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Open AccessReview

Recent Insights into the Paradoxical Effect of Echinocandins

Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, 80336 Munich, Germany
Institut für Hygiene und Mikrobiologie, Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany
Author to whom correspondence should be addressed.
J. Fungi 2018, 4(1), 5;
Received: 5 December 2017 / Revised: 21 December 2017 / Accepted: 22 December 2017 / Published: 28 December 2017
(This article belongs to the Special Issue Fungal Cell Wall)
PDF [783 KB, uploaded 28 December 2017]


Echinocandin antifungals represent one of the most important drug classes for the treatment of invasive fungal infections. The mode of action of the echinocandins relies on inhibition of the β-1,3-glucan synthase, an enzyme essentially required for the synthesis of the major fungal cell wall carbohydrate β-1,3-glucan. Depending on the species, echinocandins may exert fungicidal or fungistatic activity. Apparently independent of this differential activity, a surprising in vitro phenomenon called the “paradoxical effect” can be observed. The paradoxical effect is characterized by the ability of certain fungal isolates to reconstitute growth in the presence of higher echinocandin concentrations, while being fully susceptible at lower concentrations. The nature of the paradoxical effect is not fully understood and has been the focus of multiple studies in the last two decades. Here we concisely review the current literature and propose an updated model for the paradoxical effect, taking into account recent advances in the field. View Full-Text
Keywords: echinocandin; caspofungin; micafungin; anidulafungin; paradoxical effect; paradoxical growth; glucan synthase; Fks1; antifungals; echinocandins echinocandin; caspofungin; micafungin; anidulafungin; paradoxical effect; paradoxical growth; glucan synthase; Fks1; antifungals; echinocandins

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Wagener, J.; Loiko, V. Recent Insights into the Paradoxical Effect of Echinocandins. J. Fungi 2018, 4, 5.

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