Fungal Drug Response and Antimicrobial Resistance

Antifungal resistance in dermatophytes: Essential oil-based nanoformulations as new generation therapeutics against dermatophytes

Dermatophytosis is the most prevalent infection globally, affecting the stratum corneum of the skin, nails, and hair with a high recurrence rate. It transmits between humans and from humans to animals. Despite progress in medicine, its prevalence continues to increase. Therefore, current treatments, such as terbinafine, fluconazole, and other antifungal drugs, face challenges related to the emergence of fungal resistance, side effects, and toxicity associated with prolonged use, thereby highlighting the need for new therapeutic options. Medicinal plants are a never-ending source of bioactive chemicals, and their volatile and non-volatile extracts are widely acknowledged for therapeutic healthcare. Natural plant-derived products, especially essential oils (EOs) exhibit multiple modes of action that reduce the chances of resistance development in fungi. EOs have been reported as highly efficacious plant-based antifungals against different dermatophytes. Nanoencapsulation of EOs has emerged as an innovative strategy for maintaining and managing the volatile and reactive properties of EOs. The review presents current information on the emergence of resistance development in dermatophytes and investigates the potential of EOs and their nanoformulations as next-generation nano-therapeutics against dermatophytic infections. It also highlights advancements in nanosystems, along with findings from animal and clinical studies to improve treatment efficacy and address the limits of traditional therapy by combining diverse antifungal medicines with novel delivery methods.

Exploring the antifungal potential and action mechanism of pomegranate peel extract against Candida species in planktonic and biofilm conditions

Candidiasis, a fungal infection caused by Candida spp., poses a growing clinical challenge due to the development of antifungal resistance. This study assessed the efficacy of dry crude pomegranate peel extract (DCPPE) as an antifungal agent against Candida infections (C. albicans, C. parapsilosis, C. krusei and C. glabrata) by investigating its effects on fungal growth, biofilm disruption, and fungal cell membrane integrity, as well as evaluating its safety regarding hemolysis at different concentrations. The DCPPE exhibited inhibitory activity against all tested Candida strains, with MIC of 1 % (10 mg/mL). These results may be associated with the phenolic composition of the peel extract, which includes compounds like gallic acid, punicalagin A, punicalagin B, and ellagic acid. Furthermore, the DCPPE disrupted Candida biofilms and demonstrated safety with respect to hemolysis at concentrations up to 60 mg/mL. However, no evidence of a direct interaction with the fungal cell wall or ergosterol in the fungal membrane was found. Thus, our results highlight the potential of DCPPE as a promising alternative for the treatment of candidiasis. Nevertheless, further research is needed to fully clarify the underlying mechanisms and optimize its clinical efficacy.

Antifungal activity of guanidine compounds

Guanidinic compounds are a class of compounds distributed in nature but also synthesized in vitro with a wide variety of applicability. One of the potentials of those molecules is antimicrobial activity. In that sense, although mainly limited to immunocompromised people, fungi pathogens are a cause of concern, even more so after the COVID-19 pandemic. Susceptible groups and increased geographical distribution, besides drug toxicity, resistance, and high costs, made the World Health Organization (WHO) establish a guideline for research and public health politics against different fungi opportunist agents. Our present work evaluated the antifungal activity of 11 guanidine compounds (one of them synthesized for the first time) against six fungi species in the WHO Fungi Priority Pathogens List and their potential for antimicrobial selectivity. The newly synthesized compound, named LQOF-G2-S, was successfully obtained and chemically characterized as spermidine tri-substituted by guanidine moieties in benzylamine-4-bromoaniline groups, and it presented the best antifungal activity and selectivity among the others. It was the only compound active against Candida spp.; however, its activity was more promising against Cryptococcus neoformans, Cryptococcus gattii, and even more against Paracoccidioides brasiliensis and Paracoccidioides lutzii, with a selective index higher than 10. The LQOF-G2-S potential opened up the opportunity to design and evaluate other similar compounds, contributing to finding new effective, less toxic, and more affordable compounds for fungi treatment.

