Logo

Journal of Mycology and Truffle | Vol. 1, No. 1 (2026), Pages: 12-18

Host Immune Responses to Pathogenic Fungi and Contemporary Therapeutic Strategies

Ahmed Farhan SHALLAL
College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan Region, Iraq. Department of Biology, College of Science, University of Raparin, Sulaymaniyah, Kurdistan Region, Iraq

Chawan Hazhar RAZAQ
Department of Biology, College of Science, University of Raparin, Sulaymaniyah, Kurdistan Region, Iraq

Asmaa Sayed AHMED
Department of Biology, College of Science, University of Raparin, Sulaymaniyah, Kurdistan Region, Iraq

Syamand Ahmed AHMED
Department of Biology, Faculty of Science, Soran University, Kurdistan Region, Iraq. Department of Nursing, Rwandz Private Technical Institute, Rwandz, Erbil, Kurdistan, Iraq

Volkan EYUPOGLU
Department of Chemistry, Cankırı Karatekin University, Cankırı, 18100, Turkey

Ruqaia Sabbar SALMAN
Department of Microbiology, College of Medicine, Al-Iraqia University, Bagdad, Iraq

Received: 2026-03-06 Revised: 2026-04-09 Accepted: 2026-05-06 Published: 2026-05-31

https://doi.org/10.65999/mycotruffle/2026.26

ABSTRACT

Opportunistic infections such as Candida, Aspergillus, and Cryptococcus are significant contributors to illness and mortality, particularly in those with compromised immune systems. The innate and adaptive immune systems collaborate to ensure host protection. Pattern recognition receptors in innate immunity are the primary line of defense. They identify fungal fragments and emit signals that induce swelling. The immune system must generate cytokines and activate immune cells to eradicate fungi. This is particularly applicable to reactions from Th1 and Th17. Fungal diseases are emerging numerous strategies to circumvent human defenses, such as altering their morphology, developing biofilms, and concealing characteristics that elicit an immune response. These modifications facilitate prolonged infection persistence. The rise of antifungal resistance, caused by genetic mutations, efflux pumps, and biofilm-associated protection, has diminished the efficacy of conventional antifungal medicines. This review delineates the host immune system's response to fungal infections and examines the primary mechanisms of antifungal resistance. It also discusses novel approaches to treatment, such as combination therapy and immunomodulatory techniques, aimed at enhancing the immune system and improving treatment efficacy. To enhance the efficacy and specificity of antifungal therapies, it is imperative to deepen our understanding of the interactions between infections and hosts.

Keywords: Antifungal Resistance, Drug Resistance, Immune Response, Immunotherapy, Pathogenic Fungi.

Download PDF Downloads: (4) Views: (16) XML Open Access Indexing in Google Scholar

Full Text (PDF)

Open the PDF in a new tab

Cite:

SHALLAL, Ahmed Farhan , RAZAQ, Chawan Hazhar , AHMED, Asmaa Sayed , AHMED, Syamand Ahmed , EYUPOGLU, Volkan , & SALMAN, Ruqaia Sabbar (2026). Host Immune Responses to Pathogenic Fungi and Contemporary Therapeutic Strategies. Journal of Mycology and Truffle, 1(1): 12-18. https://doi.org/10.65999/mycotruffle/2026.26

