Дисертації: "MULTI- DRUG RESISTANCE (MDR)"

1

Sheth, Disha B. "Multielectrode platform for measuring oxygenation status in multicellular tumor spheroids." Case Western Reserve University School of Graduate Studies / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=case1301516012.

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2

Firfirey, Nousheena. "Occupational adaptation : the experiences of adult patients with MDR- TB who undergo long- term hospitalisation." University of the Western Cape, 2011. http://hdl.handle.net/11394/5300.

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Magister Scientiae (Occupational Therapy) - MSc(OT)
TB is a multi- faceted public health problem spurred on by the biological progression of the disease as well as the social issues associated with it. The treatment of TB is however primarily driven by the medical model where the focus is on the disease and not on a holistic view of the patient. Occupational therapy is a profession concerned with the use of occupation in the promotion of health and well being through the facilitation of the process of occupational adaptation. There is however a paucity of literature pertaining to the role that occupational therapy could play within the TB context. The aim of this study was to explore how adults with MDR- TB who undergo long-term hospitalisation at a hospital in the Western Cape experience occupational adaptation. The objectives of the study were to explore how the participants perceive their occupational identity, to explore the meaning and purpose the participants assign to their occupational engagement and to explore the how the participants perceive their occupational competence. The interpretive research paradigm employing a phenomenological qualitative research approach was utilized in this study. Purposive sampling was used to select four participants based on specific selection criteria. The data gathering methods utilized included diaries, semistructured interviews, participant observation and a focus group. Photographs taken by the researcher for the purpose of participant observation were used to elicit a rich, in depth response from the participants during the focus group discussion. All data was analysed through thematic content analysis. The study findings highlighted that the participants viewed themselves as occupational beings and that they valued the role that occupational engagement played in facilitating their occupational competence and ultimately their ability to adapt to long- term hospitalisation. The environmental demands and constraints that they experienced however infringed their engagement in meaningful occupation and hampered their ability to achieve occupational competence. It was recommended that the hospital adopt an integrative intervention approach to the management of MDR- TB patients that include principles of psychosocial rehabilitation and occupational enrichment to address occupational risk factors and institutionalisation.

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3

Alame, Ghina. "Étude de la réversion du phénotype de Multi Drug Resistance (MDR) par de nouveaux dérivés stéroïdiens, in vitro sur des lignées cellulaires humaines et murines résistantes et in vivo par xénogreffes." Phd thesis, Université Claude Bernard - Lyon I, 2009. http://tel.archives-ouvertes.fr/tel-00877481.

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La chimiorésistance des cancers est caractérisée par une résistance pléïotropique à de multiples médicaments. Ce mécanisme est en partie causé par la surexpression des transporteurs à "ATP binding cassette" (Pgp, MRP1, BCRP...). Les inhibiteurs connus de ces transporteurs comme la cyclosporine A, le vérapamil et le RU486 sont toxiques à doses élevées. Dans cette étude, de nombreux dérivés stéroïdiens synthétisés au laboratoire à base de progestérone ou d'acides biliaires ont été évalués pour leur capacité à inhiber les transporteurs ABC et plus spécifiquement les fonctions de transport par la Pgp ou la BCRP. Plusieurs de ces dérivés synthétisés se sont avérés capables de restaurer complètement la sensibilité des cellules résistantes d'une manière plus importante que la cyclosporine A in vitro. De plus, le meilleur des nos dérivés testés s'est avéré capable in vivo de diminuer significativement la progression tumorale de xénogreffe sur les souris et d'augmenter la durée de survie des souris. Cette étude a ainsi permis d'ouvrir la voie au développement de nouveaux dérivés stéroïdiens peu toxiques ayant la capacité d'inhiber le phénotype MDR et de restaurer la sensibilité des cellules cancéreuses vis-à-vis des agents chimiothérapeutiques utilisés, avec un perspective d'application clinique

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Morrison, Scott Macdonald. "Elucidation of the structure activity relationship of the multi drug resistance (Mdr) transport protein (NorA) of Escherichia coli and the putative protein (HP1181) of Helicobacter pylori." Thesis, University of Leeds, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270864.

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5

Aguilar, Mónica Alejandra Pavez. "Análise molecular da expressão do fenótipo multi-droga resistente (MDR) em enterobactérias isoladas de amostras clínicas após exposição in vitro ao Imipenem." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/9/9136/tde-22062015-153149/.

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Após o surgimento e disseminação das β-lactamases de amplo espectro em membros da família Enterobacteriaceae, os antibióticos carbapenêmicos (imipenem, meropenemeertapenem) têm sido considerados a terapia de escolha devido à estabilidade apresentada contra estas enzimas. A desvantagem destes antibióticos é a sua capacidade de induzir resistência aos β-lactâmicos e a outros antibióticos quimicamente não relacionados. O imipenem tem favorecido a indução de cefalosporinases cromossômicas (AmpC) e também tem sido relacionado, in vivo, com a seleção de mecanismos intrínsecos de resistência, contribuindo com o perfil multi -droga resistente (MDR). Esse perfil é freqüentemente associado à diminuição da permeabilidade por alteração na síntese de porinas em conjunto com um aumento da atividade de bombas de efluxo, as quais não permitem o estabelecimento de uma concentração ativa do antibiótico no interior da célula bacteriana. O presente trabalho teve como objetivo avaliar o estabelecimento do perfil MDR em enterobactérias provenientes de isolados clínicos em função da exposição a diferentes concentrações de imipenemin vitro. A seleção do grupo das amostras estudadas foi feito por meio da determinação do perfil de sensibilidade dos isolados, tipagem molecular e ensaio de hidrólise de Imipenem. Nos isolados selecionados para a indução foi realizada numa etapa inicial (etapa basal) a análise de porinas de membrana externa por SDS-PAGE e o estudo de genes codificadores de β-lactamases pela técnica de PCR. O estudo do estabelecimento do perfil MDR foi feito por meio de passagens sucessivas das amostras em meio contendo concentrações sub-inibitórias de imipenem seguido de análise fenotípica (CIM e acúmulo do antibiótico intracelular e SDS-PAGE), e a análise da expressão gênica de genes associados a permeabilidade de membrana (ompC, ompF eAcrA) e genes reguladores(marA e ompR). Após a indução com o imipenem, 77% dos isolados induzidos aumentaram a CIM para os carbapenêmicos, mudando assim o perfil de resistência observado na etapa basal Também foi afetado o perfil de resistência para outros antibióticos não relacionados a β-lactámicos, porém numa percentagem menor. Com relação à alteração da permeabilidade, a perda de porina foi observada apenas para um isolado, no entanto a diminuição na expressão gênica de Omp36 foi significativa desde o começo da indução. A expressão da bomba de efluxoAcrAB foi afetada pela indução com imipenem, aumentando significativamente a expressão de AcrA, enquanto os reguladores estudados, MarA e OmpR tiveram a sua expressão induzida pelo imipenem. Foi possível observar também associação do nível de expressão gênica do regulador MarA com a expressão de AcrA,porém não foi possível observar uma associação estatisticamente significativa deste regulador com o perfil de expressão de OMPs. A indução de OmpR foi associado com um aumento da expressão de RNAm de Omp35, já para Omp36 foi possível observar apenas uma tendência na repressão deste gene. O estudo da resposta destes genes reguladores e determinantes de resistência, em resposta à exposição ao com o imipenem in vitro, permitiu reportar o comportamento molecular da bactéria numa resposta adaptativa no estagio inicial do estabelecimento do fenótipo MDR. A utilização de isolados clínicos com diversos determinantes de resistência permitiu observar a variabilidade nas respostas adaptativas das enterobacterias, o que é fundamental para a compreensão dos mecanismos de adaptação da bactéria e sua contribuição na falha terapêutica.
After emergence and broad dissemination of extended spectrum β-lactamases into the Enterobacteriaceae family, the carbapenemic antibiotics (imipenem, meropenem and ertapenem) have been considered the chosen therapy in the treatment of nosocomial infections by the stability that these antibiotics show to these enzymes. The disadvantage of carbapenems is theirs capacity to induce resistance against β-lactamics and to other chemically unrelated antibiotics. The imipenem has been shown to induce chromosomal cephalosporinases (AmpC) and it was also related, in vivo, with the selection of intrinsic mechanism leading to multi-drug resistance profile (MDR). This profile is usually associated with membrane impermeability due to reduced outer membrane porin synthesis with an incremented activity of efflux pumps, which results in a reduced concentration of antibiotics inside the bacteria. This study aimed to evaluate the establishment of the MDR profile in Enterobacteriaceae from clinical isolates by exposure to different concentrations of imipenem in vitro. The selection of the study group was performed by determination of antibiotic susceptibility profile,molecular typing and hydrolysis assay of imipenem. In the selected isolates submitted to induction, in an initial step (baseline), was performed the outer membrane porin analysis by SDS-PAGE and the gene-specific amplification of B-lactamase enzymes by PCR. The study of the establishment of MDR was performed by progressive passages with subclinical concentrations of imipenem, followed each one by the evaluation of phenotypic profile (MIC, accumulation antibiotic in celland SDS-PAGE) and gene expression analysisof genes related to membrane permeability (ompC, ompF and acrA) and regulatory genes(MarA and ompR). After induction with imipenem, 77 % of the isolates increased the MIC for the carbapenems, changing the resistance profile at the baseline. In a lesser percentage, the resistance profile to other β-lactams-unrelated antibiotics was also affected. Loss of porin was observed only for an isolated, however a significantly decreased Omp36 mRNA expression was observed from the start of induction. The expression of the efflux pump AcrAB ,was also affected by the imipenem induction, significantly increasing the AcrA gene expression, whereas the studied regulatory genes,MarA and OmpR,were induced by the imipenem. It was also possible to observe an association between the expression of the regulator MarA and the expression of AcrA, nevertheless no association was observed between this regulator and OMPs . OmpR induction was associated with an increased Omp35mRNA expression, however only a trend for the repression of Omp36was observed. The study of the response of these regulatory genes and genetic determinants of resistance, in response to the imipenem exposure in vitro, allowed to report the molecular behavior of the bacteria in an adaptive response in the initial stage of the establishment of a MDR phenotype. The use of clinical isolates with diverse resistance determinants allowed observing the variability in adaptive responses in enterobacteria, which is important to understand the adaptive mechanisms of bacteria to this antibiotic, the involvement in the emergence of the MDR profile and its contribution to the treatment failure.

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6

Liu, Miaomiao. "Actinomycetes Sourced From Unique Environments as a Promising Source of New TB-Active Natural Products." Thesis, Griffith University, 2017. http://hdl.handle.net/10072/366523.

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Tuberculosis (TB) is the leading cause of death from infectious diseases in the world, affecting more than ten million patients each year. However, multi-drug resistance (MDR-TB) threatens progress achieved in TB care and control, and there are few drugs available to treat MDR-TB. Our overall aim was to identify anti-TB natural products from microbes sourced from unique environments. This thesis presents efforts to achieve an effective approach to identify anti-TB microbial natural products with the combination of one strain many compounds (OSMAC) strategy, NMR fingerprint and principal component analysis. The thesis begins with an introduction of TB and the current anti-TB drugs and candidates. It also covers a review on anti-TB natural products from marine microbe and endophyte origin and analysis of their physicochemical properties using Lipinski’s rule of five as well as the ChemGPS tool. As part of a research program aiming to identify anti-TB microbial constituents, a cell-based screening assay was developed to screen 2562 crude extracts. Among the active hits, 46 actinomyces isolated from marine, desert or Traditional Chinese Medicines were selected for further chemical investigation according to their chemical profiles or anti-TB activities. The results are presented in chapters 2 to 7.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Natural Sciences
Science, Environment, Engineering and Technology
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7

AMBIKA, KM. "ROLE OF LACTOSMART AS A NOVEL THERAPEUTIC AGENT IN ANTIMICROBIAL DEFENSE." Thesis, DELHI TECHNOLOGICAL UNIVERSITY, 2021. http://dspace.dtu.ac.in:8080/jspui/handle/repository/18433.