(E)-2-Octenal inhibits Neofusicoccum parvum growth by disrupting mitochondrial energy metabolism and is a potential preservative for postharvest mango

Stem-end rot caused by Neofusicoccum parvum is among the most detrimental diseases affecting postharvest mangoes. The present investigation utilized (E)-2-octenal to manage N. parvum infections, elucidating its mechanism of action. The findings revealed that (E)-2-octenal exhibited outstanding antimicrobial potency against N. parvum in vitro within the concentration range of 0.4-1.6 µL/mL. Additionally, (E)-2-octenal significantly compromised the cell membrane integrity and mitochondrial energy metabolism of N. parvum, evidenced by dramatically increased intracellular material leakage and ROS levels, along with reduced mitochondrial membrane potential, ATP, and energy charge. Further experiments showed noteworthy effects on the tricarboxylic acid cycle (TCA) cycle and the key enzyme activities of succinate dehydrogenase (SDH) and malate dehydrogenase (MDH). Molecular docking revealed hydrogen bonding between (E)-2-octenal's aldehyde group and SDH (Trp-307) and MDH (Gly-101), indicating direct targeting of these enzymes for inhibition. To enhance the practical application of (E)-2-octenal, we developed an aerogel-loaded (E)-2-octenal material (ALO) that exhibited superior antimicrobial efficacy in vitro. In vivo, ALO effectively controlled mango stem-end rot, with optimal efficacy at 20 µL/L. This concentration also delayed the natural disease of mango without degrading fruit quality. According to these findings, (E)-2-octenal is a promising preservative against postharvest mango infections, potentially by impeding cellular energy metabolism through direct interaction with SDH and MDH within the TCA pathway, culminating in mitochondrial dysfunction and cell membrane damage.

The Significance of Mono- and Dual-Effective Agents in the Development of New Antifungal Strategies

Invasive fungal infections (IFIs) pose significant challenges in clinical settings, particularly due to their high morbidity and mortality rates. The rising incidence of these infections, coupled with increasing antifungal resistance, underscores the urgent need for novel therapeutic strategies. Current antifungal drugs target the fungal cell membrane, cell wall, or intracellular components, but resistance mechanisms such as altered drug-target interactions, enhanced efflux, and adaptive cellular responses have diminished their efficacy. Recent research has highlighted the potential of dual inhibitors that simultaneously target multiple pathways or enzymes involved in fungal growth and survival. Combining pharmacophores, such as lanosterol 14α-demethylase (CYP51), heat shock protein 90 (HSP90), histone deacetylase (HDAC), and squalene epoxidase (SE) inhibitors, has led to the development of compounds with enhanced antifungal activity and reduced resistance. This dual-target approach, along with novel chemical scaffolds, not only represents a promising strategy for combating antifungal resistance but is also being utilized in the development of anticancer agents. This review explores the development of new antifungal agents that employ mono-, dual-, or multi-target strategies to combat IFIs. We discuss emerging antifungal targets, resistance mechanisms, and innovative therapeutic approaches that offer hope in managing these challenging infections.

Trans-2-hexenal reduces postharvest mango stem-end rot by oxidative damage to Neofusicoccum parvum cell membranes

Neofusicoccum parvum is one of the most hazardous pathogens causing mango fruit decay. The present study utilized trans-2-hexenal (TH), a typical antifungal component of plant essential oils (EOs), to control N. parvum both in vivo and in vitro, and attempted to explore the mechanisms involved. The findings showed that at concentrations greater than 0.4 µL/mL, TH exhibited exceptional antifungal activity against N. parvum in vitro. TH application led to the disruption of the structural integrity of both cell walls and cell membranes, with a particular impact on the latter, as evidenced by the dramatically increased propidium iodide level, as well as reduced total lipids and ergosterol content. Further DCFH-DA staining experiments showed that TH induced mycelial reactive oxygen species (ROS) accumulation, which exacerbated cell membrane lipid peroxidation. For easier application of TH, we fabricated aerogel-loaded TH (ALTH) materials, which demonstrated excellent antifungal activity in vitro. Infestation studies on fruits demonstrated that ALTH mitigated mango stem-end rot in a dose-dependent fashion, with a concentration of 40 µL/L showing efficacy comparable to the conventional fungicide prochloraz, while maintaining fruit quality. In light of these results, TH works by inducing ROS buildup and oxidative damage to the cell membrane of N. parvum, and is a particularly promising preservative for preventing postharvest infections in mangoes.

