Journal
DRUG RESISTANCE UPDATES
Volume 38, Issue -, Pages 12-26Publisher
CHURCHILL LIVINGSTONE
DOI: 10.1016/j.drup.2018.03.002
Keywords
Persister; Antibiotic; Treatment; Clinic; Anti-persister molecule; Therapy; Pathogen; Dormancy; Escherichia coli; Pseudomonas aeruginosa; Staphylococcus aureus; Mycobacterium tuberculosis
Categories
Funding
- Agency for Innovation through Science and Technology (IWT)
- KU Leuven Center of Excellence [PF/2010/07]
- KU Leuven Research Council [PF/10/010]
- Belgian Science Policy Office (BELSPO) [IAP P7/28]
- Fund for Scientific Research, Flanders (FWO) [G047112N, G0B2515N, G055517N]
- Flemish Institute for Biotechnology (VIB)
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In addition to the well-known strategies of antibiotic resistance and biofilm formation, bacterial populations possess an additional survival strategy to endure hostile environments or antibiotic exposure. A small fraction of transiently antibiotic-tolerant phenotypical variants, called persister cells, is capable of surviving treatment with high doses of antibiotics. When antibiotic pressure drops, persisters that switch back to a normal phenotype can resume growth, ensuring survival of the bacterial population. Persister cells have been identified in every major pathogen, contribute to the antibiotic tolerance observed in biofilms, and are responsible for the recalcitrant nature of chronic infections. Also, evidence is accumulating that persister cells can contribute to the emergence of antibiotic resistance. Consequently, effective treatment of persister cells could greatly improve patient outcome. The small number of persisters and the redundancy in mechanisms of persister formation impede target based development of anti-persister therapies. Nonetheless, the armory of anti-persister molecules is increasing. This review presents a comprehensive overview of anti-persister molecules and strategies described in literature to date and offers perspectives on potential anti-persistence targets and methods for the development of future therapies. Furthermore, we highlight in vivo model systems for pre-clinical testing and summarize ongoing clinical trials of candidate anti-persister therapeutics.
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