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Abstract

Chemotherapeutic agents are substances that cure infectious diseases for many years. However, problems arose due to drug resistance that developed over time and it was observed that the drugs failed to kill the bacteria. Studies have been carried out to find the factor caused by drug resistance that adversely affect the disease treatment, and these studies continue today. There are different types of resistance mechanisms. Efflux pumps are just one of these mechanisms. Efflux pumps cannot enter and release the drug into the cell. Thus, the microorganism becomes resistant to the drug used. If this resistance is inhibited, the drug may work. A variety of chemical or natural inhibitors are available for inhibition. However, since they cause toxicity problems, their clinical use is not currently available. Studies in this area are ongoing. There are studies to determine the activity of the efflux pump. The activity of this mechanism can be detected with ethidium bromide (EtBr). In this study, it was aimed to determine the efflux pump activity of some resistant clinically isolated strains using EtBr dye. The strains that are Acinetobacter baumannii, Candida albicans, Candida glabrata, Candida tropicalis, Klebsiella pneumoniae, Providencia rustigianii, Serratia odorifera, Shigella flexneri, Staphylococcus aureus and Streptococcus pneumoniae microorganisms. Cartwheel method was applied on agars containing TSB with EtBr with different concentrations (0.0 mg/L, 0.5 mg/L, 1.0 mg/L, 1.5 mg/L, 2.0 mg/L and 2.5 mg/L). After the incubation, activation case was observed under UV light. It is concluded that each strain used has efflux pump activity. EtBr was released at 0.5 mg/L and did not fluoresce. Different fluorescence were observed under EtBr UV between 1.0 mg/L and 2.5 mg /L.
© 2022 al-Farabi Kazakh National University Int. j. biol. chem. (Online)
International Journal of Biology and Chemist48
IRSTI 31.23.25 https://doi.org/10.26577/ijbch.2022.v15.i1.05
*, E.M. Altuner
Kastamonu University, Kastamonu, Turkey
*e-mail: altinozedaa@gmail.com
(Received 2 March 2021; received in revised form 30 March 2022; accepted 13 May 2022)


AbstChemotherapeutic agents are substances that cure infectious diseases for many years. However,
problems arose due to drug resistance that developed over time and it was observed that the drugs failed to
stance that adversely
ststance mecha-
st
the cell. Thus, the microorganism becomes resistant to the drug used. If this resistance is inhibited, the drug
may work. A variety of chemical or natural inhibitors are available for inhibition. However, since they
cause toxicity problems, their clinical use is not currently available. Studies in this area are ongoing. There
are st
ststant
clinically isolated strains using EtBr dye. The strains that are Acinetobacter baumannii, Candida albicans,
Candida glabrata, Candida tropicalis, Klebsiella pneumoniae, Providencia rustigianii, Serratia odorif-
era, , Staphylococcus aureus and Streptococcus pneumoniae microorganisms. Cartwheel

1.0 mg/L, 1.5 mg/L, 2.0 mg/L and 2.5 mg/L). After the incubation, activation case was observed under UV
light. It is concluded that each st

 Drug resistst
UV.

    
reached a very important stage. As a result, the
researches to discover new antibiotic hit compounds

of the important phenomena for antibiotic resistance.
Gram negative bacteria also have more
antibacterial resistance than gram positive bacteria
because gram negative bacteria have an outer
membrane in addition to the cell wall structure [1-3].
       
role in expelling substances from inside towards the
outside of the cells [4]. It can be present in all types
of living cells [5].

was the excretion of tetracycline in Escherichia coli

      
     
     
    
     
     
The Proteobacterial Antimicrobial Compound
 
published by Du et al. [12] and the Drug Metabolite
       
DMT is a large group of membrane transporters
present in eukaryotes, bacteria and archaea, and
includes exporters for a wide range of substrates such
as toxic compounds and metabolites [13-15].
       
antimicrobial compounds can accumulate inside the
cell, which may cause a cell death. Although there
     
they are not commonly used clinically due to their
toxicity [16].
       
