The process of lipid A synthesis begins in the cytoplasm with the precursor molecule
N-acetylglucosamine linked to a nucleotide carrier (UDP-GlcNAc). This UDP-GlcNAc precursor is initially acylated by the enzyme LpxA to yield UDP-3-
O-(acyl)-GlcNAc (
36–
38). LpxA is selective for the 14-carbon acyl group β-hydroxymyristate carried by the acyl carrier protein (ACP) (
37). This selectivity is based on the LpxA active site functioning as a hydrocarbon ruler that most readily incorporates 14-carbon substrates (
39,
40). The acylation of UDP-GlcNAc is unfavorable, however, and thus the first committed step of lipid A synthesis is the second reaction in the pathway, which is the irreversible deacetylation of UDP-3-
O-(acyl)-GlcNAc to UDP-3-
O-(acyl)-GlcN by the Zn
2+-dependent metalloenzyme LpxC (
41–
43). Because LpxC catalyzes the first committed step in the synthesis of LPS, much of the regulation of this pathway, which will be discussed below, appears to center around this enzyme. Following the action of LpxC, UDP-3-
O-(acyl)-GlcN is subsequently acylated a second time by LpxD to yield UDP-2,3-diacylglucosamine (
44,
45). Like its earlier homologous counterpart LpxA, LpxD is selective for β-hydroxymyristate-ACP as a donor (
44). In fact, it has been suggested that LpxD could, to some extent, be capable of substituting for LpxA in the first acylation step. However, since both enzymes are essential (
44,
46,
47), it appears any cross-specificity between LpxA and LpxD is insufficient to support growth. After the second acylation by LpxD, LpxH removes the sugar nucleotide carrier from UDP-2,3-diacylglucosamine to generate 2,3-diacylglucosamine-1-phosphate, otherwise known as lipid X (
48–
50). Lipid X is subsequently added by LpxB to a molecule of UDP-2,3-diacylglucosamine (the product of the LpxD reaction) through a β-1′-6 linkage that releases the UDP nucleotide carrier. The resulting product is a tetraacylated glucosamine disaccharide that is inserted in the inner leaflet of the IM and is sometimes referred to as lipid A disaccharide (
51,
52). Following this condensation step, lipid A disaccharide is phosphorylated at the 4′ position by the kinase LpxK, becoming the bisphosphorylated lipid IV
A (
53,
54). As noted above, while not strictly part of lipid A synthesis, the next step is the addition of two Kdo sugar groups of the core oligosaccharide to lipid IV
A (
55–
57). This step is mediated by the enzyme WaaA, previously known as KdtA, which sequentially adds Kdo groups to lipid IV
A from activated Kdo (CMP-Kdo) (
56,
57). Finally, two additional acylation events catalyzed by the LpxL and LpxM acyltransferases occur in sequence (
58–
60). LpxL adds a lauroyl group to the hydroxyl of the 2′-hydroxymyristoyl group and, subsequently, LpxM transfers a myristoyl group to the hydroxyl of the 3′-hydroxymyristoyl group (
58–
60). Like their earlier counterparts LpxA and LpxD, LpxL and LpxM only utilize substrates carried by ACP (
58–
60). LpxM functions best after the lauroyl group has already been added by LpxL, but it is capable of functioning to some extent in the absence of LpxL activity (
60). After the sequential action of LpxL and LpxM, mature, hexacylated lipid A, which also contains the first two Kdo residues of the inner core, is ready to serve as an acceptor for the sugar groups composing the core oligosaccharide.