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GPI-anchor structure
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In order to make good decisions, we use our knowledge and our reasoning. Often, this knowledge and reasoning is sound and solid. However, sometimes, we are swayed by biases or by others manipulating a situation. For example, let’s say you and three friends wanted to rent a house and had a combined target budget of $1,600. The realtor shows you only very run-down houses for $1,600 and then shows you a very nice house for $2,000. Might you ask each person to pay more in rent to get the...
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Anchoring junctions are multiprotein complexes that help cells connect to other cells and the extracellular matrix. Anchoring junctions are present on the lateral and basal surfaces of cells, providing strong and flexible connections. Focal adhesions are often formed due to cell interactions with the ECM substrata, which initiate signal transduction via kinase cascades and other mechanisms. Together, they provide stability and tissue integrity. There are three types of anchoring junctions:...
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In the plasma membrane, the lipids forming the bilayer can also act as an anchor to tether proteins to the membrane. The three main types of lipid anchors found in eukaryotes are – prenyl groups, fatty acyl groups, and glycosylphosphatidylinositol or GPI groups. Prenyl and fatty acyl groups act as anchors on the cytosolic surface of the membrane, whereas GPI anchors proteins on the extracellular side.
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Related Experiment Video

Updated: Feb 7, 2026

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Combination antifungal therapy for cryptococcal meningitis.

Jeremy N Day1, Tran T H Chau1, Marcel Wolbers1

  • 1Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme Vietnam (J.N.D., T.T.H.C., M.W., N.H.M., N.H.P., H.D.N., C.Q.T., L.H.T., V.A.D., T.N.H., P.T.D., S.G.B., T.T.H., J.J.F.), and the Hospital for Tropical Diseases (T.T.H.C., P.P.M., N.T.D., N.H.M., N.H.P., H.D.N., N.D.P., L.V.C., D.X.S., T.P.M.S., N.V.V.C.) - both in Ho Chi Minh City, Vietnam; and the Centre for Tropical Medicine, Oxford University, Oxford (J.N.D., M.W., J.I.C., S.G.B., T.T.H., J.J.F.), and the Liverpool School of Tropical Medicine, Liverpool (D.G.L.) - both in the United Kingdom.

The New England Journal of Medicine
|April 5, 2013
PubMed
Summary

Combination antifungal therapy with amphotericin B and flucytosine improved survival for cryptococcal meningitis patients. High-dose fluconazole did not show a survival benefit compared to amphotericin B alone.

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Area of Science:

  • Infectious Diseases
  • Mycology
  • Clinical Pharmacology

Background:

  • Cryptococcal meningitis is a life-threatening fungal infection, particularly in individuals with HIV.
  • Standard treatment with amphotericin B deoxycholate has limitations in reducing mortality.
  • Combination antifungal therapy is recommended but its survival benefit requires further investigation.

Purpose of the Study:

  • To evaluate the efficacy of combination antifungal therapy in improving survival rates for cryptococcal meningitis.
  • To compare the outcomes of amphotericin B plus flucytosine versus amphotericin B alone.
  • To assess the impact of adding high-dose fluconazole to amphotericin B therapy.

Main Methods:

  • A randomized, three-group, open-label trial was conducted involving 299 patients with HIV and cryptococcal meningitis.
  • All patients received amphotericin B; treatment groups differed in duration and addition of flucytosine or fluconazole.
  • Induction therapy involved daily amphotericin B, with flucytosine or fluconazole administered for two weeks.

Main Results:

  • Amphotericin B plus flucytosine significantly reduced mortality at 70 days (P=0.04) and showed a trend towards reduced mortality at 14 days (P=0.08).
  • Combination therapy with amphotericin B and flucytosine led to significantly faster yeast clearance from cerebrospinal fluid (P<0.001).
  • High-dose fluconazole combination therapy did not significantly improve survival compared to amphotericin B monotherapy.

Conclusions:

  • Amphotericin B plus flucytosine is associated with improved survival in cryptococcal meningitis patients.
  • The addition of high-dose fluconazole to amphotericin B did not demonstrate a survival benefit.
  • Combination therapy with amphotericin B and flucytosine offers a promising strategy for treating cryptococcal meningitis.