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Melo AM, Poester VR, Trápaga MR, Faria FA, Aquino V, Severo CB, Stevens DA, Veríssimo C, Sabino R, Xavier MO. Aspergillus fumigatus sensu stricto genetic diversity from cystic fibrosis patients. Int J Med Microbiol 2024; 317:151639. [PMID: 39490213 DOI: 10.1016/j.ijmm.2024.151639] [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: 06/24/2024] [Revised: 09/27/2024] [Accepted: 10/17/2024] [Indexed: 11/05/2024] Open
Abstract
We aimed to access the genetic diversity of Apergillus fumigatus strains obtained from cystic fibrosis (CF) patients from southern Brazil. A. fumigatus sensu stricto isolates from respiratory clinical specimens were genotyped by microsatellite markers and azole resistance was evaluated by azole-agar screening. Twenty-seven isolates from twenty-seven patients showed a high genetic diversity, with the differentiation of 25 different genotypes (25 unique and one common to two isolates). All isolates were susceptible to the azoles tested. We believe that prospectively monitoring A. fumigatus genetic diversity is essential to identify interpatient transmission and outbreaks, as is the identification of resistant strains.
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Affiliation(s)
- Aryse Martins Melo
- One Health Disease Control Lab Group, Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
| | - Vanice Rodrigues Poester
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
| | - Mariana Rodrigues Trápaga
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
| | - Fernando Azevedo Faria
- Laboratório de Aves Aquáticas e Tartarugas Marinhas, Instituto de Ciências Biológicas, FURG, Rio Grande, RS, Brazil
| | - Valério Aquino
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - David A Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
| | - Cristina Veríssimo
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases National Institute of Health, Dr. Ricardo Jorge, Lisbon, Portugal
| | - Raquel Sabino
- Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal; Faculdade de Medicina, Instituto de Saúde Ambiental, Universidade de Lisboa, Lisbon, Portugal; Laboratório Associado TERRA-Laboratório para o Uso Sustentável da Terra e dos Serviços dos Ecossistemas, Instituto Superior de Agronomia, Lisbon, Portugal
| | - Melissa Orzechowski Xavier
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande (FURG), Rio Grande, Rio Grande do Sul, Brazil
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2
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Battersby JL, Stevens DA, Coutts RHA, Havlíček V, Hsu JL, Sass G, Kotta-Loizou I. The Expanding Mycovirome of Aspergilli. J Fungi (Basel) 2024; 10:585. [PMID: 39194910 DOI: 10.3390/jof10080585] [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: 06/27/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024] Open
Abstract
Mycoviruses are viruses that infect fungi and are widespread across all major fungal taxa, exhibiting great biological diversity. Since their discovery in the 1960s, researchers have observed a myriad of fungal phenotypes altered due to mycoviral infection. In this review, we examine the nuanced world of mycoviruses in the context of the medically and agriculturally important fungal genus, Aspergillus. The advent of RNA sequencing has revealed a previous underestimate of viral prevalence in fungi, in particular linear single-stranded RNA viruses, and here we outline the diverse viral families known to date that contain mycoviruses infecting Aspergillus. Furthermore, we describe these novel mycoviruses, highlighting those with peculiar genome structures, such as a split RNA dependent RNA polymerase gene. Next, we delineate notable mycovirus-mediated phenotypes in Aspergillus, in particular reporting on observations of mycoviruses that affect their fungal host's virulence and explore how this may relate to virus-mediated decreased stress tolerance. Furthermore, mycovirus effects on microbial competition and antifungal resistance are discussed. The factors that influence the manifestation of these phenotypes, such as temperature, fungal life stage, and infection with multiple viruses, among others, are also evaluated. In addition, we attempt to elucidate the molecular mechanisms that underpin these phenotypes, examining how mycoviruses can be targets, triggers, and even suppressors of RNA silencing and how this can affect fungal gene expression and phenotypes. Finally, we highlight the potential therapeutic applications of mycoviruses and how, in an approach analogous to bacteriophage therapy, their ability to produce hypovirulence in Aspergillus might be used to attenuate invasive aspergillosis infections in humans.
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Affiliation(s)
- Josephine L Battersby
- Department of Life Sciences, Imperial College London, London SW7 2AZ, UK
- Department of Clinical, Pharmaceutical and Biological Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert H A Coutts
- Department of Clinical, Pharmaceutical and Biological Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Vladimír Havlíček
- Institute of Microbiology of the Czech Academy of Sciences, Videnska 1083, 142 00 Prague, Czech Republic
- Department of Analytical Chemistry, Palacky University, 17. Listopadu 2, 779 00 Olomouc, Czech Republic
| | - Joe L Hsu
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gabriele Sass
- California Institute for Medical Research, San Jose, CA 95128, USA
| | - Ioly Kotta-Loizou
- Department of Life Sciences, Imperial College London, London SW7 2AZ, UK
- Department of Clinical, Pharmaceutical and Biological Science, University of Hertfordshire, Hatfield AL10 9AB, UK
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3
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Of Mycelium and Men: Inherent Human Susceptibility to Fungal Diseases. Pathogens 2023; 12:pathogens12030456. [PMID: 36986378 PMCID: PMC10058615 DOI: 10.3390/pathogens12030456] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
In medical mycology, the main context of disease is iatrogenic-based disease. However, historically, and occasionally, even today, fungal diseases affect humans with no obvious risk factors, sometimes in a spectacular fashion. The field of “inborn errors of immunity” (IEI) has deduced at least some of these previously enigmatic cases; accordingly, the discovery of single-gene disorders with penetrant clinical effects and their immunologic dissection have provided a framework with which to understand some of the key pathways mediating human susceptibility to mycoses. By extension, they have also enabled the identification of naturally occurring auto-antibodies to cytokines that phenocopy such susceptibility. This review provides a comprehensive update of IEI and autoantibodies that inherently predispose humans to various fungal diseases.
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4
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Verburg K, van Neer J, Duca M, de Cock H. Novel Treatment Approach for Aspergilloses by Targeting Germination. J Fungi (Basel) 2022; 8:758. [PMID: 35893126 PMCID: PMC9331470 DOI: 10.3390/jof8080758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/03/2022] [Accepted: 07/19/2022] [Indexed: 12/24/2022] Open
Abstract
Germination of conidia is an essential process within the Aspergillus life cycle and plays a major role during the infection of hosts. Conidia are able to avoid detection by the majority of leukocytes when dormant. Germination can cause severe health problems, specifically in immunocompromised people. Aspergillosis is most often caused by Aspergillus fumigatus (A. fumigatus) and affects neutropenic patients, as well as people with cystic fibrosis (CF). These patients are often unable to effectively detect and clear the conidia or hyphae and can develop chronic non-invasive and/or invasive infections or allergic inflammatory responses. Current treatments with (tri)azoles can be very effective to combat a variety of fungal infections. However, resistance against current azoles has emerged and has been increasing since 1998. As a consequence, patients infected with resistant A. fumigatus have a reported mortality rate of 88% to 100%. Especially with the growing number of patients that harbor azole-resistant Aspergilli, novel antifungals could provide an alternative. Aspergilloses differ in defining characteristics, but germination of conidia is one of the few common denominators. By specifically targeting conidial germination with novel antifungals, early intervention might be possible. In this review, we propose several morphotypes to disrupt conidial germination, as well as potential targets. Hopefully, new antifungals against such targets could contribute to disturbing the ability of Aspergilli to germinate and grow, resulting in a decreased fungal burden on patients.
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Affiliation(s)
- Kim Verburg
- Molecular Microbiology, Department of Biology, Faculty of Science, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands; (K.V.); (J.v.N.)
| | - Jacq van Neer
- Molecular Microbiology, Department of Biology, Faculty of Science, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands; (K.V.); (J.v.N.)
| | - Margherita Duca
- Department of Chemical Biology & Drug Discovery, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, The Netherlands;
| | - Hans de Cock
- Molecular Microbiology, Department of Biology, Faculty of Science, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands; (K.V.); (J.v.N.)
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5
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Géry A, Séguin V, Eldin de Pécoulas P, Bonhomme J, Garon D. Aspergilli series Versicolores: importance of species identification in the clinical setting. Crit Rev Microbiol 2022:1-14. [PMID: 35758008 DOI: 10.1080/1040841x.2022.2082267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The moulds of the genus Aspergillus section Nidulantes series Versicolores are ubiquitous and particularly recurrent in indoor air. They are considered present in 70% of the bioaerosols to which we are exposed most of our time spent indoors. With the taxonomic revision proposed in 2012 and the discovery of four new species, the series Versicolores currently includes 18 species. These moulds, although considered as cryptic (except Aspergillus sydowii), are opportunistic pathogens that can exhibit increased minimal inhibitory concentrations to conventional antifungal agents. In this review, we discuss the ecology and clinical implications of each species belonging to the series Versicolores. This survey also highlights the lack of consideration for taxonomic revisions in clinical practice and in scientific studies which greatly limits the acquisition of specific knowledge on species belonging to the series Versicolores.
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Affiliation(s)
- Antoine Géry
- Unicaen and Unirouen, ToxEMAC-ABTE, Centre F. Baclesse, Normandie Univ, Caen, France
| | - Virginie Séguin
- Unicaen and Unirouen, ToxEMAC-ABTE, Centre F. Baclesse, Normandie Univ, Caen, France
| | | | - Julie Bonhomme
- Unicaen and Unirouen, ToxEMAC-ABTE, Centre F. Baclesse, Normandie Univ, Caen, France.,Department of Microbiology, Caen University Hospital, Caen, France
| | - David Garon
- Unicaen and Unirouen, ToxEMAC-ABTE, Centre F. Baclesse, Normandie Univ, Caen, France
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6
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Species Distribution and Antifungal Susceptibilities of
Aspergillus
Section
Fumigati
Isolates in Clinical Samples from the United States. J Clin Microbiol 2022; 60:e0028022. [DOI: 10.1128/jcm.00280-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aspergillus
species are capable of causing both invasive disease and chronic infections in immunocompromised patients or those with preexisting lung conditions.
Aspergillus fumigatus
is the most commonly cultured species, and there is increasing concern regarding resistance to the azoles, which are the mainstays of antifungal therapy against aspergillosis. We evaluated the species distribution and susceptibility profiles of isolates within
Aspergillus
section
Fumigati
in the United States over a 52-month period.
