Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5219_Библиотеки_им_академика_М_И_Перельмана.pdf
X
- •Foreword
- •Preface
- •Contents
- •Editors and Contributors
- •About the Editors
- •Contributors
- •1.1 Introduction
- •1.2 Conventional Methods
- •1.2.1 Microscopy
- •1.2.2 Culture
- •1.2.3 Germ Tube Test
- •1.2.5 Carbohydrate Assimilation Test
- •1.2.6 Nitrogen Assimilation Test
- •1.2.7 Carbohydrate Fermentation Test
- •1.2.8 Urease Test
- •1.2.9 Tween 80 Opacity Test
- •1.3 Nonculture-Based Conventional Methods
- •1.3.1 Serological Methods
- •1.3.1.2 ß-d-Glucan
- •1.3.1.3 C. albicans Germ Tube Antibody Assay (CAGTA)
- •1.4 Nucleic Acid-Based Detection
- •1.4.1 Polymerase Chain Reaction (PCR)
- •1.4.3 Peptide Nucleic Acid FISH (PNA-FISH)
- •1.4.4 PCR-Based Innovative Diagnosis
- •1.4.5 FilmArray System
- •1.4.6 Sepsis Flow Chip
- •1.4.7 ePlex System
- •1.4.8 The T2 Candida Assay
- •1.5 Rapid Identification Systems
- •1.5.1 Manual Rapid Identification System
- •1.5.1.1 The API System
- •1.5.1.2 The VITEK System
- •1.5.2 Automatic Rapid Identification System
- •1.5.2.1 MALDI-TOF MS
- •1.5.2.2 The MALDI Sepsityper IVD Kit
- •1.5.2.3 The BioFire FilmArray BCID2 Panel
- •1.5.2.4 The Accelerate Pheno BC Panel
- •1.6 Advanced Diagnostics
- •1.6.2 Biosensor-Based Tests
- •1.6.3 Next-Generation Sequencing (NGS)
- •1.7 Conclusion
- •References
- •2.1 Introduction
- •2.2.1.2 Echinocandins
- •First-Generation Echinocandin
- •Second-Generation Echinocandin
- •2.2.1.3 Other Cell Wall Inhibitors
- •2.2.2.1 Azoles
- •Imidazole
- •Triazole
- •Second-Generation Azole
- •Third-Generation Azole
- •2.2.2.2 Polyenes
- •Other Polyene Under Development
- •2.2.2.3 Allylamines
- •2.2.3 Flucytosine
- •2.3 Conclusion
- •References
- •3.1 Introduction
- •3.2.1 Control Diet
- •3.2.3 Toxification
- •3.2.4 Alternative Treatments
- •3.3.1 Prophylaxis
- •3.3.2 Preemptive Therapies
- •3.3.3 Empirical Therapies
- •3.4 Therapeutic Approach
- •3.4.1 Azoles
- •3.4.2 Echinocandins
- •3.4.3 Polyenes
- •References
- •4.1 Introduction
- •4.3 Eukarya Domain
- •4.4.1 Cryptococcus
- •4.4.2 Aspergillus
- •4.4.3 Mucorales
- •4.4.4 Candida
- •4.5.1 Candida albicans
- •4.5.2 Morphogenesis
- •4.5.3 Pathogenesis
- •4.5.4 Adherence
- •4.5.5 Morphological Switching
- •4.5.6 Invasion
- •4.6 Induced Endocytosis
- •4.7 Active Penetration
- •4.8.2 Biofilm Formation
- •4.8.4.1 Antifungals
- •4.8.4.2 Antifungal Resistance
- •References
- •5.1 Introduction
- •5.2.3.1 Serum
- •5.2.3.2 Low Nitrogen
- •5.2.3.5 Carbon Source
- •5.2.3.6 pH
- •5.2.3.7 N-acetylglucosamine (GlcNAc)
- •5.2.3.8 Quorum Sensing Molecule
- •5.5.5 Surface Colonization Factor1 (SCF1)
- •5.5.6 Other Putative Adhesins
- •5.6.1 Phospholipases
- •5.6.2 Proteinases
- •5.6.3 Hemolysins
- •5.6.4 Lipases
- •5.7 Secreted Cytolytic Peptide: Candidalysin
- •5.5.1 ALS Family
- •5.5.2 HWP Adhesin
- •5.5.3 HYR/IFF Family
- •5.5.4 EPA Family
- •5.9.2 Low Molecular Weight Hsp/Small Heat Shock Proteins
- •5.10.1 Amino Acid/Nitrogen Metabolism
- •5.10.1.1 Amino Acid Sensing Pathway
- •5.12.1.1 Glycolysis
- •5.12.1.2 Gluconeogenesis
- •5.12.1.3 Glyoxylate Cycle
- •5.12.1.4 Fatty Acid Oxidation
- •5.12.3.2 Iron Metabolism
- •5.12.3.3 Candida Iron Transport
- •5.12.3.4 Reductive System
- •5.12.3.5 Siderophore Uptake System
- •5.12.3.6 Haemoglobin-Iron Uptake System
- •5.13.2 Zinc Metabolism
- •References
- •6.1 Introduction
- •6.2 Morphological Switching
- •6.3 Phenotypic Switching
- •6.4 Biofilm Formation
- •6.5 Metabolic Flexibility
- •6.8.1 Hemolysin
- •6.8.2 Phospholipases
- •6.8.3 Proteinase
- •6.8.4 Candidalysin
- •6.12 Conclusion
- •References
- •7.1 Introduction
- •7.2.4 Polymorphism
- •7.2.5.1 Secreted Aspartyl Proteinases
- •7.2.5.2 Phospholipase
- •7.2.6 Calcineurin-Signalling Pathway
- •7.2.7 Ion Homeostasis
- •7.2.7.1 Iron
- •7.2.7.2 Copper
- •7.2.8.1 Capsule
- •7.2.8.2 Melanin
- •7.2.8.3 Heat Shock Proteins
- •7.3 Conclusions
- •References
- •8.1 Introduction
- •8.4.1 ATP-Binding Cassette (ABC) Transporters
