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Multidrug resistance mechanisms. Altered drug metabolism (A), ABC transporters increasing drug efflux (B) and stress and oncogenic signals induce the acetylation of transcription factors (e.g., Foxo3, E2F1) and tumor suppressor genes (p53) (C) while enzymes such as SIRT1 cause deacetylation, thus suppressing apoptotic processes and conferring resistance to oxidative stress.