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7
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Subroto E, van Neer J, Valdes I, de Cock H. Growth of Aspergillus fumigatus in Biofilms in Comparison to Candida albicans. J Fungi (Basel) 2022; 8:48. [PMID: 35049988 PMCID: PMC8779434 DOI: 10.3390/jof8010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 12/18/2022] Open
Abstract
Biofilm formation during infections with the opportunistic pathogen Aspergillus fumigatus can be very problematic in clinical settings, since it provides the fungal cells with a protective environment. Resistance against drug treatments, immune recognition as well as adaptation to the host environment allows fungal survival in the host. The exact molecular mechanisms behind most processes in the formation of biofilms are unclear. In general, the formation of biofilms can be categorized roughly in a few stages; adhesion, conidial germination and development of hyphae, biofilm maturation and cell dispersion. Fungi in biofilms can adapt to the in-host environment. These adaptations can occur on a level of phenotypic plasticity via gene regulation. However, also more substantial genetic changes of the genome can result in increased resistance and adaptation in the host, enhancing the survival chances of fungi in biofilms. Most research has focused on the development of biofilms. However, to tackle developing microbial resistance and adaptation in biofilms, more insight in mechanisms behind genetic adaptations is required to predict which defense mechanisms can be expected. This can be helpful in the development of novel and more targeted antifungal treatments to combat fungal infections.
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Affiliation(s)
| | | | | | - Hans de Cock
- Molecular Microbiology Laboratory, Department of Biology, Faculty of Science, Utrecht University, Padualaan 8, 3584 CH Utrecht, The Netherlands; (E.S.); (J.v.N.); (I.V.)
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8
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Sass G, Nazik H, Chatterjee P, Shrestha P, Groleau MC, Déziel E, Stevens DA. Altered Pseudomonas Strategies to Inhibit Surface Aspergillus Colonies. Front Cell Infect Microbiol 2021; 11:734296. [PMID: 34746024 PMCID: PMC8570168 DOI: 10.3389/fcimb.2021.734296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/17/2021] [Indexed: 01/23/2023] Open
Abstract
Pseudomonas aeruginosa and Aspergillus fumigatus infections frequently co-localize in lungs of immunocompromised patients and individuals with cystic fibrosis (CF). The antifungal activity of P. aeruginosa has been described for its filtrates. Pyoverdine and pyocyanin are the principal antifungal P. aeruginosa molecules active against A. fumigatus biofilm metabolism present in iron-limited or iron-replete planktonic P. aeruginosa culture filtrates, respectively. Using various P. aeruginosa laboratory wild-type strains (PA14, PAO1, PAK), we found antifungal activity against Aspergillus colonies on agar. Comparing 36 PA14 and 7 PAO1 mutants, we found that mutants lacking both major siderophores, pyoverdine and pyochelin, display higher antifungal activity on agar than their wild types, while quorum sensing mutants lost antifungal activity. Addition of ferric iron, but not calcium or magnesium, reduced the antifungal effects of P. aeruginosa on agar, whereas iron-poor agar enhanced antifungal effects. Antifungal activity on agar was mediated by PQS and HHQ, via MvfR. Among the MvfR downstream factors, rhamnolipids and elastase were produced in larger quantities by pyoverdine–pyochelin double mutants and showed antifungal activity on agar. In summary, antifungal factors produced by P. aeruginosa on agar differ from those produced by bacteria grown in liquid cultures, are dependent on quorum sensing, and are downregulated by the availability of ferric iron. Rhamnolipids and elastase seem to be major mediators of Pseudomonas’ antifungal activity on a solid surface.
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Affiliation(s)
- Gabriele Sass
- Infectious Disease Research Laboratory, San Jose, CA, United States
| | - Hasan Nazik
- Infectious Disease Research Laboratory, San Jose, CA, United States
| | | | - Pallabi Shrestha
- Infectious Disease Research Laboratory, San Jose, CA, United States
| | - Marie-Christine Groleau
- Centre Armand-Frappier Santé Biotechnologie, Institute National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - Eric Déziel
- Centre Armand-Frappier Santé Biotechnologie, Institute National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - David A Stevens
- Infectious Disease Research Laboratory, San Jose, CA, United States.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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9
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McLean SA, Cullen L, Gardam DJ, Schofield CJ, Laucirica DR, Sutanto EN, Ling KM, Stick SM, Peacock CS, Kicic A, Garratt LW. Cystic Fibrosis Clinical Isolates of Aspergillus fumigatus Induce Similar Muco-inflammatory Responses in Primary Airway Epithelial Cells. Pathogens 2021; 10:pathogens10081020. [PMID: 34451484 PMCID: PMC8399118 DOI: 10.3390/pathogens10081020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022] Open
Abstract
Aspergillus is increasingly associated with lung inflammation and mucus plugging in early cystic fibrosis (CF) disease during which conidia burden is low and strains appear to be highly diverse. It is unknown whether clinical Aspergillus strains vary in their capacity to induce epithelial inflammation and mucus production. We tested the hypothesis that individual colonising strains of Aspergillus fumigatus would induce different responses. Ten paediatric CF Aspergillus isolates were compared along with two systemically invasive clinical isolates and an ATCC reference strain. Isolates were first characterised by ITS gene sequencing and screened for antifungal susceptibility. Three clusters (A-C) of Aspergillus isolates were identified by ITS. Antifungal susceptibility was variable, particularly for itraconazole. Submerged CF and non-CF monolayers as well as differentiated primary airway epithelial cell cultures were incubated with conidia for 24 h to allow germination. None of the clinical isolates were found to significantly differ from one another in either IL-6 or IL-8 release or gene expression of secretory mucins. Clinical Aspergillus isolates appear to be largely homogenous in their mucostimulatory and immunostimulatory capacities and, therefore, only the antifungal resistance characteristics are likely to be clinically important.
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Affiliation(s)
- Samantha A. McLean
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Crawley 6009, Australia; (S.A.M.); (C.J.S.); (D.R.L.); (E.N.S.); (K.-M.L.); (S.M.S.); (A.K.)
| | - Leilani Cullen
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley 6009, Australia; (L.C.); (C.S.P.)
| | - Dianne J. Gardam
- PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch 6150, Australia;
| | - Craig J. Schofield
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Crawley 6009, Australia; (S.A.M.); (C.J.S.); (D.R.L.); (E.N.S.); (K.-M.L.); (S.M.S.); (A.K.)
| | - Daniel R. Laucirica
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Crawley 6009, Australia; (S.A.M.); (C.J.S.); (D.R.L.); (E.N.S.); (K.-M.L.); (S.M.S.); (A.K.)
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley 6009, Australia; (L.C.); (C.S.P.)
| | - Erika N. Sutanto
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Crawley 6009, Australia; (S.A.M.); (C.J.S.); (D.R.L.); (E.N.S.); (K.-M.L.); (S.M.S.); (A.K.)
| | - Kak-Ming Ling
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Crawley 6009, Australia; (S.A.M.); (C.J.S.); (D.R.L.); (E.N.S.); (K.-M.L.); (S.M.S.); (A.K.)
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley 6009, Australia; (L.C.); (C.S.P.)
| | - Stephen M. Stick
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Crawley 6009, Australia; (S.A.M.); (C.J.S.); (D.R.L.); (E.N.S.); (K.-M.L.); (S.M.S.); (A.K.)
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley 6009, Australia; (L.C.); (C.S.P.)
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Nedlands 6009, Australia
| | - Christopher S. Peacock
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley 6009, Australia; (L.C.); (C.S.P.)
| | - Anthony Kicic
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Crawley 6009, Australia; (S.A.M.); (C.J.S.); (D.R.L.); (E.N.S.); (K.-M.L.); (S.M.S.); (A.K.)
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley 6009, Australia; (L.C.); (C.S.P.)
- Department of Respiratory and Sleep Medicine, Perth Children’s Hospital, Nedlands 6009, Australia
- Occupation and Environment, School of Public Health, Curtin University, Bentley 6102, Australia
| | - Luke W. Garratt
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Crawley 6009, Australia; (S.A.M.); (C.J.S.); (D.R.L.); (E.N.S.); (K.-M.L.); (S.M.S.); (A.K.)
- Correspondence:
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10
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Vasconcellos I, Silveira J, Severo C, Allende O, Pasqualotto A. A search for cryptic Aspergillus species in South Brazil. Rev Iberoam Micol 2021; 38:154. [PMID: 34247935 DOI: 10.1016/j.riam.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/16/2021] [Accepted: 04/14/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Izadora Vasconcellos
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Juliano Silveira
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cecília Severo
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Odelta Allende
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Alessandro Pasqualotto
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
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11
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Sass G, Miller Conrad LC, Nguyen TTH, Stevens DA. The Pseudomonas aeruginosa product pyochelin interferes with Trypanosoma cruzi infection and multiplication in vitro. Trans R Soc Trop Med Hyg 2021; 114:492-498. [PMID: 32193540 DOI: 10.1093/trstmh/trz136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/09/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Bacteria are sources of numerous molecules used in treatment of infectious diseases. We investigated effects of molecules produced by 26 Pseudomonas aeruginosa strains against infection of mammalian cell cultures with Trypanosoma cruzi, the aetiological agent of Chagas disease. METHODS Vero cells were infected with T. cruzi in the presence of wild-type P. aeruginosa supernatants or supernatants of mutants with defects in the production of various virulence, quorum sensing and iron acquisition factors. Quantification of T. cruzi infection (percentage of infected cells) and multiplication (number of amastigotes per infected cell) was performed and cell viability was determined. RESULTS Wild-type P. aeruginosa products negatively affected T. cruzi infection and multiplication in a dose-dependent manner, without evident toxicity for mammalian cells. PvdD/pchE mutation (loss of the P. aeruginosa siderophores pyoverdine and pyochelin) had the greatest impact on anti-T. cruzi activity. Negative effects on T. cruzi infection by pure pyochelin, but not pyoverdine, or other P. aeruginosa exoproducts studied, were quantitatively similar to the effects of benznidazole, the current standard therapy against T. cruzi. CONCLUSIONS The P. aeruginosa product pyochelin showed promising activity against T. cruzi and might become a new lead molecule for therapy development.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, CA 95128, USA
| | | | | | - David A Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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12
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Nazik H, Sass G, Williams P, Déziel E, Stevens DA. Molecular Modifications of the Pseudomonas Quinolone Signal in the Intermicrobial Competition with Aspergillus. J Fungi (Basel) 2021; 7:jof7050343. [PMID: 33925067 PMCID: PMC8146305 DOI: 10.3390/jof7050343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 02/03/2023] Open
Abstract
The Pseudomonas quinolone signal (PQS) is an important quorum-sensing molecule for Pseudomonas aeruginosa that regulates virulence factors, chelates iron, and is an important factor in interactions with eukaryotes, including fungi and mammalian hosts. It was previously shown to inhibit or boost Aspergillus, depending on the milieu iron concentration. We studied several molecular modifications of the PQS molecule, and their effects on Aspergillus biofilm metabolism and growth in vitro, and the effects of iron supplementation. We found that most molecules inhibited Aspergillus at concentrations similar to that of PQS, but with relatively flat dose-responses, and all were less potent than PQS. The inhibition was reversible by iron, suggesting interference with fungal iron metabolism. Stimulation of Aspergillus was not noted. We conclude that the critical Aspergillus-inhibiting moeities of the PQS molecule were partially, but not completely, interfered with by molecular modifications at several sites on the PQS molecule. The mechanism, as with PQS, appears to relate to fungal iron metabolism.
