雌马酚用于抗真菌治疗的潜力与困境

The Antifungal Potential of Equol as a Selective Estrogen Receptor Modulator

摘要: 侵袭性真菌感染及其耐药性已构成全球公共卫生重大威胁，世界卫生组织(WHO)于2022年首次发布《真菌优先病原体清单》(FPPL)，突显其紧迫性。本文聚焦植物雌激素代谢产物雌马酚(equol)的治疗价值，探讨老药新用策略在抗真菌领域的应用前景。通过系统解析真菌耐药机制，结合雌马酚独特的双向雌激素调节特性，阐明其对白念珠菌的抑制机制。尽管该化合物在改善更年期综合征、骨质疏松及心血管保护等领域疗效明确，但其当前抗真菌谱仍局限于白念珠菌。本文主张拓展针对FPPL高危病原体(如耳念珠菌、烟曲霉)的研究，并探索与传统抗真菌药的协同作用，为耐药真菌感染提供创新解决方案。

Abstract: Invasive fungal diseases (IFDs) and their drug resistance pose a significant global public health threat. Highlighting its urgency, the World Health Organization (WHO) released its inaugural “Fungal Priority Pathogens List” (FPPL) in 2022. This review focuses on the therapeutic value of equol, a phytoestrogen metabolite, and explores the application prospects of drug repurposing strategies in antifungal fields. By systematically investigating fungal resistance mechanisms and leveraging equol’s unique dual-directional estrogenic regulatory properties, this study elucidates its inhibitory mechanism against Candida albicans. Although this compound demonstrates established efficacy in alleviating menopausal syndromes, osteoporosis, and cardiovascular protection, its current antifungal spectrum remains limited to C. albicans. This work calls for expanded research targeting high-risk FPPL pathogens (e.g., C. auris, Aspergillus fumigatus) and exploration of synergistic effects with conventional antifungals, thereby offering novel therapeutic solutions for drug-resistant fungal infections.