Structure and mechanism of taniborbactam inhibition of the cefepime-hydrolyzing, partial R2-loop deletion Pseudomonas -derived cephalosporinase variant PDC-88.
Mack, A.R., Kumar, V., Bethel, C.R., Taracila, M.A., Miller, B.A., Uehara, T., Six, D.A., Papp-Wallace, K.M., van den Akker, F., Bonomo, R.A.(2025) Antimicrob Agents Chemother : e0007825-e0007825
- PubMed: 40503958 
- DOI: https://doi.org/10.1128/aac.00078-25
- Primary Citation of Related Structures:  
9AZU, 9AZW, 9AZY - PubMed Abstract: 
Pseudomonas aeruginosa is a major gram-negative pathogen responsible for a variety of infections and possessing an array of both intrinsic and acquired resistance mechanisms, including ¦Â-lactamases, like the chromosomal Pseudomonas -derived cephalosporinase (PDC). ¦Â-Lactams are the most widely prescribed class of antibiotics in the United States, and antipseudomonal cephalosporins (including cefepime) are important therapies (alone or combined with ¦Â-lactamase inhibitors) for P. aeruginosa infections. Taniborbactam is a novel, bicyclic boronate ¦Â-lactamase inhibitor with activity against all ¦Â-lactamase classes and is being developed in combination with cefepime. PDC-88 is an R2-loop deletion variant conferring resistance to cefepime and ceftazidime and elevating ceftolozane/tazobactam minimum inhibitory concentration (MIC). Herein, we elucidated PDC-88 resistance mechanisms and compared inhibition by taniborbactam and avibactam. In an isogenic background, PDC-88 increased cefepime MICs by 16-fold compared to PDC-3. In vitro , compared to PDC-3, PDC-88 had 8.3-fold higher catalytic efficiency for cefepime achieved by decreasing K M 12.8-fold and decreasing k cat 1.6-fold. This is supported by our crystallographic observation that the PDC-88 deletion enlarged the active site in the vicinity of the R2-loop, likely better accommodating cefepime. Taniborbactam and avibactam restored cefepime activity by inhibiting PDC-88. Compared to avibactam, taniborbactam had 4.1- and 9-fold lower K i app values for PDC-3 and PDC-88, respectively, with higher k on ( k 2 / K ) and similar k off for both enzymes. Structurally, taniborbactam positioned very similarly in the PDC-3 and PDC-88 active sites, interacting with many nearby residues. Based upon these data, cefepime-taniborbactam may represent an important alternative to ceftazidime-avibactam and ceftolozane-tazobactam for P. aeruginosa infections.
Organizational Affiliation: 
Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, USA.