An oxindole efflux inhibitor potentiates azoles and impairs virulence in the fungal pathogen Candida auris

Kali R. Iyer, Kaddy Camara, Martin Daniel-Ivad, Richard Trilles, Sheila M. Pimentel-Elardo, Jen L. Fossen, Karen Marchillo, Zhongle Liu, Shakti Singh, José F. Muñoz, Sang Hu Kim, John A. Porco, Christina A. Cuomo, Noelle S. Williams, Ashraf S. Ibrahim, John E. Edwards, David R. Andes, Justin R. Nodwell, Lauren E. Brown, Luke WhitesellNicole Robbins, Leah E. Cowen

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Candida auris is an emerging fungal pathogen that exhibits resistance to multiple drugs, including the most commonly prescribed antifungal, fluconazole. Here, we use a combinatorial screening approach to identify a bis-benzodioxolylindolinone (azoffluxin) that synergizes with fluconazole against C. auris. Azoffluxin enhances fluconazole activity through the inhibition of efflux pump Cdr1, thus increasing intracellular fluconazole levels. This activity is conserved across most C. auris clades, with the exception of clade III. Azoffluxin also inhibits efflux in highly azole-resistant strains of Candida albicans, another human fungal pathogen, increasing their susceptibility to fluconazole. Furthermore, azoffluxin enhances fluconazole activity in mice infected with C. auris, reducing fungal burden. Our findings suggest that pharmacologically targeting Cdr1 in combination with azoles may be an effective strategy to control infection caused by azole-resistant isolates of C. auris.

Original languageEnglish (US)
Article number6429
JournalNature communications
Issue number1
StatePublished - Dec 2020

ASJC Scopus subject areas

  • Chemistry(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Physics and Astronomy(all)


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