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Gómez-Gaviria M, Martínez-Duncker I, García-Carnero LC, Mora-Montes HM. Differential Recognition of Sporothrix schenckii, Sporothrix brasiliensis, and Sporothrix globosa by Human Monocyte-Derived Macrophages and Dendritic Cells. Infect Drug Resist 2023; 16:4817-4834. [PMID: 37520448 PMCID: PMC10386844 DOI: 10.2147/idr.s419629] [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: 05/03/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023] Open
Abstract
Background Sporotrichosis is a mycosis frequently caused by Sporothrix schenckii, Sporothrix brasiliensis, and Sporothrix globosa. The cell wall is a species-specific fungal structure with a direct role in activating the host's immune response. The current knowledge about anti-Sporothrix immunity comes from studies using S. schenckii or S. brasiliensis and murine cells. Macrophages and dendritic cells detect and eliminate pathogens, and although the function of these cells links innate with adaptive immunity, little is known about their interaction with Sporothrix spp. Methods S. schenckii, S. brasiliensis, and S. globosa conidia or yeast-like cells were co-incubated with human monocyte-derived macrophages or dendritic cells, and the phagocytosis and cytokine stimulation were assessed. These interactions were also performed in the presence of specific blocking agents of immune receptors or fungal cells with altered walls to analyze the contribution of these molecules to the immune cell-fungus interaction. Results Both types of immune cells phagocytosed S. globosa conidia and yeast-like cells to a greater extent, followed by S. brasiliensis and S. schenckii. Furthermore, when the wall internal components were exposed, the phagocytosis level increased for S. schenckii and S. brasiliensis, in contrast to S. globosa. Thus, the cell wall components have different functions during the interaction with macrophages and dendritic cells. S. globosa stimulated an increased proinflammatory response when compared to the other species. In macrophages, this was a dectin-1-, mannose receptor-, and TLR2-dependent response, but dectin-1- and TLR2-dependent stimulation in dendritic cells. For S. schenckii and S. brasiliensis, cytokine production was dependent on the activation of TLR4, CR3, and DC-SIGN. Conclusion The results of this study indicate that these species are recognized by immune cells differently and that this may depend on both the structure and cell wall organization of the different morphologies.
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Affiliation(s)
- Manuela Gómez-Gaviria
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, GuanajuatoMéxico
| | - Iván Martínez-Duncker
- Laboratorio de Glicobiología Humana y Diagnóstico Molecular; Centro de Investigación en Dinámica Celular, Instituto de Investigación en Ciencias Básicas y Aplicadas, Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, México
| | - Laura C García-Carnero
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, GuanajuatoMéxico
| | - Héctor M Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, GuanajuatoMéxico
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Guan M, Yao L, Zhen Y, Song Y, Liu X, Liu Y, Chen R, Cui Y, Li S. Sporothrix globosa melanin regulates autophagy via the TLR2 signaling pathway in THP-1 macrophages. PLoS Negl Trop Dis 2023; 17:e0011281. [PMID: 37141335 DOI: 10.1371/journal.pntd.0011281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/19/2023] [Accepted: 03/28/2023] [Indexed: 05/06/2023] Open
Abstract
Melanin, an important virulence factor of pathogenic fungi, has been shown to suppress host immune responses in multiple ways. Autophagy is a vital cellular mechanism underlying the host's innate immunity against microbial infections. However, the potential influence of melanin on autophagy has not been explored. We investigated the effect of melanin on autophagy in macrophages, which play a key role in controlling Sporothrix spp. infection, as well as the mechanism of melanin interaction with Toll-like receptor (TLR)-induced pathways. Sporothrix globosa conidia (wild-type and melanin-deficient mutant strains) or yeast cells were co-cultured with THP-1 macrophages to demonstrate that, although S. globosa infection led to the activation of autophagy-related proteins and increased autophagic flux, S. globosa melanin suppressed macrophage autophagy. Incubation with S. globosa conidia also increased the expression levels of reactive oxygen species and multiple proinflammatory cytokines (interleukin-6, tumor necrosis factor-α, interleukin-1β and interferon-γ) in macrophages. These effects were attenuated as melanin presented. Furthermore, while S. globosa conidia significantly increased the expression of both TLR2 and TLR4 in macrophages, the knockdown of TLR2, but not TLR4, with small interfering RNA suppressed autophagy. Overall, this study revealed the novel immune defense ability of S. globosa melanin to inhibit macrophage functionality by resisting macrophage autophagy through the regulation of TLR2 expression.
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Affiliation(s)
- Mengqi Guan
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, China
| | - Lei Yao
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, China
| | - Yu Zhen
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, China
| | - Yang Song
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, China
| | - Xiaobo Liu
- Laboratory of Cancer Precision Medicine, First Hospital of Jilin University, Changchun, China
| | - Yuanyuan Liu
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, China
| | - Ruili Chen
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, China
- Department of Dermatology and Venereology, Zhuhai People's Hospital, Zhuhai, China
| | - Yan Cui
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, China
| | - Shanshan Li
- Department of Dermatology and Venereology, First Hospital of Jilin University, Changchun, China
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García-Carnero LC, Martínez-Duncker I, Gómez-Gaviria M, Mora-Montes HM. Differential Recognition of Clinically Relevant Sporothrix Species by Human Mononuclear Cells. J Fungi (Basel) 2023; 9:jof9040448. [PMID: 37108903 PMCID: PMC10146672 DOI: 10.3390/jof9040448] [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: 03/01/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Sporotrichosis is a human and animal fungal infection distributed worldwide that is caused by the thermodimorphic species of the Sporothrix pathogenic clade, which includes Sporothrix brasiliensis, Sporothrix schenckii, and Sporothrix globosa. The cell wall composition and the immune response against the Sporothrix species have been studied mainly in S. brasiliensis and S. schenckii, whilst little is known about the S. globosa cell wall and the immune response that its components trigger. Therefore, in this study, we aimed to analyze the cell wall composition of S. globosa in three morphologies (germlings, conidia, and yeast-like cells) and the differences in cytokine production when human peripheral blood mononuclear cells (PBMCs) interact with these morphotypes, using S. schenckii and S. brasiliensis as a comparison. We found that S. globosa conidia and yeast-like cells have a higher cell wall chitin content, while all three morphologies have a higher β-1,3-glucan content, which was found most exposed at the cell surface when compared to S. schenckii and S. brasiliensis. In addition, S. globosa has lower levels of mannose- and rhamnose-based glycoconjugates, as well as of N- and O-linked glycans, indicating that this fungal cell wall has species-specific proportions and organization of its components. When interacting with PBMCs, S. brasiliensis and S. globosa showed a similar cytokine stimulation profile, but with a higher stimulation of IL-10 by S. globosa. Additionally, when the inner cell wall components of S. globosa were exposed at the surface or N- and O-glycans were removed, the cytokine production profile of this species in its three morphotypes did not significantly change, contrasting with the S. schenckii and S. brasiliensis species that showed different cytokine profiles depending on the treatment applied to the walls. In addition, it was found that the anti-inflammatory response stimulated by S. globosa was dependent on the activation of dectin-1, mannose receptor, and TLR2, but not TLR4. All of these results indicate that the cell wall composition and structure of the three Sporothrix species in the three morphologies are different, affecting their interaction with human PBMCs and generating species-specific cytokine profiles.
