1
|
Beredaki MI, Arendrup MC, Mouton JW, Meletiadis J. In-vitro pharmacokinetic/pharmacodynamic model data suggest a potential role of new formulations of posaconazole against Candida krusei but not Candida glabrata infections. Int J Antimicrob Agents 2021; 57:106291. [PMID: 33508404 DOI: 10.1016/j.ijantimicag.2021.106291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/21/2020] [Accepted: 01/20/2021] [Indexed: 01/08/2023]
Abstract
Posaconazole exhibits in-vitro activity against Candida glabrata and Candida krusei. Epidemiological cut-off values set by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the Clinical and Laboratory Standards Institute (CLSI) are 1/1 and 0.5/0.5 mg/L, respectively, but clinical breakpoints have not been established to date. This study explored the pharmacodynamics (PD) of posaconazole in a validated one-compartment in-vitro pharmacokinetic (PK)/PD model, and determined the probability of PK/PD target attainment (PTA) for the available formulations. Five C. glabrata and three C. krusei isolates with posaconazole minimum inhibitory concentrations (MICs) of 0.06-2 and 0.03-0.25 mg/L, respectively, were tested in the PK/PD model simulating different time-concentration profiles of posaconazole. The exposure-effect relationship fAUC0-24/MIC was described for EUCAST/CLSI methods, and PTA was calculated in order to determine PK/PD susceptibility breakpoints for oral solution (400 mg q12h), and intravenous (i.v.)/tablet formulations (300 mg q24h). Fungicidal activity (~2log kill) was found against the most susceptible C. glabrata isolate alone, and against all three C. krusei isolates. The corresponding EUCAST/CLSI PK/PD targets (fAUC0-24/MIC) were 102/79 for C. glabrata and 12/8 for C. krusei. Mean PTA was high (>95%) for C. glabrata isolates with EUCAST/CLSI MICs ≤0.03/≤0.03 mg/L for oral solution and ≤0.125/≤0.125 mg/L for i.v. and tablet formulations for the wild-type population. For C. krusei isolates, mean PTA was high (>95%) for EUCAST/CLSI MICs ≤0.25/≤0.5 mg/L for oral solution and ≤1/≤2 mg/L for i.v. and tablet formulations for the wild-type population. The use of posaconazole to treat C. glabrata infections is questionable. Intravenous and tablet formulations may be therapeutic options for the treatment of C. krusei infections, and oral exposure can be optimized with therapeutic drug monitoring (trough levels >0.6-0.9 mg/L).
Collapse
Affiliation(s)
- Maria-Ioanna Beredaki
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands.
| |
Collapse
|
2
|
Cebeci YU, Ceylan S, Demirbas N, Karaoğlu ŞA. Conventional and Microwave-Assisted Synthesis of Novel 1,2,4-Triazole Derivatives Containing Tryptamine Skeleton and Evaluation of Antimicrobial Activity. LETT ORG CHEM 2021. [DOI: 10.2174/1570178617999200721010921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
1,2,4-Triazole-3-one (3) obtained from tryptamine was transformed to the corresponding carbox(
thio)amides via several steps (6a-d). Their reaction with sodium hydroxide performed the 1,2,4-
triazole derivatives (7a-d). Compounds 7a-d treatment by 2-bromo-1-(4-chlorophenyl)ethanoneain an
ambiance with sodium ethoxide afforded the compounds (8a-d). The reduction reaction of 8a-d afforded
1,2,4-triazoles (9a-d). The synthesis of (10a-d), (11a-d) and (12a-d) was afforded treatment of
products 9a-d with 4-chlorobenzyl chloride (for 10a-d) or 2,6-dichlorobenzyl chloride (for 11a-d) or
2,4-dichlorobenzyl chloride (for 12a-d). Besides the improved of entirely novel agents having various
chemical features than those of the existing ones, another aim is to combined two or more groups into a
single hybrid compound. For this reason, a single compound containing more than one group, each
with various modes of effect, could be helpful for the cure of bacterial infections. Microwave-assisted
and conventional techniques were utilized for the syntheses. The structures of recently obtained molecules
were elucidated on the foundation of 1H NMR, <sup>13</sup>C NMR, FT IR, EI MS methods and elemental
analysis. All novel synthesized molecules were investigated for their antimicrobial activity using MIC
(minimum inhibitory concentration) method. The aminoalkylation of triazoles (7a-d) formed products
8a-d which have excellent activity against testing bacteria with values between 0.24 and 125 μg/mL.
