1. Introduction
Currently, there is an urgent problem of efficient prevention of plants, animal and human diseases triggered by pathogenic fungi [
1,
2,
3]. Infections that cause plant diseases annually affect food crops and destroy the harvested crop during storage, which entails the formation of serious social and economic problems. In addition, among plant protection products there are many fungicides which are toxic to humans, as well as those that have a negative impact on agrobiocenoses, causing environmental pollution and the accumulation of remaining amounts of the pesticides in agricultural products [
4]. Filamentous fungi (
Aspergillus, Cladosporium, Penicillium, Stachybotrys, Fusarium) synthesizing various mycotoxins are particularly dangerous, both at the stage of crop growth and at the stage of its storage [
5].
With fungal (yeast) contaminations of humans and animals, special difficulties arise in the treatment of invasive infections characterized by high mortality [
6]. Currently, various antifungals are used to combat such fungal pathogens as polyene antibiotics (nistatin, amphotericin B), azoles (fluconazole), modified lipopeptides (echinocandins), allylamines (terbinafine), etc. [
7,
8]. Most of them are synthetic compounds, since then there are concerns about their high toxicity due to limited water solubility and the need to use their relatively high concentrations, as well as about the decrease in the effectiveness of their action due to the emerging resistance in fungi. [
9].
The interest exits to the natural compounds possessing strong antifungal activity with low enough toxicity to other eukaryotic cells, however most of such compounds appeared to be biodegradable by fungal strains. The fungal pathogens can use almost any natural substrates, due to their ability to synthesize various hydrolases and oxidoreductases with a wide substrate specificity of action [
10,
11]. Having a unique ability to adapt to changing environmental conditions, fungi can overcome the effects of various antifungal agents. In addition, the frequent and irregular use of fungicides has led to the emergence of resistant strains [
12]. At the same time, such resistance of fungi at the present stage of research of these microorganisms is also associated with the presence of a "Quorum Sensing" (QS) mechanism similar to bacterial populations [
13].
In this regard, the development of new antifungal agents is an urgent task and there is a huge interest in biomimetics, that is, substances imitating their natural analogues. Thus, natural antifungal peptides (AFPs) have demonstrated unprecedented advantages as selective biomaterials for obtaining effective biologics [
14]. Therefore, AFPs obtained from natural sources (plants, fungi, bacteria), which can be chemically modified or artificially synthesized to improve their antifungal properties and reduce side effects are of great interest. When obtaining AFPs as biomimetics, the possibility of increasing their stability and bioavailability turns out to be very attractive.
In addition to AFPs, the synthesis of a number of other compounds and materials forming various surfaces imitating natural analogues that can be attributed to biomimetics is also interesting from scientific and practical point of view. The antifungal effect of these compounds and materials is not limited to the destruction of the cell wall and membranes of fungi, but affects their various metabolically important pathways, growth and spore formation [
15,
16,
17]. Of great interest is the possible synergistic effect among such biomimetics with antifungal drugs, which allows to reduce the doses of individual substances used [
18,
19].
Thus, the purpose of this review was to analyze and summarize the main current trends in research on the production of antifungal biomimetics using various approaches (
Figure 1) based on damage to the integrity of cells and individual organelles, disruption of synthetic processes in fungal cells, inhibition of the activity of various enzymatic systems, etc. A separate emphasis in the review was made on comparing the antifungal effect that various variants of biomimetics have on different fungal cells, and their studied combinations in order to identify the most effective and promising ones for further improvement and application.
2. Antifungal peptides (AFPs)
Antimicrobial peptides (AMPs) produced by living organisms attract particular interest as new antimicrobial agents with a wide range of biotargets (bacteria, fungi, parasites) capable of replacing blockbuster antibiotics [
20]. To date, there are a number of databases for documenting AMPs [
21]. In this review, we considered information from four of them: the Antimicrobial Peptides Database (APD3), the Collection of Antimicrobial Peptides (CAMP
R3), the Database of Antimicrobial Activity and Structure of Peptides (DBAASP), and the Database of Antimicrobial Peptides (dbAMPs) [
22,
23,
24,
25] (
Figure 2).
APD3 is a system dedicated to discovery timeline, glossary, nomenclature, classification, structure, information search, prediction, design, statistics and tools of AMPs and beyond. As of August 2023, the APD3 contains totally 3,569 AMPs.
