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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cell. Infect. Microbiol.</journal-id>
<journal-title>Frontiers in Cellular and Infection Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cell. Infect. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">2235-2988</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fcimb.2023.1200747</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Cellular and Infection Microbiology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Cyclometalated iridium(III) complexes combined with fluconazole: antifungal activity against resistant <italic>C. albicans</italic>
</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Lu</surname>
<given-names>Jun-Jian</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Xu</surname>
<given-names>Zhi-Chang</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2271873"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhu</surname>
<given-names>Hou</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2274362"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhu</surname>
<given-names>Lin-Yuan</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ma</surname>
<given-names>Xiu-Rong</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1816542"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Wang</surname>
<given-names>Rui-Rui</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/990603"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Li</surname>
<given-names>Rong-Tao</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/974329"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Ye</surname>
<given-names>Rui-Rong</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/818304"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Faculty of Life Science and Technology, Kunming University of Science and Technology</institution>, <addr-line>Kunming</addr-line>, <country>China</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>College of Chinese Materia Medica, Yunnan University of Chinese Medicine</institution>, <addr-line>Kunming</addr-line>, <country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Sanjay Kumar Rohaun, University of Illinois at Urbana-Champaign, United States</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Shrikant Nilewar, Texas Christian University, United States; Kathiresan Selvam, Washington State University, United States</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Rui-Rui Wang, <email xlink:href="mailto:wangrryucm@126.com">wangrryucm@126.com</email>; Rui-Rong Ye, <email xlink:href="mailto:yerr@mail2.sysu.edu.cn">yerr@mail2.sysu.edu.cn</email>
</p>
</fn>
<fn fn-type="equal" id="fn003">
<p>&#x2020;These authors have contributed equally to this work</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>21</day>
<month>07</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="collection">
<year>2023</year>
</pub-date>
<volume>13</volume>
<elocation-id>1200747</elocation-id>
<history>
<date date-type="received">
<day>05</day>
<month>04</month>
<year>2023</year>
</date>
<date date-type="accepted">
<day>06</day>
<month>07</month>
<year>2023</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2023 Lu, Xu, Zhu, Zhu, Ma, Wang, Li and Ye</copyright-statement>
<copyright-year>2023</copyright-year>
<copyright-holder>Lu, Xu, Zhu, Zhu, Ma, Wang, Li and Ye</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>
<italic>Candida albicans</italic> (<italic>C. albicans</italic>) is a ubiquitous clinical fungal pathogen. In recent years, combination therapy, a potential treatment method to overcome <italic>C. albicans</italic> resistance, has gained traction. In this study, we synthesized a series of cyclometalated iridium(III) complexes with the formula [Ir(C-N)<sub>2</sub>(tpphz)](PF<sub>6</sub>) (C-N = 2-phenylpyridine (ppy, in <bold>Ir1</bold>), 2-(2-thienyl)pyridine (thpy, in <bold>Ir2</bold>), 2-(2,4-difluorophenyl) pyridine (dfppy, in <bold>Ir3</bold>), tpphz = tetrapyrido[3,2-a:2',3'-c:3'',2''-h:2''',3'''-j]phenazine) and polypyridyl ruthenium(II) complexes with the formula [Ru(N-N)<sub>2</sub>(tpphz)](PF<sub>6</sub>)<sub>2</sub> (N-N = 2,2'-bipyridine (bpy, in <bold>Ru1</bold>), 1,10-phenanthroline (phen, in <bold>Ru2</bold>), 4,7-diphenyl-1,10-phenanthroline (DIP, in <bold>Ru3</bold>)), and investigated their antifungal activities against drug-resistant <italic>C. albicans</italic> and their combination with fluconazole (FLC). Of which, the combination of the lead iridium(III) complex <bold>Ir2</bold> and FLC showed strong antifungal activity against drug-resistant <italic>C. albicans.</italic> Mechanism studies have shown that they can inhibit the formation of hyphae and biofilm, damage mitochondrial function and accumulate intracellular ROS. Therefore, iridium(III) complexes combined with FLC can be used as a promising treatment to exert anti-drug-resistant <italic>C. albicans</italic> activity, in order to improve the treatment efficiency of fungal infection.</p>
</abstract>
<kwd-group>
<kwd>iridium(III) complexes</kwd>
<kwd>fluconazole</kwd>
<kwd>
<italic>C. albicans</italic>
</kwd>
<kwd>ROS</kwd>
<kwd>antifungal activity</kwd>
</kwd-group>
<counts>
<fig-count count="6"/>
<table-count count="2"/>
<equation-count count="0"/>
<ref-count count="58"/>
<page-count count="10"/>
<word-count count="4765"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Clinical Microbiology</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<label>1</label>
<title>Introduction</title>
<p>
