Produced by microbes both, bacteriophages and bactericines are two types’ antibacterial agents of especial interest in the combating the antimicrobial resistance (AMR).
3.2.3.1. Bacteriophages
Bacteriophages (phages) are viruses, able to infect bacterial cells and force them to produce viral components, using a lytic or lysogenic cycle. Bacteriophages are potential alternative of chemical antimicrobial agents used against pathogens that are of public health significance. Understanding the phage diversity and host specificity is important for the development of effective phage biocontrol approaches, [
184].
Thousands bacteriophages of different types could be find everywhere. Bacteriophages were discovered over a century ago, but their use for treatment of antibiotic-resistant infections regained popularity only recently. In contrast to many antibiotics, which damage harmful bacteria, and simultaneously disturb the all microbiota thus triggering a new set of problems, each phage more narrowly targets bacterial strains or species. This specificity makes phage therapy an attractive approach for treating of antibiotic-resistant bacterial infections, including such caused by multi-drug resistant bacteria. The bacteriophages provide other advantages over antibiotics, like less significant side effects, less time-consuming and less costly development process, [
185,
186]. Because it’s many advantages, phage therapy survives currently its renaissance after long years of different doubts. Recently, the U.S. National Institutes of Health (NIH) awarded
$2.5 million to 12 institutes around the world to study phage therapy, [
187,
188].
Phages are the only drug that reproduces itself at the site of infection and disintegrates again after lysis of all suitable bacteria. They contain DNA or RNA in their genome that is encapsulated in a protein coat. Many phage proteins, including endolysins (lysins), virion-associated peptidoglycan hydrolases (VAPGHs), depolymerases, and holins display antibacterial activity. Since several phage types may be suitable for one bacterial pathogen from a set of available phage types, the therapeutic use of mixtures of different phage types is optimal. The specificity of phages is their major advantage over antibiotics. It is also the main reason for the individual character of phage application as a tailor-made therapy in individual cases. Main families and characteristics of bacteriophages are in debt presented by Bin Hafeez et al., [
139].
Phages against Staphylococcal Infections
In terms of potential medical applications, phages belonging to the Kayvirus genus of the Herelleviridae family are regarded as the most interesting ones. Kayviruses have already demonstrated their efficacy in the treatment of various
Staphylococcus aureus infections, both in animal models and human clinical cases, [
189,
190]. A phage belonging to the kayvirus lytic module was isolated that encodes an additional endolysin, [
191]. The polyvalent, Kayvirus genus phages, infecting mostly
S. aureus and some CoNS and displaying a broad spectrum biological activity are one of the best agents controlling staphylococcal infections, [
192,
193,
194]. Some of the kayvirus phages have already been used in commercial phage-based preparations to treat DFI, [
195]. Studies on phage therapy for staphylococcal infections are focused mainly on
S. aureus and only a few on the isolation and characterization of phages infecting the clinical isolates of CoNS, especially
Staphylococcus epidermidis, [
192,
195].
Fanaei Pirlar et al. [
196] describe one of the novel bacteriophages specific against
S. epidermidis and with antibiofilm activity. Important for the success of phage therapy,
in vitro techniques and measurements of phage characteristics are presented, [
197]. Comparative assessment of the bacteriophage and antibiotic activity against multidrug-resistant
S. aureus biofilms shows that while the antibiotics cannot diffuse through the polymeric matrix of a biofilm, the Kayviruses can effectively penetrate and disrupt
S. aureus and
S. epidermidis biofilm structures, [
198,
199].
Alsaadi et al. [
200] report the isolation and genome sequencing of 40 bacteriophages from human skin SWABS that infect coagulase-negative
Staphylococcus (CoNS) species, which extends the knowledge of phage diversity. Six genetic clusters of phages were identified with two clusters representing novel phage species, one of which was characterized and named Alsa phages. The identified Alsa phages have a greater ability to infect the species
S. hominis that were otherwise less infected than other CoNS species by the isolated phages. This indicates an undescribed barrier to phage infection that could be due to numerous restriction-modification systems. The extended diversity of
Staphylococcus phages here enables further research to define their contribution to skin microbiome research and the mechanisms that limit phage infection.
