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Methicillin-resistant S. aureus (MRSA) is the leading cause of healthcare-associated infection and the associated antibiotic resistance is a considerable clinical challenge1,2,3. Therefore, the development of novel therapeutic strategies is a high priority. A promising treatment strategy for Gram-positive pathogens is inhibiting fatty acid synthesis, a requirement for membrane phospholipid production that, in S. aureus, includes phosphatidylglycerol (PG), lysyl-PG, and cardiolipin4. In bacteria, fatty acid production occurs via the fatty acid synthesis II pathway (FASII)5, which is considerably different from the eukaryotic counterpart, making FASII an attractive target for antibiotic development5,6. FASII inhibitors primarily target FabI, an enzyme required for fatty acid carbon chain elongation7. The FabI inhibitor triclosan is broadly used in consumer and medical goods8,9. Additional FabI inhibitors are being developed by several pharmaceutical companies for the treatment of S. aureus infection10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26. However, many Gram-positive pathogens, including S. aureus, are capable of scavenging exogenous fatty acids for phospholipid synthesis, bypassing FASII inhibition27,28,29. Thus, the clinical potential of FASII inhibitors is debated due to considerable gaps in our knowledge of the sources of host fatty acids and the mechanisms by which pathogens extract fatty acids from the host27,28. To address these gaps, we developed an unbiased lipidomic analysis method to monitor incorporation of exogenous fatty acid from lipoprotein particles into membrane phospholipids of S. aureus.
During sepsis, host lipoprotein particles represent a potential source of host-derived fatty acids within the vasculature, as a majority of host fatty acids are associated with the particles30. Lipoproteins consist of a hydrophilic shell composed of phospholipids and proteins that enclose a hydrophobic core of triglycerides and cholesterol esters31. Four major classes of lipoproteins--chylomicron, very low-density lipoprotein, high-density lipoprotein, and low-density lipoprotein (LDL)—are produced by the host and function as lipid transport vehicles, delivering fatty acids and cholesterol to and from host cells via the vasculature. LDLs are abundant in esterified fatty acid including triglycerides and cholesterol esters31. We have previously demonstrated that highly purified human LDLs are a viable source of exogenous fatty acids for PG synthesis, thus providing a mechanism for FASII inhibitor bypass32. Purifying human LDLs can be technically challenging and time consuming while commercial sources of purified human LDLs are prohibitively expensive to use on a routine basis or to perform large-scale bacterial screens. To address these limitations, we have modified a procedure for the enrichment of LDLs from chicken egg yolk, a rich source of lipoprotein particles33. We have successfully used untargeted, high-resolution/accurate mass spectrometry and tandem mass spectrometry to monitor incorporation of human LDL-derived fatty acids into the membrane of S. aureus32. Unlike previously reported methods, this approach can quantify individual fatty acid isomers for each of the three major staphylococcal phospholipid types. Oleic acid (18:1) is an unsaturated fatty acid present within all host lipoprotein particles that is readily incorporated into S. aureus phospholipids29,30,32. S. aureus is not capable of oleic acid synthesis29; therefore, the quantity of phospholipid-incorporated oleic acid establishes the presence of host lipoprotein-derived fatty acids within the staphylococcal membrane29. These phospholipid species can be identified by the state-of-the-art mass spectrometry method described here, offering unprecedented resolution of the membrane composition of S. aureus cultured in the presence of a fatty acid source it likely encounters during infection.