REFERENCES

Abbas, A. K., Lichtman, A. H., & Pillai, S. (2023). Immunology Fundamentals and Disorders of the Immune System. Elsevier Health Sciences. 7th Ed. Pp. 334.
Ademe, M. (2020). Immunomodulation for the treatment of fungal infections: opportunities and challenges. Frontiers in Cellular and Infection Microbiology, 10, 469. https://doi.org/10.3389/fcimb.2020.00469
Akdis, M., Burgler, S., Crameri, R., Eiwegger, T., Fujita, H., Gomez, E., Klunker, S., Meyer, N., O’Mahony, L., Palomares, O. & Rhyner, C. (2011). Interleukins, from 1 to 37, and interferon-γ: receptors, functions, and roles in diseases. Journal of Allergy and Clinical Immunology, 127(3), 701-721. https://doi.org/10.1016/j.jaci.2010.11.050
Alexander, B. D., Johnson, M. D., Pfeiffer, C. D., Jiménez-Ortigosa, C., Catania, J., Booker, R., Castanheira, M., Messer, S. A., Perlin, D. S. & Pfaller, M. A. (2013). Increasing echinocandin resistance in Candida glabrata: clinical failure correlates with presence of FKS mutations and elevated minimum inhibitory concentrations. Clinical Infectious Diseases, 56(12), 1724-1732. https://doi.org/10.1093/cid/cit136
Arcangeli, S., Bove, C., Mezzanotte, C., Camisa, B., Falcone, L., Manfredi, F., Bezzecchi, E., El Khoury, R., Norata, R., Sanvito, F. & Ponzoni, M. (2022). CAR T cell manufacturing from naive/stem memory T lymphocytes enhances antitumor responses while curtailing cytokine release syndrome. The Journal of Clinical Investigation, 132(12): e150807. https://doi.org/10.1172/JCI150807
Armstrong-James, D., Teo, I., Herbst, S., Petrou, M., Shiu, K., McLean, A., & Shaunak, S. (2012). Renal allograft recipients fail to increase interferon-γ during invasive fungal diseases. Brief Communications, 12(12), 3437-3440. https://doi.org/10.1111/j.1600-6143.2012.04254.x
Armstrong-James, D., Youngs, J., Bicanic, T., Abdolrasouli, A., Denning, D.W., Johnson, E., Mehra, V., Pagliuca, T., Patel, B., Rhodes, J. & Schelenz, S. (2020). Confronting and mitigating the risk of COVID-19 associated pulmonary aspergillosis. European Respiratory Journal, 56(4), 2002554. https://doi.org/10.1183/13993003.02554-2020
Bacher, P., Jochheim-Richter, A., Mockel-Tenbrink, N., Kniemeyer, O., Wingenfeld, E., Alex, R., Ortigao, A., Karpova, D., Lehrnbecher, T., Ullmann, A.J., & Hamprecht, A. (2015). Clinical-scale isolation of the total aspergillus fumigatus–reactive T–helper cell repertoire for adoptive transfer. Cytotherapy, 17(10), 1396-1405. https://doi.org/10.1016/j.jcyt.2015.05.011
Balcerek, M. I., Stewart, A. G., Chapman, P., & Lazarus, S. (2022). Reducing the off-target endocrinologic adverse effects of azole antifungals-can it be done?. International Journal of Antimicrobial Agents, 59(5), 106587. https://doi.org/10.1016/j.ijantimicag.2022.106587
Bastos, R. W., Rossato, L., Goldman, G. H., & Santos, D. A. (2021). Fungicide effects on human fungal pathogens: cross-resistance to medical drugs and beyond. PLoS Pathogens, 17(12), e1010073. https://doi.org/10.1371/journal.ppat.1010073
Bates, D.W., Su, L., Yu, D.T., Chertow, G.M., Seger, D.L., Gomes, D.R.J., Dasbach, E.J., & Platt, R. (2001). Mortality and costs of acute renal failure associated with amphotericin B therapy. Clinical Infectious Diseases, 32(5), 686-693. https://doi.org/10.1086/319211
Baym, M., Stone, L. K., & Kishony, R. (2016). Multidrug evolutionary strategies to reverse antibiotic resistance. Science, 351(6268), aad3292. https://doi.org/10.1126/science.aad3292
Bemiller, L. S., Roberts, D. H., Starko, K. M., & Curnutte, J. T. (1995). Safety and effectiveness of long-term interferon gamma therapy in patients with chronic granulomatous disease. Blood Cells, Molecules, and Diseases, 21(3), 239-247. https://doi.org/10.1006/bcmd.1995.0028
Bennett, J. W., & Klich, M. (2003). Clinical microbiology reviews. Mycotoxins, 16(1), 497-516. https://doi.org/10.1128/CMR.16.3.497-516.2003
Bongomin, F., Gago, S., Oladele, R. O., & Denning, D. W. (2017). Global and multi-national prevalence of fungal diseases-estimate precision. Journal of Fungi, 3(4), 57. https://doi.org/10.3390/jof3040057
Bonilla, F. A., & Oettgen, H. C. (2010). Adaptive immunity. Journal of Allergy and Clinical Immunology, 125(2), S33-S40. https://doi.org/10.1016/j.jaci.2009.09.017
