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May 8th, 2025
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Universite Laval
biochemistry
biorxiv

Predicting antifolate resistance in the unculturable fungal pathogen Pneumocystis jirovecii

Rouleau, F. D.Open in Google Scholar•Dube, A. K.Open in Google Scholar•Pageau, A.Open in Google Scholar•Desautels, L.Open in Google Scholar•Dufresne, P. J.Open in Google Scholar•Landry, C. R.Open in Google Scholar

Pneumocystis jirovecii is a fungal pathogen causing Pneumocystis pneumonia in humans, mainly in immunocompromised individuals. Infections by P. jirovecii are treated using the antifolate combination drug trimethoprim-sulfamethoxazole (TMP-SMX), targeting the dihydrofolate reductase (DHFR) and the dihydropteroate synthase (DHPS). In recent years, there has been an increase of treatment failure, with no mutations observed in the DHPS, implying the potential evolution of resistance through this pathogen\'s DHFR (PjDHFR). Experimental methods to study this pathogen are limited, as it cannot be grown in vitro. Model fungi are insensitive to TMP-SMX due to unknown mechanisms, preventing the use of functional complementation to study mutations causing resistance to this specific drug combination. In a previous study, we conducted deep mutational scanning (DMS) on PjDHFR to identify resistance mutations to methotrexate (MTX), another antifolate drug. Here, by leveraging this data, as well as computational data modeling aspects of protein function and stability in the PjDHFR-MTX complex, we train a machine learning model to predict the effect of mutations on MTX resistance. We find that the model can predict the effect of mutations outside of its training dataset (balanced accuracy on training set: 98.3%, and 88.3% on testing set). We also find that the best predictors of resistance, such as distance to ligand and effect on region flexibility, are coherent with previously established models, and that experimental data about the effect of mutations on protein function is critical to optimize model performance. Using this model on computational data generated using the PjDHFR-TMP complex, we predict the effect of mutations on resistance to TMP. We predict TMP resistance mutations in PjDHFR that did not confer resistance to MTX, one of which had been characterized in vitro as reducing affinity to TMP by 100-folds. We compare the predictions from this model to PjDHFR sequences from previously and newly sequenced clinical samples. Our results offer a resource to interpret the impact of amino acid variants in PjDHFR on TMP resistance, as well as methods to predict resistance in hard-to-study organisms.

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