Multi-drug efflux pumps contribute to the resistance of Escherichia coli to many antibiotics and biocides. In this study, we report that the AraC-XylS family regulator YdeO increases the multi-drug resistance of E. coli through activation of the MdtEF efflux pump. Screening of random fragments of genomic DNA for their ability to increase b-lactam resistance led to the isolation of a plasmid containing ydeO, which codes for the regulator of acid resistance. When overexpressed, ydeO significantly increased the resistance of the E. coli strain to oxacillin, cloxacillin, nafcillin, erythromycin, rhodamine 6G and sodium dodecyl sulfate. The increase in drug resistance caused by ydeO overexpression was completely suppressed by deleting the multifunctional outer membrane channel gene tolC. TolC interacts with different drug efflux pumps. Quantitative real-time PCR showed that YdeO activated only mdtEF expression and none of the other drug efflux pumps in E. coli. Deletion of mdtEF completely suppressed the YdeO-mediated multi-drug resistance. YdeO enhances the MdtEF-dependent drug efflux activity in E. coli. Our results indicate that the YdeO regulator, in addition to its role in acid resistance, increases the multi-drug resistance of E. coli by activating the MdtEF multi-drug efflux pump. Keywords: drug efflux pump; Escherichia coli; MdtEF; multidrug resistance; YdeO INTRODUCTION Multi-drug efflux pumps cause serious problems in cancer chemotherapy and in the treatment of bacterial infections. Bacterial drug resistance is often associated with multi-drug efflux pumps that decrease drug accumulation in the cell. 1,2 Bacterial multi-drug efflux pumps are classified into five families on the basis of sequence similarity: major facilitator, resistance-nodulation-cell division (RND), small multi-drug resistance, multidrug and toxic compound extrusion, and ATP-binding cassette. [3][4][5] Of these, RND family efflux pumps play major roles in both intrinsic and elevated resistance of Gram-negative bacteria to a wide range of compounds, including b-lactams. 1,6-12 RND efflux pumps require two other proteins to function: a membrane fusion protein and an outer membrane protein.Many drug efflux pumps in Escherichia coli need TolC to function. [12][13][14][15] TolC is responsible for resistance to various antibiotics, including b-lactams, 12 quinolones 16 and macrolides. 17 Bacterial genome sequencing enables us to trace drug-resistance genes. [18][19][20] There are many putative and proven drug efflux pumps in the E. coli genome, and we have identified earlier 20 functional drug efflux pumps. 9,20 As many such efflux pumps have overlapping substrate spectra, 9 it is intriguing that bacteria, with their economically organized genomes, harbor such large sets of multi-drug efflux genes.