- •8.4.2 Major Facilitator Superfamily (MFS) Transporter
- •8.5.1 Biofilm Architecture Among Candida Species
- •References
- •9.1 Introduction
- •References
- •10.1 Introduction
- •10.3 Biofilm
- •10.5 Adherence
- •10.6 Maturation
- •10.8 Dispersion
- •10.11 Animal Models
- •10.18 Photodynamic Therapy
- •References
- •11.1 Introduction
- •11.9 Concluding Remarks
- •References
- •12.1 Introduction
- •12.2 Epidemiology
- •12.3.1 Humoral Response
- •12.3.2 Cellular Immunity
- •12.4 Virulence Factors
- •12.6.1 Fluconazole
- •12.6.2 Polyenes
- •12.6.3 Echinocandins
- •12.7 Drug Resistance
- •12.8 Future Prospects
- •12.9 Conclusions
- •References
- •13.1 Introduction
- •13.4 Translation Research
- •13.4.1 Disease-Oriented Translational Research
- •13.4.2 Lab-Oriented Translational Research
- •13.4.3 Patient-Oriented Translational Research
- •13.5 Conclusion
- •References
- •14.1 Introduction
- •14.2.3 Cutaneous Aspergillosis
- •14.2.4 Ocular Aspergillosis
- •14.2.5 Aspergillus Endocarditis
- •14.2.6 Aspergillus Osteomyelitis
- •14.2.7 Sinus Aspergillosis
- •14.3.2 Histopathology
- •14.3.3 Serological
- •14.3.4 Breath Testing
- •14.3.5 Monoclonal Antibody (mAbs)-Mediated Methods
- •14.4.1 Conventional Therapeutics
- •14.4.1.1 Azoles
- •14.4.1.2 Polyenes
- •14.4.1.3 Echinocandins
- •14.4.1.4 Fluoropyrimidines
- •14.5 Nonconventional Therapeutics
- •14.5.1 Vaccine
- •14.5.2 Monoclonal Antibodies (mAbs)
- •14.5.3 Nanotechnology-Based Therapeutics
- •14.5.4 Immune Therapy
- •14.5.5 Combination Therapy
- •14.8 Conclusion
- •References
- •15: Aspergillus Therapeutics: Future Agents
- •15.1 Introduction
- •15.2.1 Fosmanogepix
- •15.2.2 Ibrexafungerp
- •15.2.3 Olorofim
- •15.2.4 Opelconazole
- •15.2.5 Rezafungin
- •15.2.6 MGCD290
- •15.2.7 Tetrazoles (VT-1129/VT-1161/VT-1598)
- •15.2.8 Nikkomycin Z
- •15.2.9 VL-2397
- •15.2.10 T-2307/ATI-2307
- •15.2.11 Encochleated Amphotericin-B
- •15.2.12 SUBA-Itraconazole
- •15.2.13 Immunotherapy
- •15.2.14 Drug Repurposing
- •References
- •16.1 Introduction
- •16.2 Antifungal Agents
- •16.2.1 Azoles
- •16.2.2 Posaconazole
- •16.2.3 Isavuconazole
- •16.2.4 SUBA—Itraconazole
- •16.2.5 Nanovoriconazole
- •16.2.6 Adverse Effects
- •16.3 Liposomal Amphotericin B (LAMB)
- •16.3.1 Echinocandins
- •16.4 Combination Antifungal Therapy
- •16.5 Therapeutic Drug Monitoring (TDM)
- •16.5.1 Azole-Resistant Aspergillus Spp.
- •16.6 Guideline Recommendations
- •16.10 Conclusion
- •References
- •17.1 Introduction
- •17.3 Potent Antifungal Molecules Under Investigations
- •References
- •19.2 Host–A. fumigatus Interactions
- •19.3.1 Hydrophobicity or Rodlet Layer
- •19.3.2 Conidiation
- •19.3.3 DHN Melanin
- •19.3.5 Siderophores
- •19.3.6 Biofilm Formation
- •19.4 Conclusion
- •References

2 Fungal Fighters: A Comprehensive Guide to Antifungal Therapies of the Past…
57
Butenane Butenane is the benzyl derivative of terbinane and is superior to
terbinane and naftine in topical usage (Das etal. 2010). Butenane was made by
replacing the phenylpropene group with the toluene group, and like terbinane, the
isobutane group was attached to the second carbon of toluene. This change in the
side chain prole further increases the antifungal activity. Butenane was approved
for medical use in the year 1993.
Amorolne It is a morpholine derivative of naftine (Banerjee etal. 2011). The
phenylpropene group is replaced by 1-methylpropyl benzene, and an isobutane
group was attached to the benzene ring. Amorolne is used topically. It inhibits
sterol isomerase (Erg2) and C14 sterol reductase (Erg24), so reduces ergosterol
content and also causes the accumulation of ignosterol (Polak 1992). Amorolne is
in medical use from 1981 (Fig.2.2).
2.2.3 Flucytosine
Flucytosine or 5-uorocytosine is uorinated antibiotic and is very specic to fungus. It is used against candidiasis. It has low-off targets since it is taken up by cytosine permease and cleaved by the enzyme cytosine deaminase (Park etal. 2017).
