Mode of action of miconazole on yeasts: inhibition of the mitochondrial ATPase

Trafficking through the late endosome significantly impacts Candida albicans tolerance of the azole antifungals

The azole antifungals block ergosterol biosynthesis by inhibiting lanosterol demethylase (Erg11p). The resulting depletion of cellular ergosterol and the accumulation of "toxic" sterol intermediates are both thought to compromise plasma membrane function. However, the effects of ergosterol depletion upon the function of intracellular membranes and organelles are not well described. The purpose of this study was to characterize the effects of azole treatment upon the integrity of the Candida albicans vacuole and to determine whether, in turn, vacuolar trafficking influences azole susceptibility. Profound fragmentation of the C. albicans vacuole can be observed as an early consequence of azole treatment, and it precedes significant growth inhibition. In addition, a C. albicans vps21Δ/Δ mutant, blocked in membrane trafficking through the late endosomal prevacuolar compartment (PVC), is able to grow significantly more than the wild type in the presence of several azole antifungals under standard susceptibility testing conditions. Furthermore, the vps21Δ/Δ mutant is able to grow despite the depletion of cellular ergosterol. This phenotype resembles an exaggerated form of "trailing growth" that has been described for some clinical isolates. In contrast, the vps21Δ/Δ mutant is hypersensitive to drugs that block alternate steps in ergosterol biosynthesis. On the basis of these results, we propose that endosomal trafficking defects may lead to the cellular "redistribution" of the sterol intermediates that accumulate following inhibition of ergosterol biosynthesis. Furthermore, the destination of these intermediates, or the precise cellular compartments in which they accumulate, may be an important determinant of their toxicity and thus ultimately antifungal efficacy.

Miconazole induces fungistasis and increases killing of Candida albicans subjected to photodynamic therapy

Cutaneous and mucocutaneous Candida infections are considered to be important targets for antimicrobial photodynamic therapy (PDT). Clinical application of antimicrobial PDT will require strategies that enhance microbial killing while minimizing damage to host tissue. Increasing the sensitivity of infectious agents to PDT will help achieve this goal. Our previous studies demonstrated that raising the level of oxidative stress in Candida by interfering with fungal respiration increased the efficiency of PDT. Therefore, we sought to identify compounds in clinical use that would augment the oxidative stress caused by PDT by contributing to reactive oxygen species (ROS) formation themselves. Based on the ability of the antifungal miconazole to induce ROS in Candida, we tested several azole antifungals for their ability to augment PDT in vitro. Although miconazole and ketoconazole both stimulated ROS production in Candida albicans, only miconazole enhanced the killing of C. albicans and induced prolonged fungistasis in organisms that survived PDT using the porphyrin TMP-1363 and the phenothiazine methylene blue as photosensitizers. The data suggest that miconazole could be used to increase the efficacy of PDT against C. albicans, and its mechanism of action is likely to be multifactorial.

Ketoconazole and miconazole alter potassium homeostasis in Saccharomyces cerevisiae

The effects of ketoconazole and miconazole uptake on K(+) transport and the internal pH of Saccharomyces cerevisiae were studied. The uptake of both drugs was very fast, linear with concentration and not dependent on glucose, indicating entrance by diffusion and concentrating inside. Low (5.0μM) to intermediate concentrations (40μM) of both drugs produced a glucose-dependent K(+) efflux; higher ones also produced a small influx of protons, probably through a K(+)/H(+) exchanger, resulting in a decrease of the internal pH of the cells and the efflux of material absorbing at 260nm and phosphate. The cell membrane was not permeabilized. The K(+) efflux with miconazole was dependent directly on the medium pH. This efflux results in an increased membrane potential, responsible for an increased Ca(2+) uptake and other effects. These effects were not observed with two triazolic antifungals. A decrease of the Zeta (ζ) potential was observed at low concentrations of miconazole. Although the main effect of these antifungals is the inhibition of ergosterol synthesis, K(+) efflux is an important additional effect to be considered in their therapeutic use. Under certain conditions, the use of single mutants of several transporters involved in the movements of K(+) allowed to identify the participation of several antiporters in the efflux of the cation.

