# ArcA modulates multidrug resistance and compound susceptibility in Klebsiella pneumoniae through ArcB-independent regulation of the SMR efflux pump kpnEF

## TL;DR

This study shows that ArcA in Klebsiella pneumoniae increases antibiotic resistance by regulating the KpnEF efflux pump, independent of ArcB and through the AckA-Pta pathway.

## Contribution

The study reveals ArcA's direct regulation of KpnEF efflux pump and its phosphorylation via the AckA-Pta pathway, independent of ArcB.

## Key findings

- Deletion of arcA increases resistance to antibiotics and disinfectants independently of arcB.
- ArcA directly regulates kpnEF transcription by binding to its promoter region.
- ArcA phosphorylation in ΔarcB is mediated by the AckA-Pta pathway.

## Abstract

Klebsiella pneumoniae has become a major clinical and public health threat due to the increasing prevalence of healthcare-associated infections caused by multidrug-resistant strains. In this study, we demonstrated that the deletion of arcA of ArcAB two-component system diminished the susceptibility of K. pneumoniae to antibiotics, osmotic agents, disinfectants, and structural compounds, which was independent of arcB. RNA-seq analysis revealed a marked upregulation of SMR efflux pump genes kpnEF in the ΔarcA strain compared to the wild-type strain, while the ΔarcB strain exhibited no significant changes. Notably, the deletion of kpnEF in both ΔarcA and wild-type strains abolished their differential susceptibility to antibiotics, osmotic agents, disinfectants, and structural compounds. The EMSA experiments showed that ArcA-P regulated the kpnEF transcriptional expression by directly binding to its promoter region. These findings indicated that ArcA could directly modulate the expression of the KpnEF efflux pump independently of its sensor kinase ArcB. Through phosphorylation level detection and gene knockout experiments, we found that ArcA phosphorylation in the ΔarcB strain was primarily mediated by the AckA-Pta pathway. This study expanded the function of the ArcAB system and provided a critical theoretical foundation for elucidating the mechanisms underlying bacterial antibiotic resistance in K. pneumoniae.

Klebsiella pneumoniae is an important opportunistic bacterial pathogen, which can acquire a series of antimicrobial resistance (AMR) genes. The emergence of carbapenem-resistant K. pneumoniae (CRKP) posed significant challenges to public health. Polymyxins are often regarded as the last line of defense against CRKP infections. In this study, the deletion of arcA, the regulator of the two-component system ArcAB, increased resistance of K. pneumoniae to antibiotics and decreased susceptibility to osmotic agents, disinfectants, and structural compounds, which was independent of ArcB. Further experiments have shown that ArcA regulated the expression of the small multidrug resistance (SMR) pump KpnEF through direct binding. This process required ArcA phosphorylation, which was independent of ArcB but dependent on the AckA-Pta pathway. This study deepened the regulatory network of ArcAB and provided a new target for the treatment of K. pneumoniae.