<italic>Candida albicans</italic> (<italic>C. albicans</italic>) is an opportunistic pathogen (<xref ref-type="bibr" rid="B52">Witchley et&#xa0;al., 2019</xref>), which widely exists in many parts of human body. Generally, it does not cause disease, but when the body's immune function is impaired and its immune response ability is insufficient, infection will occur (<xref ref-type="bibr" rid="B13">Dadar et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B6">Celiksoy et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B31">Lubkin and Lionakis, 2022</xref>; <xref ref-type="bibr" rid="B38">Maurya and Mishra, 2022</xref>). The pathogenicity of <italic>C. albicans</italic> is related to both the body's immune function and its own virulence. <italic>C. albicans</italic> has two forms, yeast form and hyphal form (<xref ref-type="bibr" rid="B28">Lo et&#xa0;al., 1997</xref>). Yeast form hardly causes disease, when it is transformed into hyphal form, its adhesion to host epidermal cells increases sharply (<xref ref-type="bibr" rid="B21">Huang, 2012</xref>), and easier to cause invasive infection. Another virulence factor is the ability to form biofilms (<xref ref-type="bibr" rid="B45">Ponde et&#xa0;al., 2021</xref>), which refers to the organized fungal colony attached to the surface of living or inanimate objects and wrapped by fungal extracellular macromolecules. Biofilms are highly resistant to antibiotics and host immune defense (<xref ref-type="bibr" rid="B12">Crump and Collignon, 2000</xref>; <xref ref-type="bibr" rid="B39">Nobile and Johnson, 2015</xref>; <xref ref-type="bibr" rid="B44">Pohl, 2022</xref>).</p>
<p>
<italic>C. albicans</italic> increases its virulence mainly by forming hyphae and biofilm. At present, the conventional drugs mainly used for the treatment of <italic>C. albicans</italic> infection are azole compounds (<xref ref-type="bibr" rid="B53">Yu et&#xa0;al., 2022</xref>), such as fluconazole (FLC), nystatin, etc. However, because these drugs can only play a role in inhibiting fungi, they cannot directly kill <italic>C. albicans</italic>. In recent years, the repeated use of antifungal drugs such as azole drugs and long-term abuse of antibiotics have led to the sharp increase of drug-resistant <italic>C. albicans</italic> (<xref ref-type="bibr" rid="B48">Prasad et&#xa0;al., 2019</xref>), which has dramatically decreased the therapeutic effect of <italic>C. albicans</italic> infection (<xref ref-type="bibr" rid="B11">Cowen and Steinbach, 2008</xref>; <xref ref-type="bibr" rid="B43">Perfect, 2017</xref>; <xref ref-type="bibr" rid="B46">Popp et&#xa0;al., 2019</xref>). The need for new drug development and new therapeutic regimens for the treatment of <italic>C. albicans</italic> infection has become urgent. However, due to high investment, long cycle and slow progress in the research and development of new drugs, the combination medication can well exert the synergistic effects of drugs (<xref ref-type="bibr" rid="B27">Li et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B22">Lee et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B23">Li et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B3">An et&#xa0;al., 2022</xref>), improve the curative effect and effectively reduce the generation of drug resistance.</p>
<p>In the past decade, cyclometalated iridium(III) complexes and polypyridyl ruthenium(II) complexes exhibited noteworthy applications as anticancer agents (<xref ref-type="bibr" rid="B14">Das et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B47">Pragti et&#xa0;al., 2021</xref>). A large number of cyclomethylated iridium(III) complexes and polypyridyl ruthenium(II) complexes have been reported as enzyme inhibitors (<xref ref-type="bibr" rid="B40">P&#x103;unescu et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B20">He et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B58">Zhao et&#xa0;al., 2023</xref>), mitochondrial targeting agents (<xref ref-type="bibr" rid="B18">Guan et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B41">Peng et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B49">Qin et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B57">Zhang et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B55">Yuan et&#xa0;al., 2023</xref>), apoptosis (<xref ref-type="bibr" rid="B36">Ma et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B56">Zhang et&#xa0;al., 2022</xref>), autophagy (<xref ref-type="bibr" rid="B19">He et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B8">Chen et&#xa0;al., 2021</xref>), or ferroptosis inducers (<xref ref-type="bibr" rid="B50">Wang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B54">Yuan et&#xa0;al., 2021</xref>). Our research group has also done some work on the anti-tumor effects of cyclometalated iridium(III) complexes and polypyridyl ruthenium(II) complexes (<xref ref-type="bibr" rid="B30">Lu et&#xa0;al., 2022b</xref>; <xref ref-type="bibr" rid="B34">Ma et&#xa0;al., 2022a</xref>; <xref ref-type="bibr" rid="B33">Ma et&#xa0;al., 2023b</xref>). Recently, we have reported a series of iridium(III) and ruthenium(II) complexes with Jumonji domain-containing protein (JMJD) histone demethylase inhibitory activity (<xref ref-type="bibr" rid="B29">Lu et&#xa0;al., 2022a</xref>; <xref ref-type="bibr" rid="B35">Ma et&#xa0;al., 2022b</xref>). In addition to the research on tumors, metal complexes have also attracted widespread attention as promising candidates for addressing antimicrobial resistance and drug-resistant bacterial infections (<xref ref-type="bibr" rid="B24">Li et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B15">Frei et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B51">Wang et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B25">Li et&#xa0;al., 2023</xref>). However, to the best of our knowledge, most of them mainly focus on antibacterial activities, and there are relatively few reports of metal complexes with antifungal activities (<xref ref-type="bibr" rid="B7">Chen et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B16">Fu et&#xa0;al., 2022</xref>).</p>
