Project Summary For something as complex and multifaceted as bacterial antibiotic resistance (AR), our drug evaluation paradigm is strikingly narrow and homogenous: MIC/MBC testing in standardized bacteriologic media. We have shown that this drug evaluation paradigm is inadequate, even misleading, as changes in the media conditions of the procedure lead to dramatically different results. A more holistic definition of antibiotic therapy that centers on understanding antibiotic activity in synergy with host innate immune factors such as cationic antimicrobial peptides (AMPs), serum and phagocytic cells (e.g. neutrophils) reveals therapeutic options unrecognized in standard testing. The proposed U01 program represents a groundbreaking approach to use systems biology approaches and inform more effective antibiotic utilization in the context of host innate immunity. We propose to: 1) build an iterative systems biology workflow that integrates multiple experimental and computational approaches to give a comprehensive assessment of AR; and 2) apply this workflow to high priority pathogens to systematically elucidate AR mechanisms and their conditiondependency. The iterative workflow includes: (i) omics and physiological data generation. Clinically isolated strains of the selected pathogens will be grown under conventional testing (bacteriologic media) and more physiologic conditions (tissue culture media, serum, and in presence of AMPs and neutrophils) to probe for advantageous gain of activity. The omics data types collected are: DNA resequencing, RNAseq, and metabolomics. (ii) Bioinformatics and data modeling analysis involves three approaches: big data analysis for data set dimensionality and coarse grained variable dependencies assessment, genomescale modeling for mechanistic elucidation and analysis, and machine learning that uses ARrelated metadata to classify the overall biological functions. This analysis will lead to understanding of AR mechanisms. (iii) Multiscale validation from animal models, to laboratory evolution, to cytology, to gene expression alteration, to structural protein analysis of putative targets. The validation thus ranges from host behavior to atomistic detail of ligandtarget interactions. The iterative loop then closes, comparing computational prediction to experimental outcomes. Falsenegative and falsepositive predictions are then algorithmically analyzed by a hypothesis generating family of algorithms that then makes suggestions about what conditions to use in the next iteration of the loop. The pathogens that we will focus on are methicillinresistant Staphylococcus aureus (MRSA), the carbapenemresistant Enterobacteriaceae (CRE) Klebsiella pneumoniae and Acinetobacter baumannii, and Pseudomonas aeruginosa. The team of investigators has made the foundational observations and led the development of the technologies on which the iterative workflow is based. A multi and genom...