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The emergence of multi – drug resistance (MDR ) in microorganisms against antibiotics has become a global problem [1,2,3]. Various conventional drugs with promised efficacy and specificity are unable to withstand the threat of antibiotic drug resistance [4,5,6]. The rising crisis of MDR bacteria has led to the channelization of relevant research in the direction of antimicrobial molecules from natural sources as potential novel antibiotics. The spectrum of innate immune proteins and their potent fragments herald a promising approach to fight the problem of drug resistance. Among the natural antimicrobial proteins, Lactoferrin (LF) has been identified as a potent host defense system based on its wide spectrum bactericidal and bacteriostatic activities [7,8,9,10,11,12,13] . In the past , several studies have demonstrated the antibacterial and antifungal effects of LF and its derivative peptides, for instance, lactoferricin B [14,15,16,17,18,19] and lactoferrampin [20,21]. Structurally, LF consists of two iron bound lobes, N -lobe (1-333) and C -lobe (345-692) [22,23,24,25]. Amongst the two lobes , the highly cationic properties of N- lobe are responsible for membrane disruption by interacting with anionic components present on bacterial surface [26,27]. It has been established that the lipid A component of the LPS is a known drug target for antimicrobial therapeutics [ 28,29]. One of the mechanisms by which Lf acts as an antimicrobial agent is through binding to pathogen associated molecular patterns (PAMP) such as Lipopolysaccharide (LPS), thereby disrupting the bacterial membrane integrity and activating the chemical signaling pathway[30- 32]. This leads to the secretion of pro- inflammatory responses which down regulates the release of cytokine production [33,34]. In the past, it had been reported that LF binds to LPS with its hexameric sequence present in the 18 - loop region of the lactoferricin [35-37] . In the present study , we have performed the partial digestion of LF with trypsin which generates a potent antimicrobial molecule of the size of about 21kDa (85-281). We have proposed its name as Lactosmart due to its higher potency against pathogens when compared to native LF as a whole protein . The lactosmart has been tested for antibacterial and antifungal properties along with its inhibitory potential of biofilm formation by Pseudomonas aeruginosa through established assays [41]. Our primary focus was on the comparison of LPS binding properties of lactosmart with native LF using surface plasmon resonance technique . The docking and molecular dynamics simulations (MD) studies with LPS have also been performed to further substantiate our claims. Through our studies , we have demonstrated that LF sequesters LPS through two binding sites which are situated on the N- lobe.

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Firfirey, Nousheena. "The evaluation of the integrated client-centred intervention programme (ICIP) for clients with MDR-TB at DP Marais Hospital in the Western Cape." University of Western Cape, 2020. http://hdl.handle.net/11394/7687.

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Philosophiae Doctor - PhD
Although TB is a curable communicable disease, poor adherence to TB treatment is a major barrier to TB control in South Africa as it increases the risks of morbidity, mortality and drug resistance at individual and community level. As a result, multi-drug-resistant TB (MDR-TB) has become a serious public health issue. Underpinning this study was the assumption that a client-centred approach to treatment of MDR-TB clients, with a hospital programme which adopts an integrated multidisciplinary approach that is client-centred and is not purely biomedically driven, would improve treatment outcomes of MDR-TB clients.

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Greeff, Wildine Marion. "Ototoxicity Monitoring using Automated Extended High-Frequency Audiometry and the Sensitive Range of Ototoxicity in Patients with MDR-TB." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32696.

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Background: Disabling hearing loss is a global burden. This burden is worsened by the emergence of multi-drug resistant tuberculosis (MDR-TB). Some of the medications used to treat MDR-TB are damaging to the cochlea and auditory nerve (ototoxic) and can lead to permanent hearing loss and/or balance disorders. Ototoxicity monitoring aims to reduce this burden by preventing or minimising the damage caused by ototoxic treatment as it can progress and worsen speech perception difficulties. However, the proposed test battery for ototoxicity monitoring is lengthy and demands active participation which is not ideal for ill patients (such as those on MDR-TB treatment). The Sensitive Range of Ototoxicity (SRO) technique is recommended to shorten the test time. The SRO consists of seven consecutive relatively high frequencies determined from the highest frequency the participant responded to. The SRO technique is time efficient. Although the SRO technique provides the prospect of a shortened test battery, there is still a global lack of audiologists. Automated audiometry is a vital application for testing especially when audiologists are not available to physically do the test. Automated audiometry has been previously validated. Clinically, automated audiometry is objective and allows for standardisation. Even though automated audiometry helps improve access to monitoring more patients, patient preference is an important factor when using automated audiometry to ensure patient-centred care is not compromised. Aims and Objectives: This study aimed to investigate the specificity and sensitivity of the SRO technique with automated audiometry compared to the gold standard (manual audiometry). This comparison was made by firstly, determining the testing time efficiency and the correlation of thresholds obtained with the different test methods and, secondly, testing the diagnostic value of automated audiometry using the SRO technique. The incidence of an ototoxicity-induced hearing loss was described by determining the time interval between starting ototoxic MDR-TB treatment and the onset of a significant threshold shift (STS) according to ASHA's criteria. Lastly, the test method preference of the participants with MDR-TB was described and compared using a short exit survey. Study Design: A prospective repeated-measures study design was used. Participants were chosen based on a risk factor (i.e. exposure to ototoxic medication) for an outcome of interest (i.e. the presence or absence of an STS). With a repeated measures study, multiple tests using different test methods can be compared with the same sample. Participants: Twenty-seven in-patients at Brooklyn Chest Hospital and DP Marais TB Hospital with normal hearing and on MDR-TB medication were included in the study. Their age range was from 19 to 51 years old with an average age of 33 years old. Non-probability convenience sampling was used as it was cost-effective, reduced data collection time and was relatively easy to execute. Data collection materials and procedures: The procedure for data collection included weekly follow-up testing for a maximum of four weeks. The test battery was as follows: an auditory symptom questionnaire, otoscopy examination, and manual and automated audiometry using the SRO technique with a fifteen-minute break in between. Participants were tested with the KUDUwave ™ in a non-sound treated room. The frequency range was determined with the SRO technique. If an STS was obtained, the patient was discharged from the study after completing an exit survey. Statistics: Analysis included descriptive statistics and inferential statistics. A Bonferroni corrected p-value (initially p ≤ 0.05) was used. Manual and automated audiometry thresholds were compared using the Pearson's Correlation Coefficient test. Manual and automated audiometry testing time and threshold means were compared using paired sample's t-tests. The diagnostic value of automated audiometry with the SRO technique was assessed with Receiver Operating Characteristics (ROC) Curves. Results: Manual audiometry was statistically more time-efficient compared to automated audiometry by an average of one minute and ten seconds (t (94) = -5.44; p< 0.003). There was a strong positive correlation for both left and right ears between the thresholds' obtained from manual and automated audiometry at 8kHz to 16 kHz (df> 28 = r > 0.70, p< 0.003). Automated audiometry was found to be a fair diagnostic test (area under the curve was 0.75; p= 0.002). Also, the ROC curve revealed that automated audiometry had a sensitivity of 61% and specificity of 90% when compared to manual audiometry (gold standard). Only participants that started data collection within 31 days after starting their MDR-TB treatment were included in the analysis of determining the incidence of an ototoxicity-induced hearing loss (n= 24 ears). This study found that 41.67% of ears (n= 10) had an ototoxicity-induced hearing loss. A box and whisker plot revealed that data was skewed to the right (i.e. more variation in data between the median and the maximum values) and that the median number of days for an ototoxicity-induced hearing loss to appear was 33 days. Secondly, 55.55% of participants (n=15 out of 27) reported auditory symptoms before data collection commencement. Aural fullness was the most reported symptom (n= eight out of 15). Ten out of 15 (66.66%) participants that reported auditory symptoms obtained an ototoxicity-induced hearing loss. Lastly, most participants (i.e. 13 out of 19; 68.42%) that completed the exit survey had no preference between manual or automated audiometry. The common rationale among these participants was “No difference noted.” Conclusion: This research study has revealed that manual audiometry was more time-efficient compared to automated audiometry in patients with MDR-TB. Also, automated audiometry was a fair diagnostic test. It may aid in reducing the disproportionate audiologist to patient ratio, especially in a developing country. However, manual audiometry (with the SRO technique) is more clinically appropriate in patients that are difficult-to-test. Secondly, audiometric settings can be changed to accommodate testing frequencies in 1/6 octaves so that the SRO technique can be clinically adopted. An ototoxicity-induced hearing loss seems to appear 33 days after ototoxic MDR-TB treatment commencement. Aural fullness was a commonly reported symptom among participants with MDRTB. Aural fullness is omnipresent in peripheral auditory pathologies. Therefore, auditory symptoms reported by patients' needs a comprehensive audiological investigation. Lastly, more research is needed on how patients (and clinicians) experience the advances in technology innovation especially in audiology where technology innovation is continuously evolving.

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10

Vallie, Razia. "Assessing and comparing the effectiveness of treatment for multidrug resistant tuberculosis between specialized TB hospital in-patient and general outpatient clinic settings within the Western Cape Province, South Africa." University of the Western Cape, 2016. http://hdl.handle.net/11394/5600.

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Magister Public Health - MPH
Background: Multidrug resistant tuberculosis (MDR TB) is a growing threat globally. The large increase in the incidence and prevalence of MDR TB in South Africa in recent years has impacted on the way in which MDR TB is managed within the health services. It became logistically difficult to manage MDR TB by treating all patients as in-patients in a specialized tuberculosis (TB) hospital. The clinics, which are run by nurses and/or general medical officers, are then required to manage this more complex form of TB, with limited resources, less experience and assumingly with less MDR TB knowledge. Of particular concern is that shifting of the patient management from specialized TB hospitals to Primary Health Care clinics which might worsen the already poor MDR TB treatment outcomes. There has been minimal assessment of the management of MDR TB at clinic level and hence the comparison of treatment outcomes for those patients initiated on treatment in clinics compared to in-patients in specialized TB hospitals is urgently needed. Aim: To compare the treatment outcomes and the effectiveness of medication regimens provided to MDR TB patients initiated on treatment in specialized TB hospitals as inpatients, to that of MDR TB patients initiated on treatment as outpatients at community clinics within the Western Cape Province, South Africa. Methodology Study Design: A retrospective cohort study was undertaken, as the length of treatment for a MDR TB patient can be for 24 months or longer and this study was based on treatment outcome data. Study Population and sample: The study population was uncomplicated MDR TB patients initiated on treatment in hospitals and clinics from January 2010 to December 2012. The sample comprised of 568 participants that were laboratory confirmed to have MDR TB and had the outcomes of their treatment recorded in an electronic database or a paper register. Data Collection: The researcher collected MDR TB information from standardized MDR TB registers as well as an electronic MDR TB database. Analysis: Data was analyzed comparing the exposed (clinic initiated) and unexposed (hospital initiated) cohorts incidence of 4 key treatment outcomes, namely: successfully treated, failed treatment, died and defaulted treatment. Bivariate analysis (relative and absolute) was done to determine the cumulative incidence ratio and cumulative incidence difference and multivariate logistic regression analysis for the adjusted odds ratio to control for confounders and effect modifiers. Ethics: Permission to conduct this research was obtained from the relevant authorities. The confidentiality of the participants as per the Department of Health policy and in adherence to general ethical guidelines was strictly maintained. The study proposal received ethical clearance and approval from the University of the Western Cape Research Committee. Results: All participants within this study received the appropriate treatment as per the MDR TB guidelines. The incidence rate for the main outcomes of this study indicated that successfully treated for the clinic initiated participants was 41% and 31% for the hospital initiated participants. ‘Defaulted’ treatment was 39% and 41%, ‘failed’ treatment 7% and 13% and ‘died’ was 14% and 16%, respectively. The clinic initiated participants appeared to have better treatment outcomes on bivariate analysis, however on multivariate analysis, there was no difference in the treatment outcomes of the clinic initiated participants compared to the hospital initiated participants, and therefore the clinic initiated treatment is seen as effective. The time to treatment initiation for clinic and hospital initiated participants is excessively long for both cohorts, with a median of 29 days, and 37 days respectively. The key findings of note in the multivariate analysis is that the Human Immunodeficiency Virus positive (HIV+) participants provided with antiretrovirals therapy (ART) were, based on adjusted cumulative incidence ratios, 6.6 times more likely to have a successfully treated outcome (95% CI 1.48-29.84), and were 0.2 times less likely to die (95% CI 0.08-0.53). Having a previous cured history of TB and no previous history of TB were 2.9 times more likely to have a successfully treated outcome (95% CI 1.48-5.56) and were 0.1 times (0.04-0.38) less likely to fail treatment. An interesting finding was that participants living in the rural districts were 2.6 times more likely to die. Conclusion: Clinic initiated treatment for uncomplicated MDR TB is as effective as hospital initiated treatment. Also, those provided with ART and those without previous TB or who had a previous bout of TB cured, had better outcomes. Main Recommendations: The Western Cape health department should continue with the decentralization of MDR TB services to the clinics and could safely consider expanding the decentralization to include uncomplicated Preextensively drug-resistant TB and Extensively drug-resistant TB patients. Offering ART to HIV+ patients should be mandatory. The delays in the time to treatment initiation of MDR TB need to be further investigated.

