جستجوی مقالات مرتبط با کلیدواژه "multi-drug resistance" در نشریات گروه "پزشکی"

The increasing trend of consuming ready-to-eat (RTE) food has become a global phenomenon, and this has raised concerns about the potential negative impacts on human health. Recent studies have shown a correlation between the consumption of RTE foods and the expansion of multidrug resistance (MDR) in humans. MDR is a significant challenge in the effective theory of infectious diseases, as it limits the effectiveness of antibiotics and other drugs used in therapy. Consumption of RTE food contribute to the development of MDR in humans. Additionally, there are potential risks of consuming RTE food contaminated with antibiotic-resistant bacteria, which can cause severe health consequences. The article highlights the need for awareness campaigns on the potential hazard related to the ingestion of RTE food and the importance of responsible and safe food production practices. It also recommends the need for regulatory bodies to establish strict guidelines for the production and distribution of RTE food to ensure that they are free from harmful contaminants and that their consumption does not lead to the development of MDR in humans. Overall, this article provides a comprehensive analysis of the potential negative impacts of RTE food consumption on human health and emphasizes the need for a more cautious approach to food consumption to protect public health.

Staphylococcal infections are one of the major infectious diseases affecting globally in spite of advances in development of antimicrobial agents. Knowledge and awareness about the local pattern and prevalence of MRSA infections plays a key role in treatment. The aim of this study was to identify MRSA strains by phenotypic and ge- notypic methods and to analyze the antibiotic susceptibility pattern of MRSA strains from patients attending a tertiary care hospital.

This study was conducted over a period of 1 year, where 296 isolates of Staphylococcus aureus were isolated from various clinical specimens. The isolated strains were examined for antibiotic susceptibility by the modi- fied Kirby Bauer disc diffusion method. Methicillin resistance was detected by cefoxitin disk diffusion test.

A total of 104 isolates were found to be MRSA and 192 were found to be MSSA. Among the 104 MRSA isolates, 10 strains that were multidrug resistant were subjected to 16S rRNA gene sequencing analysis. All the 10 strains had a 99% match with S. aureus strains that were responsible for causing some serious biofilm mediated clinical manifestations like cystic fibrosis and device mediated infections. The biofilms were quantified using crystal violet staining and their ability to produce biofilms was analyzed using scanning electron microscopy and matched with the Genbank.

Hence these phylogenetic analysis aid in treating the patients and combating resistance to antibiotics.

Integrons are recognized for their capacity to transfer antibiotic resistance genes between pathogenic bacteria including K. pneumoniae. The objective of this study was to assess the correlation between class I and II integrons and the antimicrobial resistance among clinical strains of K. pneumoniae, in patients in Isfahan. A total of 96 strains of K. pneumoniae were procured from 200 clinical specimens. The identification of the isolates was carried out through biochemical analyses and tracing the 16S-23S ITS sequence. The antibiotic sensitivity pattern was assessed by disk diffusion. Detection of the genes encoding class I and II integrons in resistant clinical isolates was done by PCR. From 96 K. pneumoniae isolates, 81 isolates (84.4%), exhibited resistance to multiple antibiotics. The isolates exhibited the maximum level of resistance towards meropenem, which was evident in 73 of the isolates, followed closely by amikacin in 67 isolates. Conversely, gentamicin displayed the least level of resistance (in 12 isolates). Men from the emergency and intensive care units exhibited a higher frequency of isolates and associated drug-resistant strains. Elderly individuals exhibited a notably elevated frequency of the isolates and resistant variants. A significant proportion of resistant strains were found to possess both class I and II integrons (82.72% and 86.42%, respectively). Moreover, a relatively high percentage of resistant strains (70.37%) were found to harbor both classes of integrons. The results indicated a notable incidence of integron-dependent resistance, thereby emphasizing the need for an informed approach towards diagnosis and management of such infections.

 Bloodstream infection with multi-drug resistant (MDR) bacteria has been introduced as the main risk factor for in-hospital mortality in vulnerable children worldwide. COVID-19 can complicate the treatment process in patients with bacteremia; however, data about this co-infection in children are scant.

 This was a study on the antimicrobial patterns of Gram-negative bacteria (GNB) isolated from blood samples of children with bacteremia and their correlation with COVID-19.

