Caspofungin binding to iron compromises its antifungal efficacy against Candida albicans

Abstract

Echinocandin drugs, such as caspofungin, inhibit the synthesis of {beta}-1,3-D-glucans, which are essential components of the fungal cell wall. These drugs are often the preferred option for treating invasive fungal infections (IFIs) caused by Candida spp. due to their superior efficacy compared to other antifungal agents. Iron overload conditions, which exacerbate fungal burden, are well-documented as significant risk factors for the progression of IFIs. Recent in vitro studies have suggested that iron overload may also reduce the efficacy of cell wall-perturbing agents, such as echinocandins, against Candida albicans, by altering the composition of the fungal cell wall. Here, we show that iron loading conditions which do not interfere with the cell wall composition are still capable of recapitulating the caspofungin-resistant phenotype induced by iron in C. albicans. Spectroscopic analyses provided evidence that caspofungin binds to iron through its ethylenediamine moiety and two amide groups. Consistent with the in vitro activity of {beta}-1,3-D-glucan synthase, molecular dynamics simulations revealed that, when bound to iron, caspofungin undergoes conformational changes that may reduce its ability to inhibit the enzyme. Importantly, the in vivo antifungal efficacy of caspofungin is compromised in a Galleria mellonella model of IFI caused by C. albicans simulating a context of iron overload. This effect may extend beyond C. albicans infections, as the antagonism between iron and caspofungin was also observed in other medically important fungi causing IFIs.