There is compelling evidence that
aminoglycoside (AG)
antibiotics can induce the mammalian ribosome to suppress disease-causing
nonsense mutations and partially restore the expression of functional
proteins. However, prolonged AG treatment can cause detrimental side effects in patients, including most prominently,
ototoxicity. Recent mechanistic discussions have considered the relative contributions of mitochondrial and cytoplasmic
protein synthesis inhibition to AG-induced
ototoxicity. We show that AGs inhibit
mitochondrial protein synthesis in mammalian cells and perturb cell respiration, leading to a time- and dose-dependent increase in
superoxide overproduction and accumulation of free ferrous
iron in mitochondria caused by oxidative damage of mitochondrial
aconitase, ultimately leading to cell apoptosis via the Fenton reaction. These deleterious effects increase with the increased potency of AG to inhibit the mitochondrial rather than cytoplasmic
protein synthesis, which in turn correlates with their ototoxic potential in both murine cochlear explants and the guinea pig in vivo. The deleterious effects of AGs were alleviated in synthetic derivatives specially designed for the treatment of
genetic diseases caused by
nonsense mutations and possessing low affinity toward mitochondrial ribosomes. This work highlights the benefit of a mechanism-based
drug redesign strategy that can maximize the translational value of "readthrough
therapy" while mitigating
drug-induced side effects. This approach holds promise for patients suffering from
genetic diseases caused by
nonsense mutations.