Les polluants atmosphériques de type oxydes d’azote (NOx), principalement constitués du NO, NO2 et leurs dérivés, représentent une énorme menace d’un point de vue environnemental et sanitaire. Leurs propriétés chimiques sont largement exploitées à l’échelle du vivant pour leur rôle dans divers processus de signalisation (systèmes nerveux et cardiovasculaire) ou l’élimination de pathogènes (système immunitaire). Néanmoins, des dérégulations dans la production cellulaire ou l’apport exogène de ces composés est à l’origine de nombreuses pathologies humaines (e.g. pulmonaires), généralement attribuées à la pollution. Toutefois, un grand nombre de microorganismes aéroportés sont continuellement exposés à ces composés délétères, intimement connectés aux espèces réactives de l’oxygène (ROS). Ainsi l’hypothèse de l’ensemble de ce travail a porté sur l’impact du NO2, NOx majoritairement retrouvés dans l’atmosphère, sur une souche aéroportée de P. fluorescens, espèce désormais associée aux voies aériennes et potentiellement pathogène. A l’issue d’une exposition à 45 ppm de NO2, la survie de P. fluorescens MFAF76a est significativement impactée suggérant un effet bactériostatique, conforté par l’impact observé sur le métabolisme énergétique. De plus, le NO2 induit un stress d’enveloppe via la perte d’un glycérophospholipide (UGP) et le remaniement de divers composants membranaires (LPS, peptidoglycane, acides gras). La pompe à efflux MexEF-OprN semblent participer à la stabilisation de la membrane et pourraient être également impliquée dans l’efflux des oxydes d’azotes, mécanismes confortés par l’étude d’un mutant MFAF76a-oprN. La porine majoritaire OprF semble également contribuer à la stabilisation de la membrane externe, néanmoins son implication reste à confirmer. De plus, une interconnexion entre ROS et NOx dans la signalisation (OxyR, IscR), et les mécanismes de détoxification, a été observée. La flavohémoprotéine Hmp semble être un élément crucial dans la détoxification des NOx chez P. fluorescens comme l’illustre un mutant MFAF76a-hmp. Les similitudes importantes entre les effets connus du NO et ceux observés lors d’une exposition au NO2 suggèrent une conversion non enzymatique du NO2, une fois pénétré dans la cellule, en NO. Désormais, une étude plus approfondie est nécessaire afin de décrypter (i) les mécanismes impliqués dans la régulation de la pompe à efflux RND MexEF-OprN et de la flavohémoprotéine Hmp, (ii) d’autres acteurs intervenant dans la réponse au stress d’enveloppe et la détoxification ainsi que (iii) le devenir de NO2 dans la cellule. / Nitrogen oxides (NOx) atmospheric pollutants, mainly constituted of NO, NO2 and derived compounds, are a big threat to the environment and health. Their chemical properties are largely exploited at the cellular scale for their role in diverse physiological processes such as signalisation (nervous and cardiovascular systems) or in pathogens eradication (immunity system).However, dysregulation in production pathways or exogenous input of these compounds lead to several pathologies (e.g. respiratory diseases), usually attributed to atmospheric pollution. However, a wide range of airborne microorganisms are constantly exposed to these deleterious compounds, intimately connected to reactive oxygen species (ROS). Thus, the hypothesis of this work deals with the impact of NO2, the main atmospheric NOx, on an airborne P. fluorescens, a strain usually neglected but yet associated with human airways, and potentially pathogenic. Following an exposure to 45 ppm of NO2, the survival of P. fluorescens MFAF76a is severely impaired, suggesting a bacteriostatic effect, as comforted by NO2 impact on energetic metabolism. Moreover, an exposure to NO2 induces an envelope stress through the loss of an Unknown Glycerophospholipid (UGP) and the reorganisation of membrane constituents (LPS, peptidoglycan, fatty acids). The efflux pump MexEF-OprN is involved in membrane stabilization and could also efflux NOx, as highlighted by a MFAF76a-oprN mutant. The major porin OprF could also contribute in external membrane stabilisation, however its implication is still under investigation. Moreover, ROS and NOx are interconnected as illustrated by their shared signalisation (OxyR, IscR) and detoxification pathways. The flavohemoprotein Hmp is a crucial element in the detoxification of NOx in P. fluorescens as illustrated in an MFAF76a-hmp mutant. The similarities between the known effects of NO and those observed in the case of an exposure to NO2, suggest a non-enzymatic conversion of NO2, following cell penetration, into NO. Henceforth, deeper studies are required to decode (i) the mechanisms involved in the regulation of the RND efflux pump MexEF-OprN and the flavohemoprotein Hmp, (ii) other relevant actor implicated in the envelope stress response and in detoxification pathways as well as (iii) the fate of NO2 within the cell.

