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Hydrogen sulfide mediates bacterial antibiotic tolerance through iron chelation, efflux pump activation, and metabolic dormancyHydrogen Sulfide May Help Overcome Bacterial Antibiotic Tolerance

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Key Takeaway
Note hydrogen sulfide as a potential target to overcome bacterial antibiotic tolerance and eliminate persisters.

This systematic review synthesizes current evidence regarding the role of hydrogen sulfide (H2S) in mediating multidrug tolerance in bacteria. The scope focuses on identifying mechanisms by which H2S contributes to antibiotic resistance and the identification of potential targets to overcome these defenses.

The authors identify three core pathways for H2S-mediated tolerance: iron chelation for antioxidant defense, reactive sulfur species-mediated antibiotic inactivation combined with efflux pump activation, and metabolic dormancy induced by respiratory inhibition. The review also notes the utility of H2S fluorescent probes for monitoring intracellular levels and the potential of inhibitors targeting H2S biosynthesis.

While the evidence suggests H2S is a promising strategic target for overcoming tolerance and eliminating persisters to restore antibiotic efficacy, the findings are based on mechanisms described in literature reviews. The review does not report specific clinical trial data or safety outcomes. Clinical application remains theoretical as these mechanisms are currently being explored to address persistent bacterial infections.

How this fits prior evidence

This systematic review addresses a gap in understanding the molecular mechanisms of multidrug tolerance in bacteria. While prior coverage has identified critical knowledge gaps in secondary bacterial infections and highlighted the importance of adequate antimicrobial therapy for reducing hospital stays, this review specifically focuses on H2S as a target to overcome antibiotic resistance.

Researchers reviewed existing data to understand how bacteria survive treatment. They found that a gas called hydrogen sulfide (H2S) plays a major role in helping bacteria tolerate multiple drugs. This means the gas can help bacteria stay alive even when they are exposed to antibiotics.

The study identified three main ways this happens. These include iron chelation for defense, the inactivation of antibiotics by sulfur species, and the activation of pumps that push medicine out of the cell. Additionally, hydrogen sulfide can cause metabolic dormancy, which puts the bacteria into a sleep-like state where they are harder to kill.

Because these mechanisms help bacteria survive, targeting hydrogen sulfide could be a way to restore the power of antibiotics. This research is currently focused on understanding these biological pathways. While it shows promise for treating persistent infections, more research is needed to see how this can be applied in clinical settings.

What this means for you:
Hydrogen sulfide helps bacteria resist antibiotics through several mechanisms that could be targeted to improve treatment.

Common questions

What role does hydrogen sulfide play in bacterial infections?

Hydrogen sulfide acts as a key mediator of antibiotic tolerance. It helps bacteria survive treatment by enabling them to withstand multiple drugs. This makes it a potential target for researchers looking to eliminate persistent bacteria and restore the effectiveness of standard antibiotics.

How does hydrogen sulfide help bacteria resist medicine?

The research identified three main pathways: iron chelation for antioxidant defense, the inactivation of antibiotics by reactive sulfur species, and the activation of efflux pumps. It can also cause metabolic dormancy, which essentially puts the bacteria into a dormant state to avoid being killed by drugs.

Can targeting hydrogen sulfide help treat infections?

Because hydrogen sulfide is linked to how bacteria survive, it is considered a promising target for overcoming drug tolerance. By targeting these specific pathways, scientists hope to find ways to eliminate persistent bacteria and make antibiotics more effective again.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Hydrogen sulfide (H2S) is fundamentally a gaseous signaling molecule in bacteria. Recent studies have reported that H2S is a key mediator of bacterial antibiotic tolerance, making it a promising strategic target for overcoming tolerance, eliminating persisters, and restoring antibiotic efficacy. We systematically review recent advances in H2S-mediated multidrug tolerance mechanisms, highlighting three core pathways: iron chelation for antioxidant defense, reactive sulfur species-mediated antibiotic inactivation and efflux pump activation, and metabolic dormancy induced by respiratory inhibition, and note that recent advances in H2S fluorescent probes have provided important tools for monitoring intracellular H2S changes in bacteria under antibiotic stress. Furthermore, this review systematically summarizes recent advances in the development of novel inhibitors targeting intracellular H2S biosynthesis in bacteria.
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