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11

Jikijela, Olwethu. "Clinical characteristics and treatment outcomes of multi-drug resistant tuberculosis patients attending a hospital in Buffalo City Metropolitan Municipality, Eastern Cape." University of the Western Cape, 2018. http://hdl.handle.net/11394/6423.

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Magister Public Health - MPH (Public Health)
The presence of highly effective medicines has made very little impact in reducing deaths as a result of tuberculosis (TB), a curable condition but when managed inappropriately, may result in Drug Resistant TB. TB accounts for about one in four deaths that occur in HIV positive people and HIV has been found to be a risk factor for complex unfavorable outcomes in MDR TB patients and a very strong predictor for death and default. The relationship between diabetes and TB has also been explored, with some authors identifying diabetes as a risk factor for TB, and with related poor clinical outcomes in both conditions when they co-exist. Exploring the clinical characteristics and treatment outcomes of MDR TB patients in the presence of these risk factors could present an opportunity to provide better care through increased case-detection activities, improved clinical management and better access to care for all these conditions. The aim of the study was to describe the clinical characteristics and treatment outcomes of MDR TB patients initiated on treatment at Nkqubela and Fort Grey Hospitals.

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12

Shah, Monic. "Antimicrobial Nanoparticles: A Green and Novel Approach for Enhancing Bactericidal Efficacy of Commercial Antibiotics." TopSCHOLAR®, 2014. http://digitalcommons.wku.edu/theses/1389.

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On the verge of entering the post-antibiotic era, numerous efforts are in place to regain the waning charm of antibiotics which are proving ineffective against most “Superbugs”. Engineered nanomaterials, especially gold nanoparticles (GNPs) capped with antibacterial agents, are proving to be an effective and novel strategy against multidrug resistant (MDR) bacteria. In this study, we report a one-step synthesis of antibioticcapped GNPs (25 ± 5 nm) utilizing the combined reducing and capping ability of a cephalosporin antibiotic, ceftazidime. No signs of aggregation or leaching of ceftazidime from GNP surface was observed upon its storage. Antibacterial testing showed dosedependent broad spectrum activity of Cef-GNPs against both Gram-positive (S. bovis and E. durans) and Gram-negative (P. aeruginosa and E. aerogenes) bacteria. A significant reduction in the minimum inhibition concentration (MIC) of Cef-GNPs was observed as compared to the ceftazidime by itself against Gram-negative bacteria. The MIC of Cef- GNPs were 0.1 mg mL-1 (P. aeruginosa and E. aerogenes) and 1.2 mg mL-1 (E. durans and S. bovis). Cef-GNPs exerted bactericidal action on both P. aeruginosa and E. durans by disrupting the cellular membrane resulting in leakage of cytoplasmic content and death of bacterial cell. Our investigation and results provides an additional step in the development of antibiotic capped GNP as potent next generation antibacterial agents.

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13

Halley, Patrick D. "DNA Origami as a Drug Delivery Vehicle for in vitro and in vivo Applications." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1480632777328142.

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14

Giyose, Patela. "Strategies used to implement the national guidelines on preventing and early management of multi-drug resistant tuberculosis (MDR-TB) at the buffalo city municipality clinics in East London Eastern Cape province." Thesis, University of Fort Hare, 2013. http://hdl.handle.net/10353/1297.

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The purpose of the study was to explore and describe the strategies used by nurses to implement the national treatment guidelines to prevent, detect and manage multi-drug resistant tuberculosis (MDR-TB) patients. Tuberculosis remains one of the leading infectious diseases and the major cause of death worldwide with estimates of 9.2 million new TB cases in 2008 and 1.7 deaths including 200 000 in clients co-infected with HIV. South Africa is currently ranked 3rd among the 22 high TB burden countries in the world. The HIV/AIDS epidemic contributes significantly to the upward trend in TB morbidity and it is estimated that more than 50% of TB patients are also HIV positive (South African Department of Health 2009:10). The current rate of tuberculosis infections as a result of new infections as well as re-infections of patients is of concern to the disease control and policy making bodies of South Africa. Questions regarding the effectiveness of tuberculosis policies and programmes emerge at all times (Luhulima, Netshandama and Davhana-Maselesele, 2008: 36). Patients with multidrug-resistant (MDR) tuberculosis (TB) are at high risk of treatment failure. It is anticipated that early identification of MDR-TB and appropriate treatment will improve patient outcome and disease control. This study intends to explore the effectiveness of health systems in the prompt identification and management of MDR patients. This study was conducted using a qualitative, explorative and descriptive design. A purposive sample of clinics and professional nurses was selected, and voluntary participation was ensured. The data was collected through individual interviews which were audio taped and then transcribed verbatim. Findings revealed that MDR-TB guidelines were available at the clinics. The professional nurses implemented the guidelines to prevent, detect and manage multi-drug resistant tuberculosis, by screening and testing symptomatic high risk groups, contact tracing and monitoring, providing initial counselling and education to patients and family, preparing patients for admission when indicated and coordinating referrals to the centralised MDR-TB unit. However, there were notable constraints with regards to the management of MDR-TB patients and the overall TB programme. These included MDR-TB specific training, staff shortages, dysfunctional community DOT programme, shortage of beds at the MDR-TB treatment centres, and patient factors like defaulting, migration for various reasons, alcoholism. All these constraints call for intensified strategic management at both policy and facility level. It is also necessary that all policies related to patient management need extensive scientific study to monitor and evaluate their effectiveness. More research studies are required on policy analysis and utilization.

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15

Wilburn, Kaylee Marie. "Isolation and Characterization of Broad Host Range Phage that infect P. aeruginosa Pathogens." Bowling Green State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1594224687661359.

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16

Hoffman, Mary M. "Mechanism of MDR protein mediated multidrug resistance /." Access full-text from WCMC, 1997. http://proquest.umi.com/pqdweb?did=733008491&sid=6&Fmt=2&clientId=8424&RQT=309&VName=PQD.

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17

Dandachi, Iman. "Multi drug resistant organisms in Lebanese livestock." Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0286/document.

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De nos jours, l'épidémiologie des bactéries multi-résistantes a évolué et ne se limite plus aux milieux hospitaliers. En effet, les animaux sont désormais considérés comme d’importants réservoirs de bactéries multi-résistantes, notamment des Bacilles à Gram négatif sécréteurs de bêta-lactamases et/ou résistant à la colistine. L'émergence de ces bactéries chez les animaux est due principalement à l’utilisation excessive d’antibiotiques en tant que prophylaxie et facteurs de croissance. Le transfert d’organismes multi-résistants aux antibiotiques provenant d’animaux vers les humains est un problème majeur pouvant entrainer de graves infections. La transmission zoonotique se fait par contact direct/indirect mais aussi par voie environnementale. Au Liban, plusieurs études ont été menées dans les hôpitaux et ont montré une prévalence élevée de bactéries multi-résistantes. En revanche, ces études sont rares dans le milieu vétérinaire. Le but de ce travail de thèse est de décrire l'épidémiologie des organismes multi-résistants dans les animaux d’élevage destinés à la consommation au Liban. Le typage des bactéries par MLST et le séquençage du génome entier ont été utilisés pour décrire la prévalence des organismes multi-résistants et les mécanismes de résistance chez les souches isolées. Nous pouvons ainsi conclure que les élevages de poulets et de porcs sont de puissants réservoirs de gènes de résistance BLSE et mcr-1 au Liban. La dissémination de la résistance semble être polyclonale et liée à la propagation de plasmides porteurs de gènes de résistance. Par conséquent, l'utilisation de la colistine en médecine vétérinaire au Liban doit être interdite
Nowadays, the epidemiology of multi-drug resistance has changed and is no more confined to the hospital settings. Food producing animals are increasingly regarded as potent reservoirs of multi-drug resistant organisms i.e. beta lactamase producers and colistin-resistant Gram-negative bacilli. The emergence of multi-drug resistance in animals is thought to be mainly driven by the overuse of antibiotics as growth promoters and prophylaxis. The dissemination of resistant organisms in animals is sparked by the concern of being transferred to humans where they can be candidates for infections with limited therapeutic options. The zoonotic transmission of resistant organisms from animals to humans occurs mainly via direct/indirect contact but also via environmental routes. In Lebanon, several studies were conducted in hospitals and showed a high prevalence of multi-drug resistance; unlikely, these studies are scarce in animals. The aim of this thesis research was thus to describe the epidemiology of multi-drug resistant organisms in Lebanese Livestock Multi-locus sequence typing and whole genome sequencing were used to describe the prevalence of multi-drug resistant organisms and the corresponding mechanisms of resistance in the isolated strains from chicken, pigs, farmers and environment. Chicken and swine farms showed to be potent reservoirs of ESBL and mcr-1 genes in Lebanon. The dissemination of multi-drug resistance appears to be multi-clonal and related to the spread of plasmid carrying resistance genes. Colistin use in veterinary medicine in Lebanon should be banned

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18

Taylor, LaShan Denise. "Antibiotic Resistance: Multi-Drug Profiles and Genetic Determinants." [Johnson City, Tenn. : East Tennessee State University], 2001. http://etd-submit.etsu.edu/etd/theses/available/etd-1210101-134219/unrestricted/taylorl121101a.pdf.

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19

Woodahl, Erica Lynn. "Genetic variation in the multidrug resistance gene (MDRI) : impact on drug delivery and disposition /." Thesis, Connect to this title online; UW restricted, 2004. http://hdl.handle.net/1773/7950.

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20

Stoffels, Karolien. "Contribution to the research on drug resistant Mycobacterium tuberculosis." Doctoral thesis, Universite Libre de Bruxelles, 2014. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209194.

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Tuberculosis (TB) is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. It is caused by micro-organisms of the Mycobacterium tuberculosis complex. It is the second greatest killer worldwide due to a single infectious agent, after the Human Immunodeficiency Virus (HIV). Without treatment, fatality is 50% in immune competent persons. TB remains the leading cause of death among HIV positive persons, causing one fifth of the deaths. The World Health Organization estimates that one third of the world population is infected by this micro-organism but only 5 to 10% develop TB disease. Nevertheless, this enormous reservoir leads to around 1.4 millions deaths annually. Standard curative treatment lasts at least 6 months and includes 4 different drugs. Toxicity of the drugs leading to (severe) adverse events and the long duration of the daily administration challenges patient’s compliance. Subinhibitory concentration of the drugs (due to poor adherence) can induce resistance of the mycobacteria to the provided drugs. Unlike most bacteria where resistance is acquired by plasmids, drug resistance of mycobacteria is obtained by genomic mutations. “Multi drug-resistant tuberculosis (MDR-TB)” is strictly defined as TB resistant to specifically isoniazid and rifampicin, the two main first line drugs. “Extensively drug resistance (XDR)” is defined as MDR-TB with additional resistance to any of the fluoroquinolones (such as ofloxacin or moxifloxacin) and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin). The increase of MDR-TB represents an enormous challenge to Public Health globally. This research examined different aspects of tuberculosis resistance performed in the Belgian National Reference Center, a clinical laboratory setting.

