The second generation of penicillins (including methicillin) was introduced to the clinic in 1959, and by 1961 strains of methicillin-resistant Staphylococcus aureus (MRSA) had emerged. 1 β-Lactam antibiotics were the standard treatment for staphylococcal infections prior to the emergence of MRSA. MRSA is now a global health threat, 2 and community-acquired MRSA has become a significant challenge in the clinic. 2 β-Lactams, which include penicillins, cephalosporins, and carbapenems, target the transpeptidase activity of penicillin-binding proteins (PBPs) involved in cell wall biosynthesis. The molecular basis for resistance to β-lactams in MRSA is complex and a full discussion is outside of the scope of this report; however, the key component is the presence in MRSA isolates of a gene, mecA, absent in methicillin susceptible strains, which encodes a novel PBP (PBP 2a). 3-5 Whereas other S. aureus PBP transpeptidases are susceptible to inhibition by β-lactams, the strains that possess PBP 2a are able to perform the critical cell wall cross-linking reaction even in the presence of β-lactam antibiotics. 3,6,7 PBP 2a escapes inhibition by β-lactams because they fail to readily gain access to the active site of this enzyme.The crystal structure of PBP 2a reveals it to have a closed active site. 8 This is a paradox, as the enzyme must bind to the peptidoglycan to carry out the cross-linking reaction. We previously disclosed that the two strands of peptidoglycan occupy in excess of 1000 Å 3 of volume, 9 hence the X-ray structure does not reveal how peptidoglycan could bind the active site. We presented evidence that interactions of PBP 2a with the peptidoglycan at an allosteric site trigger a conformational change that leads to accessibility to the active site, an event that should play a critical role in the physiological function of this important enzyme. 10,11 In this report we characterize the mode of action of two new anti-MRSA β-lactam antibiotics from Cerexa, Inc., ceftaroline (CPT) a cephalosporin and ME1036 (ME) a carbapenem, which are currently undergoing clinical trials. Both compounds are broad-spectrum antibiotics, but their activities against MRSA and multidrug resistant streptococci are especially noteworthy. In contrast to the commercially available β-lactam antibiotics, CPT and ME are exquisite inhibitors of PBP 2a of MRSA.The backbone of the peptidoglycan is made up of repeating units of N-acetylglucosamine (NAG) and N-acetylmuramic acid (NAM). A peptide stem-terminating with two D-Ala residues and typically a pentapeptide-is appended to the NAM unit. Compound 1 is a synthetic surrogate for the repeat unit of the peptidoglycan, whose synthesis was reported recently. 12 © 2008 American Chemical Society E-mail: mobashery@nd.edu. The penultimate D-Ala residue of the peptidoglycan acylates an active site serine in PBP 2a resulting in an acyl-enzyme species, with concomitant departure of the terminal D-Ala as the leaving group. This acyl-enzyme species reacts with the second strand of peptidoglycan in the ...