Oxazolidinone antibiotics inhibit bacterial protein synthesis by interacting with the large ribosomal subunit. The structure and exact location of the oxazolidinone binding site remain obscure, as does the manner in which these drugs inhibit translation. To investigate the drug-ribosome interaction, we selected Escherichia coli oxazolidinone-resistant mutants, which contained a randomly mutagenized plasmid-borne rRNA operon. The same mutation, G2032 to A, was identified in the 23S rRNA genes of several independent resistant isolates. Engineering of this mutation by site-directed mutagenesis in the wild-type rRNA operon produced an oxazolidinone resistance phenotype, establishing that the G2032A substitution was the determinant of resistance. Engineered U and C substitutions at G2032, as well as a G2447-to-U mutation, also conferred resistance to oxazolidinone. All the characterized resistance mutations were clustered in the vicinity of the central loop of domain V of 23S rRNA, suggesting that this rRNA region plays a major role in the interaction of the drug with the ribosome. Although the central loop of domain V is an essential integral component of the ribosomal peptidyl transferase, oxazolidinones do not inhibit peptide bond formation, and thus these drugs presumably interfere with another activity associated with the peptidyl transferase center.During the course of evolution, a disproportionately large number of natural antibiotics have been selected to act upon the ribosome. In the majority of cases, these drugs bind to ribosomes by interacting directly with rRNA (8). Due to the presence of multiple copies of rRNA genes in most species, it is difficult for a sensitive organism to develop resistance by mutating the antibiotic binding site, which is probably one of the main reasons why the ribosome has been repeatedly selected as an antibiotic target.Conditions created by the extensive and sometimes uncontrolled use of natural and synthetic antibiotics for antimicrobial therapy have promoted the selection and rapid spread of resistant pathogens that exhibit high tolerance to many drugs, including those which are targeted against the ribosome. Although the occurrence of antibiotic resistance mutations in rRNA genes is fairly rare in comparison with other types of resistance, a number of such cases have been reported, especially in those pathogens which contain only one or two copies of rRNA operons in their chromosome (B. Vester and S. Douthwaite, submitted for publication).The rapidly growing incidence of drug resistance in pathogenic bacteria urges the development of new antibiotics. Several new drugs targeted against the ribosome are currently being developed, including the oxazolidinones (3, 18). After first being identified as prospective antimicrobial agents in 1987 (32), oxazolidinones were abandoned for some time due to their high toxicity. Later on, new derivatives with superior pharmacological properties were found (3, 16), and recently one of the oxazolidinone antibiotics, linezolid (Fig. 1A), has ...