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Affiliation(s)
- Laura C García-Carnero
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Gto., Mexico
| | - Iván Martínez-Duncker
- Laboratorio de Glicobiología Humana y Diagnóstico Molecular, Centro de Investigación en Dinámica Celular, Instituto de Investigación en Ciencias Básicas y Aplicadas, Universidad Autónoma del Estado de Morelos, Cuernavaca 62209, Mor., Mexico
| | - Manuela Gómez-Gaviria
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Gto., Mexico
| | - Héctor M Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P., Guanajuato 36050, Gto., Mexico
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Lin P, Zhang J, Xie G, Li J, Guo C, Lin H, Zhang Y. Innate Immune Responses to Sporothrix schenckii: Recognition and Elimination. Mycopathologia 2022; 188:71-86. [PMID: 36329281 DOI: 10.1007/s11046-022-00683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
Sporothrix schenckii (S. schenckii), a ubiquitous thermally dimorphic fungus, is the etiological agent of sporotrichosis, affecting immunocompromised and immunocompetent individuals. Despite current antifungal regimens, sporotrichosis results in prolonged treatment and significant mortality rates in the immunosuppressed population. The innate immune system forms the host's first and primary line of defense against S. schenckii, which has a bi-layered cell wall structure. Many components act as pathogen-associated molecular patterns (PAMPs) in pathogen-host interactions. PAMPs are recognized by pattern recognition receptors (PRRs) such as toll-like receptors, C-type lectin receptors, and complement receptors, triggering innate immune cells such as neutrophils, macrophages, and dendritic cells to phagocytize or produce mediators, contributing to S. schenckii elimination. The ultrastructure of S. schenckii and pathogen-host interactions, including PRRs and innate immune cells, are summarized in this review, promoting a better understanding of the innate immune response to S. schenckii and aiding in the development of protective and therapeutic strategies to combat sporotrichosis.
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Affiliation(s)
- Peng Lin
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jianfeng Zhang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guinan Xie
- Department of Traditional Chinese Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Junchen Li
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chenqi Guo
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Haiyue Lin
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Yu Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China.
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Kischkel B, Lopes-Bezerra L, Taborda CP, A. B. Joosten L, Cristina dos Santos J, Netea MG. Differential recognition and cytokine induction by the peptidorhamnomannan from Sporothrix brasiliensis and S. schenckii. Cell Immunol 2022; 378:104555. [DOI: 10.1016/j.cellimm.2022.104555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/26/2022] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
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Nava-Pérez N, Neri-García LG, Romero-González OE, Terrones-Cruz JA, García-Carnero LC, Mora-Montes HM. Biological and Clinical Attributes of Sporothrix globosa, a Causative Agent of Sporotrichosis. Infect Drug Resist 2022; 15:2067-2090. [PMID: 35498634 PMCID: PMC9041366 DOI: 10.2147/idr.s362099] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/13/2022] [Indexed: 12/26/2022] Open
Abstract
Sporotrichosis is an important subcutaneous mycosis with high prevalence and threat to human and animal health worldwide. Sporothrix schenckii, Sporothrix brasiliensis, and Sporothrix globosa are the main etiological agents of this disease; and even though many efforts have been made recently to understand the Sporothrix-host interaction, little is known about S. globosa, an underestimated species. This organism shows the lowest virulence among the members of the Sporothrix pathogenic clade and represents an important pathogenic agent due to its global distribution. Here, we offer a review with all the known information about S. globosa, including its genome and proteomic information, and compare it with S. schenckii and S. brasiliensis, to explain the differences observed among these species, in terms of virulence, the host immune response, and the antifungal sensitivity. Also, we provide the gene prediction of some S. globosa putative virulence factors.
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Affiliation(s)
- Nallely Nava-Pérez
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, 36050, Gto., México
| | - Lisset G Neri-García
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, 36050, Gto., México
| | - Oscar E Romero-González
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, 36050, Gto., México
| | - Joshua A Terrones-Cruz
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, 36050, Gto., México
| | - Laura C García-Carnero
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, 36050, Gto., México
- Correspondence: Laura C García-Carnero; Héctor M Mora-Montes, Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta s/n, col. Noria Alta, C.P, Guanajuato, 36050, Gto., México, Tel +52 473-7320006 Ext. 8193, Fax +52 473-7320006 Ext. 8153, Email ;
| | - Héctor M Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, 36050, Gto., México
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Vargas-Macías AP, Gómez-Gaviria M, García-Carnero LC, Mora-Montes HM. Current Models to Study the Sporothrix-Host Interaction. FRONTIERS IN FUNGAL BIOLOGY 2022; 3:833111. [PMID: 37746241 PMCID: PMC10512367 DOI: 10.3389/ffunb.2022.833111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/31/2022] [Indexed: 09/26/2023]
Abstract
Sporotrichosis is a worldwide distributed subcutaneous mycosis that affects mammals, including human beings. The infection is caused by members of the Sporothrix pathogenic clade, which includes Sporothrix schenckii, Sporothrix brasiliensis, and Sporothrix globosa. The fungus can be acquired through traumatic inoculation of conidia growing in vegetal debris or by zoonotic transmission from sick animals. Although is not considered a life-threatening disease, it is an emergent health problem that affects mostly immunocompromised patients. The sporotrichosis causative agents differ in their virulence, host range, and sensitivity to antifungal drugs; therefore, it is relevant to understand the molecular bases of their pathogenesis, interaction with immune effectors, and mechanisms to acquired resistance to antifungal compounds. Murine models are considered the gold standard to address these questions; however, some alternative hosts offer numerous advantages over mammalian models, such as invertebrates like Galleria mellonella and Tenebrio molitor, or ex vivo models, which are useful tools to approach questions beyond virulence, without the ethical or budgetary features associated with the use of animal models. In this review, we analyze the different models currently used to study the host-Sporothrix interaction.
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Affiliation(s)
| | | | | | - Héctor M. Mora-Montes
- División de Ciencias Naturales y Exactas, Departamento de Biología, Universidad de Guanajuato, Guanajuato, Mexico
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The Role of Macrophages in the Host's Defense against Sporothrix schenckii. Pathogens 2021; 10:pathogens10070905. [PMID: 34358055 PMCID: PMC8308788 DOI: 10.3390/pathogens10070905] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 01/19/2023] Open
Abstract
The role of immune cells associated with sporotrichosis caused by Sporothrix schenckii is not yet fully clarified. Macrophages through pattern recognition receptors (PRRs) can recognize pathogen-associated molecular patterns (PAMPs) of Sporothrix, engulf it, activate respiratory burst, and secrete pro-inflammatory or anti-inflammatory biological mediators to control infection. It is important to consider that the characteristics associated with S. schenckii and/or the host may influence macrophage polarization (M1/M2), cell recruitment, and the type of immune response (1, 2, and 17). Currently, with the use of new monocyte-macrophage cell lines, it is possible to evaluate different host-pathogen interaction processes, which allows for the proposal of new mechanisms in human sporotrichosis. Therefore, in order to contribute to the understanding of these host-pathogen interactions, the aim of this review is to summarize and discuss the immune responses induced by macrophage-S. schenckii interactions, as well as the PRRs and PAMPs involved during the recognition of S. schenckii that favor the immune evasion by the fungus.
