Midecamycin inhibits bacterial growth by targeting the 50S ribosomal subunit preventing peptide bond formation and translocation during protein synthesis. Resistance to midecamycin is commonly attributed to mutations in 50S rRNA preventing midecamycin binding allowing the cell to synthesize proteins free of error.
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Morikawa, K. "Immunomodulatory Effects of Three Macrolides, Midecamycin Acetate, Josamycin, and Clarithromycin, on Human T-lymphocyte Function in Vitro." Antimicrobial Agents and Chemotherapy 38.11 (1994): 2643-647.
Lovmar, Martin, and Tanel Tenson. "The Mechanism of Action of Macrolides, Lincosamides and Streptogramin B Reveals the Nascent Peptide Exit Path in the Ribosome."Journal of Molecular Microbiology 330.5 (2003): 1005-014.
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