O reconhecimento da resistência antimicrobiana como um fenômeno emergente em saúde pública, tem constituído um problema em nível mundial. O abuso na utilização de antibióticos na medicina humana e veterinária, e na agricultura, tem originado incremento na diversidade de micro-organismos resistentes, refletindo em falha terapêutica. Os mecanismos de resistência a antibióticos em micro-organismos são mediados principalmente por genes adquiridos de DNA exógeno. A dinâmica da transferência horizontal é realizada por meio de elementos genéticos móveis que carregam genes de resistência. A ampla distribuição deste tipo de estruturas, como o elemento SXT, isolado inicialmente em V. cholerae, tem contribuído para a disseminação de complexos específicos clonais em determinadas áreas geográficas. Este estudo pioneiro no Brasil pesquisou a presença de elementos SXT, em espécies bacterianas do grupo das gama proteobactérias em espécies ambientais, determinou suas características estruturais e funcionais, incluindo genes de resistência a antibióticos, bem como a sensibilidade aos antibióticos dentre os isolados bacterianos que os abrigam. O resultado foi a classificação de 43 elementos SXT obtidos no Brasil, através da comparação com aqueles descritos na literatura. Dentre os elementos SXT obtidos, quatro são albergados por Morganella morganii, fato inédito na literatura. O conhecimento da evolução bacteriana constitui importante ferramenta para estabelecer estratégias eficazes de controle e tratamento de infecções, sem aumentar a pressão seletiva sobre os micro-organismos, bem como instrumento preciso e de grande importância para subsidiar estudos epidemiológicos. / Recognition of antimicrobial resistance as an emerging phenomenon in public health has been a problem worldwide. The abuse in the use of antibiotics in human and veterinary medicine, and agriculture, has caused an increase in the diversity of resistant microorganisms, reflecting in treatment failure. The mechanisms of antibiotic resistance in microorganisms are primarily mediated by genes acquired from exogenous DNA. The dynamics of the horizontal transfer is performed by mobile genetic elements which carry resistance genes. The wide distribution of these structures, such as the SXT element originally isolated from V. cholerae, has contributed to the spread of specific clonal complexes in certain geographical areas. This pioneering study in Brazil researched the presence of SXT elements in the group of bacterial species in environmental gamma-proteobacteria species, determined their structural and functional characteristics, including genes for resistance to antibiotics and the antibiotic susceptibility among bacterial isolates that harbor them. The result was the classification of 43 SXT elements found in Brazil, by comparison with those found in the literature. Among the SXT elements found, four are sheltered by Morganella morganii, unprecedented in the literature. Knowledge of bacterial evolution is an important to establish effective strategies to control and treat infections without increasing the selective pressure on microorganisms, as well as a precise instrument and very important tool to support epidemiological studies.

