General Information and Variability Data of DT
Gene Name ABCC4
Protein Name Multidrug resistance-associated protein 4
Synonyms ABCC4; ATP-binding cassette sub-family C member 4; MOAT-B; MOATB; MRP/cMOAT-related ABC transporter; MRP4; Multi-specific organic anion transporter B
Gene ID
UniProt ID
DT Family ATP-Binding Cassette (ABC) Superfamily
Drug Conjugate Transporter (DCT) Family (ABCC)
Tissue Specificity Widely expressed, with particularly highlevels in prostate, but is barely detectable in liver.
Function This transporter may be an organic anion pump relevant to cellular detoxification.
Disease(s) Acute myeloid leukemia [ICD-11: 2A60]
Colorectal cancer [ICD-11: 2B91]
Erectile dysfunction [ICD-11: HA01]
High blood pressure [ICD-11: BA00]
Human immunodeficiency virus infection [ICD-11: 1C62.Z]
Influenza virus [ICD-11: 1E30-1E32]
Ovarian cancer [ICD-11: 2C73]
Hypercalcemia [ICD-11: 5B91.0]
Seizure [ICD-11: 8A68]
Genetic Polymorphisms & Epigenetic Regulations of DT
Species-, Tissue- and Disease-specific Protein Abundances of DT
Exogenous Factor Altering DT Activity
Approved Drug(s) Transported by This DT Abacavir Drug Info Human immunodeficiency virus infection [ICD-11: 1C62.Z] Approved [1]
Adefovir Drug Info Herpes simplex virus infection [ICD-11: 1F00] Approved [2]
Alprostadil Drug Info Erectile dysfunction [ICD-11: HA01] Approved [3]
Cefadroxil Drug Info Gram-positive & negative bacteria infections [ICD-11: 1A00-1H0Z] Approved [4]
Cefazolin Drug Info Methicillin-susceptible staphylococcus aureus [ICD-11: 1B74.0] Approved [4]
Ceftizoxime Drug Info Gram-positive & negative bacteria infections [ICD-11: 1A00-1H0Z] Approved [4]
Cholic acid Drug Info Synthesis disorders [ICD-11: 5C52.10] Approved [1]
Ciprofloxacin Drug Info Seizure [ICD-11: 8A68] Approved [5]
Cladribine Drug Info Hairy cell leukemia [ICD-11: 2A82.2] Approved [1]
Cyclophosphamide Drug Info Lymphomas [ICD-11: 2B33.5] Approved [6]
Dehydroepiandrosterone sulfate Drug Info Dyspareunia [ICD-11: GA12] Approved [7]
Dinoprostone Drug Info Medical abortion [ICD-11: JA00.1] Approved [3]
Fluorouracil Drug Info Stomach cancer [ICD-11: 2B72] Approved [8]
Folic acid Drug Info Vitamin deficiency [ICD-11: 5B55-5B7Z] Approved [9]
Ganciclovir Drug Info Cytomegalovirus infections [ICD-11: 1D82] Approved [1]
Glutathione Drug Info Human immunodeficiency virus infection [ICD-11: 1C62.Z] Approved [10]
Irinotecan Drug Info Colorectal cancer [ICD-11: 2B91] Approved [11]
Leucovorin Drug Info Colorectal cancer [ICD-11: 2B91] Approved [9]
Mercaptopurine Drug Info Acute lymphoblastic leukemia [ICD-11: 2B33.0] Approved [12]
Methotrexate Drug Info Leukemia [ICD-11: 2A60-2B33] Approved [13]
Olmesartan medoxomil Drug Info High blood pressure [ICD-11: BA00] Approved [14]
Oseltamivir Drug Info Influenza virus [ICD-11: 1E30-1E32] Approved [15]
Prasterone Drug Info Hypercalcemia [ICD-11: 5B91.0] Approved [7]
Quercetin Drug Info Coronary artery disease [ICD-11: BA6Z] Approved [1]
Sulindac Drug Info Rheumatoid arthritis [ICD-11: FA20] Approved [16]
Tenofovir Drug Info Human immunodeficiency virus infection [ICD-11: 1C62.Z] Approved [2]
Thioguanine Drug Info Acute myeloid leukemia [ICD-11: 2A60] Approved [17]
Topotecan Drug Info Ovarian cancer [ICD-11: 2C73] Approved [18]