<p>Metal complexes using tetrapyrido[3,2-a:2',3'-c:3'',2''-h:2''',3'''-j]phenazine (tpphz) as bridging ligands are focused on targeting DNA, interacting with DNA and acting as DNA imaging probes (<xref ref-type="bibr" rid="B4">Archer et&#xa0;al., 2019</xref>). These complexes are also potential phototherapeutic agents that can exert photocytotoxic effects by damaging duplex sequences (<xref ref-type="bibr" rid="B4">Archer et&#xa0;al., 2019</xref>). Being inspired by the above, and combined with the current research and development trends of antifungal drugs, we synthesized a series of tpphz modified cyclometalated iridium(III) complexes [Ir(C-N)<sub>2</sub>(tpphz)](PF<sub>6</sub>) (C-N = 2-phenylpyridine (ppy, in <bold>Ir1</bold>), 2-(2-thienyl)pyridine (thpy, in <bold>Ir2</bold>), 2-(2,4-difluorophenyl) pyridine (dfppy, in <bold>Ir3</bold>) and polypyridyl ruthenium(II) complexes [Ru(N-N)<sub>2</sub>(tpphz)](PF<sub>6</sub>)<sub>2</sub> (N-N = 2,2'-bipyridine (bpy, in <bold>Ru1</bold>), 1,10-phenanthroline (phen, in <bold>Ru2</bold>), 4,7-diphenyl-1,10-phenanthroline (DIP, in <bold>Ru3</bold>)). The minimum inhibitory concentration (MIC) and fractional inhibitory concentration index (FICI) of <bold>Ir1</bold>-<bold>Ir3</bold> and <bold>Ru1</bold>-<bold>Ru3</bold> against <italic>C. albicans</italic> were tested. The time killing effect of the lead compound <bold>Ir2</bold> combined with FLC on drug-resistant <italic>C. albicans</italic>, their ability to inhibit biofilm formation, and the impact on morphological transformation and mitochondrial function were evaluated. Through this study, it is expected to obtain a new therapeutic strategy to improve the current therapeutic effectiveness of antifungal infections.</p>
</sec>
<sec id="s2" sec-type="results">
<label>2</label>
<title>Results and discussion</title>
<sec id="s2_1">
<label>2.1</label>
<title>Synthesis and characterization</title>
<p>The synthetic methods of cyclometalated iridium(III) complexes (<bold>Ir1</bold> (<xref ref-type="bibr" rid="B9">Chen et&#xa0;al., 2011</xref>) and <bold>Ir3</bold> (<xref ref-type="bibr" rid="B10">Cho et&#xa0;al., 2016</xref>)) and polypyridyl ruthenium(II) complexes (<bold>Ru1</bold> (<xref ref-type="bibr" rid="B17">Gill et&#xa0;al., 2011</xref>), <bold>Ru2</bold> (<xref ref-type="bibr" rid="B17">Gill et&#xa0;al., 2011</xref>) and <bold>Ru3</bold> (<xref ref-type="bibr" rid="B2">Alatrash et&#xa0;al., 2017</xref>)) were modified according the literatures, and the synthetic route was shown in <xref ref-type="fig" rid="f6">
<bold>Scheme&#xa0;2</bold>
</xref>. Briefly, 1,10-phenanthroline-5,6-dione was first coordinated with the precursors of cyclometalated iridium(III) or polypyridyl ruthenium(II) to obtain the intermediate products, which were then condensed with 5,6-diamino-1,10-phenanthroline to obtain the target products. Among these, <bold>Ir2</bold> is a newly synthesized compound. The synthesized metal complexes were characterized by ESI-HRMS, <sup>1</sup>H NMR (<xref ref-type="supplementary-material" rid="SM1">
<bold>Figures S1</bold>
</xref>-<xref ref-type="supplementary-material" rid="SM1">
<bold>S12</bold>
</xref>) and elemental analysis.</p>
</sec>
<sec id="s2_2">
<label>2.2</label>
<title>Determination of MIC and FICI of <italic>C. albicans</italic> by Ir1-Ir3 and Ru1-Ru3</title>
<p>Here, we determined the antifungal effects of <bold>Ir1</bold>-<bold>Ir3</bold> and <bold>Ru1</bold>-<bold>Ru3</bold> on <italic>C. albicans</italic> strains, including a sensitive strain SC5314 and a FLC-resistant strain CA23. As shown in <xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>, these compounds alone did not inhibit both sensitive and resistant strain of <italic>C. albicans</italic> (MIC &gt; 100 &#x3bc;g/mL). The combination of <bold>Ru1</bold>-<bold>Ru3</bold> with FLC exhibited moderate antifungal activity against <italic>C. albicans</italic> susceptible strain, with MIC<sub>50</sub> values of 25.32 &#xb5;g/mL, 11.02 &#xb5;g/mL and 8.93 &#xb5;g/mL, respectively. The combination of <bold>Ir1</bold>-<bold>Ir3</bold> with FLC did not inhibit <italic>C. albicans</italic> susceptible strain. It has been reported that FLC exerts its antifungal mechanism by binding with ergosterol synthase on fungal cell membrane (<xref ref-type="bibr" rid="B1">Ahmad et&#xa0;al., 2010</xref>). The new newly synthesized complexes <bold>Ir1</bold>-<bold>Ir3</bold> and <bold>Ru1</bold>-<bold>Ru3</bold> did not show inhibitory effect on sensitive strains, possibly due to their inability to bind with ergosterol synthase on fungal cell membrane. The combination of <bold>Ir1</bold>-<bold>Ir3</bold> and to some extent <bold>Ru1</bold>-<bold>Ru3</bold> with FLC makes the sensitive strain not susceptible to FLC anymore, which may be due to the addition of <bold>Ir1</bold>-<bold>Ir3</bold> or <bold>Ru1</bold>-<bold>Ru3</bold> leads to the inability or weak binding of FLC to ergosterol synthase on the cell membrane of sensitive strain. While, the combination of <bold>Ir1</bold>-<bold>Ir3</bold> with FLC showed synergistic antifungal activity against resistant strain (FICI &lt; 0.5). Notably, the combination of <bold>Ir2</bold> and FLC showed significant antifungal activity (MIC 2.09 &#x3bc;g/mL) and synergistic effect (FICI 0.02), which was the best among these combinations. Our previous research found that the change in energy metabolism of <italic>C. albicans</italic> was crucial to the production of FLC resistance (<xref ref-type="bibr" rid="B27">Li et&#xa0;al., 2020</xref>). Therefore, we speculate that the combination of the newly synthesized complex with FLC may affect the energy metabolism of drug resistant strains and reverse the drug resistance of FLC. This speculation has been confirmed by subsequent experiments (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1C</bold>
</xref>).</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>The antifungal activity of <bold>Ir1</bold>-<bold>Ir3</bold> and <bold>Ru1</bold>-<bold>Ru3</bold> against the sensitive strain SC5314 and the FLC-resistant strain CA23.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" rowspan="2" align="center">Entry</th>
<th valign="middle" rowspan="2" align="center">Compounds</th>
<th valign="middle" colspan="2" align="center">MIC<sub>50</sub> (&#x3bc;g/mL)</th>
<th valign="middle" colspan="2" align="center">FICI</th>
</tr>
<tr>
<th valign="middle" align="center">SC5314</th>
<th valign="middle" align="center">CA23</th>
<th valign="middle" align="center">SC5314</th>