Boots, R. J., Paterson, D. L., Allworth, A. M., & Faoagali, J. L. (1999). Successful treatment of post-influenza pseudomembranous necrotising bronchial aspergillosis with liposomal amphotericin, inhaled amphotericin B, gamma interferon and GM-CSF. Thorax, 54(11), 1047-1049. https://doi.org/10.1136/thx.54.11.1047
Brown, G. D., Denning, D. W., & Levitz, S. M. (2012). Tackling human fungal infections. Science, 336(6082), 647-647. https://doi.org/10.1126/science.1222236
Buddingh, E.P., Leentjens, J., van der Lugt, J., Dik, W.A., Gresnigt, M.S., Netea, M.G., Pickkers, P. and Driessen, G.J. (2015). Interferon-gamma immunotherapy in a patient with refractory disseminated candidiasis. The Pediatric Infectious Disease Journal, 34(12), 1391-1394. https://doi.org/10.1097/INF.0000000000000909
Buscaino, A. (2019). Chromatin-mediated regulation of genome plasticity in human fungal pathogens. Genes, 10(11), 855. https://doi.org/10.3390/genes10110855
Casadevall, A., & Pirofski, L. A. (2012). Immunoglobulins in defense, pathogenesis, and therapy of fungal diseases. Cell Host & Microbe, 11(5), 447-456. https://doi.org/10.1016/j.chom.2012.04.004
Casqueiro, J., Casqueiro, J., & Alves, C. (2012). Infections in patients with diabetes mellitus: A review of pathogenesis. Indian Journal of Endocrinology and Metabolism, 16(Suppl1), S27-S36. https://doi.org/10.4103/2230-8210.94253
Cornely, O.A., Alastruey-Izquierdo, A., Arenz, D., Chen, S.C., Dannaoui, E., Hochhegger, B., Hoenigl, M., Jensen, H.E., Lagrou, K., Lewis, R.E. & Mellinghoff, S.C. (2019). Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. The Lancet Infectious Diseases, 19(12), e405-e421. https://doi.org/10.1016/S1473-3099(19)30312-3
Cortegiani, A., Russotto, V., Raineri, S. M., Gregoretti, C., & Giarratano, A. (2016). Dying with or because of invasive fungal infection? The role of immunity exhaustion on patient outcome. Turkish Journal of Anaesthesiology and Reanimation, 44(6), 285. https://doi.org/10.5152/TJAR.2016.0013
Costanzo, M., Baryshnikova, A., Bellay, J., Kim, Y., Spear, E.D., Sevier, C.S., Ding, H., Koh, J.L., Toufighi, K., Mostafavi, S. and Prinz, J. (2010). The genetic landscape of a cell. Science, 327(5964), 425-431. https://doi.org/10.1126/science.1180823
Cowen, L. E., Sanglard, D., Howard, S. J., Rogers, P. D., & Perlin, D. S. (2015). Mechanisms of antifungal drug resistance. Cold Spring Harbor Perspectives in Medicine, 5(7), a019752. https://doi.org/10.1101/cshperspect.a019752
Day, J.N., Chau, T.T., Wolbers, M., Mai, P.P., Dung, N.T., Mai, N.H., Phu, N.H., Nghia, H.D., Phong, N.D., Thai, C.Q. & Thai, L.H. (2013). Combination antifungal therapy for cryptococcal meningitis. New England Journal of Medicine, 368(14), 1291-1302. https://doi.org/10.1056/NEJMoa1110404
Denning, D. W. (2024). Global incidence and mortality of severe fungal disease. The Lancet Infectious Diseases, 24(7), e428-e438. https://doi.org/10.1016/S1473-3099(23)00692-8
Drummond, R. A., & Lionakis, M. S. (2016). Mechanistic insights into the role of C-type lectin receptor/CARD9 signaling in human antifungal immunity. Frontiers in Cellular and Infection Microbiology, 6, 39. https://doi.org/10.3389/fcimb.2016.00039
Edris, A., & Lahousse, L. (2021). Monoclonal antibodies in type 2 asthma: an updated network meta-analysis. Minerva Medica, 112(5), 573-581. https://doi.org/10.23736/S0026-4806.21.07623-0
Erwig, L. P., & Gow, N. A. (2016). Interactions of fungal pathogens with phagocytes. Nature Reviews Microbiology, 14(3), 163-176. https://doi.org/10.1038/nrmicro.2015.21
Fanning, S., & Mitchell, A. P. (2012). Fungal biofilms. PLoS Pathogens, 8(4), e1002585. https://doi.org/10.1371/journal.ppat.1002585
Fioriti, S., Brescini, L., Pallotta, F., Canovari, B., Morroni, G., & Barchiesi, F. (2022). Antifungal combinations against Candida species: from bench to bedside. Journal of Fungi, 8(10), 1077. https://doi.org/10.3390/jof8101077
Fisher, M.C., Gurr, S.J., Cuomo, C.A., Blehert, D.S., Jin, H., Stukenbrock, E.H., Stajich, J.E., Kahmann, R., Boone, C., Denning, D.W. & Gow, N.A. (2020). Threats posed by the fungal kingdom to humans, wildlife, and agriculture. mBio, 11(3), 10-1128. https://doi.org/10.1128/mbio.00449-20
