Miltefosine repositioning: A review of potential alternative antifungal therapy

Fungal infections are a global health problem with high mortality and morbidity rates. Available antifungal agents have high toxicity and pharmacodynamic and pharmacokinetic limitations. Moreover, the increased incidence of antifungal-resistant isolates and the emergence of intrinsically resistant species raise concerns about seeking alternatives for efficient antifungal therapy. In this context, we review literature data addressing the potential action of miltefosine (MFS), an anti-Leishmania and anticancer agent, as a repositioning drug for antifungal treatment. Here, we highlight the in vitro and in vivo data, MFS possible mechanisms of action, case reports, and nanocarrier-mediated MFS delivery, focusing on fungal infection therapy. Finally, many studies have demonstrated the promising antifungal action of MFS in vitro, but there is little or no data on antifungal activity in vertebrate animal models and clinical trials, so have a need to develop more research for the repositioning of MFS as an antifungal therapy. (c) 2023 SFMM. Published by Elsevier Masson SAS. All rights reserved.

Automated summary

Fungal infections are a global health problem, and current antifungal drugs have limitations. This review discusses the potential of miltefosine (MFS) as a repositioned drug for antifungal treatment, including its mechanisms of action, case reports, and nanocarrier-mediated delivery. Although promising in vitro, there is a lack of data on MFS's antifungal activity in vertebrate animal models and clinical trials, necessitating further research.