This cytosine deaminase is only present in fungal cells and not in mammalian cells
(Delma et al. 2021). The cytosine deaminase converts 5-uorocytosine to
5- uorouracil and is further metabolized to form 5-uorodeoxyuridine monophosphate. This 5-uorodeoxyuridine monophosphate is a competitive inhibitor of thymidylate synthetase (Santi 1980). Thus, the formation of thymidine monophosphate
from deoxyuridine monophosphate which causes the lowering of the pool of
dTTP.Also, it can incorporate into DNA in the form of uorodeoxyuridine triphosphate and uorouridine triphosphate, causing cell cytotoxicity. Flucytosine should
not be used in patients suffering from hepatic and renal failure or with hematologic
insufciency. Patients suffering from acute candidemia should not be treated with
this drug alone as it will be insufcient and generally creates resistance (Lopes etal.
1979). It is generally used with amphotericin-B or itraconazole (Lopes etal. 1979).
Flucytosine can be given orally or intravenously and is well absorbed orally
(70–90%) (Brouwer etal. 2007).
2.3 Conclusion
As eukaryotic organisms, fungi have limited druggable targets, making it crucial to
develop effective antifungal strategies. However, the differences in the cell wall
composition provide potential targets for therapeutic intervention. The susceptibility of fungi to antifungal agents is exploited through targeting key pathways involved
in cell wall synthesis and ergosterol biosynthesis. First-generation echinocandins,
such as anidulafungin and caspofungin, have paved the way for second-generation

58
B. Biswas and A. Thakur
drugs like micafungin and rezafungin, demonstrating enhanced solubility and bioavailability. Interesting facts are how the drug discovery and various side chains
showed the structure-function relationship. Micafungin and its isoxazole ring system are discovered. It is observed that the lipophilicity or the partition coefcient is
the reason for the hemolytic property of the drug. It was observed that the more the
partition coefcient or alkyl side chain length, the more the hemolysis, and the
chain length of 7 was observed to be the chain length which has the highest lowest
MIC value. Thus, the lipophilicity was optimized according to the calculated partition coefcient value to (Clogp=6). With the advent of newer drugs, will the spectrum and diversity of the drugs help us ght drug resistance? Other cell wall
inhibitors, such as lufenuron, carvacrol, nikkomycin-Z, and polyoxins, will provide
additional options to target various cell wall synthesis pathway stages. These compounds exhibit inhibitory effects on chitin synthases and may further contribute to
the diversication of antifungal strategies.
The ergosterol biosynthetic pathway, vital for the membrane structure, serves as
a target for azole-class antifungals. The development of azoles, from the rstgeneration ketoconazole to the third-generation agents like voriconazole and
posaconazole, represents a milestone in combating fungal infections. We also
observe the structural and functional relationship between the various side chain
modications. We observed the upgradation from a two nitrogen imidazole system
to a three nitrogen triazole system, signicantly increased the resistance of the drugs
to acid and alkaline hydrolysis, as evidenced in uconazole compared to ketoconazole. Also, with the introduction of more electronegative halogens like uorine,
there is further increase in the binding of the antifungals with the CYP51. By inhibiting the fungal cytochrome p450 enzyme (CYP51 or Erg11), azoles disrupt ergosterol biosynthesis, contributing to their efcacy. The CYP51 or Erg11 is the fungal
cytochrome p450 and is responsible for xenobiotic degradation. Also, this enzyme
is responsible for the ergosterol biosynthesis. Thus, by function, even though the
CYP51 tries to clear the xenobiotic azole, in turn it gets inhibited by azole itself.
Now, the question arises why it is not able to be metabolized azole by the CYP51
like any other xenobiotic? Well, the answer lies in the mechanism. In the resting
state, cytochrome, a water molecule, remains bound to the heme moiety of CYP51.
The azole moiety of the drug breaks the hydrogen bonding between water and heme
by forming a pentacoordinate bond. This strong binding hampers electron transfer
to and oxygen binding further, and thus, the CYP51 could not perform oxidation
and thus could not break the cyclic structures (Balding etal. 2008).
The landscape of antifungal treatments is marked by the limitations of existing
drugs, manifesting in undesirable side effects, inefcacy against emerging fungal
strains, and the hastening development of resistance. Although around 1997, the
rst report of uconazole resistance arrived, and by 2007, it was alarming for the
use azole resistance (Denning 2022). A comprehensive understanding of the mechanisms of action and resistance associated with current antifungals serves as a cornerstone for the development of new and improved drugs to tackle fungal infections

2 Fungal Fighters: A Comprehensive Guide to Antifungal Therapies of the Past…
59
effectively. This imperative recognizes the urgent need for a next generation of antifungal agents capable of overcoming the shortcomings of their predecessors.
The imperative for innovation in antifungal therapies arises from the pressing
challenges that currently available drugs face. The emergence of resistance within
Candida species highlights the dynamic nature of fungal pathogens and necessitates
a continuous cycle of research and innovation in antifungal drug development. As
we delve into the complexities of drug resistance patterns, it becomes clear that a
proactive approach is required to stay ahead of evolving fungal threats. Also, taking
care of the vulnerabilities of host will help the patient to recover fungal diseases at
least from recurrent threats like in patients with particular comorbidities like diabetes and HIV. Blood sugar causes Candida to grow invivo and also the immune
system gets weaker with diabetes mellitus, and it is seen in patient studies
(Mohammed etal. 2021). Keeping the blood sugar level in check will help in proper
immune functioning and thus lowering the threat level. HIV specically targets
T-helper subsets and thus adaptive immunity perturbs. Th-17 on the other hand is
the immune cell subset designed to target fungal cells which also goes down in HIV
infection (Vautier etal. 2010; Wiche Salinas etal. 2021). Thus, having HIV drugs in
regular basis amongst HIV-infected patients will keep the fungal infection in check.
