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Bouqellah NA, Abdel-Hafez LJM, Mostafa IY, Faraag AHI. Investigating the antifungal potential of genetically modified hybrid chitinase enzymes derived from Bacillus subtilis and Serratia marcescens. Int Microbiol 2024:10.1007/s10123-024-00591-x. [PMID: 39356373 DOI: 10.1007/s10123-024-00591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 08/04/2024] [Accepted: 09/06/2024] [Indexed: 10/03/2024]
Abstract
Chitinases are glycosyl hydrolase enzymes that break down chitin, an integral component of fungal cell walls. Bacteria such as Bacillus subtilis and Serratia marcescens produce chitinases with antifungal properties. In this study, we aimed to generate hybrid chitinase enzymes with enhanced antifungal activity by combining functional domains from native chitinases produced by B. subtilis and S. marcescens. Chitinase genes were cloned from both bacteria and fused together using overlap extension PCR. The hybrid constructs were expressed in E. coli and the recombinant enzymes purified. Gel electrophoresis and computational analysis confirmed the molecular weights and isoelectric points of the hybrid chitinases were intermediate between the parental enzymes. Antifungal assays demonstrated that the hybrid chitinases inhibited growth of the fungus Fusarium oxysporum significantly more than the native enzymes and also showed fungicidal activity against Candida albicans, Alternaria solani, and Rhizoctonia solani. The results indicate that hybrid bacterial chitinases are a promising approach to engineer novel antifungal proteins. This study provides insight into structure-function relationships of chitinases and strategies for generating biotherapeutics with enhanced bioactive properties. These hybrid chitinases result in a more potent and versatile antifungal agent.
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Affiliation(s)
- Nahla Alsayd Bouqellah
- Biology Department, Science College, Taibah University, 42317-8599, Al Madinah Al Munawwarah, Saudi Arabia.
| | | | - Islam Yousif Mostafa
- Department of Microbiology, Faculty of Dentistry and Oral Medicine, Future University, Cairo, Egypt
| | - Ahmed Hassan Ibrahim Faraag
- Department of Botany and Microbiology, Faculty of Science, Helwan University, Ain Helwan, Cairo, 11795, Egypt.
- School of Biotechnology, Badr University in Cairo, Badr City, 11829, Cairo, Egypt.
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Gao N, Ju X, Jiao X, Qi Y, Tian Y, Jiang S, Niu Z, Zhao S, Yang R. Breaking Down the Barriers of Drug Resistance and Corneal Permeability with Chitosan-Poly(ethylene glycol)-LK 13 Peptide Conjugate to Combat Fungal Keratitis. ACS Infect Dis 2024; 10:2950-2960. [PMID: 38990785 DOI: 10.1021/acsinfecdis.4c00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Fungal keratitis (FK) is a leading cause of preventable blindness and eye loss. The poor antifungal activity, increased drug resistance, limited corneal permeability, and unsatisfactory biosafety of conventional antifungal eye drops are among the majority of the challenges that need to be addressed for currently available antifungal drugs. Herein, this study proposes an effective strategy that employs chitosan-poly(ethylene glycol)-LK13 peptide conjugate (CPL) in the treatment of FK. Nanoassembly CPL can permeate the lipophilic corneal epithelium in the transcellular route, and its hydrophilicity surface is a feature to drive its permeability through hydrophilic stroma. When encountering fungal cell membrane, CPL dissembles and exposes the antimicrobial peptide (LK13) to destroy fungal cell membranes, the minimum inhibitory concentration values of CPL against Fusarium solani (F. solani) are always not to exceed 8 μg peptide/mL before and after drug resistance induction. In a rat model of Fusarium keratitis, CPL demonstrates superior therapeutic efficacy than commercially available natamycin ophthalmic suspension. This study provides more theoretical and experimental supports for the application of CPL in the treatment of FK.
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Affiliation(s)
- Ning Gao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiaoyan Ju
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiting Jiao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Yuanyuan Qi
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Ye Tian
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Shidong Jiang
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Zhongwei Niu
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shaozhen Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Ruibo Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
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Engle K, Kumar G. Tackling multi-drug resistant fungi by efflux pump inhibitors. Biochem Pharmacol 2024; 226:116400. [PMID: 38945275 DOI: 10.1016/j.bcp.2024.116400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/02/2024]
Abstract
The emergence of multidrug-resistant fungi is of grave concern, and its infections are responsible for significant deaths among immunocompromised patients. The treatment of fungal infections primarily relies on a clinical class of antibiotics, including azoles, polyenes, echinocandins, polyketides, and a nucleotide analogue. However, the incidence of fungal infections is increasing as the treatment for human and plant fungal infections overlaps with antifungal drugs. The need for new antifungal agents acting on different targets than known targets is undeniable. Also, the pace at which loss of fungal susceptibility to antibiotics cannot be undermined. There are several modes by which fungi can develop resistance to antibiotics, including reduced drug uptake, drug target alteration, and a reduction in the cellular concentration of the drug due to active extrusions and biofilm formation. The efflux pump's overexpression in the fungi primarily reduced the antibiotic's concentration to a sub-lethal concentration, thus responsible for developing resistant fungus strains. Several strategies are used to check antibiotic resistance in multi-drug resistant fungi, including synthesizing antibiotic analogs and giving antibiotics in combination therapies. Among them, the efflux pump protein inhibitors are considered potential adjuvants to antibiotics and can block the efflux of antibiotics by inhibiting efflux pump protein transporters. Moreover, it can sensitize the antifungal drugs to multi-drug resistant fungi with overexpressed efflux pump proteins. This review discusses the natural lead molecules, repurposable drugs, and formulation strategies to overcome the efflux pump activity in the fungi.
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Affiliation(s)
- Kritika Engle
- Department of Natural Products, Chemical Sciences, National Institute of Pharmaceutical Education and Research-Hyderabad, Hyderabad, Balanagar 500037, India
| | - Gautam Kumar
- Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Rajasthan 333031, India.
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Zöngür A. Antimicrobial, Antioxidant and Cytotoxic Effects of Essential Oil, Fatty Acids and Bioactive Compounds of Beta vulgaris var. crassa (Fodder Beet). Indian J Microbiol 2024; 64:719-731. [PMID: 39010984 PMCID: PMC11246347 DOI: 10.1007/s12088-024-01269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/24/2024] [Indexed: 07/17/2024] Open
Abstract
Beta vulgaris var. crassa is undoubtedly a very important plant that is not used enough in the world. In this study, it was aimed to determine the cytotoxic activities of the components (essential oils, fatty acids, total phenol and flavonoid) found in the leaf parts of Beta vulgaris var. crassa against PC-3, MCF-7 and HeLa cancer cell lines. In addition, the effectiveness of these ingredients against bacteria and fungi that can cause serious health problems in humans was tested. In experiments, three tumor cell lines were exposed to various plant extract concentrations (31.25, 62.5, 125, 250, 500 and 1000 µg/mL) for 72 h. It was found that plant extracts showed high (SI: 2.14 > 2) cytotoxicity to PC-3 cells, moderate (SI: 1.62 < 2) to HeLa cells, and low (SI: 0.93 < 2) cytotoxicity to MCF-7 cells. Also, different plant extract concentrations were found to cause an inhibition rate of 16.3-22.3% in Staphylococcus aureus, 16.8-23.5% in Streptococcus pyogenes and 12-16.2% in Cutibacterium acnes. Similarly, inhibition rates were determined between 9.5-20.7% for Candida albicans, 3.5-7.7% for Candida auris, and 5.5-15.1% for Candida glabrata. The results showed that the plant extract exhibited a concentration-dependent cytotoxic and antimicrobial effect against both cancer cell lines and microbial pathogens. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s12088-024-01269-8.
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Gonzalez-Jimenez I, Perlin DS, Shor E. Reactive oxidant species induced by antifungal drugs: identity, origins, functions, and connection to stress-induced cell death. Front Cell Infect Microbiol 2023; 13:1276406. [PMID: 37900311 PMCID: PMC10602735 DOI: 10.3389/fcimb.2023.1276406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023] Open
Abstract
Reactive oxidant species (ROS) are unstable, highly reactive molecules that are produced by cells either as byproducts of metabolism or synthesized by specialized enzymes. ROS can be detrimental, e.g., by damaging cellular macromolecules, or beneficial, e.g., by participating in signaling. An increasing body of evidence shows that various fungal species, including both yeasts and molds, increase ROS production upon exposure to the antifungal drugs currently used in the clinic: azoles, polyenes, and echinocandins. However, the implications of these findings are still largely unclear due to gaps in knowledge regarding the chemical nature, molecular origins, and functional consequences of these ROS. Because the detection of ROS in fungal cells has largely relied on fluorescent probes that lack specificity, the chemical nature of the ROS is not known, and it may vary depending on the specific fungus-drug combination. In several instances, the origin of antifungal drug-induced ROS has been identified as the mitochondria, but further experiments are necessary to strengthen this conclusion and to investigate other potential cellular ROS sources, such as the ER, peroxisomes, and ROS-producing enzymes. With respect to the function of the ROS, several studies have shown that they contribute to the drugs' fungicidal activities and may be part of drug-induced programmed cell death (PCD). However, whether these "pro-death" ROS are a primary consequence of the antifungal mechanism of action or a secondary consequence of drug-induced PCD remains unclear. Finally, several recent studies have raised the possibility that ROS induction can serve an adaptive role, promoting antifungal drug tolerance and the evolution of drug resistance. Filling these gaps in knowledge will reveal a new aspect of fungal biology and may identify new ways to potentiate antifungal drug activity or prevent the evolution of antifungal drug resistance.
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Affiliation(s)
- Irene Gonzalez-Jimenez
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States
| | - David S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States
- Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, United States
- Lombardi Comprehensive Cancer Center and Department of Microbiology and Immunology, Georgetown University, Washington, DC, United States
| | - Erika Shor
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States
- Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, United States
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Murcia-Galán RA, Durán SM, Leal-Pinto SM, Roa-Cordero MV, Vargas JD, Herrera LV, Muñoz-Castro A, MacLeod-Carey D, Naranjo TW, Rodríguez-Kessler PL, Hurtado JJ. Antifungal activity of Co(II) and Cu(II) complexes containing 1,3-bis(benzotriazol-1-yl)-propan-2-ol on the growth and virulence traits of fluconazole-resistant Candida species: synthesis, DFT calculations, and biological activity. BMC Chem 2023; 17:135. [PMID: 37817173 PMCID: PMC10563319 DOI: 10.1186/s13065-023-01037-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/13/2023] [Indexed: 10/12/2023] Open
Abstract
Relevant virulence traits in Candida spp. are associated with dimorphic change and biofilm formation, which became an important target to reduce antifungal resistance. In this work, Co(II) complexes containing a benzotriazole derivative ligand showed a promising capacity of reducing these virulence traits. These complexes exhibited higher antifungal activities than the free ligands against all the Candida albicans and non-albicans strains tested, where compounds 2 and 4 showed minimum inhibitory concentration values between 15.62 and 125 μg mL-1. Moreover, four complexes (2-5) of Co(II) and Cu(II) with benzotriazole ligand were synthesized. These compounds were obtained as air-stable solids and characterized by melting point, thermogravimetric analysis, infrared, Raman and ultraviolet/visible spectroscopy. The analysis of the characterization data allowed us to identify that all the complexes had 1:1 (M:L) stoichiometries. Additionally, Density Functional Theory calculations were carried out for 2 and 3 to propose a probable geometry of both compounds. The conformer Da of 2 was the most stable conformer according to the Energy Decomposition Analysis; while the conformers of 3 have a fluxional behavior in this analysis that did not allow us to determine the most probable conformer. These results provide an important platform for the design of new compounds with antifungal activities and the capacity to attack other target of relevance to reduce antimicrobial resistance.
