Tropheryma whipplei the causative agent of Whipple disease, presents a diagnostic challenge due to its diverse symptomatology, including weight loss, abdominal pain, diarrhea, joint pain, fever, and occasionally neurological manifestations. Its resistance to fluoroquinolones complicates treatment further. Traditional methods for antibiotic susceptibility testing are ineffective as Tropheryma whipplei cannot be cultured in axenic media. To address this, we explored potential drug targets within its core genome as no drug targets from this bacterium have been studied so far. murE, a macrolide-resistant enzyme, emerged as a promising candidate exhibiting both resistance and drug target characteristics. We screened over 1,000 lead-like Ayurvedic compounds against the target enzyme UDP-N-acetylmuramyl-tripeptide synthetase and identified three promising candidates: (1) Ergost-5-en-3-ol (3beta,24xi), (2) [6]-Gingerdiol 3-monoacetate, and (3) Valtrate. DiffDock and GNINA rescoring yielded consistent binding strength rankings. Molecular dynamics simulations over 100 nanoseconds confirmed stable interactions with these compounds. ADMET analysis indicated low water solubility, but coupling with cyclodextrin SBE-β-CD improved solubility. None of the compounds showed hepatotoxic effects, though Valtrate exhibited AMES toxicity. Based on the favorable properties, we propose scaffold hopping and further in vitro/in vivo studies on [6]-Gingerdiol 3-monoacetate. Our findings offer potential avenues for combating T. whipplei infections, addressing the limitations posed by antibiotic resistance.

SARS-CoV-2 (severe acute respiratory syndrome causing coronavirus 2) caused an epidemic that swept the globe and resulted in large number of casualties. It is still sporadically causing cases and has a long-term impact on the health of once infected individuals. Molnupiravir binds RNA dependent RNA polymerase (RdRp) of SARS-CoV-2 as well as spike protein. In this study, we assessed the mutated spike protein of BA.5 variant and BQ.1.1 subvariant of COVID-19 and tested their binding with it. Multiple sequence and structural alignment of homologous structures revealed highly conserved amino acid residues at the active site of the domain. The molecular docking of Molnupiravir with the active site of the domain, comprised conserved motifs (motif A-G), and exhibited considerable binding affinity against variant and subvariant protein targets. Molnupiravir exhibited stability in its interactions with the Omicron and BQ.1.1 spike proteins, preserving constant engagement within the active site. The protein and Ligand reached An equilibrium with An RMSD of 10.46 Å after 100 nanoseconds, whereas the Ligand measured 8.0 Å. Fluctuations were noted between 40 And 75 nanoseconds, stabilizing from 80 to 100 ns. In simulations including the BQ.1.1 subvariant, the RMSD values demonstrated considerable stability, exhibiting Little variations. The ligand demonstrated flexibility, altering its binding orientation over time, resulting in An average RMSD of 18.72 Å. Herein, investigation of molecular dynamics trajectories elucidated the conformational stability of Molnupiravir, emphasizing its interactions with active residues and the hydrogen bond acceptor and donor environments. The results highlighted the crucial function of protein loops in offering flexibility and enabling ligand binding within the active site. It is concluded that Molnupiravir has the potential to function as an inhibitor of both omicron and its subvariant BQ.1.1.

Background Antimicrobial resistance (AMR) is an urgent global crisis and one of the world's most complex challenges. Although there is increasing evidence of its impact on human mortality and morbidity, precise burden estimation has many challenges, and thus far has been elusive for the Eastern Mediterranean Region. Here, we present a comprehensive time-trend analysis of regional and country-level AMR burden estimates in the WHO Eastern Mediterranean Region (EMR), between 1990 and 2021, with forecasts up to 2050. Methods We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 11 infectious syndromes, 22 bacterial pathogens, and 84 pathogen–drug combinations for the WHO EMR and each of its countries from 1990 to 2021. Data were obtained from mortality registries, surveillance systems, hospital records, systematic literature reviews, and other sources. We based our modelling approach on five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths and DALYs attributable to AMR (considering an alternative scenario where drug-resistant infections are replaced with susceptible infections), and deaths and DALYs associated with AMR (considering an alternative scenario where infections would not occur at all). Predictive statistical modelling was applied to generate estimates of AMR burden for each country. We also generated AMR burden forecasts up to 2050. We generated 95% uncertainty intervals (UIs) for the final estimates by taking the 2·5th and 97·5th percentiles across 500 draws through the multistage computational pipeline, and models were cross-validated for out-of-sample predictive validity. Findings We estimated 380 000 deaths (95% UI 332 000–426 000) associated with bacterial AMR and 92 800 deaths (78 300–111 000) attributable to bacterial AMR in the EMR in 2021. In the past 31 years, there was considerable variation in AMR mortality trends across countries of the region and different age groups. Between 1990 and 2021, associated deaths among children younger than 5 years decreased by 50·0% (38·2–62·0), while those among adults aged 70 and older rose by over 85·7% (95% UI 57·0–115·7). Six pathogens were identified as the primary generators of burden: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii , and Pseudomonas aeruginosa . A substantial increase in the AMR burden due to S aureus was observed between 1990 (28 200 deaths [21 600–34 000]) and 2021 (49 500 deaths [43 100–56 200]); consequently, in 2021, methicillin-resistant S aureus was a leading pathogen–drug combination for most countries in the region for deaths and DALYs attributable to, and associated with AMR. Somalia had the highest age-standardised mortality rates in the region: for deaths attributable to and associated with AMR per 100 000 population in both 1990 and 2021; conversely, the country with the lowest burden in the EMR was Qatar. By 2050, the number of deaths attributable to AMR in region is forecasted to reach 187 000 (157 000–223 000) and deaths associated with AMR were projected to reach 752 000 (629 000–879 000). Interpretation Our study shows that bacterial AMR has been a serious public health threat in the EMR for more than 30 years, with a substantial fatal and non-fatal burden for priority bacterial pathogens and pathogen–drug combinations. The magnitude of this issue, future projects, and the inadequate response capacity in many countries underscore the need for more stringent regional leadership in this field. The insights gained from this study can direct targeted mitigation strategies for individual countries within the region, aiding in resource allocation and funding decisions, and emphasising the need for collaborative multisectoral endeavours among nations to address this issue. Funding Wellcome Trust, and the UK Department of Health and Social Care using aid funding managed by the Fleming Fund.

