Chiral evasion and stereospecific antifolate resistance in Staphylococcus aureus

Antimicrobial resistance presents a significant health care crisis. The mutation F98Y in Staphylococcus aureus dihydrofolate reductase (SaDHFR) confers resistance to the clinically important antifolate trimethoprim (TMP). Propargyl-linked antifolates (PLAs), next generation DHFR inhibitors, are much more resilient than TMP against this F98Y variant, yet this F98Y substitution still reduces efficacy of these agents. Surprisingly, differences in the enantiomeric configuration at the stereogenic center of PLAs influence the isomeric state of the NADPH cofactor. To understand the molecular basis of F98Y-mediated resistance and how PLAs’ inhibition drives NADPH isomeric states, we used protein design algorithms in the osprey protein design software suite to analyze a comprehensive suite of structural, biophysical, biochemical, and computational data. Here, we present a model showing how F98Y SaDHFR exploits a different anomeric configuration of NADPH to evade certain PLAs’ inhibition, while other PLAs remain unaffected by this resistance mechanism.Author summary: Antimicrobial resistance is a major healthcare crisis. While we were developing novel enzyme inhibitors to combat methicillin-resistant Staphylococcus aureus (MRSA), we found that the chirality of both inhibitor and cofactor can have a large influence on inhibitor potency. Our detailed study of enantiomeric propargyl-linked antifolates (PLAs) shows that the chiral state of inhibitors can affect the chiral state of the cofactor. Moreover, the bacterial enzyme target can exploit cooperative chirality to evade inhibitor binding. We call this phenomenon chiral evasion. Using crystal structures, biochemical assays, computational protein design algorithms, and statistical mechanics, a detailed mechanism for chiral evasion is proposed. While the concept that different enantiomers have different biology is well known, MRSA is unique: we do not know of any other cases where a single mutation (F98Y) flips the chirality preference for cofactor binding and induces stereospecificity for drug binding. Thus, we illuminate the effect of this clinically relevant resistance mutation on the obligate cofactor binding site. These new insights will be useful to develop more durable antibiotics that are resilient to resistance.