First of all, a profound analysis of the MDR-TB situation in Belgium was conducted. It is the first retrospective population-based survey of MDR-TB in Belgium, covering a 15-year period (1994-2008). It comprises 174 patients representing more than 80% of the culture positive MDR-TB patients reported to the Belgian register, thus this study is considered of national relevance. It includes bacteriological and molecular data on the isolates as well as clinical aspects of the patients and treatment results. Considering only the patient’s first MDR-TB isolate, an increase over time was observed in the number of isolates resistant to a second-line drug as well as the total number of drugs each isolate was resistant to. XDR-TB was detected since 2002 and panresistant TB (resistant to every available antituberculosis drug) since 2009. Overall, a successful treatment outcome was obtained for 67.8% of the MDR-TB cases. Drug susceptibility testing (DST) of Mycobacterium tuberculosis to first line drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) in liquid culture medium has a turn around time of at least two weeks, after identification of the positive culture (obtained after 2 to 4 weeks) from the patient’s clinical isolate. In order to provide the clinician with valuable information about the isolated mycobacteria leading to patient adapted therapy before bacteriological DST results are available, resistance is predicted by detection of mutations in certain genes of the mycobacteria. It is common practice for rifampicin (rpoB gene) and isoniazid (katG gene and/or inhA promoter region). In this MDR-TB collection, rifampicin resistant related mutations were found in 97.1% (168/173) of the clinical isolates and isoniazid resistant related mutations in 94.1% (160/170). The pncA, embB and gyrA genes have been sequenced to identify possible mutations because of their possible involvement with resistance to pyrazinamide, ethambutol and the fluoroquinolones respectively. However, little is known about the resistance prediction value of the mutations in these genes.

The study is also the first study on the molecular epidemiology of MDR-TB in the country. DNA fingerprinting showed a large diversity of strains (67% of the patients were infected by a strain with a unique pattern) and further epidemiological examination revealed limited local transmission of MDR-TB in Belgium.

The second part investigated the pncA gene and its association with pyrazinamide resistance in MDR-TB isolates from Belgium and in vitro cultured spontaneous mutants. The genetic analysis showed that 98.3% (59/60) of the Belgian clinical MDR pyrazinamide resistant (PZAR) isolates present a mutation in the pncA gene. We found 1.7% (1/60) of the PZAR MDR-isolates encoding wild type pncA and flank. A total (PZAR and PZAS) of 41 different amino acid changes, 3 protein truncations and 5 frameshifts were observed including eight novel mutations: 8Asp>Ala, 13Phe>Leu, 64Tyr>Ser, 107Glu>stop, 143Ala>Pro, 172Leu>Arg and frameshifts starting in codon 55 and 82. Analysis of all observed mutations (i.e. in clinical isolates as well as spontaneous mutants) revealed that they are not always associated with drug resistance and that they are not scattered randomly throughout the gene, but occur rather at preferential sites such as in codons with amino acids associated with either iron or substrate binding and catalytic active sites. The frequency of in vitro mutagenesis to pyrazinamide at pH 6.0 was determined and found to be relatively high at 10-5 CFU/ml.

Finally, the in vitro activity of tobramycin and clarithromycin (with unclear efficacy against M. tuberculosis) was evaluated on 25 M. tuberculosis clinical isolates with various resistance profiles. The effect of the drugs administered together was examined for possible synergistic effect. The median minimum inhibitory concentration (MIC) of 8 µg/ml obtained for both drugs in this study is rather high but are beyond the concentrations obtained in lung tissues. This suggests that both drugs should be investigated further as potential adjuncts to the treatment of resistant TB when other alternatives have failed; in particularly through new drug delivery systems such as the Dry Power Inhaler which allows local drug deposition with high drug concentrations in the lungs but low toxicity due to limited systemic absorption. In addition, for 36% of the tested isolates a decrease of the MIC of clarithromycin by a single or twofold dilution was observed in the presence of a subinhibitory concentration of tobramycin and no antagonistic effect was seen for the remaining isolates.

This research illustrates different (laboratory) aspects in the fight against drug resistant TB, all using the Belgian TB collection: characterisation of the Belgian MDR-TB situation on bacteriological, molecular and epidemiological level; profound analysis of genomic mutations and their possible association with drug resistance; and investigation of synergistic activity of drugs with low efficacy against M. tuberculosis.

Doctorat en Sciences biomédicales et pharmaceutiques
info:eu-repo/semantics/nonPublished

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21

Siu, Kit-hang, and 蕭傑恆. "Molecular characterization of multi-drug resistance mechanisms in mycobacterium tuberculosis." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B46076219.

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22

Joseph, Renu. "Evolution of multiple antimicrobial drug resistance conservation of genes encoding streptomycin, sulfonamide and tetracycline resistance among Escherichia coli with increasing multi-drug resistance /." Online access for everyone, 2007. http://www.dissertations.wsu.edu/Thesis/Fall2007/R_Joseph_111707.pdf.

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23

Sonawane, Amit. "Evaluation of novel efflux transport inhibitor for the improvement of drug delivery through epithelial cell monolayer." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14424.

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Blood-brain barrier (BBB) is a unique membranous barrier, which segregates brain from the circulating blood. It works as a physical and metabolic barrier between the central nervous system (CNS) and periphery. In mammals, endothelial cells were shown to be of BBB and are characterized by the tight junctions along with efflux system which are responsible for the restriction of movement of molecules within the cells. Efflux system consists of multidrug resistance proteins such as P-glycoprotein (P-gp). P-gp removes substances out back from the brain to the blood before they reach to the brain. So the barrier is impermeable to many compounds such as amino acids, ions, small peptides and proteins, making it the most challenging factor for the development of new drugs for targeting CNS. Curcumin is a bioactive compound that has a number of health promoting benefits such as anti-inflammatory, anticancer, anti-oxidant agent; as well as a role in neurodegenerative diseases, but low oral bioavailability is the major limiting factor. Low water solubility and rapid metabolism are the two important factors responsible for poor bioavailability of curcumin. Galaxolide is a musk compound and previously known for the bioaccumulation of toxic components in the aquatic animals by interference with the activity of multidrug/multixenobiotic resistance efflux transporters (MDR/MXR). The bioavailability of curcumin can be enhanced when administered with galaxolide. This study was carried out to investigate the effect of galaxolide on the permeation of curcumin through the epithelial cell monolayers. MDCKII-MDR1 cell monolayer is used an in vitro blood-brain barrier model while Caco-2 monolayer is used as an in vitro intestinal model, which also expresses the P-glycoprotein. The curcumin and galaxolide were separately solubilised in the DMSO and used in combination to perform permeation study, to determine the effect of galaxolide on curcumin permeation through epithelial cell monolayers. The galaxolide shows an efflux protein inhibition activity and this activity was used to enhance permeation of curcumin through the Caco-2 monolayer. In summary, galaxolide is a novel permeation enhancer molecule, which can be used for the improvement of drug delivery of other bioactive compounds in future.

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24

Thonghin, Nopnithi. "Structural studies of the multi-drug resistance protein P-glycoprotein (ABCB1)." Thesis, University of Manchester, 2018. https://www.research.manchester.ac.uk/portal/en/theses/structural-studies-of-the-multidrug-resistance-protein-pglycoprotein-abcb1(9f3d4a87-4d43-4984-9e41-3db5fc2be66a).html.

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P-glycoprotein (P-gp or ABCB1) is a membrane-bound active transporter belonging to the ABC protein superfamily. It is responsible for xenobioIc efflux and also contributes to multidrug resistance in diverse diseases including cancer and epilepsy. P-gp has been increasingly recognised as a potential target for future therapeutics. Although the protein has been studied for decades, understanding of the P-gp transport mechanism is still incomplete. Two P-gp orthologues, mouse (m) and human (h), were therefore expressed in yeasts and purified in the presence of the detergent, n-Dodecyl-Î²-D- Maltoside (DDM). Purified proteins were examined for aggregation and monodispersity via dynamic light scattering (DLS) and their thermal stability was determined by an assay using a thiol-specific dye (CPM). ATPase activity, measured in a detergent environment, showed that the proteins were active with a basal activity of 60 Â± 4 and 35 Â± 3 nmol/min/mg for mP-gp and hP-gp, respectively. Crystallisation trials were conducted in the presence of nucleotide. In meso crystallisation using commercial monoolein pre- dispensed plates yielded hexagonal crystal-like objects however they failed to diffract X- rays. P-gp samples were also subjected to cryo-EM where mP-gp in the post-hydrolytic (ADP-bound, vanadate-trapped) state provided the highest resolution dataset that led to a reconstruction of 3D density map at the resolution of 7.9 Ã which showed an inward- facing conformation. Rigid-body model fitting unveiled densities that were not accounted for by the fitted model illustrating new features such as bound ADP, extended NBD1- TMD2 linker and alternative allocrite-binding sites. Ultimately, the knowledge of P-gp conformation alteration was enhanced and a refined alternating access mechanism of P- gp was proposed based upon information derived from this study.

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25

Fleeman, Renee. "Discovering Antibacterial and Anti-Resistance Agents Targeting Multi-Drug Resistant ESKAPE Pathogens." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6839.

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Antibiotic resistance has been a developing problem for mankind in recent decades and multi-drug resistant bacteria are now encountered that are resistant to all treatment options available. In 2014, the World Health Organization announced that this problem is driving us towards a “post-antibiotic era” that will change the face of modern medicine as we know it. If lack of novel antibiotic development and FDA approval continues, by the year 2050, 10 million people will die each year to an antimicrobial resistant bacterial infection. With lack of pharmaceutical industry involvement in developing novel antibiotics, the responsibility now lies within the academic institutions to identify potential novel therapeutics to fuel the antibiotic drug discovery pipeline. Combinatorial chemistry is one technique used to expedite the discovery process by assessing a large chemical space in a relatively short time when compared to traditional screening approaches. Combinatorial libraries can be screened using multiple approaches and has shown successful application towards many disease states. We initially discovered broad spectrum antibacterial bis-cyclic guanidines using combinatorial libraries and expanded on the knowledge of the physiochemical attributes necessary to inhibit Gram negative bacterial pathogens. Following this success, we continued to assess the combinatorial libraries for adjunctive therapeutics that potentiate the activity of obsolete clinical antibiotics. The polyamine efflux pump inhibitors discovered in this subsequent study prove the benefits of using the large chemical space provided in the combinatorial libraries to identify a variety of therapeutics. Our studies always begin with identifying an active compound and active compounds undergo hit-to-lead optimization. This optimization studies are of utmost importance in developing a novel antibacterial agent for therapeutic applications. Our medicinal chemistry work described here is proof of the success of careful structure activity analyses to optimize a hit scaffold to create a more effective antibacterial agent. Overall, our work described here reveals the potential role of academic institutions in fending off the impending “post-antibiotic era”.

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26

Goodfellow, Hugh Robin. "The effect of phosphorylation on the function of P-glycoprotein." Thesis, University of Oxford, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308620.

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27

Al-Khateeb, Mohammed Jihad M. Jalal. "Investigation into the epidemiology of multi-drug resistance plasmids of hospital-associated coliform bacteria." Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243028.

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28

Jenkins, Caroline. "Investigation into the mechanism of Int6-induced multi-drug resistance in fission yeast." Thesis, University of Oxford, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.414148.

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29

Montesanti, Annalisa. "Characterization of human gene products homologous to fission yeast multi-drug resistance determinants." Thesis, Open University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343745.

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30

Demirel, Kars Meltem. "Molecular Mechanisms Of Vincristine And Paclitaxel Resistance In Mcf-7 Cell Line." Phd thesis, METU, 2008. http://etd.lib.metu.edu.tr/upload/3/12610241/index.pdf.

