b Brilacidin (PMX30063) has shown potent bactericidal activity against drug-resistant and -susceptible strains of multiple Gramnegative and Gram-positive pathogens. In this study, we demonstrate that brilacidin causes membrane depolarization in the Gram-positive bacterium Staphylococcus aureus, to an extent comparable to that caused by the lipopeptidic drug daptomycin. Transcriptional profiling of Staphylococcus aureus by deep sequencing shows that the global response to brilacidin treatment is well correlated to those of treatment with daptomycin and the cationic antimicrobial peptide LL37 and mostly indicates abrogation of cell wall and membrane functions. Furthermore, the upregulation of various chaperones and proteases by brilacidin and daptomycin indicates that cytoplasmic protein misfolding stress may be a contributor to the mechanism of action of these drugs. These stress responses were orchestrated mainly by three two-component systems, GraSR, VraSR, and NsaSR, which have been implicated in virulence and drug resistance against other clinically available antibiotics.
The recent rise of multidrug-resistant pathogenic bacteria is an alarming health care crisis that has outpaced the discovery of effective and novel therapeutics (1, 2). Antimicrobial peptides (AMPs), which are evolutionarily conserved, first-line host defense mechanisms, offer an attractive platform for the development of new antibiotics (3-5). Most AMPs are believed to interact with bacterial membranes and cause cell death by dysregulating the properties of the phospholipid bilayer or by causing membrane leakage, although some have been identified to have downstream cytoplasmic targets as well (6). Despite the variety of sequences and secondary and tertiary structures, most AMPs share an amphiphilic topology, with a charged, mostly positive face that allows for interaction with the negatively charged bacterial membrane and a hydrophobic face that allows for insertion into the membrane and interaction with the apolar acyl chains of the bilayer (4, 7-10). Several mechanisms have been suggested for the nature of this interaction with the membrane, including carpet, toroidal pore, and barrel stave mechanisms (6). Development of resistance to these peptides is limited (11), presumably due to the membrane being the primary target (12). As such, several strategies have been employed to mimic the activity of AMPs in order to improve efficacy, selectivity for bacteria, and bioavailability while circumventing issues associated with peptidic drugs, such as proteolytic degradation and difficulties with large-scale synthesis. These include the use of scaffolds such as D-L peptides, -amino acid helices, and antimicrobial polymers (13-15).In previous work, we developed a series of small-molecule arylamide mimics of AMPs that showed potent activity against a broad range of drug-susceptible and multidrug-resistant Gramnegative and Gram-positive bacteria (15-19). These compounds feature a small arylamide backbone that is stabilized by intramolecular hydroge...