Especially compounds 8a and 8d exhibited much better activity against E. coli than ampicillin used as
standard drug. The microwave process ensured a more efficient road to the creation of desired molecules.
The antibacterial examination demonstrated that after the carbonyl group is increased the antibacterial
activity of the compounds is greatly increased. That's why molecules formed as a result of the
alkylation reactions of triazoles has high activity.
Collapse
Affiliation(s)
- Yıldız Uygun Cebeci
- Karadeniz Technical University, Department of Chemistry, 61080, Trabzon,Turkey
| | - Sule Ceylan
- Artvin Coruh University, Department of Occupational Health and Safety, 08000, Artvin,Turkey
| | - Neslihan Demirbas
- Karadeniz Technical University, Department of Chemistry, 61080, Trabzon,Turkey
| | | |
Collapse
|
3
|
Caenorhabditis elegans as a Model System To Assess Candida glabrata, Candida nivariensis, and Candida bracarensis Virulence and Antifungal Efficacy. Antimicrob Agents Chemother 2020; 64:AAC.00824-20. [PMID: 32718968 DOI: 10.1128/aac.00824-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/19/2020] [Indexed: 12/18/2022] Open
Abstract
Although Candida albicans remains the major etiological agent of invasive candidiasis, Candida glabrata and other emerging species of Candida are increasingly isolated. This species is the second most prevalent cause of candidiasis in many regions of the world. However, clinical isolates of Candida nivariensis and Candida bracarensis can be misidentified and are underdiagnosed due to phenotypic traits shared with C. glabrata Little is known about the two cryptic species. Therefore, pathogenesis studies are needed to understand their virulence traits and their susceptibility to antifungal drugs. The susceptibility of Caenorhabditis elegans to different Candida species makes this nematode an excellent model for assessing host-fungus interactions. We evaluated the usefulness of C. elegans as a nonconventional host model to analyze the virulence of C. glabrata, C. nivariensis, and C. bracarensis The three species caused candidiasis, and the highest virulence of C. glabrata was confirmed. Furthermore, we determined the efficacy of current antifungal drugs against the infection caused by these species in the C. elegans model. Amphotericin B and azoles showed the highest activity against C. glabrata and C. bracarensis infections, while echinocandins were more active for treating those caused by C. nivariensis C. elegans proved to be a useful model system for assessing the pathogenicity of these closely related species.
Collapse
|
4
|
Combination of Posaconazole and Amphotericin B in the Treatment of Candida glabrata Biofilms. Microorganisms 2018; 6:microorganisms6040123. [PMID: 30518069 PMCID: PMC6313645 DOI: 10.3390/microorganisms6040123] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022] Open
Abstract
Candidemia cases have been increasing, especially among immunosuppressed patients. Candida glabrata is one of the most resistant Candida species, especially to the azole drugs, resulting in a high demand for therapeutic alternatives. The minimum inhibitory concentration (MIC), minimum fungicidal concentration (MFC), and minimum biofilm eradication concentration (MBEC) were determined for posaconazole (Pcz) and amphotericin B (AmB). The drug combinations of both drugs were evaluated on pre-formed biofilms of C. glabrata ATCC 2001, through XTT (2,3-bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide) assay, colony forming units (CFU), crystal violet, and the fractional inhibitory concentration index (FICI). C. glabrata revealed higher susceptibility and biofilm reduction in the presence of AmB alone, but both drugs revealed a good capacity in the biomass elimination. In the majority of the tested combinations, the interactions were defined as indifferent (FICI ≤ 4). The combination of the two drugs does not seem to bring a clear advantage in the treatment of biofilms of C. glabrata.