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Affiliation(s)
- Ricardo A. Murcia-Galán
- Grupo de Investigación en Química Inorgánica, Catálisis y Bioinorgánica, Departamento de Química, Universidad de los Andes, Carrera 1 No. 18A-12, 111711 Bogotá, Colombia
| | - Sandra M. Durán
- Facultad de Ciencias Médicas y de la Salud, Universidad de Santander, Calle 70 No. 55-210, Bucaramanga, Colombia
| | - Sandra M. Leal-Pinto
- Facultad de Ciencias Médicas y de la Salud, Universidad de Santander, Calle 70 No. 55-210, Bucaramanga, Colombia
| | - Martha V. Roa-Cordero
- Facultad de Ciencias Médicas y de la Salud, Universidad de Santander, Calle 70 No. 55-210, Bucaramanga, Colombia
| | - Jose D. Vargas
- Facultad de Ciencias Médicas y de la Salud, Universidad de Santander, Calle 70 No. 55-210, Bucaramanga, Colombia
| | - Laura V. Herrera
- Grupo Sistema Estomatognático Y Morfofisiología (SEMF), Departamento de Ciencias Básicas, Universidad Santo Tomás Seccional Bucaramanga, Carrera 27 No. 180-395, Bucaramanga, Colombia
| | - Alvaro Muñoz-Castro
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad San Sebastián, Bellavista 7, 8420524 Santiago, Chile
| | - Desmond MacLeod-Carey
- Facultad de Ingeniería, Instituto de Ciencias Químicas Aplicadas, Inorganic Chemistry and Molecular Materials Center, Universidad Autónoma de Chile, El Llano Subercaseaux 2801, Santiago, Chile
| | - Tonny W. Naranjo
- Experimental and Medical Micology Group, Corporación para Investigaciones Biológicas (CIB), 050010 Medellin, Colombia
- Facultad de Medicina, Universidad Pontificia Bolivariana, 050034 Medellín, Colombia
| | - Peter L. Rodríguez-Kessler
- Centro de Investigaciones en Óptica A.C., Loma del Bosque 115, Col. Lomas del Campestre, 37150 León, Guanajuato México
| | - John J. Hurtado
- Grupo de Investigación en Química Inorgánica, Catálisis y Bioinorgánica, Departamento de Química, Universidad de los Andes, Carrera 1 No. 18A-12, 111711 Bogotá, Colombia
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Naicker S, Mohanlall V, Ngubane S, Mellem J, Mchunu NP. Phenotypic Array for Identification and Screening of Antifungals against Aspergillus Isolates from Respiratory Infections in KwaZulu Natal, South Africa. J Fungi (Basel) 2023; 9:616. [PMID: 37367552 DOI: 10.3390/jof9060616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
The rapid emergence of invasive fungal infections correlates with the increasing population of immunocompromised individuals, with many cases leading to death. The progressive increase in the incidence of Aspergillus isolates is even more severe due to the clinical challenges in treating invasive infections in immunocompromised patients with respiratory conditions. Rapid detection and diagnosis are needed to reduce mortality in individuals with invasive aspergillosis-related infections and thus efficient identification impacts clinical success. The phenotypic array method was compared to conventional morphology and molecular identification on thirty-six Aspergillus species isolated from patients with respiratory infections at the Inkosi Albert Luthuli Hospital in Kwa-Zulu Natal. In addition, an antimicrobial array was also carried out to screen for possible novel antimicrobial compounds for treatment. Although traditional morphological techniques are useful, genetic identification was the most reliable, assigning 26 to Aspergillus fumigatus species, 8 Aspergillus niger, and 2 Aspergillus flavus including cryptic species of A. niger, A. tubingensis and A. welwitschiae. The phenotypic array technique was only able to identify isolates up to the genus level due to a lack of adequate reference clinical species in the database. However, this technique proved crucial in assessing a wide range of possible antimicrobial options after these isolates exhibited some resistance to azoles. Antifungal profiles of the thirty-six isolates on the routine azole voriconazole showed a resistance of 6%, with 61% having moderate susceptibility. All isolates resistant to the salvage therapy drug, posaconazole pose a serious concern. Significantly, A. niger was the only species resistant (25%) to voriconazole and has recently been reported as the species isolated from patients with COVID-19-associated pulmonary aspergillosis (CAPA). Phenotypic microarray showed that 83% of the isolates were susceptible to the 24 new compounds and novel compounds were identified for potentially effective combination treatment of fungal infections. This study also reports the first TR34/98 mutation in Aspergillus clinical isolates which is located in the cyp51A gene.
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Affiliation(s)
- Sarla Naicker
- Department of Biotechnology and Food Science, Durban University of Technology, Durban 4000, Kwa-Zulu Natal, South Africa
| | - Viresh Mohanlall
- Department of Biotechnology and Food Science, Durban University of Technology, Durban 4000, Kwa-Zulu Natal, South Africa
| | - Sandile Ngubane
- Department of Biotechnology and Food Science, Durban University of Technology, Durban 4000, Kwa-Zulu Natal, South Africa
| | - John Mellem
- Department of Biotechnology and Food Science, Durban University of Technology, Durban 4000, Kwa-Zulu Natal, South Africa
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Bosetti D, Neofytos D. Invasive Aspergillosis and the Impact of Azole-resistance. CURRENT FUNGAL INFECTION REPORTS 2023; 17:1-10. [PMID: 37360857 PMCID: PMC10024029 DOI: 10.1007/s12281-023-00459-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review IA (invasive aspergillosis) caused by azole-resistant strains has been associated with higher clinical burden and mortality rates. We review the current epidemiology, diagnostic, and therapeutic strategies of this clinical entity, with a special focus on patients with hematologic malignancies. Recent Findings There is an increase of azole resistance in Aspergillus spp. worldwide, probably due to environmental pressure and the increase of long-term azole prophylaxis and treatment in immunocompromised patients (e.g., in hematopoietic stem cell transplant recipients). The therapeutic approaches are challenging, due to multidrug-resistant strains, drug interactions, side effects, and patient-related conditions. Summary Rapid recognition of resistant Aspergillus spp. strains is fundamental to initiate an appropriate antifungal regimen, above all for allogeneic hematopoietic cell transplantation recipients. Clearly, more studies are needed in order to better understand the resistance mechanisms and optimize the diagnostic methods to identify Aspergillus spp. resistance to the existing antifungal agents/classes. More data on the susceptibility profile of Aspergillus spp. against the new classes of antifungal agents may allow for better treatment options and improved clinical outcomes in the coming years. In the meantime, continuous surveillance studies to monitor the prevalence of environmental and patient prevalence of azole resistance among Aspergillus spp. is absolutely crucial.
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Affiliation(s)
- Davide Bosetti
- Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Dionysios Neofytos
- Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
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Rabaan AA, Sulaiman T, Al-Ahmed SH, Buhaliqah ZA, Buhaliqah AA, AlYuosof B, Alfaresi M, Al Fares MA, Alwarthan S, Alkathlan MS, Almaghrabi RS, Abuzaid AA, Altowaileb JA, Al Ibrahim M, AlSalman EM, Alsalman F, Alghounaim M, Bueid AS, Al-Omari A, Mohapatra RK. Potential Strategies to Control the Risk of Antifungal Resistance in Humans: A Comprehensive Review. Antibiotics (Basel) 2023; 12:antibiotics12030608. [PMID: 36978475 PMCID: PMC10045400 DOI: 10.3390/antibiotics12030608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
Fungal infections are becoming one of the main causes of morbidity and mortality in people with weakened immune systems. Mycoses are becoming more common, despite greater knowledge and better treatment methods, due to the regular emergence of resistance to the antifungal medications used in clinical settings. Antifungal therapy is the mainstay of patient management for acute and chronic mycoses. However, the limited availability of antifungal drug classes limits the range of available treatments. Additionally, several drawbacks to treating mycoses include unfavourable side effects, a limited activity spectrum, a paucity of targets, and fungal resistance, all of which continue to be significant issues in developing antifungal drugs. The emergence of antifungal drug resistance has eliminated accessible drug classes as treatment choices, which significantly compromises the clinical management of fungal illnesses. In some situations, the emergence of strains resistant to many antifungal medications is a major concern. Although new medications have been developed to address this issue, antifungal drug resistance has grown more pronounced, particularly in patients who need long-term care or are undergoing antifungal prophylaxis. Moreover, the mechanisms that cause resistance must be well understood, including modifications in drug target affinities and abundances, along with biofilms and efflux pumps that diminish intracellular drug levels, to find novel antifungal drugs and drug targets. In this review, different classes of antifungal agents, and their resistance mechanisms, have been discussed. The latter part of the review focuses on the strategies by which we can overcome this serious issue of antifungal resistance in humans.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Tarek Sulaiman
- Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | - Shamsah H Al-Ahmed
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif 32654, Saudi Arabia
| | - Zainab A Buhaliqah
- Department of Family Medicine, Primary Healthcare Center, Dammam 32433, Saudi Arabia
| | - Ali A Buhaliqah
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Buthina AlYuosof
- Directorate of Public Health, Dammam Network, Eastern Health Cluster, Dammam 31444, Saudi Arabia
| | - Mubarak Alfaresi
- Department of Pathology and Laboratory Medicine, Zayed Military Hospital, Abu Dhabi 3740, United Arab Emirates
- Department of Pathology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Mona A Al Fares
- Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - Sara Alwarthan
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammed S Alkathlan
- Infectious Diseases Department, King Fahad Specialist Hospital, Buraydah 52382, Saudi Arabia
| | - Reem S Almaghrabi
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Abdulmonem A Abuzaid
- Medical Microbiology Department, Security Forces Hospital Programme, Dammam 32314, Saudi Arabia
| | - Jaffar A Altowaileb
- Microbiology Laboratory, Laboratory Department, Qatif Central Hospital, Qatif 32654, Saudi Arabia
| | - Maha Al Ibrahim
- Microbiology Laboratory, Laboratory Department, Qatif Central Hospital, Qatif 32654, Saudi Arabia
| | - Eman M AlSalman
- Department of Family Medicine, Primary Health Care Centers, Qatif Health Network, Qatif 31911, Saudi Arabia
| | - Fatimah Alsalman
- Department of Emergency Medicine, Oyun City Hospital, Al-Ahsa 36312, Saudi Arabia
| | | | - Ahmed S Bueid
- Microbiology Laboratory, King Faisal General Hospital, Al-Ahsa 31982, Saudi Arabia
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh 11372, Saudi Arabia
| | - Ranjan K Mohapatra
- Department of Chemistry, Government College of Engineering, Keonjhar 758002, India
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Zhan L, Tian X, Lin J, Zhang Y, Zheng H, Peng X, Zhao G. Honokiol reduces fungal burden and ameliorate inflammation lesions of Aspergillus fumigatus keratitis via Dectin-2 down-regulation. Int Immunopharmacol 2023; 118:109849. [PMID: 36933490 DOI: 10.1016/j.intimp.2023.109849] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 01/29/2023] [Accepted: 02/03/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To screen and identify the mechanism of honokiol on anti-fungi and anti-inflammation in fungal keratitis (FK) through bioinformatic analysis and biological experiments. METHODS Transcriptome profile demonstrated differential expression genes (DEGs) of Aspergillus fumigatus keratitis between PBS-treated and honokiol-treated groups via bioinformatics analyses. Inflammatory substances were quantified by qRT-PCR, Western blot and ELISA, and macrophage polarization was examined by flow cytometry. Periodic acid Schiff staining and morphological interference assay were used to detect hyphal distribution in vivo and fungal germination in vitro, respectively. Electron microscopy was to illustrate hyphal microstructure. RESULTS Illumina sequencing demonstrated that compared with the honokiol group, 1175 up-regulated and 383 down-regulated genes were induced in C57BL/6 mice Aspergillus fumigatus keratitis with PBS treatment. Through GO analysis, some differential expression proteins (DEPs) played major roles in biological processes, especially fungal defense and immune activation. KEGG analysis provided fungus-related signaling pathways. PPI analysis demonstrated that DEPs from multiple pathways form a close-knit network, providing a broader context for FK treatment. In biological experiments, Dectin-2, NLRP3 and IL-1β were upregulated by Aspergillus fumigatus to evaluate immune response. Honokiol could reverse the trend, comparable to Dectin-2 siRNA interference. Meanwhile, honokiol could also play an anti-inflammatory role via promoting M2 phenotype polarization. Moreover, honokiol reduced hyphal distribution in the stroma, delayed germination, and destroyed the hyphal cell membrane in-vitro. CONCLUSIONS Honokiol possesses anti-fungal and anti-inflammatory effects in Aspergillus fumigatus keratitis and may develop a potential and safe therapeutic modality for FK.