The dbAMP database created by Dr. Lee's team contains information about 28,709 different types of AMPs in 3044 organisms, including experimentally verified AMPs. The information from such protein databases as UniProt, NCBI, Protein Data Bank was used for the construction of dbAMP.
DBAASP database contains 20,876 AMPs and information about their chemical structure, amino acid sequences, target species and object, hemolytic and cytotoxic activities of peptides. I addition, DBAASP provides a tool for the in silico prediction/design of new AMPs.
CAMPR3 contains information on the AMP sequences, protein definition, accession numbers, activity, source organism, target organisms, protein family descriptions, N and C terminal modifications. Currently, the database contains 8164 peptide sequences and also provides tools for sequence alignment, pattern creation, pattern and HMM-based search.
The peptides in these databases can be classified into four categories: (i) natural AMPs; (ii) predicted peptides, which are predicted by machine learning or other technologies and tested to be active; (iii) synthetic peptides derived from natural AMPs and (iv) patented AMPs. Thus, the described AMP databases are an effective tool for the analysis, prediction and design of new peptides with desired properties, particularly AFPs.
As of August 2023, the proportion of AFPs among all AMPs reported in the APD3, CAMP
R3, DBAASP and dbAMPs databases was 36.7 %, 14 %, 28.6 % and 19.3 %, respectively (
Figure 2).
Interestingly, the ratio of synthetic AFPs (SAFPs) to natural AFPs varied depending on the database under consideration and was the maximum (68.1 %) in the DBAASP database.
According to the data of
Figure 2 and
Table 1 [
26,
27,
28,
29,
30,
31,
32,
33,
34,
35,
36,
37,
38,
39,
40,
41]), a number of AMPs with antifungal activity have already been identified, which can be obtained from various natural sources. Due to the possibility of obtaining of SAFPs capable of imitating various natural peptides, such biomimetics can find effective application in practice and are notable objects for current developments and investigations (
Table 2 [
32,
34,
37,
42,
43,
44,
45,
46,
47,
48,
49,
50,
51,
52,
53,
54,
55,
56,
57,
58]).
It should be noted that AFPs can be classified by total charge, secondary structure, mechanism of action, etc. In this review, when discussing AFPs, the main attention was paid to their origin (natural, semi-synthetic or synthetic), the object of their influence, the mechanism of their influence on fungal cells and the level of antifungal effect. Such information was summarized in
Table 1 and
Table 2.
Table 1.
Natural antimicrobial peptides with antifungal activity.
Table 1.
Natural antimicrobial peptides with antifungal activity.
Antifungal peptide |
Origin |
Molecular weight [Reference] |
Antifungal effect |
Mechanism of action: inhibition of chitin biosynthesis |
Nikkomycin Z |
fungi |
495.4 Da [26] |
0.5-64 mg/L (yeasts, fungi) a
|
Mechanism of action: destabilization of plasma membrane, pore formation, cell wall damage |
Magainin 2 |
frog |
2466.9 Da [27,28] |
6.25 µM (Saccharomyces cerevisiae), )Trichosporon beigelii, Candida albicans) a 60-100 mg/L (Penicillium digitatum; Alternaria solani; Phytophthora infestans) a
|
Halictine Hal-2 |
sweat bee |
1452.85 Da [29] |
1.6-25 µM (Candida spp.) a
|
Halocidin |
ascidian |
3445.1 Da [30] |
Effect was not estimated |
Polymyxin B |
bacteria |
1301.6 Da [31] |
16-256 mg/L (multi-drug-resistant fungal strains) a
|
Colistin |
bacteria |
1155.4 Da [31] |
Defensin DefMT3 |
ticks |
1613.1 Da [32] |
4 µM (Fusarium culmorum; F. graminearum) b
|
Indolicidin |
bovine |
1906.3 Da [33] |
12.5-50 mg/L (C. albicans) a
|
Lactoferampin B |
bovine |
2389.8 Da [34] |
0.7-39 µM (C. albicans) c
|
Lactoferricin B |
bovine |
3125.8 Da [34] |
0.31-400 mg/L (yeasts) a 4-32 µM (fungi) a
|
Lactoferricin H |
human |
5513 Da [34] |
10 mg/L (C. albicans) a
|
Leg2 |
chickpea legumin hydrolysates |
2157.6 Da [35] |
125-250 µM (S. cerevisiae, Zygosaccharomyces bailii) a
|
LL-37 |
human |
4493.3 Da [36] |
4-64 µM (Candida spp.) a
|
Mechanism of action: cell/spore lysis, cell wall perturbations |
Cecropin B |
silkworm |
3835.7 Da [38] |
0.9 mg/L (C. albicans) a 160-320 mg/L (F. solani) a
|
Osmotin |
plant |
24285.3 Da [38] |
4-25 mg/L (fungi) a
|
Stomoxyn |
stable fly |
4474.2 Da [39] |
0.8-50 µM (yeasts); 0.4-7 µM (fungi) a 50-100 µM (A. fumigatus) a
|
Temporin B |
frog |
1391.8 Da [40] |
1.4-4 µM (Candida spp.) a
|
Temporin G |
1457.8 Da [41] |
8-128 µM (yeasts/fungi) a
|
Table 2.
