Quinolones are synthetic antibiotics; therefore, it was thought that the existence of transferable quinolone resistance genes in nature would be unlikely. Resistance mechanisms for these drugs were expected to be only chromosomally encoded. It was believed that only mutations in the quinolone targets (DNA gyrase or topoisomerase IV) or mutations that led to a permeability decrease and/or overproduction of multidrug resistance (MDR) efflux pumps would result in resistance to these antibiotics [
1,
2].
It was thus assumed that resistance to quinolones could not spread as the consequence of horizontal gene transfer (HGT). Later on, the acquisition of quinolone resistance due to HGT was proposed as a possibility based on
in vitro experiments [
3]. This was later confirmed in 1998, with the description of a plasmid-encoded quinolone resistance determinant, that was named Qnr, in clinical isolates [
4]. More recently two other transferable quinolone resistance determinants have been described, the bifunctional aminoglycoside/quinolones inactivating aminoglycoside acetyltransferase AAC(6')-Ib-cr [
5,
6] and the quinolone efflux determinant, QepA [
7,
8].
Since the discovery of Qnr, the presence of different
qnr families (A, B, S) in resistance plasmids [
9] has been found worldwide in different bacterial pathogens [
10-
15]. More recently, plasmid-encoded Qnr determinants have also been described in environmental isolates of
Aeromonas spp. [
16]. The presence of Qnr genes in chromosomes has also been shown, including QnrA in
Shewanella algae, which is likely the origin of plasmid-encoded QnrA determinants [
17], and different members of the Qnr family from
Vibrionaceae species [
18,
19].
The Qnr proteins belong to the pentapeptide repeat protein (PRP) family, which is defined by the presence of repetitions in tandem of the pattern (A/C/S/T/V)(D/N)(L/F)(S/T/R)(G/R) [
20-
22,
17]. A characteristic feature of the Qnr proteins is that they are formed by two domains of pentapeptide repeats separated by a single glycine. This structure matches a motif of unknown function named Cluster of Orthologous Group of Proteins (COG) 1357
http://www.ncbi.nlm.nih.gov/COG/. Even though members of the PRP family have been identified both in prokaryotes and eukaryotes [
22],
qnr genes presenting the above described COG1357 motif have a much narrower distribution, mainly in plasmids and in the chromosomes of some bacterial species. The amino acid identity among different Qnr proteins families rates between 39–60% [
23].
Some studies have demonstrated that Qnr protects both gyrase and topoisomerase IV from the activity of quinolones [
15,
24-
26]. Other members of the PRP family, that may play a similar role include McbG, which protects microcin B17-producing bacteria from the activity of this DNA replication inhibitor [
27] and MfpA [
28], a protein that most likely binds GyrA [
22] and provides low-level quinolone resistance to
Mycobacterium tuberculosis.
Although
qnr-like elements that contribute to intrinsic quinolone resistance have been described in the chromosome of
Enterococcus faecalis [
24] and more recently in other Gram-positive bacteria [
29], their homology with
qnr genes from Gram-negative bacteria is low (around 25%), so that this family of resistance elements has not been included in our analysis.
It is important to note that plasmid-encoded quinolone resistance is more prevalent than expected considering the date of the first isolation, which suggests that these plasmids have been circulating for some time before they were first described [
30]. This highlights the need to implement methods to predict resistance before it is recognized within clinical settings.
A methodology for predicting the possibility of emergence of a new mechanism of resistance before it appears in bacterial pathogens has been recently proposed [
31]. The availability of sequenced genomes allows this type of analysis. This information was used to search for the presence of Qnr determinants in available sequenced bacterial genomes and metagenomes. A putative
qnr gene present in the chromosome of the opportunistic pathogen
Stenotrophomonas maltophilia was chosen to perform functional analyses.
S. maltophilia is a nosocomial pathogen intrinsically resistant to several antimicrobials [
32] due to the activity of antibiotic-inactivating enzymes [
33-
36] and MDR efflux pumps [
37-
43].
The possibility that chromosomally-encoded S. maltophilia qnr gene (hereafter named as Smqnr) could be functional in a heterologous host has been explored. As the result of our work, we have described new qnr genes in the chromosomes of sequenced bacterial genomes and have found that the Smqnr gene from S. maltophilia renders a low-level quinolone resistance phenotype upon its expression in Escherichia coli. This study demonstrates the feasibility of utilizing currently available databases along with bioinformatics and functional tools as an approach for predicting resistance before it emerges in human pathogens.