Escalating antibiotic resistance is now a serious menace to global public health. It may be led to the emergence of "postantibiotic age" in which most of infections are untreatable. At present, there is an essential need to explore novel therapeutic strategies as a strong and sustainable pipeline to combat antibiotic-resistant infections. This review focuses on recent advances in this area including therapeutic antibodies, antimicrobial peptides, vaccines, gene therapy, genome editing, and phage therapy for tackling drug-resistant infections.

Background Pseudomonas aeruginosa is the leading cause of nosocomial infections, especially in people with a compromised immune system. Targeting virulence factors by neutralizing antibodies is a novel paradigm for the treatment of antibiotic-resistant pseudomonas infections. In this respect, exotoxin A is one of the most potent virulence factors in P. aeruginosa. The present study was carried out to identify a novel human scFv antibody against the P. aeruginosa exotoxin A domain I (ExoA-DI) from a human scFv phage library. Methods The recombinant ExoA-DI of P. aeruginosa was expressed in E. coli, purified by Ni-NTA column, and used for screening of human antibody phage library. A novel screening procedure was conducted to prevent the elimination of rare specific clones. The phage clone with high reactivity was evaluated by ELISA and western blot. Results Based on the results of polyclonal phage ELISA, the fifth round of biopanning leads to the isolation of several ExoA-DI reactive clones. One positive clone with high affinity was selected by monoclonal phage ELISA and used for antibody expression. The purified scFv showed high reactivity with the recombinant domain I and full-length native exotoxin A. Conclusions The purified anti-exotoxin A scFv displayed high specificity against exotoxin A. The human scFv identified in this study could be the groundwork for developing a novel therapeutic agent to control P. aeruginosa infections.

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Background: Pseudomonas aeruginosa is known as the leading cause of nosocomial infections especially in people with a compromised immune system. Targeting virulence factors by neutralizing antibodies is a novel paradigm for the treatment of antibiotic-resistant pseudomonas infections.Methods: In this respect, exotoxin A is one of the most potent virulence factors in P. aeruginosa. The present study was conducted to identify a novel human scFv antibody against domain I of P. aeruginosa exotoxin A from a human scFv phage library. For this, the recombinant domain I of exotoxin A was expressed in E. coli and purified by Ni-NTA column. A novel screening procedure was conducted to prevent the elimination of rare specific clones. Based on polyclonal phage ELISA results, the fifth round of biopanning was selected to identify specific phage clones.Results: Two positive clones were found by monoclonal phage. The phage clone with high reactivity was evaluated by ELISA and western blot. The purified scFv also showed high reactivity with full length exotoxin.Conclusions: In conclusion, the purified anti-exotoxin A scFv displayed high specificity against exotoxin A. The human scFv identified can be the groundwork for development of a novel therapeutic agent for control of P. aeruginosa infections.