<th valign="middle" align="center">CA23</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="center">1</td>
<td valign="middle" align="center">FLC</td>
<td valign="middle" align="center">3.41</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">&#x2013;</td>
</tr>
<tr>
<td valign="middle" align="center">2</td>
<td valign="middle" align="center">
<bold>Ir1</bold>
</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">&#x2013;</td>
</tr>
<tr>
<td valign="middle" align="center">3</td>
<td valign="middle" align="center">
<bold>Ir1</bold> + FLC</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">10.14</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">0.10</td>
</tr>
<tr>
<td valign="middle" align="center">4</td>
<td valign="middle" align="center">
<bold>Ir2</bold>
</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">&#x2013;</td>
</tr>
<tr>
<td valign="middle" align="center">5</td>
<td valign="middle" align="center">
<bold>Ir2</bold> + FLC</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">2.09</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">0.02</td>
</tr>
<tr>
<td valign="middle" align="center">6</td>
<td valign="middle" align="center">
<bold>Ir3</bold>
</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">&#x2013;</td>
</tr>
<tr>
<td valign="middle" align="center">7</td>
<td valign="middle" align="center">
<bold>Ir3</bold> + FLC</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">10.96</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">0.11</td>
</tr>
<tr>
<td valign="middle" align="center">8</td>
<td valign="middle" align="center">
<bold>Ru1</bold>
</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">&#x2013;</td>
</tr>
<tr>
<td valign="middle" align="center">9</td>
<td valign="middle" align="center">
<bold>Ru1</bold> + FLC</td>
<td valign="middle" align="center">25.32</td>
<td valign="middle" align="center">57.65</td>
<td valign="middle" align="center">7.55</td>
<td valign="middle" align="center">0.58</td>
</tr>
<tr>
<td valign="middle" align="center">10</td>
<td valign="middle" align="center">
<bold>Ru2</bold>
</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">&#x2013;</td>
</tr>
<tr>
<td valign="middle" align="center">11</td>
<td valign="middle" align="center">
<bold>Ru2</bold> + FLC</td>
<td valign="middle" align="center">11.02</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">3.29</td>
<td valign="middle" align="center">&#x2013;</td>
</tr>
<tr>
<td valign="middle" align="center">12</td>
<td valign="middle" align="center">
<bold>Ru3</bold>
</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">&#x2013;</td>
<td valign="middle" align="center">&#x2013;</td>
</tr>
<tr>
<td valign="middle" align="center">13</td>
<td valign="middle" align="center">
<bold>Ru3</bold> + FLC</td>
<td valign="middle" align="center">8.93</td>
<td valign="middle" align="center">&gt; 100</td>
<td valign="middle" align="center">2.66</td>
<td valign="middle" align="center">&#x2013;</td>
</tr>
</tbody>
</table>
</table-wrap>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Changes of ROS <bold>(A)</bold>, MMP <bold>(B)</bold> and ATP <bold>(C)</bold> levels in drug-resistant <italic>C. albicans</italic> (****<italic>P</italic> &lt; 0.0001 <italic>vs</italic> Control group, ***<italic>P</italic> &lt; 0.001 <italic>vs</italic> Control group). <italic>C. albicans</italic> SC5314FR was incubated with FLC, <bold>Ir2</bold> or <bold>Ir2</bold> + FLC at 37 &#xb0;C for 16 h. After that, the levels of ROS, MMP and ATP were measured using a multifunctional enzyme-labeled instrument.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1200747-g001.tif"/>
</fig>
<p>Resistance of <italic>C. albicans</italic> is currently the main reason for the reduced efficacy of antifungal agents. We further tested the antifungal activity of <bold>Ir2</bold> against different resistant strains of <italic>C. albicans</italic>. As shown in <xref ref-type="table" rid="T2">
<bold>Table&#xa0;2</bold>
</xref>, <bold>Ir2</bold> alone had no inhibitory effect on resistant strains of <italic>C. albicans</italic> (MIC &gt; 200 &#x3bc;g/mL). While <bold>Ir2</bold> combined with FLC exhibited significant antifungal activity, with MICs of 1.88-13.27 &#x3bc;g/mL, and FICIs of 0.009-0.07, indicating a strong synergistic effect. Therefore, we choose compound <bold>Ir2</bold> as a more promising drug and the drug-resistant strain SC5314FR for further research.</p>
<table-wrap id="T2" position="float">
<label>Table&#xa0;2</label>
<caption>
<p>Antifungal activity of compound <bold>Ir2</bold> against different resistant strains of <italic>C. albicans</italic>.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" rowspan="2" align="center">Entry</th>
<th valign="middle" rowspan="2" align="center">Organism</th>
<th valign="middle" colspan="3" align="center">MIC<sub>50</sub> (&#x3bc;g/mL)</th>
<th valign="middle" rowspan="2" align="center">FICI</th>
</tr>
<tr>
<th valign="middle" align="center">FLC</th>
<th valign="middle" align="center">Ir2</th>
<th valign="middle" align="center">Ir2 + FLC</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="center">1</td>
<td valign="middle" align="center">CA23</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">2.09</td>
<td valign="middle" align="center">0.02</td>
</tr>
<tr>
<td valign="middle" align="center">2</td>
<td valign="middle" align="center">CA556</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">2.05</td>
<td valign="middle" align="center">0.01</td>
</tr>
<tr>
<td valign="middle" align="center">3</td>
<td valign="middle" align="center">SC5314FR</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">1.88</td>
<td valign="middle" align="center">0.009</td>
</tr>
<tr>
<td valign="middle" align="center">4</td>
<td valign="middle" align="center">ATCC14053FR</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">8.64</td>
<td valign="middle" align="center">0.04</td>
</tr>
<tr>
<td valign="middle" align="center">5</td>
<td valign="middle" align="center">ATCC10231FR</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">&gt; 200</td>
