Adaptation of Enterococcus faecalis to daptomycin reveals an ordered progression to resistance

Antimicrob Agents Chemother. 2013 Nov;57(11):5373-83. doi: 10.1128/AAC.01473-13. Epub 2013 Aug 19.

Abstract

With increasing numbers of hospital-acquired antibiotic resistant infections each year and staggering health care costs, there is a clear need for new antimicrobial agents, as well as novel strategies to extend their clinical efficacy. While genomic studies have provided a wealth of information about the alleles associated with adaptation to antibiotics, they do not provide essential information about the relative importance of genomic changes, their order of appearance, or potential epistatic relationships between adaptive changes. Here we used quantitative experimental evolution of a single polymorphic population in continuous culture with whole-genome sequencing and allelic frequency measurements to study daptomycin (DAP) resistance in the vancomycin-resistant clinical pathogen Enterococcus faecalis S613. Importantly, we sustained both planktonic and nonplanktonic (i.e., biofilm) populations in coculture as the concentration of antibiotic was raised, facilitating the development of more ecological complexity than is typically observed in laboratory evolution. Quantitative experimental evolution revealed a clear order and hierarchy of genetic changes leading to resistance, the signaling and metabolic pathways responsible, and the relative importance of these mutations to the evolution of DAP resistance. Despite the relative simplicity of this ex vivo approach compared to the ecological complexity of the human body, we showed that experimental evolution allows for rapid identification of clinically relevant adaptive molecular pathways and new targets for drug design in pathogens.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Physiological / drug effects
  • Adaptation, Physiological / genetics*
  • Alleles
  • Anti-Bacterial Agents / pharmacology*
  • Daptomycin / pharmacology*
  • Drug Resistance, Multiple, Bacterial / drug effects
  • Drug Resistance, Multiple, Bacterial / genetics*
  • Enterococcus faecalis / drug effects
  • Enterococcus faecalis / genetics*
  • Enterococcus faecalis / metabolism
  • Epistasis, Genetic
  • Evolution, Molecular
  • Gene Expression Regulation, Bacterial*
  • Gene Frequency
  • Genome, Bacterial*
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Mutation
  • Signal Transduction
  • Vancomycin / pharmacology
  • Vancomycin Resistance / drug effects
  • Vancomycin Resistance / genetics

Substances

  • Anti-Bacterial Agents
  • Vancomycin
  • Daptomycin