Collapse
|
5
|
Soultanov VS, Kulyashova LB, Nikitina TV, Roschin VI. Antimycotic Activity of Conifer Green Needle Complex against Clinical Strains of Candida Species. Nat Prod Commun 2018. [DOI: 10.1177/1934578x1801300123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Resistance of some Candida species to antimycotic agents is a public health threat, with new treatments a priority. Conifer Green Needle Complex (CGNC) is a pharmaceutical-grade complex substance from the green verdure of Pinus sylvestris and Picea abies. Characterization of the chemical composition of CGNC (gas chromatography/mass spectrometry/HPLC) showed resin acids (ca 20 %w/w), unsaponafiables, primarily terpenoid alcohols (ca 22% w/w), higher fatty acids (ca 10% w/w), bound acids (ca 11% w/w) and polyprenols (ca 2.5% w/w). Other significant components include phytosterols, carotenoids, chlorophyll derivatives, vitamin E acetate and vitamin K1. CGNC has high antioxidant activity. Preliminary results for antimycotic activity against clinical strains of Candida albicans, C. glabrata and C. krusei showed some Candida spp. were sensitive to CGNC, including fluconazole- and ketoconazole-resistant strains. Antimycotic activity of CGNC should be investigated in larger studies.
Collapse
Affiliation(s)
- Vagif S. Soultanov
- Honorary Doctor, Saint Petersburg State Forest Technical University, 5 Institutskiy pereulok, 194021, Saint Petersburg, Russia
- Prenolica Limited, 98–106, Moray St, South Melbourne, 3205, Australia
| | | | - Tamara V. Nikitina
- I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, Saint Petersburg pr. Torez 44, Saint Petersburg, 194223, Saint Petersburg, Russia
| | - Viktor I. Roschin
- Saint Petersburg State Forest Technical University 5, Institutskiy pereulok, 194021, Saint Petersburg, Russia
| |
Collapse
|
6
|
Synthesis, X-ray Single Crystal Structure, Molecular Docking and DFT Computations on N-[(1E)-1-(2H-1,3-Benzodioxol-5-yl)-3-(1H-imidazol-1-yl)propylidene]-hydroxylamine: A New Potential Antifungal Agent Precursor. Molecules 2017; 22:molecules22030373. [PMID: 28264518 PMCID: PMC6155236 DOI: 10.3390/molecules22030373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/12/2017] [Accepted: 02/21/2017] [Indexed: 11/17/2022] Open
Abstract
Mycoses are serious health problem, especially in immunocompromised individuals. A new imidazole-bearing compound containing an oxime functionality was synthesized and characterized with different spectroscopic techniques to be used for the preparation of new antifungal agents. The stereochemistry of the oxime double bond was unequivocally determined via the single crystal X-ray technique. The title compound 4, C13H13N3O3·C3H8O, crystallizes in the monoclinic space group P21with a = 9.0963(3) Å, b = 14.7244(6) Å, c = 10.7035(4) Å, β = 94.298 (3)°, V = 1429.57(9) Å3, Z = 2. The molecules were packed in the crystal structure by eight intermolecular hydrogen bond interactions. A comprehensive spectral analysis of the title molecule 4 has been performed based on the scaled quantum mechanical (SQM) force field obtained by density-functional theory (DFT) calculations. A molecular docking study illustrated the binding mode of the title compound 4 into its target protein. The preliminary antifungal activity of the title compound 4 was determined using a broth microdilution assay.
Collapse
|
7
|
Sanchis M, Guarro J, Sutton DA, Fothergill AW, Wiederhold N, Capilla J. Voriconazole and posaconazole therapy for experimental Candida lusitaniae infection. Diagn Microbiol Infect Dis 2015; 84:48-51. [PMID: 26456387 DOI: 10.1016/j.diagmicrobio.2015.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/10/2015] [Accepted: 09/11/2015] [Indexed: 11/16/2022]
Abstract
The in vitro activity of posaconazole (PSC) and voriconazole (VRC) was tested by using time-kill studies against 3 strains of Candida lusitaniae. Both drugs showed fungistatic activity against all strains. The efficacy of those compounds was evaluated by reducing kidney fungal burden and by determining (1→3)-β-d-glucan serum levels in a murine model of invasive infection of C. lusitaniae. The therapies tested were VRC at 10, 25, or 40 mg/kg/day and PSC at 5, 12.5, or 20 mg/kg/twice a day. All the dosages showed efficacy in a dose-dependant manner being high doses of both antifungals able to sterilize some kidneys after 10 days. With the exception of the strain FMR 9474, against which PSC was more effective than VRC, no differences in reducing tissue burden were found between the treatments. All doses of both antifungals were able to significantly reduce (1→3)-β-d-glucan serum levels with no significant differences between treatments and between the same doses of both drugs.
