Antifungal resistance The common class of
antifungal drugs known as
azoles disrupts the fungal sterol biosynthesis pathway, upstream of C-5 sterol desaturase leading to the accumulation of nontoxic 14α-methylated sterols. C5SD then converts these intermediates into a toxic product. Consequently, in both the pathogenic fungus
Candida albicans and model organism
S. cerevisiae mutations in the gene encoding C-5 sterol desaturase (
ERG3) allow the cell to avoid synthesizing the toxic sterol products and have been shown to confer
azole resistance. In at least the case of fluconazole, antifungal resistance due to C5SD inactivation is dependent on the activity of the
chaperone protein Hsp90 and the
phosphatase calcineurin. However, the clinical relevance of this azole resistance mechanism is controversial because while the deletion of ERG3 alone confers fluconazole resistance to
C. albicans in vitro, it is insufficient to confer fluconazole resistance in a live mouse model.
Lathosterolosis In at least one patient, a deficiency in C-5 sterol desaturase activity (termed
lathosterolosis) was associated with multiple malformations, metal retardation, and liver disease. This patient was also found to have low levels of blood cholesterol and high levels of lathosterol in cell membranes when compared to those of healthy control subjects. These symptoms resemble those of other defects in cholesterol synthesis such as
Smith–Lemli–Opitz syndrome. ==Potential applications==