Over-expression of the human P-glycoprotein (P-gp) in tumor cells is a classic example of an ABC protein serving as a hindrance to effective chemotherapy. The existence of proteins homologous to P-gp in organisms encompassing the entire living kingdom highlights extrusion of drugs as a general mechanism of multidrug resistance. Infections caused by opportunistic human fungal pathogens such as Candida species are very common and has intensified in recent years. The typical hosts, who possess suppressed immune systems due to conditions such as HIV and transplantation surgery etc., are prone to fungal infections. Prolonged chemotherapy induces fungal cells to eventually develop tolerance to most of the antifungals currently in clinical use. Amongst other prominent mechanisms of antifungal resistance such as manipulation of the drug target, rapid efflux achieved through overexpression of multidrug transporters has emerged as a major resistance mechanism for azoles. Herein, the azole-resistant clinical isolates of Candida species utilize a few select efflux pump proteins belonging to the ABC and MFS superfamilies, to deter the toxic accumulation of therapeutic azoles and thus, facilitating cell survival. In this article, we summarize and discuss the clinically relevant mechanisms of azole resistance in Candida albicans and non-albicans Candida (NAC) species, specifically highlighting the role of multidrug efflux proteins in the phenomenon.

中文翻译：

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临床念珠菌耐药性假丝酵母菌的多药转运蛋白。

人P-糖蛋白（P-gp）在肿瘤细胞中的过表达是ABC蛋白阻碍有效化疗的经典例子。在涵盖整个生命王国的生物体中，与P-gp同源的蛋白质的存在突显了药物的挤出是多药耐药性的一般机制。由机会性人类真菌病原体（例如念珠菌）引起的感染非常常见，并且近年来已经加剧。由于诸如HIV和移植手术等条件而具有抑制的免疫系统的典型宿主易于发生真菌感染。长时间的化疗会诱导真菌细胞最终发展出对目前临床上使用的大多数抗真菌药的耐受性。在其他重要的抗真菌耐药性机制中，例如操纵药物靶标，通过多药转运蛋白的过表达实现快速外排已成为对唑类的主要耐药机制。在此，念珠菌属物种的抗唑类临床分离物利用了一些属于ABC和MFS超家族的外排泵蛋白，以阻止治疗性唑类的毒性积累，从而促进细胞存活。在本文中，我们总结并讨论了白色念珠菌和非白色念珠菌（NAC）物种中唑类抗药性的临床相关机制，特别强调了多药外排蛋白在该现象中的作用。念珠菌属物种的耐唑类临床分离物利用了一些属于ABC和MFS超家族的外排泵蛋白，以阻止治疗性唑类的毒性积累，从而促进细胞存活。在本文中，我们总结并讨论了白色念珠菌和非白色念珠菌（NAC）物种中唑耐药的临床相关机制，特别强调了多药外排蛋白在该现象中的作用。念珠菌属物种的耐唑类临床分离物利用了一些属于ABC和MFS超家族的外排泵蛋白，以阻止治疗性唑类的毒性积累，从而促进细胞存活。在本文中，我们总结并讨论了白色念珠菌和非白色念珠菌（NAC）物种中唑耐药的临床相关机制，特别强调了多药外排蛋白在该现象中的作用。