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Zu J, Yao L, Song Y, Cui Y, Guan M, Chen R, Zhen Y, Li S. Th2 Biased Immunity With Altered B Cell Profiles in Circulation of Patients With Sporotrichosis Caused by Sporothrix globosa. Front Immunol 2020; 11:570888. [PMID: 33281813 PMCID: PMC7691245 DOI: 10.3389/fimmu.2020.570888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022] Open
Abstract
Sporotrichosis is a subcutaneous mycotic infection, and Sporothrixglobosa is one of the causative agents with a worldwide distribution, notably in Asia. However, the immune profile in human sporotrichosis caused by S. globosa still remains obscure. Here, we demonstrated enhanced Th2 response in circulation with significant increases in Th2 frequency, Th2/Tregs as well as IL-4 seretion in patients. Elevated IL-17A+Th17 percentage was accompanied with reduced IL-17A level in serum, which may imply a dysfunction of this CD4+T subset in S. globosa infection. In addition, Th2 percentage, the ratios of Th2/Tregs and Th17/Tregs were all raised in patients with fixed cutaneous form, while only Th2/Tregs displayed increment in lymphocutaneous form. Meanwhile, the percentage of double negative B cells was significantly increased and positively correlated with Th2 and Tregs in whole patients. Except naïve B cells, all memory B cells together with Th2 cells increased in patients with short duration (less than 6 months), which may suggest a collaboration of T cells with altered B cell profile in human sporotrichosis caused by S. globosa. In consistent with the changes of IFN-γ+Th1, IL-4+Th2 and IL-17A+Th17 in patients with short duration, the percentages of these effector T cells all expanded when cocultured with S. globosa yeast cells in vitro. These data shed light on the potential involvement of peripheral T and B cell immunity against this mycotic infection and indicated that different immune responses existed in different stages of sporotrichosis; meanwhile different immune profile may contribute to different clinical manifestations of this disease.
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Affiliation(s)
- Jianjiao Zu
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
| | - Lei Yao
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
| | - Yang Song
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
| | - Yan Cui
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
| | - Mengqi Guan
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
| | - Ruili Chen
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
| | - Yu Zhen
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
| | - Shanshan Li
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
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Marques PT, Kay CSK, Basílio FMA, Pinheiro RL, Werneck LC, Lorenzoni PJ, Scola RH. Localized sporotrichosis during natalizumab treatment in Multiple Sclerosis. Mult Scler Relat Disord 2020; 41:102029. [DOI: 10.1016/j.msard.2020.102029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
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Queiroz-Telles F, Buccheri R, Benard G. Sporotrichosis In Immunocompromised Hosts. J Fungi (Basel) 2019; 5:jof5010008. [PMID: 30641918 PMCID: PMC6463096 DOI: 10.3390/jof5010008] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 02/06/2023] Open
Abstract
Sporotrichosis is a global implantation or subcutaneous mycosis caused by several members of the genus Sporothrix, a thermo-dimorphic fungus. This disease may also depict an endemic profile, especially in tropical to subtropical zones around the world. Interestingly, sporotrichosis is an anthropozoonotic disease that may be transmitted to humans by plants or by animals, especially cats. It may be associated with rather isolated or clustered cases but also with outbreaks in different periods and geographic regions. Usually, sporotrichosis affects immunocompetent hosts, presenting a chronic to subacute evolution course. Less frequently, sporotrichosis may be acquired by inhalation, leading to disseminated clinical forms. Both modes of infection may occur in immunocompromised patients, especially associated with human immunodeficiency virus (HIV) infection, but also diabetes mellitus, chronic alcoholism, steroids, anti-TNF treatment, hematologic cancer and transplanted patients. Similar to other endemic mycoses caused by dimorphic fungi, sporotrichosis in immunocompromised hosts may be associated with rather more severe clinical courses, larger fungal burden and longer periods of systemic antifungal therapy. A prolonged outbreak of cat-transmitted sporotrichosis is in progress in Brazil and potentially crossing the border to neighboring countries. This huge outbreak involves thousands of human and cats, including immunocompromised subjects affected by HIV and FIV (feline immunodeficiency virus), respectively. We reviewed the main epidemiologic, clinical, diagnostic and therapeutic aspects of sporotrichosis in immunocompromised hosts.
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Affiliation(s)
- Flavio Queiroz-Telles
- Department of Public Health, Federal University of Paraná, Curitiba 80060-000, Brazil.
| | - Renata Buccheri
- Emilio Ribas Institute of Infectious Diseases, São Paulo 05411-000, Brazil.
| | - Gil Benard
- Laboratory of Medical Mycology, Department of Dermatology, and Tropical Medicine Institute, University of São Paulo, Sao Paulo 05403-000, Brazil.
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Ikeda MAK, de Almeida JRF, Jannuzzi GP, Cronemberger-Andrade A, Torrecilhas ACT, Moretti NS, da Cunha JPC, de Almeida SR, Ferreira KS. Extracellular Vesicles From Sporothrix brasiliensis Are an Important Virulence Factor That Induce an Increase in Fungal Burden in Experimental Sporotrichosis. Front Microbiol 2018; 9:2286. [PMID: 30333803 PMCID: PMC6176056 DOI: 10.3389/fmicb.2018.02286] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022] Open
Abstract
Sporotrichosis is a mycosis that affects the skin, lymphatic system and other organs in humans and animals. The disease has a worldwide distribution, with endemic areas in Brazil, and is caused by a complex of species, including Sporothrix brasiliensis. Some fungi release extracellular vesicles (EVs) that can interact with the host cell and modulate the host immune response. The aim of this study was to analyze the participation of S. brasiliensis EVs in the modulation of dendritic cells (DCs) and in the control of infection in vivo. Our results showed that in vitro, the EVs isolated from S. brasiliensis induced an increase in the phagocytic index and fungal burden in DCs. In addition, we observed a significant increase in IL-12p40 and TNF-α cytokine production. Then, the EVs were inoculated into BALB/c mice before subcutaneous infection with yeast, and the lesion was analyzed after 21, 35, and 42 days. An increase in fungal burden and lesion diameter were observed after 21 days in mice inoculated with a high concentration of EVs. However, after 35 days, we observed a regression of the lesion, which persisted until 42 days after infection. Interestingly, we observed an increase in fungal burden in these mice. In addition, we observed the presence of immunogenic components and proteins that could be related with virulence in EVs. These results suggest that EVs can play an important role in virulence and modulation of the host immune system during experimental S. brasiliensis infection.
