A whole cell-based assay using Saccharomyces cerevisiae strains that overexpress Candida albicans CDR1 and MDR1 efflux pumps has been employed to screen natural product extracts for reversal of fluconazole resistance. The tropical green alga Penicillus capitatus was selected for bioassay-guided isolation, leading to the identification of capisterones A and B (1 and 2), which were recently isolated from this alga and shown to possess antifungal activity against the marine pathogen Lindra thallasiae. Current work has assigned their absolute configurations using electronic circular dichroism and determined their preferred conformations in solution based on detailed NOE analysis. Compounds 1 and 2 significantly enhanced fluconazole activity in S. cerevisiae, but did not show inherent antifungal activity when tested against several opportunistic pathogens, or cytotoxicity to several human cancer and non-cancerous cell lines (up to 35 μM). These compounds may have a potential for combination therapy of fungal infections caused by clinically relevant azole-resistant strains.The molecular mechanisms of antifungal drug resistance may involve a variety of factors such as mutation of target genes and decreased drug concentrations in the cells due to overexpression of efflux pumps. 1,2 In recent years, the rapid development of such drug resistance, particularly for azole antifungals, has highlighted the need for new strategies in antimycotic therapies. 1-5 Efflux pump inhibition has been considered as a promising approach in this regard. Two families of efflux pumps found in Candida albicans include the major facilitators (multidrug resistance, MDR) that are fueled by a proton gradient and the P-glycoprotein ABC transporters (Candida drug resistance, CDR) that require ATP hydrolysis for energy. Within each family, several subtypes have been discovered (i.e., CDR1, CDR2, MDR1). 1,2 We have established a whole cell-based assay using Saccharomyces cerevisiae strains that overexpress C. albicans CDR1 and MDR1 efflux pumps to screen for natural products that can reverse fluconazole resistance and may not be necessarily antifungal. 6In a continuing effort to search for new efflux inhibitors from natural sources, we have screened over 5000 marine extracts from the National Cancer Institute Open Repository. In the presence of a subinhibitory concentration of fluconazole, an extract of the tropical green alga Penicillus capitatus (Halimedaceae) that had an IC 50 value of 55 μg/mL against S. cerevisiae DSY 415 strain (overexpressing the CDR1 efflux pump) and an IC 50 value of < 6 μg/mL against S.