The effective treatment of bacterial infections of skin, deep soft tissues and wounds continues to be a
major unmet challenge in healthcare settings, especially among patients with chronic diabetes. Staphylococcus
aureus and Pseudomonas aeruginosa are the most common bacteria that are isolated from chronic, non-
healing wounds. Antibiotic resistance has arisen in these particular bacteria, causing these infections to
become increasingly difficult to treat and giving rise to multi-drug resistant strains, including Methicillin-resistant
Staphylococcus aureus (MRSA).
The goal of the proposed work is to develop the next generation of therapeutics for which the design is
inspired by a better mechanistic understanding of mammalian antimicrobial defense pathways. We focus our
attention on the antimicrobial activities of neutrophil extracellular traps (NETs) and lipid droplet (LDs), which
use histones to kill or suppress fungal and bacterial proliferation. The antimicrobial mechanism of histones has
not been understood. The Siryaporn and Gross labs recently reported that the pairing of histones with an
additional component found in NETs and LDs – the antimicrobial peptide (AMP) LL-37 (cathelicidin) –
produces potent antimicrobial synergy. LL-37 forms pores in the bacterial membrane, which enable histones to
enter the bacterium and interfere with gene expression. This has an irreversible bactericidal (killing) effect on
bacteria. The work proposed here will exploit this discovery by identifying combinations of human histones and
pore-forming antimicrobial agents that produce potent antimicrobial activity and synergy. The overall objective
of the project is to better understand the mechanism of antimicrobial synergy between histones and pore-
forming agents, and to harness it to create a class of new therapeutics for the treatment of skin infections and
We will accomplish this objective by identifying combinations of human histones with LL-37 and other
pore-forming antimicrobials that produce the greatest antimicrobial activities and synergies. We will test these
against S. aureus, P. aeruginosa, and communities of skin bacteria in vitro (Aim 1). We will attempt to augment
the antimicrobial activity by engineering in factors that impact histone function in NET and LDs, specifically
chemical modification through citrullination and spatial localization to structures (Aim 2). To bring the strategy
closer to the clinic, we will test the combinations of histones and pore-forming antimicrobials identified in Aims
1 and 2 in a standardized mouse skin infection model (Aim 3). To additionally address the unmet challenge of
treating skin infection and wounds in diabetes patients, we will perform the tests in a diabetic mouse model.
The results of this work will provide a mechanistic understanding of antimicrobial synergy and develop
a strategy to combat the rise of antibiotic resistance. The results of the study could create a new class of
antimicrobial therapeutics for the treatment of skin infections and wounds in diabetic and non-diabetic patients.
This would represent a game-changer in the approach to antimicrobial treatments.