Synergy Over Monotherapy.

Pathogenic fungi, as an increasing global threat to human health, represent a sizable risk. However, significant attention should also be paid to the yeast biofilms. One promising strategy for combating resistant microbes, as well as fungal biofilms, is to extend the lifespan and efficacy of our currently employed drugs by using combination therapy. Since the application of combined therapy of fungal infections is currently accepted, we have decided to verify the efficacy of derivative H in combination with fluconazole on C. albicans biofilm. The main advantage of synergy over monotherapy lies in reducing or even completely preventing the induction of resistance of fungal cells. We have decided to verify the derivative H (1,4-dihydropyridine-2,3,5-tricarboxylate), an intermediate of nilvadipine synthesis, in the resistance of C. albicans to fluconazole. Therefore, we have focused on the influence of derivative H on the gene expression of the main C. albicans adhesin (ALS3), which is important for the tissue colonization during the infection process. Our results show that the newly synthesized derivative H had an impact on biofilm eradication. The effect of biofilm diminution could, therefore, be explained as derivative H preventing the adherence of C. albicans cells. This study supports even more the attractiveness of this substance as a potential agent that could be used in synergy with commonly used azoles to treat various fungal infections.

Synergy between azoles and 1,4-dihydropyridine derivative as an option to control fungal infections.

With emerging fungal infections and developing resistance, there is a need for understanding the mechanisms of resistance as well as its clinical impact while planning the treatment strategies. Several approaches could be taken to overcome the problems arising from the management of fungal diseases. Besides the discovery of novel effective agents, one realistic alternative is to enhance the activity of existing agents. This strategy could be achieved by combining existing antifungal agents with other bioactive substances with known activity profiles (combination therapy). Azole antifungals are the most frequently used class of substances used to treat fungal infections. Fluconazole is often the first choice for antifungal treatment. The aim of this work was to study potential synergy between azoles and 1,4-dihydropyridine-2,3,5-tricarboxylate (termed derivative H) in order to control fungal infections. This article points out the synergy between azoles and newly synthesized derivative H in order to fight fungal infections. Experiments confirmed the role of derivative H as substrate/inhibitor of fungal transporter Cdr1p relating to increased sensitivity to fluconazole. These findings, plus decreased expression of ERG11, are responsible for the synergistic effect.