Zidovudine Drug Info Human immunodeficiency virus infection [ICD-11: 1C62.Z] Approved [1]
Clinical Trial Drug(s) Transported by This DT Camptothecin Drug Info Non-small cell lung cancer [ICD-11: 2C25] Phase 3 [1]
Glycocholic acid Drug Info Bile acid synthesis defect [ICD-11: 5C52.11] Phase 3 [1]
SN-38 Drug Info Colon cancer [ICD-11: 2B90.Z] Phase 2 [1]
Rubitecan Drug Info Ewing's sarcoma [ICD-11: 2B52] Phase 1/2 [1]
Hydroxycamptothecin Drug Info Solid tumours [ICD-11: 2D4Z] Phase 1 [1]
Withdrawn, Discontinued or Preclinical Drug(s) Transported by This DT Aminohippuric acid Drug Info Renal function tests [ICD-11: MG02] Withdrawn [19]
Resveratrol Drug Info Colorectal cancer [ICD-11: 2B91] Discontinued in Phase 2 [1]
Azidothymidine monophosphate Drug Info Cancer [ICD-11: 2A00-2F9Z] Preclinical [20]
Glycodeoxycholic acid Drug Info Asthma [ICD-11: CA23] Preclinical [1]
Prostaglandin f2Alpha Drug Info Solid tumours [ICD-11: 2D4Z] Preclinical [1]
Taurocholic acid Drug Info Type 2 diabetes [ICD-11: 5A11] Terminated [1]
Endogenous Substrate(s) 9-(2-phosphonylmethyoxyethyl)adenine; Cyclic nucleotides; Estradiol 17-beta-D-glucuronides; Leukotrienes; Nucleotide analogues; Prostagland E1; Reduced folates; Bile acids; Cholate; Cholyltaurine; Dehydroepiandrosterone sulfate
Endogenous Metabolites (EMs) Handled by This DT Urate EM Info Identified using Aldh16a1 knockout mice [21]
Drug-DT Affinity Assessed by Cell Line
Drug(s) with Drug-DT Affinity Data Alprostadil Drug Info Spodoptera frugiperda (Sf9) cells-MRP4 Km = 2.1 microM [3]
Aminohippuric acid Drug Info Spodoptera frugiperda (Sf9) cells-MRP4 Km = 160 microM [19]
Cefadroxil Drug Info Spodoptera frugiperda 21 (Sf21) cells-MRP4 Km = 0.25 microM [4]
Cefazolin Drug Info Human embryonic kidney cells (HEK293)-MRP4 Km = 81 microM [4]
Ceftizoxime Drug Info Human embryonic kidney cells (HEK293)-MRP4 Km = 18 microM [4]
Cyclic adenosine monophosphate Drug Info Spodoptera frugiperda (Sf9) cells-MRP4 Km = 44.5 microM [22]
Dinoprostone Drug Info Spodoptera frugiperda (Sf9) cells-MRP4 Km = 3.4 microM [3]
Estradiol-17beta-glucuronide Drug Info Spodoptera frugiperda (Sf9) cells-MRP4 Km = 30.3 microM [22]
Folic acid Drug Info Spodoptera frugiperda (Sf9) cells-MRP4 Km = 170 microM [9]
Leucovorin Drug Info Spodoptera frugiperda (Sf9) cells-MRP4 Km = 640 microM [9]
Methotrexate Drug Info Human embryonic kidney cells (HEK293)-MRP4 Km = 220 microM [13]
Methotrexate Drug Info Spodoptera frugiperda (Sf9) cells-MRP4 Km = 220 microM [9]
Methotrexate Drug Info Spodoptera frugiperda (Sf9) cells-MRP4 Km = 1300 microM [23]
Olmesartan medoxomil Drug Info LLC-PK1 cells-MRP4 Km = 26.2 microM [14]
Topotecan Drug Info Human liver cancer cells (HepG2)-MRP4 Km = 1.66 microM [18]
1 Human intestinal transporter database: QSAR modeling and virtual profiling of drug uptake, efflux and interactions. Pharm Res. 2013 Apr;30(4):996-1007.
2 Functional involvement of multidrug resistance-associated protein 4 (MRP4/ABCC4) in the renal elimination of the antiviral drugs adefovir and tenofovir. Mol Pharmacol. 2007 Feb;71(2):619-27.
3 The human multidrug resistance protein MRP4 functions as a prostaglandin efflux transporter and is inhibited by nonsteroidal antiinflammatory drugs. Proc Natl Acad Sci U S A. 2003 Aug 5;100(16):9244-9.
