药结核病广泛传播与流行的生物学基础。近年来,在结核病分子流行病学和基础研究领域,针对耐药结核分枝杆菌的补偿性进化开展了大量研究。本文从结核分枝杆菌的耐药分子机制、耐药突变的适应性代价与补偿性进化,以及补偿性进化如何影响耐药结核病传播等方面,综述耐药结核分枝杆菌补偿性进化的研究进展。     

耐多药结核分枝杆菌的研究进展

耐多药结核分枝杆菌(Mycobacterium tuberculosis,Mtb)的产生和播散,尤其是泛耐药菌株的出现,已成为新世纪结核病控制的三大难题之一。Mtb耐药机制的研究有助于快速分子诊断工具的发展,且能指导抗结核新药的开发。了解耐多药结核分枝杆菌的耐药机制、分子特征及治疗的研究进展,将为耐多药Mtb的防治提供依据。     

结核分枝杆菌耐药机制研究进展

结核分枝杆菌为结核病的病原体.最近几年,由于基因突变导致多耐药及广泛耐药结核菌株的出现,以及抗结核病药近几十年来没有换代,使之前基本得到控制的结核痛死灰复燃,成为世界上病死率最高的传染病.为了遏制其进一步的恶化,必须从根本上透彻了解其耐药分子机制.近年来,各国学者采用先进分子生物学技术对结核杆菌耐药机制进行深入研究,定位了结核分枝杆菌耐药基因的位置和基因突变位点,比如耐异烟肼、利福平、乙胺丁醇、链霉素、吡嗪酰胺、喹诺酮类、外排泵等菌株新的基因突变位点引起新的功能改变有新的发现,特别是gidB基因、外排泵基因等有突破性的发现,对研制新一代抗结核病药提供了理论支持及新的方向,但仍有很多耐药机制未阐明,为后续研究者提供些许查考,故笔者就近几年来从分子水平对耐药机制的研究进展做一概述.     

结核分枝杆菌耐氟喹诺酮类药物的分子机制研究进展

结核病是由结核分枝杆菌(Mycobacterium tuberculosis)通过空气传播引起人类感染的慢性传染病,耐药结核分枝杆菌的流行是目前结核病防治的世界难题。氟喹诺酮类药物是人工合成药物,应用于耐药结核的临床治疗中,在治疗中起着核心的作用。但近年来,氟喹诺酮类药物的抗性菌株不断出现,愈发增加了结核病治疗的困难与治疗失败风险。在临床中氟喹诺酮药物的靶点比较清楚,是结核分枝杆菌的DNA旋转酶。目前发现结核分枝杆菌耐氟喹诺酮类药物的机制主要包括药物靶点DNA旋转酶的关键氨基酸改变、药物外排泵系统、细菌细胞壁厚度的增加以及喹诺酮抗性蛋白MfpA介导的DNA旋转酶活性调控。其中在氟喹诺酮靶标DNA旋转酶功能活性改变的耐药机制方面,编码DNA旋转酶基因突变一直是研究的热点,但近年来发现DNA旋转酶的调控蛋白MfpA以及DNA旋转酶的修饰在细菌耐药性中起着重要的作用,相关机制还亟待发现。本文综述了当前结核分枝杆菌耐氟喹诺酮类药物的作用机制,旨在为研发精准诊断技术和药物发掘提供科学理论基础和参考。     

MTB新疆临床分离株MDR-TB和XDR-TB耐药情况初步调查

目的:分析新疆喀什地区结核分枝杆菌(MTB)临床分离株对4种一线和7种二线抗结核药物的耐药情况,初步探讨本地区耐多药结核病(MDR-TB)和广泛耐药结核病(XDR-TB)的流行情况。方法:收集2008.11.1~2009.10.31日期间新疆喀什地区结核病患者痰液标本,进行分离培养及菌种鉴定,并应用比例法对所分离得到的菌株进行耐药性检测。结果:102株分枝杆菌中,88株(86.3%)属于结核分枝杆菌复合群,7株(6.9%)属于牛型分枝杆菌,7株(6.9%)属于非结核分枝杆菌。对一种以上的抗结核药物具有耐药性的有20株,总耐药率为22.7%(20/88),耐多药率为6.8%(6/88),pre-XDR为33.3%(2/6),无XDR-TB病例。结论:新疆喀什地区结核病患者耐药率较高,在结核病治疗工作中应给予重视,尤其应加强对Pre-XDR的重视,以免发展成XDR-TB。     

