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Cited by 171Antifungal resistance and susceptibilityFungal and yeast genetics researchFungal Plant Pathogen Control

Paradoxical Effect of Echinocandins across Candida Species In Vitro: Evidence for Echinocandin-Specific and Candida Species-Related Differences

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Chamilos, Georgios, Lewis, Russell E., Albert, Nathaniel, Kontoyiannis, Dimitrios P.·2007·Antimicrobial Agents and Chemotherapy
DOI 10.1128/aac.00095-07PMC PMC1891358
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Abstract

Paradoxical growth of some Candida isolates occurs at concentrations above the MIC for echinocandins. In 60 Candida bloodstream isolates from cancer patients (20 C. albicans isolates and 10 isolates each of C. parapsilosis, C. tropicalis, C. krusei, and C. glabrata), paradoxical growth was more frequent with caspofungin than micafungin or anidulafungin, was unrelated to MIC, and was strikingly absent in C. glabrata isolates.

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Crossref · 10.1128/aac.00095-07

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  • Chitin content increased following caspofungin treatment, with higher intensities observed for the signature Ch4 and Ch2 peaks.

    “Conversely, the chitin content increased, with higher intensities observed for the signature Ch4 and Ch2 peaks, reflecting the induction of the classical chitin upregulation compensatory mechanism that has been identified in different fungal species in response to echinocandin treatment28,77–79.”

    From Distinct echinocandin responses of Candida albicans and Candida auris cell walls revealed by solid-state NMR (2025) · cites this paper as [77]

    The introductory passage labeled Abstract reports a compensatory increase in cell-wall chitin synthesis in a single C. albicans isolate exhibiting paradoxical growth under caspofungin. It does not establish chitin upregulation across different fungal species, and the paper reports no Ch4 or Ch2 peak measurements. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • EUCAST or CLSI methods are not recommended for testing susceptibility towards caspofungin due to a lack of reproducibility across laboratories or drug batches and paradoxical growth of Candida at concentrations above MIC.

    “For example, these methods are not recommended for testing the susceptibility towards caspofungin (an echinocandin), given a lack of reproducibility across laboratories or even drug batches [120] and the paradoxical growth of Candida at concentrations above MIC [121].”

    From Evolutionary Emergence of Drug Resistance in Candida Opportunistic Pathogens (2018) · cites this paper as [121]

  • A paradoxical echinocandin effect has been observed in which increased Candida growth is detected at higher than MIC drug concentrations.

    “A paradoxical (or eagle) echinocandin effect has been observed in which increased Candida growth is detected at higher than MIC drug concentrations.”

    From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [37]

  • The paradoxical echinocandin effect is more pronounced with caspofungin than with other echinocandins, is unrelated to MIC, appears to be most common with C. albicans and C. dubliniensis, and is strikingly absent in C. glabrata.

    “This effect is more pronounced with caspofungin than with other echinocandins, is unrelated to MIC, appears to be most common with C. albicans and C. dubliniensis, and is strikingly absent in C. glabrata [37,38,39].”

    From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [37]

  • Several Candida species isolates observed in vitro reflect a high-dose paradox linked to a complex network of pathways, causing slightly elevated MIC levels, in which cells appear to regain susceptibility at high levels of a drug.

    “Several Candida species isolates observed in vitro reflect a curious high-dose paradox which is being linked to a complex network of pathways, causing slightly elevated MIC levels, in which cells appear to regain susceptibility at high levels of a drug [127,128].”

    From Candida glabrata Biofilms: How Far Have We Come? (2017) · cites this paper as [128]

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Authors
Chamilos, G., Lewis, R. E., Albert, N., & Kontoyiannis, D. P.
Affiliations
  • The University of Texas MD Anderson Cancer Center (US)
  • University of Houston (US)
Corresponding author
Kontoyiannis, Dimitrios P.
ORCID
Venue
Antimicrobial Agents and Chemotherapy
Publisher
American Society for Microbiology
Published
2007-06
Volume
51
Issue
6
Pages
2257-2259
ISSN
  • 0066-4804 (ISSN-L)
  • 1098-6596
DOI
10.1128/aac.00095-07
PMC
PMC1891358
OpenAlex
W2159338055
Cited by
171
References
14
Citations by year
2026: 5 · 2025: 5 · 2023: 3 · 2022: 4 · 2021: 4 · 2020: 6 · 2019: 10 · 2018: 9 · 2017: 12 · 2016: 7 · 2015: 8 · 2014: 1 · 2013: 15 · 2012: 8
FWCI
11.76
Type
journal article
Language
en
Open access
Licence
journals.asm.org/non-commercial-tdm-license (tdm)
Locations
  • Antimicrobial Agents and Chemotherapy (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
  • Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Keywords
echinocandins, Candida, caspofungin, micafungin, anidulafungin, Candida albicans, Candida parapsilosis, Candida tropicalis, Candida krusei, Candida glabrata, bloodstream candidiasis, antifungal susceptibility
MeSH terms
Antifungal Agents, Candida, Candidiasis, Culture Media, Humans, Microbial Sensitivity Tests, Neoplasms, Peptides, Cyclic, Species Specificity, Fungemia

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