<td valign="middle" align="center">13.27</td>
<td valign="middle" align="center">0.07</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s2_3">
<label>2.3</label>
<title>Time-kill curve of Ir2 combined with FLC</title>
<p>To evaluate the fungicidal effect of the combination of <bold>Ir2</bold> and FLC on drug-resistant <italic>C. albicans</italic> SC5314FR, a three-day concentration-dependent time-kill curve was performed. The results showed (<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2</bold>
</xref>) that <bold>Ir2</bold> had no fungicidal effect on drug-resistant <italic>C. albicans</italic> SC5314FR alone, and FLC only showed a fungicidal effect within 24-36 h, which weakened with the passage of time. Only when the two drugs were used in combination, they showed a strong fungicidal effect, all combined groups still showed a strong fungicidal activity after 72 h treatment. These results indicated that <bold>Ir2</bold> combined with FLC killed <italic>C. albicans</italic> SC5314FR directly.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Time-kill curve of <bold>Ir2</bold> combined with FLC against <italic>C. albicans</italic> SC5314FR. <bold>Ir2</bold>(H) represents the <bold>Ir2</bold> dose of 6 &#x3bc;g/mL, <bold>Ir2</bold>(M) represents the <bold>Ir2</bold> dose of 3 &#x3bc;g/mL, <bold>Ir2</bold>(L) represents the <bold>Ir2</bold> dose of 1.5 &#x3bc;g/mL. The OD value at 625 nm wavelength was detected by enzyme-labeled instrument.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1200747-g002.tif"/>
</fig>
</sec>
<sec id="s2_4">
<label>2.4</label>
<title>Ir2 combined with FLC inhibit the formation of <italic>C. albicans</italic> SC5314FR biofilm</title>
<p>The formation of biofilm is a major virulence factor of <italic>C. albicans.</italic> In fact, a tightly arranged fungal cell community is extremely difficult to eradicate, which is the main reason for the resistance of commonly used antifungal drugs (<xref ref-type="bibr" rid="B45">Ponde et&#xa0;al., 2021</xref>). For this reason, we chose <bold>Ir2</bold> combined with FLC to inhibit the formation of biofilm. The results showed that <bold>Ir2</bold> alone could not inhibit the biofilm formation of <italic>C. albicans</italic> SC5314FR, while FLC had a certain inhibitory effect on biofilm formation. However, when two drugs were used together, the biofilm formation was more obviously inhibited in a dose-dependent manner (<xref ref-type="fig" rid="f3">
<bold>Figure&#xa0;3</bold>
</xref>).</p>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Effect of <bold>Ir2</bold> combined with FLC on biofilm formation of drug-resistant <italic>C. albicans</italic> SC5314FR (20 &#xd7;). <italic>C. albicans</italic> SC5314FR was incubated with FLC, <bold>Ir2</bold> or <bold>Ir2</bold> + FLC at 37 &#xb0;C for 24 h, and the biofilm mass was determined by crystal violet staining.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1200747-g003.tif"/>
</fig>
</sec>
<sec id="s2_5">
<label>2.5</label>
<title>Ir2 combined with FLC inhibit the hyphal formation of <italic>C. albicans</italic> SC5314FR</title>
<p>When <italic>C. albicans</italic> changed from yeast state to hyphal state, its virulence would be changed, which was the main cause of its disease. To this end, we evaluated the effect of the combination of <bold>Ir2</bold> and FLC on the morphological transformation of hyphae of drug-resistant <italic>C. albicans</italic> SC5314FR through hypha formation experiments. The results showed (<xref ref-type="fig" rid="f4">
<bold>Figures&#xa0;4A, B</bold>
</xref>) that the drug-resistant strain SC5314FR had formed complex, elongated, and coiled hyphae after 8 h of culture in two different hypha induction media, Synthetic Dropout medium (SD) (containing 10% fetal bovine serum (FBS)) and Spider medium. After FLC treatment, it inhibited the mycelia growth to a certain extent at 4 h, but it could not inhibit the formation of complex mycelia at 8 h. However, <bold>Ir2</bold> alone did not inhibit the formation of hypha. In contrast to FLC, the combination of <bold>Ir2</bold> and FLC inhibited hyphal formation in a dose-dependent manner. These results indicated that the combined use of the two drugs reduced the formation of hyphae of drug-resistant <italic>C. albicans</italic> and its virulence. We further detected the effect of drug combinations on the expression of virulence genes related to <italic>C. albicans</italic> SC5314FR hyphae using PCR experiments. The data (<xref ref-type="supplementary-material" rid="SM1">
<bold>Figure S13</bold>
</xref>) showed that their impact on these gene expressions was not significant. So, we next explored the effects of <bold>Ir2</bold> combined with FLC on intracellular reactive oxygen species (ROS), mitochondrial membrane potential (MMP) and ATP levels.</p>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>Effects of the combination of <bold>Ir2</bold> and FLC on hyphal morphological transformation. <bold>(A)</bold> Spider liquid medium, <bold>(B)</bold> SD + 10% FBS (20 &#xd7;). <italic>C. albicans</italic> SC5314FR was incubated with FLC, <bold>Ir2</bold> or <bold>Ir2</bold> + FLC at 37 &#xb0;C for 4 h or 8 h, and the mycelia of different groups were observed under an inverted microscope for growth and photographed.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1200747-g004.tif"/>
</fig>
</sec>
<sec id="s2_6">
<label>2.6</label>
<title>Ir2 combined with FLC promote the accumulation of intracellular ROS, and decrease MMP and ATP levels</title>
