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Figure 3: The mechanisms of pentamidine resistance in Leishmania. (a) Change in kDNA sequence confers resistance. The exact mechanism of conferring resistance remains unknown. (b) Presence of drug efflux pumps like PRP1 to remove the drug molecules from the cell and thus protect it from damage. (c) Reduced uptake of pentamidine in mitochondria due to altered polyamine biosynthetic pathways and lowered membrane potential. Blue lines indicate the probable drug action in sensitive Leishmania strains while red lines depict the probable routes to achieve resistance as observed in resistant cells.