Abstract
Vancomycin is a widely used clinical drug to treat for infection by methicillin-resistant Staphylococcus aureus. Some patients show a weak response to vancomycin treatment. We previously reported that β-lactams increase the susceptibility to vancomycin by vancomycin-highly resistant S. aureus (VRSA) strains obtained following repeated in vitro mutagenesis and vancomycin selection. Here we found that the susceptibility of the VRSA strains to vancomycin was remarkably increased by combined treatment with D-cycloserine. On the other hand, VRSA did not show increased susceptibility to vancomycin in combination with bacitracin, fosfomycin, erythromycin, lincomycin, gentamicin, levofloxacin or nisin. Furthermore, in an in vivo infection model with silkworms, combined treatment with vancomycin and D-cycloserine exhibited therapeutic effects, whereas treatment with each compound alone did not. These findings suggest that combined treatment with vancomycin and D-cycloserine could be therapeutically effective against infectious diseases caused by VRSA.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Howden, B. P., Davies, J. K., Johnson, P. D., Stinear, T. P. & Grayson, M. L. Reduced vancomycin susceptibility in Staphylococcus aureus, including vancomycin-intermediate and heterogeneous vancomycin-intermediate strains: resistance mechanisms, laboratory detection, and clinical implications. Clin. Microbiol. Rev. 23, 99–139 (2010).
Chang, S. et al. Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N. Engl. J. Med. 348, 1342–1347 (2003).
Melo-Cristino, J., Resina, C., Manuel, V., Lito, L. & Ramirez, M. First case of infection with vancomycin-resistant Staphylococcus aureus in Europe. Lancet 382, 205 (2013).
Robert, J., Bismuth, R. & Jarlier, V. Decreased susceptibility to glycopeptides in methicillin-resistant Staphylococcus aureus: a 20 year study in a large French teaching hospital, 1983-2002. J. Antimicrob. Chemother. 57, 506–510 (2006).
Wilson, P. et al. Linezolid resistance in clinical isolates of Staphylococcus aureus. J. Antimicrob. Chemother. 51, 186–188 (2003).
Bayer, A. S., Schneider, T. & Sahl, H. G. Mechanisms of daptomycin resistance in Staphylococcus aureus: role of the cell membrane and cell wall. Ann. N. Y. Acad. Sci. 1277, 139–158 (2013).
Ishii, K. et al. Phenotypic and genomic comparisons of highly vancomycin-resistant Staphylococcus aureus strains developed from multiple clinical MRSA strains by in vitro mutagenesis. Sci. Rep. 5, 17092 (2015).
Tabuchi, F. et al. Synergistic effects of vancomycin and beta-lactams against vancomycin highly resistant Staphylococcus aureus. J. Antibiot. (Tokyo) (2017).
Brunetti, J., Falciani, C., Bracci, L. & Pini, A. Models of in-vivo bacterial infections for the development of antimicrobial peptide-based drugs. Curr. Top. Med. Chem. 17, 613–619 (2016).
Krezdorn, J., Adams, S. & Coote, P. J. A Galleria mellonella infection model reveals double and triple antibiotic combination therapies with enhanced efficacy versus a multidrug-resistant strain of Pseudomonas aeruginosa. J. Med. Microbiol. 63, 945–955 (2014).
Zhao, M., Lepak, A. J. & Andes, D. R. Animal models in the pharmacokinetic/pharmacodynamic evaluation of antimicrobial agents. Bioorg. Med. Chem. 24, 6390–6400 (2016).
Poulsen, M. O. et al. Combination therapy with thioridazine and dicloxacillin combats meticillin-resistant Staphylococcus aureus infection in Caenorhabditis elegans. J. Med. Microbiol. 63, 1174–1180 (2014).
Kaito, C., Akimitsu, N., Watanabe, H. & Sekimizu, K. Silkworm larvae as an animal model of bacterial infection pathogenic to humans. Microb. Pathog. 32, 183–190 (2002).