Synthetic / (semi)synthetic antimicrobial peptides with antifungal activity.
Table 2.
Synthetic / (semi)synthetic antimicrobial peptides with antifungal activity.
Antifungal peptide |
Molecular weight; [Reference] |
Antifungal effect |
Mechanism of action: inhibition of 1,3-β-d-glucan synthase
|
Anidulafungin |
1140.2 Da [42,43,44] |
0.06-0.25 mg/L (Candida spp.) a 0.015-32 mg/L (fungi) a
|
Caspofungin |
1093.3 Da [42,43,44] |
0.25-4 mg/L (Candida spp.) a
|
Micafungin |
1270.3 Da [42,43,44] |
0.015-4 mg/L (Candida spp.) a
|
Mechanism of action: destabilization of plasma membrane, pore formation, cell wall damage |
Lf(1-11) H |
1317.5 Da [37] |
> 12.5 mg/L (Candida sp.); 80-160 mg/L (F. solani) a 4.3 µM (A.fumigatus) a
|
Lfchimera (bLfcin/Lfampin) |
4422 Da [34] |
6.25 mg/L (C. parapsilosis) a
|
γ-core DefMT3 |
1611.8 Da [32] |
1-2 µM (F. culmorum; F. graminearum) b
|
Brilacidind
|
936.9 Da [45] |
2.5- >80 µM (C. neoformans, C. albicans, C. auris, A. fumigatus) a
|
RcAlb-PepII |
637.77 Da [46,47] |
17-250 µM (Candida spp.) a 0.04 mg/L (Cryptococcus neoformans) a
|
Halictine Hal-2 derivatives |
1471 Da [48] |
0.5-1 µM (Candida spp., S. cerevisiae) a
|
di-K19Hc |
4115.1 Da [49] |
< 4 mg/L (C. albicans); <16 mg/L (Aspergillus sp.) a
|
Pexiganan/MSI-78 |
2478.2 Da [37] |
10-80 mg/L (F. solani) a
|
PepGAT |
1044.18 Da [46,50,51] |
40-80 mg/L (Candida spp., P. digitatum) a
|
PepKAA |
1238.44 Da [46,50,51] |
Peptide 77-3 |
994.2 Da [52,53] |
3.5-5 mg/L (A. flavus, A. parasiticus)a
|
KK14 |
144.2 Da [54] |
6.25-100 mg/L (fungi) a
|
D4E1 |
2079.4 Da [52,53] |
7.75 µM (A. flavus); 0.60 µM (V. dahliae) b 13.02 µM (C. destructivum) b
|
PAF26 |
991.2 Da [55] |
4-6 µM (P. digitatum) a
|
Mechanism of action: production of reactive oxygen species, cell wall degradation |
Octominin |
2652.2 Da [56] |
50 mg/L (C. albicans) a
|
Mo-CBP3-PepI |
893.12 Da [57] |
2.2 µM (C. albicans) c
|
Mechanism of action: Cell/spore lysis, cell wall perturbations |
Osm-pepA |
3050.5 Da [58] |
40 µM (S. cerevisiae) a 20 µM (Pichia pastoris) a
|
Despite the fact that the mechanism of action of AMPs in relation to fungal cells is not as well studied as in relation to bacteria, the basic principle of their antifungal action is similar to antibacterial one and most often consists in a violation of the functions and integrity of the cell wall and plasma membrane. Due to this principle of action of AMPs, the development of resistance to them in microorganisms is considered to become almost impossible. AFPs, in addition to mentioned effect on fungal cells, are able to specifically inhibit membrane proteins, β-1,3-glucan and chitin synthases, thereby contributing to the formation of defects in the cell wall, or inhibit H+-ATPase, causing an apoptosis-like process. Some AFPs can also induce intracellular generation of reactive oxygen species (ROS) destroying various biomolecules (lipids, proteins, nucleic acids, etc.) by their active oxidation [
59,
60] (
Table 1).
