intrinsic resistance

本征电阻
  • 文章类型: Journal Article
    背景:预后差,死亡率高,胰腺导管腺癌(PDAC)是最致命的恶性肿瘤之一。在过去的三十年中,PDAC的护理疗法标准包括吉西他滨,尽管耐药通常通过一系列可能的机制在化疗开始后的几周内发展。
    方法:我们在吉西他滨治疗21天之前和之后,重新分析了28例PDAC患者来源的异种移植(PDX)模型的公开RNA-seq基因表达谱。
    结果:使用归一化RNA-seq定量测量,我们首先确定氧化磷酸化和干扰素α途径是与固有吉西他滨抗性和敏感性相关的基线基因表达谱中两个最丰富的癌症标志基因集。分别。此外,我们发现药物诱导的糖酵解和氧化磷酸化基因的表达变化与吉西他滨的反应之间存在很强的相关性,这表明这些途径可能与获得性吉西他滨耐药机制有关。因此,我们使用这些通路中的基线基因表达谱建立了预测模型,并在诺华的12个PDAC模型的另一个数据集中进行了验证.我们还开发了基于分子特征数据库(MSigDB)精选的50个癌症标志基因集的药物诱导基因表达变化的预测模型。最后,致病性TP53突变与治疗耐药相关。
    结论:我们的结果表明,在吉西他滨治疗后,PDACPDX体内糖酵解和氧化磷酸化途径同时上调,并且在这些模型中,致病性TP53状态与吉西他滨耐药有关。我们的发现可以阐明吉西他滨耐药的分子基础,并为PDAC化疗中的有效药物组合提供见解。
    BACKGROUND: With poor prognosis and high mortality, pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies. Standard of care therapies for PDAC have included gemcitabine for the past three decades, although resistance often develops within weeks of chemotherapy initiation through an array of possible mechanisms.
    METHODS: We reanalyzed publicly available RNA-seq gene expression profiles of 28 PDAC patient-derived xenograft (PDX) models before and after a 21-day gemcitabine treatment using our validated analysis pipeline to identify molecular markers of intrinsic and acquired resistance.
    RESULTS: Using normalized RNA-seq quantification measurements, we first identified oxidative phosphorylation and interferon alpha pathways as the two most enriched cancer hallmark gene sets in the baseline gene expression profile associated with intrinsic gemcitabine resistance and sensitivity, respectively. Furthermore, we discovered strong correlations between drug-induced expression changes in glycolysis and oxidative phosphorylation genes and response to gemcitabine, which suggests that these pathways may be associated with acquired gemcitabine resistance mechanisms. Thus, we developed prediction models using baseline gene expression profiles in those pathways and validated them in another dataset of 12 PDAC models from Novartis. We also developed prediction models based on drug-induced expression changes in genes from the Molecular Signatures Database (MSigDB)\'s curated 50 cancer hallmark gene sets. Finally, pathogenic TP53 mutations correlated with treatment resistance.
    CONCLUSIONS: Our results demonstrate that concurrent upregulation of both glycolysis and oxidative phosphorylation pathways occurs in vivo in PDAC PDXs following gemcitabine treatment and that pathogenic TP53 status had association with gemcitabine resistance in these models. Our findings may elucidate the molecular basis for gemcitabine resistance and provide insights for effective drug combination in PDAC chemotherapy.