Moreover, the development of new and efcacious antifungal therapeutics is
required on an urgent basis in the scenario of persistent resistance observed in
Candida species against existing drugs. Talking of new therapeutic strategies, the
anticandida antibodies may show a good therapeutic response when administered to
patients. This will begin a plethora of immune reactions by innate and complement
systems even if the adaptive branch is not working. They can also benet critically
admitted ICU patients. This concept is called prophylaxis by vaccination (Pletz
etal. 2016). A similar therapy is being used for multidrug-resistant bacteria (Pletz
et al. 2016). A fewer resistance was observed in the case of the polyenes group
(Carolus etal. 2020). Although hepatotoxic, these drugs can cause lesser resistance
invivo. It is seen that it gains resistance invitro easily. A study report shows that
resistant strains exhibit severe tness trade-offs in vivo (Vincent etal. 2013). It
underscores the ongoing need for cutting-edge research and inventive strategies in
antifungal drug development. Insights gleaned from the current literature can provide a basis for understanding the intricacies of Candida infections and lay the
groundwork for future endeavours. The emphasis lies in identifying novel therapeutic targets and developing next-generation antifungals. These collective efforts aim
to mitigate the impact of fungal pathogens on global health, ensuring the continued
efcacy of treatments and fostering improved outcomes for patients grappling with
Candidiasis and other fungal-related conditions.
Keeping in mind the resistance pattern for existing drugs by various fungus
underscores the necessity of a diverse arsenal to combat resistance and address specic vulnerabilities in different fungal species. Continued research into novel compounds and innovative strategies is essential to stay ahead of emerging resistance
and improve the treatment of fungal infections.

60
B. Biswas and A. Thakur
References
Balding PR, Porro CS, McLean KJ, Sutcliffe MJ, Maréchal J-D, Munro AW, Visser SP (2008)
How do azoles inhibit cytochrome P450 enzymes? A density functional study. Chem Eur J
112:12911–12918
Balkovec JM, Hughes DL, Masurekar PS, Sable CA, Schwartz RE, Singh SB (2014) Discovery
and development of rst in class antifungal caspofungin (CANCIDAS®)—a case study. Nat
Prod Rep 31:15–34
Banerjee M, Ghosh AK, Basak S, Das KD, Gangopadhyay DN (2011) Comparative evaluation of
effectivity and safety of topical amorolne and clotrimazole in the treatment of tinea corporis.
Indian J Dermatol 56:657–662
Bardal SK, Waechter JE, Martin DS (2011) Chapter 18—Infectious diseases. In: Bardal SK,
Waechter JE, Martin DS (eds) Applied pharmacology. WB Saunders, Philadelphia, pp233–291.
https://doi.org/10.1016/B978- 1- 4377- 0310- 8.00018- X
Bellmann R, Smuszkiewicz P (2017) Pharmacokinetics of antifungal drugs: practical implications
for optimized treatment of patients. Infection 45:737–779
Ben-Ziony Y, Arzi B (2000) Use of lufenuron for treating fungal infections of dogs and cats: 297
cases (1997–1999). J Am Vet Med Assoc 217:1510–1513
Berg D, Regel E, Harenberg HE, Plempel M (1984) Bifonazole and clotrimazole. Their mode of
action and the possible reason for the fungicidal behaviour of bifonazole. Arzneimittelforschung
34:139–146
Birch M, Sibley G (2017) 5.22—Antifungal chemistry review. In: Chackalamannil S, Rotella D,
Ward SE (eds) Comprehensive medicinal chemistry III.Elsevier, Oxford, pp703–716. https://
doi.org/10.1016/B978- 0- 12- 409547- 2.12410- 2
Bladin JA (1885) Ueber von dicyanphenylhydrazin abgeleitete verbindungen. Ber Dtsch Chem
Ges 18:1544–1551
Borzyszkowska-Bukowska J, Górska J, Szczeblewski P, Laskowski T, Gabriel I, Jurasz J,
Kozłowska-Tylingo K, Szweda P, Milewski S (2021) Quest for the molecular basis of improved
selective toxicity of all-trans isomers of aromatic heptaene macrolide antifungal antibiotics. Int
J Mol Sci 22(18):10108
Bouffard FA, Zambias RA, Dropinski JF, Balkovec JM, Hammond ML, Abruzzo GK, Bartizal
KF, Marrinan JA, Kurtz MB etal (1994) Synthesis and antifungal activity of novel cationic
pneumocandin Bo derivatives. J Med Chem 37:222–225
Bozorov K, Zhao J, Aisa HA (2019) 1,2,3-triazole-containing hybrids as leads in medicinal chem-
istry: a recent overview. Bioorg Med Chem 27:3511–3531
Brautaset T, Sekurova ON, Sletta H, Ellingsen TE, Strøm AR, Valla S, Zotchev SB (2000)
Biosynthesis of the polyene antifungal antibiotic nystatin in Streptomyces noursei ATCC
11455: analysis of the gene cluster and deduction of the biosynthetic pathway. Chem Biol
7:395–403
