Combined anti-PD-1 and amphotericin B therapy reduces fungal burden and enhances control of murine paracoccidioidomycosis

Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides spp. It is endemic to the Americas, with the highest incidence reported in Brazil. Pulmonary involvement occurs in nearly all adult patients. The current standard of care relies on antifungal agents such as amphotericin B (AmB), itraconazole, and fluconazole. However, long-term treatment is often associated with poor patient adherence and sequelae, attributable to drug toxicity, chronic inflammation, and fibrosis, which can impair organ function. In this context, therapies that modulate the host immune response have gained prominence. Antibodies targeting the PD-1 immune checkpoint, a regulatory protein highly expressed on lymphocytes, represent a particularly promising strategy. Previous work from our group demonstrated that anti-PD-1 administration in P. brasiliensis -infected mice led to controlled disease, characterized by a reduced fungal burden and improved survival. Notably, this clinical improvement correlated with the preservation of protective Th1/Th17 responses. Based on these findings, this study aimed to evaluate the efficacy of a combined therapy using anti-PD-1 alongside a conventional antifungal. We sought to assess its impact on host immune modulation and fungal clearance. To this end, C57BL/6 mice were inoculated with 1×10 6 P. brasiliensis yeast cells. After six weeks, the mice were treated with anti-PD-1, either alone or in combination with AmB. The disease course was evaluated for two weeks post-treatment through CFU counts, histological analysis, and survival monitoring. The host immune response in the lungs was characterized using ELISA and flow cytometry. Our results demonstrate that the anti-PD-1 + AmB combination led to superior disease control compared to monotherapies. This was evidenced by a significant reduction in fungal load, diminished pulmonary lesion size, and enhanced survival. Furthermore, the combined treatment promoted an increase in the pulmonary effector lymphocyte population while reducing overall cytokine levels, indicating effective pathogen control without excessive inflammation. Collectively, these data indicate that restoring an effective immune response via PD-1 blockade, in conjunction with the direct antifungal activity of AmB, results in superior control of PCM. This study provides a rationale for future research into immunomodulatory strategies as an adjunct to conventional antifungal treatment for PCM.