Polymyxins are antibiotics,[1] with a general structure consisting of a cyclic peptide with a long hydrophobic tail. They disrupt the structure of the bacterial cell membrane by interacting with its phospholipids. They are produced by nonribosomal peptide synthetase systems in Gram-positive bacteria such as Paenibacillus polymyxa[2] and are selectively toxic for Gram-negative bacteria due to their specificity for the lipopolysaccharide molecule that exists within many Gram-negative outer membranes.

Polymyxins B and E (also known as colistin) are used in the treatment of Gram-negative bacterial infections. The global problem of advancing antimicrobial resistance has led to a renewed interest in their use recently.[3]

Polymyxin M is also known as "mattacin".[4]

Mechanism of action

After binding to lipopolysaccharide (LPS) in the outer membrane of Gram-negative bacteria, polymyxins disrupt both the outer and inner membranes. The hydrophobic tail is important in causing membrane damage, suggesting a detergent-like mode of action.

Removal of the hydrophobic tail of polymyxin B yields polymyxin nonapeptide, which still binds to LPS but no longer kills the bacterial cell. However, it still detectably increases the permeability of the bacterial cell wall to other antibiotics, indicating that it still causes some degree of membrane disorganization.

Gram-negative bacteria can develop resistance to polymyxins through various modifications of the LPS structure that inhibit the binding of polymyxins to LPS.[5]

Clinical use

Polymyxin antibiotics are relatively neurotoxic and nephrotoxic[6] and are usually used only as a last resort if modern antibiotics are ineffective or are contraindicated. Typical uses are for infections caused by strains of multidrug-resistant Pseudomonas aeruginosa or carbapenemase-producing Enterobacteriaceae.

Polymyxins are not absorbed from the gastrointestinal tract, and, therefore, another route of administration must be chosen, e.g., parenteral (often intravenously) or by inhalation (unless perhaps the target is bacteria in the gastrointestinal tract).

Polymyxins have less effect on Gram positive organisms, and are sometimes combined with other agents (as with Trimethoprim/polymyxin) to broaden the effective spectrum.

Use in biomedical research

Polymyxins are used to neutralize or absorb LPS, which contaminates samples that are intended for use in, e.g., immunological experiments. Minimization of LPS contamination can be important because LPS can evoke strong reactions from immune cells and, therefore, distort experimental results.

By increasing permeability of the bacterial membrane system, polymyxin is also used in clinical work to increase release of secreted toxins, such as Shiga toxin from Escherichia coli.[7]

See also


Further reading

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