Brouwer AE, van Kan HJ, Johnson E, Rajanuwong A, Teparrukkul P, Wuthiekanun V, Chierakul
W, Day N, Harrison TS (2007) Oral versus intravenous ucytosine in patients with human
immunodeciency virus-associated cryptococcal meningitis. Antimicrob Agents Chemother
51:1038–1042
Byers B, Goetsch L (1976a) A highly ordered ring of membrane-associated laments in budding
yeast. J Cell Biol 69:717–721
Byers B, Goetsch L (1976b) Loss of the lamentous ring in cytokinesis-defective mutants of bud-
ding yeast. J Cell Biol 70:35
Cao X, Yang S, Cao C, Zhou YJ (2020) Harnessing sub-organelle metabolism for biosynthesis of
isoprenoids in yeast. Synth Syst Biotechnol 5:179–186
Carolus H, Pierson S, Lagrou K, Van Dijck P (2020) Amphotericin B and other polyenes- discovery,
clinical use, mode of action and drug resistance. J Fungi (Basel) 6(4):321
Chen L, Krekels EHJ, Verweij PE, Buil JB, Knibbe CAJ, Brüggemann RJM (2020) Pharmacokinetics
and pharmacodynamics of posaconazole. Drugs 80:671–695

2 Fungal Fighters: A Comprehensive Guide to Antifungal Therapies of the Past…
Chen SC-A, Slavin MA, Sorrell TC (2011) Echinocandin antifungal drugs in fungal infections: a
comparison. Drugs 71:11–41
Dähn U, Hagenmaier H, Höhne H, König W, Wolf G, Zähner H (1976) Stoffwechselprodukte von
mikroorganismen. 154. Mitteilung. Nikkomycin, ein neuer hemmstoff der chitinsynthese bei
pilzen. Arch Microbiol 107:143–160
Das S, Barbhuniya JN, Biswas I, Bhattacharya S, Kundu PK (2010) Studies on comparison of the
efcacy of terbinane 1% cream and butenane 1% cream for the treatment of Tinea cruris.
Indian Dermatol Online J 1:8–9
Delma FZ, Al-Hatmi AMS, Brüggemann RJM, Melchers WJG, de Hoog S, Verweij PE, Buil JB
(2021) Molecular mechanisms of 5-uorocytosine resistance in yeasts and lamentous fungi.
J Fungi (Basel) 7(11):909
Denning DW (2022) Antifungal drug resistance: an update. Eur J Hosp Pharm 29:109–112
Dixon DM, Walsh TJ (1996) Antifungal agents. In: Baron S (ed) Medical microbiology, 4th edn.
Univ of Texas, Galveston
Fernandes C, Gow NA, Gonçalves T (2016) The importance of subclasses of chitin synthase
enzymes with myosin-like domains for the tness of fungi. Fungal Biol Rev 30:1–14
Ford SK, Pringle JR (1991) Cellular morphogenesis in the Saccharomyces cerevisiae cell cycle:
localization of the CDC11 gene product and the timing of events at the budding site. Dev Genet
12:281–292
Fromtling RA, Abruzzo GK (1989) L-671,329, a new antifungal agent. III.In vitro activity, toxic-
ity and efcacy in comparison to aculeacin. J Antibiot (Tokyo) 42:174–178
Garcia-Effron G (2020) Rezafungin-mechanisms of action, susceptibility and resistance: similari-
ties and differences with the other echinocandins. J Fungi (Basel) 6(4):262
Goodman L, Gilman A, Hart N (1943) Preliminary investigations on the pharmacology of benz-
imidazole. Fed Proc 2:80
Gow NAR, Latge J-P, Munro CA (2017) The fungal cell wall: structure, biosynthesis, and function.
Microbiol Spectr 5. https://doi.org/10.1128/microbiolspec.funk- 0035- 2016
Grabińska KA, Edani BH, Park EJ, Kraehling JR, Sessa WC (2017) A conserved C-terminal RXG
motif in the NgBR subunit of cis-prenyltransferase is critical for prenyltransferase activity. J
Biol Chem 292:17351–17361
Gupta AK, Venkataraman M, Shear NH, Piguet V (2020) Labeled use of enaconazole topical
solution 10% in treating onychomycosis in children and a review of the management of pedi-
atric onychomycosis. Dermatol Ther 33:e13613
Gupta AK, Mays RR, Foley KA (2021) 42—Topical antifungal agents. In: Wolverton SE (ed)
Comprehensive dermatologic drug therapy, 4th edn. Elsevier, pp 480–492.e5. https://doi.
org/10.1016/B978- 0- 323- 61211- 1.00042- 5
Haarer BK, Pringle JR (1987) Immunouorescence localization of the Saccharomyces cerevisiae
CDC12 gene product to the vicinity of the 10-nm laments in the mother-bud neck. Mol Cell
Biol 7(10):3678–3687
Hammoudi Halat D, Younes S, Mourad N, Rahal M (2022) Allylamines, benzylamines, and fungal
cell permeability: a review of mechanistic effects and usefulness against fungal pathogens.
Membranes (Basel) 12(12):1171
Hashimoto S (2009) Micafungin: a sulfated echinocandin. J Antibiot 62:27–35
Heeres J, Meerpoel L, Lewi P (2010) Conazoles. Molecules 15:4129–4188
Holt RJ (1976) Topical pharmacology of imidazole antifungals. J Cutan Pathol 3:45–59
Jiang K, Luo P, Wang X, Lu L (2024) Insight into advances for the biosynthetic progress of fer-
mented echinocandins of antifungals. Microb Biotechnol 17(1):e14359
Kim HB, Haarer BK, Pringle JR (1991) Cellular morphogenesis in the Saccharomyces cerevisiae
cell cycle: localization of the CDC3 gene product and the timing of events at the budding site.