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Affiliation(s)
- Hasan Nazik
- Infectious Diseases Research Laboratory, California Institute for Medical Research, San Jose, CA 95128, USA; (H.N.); (G.S.)
| | - Gabriele Sass
- Infectious Diseases Research Laboratory, California Institute for Medical Research, San Jose, CA 95128, USA; (H.N.); (G.S.)
| | - Paul Williams
- Biodiscovery Institute and School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Eric Déziel
- Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC H7V 1B7, Canada;
| | - David A. Stevens
- Infectious Diseases Research Laboratory, California Institute for Medical Research, San Jose, CA 95128, USA; (H.N.); (G.S.)
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-408-998-4554
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Simões D, Aranha Caetano L, Veríssimo C, Viegas C, Sabino R. Aspergillus collected in specific indoor settings: their molecular identification and susceptibility pattern. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:248-257. [PMID: 31405297 DOI: 10.1080/09603123.2019.1650903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
Exposure to Aspergillus conidia is an increased risk factor for the development of respiratory symptoms. The emergence of azole resistance in Aspergillus fumigatus is a major concern for the scientific community. The aim of this study was to perform the molecular identification of Aspergillus species collected from different occupational and non-occupational indoor settings and to study the azole susceptibility profile of the collected Fumigati isolates. The selected Aspergillus isolates were identified as belonging to the sections Fumigati, Nigri Versicolores, Terrei, Clavati and Nidulantes. All the Aspergillus fumigatus were screened for azole resistance using an agar media supplemented with itraconazole, voriconazole and posaconazole. None of the tested isolates showed resistance to those azoles. Knowledge of Aspergillus epidemiology in specific indoor environments allows a better risk characterization regarding Aspergillus burden. This study allowed the analysis of the molecular epidemiology and the determination of the susceptibility pattern of Aspergillus section Fumigati found in the studied indoor settings.
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Affiliation(s)
- Daniela Simões
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge , Lisbon, Portugal
- Animal Biology Department, Faculty of Sciences of the University of Lisbon , Campo Grande, Lisbon, Portugal
| | - Liliana Aranha Caetano
- H&TRC- Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa , Lisbon, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon. Avenida Professor Gama Pinto , Lisbon, Portugal
| | - Cristina Veríssimo
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge , Lisbon, Portugal
| | - Carla Viegas
- H&TRC- Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa , Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa , Lisbon, Portugal
| | - Raquel Sabino
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge , Lisbon, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa , Lisbon, Portugal
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Curran AK, Hava DL. Allergic Diseases Caused by Aspergillus Species in Patients with Cystic Fibrosis. Antibiotics (Basel) 2021; 10:antibiotics10040357. [PMID: 33800658 PMCID: PMC8067098 DOI: 10.3390/antibiotics10040357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 01/04/2023] Open
Abstract
Aspergillus spp. are spore forming molds; a subset of which are clinically relevant to humans and can cause significant morbidity and mortality. A. fumigatus causes chronic infection in patients with chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). In patients with CF, A. fumigatus infection can lead to allergic disease, such as allergic bronchopulmonary aspergillosis (ABPA) which is associated with high rates of hospitalizations for acute exacerbations and lower lung function. ABPA results from TH2 immune response to Aspergillus antigens produced during hyphal growth, marked by high levels of IgE and eosinophil activation. Clinically, patients with ABPA experience difficulty breathing; exacerbations of disease and are at high risk for bronchiectasis and lung fibrosis. Oral corticosteroids are used to manage aspects of the inflammatory response and antifungal agents are used to reduce fungal burden and lower the exposure to fungal antigens. As the appreciation for the severity of fungal infections has grown, new therapies have emerged that aim to improve treatment and outcomes for patients with CF.
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Affiliation(s)
| | - David L. Hava
- Synlogic Inc., 301 Binney Street, Cambridge, MA 02142, USA
- Correspondence:
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15
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The Environmental Spread of Aspergillus terreus in Tyrol, Austria. Microorganisms 2021; 9:microorganisms9030539. [PMID: 33808004 PMCID: PMC7998223 DOI: 10.3390/microorganisms9030539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
Fungal infections due to Aspergillus species have become a major cause of morbidity and mortality among immunocompromised patients. At the Medical University of Innsbruck, A. terreus and related species are the second most common causative agents of aspergillosis. In this one-year study we collected environmental samples to investigate (i) the environmental distribution, (ii) the ecological niche of A. terreus in Tyrol, (iii) the genetic relatedness of environmental and clinical isolates and the correlation between those two groups of isolates, and (iv) the antifungal susceptibility patterns. A. terreus was present in 5.4% of 3845 environmental samples, with a significantly higher frequency during winter (6.8%) than summer (3.9%). An increased A. terreus abundance in Tyrol’s Eastern part was detected which is in agreement with the proof of clinical cases. In total, 92% of environmental and 98% of clinical A. terreus isolates were amphotericin B resistant; 22.6% and 9.8% were resistant against posaconazole. Overall, 3.9% of clinical isolates were resistant against voriconazole. Short tandem repeat analysis identified three major genotypes persisting in Tyrol. Soil from agricultural cornfields seems to be an important source; the environmental frequency of A. terreus correlates with the high incidence of A. terreus infections in certain geographical areas.
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16
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Sass G, Nazik H, Chatterjee P, Stevens DA. Under nonlimiting iron conditions pyocyanin is a major antifungal molecule, and differences between prototypic Pseudomonas aeruginosa strains. Med Mycol 2020; 59:453-464. [PMID: 32827431 DOI: 10.1093/mmy/myaa066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 01/09/2023] Open
Abstract
Airways of immunocompromised patients, or individuals with cystic fibrosis (CF), are common ground for Pseudomonas aeruginosa and Aspergillus fumigatus infections. Hence, in such a microenvironment both pathogens compete for resources. While under limiting iron conditions the siderophore pyoverdine is the most effective antifungal P. aeruginosa product, we now provide evidence that under nonlimiting iron conditions P. aeruginosa supernatants lack pyoverdine but still possess considerable antifungal activity. Spectrometric analyses of P. aeruginosa supernatants revealed the presence of phenazines, such as pyocyanin, only under nonlimiting iron conditions. Supernatants of quorum sensing mutants of strain PA14, defective in phenazine production, as well as supernatants of the P. aeruginosa strain PAO1, lacked pyocyanin, and were less inhibitory toward A. fumigatus biofilms under nonlimiting iron conditions. When blood as a natural source of iron was present during P. aeruginosa supernatant production, pyoverdine was absent, and phenazines, including pyocyanin, appeared, resulting in an antifungal effect on A. fumigatus biofilms. Pure pyocyanin reduced A. fumigatus biofilm metabolism. In summary, P. aeruginosa has mechanisms to compete with A. fumigatus under limiting and non-limiting iron conditions, and can switch from iron-denial-based to toxin-based antifungal activity. This has implications for the evolution of the microbiome in clinical settings where the two pathogens co-exist. Important differences in the iron response of P. aeruginosa laboratory strains PA14 and PAO1 were also uncovered.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, California, USA
| | - Hasan Nazik
- California Institute for Medical Research, San Jose, California, USA
| | | | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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17
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Nazik H, Sass G, Déziel E, Stevens DA. Aspergillus Is Inhibited by Pseudomonas aeruginosa Volatiles. J Fungi (Basel) 2020; 6:jof6030118. [PMID: 32722412 PMCID: PMC7557479 DOI: 10.3390/jof6030118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Pseudomonas aeruginosa (Pa) and Aspergillus fumigatus (Af) compete with each other for nutrients and survival in natural environments, and have been extensively studied because of their intermicrobial interactions in the human microbiome. These are the principal microbes infecting immunocompromised patients and persons with cystic fibrosis, particularly the airways. These intermicrobial studies have largely been conducted in liquid medium or on agar, and thus focus on soluble or diffusible microbial products. Several key inhibitory molecules were defined in such studies. Methods: in the present report, we examine several methodologies which can be conveniently used to study the interaction of microbial volatiles, including capture methods and kinetics. Results: Pa volatiles inhibit Af, and the inhibitory mechanism appears to be the incorporation of the inhibitory molecules into the substrate nourishing the Af, rather than directly onto Af structures. We define by mass spectroscopy some specific volatile Pa products that can inhibit Af. Some of these molecules are selected for interest by the study of gene deletion mutants, producing a few Pa strains that were impaired in inhibition. We presumed the volatiles of these latter strains could be excluded from the search for inhibitors. Conclusion: the Pa inhibition of Af via a gaseous phase could be critical components in their competition, particularly in airways, where more direct contact may not be extensive.
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Affiliation(s)
- Hasan Nazik
- California Institute for Medical Research, San Jose, CA 95128, USA; (H.N.); (G.S.)
| | - Gabriele Sass
- California Institute for Medical Research, San Jose, CA 95128, USA; (H.N.); (G.S.)
| | - Eric Déziel
- Institut National de la Recherche Scientifique, Institut Armand-Frappier, Laval, QC H7V 1B7, Canada;
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA; (H.N.); (G.S.)