Sublethal injury and resuscitation of Candida albicans after amphotericin B treatment

Amphotericin B treatment was previously shown to inhibit Candida albicans reproduction and reduce the fluorescence of vitality-specific dyes without causing a corresponding increase in the fluorescence of the mortality-specific dyes bis-(1,3-dibutylbarbituric acid)trimethine oxonol and SYBR Green I. In the present study, we have confirmed these results and have shown that the numbers of CFU are reduced by 99.9% by treatment with 0.5 micro g of amphotericin B per ml for 10 h at 35 degrees C. This reduction was not due to fungal cell death. First, the level of reduction of the tetrazolium salt 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-tetrazolium hydroxide increased in the presence of concentrations of amphotericin B that caused greater than 90% reductions in the numbers of CFU. Second, fungal cells treated with amphotericin B at a concentration of 0.5 micro g/ml were resuscitated by further incubation at 22 degrees C for 15 h in the continued presence of amphotericin B. Third, recovery of the ability to replicate was prevented by sequential treatment with 20 micro g of miconazole per ml, which also increased the fluorescence of mortality-specific dyes to near the maximal levels achieved with 0.9 micro g of amphotericin B per ml. Sequential treatment with fluconazole and flucytosine did not increase the levels of staining with the mortality-specific dyes. Itraconazole was less effective than ketoconazole, which was less effective than miconazole. The practice of equating the loss of the capacity of C. albicans to form colonies with fungal cell death may give incorrect results in assays with amphotericin B, and the results of assays with caution with other antifungal agents that are lipophilic or that possess significant postantifungal effects may need to be interpreted.

Imidazole-induced morphological abnormalities of mitochondria of Candida albicans

The mitochondrial morphology of live Candida albicans samples treated with several imidazoles (miconazole, econazole and clotrimazole) was observed with a fluorescent carbocyanine probe, 3,3'-dihexyloxacarbocyanine [diO-C6-(3)], under a fluorescence microscope. Nearly all non-treated C. albicans cells carried only long tubular mitochondria. Treatment with antimycotics at half the minimum inhibitory concentrations (MIC100) rapidly induced mitochondrial cleavage or fragmentation, which was followed by recovery to the normal tubular morphology within 1 h. Exposing the yeast to drugs at concentrations higher than the MICs resulted in the development of swollen mitochondria or amorphous bodies. These phenomena were concentration dependent. The fluorescence images were also compared with ultrastructural images obtained by transmission electron microscopy.

Genetics and physiology of aflatoxin biosynthesis

Aflatoxins are the most thoroughly studied mycotoxins. Elegant early research on the biosynthetic scheme of the pathway has allowed a molecular characterization of aflatoxin biosynthesis and its regulation. Genetic studies on aflatoxin biosynthesis in Aspergillus flavus and A. parasiticus, and sterigmatocystin biosynthesis in A. nidulans, led to the cloning of 17 genes responsible for 12 enzymatic conversions in the AF/ST pathways. Pathway-specific regulation is by a Zn(II)2Cys6 DNA-binding protein that regulates the transcription of all pathway genes. Less is known about the global factors that regulate aflatoxin biosynthesis, but there is a clear link between development and aflatoxin biosynthesis. There is also a large body of information on physiological factors involved in aflatoxin biosynthesis, but it has been difficult to understand their role in the regulation of this pathway. This chapter discusses current knowledge on the molecular biology and genetics of the pathway, and provides a summary of the physiological factors known to influence aflatoxin formation.

A comparison of miconazole, ketoconazole and fluconazole in their effects on temperature-dependent growth and thermal death in Candida albicans

A strain of Candida albicans isolated from human sputum exhibited an associative temperature profile, with the initial maximum temperature = 42 degrees C, the final maximum temperature = 38 degrees C, and the minimum temperature of thermal death = 33 degrees C, showed a decrease in its cardinal temperatures and a reduction in the specific rates of growth and thermal death throughout the novel temperature ranges in the presence of either 25 microM of miconazole, ketoconazole or fluconazole. In the concentration range 0-30 microM, each drug concertedly depressed the kinetic and energetic parameters of growth, with lesser variation on the specific glucose transfer rate. The overall effect of miconazole was the greatest (up to one order of magnitude), while that of fluconazole was the least.