Gantner, B. N., Simmons, R. M., & Underhill, D. M. (2005). Dectin‐1 mediates macrophage recognition of Candida albicans yeast but not filaments. The EMBO Journal, 24(6), 1277-1286. https://doi.org/10.1038/sj.emboj.7600594
Grigull, L., Beilken, A., Schmid, H., Kirschner, P., Sykora, K.W., Linderkamp, C., Donnerstag, F., Goudeva, L., Heuft, H.G. & Welte, K. (2006). Secondary prophylaxis of invasive fungal infections with combination antifungal therapy and G-CSF-mobilized granulocyte transfusions in three children with hematological malignancies. Supportive Care in Cancer, 14(7), 783-786. https://doi.org/10.1007/s00520-005-0910-8
Groll, A. H., Piscitelli, S. C., & Walsh, T. J. (1998). Clinical pharmacology of systemic antifungal agents: a comprehensive review of agents in clinical use, current investigational compounds, and putative targets for antifungal drug development. Advances in Pharmacology, 44, 343-500. https://doi.org/10.1016/S1054-3589(08)60129-5
Guerra, E.S., Lee, C.K., Specht, C.A., Yadav, B., Huang, H., Akalin, A., Huh, J.R., Mueller, C. & Levitz, S.M (2017). Central role of IL-23 and IL-17 producing eosinophils as immunomodulatory effector cells in acute pulmonary aspergillosis and allergic asthma. PLoS Pathogens, 13(1), e1006175. https://doi.org/10.1371/journal.ppat.1006175
Gulati, K., Guhathakurta, S., Joshi, J., Rai, N., & Ray, A. J. M. I. (2016). Cytokines and their role in health and disease: a brief overview. MOJ Immunology, 4(2), 00121. https://doi.org/10.15406/moji.2016.04.00121
Gupta, A. K., Sauder, D. N., & Shear, N. H. (1994). Antifungal agents: an overview. Part II. Journal of the American Academy of Dermatology, 30(6), 911-933. https://doi.org/10.1016/S0190-9622(08)81495-8
Hamad, M. (2008). Antifungal immunotherapy and immunomodulation: a double‐hitter approach to deal with invasive fungal infections. Scandinavian Journal of Immunology, 67(6), 533-543. https://doi.org/10.1111/j.1365-3083.2008.02101.x
Herbrecht, R., Denning, D.W., Patterson, T.F., Bennett, J.E., Greene, R.E., Oestmann, J.W., Kern, W.V., Marr, K.A., Ribaud, P., Lortholary, O. & Sylvester, R. (2002). Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. New England Journal of Medicine, 347(6), 408-415. https://doi.org/10.1056/NEJMoa020191
Hernández-Santos, N., & Gaffen, S. L. (2012). Th17 cells in immunity to Candida albicans. Cell Host & Microbe, 11(5), 425-435. https://doi.org/10.1016/j.chom.2012.04.008
Hetta, H.F., Melhem, T., Aljohani, H.M., Salama, A., Ahmed, R., Elfadil, H., Alanazi, F.E., Ramadan, Y.N., Battah, B., Rottura, M. & Donadu, M.G. (2025). Beyond conventional antifungals: combating resistance through novel therapeutic pathways. Pharmaceuticals, 18(3), 364. https://doi.org/10.3390/ph18030364
Hill, J. A., & Cowen, L. E. (2015). Using combination therapy to thwart drug resistance. Future Microbiology, 10(11), 1719-1726. https://doi.org/10.2217/fmb.15.68
Hoenigl, M., Salmanton-García, J., Egger, M., Gangneux, J.-P., Bicanic, T., Arikan-Akdagli, S., Alastruey-Izquierdo, A., Klimko, N., Barac, A., Özenci, V., Meijer, E.F.J., Khanna, N., Bassetti, M., Rautemaa-Richardson, R., Lagrou, K., Adam, K.-M., Akalin, E.H., Akova, M., Arsic Arsenijevic, V., Aujayeb, A., Blennow, O., Bretagne, S., Danion, F., Denis, B., de Jonge, N.A., Desoubeaux, G., Drgona, L., Erben, N., Gori, A., García Rodríguez, J., Garcia-Vidal, C., Giacobbe, D.R., Goodman, A.L., Hamal, P., Hammarström, H., Toscano, C., Lanternier, F., Lass-Flörl, C., Lockhart, D.E.A., Longval, T., Loughlin, L., Matos, T., Mikulska, M., Narayanan, M., Martín-Pérez, S., Prattes, J., Rogers, B., Rahimli, L., Ruiz, M., Roilides, E., Samarkos, M., Scharmann, U., Sili, U., Sipahi, O.R., Sivakova, A., Steinmann, J., Trauth, J., Turhan, O., Van Praet, J., Vena, A., White, P.L., Willinger, B., Tortorano, A.M., Arendrup, M.C., Koehler, P., & Cornely, O.A. (2023). Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study. The Lancet Infectious Diseases, 23(6), 751-761. https://doi.org/10.1016/S1473-3099(22)00872-6
Hokken, M. W., Zwaan, B. J., Melchers, W. J. G., & Verweij, P. E. (2019). Facilitators of adaptation and antifungal resistance mechanisms in clinically relevant fungi. Fungal Genetics and Biology, 132, 103254. https://doi.org/10.1016/j.fgb.2019.103254