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Affiliation(s)
- Marcelo Augusto Kazuo Ikeda
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, Diadema, Brazil
| | | | - Grasielle Pereira Jannuzzi
- Department of Clinical Chemistry, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - André Cronemberger-Andrade
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, Diadema, Brazil
| | - Ana Cláudia Trocoli Torrecilhas
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, Diadema, Brazil
| | - Nilmar Silvio Moretti
- Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil
| | - Julia Pinheiro Chagas da Cunha
- Special Laboratory of Cell Cycle, Center of Toxins, Immune Response and Cell Signaling, Butantan Institute, São Paulo, Brazil
| | - Sandro Rogério de Almeida
- Department of Clinical Chemistry, Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Karen Spadari Ferreira
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo, Diadema, Brazil
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14
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Quinello C, Souza Ferreira L, Picolli I, Loesch ML, Portuondo DL, Batista-Duharte A, Zeppone Carlos I. Sporothrix schenckii Cell Wall Proteins-Stimulated BMDCs Are Able to Induce a Th1-Prone Cytokine Profile In Vitro. J Fungi (Basel) 2018; 4:E106. [PMID: 30200530 PMCID: PMC6162427 DOI: 10.3390/jof4030106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 02/07/2023] Open
Abstract
Sporotrichosis is a subcutaneous mycosis affecting humans and other animals. The disease can be acquired by accidental inoculation of the fungus through the skin or through the respiratory system. Sporotrichosis can also be transmitted through bites or scratches by infected cats and more rarely by other animals (zoonotic transmission). Conventional antifungal therapy is especially inefficient in immunocompromised patients, who tend to develop the most severe forms of the disease, thus prompting the search for alternative therapies. Given their antigen-presenting properties, dendritic cells (DCs) have been used in both prophylactic and therapeutic vaccination strategies. Hence, this study aims to assess the use of DCs as a prophylactic tool in sporotrichosis by evaluating the immune profile induced by Sporothrix schenckii cell wall proteins (SsCWP)-stimulated, bone-marrow-derived DCs (BMDCs). Mouse BMDCs were stimulated with SsCWP for 24 h and analyzed for the surface expression of costimulatory molecules and TLR-4, as well as for the secretion of proinflammatory cytokines and IL-10. Following that, activated BMDCs were cocultured with splenocytes for 72 h and had the same cytokines measured in the supernatant. SsCWP-stimulated BMDCs showed higher expression of CD80, CD86, and CD40, but not TLR-4, and higher secretion of IL-6, IL-17A, and TNF. On the other hand, higher levels of IFN-γ, IL-10, and IL-2 were found in the supernatants of the coculture as compared with the BMDCs alone; TNF secretion was almost completely abrogated, whereas IL-6 was only partially inhibited and IL-17A was unaffected. Our results thus suggest that SsCWP-stimulated BMDCs are able to induce a Th1-prone cytokine profile which is known to be protective against other fungal diseases. This result could lead to studies which evaluate the development of prophylactic and/or therapeutic DC-based tools against sporotrichosis.
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Affiliation(s)
- Camila Quinello
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Araraquara, São Paulo State University (UNESP), Rodovia Araraquara-Jaú-Km 1, Araraquara 14800-903, SP, Brazil.
| | - Lucas Souza Ferreira
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Araraquara, São Paulo State University (UNESP), Rodovia Araraquara-Jaú-Km 1, Araraquara 14800-903, SP, Brazil.
| | - Isabella Picolli
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Araraquara, São Paulo State University (UNESP), Rodovia Araraquara-Jaú-Km 1, Araraquara 14800-903, SP, Brazil.
| | - Maria Luiza Loesch
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Araraquara, São Paulo State University (UNESP), Rodovia Araraquara-Jaú-Km 1, Araraquara 14800-903, SP, Brazil.
| | - Deivys Leandro Portuondo
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Araraquara, São Paulo State University (UNESP), Rodovia Araraquara-Jaú-Km 1, Araraquara 14800-903, SP, Brazil.
| | - Alexander Batista-Duharte
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Araraquara, São Paulo State University (UNESP), Rodovia Araraquara-Jaú-Km 1, Araraquara 14800-903, SP, Brazil.
| | - Iracilda Zeppone Carlos
- Department of Clinical Analysis, School of Pharmaceutical Sciences, Araraquara, São Paulo State University (UNESP), Rodovia Araraquara-Jaú-Km 1, Araraquara 14800-903, SP, Brazil.
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15
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Conceição-Silva F, Morgado FN. Immunopathogenesis of Human Sporotrichosis: What We Already Know. J Fungi (Basel) 2018; 4:jof4030089. [PMID: 30065160 PMCID: PMC6162489 DOI: 10.3390/jof4030089] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 12/19/2022] Open
Abstract
Sporotrichosis is a subacute/chronic mycosis caused by dimorphic fungus of the genus Sporothrix. This mycosis may affect both human and domestic animals and in the last few years, the geographic dispersion and increase of sporotrichosis worldwide has been observed. The occurrence of cases related to scratching/bites of domestic felines have increased, characterizing the disease as predominantly a zoonosis. In humans, sporotrichosis mainly involves the cutaneous tegument of infected patients, but other tissues may also present the infection. The main forms of clinical presentation are lymphocutanous sporotrichosis (LC) and fixed sporotrichosis (F). Although less common, mucosal, cutaneous disseminated, and extracutaneous forms have also been described. Multiple factors from the fungus and host can play a role in driving the clinical evolution of sporotrichosis to benign or severe disease. In this review, we discuss the immunopathological aspects involved in human sporotrichosis. Putting together the two branches of knowledge—host immune response and fungal evading mechanisms—we may perceive new possibilities in understanding the fungus–host interaction in order to be in a position to go further in the control of sporotrichosis.
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Affiliation(s)
- Fatima Conceição-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute, IOC/Fiocruz, Avenida Brasil 4365 Pavilhão 26 sala 408-Manguinhos, Rio de Janeiro 21040-360, Brazil.
| | - Fernanda Nazaré Morgado
- Laboratory of Leishmaniasis Research, Oswaldo Cruz Institute, IOC/Fiocruz, Avenida Brasil 4365 Pavilhão 26 sala 509-Manguinhos, Rio de Janeiro 21040-360, Brazil.