Our research aim was to design, synthesize, and study the competitive enzyme inhibition kinetics of pyrrolo[2,1-c][1,4]benzodiazepine (PBD) derivatives as potential non-²-lactam ²-lactamase inhibitors. All compounds (1-13) passed the Lipinski’s rule of 5 test and were docked into the active site of TEM-1 ²-lactamase. PBD derivatives 1-7 were synthesized in high yields and tested for their potency against TEM-1 and P99 ²-lactamases. Kinetic data showed that compounds 1, 4, 5, and 7 possessed inhibitory activity against TEM-1 ranging from 4-34 %. Docking results revealed significant interactive spanning of the active site of TEM-1 by PBDs. The limited inhibitory activity of the compounds, 1-7 could be attributed to the lack of solubility and bulky nature of the molecules, thus limiting the optimal ligand-enzyme interactions. 1,2,4- Oxadiazolinones (8-13) were further synthesized to reduce the steric hindrance of the PBD scaffolds while promoting the electrophilicity of the potentially active lactam and also evaluated for potency.

Le monoxyde d'azote NO• est impliqué dans de nombreux processus biologiques. Il intervient, entre autres, dans la vasodilatation, la neurotransmission, il peut impliquer le développement ou l'apoptose des cellules et possède également des propriétés bactéricides. Le contrôle de la libération de ce radical est donc de grand intérêt pour des applications biomédicales en chimiothérapie photo-activée (PACT) ainsi qu'en inactivation photo-dynamique (PDI). La stratégie ici est de synthétiser des complexes de ruthénium à ligand nitrosyle photoréactifs, qui sont capables de libérer NO• sous irradiation mono ou biphotonique. L'excitation à deux photons permet une irradiation dans la fenêtre thérapeutique, très focalisée et une pénétration du faisceau plus profonde qu'en monophotonique. Ces travaux de thèse sont consacrés à la synthèse et l'étude des propriétés photochimiques de complexes [RuNO] et à leurs applications en biologie. Le premier chapitre de cette thèse développe l'état de l'art dans le domaine des complexes de ruthénium à ligand nitrosyle et présente les enjeux biologiques. Le second chapitre présente les propriétés de photolibération de NO• de complexes possédant le ligand 4'-(2-fluorényl)-2,2':6',2''-terpyridine, sous excitation à un et à deux photons par des études spectroscopiques. Les photoproduits obtenus sont caractérisés par diffraction des rayons X. Dans un troisième chapitre, l'étude des complexes cis (Cl,Cl)- et trans (Cl,Cl)-[RuII(fluorène-terpyridine)Cl2NO]PF6 est menée dans l'eau. Les capacités de photolibération du trans (NO,OH)-[RuII(fluorène-terpyridine)(Cl)(OH)(NO)]PF6 dans les conditions biologiques sont étudiées. Le quatrième chapitre s'intéresse à la synthèse de nouveaux complexes constitués de ligands dérivés du 4'-(2-fluorényl)-2,2':6',2''-terpyridine et à leurs propriétés de photolibération de NO•. Le cinquième chapitre s'intéresse aux propriétés phototoxiques de ces complexes envers des cellules cancéreuses (HCT 116 et FaDu). Enfin, dans le sixième chapitre, les propriétés remarquables de ces systèmes dans la levée de la résistance de Staphylococcus epidermidis aux antibiotiques sont exposées. / Nitric oxide NO• is involved in numerous biological processes. It takes part to vasodilatation, neurotransmission, it can trigger cell proliferation or apoptosis and it also has bactericidal properties. Thus, NO• release control is of high interest for biomedical applications such as photo-activated chemotherapy (PACT) or photodynamic inactivation (PDI). The strategy here is to synthesize photoreactive ruthenium complexes with nitrosyl ligand which can release NO• under one and two-photon absorption. Compared with one-photon excitation, two-photon excitation allows high focalization and deep penetration of the beam, while exciting in the therapeutic window. This thesis is dedicated to the synthesis of [RuNO] complexes and their biological applications. The first chapter develops the state of the art in the field of ruthenium nitrosyl complexes and presents the biological issues. The second chapter presents the NO• photorelease properties of complexes with 4'-(2-fluorenyl)-2,2':6',2''-terpyridine ligand under one and two-photon excitation by spectroscopic studies. Photoproducts are characterized by X-ray diffraction. In a third chapter, cis (Cl,Cl)- and trans (Cl,Cl)-[RuII(2-fluorene-terpyridine)Cl2NO]PF6 are studied in water. The photorelease capacities of trans (NO,OH)-[RuII(fluorene-terpyridine)(Cl)(OH)(NO)]PF6 are studied in biological conditions. The fourth chapter presents the synthesis of new complexes with 4'-(2-fluorenyl)-2,2':6',2''-terpyridine ligand derivatives and their photorelease properties. The fifth chapter describes the phototoxic studies of these complexes on cancer cells (HCT 116 and FaDu). Finally, in the sixth chapter, the outstanding properties of these systems in the falling of antibiotic resistance in Staphylococcus epidermidis are exposed.