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  • 文章类型: Journal Article
    肺腺癌是最常见的肺癌,和耐药性对其治疗构成重大障碍。这项研究旨在研究长链非编码RNA(lncRNAs)的过表达作为从治疗开始就促进肿瘤细胞固有抗性的机制。药物耐受(DTP)细胞是在暴露于治疗药物后存活和增殖的癌细胞的一个子集,使它们成为癌症治疗的重要研究对象。DTP细胞存活的分子机制尚不完全清楚;然而,长链非编码RNA(lncRNAs)已被认为起着至关重要的作用。在单次暴露于酪氨酸激酶抑制剂(TKIs;厄洛替尼或奥希替尼)后获得来自肺腺癌细胞系的DTP细胞。建立DTP细胞后,进行RNA测序以研究lncRNA的差异表达。一些lncRNAs和一个mRNA在DTP细胞中过表达。lncRNA的临床相关性在来自癌症基因组图谱(TCGA)的肺腺癌患者队列中进行了评估。RT-qPCR验证了残余DTP细胞和LUAD活检中lncRNA和mRNA的过表达。这些lncRNAs的敲除增加了DTP细胞对治疗药物的敏感性。这项研究提供了一个机会来研究lncRNAs在遗传和表观遗传机制中的参与,这些机制是内在抗性的基础。鉴定的lncRNAs和CD74mRNA可以作为潜在的预后标志物或治疗靶标,以改善肺癌患者的总体生存率(OS)。
    Lung adenocarcinoma is the most prevalent form of lung cancer, and drug resistance poses a significant obstacle in its treatment. This study aimed to investigate the overexpression of long non-coding RNAs (lncRNAs) as a mechanism that promotes intrinsic resistance in tumor cells from the onset of treatment. Drug-tolerant persister (DTP) cells are a subset of cancer cells that survive and proliferate after exposure to therapeutic drugs, making them an essential object of study in cancer treatment. The molecular mechanisms underlying DTP cell survival are not fully understood; however, long non-coding RNAs (lncRNAs) have been proposed to play a crucial role. DTP cells from lung adenocarcinoma cell lines were obtained after single exposure to tyrosine kinase inhibitors (TKIs; erlotinib or osimertinib). After establishing DTP cells, RNA sequencing was performed to investigate the differential expression of the lncRNAs. Some lncRNAs and one mRNA were overexpressed in DTP cells. The clinical relevance of lncRNAs was evaluated in a cohort of patients with lung adenocarcinoma from The Cancer Genome Atlas (TCGA). RT-qPCR validated the overexpression of lncRNAs and mRNA in the residual DTP cells and LUAD biopsies. Knockdown of these lncRNAs increases the sensitivity of DTP cells to therapeutic drugs. This study provides an opportunity to investigate the involvement of lncRNAs in the genetic and epigenetic mechanisms that underlie intrinsic resistance. The identified lncRNAs and CD74 mRNA may serve as potential prognostic markers or therapeutic targets to improve the overall survival (OS) of patients with lung cancer.
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  • 文章类型: Journal Article
    革兰氏阴性菌对大环内酯类的固有抗性主要归因于外膜的低渗透性,尽管潜在的遗传和分子机制仍有待完全阐明。这里,我们使用转座子定向插入位点测序(TraDIS)来鉴定与大肠杆菌对大环内酯类抗生素的内在抗性有关的染色体非必需基因,替米考星.我们在临床肠产毒性菌株(ETEC5621)和实验室菌株(K-12MG1655)中构建了两个>290,000和>390,000个独特Tn5插入的高度饱和转座子突变文库,分别。TraDIS分析鉴定了ETEC5621和MG1655在替米考星的1/8MIC(分别为n=15和16)和1/4MIC(分别为n=38和32)下生长所需的基因。对于这两种菌株,23个与脂多糖生物合成相关的基因,外膜组件,托尔帕尔系统,外排泵,和肽聚糖代谢在抗生素的存在下富集。野生型菌株中基因的个体缺失(n=10)导致替米考星的MIC降低了64至2倍,红霉素,和阿奇霉素,验证Tradis分析的结果。值得注意的是,删除surA或waaG,损害外膜,导致ETEC5621中所有三种大环内酯类药物的MIC下降最显著。我们的发现有助于全基因组理解大肠杆菌中固有的大环内酯抗性,揭示肽聚糖层的潜在作用。它们还提供了体外的概念证据,即大肠杆菌可以通过靶向维持外膜的蛋白质(如SurA和WaaG)而对大环内酯类敏感。
    Intrinsic resistance to macrolides in Gram-negative bacteria is primarily attributed to the low permeability of the outer membrane, though the underlying genetic and molecular mechanisms remain to be fully elucidated. Here, we used transposon directed insertion-site sequencing (TraDIS) to identify chromosomal non-essential genes involved in Escherichia coli intrinsic resistance to a macrolide antibiotic, tilmicosin. We constructed two highly saturated transposon mutant libraries of >290,000 and >390,000 unique Tn5 insertions in a clinical enterotoxigenic strain (ETEC5621) and in a laboratory strain (K-12 MG1655), respectively. TraDIS analysis identified genes required for growth of ETEC5621 and MG1655 under 1/8 MIC (n = 15 and 16, respectively) and 1/4 MIC (n = 38 and 32, respectively) of tilmicosin. For both strains, 23 genes related to lipopolysaccharide biosynthesis, outer membrane assembly, the Tol-Pal system, efflux pump, and peptidoglycan metabolism were enriched in the presence of the antibiotic. Individual deletion of genes (n = 10) in the wild-type strains led to a 64- to 2-fold reduction in MICs of tilmicosin, erythromycin, and azithromycin, validating the results of the TraDIS analysis. Notably, deletion of surA or waaG, which impairs the outer membrane, led to the most significant decreases in MICs of all three macrolides in ETEC5621. Our findings contribute to a genome-wide understanding of intrinsic macrolide resistance in E. coli, shedding new light on the potential role of the peptidoglycan layer. They also provide an in vitro proof of concept that E. coli can be sensitized to macrolides by targeting proteins maintaining the outer membrane such as SurA and WaaG.
