Lee Yunjin, Robbins Nicole, Cowen Leah E
Department of Molecular Genetics, University of Toronto, Toronto, ON M5G 1M1 Canada.
NPJ Antimicrob Resist. 2023;1(1):5. doi: 10.1038/s44259-023-00007-2. Epub 2023 Jul 17.
Fungal pathogens are a severe public health problem. The leading causative agents of systemic fungal infections include species from the , , and genera. As opportunistic pathogens, these fungi are generally harmless in healthy hosts; however, they can cause significant morbidity and mortality in immunocompromised patients. Despite the profound impact of pathogenic fungi on global human health, the current antifungal armamentarium is limited to only three major classes of drugs, all of which face complications, including host toxicity, unfavourable pharmacokinetics, or limited spectrum of activity. Further exacerbating this issue is the growing prevalence of antifungal-resistant infections and the emergence of multidrug-resistant pathogens. In this review, we discuss the diverse strategies employed by leading fungal pathogens to evolve antifungal resistance, including drug target alterations, enhanced drug efflux, and induction of cellular stress response pathways. Such mechanisms of resistance occur through diverse genetic alterations, including point mutations, aneuploidy formation, and epigenetic changes given the significant plasticity observed in many fungal genomes. Additionally, we highlight recent literature surrounding the mechanisms governing resistance in emerging multidrug-resistant pathogens including and . Advancing our knowledge of the molecular mechanisms by which fungi adapt to the challenge of antifungal exposure is imperative for designing therapeutic strategies to tackle the emerging threat of antifungal resistance.
真菌病原体是一个严重的公共卫生问题。系统性真菌感染的主要病原体包括来自曲霉属、念珠菌属和隐球菌属的菌种。作为机会性病原体,这些真菌在健康宿主中通常无害;然而,它们可在免疫功能低下的患者中导致显著的发病率和死亡率。尽管致病真菌对全球人类健康有深远影响,但目前的抗真菌药物库仅限于三大类药物,所有这些药物都面临并发症,包括宿主毒性、不良药代动力学或有限的活性谱。抗真菌耐药感染的日益流行和多重耐药病原体的出现进一步加剧了这一问题。在本综述中,我们讨论了主要真菌病原体为产生抗真菌耐药性而采用的多种策略,包括药物靶点改变、增强药物外排以及诱导细胞应激反应途径。这种耐药机制通过多种基因改变发生,包括点突变、非整倍体形成以及鉴于在许多真菌基因组中观察到的显著可塑性而产生的表观遗传变化。此外,我们强调了围绕新兴多重耐药病原体(包括耳念珠菌和烟曲霉)耐药机制的最新文献。深入了解真菌适应抗真菌暴露挑战的分子机制对于设计应对抗真菌耐药性这一新兴威胁的治疗策略至关重要。
NPJ Antimicrob Resist. 2023
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