The emergence of CTX-M class-A extended-spectrum β-lactamases, which confer resistance to second and third-generation cephalosporins, poses a serious health threat to the public. CTX-M β-lactamases use a catalytic serine to hydrolyze the β-lactam ring. Specifically, the hydrolysis reaction catalyzed by CTX-M β-lactamase proceeds through a pre-covalent complex, a high-energy tetrahedral acylation intermediate, a low-energy acyl-enzyme complex, a high-energy tetrahedral deacylation intermediate after attack via a catalytic water, and lastly, the hydrolyzed β-lactam ring product which is released from the enzyme complex. The crystallographic structure of CTX-M at sub-angstrom resolution has enabled us to study enzyme catalysis as well as perform computational molecular docking in our efforts to develop new inhibitors against CTX-M. The goal of this project was to determine the hydrogen bonding network and proton transfer process at different stages of the reaction pathway as well as develop novel inhibitors against CTX-M β-lactamases. The results I have obtained from the project have elucidated the catalytic mechanism of CTX-M β-lactamase in unprecedented detail and facilitated the development of novel inhibitors for antibiotic drug discovery. The first aim of the project focused on developing high affinity inhibitors against class A β-lactamase using a structure-based drug discovery approach, which ultimately led to the identification of CTX-M9 inhibitors with nanomolar affinity. Compound design was based on the initial use of computational molecular docking results along with x-ray crystal structures with known inhibitors bound in the active site. In addition, chemical synthesis was used to build and extend the existing inhibitor scaffold to improve affinity to CTX-M9 and related serine β-lactamases. Through a fragment-based screening approach, we recently identified a novel non-covalent tetrazole-containing inhibitor of CTX-M. Structure-based design was used to improve the potency of the original tetrazole lead compound more than 200-fold with the use of small, targeted structural modifications. A series of compounds were used to probe specific binding hotspots present in CTX-M. The designed compounds represent the first nM-affinity non-covalent inhibitors of a class A β-lactamase. The complex structures of these potent compounds have been solved using high resolution x-ray crystallography at ~ 1.2-1.4 Å, which provides valuable insight about ligand binding and future inhibitor design against class A β-lactamases. Specifically, the first aim of the project was to use ultra-high resolution x-ray crystallography to study β-lactamase catalysis. Through the use of ultra-high resolution x-ray crystallography with non-covalent and covalent inhibitors, I was able to structurally characterize the critical stages of the enzyme mechanism. Here we report a series of ultra-high resolution x-ray crystallographic structures that reveal the proton transfer process for the early stages of the class A β-lactamase catalytic mechanism. The structures obtained include an a 0.89 Å crystal structure of CTX-M β-lactamase in complex with a recently-developed 89 nM non-covalent inhibitor, and a 0.80 Å structure in complex with an acylation transition state boronic acid inhibitor. Nearly all the hydrogen atoms in the active site, including those on the ligand, polar protein side chains and catalytic water, can be identified in the unbiased difference electron density map. Most surprisingly, compared with a previously determined 0.88 Å apo structure determined under the same conditions, the hydrogen-bonding network has undergone a series of reshuffling upon the binding of the non-covalent ligand. Two key catalytic residues, Lys73 