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16
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García-Lozano A, Toriello C, Antonio-Herrera L, Bonifaz LC. Sporothrix schenckii Immunization, but Not Infection, Induces Protective Th17 Responses Mediated by Circulating Memory CD4 + T Cells. Front Microbiol 2018; 9:1275. [PMID: 29946313 PMCID: PMC6005866 DOI: 10.3389/fmicb.2018.01275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/25/2018] [Indexed: 01/24/2023] Open
Abstract
Sporotrichosis is a chronic subcutaneous mycosis caused by the Sporothrix schenckii species complex and it is considered an emerging opportunistic infection in countries with tropical and subtropical climates. The host’s immune response has a main role in the development of this disease. However, it is unknown the features of the memory cellular immune response that could protect against the infection. Our results show that i.d. immunization in the ears of mice with inactivated S. schenckii conidia (iC) combined with the cholera toxin (CT) induces a cellular immune response mediated by circulating memory CD4+ T cells, which mainly produce interleukin 17 (IL-17). These cells mediate a strong delayed-type hypersensitivity (DTH) reaction. Systemic and local protection against S. schenckii was mediated by circulating CD4+ T cells. In contrast, the infection induces a potent immune response in the skin mediated by CD4+ T cells, which have an effector phenotype that preferentially produce interferon gamma (IFN-γ) and mediate a transitory DTH reaction. Our findings prove the potential value of the CT as a potent skin adjuvant when combined with fungal antigens, and they also have important implications for our better understanding of the differences between the memory immune response induced by the skin immunization and those induced by the infection; this knowledge enhances our understanding of how a protective immune response against a S. schenckii infection is developed.
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Affiliation(s)
- Alberto García-Lozano
- Unidad de Investigación Médica en Inmunoquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Conchita Toriello
- Laboratorio de Micología Básica, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Laura Antonio-Herrera
- Unidad de Investigación Médica en Inmunoquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Laura C Bonifaz
- Unidad de Investigación Médica en Inmunoquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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17
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Lopes-Bezerra LM, Mora-Montes HM, Zhang Y, Nino-Vega G, Rodrigues AM, de Camargo ZP, de Hoog S. Sporotrichosis between 1898 and 2017: The evolution of knowledge on a changeable disease and on emerging etiological agents. Med Mycol 2018. [DOI: 10.1093/mmy/myx103] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Leila M Lopes-Bezerra
- Laboratory of Cellular Mycology and Proteomics, Department of Cell Biology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Hector M Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, Mexico
| | - Yu Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Gustavo Nino-Vega
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Guanajuato, Mexico
| | - Anderson Messias Rodrigues
- Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil
| | - Zoilo Pires de Camargo
- Cell Biology Division, Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil
| | - Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, and Center of Expertise in Mycology of Radboudumc/CWZ, Nijmegen, The Netherlands
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18
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An immunoproteomic approach revealing peptides from Sporothrix brasiliensis that induce a cellular immune response in subcutaneous sporotrichosis. Sci Rep 2018. [PMID: 29520092 PMCID: PMC5843658 DOI: 10.1038/s41598-018-22709-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sporothrix brasiliensis is the most virulent fungus of the Sporothrix complex and is the main species recovered in the sporotrichosis zoonotic hyperendemic area in Rio de Janeiro. A vaccine against S. brasiliensis could improve the current sporotrichosis situation. Here, we show 3 peptides from S. brasiliensis immunogenic proteins that have a higher likelihood for engaging MHC-class II molecules. We investigated the efficiency of the peptides as vaccines for preventing subcutaneous sporotrichosis. In this study, we observed a decrease in lesion diameters in peptide-immunized mice, showing that the peptides could induce a protective immune response against subcutaneous sporotrichosis. ZR8 peptide is from the GP70 protein, the main antigen of the Sporothrix complex, and was the best potential vaccine candidate by increasing CD4+ T cells and higher levels of IFN-γ, IL-17A and IL-1β characterizing a strong cellular immune response. This immune environment induced a higher number of neutrophils in lesions that are associated with fungus clearance. These results indicated that the ZR8 peptide induces a protective immune response against subcutaneous sporotrichosis and is a vaccine candidate against S. brasiliensis infection.
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19
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Manente FA, Quinello C, Ferreira LS, de Andrade CR, Jellmayer JA, Portuondo DL, Batista-Duharte A, Carlos IZ. Experimental sporotrichosis in a cyclophosphamide-induced immunosuppressed mice model. Med Mycol 2017; 56:711-722. [DOI: 10.1093/mmy/myx098] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/06/2017] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Camila Quinello
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
| | - Lucas Souza Ferreira
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
| | | | | | | | - Alexander Batista-Duharte
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
| | - Iracilda Zeppone Carlos
- School of Pharmaceutical Sciences, São Paulo State University – UNESP, Araraquara, SP, Brazil
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20
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Della Terra PP, Rodrigues AM, Fernandes GF, Nishikaku AS, Burger E, de Camargo ZP. Exploring virulence and immunogenicity in the emerging pathogen Sporothrix brasiliensis. PLoS Negl Trop Dis 2017; 11:e0005903. [PMID: 28854184 PMCID: PMC5595342 DOI: 10.1371/journal.pntd.0005903] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/12/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022] Open
Abstract
Sporotrichosis is a polymorphic chronic infection of humans and animals classically acquired after traumatic inoculation with soil and plant material contaminated with Sporothrix spp. propagules. An alternative and successful route of transmission is bites and scratches from diseased cats, through which Sporothrix yeasts are inoculated into mammalian tissue. The development of a murine model of subcutaneous sporotrichosis mimicking the alternative route of transmission is essential to understanding disease pathogenesis and the development of novel therapeutic strategies. To explore the impact of horizontal transmission in animals (e.g., cat-cat) and zoonotic transmission on Sporothrix fitness, the left hind footpads of BALB/c mice were inoculated with 5×106 yeasts (n = 11 S. brasiliensis, n = 2 S. schenckii, or n = 1 S. globosa). Twenty days post-infection, our model reproduced both the pathophysiology and symptomology of sporotrichosis with suppurating subcutaneous nodules that progressed proximally along lymphatic channels. Across the main pathogenic members of the S. schenckii clade, S. brasiliensis was usually more virulent than S. schenckii and S. globosa. However, the virulence in S. brasiliensis was strain-dependent, and we demonstrated that highly virulent isolates disseminate from the left hind footpad to the liver, spleen, kidneys, lungs, heart, and brain of infected animals, inducing significant and chronic weight loss (losing up to 15% of their body weight). The weight loss correlated with host death between 2 and 16 weeks post-infection. Histopathological features included necrosis, suppurative inflammation, and polymorphonuclear and mononuclear inflammatory infiltrates. Immunoblot using specific antisera and homologous exoantigen investigated the humoral response. Antigenic profiles were isolate-specific, supporting the hypothesis that different Sporothrix species can elicit a heterogeneous humoral response over time, but cross reaction was observed between S. brasiliensis and S. schenckii proteomes. Despite great diversity in the immunoblot profiles, antibodies were mainly derived against 3-carboxymuconate cyclase, a glycoprotein oscillating between 60 and 70 kDa (gp60-gp70) and a 100-kDa molecule in nearly 100% of the assays. Thus, our data broaden the current view of virulence and immunogenicity in the Sporothrix-sporotrichosis system, substantially expanding the possibilities for comparative genomic with isolates bearing divergent virulence traits and helping uncover the molecular mechanisms and evolutionary pressures underpinning the emergence of Sporothrix virulence.
