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Mohammad Subkhan , Sukardiman Sukardiman^*✉ , Isnin Anang Marhana , Laily Irfana

1. Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
2. Department of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.
3. Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Abstract

Ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa poses a significant clinical challenge due to its robust biofilm formation and resistance mechanisms. Chlorhexidine (CHX), an antiseptic agent, has shown potential in inhibiting biofilm formation, though its mechanism is not fully understood.  To elucidate the mechanism of action and potential of chlorhexidine in mitigating biofilm formation, we conducted reverse docking analyses targeting key quorum-sensing proteins in P. aeruginosa. Protein structures of six quorum sensing and biofilm proteins were obtained from the Protein Data Bank. The structure of CHX was retrieved from PubChem and prepared for docking. Potential binding pockets in the protein structures were identified using Fpocket, and docking simulations were performed with SMINA. We generated 395 docking poses across all proteins. The highest binding affinity was observed at PslG. Additionally, CHX's high binding affinities with RhlR and LasR indicate its potential to interfere with quorum sensing pathways. CHX shows strong binding affinities to key quorum-sensing proteins, particularly PslG, RhlR, and LasR. This suggests CHX could disrupt biofilm formation and quorum sensing in P. aeruginosa‎.

Keywords: Ventilator-associated pneumonia, Pseudomonas aeruginosa, Chlorhexidine, Quorum sensing, Biofilm

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