J Cell Biol 112:535–544
Kim H-J, Han C-Y, Park J-S, Oh S-H, Kang S-H, Choi S-S, Kim J-M, Kwak J-H, Kim E-S (2018)
Nystatin-like Pseudonocardia polyene B1, a novel disaccharide-containing antifungal heptaene
antibiotic. Sci Rep 8:13584
61

62
Lakota EA, Ong V, Flanagan S, Rubino CM (2018) Population pharmacokinetic analyses for
Rezafungin (CD101) efcacy using phase 1 data. Antimicrob Agents Chemother 62(6):e02603–
e02617. https://doi.org/10.1128/aac.02603- 17
Lampen JO, Arnow PM, Safferman RS (1960) Mechanism of protection by sterols against polyene
antibiotics. J Bacteriol 80:200–206
Larwood DJ (2020) Nikkomycin Z-ready to meet the promise? J Fungi (Basel) 6(4):261
Lin TS, Chen B, Chiang YM, Wang CCC (2019) Discovery and elucidation of the biosynthesis of
aspernidgulenes: novel polyenes from Aspergillus nidulans by using serial promoter replace-
ment. Chembiochem 20:329–334
Lopes CF, Resende MA, Alvarenga RJ, Moreira YK (1979) Combination of 5-uorocytosine and
amphotericin B in the treatment of chromomycosis. Med Cutan Ibero Lat Am 7:1–7
Lu S, Zhou C, Guo X, Du Z, Cheng Y, Wang Z, He X (2022) Enhancing uxes through the meval-
onate pathway in Saccharomyces cerevisiae by engineering the HMGR and β-alanine metabo-
lism. Microb Biotechnol 15:2292–2306
Luthra U, Trivedi A, Khadpekar S (2014) Screening for signicant medium components for
Pneumoncandin B0 production at shake ask level through factorial design. Am Int J Contemp
Res 1(2):89–93
Marr KA, Crippa F, Leisenring W, Hoyle M, Boeckh M, Balajee SA, Nichols WG, Musher B,
Corey L (2004) Itraconazole versus uconazole for prevention of fungal infections in patients
receiving allogeneic stem cell transplants. Blood 103:1527–1533
Matin MM, Matin P, Rahman MR, Ben Hadda T, Almalki FA, Mahmud S, Ghoneim MM,
Alruwaily M, Alshehri S (2022) Triazoles and their derivatives: chemistry, synthesis, and thera-
peutic applications. Front Mol Biosci 9:864286
Mieth H (1990) The early development of allylamine antimycotics. J Dermatol Treat 1:5–6
Mohammed L, Jha G, Malasevskaia I, Goud HK, Hassan A (2021) The interplay between sugar
and yeast infections: do diabetics have a greater predisposition to develop oral and vulvovagi-
nal candidiasis? Cureus 13:e13407
Murphy SE, Bicanic T (2021) Drug resistance and novel therapeutic approaches in invasive candi-
diasis. Front Cell Infect Microbiol 11:759408
Nigam M (2021) Chapter 3—Phytomedicine: scope and current highlights. In: Egbuna C, Mishra
AP, Goyal MR (eds) Preparation of phytopharmaceuticals for the management of disorders.
Academic Press, pp39–54. https://doi.org/10.1016/B978- 0- 12- 820284- 5.00013- 7
Niu C, Wang C, Yang Y, Chen R, Zhang J, Chen H, Zhuge Y, Li J, Cheng J, Xu K, Chu M, Ren C,
Zhang C, Jia C (2020) Carvacrol induces Candida albicans apoptosis associated with ca(2+)/
calcineurin pathway. Front Cell Infect Microbiol 10:192
Nix DE, Swezey RR, Hector R, Galgiani JN (2009) Pharmacokinetics of nikkomycin Z after single
rising oral doses. Antimicrob Agents Chemother 53:2517–2521
Nyfeler R, Keller-Schierlein W (1974) Metabolites of microorganisms. 143. Echinocandin B, a
novel polypeptide-antibiotic from Aspergillus nidulans var. echinulatus: isolation and struc-
tural components. Helv Chim Acta 57:2459–2477
Ohwada J, Murasaki C, Yamazaki T, Ichihara S, Umeda I, Shimma N (2002) Synthesis of novel
water soluble benzylazolium prodrugs of lipophilic azole antifungals. Bioorg Med Chem Lett
12:2775–2780
Papich MG (2016) Lufenuron. In: Papich MG (ed) Saunders handbook of veterinary drugs, 4th edn.
W.B.Saunders, St. Louis, pp461–463. https://doi.org/10.1016/B978- 0- 323- 24485- 5.00347- 8
Park N-H, Shin K-H, Kang MK (2017) 34—Antifungal and antiviral agents. In: Dowd FJ,
Johnson BS, Mariotti AJ (eds) Pharmacology and therapeutics for dentistry, 7th edn. Mosby,
pp488–503. https://doi.org/10.1016/B978- 0- 323- 39307- 2.00034- 5
Partha ADSL, Widodo ADW, Endraswari PD (2022) Evaluation of uconazole, itraconazole, and
voriconazole activity on Candida albicans: a case control study. Ann Med Surg 84:104882
Pasqualotto AC, Thiele KO, Goldani LZ (2010) Novel triazole antifungal drugs: focus on isavuco-
nazole, ravuconazole and albaconazole. Curr Opin Investig Drugs 11:165–174
Pletz MW, Uebele J, Götz K, Hagel S, Bekeredjian-Ding I (2016) Vaccines against major ICU
pathogens: where do we stand? Curr Opin Crit Care 22:470–476
B. Biswas and A. Thakur

2 Fungal Fighters: A Comprehensive Guide to Antifungal Therapies of the Past…
Polak A (1992) Preclinical data and mode of action of amorolne. Dermatology 184(Suppl 1):3–7
Pulver R, Heisel T, Gonia S, Robins R, Norton J, Haynes P, Gale CA (2013) Rsr1 focuses Cdc42
activity at hyphal tips and promotes maintenance of hyphal development in Candida albicans.
