搜索结果：Infection and drug resistance

Drug resistance remains a major problem for the treatment of HIV. Resistance can occur due to mutations that were present before treatment starts or due to mutations that occur during treatment. The relative importance of these two sources is unknown. We study three different situations in which HIV drug resistance may evolve: starting triple-drug therapy, treatment with a single dose of nevirapine and interruption of treatment. For each of these three cases good data are available from literature, which allows us to estimate the probability that resistance evolves from standing genetic variation. Depending on the treatment we find probabilities of the evolution of drug resistance due to standing genetic variation between 0 and 39%. For patients who start triple-drug combination therapy, we find that drug resistance evolves from standing genetic variation in approximately 6% of the patients. We use a population-dynamic and population-genetic model to understand the observations and to estimate important evolutionary parameters. We find that both, the effective population size of the virus before treatment, and the fitness of the resistant mutant during treatment, are key-parameters

Access to combination antiretroviral treatment (ART) has improved greatly over recent years. At the end of 2011, more than eight million HIV infected people were receiving antiretroviral therapy in low-income and middle-income countries. ART generally works well in keeping the virus suppressed and the patient healthy. However, treatment only works as long as the virus is not resistant against the drugs used. In the last decades, HIV treatments have become better and better at slowing down the evolution of drug resistance, so that some patients are treated for many years without having any resistance problems. However, for some patients, especially in low-income countries, drug resistance is still a serious threat to their health. This essay will review what is known about transmitted and acquired drug resistance, multi-class drug resistance, resistance to newer drugs, resistance due to treatment for the prevention of mother-to-child transmission, the role of minority variants (low-frequency drug-resistance mutations), and resistance due to pre-exposure prophylaxis.

Antimicrobial resistance is an emerging global health crisis that is undermining advances in modern medicine and, if unmitigated, threatens to kill 10 million people per year worldwide by 2050. Research over the last decade has demonstrated that the differences between genetically identical cells in the same environment can lead to drug resistance. Fluctuations in gene expression, modulated by gene regulatory networks, can lead to non-genetic heterogeneity that results in the fractional killing of microbial populations causing drug therapies to fail; this non-genetic drug resistance can enhance the probability of acquiring genetic drug resistance mutations. Mathematical models of gene networks can elucidate general principles underlying drug resistance, predict the evolution of resistance, and guide drug resistance experiments in the laboratory. Cells genetically engineered to carry synthetic gene networks regulating drug resistance genes allow for controlled, quantitative experiments on the role of non-genetic heterogeneity in the development of drug resistance. In this perspective article, we emphasize the contributions that mathematical, computational, and synthetic gene network

We develop a variable population age-structured ODE model to investigate the role of Intermittent Preventive Treatment (IPT) in averting malaria-induced mortalities in children, as well as its related cost in promoting the spread of anti-malarial drug resistance. IPT, a malaria control strategy in which a full curative dose of an antimalarial medication is administered to vulnerable asymptomatic individuals at specified intervals, has been shown to have a positive impact on reducing malaria transmission and deaths in children and pregnant women. However, it can also promote drug resistance spread. Our mathematical model is used to explore IPT effects on drug resistance in holoendemic malaria regions while quantifying the benefits in deaths averted. Our model includes both drug-sensitive and drug-resistant strains of the parasite as well as interactions between human hosts and mosquitoes. The basic reproduction numbers for both strains as well as the invasion reproduction numbers are derived and used to examine the role of IPT on drug resistance. Numerical simulations show the individual and combined effects of IPT and treatment of symptomatic infections on the prevalence levels of

While the mechanisms and quantitative details are complex, few analysts would doubt that antibiotic use increases the prevalence of drug-resistant bacterial pathogens among all bacteria causing disease in a population. The causal connection between antibiotic use and the total incidence of severe bacterial infections, possibly mediated by antibiotic resistance, is less clearly established. The increasing burden of severe bacterial infections and their sequelae, particularly sepsis, in the United States and other countries, calls out for an explanation. In this Perspective we consider the evidence bearing on the hypothesis that prevalence of antibiotic resistance and levels of antibiotic use are important contributors to the rates of sepsis hospitalizations and other outcomes with bacterial etiology. In the process, we discuss the consequences of resistance to/use of commonly prescribed antibiotics, including fluoroquinolones, and provide a comparison of the epidemiology of antibiotic use/resistance and severe outcomes associated with infections with bacterial pathogens, particularly Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium Difficile in t