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-408-998-4554
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18
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A Novel Combination of CYP51A Mutations Confers Pan-Azole Resistance in Aspergillus fumigatus. Antimicrob Agents Chemother 2020; 64:AAC.02501-19. [PMID: 32423948 DOI: 10.1128/aac.02501-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/25/2020] [Indexed: 01/25/2023] Open
Abstract
The treatment of invasive and chronic aspergillosis involves triazole drugs. Its intensive use has resulted in the selection of resistant isolates, and at present, azole resistance in Aspergillus fumigatus is considered an emerging threat to public health worldwide. The aim of this work is to uncover the molecular mechanism implicated in the azole resistance phenotype of three Aspergillus fumigatus clinical strains isolated from an Argentinian cystic fibrosis patient under long-term triazole treatment. Strain susceptibilities were assessed, and CYP51A gene sequences were analyzed. Two of the studied Aspergillus fumigatus strains harbored the TR34-L98H allele. These strains showed high MIC values for all tested triazoles (>16.00 μg/ml, 1.00 μg/ml, 1.00 μg/ml, and 2.00 μg/ml for itraconazole, isavuconazole, posaconazole, and voriconazole, respectively). The third strain had a novel amino acid change (R65K) combined with the TR34-L98H mutations. This new mutation combination induces a pan-azole MIC augment compared with TR34-L98H mutants (>16 μg/ml, 4.00 μg/ml, 4.00 μg/ml, and 8.00 μg/ml for itraconazole, isavuconazole, posaconazole, and voriconazole, respectively). The strain harboring the TR34-R65K-L98H allele showed no inhibition halo when voriconazole susceptibility was evaluated by disk diffusion. The effect of these mutations in the azole-resistant phenotype was confirmed by gene replacement experiments. Transformants harboring the TR34-L98H and TR34-R65K-L98H alleles mimicked the azole-resistant phenotype of the clinical isolates, while the incorporation of the TR34-R65K and R65K alleles did not significantly increase azole MIC values. This is the first report of the TR34-L98H allele in Argentina. Moreover, a novel CYP51A allele (TR34-R65K-L98H) that induces a pan-azole MIC augment is described.
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19
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Chatterjee P, Sass G, Swietnicki W, Stevens DA. Review of Potential Pseudomonas Weaponry, Relevant to the Pseudomonas-Aspergillus Interplay, for the Mycology Community. J Fungi (Basel) 2020; 6:jof6020081. [PMID: 32517271 PMCID: PMC7345761 DOI: 10.3390/jof6020081] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022] Open
Abstract
Pseudomonas aeruginosa is one of the most prominent opportunistic bacteria in airways of cystic fibrosis patients and in immunocompromised patients. These bacteria share the same polymicrobial niche with other microbes, such as the opportunistic fungus Aspergillus fumigatus. Their inter-kingdom interactions and diverse exchange of secreted metabolites are responsible for how they both fare in competition for ecological niches. The outcomes of their contests likely determine persistent damage and degeneration of lung function. With a myriad of virulence factors and metabolites of promising antifungal activity, P. aeruginosa products or their derivatives may prove useful in prophylaxis and therapy against A. fumigatus. Quorum sensing underlies the primary virulence strategy of P. aeruginosa, which serves as cell–cell communication and ultimately leads to the production of multiple virulence factors. Understanding the quorum-sensing-related pathogenic mechanisms of P. aeruginosa is a first step for understanding intermicrobial competition. In this review, we provide a basic overview of some of the central virulence factors of P. aeruginosa that are regulated by quorum-sensing response pathways and briefly discuss the hitherto known antifungal properties of these virulence factors. This review also addresses the role of the bacterial secretion machinery regarding virulence factor secretion and maintenance of cell–cell communication.
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Affiliation(s)
- Paulami Chatterjee
- California Institute for Medical Research, San Jose, CA 95128, USA; (P.C.); (G.S.)
| | - Gabriele Sass
- California Institute for Medical Research, San Jose, CA 95128, USA; (P.C.); (G.S.)
| | - Wieslaw Swietnicki
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-114 Wroclaw, Poland;
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA; (P.C.); (G.S.)
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-408-998-4554
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20
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Filippou C, Coutts RHA, Stevens DA, Sabino R, Kotta-Loizou I. Completion of the sequence of the Aspergillus fumigatus partitivirus 1 genome. Arch Virol 2020; 165:1891-1894. [PMID: 32458177 PMCID: PMC7351820 DOI: 10.1007/s00705-020-04660-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/12/2020] [Indexed: 11/26/2022]
Abstract
A Portuguese isolate of Aspergillus fumigatus was found to contain three double-stranded (ds) RNA elements ranging in size from 1.1 to 1.8 kbp and comprising the genome of a strain of Aspergillus fumigatus partitivirus 1 (AfuPV-1) previously thought to contain only the two largest dsRNA elements. The sequence of the smallest dsRNA element is described here, completing the sequence of the AfuPV-1 genome. Sequence analysis of the element revealed an open reading frame encoding a protein of unknown function similar in size and distantly related to elements previously identified in other members of the family Partitiviridae.
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Affiliation(s)
- Charalampos Filippou
- Department of Biological and Environmental Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Robert H A Coutts
- Department of Biological and Environmental Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - David A Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
- California Institute for Medical Research, San Jose, California, USA
| | - Raquel Sabino
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Ioly Kotta-Loizou
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London, UK.
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21
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Fungal Infections and ABPA. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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A Peculiar Case of Pneumonia due to Mycoplasma pneumoniae in a Child with Cystic Fibrosis and Sensibilization to Aspergillus fumigatus. Pathogens 2019; 9:pathogens9010015. [PMID: 31877884 PMCID: PMC7168586 DOI: 10.3390/pathogens9010015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 12/29/2022] Open
Abstract
Aspergillus fumigatus plays a major role in pulmonary exacerbations in patients with cystic fibrosis. The most common A. fumigatus diseases are those based on immune-mediated response to A. fumigatus antigens; including allergic bronchopulmonary aspergillosis (ABPA). In this condition; the presence of A. fumigatus in the lower respiratory tract triggers an IgE-mediated hypersensitivity response that causes airway inflammation; bronchospasms; and bronchiectasis. This case report describes a ten-year-old male patient suffering from cystic fibrosis (CF) in whom the diagnosis of ABPA occurred in association with pneumonia due to Mycoplasma pneumoniae more than two weeks after hospitalization. This case is a good example of how difficult the identification of ABPA in CF patients can be and highlights that ABPA can occur in association with co-infections due to other pathogens. In order to avoid the risk of a late ABPA diagnosis, it is imperative that the diagnostic criteria guidelines are reviewed and standardized.
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23
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Nazik H, Sass G, Ansari SR, Ertekin R, Haas H, Déziel E, Stevens DA. Novel intermicrobial molecular interaction: Pseudomonas aeruginosa Quinolone Signal (PQS) modulates Aspergillus fumigatus response to iron. MICROBIOLOGY-SGM 2019; 166:44-55. [PMID: 31778108 DOI: 10.1099/mic.0.000858] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Pseudomonas aeruginosa (Pa) and Aspergillus fumigatus (Af), the commonest bacterium and fungus in compromised host airways, compete for iron (Fe). The Pseudomonas quinolone signal (PQS), a Pa quorum sensing molecule, also chelates Fe, and delivers Fe to the Pa cell membrane using Pa siderophores. In models of Af biofilm formation or preformed biofilms, PQS inhibited Af in a low Fe environment. AfΔsidA (mutant unable to produce siderophores) biofilm was more sensitive to PQS inhibition than wild-type (WT), as was planktonic AfΔsidA growth. PQS decreased WT Af growth on agar. All these inhibitory actions were reversed by Fe. The Pa siderophore pyoverdin, or Af siderophore inhibitor celastrol, act cooperatively with PQS in Af inhibition. These findings all indicate PQS inhibition is owing to Fe chelation. Remarkably, in high Fe environments, PQS enhanced Af biofilm at 1/100 to 1/2000 Fe concentration required for Fe alone to enhance. Planktonic Af growth, and on agar, Af conidiation, were also enhanced by PQS+Fe compared to Fe alone. In contrast, neither AfΔsidA biofilm, nor planktonic AfΔsidA, were enhanced by PQS-Fe compared to Fe. When Af siderophore ferricrocin (FC),+PQS, were added to AfΔsidA, Af was then boosted more than by FC alone. Moreover, FC+PQS+Fe boosted AfΔsidA more than Fe, FC, FC+Fe, PQS+FC or PQS+Fe. Thus PQS-Fe maximal stimulation requires Af siderophores. PQS inhibits Af via chelation under low Fe conditions. In a high Fe environment, PQS paradoxically stimulates Af efficiently, and this involves Af siderophores. PQS production by Pa could stimulate Af in cystic fibrosis airways, where Fe homeostasis is altered and Fe levels increase, supporting fungal growth.
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Affiliation(s)
- Hasan Nazik
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.,California Institute for Medical Research, San Jose, CA, USA
| | - Gabriele Sass
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.,California Institute for Medical Research, San Jose, CA, USA
| | - Shajia R Ansari
- California Institute for Medical Research, San Jose, CA, USA
| | - Reyhan Ertekin
- California Institute for Medical Research, San Jose, CA, USA
| | - Hubertus Haas
- Division of Molecular Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Eric Déziel
- INRS-Institut Armand-Frappier, Laval, Quebec, Canada
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Iron: an essential nutrient for Aspergillus fumigatus and a fulcrum for pathogenesis. Curr Opin Infect Dis 2019; 31:506-511. [PMID: 30379731 DOI: 10.1097/qco.0000000000000487] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Aspergillus fumigatus is a ubiquitous saprophytic fungus that can cause life-threatening invasive aspergillosis in immunocompromised patients. Apart from the immune status of the host only a few characterized virulence factors have been identified. In this review, we describe the role of iron in the manifestation of A. fumigatus virulence. RECENT FINDINGS We gathered recent clinical evidence suggesting that tissue iron overload increases the risk of invasive aspergillosis occurrence. Furthermore, we summarize the mechanisms that A. fumigatus employs to achieve iron homeostasis and their importance in A. fumigatus proliferation in vitro. We describe two recent in-vivo models that clearly demonstrate the importance of iron in A. fumigatus growth and invasion. SUMMARY Based on these recent findings, therapy aimed at managing A. fumigatus iron homeostasis locally could make conditions more favorable to the host.
