Figure 1. Oxyclozanide enhances aminoglycosides and tetracycline

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Figure 1. Oxyclozanide enhances aminoglycosides and tetracycline Figure 1. Oxyclozanide enhances aminoglycosides and tetracycline. Biofilms (24 h old) were treated for 6 h with oxyclozanide (100 μM), tobramycin (500 μM), gentamicin (100 μM), streptomycin (100 μM) or tetracycline (100 μM), alone and in combination, and the number of viable cells within the biofilms was quantified by BacTiter-Glo<sup>TM</sup>. The assay was performed at least three times in triplicate. The results represent means plus the SEM. A one-way ANOVA followed by Bonferroni’s multiple comparison post hoc test was used to determine statistical significance between the combination and each antibiotic alone (*P < 0.05). From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 2. Oxyclozanide kills S. aureus biofilms. S Figure 2. Oxyclozanide kills S. aureus biofilms. S. aureus biofilms (24 h old) were treated with oxyclozanide (100 μM) or tobramycin (100 μM), alone and in combination, for 6 h. The number of viable cells within the biofilms was quantified by BacTiter-Glo<sup>TM</sup>. The assay was performed twice in triplicate. The results represent means plus the SEM. A two-way ANOVA followed by Bonferroni’s multiple comparison post hoc test was used to determine statistical significance between either oxyclozanide alone and tobramycin alone or the combination and tobramycin alone (*P < 0.05). From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 3. Dose–response curve of oxyclozanide or tobramycin alone and in combination. P. aeruginosa biofilms (24 h old) were treated for 6 h with oxyclozanide or tobramycin alone and in combination, in equal molar two-fold dilutions, and the number of viable cells within the biofilms was quantified by BacTiter-Glo<sup>TM</sup>. The assay was performed at least three times in triplicate. The results represent means ± SEM. A one-way ANOVA followed by Bonferroni’s multiple comparison post hoc test was used to determine statistical significance between the combination and tobramycin alone (*P < 0.05). From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 4. A chequerboard dilution series of oxyclozanide and tobramycin. Twenty-four hour biofilms were treated with varying combinations of oxyclozanide and tobramycin for 6 h. The number of viable cells within the biofilms was quantified by BacTiter-Glo<sup>TM</sup>. The assay was performed twice in triplicate. The results represent means ± SD. A two-way ANOVA followed by Bonferroni’s multiple comparison post hoc test was used to determine statistical significance between the combination and tobramycin alone. Shaded cells indicate significance compared with tobramycin alone (P < 0.05). From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 5. Oxyclozanide accelerates tobramycin killing of P Figure 5. Oxyclozanide accelerates tobramycin killing of P. aeruginosa biofilms. Twenty-four hour biofilms were treated with oxyclozanide (100 μM) or tobramycin (500 μM), alone and in combination. At 0, 2, 4, 6, and 8 h, the number of viable cells within the biofilms was determined by BacTiter-Glo<sup>TM</sup>. The assay was performed at least three times in triplicate. The results represent means ± SEM. A one-way ANOVA followed by Bonferroni’s multiple comparison post hoc test was used to determine statistical significance between the combination and tobramycin alone (*P < 0.05). From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 6. Oxyclozanide does not induce biofilm dispersal Figure 6. Oxyclozanide does not induce biofilm dispersal. Twenty-four hour biofilms were treated with oxyclozanide, tobramycin or the combination, in equal molar two-fold dilutions, for 6 h. The effect on biofilm biomass was quantified by staining with crystal violet. The experiment was performed twice in triplicate. The results represent the means plus SEM. A one-way ANOVA followed by Bonferroni’s multiple comparison post hoc test was used to determine statistical significance between tobramycin alone and the untreated control (*P < 0.05) and between the combination and tobramycin alone. NS, not significant. From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 7. Oxyclozanide is broadly active against P. aeruginosa