In 2005 there was an outbreak of XDR (extensively drug resistant) TB in Tugela Ferry, which is served by the Church of Scotland Hospital (COSH), in the uMzinyathi District, KwaZulu-Natal, South Africa. An investigation was carried out to determine if XDR TB was occurring elsewhere in the province, and to develop hypotheses for the rise in drug resistance with a view to developing a strategy for the control of MDR (multi-drug resistant) and XDR TB in the province and elsewhere. TB incidence and treatment success rates, for each of the 11 districts in the province, were obtained from the provincial electronic TB register for the years 2002-2007. The results of culture and drug sensitivity tests for the years 2002 to 2007 in each of the districts were compiled and culture taking practices were compared to the number of MDR TB cases. Interviews were conducted with key personnel in affected sites. In 2007, 2799, or 2.3% of 119,218 notified TB cases in the province were multi-drug resistant (MDR), and of these 270 (9.6%) were XDR. The two worst affected districts were uMzinyathi where 226 (4.1%) of 5522 notified TB cases were MDR, and of these 120 (53%) were extensively drug resistant (X

The evolutionary and ecological dynamics of tumors under immune responses and therapeutic interventions pose major challenges to long-term treatment success. Although treatment may initially achieve short-term disease control, resistant cancer cell subpopulations often arise, leading to relapse with more aggressive and treatment-resistant forms of the disease. Here, we develop and analyze mathematical models describing the interactions among effector cells, chemo-resistant tumor cells, and immuno-resistant tumor cells under distinct immune-evasion strategies. The models incorporate competition and cooperation between resistant and sensitive tumor subpopulations. We identify threshold conditions governing tumor persistence, elimination, and phenotype dominance under varying therapeutic intensities. These findings provide a theoretical framework for designing targeted and combination therapies and offer insights into strategies for mitigating the treatment resistance.

The emergence of acquired drug resistance in cancer represents a major barrier to treatment success. While research has traditionally focused on genetic sources of resistance, recent findings suggest that cancer cells can acquire transient resistant phenotypes via epigenetic modifications and other non-genetic mechanisms. Although these resistant phenotypes are eventually relinquished by individual cells, they can temporarily 'save' the tumor from extinction and enable the emergence of more permanent resistance mechanisms. These observations have generated interest in the potential of epigenetic therapies for long-term tumor control or eradication. In this work, we develop a mathematical model to study how phenotypic switching at the single-cell level affects resistance evolution in cancer. We highlight unique features of non-genetic resistance, probe the evolutionary consequences of epigenetic drugs and explore potential therapeutic strategies. We find that even short-term epigenetic modifications and stochastic fluctuations in gene expression can drive long-term drug resistance in the absence of any bona fide resistance mechanisms. We also find that an epigenetic drug that slight

The role of Artificial Intelligence (AI) is growing in every stage of drug development. Nevertheless, a major challenge in drug discovery AI remains: Drug pharmacokinetic (PK) and Drug-Target Interaction (DTI) datasets collected in different studies often exhibit limited overlap, creating data overlap sparsity. Thus, data curation becomes difficult, negatively impacting downstream research investigations in high-throughput screening, polypharmacy, and drug combination. We propose xImagand-DKI, a novel SMILES/Protein-to-Pharmacokinetic/DTI (SP2PKDTI) diffusion model capable of generating an array of PK and DTI target properties conditioned on SMILES and protein inputs that exhibit data overlap sparsity. We infuse additional molecular and genomic domain knowledge from the Gene Ontology (GO) and molecular fingerprints to further improve our model performance. We show that xImagand-DKI-generated synthetic PK data closely resemble real data univariate and bivariate distributions, and can adequately fill in gaps among PK and DTI datasets. As such, xImagand-DKI is a promising solution for data overlap sparsity and may improve performance for downstream drug discovery research tasks. Code

This research presents a mathematical model of glioma growth dynamics with drug resistance, capturing interactions among five cell populations: glial cells, sensitive glioma cells, resistant glioma cells, endothelial cells, and neuron cells, along with two therapy agent populations: chemotherapy and anti-angiogenic therapy. Glioma is a malignant tumor originating from glial cells, undergoes chemotherapy-induced mutations, leading to drug-resistant glioma cells. This not only impacts glioma cells but also normal cells. Combining chemotherapy and anti-angiogenic therapy, the model employs a Holling type II response function, considering optimal dosages for treatment optimization. Through analysis, three equilibrium are identified: two stable and one unstable equilibrium points. Numerical simulations, employing phase portraits and trajectory diagrams, illustrate the combined therapies impact on glioma cells. In summary, this concise model explores glioma dynamics and drug resistance, offering insights into the efficacy of combined therapies, crucial for optimizing glioma treatment.

