Ellagic acid: an alternative for antifungal drugs resistance in HIV/AIDS patients with oropharyngeal candidiasis

Abstract

Oropharyngeal candidiasis (OPC) is considered the most common fungal infection in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. Antifungal drug, azole group, is the preferred treatment. However, the long-term use of antifungal drug as prophylaxis and therapy for OPC may lead to a compromised side effects and drug resistance. Nowadays, the prevalence of antifungal Candida albicans resistance is approximately 56.7%. Ellagic acid (EA) presents broad spectrum of antifungal activities. Based on previous studies, EA can act as natural antifungal agent. It also helps enhancing oral mucosal innate immunity. This review explores the antifungal activity of EA as an alternative for antifungal drugs resistance in HIV/AIDS patients with OPC. A web-based search was conducted via PubMed, NCBI, Scopus, ScienceDirect, and Research-Gate databases, with "antifungal resistance", "ellagic acid", "HIV/AIDS", and "OPC" as the keywords. EA is a dimeric derivative of gallic acid that is found in several plants. EA can induce the expression of hBD2 and SLPI in the oral mucosa. Those proteins play a pivotal role in immunomodulation and anti-inflammation of oral microenvironment innate immunity, which inhibit several opportunistic pathogens and microbes, including Candida. Furthermore, EA also inhibits ergosterol biosynthesis (EB), which is the primary component of fungi cell membrane. EA breakdown fungal membrane permeability and enzyme activity, leading to cessation of fungal growth. EA presents antifungal activity in HIV/AIDS patients with OPC; thus, it can be used as an alternative in antifungal drug resistance.

Marine Ascomycetes Extract Antifungal Susceptibility against Candida spp. Isolates from Oral Candidiasis HIV/AIDS Patient: An In Vitro Study

“…21 The inability of current antifungal medications to treat OC in HIV/AIDS patients as a result of drug resistance has sparked basic research to develop novel antifungal medicines and HIV/AIDS medicine. 3,22 The sponge-associated microorganisms are renowned for being among the top producers of antibacterial chemicals. Moreover, numerous antibiotics including averantin, nidurufin, citrinin, Chlorohydroaspyrones A and B are isolated from sponge-associated fungi, especially from phylum ascomycetes.…”

“… 2 Several OC manifestations, including pseudomembranous candidiasis, acute and chronic erythematous candidiasis, and chronic hyperplastic candidiasis, can occur in HIV/AIDS patients. 3 Linear gingival erythema and oral hairy leukoplakia are two conditions that resemble the clinical sign of OC. 4 5 Immunosuppressive condition in HIV/AIDS patient may lead to decrease in oral mucosal immunity that gives the chance of normal flora in the oral cavity to become opportunistic.…”

“…1 2 A fungal overgrowth on the tissues and, occasionally, the appearance of a white flake on the mucosal areas describe this illness. 3 The most common cause of OC is Candida albicans . This species is frequently cited as the cause of oral thrush.…”

IL-17 plasma levels and erythrocyte sedimentation rate on oral candidiasis animal model

“…The prevalence of C. albicans's antifungal resistance is approximately 56.7% in patients with HIV infection. 10 This fact has resulted in the need for research to find alternative drugs that are safer for long-term use and this research requires appropriate animal models Previous study believed the estrus cycle in females leads to significant variation response and need to increased sample sizes if using this gender in the study even though this is not proven. Female subjects are underrepresented in animal research across disciplines.…”

Tea catechin as antiviral agent via apoptosis agonist and triple inhibitor mechanism against HIV-1 infection: A bioinformatics approach

“…The suppression immunity or immunodeficiency condition in HIV/AIDS also makes the patients susceptible to dental caries and periodontal diseases (Nugraha et al, 2019b). The prolonged duration of antifungal administration to treat candidiasis in people living with HIV/AIDS (PLWHA) may lead to adverse drug effects or antifungal drug resistance (Nugraha et al, 2018a;Wicaksono et al, 2020). The oral manifestation that occurred due to opportunistic infection during HIV/AIDS infection may increase the morbidity that decreases PLWHA quality of life (Nugraha et al, 2018b).…”