Molecular basis for atovaquone resistance in Pneumocystis jirovecii modeled in the cytochrome bc1 complex of Saccharomyces cerevisiae

Atovaquone is a substituted hydroxynaphthoquinone that is widely used to prevent and clear Plasmodium falciparum malaria and Pneumocystis jirovecii pneumonia. Atovaquone inhibits respiration in target organisms by specifically binding to the ubiquinol oxidation site at center P of the cytochrome bc(1) complex. The failure of atovaquone treatment and mortality of patients with malaria and P. jirovecii pneumonia has been linked to the appearance of mutations in the cytochrome b gene. To better understand the molecular basis of atovaquone resistance, we have introduced seven of the mutations from atovaquone-resistant P. jirovecii into the cytochrome b gene of Saccharomyces cerevisiae and thus obtained cytochrome bc1 complexes resistant to inhibition by atovaquone. In these enzymes, the IC(50) for atovaquone increases from 25 nM for the enzyme from wild-type yeast to > 500 nM for some of the mutated enzymes. Modeling of the changes in cytochrome b structure and atovaquone binding with the mutated bc1 complexes provides the first quantitative explanation for the molecular basis of atovaquone resistance.