Matsumoto, Y. et al. Quantitative evaluation of cryptococcal pathogenesis and antifungal drugs using a silkworm infection model with Cryptococcus neoformans. J. Appl. Microbiol. 112, 138–146 (2012).
Hamamoto, H. et al. Quantitative evaluation of the therapeutic effects of antibiotics using silkworms infected with human pathogenic microorganisms. Antimicrob. Agents Chemother. 48, 774–779 (2004).
Fujiyuki, T., Imamura, K., Hamamoto, H. & Sekimizu, K. Evaluation of therapeutic effects and pharmacokinetics of antibacterial chromogenic agents in a silkworm model of Staphylococcus aureus infection. Drug Discov. Ther. 4, 349–354 (2010).
Usui, K. et al. Acute oral toxicity test of chemical compounds in silkworms. Drug Discov. Ther. 10, 57–61 (2016).
Hamamoto, H. et al. Lysocin E is a new antibiotic that targets menaquinone in the bacterial membrane. Nat. Chem. Biol. 11, 127–133 (2015).
Uchida, R. et al. In vitro and in vivo anti-MRSA activities of nosokomycins. Drug Discov. Ther. 8, 249–254 (2014).
Uchida, R. et al. Nosokomycins, new antibiotics discovered in an in vivo-mimic infection model using silkworm larvae. I: fermentation, isolation and biological properties. J. Antibiot. (Tokyo) 63, 151–155 (2010).
Tomoda, H. New approaches to drug discovery for combating MRSA. Chem. Pharm. Bull. (Tokyo) 64, 104–111 (2016).
Uchida, R., Iwatsuki, M., Kim, Y. P., Omura, S. & Tomoda, H. Nosokomycins, new antibiotics discovered in an in vivo-mimic infection model using silkworm larvae. II: structure elucidation. J. Antibiot. (Tokyo) 63, 157–163 (2010).
Nakamura, I. et al. Discovery of a new antifungal agent ASP2397 using a silkworm model of Aspergillus fumigatus infection. J. Antibiot. (Tokyo) 70, 41–44 (2017).
Peng, H. L., Novick, R. P., Kreiswirth, B., Kornblum, J. & Schlievert, P. Cloning, characterization, and sequencing of an accessory gene regulator (agr in Staphylococcus aureus. J. Bacteriol. 170, 4365–4372 (1988).
Walsh, C. Molecular mechanisms that confer antibacterial drug resistance. Nature 406, 775–781 (2000).
Prosser, G. A. & de Carvalho, L. P. Kinetic mechanism and inhibition of Mycobacterium tuberculosis D-alanine:D-alanine ligase by the antibiotic D-cycloserine. FEBS J. 280, 1150–1166 (2013).
Gasch, O. et al. Daptomycin in vitro activity against methicillin-resistant Staphylococcus aureus is enhanced by D-cycloserine in a mechanism associated with a decrease in cell surface charge. Antimicrob. Agents Chemother. 57, 4537–4539 (2013).
Acknowledgements
We thank Kana Hashimoto, Mari Maeda and Miki Takahashi (Genome Pharmaceuticals Institute Co., Ltd, Tokyo, Japan) for their technical assistance rearing the silkworms. This project was supported by JSPS KAKENHI grant number JP15H05783 (Scientific Research (S) to KS).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
KS has an advisory role at Genome Pharmaceuticals Institute Co., Ltd (Tokyo, Japan). All remaining authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Tabuchi, F., Matsumoto, Y., Ishii, M. et al. D-cycloserine increases the effectiveness of vancomycin against vancomycin-highly resistant Staphylococcus aureus. J Antibiot 70, 907–910 (2017). https://doi.org/10.1038/ja.2017.56
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/ja.2017.56
This article is cited by
-
Discovery of new AMR drugs targeting modulators of antimicrobial activity using in vivo silkworm screening systems
The Journal of Antibiotics (2025)