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Affiliation(s)
- Lu Zhan
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xue Tian
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Lin
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yingxue Zhang
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine 540 E. Canfield Avenue Detroit, MI 48201, USA
| | - Hengrui Zheng
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xudong Peng
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Ophthalmology, University of Washington, Seattle WA98104, USA.
| | - Guiqiu Zhao
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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11
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Kaur H, Kanaujia R, Singh S, Kajal K, Jayashree M, Peter NJ, Verma S, Gupta M, Ray P, Ghosh A, Samujh R, Rudramurthy SM. Clinical utility of time to positivity of blood cultures in cases of fungaemia: A prospective study. Indian J Med Microbiol 2022; 43:85-89. [PMID: 36153287 DOI: 10.1016/j.ijmmb.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/18/2022] [Accepted: 08/27/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Fungaemia due to yeast is a major cause of morbidity and mortality in critically ill patients. Although, automated blood cultures have improved the time to diagnosis, very few studies have systematically evaluated the utility of blood culture time to positivity (TTP) of fungaemia in the clinical scenario. In this study, we evaluated the TTP for different yeast species to determine its clinical utility. MATERIAL AND METHODS A prospective study including 244 consecutive patients admitted to the adult (n = 76) and paediatric (n = 168) intensive care units (ICUs) was conducted between December 2017 through March 2019. The clinical and demographic characteristics, BACTEC blood culture results and TTP for yeast positive blood cultures were recorded for analysis. RESULTS A total of 244 patients with 357 episodes of candidaemia were enrolled during the study period. The TTP (mean ± SD) for all yeast species was 26.8 ± 23.6 h while it was significantly longer in paediatric than adult patients (30.5 ± 24.7 vs. 25.2 ± 22.9 h; p = <0.0001). Wickerhamomyces anomalus and Cyberlindnera jadinii (previously C. utilis) were exclusively isolated from paediatric population where W. anomalus demonstrated significantly longer TTP than C. jadinii. Among adult cases, C. albicans exhibited significantly longer TTP than C. tropicalis. In paediatric cases, >80% of C. tropicalis and C. utilis flagged positive in blood culture before 24 h while majority (65.9%) of W. anomalus isolates flagged positive later than 24 h. Similarly in adult samples, 63% of C. tropicalis isolates beeped positive before 24 h. CONCLUSION TTP for yeast may provide insight regarding the responsible yeast species before final identification among critical patients with candidaemia. Larger studies are warranted for evaluating clinical utility of TTP considering other complex factors like yeast burden, generation time, virulence and host factors, which may affect TTP.
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Affiliation(s)
- Harsimran Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | | | - Shreya Singh
- Dr B.R. Ambedkar State Institute of Medical Sciences (AIMS Mohali), India
| | - Kamal Kajal
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Muralidharan Jayashree
- Department of Paediatric Medicine, Advanced Paediatric Centre, PGIMER, Chandigarh, India
| | - Nitin James Peter
- Department of Paediatric Surgery, Advanced Paediatric Centre, PGIMER, Chandigarh, India
| | - Shristi Verma
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Mantavya Gupta
- Precise Healthcare Clinical Laboratory, Sector 30, Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Anup Ghosh
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Ram Samujh
- Department of Paediatric Surgery, Advanced Paediatric Centre, PGIMER, Chandigarh, India
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12
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Honey: An Advanced Antimicrobial and Wound Healing Biomaterial for Tissue Engineering Applications. Pharmaceutics 2022; 14:pharmaceutics14081663. [PMID: 36015289 PMCID: PMC9414000 DOI: 10.3390/pharmaceutics14081663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 01/18/2023] Open
Abstract
Honey was used in traditional medicine to treat wounds until the advent of modern medicine. The rising global antibiotic resistance has forced the development of novel therapies as alternatives to combat infections. Consequently, honey is experiencing a resurgence in evaluation for antimicrobial and wound healing applications. A range of both Gram-positive and Gram-negative bacteria, including antibiotic-resistant strains and biofilms, are inhibited by honey. Furthermore, susceptibility to antibiotics can be restored when used synergistically with honey. Honey’s antimicrobial activity also includes antifungal and antiviral properties, and in most varieties of honey, its activity is attributed to the enzymatic generation of hydrogen peroxide, a reactive oxygen species. Non-peroxide factors include low water activity, acidity, phenolic content, defensin-1, and methylglyoxal (Leptospermum honeys). Honey has also been widely explored as a tissue-regenerative agent. It can contribute to all stages of wound healing, and thus has been used in direct application and in dressings. The difficulty of the sustained delivery of honey’s active ingredients to the wound site has driven the development of tissue engineering approaches (e.g., electrospinning and hydrogels). This review presents the most in-depth and up-to-date comprehensive overview of honey’s antimicrobial and wound healing properties, commercial and medical uses, and its growing experimental use in tissue-engineered scaffolds.
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13
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Babu CK, Shubhra, Ghouse SM, Singh PK, Khatri DK, Nanduri S, Singh SB, Madan J. Luliconazole topical dermal drug delivery for superficial fungal infections: Penetration hurdles and role of functional nanomaterials. Curr Pharm Des 2022; 28:1611-1620. [PMID: 35747957 DOI: 10.2174/1381612828666220623095743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
Abstract
Luliconazole is the first and only anti-fungal agent approved for the short-term treatment of superficial fungal infections. However, commercially available conventional topical dermal drug delivery cargo of luliconazole is associated with certain limitations like lower skin permeation and shorter skin retention of drug. Therefore, present review is an attempt to decode the penetration hurdles in luliconazole topical dermal drug delivery. Moreover, we also summarized the activity of functional nanomaterials based drug delivery systems employed by the scientific fraternity to improve luliconazole efficacy in superficial fungal infections on case-to-case basis. In addition, efforts have also been made to unbox the critically acclaimed mechanism of action of luliconazole against fungal cells. Under the framework of future prospects, we have analyzed the combination of luliconazole with isoquercetin using in-silico docking technique for offering synergistic antifungal activity. Isoquercetin exhibited a good affinity for superoxide dismutase (SOD), a fungal target owing to the formation of hydrogen bond with Glu132, Glu133, and Arg143, in addition to few hydrophobic interactions. On the other hand, luliconazole inhibited lanosterol-14α-demethylase and consequently blocked ergosterol. In addition, nanotechnology and artificial neural network (ANN) derived integrated drug delivery systems may also be explored for augmenting the luliconazole therapeutic efficacy in topical fungal infections. Synergy of ANN models along with topical nanoscaled drug delivery may help to achieve critical quality attributes (CQA) to gain commercial success.
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Affiliation(s)
- Chanti Katta Babu
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Shubhra
- Department of Pharmacy, Birla Institute of Technology and Science, Hyderabad, Telangana, India
| | - Shaik Mahammad Ghouse
- Department of Chemical Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Pankaj Kumar Singh
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Dharmendra Kumar Khatri
- Department of Biological Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Srinivas Nanduri
- Department of Chemical Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Shashi Bala Singh
- Department of Biological Sciences, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Jitender Madan
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
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14
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Parslow BY, Thornton CR. Continuing Shifts in Epidemiology and Antifungal Susceptibility Highlight the Need for Improved Disease Management of Invasive Candidiasis. Microorganisms 2022; 10:microorganisms10061208. [PMID: 35744725 PMCID: PMC9228503 DOI: 10.3390/microorganisms10061208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 12/07/2022] Open
Abstract
Invasive candidiasis (IC) is a systemic life-threatening infection of immunocompromised humans, but remains a relatively neglected disease among public health authorities. Ongoing assessments of disease epidemiology are needed to identify and map trends of importance that may necessitate improvements in disease management and patient care. Well-established incidence increases, largely due to expanding populations of patients with pre-disposing risk factors, has led to increased clinical use and pressures on antifungal drugs. This has been exacerbated by a lack of fast, accurate diagnostics that have led treatment guidelines to often recommend preventative strategies in the absence of proven infection, resulting in unnecessary antifungal use in many instances. The consequences of this are multifactorial, but a contribution to emerging drug resistance is of primary concern, with high levels of antifungal use heavily implicated in global shifts to more resistant Candida strains. Preserving and expanding the utility and number of antifungals should therefore be of the highest priority. This may be achievable through the development and use of biomarker tests, bringing about a new era in improved antifungal stewardship, as well as novel antifungals that offer favorable profiles by targeting Candida pathogenesis mechanisms over cell viability.
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Affiliation(s)
- Ben Y. Parslow
- Biosciences, College of Life and Environmental Sciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK;
| | - Christopher R. Thornton
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
- Correspondence:
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15
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Ayalew Tiruneh T, Ayalew Tiruneh G, Chekol Abebe E, Mengie Ayele T. Phytochemical Investigation and Determination of Antibacterial Activity of Solvent Leave Extracts of Carissa spinarum. Infect Drug Resist 2022; 15:807-819. [PMID: 35281572 PMCID: PMC8904435 DOI: 10.2147/idr.s352049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Among many traditionally used medicinal plants, Carissa spinarum (Agam) is a well-known indigenous plant in Ethiopia. It is used in its raw form to treat different diseases in different parts of the country. Therefore, the aim of this study is to investigate extraction, isolation, and determination of the antibacterial properties of the solvent leaf extract of Carissa spinarum. Methods In this study, 800 g of powdered leaves of Carissa spinarum were macerated with 2500 mL of methanol and yielded 58 g (7.25%, w/w) of gummy material. The extract was then further partitioned by using ethyl acetate and chloroform. The extracts were subjected to phytochemical screening test. The antibacterial activity of the three solvent leaf extracts of Carissa spinarum were evaluated using disc diffusion method. The methanol extract was subjected to column chromatography silica gel (60-200 mesh) by mixing methanol:petroleum ether (4:1). Then fractions were collected and investigated by TLC and finally identified using spectroscopy. Results The three extracts (methanol, ethyl acetate, and chloroform) of Carissa spinarum were presented to antimicrobial activity by disc diffusion method against four bacterial species using gentamycin and ampicillin discs as positive controls and DMSO as a negative control. All extracts had a relatively antibacterial effect with different extent zones of inhibition. However, the methanol extract showed superior antibacterial activity compared with DMSO and ethyl acetate and chloroform extracts. These could due to variation of the phytoconstituents. The most probable structure of the compound isolated was 5-(2',3',4',6'-tetrahydroxy-5'-methoxycyclohexyloxy)-2,3,4 trihydroxypentanoic acid. Conclusion Data obtained from this study collectively indicated that the three solvent extracts of Carissa spinarum have a promising antimicrobial activity which supports the traditional claim of the plant for treatment of infection.
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Affiliation(s)
- Tizezew Ayalew Tiruneh
- Department of Chemistry, College of Natural and Computational Science, University of Gondar, Gondar, Ethiopia
| | | | - Endeshaw Chekol Abebe
- Department of Medical Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Teklie Mengie Ayele
- Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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16
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Gil J, Solis M, Higa A, Davis SC. Candida albicans Infections: a novel porcine wound model to evaluate treatment efficacy. BMC Microbiol 2022; 22:45. [PMID: 35120444 PMCID: PMC8815218 DOI: 10.1186/s12866-022-02460-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Candida albicans is a common cause of opportunistic mycoses worldwide and a major contributor in wound infections. The purpose of this study was to establish a fungal wound model and analyze the effects of a common antifungal agent against the proliferation of three C. albicans strains. Second degree burns were created, and then inoculated with one of three different C. albicans ATCC strains: 10261 reference strain, 64550 fluconazole resistant and 26310 fluconazole sensitive. After fungal inoculation, every wound was covered with dressings for 4 h to allow fungal colonization on every wound bed. After 4 h, the dressings were removed, and each wound was treated either once or twice daily with a topical terbinafine hydrochloride or left untreated. On days 2, 4 and 7 post inoculation, three wounds from each treatment group were scrub cultured and quantified. On day 2, wounds infected with the sensitive strains 26310 and 10261 and treated twice showed a significant reduction when compared against those infected wounds receiving once daily treatment. On day 4, wounds which were infected with C. albicans fluconazole sensitive (ATCC 26310) showed a significant reduction in fungal cell counts with treatment applied twice daily. A significant reduction in the colony counts was exhibited in all three strains at the seventh day with active as compared to the non-treated wounds. Twice daily treatment resulted in a lower fungal count than once daily treatment. Neither treatment was able to entirely eradicate C. albicans during the duration of this study. Establishing a reliable fungal wound model will help in the translational goal of identifying new antifungal that could be used clinically by wound care providers.