4 Oral availability of cefadroxil depends on ABCC3 and ABCC4. Drug Metab Dispos. 2012 Mar;40(3):515-21.
5 Identification of the efflux transporter of the fluoroquinolone antibiotic ciprofloxacin in murine macrophages: studies with ciprofloxacin-resistant cells. Antimicrob Agents Chemother. 2009 Jun;53(6):2410-6.
6 Interaction of oxazaphosphorines with multidrug resistance-associated protein 4 (MRP4). AAPS J. 2010 Sep;12(3):300-8.
7 Steroid and bile acid conjugates are substrates of human multidrug-resistance protein (MRP) 4 (ATP-binding cassette C4). Biochem J. 2003 Apr 15;371(Pt 2):361-7.
8 ATP-binding cassette C transporters in human pancreatic carcinoma cell lines. Upregulation in 5-fluorouracil-resistant cells. Pancreatology. 2009;9(1-2):136-44.
9 Analysis of methotrexate and folate transport by multidrug resistance protein 4 (ABCC4): MRP4 is a component of the methotrexate efflux system. Cancer Res. 2002 Jun 1;62(11):3144-50.
10 Role of glutathione in the multidrug resistance protein 4 (MRP4/ABCC4)-mediated efflux of cAMP and resistance to purine analogues. Biochem J. 2002 Feb 1;361(Pt 3):497-503.
11 P-glycoprotein, but not multidrug resistance protein 4, plays a role in the systemic clearance of irinotecan and SN-38 in mice. Drug Metab Lett. 2010 Dec;4(4):195-201.
12 Polymorphisms in multidrug resistance-associated protein gene 4 is associated with outcome in childhood acute lymphoblastic leukemia. Blood. 2009 Aug 13;114(7):1383-6.
13 Interaction of nonsteroidal anti-inflammatory drugs with multidrug resistance protein (MRP) 2/ABCC2- and MRP4/ABCC4-mediated methotrexate transport. J Pharmacol Exp Ther. 2007 Jan;320(1):229-35.
14 Multiple human isoforms of drug transporters contribute to the hepatic and renal transport of olmesartan, a selective antagonist of the angiotensin II AT1-receptor. Drug Metab Dispos. 2007 Dec;35(12):2166-76.
15 Limited brain distribution of [3R,4R,5S]-4-acetamido-5-amino-3-(1-ethylpropoxy)-1-cyclohexene-1-carboxylate phosphate (Ro 64-0802), a pharmacologically active form of oseltamivir, by active efflux across the blood-brain barrier mediated by organic anion transporter 3 (Oat3/Slc22a8) and multidrug resistance-associated protein 4 (Mrp4/Abcc4). Drug Metab Dispos. 2009 Feb;37(2):315-21.
16 Fluo-cAMP is transported by multidrug resistance-associated protein isoform 4 in rat choroid plexus. J Neurochem. 2010 Oct;115(1):200-8.
17 Multidrug resistance protein 4 (MRP4/ABCC4) mediates efflux of bimane-glutathione. Int J Biochem Cell Biol. 2004 Feb;36(2):247-57.
18 Topotecan is a substrate for multidrug resistance associated protein 4. Curr Drug Metab. 2006 Jan;7(1):105-18.
19 Contribution of multidrug resistance protein 2 (MRP2/ABCC2) to the renal excretion of p-aminohippurate (PAH) and identification of MRP4 (ABCC4) as a novel PAH transporter. J Am Soc Nephrol. 2004 Nov;15(11):2828-35.
20 MRP4: A previously unidentified factor in resistance to nucleoside-based antiviral drugs. Nat Med. 1999 Sep;5(9):1048-51.
21 Transcriptomic analysis and plasma metabolomics in Aldh16a1-null mice reveals a potential role of ALDH16A1 in renal function. Chem Biol Interact. 2017 Oct 1;276:15-22.
22 Transport of cyclic nucleotides and estradiol 17-beta-D-glucuronide by multidrug resistance protein 4. Resistance to 6-mercaptopurine and 6-thioguanine. J Biol Chem. 2001 Sep 7;276(36):33747-54.
23 The MRP4/ABCC4 gene encodes a novel apical organic anion transporter in human kidney proximal tubules: putative efflux pump for urinary cAMP and cGMP. J Am Soc Nephrol. 2002 Mar;13(3):595-603.

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