Ibrahim, A. S., Spellberg, B., & Edwards Jr, J. (2008). Iron acquisition: a novel perspective on mucormycosis pathogenesis and treatment. Current Opinion in Infectious Diseases, 21(6), 620-625. https://doi.org/10.1097/QCO.0b013e3283165fd1
Isticato, R., & Ricca, E. (2016). Spore surface display. The Bacterial Spore: from Molecules to Systems, 349-366. https://doi.org/10.1128/9781555819323.ch17
Jarvis, J.N., Meintjes, G., Rebe, K., Williams, G.N., Bicanic, T., Williams, A., Schutz, C., Bekker, L.G., Wood, R., & Harrison, T.S. (2012). Adjunctive interferon-γ immunotherapy for the treatment of HIV-associated cryptococcal meningitis: a randomized controlled trial. Aids, 26(9), 1105-1113. https://doi.org/10.1097/QAD.0b013e3283536a93
Kim, J. Y. (2016). Human fungal pathogens: why should we learn?. Journal of Microbiology, 54(3), 145-148. https://doi.org/10.1007/s12275-016-0647-8
Kollath, D. R., de Melo Teixeira, M., & Barker, B. M. (2018). Advances in genomics of human fungal pathogens. In: Population Genomics: Microorganisms (pp. 159-206). Cham: Springer International Publishing. https://doi.org/10.1007/13836_2018_41
Kontoyiannis, D. P., & Lewis, R. E. (2004). Toward more effective antifungal therapy: the prospects of combination therapy. British Journal of Haematology, 126(2), 165-175. https://doi.org/10.1111/j.1365-2141.2004.05007.x
Kumaresan, P.R., Manuri, P.R., Albert, N.D., Maiti, S., Singh, H., Mi, T., Roszik, J., Rabinovich, B., Olivares, S., Krishnamurthy, J., Zhang, L., Najjar, A.M., Huls, M.H., Lee, D.A., Champlin, R.E., Kontoyiannis, D.P., & Cooper, L.J.N. (2014). Bioengineering T cells to target carbohydrate to treat opportunistic fungal infection. Proceedings of the National Academy of Sciences, 111(29), 10660-10665. https://doi.org/10.1073/pnas.1312789111
Lass‐Flörl, C., Roilides, E., Löffler, J., Wilflingseder, D., & Romani, L. (2013). Minireview: host defence in invasive aspergillosis. Mycoses, 56(4), 403-413. https://doi.org/10.1111/myc.12052
Latgé, J. P., & Chamilos, G. (2019). Aspergillus fumigatus and Aspergillosis in 2019. Clinical Microbiology Reviews, 33(1), 10-1128. https://doi.org/10.1128/cmr.00140-18
Lee, D. G., Lee, H. J., Yan, J. L., Lin, S. S. F., & Aram, J. A. (2019). Efficacy and safety of combination antifungal therapy in Korean haematological patients with invasive aspergillosis. Mycoses, 62(10), 969-978. https://doi.org/10.1111/myc.12972
Lehrnbecher, T., Tramsen, L., Koehl, U., Schmidt, S., Bochennek, K., & Klingebiel, T. (2011). Immunotherapy against invasive fungal diseases in stem cell transplant recipients. Immunological Investigations, 40(7-8), 839-852. https://doi.org/10.3109/08820139.2011.581732
Lionakis, M. S., & Levitz, S. M. (2018). Host control of fungal infections: lessons from basic studies and human cohorts. Annual Review of Immunology, 36, 157-191. https://doi.org/10.1146/annurev-immunol-042617-053318
Lionakis, M. S., & Netea, M. G. (2013). Candida and host determinants of susceptibility to invasive candidiasis. PLoS Pathogens, 9(1), e1003079. https://doi.org/10.1146/annurev-immunol-042617-053318
Lionakis, M. S., Drummond, R. A., & Hohl, T. M. (2023). Immune responses to human fungal pathogens and therapeutic prospects. Nature Reviews Immunology, 23(7), 433-452. https://doi.org/10.1038/s41577-022-00826-w
Loh, J. T., & Lam, K. P. (2023). Fungal infections: Immune defense, immunotherapies and vaccines. Advanced Drug Delivery Reviews, 196, 114775. https://doi.org/10.1016/j.addr.2023.114775
Maertens, J.A., Raad, I.I., Marr, K.A., Patterson, T.F., Kontoyiannis, D.P., Cornely, O.A., Bow, E.J., Rahav, G., Neofytos, D., Aoun, M., Baddley, J.W., Giladi, M., Heinz, W.J., Herbrecht, R., Hope, W., Karthaus, M., Lee, D.G., Lortholary, O., Morrison, V.A., Oren, I., Selleslag, D., Shoham, S., Thompson, G.R., Lee, M., Maher, R.M., Schmitt-Hoffmann, A.H., Zeiher, B., & Ullmann, A.J. (2016). Isavuconazole versus voriconazole for primary treatment of invasive mould disease caused by Aspergillus and other filamentous fungi (SECURE): a phase 3, randomised-controlled, non-inferiority trial. The Lancet, 387(10020), 760-769. https://doi.org/10.1016/S0140-6736(15)01159-9
May, R. C., Stone, N. R., Wiesner, D. L., Bicanic, T., & Nielsen, K. (2016). Cryptococcus: from environmental saprophyte to global pathogen. Nature Reviews Microbiology, 14(2), 106-117. https://doi.org/10.1038/nrmicro.2015.6
