bAcanthamoeba cysts are resistant to extreme physical and chemical conditions. Autophagy is an essential pathway for encystation of Acanthamoeba cells. To evaluate the possibility of an autophagic Acanthamoeba encystation mechanism, we evaluated autophagy inhibitors, such as 3-methyladenine (3MA), LY294002, wortmannin, bafilomycin A, and chloroquine. Among these autophagy inhibitors, the use of 3MA and chloroquine showed a significant reduction in the encystation ratio in Acanthamoeba cells. Wortmannin also inhibited the formation of mature cysts, while LY294002 and bafilomycin A did not affect the encystation of Acanthamoeba cells. Transmission electron microscopy revealed that 3MA and wortmannin inhibited autophagy formation and that chloroquine interfered with the formation of autolysosomes. Inhibition of autophagy or autolysosome formation resulted in a significant block in the encystation in Acanthamoeba cells. Clinical treatment with 0.02% polyhexamethylene biguanide (PHMB) showed high cytopathic effects on Acanthamoeba trophozoites and cysts; however, it also revealed high cytopathic effects on human corneal epithelial cells. In this study, we investigated effects of the combination of a low (0.00125%) concentration of PHMB with each of the autophagy inhibitors 3MA, wortmannin, and chloroquine on Acanthamoeba and human corneal epithelial cells. These new combination treatments showed low cytopathic effects on human corneal cells and high cytopathic effects on Acanthamoeba cells. Taken together, these results provide fundamental information for optimizing the treatment of Acanthamoeba keratitis.A canthamoeba trophozoites differentiate into cysts under conditions of physical stresses, starvation, and chemical exposure (1-3); the cysts are resistant to several chemical biocides (4). Resistance of the cysts to chemotherapeutic drugs makes the treatment of Acanthamoeba infections difficult (4, 5). Although polyhexamethylene biguanide (PHMB) (0.02%), alone or in combination with a diamidine (0.1% propamidine or 0.1% hexamidine), showed therapeutic efficacy against Acanthamoeba keratitis (6), PHMB was reported to be cytotoxic to human corneal epithelial (HCE) cells (7). Although therapy for Acanthamoeba keratitis needs better-acting drugs, due to the encystation of Acanthamoeba cells, cytotoxicity toward mammalian cells must also be considered.Recent studies have demonstrated anticancer therapies that include autophagy targeting in different tumor cell lines (8, 9). One change in the cellular composition during the encystation of protozoa is the formation of an autophagy (10). The biological significance of autophagy associated with starvation, differentiation, development, and immunity has been previously demonstrated (10-13). In Acanthamoeba cells, several genes associated with autophagy, including those encoding Atg8, Atg8 isoform, Atg3, and Atg16L, were identified and their roles in the encystation of Acanthamoeba cells were studied (14-17). Autophagy is a major cellular pathway for the encystation of Acanth...