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25
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The Human Lung Mycobiome in Chronic Respiratory Disease: Limitations of Methods and Our Current Understanding. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00347-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Sass G, Ansari SR, Dietl AM, Déziel E, Haas H, Stevens DA. Intermicrobial interaction: Aspergillus fumigatus siderophores protect against competition by Pseudomonas aeruginosa. PLoS One 2019; 14:e0216085. [PMID: 31067259 PMCID: PMC6505954 DOI: 10.1371/journal.pone.0216085] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/12/2019] [Indexed: 12/27/2022] Open
Abstract
Pseudomonas aeruginosa and Aspergillus fumigatus are pathogens frequently co-inhabiting immunocompromised patient airways, particularly in people with cystic fibrosis. Both microbes depend on the availability of iron, and compete for iron in their microenvironment. We showed previously that the P. aeruginosa siderophore pyoverdine is the main instrument in battling A. fumigatus biofilms, by iron chelation and denial of iron to the fungus. Here we show that A. fumigatus siderophores defend against anti-fungal P. aeruginosa effects. P. aeruginosa supernatants produced in the presence of wildtype A. fumigatus planktonic supernatants (Afsup) showed less activity against A. fumigatus biofilms than P. aeruginosa supernatants without Afsup, despite higher production of pyoverdine by P. aeruginosa. Supernatants of A. fumigatus cultures lacking the sidA gene (AfΔsidA), unable to produce hydroxamate siderophores, were less capable of protecting A. fumigatus biofilms from P. aeruginosa supernatants and pyoverdine. AfΔsidA biofilm was more sensitive towards inhibitory effects of pyoverdine, the iron chelator deferiprone (DFP), or amphothericin B than wildtype A. fumigatus biofilm. Supplementation of sidA-deficient A. fumigatus biofilm with A. fumigatus siderophores restored resistance to pyoverdine. The A. fumigatus siderophore production inhibitor celastrol sensitized wildtype A. fumigatus biofilms towards the anti-fungal activity of DFP. In conclusion, A. fumigatus hydroxamate siderophores play a pivotal role in A. fumigatus competition for iron against P. aeruginosa.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, California, United States of America
- * E-mail:
| | - Shajia R. Ansari
- California Institute for Medical Research, San Jose, California, United States of America
| | - Anna-Maria Dietl
- Division of Molecular Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Eric Déziel
- INRS-Institut Armand-Frappier, Laval, Quebec, Canada
| | - Hubertus Haas
- Division of Molecular Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - David A. Stevens
- California Institute for Medical Research, San Jose, California, United States of America
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
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27
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Sass G, Nazik H, Penner J, Shah H, Ansari SR, Clemons KV, Groleau MC, Dietl AM, Visca P, Haas H, Déziel E, Stevens DA. Aspergillus-Pseudomonas interaction, relevant to competition in airways. Med Mycol 2019; 57:S228-S232. [PMID: 30816973 DOI: 10.1093/mmy/myy087] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/06/2018] [Indexed: 12/29/2022] Open
Abstract
In airways of immunocompromised patients and individuals with cystic fibrosis, Pseudomonas aeruginosa and Aspergillus fumigatus are the most common opportunistic bacterial and fungal pathogens. Both pathogens form biofilms and cause acute and chronic illnesses. Previous studies revealed that P. aeruginosa is able to inhibit A. fumigatus biofilms in vitro. While numerous P. aeruginosa molecules have been shown to affect A. fumigatus, there never has been a systematic approach to define the principal causative agent. We studied 24 P. aeruginosa mutants, with deletions in genes important for virulence, iron acquisition, or quorum sensing, for their ability to interfere with A. fumigatus biofilms. Cells, planktonic or biofilm culture filtrates of four P. aeruginosa mutants, pvdD-pchE-, pvdD-, lasR-rhlR-, and lasR-, inhibited A. fumigatus biofilm metabolism or planktonic A. fumigatus growth significantly less than P. aeruginosa wild type. The common defect of these four mutants was a lack in the production of the P. aeruginosa siderophore pyoverdine. Pure pyoverdine affected A. fumigatus biofilm metabolism, and restored inhibition by the above mutants. In lungs from cystic fibrosis patients, pyoverdine production and antifungal activity correlated. The key inhibitory mechanism for pyoverdine was iron-chelation and denial of iron to A. fumigatus. Further experiments revealed a counteracting, self-protective mechanism by A. fumigatus, based on A. fumigatus siderophore production.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, California, USA
| | - Hasan Nazik
- California Institute for Medical Research, San Jose, California, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Microbiology, Istanbul University, Istanbul, Turkey
| | - John Penner
- California Institute for Medical Research, San Jose, California, USA
| | - Hemi Shah
- California Institute for Medical Research, San Jose, California, USA
| | - Shajia R Ansari
- California Institute for Medical Research, San Jose, California, USA
| | - Karl V Clemons
- California Institute for Medical Research, San Jose, California, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Anna-Maria Dietl
- Division of Molecular Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Paolo Visca
- Department of Sciences, Roma Tre University, Rome, Italy
| | - Hubertus Haas
- Division of Molecular Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Eric Déziel
- INRS-Institut Armand-Frappier, Laval, Quebec, Canada
| | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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28
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Melloul E, Roisin L, Durieux MF, Woerther PL, Jenot D, Risco V, Guillot J, Dannaoui E, Decousser JW, Botterel F. Interactions of Aspergillus fumigatus and Stenotrophomonas maltophilia in an in vitro Mixed Biofilm Model: Does the Strain Matter? Front Microbiol 2018; 9:2850. [PMID: 30542331 PMCID: PMC6277776 DOI: 10.3389/fmicb.2018.02850] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/06/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction:Aspergillus fumigatus (Af) and Stenotrophomonas maltophilia (Sm) are pathogenic microorganisms, which coexist in the respiratory tract of cystic fibrosis (CF) patients. We recently developed an in vitro model of mixed biofilm associating Af ATCC 13073-GFP (Af13073) and Sm ATCC 13637 (Sm13637) and described an antibiosis effect. The present study aim was to assess the antibiosis of Sm on Af using different strains and to analyze the potential synergistic virulence of these strains in an in vivo Galleria mellonella model. Methods: The effect of Sm13637 was evaluated on eight Af strains and the effect of nine Sm strains was evaluated on Af13073. The strains originated from clinical cases (human and animal) and from environment. Fungal and bacterial inocula were simultaneously inoculated to initiate mixed biofilm formation. Fungal growth inhibition was analyzed by qPCR and CLSM and the fungal cell wall modifications by TEM analysis. The virulence of different Sm strains was assessed in association with Af in G. mellonella larvae. Results: All strains of Af and Sm were able to produce single and mixed biofilms. The antibiosis effect of Sm13637 was similar whatever the Af strain tested. On the other hand, the antibiosis effect of Sm strains was bacterial-fitness and strain dependent. One strain (1/9) originated from animal clinical case was never able to induce an antibiosis, even with high bacterial concentration. In the G. mellonella model, co-inoculation with Sm13637 and Af13073 showed synergism since the mortality was 50%, i.e., more than the summed virulence of both. Conclusion: Human clinical strains of Sm yielded in higher antibiosis effect on Af and in a thinner mixed biofilm, probably due to an adaptive effect of these strains. Further research covering Af increased wall thickness in the presence of Sm strains, and its correlation with modified antifungal susceptibility is encouraged in patients with chronic respiratory infections by these 2 microorganisms.
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Affiliation(s)
- Elise Melloul
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France
| | - Lolita Roisin
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France
| | - Marie-Fleur Durieux
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France.,Service de Parasitologie-Mycologie, Limoges, France
| | - Paul-Louis Woerther
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France.,Unité de Bactériologie-Hygiéne, Département de Microbiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France
| | - Delphine Jenot
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France.,Unité de Parasitologie-Mycologie, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Veronica Risco
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France.,Unité de Parasitologie-Mycologie, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Jacques Guillot
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France.,Unité de Parasitologie-Mycologie, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Eric Dannaoui
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France.,Unité de Parasitologie-Mycologie, Service de Microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, Paris, France
| | - Jean-Winoc Decousser
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France.,Unité de Bactériologie-Hygiéne, Département de Microbiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Henri Mondor, Créteil, France
| | - Françoise Botterel
- EA 7380 Dynamyc, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est Créteil, Créteil, France.,Unité de Parasitologie-Mycologie, Département de Microbiologie, Groupe Hospitalier Henri Mondor - Albert Chenevier, Assistance Publique - Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France
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29
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Pinto E, Monteiro C, Maia M, Faria MA, Lopes V, Lameiras C, Pinheiro D. Aspergillus Species and Antifungals Susceptibility in Clinical Setting in the North of Portugal: Cryptic Species and Emerging Azoles Resistance in A. fumigatus. Front Microbiol 2018; 9:1656. [PMID: 30083151 PMCID: PMC6065200 DOI: 10.3389/fmicb.2018.01656] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022] Open
Abstract
Aspergillus spp. are agents of a broad-spectrum of diseases among humans. Their growing resistance to azoles, the cornerstone in the management of human aspergillosis, is a worrisome problem around the world. Considering lack of data from Portugal on this topic, particularly from the northern region, a retrospective surveillance study was planned to assess frequency of cryptic Aspergillus species and azoles resistance. A total of 227 clinical isolates, mainly from the respiratory tract (92.1%), collected from three hospitals serving a population of about three million people, were studied for their epidemiology and antifungal susceptibility patterns determined by the E.DEF.9.3 protocol of EUCAST. Employing molecular methods, seven Aspergillus complexes were identified; Aspergillus fumigatus sensu stricto was the most frequent isolate (86.7%). A 7.5% prevalence of cryptic species was found; A. welwitschiae (A. niger complex-3.1%) and A. lentulus (A. fumigatus complex-2.2%) were the most frequent. Amongst cryptic species, it was found a percentage of resistance to voriconazole, posaconazole and isavuconazole of 47.1, 82.4, and 100%, respectively. Five A. fumigatus sensu stricto showed pan-azole resistance. Sequencing their cyp51A gene revealed the presence of one isolate with TR46/Y121F/T289A mutation and two isolates with TR34/L98H mutation. This study emphasizes the need to identify strains to the species level and to evaluate their antifungal susceptibility in all human originated Aspergillus spp. isolates, particularly those from invasive aspergillosis.