耐药结核分枝杆菌潜伏-复发感染动物模型的研究进展

潜伏结核感染(latent tuberculosis infection,LTBI)复发是新发结核病的主要来源,其中耐药结核病所占比例较大,使耐药LTBI复发的防控成为结核病研究的重点。耐药结核分枝杆菌潜伏-复发感染动物模型是开展耐药结核病防控相关机制研究、抗耐药结核分枝杆菌药物和疫苗研究的基础。目前耐药结核分枝杆菌感染动物模型缺乏,而已有的结核分枝杆菌标准株H37Rv潜伏-复发感染模型存在缺陷,如小鼠模型的潜伏期荷菌量偏高、复发期变异大,而猴模型的潜伏期和复发期不可预测。模型的可控性差使其应用困难,且缺乏可用的免疫学评价指标,导致远期复发无法预测。因此,基于现有H37Rv潜伏-复发感染动物模型的制备方法,展望耐药结核分枝杆菌潜伏-复发感染动物模型可能存在的缺陷,通过选用新的抑菌剂和诱导剂,制备有稳定潜伏期、潜伏时长适中、复发起点和复发水平变异小的动物模型,是未来耐药结核分枝杆菌潜伏-复发感染动物模型研究的方向。     

导读与评议（2017年第6期）

精准医疗概念的提出开启了一个医学新时代,其实质包括精准诊断和精准治疗。张文宏课题组围绕结核病治疗中的精准医疗进行了阐述,涉及结核病的精准诊断,包括结核病的临床诊断及结核分枝杆菌的检测(分子检测及耐药检测技术等)、特殊人群的药理学参数与药物代谢相关的分子标记、针对病原体生命周期分子靶点的直接作用药物研发、通过正向调控或负向调控药物的使用实现宿主导向抗结核精准治疗。本期刊登了3篇关于结核病耐药的综述。鉴于耐药结核分枝杆菌的补偿性进化是其传播与流行的基础,高谦课题组从结核分枝杆菌的耐药分子机制、耐药突变的适应性代价与补偿性进化,以及补偿性进化如何影响耐药结核病传播等方面进行了综述。袁莉课题组就近年来结核分枝杆菌“毒素-抗毒素系统”(TAS)与生物膜的研究及抗结核药物对生物膜形成的影响进行综述......     

Screening and molecular dynamics simulation of compounds inhibiting MurB enzyme of drug-resistant Mycobacterium tuberculosis: An in-silico approach

Mycobacterium tuberculosis (MTB) is becoming more and more resistant to drugs and it is a common problem, making current antimicrobials ineffective and highlighting the need for new TB drugs. One of the promising targets for treating MTB is MurB enzymes. This study aimed to identify potential inhibitors of MurB enzymes in M. tuberculosis, as drug resistance among MTB is a significant problem. Attempts are being made to conduct a virtual screening of 30,417 compounds, and thirty-two compounds were chosen for further analysis based on their binding conformations. The selected compounds were assessed for their drug-likeness, pharmacokinetics, and physiochemical characteristics, and seven compounds with binding energy lower than flavin (FAD) were identified. Further, molecular dynamics simulation analysis of these seven compounds found that four of them, namely DB12983, DB15688, ZINC084726167, and ZINC254071113 formed stable complexes with the MurB binding site, exhibiting promising inhibitory activity. These compounds have not been mentioned in any other study, indicating their novelty. The study suggests that these four compounds could be promising candidates for treating MTB, but their effectiveness needs to be validated through in vitro and in vivo experiments. Overall, the findings of this study provide new insight into potential drug targets and candidates for combating drug-resistant MTB.     

Mechanistic analysis of A46V,H57Y,and D129N in pyrazinamidase associated with pyrazinamide resistance

Pyrazinamide (PZA) is a component of first-line drugs, active against latent Mycobacterium tuberculosis (MTB) isolates. The prodrug is activated into the active form, pyrazinoic acid (POA) via pncA gene-encoded pyrazinamidase (PZase). Mutations in pncA have been reported, most commonly responsible for PZA-resistance in more than 70% of the resistant cases. In our previous study, we detected many mutations in PZase among PZA-resistance MTB isolates including A46V, H71Y, and D129N. The current study was aimed to investigate the molecular mechanism of PZA-resistance behind mutants (MTs) A46V, H71Y, and D129N in comparison with the wild type (WT) through molecular dynamic (MD) simulation. MTB positive samples were subjected to PZA drug susceptibility testing (DST) against critical concentration (100ug/ml). The resistant samples were subjected to pncA sequencing. Thirty-six various mutations have been observed in the coding region of pncA of PZA-resistant isolates (GenBank accession No. MH461111) including A46V, H71Y, and D129N. The post-simulation analysis revealed a significant variation in MTs structural dynamics as compared to the WT. Root means square deviations (RMSD) and Root means square fluctuation (RMSF) has been found in variation between WT and MTs. Folding effect and pocket volume were altered in MTs when compared with WT. Geometric matching supports the effect of mutation A46V, H71Y, and D129N on PZase structure that may have an insight effect on PZase dynamics, making them vulnerable to convert pro-PZA into active form, POA. In conclusion, the current analyses will provide useful information behind PZA-resistance for better management of drug-resistant TB.     