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Resistance to broad spectrum of chemotherapeutic agents in cancer cell lines and tumors has been called multiple drug resistance (MDR). In this study, the molecular mechanisms of resistance to two anticancer agents (paclitaxel and vincristine) in mammary carcinoma cell line MCF-7 were investigated. MCF-7 cells were selected in the presence of paclitaxel and vincristine by stepwise dose increments. The cell viability and growth profiles of resistant sublines were examined. As the resistance indices increased, the growth rates of sublines were found to decrease. Gene and protein expression levels of the basic drug resistance proteins P-gp and MRP1 were studied in sensitive and drug resistant MCF-7 cells. It was shown that P-gp overexpression is significantly contributing to the developed drug resistance phenotype. Mutation analysis of beta tubulin gene which encodes the target of paclitaxel and vincristine was performed. Single histidine to proline mutation was identified near GTP binding site of beta tubulin in vincristine resistant subline which was not reported before. Apoptosis related BCL-2 and BAX were examined at both gene and protein expression levels and they were not found to be significantly related to the developed resistance in the sublines. The reversal of drug resistance by various inhibitory agents of P-gp and MRP1 was investigated by using flow cytometry. Synthetic silicon compounds were found to be the most effective MDR reversal agents. The effects of various combinations of anticancer drugs and reversal agents on cell proliferation were examined by checkerboard microplate method. ALIS409-paclitaxel and paclitaxel-doxorubicin pairs seem to have highest antiproliferative effects on resistant sublines. The microarray expression profiling of sensitive and resistant MCF-7 cells was performed for a much detailed and comprehensive analysis of drug resistance. The results indicated that the upregulation of MDR1 gene is the dominating mechanism of paclitaxel and vincristine drug resistance. Additionally up regulation of the genes encoding the detoxifying enzymes (i.e. GSTP1) was observed. Significant down regulation of apoptotic genes (i.e. PDCD2/4/6/8) and alterations in expression levels of genes related to invasion and metastasis (MMPs, ADAMs, COL4A2, LAMA etc.) were detected. Upregulation of some oncogenes (i.e. ETS, RAS) and cell cycle regulatory genes (CDKN2A, CCNA2 etc.) was seen which may be in close relation to MDR in breast cancer. Further studies will demonstrate the relationship between the components contributing to drug resistance phenotype in breast cancer cells.

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31

Jönsson, Videsäter Kerstin. "Expression of multidrug resistance genes and proteins and effect of selenite in anthracycline-resistant human tumor cell lines /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-889-0/.

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32

D'Cunha, Ronilda Raymond. "Treatment strategies to reverse efflux transporter-mediated resistance to Tyrosine kinase inhibitors." Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6563.

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Multidrug resistance (MDR), a phenomenon in which tumors that were initially sensitive, recur and start showing resistance not only to the initial chemotherapeutic agent but also to various anticancer drugs that are structurally and functionally different from the initial drug, constitutes one of the main reasons for the failure of chemotherapy. An important mechanism of MDR is the enhanced cellular efflux of anticancer agents due to an overexpression of ATP-binding cassette (ABC) transporters (i.e. efflux transporters), especially P-glycoprotein (Pgp), Multidrug Resistance-associated Protein 1 (MRP1) and Breast Cancer Resistance Protein (BCRP), in cancer cells. In order to reverse this resistance, there has been a lot of emphasis on the development of Pgp, MRP1 and BCRP inhibitors. Although this search has been ongoing for three decades, there are still no clinically available efflux transporter modulators. Tyrosine kinase inhibitors (TKIs) are a novel, rapidly growing class of anticancer agents that have a target-based mechanism of action, and their use transformed cancer chemotherapy due to higher specificity and enhanced safety profiles compared to conventional chemotherapeutic agents. Despite their tremendous success in treating various types of tumors, patients develop resistance to TKIs over time. Most of the FDA- approved TKIs are substrates of Pgp and/or BCRP, and as a result, these efflux transporters are also an important cause of conferred resistance against TKIs in cancer cells. Additionally, none of the 31 approved TKIs have an indication for use in brain tumors and interestingly, this may also due to the presence of Pgp and BCRP at the blood-brain barrier (BBB) and in the tumor cells, which prevent the TKI from crossing the BBB and reaching its target tumor site. Since Pgp- and BCRP- mediated TKI efflux has been shown to be involved in TKI resistance, the inhibition of these transporters could represent a potential TKI resistance reversal strategy. Over the last three decades, a large number of Pgp and/or BCRP inhibitors have been identified, but none of them have successfully made it to the clinic. It was observed that most drugs identified as inhibitors were either unable to achieve Pgp and BCRP inhibitory concentrations in-vivo without imparting severe toxicity, or did not possess adequate bioavailability and tissue distribution profiles in order to reach the tumor site. From these identified candidate inhibitors, after much thought and consideration, we chose to investigate TKIs and methylated flavones as modulators of efflux transporter-mediated TKI resistance. The overall goal of this project was to investigate the promising chemosensitizing potential of TKIs and methylated flavones in efflux transporter-mediated TKI resistance, both in-vitro and in-vivo. To identify potent efflux transporter inhibitor TKIs, we evaluated the effect of various TKIs on the accumulation of afatinib, the model TKI substrate, in Pgp- and BCRP- overexpressing cell lines. Afatinib was chosen as the model TKI substrate for our study because it undergoes very minimal metabolism in several species. Afatinib is a substrate of both Pgp and BCRP, but is not a substrate of uptake transporters. Therefore, it was anticipated that an in-vivo efflux transporter-mediated interaction with afatinib would most likely not be confounded or masked by other factors influencing its disposition. From the in-vitro cell uptake studies, we found that nilotinib is a potent inhibitor of both Pgp and BCRP, and it reversed Pgp- and BCRP- mediated afatinib efflux. Subsequently, an in-vivo study was carried out in mice to investigate the interaction between afatinib and nilotinib; and also the impact of nilotinib on the pharmacokinetics and tissue distribution of afatinib. Afatinib exposure in the plasma and in most tissues, namely liver, lung, kidney, heart, muscle, fat, and skin, was found to be significantly increased when nilotinib was coadministered with afatinib. Further, the nilotinib concentrations in most mice tissues was above that needed for Pgp and BCRP inhibition. These results showed that nilotinib could be a potent chemosensitizing agent for Pgp- and BCRP- mediated TKI resistance. Additionally, a significant increase in afatinib brain exposure was observed in the mice which were administered afatinib in combination with nilotinib. This is an interesting and important finding that could potentially be very useful in the treatment of primary and metastasized brain tumors. We also developed a physiologically based pharmacokinetic model of afatinib to characterize its tissue disposition in mice organs, and this model was then scaled up to humans. The developed model accurately predicted afatinib plasma exposure in healthy volunteers and patients with solid malignant tumors, renal impairment, and hepatic impairment. To investigate the chemosensitizing potential of methylated flavones in efflux transporter-mediated TKI resistance, the Bcrp1 inhibitory effect of 5,7-DMF and its effect on sorafenib accumulation was evaluated in-vitro. 5,7- DMF was found to be a potent inhibitor of Bcrp1 and consequently, its impact on the pharmacokinetics and tissue distribution of sorafenib was evaluated in mice. Results showed that co-administration with 5,7-DMF led to significantly greater sorafenib exposure in plasma and in most tissues collected. This indicated that 5,7-DMF may represent a promising chemosensitizing agent for Bcrp1-mediated TKI resistance due to its low toxicity and potent Bcrp1 inhibition. Our results may have important clinical implications as TKIs are currently the most widely used anticancer agents. 5,7-DMF may show great potential in reversing MDR in tumors expressing BCRP. On the other hand, TKI-TKI combination therapy, especially with nilotinib as the perpetrator, is an attractive strategy to combat both Pgp- and BCRP-mediated TKI resistance. Additionally, since nilotinib has a wide volume of distribution and can reach various tissues at concentrations sufficient enough to inhibit Pgp and BCRP; it could potentially be used as a chemosensitizer in the treatment of numerous types of cancers. Furthermore, its chemosensitizing potential could particularly be useful in the treatment of primary and metastatic brain tumors. Further studies are warranted to assess the chemosensitizing effect of nilotinib in tumor xenograft models.

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33

Nguyen, Quang Huy. "Genetic determinants and evolution of drug resistance in Mycobacterium tuberculosis in Vietnam : toward new diagnostic tools." Thesis, Montpellier, 2016. http://www.theses.fr/2016MONTT081/document.

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La tuberculose (TB), provoquée par Mycobacterium tuberculosis, est une des trois maladies prioritaires dans le monde. Les TB multi-résistantes (MDR) et ultra-résistantes (XDR-TB) représentent des obstacles majeurs pour la lutte antituberculeuse. Dans les pays à MDR-TB élevée, comme le Vietnam, la détection insuffisante de la résistance aux antibiotiques est un des facteurs principaux qui favorisent la transmission des souches résistantes. De plus, dans ces pays, encore très peu de choses sont connues sur la résistance à la pyrazinamide et aux antibiotiques de seconde ligne et sur les déterminants génétiques liés à ces résistances. Dans ce contexte, ce travail vise donc à acquérir des connaissances sur la résistance aux antibiotiques au Vietnam et à étudier comment M. tuberculosis évolue de l’état sensible à l’état ultra-résistant.260 isolats cliniques collectés au Vietnam entre 2005 et 2009 ont été inclus. Diverses techniques et analyses ont été utilisées: tests de sensibilité aux médicaments (développement d'un test à temps réduit), spoligotypage et MIRU-VNTR (24 loci) et séquençage de gènes. Les données ont été analysées par des analyses statistiques et phylogénétiques. Ce travail s’est d’abord focalisé sur la caractérisation d’isolats hautement résistants et sur la résistance à la pyrazinamide. Une forte proportion d'isolats quadruple résistants aux antibiotiques de première ligne a été identifiée comme pré-XDR et XDR et en majorité appartenant à la famille Beijing. L'analyse moléculaire a également révélé une forte proportion d'isolats, en particulier MDR, quadruple résistants et de la famille Beijing, portant des mutations associées à la résistance à la pyrazinamide.L'analyse génétique et phylogénétique globale a ensuite montré une grande diversité de profils de mutations dans chaque famille et chaque cluster MIRU-VNTR. Ces données suggèrent que M. tuberculosis peut suivre des chemins évolutifs variés pour devenir ultra-résistant. La prédominance de mutations et de combinaisons de mutations associées à un haut niveau de résistance et à un faible coût en termes de fitness suggère un effet cumulatif des mutations et un rôle de l’épistasie dans l'acquisition de la résistance multiple. De plus, une fréquence élevée de mutations compensatoires associées à la résistance à la rifampicine a été détectée chez les isolats très résistants. Ces processus semblent donc influencer fortement l'évolution de la résistance dans notre échantillon. Il est à noter que les mutations liées à des niveaux de résistance élevée et à de faibles coûts en termes de fitness, ainsi que les mutations compensatoires étaient plus particulièrement associées à la famille Beijing.En conclusion, ce travail fournit des connaissances uniques sur la résistance aux antibiotiques chez M. tuberculosis au Vietnam. En particulier, ces données prédisent une évolution de la résistance vers une situation de plus en plus préoccupante. Premièrement, la famille Beijing, en cours d’invasion au Vietnam, apparaît associée à de hauts niveaux de résistance, de faible coût en termes de fitness et aux mutations compensatoires. Deuxièmement, le risque élevé de résistance à la pyrazinamide remet en question son efficacité et son utilisation dans les traitements contre la MDR et la XDR-TB. Troisièmement, les données suggèrent une évolution de M. tuberculosis vers un potentiel de résistance plus élevé par effet cumulatif des mutations associés à la résistance et l’existence de phénomènes d’épistasie. Comme les échantillons étudiés dans ce travail ont été collectés, l’étape suivante est de valider nos hypothèses sur des données actualisées.Enfin, ce travail avec les données déjà publiées a permis d’établir, pour la première fois, un inventaire des mutations associées à la résistance aux antibiotiques chez M. tuberculosis au Vietnam. Cette base de données sera utilisée pour le développement d'une puce à ADN pour la détection rapide de la résistance aux antibiotiques au Vietnam
Tuberculosis (TB) is one of the deadliest infectious diseases worldwide, mainly caused by Mycobacterium tuberculosis. Multidrug resistant (MDR) and extensively drug resistant (XDR) TB are currently main challenges for TB control. In high MDR-TB burden countries like Vietnam, one of the main factors of drug resistant strain spread is the insufficient capacity of drug resistance detection. Besides, still little is known in these countries about the resistance to second line and pyrazinamide drugs (key drugs in the MDR-TB treatment) and the genetic determinants linked to these resistances. In this context, this work aimed to acquire knowledge on drug resistance in Vietnam and to understand how M. tuberculosis evolved from sensitive to highly drug resistance form by molecular analysis.260 clinical isolates collected in Vietnam between 2005 and 2009 were included. Various techniques and analyses were used: drug susceptibility testing (development of a test with a reduced turn-around time), spoligotyping and 24-MIRU-VNTR typing and gene sequencing. The data were analyzed by statistical and phylogenetic analyses.First, this work was focused on highly drug resistant M. tuberculosis clinical isolates and pyrazinamide resistance. A high proportion of quadruple first-line drug resistant isolates (resistant to isoniazid, rifampicin, streptomycin and ethambutol) have been characterized as pre-XDR and XDR isolates, belonging especially to Beijing family. The molecular analysis revealed also high proportion of drug resistant isolates carrying highly confident pyrazinamide resistance-associated mutations, particularly in MDR and quadruple resistant isolates and in Beijing family.Second, the genetic and phylogenetic analyses showed high diversity of mutation patterns within each family and each MIRU-VNTR cluster suggesting various evolutionary trajectories towards first and second-line drug resistance. The predominance of specific mutations and combinations of mutations associated with high level of resistance and low fitness cost suggests a cumulative effect of mutations and a role for epistasis in multiple-drug resistance acquisition. In addition, high frequency of fitness-compensatory mutations associated with rifampicin resistant mutations was detected in highly drug resistant isolates. These processes may drive the evolution of drug resistance in this sample and lead to a successful spread of highly drug resistant strains. It is worth noting that Beijing family was specifically linked to high-level drug resistance and low fitness cost mutations and to compensatory mutations.In conclusion, this work provides knowledge on the resistance to the first and second-line anti-TB drugs in clinical M. tuberculosis samples collected in Vietnam between 2005 and 2009. These data predict an evolution towards a more problematic situation in terms of drug resistance. First, because the Beijing family, which is currently invading Vietnam, is associated with highly drug resistance, mutations linked to high-level drug resistance and low fitness cost and compensatory mutations. Second, the high risk of pyrazinamide resistance in our sample challenges the efficacy and the use of this drug in MDR-TB treatment. Third, our data suggest an evolution of M. tuberculosis towards a higher potential of drug resistance because of a probable cumulative effect of drug resistant mutations and epistatic interactions. Since the samples under study were collected between 2005-2009, the next step is to test our hypotheses on a recent sampling. Finally, this study together with published data allowed making, for the first time, an inventory of the drug resistance associated mutations in M. tuberculosis isolates from Vietnam

