Dendrimers against fungi - A state of the art review

Fungal based diseases currently affect nearly a quarter of the population around the world, which diseases are usually limited to superficial infections. Perversely, along with the development of modern medicine, cases of life-threatening systemic fungi are more and more often encountered. Compared to antibacterial drugs, significantly fewer fungicides are tested and introduced to clinical practice. At the same time, the drug resistance of pathological fungi is constantly growing. In addition to obtaining new derivatives of already-established classes of drugs, such as azoles, there is a growing interest in new compounds with potentially new mechanisms and application possibilities. Polymers are included in the flow of these studies, and among them - dendrimers. Dendrimers are a special type of polymers with a strictly defined structure and a plethora of functionalization possibilities. This allows them to not only be used as effective antifungal drug carriers but also enables them to exhibit antifungal activity per se. In this review, we have introduced to the epidemiology of fungal infections and summarized the aspects related to their control and therapy. Various polymers and dendrimers with antifungal activity were presented. In the subsequent sections antifungal acting dendrimers were discussed within three subchapters, based on their chemical structure: (i) amino acid-based dendrimers, (ii) amino based dendrimers, and (iii) other, which do not share similarities in structure. We have gathered and summarized the reports regarding the direct action of dendrimers on infectious fungi, as well as their effect when used as solubilizers, carriers or adjuvants with currently used antifungals. Use of dendrimers for the sensing of fungi or their metabolites are also considered. Special attention was also paid to the applications of dendrimers together with photosensitizers in antimicrobial photodynamic therapy.