New Ground in Antifungal Discovery and Therapy for Invasive Fungal Infections: Innovations, Challenges, and Future Directions

This review explores current advancements and challenges in antifungal therapies amid rising fungal infections, particularly in immunocompromised patients. We detail the limitations of existing antifungal classes-azoles, echinocandins, polyenes, and flucytosine-in managing systemic infections and the urgent need for alternative solutions. With the increasing incidence of resistance pathogens, such as Candida auris and Aspergillus fumigatus, we assess emerging antifungal agents, including Ibrexafungerp, T-2307, and N'-Phenylhydrazides, which target diverse fungal cell mechanisms. Innovations, such as nanoparticles, drug repurposing, and natural products, are also evaluated for their potential to improve efficacy and reduce resistance. We emphasize the importance of novel approaches to address the growing threat posed by fungal infections, particularly for patients with limited treatment options. Finally, we briefly examine the potential use of artificial intelligence (AI) in the development of new antifungal treatments, diagnoses, and resistance prediction, which provides powerful tools in the fight against fungal pathogens. Overall, we highlight the pressing need for continued research to advance antifungal treatments and improve outcomes for high-risk populations.

Proline-Modified RWn Peptides: Enhanced Antifungal Efficacy and Synergy with Conventional Antibiotics for Combating Resistant Fungal Infections

Candida albicans (Ca) and Cryptococcus neoformans (Cn) infections pose a growing threat due to rising antifungal resistance. This study explores a new class of antifungal agents, the RWn series (n = 4, 6, 8) peptides. These synthetic peptides were evaluated for their ability to inhibit Ca and Cn growth. All peptides except RW4 displayed antifungal activity, with RW6 exhibiting exceptional potency against Cn. Importantly, the incorporation of a proline residue significantly reduced cytotoxicity while maintaining antifungal activity against Cn for all RWnP peptides. Notably, RW6P demonstrated broad-spectrum activity against both Ca and Cn with low minimum inhibitory concentrations (MICs) and minimal toxicity. Furthermore, combining RW6P with trace amounts of traditional antibiotics (penicillin, vancomycin, and ampicillin) achieved synergistic effects, significantly reducing MICs against both fungi. These findings suggest that RWnP peptides, particularly RW6P, have promising potential as novel antifungal agents due to their high potency, broad-spectrum activity, and ability to resensitize fungi to existing antibiotics.

Improving antifungal lipid-based drug delivery against Candida: a review

INTRODUCTION

Fungal infections, particularly those caused by Candida spp. have increased in recent years. A primary contributor to this surge was the COVID-19 pandemic, where many hospitalized patients had secondary fungal infections. Additionally, the emergence of resistant and multi-resistant fungal strains has become increasingly problematic due to the limited therapeutic options available in antifungal treatments.

AREAS COVERED

This review presents a comprehensive analysis of recent studies focused on the development and characterization of lipid-based nanosystems as an emerging and promising therapeutic alternative. These systems have been evaluated for their potential to deliver antifungal agents specifically targeting resistant Candida spp. strains, offering a controlled and sustained release of drugs.

EXPERT OPINION

Lipid-based nanomaterials are promising tools for the controlled and sustained release of drugs, particularly in treating Candida spp. infections. Although substantial research has been dedicated to development of these nanomaterials, only a few have reached clinical application, such as liposomal amphotericin B, for example. Therefore, it is critical to push forward with advancements to bring these nanomedicines into clinical practice, where they can contribute meaningfully to mitigating the challenge of resistant and lethal fungal strains.

Anti-fungal peptides: an emerging category with enthralling therapeutic prospects in the treatment of candidiasis

Candida infections, particularly invasive candidiasis, pose a serious global health threat. Candida albicans is the most prevalent species causing candidiasis, and resistance to key antifungal drugs, such as azoles, echinocandins, polyenes, and fluoropyrimidines, has emerged. This growing multidrug resistance (MDR) complicates treatment options, highlighting the need for novel therapeutic approaches. Antifungal peptides (AFPs) are gaining recognition for their potential as new antifungal agents due to their diverse structures and functions. These natural or recombinant peptides can effectively target fungal virulence and viability, making them promising candidates for future antifungal development. This review examines infections caused by Candida species, the limitations of current antifungal treatments, and the therapeutic potential of AFPs. It emphasizes the importance of identifying novel AFP targets and their production for advancing treatment strategies. By discussing the therapeutic development of AFPs, the review aims to draw researchers' attention to this promising field. The integration of knowledge about AFPs could pave the way for novel antifungal agents with broad-spectrum activity, reduced toxicity, targeted action, and mechanisms that limit resistance in pathogenic fungi, offering significant advancements in antifungal therapeutics.

