Transcriptomics

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Synergistic activity of caspofungin and posaconazole against Candida (Candidozyma) auris biofilms based on phenotypic, transcriptomic, and in vivo insights


ABSTRACT: Candida (Candidozyma) auris is an emerging multidrug-resistant fungal pathogen capable of establishing persistent skin colonization, contaminating the environment, and causing nosocomial outbreaks associated with high mortality rates. Conventional monotherapy frequently proves inadequate against biofilm-associated infections, underscoring the urgent need for novel therapeutic strategies. Therefore, we investigated the physiological and molecular responses of South Asian clade C. auris biofilms to treatment with a caspofungin–posaconazole combination. This regimen markedly reduced the median minimum inhibitory concentrations (4- to 32-fold for caspofungin; 8- to 64-fold for posaconazole) compared with monotherapies. Synergistic interactions were observed in all isolates, with fractional inhibitory concentration indices ranging from 0.078 to 0.31, and were further confirmed in vivo. Transcriptomic profiling revealed activation of multiple stress-response pathways, driving adaptive changes such as enhanced extracellular matrix production and biofilm-forming capacity, maintenance of intracellular cation homeostasis, osmotic stress response, and extensive cell wall and membrane remodeling affecting the mannan–glucan complex, chitin, sphingolipids, phosphatidylinositol- (4, 5)-bisphosphate, and ergosterol content. Additional responses included activation of RCT1 (fluconazole-inducible protein) and MDR1 (drug efflux pump), collectively promoting survival under combined antifungal pressure. These findings demonstrate the potent synergistic activity of caspofungin and posaconazole against C. auris biofilms, thereby supporting the development of effective combination therapies for this high-risk pathogen.

ORGANISM(S): Candidozyma auris

PROVIDER: GSE302377 | GEO | 2025/09/01

REPOSITORIES: GEO

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