Cited by 608Antifungal resistance and susceptibilityDrug Transport and Resistance MechanismsFungal and yeast genetics research

The DOI matches its Crossref record; 399 of the 399 references it cites were found in a registry or an index.

Efflux-Mediated Antifungal Drug Resistance

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Abstract

SUMMARY: Fungi cause serious infections in the immunocompromised and debilitated, and the incidence of invasive mycoses has increased significantly over the last 3 decades. Slow diagnosis and the relatively few classes of antifungal drugs result in high attributable mortality for systemic fungal infections. Azole antifungals are commonly used for fungal infections, but azole resistance can be a problem for some patient groups. High-level, clinically significant azole resistance usually involves overexpression of plasma membrane efflux pumps belonging to the ATP-binding cassette (ABC) or the major facilitator superfamily class of transporters. The heterologous expression of efflux pumps in model systems, such Saccharomyces cerevisiae, has enabled the functional analysis of efflux pumps from a variety of fungi. Phylogenetic analysis of the ABC pleiotropic drug resistance family has provided a new view of the evolution of this important class of efflux pumps. There are several ways in which the clinical significance of efflux-mediated antifungal drug resistance can be mitigated. Alternative antifungal drugs, such as the echinocandins, that are not efflux pump substrates provide one option. Potential therapeutic approaches that could overcome azole resistance include targeting efflux pump transcriptional regulators and fungal stress response pathways, blockade of energy supply, and direct inhibition of efflux pumps.

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Crossref · 10.1128/cmr.00051-08

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Metadata

Authors
Cannon, R. D., Lamping, E., Holmes, A. R., Niimi, K., Baret, P. V., Keniya, M. V., Tanabe, K., Niimi, M., Goffeau, A., & Monk, B. C.
Affiliations
  • University of Otago (NZ)
  • UCLouvain (BE)
  • National Institute of Infectious Diseases (JP)
  • Université Catholique de Louvain, Louvain-la-Neuve, Belgium
Venue
Clinical Microbiology Reviews
Published
2009-04
Volume
22
Issue
2
Pages
291-321
ISSN
  • 0893-8512 (ISSN-L)
  • 1098-6618
OpenAlex
W2163758697
Cited by
608
References
399
Citations by year
2026: 28 · 2025: 30 · 2024: 33 · 2023: 35 · 2022: 32 · 2021: 44 · 2020: 42 · 2019: 34 · 2018: 28 · 2017: 40 · 2016: 35 · 2015: 36 · 2014: 51 · 2013: 42 · 2012: 32
FWCI
3.56
Type
journal article
Language
en
Open access
Locations
  • Clinical Microbiology Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DIAL (Catholic University of Leuven) (submittedVersion)
Funders
National Institute of Dental and Craniofacial Research (R01DE016885)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Oncology › Drug Transport and Resistance Mechanisms
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
Keywords
azole resistance, ABC transporters, major facilitator superfamily, pleiotropic drug resistance, echinocandins, fungal stress response, efflux pump inhibition, invasive fungal infections, antifungal drug development
MeSH terms
Antifungal Agents, DNA-Binding Proteins, Fungal Proteins, Fungi, Humans, Membrane Proteins, Mycoses, Transcription Factors, ATP-Binding Cassette Transporters, Drug Resistance, Fungal, Membrane Transport Proteins

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