Multidrug resistance (MDR) remains a major obstacle to ensure effective chemotherapy in cancer patients. Several factors could be associated with cancer cells' drug resistance such as overexpression of P-glycoprotein (P-gp), cancer stem cells (CSCs), defect in apoptosis, mutation and alteration in DNA repair pathways, angiogenesis, autophagy, and modulation in metabolic enzymes. Until now, drug efflux by ABC transporters has been a univocal and well-established mechanism of chemotherapeutic associated drug resistance. To explore the mechanics involved in ABC transporter associated drug resistance, many crucial studies have been conducted from identification of drug binding sites to elucidation of their structure. Due to our continuous battle with drug resistance, several strategies have been employed to combat MDR, including P-gp modulators, siRNAs, antibodies, as well as peptides. Furthermore, various nanoparticle and different effective combination nanomedicine strategies also suggest some exciting results. Thus, to improve nanomedicine approaches to overcome MDR, in this evolutionary review, we have focused on fundamentals of possible strategies as well as the latest accomplishments to reverse MDR.

中文翻译：

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多药耐药性和纳米药物克服MDR的见解

多药耐药性（MDR）仍然是确保癌症患者有效化疗的主要障碍。癌细胞的耐药性可能与多种因素有关，例如P-糖蛋白（P-gp）的过表达，癌症干细胞（CSCs），细胞凋亡的缺陷，DNA修复途径的突变和改变，血管生成，自噬和肿瘤的调节。代谢酶。到目前为止，ABC转运蛋白的药物外排一直是化学治疗相关药物耐药性的明确且公认的机制。为了探索涉及ABC转运蛋白相关耐药性的机制，从鉴定药物结合位点到阐明其结构已进行了许多关键研究。由于我们一直在与耐药性作斗争，因此已采用了多种抗击MDR的策略，包括P-gp调节剂，siRNA，抗体和肽。此外，各种纳米颗粒和不同的有效组合纳米医学策略也表明了一些令人兴奋的结果。因此，为了改进克服MDR的纳米医学方法，在本次进化综述中，我们将重点放在可能策略的基础以及逆转MDR的最新成就上。