Staphylococcus sp. is the most common bacterial genus in infections related to diabetic foot ulcers (DFUs). Plumet et al. [
201] isolate six phages (SAVM01 to SAVM06) from effluents of diabetic foot ulcers (DFUs), belonging to the
Herelleviridae family, with sequences similar to those of the
Kayvirus genus. No lysogeny-associated genes, known virulence or drug resistance genes were identified in the phage genomes. The phages display a strong lytic and antibiofilm activity against DFU clinical isolates, as well as against opportunistic pathogenic coagulase-negative staphylococci. The experimental results suggest that these phages could be effective biocontroling agents against staphylococcal clinical isolates from DFUs.
Phages against Pseudomonas Infections
Bacteria surviving in extreme conditions and the bacteriophages that infect them are sources of heat-stable proteins that are utilized in biotechnological applications but not as antimicrobial agents. Plotka et al. [
202] demonstrate that the Ts2631 endolysin from the extremophilic bacteriophage vB_Tsc2631, which infects
Thermus scotoductus, is very active against the multidrug-resistant clinical strains of
Acinetobacter baumannii,
Pseudomonas aeruginosa and pathogens from the
Enterobacteriaceae family, i.e. Ts2631 endolysin could be an effective antimicrobial agent against Gram-negative multidrug-resistant bacteria. Transmission electron microscopy (TEM) and fluorescence microscopy observations of
A. baumannii cells, treated with Ts2631 endolysin variants, demonstrate that the intrinsic antibacterial activity of Ts2631 endolysin depends on the presence of its N-terminal tail, [
202].
A novel phage, pPa_SNUABM_DT01, infecting
Pseudomonas aeruginosa canine otitis externa isolates was characterized by its morphology, growth, lysis kinetics, and genomic characteristics. Comparative genome analysis demonstrates that the phage is a novel species in
Myoviridae. The nucleotide similarity was moderately high compared to the
Pseudomonas virus, Noxifer. However, a phylogenetic analysis and a dot plot indicate that pPa_SNUABM_DT01 is not closely related to the
Phikzvirus or
Noxifervirus genus, instead, it belongs to a novel one, [
203].
Proteus mirabilis and
P. aeruginosa are two bacterial species commonly associated with urinary tract infections in humans. Novel bacteriophages and their derived proteins were developed for the biocontrol of
Proteus and
Pseudomonas biofilms. The identification and utilisation of both, the whole phage and its tail-spike protein with the pectate lyase activity are described to treat
P. mirabilis biofilms. The phage and the tail-spike protein were assessed by different
in vivo and
in vitro assays that demonstrate their antibacterial and antivirulence properties against
P. mirabilis biofilms. The combinational treatment of
P. aeruginosa biofilms by phage and cold atmospheric plasma establishes that the use of cold atmospheric plasma followed by exposure to
P. aeruginosa phages is the most effective for eradication of
P. aeruginosa biofilms, [
204].
Two bacteriophage genera (targeting
B. mycoides and
Pseudomonas species) discovered in a groundwater reservoir highlight subsurface environments as underexplored biotopes in bacteriophage ecology, [
205].
Phages against Escherichia coli Infections
Sattar et al. [
206] report isolation, preliminary characterization, and genome analysis of two novel lytic phage species (
Escherichia phage SKA49 and
Escherichia phage SKA64) having lysis potential against MDR strain of avian pathogenic
E. coli, QZJM25. Both phages, SKA49 and SKA64, are able to keep QZJM25 growth significantly less than the untreated bacterial control for approximately 18 h, being stable at 37 °C only. In contrast to SKA64, SKA49 demonstrates a broader host range against
Escherichia coli strains. Genome analysis indicates their safety because no recombination, integration and host virulence genes were identified.
Nicolas et al. [
207] isolate and characterize a novel phage collection against avian-pathogenic
E. coli (APEC). The collection includes nineteen genetically diverse, lytic
E. coli phages, eighth of which were tested in combinations for their efficacy in controlling of avian patogenic
E. coli infections. Genome homology analysis reveals that the phages belong to nine different genera, one of them being a novel genus (Nouzillyvirus). The broad host range of some phages is partially explained by the presence of receptor-binding protein carrying a polysaccharidase domain. To demonstrate their therapeutic potential, a phage cocktail consisting of eight phages belonging to eight different genera, was tested against BEN4358, an APEC O2 strain. This phage cocktail fully inhibits
in vitro, the growth of BEN4358.
Phages for Global Health (PGH) is training scientists in the region of East Asia to isolate relevant therapeutic phages for pathogenic bacteria within their locality, and thus contributing to making phage technology universally available. During the inaugural PGH workshop in East Africa, samples from Ugandan municipal sewage facilities were collected and two novel E. coli lytic phages were isolated and characterized.
