Global Antibiotic Research & Development Partnership (GARDP), Chemin Camille-Vidart 15, 1202 Geneva, Switzerland.
ACS Infect Dis. 2024 May 10;10(5):1458-1482. doi: 10.1021/acsinfecdis.4c00091. Epub 2024 Apr 25.
Efflux is a natural process found in all prokaryotic and eukaryotic cells that removes a diverse range of substrates from inside to outside. Many antibiotics are substrates of bacterial efflux pumps, and modifications to the structure or overexpression of efflux pumps are an important resistance mechanism utilized by many multidrug-resistant bacteria. Therefore, chemical inhibition of bacterial efflux to revitalize existing antibiotics has been considered a promising approach for antimicrobial chemotherapy over two decades, and various strategies have been employed. In this review, we provide an overview of bacterial multidrug resistance (MDR) efflux pumps, of which the resistance nodulation division (RND) efflux pumps are considered the most clinically relevant in Gram-negative bacteria, and describe over 50 efflux inhibitors that target such systems. Although numerous efflux inhibitors have been identified to date, none have progressed into clinical use because of formulation, toxicity, and pharmacokinetic issues or a narrow spectrum of inhibition. For these reasons, the development of efflux inhibitors has been considered a difficult and complex area of research, and few active preclinical studies on efflux inhibitors are in progress. However, recently developed tools, including but not limited to computational tools including molecular docking models, offer hope that further research on efflux inhibitors can be a platform for research and development of new bacterial efflux inhibitors.
外排是一种在所有原核和真核细胞中发现的自然过程,它将各种底物从细胞内排出到细胞外。许多抗生素是细菌外排泵的底物,而对外排泵的结构进行修饰或过度表达是许多多药耐药菌使用的重要耐药机制。因此,化学抑制细菌外排以恢复现有抗生素的活力,被认为是二十多年来抗菌化学疗法的一种有前途的方法,并且已经采用了各种策略。在这篇综述中,我们概述了细菌多药耐药性(MDR)外排泵,其中抗性结节分化(RND)外排泵在革兰氏阴性菌中被认为是最具临床相关性的,并且描述了 50 多种针对此类系统的外排抑制剂。尽管迄今为止已经鉴定出许多外排抑制剂,但由于制剂、毒性和药代动力学问题或抑制谱狭窄,没有一种进入临床使用。由于这些原因,外排抑制剂的开发被认为是一个困难和复杂的研究领域,很少有关于外排抑制剂的积极临床前研究正在进行。然而,最近开发的工具,包括但不限于包括分子对接模型在内的计算工具,为进一步研究外排抑制剂提供了希望,这可能成为研究和开发新的细菌外排抑制剂的平台。
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