and Glu166, appear to have both changed from a charged state to being neutral. Interestingly, structural evidence suggests the presence of a low barrier hydrogen bond (LBHB) shared between Lys73 and Ser70. These unprecedented detailed snapshots offer direct evidence that ligand binding can alter the pKa's of polar protein side chains and their affinities for protons. Such effects can be a common mechanism utilized by enzymes to facilitate the proton transfer process of a reaction pathway. They also have important implications for computational modeling of protein-ligand interactions. Ultra-high resolution x-ray crystallography allowed us to determine the hydrogen atom positions for key active site residues involved in catalysis. As a result, the ability to characterize the hydrogen bonding network led to the determination of the specific proton transfer process that occurs during the reaction stages of the CTX-M β-lactamase mechanism. Overall, the results from this project demonstrate the effectiveness of using ultra high resolution x-ray crystallography as a useful tool to study enzyme catalysis as well as develop and discover novel inhibitors.

A recent study using human fecal samples in conjunction with a culture-independent approach revealed immense diversity of antibiotic resistance (AR) genes in the human gut microflora. We hypothesize that food animal gut microflora also contain diverse and novel AR genes which could contribute to the emergence and transmission of AR in pathogens important in animal and human health. To test this, we examined AR reservoir in chicken gut microflora using a metagenomic, functional cloning method. Total genomic DNA was extracted from individual cecal contents of two free range chickens and two conventionally raised chickens. The DNAs were physically sheered into 1 to 3 kb fragments, cloned into expression vector pZE21-MCS, and transformed into E. coli TOP10 host strain, resulting in four metagenomic libraries of a total size of 108 base pairs per library. The AR transformants from the libraries were selected on plates containing the specific antibiotic of interest; six antibiotics including ampicillin, tetracycline, chloramphenicol, spectinomycin, ciprofloxacin and norfloxacin were used for screening. Plasmids from selected transformants were extracted and subjected to sequence analysis of inserted fragments. Identified AR genes were annotated and aligned with homologs that have been deposited in GenBank. A total of 12 AR genes and 3 AR genes were identified from the microbiome in conventionally raised chickens and free-range chickens, respectively. Of the identified 15 AR genes, 8 genes that confer resistance to ampicillin, spectinomycin or chloramphenicol shared low sequence similarity (58% - 76% at amino acid level) with the corresponding AR genes previously identified using culture-dependent approaches. Notably, among the 8 novel AR genes identified in this study, 4 genes also shared low sequence similarities (59%-76% at amino acid level) with recently identified AR genes in human gut. An E. coli-Campylobacter shuttle vector bearing the flaA sigma 28 promoter was constructed. Two novel genes conferring resistance to ampicillin (FRAmp1.1) and spectinomycin (FRSpe1.1) were cloned into this new expression vector, respectively. The derived vectors have conferred increased AR in C. jejuni, a leading zoonotic bacterial pathogen causing human gastroenteritidis in many industrialized countries. Together, findings from this study showed the effectiveness of the metagenomic approach for examination of AR reservoir in food animals, revealed novel AR resistance genes in chicken gut microflora, and demonstrated the functionality of such AR genes in foodborne human pathogens.