Collapse
Affiliation(s)
- Marta Sanchis
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Josep Guarro
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Deanna A Sutton
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | - Annette W Fothergill
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | - Nathan Wiederhold
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | - Javier Capilla
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
| |
Collapse
|
8
|
Smith WJ, Drew RH, Perfect JR. Posaconazole’s impact on prophylaxis and treatment of invasive fungal infections: an update. Expert Rev Anti Infect Ther 2014; 7:165-81. [DOI: 10.1586/14787210.7.2.165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
9
|
New azole antifungal agents with novel modes of action: Synthesis and biological studies of new tridentate ligands based on pyrazole and triazole. Eur J Med Chem 2011; 46:4117-24. [DOI: 10.1016/j.ejmech.2011.06.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 06/09/2011] [Accepted: 06/09/2011] [Indexed: 11/18/2022]
|
10
|
González GM, Elizondo M, Garza-González E, González JG. Therapeutic efficacy of posaconazole against Candida glabrata in a murine model of vaginitis. Mycoses 2011; 54:119-22. [PMID: 19811615 DOI: 10.1111/j.1439-0507.2009.01775.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The frequency of mucosal infections caused by Candida glabrata has increased significantly. Candida glabrata infections are often resistant to many azole antifungal agents, especially fluconazole. The purpose of this study was to compare the efficacies of posaconazole (PSC) and fluconazole (FLC) in the treatment of experimental C. glabrata vaginitis caused by isolates with different FLC susceptibilities. A battery of 36 vaginal isolates of C. glabrata was tested against PSC and FLC to determine their in vitro susceptibilities. The 48-h geometric mean MICs for all isolates tested were 0.156 and 4.238 μg ml(-1) for PSC and FLC respectively. Two strains of C. glabrata for which FLC MICs were different were selected for in vivo study. The treatment regimens for the vaginal murine infection model were PSC or FLC at 10 or 20 mg kg(-1) of body weight/day and 20 mg kg(-1) twice a day. Regimens with PSC at 20 mg kg(-1) once or twice a day were effective in reducing the load of both the FLC-susceptible and -resistant isolates of C. glabrata. FLC at 20 mg kg(-1) twice a day was effective in reducing the load of both the isolates of C. glabrata. PSC displayed a more effective in vivo activity than FLC in the treatment of murine C. glabrata vaginitis.
Collapse
Affiliation(s)
- Gloria M González
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico.
| | | | | | | |
Collapse
|
11
|
Guarro J. Lessons from animal studies for the treatment of invasive human infections due to uncommon fungi. J Antimicrob Chemother 2011; 66:1447-66. [PMID: 21493649 DOI: 10.1093/jac/dkr143] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Clinical experience in the management of opportunistic infections, especially those caused by less common fungi, is, due to their rarity, very scarce; therefore, the most effective treatments remain unknown. The ever-increasing numbers of fungal infections due to opportunistic fungi have repeatedly proven the limitations of the antifungal armamentarium. Moreover, some of these fungi, such as Fusarium spp. or Scedosporium spp., are innately resistant to almost all the available antifungal drugs, which makes the development of new and effective therapies a high priority. Since it is difficult to conduct randomized clinical trials in these uncommon mycoses, the use of animal models is a good alternative for evaluating new therapies. This is an extensive review of the numerous studies that have used animal models for this purpose against a significant number of less common fungi. A table describing the different studies performed on the efficacy of the different drugs tested is included for each fungal species. In addition, there is a summary table showing the conclusions that can be derived from the analysis of the studies and listing the drugs that showed the best results. Considering the wide variability in the response to the antifungals that the different strains of a given species can show, the table highlights the drugs that showed positive results using at least two parameters for evaluating efficacy against at least two different strains without showing any negative results. These data can be very useful for guiding the treatment of rare infections when there is very little experience or when controversial results exist, or when treatment fails.
Collapse
Affiliation(s)
- Josep Guarro
- Mycology Unit, Medical School, IISPV, Rovira i Virgili University, 43201 Reus, Spain.
| |
Collapse
|
12
|
Ianas V, Matthias KR, Klotz SA. Role of posaconazole in the treatment of oropharyngeal candidiasis. Infect Drug Resist 2010; 3:45-51. [PMID: 21694893 PMCID: PMC3108746 DOI: 10.2147/idr.s10588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Indexed: 11/23/2022] Open
Abstract
Posaconazole is the newest azole antifungal approved by the US Food and Drug Administration, and possesses a broad spectrum of activity against numerous yeasts and filamentous fungi. It is available as an oral suspension and is generally well tolerated by patients, but gastrointestinal absorption is sometimes inadequate and remains a clinical concern in treating deep-seated infections. It is used routinely and effectively for the prophylaxis of invasive fungal infections in immunosuppressed hosts and is an effective treatment of oropharyngeal candidiasis, including azole-resistant disease.
