Metallo-β-lactamases: structure, function, epidemiology, treatment options, and the development pipeline

Sara E. Boyd, David Livermore, David C. Hooper

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131 Citations (Scopus)
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Modern medicine is threatened by the global rise of antibiotic resistance, especially among Gram-negative bacteria. Metallo-β-lactamase (MBL) enzymes are a particular concern and are increasingly disseminated worldwide, though particularly in Asia. Many MBL producers have multiple further drug resistances, leaving few obvious treatment options. Nonetheless, and more encouragingly, MBLs may be less effective agents of carbapenem resistance in vivo, under zinc limitation, than in vitro. Owing to their unique structure and function and their diversity, MBLs pose a particular challenge for drug development. They evade all recently licensed β-lactam-β-lactamase inhibitor combinations, although several stable agents and inhibitor combinations are at various stages in the development pipeline. These potential therapies, along with the epidemiology of producers and current treatment options, are the focus of this review.

Original languageEnglish
Article numbere00397-20
JournalAntimicrobial Agents and Chemotherapy
Issue number10
Early online date20 Jul 2020
Publication statusPublished - Oct 2020


  • Drug development
  • Metallo-β-lactamase
  • Metalloenzymes
  • Pharmacology
  • Treatment

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