The efflux pump inhibitor phenyl-arginine--naphthylamide (PAN) was paired with iron chelators 2,2-dipyridyl, acetohydroxamic acid, and EDTA to assess synergistic activities against Pseudomonas aeruginosa growth and biofilm formation. All of the tested iron chelators synergistically inhibited P. aeruginosa growth and biofilm formation with PAN. PAN-EDTA showed the most promising activity against P. aeruginosa growth and biofilm formation.Pseudomonas aeruginosa is an important opportunistic pathogen that can cause a wide range of human infections (4). P. aeruginosa is notorious for its tolerance to antimicrobial agents and continues to cause a serious public health problem worldwide (1). The intrinsic multidrug resistance of P. aeruginosa is due, to a large extent, to the expression of efflux pump systems, which include MexAB-oprM, MexXY-OprM, . These efflux systems are reported to promote the export of antibiotics, organic solvents, biocides, and dyes (14). Recently, efflux pump inhibitors (EPIs), which specifically target the efflux activity and pump components, have been identified and proposed as novel agents to combat drug efflux mechanisms of pathogen (10). For example, phenyl-arginine--naphthylamide (PAN) has been reported to be an efficient EPI for P. aeruginosa, as it can potentiate fluoroquinolone activity in resistant P. aeruginosa strains (9).Among all of the reported P. aeruginosa Mex efflux systems, MexAB-OprM is the only system that is expressed constitutively in cells grown in standard laboratory media (15). This suggests that the export of antimicrobial agents is not the primary function of the MexAB-OprM efflux system. The MexAB-OprM system was identified initially by growing P. aeruginosa in iron-depleted minimal medium containing 2,2Ј-dipyridyl (Dipy) (13). In that study, Poole and colleagues reported that MexAB-OprM is overexpressed under severe iron limitation conditions, suggesting that the MexAB-OprM system plays an essential role for P. aeruginosa survival under iron limitation conditions (13). The study thus suggests that the combination of efflux inhibitors and iron chelators synergistically inhibits P. aeruginosa growth. In the present study, we evaluated the synergistic activities of EPI with iron chelators against P. aeruginosa growth and biofilm formation.The wild-type P. aeruginosa strain PAO1 (7) and two isogenic mutants, pvdA (deficient in the synthesis of the iron siderophore pyoverdine [18]) and mexAB-oprM (deficient in the synthesis of the entire MexAB-OprM efflux pump [11]) were used in this study. Bacterial strains were cultivated in AB minimal medium supplemented with 30 mg/liter glucose (5). The AB minimal medium is an iron-restricted medium that promotes the production of the iron siderophore pyoverdine in P. aeruginosa (17). Stock solutions of 100 mg/ml Dipy (SigmaAldrich) in ethanol, 100 mg/ml acetohydroxamic acid (SigmaAldrich) in water, and 100 mg/ml EDTA (Sigma-Aldrich) in water were kept at 4°C until use. A stock solution of 10 mg/ml PAN (Sigma-Aldrich) in wat...