Semi-synthetic AFPs are chemically modified natural peptides, while preserving the active centers of the origin molecule, in order to achieve optimal properties [
61]. Echinocandins (anidulafungin, caspofungin, micafungin), having a lipopeptide nature, are members of the "youngest" clinically used group of semi-synthetic AFPs. Echinocandins consist of a cyclic hexapeptide nucleus with a lipid side chain. The peptide lipid tail anchors the lipopeptide in the cell membrane next to the target enzyme. These peptides act as non-competitive inhibitors of a key enzyme in the synthesis of β-1,3-glucan. Unlike semi-synthetic AFPs, SAFPs are obtained entirely by chemical synthesis. Most often, a solid-phase method is used for the synthesis of SAFPs, based on the addition of one amino acid at one step of synthesis, which allows investigators to study the role of each amino acid in the synthesized sequence.
When analyzing examples of currently created semi-synthetic and synthetic AFPs, the result of studying their properties and mechanisms of action, as well as comparing them with natural analogues, is always interesting and useful. It appeared that targets of action of AFPs can be different and that depends on their chemical structure.
The mechanism of action and activity of a series of synthetic analogues of the halictine HAL-2 peptide (from the venom of the wild bee
Halictus sexcinctus) was investigated in relation to cells
Candida spp. It has been found, that halictines can rapidly permeabilize cell membranes and cause the leakage of cytosolic components, and that their mode of action is likely to depend on the plasma-membrane sterols. The pre-treatment with the inhibitors of sterol synthesis (terbinafine and fluconazole) resulted in a significant reduction of peptides efficacy, while their killing efficacy increased when combined with amphotericin B [
48].
It was shown, that peptides naturally derived from milk protein lactoferrin, such as lactoferricin (Lfcin), lactoferrampin (Lfampin) and Lf(1–11) and some modified or synthesized peptides can also exhibit strong antifungal activity. In particular, antifungal activity of bovine lactoferrin-derived Lfcin was investigated against a wide range of fungal species and it was shown, that bLfcin demonstrates strongly enhanced antimicrobial activity compared to lactoferrin [
34,
62,
63,
64].
The cacao osmotin-like protein (TcOsm1) -derived peptides, named Osm-pepA and Osm-pepB inhibited growth of yeasts (
Saccharomyces cerevisiae S288C and
Pichia pastoris X-33) and spore germination of the phytopathogenic fungi
Fusarium f. sp.
glycines and
Colletotrichum gossypi. Osm-pepA was more efficient than Osm-pepB [
58].
A synthetic analogue of antimicrobial peptide halocidin, di-K19Hc, has been exhibited improved antifungal activity against a panel of fungi including several strains of
Aspergillus and
Candida [
49].
The small antimicrobial peptide PAF26 (Ac-RKKWFW-NH2) demonstrated multiple detrimental effects on the filamentous fungi
Penicillium digitatum, which ultimately resulted in permeation and killing the growing cells [
55].
The full-length
Neosartorya (Aspergillus) fischeri AMPs and novel rationally designed γ-core peptide derivatives γ
NFAP-opt and γ
NFAP-optGZ exhibited high efficacy by inhibiting the growth of the agriculturally relevant filamentous ascomycetes in vitro [
65].
Small peptide, RcAlb-PepII, designed based on the primary structure of Rc-2S-Alb, a 2S albumin from the seed cake of
Ricinus communis, strongly inhibited the growth of
Klebsiella pneumoniae and
Candida parapsilosis, and induced morphological alterations in their cell surface. The peptide also degraded and reduced the biofilm formation in
C. parapsilosis and in
K. pneumonia cells [
47].
