Onset of the adaptive immune response in mice infected with Mycobacterium tuberculosis is accompanied by slowing of bacterial replication and establishment of a chronic infection. Stabilization of bacterial numbers during the chronic phase of infection is dependent on the activity of the gamma interferon (IFN-␥)-inducible nitric oxide synthase (NOS2). Previously, we described a differential signature-tagged mutagenesis screen designed to identify M. tuberculosis "counterimmune" mechanisms and reported the isolation of three mutants in the H37Rv strain background containing transposon insertions in the rv0072, rv0405, and rv2958c genes. These mutants were impaired for replication and virulence in NOS2 ؊/؊ mice but were growth-proficient and virulent in IFN-␥ ؊/؊ mice, suggesting that the disrupted genes were required for bacterial resistance to an IFN-␥-dependent immune mechanism other than NOS2. Here, we report that the attenuation of these strains is attributable to an underlying transposon-independent deficiency in biosynthesis of phthiocerol dimycocerosate (PDIM), a cell wall lipid that is required for full virulence in mice. We performed whole-genome resequencing of a PDIM-deficient clone and identified a spontaneous point mutation in the putative polyketide synthase PpsD that results in a G44C amino acid substitution. We demonstrate by complementation with the wild-type ppsD gene and reversion of the ppsD gene to the wild-type sequence that the ppsD(G44C) point mutation is responsible for PDIM deficiency, virulence attenuation in NOS2 ؊/؊ and wild-type C57BL/6 mice, and a growth advantage in vitro in liquid culture. We conclude that PDIM biosynthesis is required for M. tuberculosis resistance to an IFN-␥-mediated immune response that is independent of NOS2.Pathogenic mycobacteria possess a unique array of complex cell wall-associated lipids. The most abundant of these lipids, the phthiocerol dimycocerosates (PDIMs) (Fig. 1), are among the best characterized (23). PDIMs contain long-chain diols esterified by methyl-branched fatty acid chains. As early as 1974, it was recognized that a spontaneously arising PDIMdeficient variant of the laboratory strain H37Rv was attenuated in a guinea pig model of infection (11). Shortly thereafter, it was shown that the in vivo survival of an avirulent Mycobacterium tuberculosis strain was enhanced by coating the bacteria with cholesterol oleate and purified PDIM (16). A genetic link between PDIM production and virulence was not established until a quarter century later, when a large chromosomal locus was identified as playing an essential role in the biosynthesis and export of PDIM (3,4,6). Transposon insertions within the fadD26, fadD28, mmpL7, and drrC genes, and in the putative transcriptional promoter region upstream of the fadD26 gene, were identified in strains deficient in surface-localized PDIM. The fadD26 and fadD28 mutants apparently fail to synthesize PDIM, whereas the mmpL7 and drrC mutants produce PDIM but accumulate it intracellularly, thus implicating these ...