Melzer, J. M., Driskill, B. R., Clenney, T. L., & Gessler, E. M. (2015). Sublingual immunotherapy for allergic fungal sinusitis. Annals of Otology, Rhinology & Laryngology, 124(10), 782-787. https://doi.org/10.1177/0003489415583686
Murphy, K., & Weaver, C. (2016). Janeway's immunobiology. 9th edition. Garland Science.
Naglik, J. R., Challacombe, S. J., & Hube, B. (2003). Candida albicans secreted aspartyl proteinases in virulence and pathogenesis. Microbiology and Molecular Biology Reviews, 67(3), 400-428. https://doi.org/10.1128/mmbr.67.3.400-428.2003
Netea, M.G., Domínguez-Andrés, J., Barreiro, L.B., Chavakis, T., Divangahi, M., Fuchs, E., Joosten, L.A.B., van der Meer, J.W.M., Mhlanga, M.M., Mulder, W.J.M., & Riksen, N.P. (2020). Defining trained immunity and its role in health and disease. Nature Reviews Immunology, 20(6), 375-388. https://doi.org/10.1038/s41577-020-0285-6
Okazaki, T., & Wang, J. (2005). PD-1/PD-L pathway and autoimmunity. Autoimmunity, 38(5), 353-357. https://doi.org/10.1080/08916930500124072
Osset-Trénor, P., Pascual-Ahuir, A., & Proft, M. (2023). Fungal drug response and antimicrobial resistance. Journal of Fungi, 9(5), 565. https://doi.org/10.1080/08916930500124072
Ostrosky‐Zeichner, L. (2008). Combination antifungal therapy: a critical review of the evidence. Clinical Microbiology and Infection, 14, 65-70. https://doi.org/10.1111/j.1469-0691.2008.01983.x
Papadopoulou, A., Kaloyannidis, P., Yannaki, E., & Cruz, C. R. (2016). Adoptive transfer of Aspergillus-specific T cells as a novel anti-fungal therapy for hematopoietic stem cell transplant recipients: Progress and challenges. Critical Reviews in Oncology/Hematology, 98, 62-72. https://doi.org/10.1016/j.critrevonc.2015.10.005
Pappas, P. G., Kauffman, C. A., Andes, D., Benjamin, D. K. Jr., Calandra, T. F., Edwards, J. E. Jr., Filler, S. G., Fisher, J. F., Kullberg, B. J., Ostrosky-Zeichner, L., Reboli, A. C., Rex, J. H., Walsh, T. J. & Sobel, J. D. (2009). Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 48, 503-535. https://doi.org/10.3314/mmj.54.147
Paul, W. E., & Zhu, J. (2010). How are TH2-type immune responses initiated and amplified?. Nature Reviews Immunology, 10(4), 225-235. https://doi.org/10.1038/nri2735
Perfect, J. R., Dismukes, W. E., Dromer, F., Goldman, D. L., Graybill, J. R., Hamill, R. J., Harrison, T. S., Larsen, R. A., Lortholary, O., Nguyen, M.-H., Pappas, P. G, Powderly,W. G., Singh, N., Sobel, J. D., & Sorrell, T. C. (2010). Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 50(3), 291-322. https://doi.org/10.1086/649858
Perlin, D. S., Rautemaa-Richardson, R., & Alastruey-Izquierdo, A. (2017). The global problem of antifungal resistance: prevalence, mechanisms, and management. The Lancet Infectious Diseases, 17(12), e383-e392. https://doi.org/10.1016/S1473-3099(17)30316-X
Pfaller, M. A., & Diekema, D. J. (2010). Epidemiology of invasive mycoses in North America. Critical Reviews in Microbiology, 36(1), 1-53. https://doi.org/10.3109/10408410903241444
Pierce, C. G., Srinivasan, A., Uppuluri, P., Ramasubramanian, A. K., & López-Ribot, J. L. (2013). Antifungal therapy with an emphasis on biofilms. Current Opinion in Pharmacology, 13(5), 726-730. https://doi.org/10.1016/j.coph.2013.08.008
Posch, W., Wilflingseder, D., & Lass-Flörl, C. (2020). Immunotherapy as an antifungal strategy in immune compromised hosts. Current Clinical Microbiology Reports, 7(3), 57-66. https://doi.org/10.1007/s40588-020-00141-9
Pristov, K. E., & Ghannoum, M. A. (2019). Resistance of Candida to azoles and echinocandins worldwide. Clinical Microbiology and Infection, 25(7), 792-798. https://doi.org/10.1016/j.cmi.2019.03.028
Qiu, K. Y., Liao, X. Y., Fang, J. P., Xu, H. G., Li, Y., Huang, K., & Zhou, D. H. (2019). Combination antifungal treatment for invasive fungal disease after hematopoietic stem cell transplantation in children with hematological disorders. Transplant Infectious Disease, 21(3), e13066. https://doi.org/10.1111/tid.13066
Ramonell, R. P., Lee, F. E. H., Swenson, C., & Kuruvilla, M. (2019). Dupilumab treatment for allergic bronchopulmonary aspergillosis: a case series. The Journal of Allergy and Clinical Immunology. In practice, 8(2), 742-743. https://doi.org/10.1016/j.jaip.2019.11.031