Figure 7. Oxyclozanide is broadly active against P. aeruginosa. Twenty-four hour biofilms were treated with oxyclozanide (100 μM) or tobramycin (500 μM), alone and in combination for 6 h. The number of viable cells within the biofilms was quantified by BacTiter-Glo<sup>TM</sup>. The assay was performed three times in triplicate. The results represent means plus the SEM. A one-way ANOVA followed by Bonferroni’s multiple comparison post hoc test was used to determine statistical significance between the combination and tobramycin alone (*P < 0.05; NS, not significant). From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 11. Oxyclozanide sensitizes P Figure 11. Oxyclozanide sensitizes P. aeruginosa to tobramycin by depolarizing the Δψ and further permeabilizing cells. (a) (1) Tobramycin corrupts protein synthesis triggering adaptive resistance, which includes the (2) induction of RND-type efflux pumps such as MexXY-OprM, resulting in reduced accumulation of tobramycin within the cytosol.<sup>42</sup><sup>,</sup><sup>43</sup> (3) During this time, an increase in Δψ is observed driving RND-type efflux pump activity and providing temporary resistance to tobramycin. (b) (4) Oxyclozanide permeabilizes cells and (5) shuttles protons across the IM, depolarizing the Δψ. We hypothesize that both of these activities interfere with adaptive resistance (6), allowing for greater accumulation of tobramycin within cells resulting in (7) accelerated activity and increased effectiveness. OM, outer membrane; IM, inner membrane. From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 9. Oxyclozanide induces permeabilization and depolarizes the Δψ of P. aeruginosa. Twenty-four hour biofilms were treated with oxyclozanide (100 μM) or tobramycin (500 μM), alone and in combination, for 2 h. (a) Cells were stained with TO-PRO-3 and analysed by flow cytometry to determine the number of cells that were permeabilized. (b) Cells were also stained with DiOC2(3) and analysed by flow cytometry to determine the number of cells maintaining a Δψ. Permeabilized cells were excluded from Δψ analysis. The experiment was performed two separate times in duplicate. The results are percentage averages plus the SEM. Percentage values indicate the average relative abundance of events within each gate normalized to the total number of events analysed, excluding artefacts, aggregates and debris. A one-way ANOVA followed by Dunnett’s multiple comparison post hoc test was used to determine statistical significance between each treatment and the untreated control (*P < 0.05) and oxyclozanide treatment alone was compared with tobramycin treatment alone in panel (a) (NS, not significant). A one-way ANOVA followed by Bonferroni’s multiple comparison post hoc test was used to compare tobramycin to the combination in panel (a) and (b) (*P < 0.05). From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 8. Tobramycin combined with oxyclozanide is more effective against stationary phase cells. Twenty-hour-old stationary phase cells were treated with oxyclozanide (100 μM) or tobramycin (50 μM), alone and in combination. At 0, 2, 4, 6, 8 and 24 h post-treatment, aliquots were enumerated for cfu/mL. The experiment was performed two times in triplicate. The results represent means ± SD. From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Figure 10. Oxyclozanide results in increased cellular accumulation of tobramycin. Twenty-four hour biofilms grown in glass test tubes were treated for 30 min with oxyclozanide (100 μM) and Texas Red<sup>®</sup>-labelled tobramycin (250 μg/mL). After washing off the planktonic cells, the biofilms were lysed with 0.2% Triton-X 100<sup>®</sup> and relative fluorescence units with excitation at 595 nm and emission at 615 nm were measured to quantify labelled tobramycin. The assay was performed twice in duplicate. The results represent means plus the SEM. An unpaired t-test was performed comparing tobramycin versus oxyclosanide and tobramycin (*P < 0.05). From: The ionophore oxyclozanide enhances tobramycin killing of Pseudomonas aeruginosa biofilms by permeabilizing cells and depolarizing the membrane potential J Antimicrob Chemother. Published online January 08, 2019. doi:10.1093/jac/dky545 J Antimicrob Chemother | © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)