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Affiliation(s)
- Joel Gil
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery Wound Healing Research Laboratory Miami, University of Miami, Miami, 33136, FL, United States.
| | - Michael Solis
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery Wound Healing Research Laboratory Miami, University of Miami, Miami, 33136, FL, United States
| | - Alexander Higa
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery Wound Healing Research Laboratory Miami, University of Miami, Miami, 33136, FL, United States
| | - Stephen C Davis
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery Wound Healing Research Laboratory Miami, University of Miami, Miami, 33136, FL, United States
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17
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Dai JK, Dan WJ, Wan JB. Natural and synthetic β-carboline as a privileged antifungal scaffolds. Eur J Med Chem 2021; 229:114057. [PMID: 34954591 DOI: 10.1016/j.ejmech.2021.114057] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 01/04/2023]
Abstract
The discovery of antifungal agents with novel structure, broad-spectrum, low toxicity, and high efficiency has been the focus of medicinal chemists. Over the past decades, β-carboline scaffold has attracted extensive attention in the scientific community due to its potent and diverse biological activities with nine successfully marketed β-carboline-based drugs. In this review, we summarized the current states and advances in the antifungal activity of natural and synthetic β-carbolines. Additionally, the structure-activity relationships and their antifungal mechanisms targeting biofilm, cell wall, cell membrane, and fungal intracellular targets were also systematically discussed. In summary, β-carbolines have the great potential to develop new efficient scaffolds to combat fungal infections.
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Affiliation(s)
- Jiang-Kun Dai
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China; College of Veterinary Medicine, Northwest A&F University, Shaanxi, China; School of Life Science and Technology, Weifang Medical University, Shandong, China
| | - Wen-Jia Dan
- School of Life Science and Technology, Weifang Medical University, Shandong, China.
| | - Jian-Bo Wan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China.
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18
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Hu Y, Jiao S, Wang Y, Chen R, Li G, Zou Z. Design, Synthesis, Molecular Docking Studies of Deferasirox Derivatives of 1,2,4‐Triazole as Potential Antimicrobial Agents. ChemistrySelect 2021. [DOI: 10.1002/slct.202103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yiping Hu
- College of chemistry and chemical engineering Southeast University Nanjing 211189 People's Republic of China
| | - Shulin Jiao
- College of chemistry and chemical engineering Southeast University Nanjing 211189 People's Republic of China
| | - Yanyan Wang
- College of chemistry and chemical engineering Southeast University Nanjing 211189 People's Republic of China
| | - Ruicheng Chen
- College of chemistry and chemical engineering Southeast University Nanjing 211189 People's Republic of China
| | - Gen Li
- College of chemistry and chemical engineering Southeast University Nanjing 211189 People's Republic of China
| | - Zhihong Zou
- College of chemistry and chemical engineering Southeast University Nanjing 211189 People's Republic of China
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19
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M El-Ganiny A, E Yossef N, A Kamel H. Prevalence and antifungal drug resistance of nosocomial Candida species isolated from two university hospitals in Egypt. Curr Med Mycol 2021; 7:31-37. [PMID: 34553095 PMCID: PMC8443875 DOI: 10.18502/cmm.7.1.6181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/17/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: There is a significant rise in morbidity and mortality of infections caused by Candida. Candida spp. infections are currently ranked fourth among nosocomial infections which are difficult
to diagnose and refractory to therapy. Given the differences in susceptibility among various spp., identification of Candida spp. is an important step that leads to the selection of a suitable antifungal. Materials and Methods: A prevalence study was conducted on 122 Candida isolates. The Candida spp. were identified using Chromogenic agar and polymerase chain reaction (PCR).
The antifungal susceptibility (AFS) of Candida spp. to amphotericin B, fluconazole, voriconazole, and caspofungin was determined by the disc diffusion method. Results: In total, 122 Candida clinical isolates were investigated in this study. Candida albicans with 57.4% (70 isolates) had the highest prevalence rate,
while 52 isolates (42.6%) were non-albicansCandida species (NAC). The NAC include Candida krusei (20.4%), Candida tropicalis (6.5%), Candida parapsilolsis (5.7%),
Candida dubliniensis (4.9%), and Candida glabrata (4.9%). The AFS showed that the resistance rates of Candida spp. to fluconazole and voriconazole were 13.1% (16 isolates)
and 9.8% (12 isolates), respectively. Moreover, only five isolates (4.1%) were resistant to caspofungin. Furthermore, there was no resistance against amphotericin B. The spp.
that showed the highest resistance were C. glabrata and C. tropicalis, while the lowest resistance was observed in C. albicans and C. dubliniensis. Conclusion: In conclusion, rapid identification of clinical Candida isolates and standard AFS are essential procedures for controlling the rise of resistant NAC spp. in clinical settings.
Usage of fluconazole should be restricted, especially in patients with recurrent Candida infections.
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Affiliation(s)
- Amira M El-Ganiny
- Microbiology and Immunology Department, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Nehal E Yossef
- Microbiology and Immunology Department, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Hend A Kamel
- Microbiology and Immunology Department, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt.,Microbiology Department, Faculty of Pharmacy and Pharmaceutical Industries, Sinai University, Kantara, Egypt
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20
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Jain N, Jansone I, Obidenova T, Sīmanis R, Meisters J, Straupmane D, Reinis A. Epidemiological Characterization of Clinical Fungal Isolates from Pauls Stradinš Clinical University Hospital, Latvia: A 4-Year Surveillance Report. Life (Basel) 2021; 11:1002. [PMID: 34685374 PMCID: PMC8537438 DOI: 10.3390/life11101002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022] Open
Abstract
Nosocomial fungal infections are an emerging global public health threat that requires urgent attention and proper management. With the limited availability of treatment options, it has become necessary to understand the emerging epidemiological trends, mechanisms, and risk factors. However, very limited surveillance reports are available in the Latvian and broader European context. We therefore conducted a retrospective analysis of laboratory data (2017-2020) from Pauls Stradinš Clinical University Hospital (PSCUH), Riga, Latvia, which is one of the largest public multispecialty hospitals in Latvia. A total of 2278 fungal isolates were analyzed during the study period, with Candida spp. comprising 95% of the isolates, followed by Aspergillus spp. and Geotrichum spp. Amongst the Candida spp., C. albicans and C. glabrata made up about 75% of the isolates. The Department of Lung Diseases and Thoracic Surgery had the highest caseload followed by Intensive Care Department. Majority of the fungal isolates were collected from the bronchoalveolar lavage (37%), followed by urine (19%) and sputum (18%) samples. A total of 34 cases of candidemia were noted during the study period with C. albicans being the most common candidemia pathogen. Proper surveillance of emerging epidemiological trends serve as the most reliable and powerful cornerstone towards tackling this emerging threat.
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Affiliation(s)
- Nityanand Jain
- Department of Biology and Microbiology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Inese Jansone
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Tatjana Obidenova
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Raimonds Sīmanis
- Department of Infectology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Jānis Meisters
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Dagnija Straupmane
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
| | - Aigars Reinis
- Department of Biology and Microbiology, Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
- Joint Laboratory, Pauls Stradiņš Clinical University Hospital, LV-1002 Riga, Latvia; (I.J.); (T.O.); (J.M.); (D.S.)
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21
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Kaur N, Bains A, Kaushik R, Dhull SB, Melinda F, Chawla P. A Review on Antifungal Efficiency of Plant Extracts Entrenched Polysaccharide-Based Nanohydrogels. Nutrients 2021; 13:2055. [PMID: 34203999 PMCID: PMC8232670 DOI: 10.3390/nu13062055] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 02/08/2023] Open
Abstract
Human skin acts as a physical barrier; however, sometimes the skin gets infected by fungi, which becomes more severe if the infection occurs on the third layer of the skin. Azole derivative-based antifungal creams, liquids, or sprays are available to treat fungal infections; however, these formulations show various side effects on the application site. Over the past few years, herbal extracts and various essential oils have shown effective antifungal activity. Additionally, autoxidation and epimerization are significant problems with the direct use of herbal extracts. Hence, to overcome these obstacles, polysaccharide-based nanohydrogels embedded with natural plant extracts and oils have become the primary choice of pharmaceutical scientists. These gels protect plant-based bioactive compounds and are effective delivery agents because they release multiple bioactive compounds in the targeted area. Nanohydrogels can be applied to infected areas, and due to their contagious nature and penetration power, they get directly absorbed through the skin, quickly reaching the skin's third layer and effectively reducing the fungal infection. In this review, we explain various skin fungal infections, possible treatments, and the effective utilization of plant extract and oil-embedded polysaccharide-based nanohydrogels.
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Affiliation(s)
- Navkiranjeet Kaur
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara 144411, Punjab, India;
| | - Aarti Bains
- Department of Biotechnology, Chandigarh Group of Colleges Landran, Mohali 140307, Punjab, India;
| | - Ravinder Kaushik
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun 248007, Uttrakhand, India;
| | - Sanju B. Dhull
- Department of Food Science and Technology, Chaudhary Devi Lal University, Sirsa 125055, Haryana, India;
| | - Fogarasi Melinda
- Department of Food Engineering, University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Mănăstur 3–5, 400372 Cluj-Napoca, Romania
| | - Prince Chawla
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara 144411, Punjab, India;
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22
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Synthesis and antifungal activity of new hybrids thiazolo[4,5-d]pyrimidines with (1H-1,2,4)triazole. Bioorg Med Chem Lett 2021; 40:127944. [PMID: 33713781 DOI: 10.1016/j.bmcl.2021.127944] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022]
Abstract
Synthesis and antifungal activity of hybrids of thiazolo[4,5-d]pyrimidines with (1H-1,2,4)triazoles are presented. The solubility and lipophilicity of compounds was assessed and it was discovered that compounds with piperazine linker exhibited significant antifungal activity against filamentous and yeast fungi.
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23
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Demirci-Duarte S, Arikan-Akdagli S, Gülmez D. Species distribution, azole resistance and related molecular mechanisms in invasive Candida parapsilosis complex isolates: Increase in fluconazole resistance in 21 years. Mycoses 2021; 64:823-830. [PMID: 33934400 DOI: 10.1111/myc.13296] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Candida parapsilosis complex consists of three species, the prevalence and geographical distribution of which might vary. Increasing rates of fluconazole resistance among C. parapsilosis complex were reported from various centres. OBJECTIVES Aim of this study was to identify invasive C. parapsilosis complex strains up to species level, explore rates and molecular mechanisms of azole resistance and analyse temporal changes at a single centre. METHODS Isolates from blood cultures from 1997 to 2017 were included. Species were identified using RFLP of the SADH gene and confirmed with ITS sequencing when needed. In vitro susceptibility to fluconazole, voriconazole and posaconazole was tested and evaluated using EUCAST guidelines. Sequences of ERG11 and MRR1 genes were analysed for fluconazole non-susceptible isolates. RESULTS A total of 283 isolates from 181 patients were tested for azole susceptibility. All were C. parapsilosis sensu stricto, except one C. orthopsilosis. All three azoles were effective against 213 of the isolates from 135 patients, including one C. orthopsilosis. Fluconazole resistance was 13.3% (24/181 patients). While the first fluconazole-resistant isolates were detected in 2004, increase was evident after 2011. In ERG11, Y132F mutation was the most common among fluconazole non-susceptible isolates (71.7%), followed by G458S (10.9%) and D421N (4.3%). In MRR1, R405K (56.5%) and G927C (8.7%) were detected. However, association of these mutations to azole resistance is yet to be investigated. CONCLUSIONS Rising azole resistance rates in C. parapsilosis sensu stricto isolates particularly after 2011 were of concern. The well-known Y132F mutation was the predominant mechanism of azole resistance while accompanied with other genetic mutations.
