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Hypothetical binding of polymyxins (PMX) to wild type (wt) or resistant (mcr-1) lipid A. In the mcr-1 mutation, one of the phosphate groups (P) is modified to give a phosphoethanolamine (PE), reducing the number of binding sites for monomeric PMX. However, due to entropic effects, dimeric PMX benefits from additional interactions through an adjacent lipid A molecule.