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Affiliation(s)
- Eugénia Pinto
- Laboratory of Microbiology, Biological Sciences Department, Faculty of Pharmacy of University of Porto, Porto, Portugal.,Interdisciplinary Centre of Marine and Environmental Research (CIIMAR/CIMAR), University of Porto, Matosinhos, Portugal
| | - Carolina Monteiro
- Laboratory of Microbiology, Biological Sciences Department, Faculty of Pharmacy of University of Porto, Porto, Portugal
| | - Marta Maia
- Laboratory of Microbiology, Biological Sciences Department, Faculty of Pharmacy of University of Porto, Porto, Portugal
| | - Miguel A Faria
- LAQV-REQUIMTE, Laboratory of Bromatology and Hydrology, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Virgínia Lopes
- Microbiology Laboratory, Pathology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Catarina Lameiras
- Microbiology Service, Laboratorial Diagnostic Department, Instituto Português Oncologia do Porto Francisco Gentil, EPE (IPOFG-Porto), Porto, Portugal
| | - Dolores Pinheiro
- Laboratory of Microbiology, Service of Clinical Pathology, Centro Hospitalar S. João EPE, Porto, Portugal
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30
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Fungi in Bronchiectasis: A Concise Review. Int J Mol Sci 2018; 19:ijms19010142. [PMID: 29300314 PMCID: PMC5796091 DOI: 10.3390/ijms19010142] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 12/13/2022] Open
Abstract
Although the spectrum of fungal pathology has been studied extensively in immunosuppressed patients, little is known about the epidemiology, risk factors, and management of fungal infections in chronic pulmonary diseases like bronchiectasis. In bronchiectasis patients, deteriorated mucociliary clearance—generally due to prior colonization by bacterial pathogens—and thick mucosity propitiate, the persistence of fungal spores in the respiratory tract. The most prevalent fungi in these patients are Candida albicans and Aspergillus fumigatus; these are almost always isolated with bacterial pathogens like Haemophillus influenzae and Pseudomonas aeruginosa, making very difficult to define their clinical significance. Analysis of the mycobiome enables us to detect a greater diversity of microorganisms than with conventional cultures. The results have shown a reduced fungal diversity in most chronic respiratory diseases, and that this finding correlates with poorer lung function. Increased knowledge of both the mycobiome and the complex interactions between the fungal, viral, and bacterial microbiota, including mycobacteria, will further our understanding of the mycobiome’s relationship with the pathogeny of bronchiectasis and the development of innovative therapies to combat it.
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31
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Studies of Pseudomonas aeruginosa Mutants Indicate Pyoverdine as the Central Factor in Inhibition of Aspergillus fumigatus Biofilm. J Bacteriol 2017; 200:JB.00345-17. [PMID: 29038255 DOI: 10.1128/jb.00345-17] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/02/2017] [Indexed: 01/05/2023] Open
Abstract
Pseudomonas aeruginosa and Aspergillus fumigatus are common opportunistic bacterial and fungal pathogens, respectively. They often coexist in airways of immunocompromised patients and individuals with cystic fibrosis, where they form biofilms and cause acute and chronic illnesses. Hence, the interactions between them have long been of interest and it is known that P. aeruginosa can inhibit A. fumigatusin vitro We have approached the definition of the inhibitory P. aeruginosa molecules by studying 24 P. aeruginosa mutants with various virulence genes deleted for the ability to inhibit A. fumigatus biofilms. The ability of P. aeruginosa cells or their extracellular products produced during planktonic or biofilm growth to affect A. fumigatus biofilm metabolism or planktonic A. fumigatus growth was studied in agar and liquid assays using conidia or hyphae. Four mutants, the pvdD pchE, pvdD, lasR rhlR, and lasR mutants, were shown to be defective in various assays. This suggested the P. aeruginosa siderophore pyoverdine as the key inhibitory molecule, although additional quorum sensing-regulated factors likely contribute to the deficiency of the latter two mutants. Studies of pure pyoverdine substantiated these conclusions and included the restoration of inhibition by the pyoverdine deletion mutants. A correlation between the concentration of pyoverdine produced and antifungal activity was also observed in clinical P. aeruginosa isolates derived from lungs of cystic fibrosis patients. The key inhibitory mechanism of pyoverdine was chelation of iron and denial of iron to A. fumigatusIMPORTANCE Interactions between human pathogens found in the same body locale are of vast interest. These interactions could result in exacerbation or amelioration of diseases. The bacterium Pseudomonas aeruginosa affects the growth of the fungus Aspergillus fumigatus Both pathogens form biofilms that are resistant to therapeutic drugs and host immunity. P. aeruginosa and A. fumigatus biofilms are found in vivo, e.g., in the lungs of cystic fibrosis patients. Studying 24 P. aeruginosa mutants, we identified pyoverdine as the major anti-A. fumigatus compound produced by P. aeruginosa Pyoverdine captures iron from the environment, thus depriving A. fumigatus of a nutrient essential for its growth and metabolism. We show how microbes of different kingdoms compete for essential resources. Iron deprivation could be a therapeutic approach to the control of pathogen growth.
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32
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Hamprecht A, Morio F, Bader O, Le Pape P, Steinmann J, Dannaoui E. Azole Resistance in Aspergillus fumigatus in Patients with Cystic Fibrosis: A Matter of Concern? Mycopathologia 2017; 183:151-160. [DOI: 10.1007/s11046-017-0162-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/14/2017] [Indexed: 02/05/2023]
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33
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Gupta K, Gupta P, Mathew JL, Bansal A, Singh G, Singh M, Chakrabarti A. Fatal Disseminated Aspergillus penicillioides Infection in a 3-Month-Old Infant with Suspected Cystic Fibrosis: Autopsy Case Report with Review of Literature. Pediatr Dev Pathol 2017; 19:506-511. [PMID: 26579953 DOI: 10.2350/15-10-1729-cr.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with cystic fibrosis (CF) often are colonized by Aspergillus species in their respiratory tract, but invasive aspergillosis is a rare complication. We describe the autopsy findings of an infant with cystic fibrosis who had fatal disseminated aspergillosis. The causative agent was identified as A. penicillioides by molecular technique. To our knowledge, this is the first report of disseminated aspergillosis caused by A. penicillioides in any type of patient. The literature on invasive aspergillosis in patients with cystic fibrosis also is reviewed.
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Affiliation(s)
- Kirti Gupta
- 1 Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Parikshaa Gupta
- 1 Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Joseph L Mathew
- 2 Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Bansal
- 2 Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gangandeep Singh
- 3 Department of Medical Mycology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Meenu Singh
- 2 Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- 3 Department of Medical Mycology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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34
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Anand R, Clemons KV, Stevens DA. Effect of Anaerobiasis or Hypoxia on Pseudomonas aeruginosa Inhibition of Aspergillus fumigatus Biofilm. Arch Microbiol 2017; 199:881-890. [PMID: 28357473 DOI: 10.1007/s00203-017-1362-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/26/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
Pseudomonas aeruginosa (Pa) and Aspergillus fumigatus (Af) are the major bacterial and fungal pathogens in the airways of cystic fibrosis (CF) patients. This is likely related to their ability to form biofilms. Both microbes have been associated with CF disease progression. The interplay between these two pathogens has been studied under aerobic conditions, though accumulating data indicates that much of the CF airway is hypoxic or anaerobic. We studied the microbial interaction in these latter environments. Pa is an aggressor against Af forming biofilm or as established Af biofilm, whether Pa is cultivated in aerobic, hypoxic, or anaerobic conditions, or tested in aerobic or hypoxic conditions. Pa cells are generally more effective than planktonic or biofilm culture filtrates. Pa growth is less in anaerobic conditions, and filtrates less effective after anaerobic or hypoxic growth, or against hypoxic Af. These, and other comparisons shown, indicate that Pa would be less effective in such environments, as would be the case in a CF mucus plug. These observations would explain why Pa becomes established in CF airways before Af, and why Af may persist during disease progression.
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Affiliation(s)
- Rajesh Anand
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA, 95128, USA.,Division of Infectious Disease and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, 94305, USA.,Department of Biotechnology, Guru Ghasidas Vishwavidyalaya (A Central University), C.G., Bilaspur, 495009, India
| | - Karl V Clemons
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA, 95128, USA.,Division of Infectious Disease and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - David A Stevens
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA, 95128, USA. .,Division of Infectious Disease and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, 94305, USA.
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35
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Characteristics of Aspergillus fumigatus in Association with Stenotrophomonas maltophilia in an In Vitro Model of Mixed Biofilm. PLoS One 2016; 11:e0166325. [PMID: 27870863 PMCID: PMC5117647 DOI: 10.1371/journal.pone.0166325] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/26/2016] [Indexed: 11/21/2022] Open
Abstract
Background Biofilms are communal structures of microorganisms that have long been associated with a variety of persistent infections poorly responding to conventional antibiotic or antifungal therapy. Aspergillus fumigatus fungus and Stenotrophomonas maltophilia bacteria are examples of the microorganisms that can coexist to form a biofilm especially in the respiratory tract of immunocompromised patients or cystic fibrosis patients. The aim of the present study was to develop and assess an in vitro model of a mixed biofilm associating S. maltophilia and A. fumigatus by using analytical and quantitative approaches. Materials and Methods An A. fumigatus strain (ATCC 13073) expressing a Green Fluorescent Protein (GFP) and an S. maltophilia strain (ATCC 13637) were used. Fungal and bacterial inocula (105 conidia/mL and 106 cells/mL, respectively) were simultaneously deposited to initiate the development of an in vitro mixed biofilm on polystyrene supports at 37°C for 24 h. The structure of the biofilm was analysed via qualitative microscopic techniques like scanning electron and transmission electron microscopy, and fluorescence microscopy, and by quantitative techniques including qPCR and crystal violet staining. Results Analytic methods revealed typical structures of biofilm with production of an extracellular matrix (ECM) enclosing fungal hyphae and bacteria. Quantitative methods showed a decrease of A. fumigatus growth and ECM production in the mixed biofilm with antibiosis effect of the bacteria on the fungi seen as abortive hyphae, limited hyphal growth, fewer conidia, and thicker fungal cell walls. Conclusion For the first time, a mixed A. fumigatus—S. maltophilia biofilm was validated by various analytical and quantitative approaches and the bacterial antibiosis effect on the fungus was demonstrated. The mixed biofilm model is an interesting experimentation field to evaluate efficiency of antimicrobial agents and to analyse the interactions between the biofilm and the airways epithelium.