Environment by environment interactions (ExE) differ across genetic backgrounds (ExExG)

While the terms "gene-by-gene interaction" (GxG) and "gene-by-environment interaction" (GxE) are widely recognized in the fields of quantitative and evolutionary genetics, "environment-byenvironment interaction" (ExE) is a term used less often. In this study, we find that environmentby-environment interactions are a meaningful driver of phenotypes, and moreover, that they differ across different genotypes (suggestive of ExExG). To support this conclusion, we analyzed a large dataset of roughly 1,000 mutant yeast strains with varying degrees of resistance to different antifungal drugs. Our findings reveal that the effectiveness of a drug combination, relative to single drugs, often differs across drug resistant mutants. Remarkably, even mutants that differ by only a single nucleotide change can have dramatically different drug × drug (ExE) interactions. We also introduce a new framework that more accurately predicts the direction and magnitude of ExE interactions for some mutants. Understanding how ExE interactions change across genotypes (ExExG) is crucial not only for modeling the evolution of pathogenic microbes, but also for enhancing our knowledge of the underlying cell biology and the sources of phenotypic variance within populations. While the significance of ExExG interactions has been overlooked in evolutionary and population genetics, these fields and others stand to benefit from understanding how these interactions shape the complex behavior of living systems.

Anti-infective therapies for Pythium insidiosum keratitis

INTRODUCTION

Pythium insidiosum keratitis (PIK) is a rapidly progressing ocular disease predominantly found in tropical and subtropical regions. Characterized by severe corneal damage and high morbidity, this infection poses significant challenges in diagnosis and management, necessitating effective anti-infective therapies.

AREAS COVERED

This report delves into the pathophysiology, clinical and microbiological diagnosis, and detailed insights into the anti-infective therapy for PIK, outlining current diagnostic challenges that complicate treatment. We review existing anti-infective therapies, including their efficacy and limitations, and discuss the role of surgical interventions in managing advanced cases. The report also highlights ongoing research into novel treatment approaches and the critical need for developing targeted therapies.

EXPERT OPINION

Despite advances in understanding PIK, treatment remains complex due to pathogen resistance and diagnostic hurdles. Future research should focus on innovative anti-infective strategies, improved diagnostic techniques, and global surveillance to enhance therapeutic outcomes. Collaboration between ophthalmologists, microbiologists, and pharmacologists is essential to advance treatment protocols and improve patient prognosis.

Distinguishing mutants that resist drugs via different mechanisms by examining fitness tradeoffs

There is growing interest in designing multidrug therapies that leverage tradeoffs to combat resistance. Tradeoffs are common in evolution and occur when, for example, resistance to one drug results in sensitivity to another. Major questions remain about the extent to which tradeoffs are reliable, specifically, whether the mutants that provide resistance to a given drug all suffer similar tradeoffs. This question is difficult because the drug-resistant mutants observed in the clinic, and even those evolved in controlled laboratory settings, are often biased towards those that provide large fitness benefits. Thus, the mutations (and mechanisms) that provide drug resistance may be more diverse than current data suggests. Here, we perform evolution experiments utilizing lineage-tracking to capture a fuller spectrum of mutations that give yeast cells a fitness advantage in fluconazole, a common antifungal drug. We then quantify fitness tradeoffs for each of 774 evolved mutants across 12 environments, finding these mutants group into classes with characteristically different tradeoffs. Their unique tradeoffs may imply that each group of mutants affects fitness through different underlying mechanisms. Some of the groupings we find are surprising. For example, we find some mutants that resist single drugs do not resist their combination, while others do. And some mutants to the same gene have different tradeoffs than others. These findings, on one hand, demonstrate the difficulty in relying on consistent or intuitive tradeoffs when designing multidrug treatments. On the other hand, by demonstrating that hundreds of adaptive mutations can be reduced to a few groups with characteristic tradeoffs, our findings may yet empower multidrug strategies that leverage tradeoffs to combat resistance. More generally speaking, by grouping mutants that likely affect fitness through similar underlying mechanisms, our work guides efforts to map the phenotypic effects of mutation.

