Escape of Candida from Caspofungin Inhibition at Concentrations above the MIC (Paradoxical Effect) Accomplished by Increased Cell Wall Chitin; Evidence for β-1,6-Glucan Synthesis Inhibition by Caspofungin

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Abstract
Concentrations above the MIC of caspofungin allow growth of some Candida isolates. A strain demonstrating paradoxical growth was grown in the presence and absence of caspofungin, and the cell wall content was analyzed. β-1,3-Glucan declined 81% in the presence of caspofungin, as expected. β-1,6-Glucan declined 73%. Chitin increased 898%, demonstrating a mechanism for paradoxical growth—a rapid shift in the key polymer.
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