1
|
Pontes L, Perini Leme Giordano AL, Reichert-Lima F, Gualtieri Beraquet CA, Leite Pigolli G, Arai T, Ribeiro JD, Gonçalves AC, Watanabe A, Goldman GH, Moretti ML, Zaninelli Schreiber A. Insights into Aspergillus fumigatus Colonization in Cystic Fibrosis and Cross-Transmission between Patients and Hospital Environments. J Fungi (Basel) 2024; 10:461. [PMID: 39057346 PMCID: PMC11277961 DOI: 10.3390/jof10070461] [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: 05/20/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Approximately 60% of individuals with cystic fibrosis (CF) are affected by Aspergillus fumigatus infection. This condition is correlated with a decline in lung function and is identified as an independent risk factor contributing to hospital admissions among CF patients. This study investigates the dynamic interplay of A. fumigatus within the context of CF patients, tracing its evolution over time, with a specific emphasis on colonization dynamics. METHODS An analysis was conducted on 83 sequential A. fumigatus isolates derived from sputum samples of six patients receiving care at a renowned CF hospital in Brazil. Employing microsatellite genotyping techniques, alongside an investigation into cyp51A gene mutations, this research sheds light on the genetic variations, colonization, and resistance of A. fumigatus within the CF respiratory environment. RESULTS Our research findings indicate that CF patients can harbor A. fumigatus strains from the same clonal complexes for prolonged periods. Additionally, we identified that clinical isolates have the potential to spread among patients in the same healthcare facility, evidencing hospital contamination. Two patients who underwent long-term Itraconazole treatment did not show phenotypic resistance. However, one of these patients exhibited mutations in the cyp51A gene, indicating the need to monitor resistance to azoles in these patients colonized for long periods by A. fumigatus. We also observed co-colonization or co-infection involving multiple genotypes in all patients over time. CONCLUSION This comprehensive examination offers valuable insights into the pathogenesis of A. fumigatus infections in CF patients, potentially shaping future therapeutic strategies and management approaches. This enhanced understanding contributes to our knowledge of A. fumigatus impact on disease progression in individuals with cystic fibrosis. Additionally, the study provides evidence of cross-contamination among patients undergoing treatment at the same hospital.
Collapse
Affiliation(s)
- Laís Pontes
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Ana Luisa Perini Leme Giordano
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Franqueline Reichert-Lima
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Caio Augusto Gualtieri Beraquet
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Guilherme Leite Pigolli
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Teppei Arai
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba 260-0856, Japan; (T.A.); (A.W.)
| | - José Dirceu Ribeiro
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Aline Cristina Gonçalves
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba 260-0856, Japan; (T.A.); (A.W.)
| | - Gustavo Henrique Goldman
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14040-903, Brazil;
| | - Maria Luiza Moretti
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| | - Angélica Zaninelli Schreiber
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil; (A.L.P.L.G.); (F.R.-L.); (C.A.G.B.); (G.L.P.); (J.D.R.); (A.C.G.); (M.L.M.)
| |
Collapse
|
2
|
Majima H, Inoue Y, Otsuka Y, Yaguchi T, Watanabe A, Kamei K. Lymphadenitis caused by Purpureocillium lilacinum in a patient with CARD9 deficiency. Med Mycol Case Rep 2023; 42:100609. [PMID: 37767185 PMCID: PMC10520493 DOI: 10.1016/j.mmcr.2023.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
We hereby make the first report of a case of mycosis caused by Purpureocillium lilacinum in CARD9 deficiency. A 40-year-old woman complained of lymph node swellings in the left cervical area. She also had chronic mucocutaneous candidiasis (CMC), and was found to have CARD9 deficiency. Lymphadenitis by P. lilacinum was confirmed. The diagnosis was difficult, as culturing the biopsy specimen at a cautiously selected temperature (25 °C) and genetic analysis were both required. Oral administration of voriconazole improved her lymphadenopathy.
Collapse
Affiliation(s)
- Hidetaka Majima
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Yuzaburo Inoue
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuichiro Otsuka
- Division of Otolaryngology, Chiba Kaihin Municipal Hospital, Chiba, Japan
| | - Takashi Yaguchi
- Management of Unit of Microbiological Resources, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Katsuhiko Kamei
- Department of Infectious Disease, Japanese Red Cross Ishinomaki Hospital, Miyagi, Japan
- Division of Infection Control and Prevention, Medical Mycology Research Center, Chiba University, Chiba, Japan
| |
Collapse
|
3
|
Majima H, Arai T, Kamei K, Watanabe A. In vivo efficacy of pitavastatin combined with itraconazole against Aspergillus fumigatus in silkworm models. Microbiol Spectr 2023; 11:e0266623. [PMID: 37655910 PMCID: PMC10581172 DOI: 10.1128/spectrum.02666-23] [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: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 09/02/2023] Open
Abstract
Azole resistance in Aspergillus fumigatus is a worldwide concern and new antifungal drugs are required to overcome this problem. Statin, a 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, has been reported to suppress the growth of A. fumigatus, but little is known about its in vivo antifungal effect against A. fumigatus. In this study, we evaluated the in vivo efficacy of pitavastatin (PIT) combined with itraconazole (ITC) against azole-susceptible and azole-resistant strains with silkworm models. Prolongation of survival was confirmed in the combination-therapy (PIT and ITC) group compared to the no-treatment group in both azole-susceptible and azole-resistant strain models. Furthermore, when the azole-susceptible strain was used, the combination-therapy resulted in a higher survival rate than with ITC alone. Histopathological analysis of the silkworms revealed a reduction of the hyphal amount in both azole-susceptible and azole-resistant strain models. Quantitative evaluation of fungal DNA by qPCR in azole-susceptible strain models clarified the reduction of fungal burden in the combination-therapy group compared with the no-treatment group and ITC-alone group. These results indicate that the efficacy of PIT was enhanced when combined with ITC in vivo. As opposed to most statins, PIT has little drug-drug interaction with azoles in humans and can be used safely with ITC. This combination therapy may be a promising option as an effective treatment in clinical settings in the future. IMPORTANCE Azole resistance among A. fumigatus isolates has recently been increasingly recognized as a cause of treatment failure, and alternative antifungal therapies are required to overcome this problem. Our study shows the in vivo efficacy of PIT combined with ITC against A. fumigatus using silkworm models by several methods including evaluation of survival rates, histopathological analysis, and assessment of fungal burden. Contrary to most statins, PIT can be safely administered with azoles because of less drug-drug interactions, so this study should help us to verify how to make use of the drug in clinical settings in the future.
