Strategies for Quorum Sensing inhibition as a tool for controlling Pseudomonas aeruginosa infections.

Antibiotic resistance is one of the most important concerns in global health today. Thus, a growing number of different infections are becoming harder to treat with conventional drugs and this is aggravated by the fact that fewer new antibiotics are being developed. In this context, strategies based on blocking or attenuating virulence pathways could position as very interesting therapeutic approaches since they do not focus on bacteria eradication, which should reduce the selective pressure exerted on the pathogen. This virulence depletion can be achieved by inhibiting the conserved quorum sensing (QS) system, a mechanism that enables bacteria to communicate one another in a density dependent manner. QS regulates gene expression leading to the activation of some important processes such as virulence and biofilm formation among others. Therefore, this review points out the approaches reported so far for disrupting different steps of the QS system of the multiresistant pathogen Pseudomonas aeruginosa. With this aim, the authors describe different types of molecules (enzymes, natural and synthetic small molecules, antibodies…) already identified as P. aeruginosa quorum quenchers (QQs) or QS inhibitors (QSIs) grouped according to the QS circuit that they block (Las, Rhl, Pqs and some examples from the controversial pathway Iqs). The importance of the discovery of new QSIs and QQs is expected to help on reducing antibiotic doses or at least to act as adjuvants to increase antibiotic treatment effect. Moreover, this article also highlights the advantages and possible drawbacks of each strategy and it also summarizes future perspectives in the field.