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Clinically Relevant Chromosomally Encoded Multidrug Resistance Efflux Pumps in Bacteria
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SUMMARY: Efflux pump genes and proteins are present in both antibiotic-susceptible and antibiotic-resistant bacteria. Pumps may be specific for one substrate or may transport a range of structurally dissimilar compounds (including antibiotics of multiple classes); such pumps can be associated with multiple drug (antibiotic) resistance (MDR). However, the clinical relevance of efflux-mediated resistance is species, drug, and infection dependent. This review focuses on chromosomally encoded pumps in bacteria that cause infections in humans. Recent structural data provide valuable insights into the mechanisms of drug transport. MDR efflux pumps contribute to antibiotic resistance in bacteria in several ways: (i) inherent resistance to an entire class of agents, (ii) inherent resistance to specific agents, and (iii) resistance conferred by overexpression of an efflux pump. Enhanced efflux can be mediated by mutations in (i) the local repressor gene, (ii) a global regulatory gene, (iii) the promoter region of the transporter gene, or (iv) insertion elements upstream of the transporter gene. Some data suggest that resistance nodulation division systems are important in pathogenicity and/or survival in a particular ecological niche. Inhibitors of various efflux pump systems have been described; typically these are plant alkaloids, but as yet no product has been marketed.
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“There are 5 major families of efflux pumps, including i) the major facilitator superfamily (MFS), ii) the small multidrug resistance family (SMR), iii) the resistance-nodulation-cell-division family (RND), iv) the ATP-binding cassette family (ABC), and v) the multidrug and toxic compound extrusion family (MATE).”
From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [46]
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Metadata
- Authors
- Piddock, L. J. V.
- Affiliations
- University of Birmingham (GB)
- Corresponding author
- Piddock, Laura J. V.
- ORCID
- Piddock, Laura J. V.
- Venue
- Clinical Microbiology Reviews
- Publisher
- American Society for Microbiology
- Published
- 2006-04
- Volume
- 19
- Issue
- 2
- Pages
- 382-402
- ISSN
- 0893-8512 (ISSN-L)
- 1098-6618
- PMC
- PMC1471989
- OpenAlex
- W2112586763
- Cited by
- 1,231
- References
- 242
- Citations by year
- 2026: 37 · 2025: 45 · 2024: 66 · 2023: 65 · 2022: 69 · 2021: 99 · 2020: 75 · 2019: 69 · 2018: 53 · 2017: 79 · 2016: 72 · 2015: 69 · 2014: 72 · 2013: 57 · 2012: 63
- FWCI
- 2.45
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Microbiology Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Oncology › Drug Transport and Resistance Mechanisms
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Bacterial Genetics and Biotechnology
- Keywords
- multidrug resistance, efflux pumps, antibiotic resistance, pathogenic bacteria, efflux pump regulation, efflux pump inhibitors, plant alkaloids, drug transport mechanisms, insertion elements
- MeSH terms
- Alkaloids, Anti-Infective Agents, Bacteria, Bacterial Proteins, Biological Transport, Chromosomes, Bacterial, Disinfectants, DNA Transposable Elements, Genes, Regulator, Mutation, Promoter Regions, Genetic, Virulence, Drug Resistance, Multiple, Bacterial, Membrane Transport Proteins, ATP-Binding Cassette, Sub-Family C Proteins
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