Exporter Mdr1 as an importer is an achilles' heel for combating drug-resistant Candida

The overexpression of drug exporters is a well-known mechanism driving antifungal drug resistance. Here, we investigate that converting the exporter to function as a drug importer provides an alternative approach to combat drug resistance. Using high-throughput screening, we identified quaternary ammonium compounds exhibiting hypersensitivity in Candida albicans strains overexpressing MDR1. Further experiments involving CRISPR-Cas9-mediated deletion in C. albicans, heterologous expression of CaMdr1 in Saccharomyces cerevisiae and construction of CaMdr1-containing proteoliposomes confirmed Mdr1 acts as an importer of MKT-077, a potent cyanine derivative highly selective against MDR1-overexpressing strains. By combining computational simulations and the site-directed mutagenesis, critical residues within the transmembrane domains of CaMdr1 involved in MKT-077 import were further identified. Moreover, MKT-077 exhibited therapeutic efficacy in Galleria mellonella infected with Mdr1-overexpressing C. albicans. This work opens an avenue to convert drug resistance into drug sensitivity-a paradigm-shifting strategy in antifungal drug discovery.