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  • 文章类型: Case Reports
    表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(TKI)对于EGFR突变的肺癌患者至关重要。然而,几乎所有患者都经历疾病进展,不管他们对靶向治疗的反应如何,需要开发额外的治疗方案。在成功的奥希替尼治疗期间,对两名在外显子21中具有EGFR-L858R突变的肺癌患者进行了手术切除治疗。因为病理诊断怀疑是胸膜转移,奥希替尼继续治疗直至疾病进展.我们使用在治疗过程中通过重复活检获得的肿瘤标本分析了基因组改变和AXL水平的演变:初步诊断,操作,和疾病进展。在三个时间点检测到的遗传改变发生了巨大变化,并显示出数量减少,而在两个患者的所有检测样本中均检测到EGFR-L858R突变.AXL的免疫组织化学表达从分析开始到疾病进展保持阳性。肿瘤发生下的克隆进化与肿瘤生长过程中基因组改变的逐渐积累有关。然而,我们的案例系列显示,体积减少程序可能会导致这种现象。因此,鉴定肿瘤中的内在耐药细胞可能与检测获得性遗传改变同样重要.
    Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) is crucial for patients with lung cancer harboring EGFR mutations. However, almost all patients experience disease progression, regardless of their response to the targeted therapy, necessitating the development of additional treatment options. Two patients with lung cancer harboring EGFR-L858R mutations in exon 21 were treated by surgical resection during successful osimertinib treatment. Because the pathological diagnosis was suspected to be pleural metastasis, osimertinib treatment was continued until disease progression. We analyzed the evolution of genomic alterations and the levels of AXL using tumor specimens obtained by repeated biopsies during the course of treatment: initial diagnosis, operation, and disease progression. Genetic alterations detected at the three time points were dramatically changed and showed reductions in numbers, while EGFR-L858R mutations were detected in all samples tested in both patients. Immunohistochemical expression of AXL remained positive from the beginning of analysis to disease progression. Clonal evolution under oncogenesis is related to gradual accumulation of genomic alterations during tumor growth. However, our case series revealed that volume reduction procedures may cause this phenomenon. Therefore, identification of intrinsic drug-resistant cells in tumors may be as important as detection of acquired genetic alterations.
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  • 文章类型: Journal Article
    BRAFV600E突变常见于癌症。它激活MAPK通路并促进癌细胞增殖,使BRAF成为抗癌治疗的良好靶点。虽然BRAF靶向治疗对黑色素瘤非常有效,它通常对携带BRAF突变的其他癌症无效。在这项研究中,我们评估了蛋白水解靶向嵌合体(PROTAC)的有效性,SJF-0628,指导突变的BRAF在不同的癌细胞组中的降解,并确定这些细胞如何响应降解。SJF-0628处理导致BRAFV600E的降解和所有测试细胞系中Mek活化的降低,但治疗对细胞信号传导和细胞增殖的影响是细胞系特异性的。首先,BRAF降解通过凋亡杀死DU-4475和Colo-205细胞,但仅部分抑制其他癌细胞系的增殖。第二,SJF-0628处理导致Colo-205细胞中MEK的共降解,但在其他细胞系中没有相同的作用。最后,受BRAF降解部分抑制的细胞系还含有其他致癌驱动因素,使它们成为多驱动癌细胞。这些结果证明了PROTAC指导BRAF降解的实用性,并揭示了多驱动因子肿瘤发生使一些结直肠癌细胞对BRAF靶向治疗具有抗性。
    The BRAF V600E mutation is frequently found in cancer. It activates the MAPK pathway and promotes cancer cell proliferation, making BRAF an excellent target for anti-cancer therapy. While BRAF-targeted therapy is highly effective for melanoma, it is often ineffective against other cancers harboring the BRAF mutation. In this study, we evaluate the effectiveness of a proteolysis targeting chimera (PROTAC), SJF-0628, in directing the degradation of mutated BRAF across a diverse panel of cancer cells and determine how these cells respond to the degradation. SJF-0628 treatment results in the degradation of BRAF V600E and a decrease in Mek activation in all cell lines tested, but the effects of the treatment on cell signaling and cell proliferation are cell-line-specific. First, BRAF degradation killed DU-4475 and Colo-205 cells via apoptosis but only partially inhibited the proliferation of other cancer cell lines. Second, SJF-0628 treatment resulted in co-degradation of MEK in Colo-205 cells but did not have the same effect in other cell lines. Finally, cell lines partially inhibited by BRAF degradation also contain other oncogenic drivers, making them multi-driver cancer cells. These results demonstrate the utility of a PROTAC to direct BRAF degradation and reveal that multi-driver oncogenesis renders some colorectal cancer cells resistant to BRAF-targeted treatment.
