Efflux Pumps and Biofilms in Candida albicans: Linking Antifungal Resistance with Neutrophil and Macrophage Evasion

Authors: Veradine Ifebuche Udeh; Onyinyechukwu Yvonne Obioha; Gift Esosa Omoregie; Juliet Augustine Stephen

Affiliation: Department of Microbiology, University of Nigeria, Nsukka, Nigeria

Corresponding Author: [email protected]

June 16, 2026

SIAR-Global Journal of Medicine & Pharmaceutical Review

Zenodo DOI: 10.5281/zenodo.20722962

Crossref DOI: 10.66694/siar.gjmpr2026004

Efflux Pumps and Biofilms in Candida albicans: Linking Antifungal Resistance with Neutrophil and Macrophage Evasion

Research Article Medicine

Abstract

Candida albicans is an opportunistic fungal pathogen capable of causing mucosal, bloodstream, and device-associated infections, particularly in immunocompromised individuals. Treatment is often complicated by antifungal resistance and biofilm-associated tolerance. This systematic review examined the crosstalk between antifungal resistance mechanisms and host innate immune defenses, focusing on multidrug efflux pumps, biofilm formation, neutrophil responses, and macrophage responses. Relevant studies published between 2010 and 2026 were reviewed from Scopus, PubMed/MEDLINE, Web of Science, ScienceDirect, and Google Scholar. A total of 15 studies were included in the qualitative synthesis. The findings showed that efflux pumps such as Cdr1, Cdr2, and Mdr1 contribute mainly to azole resistance by reducing intracellular drug accumulation. Biofilm formation provided broader protection through extracellular matrix production, hyphal development, altered metabolism, persister-cell survival, and reduced antifungal penetration. The reviewed evidence also showed that mature C. albicans biofilms impair innate immune responses by reducing neutrophil reactive oxygen species production, suppressing neutrophil extracellular trap formation, limiting macrophage migration, and reducing phagocytic clearance. Overall, C. albicans biofilms function as both antifungal-resistance structures and immune-evasion niches. Effective management of biofilm-associated candidiasis may require strategies that combine antifungal therapy with biofilm disruption, efflux-pump inhibition, matrix weakening, and restoration of neutrophil and macrophage function.

Keywords

Candida albicans; antifungal resistance; efflux pumps; biofilm; neutrophils; macrophages; immune evasion; NETosis

Full Article

Download Full Article (PDF)

How to Cite

Veradine Ifebuche Udeh; Onyinyechukwu Yvonne Obioha; Gift Esosa Omoregie; Juliet Augustine Stephen (2026). Efflux Pumps and Biofilms in Candida albicans: Linking Antifungal Resistance with Neutrophil and Macrophage Evasion. SIAR-Global Journal of Medicine & Pharmaceutical Review, Vol. 2, No. 1. DOI: 10.5281/zenodo.20722962

Share This Article

Facebook LinkedIn

Efflux Pumps and Biofilms in Candida albicans: Linking Antifungal Resistance with Neutrophil and Macrophage Evasion

Abstract

Keywords

Full Article

How to Cite

Share This Article

Article Information

Related Articles

Nephroproctective Effect of Cocoa Leaf (Theobroma Cacao L) …

The Spread of Health Misinformation on Social Media: …

About This Journal

SIAR-Global Journal of Medicine & Pharmaceutical Review