Unlocking the Potential: PEGylation and Molecular Weight Reduction of Ionenes for Enhanced Antifungal Activity and Biocompatibility

Numerous synthetic polymers, imitating natural antimicrobial peptides, have demonstrated potent antimicrobial activity, positioning them as potential candidates for new antimicrobial drugs. However, the high activity of these molecules often comes at the cost of elevated toxicity against eukaryotic organisms. In this study, a series of cationic ionenes with varying molecular weights to assess the influence of polymer chain length on ionene activity is investigated. To enhance polymer antimicrobial activity and limit toxicity a PEG side chain is introduced into the repeating unit. The resulting molecules consistently exhibited high activity against three model organisms: E. coli, S. aureus and C. albicans. The incorporation of side PEG chain improves antifungal properties and biocompatibility, regardless of molecular weight. The most important finding of this work is that the reduction of polymer molecular mass led to increased antifungal activity and reduced cytotoxicity against HMF and MRC-5 cell lines simultaneously. As a result, the best-performing molecules reported herein displayed minimal inhibitory concentrations (MIC) as low as 2 and 0.0625 µg mL1 for C. albicans and C. tropicalis respectively, demonstrating exceptional selectivity. It is plausible that some of described herein molecules can serve as potential lead candidates for new antifungal drugs.

Comprehensive Overview of Candida auris: An Emerging Multidrug-Resistant Fungal Pathogen

The rise of Candida auris, a multidrug-resistant fungal pathogen, across more than 40 countries, has signaled an alarming threat to global health due to its significant resistance to existing antifungal therapies. Characterized by its rapid spread and robust drug resistance, C. auris presents a critical challenge in managing infections, particularly in healthcare settings. With research on its biological traits and genetic basis of virulence and resistance still in the early stages, there is a pressing need for a concerted effort to understand and counteract this pathogen. This review synthesizes current knowledge on the epidemiology, biology, genetic manipulation, pathogenicity, diagnostics, and resistance mechanisms of C. auris, and discusses future directions in research and therapeutic development. By exploring the complexities surrounding C. auris, we aim to underscore the importance of advancing research to devise effective control and treatment strategies.

Hospitalized COVID-19 Patients with Urinary Tract Infection in Iran: Candida Species Distribution and Antifungal Susceptibility Patterns

Candida species, typically part of the human skin and mucous membrane flora, can cause opportunistic fungal infections, notably urinary tract infections (UTIs), which are on the rise among hospitalized COVID-19 patients. The lack of understanding of UTIs in this population, coupled with the emergence of multidrug-resistant strains, poses significant challenges for effective treatment and further investigations. In this study, urine samples were collected from 70 COVID-19 patients with UTIs in sterile containers for microbiology examination. After microscopic observation, the isolates were identified both by phenotypic and molecular techniques such as multiplex PCR. Antifungal susceptibility testing (AFST) against fluconazole (Flu), itraconazole (Itr), and amphotericin B (AMB) was performed according to CLSI M27/S4 standard methods, with the frequency of isolates including Candida albicans (n = 20, 51.3%), Candida tropicalis (n = 15, 38.4%), Nakaseomyces glabrata (previously Candida glabrata) (n = 2, 5.1%), Pichia kudriavzevii (previously Candida krusei), and Candida parapsilosis (n = 1, 2.5%). All isolates of C. albicans, C. tropicalis, C. glabrata, and C. parapsilosis were sensitive to amphotericin B, while C. kruzei was resistant to AMB. Around 70% of C. albicans isolates were sensitive to Flu; 20% of C. tropicalis were resistant to itraconazole, while 33% were resistant to fluconazole. C. albicans and C. tropicalis were the main causes of candiduria in infected cases and both Flu and AMB showed good results in AFST in these species. Performing drug susceptibility testing for clinical isolates of Candida spp. provided guidance for appropriate management and control, and timely antifungal treatment.

