In VitroActivity of Miltefosine against Candida albicans under Planktonic and Biofilm Growth Conditions andIn VivoEfficacy in a Murine Model of Oral Candidiasis

Abstract

ABSTRACTThe generation of a new antifungal againstCandida albicansbiofilms has become a major priority, since biofilm formation by this opportunistic pathogenic fungus is usually associated with an increased resistance to azole antifungal drugs and treatment failures. Miltefosine is an alkyl phospholipid with promising antifungal activity. Here, we report that, when tested under planktonic conditions, miltefosine displays potentin vitroactivity against multiple fluconazole-susceptible and -resistantC. albicansclinical isolates, including isolates overexpressing efflux pumps and/or with well-characterized Erg11 mutations. Moreover, miltefosine inhibitsC. albicans biofilm formation and displays activity against preformed biofilms. Serial passage experiments confirmed that miltefosine has a reduced potential to elicit resistance, and screening of a library ofC. albicanstranscription factor mutants provided additional insight into the activity of miltefosine againstC. albicansgrowing under planktonic and biofilm conditions. Finally, we demonstrate thein vivoefficacy of topical treatment with miltefosine in the murine model of oropharyngeal candidiasis. Overall, our results confirm the potential of miltefosine as a promising antifungal drug candidate, in particular for the treatment of azole-resistant and biofilm-associated superficial candidiasis.