Introduction: Nosocomial infections remain a major cause of mortality and morbidity. The problem is most apparent in intensive care units (ICUs). Most ICU patients are compromised and vulnerable as a result of disease or severe trauma. One in ten people admitted to hospital is given an antibiotic for infection. The risk of acquiring a nosocomial infection in a European ICU is approximately 20%. It is vitally important that ways are found to prevent transmission between patients and personnel, and that local hygiene routines and antibiotic policies are developed. This thesis is a holistic work focused particularly on antimicrobial antibiotic resistance, antibiotic consumption and to some extent on hygiene in Swedish ICUs. Aims: The general aim of this thesis was to investigate bacterial resistance and antibiotic consumption in Swedish ICUs and to try to correlate ICU demographic data with antibiotic consumption and antibiotic resistance. Additional aims were to investigate on which clinical indications antibacterial drugs are prescribed in the ICU, and to investigate the emergence of resistance and transmission of Pseudomonas aeruginosa in the ICU using cluster analysis based on antibiograms and genotype data obtained by AFLP. Material and methods: In paper 1-3, antibiotic consumption data together with bacterial antibiotic resistance data and specific ICU-demographic data were collected from an increasing number of ICUs over the years 1997-2001. Data from ICUs covering up to six million out of Sweden’s nine million inhabitants were included. In paper 4, the indications for antibiotic prescribing were studied during two weeks in 2000. Paper 5 investigated Pseudomonas aeruginosa isolates in order to detect cross-transmission with genotype obtained by AFLP, and antibiogram-based cluster analysis was also performed in order to see if this could be a quicker and easier substitute for AFLP. Results: This thesis has produced three important findings. Firstly, antibiotic consumption in participating ICUs was relatively high during the study period, and every patient received on average more than one antimicrobial drug per day (I-IV). Secondly, levels of antimicrobial drug resistance seen in S. aureus, E. coli and Klebsiella spp remained low when data were pooled from all ICUs throughout the study period, despite relatively high antibiotic consumption (I-V). Thirdly, the prevalence of antibiotic resistance in CoNS and E. faecium, cefotaxime resistance in Enterobacter, and ciprofloxacin and imipenem resistance in P. aeruginosa was high enough to cause concern. Conclusion: For the period studied, multidrug resistance in Swedish ICUs was not a major problem. Signs of cross-transmission with non-multiresistant bacteria were observed, indicating a hygiene problem and identifying simple improvements that could be made in patient care guidelines and barrier precautions. A need for better follow up of prescribed antibiotics was evident. With further surveillance studies and monitoring of antibiotics and bacterial resistance patterns in the local setting as well as on a national and international level, some of the strategic goals in the prevention and control of the emergence of antimicrobial-resistant microbes may be achievable.

Bacterial infections are again becoming difficult to treat because the microbes are growing increasingly resistant to the antibiotics in use today. The need for novel antimicrobial compounds is urgent and to achieve this new targets are crucial. In this thesis we present a strategy for identification of such targets via a bioinformatics approach. In our first study we compared proteins with unknown and hypothetical function of the spirochete Treponema pallidum to five other pathogens also causing chronic or persistent infections in humans (Yersinia pestis, Neisseria gonorrhoeae, Helicobacter pylori, Borrelia burgdorferi and Streptococcus pneumoniae). T. pallidum was used as a starting point for the comparisons since this organism has a condensed genome (1.1 Mb). As we aimed at identifying conserved proteins important for in vivo survival or virulence of the pathogens we reasoned that T. pallidum would have deleted genes not important in the human host. This comparison yielded 17 ORFs conserved in all six pathogens, these were deleted in our model organism, Yersinia pseudotuberculosis, and the virulence of these mutant strains was evaluated in a mouse model of infection. Five genes were found to be essential for virulence and thus constitute possible antimicrobial drug targets. We have studied one of these virulence associated genes (vags), vagH, in more detail. Functional and phenotypic analysis revealed that VagH is an S-adenosyl-methionine dependent methyltransferase targeting Release factor 1 and 2 (RF1 and RF2). The analysis also showed that very few genes and proteins were differentially expressed in the vagH mutant compared to wild-type Yersinia. One major finding was that expression of the Type III secretion system effectors, the Yops, were down regulated in a vagH mutant. We dissected this phenotype further and found that the down regulation was due to lowered amounts of the positive regulator LcrF. This can be suppressed either by a deletion of yopD or by over expression of the Ribosomal Recycling Factor (RRF). These results indicate that YopD in addition to its role in translational regulation of the Yops also plays a part in the regulation of LcrF translation. We suggest also that the translation of LcrF is particularly sensitive to the amount of translation competent ribosomes and that one effect of a vagH mutation in Y. pseudotuberculosis is that the number of free ribosomes is reduced; this in turn reduces the amount of LcrF produced thereby causing a down regulation of the T3SS. This down regulation is likely the cause of the attenuated virulence of the vagH mutant. Finally, we set up a high throughput screening assay to screen a library of small molecules for compounds with inhibiting the VagH methyltransferase activity. Five such compounds were identified and two were found to inhibit VagH also in bacterial culture. Furthermore, analogues to one of the compounds showed improved inhibitory properties and inhibited the T3SS-dependent cytotoxic response induced by Y. pseudotuberculosis on HeLa cells. We have successfully identified five novel targets for antimicrobial compounds and in addition we have discovered a new class of molecules with antimicrobial properties.

