{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:54:05Z","timestamp":1791302045845,"version":"4.1.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100004948","name":"Astellas Pharma Inc.","doi-asserted-by":"publisher","award":["CRES21F01"],"award-info":[{"award-number":["CRES21F01"]}],"id":[{"id":"10.13039\/501100004948","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Robert C. Hickey Chair for Clinical Care endowment"},{"name":"MD Anderson\u2019s Advanced Technology Genomics Core"},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30 CA016672"],"award-info":[{"award-number":["P30 CA016672"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Azole\/echinocandin combinations are often considered in invasive aspergillosis caused by azole-resistant Aspergillus fumigatus (ARAF). Therefore, we studied both direct and immune-mediated activity of isavuconazole and micafungin against 3 ARAF isolates. We observed synergistic activity against all isolates (checkerboard assay). In addition, pre-exposure of all ARAF isolates to subinhibitory concentrations of either drug enhanced hyphal inactivation by human mononuclear cells. While only micafungin-pretreated ARAF hyphae triggered increased NF-\u03baB signaling in reporter macrophages, direct exposure of macrophages to low isavuconazole concentrations (\u22641\u2005\u03bcg\/mL) enhanced Toll-like receptor signaling and stimulated effector pathways. Inversely, high isavuconazole concentrations (\u22655\u2005\u03bcg\/mL) attenuated Toll-like receptor signaling, suggesting immunotoxicity.<\/jats:p>","DOI":"10.1093\/infdis\/jiag461","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T11:45:49Z","timestamp":1790941549000},"source":"Crossref","is-referenced-by-count":0,"title":["Isavuconazole and Micafungin Elicit Synergistic Antifungal and Immunomodulatory Activity Against Azole-Resistant\n                    <i>Aspergillus fumigatus<\/i>"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7784-7256","authenticated-orcid":false,"given":"Sebastian","family":"Wurster","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center , Houston, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel D","family":"Albert","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center , Houston, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Matula","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center , Houston, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5392-3405","authenticated-orcid":false,"given":"Sung-Yeon","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center , Houston, Texas ,","place":["USA"]},{"name":"Division of Infectious Diseases, Catholic University of Korea\/St. Mary's Hospital , Seoul ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8051-2940","authenticated-orcid":false,"given":"Dimitrios P","family":"Kontoyiannis","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center , Houston, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"2026100611082537300_jiag461-B1","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.cmi.2018.11.027","article-title":"Triazole resistance in Aspergillus fumigatus: recent insights and challenges for patient management","volume":"25","author":"Lestrade","year":"2019","journal-title":"Clin Microbiol Infect"},{"key":"2026100611082537300_jiag461-B2","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1093\/jac\/dkz258","article-title":"Prevalence of voriconazole-resistant invasive aspergillosis and its impact on mortality in haematology patients","volume":"74","author":"Resendiz-Sharpe","year":"2019","journal-title":"J Antimicrob Chemother."},{"key":"2026100611082537300_jiag461-B3","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1093\/jac\/dkx354","article-title":"Isavuconazole susceptibility of clinical Aspergillus fumigatus isolates and feasibility of isavuconazole dose escalation to treat isolates with elevated MICs","volume":"73","author":"Buil","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"2026100611082537300_jiag461-B4","doi-asserted-by":"crossref","first-page":"e01382-17","DOI":"10.1128\/AAC.01382-17","article-title":"In vitro combination of isavuconazole with echinocandins against azole-susceptible and -resistant Aspergillus spp","volume":"62","author":"Raffetin","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2026100611082537300_jiag461-B5","doi-asserted-by":"crossref","first-page":"2582","DOI":"10.1093\/jac\/dkaa185","article-title":"In vitro interaction of isavuconazole and anidulafungin against azole-susceptible and azole-resistant Aspergillus fumigatus isolates","volume":"75","author":"Buil","year":"2020","journal-title":"J Antimicrob Chemother"},{"key":"2026100611082537300_jiag461-B6","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1086\/589305","article-title":"Caspofungin-mediated beta-glucan unmasking and enhancement of human polymorphonuclear neutrophil activity against Aspergillus and non-Aspergillus hyphae","volume":"198","author":"Lamaris","year":"2008","journal-title":"J Infect Dis"},{"key":"2026100611082537300_jiag461-B7","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1086\/589304","article-title":"Caspofungin modulates inflammatory responses to Aspergillus fumigatus through stage-specific effects on fungal beta-glucan exposure","volume":"198","author":"Hohl","year":"2008","journal-title":"J Infect Dis"},{"key":"2026100611082537300_jiag461-B8","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1086\/589290","article-title":"Immunocompromised hosts: immunopharmacology of modern antifungals","volume":"47","author":"Ben-Ami","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2026100611082537300_jiag461-B9","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1093\/jac\/dkae415","article-title":"The distinctive pharmacokinetic profile of rezafungin, a long-acting echinocandin developed in the era of modern pharmacometrics","volume":"80","author":"Andes","year":"2025","journal-title":"J Antimicrob Chemother"},{"key":"2026100611082537300_jiag461-B10","doi-asserted-by":"crossref","first-page":"3098","DOI":"10.1038\/s41467-018-05497-7","article-title":"Azole-induced cell wall carbohydrate patches kill Aspergillus 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