Robbins, N., Spitzer, M., Yu, T., Cerone, R. P., Averette, A. K., Bahn, Y. S., Heitman, J., Sheppard, D. C., Tyers, M., & Wright, G. D. (2015). An antifungal combination matrix identifies a rich pool of adjuvant molecules that enhance drug activity against diverse fungal pathogens. Cell Reports, 13(7), 1481-1492. https://doi.org/10.1016/j.celrep.2015.10.018
Rogers, T. R., Verweij, P. E., Castanheira, M., Dannaoui, E., White, P. L., & Arendrup, M. C. (2022). Molecular mechanisms of acquired antifungal drug resistance in principal fungal pathogens and EUCAST guidance for their laboratory detection and clinical implications. Journal of Antimicrobial Chemotherapy, 77(8), 2053-2073. https://doi.org/10.1093/jac/dkac161
Rokas, A. (2022). Evolution of the human pathogenic lifestyle in fungi. Nature Microbiology, 7(5), 607-619. https://doi.org/10.1038/s41564-022-01112-0
Romani, L. (2011). Immunity to fungal infections. Nature Reviews Immunology, 11(4), 275-288. https://doi.org/10.1038/nri2939
Safdar, A. (2007). Antifungal immunity and adjuvant cytokine immune enhancement in cancer patients with invasive fungal infections. Clinical Microbiology and Infection, 13(1), 1-4. https://doi.org/10.1111/j.1469-0691.2006.01571.x
Schmidt, S., Tramsen, L., & Lehrnbecher, T. (2017). Natural killer cells in antifungal immunity. Frontiers in Immunology, 8, 1623. https://doi.org/10.3389/fimmu.2017.01623
Schroeder Jr, H. W., & Cavacini, L. (2010). Structure and function of immunoglobulins. Journal of Allergy and Clinical Immunology, 125(2), S41-S52. https://doi.org/10.1016/j.jaci.2009.09.046
Seyedmousavi, S., Rafati, H., Ilkit, M., Tolooe, A., Hedayati, M. T., & Verweij, P. (2016). Systemic antifungal agents: current status and projected future developments. In Human Fungal Pathogen Identification: Methods and Protocols (pp. 107-139). New York, NY: Springer New York.Springer. https://doi.org/10.1007/978-1-4939-6515-1_5
Shallal, A. F. (2025a). Immunomodulatory Pathways of Some Biomarkers in Individuals with Renal Failure. Aro-the Scientific Journal of Koya University, 13(2), 326-333. https://doi.org/10.14500/aro.12474
Shallal, A. F. (2025c). Modulation of immune pathway and biomarkers: impacts of lifestyle, nutrition, and therapeutic interventions. Journal of Pharmaceutical Research, 14(24), 419-430. https://doi.org/10.5281/zenodo.17750333
Shallal, A. F. (2026a). Immune System Modulation: The Roles of Leukocytes, Vitamin D, Plant Extracts, Nanotechnology, and Biomarkers in Disease and Health. World Journal of Pharmaceutical Research, 15(3), 250-263. https://doi.org/10.5281/zenodo.18427459
Shallal, A. F. (2026c). Association of immunomodulation with biological agents: a review. World Journal of Pharmaceutical Research, 15(6), 849-860. https://doi.org/10.5281/zenodo.19045651
Shallal, A. F., Abdullah, S. M., & Razaq, C. H. (2026b). The Significance of Truffles for Human Health. Journal of Mycology and Truffle, 1(1), 1-11. https://doi.org/10.65999/mycotruffle.2026.22
Shallal, A. F., Razaq, C. H., & Owaid, M. N. (2025b). Immunomodulatory Effects of Ganoderma lucidum on NK Cells: From Traditional Use to Modern Immunotherapy. Journal of Macrofungi, 1(1), 14-29. https://doi.org/10.65999/macrofungi.2025.27
Shoham, S., & Levitz, S. M. (2005). The immune response to fungal infections. British Journal of Haematology, 129(5), 569-582. https://doi.org/10.1111/j.1365-2141.2005.05397.x
Spellberg, B., Edwards Jr, J., & Ibrahim, A. (2005). Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clinical Microbiology Reviews, 18(3), 556-569. https://doi.org/10.1128/cmr.18.3.556-569.2005
Speth, C., Rambach, G., Würzner, R., & Lass‐Flörl, C. (2008). Complement and fungal pathogens: an update. Mycoses, 51(6), 477-496. https://doi.org/10.1111/j.1439-0507.2008.01597.x
Spitzer, M., Robbins, N., & Wright, G. D. (2017). Combinatorial strategies for combating invasive fungal infections. Virulence, 8(2), 169-185. https://doi.org/10.1080/21505594.2016.1196300
Steimbach, L. M., Tonin, F. S., Virtuoso, S., Borba, H. H., Sanches, A. C., Wiens, A., Fernandez-Llimós, F., & Pontarolo, R. (2017). Efficacy and safety of amphotericin B lipid‐based formulations-A systematic review and meta‐analysis. Mycoses, 60(3), 146-154. https://doi.org/10.1111/myc.12585