Antibiotic resistance is a growing problem on a global scale. Increasing numbers of bacteria resistant toward one or multiple antibiotics could return us to the high mortality rates for infectious diseases of the pre-antibiotic era. The need for development of new classes of antibiotics is great as is increased understanding of the mechanisms underlying the development of antibiotic resistance. We have investigated the emergence of resistance to peptide deformylase inhibitors, a new class of antibiotics that target bacterial protein synthesis. The fitness of resistant mutants as well as their propensity to acquire secondary compensatory mutations was assessed in order to gain some insight into the potential clinical risk of resistance development. Most of this work was done in the bacterium Salmonella typhimurium, due to the availability of excellent genetic tools to study these phenomena. In addition, we have studied the bacterium Staphylococcus aureus as peptide deformylase inhibitors have been shown to have the greatest effect on Gram-positive organisms. In the course of this work we also examined the mechanistic aspects of translation initiation. Using a cell-free in vitro translation system we studied the effects of various components on translation initiation. These results have been combined with results obtained from resistant and compensated bacterial strains in vivo to gain new insights into the mechanisms of translation initiation.

As one of the mechanisms of antibiotic resistance, bacteria use several families of membrane-embedded α-helical transporters to remove cytotoxic molecules from the cell. The small multidrug resistance protein family (SMR) is one such group of drug transporters that because of their relative small size [ca. 110 residues with four transmembrane (TM) helices] must form at the minimum dimers to efflux drugs. We have used the SMR homologue Hsmr from Halobacterium salinarum to investigate the oligomerization properties of the protein family at TM helix 4. We produced point mutations along the length of the TM4 helix in the full length Hsmr protein and assayed their dimerization and functional properties via SDS-PAGE and bacterial cell growth assays. We found that Hsmr forms functionally dependent dimers via an evolutionarily conserved 90GLxLIxxGV98 small residue heptad repeat. Upon investigation of the large hydrophobic residues in this motif by substituting each large residue to Ile, Leu, Met, Phe, and Val, we determined that Hsmr efflux function relies on an optimal level of dimerization. While some substitutions led to either decreased or increased dimer and substrate-binding strength, several Ile94 and Val98 mutants were equal to wild type dimerization levels but were nonfunctional, leading to the hypothesis of a mechanistic role at TM4 in addition to the locus of dimerization. The functionally sensitive TM4 dimer represents a potential target for SMR inhibition using a synthetic TM4 peptide mimetic. Using exponential decay measurements from a real-time cellular efflux assay, we observed the efflux decay constant was decreased by up to ~60% after treatment with the TM4 peptide inhibitor compared to control peptide treatments. Our results suggest that this approach could conceivably be used to design hydrophobic peptides for disruption of key TM-TM interactions of membrane proteins, and represent a valuable route to the discovery of new therapeutics.