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  • 文章类型: Journal Article
    Regardless of etiology, complications with bacterial infection in patients with cirrhosis are reported in the range of 25%-46% according to the most recent data. Due to frequent episodes of bacterial infection and repetitive antibiotic treatment, most often with broad-spectrum gram negative coverage, patients with cirrhosis are at increased risk of encountering multidrug resistant bacteria, and this raises concern. In such patients, extended-spectrum beta-lactamase and AmpC-producing Enterobacterales, methicillin- or vancomycin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii, all of which are difficult to treat, are the most common. That is why novel approaches to the prophylaxis and treatment of bacterial infections to avoid antibiotic resistance have recently been developed. At the same time, our knowledge of resistance mechanisms is constantly updated. This review summarizes the current situation regarding the burden of antibiotic resistance, including the prevalence and mechanisms of intrinsic and acquired resistance in bacterial species that most frequently cause complications in patients with liver cirrhosis and recent developments on how to deal with multidrug resistant bacteria.
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  • 文章类型: Journal Article
    镰刀菌是导致各种作物根腐病的原因,导致枯萎和最终死亡。非那普利,一种特定的肌球蛋白5蛋白抑制剂,作为一种有效的杀真菌剂已获得广泛的镰刀菌属物种的认可。它已经通过喷雾应用正式注册控制镰刀菌疾病,根系灌溉,和种子浸渍。在这项研究中,观察到非那普利对引起作物根腐病的F.solani表现出可忽略的抑制作用,尽管没有事先接触过非尼马普利。考虑到非那普利的高选择性,这种现象归因于内在抗性,并进一步研究了其潜在机制。不同镰刀菌属物种的肌酸5蛋白的序列比对分析显示在位置218和376处存在显著差异。随后的同源性建模和分子对接结果表明,取代T218S,K376M,和T218S&K376M削弱了非那普利与solani中肌球蛋白5的结合亲和力。通过定点诱变产生携带这些取代的突变体。菲马普利敏感性试验表明,携带T218S的突变体的EC50值,K376M,T218S和K376M减少了至少6.13倍,9.66折,与野生型菌株相比分别为761.90倍。适应性测试表明,与野生型菌株相比,携带K376M或T218S&K376M的突变体具有减少的孢子形成。此外,与野生型菌株相比,携带T218S的突变体表现出增强的毒力。然而,突变体和野生型菌株之间的菌丝生长速率没有显着差异。因此,在SolaniF.和其他镰刀菌属物种之间在Myosin5的位置218和376处观察到的内在差异与非那莫曲抗性特别相关。这些抗性相关的位置的鉴定在F.solani的myosin5显著促进了对非那普利抗性机制的理解。因此不鼓励使用非那普利来控制F.solani。
    Fusarium solani is responsible for causing root rot in various crops, resulting in wilting and eventual demise. Phenamacril, a specific inhibitor of myosin5 protein, has gained recognition as an effective fungicide against a broad spectrum of Fusarium species. It has been officially registered for controlling Fusarium diseases through spray application, root irrigation, and seed dipping. In this study, phenamacril was observed to exhibit negligible inhibitory effects on F. solani causing crop root rot, despite the absence of prior exposure to phenamacril. Considering the high selectivity of phenamacril, this phenomenon was attributed to intrinsic resistance and further investigated for its underlying mechanism. Sequence alignment analysis of myosin5 proteins across different Fusarium species revealed significant differences at positions 218 and 376. Subsequent homology modeling and molecular docking results indicated that substitutions T218S, K376M, and T218S&K376M impaired the binding affinity between phenamacril and myosin5 in F. solani. Mutants carrying these substitutions were generated via site-directed mutagenesis. A phenamacril-sensitivity test showed that the EC50 values of mutants carrying T218S, K376M, and T218S&K376M were reduced by at least 6.13-fold, 9.66-fold, and 761.90-fold respectively compared to the wild-type strain. Fitness testing indicated that mutants carrying K376M or T218S&K376M had reduced sporulation compared to the wild-type strain. Additionally, mutants carrying T218S exhibited an enhanced virulence compared to the wild-type strain. However, there were no significant differences observed in mycelial growth rates between the mutants and the wild-type strain. Thus, the intrinsic differences observed at positions 218 and 376 in myosin5 between F. solani and other Fusarium species are specifically associated with phenamacril resistance. The identification of these resistance-associated positions in myosin5 of F. solani has significantly contributed to the understanding of phenamacril resistance mechanisms, thereby discouraging the use of phenamacril for controlling F. solani.