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Affiliation(s)
- Selay Demirci-Duarte
- Medical Microbiology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevtap Arikan-Akdagli
- Medical Microbiology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dolunay Gülmez
- Medical Microbiology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Hind LE, Giese MA, Schoen TJ, Beebe DJ, Keller N, Huttenlocher A. Immune Cell Paracrine Signaling Drives the Neutrophil Response to A. fumigatus in an Infection-on-a-Chip Model. Cell Mol Bioeng 2021; 14:133-145. [PMID: 33868496 PMCID: PMC8010091 DOI: 10.1007/s12195-020-00655-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/24/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Neutrophils act as first responders during an infection, following signals from the pathogen as well as other host cells to migrate from blood vessels to the site of infection. This tightly regulated process is critical for pathogen clearance and, in many cases, eliminates the pathogen without the need for an additional immune response. It is, therefore, critical to understand what signals drive neutrophil migration to infection in a physiologically relevant environment. METHODS In this study, we used an infection-on-a-chip model to recapitulate many important aspects of the infectious microenvironment including an endothelial blood vessel, an extracellular matrix, and the environmental fungal pathogen Aspergillus fumigatus. We then used this model to visualize the innate immune response to fungal infection. RESULTS We found that A. fumigatus germination dynamics are influenced by the presence of an endothelial lumen. Furthermore, we demonstrated that neutrophils are recruited to and swarm around A. fumigatus hyphae and that the presence of monocytes significantly increases the neutrophil response to A. fumigatus. Using secreted protein analysis and blocking antibodies, we found that this increased migration is likely due to signaling by MIP-1 family proteins. Finally, we demonstrated that signal relay between neutrophils, mediated by LTB4 signaling, is also important for sustained neutrophil migration and swarming in response to A. fumigatus infection in our system. CONCLUSIONS Taken together, these results suggest that paracrine signaling from both monocytes and neutrophils plays an important role in driving the neutrophil response to A. fumigatus.
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Affiliation(s)
- Laurel E. Hind
- Department of Chemical and Biological Engineering, University of Colorado Boulder, Boulder, CO USA
| | - Morgan A. Giese
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI USA
| | - Taylor J. Schoen
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI USA
| | - David J. Beebe
- Department of Pathology, University of Wisconsin-Madison, Madison, WI USA
| | - Nancy Keller
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI USA
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI USA
| | - Anna Huttenlocher
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI USA
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Xu H, Yan ZZ, Guo MB, An R, Wang X, Zhang R, Mou YH, Hou Z, Guo C. Lead optimization generates selenium-containing miconazole CYP51 inhibitors with improved pharmacological profile for the treatment of fungal infections. Eur J Med Chem 2021; 216:113337. [PMID: 33713977 DOI: 10.1016/j.ejmech.2021.113337] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/19/2022]
Abstract
A series of selenium-containing miconazole derivatives were identified as potent antifungal drugs in our previous study. Representative compound A03 (MIC = 0.01 μg/mL against C.alb. 5314) proved efficacious in inhibiting the growth of fungal pathogens. However, further study showed lead compound A03 exhibited potential hemolysis, significant cytotoxic effect and unfavorable metabolic stability and was therefore modified to overcome these drawbacks. In this article, the further optimization of selenium-containing miconazole derivatives resulted in the discovery of similarly potent compound B17 (MIC = 0.02 μg/mL against C.alb. 5314), exhibiting a superior pharmacological profile with decreased rate of metabolism, cytotoxic effect and hemolysis. Furthermore, compound B17 showed fungicidal activity against Candida albicans and significant effects on the treatment of resistant Candida albicans infections. Meanwhile, compound B17 not only could reduce the ergosterol biosynthesis pathway by inhibiting CYP51, but also inhibited biofilm formation. More importantly, compound B17 also shows promising in vivo efficacy after intraperitoneal injection and the PK study of compound B17 was evaluated. In addition, molecular docking studies provide a model for the interaction between the compound B17 and the CYP51 protein. Overall, we believe that these selenium-containing miconazole compounds can be further developed for the potential treatment of fungal infections.
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Affiliation(s)
- Hang Xu
- Key Laboratory of Structure-Based Drugs Design and Discovery (Ministry of Education), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016 China
| | - Zhong-Zuo Yan
- Key Laboratory of Structure-Based Drugs Design and Discovery (Ministry of Education), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016 China
| | - Meng-Bi Guo
- Key Laboratory of Structure-Based Drugs Design and Discovery (Ministry of Education), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016 China
| | - Ran An
- Key Laboratory of Structure-Based Drugs Design and Discovery (Ministry of Education), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016 China
| | - Xin Wang
- Key Laboratory of Structure-Based Drugs Design and Discovery (Ministry of Education), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016 China
| | - Rui Zhang
- Key Laboratory of Structure-Based Drugs Design and Discovery (Ministry of Education), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016 China
| | - Yan-Hua Mou
- School of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Zhuang Hou
- Key Laboratory of Structure-Based Drugs Design and Discovery (Ministry of Education), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016 China.
| | - Chun Guo
- Key Laboratory of Structure-Based Drugs Design and Discovery (Ministry of Education), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang 110016 China.
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Branco J, Martins-Cruz C, Rodrigues L, Silva RM, Araújo-Gomes N, Gonçalves T, Miranda IM, Rodrigues AG. The transcription factor Ndt80 is a repressor of Candida parapsilosis virulence attributes. Virulence 2021; 12:601-614. [PMID: 33538224 PMCID: PMC7872087 DOI: 10.1080/21505594.2021.1878743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Candida parapsilosis is an emergent opportunistic yeast among hospital settings that affects mainly neonates and immunocompromised patients. Its most remarkable virulence traits are the ability to adhere to prosthetic materials, as well as the formation of biofilm on abiotic surfaces. The Ndt80 transcription factor was identified as one of the regulators of biofilm formation by C. parapsilosis; however, its function in this process was not yet clarified. By knocking out NDT80 (CPAR2-213640) gene, or even just one single copy of the gene, we observed substantial alterations of virulence attributes, including morphogenetic changes, adhesion and biofilm growth profiles. Both ndt80Δ and ndt80ΔΔ mutants changed colony and cell morphologies from smooth, yeast-shaped to crepe and pseudohyphal elongated forms, exhibiting promoted adherence to polystyrene microspheres and notably, forming a higher amount of biofilm compared to wild-type strain. Interestingly, we identified transcription factors Ume6, Cph2, Cwh41, Ace2, Bcr1, protein kinase Mkc1 and adhesin Als7 to be under Ndt80 negative regulation, partially explaining the phenotypes displayed by the ndt80ΔΔ mutant. Furthermore, ndt80ΔΔ pseudohyphae adhered more rapidly and were more resistant to murine macrophage attack, becoming deleterious to such cells after phagocytosis. Unexpectedly, our findings provide the first evidence for a direct role of Ndt80 as a repressor of C. parapsilosis virulence attributes. This finding shows that C. parapsilosis Ndt80 functionally diverges from its homolog in the close related fungal pathogen C. albicans.
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Affiliation(s)
- Joana Branco
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto , Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto , Porto, Portugal
| | - Cláudia Martins-Cruz
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto , Porto, Portugal
| | - Lisa Rodrigues
- CNC - Centre for Neuroscience and Cell Biology, University of Coimbra , Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra , Coimbra, Portugal
| | - Raquel M Silva
- Faculdade De Medicina Dentária, CIIS - Centro De Investigação Interdisciplinar Em Saúde, Universidade Católica Portuguesa , Viseu, Portugal
| | - Nuno Araújo-Gomes
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto , Porto, Portugal
| | - Teresa Gonçalves
- CNC - Centre for Neuroscience and Cell Biology, University of Coimbra , Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra , Coimbra, Portugal
| | - Isabel M Miranda
- Cardiovascular R&D Centre, Faculty of Medicine, University of Porto , Porto, Portugal
| | - Acácio G Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto , Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto , Porto, Portugal
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Investigating natural antibiofilm components: a new therapeutic perspective against candidal vulvovaginitis. Med Hypotheses 2021; 148:110515. [PMID: 33549963 DOI: 10.1016/j.mehy.2021.110515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 11/23/2022]
Abstract
The rampant emergence of Candida albicans in the vagina and its ability to thrive as a biofilm has outstood the prevalence of candidal vulvovaginitis (CVV), a gender-based fungal infection approximately affecting 75% of the global female population. The biofilm represents a multidimensional microbial population, which often dictates prominent caveats of CVV such as increased fungal virulence, drug resistance and infection relapse/recurrence. Additionally, the conjugated issues of the ineffectiveness of conventional antifungals (azoles), prolonged treatment durations, compromised patient compliance, economic and social burden, exacerbates CVV complications as well. Henceforth, the current hypothesis narrates an investigational proposal for exploration and combination of naturally derived antibiofilm components with luliconazole (imidazole antifungal agent) as a new therapeutic paradigm against CVV. The purported hypothesis unravels a synergistic approach for fabricating Nanostructured Lipid Carriers, NLCs loaded transvaginal gel with dual APIs of natural (antibiofilm) as well as the synthetic (antifungal) origin to target high therapeutic efficacy, delivery, retention, controlled release and bioadhesion in a vaginal milieu. The multipronged effect of antibiofilm and antifungal agents will expectably enhance drug susceptibility thus, maintaining Minimum Inhibitory Concentration (MIC) against cells of C. albicans and targeting its biofilm in planktonic, adherent, and sessile phases. The effective disruption of a biofilm could further lower infection resistance and recurrence as well. In conclusion, the purported hypothesis could speed up the emergence of novel drug combinations and accelerates new product development with solid, synergistic, and complementary activities against C. albicans and its biofilm, making it amenable for generating pre-clinical and clinical results therebycreating a suitableroadmap for commercialization.
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28
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Li Y, Dai M, Zhang Y, Lu L. The sterol C-14 reductase Erg24 is responsible for ergosterol biosynthesis and ion homeostasis in Aspergillus fumigatus. Appl Microbiol Biotechnol 2021; 105:1253-1268. [PMID: 33475797 DOI: 10.1007/s00253-021-11104-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Abstract
Ergosterol, a major lipid present in the fungal cell membrane, is considered as an effective antifungal drug target. A rational strategy for increasing drug reservoir relies on functionally validation of essential enzymes involved in fungal key biological pathway. Current knowledge regarding the essential genes in the ergosterol biosynthesis pathway is still limited in the opportunistic human pathogen Aspergillus fumigatus. In this study, we characterized two endoplasmic reticulum-localized sterol C-14 reductases encoded by both erg24A and erg24B homologs that are essential for the viability of A. fumigatus despite the fact that neither paralog is essential individually. Loss of one homolog of Erg24 impairs hyphal growth, conidiation, and virulence but has no effect on ergosterol biosynthesis. To investigate the functional significance of erg24, a conditional double mutant (Δerg24B niiA::erg24A) was constructed in the Δerg24B background. Strikingly, the conditional erg24 double mutant exhibited severe growth defects and accumulation of sterol intermediate. Moreover, the addition of metal ions and the overexpression of the corresponding ion transporters could rescue the growth defects of the erg24 double mutant in A. fumigatus, implying that the defective phenotype of the erg24 double mutant is tightly associated with dysregulation of ion homeostasis. Taken together, our results demonstrate the critical role of Erg24 in ergosterol biosynthesis and ion homeostasis in A. fumigatus, which may have important implications for antifungal discovery. KEY POINTS: • We characterized two endoplasmic reticulum-localized sterol C-14 reductases Erg24A and Erg24B in A. fumigatus. • Erg24A and Erg24B in combination, but not individually, are required for the viability of A. fumigatus. • Inactivation of Erg24 leads to the disruption of ion homeostasis and affects ergosterol biosynthesis.