Drug resistance mechanisms and novel drug targets for tuberculosis therapy

Drug-resistant tuberculosis (TB) poses a significant challenge to the successful treatment and control of TB worldwide. Resistance to anti-TB drugs has existed since the beginning of the chemotherapy era. New insights into the resistant mechanisms of anti-TB drugs have been provided. Better understanding of drug resistance mechanisms helps in the development of new tools for the rapid diagnosis of drug-resistant TB. There is also a pressing need in the development of new drugs with novel targets to improve the current treatment of TB and to prevent the emergence of drug resistance in Mycobacterium tuberculosis. This review summarizes the anti-TB drug resistance mechanisms, furnishes some possible novel drug targets in the development of new agents for TB therapy and discusses the usefulness using known targets to develop new anti-TB drugs. Whole genome sequencing is currently an advanced technology to uncover drug resistance mechanisms in M. tuberculosis. However, further research is required to unravel the significance of some newly discovered gene mutations in their contribution to drug resistance.     

转录因子及miRNA调控食管癌耐药机制研究

由于耐药性的存在,不同患者在使用相同药物时会导致治疗效果的差异.因此识别耐药性相关的关键生物学标记,有助于临床医生快速选择出适合的药物,延长患者的生存时间,对药物研发以及药物的作用机制的详细研究具有重要意义.首先在食管癌细胞系中筛选不同药物的耐药及敏感细胞系,从中找到不同药物耐药相关的基因,将这些计算得到的耐药相关基因...     

鲍曼不动杆菌对碳青霉烯类抗生素的耐药性分析

目的了解鲍曼不动杆菌的耐药情况,并检测耐碳青霉烯类鲍曼不动杆菌的耐药基因,为指导临床合理用药、控制院内感染提供依据。方法利用K-B法检测45株鲍曼不动杆菌临床分离株的耐药情况,通过改良Hodge试验、Carba NP试验和EDTA协同试验对多重耐药鲍曼不动杆菌的碳青霉烯酶进行表型检测,并采用PCR技术检测鲍曼不动杆菌携带OXA-23和NDM-1型耐药基因的情况。结果 45株鲍曼不动杆菌临床分离株中共筛出42株多重耐药菌株;利用改良Hodge试验和Carba NP试验检出36株碳青霉烯酶阳性菌株;采用PCR扩增出OXA-23,未扩增出NDM-1。结论鲍曼不动杆菌耐药情况严重,且耐药基因OXA-23携带率高,治疗时应根据药敏试验结果合理用药。     

Transporters as mediators of drug resistance in Plasmodium falciparum

Drug resistance represents a major obstacle in the radical control of malaria. Drug resistance can arise in many different ways, but recent developments highlight the importance of mutations in transporter molecules as being major contributors to drug resistance in the human malaria parasite Plasmodium falciparum. While approximately 2.5% of the P. falciparum genome encodes membrane transporters, this review concentrates on three transporters, namely the chloroquine resistance transporter PfCRT, the multi-drug resistance transporter 1 PfMDR1, and the multi-drug resistance-associated protein PfMRP, which have been strongly associated with resistance to the major antimalarial drugs. The studies that identified these entities as contributors to resistance, and the possible molecular mechanisms that can bring about this phenotype, are discussed. A deep understanding of the underpinning mechanisms, and of the structural specificities of the players themselves, is a necessary basis for the development of the new drugs that will be needed for the future armamentarium against malaria.     

肠杆菌科细菌肺部感染病原菌分布与耐药性监测

目的了解浙江龙游县人民医院肠杆菌科细菌肺部感染病原菌分布及耐药性,为临床合理使用抗菌药物提供依据。方法采用纸片扩散法对病原菌进行药敏试验,并进行ESBLs检测,按CLSI 2012年标准判定药敏结果,用WHONET 5.6软件分析结果。结果痰培养共分离出371株肠杆科细菌,主要为肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌,产ESBLs菌阳性率高,对碳青霉烯类抗菌药物耐药率低,均在10.00%以下,其他药物均有不同程度耐药,测试抗菌药物的耐药率差异有统计学意义（P〈0.05）。结论临床常见肠杆菌科细菌耐药率高,开展病原菌耐药性监测,对指导临床抗感染治疗合理选择抗菌药物具有重要意义。