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Research ArticleOriginal Article
Open Access

Synergistic efficacies of thymoquinone and standard antibiotics against multi-drug resistant isolates

Ayed A. Dera, Irfan Ahmad, Prasanna Rajagopalan, Mesfer Al Shahrani, Ahmed Saif, Mohammad Y. Alshahrani, Yasser Alraey, Ahmad M. Alamri, Sultan Alasmari, Mohammed Makkawi, Ali G. Alkhathami, Gaffar Zaman, Abdulrahim Hakami, Razan Alhefzi and Mohammad A. Alfhili
Saudi Medical Journal February 2021, 42 (2) 196-204; DOI: https://doi.org/10.15537/smj.2021.2.25706
Ayed A. Dera
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Irfan Ahmad
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Prasanna Rajagopalan
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Mesfer Al Shahrani
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Ahmed Saif
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Mohammad Y. Alshahrani
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Yasser Alraey
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Ahmad M. Alamri
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Sultan Alasmari
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Mohammed Makkawi
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Ali G. Alkhathami
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Gaffar Zaman
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Abdulrahim Hakami
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Razan Alhefzi
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Mohammad A. Alfhili
From the Department of Clinical Laboratory Sciences, Central Research Laboratory (Dera, Ahmad, Rajagopalan, Al Shahrani, Alshahrani, Alraey, Alamri, Alasmari, Makkawi, Alkhathami, Zaman, Hakami, Alhefzi), College of Applied Medical Sciences, King Khalid University, and From the Department of Clinical Laboratory Sciences, Central Research Laboratory (AlAmri), College of Applied Medical Sciences, and Cancer Research Unit, King Khalid University, Abha; from the Department of Clinical Laboratory Sciences (Saif), College of Applied Medical Sciences, Najran University, Najran; and the Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences (Alfhili), College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Article Figures & Data

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  • Figure 1
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    Figure 1

    - Antibacterial activity of TQ. A) Antibacterial acitivity of thymoquinone (TQ) against Klebsiella pneumoniae. B) Antibacterial acitivity of TQ against Staphylococcus epidermidis (ATCC 1228).

  • Figure 2
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    Figure 2

    - Effect of thymoquinone (TQ) on cell morphology of Staphylococcus epidermidis. Changes in the cellular morphology were observed by scanning electron microscopy. A) Control cell B) shows bacterial cell treated with TQ.

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    Figure 3

    - Thymoquinone (TQ) inhibits bacterial adhesion. Alamar Blue based polystyrene adhesion assay was used to evaluate the effect of TQ on Klebsiella pneumoniae, Staphylococcus epidermidis (ATCC 12228), Staphylococcus aureus and Staphylococcus epidermidis adherence. All the tested bacterial strains were exposed to MIC x 0.5, MIC x 1 and MIC x 2 values of TQ for 6 h at 37°C. Control bars indicate all untreated bacterial strains, accepted as 0% inhibition. Results are presented from three independent experiments using means ± SD ***p<0.0001.

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    Figure 4

    - Thymoquinone (TQ) reduces biofilm formation. A) Klebsiella pneumoniae and Staphylococcus epidermidis (ATCC 12228), B) Staphylococcus aureus and Staphylococcus epidermidis were incubated with MIC x 0.5, MIC x 1 and MIC x 2 values of TQ under biofilm growing conditions for 24 and 48 h. Control bars indicate all untreated bacterial strains, accepted as 0% inhibition. Results are presented from 3 independent experiments using means±SD ***p<0.0001.

Tables

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    Table 1

    - Antibacterial activity of thymoquinone against pathogenic bacterial strains.

    OrganismOriginThymoquinone
    Zone of inhibition (50 μg/ml)μg/ml
    mm Mean (SD)MIC Mean (SD)MBC Mean (SD)
    Gram negative bacteria
     Pseudomonas aeruginosa (ATCC 27853)ATCC---
     Escherichia coli (ATCC 25922)ATCC---
     PseudomonasClinical---
     Salmonella typhiClinical---
     Klebsiella pneumoniaeClinical15 (2)1.30 (0.45)33.33 (14.43)
     ShigellaClinical---
     Escherichia coliClinical---
    Gram positive bacteria
     Enterococcus faecalis (ATCC 29212)ATCC---
     Staphylococcus epidermidis (ATCC 12228)ATCC17 (1.73)1.04 (0.45)10.41 (3.60)
     Mycobacterium smegmatisClinical---
     Staphylococcus aureusClinical15 (1)2.60 (0.90)41 (14.43)
     Staphylococcus saprophyticusClinical---
     Staphylococcus epidermidisClinical13 (1.73)8.3 (3.60)66.66 (28.86)
     Streptococcus pyogenesClinical---
    • -: no effect, MIC: minimum inhibitory concentration, MBC: minimum bactericidal concentration, ATCC: American Type Culture Collection