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Affiliation(s)
- Yeqi Li
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Centre for Microbiology, College of Life Sciences, Nanjing Normal University, Nanjing, China
| | - Mengyao Dai
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Centre for Microbiology, College of Life Sciences, Nanjing Normal University, Nanjing, China
| | - Yuanwei Zhang
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Centre for Microbiology, College of Life Sciences, Nanjing Normal University, Nanjing, China.
| | - Ling Lu
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Centre for Microbiology, College of Life Sciences, Nanjing Normal University, Nanjing, China.
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29
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Ré ACS, Martins JF, Cunha-Filho M, Gelfuso GM, Aires CP, Gratieri T. New perspectives on the topical management of recurrent candidiasis. Drug Deliv Transl Res 2021; 11:1568-1585. [PMID: 33469892 DOI: 10.1007/s13346-021-00901-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 12/24/2022]
Abstract
Candidiasis is a common opportunistic infection caused by fungi of the Candida genus that affects mainly mucocutaneous tissues (e.g., vaginal, oral, and mammary). This condition has been known for a long time; thus, innumerous topical and systemic treatments are already available on the market worldwide. Yet, recurrent superficial candidiasis (RSC) is an expected outcome, still lacking effective and convenient treatments. Although several individual conditions may contribute to disease recurrence, biofilms' presence seems to be the main etiological factor contributing to antifungal resistance. More than proposing novel antifungal agents, current research seems to be focusing on improving the pharmaceutical technology aspects of formulations to address such a challenge. These include extending and improving intimate contact of drug delivery systems with the mucocutaneous tissues, increasing drug loading dose, and enhancing topical drug permeation. This review discusses the current understanding of the RSC and the use of pharmaceutical technology tools in obtaining better results. Even though several drawbacks of conventional formulations have been circumvented with the help of nano- or microencapsulation techniques and with the use of mucoadhesive formulation excipients, many challenges remain. In particular, the need to mask the unpalatable taste of formulations for the treatment of oral candidiasis, and the necessity of formulations with a "dryer" sensorial feeling and improved performances in providing higher bioavailability for the treatment of mammary and vaginal candidiasis.
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Affiliation(s)
- Ana Carolina S Ré
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, 14040-903, Brazil
| | - Jayanaraian F Martins
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Marcílio Cunha-Filho
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Guilherme M Gelfuso
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Carolina P Aires
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, 14040-903, Brazil
| | - Taís Gratieri
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil. .,Campus Universitário Darcy Ribeiro, Asa Norte, Brasilia, DF, 70910-900, Brazil.
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Nguyen S, Truong JQ, Bruning JB. Targeting Unconventional Pathways in Pursuit of Novel Antifungals. Front Mol Biosci 2021; 7:621366. [PMID: 33511160 PMCID: PMC7835888 DOI: 10.3389/fmolb.2020.621366] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/11/2020] [Indexed: 01/31/2023] Open
Abstract
The impact of invasive fungal infections on human health is a serious, but largely overlooked, public health issue. Commonly affecting the immunocompromised community, fungal infections are predominantly caused by species of Candida, Cryptococcus, and Aspergillus. Treatments are reliant on the aggressive use of pre-existing antifungal drug classes that target the fungal cell wall and membrane. Despite their frequent use, these drugs are subject to unfavorable drug-drug interactions, can cause undesirable side-effects and have compromised efficacy due to the emergence of antifungal resistance. Hence, there is a clear need to develop novel classes of antifungal drugs. A promising approach involves exploiting the metabolic needs of fungi by targeted interruption of essential metabolic pathways. This review highlights potential antifungal targets including enolase, a component of the enolase-plasminogen complex, and enzymes from the mannitol biosynthesis and purine nucleotide biosynthesis pathways. There has been increased interest in the enzymes that comprise these particular pathways and further investigation into their merits as antifungal targets and roles in fungal survival and virulence are warranted. Disruption of these vital processes by targeting unconventional pathways with small molecules or antibodies may serve as a promising approach to discovering novel classes of antifungals.
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Affiliation(s)
- Stephanie Nguyen
- Institute of Photonics and Advanced Sensing (IPAS), School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jia Q Truong
- School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - John B Bruning
- Institute of Photonics and Advanced Sensing (IPAS), School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
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31
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Li Z, Tu J, Han G, Liu N, Sheng C. Novel Carboline Fungal Histone Deacetylase (HDAC) Inhibitors for Combinational Treatment of Azole-Resistant Candidiasis. J Med Chem 2020; 64:1116-1126. [PMID: 33356256 DOI: 10.1021/acs.jmedchem.0c01763] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Due to the evolution and development of antifungal drug resistance, limited efficacy of existing drugs has led to high mortality in patients with serious fungal infections. To develop novel antifungal therapeutic strategies, herein a series of carboline fungal histone deacetylase (HDAC) inhibitors were designed and synthesized, which had potent synergistic effects with fluconazole against resistant Candida albicans infection. In particular, compound D12 showed excellent in vitro and in vivo synergistic antifungal efficacy with fluconazole to treat azole-resistant candidiasis. It cooperated with fluconazole in reducing the virulence of C. albicans by blocking morphological mutual transformation and inhibiting biofilm formation. Mechanism studies revealed that the reversion of drug resistance was due to downregulation of the expression of the azole target gene ERG11 and efflux gene CDR1. Taken together, fungal HDAC inhibitor D12 offered a promising lead compound for combinational treatment of azole-resistant candidiasis.
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Affiliation(s)
- Zhuang Li
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, Shanghai 200433, China
| | - Jie Tu
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, Shanghai 200433, China
| | - Guiyan Han
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, Shanghai 200433, China
| | - Na Liu
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, Shanghai 200433, China
| | - Chunquan Sheng
- Department of Medicinal Chemistry, School of Pharmacy, Second Military Medical University, Shanghai 200433, China.,School of Medicine, Tongji University, Shanghai 200072, China
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Aspergillosis, Avian Species and the One Health Perspective: The Possible Importance of Birds in Azole Resistance. Microorganisms 2020; 8:microorganisms8122037. [PMID: 33352774 PMCID: PMC7767009 DOI: 10.3390/microorganisms8122037] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 12/30/2022] Open
Abstract
The One Health context considers health based on three pillars: humans, animals, and environment. This approach is a strong ally in the surveillance of infectious diseases and in the development of prevention strategies. Aspergillus spp. are fungi that fit substantially in this context, in view of their ubiquity, as well as their importance as plant pathogens, and potentially fatal pathogens for, particularly, humans and avian species. In addition, the emergence of azole resistance, mainly in Aspergillus fumigatus sensu stricto, and the proven role of fungicides widely used on crops, reinforces the need for a multidisciplinary approach to this problem. Avian species are involved in short and long distance travel between different types of landscapes, such as agricultural fields, natural environments and urban environments. Thus, birds can play an important role in the dispersion of Aspergillus, and of special concern, azole-resistant strains. In addition, some bird species are particularly susceptible to aspergillosis. Therefore, avian aspergillosis could be considered as an environmental health indicator. In this review, aspergillosis in humans and birds will be discussed, with focus on the presence of Aspergillus in the environment. We will relate these issues with the emergence of azole resistance on Aspergillus. These topics will be therefore considered and reviewed from the “One Health” perspective.
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Arastehfar A, Gabaldón T, Garcia-Rubio R, Jenks JD, Hoenigl M, Salzer HJF, Ilkit M, Lass-Flörl C, Perlin DS. Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium. Antibiotics (Basel) 2020; 9:antibiotics9120877. [PMID: 33302565 PMCID: PMC7764418 DOI: 10.3390/antibiotics9120877] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
The high clinical mortality and economic burden posed by invasive fungal infections (IFIs), along with significant agricultural crop loss caused by various fungal species, has resulted in the widespread use of antifungal agents. Selective drug pressure, fungal attributes, and host- and drug-related factors have counteracted the efficacy of the limited systemic antifungal drugs and changed the epidemiological landscape of IFIs. Species belonging to Candida, Aspergillus, Cryptococcus, and Pneumocystis are among the fungal pathogens showing notable rates of antifungal resistance. Drug-resistant fungi from the environment are increasingly identified in clinical settings. Furthermore, we have a limited understanding of drug class-specific resistance mechanisms in emerging Candida species. The establishment of antifungal stewardship programs in both clinical and agricultural fields and the inclusion of species identification, antifungal susceptibility testing, and therapeutic drug monitoring practices in the clinic can minimize the emergence of drug-resistant fungi. New antifungal drugs featuring promising therapeutic profiles have great promise to treat drug-resistant fungi in the clinical setting. Mitigating antifungal tolerance, a prelude to the emergence of resistance, also requires the development of effective and fungal-specific adjuvants to be used in combination with systemic antifungals.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
| | - Toni Gabaldón
- Life Sciences Programme, Supercomputing Center (BSC-CNS), Jordi Girona, 08034 Barcelona, Spain;
- Mechanisms of Disease Programme, Institute for Research in Biomedicine (IRB), 08024 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies. Pg. Lluís Companys 23, 08010 Barcelona, Spain
| | - Rocio Garcia-Rubio
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
| | - Jeffrey D. Jenks
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA;
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA;
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Martin Hoenigl
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA;
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | | | - Macit Ilkit
- Division of Mycology, University of Çukurova, 01330 Adana, Turkey
- Correspondence: (M.I.); (D.S.P.); Tel.: +90-532-286-0099 (M.I.); +1-201-880-3100 (D.S.P.)
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - David S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
- Correspondence: (M.I.); (D.S.P.); Tel.: +90-532-286-0099 (M.I.); +1-201-880-3100 (D.S.P.)
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Víglaš J, Olejníková P. Signalling mechanisms involved in stress response to antifungal drugs. Res Microbiol 2020; 172:103786. [PMID: 33038529 DOI: 10.1016/j.resmic.2020.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 01/28/2023]
Abstract
The emergence of antifungal resistance is a serious threat in the treatment of mycoses. The primary susceptible fungal cells may evolve a resistance after longer exposure to antifungal agents. The exposure itself causes stress condition, to which the fungus needs to adapt. This review provides detailed description of evolutionary conserved molecular mechanisms contributing to the adaptation response to stress caused by antifungal agents as well as their interconnection. The knowledge may help us to find new ways to delay the emergence of drug resistance as the same mechanisms are used regardless of what antifungal compound causes stress.
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Affiliation(s)
- Ján Víglaš
- Institute of Biochemistry and Microbiology, Faculty of Chemical and Food Technology, Slovak University of Technology in Bratislava, Radlinského 9, 81237, Bratislava, Slovakia.
| | - Petra Olejníková
- Institute of Biochemistry and Microbiology, Faculty of Chemical and Food Technology, Slovak University of Technology in Bratislava, Radlinského 9, 81237, Bratislava, Slovakia.
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Saxon Lead Author GDGC, Edwards A, Rautemaa-Richardson R, Owen C, Nathan B, Palmer B, Wood C, Ahmed H, Ahmad Patient Representatives S, FitzGerald Ceg Editor M. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019). Int J STD AIDS 2020; 31:1124-1144. [PMID: 32883171 DOI: 10.1177/0956462420943034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Guideline Development Group Cara Saxon Lead Author
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Anne Edwards
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Riina Rautemaa-Richardson
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Caroline Owen
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Bavithra Nathan
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Bret Palmer
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Clare Wood
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Humera Ahmed
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Sameena Ahmad Patient Representatives
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Mark FitzGerald Ceg Editor
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
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36
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Heaney H, Laing J, Paterson L, Walker AW, Gow NAR, Johnson EM, MacCallum DM, Brown AJP. The environmental stress sensitivities of pathogenic Candida species, including Candida auris, and implications for their spread in the hospital setting. Med Mycol 2020; 58:744-755. [PMID: 31912151 PMCID: PMC7398771 DOI: 10.1093/mmy/myz127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022] Open
Abstract
Candida auris is an emerging pathogenic yeast of significant clinical concern because of its frequent intrinsic resistance to fluconazole and often other antifungal drugs and the high mortality rates associated with systemic infections. Furthermore, C. auris has a propensity for persistence and transmission in health care environments. The reasons for this efficient transmission are not well understood, and therefore we tested whether enhanced resistance to environmental stresses might contribute to the ability of C. auris to spread in health care environments. We compared C. auris to other pathogenic Candida species with respect to their resistance to individual stresses and combinations of stresses. Stress resistance was examined using in vitro assays on laboratory media and also on hospital linen. In general, the 17 C. auris isolates examined displayed similar degrees of resistance to oxidative, nitrosative, cationic and cell wall stresses as clinical isolates of C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. krusei, C. guilliermondii, C. lusitaniae and C. kefyr. All of the C. auris isolates examined were more sensitive to low pH (pH 2, but not pH 4) compared to C. albicans, but were more resistant to high pH (pH 13). C. auris was also sensitive to low pH, when tested on contaminated hospital linen. Most C. auris isolates were relatively thermotolerant, displaying significant growth at 47°C. Furthermore, C. auris was relatively resistant to certain combinations of combinatorial stress (e.g., pH 13 plus 47°C). Significantly, C. auris was sensitive to the stress combinations imposed by hospital laundering protocol (pH > 12 plus heat shock at >80°C), suggesting that current laundering procedures are sufficient to limit the transmission of this fungal pathogen via hospital linen.