Imidazolium-based ionic liquids disrupt saccharomyces cerevisiae cell membrane integrity

Ionic liquids (ILs) are interesting chemical compounds that have a wide range of industrial and scientific applications. They have extraordinary properties, such as the tunability of many of their physical properties and, accordingly, their activities; and the ease of synthesis methods. Hence, they became important building blocks in catalysis, extraction, electrochemistry, analytics, biotechnology, etc. This study determined antifungal activities of various imidazolium-based ionic liquids against yeast Saccharomyces cerevisiae via minimum inhibitory concentration (MIC) estimation method. Increasing the length of the alkyl group attached to the imidazolium cation, enhanced the antifungal activity of the ILs, as well as their ability of the disruption of the cell membrane integrity. FTIR studies performed on the S. cerevisiae cells treated with the ILs revealed alterations in the biochemical composition of these cells. Interestingly, the alterations in fatty acid content occurred in parallel with the increase in the activity of the molecules upon the increase in the length of the attached alkyl group. This trend was confirmed by statistical analysis and machine learning methodology. The classification of antifungal activities based on FTIR spectra of S. cerevisiae cells yielded a prediction accuracy of 83%, indicating the pharmacy and medicine industries could benefit from machine learning methodology. Furthermore, synthesized ionic compounds exhibit significant potential for pharmaceutical and medical applications.

Distinguishing mutants that resist drugs via different mechanisms by examining fitness tradeoffs

There is growing interest in designing multidrug therapies that leverage tradeoffs to combat resistance. Tradeoffs are common in evolution and occur when, for example, resistance to one drug results in sensitivity to another. Major questions remain about the extent to which tradeoffs are reliable, specifically, whether the mutants that provide resistance to a given drug all suffer similar tradeoffs. This question is difficult because the drug-resistant mutants observed in the clinic, and even those evolved in controlled laboratory settings, are often biased towards those that provide large fitness benefits. Thus, the mutations (and mechanisms) that provide drug resistance may be more diverse than current data suggests. Here, we perform evolution experiments utilizing lineage-tracking to capture a fuller spectrum of mutations that give yeast cells a fitness advantage in fluconazole, a common antifungal drug. We then quantify fitness tradeoffs for each of 774 evolved mutants across 12 environments, finding these mutants group into 6 classes with characteristically different tradeoffs. Their unique tradeoffs may imply that each group of mutants affects fitness through different underlying mechanisms. Some of the groupings we find are surprising. For example, we find some mutants that resist single drugs do not resist their combination, while others do. And some mutants to the same gene have different tradeoffs than others. These findings, on one hand, demonstrate the difficulty in relying on consistent or intuitive tradeoffs when designing multidrug treatments. On the other hand, by demonstrating that hundreds of adaptive mutations can be reduced to a few groups with characteristic tradeoffs, our findings may yet empower multidrug strategies that leverage tradeoffs to combat resistance. More generally speaking, by grouping mutants that likely affect fitness through similar underlying mechanisms, our work guides efforts to map the phenotypic effects of mutation.

Antibiofilm activity of carotenoid crocetin against Staphylococcal strains

Staphylococcus aureus and Staphylococcus epidermidis stand as notorious threats to human beings owing to the myriad of infections they cause. The bacteria readily form biofilms that help in withstanding the effects of antibiotics and the immune system. Intending to combat the biofilm formation and reduce the virulence of the pathogens, we investigated the effects of carotenoids, crocetin, and crocin, on four Staphylococcal strains. Crocetin was found to be the most effective as it diminished the biofilm formation of S. aureus ATCC 6538 significantly at 50 µg/mL without exhibiting bactericidal effect (MIC >800 µg/mL) and also inhibited the formation of biofilm by MSSA 25923 and S. epidermidis at a concentration as low as 2 µg/mL, and that by methicillin-resistant S. aureus MW2 at 100 µg/mL. It displayed minimal to no antibiofilm efficacy on the Gram-negative strains Escherichia coli O157:H7 and Pseudomonas aeruginosa as well as a fungal strain of Candida albicans. It could also curb the formation of fibrils, which partly contributes to the biofilm formation in S. epidermidis. Additionally, the ADME analysis of crocetin proclaims how relatively non-toxic the chemical is. Also, crocetin displayed synergistic antibiofilm characteristics in combination with tobramycin. The presence of a polyene chain with carboxylic acid groups at its ends is hypothesized to contribute to the strong antibiofilm characteristics of crocetin. These findings suggest that using apocarotenoids, particularly crocetin might help curb the biofilm formation by S. aureus and S. epidermidis.