    • View popup
    Table 2

    - Aynergistic antimicrobial activity of thymoquinone (TQ) with different antimicrobial agents.

    BacteriaAntimicrobial agentMean of inhibition zone with antibiotics (mm) Mean (SD)Mean of inhibition zone with Tq (mm) Mean (SD)Inhibition zone with synergism Mean (SD)OutcomeP-value
    Klebsiella pneumoniaeGentamicin20 (1.73)15 (2)37 (3.60)Synergism0.458
    Offloxacin17 (1.0)34 (1.73)Synergism0.638
    Tetracycline015 (1)Additive≤ 0.001
    Penicillin15 (2)34 (2)Synergism0.485
    Chloramphenicol015 (1.73)Additive≤ 0.001
    Nalidixic acid3 (1)20 (1)Synergism≤ 0.001
    Staphylococcus epidermidis (ATCC 12228)Gentamicin18 (2)17 (1.73)36 (1)Synergism0.254
    Offloxacin25 (3)34 (2)Antagonism1.258
    Tetracycline015 (2)Antagonism0.458
    Penicillin18 (1.73)37 (3.6)Synergism0.471
    Chloramphenicol25 (1)36 (1)Antagonism0.689
    Nalidixic acid017 (2.64)Additive≤ 0.001
    Staphylococcus aureusGentamicin015 (1)15 (2)Additive≤ 0.001
    Offloxacin13 (01)30 (1.73)Synergism0.356
    Tetracycline4 (2)21 (1)Synergism0.095
    Penicillin16 (1.73)27 (1.73)Antagonism0.245
    Chloramphenicol18 (2)35 (2)Synergism0.325
    Nalidixic acid2 (1)17 (1)Additive≤ 0.001
    Staphylococcus epidermidisGentamicin18 (1.73)13 (1.73)31 (3.6)Additive0.471
    Offloxacin17 (2.64)32 (2)Synergism0.247
    Tetracycline18 (1)29 (1)Antagonism1.784
    Penicillin3 (1)21 (1)Synergism≤ 0.001
    Chloramphenicol20 (2)26 (1.73)Antagonism0.478
    Nalidixic acid013 (2.64)Additive≤ 0.001
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Saudi Medical Journal: 42 (2)
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Synergistic efficacies of thymoquinone and standard antibiotics against multi-drug resistant isolates
Ayed A. Dera, Irfan Ahmad, Prasanna Rajagopalan, Mesfer Al Shahrani, Ahmed Saif, Mohammad Y. Alshahrani, Yasser Alraey, Ahmad M. Alamri, Sultan Alasmari, Mohammed Makkawi, Ali G. Alkhathami, Gaffar Zaman, Abdulrahim Hakami, Razan Alhefzi, Mohammad A. Alfhili
Saudi Medical Journal Feb 2021, 42 (2) 196-204; DOI: 10.15537/smj.2021.2.25706

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Synergistic efficacies of thymoquinone and standard antibiotics against multi-drug resistant isolates
Ayed A. Dera, Irfan Ahmad, Prasanna Rajagopalan, Mesfer Al Shahrani, Ahmed Saif, Mohammad Y. Alshahrani, Yasser Alraey, Ahmad M. Alamri, Sultan Alasmari, Mohammed Makkawi, Ali G. Alkhathami, Gaffar Zaman, Abdulrahim Hakami, Razan Alhefzi, Mohammad A. Alfhili
Saudi Medical Journal Feb 2021, 42 (2) 196-204; DOI: 10.15537/smj.2021.2.25706
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Keywords

  • thymoquinone
  • antibacterial
  • adhesion
  • biofilm formation
  • synergism

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