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Affiliation(s)
- Helen Heaney
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Juliette Laing
- NHS Grampian Central Decontamination Unit, Foresterhill Health Campus, Aberdeen, UK
| | - Linda Paterson
- NHS Grampian Central Decontamination Unit, Foresterhill Health Campus, Aberdeen, UK
| | - Alan W Walker
- Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Neil A R Gow
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- MRC Centre for Medical Mycology, University of Exeter, School of Biosciences, Exeter, UK
| | - Elizabeth M Johnson
- Mycology Reference Laboratory, PHE South West Laboratory, Southmead Hospital, Bristol, UK
| | - Donna M MacCallum
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Alistair J P Brown
- Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
- MRC Centre for Medical Mycology, University of Exeter, School of Biosciences, Exeter, UK
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37
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Zare-Khafri M, Alizadeh F, Nouripour-Sisakht S, Khodavandi A, Gerami M. Inhibitory effect of magnetic iron-oxide nanoparticles on the pattern of expression of lanosterol 14 α-demethylase ( ERG11) in fluconazole-resistant colonising isolate of Candida albicans. IET Nanobiotechnol 2020; 14:375-381. [PMID: 32691739 DOI: 10.1049/iet-nbt.2019.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fluconazole-resistant Candida albicans is a big scary reality. The authors assessed the antifungal effects of magnetic iron-oxide nanoparticles on fluconazole-resistant colonising isolate of C. albicans and determined the expression of ERG11 gene, protein sequence similarity and ergosterol content. C. albicans isolates were characterised and fluconazole resistance is recognised using World Health Organization's WHONET software. Susceptibility testing of magnetic iron-oxide nanoparticles against fluconazole-resistant colonising isolate of C. albicans was performed according to Clinical and Laboratory Standards Institute guidelines. The expression patterns of ERG11 and protein sequence similarity were investigated. Ergosterol quantification has been used to gauge the antifungal activity of magnetic iron-oxide nanoparticles. The findings indicated that 93% of C. albicans isolates were resistant to fluconazole. Magnetic iron-oxide nanoparticles were presented activity against fluconazole-resistant colonising isolate of C. albicans with minimum inhibitory concentration at 250-500 µg/ml. The expression level of ERG11 gene was downregulated in fluconazole-resistant colonising isolate of C. albicans. The results revealed no differences in fluconazole-resistant colonising isolate of C. albicans by comparison with ERG11 reference sequences. Moreover, significant reduction was noted in ergosterol content. The findings shed a novel light on the application of magnetic iron-oxide nanoparticles in fighting against resistant C. albicans.
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Affiliation(s)
- Mohammad Zare-Khafri
- Department of Microbiology, Yasooj Branch, Islamic Azad University, Yasooj, Iran
| | - Fahimeh Alizadeh
- Department of Microbiology, Yasooj Branch, Islamic Azad University, Yasooj, Iran
| | | | - Alireza Khodavandi
- Department of Biology, Gachsaran Branch, Islamic Azad University, Gachsaran, Iran.
| | - Majid Gerami
- Education Research Centre, Yasuj University, Yasuj, Iran
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Lemos ASO, Florêncio JR, Pinto NCC, Campos LM, Silva TP, Grazul RM, Pinto PF, Tavares GD, Scio E, Apolônio ACM, Melo RCN, Fabri RL. Antifungal Activity of the Natural Coumarin Scopoletin Against Planktonic Cells and Biofilms From a Multidrug-Resistant Candida tropicalis Strain. Front Microbiol 2020; 11:1525. [PMID: 32733416 PMCID: PMC7359730 DOI: 10.3389/fmicb.2020.01525] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022] Open
Abstract
Candida tropicalis is one the most relevant biofilm-forming fungal species increasingly associated with invasive mucosal candidiasis worldwide. The amplified antifungal resistance supports the necessity for more effective and less toxic treatment, including the use of plant-derived natural products. Scopoletin, a natural coumarin, has shown antifungal properties against plant yeast pathogens. However, the antifungal activity of this coumarin against clinically relevant fungal species such as C. tropicalis remains to be established. Here, we investigated the potential antifungal properties and mechanisms of action of scopoletin against a multidrug-resistant C. tropicalis strain (ATCC 28707). First, scopoletin was isolated by high-performance liquid chromatography from Mitracarpus frigidus, a plant species (family Rubiaceae) distributed throughout South America. Next, scopoletin was tested on C. tropicalis cultivated for 48h in both planktonic and biofilm forms. Fungal planktonic growth inhibition was analyzed by evaluating minimal inhibitory concentration (MIC), time-kill kinetics and cell density whereas the mechanisms of action were investigated with nucleotide leakage, efflux pumps and sorbitol and ergosterol bioassays. Finally, the scopoletin ability to affect C. tropicalis biofilms was evaluated through spectrophotometric and whole slide imaging approaches. In all procedures, fluconazole was used as a positive control. MIC values for scopoletin and fluconazole were 50 and 250 μg/L respectively, thus demonstrating a fungistatic activity for scopoletin. Scopoletin induced a significant decrease of C. tropicalis growth curves and cell density (91.7% reduction) compared to the growth control. Its action was related to the fungal cell wall, affecting plasma membrane sterols. When associated with fluconazole, scopoletin led to inhibition of efflux pumps at the plasma membrane. Moreover, scopoletin not only inhibited the growth rate of preformed biofilms (68.2% inhibition at MIC value) but also significantly decreased the extent of biofilms growing on the surface of coverslips, preventing the formation of elongated fungal forms. Our data demonstrate, for the first time, that scopoletin act as an effective antifungal phytocompound against a multidrug-resistant strain of C. tropicalis with properties that affect both planktonic and biofilm forms of this pathogen. Thus, the present findings support additional studies for antifungal drug development based on plant isolated-scopoletin to treat candidiasis caused by C. tropicalis.
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Affiliation(s)
- Ari S O Lemos
- Bioactive Natural Products Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Jônatas R Florêncio
- Bioactive Natural Products Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Nícolas C C Pinto
- Bioactive Natural Products Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Lara M Campos
- Bioactive Natural Products Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Thiago P Silva
- Laboratory of Cellular Biology, Department of Biology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Richard M Grazul
- Department of Chemistry, Institute of Exact Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Priscila F Pinto
- Protein Structure and Function Study Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Guilherme D Tavares
- Laboratory of Nanostructured Systems Development, Department of Pharmacy, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Elita Scio
- Bioactive Natural Products Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Ana Carolina M Apolônio
- Department of Parasitology, Microbiology, and Imunology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Rossana C N Melo
- Laboratory of Cellular Biology, Department of Biology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Rodrigo L Fabri
- Bioactive Natural Products Laboratory, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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39
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Xu H, Su X, Guo MB, An R, Mou YH, Hou Z, Guo C. Design, synthesis, and biological evaluation of novel miconazole analogues containing selenium as potent antifungal agents. Eur J Med Chem 2020; 198:112360. [DOI: 10.1016/j.ejmech.2020.112360] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
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40
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Dockrell DH, O’Shea D, Cartledge JD, Freedman AR. British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of Candidiasis 2019. HIV Med 2020; 20 Suppl 8:2-24. [PMID: 31670458 DOI: 10.1111/hiv.12806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- D H Dockrell
- University of Edinburgh, Edinburgh, UK and Regional Infectious Diseases Unit, NHS Lothian Infection Service, Edinburgh, UK
| | - D O’Shea
- University of Edinburgh, Edinburgh, UK and Regional Infectious Diseases Unit, NHS Lothian Infection Service, Edinburgh, UK
| | | | - A R Freedman
- Cardiff University School of Medicine, Cardiff, UK
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41
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Novak AR, Bradley ME, Kiser TH, Mueller SW. Azole-resistant Aspergillus and Echinocandin-resistant Candida - What are the treatment options? CURRENT FUNGAL INFECTION REPORTS 2020; 14:141-152. [PMID: 32699568 DOI: 10.1007/s12281-020-00379-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose of Review This review summarizes current treatment options for echinocandin-resistant Candida spp. (ERC) and azole-resistant Aspergillus fumigatus (ARAF), emphasizing recent in vitro/in vivo data, clinical reports, and consensus statements. Recent Findings Advances in ERC and ARAF treatment are limited to specific antifungal combinations and dose optimization but remain reliant on amphotericin products. Although novel antifungals may provide breakthroughs in the treatment of resistant fungi, these agents are not yet available. Early identification and appropriate treatment remain a paramount, albeit elusive, task. Summary When either ERC or ARAF are suspected or proven, amphotericin products remain the cornerstone of initial therapy. For ERC, azoles are de-escalation options for susceptible isolates in stable patients to avoid amphotericin toxicities. Although combination echinocandin with high-dose salvage posaconazole or isavuconazole may be attempted in ARAF, it requires careful consideration following patient stabilization. Future research defining optimal therapies and early identification of ERC and ARAF is of extreme importance.
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Affiliation(s)
- Alison R Novak
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Mary E Bradley
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Tyree H Kiser
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Scott W Mueller
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
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Abstract
PURPOSE OF REVIEW The successful treatment of surgical fungal infections depends of a timely and adequate source control alongside with the use of prompt systemic antifungals. The main challenge of antifungal use in critically ill surgical patients is to find a balance between rational versus indiscriminate use in order to accomplish an antifungal stewardship program. RECENT FINDINGS Surgical fungal infections represent an important burden in the daily clinical activity in many ICUs. The efficacy of the available antifungal drugs has not been adequately assessed in randomized controlled trials with surgical fungal infections in ICU patients. Most clinical experience is limited to case reports or uncontrolled case series. Due to the lack of adequate scientific evidence to assess the role of the different antifungals in surgical ICU patients, it is usually suggested to follow the recommendations for invasive candidiasis and candidemia. SUMMARY Antifungal use in the surgical patients admitted to an ICU is a complex matter and there are several elements to consider like the presence of septic shock and multiorgan failure, local epidemiology and antifungal resistance, among others. The proper use of antifungals alongside early recognition and prompt source control, are critical factors for improved outcomes.