<p>ROS is often accompanied by host's phagocytosis against <italic>C. albicans</italic>. It can cause oxidative stress damage by interacting with the protein of the strain and induce the programmed cell death of the strain (<xref ref-type="bibr" rid="B32">Lv et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B37">Ma et&#xa0;al., 2023a</xref>). In the cell, ROS is mainly produced by mitochondria, and the rate of ROS production by mitochondria is mainly regulated by the transmembrane potential of mitochondrial inner membrane (<xref ref-type="bibr" rid="B42">Peng et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B5">Campos et&#xa0;al., 2023</xref>). Therefore, we detected the effect of <bold>Ir2</bold> combined with FLC on intracellular ROS and mitochondrial MMP of drug-resistant <italic>C. albicans</italic> by fluorescent probe 2',7'-dichlorofluorescein diacetate (DCFH-DA) and 5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimidazolylcarbocyanine iodide (JC-1). The results showed that the combination of <bold>Ir2</bold> and FLC promoted the accumulation of intracellular ROS (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1A</bold>
</xref>) and decreased MMP (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1B</bold>
</xref>) in a dose-dependent manner. Therefore, we speculated that the combination of <bold>Ir2</bold> and FLC caused the mitochondrial damage of drug-resistant <italic>C. albicans</italic>. As the main production of ROS, the damaged mitochondria caused a large amount of ROS accumulation, and then caused the oxidative stress reaction of <italic>C. albicans</italic>, resulting in programmed death of drug-resistant <italic>C. albicans</italic>. In addition, the decrease in ATP levels is closely related to mitochondrial dysfunction. Therefore, we determined the ATP production of <italic>C. albicans</italic>. The results showed that <bold>Ir2</bold> or FLC alone could not reduce the ATP production by mitochondria of <italic>C. albicans</italic>, and the combination of <bold>Ir2</bold> and FLC significantly reduced the ATP production by <italic>C. albicans</italic> in a dose-dependent manner (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1C</bold>
</xref>).</p>
</sec>
</sec>
<sec id="s3" sec-type="conclusions">
<label>3</label>
<title>Conclusion</title>
<p>In summary, we evaluated the antifungal activity of a series of tpphz modified cyclometalated iridium(III) and polypyridyl ruthenium(II) complexes against <italic>C. albicans</italic>. The serial compounds combined with FLC have antifungal activity on <italic>C. albicans</italic>, wherein <bold>Ir2</bold> and FLC in combination have significant antifungal activities on drug resistant and sensitive strains of <italic>C. albicans in vitro</italic>. The combination of the two drugs can inhibit the time growth curve to directly kill the <italic>C. albicans</italic>; it also inhibits the formation of biofilm and hypha. In addition, the combination of the two drugs reduced the MMP of drug-resistant <italic>C. albicans</italic>, causing mitochondrial damage and sharp increase in the accumulation of ROS. To sum up, the combination of <bold>Ir2</bold> and FLC can kill drug resistant <italic>C. albicans</italic> probably by damaging mitochondria. It is expected to become an effective strategy to solve the clinical resistance of <italic>C. albicans</italic> and optimize the treatment plan of clinical fungal infection.</p>
</sec>
<sec id="s4" sec-type="materials|methods">
<label>4</label>
<title>Materials and methods</title>
<sec id="s4_1">
<label>4.1</label>
<title>Materials and instruments</title>
<p>IrCl<sub>3</sub>&#xb7;nH<sub>2</sub>O (J&amp;K), ppy (J&amp;K), thpy (J&amp;K), dfppy (J&amp;K), RuCl<sub>3</sub>&#xb7;nH<sub>2</sub>O (J&amp;K), bpy (J&amp;K), phen (J&amp;K), DIP (J&amp;K), 1,10-phenanthroline-5,6-dione (J&amp;K), 5,6-diamino-1,10-phenanthroline (J&amp;K), FLC (Nanchang Hongyi Pharmaceutical Co., Ltd.), enzyme-labeled instrument (Nanjing Detie Test Equipment Co., Ltd.), Sabouraud's Dextrose Brother (HKM), Sabouraud Dextrose Agar (HKM), FBS (VivaCell), ROS Assay Kit (BRYOTIME), MMP Assay Kit with JC-1 (BRYOTIME). FLC and the compounds were dissolved in dimethyl sulfoxide (DMSO) before the experiment, and the concentration of DMSO in the experiment was less than 1%.</p>
</sec>
<sec id="s4_2">
<label>4.2</label>
<title>Preparation of Ir1-Ir3 and Ru1-Ru3</title>
<p>[Ir(ppy)<sub>2</sub>(tpphz)](PF<sub>6</sub>) (<bold>Ir1</bold>) (<xref ref-type="bibr" rid="B9">Chen et&#xa0;al., 2011</xref>), [Ir(dfppy)<sub>2</sub>(tpphz)](PF<sub>6</sub>) (<bold>Ir3</bold>) (<xref ref-type="bibr" rid="B10">Cho et&#xa0;al., 2016</xref>), [Ru(bpy)<sub>2</sub>(tpphz)](PF<sub>6</sub>)<sub>2</sub> (<bold>Ru1</bold>) (<xref ref-type="bibr" rid="B17">Gill et&#xa0;al., 2011</xref>), [Ru(phen)<sub>2</sub>(tpphz)](PF<sub>6</sub>)<sub>2</sub> (<bold>Ru2</bold>) (<xref ref-type="bibr" rid="B17">Gill et&#xa0;al., 2011</xref>) and [Ru(DIP)<sub>2</sub>(tpphz)](PF<sub>6</sub>)<sub>2</sub> (<bold>Ru3</bold>) (<xref ref-type="bibr" rid="B2">Alatrash et&#xa0;al., 2017</xref>) were synthesized according the literatures.</p>
<p>[Ir(ppy)<sub>2</sub>(tpphz)](PF<sub>6</sub>) (<bold>Ir1</bold>): <sup>1</sup>H NMR (600 MHz, DMSO-<italic>d</italic>
<sub>6</sub>) &#x3b4; 9.62 (dd, <italic>J</italic> = 37.0, 7.4 Hz, 4H), 8.65 (s, 2H), 8.37 (dd, <italic>J</italic> = 32.9, 6.3 Hz, 4H), 8.20 (dd, <italic>J</italic> = 7.9, 5.1 Hz, 2H), 8.04 (d, <italic>J</italic> = 7.9 Hz, 2H), 7.95 &#x2013; 7.80 (m, 6H), 7.16 &#x2013; 7.01 (m, 6H), 6.40 &#x2013; 6.35 (m, 2H). ESI-HRMS (CH<sub>3</sub>OH): <italic>m/z</italic> 885.2041 [M-PF<sub>6</sub>]<sup>+</sup>.</p>
<p>[Ir(thpy)<sub>2</sub>(tpphz)](PF<sub>6</sub>) (<bold>Ir2</bold>): The synthetic route of <bold>Ir2</bold> was shown <xref ref-type="fig" rid="f6">
<bold>Scheme&#xa0;2</bold>
</xref>. The mixture of 1,10-phenanthroline-5,6-dione (2.1 equiv.) and the precursor of cyclometalated iridium(III) [Ir(thpy)<sub>2</sub>Cl]<sub>2</sub> (1.0 equiv.) was firstly refluxed in CH<sub>2</sub>Cl<sub>2</sub>/CH<sub>3</sub>OH for 4 h. Then, 5,6-diamino-1,10-phenanthroline (2.0 equiv.) in 10 mL CH<sub>3</sub>OH were added and refluxed for 6 h under nitrogen. After cooling to room temperature, the solvent was evaporated and the crude product was chromatographed over silica gel by using CH<sub>2</sub>Cl<sub>2</sub>/CH<sub>3</sub>OH (10/1, v/v) as an eluent to obtain <bold>Ir2</bold>. Yield: 38% (yellow solid). <sup>1</sup>H NMR (600 MHz, DMSO-<italic>d</italic>