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  • 文章类型: Journal Article
    顺铂耐药是肺腺癌治疗失败的主要原因。耐受药物(DTP)细胞是固有耐药性的原因,因为它们在最初的治疗周期中幸存下来,代表显示获得性抗性的克隆出现的储库。尽管已经描述了DTP细胞的分子机制,很少有研究调查DTP细胞对顺铂固有抗性的最早分子改变。在这项工作中,我们报道了与肺腺癌细胞系中顺铂-DTP细胞出现相关的基因表达特征.单次接触顺铂后,我们对顺铂-DTPs的转录组进行了测序,以鉴定差异表达的基因。生物信息学分析显示,早期顺铂-DTP细胞使代谢和增殖途径失调,从而在药物损伤中存活。相互作用网络分析确定了三个高度连接的子模块,其中SOCS1显着参与控制顺铂-DTP细胞的增殖。在肺腺癌细胞系中验证了候选基因及其相应蛋白的表达。重要的是,CDDP敏感型和CDDP耐药型肺腺癌细胞株中SOCS1的表达水平不同。此外,CDDP抗性细胞系中SOCS1的敲低部分促进了其对CDDP的敏感性。最后,在计算机上分析了候选基因的临床相关性,根据癌症基因组图谱中顺铂治疗患者的总体生存率。存活分析显示,所选基因的下调或上调与总体存活相关。获得的结果表明,这些基因可用作预测生物标志物或潜在靶标,以提高CDDP治疗在肺癌患者中的有效性。
    Resistance to cisplatin is the main cause of treatment failure in lung adenocarcinoma. Drug-tolerant-persister (DTP) cells are responsible for intrinsic resistance, since they survive the initial cycles of treatment, representing a reservoir for the emergence of clones that display acquired resistance. Although the molecular mechanisms of DTP cells have been described, few studies have investigated the earliest molecular alterations of DTP cells in intrinsic resistance to cisplatin. In this work, we report a gene expression signature associated with the emergence of cisplatin-DTP cells in lung adenocarcinoma cell lines. After a single exposure to cisplatin, we sequenced the transcriptome of cisplatin-DTPs to identify differentially expressed genes. Bioinformatic analysis revealed that early cisplatin-DTP cells deregulate metabolic and proliferative pathways to survive the drug insult. Interaction network analysis identified three highly connected submodules in which SOCS1 had a significant participation in controlling the proliferation of cisplatin-DTP cells. Expression of the candidate genes and their corresponding protein was validated in lung adenocarcinoma cell lines. Importantly, the expression level of SOCS1 was different between CDDP-susceptible and CDDP-resistant lung adenocarcinoma cell lines. Moreover, knockdown of SOCS1 in the CDDP-resistant cell line partially promoted its susceptibility to CDDP. Finally, the clinical relevance of the candidate genes was analyzed in silico, according to the overall survival of cisplatin-treated patients from The Cancer Genome Atlas. Survival analysis showed that downregulation or upregulation of the selected genes was associated with overall survival. The results obtained indicate that these genes could be employed as predictive biomarkers or potential targets to improve the effectiveness of CDDP treatment in lung cancer patients.
