Spontaneous polymyxin-resistant mutants of Pseudomonas aeruginosa were isolated. The mutations responsible for this phenotype were mapped to a two-component signal transduction system similar to PmrAB of Salmonella enterica serovar Typhimurium. Lipid A of these mutants contained aminoarabinose, an inducible modification that is associated with polymyxin resistance. Thus, P. aeruginosa possesses a mechanism that induces resistance to cationic antimicrobial peptides in response to environmental conditions. Cationic antimicrobial peptides (CAPs) are a widely conserved host defense mechanism of plants and animals. Their antimicrobial effects can be attributed to their amphipathic, detergent-like nature, which enables individual CAP molecules to interact with both anionic and hydrophobic components of the bacterial envelope. CAPs bind to lipopolysaccharide (LPS), a major component of the gram-negative cell surface, through interactions with phosphates and fatty acids of LPS core and lipid A moieties (31). These molecules cross the outer membrane and periplasm, disrupt the membrane potential of the inner membrane, and thereby cause cell death (25). In vertebrates, the CAPs that pathogens encounter at epithelial surfaces are a major component of innate immunity, an ancient system of host defense that is stimulated via receptors that recognize pathogen-associated molecular patterns (29).Pseudomonas aeruginosa is an opportunistic pathogen of humans that causes infections in those with host defense defects such as epidermal injury, immunodeficiency, and impaired epithelial clearance mechanisms. In the human host, P. aeruginosa is exposed to endogenous CAPs such as -defensins (37) and cathelicidins (5) at epithelial surfaces. It may also encounter exogenous CAPs in this setting, when agents such as the polymyxins, acylated cyclic CAPs synthesized by the grampositive soil bacterium Bacillus polymyxa, are used as antibiotics. Since the discovery and initial clinical use of the polymyxins more than 50 years ago, both clinical (12, 23, 26) and experimental (7, 16, 32) P. aeruginosa polymyxin resistance has been reported. P. aeruginosa possesses proteases that can degrade some CAPs (35); in addition, physiological (or "adaptive") polymyxin resistance may occur in response to membrane stresses such as divalent cation limitation (7,13,27,30) and polymyxin exposure (9, 16, 36), the latter being associated with the modulation of lipid A fatty acid composition (9). The P. aeruginosa PhoPQ two-component system contributes to the induction of these resistance phenotypes; however, its role appears to be complex (13,27), and the potential roles of other regulatory systems related to PmrAB, a response regulatorsensor kinase pair that regulates polymyxin resistance in Salmonella enterica serovar Typhimurium (18, 34), have not been defined.Isolation of polymyxin-resistant mutants of P. aeruginosa. Conditions that physiologically induce polymyxin resistance have not been fully defined for P. aeruginosa and could involve multiple regulatory...