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34

Barbier, Maxime. "Histoire évolutive et propagation de la tuberculose à échelle planétaire : vers une approche intégrée combinant la génomique des populations et le typage multi-locus." Thesis, Paris Sciences et Lettres (ComUE), 2017. http://www.theses.fr/2017PSLEP051/document.

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D’après un rapport de l’OMS, la tuberculose reste en 2015 l’une des 10 premières causes de décès à l’échelle mondiale. De ce fait, en matière de santé, éradiquer la maladie à l’horizon 2030 est un des objectifs majeurs fixés par les Nations Unies. La bactérie responsable de cette infection, Mycobacterium tuberculosis, est un pathogène obligatoire dont l’origine et l’évolution sont intrinsèquement liées à celles de son hôte principal, Homo sapiens. En effet, les souches actuelles de tuberculose présentent, tout comme l’homme, une forte structure phylogénétique, trace de leur origine géographique. Les pays pauvres et en développement sont les plus touchés par l’épidémie globale, favorisée par des systèmes de santé défaillants et une haute prévalence du VIH. Les pays occidentaux ne sont pas épargnés, menacés par l’émergence de souches de plus en plus résistantes aux antibiotiques provenant en grande partie de l’ex URSS. Au cours de cette thèse, j’analyse l’histoire évolutive, la propagation et l’acquisition de résistances aux antibiotiques de plusieurs épidémies de tuberculose en me basant sur des données génétiques et génomiques. Dans un premier temps je m’intéresse aux effets d’une campagne nationale de traitements en Asie Centrale sur le développement de souches multi-résistantes et met également en lumière le rôle clef de certaines mutations dans le succès des clones présentés. Ainsi cette campagne a été partiellement mise en échec par la présence de souches pré-résistantes, grâce à la survenue de mutations avant même la mise en place des traitements antibiotiques. Par la suite je me suis focalisé sur un clade particulier de souches multi-résistantes, le clone Russe W148. Je présente sa dispersion géographique et temporelle à travers l’Eurasie et démontre l’importance des mutations compensatoires dans son succès épidémique. De plus, la tuberculose ne touche pas seulement les hommes mais infecte également plusieurs autres mammifères. Afin d’appréhender les contraintes adaptatives accompagnants ces changements d’hôtes, j’ai effectué divers tests de sélection dans le but d’identifier les gènes impliqués. Pour finir, nous avons développé un indice souche spécifique, permettant de mesurer le succès épidémique de celles-ci à un niveau individuel. Dans le cadre d’études épidémiologiques, cette mesure peut être croisée avec des informations sur le patient, la souche ou même socio-économiques
According to a 2015 WHO report, tuberculosis remains one of the top 10 causes of death worldwide. Despite considerable efforts by the United Nations to eradicate the disease by 2030, a global TB epidemic still persists. Its causative agent, the bacterium Mycobacterium tuberculosis, an obligate pathogen, has been plaguing humanity since it originated, and has coevolved with its main host, Homo sapiens, over thousands of years. Contemporary tuberculosis strains exhibit a structured phylogeographic pattern, carrying the genetic print of their geographic origin. The Koch bacillus infects and kills in large numbers, in poor and developing countries, where fragile health care systems, combined with high HIV prevalence, facilitate epidemic spread. In western countries, the major current threats are the multiplication and propagation of antibiotic resistant strains (MDR/XDR) coming predominantly from former Soviet republics. In this thesis, I unravel the evolutionary history, propagation, and acquisition of drug resistance-conferring mutations in different settings, by implementing multiple genetic and genomic data sets. First, focusing on Central Asia, using whole genome sequencing and Bayesian statistics, I assess the effects of a treatment campaign on the development of MDR strains and highlight key mutations in successful strains. More importantly, the success of DOTs campaigns was compromised by the genetic make-up of these outbreak clades (pre-treatment low frequency resistance SNPs). Special attention was also given to a particular outbreak of MDR strains, i.e. the Russian W148 clone. I present its westward spatial and temporal propagation at a continental scale during the last century, and underline the key contribution of compensatory mutations in its epidemic success. However, tuberculosis does not only infect humans, but also has experienced successive mammalian host jumps. To decipher the adaptive constraints accompanying such secondary events, a systemic gene screen with selection signature-detecting algorithms was implemented to identify putative targets during diversifying selection. Finally, novel mathematical tools and indices that reflect the epidemicity of a strain were developed, jumping from a population-driven approach to a strain specific one, with broader epidemiological applications. This allows us to correlate strain fitness with patient, lineage, and socio-economic information

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Hayes, Cindy. "Prevalence and resistance gene mutations of multi-drug resistant and extensively drug resistant mycobacterium tuberculosis in the Eastern Cape." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1020374.

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The emergence and spread of multi-drug resistant (MDR-TB) and extensively drugresistant tuberculosis (XDR-TB) are a major medical and public problem threatening the global health. The objectives of this study were to (i) determine the prevalence of MDR-TB and XDR-TB in the Eastern Cape; (ii) analyze patterns of gene mutations in MDR-TB and (iii) identify gene mutations associated with resistance to second line injectable drugs in XDR-TB isolates. A total of 1520 routine sputum specimens sequentially received within a period of 12 months i.e. February 2012 to February 2013 from all MDR-TB and XDR-TB patients treated by Hospitals and clinics in the Eastern Cape were included in this study, of which 1004 had interpretable results. Samples were analyzed with the Genotype MTBDRplus VER 2.0 assay kit (Hain Lifescience) for detection of resistance to Rifampicin and Isoniazid while solid and liquid culture drug susceptibility tests were used for ethambutol, streptomycin, ethionamide, ofloxacin, capreomycin and amikacin. PCR and sequence analysis of short regions of target genes gyrA, (encode subunit of DNA topoisomerase gyrase), rrs (16S rRNA) and tlyA (encodes a 2’-O-methyltransferase) were performed on 20 XDR-TB isolates. MTBDRplus kit results and drug susceptibility tests identified 462 MDR-TB, 284 pre-XDR and 258 XDR-TB isolates from 267 clinics and 25 hospitals in the Eastern Cape. There was a high frequency of resistance to streptomycin, ethionamide, amikacin, ofloxacin and capreomycin. Mutation patterns indicated differences between the health districts as well as differences between the facilities within the health districts. The most common mutation patterns observed were: (i) ΔWT3, ΔWT4, MUT1 [D516V+del515] (rpoB), ΔWT, MUT1 [S315T1] (katG), ΔWT1 [C15T] (inhA) [39 MDR, 204 XDR-TB and 214 pre XDR-TB isolates], (ii) ΔWT8, MUT3 [L533P+S531L] (rpoB), ΔWT, MUT1 [S315T1] [145 MDR, 18 pre-XDR and 3 XDR-TB solates] and (iii) ΔWT3, WT4 [D516Y+del515] (rpoB), ΔWT, MUT1 [S315T1] (katG) [75 MDR, 1 pre-XDR and 7 XDR-TB isolates]. Mutations in inhA promoter regions were strongly associated with XDR-TB isolates. Two thirds (66.6 percent (669/1004) of the isolates had inhA mutations present with 25.4 percent (170/669) found among the MDR isolates, 39.2 percent (262/669) among the pre-XDR isolates and 35.4 percent (237/669) among the XDR-TB isolates, which implies that these resistant isolates are being spread by transmission within the community and circulating in the province. There was good correlation between XDR-TB drug susceptibility test results and sequence analyses of the gyrA and rrs genes. The majority of XDR-TB isolates contained mutations at positions C269T (6/20) and 1401G (18/20) in gyrA and rrs genes respectively. Sequence analysis of short regions of gyrA and rrs genes may be useful for detection of fluoroquinolone and amikacin/ kanamycin resistance in XDR-TB isolates but the tlyA gene is not a sensitive genetic marker for capreomycin resistance. This study highlighted the urgent need for the development of rapid diagnostics for XDR-TB and raised serious concerns regarding ineffective patientmanagement resulting in ongoing transmission of extremely resistant strains of XDRTB in the Eastern Cape suggesting that the Eastern Cape could be fast becoming the epicenter for the development of Totally Drug-resistant Tuberculosis (TDR-TB) in South Africa.

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Whiteley, Rosalind. "Effect of multiple antibiotic treatments on the evolution of antibiotic resistance in Pseudomonas aeruginosa." Thesis, University of Oxford, 2014. https://ora.ox.ac.uk/objects/uuid:ee7c9dd7-bdcf-481b-b16c-9bb7b99f5328.

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To combat the ever-growing clinical burden imposed by antibiotic-resistant pathogens, multiple-antibiotic treatments are increasingly being considered as promising treatment options. The impact of multiple-antibiotic treatments on the evolution of resistance is not well understood however, and debate is ongoing about the effectiveness of various multiple-antibiotic treatments. In this thesis, I investigate how aspects of multiple-antibiotic treatments impact the rate of evolution of antibiotic resistance in the opportunistic human pathogen Pseudomonas aeruginosa. In particular, I look at the impact of interactions between antibiotics in combination on the evolution of resistance, and how creating heterogeneity in the antibiotic environment by rotating the antibiotics used may change the rate of evolution of resistance. I characterise the interactions present in 120 combinations of antibiotics and find that the type of interaction can be predicted by the mechanism of action of the antibiotics involved. I investigate the effect of a subset of these combinations on the evolution of antibiotic resistance. My results refute the influential but poorly-evidenced hypothesis that synergistic combinations accelerate the evolution of resistance, even when synergistic combinations have the same inhibitory effect on sensitive bacteria as additive or antagonistic antibiotic combinations. I focus on a combination of the antibiotics ceftriaxone and sulfamethoxazole and test whether it is more effective in preventing the evolution of resistance than predicted by the inhibitory effect of the combination on sensitive bacteria. I do not find the combination to be more effective than predicted. Finally, I create heterogeneous antibiotic environments by rotating the antibiotic present at different rates. For the first time in a laboratory setting, I test how varying the rate of fluctuation in the antibiotics present in a heterogeneous antibiotic environment impacts the rate of evolution of resistance. Unexpectedly, I find the rate of evolution of resistance increases with increasing levels of antibiotic heterogeneity.

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37

Tärnberg, Maria. "Extended-spectrum beta-lactamase producing Enterobacteriaceae : aspects on detection, epidemiology and multi-drug resistance." Doctoral thesis, Linköpings universitet, Klinisk mikrobiologi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-76134.

