Reaction‐Induced Self‐Assembly of Polymyxin Mitigates Cytotoxicity and Reverses Drug Resistance

Abstract Polymyxins have been regarded as an efficient therapeutic against many life‐threatening, multidrug resistant Gram‐negative bacterial infections; however, the cytotoxicity and emergence of drug resistance associated with polymyxins have greatly hindered their clinical potential. Herein, the reaction‐induced self‐assembly (RISA) of polymyxins and natural aldehydes in aqueous solution is presented. The resulting assemblies effectively mask the positively charged nature of polymyxins, reducing their cytotoxicity. Moreover, the representative PMBA₄ (composed of polymyxin B (PMB) and (E)‐2‐heptenal (A₄)) assemblies demonstrate enhanced binding to Gram‐negative bacterial outer membranes and exhibit multiple antimicrobial mechanisms, including increased membrane permeability, elevated bacterial metabolism, suppression of quorum sensing, reduced ATP synthesis, and potential reduction of bacterial drug resistance. Remarkably, PMBA₄ assemblies reverse drug resistance in clinically isolated drug‐resistant strains of Gram‐negative bacteria, demonstrating exceptional efficacy in preventing and eradicating bacterial biofilms. PMBA₄ assemblies efficiently eradicate Gram‐negative bacterial biofilm infections in vivo and alleviate inflammatory response. This RISA strategy offers a practical and clinically applicable approach to minimize side effects, reverse drug resistance, and prevent the emergence of resistance associated with free polymyxins.