 In this cross-sectional study, blood samples of children with bacteremia were analyzed using BACTEC bottles. The bacterial isolates were characterized based on standard microbiology laboratory methods, and MDR strains were detected based on a standard protocol. Real-time PCR tests for COVID-19 were recorded from the patients’ hospital documents.

 A total of 255 positive blood samples were detected in children with bacteremia. The bacterial isolates included Enterobacteriaceae spp. 43.5% (111/255), Pseudomonas spp. 33.7% (86/255), Acinetobacter spp. 21.6% (55/255), and Stenotrophomonas spp. 1.2% (3/255). Of 255 GNB, 86.66% (221/255) were MDR, and the frequency of MDR strains was as follows: Enterobacteriaceae spp. 91.8% (102/111), Pseudomonas spp. 77.9% (67/86), Acinetobacter spp. 89% (49/55), and Stenotrophomonas spp. 100% (3/3). Of 255 children with GNB-related bacteremia, COVID-19 infection was confirmed in 25.1% (64/255) of them. Nearly 93.7% (60/64) of these patients had both MDR bacteremia and COVID-19. The correlation was significant between MDR bacteremia and COVID-19 (P-value = 0.002). The death rate was 43.33% (26/60) among these children.

 The results of this study showed that MDR-GNB was the main cause of bacteremia in children. Our findings showed a notable risk of concomitant COVID-19 and GNB-related bacteremia in these patients.

Tuberculosis, caused by Mycobacterium tuberculosis, is one of the most common infectious diseases worldwide. Epidemiological studies of M. tuberculosis drug resistance are critical for improving patient treatment approaches and controlling the spread of tuberculosis. The present study aimed to determine antibiotic resistance among M. tuberculosis clinical isolates using the Microplate Alamar Blue Assay (MABA).

In this descriptive cross-sectional study, 25 M. tuberculosis isolates from clinical samples were identified and confirmed using standard microbiological and biochemical tests. Then, the MIC for the antibiotics Bedaquiline, isoniazid, rifampin, ethambutol, ofloxacin, moxifloxacin, capreomycin, and streptomycin was determined using the MABA method. The results were analyzed using SPSS version 16 software.

Among the 25 investigated isolates, the frequencies for MDR, Pre-XDR, and XDR isolates were 20%, 8%, and 32%, respectively. The highest rate of drug resistance was to isoniazid (80%), rifampicin, and ethambutol (76%), and the highest rate of sensitivity was to moxifloxacin (68%). The frequency of isoniazid mono-resistance and rifampicin mono-resistance was 5 cases (50%) and 4 cases (40%), respectively.

Our study revealed an alarming rate of MDR and XDR M. tuberculosis strains, indicating that current first-line treatments may be ineffective for a significant number of patients. The bedaquiline resistance among the isolates with no history of previous exposure to this drug suggests unexplored resistance mechanisms. Molecular techniques to accurately identify these mechanisms may contribute to developing more effective treatment strategies to combat drug-resistant tuberculosis.

 The treatment of bacterial infections especially of the family Staphylococcaceae is a major health burden that has led to economic losses, high morbidity and mortality rates globally. This study aimed at isolation and characterization of coagulase positive, methicillin and multi-drug resistant Staphylococci isolated from wounds of patients.

 Forty-five wound swabs were collected using sterile swab sticks. Isolation was done by streaking technique on mannitol salt agar. The isolates obtained were screened for methicillin and multi-drug resistance using disk diffusion method. Biochemical and molecular characteristics using 16S rDNA gene were used to identify the selected isolates.

 Four Staphylococci isolates resistant to methicillin (0.00 mm to 9.0 mm) were selected out of thirty-one. Reactions to catalase and coagulase productions were positive. Three out of the four isolates were identified using their 16S rDNA genes and they were found to be closely related to other family members of Staphylococcaceae at GenBank. The fourth isolate was identified using its biochemical characteristics as Staphylococcus sp. HFS4. The three identified isolates were M. sciuri HFS1 (ON340756), M. sciuri HFS3 (ON340770) and S. haemolyticus HFS2 (ON35435). The four isolates were resistant to more than five antibiotics that cut across all the classes of antibiotics. The multiple antimicrobial indices were between 0.5 and 0.8.

 There is need for regular antimicrobial resistance surveillance within the hospital environment, earlier detection and correct prescription of potent antimicrobials will check the spread of Staphylococci infections and their virulent genes.