Practically, all chemotherapeutic agents lead to drug resistance. Clinically, it is a challenge to determine whether resistance arises prior to, or as a result of, cancer therapy. Further, a number of different intracellular and microenvironmental factors have been correlated with the emergence of drug resistance. With the goal of better understanding drug resistance and its connection with the tumor microenvironment, we have developed a hybrid discrete-continuous mathematical model. In this model, cancer cells described through a particle-spring approach respond to dynamically changing oxygen and DNA damaging drug concentrations described through partial differential equations. We thoroughly explored the behavior of our self-calibrated model under the following common conditions: a fixed layout of the vasculature, an identical initial configuration of cancer cells, the same mechanism of drug action, and one mechanism of cellular response to the drug. We considered one set of simulations in which drug resistance existed prior to the start of treatment, and another set in which drug resistance is acquired in response to treatment. This allows us to compare how both kinds of resistan

Longer timelines and lower success rates of drug candidates limit the productivity of clinical trials in the pharmaceutical industry. Promising de novo drug design techniques help solve this by exploring a broader chemical space, efficiently generating new molecules, and providing improved therapies. However, optimizing for molecular characteristics found in approved oral drugs remains a challenge, limiting de novo usage. In this work, we propose NovoMol, a novel de novo method using recurrent neural networks to mass-generate drug molecules with high oral bioavailability, increasing clinical trial time efficiency. Molecules were optimized for desirable traits and ranked using the quantitative estimate of drug-likeness (QED). Generated molecules meeting QED's oral bioavailability threshold were used to retrain the neural network, and, after five training cycles, 76% of generated molecules passed this strict threshold and 96% passed the traditionally used Lipinski's Rule of Five. The trained model was then used to generate specific drug candidates for the cancer-related PDGFRα receptor and 44% of generated candidates had better binding affinity than the current state-of-the-art drug,

Aims. Resistance to targeted therapies remains a major challenge in EGFR-mutant non-small cell lung cancer (NSCLC). Here, we describe a novel metabolic adaptation in osimertinib-resistant cells characterized by elevated acetate levels and activation of an unconventional pyruvate-acetaldehyde-acetate (PAA) shunt. Methods. Integrated transcriptomic, exometabolomic, and functional analyses reveal suppression of canonical metabolic pathways and upregulation of ALDH2 and ALDH7A1, that mediate the NADP+-dependent oxidation of acetaldehyde to acetate, generating NADPH. Results. This shift generates reducing power essential for biosynthesis and redox balance under conditions of oxidative pentose phosphate inhibition. These metabolic changes promote endurance in resistant cells and rewire the interplay between glycolysis, the pentose phosphate pathway, and the tricarboxylic acid cycle, offering a de novo bypass for anaplerosis and bioenergetics. Systematic metabolite profiling revealed distinct transcriptomic and metabolic signatures distinguishing resistant from drug sensitive parental cells. Conclusions. Together, these findings depict a unique, resistance-driven adaptive metabolic shift

Resistance to therapy remains a significant challenge in cancer treatment, often due to the presence of a stem-like cell population that drives tumor recurrence post-treatment. Moreover, many anticancer therapies induce plasticity, converting initially drug-sensitive cells to a more resistant state, e.g. through epigenetic processes and de-differentiation programs. Understanding the balance between therapeutic anti-tumor effects and induced resistance is critical for identifying treatment strategies. In this study, we introduce a robust statistical framework, based on multi-type branching process models of the evolutionary dynamics of tumor cell populations, to detect and quantify therapy-induced resistance phenomena from high throughput drug screening data. Through comprehensive in silico experiments, we show the efficacy of our framework in estimating parameters governing population dynamics and drug responses in a heterogeneous tumor population where cell state transitions are influenced by the drug. Finally, using recent in vitro data from multiple sources, we demonstrate that our framework is effective for analyzing real-world data and generating meaningful predictions.