Eukaryot Cell 12:482–495
Ren Z, Chhetri A, Guan Z, Suo Y, Yokoyama K, Lee SY (2022) Structural basis for inhibition and
regulation of a chitin synthase from Candida albicans. Nat Struct Mol Biol 29:653–664
Sagatova AA, Keniya MV, Wilson RK, Monk BC, Tyndall JD (2015) Structural insights into bind-
ing of the antifungal drug uconazole to Saccharomyces cerevisiae lanosterol 14α-demethylase.
Antimicrob Agents Chemother 59:4982–4989
Sanders SL, Field CM (1995) Cell division: bud-site selection is only skin deep. Curr Biol
5:1213–1215
Sanglard D, Ischer F, Parkinson T, Falconer D, Bille J (2003) Candida albicans mutations in the
ergosterol biosynthetic pathway and resistance to several antifungal agents. Antimicrob Agents
Chemother 47:2404–2412
Santi DV (1980) Perspectives on the design and biochemical pharmacology of inhibitors of thymi-
dylate synthetase. J Med Chem 23:103–111
Sawyer PR, Brogden RN, Pinder RM, Speight TM, Avery (1975) Clotrimazole: a review of its
antifungal activity and therapeutic efcacy. Drugs 9:424–447
Schaude M, Ackerbauer H, Mieth H (1987) Inhibitory effect of antifungal agents on germ tube
formation in Candida albicans. Mykosen 30:281–287
Schwartz RE, Giacobbe RA, Bland JA, Monaghan RL (1989) L-671,329, a new antifungal agent.
I.Fermentation and isolation. J Antibiot (Tokyo) 42:163–167
Siwach A, Verma PK (2021) Synthesis and therapeutic potential of imidazole containing com-
pounds. BMC Chem 15:12
Spierer O, Dugar J, Miller D, OʼBrien TP. (2015) Comparative antifungal susceptibility analysis of
Candida albicans versus non-albicans Candida corneal isolates. Cornea 34:576–579
Spitzer M, Wiederhold NP (2018) Reduced antifungal susceptibility of vulvovaginal candida spe-
cies at normal vaginal pH levels: clinical implications. J Low Genit Tract Dis 22:152–158
Staśkiewicz A, Ledwoń P, Rovero P, Papini AM, Latajka R (2021) Triazole-modied peptidomi-
metics: an opportunity for drug discovery and development. Front Chem 9:674705
Szwarc K, Szczeblewski P, Sowiński P, Borowski E, Pawlak J (2015) The stereostructure of can-
dicidin D.J Antibiot 68:504–510
Taber WA, Vining LC, Waksman SA (1954) Candidin, a new antifungal antibiotic produced by
streptomyces viridoavus. Antibiot Chemother (Northeld) 4:455–461
Tassel D, Madoff MA (1968) Treatment of Candida sepsis and Cryptococcus meningitis with
5-uorocytosine: a new antifungal agent. JAMA 206:830–832
Tomishima M, Ohki H, Yamada A, Maki K, Ikeda F (2008a) Novel echinocandin antifungals.
Part 1: novel side-chain analogs of the natural product FR901379. Bioorg Med Chem Lett
18:1474–1477
Tomishima M, Ohki H, Yamada A, Maki K, Ikeda F (2008b) Novel echinocandin antifungals. Part
2: optimization of the side chain of the natural product FR901379. Discovery of micafungin.
Bioorg Med Chem Lett 18:2886–2890
Ueda Y, Matiskella JD, Golik J, Connolly TP, Hudyma TW, Venkatesh S, Dali M, Kang SH,
Barbour N, Tejwani R, Varia S, Knipe J, Zheng M, Mathew M, Mosure K, Clark J, Lamb L,
Medin I, Gao Q, Huang S, Chen CP, Bronson JJ (2003) Phosphonooxymethyl prodrugs of the
broad spectrum antifungal azole, ravuconazole: synthesis and biological properties. Bioorg
Med Chem Lett 13:3669–3672
Vautier S, Sousa Mda G, Brown GD (2010) C-type lectins, fungi and Th17 responses. Cytokine
Growth Factor Rev 21:405–412
Vázquez-González D, Perusquía-Ortiz AM, Hundeiker M, Bonifaz A (2013) Opportunistic yeast
infections: candidiasis, cryptococcosis, trichosporonosis and geotrichosis. J Dtsch Dermatol
Ges 11:381–394
63

64
Veraldi S (2013) Isoconazole nitrate: a unique broad-spectrum antimicrobial azole effective in the
treatment of dermatomycoses, both as monotherapy and in combination with corticosteroids.
Mycoses 56(Suppl 1):3–15
Vincent BM, Lancaster AK, Scherz-Shouval R, Whitesell L, Lindquist S (2013) Fitness trade-offs
restrict the evolution of resistance to amphotericin B.PLoS Biol 11:e1001692
Wang X, Mohammad IS, Fan L, Zhao Z, Nurunnabi M, Sallam MA, Wu J, Chen Z, Yin L, He W
(2021) Delivery strategies of amphotericin B for invasive fungal infections. Acta Pharm Sin B
11:2585–2604
Wiche Salinas TR, Zhang Y, Sarnello D, Zhyvoloup A, Marchand LR, Fert A, Planas D, Lodha
M, Chatterjee D, Karwacz K, Oxenford S, Routy J-P, Irlbeck D, Amrine-Madsen H, Ancuta P,
Fassati A (2021) Th17 cell master transcription factor RORC2 regulates HIV-1 gene expression
and viral outgrowth. Proc Natl Acad Sci USA 118:e2105927118
Wichmann CF, Liesch JM, Schwartz RE (1989) L-671,329, a new antifungal agent. II.Structure
determination. J Antibiot (Tokyo) 42:168–173
Woolley D, White A (1943) Selective reversible inhibition of microbial growth with pyrithiamine.