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Affiliation(s)
- Paula Portella Della Terra
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Anderson Messias Rodrigues
- Department of Microbiology, Immunology and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Geisa Ferreira Fernandes
- Department of Microbiology, Immunology and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Angela Satie Nishikaku
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Eva Burger
- Department of Microbiology and Immunology, Federal University of Alfenas (UNIFAL-MG), Alfenas, Brazil
| | - Zoilo Pires de Camargo
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Microbiology, Immunology and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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21
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Portuondo DL, Batista-Duharte A, Ferreira LS, de Andrade CR, Quinello C, Téllez-Martínez D, de Aguiar Loesch ML, Carlos IZ. Comparative efficacy and toxicity of two vaccine candidates against Sporothrix schenckii using either Montanide™ Pet Gel A or aluminum hydroxide adjuvants in mice. Vaccine 2017; 35:4430-4436. [PMID: 28687406 DOI: 10.1016/j.vaccine.2017.05.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/19/2017] [Accepted: 05/15/2017] [Indexed: 12/14/2022]
Abstract
Sporotrichosis is an important zoonosis in Brazil and the most frequent subcutaneous mycosis in Latin America, caused by different Sporothrix species. Currently, there is no effective vaccine available to prevent this disease. In this study, the efficacy and toxicity of the adjuvant Montanide™ Pet Gel A (PGA) formulated with S. schenckii cell wall proteins (ssCWP) was evaluated and compared with that of aluminum hydroxide (AH). Balb/c mice received two subcutaneous doses (1st and 14th days) of either the unadjuvanted or adjuvanted vaccine candidates. On the 21st day, anti-ssCWP antibody levels (ELISA), the phagocytic index, as well as the ex vivo release of IFN-γ, IL-4, and IL-17 by splenocytes and IL-12 by peritoneal macrophages were assessed. Cytotoxicity of the vaccine formulations was evaluated in vitro and by histopathological analysis of the inoculation site. Both adjuvanted vaccine formulations increased anti-ssCWP IgG, IgG1, IgG2a, and IgG3 levels, although IgG2a levels were higher in response to PGA+CWP100, probably contributing to the increase in S. schenckii yeast phagocytosis by macrophages in the opsonophagocytosis assay when using serum from PGA+CWP100-immunized mice. Immunization with AH+CWP100 led to a mixed Th1/Th2/Th17 ex vivo cytokine release profile, while PGA+CWP100 stimulated a preferential Th1/Th2 profile. Moreover, PGA+CWP100 was less cytotoxic in vitro, caused less local toxicity and led to a similar reduction in fungal load in the liver and spleen of S. schenckii- or S. brasiliensis-challenged mice as compared with AH+CWP100. These results suggest that PGA may be an effective and safe adjuvant for a future sporotrichosis vaccine.
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Affiliation(s)
- Deivys Leandro Portuondo
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, SP, Brazil.
| | - Alexander Batista-Duharte
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, SP, Brazil.
| | - Lucas Souza Ferreira
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, SP, Brazil.
| | - Cleverton Roberto de Andrade
- São Paulo State University (UNESP), School of Dentistry, Department of Physiology & Pathology, Araraquara, SP, Brazil.
| | - Camila Quinello
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, SP, Brazil.
| | - Damiana Téllez-Martínez
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, SP, Brazil.
| | - Maria Luiza de Aguiar Loesch
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, SP, Brazil.
| | - Iracilda Zeppone Carlos
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, SP, Brazil.
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22
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Bonifaz A, Tirado-Sánchez A. Cutaneous Disseminated and Extracutaneous Sporotrichosis: Current Status of a Complex Disease. J Fungi (Basel) 2017; 3:jof3010006. [PMID: 29371525 PMCID: PMC5715962 DOI: 10.3390/jof3010006] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/31/2017] [Accepted: 02/07/2017] [Indexed: 01/19/2023] Open
Abstract
Sporotrichosis is an implantation or inoculation mycosis caused by species of Sporothrix schenckii complex; its main manifestations are limited to skin; however, cutaneous-disseminated, disseminated (visceral) and extracutaneous variants of sporotrichosis can be associated with immunosuppression, including HIV-AIDS, chronic alcoholism or more virulent strains. The most common extracutaneous form of sporotrichosis includes pulmonary, osteoarticular and meningeal. The laboratory diagnosis requires observing yeast forms and isolating the fungus; the two main causative agents are Sporothrix schenckii (ss) and Sporothrix brasiliensis. Antibody levels and species recognition by Polimerase Chain Reaction using biological samples or cultures are also useful. The treatment of choice for most cases is amphotericin B and subsequent itraconazole for maintenance therapy.
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Affiliation(s)
- Alexandro Bonifaz
- Dermatology Service, Mycology Department, Hospital General de México "Eduardo Liceaga", Balmis 148, Colonia Doctores, CP: 03020. Cd. de México, México.
| | - Andrés Tirado-Sánchez
- Dermatology Service, Mycology Department, Hospital General de México "Eduardo Liceaga", Balmis 148, Colonia Doctores, CP: 03020. Cd. de México, México.
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23
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Chen F, Jiang R, Wang Y, Zhu M, Zhang X, Dong S, Shi H, Wang L. Recombinant Phage Elicits Protective Immune Response against Systemic S. globosa Infection in Mouse Model. Sci Rep 2017; 7:42024. [PMID: 28165018 PMCID: PMC5292741 DOI: 10.1038/srep42024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 01/06/2017] [Indexed: 12/16/2022] Open
Abstract
Sporothrix globosa is a type of fungus that typically infects immunocompromised patients. Its prevention continues to pose a challenge. A 70-KDa glycoprotein (Gp70) of Sporothrix has been previously reported to protect host against infection from this fungus. Here, we displayed an epitope peptide (kpvqhalltplgldr) of Gp70 on the major coat protein (pIII), and investigated its efficiency as a vaccine for preventing S. globosa infection. The recombinant phage and the heat-killed S. globosa were used to immunize mice separately. In this study, we evaluated the humoral and cellular immune responses in the mice and demonstrated that recombinant phage could induce mice to produce a stronger immune response and generate antibodies to inhibit S. globosa infection. Furthermore, immunization with recombinant phage could increase the survival rate of S. globosa infection in mice. All these results together indicated that recombinant phages displaying kpvqhalltplgldr are a potential vaccine candidate against S. globosa infection.