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36
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Nazik H, Moss RB, Karna V, Clemons KV, Banaei N, Cohen K, Choudhary V, Stevens DA. Are Cystic Fibrosis Aspergillus fumigatus Isolates Different? Intermicrobial Interactions with Pseudomonas. Mycopathologia 2016; 182:315-318. [PMID: 27822731 DOI: 10.1007/s11046-016-0087-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Abstract
Pseudomonas aeruginosa and Aspergillus fumigatus are the leading bacterial and fungal pathogens in cystic fibrosis (CF). We have shown that Af biofilms are susceptible to Pseudomonas, particularly CF phenotypes. Those studies were performed with a reference virulent non-CF Aspergillus. Pseudomonas resident in CF airways undergo profound genetic and phenotypic adaptations to the abnormal environment. Studies have also indicated Aspergillus from CF patients have unexpected profiles of antifungal susceptibility. This would suggest that Aspergillus isolates from CF patients may be different or altered from other clinical isolates. It is important to know whether Aspergillus may also be altered, as a result of that CF environment, in susceptibility to Pseudomonas. CF Aspergillus proved not different in that susceptibility.
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Affiliation(s)
- Hasan Nazik
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA, 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Microbiology, Istanbul University, Istanbul, Turkey
| | - Richard B Moss
- Division of Pulmonology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Vyshnavi Karna
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA, 95128, USA
| | - Karl V Clemons
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA, 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Niaz Banaei
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin Cohen
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA, 95128, USA
| | - Varun Choudhary
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA, 95128, USA
| | - David A Stevens
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA, 95128, USA.
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Burgel PR, Paugam A, Hubert D, Martin C. Aspergillus fumigatus in the cystic fibrosis lung: pros and cons of azole therapy. Infect Drug Resist 2016; 9:229-238. [PMID: 27703383 PMCID: PMC5036609 DOI: 10.2147/idr.s63621] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aspergillus fumigatus is the main fungus cultured in the airways of patients with cystic fibrosis (CF). Allergic bronchopulmonary aspergillosis occurs in ~10% of CF patients and is clearly associated with airway damage and lung function decline. The effects of A. fumigatus colonization in the absence of allergic bronchopulmonary aspergillosis are less well established. Retrospective clinical studies found associations of A. fumigatus-positive cultures with computed tomography scan abnormalities, greater risk of CF exacerbations and hospitalizations, and/or lung function decline. These findings were somewhat variable among studies and provided only circumstantial evidence for a role of A. fumigatus colonization in CF lung disease progression. The availability of a growing number of oral antifungal triazole drugs, together with the results of nonrandomized case series suggesting positive effects of azole therapies, makes it tempting to treat CF patients with these antifungal drugs. However, the only randomized controlled trial that has used itraconazole in CF patients showed no significant benefit. Because triazoles may have significant adverse effects and drug interactions, and because their prolonged use has been associated with the emergence of azole-resistant A. fumigatus isolates, it remains unclear whether or not CF patients benefit from azole therapy.
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Affiliation(s)
- Pierre-Régis Burgel
- Department of Respiratory Medicine, Cochin Hospital, Assistance Publique - Hôpitaux de Paris; Université Paris Descartes, Sorbonne Paris Cité
| | - André Paugam
- Université Paris Descartes, Sorbonne Paris Cité; Parasitology-Mycology Laboratory, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dominique Hubert
- Department of Respiratory Medicine, Cochin Hospital, Assistance Publique - Hôpitaux de Paris; Université Paris Descartes, Sorbonne Paris Cité
| | - Clémence Martin
- Department of Respiratory Medicine, Cochin Hospital, Assistance Publique - Hôpitaux de Paris; Université Paris Descartes, Sorbonne Paris Cité
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Effect of Media Modified To Mimic Cystic Fibrosis Sputum on the Susceptibility of Aspergillus fumigatus, and the Frequency of Resistance at One Center. Antimicrob Agents Chemother 2016; 60:2180-4. [PMID: 26810647 DOI: 10.1128/aac.02649-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/17/2016] [Indexed: 01/07/2023] Open
Abstract
Studies of cystic fibrosis (CF) patient exacerbations attributed toPseudomonas aeruginosainfection have indicated a lack of correlation of outcome within vitrosusceptibility results. One explanation is that the media used for testing do not mimic the airway milieu, resulting in incorrect conclusions. Therefore, media have been devised to mimic CF sputum.Aspergillus fumigatusis the leading fungal pathogen in CF, and susceptibility testing is also used to decide therapeutic choices. We assessed whether media designed to mimic CF sputa would give different fungal susceptibility results than those of classical methods, assaying voriconazole, the most utilized anti-Aspergillusdrug in this setting, and 30 CFAspergillusisolates. The frequency of marked resistance (defined as an MIC of >4 μg/ml) in our CF unit by classical methods is 7%. Studies performed with classical methods and with digested sputum medium, synthetic sputum medium, and artificial sputum medium revealed prominent differences inAspergillussusceptibility results, as well as growth rate, with each medium. Clinical correlative studies are required to determine which results are most useful in predicting outcome. Comparison of MICs with non-CF isolates also indicated the CF isolates were generally more resistant.
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Cabaret O, Bonnal C, Canoui-Poitrine F, Emirian A, Bizouard G, Levesque E, Maitre B, Fihman V, Decousser JW, Botterel F. Concomitant presence of Aspergillus fumigatus and Stenotrophomonas maltophilia in the respiratory tract: a new risk for patients with liver disease? J Med Microbiol 2016; 65:414-419. [PMID: 26872817 DOI: 10.1099/jmm.0.000233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Concomitant lung colonization by Aspergillus fumigatus and Stenotrophomonas maltophilia was reported mainly in patients with cystic fibrosis (CF) and immunocompromised patients. The aim of the study was to assess the frequency of co-culture of A. fumigatus and S. maltophilia in respiratory samples of hospitalized patients, and to determine its associated factors. Between 2007 and 2011, all patients who had A. fumigatus in their respiratory samples were retrospectively enrolled in the study. Their clinical and laboratory data, including the presence of S. maltophilia in a respiratory sample, were collected within the same month. Of the 257 enrolled patients (372 respiratory samples), 71 % were immunocompromised and 32 % had chronic respiratory disease. S. maltophilia was isolated within the same month in 20 patients (7.8 %). In the univariate analysis, factors associated with concomitant culture of A. fumigatus and S. maltophilia were liver disease (P = 0.009), orotracheal intubation (P = 0.001), ventilator-associated pneumonia (P = 0.006), central venous catheter (P = 0.003), parenteral nutrition (P = 0.008) and culture of Pseudomonas aeruginosa in respiratory samples (P = 0.002). In the multivariate analysis, the simultaneous presence of P. aeruginosa in the respiratory tract (odds ratio (OR) = 3.19, 95 % confidence interval (CI) 1.11-9.14, P = 0.031), liver disease (OR = 3.92, 95 % CI 1.32-11.62, P = 0.014) and orotracheal intubation (OR = 3.42, 95 % CI 1.17-9.96, P = 0.024) were independently associated with the co-culture of S. maltophilia and A. fumigatus. Factors independently associated with the concomitant culture of A. fumigatus and S. maltophilia were identified. These results support a future prospective study focusing on liver disease and its complications.
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Affiliation(s)
- Odile Cabaret
- Unité de Mycologie, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Christine Bonnal
- Unité de Mycologie, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Florence Canoui-Poitrine
- Université Paris Est Créteil,LIC EA4393, Créteil,France.,Service de Santé publique, AP-HP, Hôpital Henri-Mondor,Créteil,France
| | - Aurélie Emirian
- Unité de Bactériologie-Hygiène, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Geoffray Bizouard
- Université Paris Est Créteil,LIC EA4393, Créteil,France.,Service de Santé publique, AP-HP, Hôpital Henri-Mondor,Créteil,France
| | - Eric Levesque
- Département d'anesthésie et de réanimation, DHU VIC, AP-HP, Hôpital Henri-Mondor,Créteil,France
| | - Bernard Maitre
- Unité de Pneumologie, Réanimation médicale Hôpital Henri Mondor, Centre Intercommunal de Créteil,Créteil,France
| | - Vincent Fihman
- Unité de Bactériologie-Hygiène, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Jean-Winoc Decousser
- Unité de Bactériologie-Hygiène, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Françoise Botterel
- Unité de Mycologie, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
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Tyrrell J, Callaghan M. Iron acquisition in the cystic fibrosis lung and potential for novel therapeutic strategies. MICROBIOLOGY-SGM 2015; 162:191-205. [PMID: 26643057 DOI: 10.1099/mic.0.000220] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Iron acquisition is vital to microbial survival and is implicated in the virulence of many of the pathogens that reside in the cystic fibrosis (CF) lung. The multifaceted nature of iron acquisition by both bacterial and fungal pathogens encompasses a range of conserved and species-specific mechanisms, including secretion of iron-binding siderophores, utilization of siderophores from other species, release of iron from host iron-binding proteins and haemoproteins, and ferrous iron uptake. Pathogens adapt and deploy specific systems depending on iron availability, bioavailability of the iron pool, stage of infection and presence of competing pathogens. Understanding the dynamics of pathogen iron acquisition has the potential to unveil new avenues for therapeutic intervention to treat both acute and chronic CF infections. Here, we examine the range of strategies utilized by the primary CF pathogens to acquire iron and discuss the different approaches to targeting iron acquisition systems as an antimicrobial strategy.