SAFPs PepGAT, PepKAA, and Mo-CBP3-PepI demonstrated strong inhibition of
P. digitatum growth. All peptides targeted the fungal membrane leading to pore formation, loss of internal content and death. The induction of high levels of ROS was also a mechanism employed by some peptides [
51,
66].
The antifungal activity of two peptides, called
Mo-CBP3-PepI (CPIAQRCC) and
Mo-CBP3-PepIII (AIQRCC), designed based on the structure of
Mo-CBP3, a chitin binding protein purified from
Moringa oleifera seeds, was evaluated against
C. albicans and
C. parapsilosis biofilms [
67]. Eight SAMPs were tested regarding their antifungal potential against
C. neoformans and five SAMPs showed an inhibitory effect on
C. neoformans growth at low concentrations. Peptides induced many morphological alterations such as cell membrane, wall damage, and loss of internal content on
C. neoformans cells [
46].
Investigation of the effect of four antimicrobial peptides - PPD1 (FRLHF), 66-10 (FRLKFH), 77-3 (FRLKFHF) and D4E1 (FKLRAKIKVRLRAKIKL) on the aflatoxin production by
A. flavus and
A. parasiticus suggested that AMPs at near minimum inhibitory concentrations (MIC) were effectively inhibiting aflatoxins, without hindering the growth of the fungi. At higher concentrations, these peptides exerted fungicidal action on
A. flavus [
52,
53].
Antimicrobial peptides polymyxin B and colistin (polymyxin E) exhibited an antifungal activity against 11 MDR yeast and filamentous fungal strains including strains belonging to the
Candida, Cryptococcus and
Rhodotorula yeast genera, along with others belonging to the
Aspergillus, Fusarium, Scedosporium, Lichtheimia and
Rhizopus with MICs ranging from 16 to 128 μg/ml, except for the
Aspergillus species [
31].
In addition to the methods of chemical modification and synthesis of AMPs molecules, the use of methods of computer molecular design played a significant role in obtaining synthetic AMPs with the desired characteristics. This made it possible to combine information about the chemical properties and biological activity acquired by new peptides and the amino acid sequences present in them. This, in turn, made it possible to develop methods for predicting and evaluating the antifungal potential of synthesized sequences in silico [
68].
Using an easy step-by-step way to choose, characterize and test potential sequences to be assayed as synthetic AMPs, two peptides (PepGAT and PepKAA) with antimicrobial potential against
Candida spp., including activity against biofilms and without any hemolytic effects, were identified and characterized [
50].
Using a simple and reliable method a set of an anti-
Candida peptide CGA-N12 analogues were rationally designed and seven CGA-N12 analogues with significantly improved antifungal activity against
C. tropicalis were screened [
69].
The rationally designed and synthesized new structural class of dipeptides Trp-His(1-Bn)-OMe/NHBn and tripeptides His(1-Bn)-Trp-His(1-Bn)-OMe/NHBn possessing modified amphiphilic histidine along with hydrophobic tryptophan residues demonstrated promising antifungal activity with membrane lytic action against
C. neoformans [
70].
A designed and synthesized synthetic peptide of 23 amino acids Octominin (1GWLIRGAIHAGKAIHGLIHRRRH23) from a defense protein 3 cDNA sequence of Octopus minor showed an inhibitory effect against
Candida albicans by causing ultrastructural cell wall deformities [
56].
Ultrashort peptide H-Orn-Orn-Trp-Trp-NH2 (O3TR) inhibited the growth of the filamentous fungi Fusarium culmorum, Penicillium expansum and A. niger and yeasts Saccharomyces cerevisiae, Zygosaccharomyces bailii, Z. rouxii, Debaryomyces hansenii and Kluyveromyces lactis. The addition of a C12 fatty-acid chain tail at the N-terminus of these peptide improved its antifungal activity by 2 - 8-fold in relation to different fungi [
71].
A C14-residue peptide named KK14, with the sequence KKFFRAWWAPRFLK-NH2, was designed and inhibited conidial germination and fungal growth of food contaminants. The substitution of a Pro residue with Arg increased the helical content of the peptide not only its antifungal activity but also its cytotoxicity. The insertion of an unnatural bulky residue β-diphenylalanine or a full denantiomerization overall increased the antifungal potency [
54].