The present systematic review aimed to investigate the drug susceptibility patterns of Iranian clinical Candida albicans isolates to antifungal drugs (azoles, polyenes, and echinocandins).

Six electronic databases including “PubMed,” “Scopus,” “Web of Science,” “IranDoc”, “SID”, and “Magiran” were searched from May 2000 to June 2021. The susceptibility of 6322 C. albicans strains from 19967 patients against 14 antifungal drugs was evaluated according to CLSI method.

The pooled prevalence of antifungal resistance ranged from 0% to 26%. The lowest resistance levels among azoles were observed in luliconazole with a frequency of 0% and voriconazole of 3.94%.

Due to the emergence of multi-drug resistant C. albicans, rational drug prescription based on the antifungal stewardship strategy and therapeutic drug monitoring is warranted.

Staphylococcus aureus, as a major food-borne pathogen, is the most commonly isolated bacterium from bovine mastitis. However, some S. aureus strains exhibit a high rate of antibiotic resistance, among which, methicillin-resistant S. aureus (MRSA) is very important. The present study was conducted to isolate, characterize, and determine the antibiotic resistance profile of MRSA strains in milk.

Staphylococcus aureus strains were isolated and identified from 415 milk samples collected from apparently healthy cattle in Hamedan province, Iran. Molecular characteristics of the strains were identified using multiplex polymerase chain reaction (PCR) and the antibiotic resistance profile of the isolates was determined by Kirby-Bauer disk diffusion susceptibility test.

A total of 76 S. aureus strains were isolated and identified. The PCR results indicated that 50 (65.78%) isolates possessed mecA gene and were found to be MRSA strains. Twelve isolates (15.78%) showed phenotypic resistance to oxacillin in disk diffusion method. All 76 S. aureus isolates (100%) were resistant to penicillin and susceptible to ciprofloxacin and gentamicin.

The results of the present study indicated that bovine milk may contain MRSA strains and this is worrying as these isolates may transfer multi-drug resistance to the isolates that circulate among humans, animals, and food chains.

An opportunistic pathogen Pseudomonas aeruginosa can cause frequent hospital-acquired infections as well as one microorganism in the food spoilage. Also, the emergence of multidrug-resistant P. aeruginosa has become a serious threat to public health.This pathogen has many virulence factors which aid in bacterial invasion as well as toxicity, during infections. Out of different virulence genes in Pseudomonas aeruginosa, oprL (Encoding membrane lipoprotein L) and toxA (encoding exotoxin A i.e. ETA), are predominantly involved in, P. aeruginosa-related infections.

A total of 120 specimens of the bacteria Pseudomonas aeruginosa were collected from Veterinary microbiology and various hospital laboratories. The isolates were initially identified by culturing on MacConkey agar and Eosin Methylene blue (EMB) agar and were further characterized by morphological and biochemical tests. An antibiotic sensitivity test was carried out on 13 antibiotics using the disc diffusion method. Genotypic detection of oprL and toxA genes was performed using a specific PCR test.

The results revealed that the toxA gene was detected by 84.62% in isolates belonging to human samples and 75% in the isolates of animal samples, whereas the oprL gene was detected by 80.77% and only 16.67 % in the isolates were derived from human and animal samples, respectively.

The PCR analysis can help in the fast and specific detection of oprL and toxA genes in P. aeruginosa. Monitoring of these pathogenic genes could prevent the risk of transmission of multi-drug resistant P. aeruginosa, from animals to humans.

 Proteus spp. are opportunistic members of Enterobacteriaceae, accounting for 10% of urinary tract infections and other primary clinical infections. They produce extended-spectrum beta-lactamases (ESBL) that can confer resistance to beta-lactam antibiotics. This study aimed to investigate the prevalence, antimicrobial susceptibility, molecular characteristics, and genetic relationship of ESBL-producing Proteus spp. clinical isolates in Babol, Northern Iran.

 In this cross-sectional study, out of 112 clinical samples, 30 Proteus spp. isolates were identified via specific biochemical assays. According to the Clinical and Laboratory Standards Institute (CLSI) guidelines, antibiotic susceptibility was evaluated using disc diffusion and agar dilution methods, and polymerase chain reaction (PCR) was used to detect blaTEM and blaSHV genes.

 The resistance rate to tetracycline and sulfamethoxazole was highest by disk diffusion and agar dilution. Multiple drug-resistant (MDR) isolates were 86% and 60% in disk diffusion and agar dilution assays. Seven (23.3%) isolates had the blaTEM genes and 18 (60%) blaSHV.