Acquired resistance is one of the major barriers to successful cancer therapy. The development of resistance is commonly attributed to genetic heterogeneity. However, heterogeneity of drug penetration of the tumor microenvironment both on the microscopic level within solid tumors as well as on the macroscopic level across metastases may also contribute to acquired drug resistance. Here we use mathematical models to investigate the effect of drug heterogeneity on the probability of escape from treatment and time to resistance. Specifically we address scenarios with sufficiently efficient therapies that suppress growth of all preexisting genetic variants in the compartment with highest drug concentration. To study the joint effect of drug heterogeneity, growth rate, and evolution of resistance we analyze a multitype stochastic branching process describing growth of cancer cells in two compartments with different drug concentration and limited migration between compartments. We show that resistance is more likely to arise first in the low drug compartment and from there populate the high drug compartment. Moreover, we show that only below a threshold rate of cell migration does spatia

The continuous evolution of the SARS-CoV-2 virus poses a significant challenge to global public health. Of particular concern is the potential resistance to the widely prescribed drug PAXLOVID, of which the main ingredient nirmatrelvir inhibits the viral main protease (Mpro). Here, we developed CAPTURE (direCted flAg laPlacian Transformer for drUg Resistance prEdictions) to analyze the effects of Mpro mutations on nirmatrelvir-Mpro binding affinities and identify potential drug-resistant mutations. CAPTURE combines a comprehensive mutation analysis with a resistance prediction module based on DFFormer-seq, which is a novel ensemble model that leverages a new Directed Flag Transformer and sequence embeddings from the protein and small-molecule-large-language models. Our analysis of the evolution of Mpro mutations revealed a progressive increase in mutation frequencies for residues near the binding site between May and December 2022, suggesting that the widespread use of PAXLOVID created a selective pressure that accelerated the evolution of drug-resistant variants. Applied to mutations at the nirmatrelvir-Mpro binding site, CAPTURE identified several potential resistance mutations,

Drug resistance is a serious public health problem that threatens to thwart our ability to treat many infectious diseases. Repeatedly, the introduction of new drugs has been followed by the evolution of resistance. In principle there are two ways to address this problem: (i) enhancing drug development, and (ii) slowing drug resistance. We present data and a modeling approach based on queueing theory that explores how interventions aimed at these two facets affect the ability of the entire drug supply system to provide service. Analytical and simulation-based results show that, all else equal, slowing the evolution of drug resistance is more effective at ensuring an adequate supply of effective drugs than is enhancing the rate at which new drugs are developed. This lends support to the idea that evolution management is not only a significant component of the solution to the problem of drug resistance, but may in fact be the most important component.

Clinicians prescribe antibiotics by looking at the patient's health record with an experienced eye. However, the therapy might be rendered futile if the patient has drug resistance. Determining drug resistance requires time-consuming laboratory-level testing while applying clinicians' heuristics in an automated way is difficult due to the categorical or binary medical events that constitute health records. In this paper, we propose a novel framework for rapid clinical intervention by viewing health records as graphs whose nodes are mapped from medical events and edges as correspondence between events in given a time window. A novel graph-based model is then proposed to extract informative features and yield automated drug resistance analysis from those high-dimensional and scarce graphs. The proposed method integrates multi-task learning into a common feature extracting graph encoder for simultaneous analyses of multiple drugs as well as stabilizing learning. On a massive dataset comprising over 110,000 patients with urinary tract infections, we verify the proposed method is capable of attaining superior performance on the drug resistance prediction problem. Furthermore, automated

Bacterial populations often have complex spatial structures, which can impact their evolution. Here, we study how spatial structure affects the evolution of antibiotic resistance in a bacterial population. We consider a minimal model of spatially structured populations where all demes (i.e., subpopulations) are identical and connected to each other by identical migration rates. We show that spatial structure can facilitate the survival of a bacterial population to antibiotic treatment, starting from a sensitive inoculum. Specifically, the bacterial population can be rescued if antibiotic resistant mutants appear and are present when drug is added, and spatial structure can impact the fate of these mutants and the probability that they are present. Indeed, the probability of fixation of neutral or deleterious mutations providing drug resistance is increased in smaller populations. This promotes local fixation of resistant mutants in the structured population, which facilitates evolutionary rescue by drug resistance in the rare mutation regime. Once the population is rescued by resistance, migrations allow resistant mutants to spread in all demes. Our main result that spatial structu