Fig. 7: Model of the mechanism of action of polymyxins.

1 Polymyxins initially localize on the OM membrane of Gram-negative bacteria through electrostatic interactions with LPS. 2 On the membrane, polymyxins form hexagonal crystalline structures that increase the membrane surface area, decrease the membrane bilayer height, and stiffen the membrane. The altered mechanical properties of the OM lead to (3a) the formation of membrane bulging protrusions and (3b) membrane rupture, content leak, which allows progression to the inner membrane and subsequent bacterial death.