  ESBL-producing Proteus spp. was highly prevalent, and the blaSHV was the most common resistance contributing gene. These findings and relatively high resistance to ampicillin demand more care in prescribing antibiotics. Also, the high prevalence of MDR isolates in patients infected with ESBL-producing Proteus spp. requires continuous surveillance.

 Integrons play an essential role in disseminating drug resistance genes among bacteria. The aim of this study was to determine the prevalence of integrons, and Extended-Spectrum β-Lactamase (ESBL) genes in Escherichia coli (E. coli) isolates collected from patients with urinary tract infection (UTI) referred to teaching hospitals in Ardabil, Iran.

 In this descriptive, cross-sectional study (2017-2018), 163 isolates of E.coli were collected from patients with UTI. The drug susceptibility pattern of these isolates to 12 common antibiotics was investigated using the disk diffusion method based on CLSI guidelines. The prevalence of class 1, 2 ,3 integrons and ESBL genes was verified by the PCR method. Finally, the genetic variation of isolates was analyzed using the ERIC-PCR method.

 Of 163 isolates, 138 (84.7%) isolates were multidrug-resistance (MDR) strains. The lowest and highest antibiotic resistance was reported to nitrofurantoin and ampicillin, with a resistance rate of 1.2% and 89.6%, respectively. The incidence of class 1 and 2 integrons was obtained in 39.9% and 14.1% of the isolates, respectively. Class 3 integron was not found in any of the isolates. Based on the ERIC-PCR fingerprinting method, 4 ERIC types were detected.

 Our study showed that E. coli isolates taken from patients mainly were MDR strain and resistant to many of the common antibiotics used to treat urinary tract infections. Using the correct dose of medication and multidrug therapy would be effective in reducing the incidence of antibiotic resistance.

High expression of P-glycoprotein (P-gp) has been linked to multidrug resistance (MDR) and chemotherapeutic failure. Previously, we demonstrated that rhinacanthin-C, a naphthoquinone from Rhinacanthus nasutus, was able to enhance the cytotoxicity of doxorubicin against breast cancer MCF-7 cells via direct P-gp inhibition. In this study, we looked at its effect on P-gp downregulation and the mechanism involved in the resistance of MCF-7 cells to doxorubicin.

Doxorubicin-resistant MCF-7 (MCF-7/DOX) cells were exposed to rhinacanthin-C for 24-48 hours prior to the assessment of their chemosensitivity via MTT assay, P-gp activity via calcein-AM uptake assay, P-gp expression, and signaling via qRT-PCR and western blot analyses.

Pretreatment with 1 µM of rhinacanthin-C for 48 hours significantly enhanced cytotoxicity of doxorubicin, as well as camptothecin and etoposide, to MCF-7/DOX cells. In the rhinacanthin-C-treated cells, reduction of MDR1 mRNA and P-gp levels and increased intracellular calcein were observed. Moreover, phosphorylation of Akt, NF-ᴋB and IκB-α, along with YB-1 expression, significantly decreased after 24-hour treatment with rhinacanthin-C. In contrast, the naphthoquinone had no effect on expression levels of ERK1/2 and phosphorylated ERK1/2 under similar conditions.

Rhinacanthin-C, at a non-cytotoxic concentration (1 µM), could downregulate P-gp expression in MCF-7/DOX cells via the inhibition of the Akt/NF-ᴋB signaling pathway and YB-1 expression. Long-term exposure to this natural naphthoquinone may increase the chemosensitivity of cancer cells with MDR phenotype.

Staphylococcus aureus, an important pathogen in bone diseases, is a highly multi-drug resistant (MDR) bacterium. This study aimed to investigate the antibiotic resistance among S. aureus isolated from patients on admission in an orthopaedic hospital.  In this cross-sectional research, 140 samples comprising urine samples, wound swabs, and nasal swabs were collected from 49 patients on admission. Samples were cultured and screened for S. aureus following standard procedures. Using the agar-disk diffusion method, the isolates were subjected to antibiotics susceptibility tests.  S. aureus were isolated from 26 (18.6%) samples, and wound swabs were found to have the highest number of the S. aureus isolates with 12 (46.2%). Among the 26 S. aureus isolated, 25 (96.2%) isolates were resistant to at least four or more of the tested antibiotics. There were 23 (88.5%) MDR isolates, while there were only 2 (7.6%) extensively drug resistant ones. The number of methicillin-resistant S. aureus were 17 (65.4% of the isolates), while the number of methicillin-susceptible S. aureus were 9 (34.6% of the isolates). A total of 22 (84.6%) isolates had multi-antibiotic resistance (MAR) index greater than 0.2. Inducible clindamycin resistance of 2 (7.6%) was observed.  This study showed that the S. aureus isolated from the patients were resistant to multiple antibiotics. Regular surveillance of antibiotic resistance is of utmost importance, since it facilitates the design or development of the treatment regimens that could check the spread of antimicrobial resistance.