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  • 文章类型: Journal Article
    开发了合格的安全推定(QPS)方法,以定期更新用于食品或饲料链中的微生物安全性的通用预评估。为分类单位(TU)确定的安全问题是,在可能的情况下,在物种/菌株或产品水平上进行确认,并通过“资格”反映,这些资格应由EFSA的科学小组在菌株和/或产品水平上进行评估。通用资格\'菌株不应包含任何对临床相关抗菌剂的获得性抗菌素耐药性(AMR)基因\'适用于所有QPS细菌TU。不同的EFSA风险评估领域使用相同的方法来评估与AMR基因相关的资格。在这份声明中,术语“内在”和“获得性”AMR基因是为了EFSA的风险评估而定义的,它们适用于食品和饲料链中使用的细菌。提出了一种生物信息学方法来证明AMR基因的“内在”/“获得性”性质。所有赋予对“至关重要”抗性的AMR基因,\'高度重要\'和\'重要\'抗菌药物,根据世界卫生组织(WHO)的定义,作为点击发现,需要被视为危害(对人类来说,动物和环境),需要进一步评估。在EFSA风险评估的框架中,被确定为负责“内在”抗性的基因可以被认为是无关紧要的。导致抗性表型的“获得性”AMR基因应被视为一个问题。如果“获得性”AMR基因的存在没有导致表型抗性,进一步的个案评估是必要的。
    The qualified presumption of safety (QPS) approach was developed to provide a regularly updated generic pre-evaluation of the safety of microorganisms intended for use in the food or feed chains. Safety concerns identified for a taxonomic unit (TU) are, where possible, confirmed at the species/strain or product level and reflected by \'qualifications\' which should be assessed at strain and/or product level by EFSA\'s Scientific Panels. The generic qualification \'the strains should not harbour any acquired antimicrobial resistance (AMR) genes to clinically relevant antimicrobials\' applies to all QPS bacterial TUs. The different EFSA risk assessment areas use the same approach to assess the qualification related to AMR genes. In this statement, the terms \'intrinsic\' and \'acquired\' AMR genes were defined for the purpose of EFSA\'s risk assessments, and they apply to bacteria used in the food and feed chains. A bioinformatic approach is proposed for demonstrating the \'intrinsic\'/\'acquired\' nature of an AMR gene. All AMR genes that confer resistance towards \'critically important\', \'highly important\' and \'important\' antimicrobials, as defined by the World Health Organisation (WHO), found as hits, need to be considered as hazards (for humans, animals and environment) and need further assessment. Genes identified as responsible for \'intrinsic\' resistance could be considered as being of no concern in the frame of the EFSA risk assessment. \'Acquired\' AMR genes resulting in a resistant phenotype should be considered as a concern. If the presence of the \'acquired\' AMR gene is not leading to phenotypic resistance, further case-by-case assessment is necessary.
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  • 抗生素耐药性在不同感染因子之间的增加的传播一直是全球范围内快速增长的公共卫生挑战;这是因为新的抗性机制的发现以及一般病原体感染的质量和有效治疗的降低。这导致微生物对标准疗法的反应不成功,这可能会导致更高的死亡风险,长期患病,和更多的医疗保健支出。大多数寄生虫,细菌,真菌,和病毒可以产生更高程度的多药耐药性(MDR),增加死亡率和发病率。此外,MDR的建立可能是一种自然现象,抗菌药物使用不当,缺乏适当的卫生条件,糟糕的食物处理方法,以及缺乏感染预防和控制(IPC),这可能是MDR进一步扩散的原因。此外,MDR蠕虫的作用机制可以通过药物运输中的遗传改变而发生,代谢和靶位点。MDR细菌的作用模式,如细胞壁合成抑制剂,DNA合成抑制剂等。然而,有不同的方法来管理和预防多药耐药性。因此,这项审查的目的是教育公众,了解全球多重耐药性的增加,以及如果不采取适当措施对抗微生物感染的危险。
    The increased spreading of antibiotic resistance among different infectious agents has been a fast-growing public health challenge worldwide; this is because of the discovery of new resistance mechanisms and the reduction in quality and effective treatments of general pathogenic infections. This has caused unsuccessful microbial responses to standard therapy, which could lead to a higher risk of mortality, prolonged illness, and more expenditures for health care. Most parasites, bacteria, fungi, and viruses can produce a higher degree of multidrug resistance (MDR) with increased mortality and morbidity. Moreover, the establishment of MDR can be a natural phenomenon, improper utilization of antimicrobial drugs, lack of proper sanitary conditions, poor method of food handling, and absence of infection prevention and control (IPC), which could be responsible for the further spreading of MDR. Moreover, MDR helminth\'s mechanism of action can occur via genetic alterations in the drug transport, metabolisms and target sites. MDR bacterial mode of action such as cell wall synthesis inhibitors, DNA synthesis inhibitors and so on. However, there have been different approaches to managing and preventing multi-drug resistance. Hence, this review\'s aim is to educate the public about the global increase of multiple drug resistance and the danger ahead if appropriate measures are not put in place to combat microbial infections.
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