Antimicrobial resistance is a health care crisis. The resistance-conferring mutation F98Y in Staphylococcus aureus dihydrofolate reductase (SaDHFR) reduces effectiveness of antifolates, e.g., trimethoprim (TMP). Although propargyl-linked antifolates (PLAs) are much more resilient than TMP towards F98Y, this substitution still vitiates their inhibition potency. Surprisingly, differences in the enantiomeric configuration at the stereogenic center of PLAs influence the isomeric state of NADPH cofactor. Is resistance correlated with chiral evasion? A mechanism of action underpinning this coupling is unknown. To understand the molecular basis of F98Y-mediated resistance and how PLAs’ inhibition drives NADPH isomeric states, we used OSPREY to analyze a comprehensive suite of structural, biophysical, biochemical, and computational data. We present a model showing how F98Y SaDHFR exploits a different anomeric configuration of NADPH to evade certain PLAs’ inhibition, while other PLAs remain resilient to resistance. Our model should enable general design of inhibitors that are resilient to chiral evasion.

Chiral evasion and stereospecific antifolate resistance inStaphylococcus aureus