Collapse
Affiliation(s)
- Voichita Ianas
- Section of Infectious Diseases and Department of Medicine
| | | | | |
Collapse
|
13
|
Ferrari S, Ischer F, Calabrese D, Posteraro B, Sanguinetti M, Fadda G, Rohde B, Bauser C, Bader O, Sanglard D. Gain of function mutations in CgPDR1 of Candida glabrata not only mediate antifungal resistance but also enhance virulence. PLoS Pathog 2009; 5:e1000268. [PMID: 19148266 PMCID: PMC2607542 DOI: 10.1371/journal.ppat.1000268] [Citation(s) in RCA: 217] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 12/15/2008] [Indexed: 11/20/2022] Open
Abstract
CgPdr1p is a Candida glabrata Zn(2)-Cys(6) transcription factor involved in the regulation of the ABC-transporter genes CgCDR1, CgCDR2, and CgSNQ2, which are mediators of azole resistance. Single-point mutations in CgPDR1 are known to increase the expression of at least CgCDR1 and CgCDR2 and thus to contribute to azole resistance of clinical isolates. In this study, we investigated the incidence of CgPDR1 mutations in a large collection of clinical isolates and tested their relevance, not only to azole resistance in vitro and in vivo, but also to virulence. The comparison of CgPDR1 alleles from azole-susceptible and azole-resistant matched isolates enabled the identification of 57 amino acid substitutions, each positioned in distinct CgPDR1 alleles. These substitutions, which could be grouped into three different “hot spots,” were gain of function (GOF) mutations since they conferred hyperactivity to CgPdr1p revealed by constitutive high expression of ABC-transporter genes. Interestingly, the major transporters involved in azole resistance (CgCDR1, CgCDR2, and CgSNQ2) were not always coordinately expressed in presence of specific CgPDR1 GOF mutations, thus suggesting that these are rather trans-acting elements (GOF in CgPDR1) than cis-acting elements (promoters) that lead to azole resistance by upregulating specific combinations of ABC-transporter genes. Moreover, C. glabrata isolates complemented with CgPDR1 hyperactive alleles were not only more virulent in mice than those with wild type alleles, but they also gained fitness in the same animal model. The presence of CgPDR1 hyperactive alleles also contributed to fluconazole treatment failure in the mouse model. In conclusion, this study shows for the first time that CgPDR1 mutations are not only responsible for in vitro/in vivo azole resistance but that they can also confer a selective advantage under host conditions. Candida glabrata is a yeast causing several diseases in humans and especially in immuno-compromised people. C. glabrata infections are treated with antifungal agents, however the use of some agents, for example azoles, is associated with the development of resistance. In this yeast species, azole resistance is mediated almost exclusively by ATP Binding Cassette (ABC) multidrug transporters. Their overexpression results in enhanced efflux of azoles and thus generates resistance. Regulation of ABC transporters is therefore of pivotal importance to understanding azole resistance. In C. glabrata, the expression of ABC transporters is mediated by a zinc finger transcription factor called CgPDR1. Gain of function (GOF) mutations in CgPDR1 result in high ABC transporter expression. In this study, we investigated the occurrence of GOF mutations in a large collection of azole-resistant isolates and found a high variety of mutations localized in three distinct domains of CgPDR1. We found that these mutations are not only associated with resistance but also enhanced virulence and fitness of C. glabrata in animal models. Our study provides for the first time evidence that mutations causing antifungal resistance can also provide a selective advantage under host conditions and thus highlights the need of carefully monitoring resistance in this pathogen.
Collapse
Affiliation(s)
- Sélène Ferrari
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - Françoise Ischer
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - David Calabrese
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - Brunella Posteraro
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giovanni Fadda
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Oliver Bader
- Institut für Medizinische Mikrobiologie, Universitätskliniken Göttingen, Göttingen, Germany
| | - Dominique Sanglard
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
- * E-mail:
| |
Collapse
|