positive or gram-negative bacteria or both [17]. The
       
mode of action are as follows.
49
Int. j. biol. chem. (Online) International Journal of Biology and Chemist

Verapamil inhibits ABC/MFS family,
Thioridazine inhibits NorA pump of the MFS family,
Carbonyl Cyanide m-Chlorophenyl Hydrazone
   
    
   
pump) family, Paroxetine inhibits RND/MFS family
and Reserpine inhibits RND/MFS family [10, 13, 18-
33].
The aim of this study is observing the presence
    
  


Enrichment of microorganisms and isolation
of pure colonies. In this study, totally 10 clinical
isolate MDR strains were used. 7 of the strains
  Acinetobacter baumannii, Klebsiella
pneumoniae, Providencia rustigianii, Serratia
odorifera,  , Staphylococcus aureus
and Streptococcus pneumoniae) and 3 are yeast
Candida albicans, Candida glabrata and Candida
tropicalis). Microorganisms were activated Luria-
      

for pure colony formation. Pure colonies obtained
in NA were transferred into sterile saline solution
      
0.5 McFarland standards.
Ethidium bromide (EtBr)-Tryptic Soy Agar (TSB)
     
     

were prepared. Microorganisms were inoculated on
the plates according the cartwheel method. Cartwheel
       


Cartwheel method
 After incubation, TSB
agar plates containing EtBr were observed under UV
light.
Statistical analysis. R Studio, version 4.0.2 was
used to conduct a one-way analysis of variance


In order to obtain results, plates were observed
      
      
microorganism under UV light on TSB agar plates.
0.0 mg/L concentration is the negative control group.
   
   
       
Figure 2.

50
Int. j. biol. chem. (Online) International Journal of Biology and Chemist

Since the amount of EtBr dye at 0.5 mg/L was
      

Figure 3.
       
     
         
purple fluorescence started to appear. A low
,
, , ) was
 
    
on the second plate and the purple fluorescence of

C. glabrata and  . Results presented



      
        
    
     
 ,  ,  ,


were observed on the second plate. S. aureus and

 was observed to be

         

For 2.0 mg/L of EtBr concentration; EtBr was
accumulated in the cells of all microorganisms,
     
    S. odorifera,
S. pneumoniae, A. baumannii, P. rustigianii) in the

   S. aureus, K. pneumoniae and
  were observed on the second plate. The
C. albicans and C. tropicalis in the
third plate was higher than C. glabrata. Results

2.5 mg/L concentration is the highest
concentration. EtBr was accumulated in the cells
of all microorganisms. Because of the high EtBr
     
higher than other concentrations. Results presented

51
Int. j. biol. chem. (Online) International Journal of Biology and Chemist




According to the results it was observed that
      
cell changes between 1.0 and 2.0 mg/L of EtBr
for all strains used in the study. In all strains, the
       
   


In a previous study, which was conducted
by MDR E. coli      
     
were observed. Cartwheel test with EtBr was
applied to microorganisms and similar results were
observed under UV light. In addition, verapamil,
thioridazine hydrochloride and phenyl arginine
     
in combination with some antibiotics for inhibiting
bacterial growth and positive results were obtained
[11].
In a study by Anbazhagan et al. MDR Salmonella
Typhimurium
activity was evaluated. They applied the EtBr
cartwheel method in the experiment. They prepared
MH agar plates with EtBr containing 0.0 mg/L, 0.5
mg/L, 1.0 mg/L, 1.5 mg/L and 2.0 mg/L. After the
incubation, the plates were examined under UV and
      
     
52
Int. j. biol. chem. (Online) International Journal of Biology and Chemist


        
inhibitor and some antibiotics. It was stated that 8


[36]. In the study by Martins et al. MDR E. coli,
Salmonella typhimurium, Salmonella enteritidis,
Enterococcus faecalis, Enterobacter aerogenes and
Staphylococcus aureus bacteria strains were used.
They applied the cartwheel method in TSB agars
with EtBr at concentrations between 0.0 mg/L and
        