Inspired by antimicrobial peptides different side chain methionine, leucine and tyrosine based polymethacrylates (pH responsive cationic biocompatible polymers) have been designed and their fungicidal activities have been investigated against
A. niger, demonstrating the effective inhibition of hyphal growth and distortion of conidiophores [
72].
The antifungal activity of a series of peptides with a varying number of lysine and tryptophan residue repeats (KWn-NH2) was confirmed against
C. albicans [
73].
It has been shown that a number of AFPs can exhibit not only antifungal activity, but also inhibit production of mycotoxins synthesized by fungi as molecules for their self-defense [
52,
59]. It turned out that in some cases, individual AFPs may lose their ability to inhibit the growth of fungi, but retain their effectiveness in inhibiting the biosynthesis of mycotoxins by fungi. For instance, the treatment of
F. graminearum cells with the reduced form of the γ-core of the tick defensin DefMT3 (TickCore3, TC3), decreases growth of the fungal cells and abrogates mycotoxin (trichothecene B) production. The oxidation of TC3 leads to loss of its growth inhibitory activity, while the anti-mycotoxin activity is retained [
74].
Summarizing the information presented, it can be concluded that various methods of chemical modification of natural peptides, including phosphorylation, cyclization, halogenation, etc. [
60], can be used to obtain semi-synthetic AFPs (
Figure 3). However, in addition to the same methods, computer molecular analysis and the design of the peptides being created play an important role in the design of synthetic AFPs, which makes it possible to proceed not from the natural basis that can only be modified, but to obtain the synthesis of new compounds with the desired properties and taking into account the use of key amino acid motifs (
Figure 3). At the same time, of course, all new AFPs must be checked not only for the effectiveness of the antifungal effect obtained from them, but also to evaluate them for toxicity, including prion properties [
75].
Thus, the use of various AFPs for their modifications described in this section is an effective approach to solving the problem of pathogenicity and resistance of fungi. The fact that these peptides, as natural molecules, make it possible to create a number of different biomimetics/peptidomimetics based on them, which can be used as antifungals, allows us to conclude that there is a need for significant development of rational design methods today. The use of organic synthesis methods makes it possible to construct SAFPs with the most effective amino acid sequences and desired characteristics as well as changed mechanisms (targets) of action.
4. Combination of antifungal peptides with each other and/or with antifungal drugs
Despite expectations of the absence of resistance formation in fungi to the effects of new antifungals, including AFPs [
125,
126], azoles [
127] and 2-DG [
109], researchers note such cases. One of the effective solutions to this problem today is the combined use of various antifungals. Such possible combinations can include various traditional antifungal agents and AFPs (
Table 6) [
18,
37,
45,
57,
67,
128,
129,
130,
131,
132,
133,
134,
135,
136,
137,
138,
139,
140]. Such combinations make it possible to joint different mechanisms (targets) of the effects of antifungals and significantly decrease their toxicity by improving the effectiveness of the action and reducing the doses applied in comparison with individual substances.
The synergistic effect of combined antifungals makes it possible to effectively combat yeast biofilms of the genus
Candida both at the stage of their formation and already for the degradation of mature biofilms. Combination of AFPs
Mo-CBP
3-PepI and
Mo-CBP
3-PepIII with nystatin and itraconazole against
Candida species biofilms resulted in a 2 to 4-fold improvement of antibiofilm activity of antifungals [
57,
67]. The combination of
Mo-CBP
3-PepIII and
RcAlb-PepIII synthetic peptides with itraconazole enhanced the activity of the latter by 10-fold against
C. neoformans [
128]. Likewise, synthetic histidine-containing amphipathic peptides enhanced the activity of amphotericin B against
Cryptococcus neoformans by 4 to 16-fold [
134]. When combined with lactoferrin-derived synthetic peptide lactofungin, the minimum inhibitory concentration of amphotericin B for
Candida spp. and
C. neoformans decreased 4 times [
139].
