Antibiofilm Activity of Fluconazole/Terbinafine Combination in Candida albicans HWP1 Gene Expression

Abstract

Abstract Background: Biofilm formation represents one of the major virulence factors of Candida albican. However, the number of antifungal drugs is limited for the treatment of candidiasis. Combination therapy is one of the most frequently used techniques to alleviate this problem. In this study, we aimed to evaluate the antifungal activity of fluconazole and terbinafine alone and in combination on C. albicans biofilm inhibition. Materials and Methods: In this cross- sectional study, 10 clinical isolates of C. albicans were identified from the immunocompromised patients. Antifungal susceptibilities were performed using the CLSI standard reference method. The crystal violet colorimetric method, direct microscopic observation and expression of HWP1 gene at different concentrations based on MICs were carried out to investigate inhibition of biofilm formation in C. albicans treated alone and in combination with fluconazole and terbinafine. Results: The data indicated that combination of fluconazole with terbinafine exerted synergistic effects with fractional inhibitory concentration index ranged from 0.375 to 1.5. The combination of fluconazole with terbinafine reduced the number of yeast form and inhibited the biofilm formation. Finally, the expression level of HWP1 was down regulated (p< 0.05). Conclusion: These results suggest the possibility of fluconazole/ terbinafine to treat candidiasis with a higher efficiency. In addition, HWP1 gene could be probable target in synergistic interaction of fluconazole/ terbinafine against C. albicans biofilm.

Keywords

• Candida albicans
• Fluconazole/ terbinafine
• HWP1