Resistance Mechanisms to Antimicrobial Peptides in Gram-Positive Bacteria

Abstract

With the alarming increase of infections caused by pathogenic multidrug-resistant bacteria over the last decades, antimicrobial peptides (AMPs) have been investigated as a potential treatment for those infections, directly through their lytic effect or indirectly, due to their ability to modulate the immune system. There are still concerns regarding the use of such molecules in the treatment of infections, such as cell toxicity and host factors that lead to peptide inhibition. To overcome these limitations, different approaches like peptide modification to reduce toxicity and peptide combinations to improve therapeutic efficacy are being tested. Human defense peptides consist of an important part of the innate immune system, against a myriad of potential aggressors, which have in turn developed different ways to overcome the AMPs microbicidal activities. Since the antimicrobial activity of AMPs vary between Gram-positive and Gram-negative species, so do the bacterial resistance arsenal. This review discusses the mechanisms exploited by Gram-positive bacteria to circumvent killing by antimicrobial peptides. Specifically, the most clinically relevant genera, Streptococcus spp., Staphylococcus spp., Enterococcus spp. and Gram-positive bacilli, have been explored.

Keywords: AMP; antimicrobial peptides; gram-positive; resistance; streptococci.

FIGURE 1

Resistance mechanisms to antimicrobial peptides in Gram-positive bacteria. AMP resistance mechanisms employed by Gram-positive bacteria are shown, including alterations in cell envelope charge/composition; AMP inhibition by binding to surface proteins/released capsular polysaccharide; AMP degradation by bacterial proteases; bacterial adaptation to AMP challenge; AMP extrusion by efflux pumps and transport systems.