The antifungal activity of two
N. fischeri peptides NFAP and NFAP2 and their γ-core peptide derivatives (γNFAP-opt, γNFAP2-opt), was tested in vitro against
Botrytis, Cladosporium, and Fusarium spp. Synergistic mechanism of action was observed when NFAP or NFAP2 was applied in combination with γNFAP-opt. The investigated proteins and peptides did not show any toxicity to tomato plant leaves, except for γNFAP2-opt [
129].
Fusarium infections have been associated with high mortality rates due to the lack of effective treatment strategy. The in vitro activity of AFPs MSI-78, h-Lf1-11 and cecropin B combined with amphotericin B or voriconazole were tested against ten
Fusarium solani strains. All AFPs demonstrated synergistic mechanism of action when combined with conventional antifungals [
37].
The combination of brilacidin (synthetic, nonpeptidic, small molecule mimetic of defensin) with caspofungin has a synergism that is able to affect
A. fumigatus viability through multiple mechanisms of action, encompassing functional changes/depolarization of the microorganism cell membrane, interference to calcineurin signaling, and misexpression of the cell wall integrity pathway, and prevents β-1,3-glucan biosynthesis [
45].
The use of mimetic peptides DP-23 (short lipopeptide) and SPO (N-substituted polyglycine) in combination with fluconazole provided a synergistic effect on
A. niger and
A. flavus cells [
18].
Peptides P255 and P256 obtained from hexapeptide PDF 26 were combined with amphotericin B and investigated against
C. albicans. Both peptides showed a synergistic effect with a polyene antibiotic, while P256 showed stronger antifungal effect than P255. Peptides violated the integrity of the cell wall, increased membrane permeability, disrupted cell morphology and caused intracellular changes: they affected the expression of genes for replication and repair of fungal DNA, biosynthesis of cell wall components and ergosterol. They also increased the production of ROS in cells and bound to the genomic DNA of fungi [
130].
γ-AA peptides are a class of peptidomimetics with a definite folded structure and resistance to proteolytic hydrolysis. It has been shown that lipo-γ-AA peptide MW5 significantly increases the efficacy of fluconazole action against azole-resistant
C. albicans CARG5 cells. The peptide destroys the cell membrane and provokes the production of ROS [
135].
Synthetic peptidomimetics of antimicrobial α-peptides exhibit fungicidal activity as a result of hydrophobic and electrostatic interactions with cell membranes, which lead to permeabilization and subsequent cell death. These peptidomimetics were more stable than their natural counterparts and are not degraded by proteases. β-peptides were obtained structurally constructed on the basis of natural α-helical AMPs. These mimetics possessed a fungicidal effect against
C. albicans cells and inhibited the formation of yeast biofilms. The hydrophobicity of the β-peptides directly correlates with their antifungal properties and a narrow range of concentrations at which β-peptides effectively kill
C. albicans cells without lysis of erythrocytes. The combination of these peptides with isoamyl alcohol reduced their MIC for inhibiting biofilms by 4 times [
138].
Conjugates of fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) with the TP10-NH2 peptide penetrating into yeast cells showed antifungal effect against different strains of genus
Candida. At the same time, the synergistic effect of these conjugates was not revealed in experiments
C. glabrata cells [
140].
Antifungal effect against
Candida spp. cells was investigated for conjugates obtained on the basis of a modified fragment of lactoferrin HLopt2 and ciprofloxacin, levofloxacin and fluconazole. Three different nutrient media were used for these purposes. There was no activity against four different
Candida species for the substances studied on the RPMI (mimics physiological conditions) medium. The use of BP (1% peptone) and BHI1/100 (0.034% brain-heart infusion) media resulted in inhibition of cell growth, especially
C. tropicalis, whereas
C. glabrata cells were the most resistant among all tested strains [
137].
The antifungal activity of cationic antimicrobial peptides ToAP2, from a cDNA library of the scorpion
Tityus obscurus venom gland and NDBP-5.7, from a cDNA library of the scorpion
Opisthacanthus cayaporum venom gland was demonstrated against
C. albicans cells. Both peptides affected membrane permeability and caused such changes in the morphology of fungal cells as cell wall deformations and disruption of ultrastructural cell organization. Both peptides showed synergism with amphotericin B, and demonstrated synergistic and additive effect in combination with fluconazole Top 2 and NBSP-5.7, respectively [
132].