Background: Rickettsia typhi is the causative agent of epidemic murine typhus and Rocky Mountain spotted fever. The infection can affect multiple vital organs, including the heart, lungs, kidneys, and brain. Doxycycline is the recommended treatment but inflammation, mal-response, and drug resistance may arise. No natural product inhibitors have been reported against this bacterium. Aim: The objective of this study was to establish a potential connection between autoimmune disorders triggered by R. typhi, identify therapeutic targets within its core proteome, and explore novel natural product inhibitors from Streptomyces spp. that could potentially inhibit it. Methodology: Complete proteomes of four publicly available R. typhi strains were used for pan-proteomic analysis. The fni gene product (Isopentenyl pyrophosphate isomerase) was selected as the potential drug target. Molecular docking of 607 Streptomyces-derived metabolites was performed, with top hits validated using DiffDock and Vinardo scoring. Additionally, the Absorption, Distribution, Metabolism, Excretion, and Toxicity properties of the leading compounds were assessed via pkCSM, and formulation characteristics optimized using FormulationAI. Results: Out of the 803 core proteins, associations between 14 proteins were mined for autoimmune diseases (including psoriasis, rheumatoid arthritis, optic atrophy, uveitis, even-plus syndrome, Sjogren syndrome, inflammatory bowel disease, allergic rhinitis, systemic lupus erythematosus, sclerosis, Stevens-Johnson syndrome, toxic epidermal necrolysis, colitis etc.). 17 core proteins were predicted as druggable. ZINC01482946 demonstrated the strongest inhibitory potential, as confirmed by DiffDock scoring, convolutional neural network-based ranking, and Vinardo scoring. It demonstrated a stable configuration and exhibited a favorable pharmacokinetic profile, with bioavailability enhanced through cyclodextrin complexation. Conclusion: To the best of our knowledge, this is the first report identifying human autoimmune associations with R. typhi and natural product inhibitors targeting the pathogen. ZINC01482946 shows potential as an effective inhibitor of R. typhi, while SBE-β-CD appears to be a promising cyclodextrin for improving its solubility and bioavailability. Clinical trial number: Not applicable.

Background: The global burden of sepsis, a life-threatening dysregulated host response to infection leading to organ dysfunction, remains challenging to quantify. We aimed to comprehensively estimate the global, regional, and national burden of sepsis, including the impact of the COVID-19 pandemic and underlying causes of sepsis-related deaths with co-occurring infectious syndromes. Methods: We used multiple cause-of-death, hospital, minimally invasive tissue sampling, and linked death certificate and hospital record data representing 149 million deaths, covering 4290 location-years with mortality estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to capture explicit and implicit sepsis cases and deaths. We estimated age-location-sex-specific fractions of sepsis-related deaths from 195 underlying causes of death and 22 infectious syndromes from 1990 to 2021 using binomial logistic regression models, and estimated sepsis-related deaths using GBD cause-specific mortality estimates. Using 250 million hospital admissions and 7·82 million deaths from hospital data, representing 1310 location-years, we modelled case fatality rates by use of binomial logistic regression, applied to sepsis death estimates to estimate sepsis incidence by age, location, and year. Findings: In 2021, we estimated 166 million (95% uncertainty interval 135–201) sepsis cases and 21·4 million (20·3–22·5) all-cause sepsis-related deaths globally, representing 31·5% of total global deaths. Sepsis-related deaths decreased between 1990 and 2019, followed by a surge in 2020 and 2021. As of 2021, individuals aged 15 years and older experienced increases across incidence (230%) and mortality (26·3%) since 1990. Those aged 70 years and older had the highest sepsis-related mortality in 2021 (9·28 million [8·74–9·86] deaths). Sepsis-related deaths from infectious underlying causes decreased from 11·8 million (11·1–12·5) in 1990 to 8·34 million (7·72–9·01) in 2019, then increased by 86·4% to 15·5 million (14·7–16·4) in 2021. Sepsis-related mortality due to non-infectious underlying causes of death increased from 4·69 million (4·35–5·05) in 1990 to 5·81 million (5·40–6·25) in 2021; the leading non-infectious underlying causes of death with sepsis were stroke, chronic obstructive pulmonary disease, and cirrhosis. In 2021, bloodstream infections inclusive of HIV and malaria (3·08 million [2·83–3·35]) and lower respiratory infections inclusive of COVID-19 (11·33 million [1·20–1·47]) were the most prominent infectious syndromes complicating sepsis-related deaths from non-infectious underlying causes, representing a consistent trend since 1990. Interpretation: The global burden of sepsis increased in 2020 and 2021, reversing progress from 1990. Sepsis incidence and mortality increased in people aged 15 years and older, especially those aged 70 years and older, and as a complication of non-infectious underlying causes of death such as stroke, primarily through bloodstream infections and lower respiratory infections. The global burden of sepsis is substantial, and sepsis is increasingly a complication of non-infectious causes of death. Funding: Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.