The influence of caspofungin on polymorphonuclear leukocyte (PMN) phagocytosis and intracellular killing of Candida albicans was investigated. Caspofungin, at all of the concentrations tested (2, 3.2, and 8 g/ml), significantly increased intracellular killing by PMNs through its direct action on both yeast cells and PMNs, indicating the potential ability of caspofungin to synergize with phagocytes for candidal killing. Caspofungin may therefore constitute an effective therapeutic option for the treatment of invasive fungal infections, including those refractory to conventional treatment with azole agents.Echinocandins, such as caspofungin, are new drugs that broaden the available therapeutic arsenal for invasive fungal infection (IFI) treatment (6,7,11). Caspofungin displays favorable pharmacodynamic and pharmacokinetic characteristics and has an excellent toxicological profile and antifungal activity against Candida spp., Aspergillus spp., Histoplasma spp., Blastomyces spp., and Coccidioides spp. (3,7,11,12,15). As the current trend in therapy requires drugs with high in vitro activity associated with the capacity to potentiate host defense mechanisms, especially in immunocompromised hosts (2, 19), the interaction of caspofungin with human polymorphonuclear leukocytes (PMNs) was evaluated, focusing on both the phagocytosis and intracellular killing of Candida albicans.(This study was presented in part at the Congress of the Italian Society of Pharmaceutical Microbiology, Turin, Italy, 20 to 22 June 2008.)A clinical C. albicans strain isolated from blood and identified by biochemical methods was subcultured on Sabouraud dextrose agar (Oxoid S.p.A., Milan, Italy) to ensure viability and purity. Yeast cultures consisted entirely of blastoconidia and had a slight tendency to differentiate into pseudohyphae during the course of the experiments.Caspofungin acetate (Merck Sharp & Dohme Ltd., Hoddesdon, United Kingdom) was dissolved in pyrogen-free water and stored at Ϫ20°C. Antifungal susceptibility testing was performed with an inoculum of 10 3 CFU/ml, in accordance with CLSI M27-A3 (4), and an inoculum of 10 6 CFU/ml was used to perform tests with phagocytes.PMNs were separated from lithium heparinized venous blood using Ficoll-Paque (Pharmacia S.p.A., Milan, Italy) and adjusted to 10 6 cells/ml in RPMI 1640 medium (Gibco Laboratories, Grand Island, NY) (1, 5). Viability, determined by trypan blue exclusion, was greater than 95%.The effect of caspofungin on the phagocytosis of radiolabeled C. albicans ([ 3 H]uracil [specific activity, 1,270 GBq/ mmol; NEN Life Science Products, Milan, Italy]) by PMNs was investigated by incubating the yeast cells (10 6 invasive fungal cells/ml) and PMNs (10 6 cells/ml) at 37°C in a shaking water bath in the presence of 2 g/ml (MIC), 3.2 g/ml, or 8 g/ml caspofungin; the last two concentrations were within the range achieved clinically (8, 9). Caspofungin-free controls were included. After 30, 60, or 90 min, phagocytosis was assessed (18,19). PMNs were centrifuged twice at 200 ϫ g fo...