Cytochrome P-450-dependent 14 alpha-demethylation of lanosterol in Candida albicans

A novel assay for cytochrome P-450-dependent 14 alpha-sterol demethylase of the important opportunistic fungal pathogen, Candida albicans, is described. The enzyme was assayed in microsomal preparations (microsomes) by measuring the incorporation of [14C]lanosterol into (4,14)-desmethylated sterols. The efficacy of different cell-breakage methods was compared; desmethylated-sterol biosynthesis was maximal when cells were broken with a Braun disintegrator. The solubilization of [14C]lanosterol with detergent in the assay system was essential for enzyme activity, which was enhanced considerably when microsomes were gassed with O2. Under these conditions, there was a reciprocal relationship between the amount of radioactivity incorporated into desmethylated sterols and that lost from lanosterol. The major radiolabelled desmethylated sterol was ergosterol. The enzyme had an apparent Km of 52.73 +/- 2.80 microM and an apparent Vmax of 0.84 +/- 0.14 nmol/min per mg of protein (n = 3). Enzyme activity was decreased greatly when microsomes were treated with CO or the triazole antifungal ICI 153066.

The effects of azole and polyene antifungals on the plasma membrane enzymes of Candida albicans

The two clinically important classes of antimycotic drugs, the polyenes and azoles, act on the plasma membrane of the cell. The primary modes of action are believed to be through interaction with sterols (polyenes) and alteration in sterol composition of the membrane (azoles). In this report we show that, at growth inhibitory concentrations, the polyenes (nystatin and amphotericin) and azoles (miconazole and ketoconazole) also inhibit plasma membrane enzymes. There was extensive (greater than 75%) inhibition of the Candida albicans plasma membrane enzymes ATPase, glucan synthase, adenyl cyclase and 5'-nucleotidase, when assayed in situ. The antifungals papulacandin and echinocandin, which inhibit glucan synthesis, also inhibited plasma membrane enzymes in situ; glucan synthase (greater than 90%), 5'-nucleotidase (greater than 80%) and ATPase (70-80%). Purified plasma membrane was prepared from yeast cells of C. albicans by two different techniques: concanavalin A stabilization and coating of spheroplasts with silica microbeads. In the purified plasma membrane vesicles prepared from concanavalin A the adenyl cyclase and phosphodiesterase were extensively (greater than 90%) inhibited by the three different classes of antifungal drugs; variable inhibition was observed with ATPase (70-100%). The 3',5'-cyclic phosphodiesterase of the plasma membrane purified by the microbeads method was almost completely inhibited by all of the antifungals tested and there was partial inhibition of ATPase (20-85%) and adenyl cyclase (30-90%).

Effect of miconazole on growth and aflatoxin production by Aspergillus parasiticus

At 5 microM, miconazole prevented the growth of Aspergillus parasiticus Speare in a number of media. Sensitivity to miconazole was increased approximately 10-fold in a medium containing glycerol. At sub-inhibitory concentrations, miconazole stimulated aflatoxin synthesis on media which normally support toxin formation. Miconazole inhibited respiration and altered mitochondrial ultrastructure, suggesting that miconazole inhibits growth and stimulates aflatoxin production by depressing mitochondrial activity.

Effect of antifungal agents on lipid biosynthesis and membrane integrity in Candida albicans

