AbstractCandida auris is an emerging fungal pathogen that exhibits resistance to multiple drugs, including the most commonly prescribed antifungal, fluconazole. Here, we use a combinatorial screening approach to identify a bis-benzodioxolylindolinone (azoffluxin) that synergizes with fluconazole against C. auris. Azoffluxin enhances fluconazole activity through the inhibition of efflux pump Cdr1, thus increasing intracellular fluconazole levels. This activity is conserved across most C. auris clades, with the exception of clade III. Azoffluxin also inhibits efflux in highly azole-resistant strains of Candida albicans, another human fungal pathogen, increasing their susceptibility to fluconazole. Furthermore, azoffluxin enhances fluconazole activity in mice infected with C. auris, reducing fungal burden. Our findings suggest that pharmacologically targeting Cdr1 in combination with azoles may be an effective strategy to control infection caused by azole-resistant isolates of C. auris.
摘要:Candida auris是一种新兴的真菌病原体,对多种药物表现出抗药性,包括最常用的抗真菌药物
氟康唑。本研究采用组合筛选方法,发现一种双
苯并
二恶烷基
吲哚酮(azoffluxin),与
氟康唑协同作用,对Candida auris具有增强作用。Azoffluxin通过抑制外排泵Cdr1,增加细胞内
氟康唑水平,从而增强了
氟康唑的活性。这种活性在大多数Candida auris类群中都是保守的,但在III类群中除外。Azoffluxin还抑制高度
氮唑类耐药菌株的外排,增加它们对
氟康唑的敏感性。此外,azoffluxin在感染Candida auris的小鼠中增强了
氟康唑的活性,减少了真菌负担。我们的发现表明,通过药理学的方式靶向Cdr1,结合
氮唑类药物可能是控制
氮唑类耐药菌株引起感染的有效策略。