The occurrence of drug-resistant non-typhoidal Salmonella (NTS) in poultry has serious economic implications for the poultry industry and has the potential to cause human Salmonellosis. This study, therefore, aimed to determine the circulating serovars of NTS and their antibiotic susceptibility patterns in poultry in Ilorin. This cross-sectional study was conducted from January to March 2015. A total of 420 samples (cloacal, n=140; fecal, n=140; feed, n=70, and water, n=70) were aseptically collected from live adult birds from 14 farms using a systematic random sampling technique. Salmonella was isolated using the ISO 6579 method. Antibiotic sensitivity testing of NTS serovars was performed using the Kirby Bauer disc – diffusion method and interpreted using the epidemiological cut-off (ECOFF) values. The prevalence of NTS in poultry was 7.4% (n=31). Feed samples were the most contaminated samples (42%, n=13/31). Faecal sample (32%, n=10/31), cloacal swabs (19.5%, n= 6/31), and water samples (6.5%, n=2/31) also contained NTS. There was a significant difference between NTS isolation rates between farms (p<0.05). Only 21 isolates purposively selected across farms and sample types were serotyped. Salmonella nagoya was the most prevalent (52%, n=11/21). Other serovars were Salmonella brijbhumi (5%, n=1/21); Salmonella enteritidis (5%, n=1/21); and Salmonella enterica subsp. enterica serovar 6, 8: z4 (19%, n=4/21). Four isolates (19%) were untypable. All isolates showed multidrug resistance. Most of the isolates were resistant to ampicillin (82.3%) and tetracycline (76.5%). Some isolates were resistant to cefotaxime (23.5%) and ciprofloxacin (29.4%). The occurrence of multidrug-resistant salmonella isolates is considered a critical public health threat that requires urgent global action. There is a need for a coordinated national salmonella surveillance program in Nigeria.

It is widely accepted that increased prevalence of antibiotic resistance of pathogens grown in the respiratory system in intensive care unit (ICU) patients is a very serious problem causing expansion of mortality. The most important strategy to prevent the occurrence and appropriate solution to control the antibiotic resistance is to thoroughly investigate the pattern of resistance in the studied ward. Therefore, the purpose of this study was to determine the antibiotic resistance pattern of organisms isolated from endotracheal tube secretions of patients admitted to ICU of Khatam-Al-Anbia Hospital at Zahedan in Iran.

In the present retrospective and descriptive cross-sectional study, the medical records of patients hospitalized during 2013-2018 were included by census method and then selected based on inclusion criteria (n=1387). The required data, including age, gender, type of microorganism isolated from endotracheal tube cultures, antibiotic resistance and sensitivity, duration of intubation and cause of hospitalization, were recorded for each patient. Finally, the data were analyzed by descriptive statistics using SPSS 16 software.

Mean age of patients was 44.66 ± 21.39 years and mean duration of intubation was 17.96 ± 10.99 days. Stroke was the most common cause of hospitalization with a prevalence of 553 patients (49%). The prevalence of positive culture of endotracheal tube secretions was 1128 (81.3%) of which 71.5% were male (n=807) and 28.5% were female (n=321). The cultures of endotracheal tube secretions resulted in 933 (82.7%) gram-negative bacteria, 191 (16.9%) gram-positive bacteria and 4 (0.4%) mixed isolates. The most prevalent gram-negative bacterium was Acinetobacter baumannii (37.2%) with the highest and lowest antibiotic resistance to Meropenem (95.1% resistance) and colistin (99.5% sensitivity), respectively. In addition, the most prevalent gram-positive bacterium was Staphylococcus epidermidis (50.3%) with the highest and lowest antibiotic resistance to Meropenem (85.7% resistance) and Vancomycin (92.2% sensitivity).