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Siopi M, Tarpatzi A, Kalogeropoulou E, Damianidou S, Vasilakopoulou A, Vourli S, Pournaras S, Meletiadis J. Epidemiological Trends of Fungemia in Greece with a Focus on Candidemia during the Recent Financial Crisis: a 10-Year Survey in a Tertiary Care Academic Hospital and Review of Literature. Antimicrob Agents Chemother 2020; 64:e01516-19. [PMID: 31871083 PMCID: PMC7038287 DOI: 10.1128/aac.01516-19] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/15/2019] [Indexed: 01/05/2023] Open
Abstract
Updated information on the epidemiology of candidemia, particularly during severe socioeconomic events, is important for proper management of these infections. A systematic literature review on candidemia in Greece and a retrospective surveillance study were conducted in a tertiary university hospital during the years of the recent financial crisis (2009 to 2018) in order to assess changes in incidence rates, patient characteristics, species distribution, antifungal susceptibilities, and drug consumption. The average annual incidence of 429 candidemic episodes was 2.03/10,000 bed days, with 9.88 in adult intensive care units (ICUs), 1.74 in surgical wards, and 1.81 in internal medicine wards, where a significant increase was observed (1.15, 1.85, and 2.23/10,000 bed days in 2009 to 2011, 2012 to 2014, and 2015 to 2018, respectively; P = 0.004). Candida albicans was the most common species (41%), followed by Candida parapsilosis species complex [SC] (37%), Candida glabrata SC (11%), Candida tropicalis (7%), Candida krusei (1%), and other rare Candida spp. (3%). Mixed infections were found in 20/429 (4.7%) cases, while 33 (7%) cases were due to non-Candida spp. Overall, 44/311 (14%) isolates were resistant/non-wild type (WT) to the nine antifungals tested, with 23/113 (20%) C. parapsilosis SC and 2/34 (6%) C. glabrata SC isolates being resistant to fluconazole (1 panechinocandin and 2 panazole resistant). All isolates were susceptible/WT to amphotericin B and flucytosine. While the overall consumption of antifungals diminished (P = 0.02), with a mean of 17.93 defined daily doses (DDD)/100 bed days, increased micafungin use was correlated with the rise in C. parapsilosis SC (P = 0.04). A significant increase of candidemia in internal medicine wards and of C. parapsilosis SC infections was found during the years of financial crisis. Although resistance rates remain low (<14%), fluconazole-resistant C. parapsilosis SC and multidrug-resistant C. glabrata SC isolates are of major concern.
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Affiliation(s)
- Maria Siopi
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Tarpatzi
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Kalogeropoulou
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Damianidou
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Vasilakopoulou
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Vourli
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyros Pournaras
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Koutsoumanis K, Allende A, Alvarez‐Ordóñez A, Bolton D, Bover‐Cid S, Chemaly M, Davies R, De Cesare A, Hilbert F, Lindqvist R, Nauta M, Peixe L, Ru G, Simmons M, Skandamis P, Suffredini E, Cocconcelli PS, Fernández Escámez PS, Maradona MP, Querol A, Suarez JE, Sundh I, Vlak J, Barizzone F, Correia S, Herman L. Scientific Opinion on the update of the list of QPS-recommended biological agents intentionally added to food or feed as notified to EFSA (2017-2019). EFSA J 2020; 18:e05966. [PMID: 32874212 PMCID: PMC7448045 DOI: 10.2903/j.efsa.2020.5966] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The qualified presumption of safety (QPS) was developed to provide a safety pre-assessment within EFSA for microorganisms. Strains belonging to QPS taxonomic units (TUs) still require an assessment based on a specific data package, but QPS status facilitates fast track evaluation. QPS TUs are unambiguously defined biological agents assessed for the body of knowledge, their safety and their end use. Safety concerns are, where possible, to be confirmed at strain or product level, and reflected as 'qualifications'. Qualifications need to be evaluated at strain level by the respective EFSA units. The lowest QPS TU is the species level for bacteria, yeasts and protists/algae, and the family for viruses. The QPS concept is also applicable to genetically modified microorganisms used for production purposes if the recipient strain qualifies for the QPS status, and if the genetic modification does not indicate a concern. Based on the actual body of knowledge and/or an ambiguous taxonomic position, the following TUs were excluded from the QPS assessment: filamentous fungi, oomycetes, streptomycetes, Enterococcus faecium, Escherichia coli and bacteriophages. The list of QPS-recommended biological agents was reviewed and updated in the current opinion and therefore now becomes the valid list. For this update, reports on the safety of previously assessed microorganisms, including bacteria, yeasts and viruses (the latter only when used for plant protection purposes) were reviewed, following an Extensive Literature Search strategy. All TUs previously recommended for 2016 QPS list had their status reconfirmed as well as their qualifications. The TUs related to the new notifications received since the 2016 QPS opinion was periodically evaluated for QPS status in the Statements of the BIOHAZ Panel, and the QPS list was also periodically updated. In total, 14 new TUs received a QPS status between 2017 and 2019: three yeasts, eight bacteria and three algae/protists.
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Efficacy of Voriconazole against Aspergillus fumigatus Infection Depends on Host Immune Function. Antimicrob Agents Chemother 2020; 64:AAC.00917-19. [PMID: 31740552 DOI: 10.1128/aac.00917-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/10/2019] [Indexed: 12/17/2022] Open
Abstract
Antifungal therapy can fail in a remarkable number of patients with invasive fungal disease, resulting in significant morbidity worldwide. A major contributor to this failure is that while these drugs have high potency in vitro, we do not fully understand how they work inside infected hosts. Here, we used a transparent larval zebrafish model of Aspergillus fumigatus infection amenable to real-time imaging of invasive disease as an in vivo intermediate vertebrate model to investigate the efficacy and mechanism of the antifungal drug voriconazole. We found that the ability of voriconazole to protect against A. fumigatus infection depends on host innate immune cells and, specifically, on the presence of macrophages. While voriconazole inhibits fungal spore germination and growth in vitro, it does not do so in larval zebrafish. Instead, live imaging of whole, intact larvae over a multiday course of infection revealed that macrophages slow down initial fungal growth, allowing voriconazole time to target and kill A. fumigatus hyphae postgermination. These findings shed light on how antifungal drugs such as voriconazole may synergize with the immune response in living hosts.
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46
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Azole resistance mechanisms in Aspergillus: update and recent advances. Int J Antimicrob Agents 2020; 55:105807. [DOI: 10.1016/j.ijantimicag.2019.09.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/05/2019] [Accepted: 09/15/2019] [Indexed: 12/11/2022]
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47
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In vitro Resistance Pattern of Selected Antifungal Azoles against Candida albicans Biofilms on Silicone Nasogastric Tube. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2019. [DOI: 10.22207/jpam.13.4.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Mitochondrial dysfunctions trigger the calcium signaling-dependent fungal multidrug resistance. Proc Natl Acad Sci U S A 2019; 117:1711-1721. [PMID: 31811023 DOI: 10.1073/pnas.1911560116] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Drug resistance in fungal pathogens has risen steadily over the past decades due to long-term azole therapy or triazole usage in agriculture. Modification of the drug target protein to prevent drug binding is a major recognized route to induce drug resistance. However, mechanisms for nondrug target-induced resistance remain only loosely defined. Here, we explore the molecular mechanisms of multidrug resistance resulted from an efficient adaptation strategy for survival in drug environments in the human pathogen Aspergillus fumigatus We show that mutants conferring multidrug resistance are linked with mitochondrial dysfunction induced by defects in heme A biosynthesis. Comparison of the gene expression profiles between the drug-resistant mutants and the parental wild-type strain shows that multidrug-resistant transporters, chitin synthases, and calcium-signaling-related genes are significantly up-regulated, while scavenging mitochondrial reactive oxygen species (ROS)-related genes are significantly down-regulated. The up-regulated-expression genes share consensus calcium-dependent serine threonine phosphatase-dependent response elements (the binding sites of calcium-signaling transcription factor CrzA). Accordingly, drug-resistant mutants show enhanced cytosolic Ca2+ transients and persistent nuclear localization of CrzA. In comparison, calcium chelators significantly restore drug susceptibility and increase azole efficacy either in laboratory-derived or in clinic-isolated A. fumigatus strains. Thus, the mitochondrial dysfunction as a fitness cost can trigger calcium signaling and, therefore, globally up-regulate a series of embedding calcineurin-dependent-response-element genes, leading to antifungal resistance. These findings illuminate how fitness cost affects drug resistance and suggest that disruption of calcium signaling might be a promising therapeutic strategy to fight against nondrug target-induced drug resistance.
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Xu H, Yu SY, Zhou ML, Ning YT, Xiao M, Li XG, Chen M, Kong F, Chen S, Ming L, Xu YC. Epidemiology And Antifungal Susceptibility Patterns Of Invasive Fungal Infections From 2012 To 2014 In A Teaching Hospital In Central China. Infect Drug Resist 2019; 12:3641-3651. [PMID: 31819547 PMCID: PMC6878932 DOI: 10.2147/idr.s227839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction As participants of the national China Hospital Invasive Fungal Surveillance Net program, we sought to describe the epidemiology and antifungal susceptibility patterns of yeast isolates obtained from patients with invasive fungal infection at the First Affiliated Hospital of Zhengzhou University, China. Methods A total of 434 yeast isolates recovered from blood and other sterile body fluids were identified to species by matrix-assisted laser desorption ionization –time of flight mass spectrometry with or without supplementation by DNA sequencing. Antifungal susceptibilities were determined by Sensititre YeastOneTM YO10 methodology. Results Candida albicans was the most common causative species (33.9% of isolates) but significantly decreased in frequency from 37.2% to 27.7% from 2012 to 2014. C. tropicalis was the next most common pathogen (25.1%), followed by C. parapsilosis complex (17.3%), C. glabrata (9%), and C. pelliculosa (6.7%), with other species comprising 8% of isolates. Caspofungin, micafungin, and anidulafungin exhibited potent in vitro activities against the majority of Candida isolates. Azoles demonstrated in vitro activities against C. albicans with a susceptibility rate of >95% and against C. parapsilosis complex, >95% isolates were susceptible. Among C. tropicalis and C. glabrata isolates, resistance rates to fluconazole and voriconazole were 11.9%, 9.1% and 7.7%, 28.2%, respectively. Of note, C. pelliculosa had a high incidence rate in newborns and high rates of resistance to fluconazole and voriconazole of 55.2% and 41.4%, respectively. Conclusion The present study provided valuable local surveillance data on the epidemiology and antifungal susceptibilities of invasive yeast species, which is essential for guiding antifungal treatment protocol development.
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Affiliation(s)
- Hui Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University and Key Laboratory of Clinical Laboratory of Henan Province, Henan 450003, People's Republic of China
| | - Shu-Ying Yu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Meng-Lan Zhou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Ya-Ting Ning
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Meng Xiao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing, People's Republic of China
| | - Xiao-Gai Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University and Key Laboratory of Clinical Laboratory of Henan Province, Henan 450003, People's Republic of China
| | - Meng Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Department of Clinical Laboratory, Beijing Pinggu Hospital of Traditional Chinese Medicine, Beijing 101200, People's Republic of China
| | - Fanrong Kong
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - New South Wales Health Pathology, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - New South Wales Health Pathology, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Liang Ming
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University and Key Laboratory of Clinical Laboratory of Henan Province, Henan 450003, People's Republic of China
| | - Ying-Chun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China
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John J, Loo A, Mazur S, Walsh TJ. Therapeutic drug monitoring of systemic antifungal agents: a pragmatic approach for adult and pediatric patients. Expert Opin Drug Metab Toxicol 2019; 15:881-895. [PMID: 31550939 DOI: 10.1080/17425255.2019.1671971] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Therapeutic drug monitoring (TDM) has been shown to optimize the management of invasive fungal infections (IFIs), particularly for select antifungal agents with a well-defined exposure-response relationship and an unpredictable pharmacokinetic profile or a narrow therapeutic index. Select triazoles (itraconazole, voriconazole, and posaconazole) and flucytosine fulfill these criteria, while the echinocandins, fluconazole, isavuconazole, and amphotericin B generally do not do so. Given the morbidity and mortality associated with IFIs and the challenges surrounding the use of currently available antifungal agents, TDM plays an important role in therapy.Areas covered: This review seeks to describe the rationale for TDM of antifungal agents, summarize their pharmacokinetic and pharmacodynamic properties, identify treatment goals for efficacy and safety, and provide recommendations for optimal dosing and therapeutic monitoring strategies.Expert opinion: Several new antifungal agents are currently in development, including compounds from existing antifungal classes with enhanced pharmacokinetic or safety profiles as well as agents with novel targets for the treatment of IFIs. Given the predictable pharmacokinetics of these newly developed agents, use of routine TDM is not anticipated. However, expanded knowledge of exposure-response relationships of these compounds may yield a role for TDM to improve outcomes for adult and pediatric patients.
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Affiliation(s)
- Jamie John
- Department of Pharmacy, New York-Presbyterian Hospital, New York, NY, USA
| | - Angela Loo
- Department of Pharmacy, New York-Presbyterian Hospital, New York, NY, USA
| | - Shawn Mazur
- Department of Pharmacy, New York-Presbyterian Hospital, New York, NY, USA
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
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