Cited by 276Antifungal resistance and susceptibilityFungal and yeast genetics researchFungal Plant Pathogen Control

Current Perspectives on Echinocandin Class Drugs

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Perlin, David S·2011·Future Microbiology

Abstract

It has been nearly a decade since caspofungin was approved for clinical use as the first echinocandin class antifungal agent, followed by micafungin and anidulafungin. The echinocandin drugs target the fungal cell wall by inhibiting the synthesis of β-1,3-D-glucan, a critical cell wall component of many pathogenic fungi. They are fungicidal for Candida spp. and fungistatic for moulds, such as Aspergillus fumigatus, where they induce abnormal morphology and growth properties. The echinocandins have a limited antifungal spectrum but are highly active against most Candida spp., including azole-resistant strains and biofilms. As they target glucan synthase, an enzyme absent in mammalian cells, the echinocandins have a favorable safety profile. They show potent MIC and epidemiological cutoff values against susceptible Candida and Aspergillus isolates, and the frequency of resistance is low. When clinical breakthrough occurs, it is associated with high MIC values and mutations in Fks subunits of glucan synthase, which can reduce the sensitivity of the enzyme to the drug by several thousand-fold. Such strains were not adequately captured by an early clinical breakpoint for susceptibility prompting a revised lower value, which addresses the FKS resistance mechanism and new pharmacokinetic/pharmacodynamic studies. Elevated MIC values unlinked to therapeutic failure can occur and result from adaptive cell behavior, which is FKS-independent and involves the molecular chaperone Hsp90 and the calcineurin pathway. Mutations in FKS1 and/or FKS2 alter the kinetic properties of glucan synthase, which reduces the relative fitness of mutant strains causing them to be less pathogenic. The echinocandin drugs also modify the cell wall architecture exposing buried glucans, which in turn induce a variety of important host immune responses. Finally, the future for glucan synthase inhibitors looks bright with the development of new orally active compounds.

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Authors
Perlin, D. S.
Affiliations
Rutgers New Jersey Medical School (US)
Corresponding author
Perlin, David S
Venue
Future Microbiology
Published
2011-04
Volume
6
Issue
4
Pages
441-457
ISSN
  • 1746-0913 (ISSN-L)
  • 1746-0921
OpenAlex
W2148709825
Cited by
274
References
163
Citations by year
2026: 13 · 2025: 16 · 2024: 21 · 2023: 21 · 2022: 18 · 2021: 23 · 2020: 19 · 2019: 18 · 2018: 18 · 2017: 20 · 2016: 14 · 2015: 17 · 2014: 23 · 2013: 12 · 2012: 16
FWCI
2.15
Type
journal article
Language
en
Open access
Locations
  • Future Microbiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
Merck, Pfizer and Astellas
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, caspofungin, micafungin, anidulafungin, beta-1,3-glucan synthase, Candida, Aspergillus fumigatus, antifungal resistance, HSP90, calcineurin pathway, fungal cell wall, biofilm, azole resistance, susceptibility breakpoints, host immune response, oral antifungal agents
MeSH terms
Antifungal Agents, Aspergillus, Candida, Glucosyltransferases, Humans, Microbial Sensitivity Tests, Drug Resistance, Fungal, Echinocandins

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