The phages, UP19 and UP30 lysed ∼82% and ∼36% of the 11 clinical isolates examined, respectively. The genomes of UP19 (171.402 kb, 282 CDS) and UP30 (49.834 kb, 75 CDS) closely match the genera Dhakavirus and Tunavirus, respectively. The isolated phages have therapeutic potential for further development of treatments against
E. coli infections, [
208].
Phages against Salmonella Infections
Plasmid-dependent phages infect bacteria carrying conjugative plasmids by recognizing the plasmid-encoded pilus. Two lytic phages from wastewater were isolated using a virulent strain of
Salmonella enterica carrying the conjugative IncN plasmid pKM101. Both phages, named Lu221 and Hi226, are novel dsDNA viruses within the class Caudoviricetes with genomes of approximately 76 kb. They show broad host range infecting
E. coli, S. enterica, Kluyvera sp., and
Enterobacter sp. carrying conjugative plasmids. They recognize plasmid-encoded receptors from 12 out of 15 tested plasmids, all of them carrying resistance determinants, [
209].
Genomic and phenotypic analysis of
S. enterica phages identifies two novel phage species. The host range, morphology, and genetic diversity of eight
S. enterica phages isolated from a wastewater treatment plant were assessed. The host range analysis revealed that six out of eight phages lysed more than 81% of the 43
S. enterica isolates tested. Whole-genome sequencing (WGS) data revealed that phage genome sizes ranged from 41 to 114 kb, with GC contents between 39.9 and 50.0%. Two of the phages SB13 and SB28 represent new species,
Epseptimavirus SB13 and
Macdonaldcampvirus, respectively, as designated by the International Committee for the Taxonomy of Viruses (ICTV) using genome-based taxonomic classification. One phage (SB18) belonges to the
Myoviridae morphotype while the remaining phages belonge to the
Siphoviridae morphotype. None of the phages possesses virulence, toxin, antibiotic resistance, type I–VI toxin–antitoxin modules, or lysogeny genes (by gene content analyses), [
210].
Others
Nakonieczna et al. [
211] discover three novel bacteriophages, J5a, F16Ba, and z1a, specific for
Bacillus anthracis (able to be highly lethal) by screening environmental samples from various regions in Poland and present their basic characteristic. The new phages and their closest relative phages Tavor_SA, Negev_SA, and Carmel_SA, form a separate clade of the
Wbetavirus genus, were designated as J5a clade. The comparative genomic analysis indicates that the new bacteriophages encode two receptor-binding proteins, of which one may bind a sugar moiety of
B. anthracis cell surface.
The global warming favored becoming of a range of bacteria, such as Aeromonas hydrophila, pathogenic to humans. They are not easy for treatment by traditional methods due to their capacity to form biofilms. Bacteriophage offer a possible alternative approach for controlling the growth of the biofilms.
Kabwe et al. [
212] first report the isolation and characterization of bacteriophages which carry intrinsic antibiotic resistance genes and are capable to disrupt biofilms caused by clinical isolates of
A. hydrophila.
Kallies et al. [
213] identify huge phages (with genomes larger than 200 kilobases) from wastewater metagenomes by screening of 165 wastewater metagenomes for the presence of viral sequences. The dataset of over 600 identified potential huge phage genomes, was reduced using manual curation by excluding these did not containing viral protein-coding genes or consisting of concatemers of several small phage genomes. A phylogenomic analysis of the huge phages and phages with smaller genomes (less than 200 kb) support the hypothesis that huge phages have undergone convergent evolution. The genomes containes typical phage protein-coding genes, sequential gene cassettes for metabolic pathways, and complete inventories of tRNA genes covering all standard and rare amino acids.
3.2.3.2. Bacteriocines
Bacteria produce a range of antimicrobial peptides, the most diverse of which are bacteriocins. Bacteriocines are small antimicrobial peptides (peptide toxins), synthesized by ribosomes of both Gram-positive and Gram-negative bacteria and usually display activity against bacteria (pathogenic and multi-drug resistant), phylogenetically related to the producing strain. The antimicrobial activity spectrum depends on the peptide that can target several bacteria, [
214,
215].
The selectivity and safety profile of the bacteriocins are their superior advantages over traditional antibiotics; however, the bacteriocins are susceptible to degradation by proteolytic enzymes and therefore have low
in vivo stability. In addition, their large-scale production is problematic. It is expected, that such limitations will be avoided by extensive research, including development novel drug delivery systems, [
216].