[34]. Jiang et al. used the LightCycler 96 instrument
      

 
   Listeria monocytogenes
they used [37].


activity was determined, inhibitor studies were
performed with antibiotic combinations. Studies
should continue to discover a non-toxic inhibitor

acts on. Thus, it is thought that it may overcome
the major problem of antibiotic resistance. In
       

    
was observed under EtBr UV between 1.0 mg/L
and 2.5 mg/L. It is clear that, researches about
      
they are important in bacterial resistance and
this study clearly presents that each strain could
   
       
    
inhibition researches. Various results can be
      
working with more various microorganisms.

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© This is an open access article under the (CC)BY-NC license (https://creativecommons.org/licenses/by-
nc/4.0/). Funded by Al-Farabi KazNU
... Keywords: Efflux pumps, inhibitor, E. coli, antibiotic resistance, multi-drug resistance, molecular docking, RND Introduction: The efflux pump, one of the antibiotic resistance mechanisms, has different superfamilies. The RND pump is just one of them (Altınöz & Altuner, 2019;2022). The research on the Resistance-nodulation-division (RND) family in this study is due to the MDR E. coli strains used in the in vitro study. ...
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Drug tolerance likely represents an important barrier to tuberculosis treatment shortening. We previously implicated the Mycobacterium tuberculosis efflux pump Rv1258c as mediating macrophage-induced tolerance to rifampicin and intracellular growth. In this study, we infected the human macrophage-like cell line THP-1 with drug-sensitive and drug-resistant M. tuberculosis strains and found that tolerance developed to most antituberculosis drugs, including the newer agents moxifloxacin, PA-824, linezolid, and bedaquiline. Multiple efflux pump inhibitors in clinical use for other indications reversed tolerance to isoniazid and rifampicin and slowed intracellular growth. Moreover, verapamil reduced tolerance to bedaquiline and moxifloxacin. Verapamil's R isomer and its metabolite norverapamil have substantially less calcium channel blocking activity yet were similarly active as verapamil at inhibiting macrophage-induced drug tolerance. Our finding that verapamil inhibits intracellular M. tuberculosis growth and tolerance suggests its potential for treatment shortening. Norverapamil, R-verapamil, and potentially other derivatives present attractive alternatives that may have improved tolerability.
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Resistance to isoniazid (INH), one of the main drugs used in tuberculosis (TB) therapy, is mostly due to chromosomal mutations in target genes. However, approximately 20-30% of INH resistant Mycobacterium tuberculosis isolates do not have mutations in any of the genes associated with INH resistance. This suggests that other mechanism(s) may be involved, namely efflux pump systems capable of extruding the drug to the exterior of the cell. In a previous work, we have induced clinical INH susceptible M. tuberculosis isolates and the H37Rv reference strain to high-level resistance to INH, by gradual exposure to increasing concentrations of this drug. In the present study, we have characterized these strains and Mycobacterium bovis BCG induced to INH resistance with respect to their efflux activity and its contribution to INH resistance using the following approach: determination of the susceptibility to INH in the presence and absence of the efflux inhibitors (EIs) chlorpromazine, thioridazine and verapamil; evaluation of efflux activity by a semi-automated fluorometric method; and quantification of the expression level of genes coding for efflux pumps by real-time RT-qPCR. The EIs decreased INH resistance in the INH induced strains, in particular verapamil promoted a reversal of resistance in some of the strains tested. The induced strains presented an increased efflux activity that was inhibited by the EIs and showed overexpression of the efflux pump genes efpA, mmpL7, mmr, p55 and the Tap-like gene Rv1258c. Altogether, these results correlate efflux activity with INH resistance and demonstrate that efflux pumps play an important role in acquired INH resistance in M. tuberculosis complex. The development of EIs that can restore the antimicrobial activity of the antibiotic subject to efflux is an approach that can be useful in order to prevent the emergence of this resistance and guide the development of new effective anti-TB therapeutical approaches.
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