Fungal Infections, Treatment and Antifungal Resistance: The Sub-Saharan African Context

Fungal pathogens cause a wide range of infections in humans, from superficial to disfiguring, allergic syndromes, and life-threatening invasive infections, affecting over a billion individuals globally. With an estimated 1.5 million deaths annually attributable to them, fungal pathogens are a major cause of mortality in humans, especially people with underlying immunosuppression. The continuous increase in the population of individuals at risk of fungal infections in sub-Saharan Africa, such as HIV patients, tuberculosis patients, intensive care patients, patients with haematological malignancies, transplant (haematopoietic stem cell and organ) recipients and the growing global threat of multidrug-resistant fungal strains, raise the need for an appreciation of the region's perspective on antifungal usage and resistance. In addition, the unavailability of recently introduced novel antifungal drugs in sub-Saharan Africa further calls for regular evaluation of resistance to antifungal agents in these settings. This is critical for ensuring appropriate and optimal use of the limited available arsenal to minimise antifungal resistance. This review, therefore, elaborates on the multifaceted nature of fungal resistance to the available antifungal drugs on the market and further provides insights into the prevalence of fungal infections and the use of antifungal agents in sub-Saharan Africa.

Transcriptional Reprogramming of Candida tropicalis in Response to Isoespintanol Treatment

Candida tropicalis, an opportunistic pathogen, ranks among the primary culprits of invasive candidiasis, a condition notorious for its resistance to conventional antifungal drugs. The urgency to combat these drug-resistant infections has spurred the quest for novel therapeutic compounds, with a particular focus on those of natural origin. In this study, we set out to evaluate the impact of isoespintanol (ISO), a monoterpene derived from Oxandra xylopioides, on the transcriptome of C. tropicalis. Leveraging transcriptomics, our research aimed to unravel the intricate transcriptional changes induced by ISO within this pathogen. Our differential gene expression analysis unveiled 186 differentially expressed genes (DEGs) in response to ISO, with a striking 85% of these genes experiencing upregulation. These findings shed light on the multifaceted nature of ISO's influence on C. tropicalis, spanning a spectrum of physiological, structural, and metabolic adaptations. The upregulated DEGs predominantly pertained to crucial processes, including ergosterol biosynthesis, protein folding, response to DNA damage, cell wall integrity, mitochondrial activity modulation, and cellular responses to organic compounds. Simultaneously, 27 genes were observed to be repressed, affecting functions such as cytoplasmic translation, DNA damage checkpoints, membrane proteins, and metabolic pathways like trans-methylation, trans-sulfuration, and trans-propylamine. These results underscore the complexity of ISO's antifungal mechanism, suggesting that it targets multiple vital pathways within C. tropicalis. Such complexity potentially reduces the likelihood of the pathogen developing rapid resistance to ISO, making it an attractive candidate for further exploration as a therapeutic agent. In conclusion, our study provides a comprehensive overview of the transcriptional responses of C. tropicalis to ISO exposure. The identified molecular targets and pathways offer promising avenues for future research and the development of innovative antifungal therapies to combat infections caused by this pathogenic yeast.

Candida albicans and Antifungal Peptides

Candida albicans, a ubiquitous opportunistic fungal pathogen, plays a pivotal role in human health and disease. As a commensal organism, it normally resides harmlessly within the human microbiota. However, under certain conditions, C. albicans can transition into a pathogenic state, leading to various infections collectively known as candidiasis. With the increasing prevalence of immunocompromised individuals and the widespread use of invasive medical procedures, candidiasis has become a significant public health concern. The emergence of drug-resistant strains further complicates treatment options, highlighting the urgent need for alternative therapeutic strategies. Antifungal peptides (AFPs) have gained considerable attention as potential candidates for combating Candida spp. infections. These naturally occurring peptides possess broad-spectrum antimicrobial activity, including specific efficacy against C. albicans. AFPs exhibit several advantageous properties, such as rapid killing kinetics, low propensity for resistance development, and diverse mechanisms of action, making them promising alternatives to conventional antifungal agents. In recent years, extensive research has focused on discovering and developing novel AFPs with improved efficacy and selectivity against Candida species. Advances in biotechnology and synthetic peptide design have enabled the modification and optimization of natural peptides, enhancing their stability, bioavailability, and therapeutic potential. Nevertheless, several challenges must be addressed before AFPs can be widely implemented in clinical practice. These include optimizing peptide stability, enhancing delivery methods, overcoming potential toxicity concerns, and conducting comprehensive preclinical and clinical studies. This commentary presents a short overview of candidemia and AFP; articles and reviews published in the last 10 years were searched on The National Library of Medicine (National Center for Biotechnology Information-NIH-PubMed). The terms used were C. albicans infections, antimicrobial peptides, antifungal peptides, antifungal peptides mechanisms of action, candidemia treatments and guidelines, synthetic peptides and their challenges, and antimicrobial peptides in clinical trials as the main ones. Older publications were cited if they brought some relevant concept or helped to bring a perspective into our narrative. Articles older than 20 years and those that appeared in PubMed but did not match our goal to bring updated information about using antifungal peptides as an alternative to C. albicans infections were not considered.

