A step forward on the in vitro and in vivo validation of rifabutin-loaded liposomes for the management of highly virulent MRSA infections

Staphylococcus aureus (S. aureus) infections, especially methicillin resistant (MRSA), constitute an alarming public health issue due to its association with high mortality, morbidity, and hospitalization costs. The increasing antibiotic resistance and biofilm-associated infections of MRSA prompted the discovery of novel and more effective therapeutic strategies. Our team has been working on alternative therapies against S. aureus infections. For this, we have been repurposing an existing antibacterial drug, rifabutin (RFB), through its association to a nanotechnological platform, liposomes, aiming to promote a preferential targeting to infected sites and maximizing its potential antibacterial effect. The therapeutic potential of RFB formulations against a MRSA commercial strain (MRSA ATCC®-33592), either in planktonic or biofilm forms, was assessed. RFB displayed higher antibacterial effects towards biofilm than vancomycin (VCM), the gold standard treatment against MRSA infections, with MBIC₅₀ values of 103 and > 800 μg/mL, respectively. Moreover, the antimicrobial effect of RFB-loaded liposomes demonstrated to be lipid composition-dependent based on MIC₅₀ and MBIC₅₀ values, which was also confirmed by confocal laser scanning microscopy. These studies supported that for positively charged RFB liposomes an electrostatic interaction at biofilm surface occurs without internalization. On the other hand, for RFB-loaded liposomes with neutral surface charge a high internalization within the biofilm was observed. Moreover, this RFB liposomal formulation has also demonstrated to be stable in human plasma, as more than 83 % of RFB was still associated to liposomes 24 h after incubation at 37 °C. The proof of concept of RFB formulations was assessed in MRSA systemic murine models of infection. Therapeutic effect and survival rates were evaluated for animals induced and treated with RFB in free and liposomal forms and compared with negative and positive controls. For the lower infection murine model, 100 % survival was achieved for all groups under study. However, in a higher infection model only for the group of animals treated with RFB incorporated in liposomes a 100 % survival was attained. In terms of bacterial burden, RFB formulations exhibited lower levels when compared to VCM, even using a lower therapeutic dose: 20 vs 40 mg/kg of body weight, respectively. Overall, RFB constitutes an alternative and effective therapeutic strategy towards MRSA infections, being this effect potentiated through its association to a lipid nanoplatform.