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Beta-lactam antibiotics are the largest and most commonly used group of antimicrobial agents in Sweden as well as world-wide. They show very good tolerability and many of the drugs can be administrated orally. Bacteria expressing extended-spectrum beta-lactamases (ESBLs), enzymes hydrolysing penicillins and cephalosporins, may not respond to therapy using some of these antibiotics. The isolates are also often co-resistant to other antimicrobial agents, thus further limiting treatment options. Often parenterally administrated carbapenems is one of few safe treatment options left. In this thesis we have investigated the occurrence of ESBL producing Enterobacteriaceae in clinical isolates from Östergötland, Sweden, from 2002 until end of 2007 and the occurrence of multiresistance among ESBL producing E. coli. During these investigations we developed a simple method well suited for high-throughput analysis, for detection and sub typing of common ESBL genes. During the six year period, the prevalence of ESBL producing Enterobacteriaceae in Östergötland was very low, <1%, but increasing. The number of patients with ESBL producing E. coli increased significantly from 5 to 47 per year; K. pneumoniae remained between one and four per year. The genes found were dominated by CTX-M group 1 (67%), followed by group 9 (27%). There has been no reason to suspect an outbreak of nosocomial origin. The total consumption of antimicrobial agents was 10.7-12.1 DID per year in primary care; 1.14-1.30 DID per year in hospital care. Of eight oral agents tested, only three showed a generally high susceptibility; mecillinam (91%), nitrofurantoin (96%) and fosfomycin (99%). The corresponding figures for the fifteen tested parenterally administrated drugs were; amikacin (96%), tigecycline (99%), colistin (99%) and ≥99% susceptibility for the carbapenems. Sixty eight percent of the isolates were multiresistant. The most common multiresistance pattern was ESBL phenotype with decreased susceptibility to trimethoprim, trimethoprimsulfamethoxazole, ciprofloxacin, gentamicin and tobramycin. A significant difference in susceptibility between CTX-M groups, in favor of group 9 over group 1, was seen for many of the antibiotics tested; amoxicillin-clavulanic acid, aztreonam, cafepime, ceftibuten, ceftazidime, ciprofloxacin, gentamicin, piperacillin-tazobactam, temocillin, and tobramycin. In conclusion this thesis shows that the prevalence of ESBL producing Enterobacteriaceae in Östergötland was very low but increasing, and the total consumption of antimicrobial agents was stable. A majority of the isolates were multiresistant and a significant difference in susceptibility between CTX-M groups, in favor of group 9 over group 1, was seen for many of the antimicrobial agents tested.

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Blott, Emma-Jane. "Organisation of the nucleotide-binding domains of the multi-drug resistance transporter, P-glycoprotein." Thesis, University of Oxford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298753.

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39

Lau, Alan. "Molecular cloning of human T-cell leukaemia virus type I (HTLV-I) proteins and the role of HTLV-I infection in multiple drug resistance (MDR)." Thesis, University of Leicester, 1997. http://hdl.handle.net/2381/29746.

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To facilitate the structural and functional analysis of Human T-cell leukaemia virus type-I (HTLV-I) a recombinant proviral expression system was to be employed in which viral protein expression is uncoupled from the inefficient process of infection. Several molecular genomic HTLV-I proviral clones were isolated and used to express viral proteins. However, none of these molecular HTLV-I proviral clones were found to be fully competent for virus expression and did not allow the further development of the expression system. HTLV-I is etiologically linked to a rapidly progressing T-cell malignancy known as adult T-cell leukaemia (ATL) and a degenerative neurological disorder called HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). These diseases are noted for their poor response and high resistance to chemotherapy. Clinical drug resistance has been associated with the overexpression of the mdr-1 gene and its protein product P-glycoprotein (PGP). The presence of multiple drug resistant (MDR) cell phenotypes in peripheral blood mononuclear cells (PMBC) from HTLV-I infected patients was assessed and enchanced mdr-1 mRNA expression and PGP drug efflux activity was observed. MDR phenotypes were found in nine out of ten HTLV-I infected subjects tested. Development of MDR was independent of disease type or status with significant MDR activity being found in ATL, lymphoma type ATL, TSP/HAM and asymptomatic individuals. Furthermore the demonstration of stimulation and trans-activation of the mdr-1 gene suggests potential molecular mechanisms for the development of drug resistant cell phenotypes induced by HTLV-I infection.

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Heinrich, Anne-Kathrin [Verfasser]. "Overcoming drug resistance by stimulus-sensitive drug delivery systems : a preclinical characterization of polymer-drug conjugates for the treatment of multi-drug resistant cancer / Anne-Kathrin Heinrich." Halle, 2017. http://d-nb.info/1144955262/34.

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Turner, Patricia Kellie. "The role of multi-drug resistance associated protein 4 and P-glycoprotein in resistance of neuroblastoma to topotecan and irinotecan." View the abstract Download the full-text PDF version, 2007. http://etd.utmem.edu/ABSTRACTS/2007-018-Turner-index.html.

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Thesis (Ph.D. )--University of Tennessee Health Science Center, 2007.
Title from title page screen (viewed on June 20, 2008 ). Research advisor: Clinton Stewart, Pharm.D. Document formatted into pages (xvi, 129 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 112-129).

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42

Beniamin, Armanos. "Establishment of an Expression and Purification System for Plasmodium falciparum Multi Drug Resistance (pfmdr) Transporter." Thesis, University of Skövde, School of Life Sciences, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-969.

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Malaria is a life threatening parasite disease caused and transmitted by infected female anopheles mosquito. However, the parasite, Plasmodium falciparum, has become resistant to most anti malarial drugs, such as chloroquine, which contributes to fever and anaemia because of its ability to digest the haemoglobin in the red blood cells. The aims of this project were to establish whether “Bac to Bac” Baculoviral Expression System is suitable for expression of pfmdr 1 gene and for purification of the pgh 1 protein. The pfmdr 1 gene encodes an ABC transporter protein, pgh 1, fixed in the cell membrane of the Plasmodium falciparuum gut, which assist in elimination of drug compounds. Furthermore, “Bac to Bac” Baculoviral Expression System uses vectors with histidine tags to clone the pfmdr 1 gene and subsequently transform these into DH10Bac cells to produce the recombinant bacmid DNA. Since pfmdr 1 gene is an AT-rich sequence, PCR was optimized, by lowering the annealing and extension temperature to 47Co and 66Co respectively. The results show that “Bac to Bac” Baculoviral Expression System can be used to express the pfmdr 1 gene, though further experiments has to be performed.

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Taylor, Jenny Carmeron. "Molecular interactions of P-glycoprotein." Thesis, University of Oxford, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.363732.

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Phee, Lynette. "Unorthodox antimicrobial combination therapies for the treatment of multi-drug resistant Gram-negative infections." Thesis, Queen Mary, University of London, 2018. http://qmro.qmul.ac.uk/xmlui/handle/123456789/44695.

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The rise of antimicrobial resistance (AMR) has culminated in the most pressing problem in modern medicine. The situation is most acute with regards to the management of multi- drug resistant Gram-negative infections (MDRGNB) with common infections increasingly untreatable due to rapidly dwindling therapeutic options. A solution to the problem of AMR is unlikely to be easily found, but revisiting and re-purposing existing antimicrobials is a viable approach in the medium term. This study investigated the use of unorthodox antimicrobial combination therapies for the treatment of MDRGNB, with particular focus on agents of last resort. A systematic review of clinical studies highlighted the potential for polymyxin (colistin) combination therapies (e.g. colistin-rifampicin, colistin-carbapenems), although this could not be supported in a formal meta-analysis. A systematic approach for screening MDRAB for susceptibility to novel colistin combinations using multiple methods was employed and uncovered a number that were more potent than those previously identfied. The most potent combination that was consistently identified was colistin when combined with fusidic acid, despite this drug having no useful activity against MDRGNB on its own. The combination was further evaluated in static time-kill assays against a range of Gram-negative pathogens with defined resistance mechanisms, including to polymyxins and using invertebrate (Galleria mellonella) and murine models of MDRGNB infection. Colistin and fusidic acid combination therapy was subsequently used to successfully treat a case of ventilator-associated pneumonia due to MDR A. baumannii. This work highlights how older drugs can be re-purposed to tackle the problem of AMR using a precision medicine approach. Further studies to elucidate the mechanism of action of the colistin- fusidic acid combination and a formal clinical trial are warranted to investigate the potential utility of this combination in the treatment of MDRGNB with the expressed goal of bridging the current antimicrobial development gap.

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Mahfouz, Norhan, Serena Caucci, Eric Achatz, Torsten Semmler, Sebastian Guenther, Thomas U. Berendonk, and Michael Schroeder. "High genomic diversity of multi-drug resistant wastewater Escherichia coli." Nature Publishing Group, 2018. https://tud.qucosa.de/id/qucosa%3A32482.

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Wastewater treatment plants play an important role in the emergence of antibiotic resistance. They provide a hot spot for exchange of resistance within and between species. Here, we analyse and quantify the genomic diversity of the indicator Escherichia coli in a German wastewater treatment plant and we relate it to isolates’ antibiotic resistance. Our results show a surprisingly large pan-genome, which mirrors how rich an environment a treatment plant is. We link the genomic analysis to a phenotypic resistance screen and pinpoint genomic hot spots, which correlate with a resistance phenotype. Besides well-known resistance genes, this forward genomics approach generates many novel genes, which correlated with resistance and which are partly completely unknown. A surprising overall finding of our analyses is that we do not see any difference in resistance and pan genome size between isolates taken from the inflow of the treatment plant and from the outflow. This means that while treatment plants reduce the amount of bacteria released into the environment, they do not reduce the potential for antibiotic resistance of these bacteria.

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Al-Akra, Lina. "The Effect of The Tumor Microenvironment on Multi-Drug Resistance and the Assessment of Agents that Overcome this Effect." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/27974.

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Multidrug resistance (MDR) development is a major obstacle in the fight against cancer, primarily because of the over expression of ATP-binding cassette transporters (ABC transporters) such as P-glycoprotein (Pgp). Pgp typically protects cancer cells through the efflux of a diverse range of cytotoxic chemotherapeutics, such as Doxorubicin (DOX). Recently developed novel iron chelators (i.e., Dp44mT, DpC) demonstrate potent anti-tumor activity in these drug resistance cells. However, while the mechanism of Pgp drug efflux and function is known, the intracellular distribution and role of Pgp is yet to be determined. Additionally, the responsiveness to chemotherapeutics has been shown to be heavily influenced by the microenvironment of tumor cells. Thus, exploring these factors would be beneficial to potentially developing alternative agents and treatments to target MDR. This thesis consists of 6 chapters: A comprehensive literature review (Chapter 1 Introduction); a general methods chapter (Chapter 2 Materials and methods); 2 result chapters (Chapters 3-4) describing and discussing the results obtained; a concluding discussion of the findings and future directions (Chapter 5 Discussion) and a Bibliography (Chapter 6).

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47

Leangapichart, Thongpan. "Phenotypic and genomic analysis of multi-drug resistant bacteria in travelers." Thesis, Aix-Marseille, 2017. http://www.theses.fr/2017AIXM0183.