<sub>6</sub>) &#x3b4; 9.60 (dd, <italic>J</italic> = 42.2, 7.6 Hz, 4H), 8.62 (s, 2H), 8.37 (d, <italic>J</italic> = 4.3 Hz, 2H), 8.25 &#x2013; 8.21 (m, 2H), 7.81 (dt, <italic>J</italic> = 12.2, 6.3 Hz, 10H), 6.86 (t, <italic>J</italic> = 6.1 Hz, 2H), 6.35 (d, <italic>J</italic> = 4.7 Hz, 2H). ESI-HRMS (CH<sub>3</sub>OH): <italic>m/z</italic> 897.1188 [M-PF<sub>6</sub>]<sup>+</sup>. Elemental analysis: calcd (%) for C<sub>42</sub>H<sub>24</sub>F<sub>6</sub>IrN<sub>8</sub>PS<sub>2</sub>: C, 48.41; H, 2.32; N, 10.75; found: C, 48.58; H, 2.40; N, 10.90.</p>
<fig id="f5" position="float">
<label>Scheme&#xa0;1</label>
<caption>
<p>Chemical structures of [Ir(C-N)<sub>2</sub>(tpphz)](PF<sub>6</sub>) (<bold>Ir1</bold>-<bold>Ir3</bold>) and [Ru(N-N)<sub>2</sub>(tpphz)](PF<sub>6</sub>)<sub>2</sub> (<bold>Ru1</bold>-<bold>Ru3</bold>).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1200747-g005.tif"/>
</fig>
<fig id="f6" position="float">
<label>Scheme&#xa0;2</label>
<caption>
<p>Synthetic routes of <bold>Ir1</bold>-<bold>Ir3 (A)</bold> and <bold>Ru1</bold>-<bold>Ru3 (B)</bold>.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-13-1200747-g006.tif"/>
</fig>
<p>[Ir(dfppy)<sub>2</sub>(tpphz)](PF<sub>6</sub>) (<bold>Ir3</bold>): <sup>1</sup>H NMR (600 MHz, DMSO-<italic>d</italic>
<sub>6</sub>) &#x3b4; 9.68 (dd, <italic>J</italic> = 45.7, 7.6 Hz, 4H), 8.66 (s, 2H), 8.50 (dd, <italic>J</italic> = 5.0, 0.9 Hz, 2H), 8.37 (d, <italic>J</italic> = 8.9 Hz, 2H), 8.21 (dd, <italic>J</italic> = 8.1, 5.1 Hz, 2H), 8.07 &#x2013; 7.95 (m, 4H), 7.87 (dd, <italic>J</italic> = 7.8, 4.2 Hz, 2H), 7.18 &#x2013; 7.08 (m, 4H), 5.80 (dd, <italic>J</italic> = 8.2, 2.2 Hz, 2H). ESI-HRMS (CH<sub>3</sub>OH): <italic>m/z</italic> 957.1691 [M-PF<sub>6</sub>]<sup>+</sup>.</p>
<p>[Ru(bpy)<sub>2</sub>(tpphz)](PF<sub>6</sub>)<sub>2</sub> (<bold>Ru1</bold>): <sup>1</sup>H NMR (600 MHz, DMSO-<italic>d</italic>
<sub>6</sub>) &#x3b4; 9.61 (dd, <italic>J</italic> = 62.9, 7.0 Hz, 4H), 8.93 (dd, <italic>J</italic> = 21.8, 8.1 Hz, 4H), 8.63 (s, 2H), 8.36 &#x2013; 8.26 (m, 4H), 8.18 &#x2013; 8.01 (m, 6H), 7.91 (dd, <italic>J</italic> = 10.9, 4.6 Hz, 4H), 7.68 &#x2013; 7.64 (m, 2H), 7.43 (t, <italic>J</italic> = 6.1 Hz, 2H). ESI-HRMS (CH<sub>3</sub>OH): <italic>m/z</italic> 399.0774 [M-2PF<sub>6</sub>]<sup>2+</sup>, 943.1164 [M-PF<sub>6</sub>]<sup>+</sup>.</p>
<p>[Ru(phen)<sub>2</sub>(tpphz)](PF<sub>6</sub>)<sub>2</sub> (<bold>Ru2</bold>): <sup>1</sup>H NMR (600 MHz, DMSO-<italic>d</italic>
<sub>6</sub>) &#x3b4; 9.61 (d, <italic>J</italic> = 7.0 Hz, 2H), 9.41 (d, <italic>J</italic> = 6.3 Hz, 2H), 8.87 &#x2013; 8.68 (m, 6H), 8.45 (s, 6H), 8.28 (d, <italic>J</italic> = 4.6 Hz, 2H), 8.16 (d, <italic>J</italic> = 4.5 Hz, 2H), 7.86 (dt, <italic>J</italic> = 20.9, 6.1 Hz, 8H). ESI-HRMS (CH<sub>3</sub>OH): <italic>m/z</italic> 423.0709 [M-2PF<sub>6</sub>]<sup>2+</sup>, 991.1191 [M-PF<sub>6</sub>]<sup>+</sup>.</p>
<p>[Ru(DIP)<sub>2</sub>(tpphz)](PF<sub>6</sub>)<sub>2</sub> (<bold>Ru3</bold>): <sup>1</sup>H NMR (600 MHz, DMSO-<italic>d</italic>
<sub>6</sub>) &#x3b4; 9.85 &#x2013; 9.45 (m, 4H), 8.75 (s, 1H), 8.62 (s, 1H), 8.44 (dd, <italic>J</italic> = 30.5, 5.0 Hz, 4H), 8.33 (s, 4H), 8.05 &#x2013; 7.97 (m, 2H), 7.87 (dd, <italic>J</italic> = 34.2, 5.3 Hz, 6H), 7.66 (dddd, <italic>J</italic> = 53.2, 23.0, 14.2, 6.9 Hz, 22H). ESI-HRMS (CH<sub>3</sub>OH): <italic>m/z</italic> 575.1413 [M-2PF<sub>6</sub>]<sup>2+</sup>, 1295.2459 [M-PF<sub>6</sub>]<sup>+</sup>.</p>
</sec>
<sec id="s4_3">
<label>4.3</label>
<title>
<italic>C. albicans</italic> strain and culture condition</title>
<p>The sensitive strain, <italic>C. albicans</italic> SC5314, was purchased from the American type culture collection. SC5314, ATCC14053 and ATCC10231 FLC-resistant strain (SC5314FR, ATCC14053FR and ATCC10231FR): sensitive strain SC5314, ATCC14053 and ATCC10231 were induced by FLC to be resistant to FLC. <italic>C. albicans</italic> CA23 and CA556, two clinical isolates, were presented by Professor Li Yuye, Department of Dermatology and Sexology, the First Affiliated Hospital of Kunming Medical University (Yunnan, China).</p>
</sec>
<sec id="s4_4">
<label>4.4</label>
<title>Determination of MIC: microdilution method</title>
<p>The MIC of a combination of <bold>Ir1</bold>-<bold>Ir3</bold> and <bold>Ru1</bold>-<bold>Ru3</bold> with FLC against <italic>C. albicans</italic> was determined using microdilution method. In short, the incubated <italic>C. albicans</italic> strains were scraped into Sabouraud's Dextrose Broth (SDB) and prepared into fungal suspension with the final concentration of 1 &#xd7; 10<sup>5</sup> colony-forming units (CFU)/mL. The corresponding drugs were added according to the groups. After 24 h, the absorbance (OD 630 nm) of each group was measured with a microplate reader, and the MIC and FICI of each group were calculated. When FICI was &#x2264; 0.5, the two drugs interacted synergistically. When 0.5 &lt; FICI &#x2264; 4, the mode of action of the two drugs was irrelevant. When FICI &gt; 4, the action mode of the two drugs was antagonism.</p>
</sec>
<sec id="s4_5">
<label>4.5</label>
<title>Research on time-kill curve</title>
<p>A proper amount of <italic>C. albicans</italic> was scraped into fresh SDB, mixed and counted until the final concentration was 1 &#xd7; 10<sup>5</sup> CFU/mL. The corresponding drugs were added according to the groups, and cultured in a constant temperature shaker at 37 &#xb0;C and with shaking at 150 rpm. 100 &#x3bc;L samples were collected in the ultra-clean benches at time points 0, 4, 8, 12, 24, 36, 48 and 72 h. Three wells were plated in each group. The OD value at 625 nm wavelength was detected by enzyme-labeled instrument (where FLC concentration was 3 &#x3bc;g/mL, <bold>Ir2</bold> used alone was 3 &#x3bc;g/mL, and the combination was <bold>Ir2</bold>(H) + FLC: 6 &#x3bc;g/mL + 3&#x3bc;g/mL, <bold>Ir2</bold>(M) + FLC: 3 &#x3bc;g/mL + 3 &#x3bc;g/mL, <bold>Ir2</bold>(L) + FLC: 1.5 &#x3bc;g/mL + 3 &#x3bc;g/mL). The concentration of drugs used in subsequent experiments was subject to this standard.</p>
</sec>
