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Steering evolution with sequential therapy to prevent the emergence of bacterial antibiotic resistance.

机译:通过序贯疗法来指导进化,以防止细菌抗生素耐药性的出现。

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摘要

The increasing rate of antibiotic resistance and slowing discovery of novel antibiotic treatments presents a growing threat to public health. Here, we consider a simple model of evolution in asexually reproducing populations which considers adaptation as a biased random walk on a fitness landscape. This model associates the global properties of the fitness landscape with the algebraic properties of a Markov chain transition matrix and allows us to derive general results on the non-commutativity and irreversibility of natural selection as well as antibiotic cycling strategies. Using this formalism, we analyze 15 empirical fitness landscapes of E. coli under selection by different β-lactam antibiotics and demonstrate that the emergence of resistance to a given antibiotic can be either hindered or promoted by different sequences of drug application. Specifically, we demonstrate that the majority, approximately 70%, of sequential drug treatments with 2-4 drugs promote resistance to the final antibiotic. Further, we derive optimal drug application sequences with which we can probabilistically 'steer' the population through genotype space to avoid the emergence of resistance. This suggests a new strategy in the war against antibiotic-resistant organisms: drug sequencing to shepherd evolution through genotype space to states from which resistance cannot emerge and by which to maximize the chance of successful therapy.
机译:抗生素耐药性的增加和新型抗生素治疗方法的发现缓慢对公共卫生构成了越来越大的威胁。在这里,我们考虑在无性繁殖种群中进化的简单模型,该模型将适应视为适应性景观上的偏向随机游动。该模型将适应性景观的整体性质与马尔可夫链转移矩阵的代数性质相关联,并允许我们得出关于自然选择的非可交换性和不可逆性以及抗生素循环策略的一般结果。使用这种形式主义,我们分析了15种不同β-内酰胺抗生素对大肠杆菌的经验适应度,并证明了不同抗生素应用顺序可能会阻碍或促进对特定抗生素耐药性的出现。具体而言,我们证明了使用2-4种药物进行相继药物治疗的大多数(约70%)可增强对最终抗生素的耐药性。此外,我们得出了最佳的药物应用序列,通过该序列我们可以通过基因型空间来概率“引导”人群,从而避免出现耐药性。这表明了在对抗抗生素抗性生物的战争中的新策略:药物测序,通过基因型空间到牧羊进化到无法产生抗药性并最大程度地获得成功治疗机会的状态。

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