The Mechanism of Transcription Factor Swi6 in Regulating Growth and Pathogenicity of Ceratocystis fimbriata: Insights from Non-Targeted Metabolomics

Ceratocystis fimbriata (C. fimbriata) is a notorious pathogenic fungus that causes sweet potato black rot disease. The APSES transcription factor Swi6 in fungi is located downstream of the cell wall integrity (CWI)-mitogen-activated protein kinase (MAPK) signaling pathway and has been identified to be involved in cell wall integrity and virulence in several filamentous pathogenic fungi. However, the specific mechanisms by which Swi6 regulates the growth and pathogenicity of plant pathogenic fungi remain elusive. In this study, the SWI6 deletion mutants and complemented strains of C. fimbriata were generated. Deletion of Swi6 in C. fimbriata resulted in aberrant growth patterns. Pathogenicity assays on sweet potato storage roots revealed a significant decrease in virulence in the mutant. Non-targeted metabolomic analysis using LC-MS identified a total of 692 potential differentially accumulated metabolites (PDAMs) in the ∆Cfswi6 mutant compared to the wild type, and the results of KEGG enrichment analysis demonstrated significant enrichment of PDAMs within various metabolic pathways, including amino acid metabolism, lipid metabolism, nucleotide metabolism, GPI-anchored protein synthesis, and ABC transporter metabolism. These metabolic pathways were believed to play a crucial role in mediating the growth and pathogenicity of C. fimbriata through the regulation of CWI. Firstly, the deletion of the SWI6 gene led to abnormal amino acid and lipid metabolism, potentially exacerbating energy storage imbalance. Secondly, significant enrichment of metabolites related to GPI-anchored protein biosynthesis implied compromised cell wall integrity. Lastly, disruption of ABC transport protein metabolism may hinder intracellular transmembrane transport. Importantly, this study represents the first investigation into the potential regulatory mechanisms of SWI6 in plant filamentous pathogenic fungi from a metabolic perspective. The findings provide novel insights into the role of SWI6 in the growth and virulence of C. fimbriata, highlighting its potential as a target for controlling this pathogen.

Quantifying Isoprenoids in the Ergosterol Biosynthesis by Gas Chromatography-Mass Spectrometry

The ergosterol pathway is a promising target for the development of new antifungals since its enzymes are essential for fungal cell growth. Appropriate screening assays are therefore needed that allow the identification of potential inhibitors. We developed a whole-cell screening method, which can be used to identify compounds interacting with the enzymes of isoprenoid biosynthesis, an important part of the ergosterol biosynthesis pathway. The method was validated according to the EMEA guideline on bioanalytical method validation. Aspergillus fumigatus hyphae and Saccharomyces cerevisiae cells were lysed mechanically in an aqueous buffer optimized for the enzymatic deconjugation of isoprenoid pyrophosphates. The residual alcohols were extracted, silylated and analyzed by GC-MS. The obtained isoprenoid pattern provides an indication of the inhibited enzyme, due to the accumulation of specific substrates. By analyzing terbinafine-treated A. fumigatus and mutant strains containing tunable gene copies of erg9 or erg1, respectively, the method was verified. Downregulation of erg9 resulted in a high accumulation of intracellular farnesol as well as elevated levels of geranylgeraniol and isoprenol. The decreased expression of erg1 as well as terbinafine treatment led to an increased squalene content. Additional analysis of growth medium revealed high farnesyl pyrophosphate levels extruded during erg9 downregulation.