Dual role of ramR mutation in enhancing immune activation and elevating eravacycline resistance in Klebsiella pneumoniae

Abstract The rise of Klebsiella pneumoniae resistant to last‐resort antimicrobials poses an urgent threat to global health. The ramR‐ramA regulatory system critically influences drug resistance by regulating the AcrAB‐TolC efflux pump, which also plays a crucial role in the pathogenicity of K. pneum...

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Main Authors: Wei Yu, Peiyao Jia, Xiaobing Chu, Shengjie Li, Xinmiao Jia, Ying Zhu, Xiaoyu Liu, Yingchun Xu, Qiwen Yang
Format: Article
Language:English
Published: Wiley 2024-12-01
Series:iMetaOmics
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Online Access:https://doi.org/10.1002/imo2.39
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author Wei Yu
Peiyao Jia
Xiaobing Chu
Shengjie Li
Xinmiao Jia
Ying Zhu
Xiaoyu Liu
Yingchun Xu
Qiwen Yang
author_facet Wei Yu
Peiyao Jia
Xiaobing Chu
Shengjie Li
Xinmiao Jia
Ying Zhu
Xiaoyu Liu
Yingchun Xu
Qiwen Yang
author_sort Wei Yu
collection DOAJ
description Abstract The rise of Klebsiella pneumoniae resistant to last‐resort antimicrobials poses an urgent threat to global health. The ramR‐ramA regulatory system critically influences drug resistance by regulating the AcrAB‐TolC efflux pump, which also plays a crucial role in the pathogenicity of K. pneumoniae. However, the mechanism of the ramR‐ramA system on bacteria‐host interaction remains unclear. To determine how specific mutations in ramR influence eravacycline (ERV) resistance and their impact on the immune activation capabilities of K. pneumoniae, thereby highlighting potential targets for therapeutic intervention, we performed genetic sequencing to identify mutations in ramR. Then, the CRISPR‐Cas9 technology was employed to construct specific ramR mutations into K. pneumoniae, which were then subjected to phenotypic and functional assays in both in vitro and in vivo (mouse models, macrophage, and blood‐killing experiment) settings. ramR L58P and F165L genetic alterations disrupt the binding affinity of RamR to the ramA promoter, thereby upregulating the efflux pump expression and increasing ERV minimum inhibitory concentration values up to 64‐fold compared to the wild‐type. Concurrently, these mutations modulate lipid A structure by increasing 2‐hydroxy fatty acid chain abundance. In mouse models, ramR L58P and F165L mutants showed lower bacterial burden in organs (spleen, lung, and kidney) 6 h post‐infection, and are fast cleared in 48 h. Furthermore, despite lower intracellular bacterial loads, ramR L58P and F165L mutants induce heightened pro‐inflammatory cytokine responses in macrophages and elevate systemic cytokine levels (interleukin [IL]2, IL4, IL6, IL12, interferon‐α, and interferon‐γ) in human blood co‐culture experiments. This study illuminates the critical role of ramR mutations in conferring ERV resistance and enhancing immune responses in K. pneumoniae. The dual impact of these mutations on both antimicrobial resistance and immune activation not only underscores the challenges in treating infections but also advocates for heightened surveillance and innovative strategies to counteract the emerging threat of antimicrobial‐resistant K. pneumoniae.
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spelling doaj-art-98d9352bc1b34cbfaf87b5221dd4a71f2025-01-31T16:15:24ZengWileyiMetaOmics2996-95062996-95142024-12-0112n/an/a10.1002/imo2.39Dual role of ramR mutation in enhancing immune activation and elevating eravacycline resistance in Klebsiella pneumoniaeWei Yu0Peiyao Jia1Xiaobing Chu2Shengjie Li3Xinmiao Jia4Ying Zhu5Xiaoyu Liu6Yingchun Xu7Qiwen Yang8Department of Clinical Laboratory State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Clinical Laboratory State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Clinical Laboratory State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Clinical Laboratory State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Clinical Laboratory State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Clinical Laboratory State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Clinical Laboratory State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Clinical Laboratory State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Clinical Laboratory State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaAbstract The rise of Klebsiella pneumoniae resistant to last‐resort antimicrobials poses an urgent threat to global health. The ramR‐ramA regulatory system critically influences drug resistance by regulating the AcrAB‐TolC efflux pump, which also plays a crucial role in the pathogenicity of K. pneumoniae. However, the mechanism of the ramR‐ramA system on bacteria‐host interaction remains unclear. To determine how specific mutations in ramR influence eravacycline (ERV) resistance and their impact on the immune activation capabilities of K. pneumoniae, thereby highlighting potential targets for therapeutic intervention, we performed genetic sequencing to identify mutations in ramR. Then, the CRISPR‐Cas9 technology was employed to construct specific ramR mutations into K. pneumoniae, which were then subjected to phenotypic and functional assays in both in vitro and in vivo (mouse models, macrophage, and blood‐killing experiment) settings. ramR L58P and F165L genetic alterations disrupt the binding affinity of RamR to the ramA promoter, thereby upregulating the efflux pump expression and increasing ERV minimum inhibitory concentration values up to 64‐fold compared to the wild‐type. Concurrently, these mutations modulate lipid A structure by increasing 2‐hydroxy fatty acid chain abundance. In mouse models, ramR L58P and F165L mutants showed lower bacterial burden in organs (spleen, lung, and kidney) 6 h post‐infection, and are fast cleared in 48 h. Furthermore, despite lower intracellular bacterial loads, ramR L58P and F165L mutants induce heightened pro‐inflammatory cytokine responses in macrophages and elevate systemic cytokine levels (interleukin [IL]2, IL4, IL6, IL12, interferon‐α, and interferon‐γ) in human blood co‐culture experiments. This study illuminates the critical role of ramR mutations in conferring ERV resistance and enhancing immune responses in K. pneumoniae. The dual impact of these mutations on both antimicrobial resistance and immune activation not only underscores the challenges in treating infections but also advocates for heightened surveillance and innovative strategies to counteract the emerging threat of antimicrobial‐resistant K. pneumoniae.https://doi.org/10.1002/imo2.39AcrAB‐TolC efflux pumperavacycline resistanceimmune activationKlebsiella pneumoniaelipid A modificationramR
spellingShingle Wei Yu
Peiyao Jia
Xiaobing Chu
Shengjie Li
Xinmiao Jia
Ying Zhu
Xiaoyu Liu
Yingchun Xu
Qiwen Yang
Dual role of ramR mutation in enhancing immune activation and elevating eravacycline resistance in Klebsiella pneumoniae
iMetaOmics
AcrAB‐TolC efflux pump
eravacycline resistance
immune activation
Klebsiella pneumoniae
lipid A modification
ramR
title Dual role of ramR mutation in enhancing immune activation and elevating eravacycline resistance in Klebsiella pneumoniae
title_full Dual role of ramR mutation in enhancing immune activation and elevating eravacycline resistance in Klebsiella pneumoniae
title_fullStr Dual role of ramR mutation in enhancing immune activation and elevating eravacycline resistance in Klebsiella pneumoniae
title_full_unstemmed Dual role of ramR mutation in enhancing immune activation and elevating eravacycline resistance in Klebsiella pneumoniae
title_short Dual role of ramR mutation in enhancing immune activation and elevating eravacycline resistance in Klebsiella pneumoniae
title_sort dual role of ramr mutation in enhancing immune activation and elevating eravacycline resistance in klebsiella pneumoniae
topic AcrAB‐TolC efflux pump
eravacycline resistance
immune activation
Klebsiella pneumoniae
lipid A modification
ramR
url https://doi.org/10.1002/imo2.39
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