Azoles are among the most successful classes of antifungals. They act by inhibiting α-14
lanosterol demethylase in the
ergosterol biosynthesis pathway. Oropharyngeal
candidiasis (OPC) occurs in about 90% of HIV-infected individuals, and 4 to 5% are refractory to current
therapies, including
azoles, due to the formation of resistant biofilms produced in the course of OPC. We reasoned that compounds affecting a different target may potentiate
azoles to produce increased killing and an antibiofilm therapeutic. 2-Adamantanamine (AC17) was identified in a screen for compounds potentiating the action of
miconazole against biofilms of Candida albicans. AC17, a close structural analog to the
antiviral amantadine, did not affect the viability of C. albicans but caused the normally fungistatic
azoles to become fungicidal. Transcriptome analysis of cells treated with AC17 revealed that the
ergosterol and filamentation pathways were affected. Indeed, cells exposed to AC17 had decreased
ergosterol contents and were unable to invade
agar. In vivo, the combination of AC17 and
fluconazole produced a significant reduction in fungal tissue burden in a guinea pig model of
cutaneous candidiasis, while each treatment alone did not have a significant effect. The combination of
fluconazole and AC17 also showed improved efficacy (P value of 0.018) compared to
fluconazole alone when fungal lesions were evaluated. AC17 is a promising lead in the search for more effective antifungal
therapeutics.