Eight antifungal agents were examined for effects on lipid biosynthesis and membrane integrity in Candida albicans. Lipids were labeled in vivo or in vitro with [14C]acetate and analyzed by thin-layer and gas chromatography. Membrane integrity was measured by a recently developed [14C]aminoisobutyric acid radiolabel release assay. The imidazole antifungal agents miconazole, econazole, clotrimazole, and ketoconazole, at concentrations inhibiting ergosterol biosynthesis (0.1 microM), decreased the ratio of unsaturated to saturated fatty acids in vivo but not in vitro. Similarly, naftifine, tolnaftate, and the azasterol A25822B, at concentrations inhibiting ergosterol biosynthesis (10, 100, and 1 microM, respectively), decreased the ratio of unsaturated to saturated fatty acids in vivo only. This suggests that the effect on fatty acids observed with ergosterol biosynthesis inhibitors may be secondary to the effect on ergosterol. With imidazoles, oleic acid antagonized inhibition of cell growth but not inhibition of ergosterol. This suggests that, with the C-14 demethylase inhibitors, decreased unsaturated fatty acids, rather than decreased ergosterol, are responsible for growth inhibition. Cerulenin, previously reported to be a potent inhibitor of both fatty acid and ergosterol biosynthesis, was found in the present study to inhibit the former (at 5 microM) but not the latter (up to 100 microM). Of the antifungal agents tested, econazole and miconazole (at 100 microM) produced complete release of [14C]aminoisobutyric acid, which is consistent with membrane damage.

Isolation of mutants of Candida glabrata resistant to miconazole

Elucidation of the mode of action of azole antifungals would be aided by studying resistant mutants. It is difficult to obtain mutants of Candida albicans in the laboratory, and there have only been a few studies on clinical isolates which seem to be resistant because of impaired drug uptake. C. glabrata, unlike C. albicans, is haploid and more likely to give rise to resistant variants. Over 30 mutants have been isolated by selection with miconazole on solid medium and have MICs of miconazole about ten times that of the parental strain. One such mutant has a reduced growth rate and final cell yield. In intact cells, ergosterol biosynthesis is tenfold less sensitive to miconazole than in the parent. However, uptake of [3H]miconazole by cells is identical in both strains. The significance of these observations is discussed.

The genetics of medically important fungi

The present review is concerned with recent progress in basic genetic investigations with a variety of fungi which are pathogenic for man and animals. The principles and strategies involved in undertaking genetic investigations of sexual species and of asexual species are discussed. Progress in genetic analysis of Cryptococcus neoformans made possible by the discovery of its sexual phase is described in detail, as is progress in development of parasexual methods of analysis in Candida albicans. The genetic bases of virulence and drug resistance are discussed for those few species in which these phenotypes have been investigated. Suggestions for future research, including the application of recent advances in molecular biology to the study of pathogenic fungi, are presented.

Effects of antifungal agents on ergosterol biosynthesis in Candida albicans and Trichophyton mentagrophytes: differential inhibitory sites of naphthiomate and miconazole

The effects of naphthiomate and miconazole showing ergosterol biosynthesis inhibition on Candida albicans and Trichophyton mentagrophytes were investigated by measuring [14C]acetate incorporation into sterols and its precursors. Naphthiomate, like allylamine compounds, was found to interfere with fungal ergosterol biosynthesis by preventing the conversion of squalene into squalene epoxide which is mediated by squalene epoxidase. This metabolic inhibition resulted in a considerable decrease of ergosterol with a corresponding increase of squalene, which is more distinct in T. mentagrophytes than in C. albicans. This indicates that naphthiomate blocks the utilization of squalene by inhibition of squalene epoxidation; unlike N-substituted imidazole, miconazole has been known to inhibit ergosterol formation by inhibiting C14-demethylation. In addition, it is of interest to note that miconazole causes a great accumulation of lanosterol in C. albicans cells, while in T. mentagrophytes cells there was instead a drastic increase of 24-methylenedihydrolanosterol but not lanosterol. The results obtained from this study indicate that repression of ergosterol synthesis by naphthiomate and miconazole is due to inhibition of squalene epoxidation for the former and C14-demethylation for the latter.

Mitochondrial resistance to miconazole in Saccharomyces cerevisiae

One mutant of mitochondrial origin resistant to miconazole has been isolated and characterized in S. cerevisiae. The mutation is linked to the locus oli1, the structural gene for subunit 9 of ATPase on mitochondrial DNA. Miconazole inhibited the mitochondrial ATPase of the wild type while the enzyme of the resistant mutant was insensitive to this effect. Levels of ATP decreased to one-third of the control in the wild type in the presence of miconazole, while they were unaffected in the mutant.