Substandard antimicrobial drugs: detection methods and their contributions to antibiotic resistance
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Substandard and counterfeit medicines are major obstacles to the treatment of infectious diseases. Substandard medicines vary from standard drugs in terms of dose, bioavailability, or the presence of impurities. Current methods to identify substandard and counterfeit antimicrobial drugs are either resource intensive or have poor specificity. This dissertation examined two issues related to poor quality antimicrobial medicines: 1) Methods to detect and prevent the consumption of substandard drugs. 2) The relationship between substandard medicines and the evolution of rifampicin resistance. This dissertation advanced two technologies that may aid in the detection of substandard medicines: aptamers and biosensors. Oligonucleotide aptamers may be adapted for drug detection by coupling binding events to changes in fluorescence, luminescence or colorimetric signals. A computational model was developed to discover experimental factors that increase the probability of selecting a high affinity aptamer. Among them are: micromolar drug target concentration, high affinity substrate to partition aptamers, and high aptamer library affinity distribution. Random losses of aptamers due to experimental noise greatly decreased the probability of selecting an aptamer. Experimental parameters to optimize the process of aptamer discovery for small molecules are discussed. Bacterial biosensors are an alternative strategy for the detection of active pharmaceutical ingredients. Here, luciferase-expressing Escherichia coli were used to create profiles of drug interactions for anti-mycobacterial drugs. Drug interactions were tested by the Loewe additivity model. A novel method to differentiate rifamycin drugs from the drug degradation product rifampicin quinone was developed by analyzing each drug’s unique interactions. While subinhibitory drug doses are known to select for antimicrobial resistance in vitro, the role of substandard anti-mycobacterial medicines in the development of rifampicin resistance remains poorly understood. The role of the drug degradation product rifampicin quinone on rifamycin resistance was assessed through in vitro studies of bacteria. Wild type Escherichia coli and Mycobacterium smegmatis cultured in the presence of rifampicin quinone acquired high levels of resistance to rifamycin drugs. Resistance was associated with genetic mutations in the rifampicin resistance cluster of the rpoB gene. The studies presented here demonstrate that substandard medicines can contribute towards rifamycin resistance, and offer methodologies to identify substandard medicines.
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