The findings of the present study illustrate that there was widespread bacterial resistance to respiratory tract infections in our ICU patients. Due to the high sensitivity of gram-negative bacteria to colistin, the use of antibiotic combination with colistin in the control of pulmonary infections caused by these organisms can be a good choice. In addition, in the case of gram-positive bacteria, the highest sensitivity was to vancomycin; therefore, it can be the selective antibiotic to control infections caused by these bacteria.

Thymoquinone (TQ) has valuable medical properties like anticancer effects. Development of multidrug resistance (MDR) phenotype is one of the most important factors in failure of cancer chemotherapy. The aim of this study was to evaluate the mode of interaction of TQ and MDR1, a major MDR-related protein in gastric cancer drug resistant EPG85-257RDB cells, and its parental non-resistant EPG85-257 cells. MTT assay was used to assess the effects of TQ and doxorubicin (DOX) on cell viability of tested cell lines and TQ effect on pump performance. HPLC analyses were used to measure the input and output of TQ in EPG85-257RDB cells. Molecular docking studies were used to identify interactions between TQ and MDR1. TQ inhibited cell viability in a time and concentration-dependent manner. Co-treatment of the cells with TQ and DOX did not significantly affect the amount of cell viability in comparison with DOX treatment alone. The HPLC analyses showed that more than 90% of TQ entered to EPG85-257RDB during 1 hr of treatment with TQ, but it was unable to exit from the cells. Moreover, there was no difference between influx and efflux amount of TQ in cells with inhibited and non-inhibited MDR1 transporters. Molecular docking studies revealed that TQ had a higher inhibitory constant to bind to active site of MDR1 protein as compared to specific inhibitor (verapamil) and substrate (vinblastine) of this transporter. These results proposed that TQ does not work as an inhibitor or a substrate of MDR1 transporter.

Breast cancer with various biological diversity known as the common reason of death in the world and despite progress in novel therapeutic approaches, it faced with failure and recurrence in general. Recent clinical and preclinical statistics support cancer stem cells (CSCs) hypothesis and its similarities with normal stem cells. Evaluation of related paper conclude in significance finding in the further characterization of CSCs biology such as surface biomarkers, microenvironment regulatory molecules, cell signaling pathways, cell to cell transition and drug efflux pumps to overcome multidrug resistance and effective therapy. Emerging novel data indicate biological concepts in the base of unsuccessful treatment. A powerful understanding of the cell signaling pathways in cancer and CSCs topics can be led us to define and control treatment problems in cancer. More recently nano medicine based on drug delivery system modification and new implications on combinatorial therapy have been used to treat breast cancer effectively. The aim of this review is focus on CSCs as a potential target of cancer therapy, to overcome the limitation and problems of current therapeutic strategies in cancer.

Sorafenib is the sole FDA approved drug conventionally used for the treatment of advanced hepatocellular carcinoma (HCC). Despite of the beneficial use of sorafenib in the treatment of HCC, multidrug resistance still remains a challenge. HCC is inherently known as chemotherapy resistant tumor due to P-glycoprotein (P-gp)-mediated multidrug resistance.

We studied the interaction energy of kaempferol with human multidrug resistance protein-1 (RCSB PDB ID: 2CBZ) using in silico method with the help of BIOVIA Discovery Studio. HepG2 and N1S1 liver cancer cell lines were treated in suitable cell culture media to evaluate the efficacy of kaempferol in chemo-sensitizing liver cancer cells towards the effect of sorafenib. Cell viability study was performed by MTT assay.

In silico analysis of kaempferol showed best docking score of 23.14 with Human Multi Drug Resistant Protein-1 (RCSB PDB ID: 2CBZ) compared with positive control verapamil. In in-vitro condition, combination of sub-toxic concentrations of both kaempferol and sorafenib produced 50% cytotoxicity with concentration of 2.5 µM each which indicates that kaempferol has the ability to reverse the MDR by decreasing the over-expression of P-gp.

Kaempferol is able to sensitize the HepG2 and N1S1 against the sub-toxic concentration of sorafenib. Hence, we consider that the efficacy of sorafenib chemotherapy can be enhanced by the significant approach of combining the sub-toxic concentrations of sorafenib with kaempferol. Thus, kaempferol can be used as a better candidate molecule along with sorafenib for enhancing its efficacy, if validated through preclinical studies.