What is the mechanism of action of azoles?

Azoles are a class of antifungal agents that primarily work by inhibiting the enzyme lanosterol 14α-demethylase, which is crucial in the biosynthesis of ergosterol, an essential component of fungal cell membranes. By inhibiting this enzyme, azoles prevent the conversion of lanosterol to ergosterol, leading to a decrease in ergosterol levels. This interference ultimately disrupts the integrity of the fungal cell membrane, compromising its function and leading to cell death.

Azoles effectively target fungal infections because ergosterol is not found in human cells; instead, human cells contain cholesterol. This selective action makes azoles valuable for treating fungal infections with minimal toxicity to human cells. The other mechanisms listed, such as binding to fungal RNA, disrupting DNA replication, or directly damaging the cell membrane, do not represent the primary action of azoles and are characteristic of other classes of antifungal agents or cellular processes.