Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.
Department of Chemistry and Center for Molecular Discovery (BU-CMD), Boston University, Boston, MA, USA.
Nat Commun. 2020 Dec 22;11(1):6429. doi: 10.1038/s41467-020-20183-3.
Candida 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.
耳念珠菌是一种新兴的真菌病原体,对多种药物具有耐药性,包括最常开的抗真菌药物氟康唑。在这里,我们使用组合筛选方法来鉴定一种双苯并二恶烷并吲哚啉酮(azoffluxin),它与氟康唑联合使用可以对抗耳念珠菌。Azoffluxin 通过抑制外排泵 Cdr1 增强氟康唑的活性,从而增加细胞内氟康唑水平。这种活性在大多数耳念珠菌进化枝中都得到了保留,除了进化枝 III。Azoffluxin 还抑制另一种人类真菌病原体白色念珠菌中高度唑类耐药株的外排,从而增加其对氟康唑的敏感性。此外,azoffluxin 增强了氟康唑在感染耳念珠菌的小鼠中的活性,降低了真菌负荷。我们的研究结果表明,药理学靶向 Cdr1 与唑类药物联合使用可能是控制耐唑类耳念珠菌分离株引起的感染的有效策略。