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Affiliation(s)
- Feng Chen
- Dermatology Department, China-Japan Union Hospital of Jilin University, 126Xiantai Street, Changchun, Jilin Province 130033, People's Republic of China
| | - Rihua Jiang
- Dermatology Department, China-Japan Union Hospital of Jilin University, 126Xiantai Street, Changchun, Jilin Province 130033, People's Republic of China
| | - Yicun Wang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, the Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, Jilin Province 130041, People's Republic of China
| | - Mingji Zhu
- Dermatology Department, China-Japan Union Hospital of Jilin University, 126Xiantai Street, Changchun, Jilin Province 130033, People's Republic of China
| | - Xu Zhang
- Department of Hang Surgery, Second Hospital of Qinhuangdao, Hebei 066600, People's Republic of China
| | - Shuai Dong
- Institute of Cytology and Genetics, School of Life Sciences, Northeast Normal University, 5268 Renmin Street, Changchun, Jilin Province 130024, People's Republic of China
| | - Hongxi Shi
- Institute of Cytology and Genetics, School of Life Sciences, Northeast Normal University, 5268 Renmin Street, Changchun, Jilin Province 130024, People's Republic of China
| | - Li Wang
- Institute of Cytology and Genetics, School of Life Sciences, Northeast Normal University, 5268 Renmin Street, Changchun, Jilin Province 130024, People's Republic of China
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24
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Impairment of Immune Response against Dematiaceous Fungi in Card9 Knockout Mice. Mycopathologia 2016; 181:631-42. [PMID: 27421992 DOI: 10.1007/s11046-016-0029-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
Dematiaceous fungi are a large group of pathogens that can cause a wide range of diseases in both immunocompetent and immunocompromised hosts. Based on our previous finding of caspase recruitment domain-containing protein 9 (CARD9) mutations in patients with subcutaneous phaeohyphomycosis caused by Phialophora verrucosa (P. verrucosa), we further investigated the exact role of CARD9 in the pathogenesis of phaeohyphomycosis using Card9 knockout (Card9 KO) mice. We showed that Card9 KO mice are profoundly susceptible to P. verrucosa infection compared with wild-type mice, reflected by significantly more severe footpad swelling, higher fungal burden, lower survival, and systemic dissemination. The inability of Card9 KO mice to control P. verrucosa infection was associated with lack of Th17 differentiation and reduction of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-17A levels in footpad homogenates. In vitro experiments showed a defect of fungal conidia killing and pro-inflammatory cytokine production in Card9 KO bone marrow-derived macrophages and dendritic cells. Furthermore, ex vivo coculture and in vitro T cell differentiation assay demonstrated that Card9 signaling pathway acts indispensably on differentiation of Th17 cells. In conclusion, our findings suggest that CARD9 mediate the innate immune and Th17-mediated adaptive immune responses against dematiaceous fungal infections at the early stage of infection.
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25
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Alba-Fierro CA, Pérez-Torres A, Toriello C, Romo-Lozano Y, López-Romero E, Ruiz-Baca E. Molecular Components of the Sporothrix schenckii Complex that Induce Immune Response. Curr Microbiol 2016; 73:292-300. [PMID: 27117164 DOI: 10.1007/s00284-016-1045-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/12/2016] [Indexed: 12/21/2022]
Abstract
Sporotrichosis is a fungal disease caused by the Sporothrix schenckii complex that includes species such as S. brasiliensis, S. schenckii sensu stricto, S. globosa, S. luriei, S. mexicana, and S. pallida, which exhibit different potentially antigenic molecular components. The immune response of susceptible hosts to control infection and disease caused by these fungi has been little studied. Besides, the fungus-host interaction induces the activation of different types of immune response. This mini-review analyzes and discusses existing reports on the identification and functional characterization of molecules from species of the S. schenckii complex with clinical relevance, and the mechanisms that mediate the type and magnitude of the immune response in experimental models in vivo and in vitro. This knowledge is expected to contribute to the development of protective and therapeutic strategies against sporotrichosis and other mycoses.
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Affiliation(s)
- Carlos A Alba-Fierro
- Facultad de Ciencias Químicas, Universidad Juárez del Estado de Durango, Av. Veterinaria S/N, 34120, Durango, Dgo., Mexico
| | - Armando Pérez-Torres
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México, 04510, Mexico, D.F., Mexico
| | - Conchita Toriello
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, 04510, Mexico, D.F., Mexico
| | - Yolanda Romo-Lozano
- Departamento de Microbiología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Av. Universidad # 940, 20131, Aguascalientes, Ags., Mexico
| | - Everardo López-Romero
- Departamento de Biología, División de Ciencias Naturales y Exactas, Campus Guanajuato, Universidad de Guanajuato, Noria Alta S/N, C.P. 36050, Guanajuato, Gto., Mexico
| | - Estela Ruiz-Baca
- Facultad de Ciencias Químicas, Universidad Juárez del Estado de Durango, Av. Veterinaria S/N, 34120, Durango, Dgo., Mexico.
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Immune Response Induced by an Immunodominant 60 kDa Glycoprotein of the Cell Wall of Sporothrix schenckii in Two Mice Strains with Experimental Sporotrichosis. J Immunol Res 2016; 2016:6525831. [PMID: 27051673 PMCID: PMC4808653 DOI: 10.1155/2016/6525831] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/21/2016] [Indexed: 12/23/2022] Open
Abstract
Cell wall (CW) components of fungus Sporothrix schenckii are the major inductors antigens of immune responses. The immunodominant 60 kDa glycoprotein (gp60) has been shown to be associated with the virulence of this fungus but its role in experimental sporotrichosis is unknown. In this work, the immunological effects of CW-purified gp60 were investigated in a model of experimental subcutaneous sporotrichosis in normal and gp60-preimmunized C57BL/6 and BALB/c mice strains which were then infected with S. schenckii conidia. Results showed that both mice strains use different cytokine profiles in order to fight S. schenckii infection; C57BL/6 mice seem to use a Th17 response while BALB/c mice tend to depend on a Th1 profile. Preimmunization with gp60 showed a downregulatory effect on the immune response since cytokines levels were diminished in both strains. There were no significant differences in the magnitude of dorsoplantar inflammation between gp60-preimmunized and nonimmunized mice of both strains. However, skin lesions due to the infection in gp60-preimmunized mice were more severe in BALB/c than in C57BL/6 mice, suggesting that the antigen exerts a higher downregulatory effect on the Th1 response.