J Exp Med 78:489–497
Woolley DW (1944) Some biological effects produced by benzimidazole and their reversal by
purines. J Biol Chem 152:225–232
Zhang B, Zhou YT, Jiang SX, Zhang YH, Huang K, Liu ZQ, Zheng YG (2020) Amphotericin B
biosynthesis in Streptomyces nodosus: quantitative analysis of metabolism via LC-MS/MS
based metabolomics for rational design. Microb Cell Factories 19:18
Zhang D, Miller MJ (1999) Polyoxins and nikkomycins: progress in synthetic and biological stud-
ies. Curr Pharm Des 5:73–99
Zhao L, Wang J, Zhang H, Wang P, Wang C, Zhou Y, Li H, Yu S, Wu R (2023) Inhibitory effect
of carvacrol against Alternaria alternata causing goji fruit rot by disrupting the integrity and
composition of cell wall. Front Microbiol 14:1139749
B. Biswas and A. Thakur

Candidiasis Treatment: AnEvolutionary
Journey fromPast toPresent
andaGlimpse into theFuture
MdNazmulIslamBappy, TanjinBarketullahRobin,
andKaziMd.AliZinnah
Abstract
The therapy of invasive candidiasis has evolved signicantly over the last
decade and must continue to adapt if we are to improve outcomes in this deadly
infection. The treatment choices for this illness are numerous. The right tech-
nique must be selected based on the circumstances and the patient prole; occa-
sionally, a combination of strategies is advised. Azoles, polyenes, and
echinocandins are the three main therapeutic classes that are widely utilized.
The success of those innovations is threatened by the rise in antibiotic resis-
tance, though, which is encouraging researchers to keep looking for alterna-
tives. Future changes to the management of invasive candidiasis may be
inuenced by these advancements as well as the continuous research underway
on dose, toxicity, and resistance development.
3
Keywords
Candida · Candidiasis · Phytocompound · Prophylaxis · Antifungal
M. N. I. Bappy · K. M. A. Zinnah (*)
Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University,
Sylhet, Bangladesh
Department of Animal and Fish Biotechnology, Sylhet Agricultural University,
Sylhet, Bangladesh
e-mail: zinnah.afb@sau.ac.bd
T. B. Robin
Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University,
Sylhet, Bangladesh
© The Author(s), under exclusive license to Springer Nature Singapore Pte
Ltd. 2024
S. Hameed, P. Vijayaraghavan (eds.), Recent Advances in Human Fungal
Diseases, https://doi.org/10.1007/978-981-97-4909-6_3
65

66
M. N. I. Bappy et al.
3.1 Introduction
Treatment for candida is incredibly successful. Although unpleasant, symptoms
start disappearing as soon as treatment starts, and depending on the type and severity of the infection, infections can clear up entirely in 2–3days or even up to 2weeks
(Graninger etal. 1993; Ruhnke etal. 2011). The symptoms will cause irritation and
discomfort if left untreated and may worsen over time. However, due to growing
antimicrobial resistance as well as the fact that there are far fewer treatment classes
for fungal infections than for bacterial diseases, fungal infections have become a
major threat to the world’s population in recent decades.
Antifungal medications are used orally (pill, lozenge, or liquid) or topically
(cream or ointment) in all candidiasis treatments (Rautemaa and Ramage 2011).
However, determining how to apply or take the medication and for how long is crucial because each antifungal medication has specic instructions. The age of the
patients, immune system, the location, and the severity of the infection all inuence
the type and dose of antifungal drugs used to treat invasive candidiasis. First-line
recommended antifungal treatment for most adults is intravenous (IV) injection of
an echinocandin (caspofungin, micafungin, or anidulafungin) (Chen etal. 2011). In
certain cases, other antifungal medications such as uconazole (FLZ) and amphotericin B (AMB) may also be appropriate. Following the prescribed treatment plan
by the healthcare provider is crucial to eradicate the infection and prevent its recurrence, as candidiasis may return even after treatment.
3.2 General Strategies forCandidiasis Treatments
Though several recommendations/interventions are required depending on the individual patient, Candida reduction and control is the best complementary treatment
(Martins etal. 2014). In most cases, direct therapy for the destruction of Candida
species is crucial as it helps the body to lower the levels of Candida species to levels
that are manageable (Murray and Pizzorno 1998; Balch and Stengler 2004; Longe
2005; Balch 2006). However, additional approaches like diet and nutrition, immune
system enhancement, detoxication, and alternative treatments might be needed
based on the patient’s prole. This chapter will discuss those common candidiasis
treatment strategies.
3.2.1 Control Diet
Following a specic diet is essential for the treatment of candidiasis because certain
dietary factors inuence and promote the growth of Candida spp. Rened sugars
like sucrose, fruit juice, honey, and other sweet foods should be avoided because
they thrive in sugary environments (Rusu etal. 2020). One should stay away from
alcoholic drinks, cheeses, bread, dried fruits, fermented goods, milk, and dairy
products because of the high lactose content and, occasionally, the trace amounts of
Соседние файлы в папке Библиотека им академика М.И. Перельмана