<sec id="s4_6">
<label>4.6</label>
<title>
<italic>C. albicans</italic> biofilm formation experiment</title>
<p>The drug-resistant <italic>C. albicans</italic> SC5314FR was dissolved in RPMI-1640 + 10% FBS medium, and the fungal concentration was adjusted to 1 &#xd7; 10<sup>5</sup> CFU/mL. They were transferred to 24-well plates with 1 mL per well, and cultured in a constant temperature and humidity box at 37 &#xb0;C for 90 min. The supernatant was sucked and discarded. According to the grouping, 1 mL of fresh 1640 + 10% FBS medium with or without drug was added, and cultured in a constant temperature and humidity box at 37 &#xb0;C for 24 h, and the supernatant was sucked and discarded. Then 400 &#x3bc;L 0.5% crystal violet was added for staining for 30 min, followed by PBS washing for three times, and then 400 &#x3bc;L PBS was added for observation and photographing under an inverted microscope.</p>
</sec>
<sec id="s4_7">
<label>4.7</label>
<title>Study on morphological transformation of <italic>C. albicans</italic> mycelium</title>
<p>
<italic>C. albicans</italic> SC5314FR was dissolved in SD + 10% FBS and Spider liquid medium, and the final concentration was adjusted to 1 &#xd7; 10<sup>5</sup> CFU/mL. The corresponding drugs were added in groups, and 1 mL of fungal suspension with or without drug was added into each well of 24-well plates. The samples were cultured in a constant temperature and humidity box at 37 &#xb0;C. After 4 and 8 h, the mycelia of different groups were observed under an inverted microscope for growth and photographed.</p>
</sec>
<sec id="s4_8">
<label>4.8</label>
<title>Detection of intracellular ROS of <italic>C. albicans</italic>
</title>
<p>A proper amount of drug-resistant <italic>C. albicans</italic> SC5314FR was scraped into SDB. And the <italic>C. albicans</italic> cell suspension was prepared according to the groups, adjusted to the medium concentration of 1 &#xd7; 10<sup>5</sup> CFU/mL. Under the dark condition, fluorescent probe DCFH-DA was added and incubated for 30 min in the dark. After being washed and re-suspended with PBS again, they were mixed evenly and absorbed 100 &#x3bc;L into a black 96-well plates, with three wells in each group. The fluorescence value was measured by the full-wavelength multifunctional enzyme-labeled instrument (excitation wavelength: 488 nm, emission wavelength: 525 nm).</p>
</sec>
<sec id="s4_9">
<label>4.9</label>
<title>Detection of MMP of <italic>C. albicans</italic>
</title>
<p>A proper amount of drug-resistant <italic>C. albicans</italic> SC5314FR was scraped into SDB, mixed and counted, the concentration of fungal suspension was 1 &#xd7; 10<sup>5</sup> CFU/mL. The corresponding drugs were added according to groups, cultured with a constant temperature shaking table for 16 h. Then JC-1 working solution was added. After uniform mixing, the samples were incubated in a constant-temperature shaking table for 20 min, and the supernatant was discarded after centrifugation. After being washed and re-suspended with JC-1 staining buffer, 100 &#x3bc;L fungal suspension was collected into a black 96-well plate with three re-wells in each group. The red (excitation wavelength: 488 nm, emission wavelength: 590 nm) and green fluorescence values (excitation wavelength: 488 nm, emission wavelength: 530 nm) were measured by the full-wavelength multifunctional enzyme-labeled instrument. The MMP was determined by the ratio of the red fluorescence value to the green fluorescence value.</p>
</sec>
<sec id="s4_10">
<label>4.10</label>
<title>Detection of ATP of <italic>C. albicans</italic>
</title>
<p>The intracellular ATP production was measured using ATP assay kits (Beyotime Institute of Biotechnology, Haimen, China) according to the manufacturer&#x2019;s instructions. Briefly, the concentration of <italic>C. albicans</italic> SC5314FR in medium were adjusted to 1 &#xd7; 10<sup>5</sup> CFU/mL, and the corresponding drugs were added according to groups, cultured at 37&#xb0;C for 16 h. Cells were then collected and washed with ice-cold PBS. ATP levels in cells were calculated according to the standard curve. The results were expressed in nmol/mg protein.</p>
</sec>
<sec id="s4_11">
<label>4.11</label>
<title>Statistical analysis</title>
<p>Biological experiments were repeated at least 3 times and the results were presented as mean &#xb1; standard deviation.</p>
</sec>
</sec>
<sec id="s5" sec-type="data-availability">
<title>Data availability statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="supplementary-material" rid="SM1">
<bold>Supplementary Material</bold>
</xref>. Further inquiries can be directed to the corresponding authors.</p>
</sec>
<sec id="s6" sec-type="author-contributions">
<title>Author contributions</title>
<p>J-JL, X-RM, HZ, and L-YZ contributed to the synthesis and characterization of complexes. Z-CX contributed to the antifungal activity and mechanism, as well as the writing of article. R-RW, R-TL, and R-RY designed the project. All authors contributed to the article and approved the submitted version.</p>
</sec>
</body>
<back>
<sec id="s7" sec-type="funding-information">
<title>Funding</title>
<p>We thank the National Natural Science Foundation of China (22007042, 21967014), Applied Basic Research Projects of Yunnan Province (202001AT070036), Yunnan Province Science and Technology Department (202101AF070001, 202103AC100005), High-level Scientific Research Foundation for Talent Introduction of Kunming University of Science and Technology (KKKP201826008).</p>
</sec>
<sec id="s8" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s9" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s10" sec-type="supplementary-material">
<title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fcimb.2023.1200747/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fcimb.2023.1200747/full#supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="DataSheet_1.docx" id="SM1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document"/>
</sec>
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