Most cancer deaths result from the cancer's either being intrinsically
resistant to chemotherapeutic drugs or becoming resistant after being
initially sensitive. Often, in cells grown in cell culture, drug resi
stance correlates with the presence of one or more of the so-called P-
glycoproteins or multidrug resistance proteins, products of the mdr fa
mily of genes. This review is largely concerned with the transport kin
etics of the P-glycoproteins. We first present a brief overview of the
P-glycoproteins, their properties, and their clinical significance. L
ater sections of the review expand on this material with special empha
sis on the substrates of P-glycoprotein and how they cross the cell me
mbrane, on the transport kinetics of the P-glycoprotein, on reversers
of its action, and on its activity as an ATPase. In a final section, w
e consider the mechanism of action of P-glycoprotein as an actively tr
ansporting membrane pump. The characteristic of P-glycoprotein conside
red the most difficult to explain is its very broad specificity (or la
ck of specificity), but there are precedents for this property in well
-known proteins such as serum albumin, which binds a range of molecula
r types, including substrates and reversers of P-glycoprotein, seeming
ly as broad as does P-glycoprotein. Pointing out this analogy does not
provide a molecular explanation for the substrate-binding properties
of P-glycoprotein but does make those properties more assimilable.