Mutations in mprF have been shown to result in reduced susceptibility to daptomycin and other cationic antibacterials. An mprF antisense-inducible plasmid was constructed and used to demonstrate that depletion of mprF can reestablish susceptibility to daptomycin. Inducing antisense to mprF also resulted in increased susceptibility to vancomycin and gentamicin but, paradoxically, decreased susceptibility to oxacillin. These results suggest that mprF mutations that reduce susceptibility to cationic antibacterials result in a gain-of-function phenotype.Daptomycin (DAP) is a cyclic lipopeptide that exhibits rapid bactericidal activity against Gram-positive bacteria, including methicillin-resistant and glycopeptide-intermediate Staphylococcus aureus (33). The mechanism of action of DAP involves a calcium-dependent insertion in the bacterial cell membrane, resulting in depolarization and cell death (4,5,7,8). According to the Food and Drug Administration, S. aureus isolates are DAP susceptible (DAP s ) at MICs of Յ1 g/ml and are DAP resistant (DAP r ) at MICs of Ն2 g/ml. In vitro, spontaneous emergence of DAP nonsusceptibility is rare (frequency, Ͻ10 Ϫ10 ) but can occur through serial passage with subinhibitory DAP concentrations (10, 28). However, since its introduction into clinical use, DAP r S. aureus isolates have been reported in which the MIC increased from 0.5 g/ml to 2 to 4 g/ml (1, 9, 11, 12, 18-20, 29, 32, 34).The precise mechanism of DAP resistance has not been determined, but several genes contributing to this phenotype have been identified, including mprF and yycG (21, 37). mprF (fmtC) encodes a nonessential integral membrane protein that catalyzes the synthesis of lysylphosphatidylglycerol (LPG), a positively charged phospholipid that constitutes up to 38% of the S. aureus membrane (24,25,31). It is unlikely that these mprF mutations result in a loss of function, because DAP susceptibility is increased in ⌬mprF strains (with a MIC of 0.125 g/ml versus 0.5 g/ml for the parent). Instead, it is postulated that the mprF-associated DAP r phenotype represents a gain of function; this phenotype has been observed for mprF point mutation alleles with other antibacterial agents (10,13,21). Although this nonsusceptibility phenotype has not been fully described, it is possible that some of these mutations increase the overall positive charge on the bacterial membrane, resulting in DAP repulsion (10, 13).