Unique ultra-short peptide KW23 had a positive effect on standard and resistant
Candida species, showing powerful synergistic antimicrobial activity in combination with fluconazole. Interesting, that effect of this combination was additive with respect to the resistant strain. In addition, the peptide showed a low enough toxicity to human erythrocytes [
136].
Persistent cells that can tolerate lethal concentrations of antimicrobials and grow again after their removal, being found in different microbial populations. It is assumed that the appearance of persistent yeast cells involves different regulations of genes correlating with the pathways of ergosterol biosynthesis (ERG1 and ERG25) and β-1,6-glucan (SKN1 and KRE1). Special studies have shown that membranes of cells in biofilms contain a lower concentration of ergosterol, mainly in the deepest layers of the biofilm, in comparison with planktonic yeast cells. It is likely that cells from mature biofilms require less ergosterol to maintain membrane fluidity, and this is also confirmed by the limited effectiveness of biomimetics aimed at inhibiting ergosterol biosynthesis. In this regard, the possibility of destroying resistant persistent-derived biofilms of
C. albicans with gH625-M peptide, which is an analogue of viral membranotropic peptide gH625, was investigated [
133]. The combination of gH625-M with various antifungals (fluconazole, 5-flucytosine, amphotericin B) demonstrated a synergistic effect when acting on persistent cells in biofilms at relatively low doses of the antifungals (
Table 6).
Among antifungals that can be used in effective combination with AFPs, metal-containing compounds and enzymes are discussed [
141,
142]. The main mechanism of the antifungal action of metals is the triggering of generation and accumulation of ROS. Enzymes are of special interest due to their wide range of substrate specificity of action and various mechanisms of antifungal actions.
Combination of metalloenzyme such as hexahistidine-containing organophosphorus hydrolase (His
6-OPH), capable of hydrolyzing signal molecules of yeast QS, with AFPs (polymyxins, bacitracin, Lfcin) resulted in a notable improvement of antimicrobial efficiency of action of the AFPs (up to 8.5 times) against different yeast species, such as
Saccharomyces cerevisiae, Candida sp
., Trichosporon beigeii, etc. It is interesting, that His
6-OPH had an increased catalytic efficiency of action in the hydrolysis of its substrates (QS molecules) when it was introduced in combination with AFPs [
143,
144]. Thus, combination of the AFPs with enzymes possessing antifungal activity is a perspective trend in the development of efficient antifungals.
To determine the effect of combining two antifungals and interpreting the results obtained, a fractional inhibitory concentration index (FICI) range (from 0.5 to 4) is usually applied. The synergistic effect corresponds to FICI values < 0.5 and is achieved through a combination of different mechanisms of action on antifungals. From the studies analyzed in this section, it follows that only in the case of a combination of fengycin with surfactin, an antagonistic effect was revealed (FICI = 4), which is an indicator of the incompatibility of the mechanisms of action of these compounds with each other [
131].
In the case of a combination of brilacidin with conventional fungicides, AFPs of
Neosartorya fischeri, among themselves and histidine-containing amphipathic peptides with fluconazole, an additive effect (FICI > 1) was marked, which means that these antifungals do not enhance the effectiveness of each other action [
45,
129,
134]. In the case of all other analyzed combinations, a synergistic effect was revealed. The most effective variants were obtained in the case of combinations of synthetic peptides Mo-CBP3-PepI and Mo-CBP3-PepII with nystatin (FICI = 0.13) [
57,
67]. It is interesting to note that when combining two synthetic peptides, MSI-78 and hLf(1-11), with a natural peptide, Cecropin B, as well as with voriconazole or with amphotericin B, the strongest synergistic effect was achieved with a natural peptide, but not with considered successful antifungals like azole and polyene antibiotic [
37].
When developing biomimetics and some combinations with them, special attention is paid to minimizing their toxicity (or its complete absence) in relation to human/animal/plant cells, as well as to the type of antifungal effect (mechanism of action) on cells in order to avoid the development of resistance [
76,
145]. At the initial stage of such investigations, toxicity is assessed using modern computer modeling methods [
146]. Erythrocytes are used as experimental models in vitro and in vivo [
147].
Taking into account the fact that a minimal number of cases of fungal resistance have been detected with respect to SAFPs, as well as the minimum level of toxicity shown in these peptides for other cells, they seem promising candidates in the development of modern antifungals.