We have discovered a novel mechanism of resistance to ?-lactams that is independent of penicillinase and the low affinity penicillin bindin protein (PBP), PBP2a, the two known mechanisms of ?-lactam resistance in Staphylococcus aureus. This new type of resistance was identified during experiments in which methicillin- susceptible S. aureus strains were passaged in the presence of each of the two so-called """"""""fifth generation"""""""" anti-MRSA cephalosporins, ceftobiprole and ceftaroline. Whole genome sequencing of a ceftobiprole- passage mutant revealed mutations in genes encoding PBP4, a non-essential, low-molecular weight PBP;GdpP, a putative signaling protein;and AcrB, a putative transporter. Ceftaroline also selected for PBP4 and GdpP mutants, but not AcrB mutants, indicating the primary importance of the former two proteins. We hypothesize 1) that a gain of transpeptidase function by mutant PBP4 accounts for high-level ?-lactam resistance;and 2) that GdpP contributes to resistance via a signaling pathway that up-regulates expression of pbp4.
Two specific aims are proposed to test these hypotheses.
Aim 1 : To determine the mechanism by which mutations in pbp4 confer high-level ?-lactam resistance. pbp4 missense mutations will be repaired in mutants or introduced into parent strains by allelic replacement mutagenesis. Isogenic strains will be tested for ?-lactam resistance to identify mutations of importance. PBP binding assays and analyses of peptidoglycan structure will be performed to determine the effect of mutations on PBP binding and to test for functional changes in carboxypeptidase or transpeptidase activities. Binding and enzymatic activity assays, including ?-lactamase, also will be conducted with model substrates for recombinant wild-type and mutant proteins. X-ray crystallography will be used to identify the structural basis of functional changes, particularly those associated with transpeptidase activity.
Aim 2 : To determine the role of gdpP in mediating response to ?-lactam antibiotics. GdpP is a putative signaling protein that has phosphodiesterase activity against cyclic diadenosine monophosphate (c-di-AMP), a recently identified second messenger. Mutations in gdpP were associated with increased expression of pbp4 and with resistance to ?-lactams. We hypothesize that these mutations lead to intracellular accumulation c-di-AMP through loss of GdpP phosphodiesterase activity. To test this hypothesis intracellular concentrations of c-di-AMP will be manipulated by mutation of gdpP or by inhibition of expression of dacA, which encodes the diadenylate cyclase that generates c-di-AMP, and effects on pbp4 expression determined. As GdpP is a signaling molecule, microarray studies will be conducted to identify potential downstream proteins in its regulatory pathway. Recombinant GdpP also will be purified and analyzed by x-ray crystallography to identify its critical structural properties. Achieving these aims will increase knowledge of ?-lactam antibiotic effects and mechanisms of resistance.

Public Health Relevance

Staphylococcus aureus is a huge problem because of the serious infections it causes and because many strains are resistant to the best antibiotics. We have discovered a new way for S. aureus to become resistant. The research we are proposing is designed to figure out how this new kind of resistance works with the ultimate goal of identifying new therapeutic approaches;better antibiotic targets;and, eventually, better antibiotics to overcome resistance.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project (R01)
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Special Emphasis Panel (ZRG1-DDR-T (09))
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Huntley, Clayton C
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Alexander, J Andrew N; Chatterjee, Som S; Hamilton, Stephanie M et al. (2018) Structural and kinetic analyses of penicillin-binding protein 4 (PBP4)-mediated antibiotic resistance in Staphylococcus aureus. J Biol Chem 293:19854-19865
da Costa, Thaina M; de Oliveira, Carolina R; Chambers, Henry F et al. (2018) PBP4: A New Perspective on Staphylococcus aureus ?-Lactam Resistance. Microorganisms 6:
Basuino, Li; Jousselin, Ambre; Alexander, J Andrew N et al. (2018) PBP4 activity and its overexpression are necessary for PBP4-mediated high-level ?-lactam resistance. J Antimicrob Chemother 73:1177-1180
Chatterjee, Som S; Chen, Liang; Gilbert, Aubre et al. (2017) PBP4 Mediates ?-Lactam Resistance by Altered Function. Antimicrob Agents Chemother 61:
Hamilton, Stephanie M; Alexander, J Andrew N; Choo, Eun Ju et al. (2017) High-Level Resistance of Staphylococcus aureus to ?-Lactam Antibiotics Mediated by Penicillin-Binding Protein 4 (PBP4). Antimicrob Agents Chemother 61:
Nigo, Masayuki; Diaz, Lorena; Carvajal, Lina P et al. (2017) Ceftaroline-Resistant, Daptomycin-Tolerant, and Heterogeneous Vancomycin-Intermediate Methicillin-Resistant Staphylococcus aureus Causing Infective Endocarditis. Antimicrob Agents Chemother 61:
Chan, Liana C; Gilbert, Aubre; Basuino, Li et al. (2016) PBP 4 Mediates High-Level Resistance to New-Generation Cephalosporins in Staphylococcus aureus. Antimicrob Agents Chemother 60:3934-41
Greninger, Alexander L; Chatterjee, Som S; Chan, Liana C et al. (2016) Whole-Genome Sequencing of Methicillin-Resistant Staphylococcus aureus Resistant to Fifth-Generation Cephalosporins Reveals Potential Non-mecA Mechanisms of Resistance. PLoS One 11:e0149541
Chambers, Henry F (2013) Cellulitis, by any other name. Clin Infect Dis 56:1763-4