Emergence of resistance to pentavalent antimonials has become a severe obstacle in the treatment of visceral leishmaniasis (VL) in the Indian subcontinent. Mitogen-activated protein kinases (MAPKs) are well-known mediators of signal transduction of eukaryotes, regulating important processes, like proliferation, differentiation, stress response, and apoptosis. In Leishmania, MAPK1 has been shown to be consistently downregulated in antimony-resistant field isolates, suggesting that it has a role in antimony resistance. The present work investigates the molecular mechanism of MAPK1 in antimony resistance in Leishmania donovani. The L. donovani MAPK1 (LdMAPK1) single-allele replacement mutants exhibited increased resistance to Sb(III) (5.57-fold) compared to wild-type promastigotes, while overexpressing parasites became much more susceptible to antimony. The LdMAPK1-mediated drug sensitivity was directly related to antimony-induced apoptotic death of the parasite, as was evidenced by a 4-to 5-fold decrease in cell death parameters in deletion mutants and a 2-to 3-fold increase in MAPK1-overexpressing cells. LdMAPK1-underexpressing parasites also exhibited increased P-glycoprotein (P-gp)-mediated efflux pump activity, while a significant decrease in pump activity was observed in overexpressing cells. This change in efflux pump activity was directly related to expression levels of P-gp in all cell lines. However, episomal complementation of the gene restored normal growth, drug sensitivity, P-gp expression, and efflux pump activity. The data indicate that LdMAPK1 negatively regulates the expression of P-glycoprotein-type efflux pumps in the parasite. The decrease in efflux pump activity with an increase in Ld-MAPK1 expression may result in increased antimony accumulation in the parasite, making it more vulnerable to the drug. L eishmania, a protozoan parasite, causes leishmaniasis, a group of diseases with clinical manifestations that range from selfhealing cutaneous and mucocutaneous skin ulcers to a fatal visceral form (visceral leishmaniasis [VL]). The disease imposes a significant burden of mortality and morbidity, affecting 12 million people in more than 88 countries in tropical and subtropical zones of the world (1). Since antileishmanial vaccines are still under development, control of the disease is dependent mostly on chemotherapy (2). However, the efficacy of Sb(V), the first-line treatment, is now threatened by the emergence of drug-resistant Leishmania parasites, as described in several regions of endemicity (3-5). During the last decade, several novel formulations of conventional antileishmanials, as well as new drugs, including the oral agent miltefosine, became available or were under investigation. However, their widespread use in poor countries is hindered by their high cost and also by concerns about toxicity and the emergence of resistance (6, 7). The present-day requirement in the treatment of leishmaniasis is to battle escalating lack of responsiveness to antimony, and hence, an urgent need exists...