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La résistance aux antibiotiques chez les bactéries est un problème majeur mondial du fait de son augmentation. Récemment, la transmission des bactéries résistantes aux humains, aux animaux et à l’environnement sont de plus en plus décrits dans la littérature. Ces dernières années, les voyages internationaux ont augmenté massivement ce qui a permis aux bactéries résistantes de se propager d’un lieu à un autre. Les voyageurs internationaux sont les principaux acteurs de l’acquisition et de la propagation des gènes de résistance aux antibiotiques. Le plus grand rassemblement annuel de personnes comme le pèlerinage à la Mecque est connu pour être un réservoir pour la transmission des maladies infectieuses telles que la grippe, les épidémies méningococciques ou la tuberculose. Par conséquent, les voyageurs en particulier les pèlerins représentent une source importante de propagation de bactéries multi-résistantes. Les études sur la transmission et l'acquisition de gènes de résistance pendant le Hajj sont rares. Par conséquent, ce projet de thèse a trois objectifs principaux permettant de mieux comprendre la prévalence des gènes de résistance et des bactéries multi-résistantes au cours du Hajj:(i)l’étude de la surveillance épidémiologique des gènes de résistance chez les pèlerins avant et après le Hajj,(ii)l’étude des facteurs de risque d'acquisition de gènes de résistance aux antibiotiques chez les pèlerins,(iii)les études épidémiologiques moléculaires des bactéries résistantes chez les pèlerins et d'autres sources, tels que les patients, les animaux et l’environnement en utilisant des techniques comme le typage des séquences multi-locus et le séquençage du génome complet
Antibiotic resistance in bacteria is increasing and become a worldwide problem. Newresistance bacteria or mechanisms are emerging and spreading rapidly. Recently, thetransmission of antibiotic-resistant (AR) bacteria among humans, animals, and the variousenvironments are vastly recognized. With the growth of international travels over the pastdecades, this provides opportunities for AR bacteria to be spread rapidly from one geographiclocation to another. During trips, travelers changed diets, lifestyles, and their environmentsresulting in the alteration of AR patterns of bacteria residing in the gut. Thus, internationaltravelers are one of the most important modes for the acquisition and spread of AR genes.The largest annual mass gathering, the Hajj (pilgrimage to Mecca) is well known as a sourcefor infectious diseases transmission such as influenza, meningococcal outbreaks ortuberculosis. Thus, travelers, especially pilgrims, are one of the most significant sources forspreading AR bacteria. However, studies of the transmission and acquisition of AR genesduring Hajj in pilgrims are scarce. Therefore, this research thesis was carried out with threemain objectives to better understanding the prevalence of AR genes and bacteria during Hajj:(i) epidemiological surveillance of AR genes in pilgrims before and after Hajj, (ii) risk factorsanalysis concerning AR genes acquisition in pilgrims, (iii) molecular epidemiological studiesof AR bacteria in pilgrims, including patients, animals, and environment with the use ofmulti-locus sequence typing and whole genome sequencing

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Gkikopoulou, Effrosyni. "Voies de signalisation cobalamine-dépendantes de l'expression du gène MDR-1 : Une cible pharmacologique nouvelle pour la chimiothérapie ?" Thesis, Université de Lorraine, 2012. http://www.theses.fr/2012LORR0305/document.

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La résistance aux agents anticancéreux souvent observée en chimiothérapie s'accompagne d'une augmentation de l'expression des gènes tels que MDR-1, gérée par des réactions de méthylation cellulaire. La physiologie des réactions de méthylation régulant l'expression de MDR-1 est insuffisamment connue. La méthionine synthase est l'enzyme clé du cycle métabolique de la méthionine et possède comme cofacteur la cobalamine (vitamine B12), suggérant un rôle crucial du couple cobalamine / méthionine synthase dans la survenue de la chimio-résistance par l'intermédiaire de la méthylation. Nous avions trouvé que l'ajout de cobalamine à des cellules d'adénocarcinome hépatique conduisait à une répression du gène MDR-1 qui ne passe pas par la méthylation du promoteur. Notre objectif est d'explorer et d'étudier les voies métaboliques situées entre le cycle de la méthionine et l'expression du gène MDR-1. Des techniques chromatographiques, électrophorétiques, de culture cellulaire, de pharmacotoxicologie et d'expression génique sont utilisées sur la lignée HepG2. La répression cobalamine-dépendante du gène MDR-1 est associée à une activation de la PLD, une diminution du facteur de signalisation Akt ainsi qu'à une inhibition de Cox2. Le ciblage pharmacologique de ces voies semble potentialiser l'effet d'agents utilisés en chimiothérapie. Cette étude devrait permettre de mieux comprendre des mécanismes de chimiorésistance, de déterminer des paramètres d'optimisation de l'utilisation de ces anticancéreux en relation avec l'expression de MDR-1 elle même en relation avec le statut vitaminique B et peut être d'orienter la recherche en chimiothérapie vers de nouvelles voies thérapeutiques
A key factor of chemioresistance is an increased expression of MDR-1 gene, partly controlled by cellular methylation reactions. Until now, the physiology of these reactions is not clearly known. The main intracellular metabolic pathway, generating methyl donors, is the methionine cycle, the activity of which is strongly depending on B-group vitamins (B12, B9). Thus, MDR-1 gene expression may be controlled by the activity of the methionine cycle and consequently presence of these vitamins. The aim of this study is to determine if, and to elucidate how, the methionine cycle influences the MDR-1 gene expression. Chromatography, pharmacotoxicology, cell culture techniques, gene and protein expression studies have been used on the human hepatocarcinoma cell line HepG2. We showed that cobalamin-induced MDR-1 gene repression was associated with phospholipase D activation, Akt phosphorylation, and Cox-2 co-repression in a complex and intricated manner. We may suggest that targeting these pathways could potentiate chimotherapy. This work shoiuld allow 1) a better understanding of mechanisms explaining why some anticancer agents may become inactive, 2) to optimize utilisation of these agents in relationship with MDR-1 gene expression and the B vitamin status, 3) to evaluate impacts of nutritionnal factors (cobalamine) in MDR-1 gene expression and 4) probably developp possible ways to improve chemotherapy

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Mabhula, Amanda N. "Investigating permeation of anti-mycobacterial agents in Mycobacterium tuberculosis and M. tuberculosis-infected macrophages in vitro as a model for early stage tuberculosis drug discovery." Doctoral thesis, Faculty of Science, 2021. http://hdl.handle.net/11427/33768.

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Tuberculosis (TB) is the leading cause of death due to a single infectious disease and remains a major threat to global public health. The increasing emergence of multi-drug resistance to current anti-TB drugs, exacerbated by the long treatment duration, highlights the need for new effective treatments or strategies to shorten the treatment duration, improve patient adherence and curb the alarming rates of resistance. A key challenge to current strategies employed in the development of anti-TB drugs is the complexity in TB disease pathology which presents as a wide spectrum of lesions in patients presenting with the disease. These lesions occur at different anatomical loci in the same individual and at different stages as the disease progresses. In addition, the interaction between the causative agent, Mycobacterium tuberculosis, and its obligate human host induces physiologic and metabolic changes in the infecting bacillus that are specific to each lesion compartment, and dynamic. This is likely to influence M. tuberculosis susceptibility to antibiotic treatment and, consequently, affect treatment duration and possibly the development of drug resistance. A major limitation in current strategies to address this problem is translation of in vitro compound potency to in vivo efficacy. To reach the target site, a drug must first distribute and accumulate in the lesion microenvironments where bacteria reside: the macrophage host cell and the caseum. This thesis focused on the development of an in vitro infection model that could be used to predict drug penetration into M. tuberculosis-infected macrophages. Of particular interest was the extent to which host intracellular drug concentrations translate into effective antimycobacterial activity. To this end, the thesis comprised three key aspects: (i) characterization of physicochemical properties, antimycobacterial activities and M. tuberculosis-mediated metabolism of selected antiTB compounds; (ii) determination of intracellular drug permeation in resting, activated and foamy macrophages; and (iii) determination of the correlation (or not) between intracellular drug concentration and effective M. tuberculosis growth inhibition. The highly lipophilic natural product, fusidic acid (FA), its known human metabolite, 3-ketofusidic (3-ketoFA or GKFA37), and two C-3 alkyl esters (GKFA16 and GKFA17) as FA prodrugs were utilized in the study. In addition, another chemical class, the less lipophilic benzoxazole-based oxime derivatives were also investigated. Moxifloxacin (MXF), levofloxacin (LVF), bedaquiline (BDQ), rifampicin (RIF) and clofazimine (CFZ) were included for reference as known anti-TB drugs with varying lipophilicities. In chapter 2, FA and derivatives showed potent antimycobacterial activity (~1 µM) with selectivity indices (SI) >20 against the THP-1 macrophage cell line. Predicted artificial membrane permeability assay (PAMPA) results suggested that FA and derivatives would readily permeate the cell membrane. M. tuberculosis metabolized the C-3 alkyl-ester prodrug GKFA17 to form both FA and 3-ketoFA, with complete hydrolysis of the prodrug. FA was metabolized to 3-ketoFA, but the low levels of the metabolite suggested that another unidentified metabolite, presumed to be 3-epifusidic acid (3-epiFA), was formed. In vitro assays revealed that the potent benzoxazole-based oxime carbamates (PMN1-201, PMN1-136 and PMN2-09) were rapidly hydrolyzed by M. tuberculosis and were also susceptible to spontaneous degradation in media, forming the poorly active corresponding free oximes (PMN1-199, PMN1-135 and PMN1-157). In chapter 3, the in vitro macrophage drug uptake assay showed that FA C-3 alkyl prodrugs, GKFA16 and GKFA17, accumulated in significantly higher amounts in resting macrophages in comparison to FA and GKFA37. Accumulation of MXF was comparable to the least accumulated FA derivative, GKFA37, and showed steady state intracellular concentrations over a 6-day period. While GKFA16 and GKFA17 showed continued increasing accumulation, intracellular concentrations of FA and GKFA37 decreased after 48 hours, suggesting a likely susceptibility to macrophage efflux. In infected macrophages, the presence of intracellular bacteria or increasing bacterial burden did not affect the host cell ability to accumulate the drugs. FA and derivatives exhibited bacteriostatic inhibition of intracellular mycobacterial growth. MXF showed a potent bactericidal effect, reducing intracellular bacterial counts significantly at 10x MIC, with complete sterilization at 50x MIC even though MXF accumulation was significantly less than that of FA alkyl esters. These results suggested that both the inherent activity of a compound and ability to accumulate within host cells drive cellular efficacy. Given that the C-3 alkyl ester prodrugs accumulated at significantly higher concentrations than FA and GKFA37, this demonstrates the limitations of this assay in ascertaining the impact of intracellular concentration on drug efficacy for bacteriostatic drugs while highlighting its ability to correlate drug penetration and intracellular activity for cidal drugs. The prodrug GKFA17 was shown to undergo metabolism in resting host cells and during infection to form FA and then 3-ketoFA. Therefore, the prodrug strategy could be used to increase intracellular exposure of FA as GKFA17 showed superior macrophage accumulation. Benzoxazole-based oxime carbamates and their corresponding free oximes failed to accumulate in host macrophages and this was corroborated by their failure to control host cell bacterial growth despite the potent in vitro activity against M. tuberculosis of the carbamates, suggesting that they are poorly permeable. Chapter 4 investigated drug permeation in different macrophage phenotypes known to exist in the granuloma during TB disease, including foamy and activated macrophages. The activation state of the host cell did not affect the ability to accumulate anti-TB drugs such as RIF and BDQ. However, FA and its prodrug GKFA17 were significantly reduced in M1 activated macrophages. Despite the significantly reduced intracellular concentration, activated macrophages treated with FA and derivatives showed superior intracellular M. tuberculosis growth inhibition, suggesting that macrophage activation potentiates the activity of these compounds. In order to assess the effect of foamy macrophage lipid bodies (LBs) on drug uptake and intracellular localization, oleic acid-induced foamy macrophages were treated with selected antiTB drugs and experimental compounds. FA and derivatives showed early increased accumulation in foamy cells compared to resting macrophages, while MXF, BDQ and RIF levels were not significantly changed. Intracellular:extracellular (I/E) ratios increased with increase in lipophilicity, with FA C-3 alkyl prodrugs exhibiting the highest I/E ratios of >100. Despite exhibiting increased foamy macrophage concentrations, FA and derivatives exhibited a similar reduction (bacteriostatic) in bacterial counts in both resting and foamy macrophages. The intracellular activity of RIF was also not affected by presence of LBsin foamy macrophages. BDQ, LVF and MXF, however, showed reduced intracellular efficacy against M. tuberculosis in foamy macrophages compared to resting macrophages, suggesting a role for LBs to impact intracellular drug distribution. In conclusion, this thesis demonstrates the potential utility in combining advanced analytical methods and an in vitro infection model to determine cellular drug permeation profiles that might be applied to prioritize compounds and combinations optimized for distribution to target bacterial populations. This will facilitate well-informed decision-making processes in progression of lead compounds in pre-clinical development and, therefore, may offer the potential to reduce high rates of attrition of compounds which enter clinical phase of development.

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Prinsloo, Andrea. "Susceptibility and synergism profiles of multi-drug resistant pseudomonas aeruginusa in an intensive care environment." Diss., University of Pretoria, 2003. http://hdl.handle.net/2263/28026.

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Дисертації з теми "MULTI- DRUG RESISTANCE (MDR)"

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