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Biguanides enhance antifungal activity against Candida glabrata.

Shuying Xu | Marianela Feliu | Allison K Lord | Daniel P Lukason | Paige E Negoro | Nida S Khan | Zeina Dagher | Michael B Feldman | Jennifer L Reedy | Samantha N Steiger | Jenny M Tam | Alexander A Soukas | David B Sykes | Michael K Mansour
Virulence | 2018

Candida spp. are the fourth leading cause of nosocomial blood stream infections in North America. Candida glabrata is the second most frequently isolated species, and rapid development of antifungal resistance has made treatment a challenge. In this study, we investigate the therapeutic potential of metformin, a biguanide with well-established action for diabetes, as an antifungal agent against C. glabrata. Both wild type and antifungal-resistant isolates of C. glabrata were subjected to biguanide and biguanide-antifungal combination treatment. Metformin, as well as other members of the biguanide family, were found to have antifungal activity against C. glabrata, with MIC50 of 9.34 ± 0.16 mg/mL, 2.09 ± 0.04 mg/mL and 1.87 ± 0.05 mg/mL for metformin, phenformin and buformin, respectively. We demonstrate that biguanides enhance the activity of several antifungal drugs, including voriconazole, fluconazole, and amphotericin, but not micafungin. The biguanide-antifungal combinations allowed for additional antifungal effects, with fraction inhibition concentration indexes ranging from 0.5 to 1. Furthermore, metformin was able to lower antifungal MIC50 in voriconazole and fluconazole-resistant clinical isolates of C. glabrata. We also observed growth reduction of C. glabrata with rapamycin and an FIC of 0.84 ± 0.09 when combined with metformin, suggesting biguanide action in C. glabrata may be related to inhibition of the mTOR complex. We conclude that the biguanide class has direct antifungal therapeutic potential and enhances the activity of select antifungals in the treatment of resistant C. glabrata isolates. These data support the further investigation of biguanides in the combination treatment of serious fungal infections.

Pubmed ID: 29962263

Research resources used in this publication

None found

Antibodies used in this publication

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Associated grants

  • Agency: NIDDK NIH HHS, United States
    Id: P30 DK040561
  • Agency: NCI NIH HHS, United States
    Id: K08 CA201640
  • Agency: NIAID NIH HHS, United States
    Id: K08 AI110655
  • Agency: NIA NIH HHS, United States
    Id: R01 AG058256
  • Agency: NHLBI NIH HHS, United States
    Id: T32 HL116275
  • Agency: NIAID NIH HHS, United States
    Id: R01 AI132638

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