Yount et al. describe discovery of Type II bacteriocins, using a new high dimensional bioinformatic algorithm. In this way, all bacteriocin families of Type II were detected whereupon identified putative bacteriocins with broad-spectrum antimicrobial activity against a range of human pathogens. The putative bacteriocin sequences are from different microorganisms:
Bacillus thuringiensis, Eubacterium rectale, B. cereus and
Enterococcus pallens, [
217].
Bacteriocines from Lactic Acid Bacteria
Lactic acid bacteria (LAB) are one of the most used bacteria to produce bacteriocins that could serve as alternatives of conventional antibiotics.
Enterococcus faecalis, Lactobacillus fermentum, L. plantarum, L. helveticus, L. pentosus, L. paracasei subsp
. paracasei, L. rhamnosus I, and L. delbrueckii subsp.
lactis are strong strains in bacteriocins production. To date, Nisin, Pediocin PA-1, and Micocin are the only FDA-approved bacteriocins to use as food preservatives, [
218].
LAB-bacteriocins could be used alone, or as potentiating agents to treat bacterial infections with aim to reduce the use of traditional antibiotics and to develop novel therapeutic options. Most LAB-bacteriocins act by disturbing the cytoplasmic membrane through forming pores, or by cell wall degradation. Some of the bacteriocines that are active against Gram-negative bacteria, still have unknown mode of action. The most bacteriocins-producing strains have immunity mechanism, involving an immunity protein and a dedicated transport system. The immunity mechanisms usually vary from one bacteriocin to another, [
184].
Lei et al. [
219] present partial purification and characterization of a broad-spectrum bacteriocin, produced by isolated from infant’s feces
Lactobacillus plantarum ZRX03. The fermentation supernatant, produced by this strain inhibits
E. coli,
Staphylococcus aureus, and
Listeria monocytogenes (inhibition zone of 12.83 ± 0.62 mm, 15.08 ± 0.31 mm, 6.75 ± 0.20 mm, respectively,) stronger than the lactic acid bacteria N1, N2, M13, M21, M31, and M37. Ethyl acetate was selected as the optimal crude extract solution. A broad-spectrum antimicrobial activity was shown for the obtained bacteriocin, inhibiting Gram-positive bacteria, Gram-negative bacteria and yeast, including
S. aureus,
Bacillus subtilis,
Bacillus anthracis,
E. coli, and
Salmonella, [
219]. Circular bacteriocin, plantacyclin B21AG from
Lactiplantibacillus Plantarum B21 (isolated from nem chua, Vietnamese sausage) was discovered with broad spectrum antimicrobial activity against Gram-positive bacteria, high thermostability and proteolytic resistance, [
220]. Bacteriocin-like peptide (SLG10), made by
Lactobacilus plantarum strain
, with antimicrobial activity against both Gram-positive and Gram-negative bacteria, was isolated from kombucha (a fermented bubble tea). Stability studies show that the peptide retains its antimicrobial properties for 14 days at 37° C and for 2 months at 4°C being stable at pH values between 2.0 and 7.0, [
221].
A novel bacteriocin LSX01 of
Lactobacillus paracasei LS-6 was isolated from a traditional fermented yogurt (produced in Yunnan, China), purified and characterized. The LSX01 exhibits an extensive antimicrobial spectrum against both Gram-positive and Gram-negative bacteria as well as a tolerance to heat, acid-base treatments, and a sensitivity to proteolytic enzymes. The treatment of
S. aureus planktonic cells with LSX01 significantly reduces their metabolic activity and disrupts the cell membrane integrity. A biofilm formation of
S. aureus is also significantly inhibited, [
222].
Thuy et al. [
223] characterize the broad-spectrum antibacterial activity of bacteriocin-like inhibitory substance-producing probiotics, isolated from fermented foods. Selected lactic acid bacteria (LAB) with probiotic potential were evaluated by various tests, including exopolysaccharide production, antibiotic susceptibility, acid and bile tolerance, antibacterial activity, and cell adhesion and cytotoxicity to gastric cell lines. Six selected LAB strains demonstrate high viability under gastrointestinal conditions, produce high exopolysaccharides, show no or less cytotoxicity, and adhere successfully to gastric cells. Three strains,
Weissella confusa ,
Lactiplantibacillus plantarum , and
Limosilactobacillus fermentum, demonstrate a strong antibacterial effect against drug-resistant
Escherichia coli, Klebsiella pneumoniae,
Pseudomonas aeruginosa,
Salmonella enterica serovar Choleraesuis,
Enterococcus faecium, and
Staphylococcus aureus. The whole genome sequencing of these three strains (using the Nanopore platform) shows that they do not harbor genes related to toxins, super antigens, and acquired antimicrobial resistance. The extract of CYLB30 and CYLB47 bacteriocin-like substances (BLIS) inhibit the growth and biofilm formation of drug-resistant
