MRSA, like S. aureus, is a Gram positive bacteria and has the characteristically thick cell wall encircling the plasma membrane and cytoplasm of the cell. This extra layer is composed of multiple strands of peptidoglycan cross-linked with stem peptides to create a semirigid and semipermeable barrier. A key class of enzymes called penicillin binding proteins (PBPs) catalyze the transpeptidation and transglycosylation reactions necessary to properly crosslink peptidoglycan strands and create a functional cell wall. While this cell wall helps to provide shape and structure to the bacteria, it is also critical to preventing osmotic lysis. Mammalian cells do not have a peptidoglycan cell wall, making this novel structure a potential target for antibiotics due to its protective role in MRSA. Penicillin and other beta-lactam antibiotics were initially able to take advantage of this fact. The defining feature of this category of drugs is their beta-lactam ring which, according to the Tipper-Strominger hypothesis, mimics the stem peptides used to connect the peptidoglycan strands and can bind to the active site of the aptly named PBPs. Once bound, the beta-lactam antibiotics take advantage of the native catalytic system to create an acetylated serine that renders the enzyme inactive. Without the continuous production of peptidoglycan linkage to repair broken strands or adjust to the growth and division of the bacteria, the cell wall is considerably weakened and the bacteria are prone to lysis.
Llarrull et al. 2009 , My et al. 2011, Acerbron et al. 2015Beta-lactam antibiotics were initially able to effectively prevent MRSA colonization by inhibiting the synthesis of the cell wall and inducing osmotic lysis. However, as mentioned previously, the bacteria began to develop resistance to this class of antibiotics. At approximately the same time that MRSA strains began to show this antibiotic resistance, a novel gene called mecA began to surface throughout various strains. This gene, and its accompanying cassette, encodes for a modified PBP that is directly correlated with antibiotic resistance. The enzyme, now recognized as PBP2a, catalyzes the transpeptidation reaction necessary to synthesize the cell wall like other PBPs but has a unique structure. In x-ray crystallographic models of the apo-PBP2a structure, a beta3-beta4 loop motif is located directly above the active site. Active site structural comparisons between PBP2a and other PBPs revealed that the active site was conserved across all proteins and maintained the same catalytic mechanism. These findings indicate that the active site of PBP2a does not determine antibiotic resistance, but rather that the inability of antibiotics to reach the active site from the obstruction of the novel beta3-beta4 loop. If beta-lactam antibiotics were able to bind and inactive other members of the PBP family through the previously mentioned acylation reaction, it would fail to affect PBP2a. As a result, the novel protein would continue to catalyze the formation of the bacterial cell wall and would not lyse. This restricting loop poses a significant challenge for future antibiotic development as not only does it block beta-lactam antibiotics, but it also prevents other categories of antibiotics from accessing the active site.
Llarrull et al. 2009, Lim and Strynadka 2002, Roemer et al. 2013