Statin-induced lipid carrier stress reveals a conserved vulnerability in β-lactam-resistant Gram-positive bacteria

Abstract

Abstract Methicillin-resistant Staphylococcus aureus resists β-lactam antibiotics through the allosteric transpeptidase penicillin-binding protein 2a, which operates within staphyloxanthin-rich membrane microdomains. Statins restore susceptibility by disrupting these microdomains and impairing penicillin-binding protein 2a oligomerization, but the mechanisms enabling resistance to this resensitization remain unclear. Here we show, using evolution experiments in strains lacking a functional staphyloxanthin pathway, that mutations in gdpP , a regulator of cyclic di-adenosine monophosphate signaling, are the predominant route for restoring oxacillin resistance during membrane microdomain disruption. This adaptation is blocked by simvastatin, revealing a synthetic lethal interaction. Mechanistically, simvastatin inhibits the mevalonate pathway, depleting the essential lipid carrier undecaprenyl phosphate and exacerbating peptidoglycan precursor imbalance, an effect phenocopied by lipid carrier–targeting antibiotics such as bacitracin. Although compensatory mutations can restore resistance, they impose a fitness cost in vivo. Importantly, this vulnerability extends to Streptococcus pneumoniae , revealing a conserved strategy to overcome β-lactam resistance in Gram-positive pathogens.