P. aeruginosa and methicillin-resistant
S. aureus, causing membrane disruption and inhibiting adhesion ability to human skin HaCaT cells.
Lacticaseibacillus paracasei-derived antibacterial peptide NGJ1D was found in the fermentation broth of
L. paracasei. The antibacterial peptide NGJ1D has minimum inhibitory concentration (MIC) of 62.5 μg/mL against
Staphylococcus aureus and could kill the bacteria within 3 h, [
224].
Enterococcus faecalis (CAUM157), a Gram-positive bacteria isolated from raw cow’s milk, was studied for its bacteriocin production.
In vitro and
in silico characterization of N-formulated, di-peptide bacteriocin from
E. faecalis was lately presented with anti-
Listeria activity. The antimicrobial activity of CAUM157 was attributed to a two-peptide class IIb bacteriocins with potent activity against food-borne pathogen
Listeria monocytogenes and periodontal disease-causing pathogens (
Prevotella intermedia KCTC 15693
T and
Fusobacterium nucleatum KCTC 2488
T). Although
E. faecalis CAUM157 innately has genes for virulence factors and antibiotical resistance (e.g., tetracycline and erythromycin), its bacteriocin production is valuable for the needs of
in live microorganisms and pathogens control, [
225]. Cui et al. [
226] perform purification and characterization of novel bacteriocins, produced by
E. faecalis CG9
from human saliva that inhibit the growth of Gram-negative bacteria. Study of the one of the isolated from
E. faecium bacteriocins, Plantacyclin B21AG, shows its excellent stability and bactericidal activity against sporulating bacteria such as
Clostridium perfringens and non-sporulating
Listeria monocytogenes. Sharma et al. [
227] found that the produced by
vaginal E. faecium enterocin 12 A inhibits multidrug resistant Gram-negative bacteria such as
Salmonella enterica, Shigella flexneri,
E. coli, and
Vibrio cholerae, as well as the proliferation of cancer cells.
Bacteriocines from Staphylococci
Newstead et al. [
228] isolate several bacteriocins from commensal coagulase-negative
Staphylococci, many of which display
in vitro and
in vivo inhibiting activity against
S. aureus. The ability of these bacteriocins to destroy a biofilm formation, their novel mechanisms of action and efficiency against antibiotic-resistant bacteria make them novel antibacterial candidate therapeutic. Ovchinnikov et al. [
229] report successful development of bacteriocins into therapeutic formulation for treatment of methicillin-resistant
Staphylococcus aureus (MRSA) skin infection in a murine model. The potential of two broad-spectrum bacteriocins, garvicin KS and micrococcin P1, were explored in this study for skin infection treatments. The two bacteriocins act synergistically with each other and with penicillin G in killing MRSA
in vitro. To assess its therapeutic potential, the three-component formulation was involved in a murine skin infection model with a multidrug-resistant luciferase-tagged MRSA Xen31, a strain derived from the clinical isolate
S. aureus ATCC 33591. The efficiency of the three-component formulation, in eradicating the pathogen from treated wounds was demonstrated by using of the tagged-luciferase activity as a reporter for the presence of Xen31 in wounds. As compared to Fucidin cream, which is an antibiotic commonly used in skin infection treatments, this formulation appears to be superior in terms of preventing the development of resistance, [
229].
Bacteriocines from Streptomyces
Exploring antibacterial properties of bioactive compounds, isolated from
Streptomyces sp. in bamboo rhizosphere soil (collected within the Megamalai forest of the Western Ghats in the Theni zone of Tamil Nadu, India) was presented lately. Bioactive compounds were extracted from the culture medium using ethyl acetate. Their antibacterial and antioxidant activities were evaluated through disc diffusion and DPPH radical scavenging methods, respectively. Ethyl acetate extracts were analysed by FT-IR and GC–MS techniques. Among total nine strains of
Actinobacteria, the strain BS-16 identified as
Streptomyces sp., displays remarkable antibacterial activity against three strains:
S. aureus,
B. subtilis, and
Streptococcus pyogenes with inhibition zone of 19 mm, 12 mm and 10 mm respectively, [
230].