Stephen-Victor, E., Karnam, A., Fontaine, T., Beauvais, A., Das, M., Hegde, P., Prakhar, P., Holla, S., Balaji, K. N., Kaveri, S. V., Latgé, J.-P., Aimanianda, V., & Bayry, J. (2017). Aspergillus fumigatus cell wall α-(1, 3)-glucan stimulates regulatory T-cell polarization by inducing PD-L1 expression on human dendritic cells. The Journal of Infectious Diseases, 216(10), 1281-1294. https://doi.org/10.1093/infdis/jix469
Sugui, J. A., Pardo, J., Chang, Y. C., Zarember, K. A., Nardone, G., Galvez, E. M., Müllbacher, A., Gallin, J. I., Simon, M. M., & Kwon-Chung, K. J., (2007). Gliotoxin is a virulence factor of Aspergillus fumigatus: gliP deletion attenuates virulence in mice immunosuppressed with hydrocortisone. Eukaryotic Cell, 6(9), 1562-1569. https://doi.org/10.1128/ec.00141-07
Sun, S., Hoy, M. J., & Heitman, J. (2020). Fungal pathogens. Current Biology, 30(19), R1163-R1169. https://doi.org/10.1016/j.cub.2020.07.032
Urban, C. F., & Nett, J. E. (2019, May). Neutrophil extracellular traps in fungal infection. In: Seminars in Cell & Developmental Biology, (Vol. 89, pp. 47-57). Academic Press. https://doi.org/10.1016/j.semcdb.2018.03.020
van de Veerdonk, F. L., Kolwijck, E., Lestrade, P. P. A., Hodiamont, C. J., Rijnders, B. J. A., van Paassen, J., Haas, P.-J., dos Santos, C. O., Kampinga, G. A., Bergmans, D. C. J. J., van Dijk, K., de Haan, A. F. J., van Dissel, J., van der Hoeven, H. G., & Verweij, P. E. (2017). Influenza-associated aspergillosis in critically ill patients. American Journal of Respiratory and Critical Care Medicine, 196(4), 524-527. https://doi.org/10.1164/rccm.201612-2540LE
Vanreppelen, G., Wuyts, J., Van Dijck, P., & Vandecruys, P. (2023). Sources of antifungal drugs. Journal of Fungi, 9(2), 171. https://doi.org/10.3390/jof9020171
Vidarsson, G., Dekkers, G., & Rispens, T. (2014). IgG subclasses and allotypes: from structure to effector functions. Frontiers in Immunology, 5, 520. https://doi.org/10.3389/fimmu.2014.00520
Vivier, E., Artis, D., Colonna, M., Diefenbach, A., Di Santo, J. P., Eberl, G., Koyasu, S., Locksley, R. M., McKenzie, A. N. J., Mebius, R. E., Powrie, F., & Spits, H. (2018). Innate lymphoid cells: 10 years on. Cell, 174(5), 1054-1066. https://doi.org/10.1016/j.cell.2018.07.017
Wang, X., Ren, J., Liang, X., & He, P. (2021). Efficacy and cost of G-CSF derivatives for prophylaxis of febrile neutropenia in lymphoma and multiple myeloma patients underwent autologous hematopoietic stem cell transplantation. Hematology, 26(1), 950-955. https://doi.org/10.1080/16078454.2021.2003071
WHO, World Health Organization. (2022). WHO fungal priority pathogens list to guide research, development and public health action. Organización Mundial de la Salud (OMS). 48 p.
Williams, T. J., Harvey, S., & Armstrong-James, D. (2020). Immunotherapeutic approaches for fungal infections. Current Opinion in Microbiology, 58, 130-137. https://doi.org/10.1016/j.mib.2020.09.007
Willment, J. A., & Brown, G. D. (2008). C-type lectin receptors in antifungal immunity. Trends in Microbiology, 16(1), 27-32. https://doi.org/10.1016/j.tim.2007.10.012
Winn, R. M., Gil-Lamaignere, C., Roilides, E., Simitsopoulou, M., Lyman, C. A., Maloukou, A., & Walsh, T. J. (2003). Selective effects of Interleukin (IL)–15 on antifungal activity and IL-8 release by Polymorphonuclear Leukocytes in response to Hyphae of Aspergillus Species. The Journal of Infectious Diseases, 188(4), 585-590. https://doi.org/10.1086/377099
Wolfgruber, S., Salmanton-García, J., Kuate, M. P. N., Hoenigl, M., & Brunelli, J. G. P. (2024). Antifungal pipeline: New tools for the treatment of mycoses. Revista Iberoamericana de Micologia, 41(4), 68-78. https://doi.org/10.1016/j.riam.2024.11.001
Zaragoza, O. (2019). Basic principles of the virulence of Cryptococcus. Virulence, 10(1), 490-501. https://doi.org/10.1080/21505594.2019.1614383
Zipfel, P. F., & Skerka, C. (2025). Why is C5a inflammatory complement inhibition not enough to improve C3 glomerulopathy?. Journal of the American Society of Nephrology, 36(3), 345-347. https://doi.org/10.1681/ASN.0000000631
Zotchev, S. B. (2003). Polyene macrolide antibiotics and their applications in human therapy. Current Medicinal Chemistry, 10(3), 211-223. https://doi.org/10.2174/0929867033368448