Magnesium modulates phospholipid metabolism to promote bacterial phenotypic resistance to antibiotics

Reviewer #1 (Public Review):

Summary:

In the manuscript entitled "Magnesium modulates phospholipid metabolism to promote bacterial phenotypic resistance to antibiotics", Li et al demonstrated the role of magnesium in promoting phenotypic resistance in V. alginolyticus. Using standard microbiological and metabolomic techniques, the authors have shown the significance of fatty acid biosynthesis pathway behind the resistance mechanism. This study is significant as it sheds light on the role of an exogenous factor in altering membrane composition, polarization, and fluidity which ultimately leads to antimicrobial resistance.

Strengths:

(1) The experiments were carried out methodically and logically.

(2) An adequate number of replicates were used for the experiments.

Weaknesses:

(1) The introduction section needs to be more informative and to the point.

(2) The weakest point of this paper is in the logistics through the results section. The way authors represented the figures and interpreted them in the results section (or the figure legends) does not match. The figures are difficult to interpret and are not at all self-explanatory.

(3) There are too many mislabeling of the figure panels in the main text which makes it difficult to find out which figures the authors are explaining. There should be more explanation on why and how they did the experiments and how the results were interpreted.

Reviewer #2 (Public Review):

Summary:

In this study, the authors aimed to identify if and how magnesium affects the ability of two particular bacteria species to resist the action of antibiotics. In my view, the authors succeeded in their goals and presented a compelling study that will have important implications for the antibiotic resistance research community. Since metals like magnesium are present in all lab media compositions and are present in the host, the data presented in this study certainly will inspire additional research by the community. These could include research into whether other types of metals also induce multi-drug resistance, whether this phenomenon can be observed in other bacterial species, especially pathogenic species that cause clinical disease, and whether the underlying molecular determinants (i.e. enzymes) of metal-induced phenotypic resistance could be new antimicrobial drug targets themselves.

Strengths:

This study's strengths include that the authors used a variety of methodologies, all of which point to a clear effect of exogenous Mg2+ on drug resistance in the targeted species. I also commend the authors for carrying out a comprehensive study, spanning evaluation of whole cell phenotypes, metabolic pathways, genetic manipulation, to enzyme activity level evaluation. The fact that the authors uncovered a molecular mechanism underlying Mg2+-induced phenotypic resistance is particularly important as the key proteins should be studied further.

Weaknesses:

I believe there are weaknesses in the manuscript, however. The authors take for granted that the reader is familiar with all the assays utilized, and do not properly explain some experiments, and thus I highly suggest that the authors add a brief statement in each situation describing the rationale for each selected methodology (more details are in the private review to the authors). The Results section is also quite long and bogs down at times, and I suggest that the authors reduce its length by 10 to 20%. In contrast, the Introduction is sparse and lacks key aspects, for example, there should be mention of the study's main purpose and approaches, plus an introduction to the authors' choice of species and their known drug resistance properties, as well as the drug of choice (balofloxacin). Another notable weakness is that the authors evaluated Mg2+-induced phenotypic resistance only against two closely related species, and thus the generalizability of this mechanism of drug resistance is not known. The paper would be strengthened if the authors could demonstrate this type of phenotypic resistance in at least one more Gram-negative species and at least one Gram-positive species (antimicrobial susceptibility evaluations would suffice), each of which should be pathogenic to humans. Demonstrating magnesium-induced phenotypic drug resistance in the WHO Priority Bacterial Pathogens would be particularly important.

In general, the conclusions drawn by the authors are justified by the data, except for the interpretation of some experiments. Importantly, this paper has discovered new antimicrobial resistance mechanisms and has also pointed to potential new targets for antimicrobials.

Author response:

Public Reviews:

Reviewer #1 (Public Review):

Summary:

In the manuscript entitled "Magnesium modulates phospholipid metabolism to promote bacterial phenotypic resistance to antibiotics", Li et al demonstrated the role of magnesium in promoting phenotypic resistance in V. alginolyticus. Using standard microbiological and metabolomic techniques, the authors have shown the significance of fatty acid biosynthesis pathway behind the resistance mechanism. This study is significant as it sheds light on the role of an exogenous factor in altering membrane composition, polarization, and fluidity which ultimately leads to antimicrobial resistance.

Strengths:

(1) The experiments were carried out methodically and logically.

(2) An adequate number of replicates were used for the experiments.

Weaknesses:

(1) The introduction section needs to be more informative and to the point.

(2) The weakest point of this paper is in the logistics through the results section. The way authors represented the figures and interpreted them in the results section (or the figure legends) does not match. The figures are difficult to interpret and are not at all self-explanatory.

(3) There are too many mislabeling of the figure panels in the main text which makes it difficult to find out which figures the authors are explaining. There should be more explanation on why and how they did the experiments and how the results were interpreted.

(1) We would like to extensive revise the introduction to make it more informative than the current version.

(2) We will check the description in the text and labeling in the figures to make it is logic.

(3) We will add the explanation of the experiments to make it clear that why we perform the assays.

Reviewer #2 (Public Review):

Summary:

In this study, the authors aimed to identify if and how magnesium affects the ability of two particular bacteria species to resist the action of antibiotics. In my view, the authors succeeded in their goals and presented a compelling study that will have important implications for the antibiotic resistance research community. Since metals like magnesium are present in all lab media compositions and are present in the host, the data presented in this study certainly will inspire additional research by the community. These could include research into whether other types of metals also induce multi-drug resistance, whether this phenomenon can be observed in other bacterial species, especially pathogenic species that cause clinical disease, and whether the underlying molecular determinants (i.e. enzymes) of metal-induced phenotypic resistance could be new antimicrobial drug targets themselves.

Strengths:

This study's strengths include that the authors used a variety of methodologies, all of which point to a clear effect of exogenous Mg2+ on drug resistance in the targeted species. I also commend the authors for carrying out a comprehensive study, spanning evaluation of whole cell phenotypes, metabolic pathways, genetic manipulation, to enzyme activity level evaluation. The fact that the authors uncovered a molecular mechanism underlying Mg2+-induced phenotypic resistance is particularly important as the key proteins should be studied further.

Weaknesses:

I believe there are weaknesses in the manuscript, however. The authors take for granted that the reader is familiar with all the assays utilized, and do not properly explain some experiments, and thus I highly suggest that the authors add a brief statement in each situation describing the rationale for each selected methodology (more details are in the private review to the authors). The Results section is also quite long and bogs down at times, and I suggest that the authors reduce its length by 10 to 20%. In contrast, the Introduction is sparse and lacks key aspects, for example, there should be mention of the study's main purpose and approaches, plus an introduction to the authors' choice of species and their known drug resistance properties, as well as the drug of choice (balofloxacin). Another notable weakness is that the authors evaluated Mg2+-induced phenotypic resistance only against two closely related species, and thus the generalizability of this mechanism of drug resistance is not known. The paper would be strengthened if the authors could demonstrate this type of phenotypic resistance in at least one more Gram-negative species and at least one Gram-positive species (antimicrobial susceptibility evaluations would suffice), each of which should be pathogenic to humans. Demonstrating magnesium-induced phenotypic drug resistance in the WHO Priority Bacterial Pathogens would be particularly important.

We will add the explanation of the experiments to make it clear that why we perform the assays. And we will revise the introduction and shorten the length of the manuscript. Expanding the bacterial species is very good idea and we will perform such experiment.