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Affiliation(s)
- Jean Tyrrell
- Centre of Microbial Host Interactions, Institute of Technology Tallaght, Dublin D24KT9, Ireland
| | - Máire Callaghan
- Centre of Microbial Host Interactions, Institute of Technology Tallaght, Dublin D24KT9, Ireland
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41
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Nazik H, Penner JC, Ferreira JA, Haagensen JAJ, Cohen K, Spormann AM, Martinez M, Chen V, Hsu JL, Clemons KV, Stevens DA. Effects of Iron Chelators on the Formation and Development of Aspergillus fumigatus Biofilm. Antimicrob Agents Chemother 2015; 59:6514-20. [PMID: 26239975 PMCID: PMC4576070 DOI: 10.1128/aac.01684-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/30/2015] [Indexed: 12/25/2022] Open
Abstract
Iron acquisition is crucial for the growth of Aspergillus fumigatus. A. fumigatus biofilm formation occurs in vitro and in vivo and is associated with physiological changes. In this study, we assessed the effects of Fe chelators on biofilm formation and development. Deferiprone (DFP), deferasirox (DFS), and deferoxamine (DFM) were tested for MIC against a reference isolate via a broth macrodilution method. The metabolic effects (assessed by XTT [2,3-bis[2-methoxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide inner salt]) on biofilm formation by conidia were studied upon exposure to DFP, DFM, DFP plus FeCl3, or FeCl3 alone. A preformed biofilm was exposed to DFP with or without FeCl3. The DFP and DFS MIC50 against planktonic A. fumigatus was 1,250 μM, and XTT gave the same result. DFM showed no planktonic inhibition at concentrations of ≤2,500 μM. By XTT testing, DFM concentrations of <1,250 μM had no effect, whereas DFP at 2,500 μM increased biofilms forming in A. fumigatus or preformed biofilms (P < 0.01). DFP at 156 to 2,500 μM inhibited biofilm formation (P < 0.01 to 0.001) in a dose-responsive manner. Biofilm formation with 625 μM DFP plus any concentration of FeCl3 was lower than that in the controls (P < 0.05 to 0.001). FeCl3 at ≥625 μM reversed the DFP inhibitory effect (P < 0.05 to 0.01), but the reversal was incomplete compared to the controls (P < 0.05 to 0.01). For preformed biofilms, DFP in the range of ≥625 to 1,250 μM was inhibitory compared to the controls (P < 0.01 to 0.001). FeCl3 at ≥625 μM overcame inhibition by 625 μM DFP (P < 0.001). FeCl3 alone at ≥156 μM stimulated biofilm formation (P < 0.05 to 0.001). Preformed A. fumigatus biofilm increased with 2,500 μM FeCl3 only (P < 0.05). In a strain survey, various susceptibilities of biofilms of A. fumigatus clinical isolates to DFP were noted. In conclusion, iron stimulates biofilm formation and preformed biofilms. Chelators can inhibit or enhance biofilms. Chelation may be a potential therapy for A. fumigatus, but we show here that chelators must be chosen carefully. Individual isolate susceptibility assessments may be needed.
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Affiliation(s)
- Hasan Nazik
- California Institute for Medical Research, San Jose, California, USA Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA Department of Medical Microbiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - John C Penner
- California Institute for Medical Research, San Jose, California, USA
| | - Jose A Ferreira
- California Institute for Medical Research, San Jose, California, USA Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Janus A J Haagensen
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California, USA
| | - Kevin Cohen
- California Institute for Medical Research, San Jose, California, USA
| | - Alfred M Spormann
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California, USA
| | - Marife Martinez
- California Institute for Medical Research, San Jose, California, USA
| | - Vicky Chen
- California Institute for Medical Research, San Jose, California, USA
| | - Joe L Hsu
- California Institute for Medical Research, San Jose, California, USA Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California, USA
| | - Karl V Clemons
- California Institute for Medical Research, San Jose, California, USA Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
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Mirković B, Lavelle GM, Azim AA, Helma K, Gargoum FS, Molloy K, Gernez Y, Dunne K, Renwick J, Murphy P, Moss RB, Greene CM, Gunaratnam C, Chotirmall SH, McElvaney NG. The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis. J Allergy Clin Immunol 2015; 137:436-443.e9. [PMID: 26388311 DOI: 10.1016/j.jaci.2015.07.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/04/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Colonization by Aspergillus fumigatus in patients with cystic fibrosis (CF) can cause A fumigatus sensitization and/or allergic bronchopulmonary aspergillosis (ABPA), which affects pulmonary function and clinical outcomes. Recent studies show that specific allergens upregulate the surface-expressed basophil marker CD203c in sensitized subjects, a response that can be readily measured by using flow cytometry. OBJECTIVE We sought to identify A fumigatus sensitization in patients with CF by using the basophil activation test (BAT). METHODS Patients with CF attending Beaumont Hospital were screened for study inclusion. BAT was used to identify A fumigatus sensitization. Serologic (total and A fumigatus-specific IgE), pulmonary function, and body mass index measurements were performed. RESULTS The BAT discriminates A fumigatus-sensitized from nonsensitized patients with CF. Persistent isolation of A fumigatus in sputum is a significant risk factor for A fumigatus sensitization. Levels of the A fumigatus-stimulated basophil activation marker CD203c inversely correlated with pulmonary function and body mass index in A fumigatus-sensitized but not nonsensitized patients with CF. Total and A fumigatus-specific IgE, but not IgG, levels are increased in A fumigatus-sensitized patients with CF and ABPA when compared with those in A fumigatus-sensitized and nonsensitized patients with CF without ABPA. Itraconazole treatment did not affect A fumigatus sensitization. CONCLUSION Combining the BAT with routine serologic testing allows classification of patients with CF into 3 groups: nonsensitized, A fumigatus-sensitized, and ABPA. Accurate and prompt identification of A fumigatus-associated clinical status might allow early and targeted therapeutic intervention, potentially improving clinical outcomes.
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Affiliation(s)
- Bojana Mirković
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Gillian M Lavelle
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Ahmed Abdul Azim
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Kristine Helma
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Fatma S Gargoum
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Kevin Molloy
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Yael Gernez
- Department of Genetics, Stanford University School of Medicine, Stanford, Calif
| | - Katie Dunne
- Clinical Microbiology Department, Trinity College Dublin, the Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
| | - Julie Renwick
- Clinical Microbiology Department, Trinity College Dublin, the Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
| | - Philip Murphy
- Clinical Microbiology Department, Trinity College Dublin, the Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
| | - Richard B Moss
- Center for Excellence in Pulmonary Biology, Department of Paediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Catherine M Greene
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Cedric Gunaratnam
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Noel G McElvaney
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Ferreira JAG, Penner JC, Moss RB, Haagensen JAJ, Clemons KV, Spormann AM, Nazik H, Cohen K, Banaei N, Carolino E, Stevens DA. Inhibition of Aspergillus fumigatus and Its Biofilm by Pseudomonas aeruginosa Is Dependent on the Source, Phenotype and Growth Conditions of the Bacterium. PLoS One 2015; 10:e0134692. [PMID: 26252384 PMCID: PMC4529298 DOI: 10.1371/journal.pone.0134692] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/13/2015] [Indexed: 12/14/2022] Open
Abstract
Aspergillus fumigatus (Af) and Pseudomonas aeruginosa (Pa) are leading fungal and bacterial pathogens, respectively, in many clinical situations. Relevant to this, their interface and co-existence has been studied. In some experiments in vitro, Pa products have been defined that are inhibitory to Af. In some clinical situations, both can be biofilm producers, and biofilm could alter their physiology and affect their interaction. That may be most relevant to airways in cystic fibrosis (CF), where both are often prominent residents. We have studied clinical Pa isolates from several sources for their effects on Af, including testing involving their biofilms. We show that the described inhibition of Af is related to the source and phenotype of the Pa isolate. Pa cells inhibited the growth and formation of Af biofilm from conidia, with CF isolates more inhibitory than non-CF isolates, and non-mucoid CF isolates most inhibitory. Inhibition did not require live Pa contact, as culture filtrates were also inhibitory, and again non-mucoid>mucoid CF>non-CF. Preformed Af biofilm was more resistant to Pa, and inhibition that occurred could be reproduced with filtrates. Inhibition of Af biofilm appears also dependent on bacterial growth conditions; filtrates from Pa grown as biofilm were more inhibitory than from Pa grown planktonically. The differences in Pa shown from these different sources are consistent with the extensive evolutionary Pa changes that have been described in association with chronic residence in CF airways, and may reflect adaptive changes to life in a polymicrobial environment.
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Affiliation(s)
- Jose A. G. Ferreira
- California Institute for Medical Research, San Jose, California, United States of America
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - John C. Penner
- California Institute for Medical Research, San Jose, California, United States of America
| | - Richard B. Moss
- Division of Pulmonology, Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Janus A. J. Haagensen
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California, United States of America
| | - Karl V. Clemons
- California Institute for Medical Research, San Jose, California, United States of America
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Alfred M. Spormann
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California, United States of America
| | - Hasan Nazik
- California Institute for Medical Research, San Jose, California, United States of America
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, United States of America
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kevin Cohen
- California Institute for Medical Research, San Jose, California, United States of America
| | - Niaz Banaei
- Department of Pathology, Stanford University, Stanford, California, United States of America
| | - Elisabete Carolino
- Escola Superior de Tecnologia da Saúde de Lisboa (Lisbon School of Health Technology), Lisbon, Portugal
| | - David A. Stevens
- California Institute for Medical Research, San Jose, California, United States of America
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, United States of America
- * E-mail:
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Dunne K, Prior AR, Murphy K, Wall N, Leen G, Rogers TR, Elnazir B, Greally P, Renwick J, Murphy P. Emergence of persistent Aspergillus terreus colonisation in a child with cystic fibrosis. Med Mycol Case Rep 2015; 9:26-30. [PMID: 26288746 PMCID: PMC4534713 DOI: 10.1016/j.mmcr.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/07/2015] [Accepted: 07/23/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Katie Dunne
- The National Children's Hospital, Tallaght Hospital, Tallaght, Dublin 24, Ireland ; Department of Clinical Microbiology, Trinity Centre for Health Science, Tallaght hospital, Trinity College Dublin, Dublin 24, Ireland
| | - Anna-Rose Prior
- The National Children's Hospital, Tallaght Hospital, Tallaght, Dublin 24, Ireland
| | - Kate Murphy
- Department of Clinical Microbiology, Trinity Centre for Health Science, Tallaght hospital, Trinity College Dublin, Dublin 24, Ireland
| | - Niall Wall
- The National Children's Hospital, Tallaght Hospital, Tallaght, Dublin 24, Ireland
| | - Geraldine Leen
- The National Children's Hospital, Tallaght Hospital, Tallaght, Dublin 24, Ireland
| | - Thomas R Rogers
- Department of Clinical Microbiology, Trinity College Dublin, St James's Hospital, Dublin 8, Ireland
| | - Basil Elnazir
- The National Children's Hospital, Tallaght Hospital, Tallaght, Dublin 24, Ireland
| | - Peter Greally
- The National Children's Hospital, Tallaght Hospital, Tallaght, Dublin 24, Ireland
| | - Julie Renwick
- The National Children's Hospital, Tallaght Hospital, Tallaght, Dublin 24, Ireland ; Department of Clinical Microbiology, Trinity Centre for Health Science, Tallaght hospital, Trinity College Dublin, Dublin 24, Ireland
| | - Philip Murphy
- The National Children's Hospital, Tallaght Hospital, Tallaght, Dublin 24, Ireland ; Department of Clinical Microbiology, Trinity Centre for Health Science, Tallaght hospital, Trinity College Dublin, Dublin 24, Ireland
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