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Portuondo DL, Batista-Duharte A, Ferreira LS, Martínez DT, Polesi MC, Duarte RA, de Paula E Silva ACA, Marcos CM, Almeida AMFD, Carlos IZ. A cell wall protein-based vaccine candidate induce protective immune response against Sporothrix schenckii infection. Immunobiology 2015; 221:300-9. [PMID: 26547105 DOI: 10.1016/j.imbio.2015.10.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/03/2015] [Accepted: 10/23/2015] [Indexed: 11/24/2022]
Abstract
Sporotrichosis is a subcutaneous mycosis caused by several closely related thermo-dimorphic fungi of the Sporothrix schenckii species complex, affecting humans and other mammals. In the last few years, new strategies have been proposed for controlling sporotrichosis owning to concerns about its growing incidence in humans, cats, and dogs in Brazil, as well as the toxicity and limited efficacy of conventional antifungal drugs. In this study, we assessed the immunogenicity and protective properties of two aluminum hydroxide (AH)-adsorbed S. schenckii cell wall protein (ssCWP)-based vaccine formulations in a mouse model of systemic S. schenckii infection. Fractioning by SDS-PAGE revealed nine protein bands, two of which were functionally characterized: a 44kDa peptide hydrolase and a 47kDa enolase, which was predicted to be an adhesin. Sera from immunized mice recognized the 47kDa enolase and another unidentified 71kDa protein, whereas serum from S. schenckii-infected mice recognized both these proteins plus another unidentified 9.4kDa protein. Furthermore, opsonization with the anti-ssCWP sera led to markedly increased phagocytosis and was able to strongly inhibit the fungus' adhesion to fibroblasts. Immunization with the higher-dose AH-adjuvanted formulation led to increased ex vivo release of IL-12, IFN-γ, IL-4, and IL-17, whereas only IL-12 and IFN-γ were induced by the higher-dose non-adjuvanted formulation. Lastly, passive transference of the higher-dose AH-adjuvanted formulation's anti-ssCWP serum was able to afford in vivo protection in a subsequent challenge with S. schenckii, becoming a viable vaccine candidate for further testing.
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Affiliation(s)
- Deivys Leandro Portuondo
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902, Araraquara, SP, Brazil.
| | - Alexander Batista-Duharte
- Immunotoxicology Laboratory, Toxicology and Biomedicine Center (TOXIMED), Medical Science University, Autopista Nacional Km. 1 1/2CP 90400, AP 4033 Santiago de Cuba, Cuba.
| | - Lucas Souza Ferreira
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902, Araraquara, SP, Brazil.
| | - Damiana Téllez Martínez
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902, Araraquara, SP, Brazil.
| | - Marisa Campos Polesi
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902, Araraquara, SP, Brazil.
| | - Roberta Aparecida Duarte
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902, Araraquara, SP, Brazil.
| | - Ana Carolina Alves de Paula E Silva
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902, Araraquara, SP, Brazil.
| | - Caroline Maria Marcos
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902, Araraquara, SP, Brazil.
| | - Ana Marisa Fusco de Almeida
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902, Araraquara, SP, Brazil.
| | - Iracilda Zeppone Carlos
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902, Araraquara, SP, Brazil.
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Ferreira LS, Gonçalves AC, Portuondo DL, Maia DCG, Placeres MCP, Batista-Duharte A, Carlos IZ. Optimal clearance of Sporothrix schenckii requires an intact Th17 response in a mouse model of systemic infection. Immunobiology 2015; 220:985-92. [PMID: 25776919 DOI: 10.1016/j.imbio.2015.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/20/2015] [Accepted: 02/21/2015] [Indexed: 01/04/2023]
Abstract
The discovery of Th17 cells, along with many other Th cell subsets in the recent years, has expanded the Th1/Th2 paradigm that had persisted since its proposition by Mosmann in 1986. Defined by the characteristic expression of the transcription factor retinoic-related orphan receptor γt (RORγt) and production of IL-17A (IL-17), Th17 cells are powerful inducers of tissue inflammation with a recognized role against extracellular bacteria and fungi. Despite this, the interest in their study came from the pivotal role they play in the development and maintenance of major chronic inflammatory conditions such as multiple sclerosis, rheumatoid arthritis and Crohn's disease, hence they have been the target of promising new anti-Th17 therapies. Accordingly, the identification of opportunistic pathogens whose clearance relies on the Th17 response is of huge prophylactic importance. As shown here for the first time, this applies to Sporothrix schenckii, a thermo-dimorphic fungus and the causative agent of sporotrichosis. Our results show that both Th17 and Th1/Th17 mixed cells are developed during the S. schenckii systemic mice infection, which also leads to augmented production of IL-17 and IL-22. Also, by using an antibody-mediated IL-23 depletion model, we further demonstrate that optimal fungal clearance, but not survival, depends on an intact Th17 response.
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Affiliation(s)
- Lucas Souza Ferreira
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902 Araraquara, SP, Brazil.
| | - Amanda Costa Gonçalves
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902 Araraquara, SP, Brazil.
| | - Deivys Leandro Portuondo
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902 Araraquara, SP, Brazil.
| | - Danielle Cardoso Geraldo Maia
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902 Araraquara, SP, Brazil.
| | - Marisa Campos Polesi Placeres
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902 Araraquara, SP, Brazil.
| | - Alexander Batista-Duharte
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902 Araraquara, SP, Brazil.
| | - Iracilda Zeppone Carlos
- Department of Clinical Analysis, Araraquara's School of Pharmaceutical Sciences, Universidade Estadual Paulista-UNESP, Júlio Mesquita Filho, Rua Expedicionários do Brasil, 1621, Postal Code: 14801-902 Araraquara, SP, Brazil.
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Romo-Lozano Y, Hernández-Hernández F, Salinas E. Sporothrix schenckii yeasts induce ERK pathway activation and secretion of IL-6 and TNF-α in rat mast cells, but no degranulation. Med Mycol 2014; 52:862-8. [DOI: 10.1093/mmy/myu055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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30
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Kusuhara M, Qian H, Li X, Tsuruta D, Tsuchisaka A, Ishii N, Ohata C, Furumura M, Hashimoto T. Mouse bone marrow-derived dendritic cells can phagocytize the Sporothrix schenckii, and mature and activate the immune response by secreting interleukin-12 and presenting antigens to T lymphocytes. J Dermatol 2014; 41:386-92. [PMID: 24750442 DOI: 10.1111/1346-8138.12472] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/18/2014] [Indexed: 11/28/2022]
Abstract
In sporotrichosis, dermal dendritic cells were considered to participate in induction of the immune responses against Sporothrix schenckii infection. However, it is still unclear whether and how dermal dendritic cells were involved in the progress. To clarify the pathogenic role of dermal dendritic cells (DC) in sporotrichosis, we examined the phagocytosis, maturation stages, cytokine production and antigen-presenting ability of mouse bone marrow-derived DC after stimulation with S. schenckii. By analysis of flow cytometry, electron microscope and confocal microscope, mouse bone marrow-derived DC were proved to be able to phagocytize the S. schenckii. The increased expression of CD40, CD80 and CD86 on the surface of S. schenckii-pulsed mouse bone marrow-derived DC was detected by flow cytometer, indicating that the S. schenckii-pulsed mouse bone marrow-derived DC underwent the maturation program. The secretory enhancement of interleukin (IL)-12, but not IL-4, was found in S. schenckii-pulsed mouse bone marrow-derived DC, suggesting the possible activation of T-helper 1 prone immune responses. Furthermore, S. schenckii-pulsed mouse bone marrow-derived DC were demonstrated to be capable of inducing the proliferation of T lymphocytes from BALB/c mice that were pre-sensitized with S. schenckii. Together, all the results implied that dermal DC may participate in the induction of immune responses against S. schenckii infection in sporotrichosis.
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Affiliation(s)
- Masahiro Kusuhara
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan; Kusuhara Dermatology Clinic, Fukuoka, Japan
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