Collapse
Affiliation(s)
- Hidetaka Majima
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Teppei Arai
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Katsuhiko Kamei
- Department of Infectious Disease, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
- Division of Infection Control and Prevention, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| |
Collapse
|
4
|
Stevenson EM, Gaze WH, Gow NAR, Hart A, Schmidt W, Usher J, Warris A, Wilkinson H, Murray AK. Antifungal Exposure and Resistance Development: Defining Minimal Selective Antifungal Concentrations and Testing Methodologies. FRONTIERS IN FUNGAL BIOLOGY 2022; 3:918717. [PMID: 37746188 PMCID: PMC10512330 DOI: 10.3389/ffunb.2022.918717] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/16/2022] [Indexed: 09/26/2023]
Abstract
This scoping review aims to summarise the current understanding of selection for antifungal resistance (AFR) and to compare and contrast this with selection for antibacterial resistance, which has received more research attention. AFR is an emerging global threat to human health, associated with high mortality rates, absence of effective surveillance systems and with few alternative treatment options available. Clinical AFR is well documented, with additional settings increasingly being recognised to play a role in the evolution and spread of AFR. The environment, for example, harbours diverse fungal communities that are regularly exposed to antifungal micropollutants, potentially increasing AFR selection risk. The direct application of effect concentrations of azole fungicides to agricultural crops and the incomplete removal of pharmaceutical antifungals in wastewater treatment systems are of particular concern. Currently, environmental risk assessment (ERA) guidelines do not require assessment of antifungal agents in terms of their ability to drive AFR development, and there are no established experimental tools to determine antifungal selective concentrations. Without data to interpret the selective risk of antifungals, our ability to effectively inform safe environmental thresholds is severely limited. In this review, potential methods to generate antifungal selective concentration data are proposed, informed by approaches used to determine antibacterial minimal selective concentrations. Such data can be considered in the development of regulatory guidelines that aim to reduce selection for AFR.
Collapse
Affiliation(s)
- Emily M. Stevenson
- European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall, United Kingdom
- Environment and Sustainability Institute, University of Exeter Medical School, Cornwall, United Kingdom
| | - William H. Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall, United Kingdom
- Environment and Sustainability Institute, University of Exeter Medical School, Cornwall, United Kingdom
| | - Neil A. R. Gow
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Alwyn Hart
- Chief Scientist’s Group, Environment Agency, Horizon House, Bristol, England, United Kingdom
| | - Wiebke Schmidt
- Chief Scientist’s Group, Environment Agency, Horizon House, Bristol, England, United Kingdom
| | - Jane Usher
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Helen Wilkinson
- Chief Scientist’s Group, Environment Agency, Horizon House, Bristol, England, United Kingdom
| | - Aimee K. Murray
- European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall, United Kingdom
- Environment and Sustainability Institute, University of Exeter Medical School, Cornwall, United Kingdom
| |
Collapse
|
5
|
Durand C, Maubon D, Cornet M, Wang Y, Aldebert D, Garnaud C. Can We Improve Antifungal Susceptibility Testing? Front Cell Infect Microbiol 2021; 11:720609. [PMID: 34568095 PMCID: PMC8461061 DOI: 10.3389/fcimb.2021.720609] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Systemic antifungal agents are increasingly used for prevention or treatment of invasive fungal infections, whose prognosis remains poor. At the same time, emergence of resistant or even multi-resistant strains is of concern as the antifungal arsenal is limited. Antifungal susceptibility testing (AFST) is therefore of key importance for patient management and antifungal stewardship. Current AFST methods, including reference and commercial types, are based on growth inhibition in the presence of an antifungal, in liquid or solid media. They usually enable Minimal Inhibitory Concentrations (MIC) to be determined with direct clinical application. However, they are limited by a high turnaround time (TAT). Several innovative methods are currently under development to improve AFST. Techniques based on MALDI-TOF are promising with short TAT, but still need extensive clinical validation. Flow cytometry and computed imaging techniques detecting cellular responses to antifungal stress other than growth inhibition are also of interest. Finally, molecular detection of mutations associated with antifungal resistance is an intriguing alternative to standard AFST, already used in routine microbiology labs for detection of azole resistance in Aspergillus and even directly from samples. It is still restricted to known mutations. The development of Next Generation Sequencing (NGS) and whole-genome approaches may overcome this limitation in the near future. While promising approaches are under development, they are not perfect and the ideal AFST technique (user-friendly, reproducible, low-cost, fast and accurate) still needs to be set up routinely in clinical laboratories.
Collapse
Affiliation(s)
| | - Danièle Maubon
- TIMC, Univ Grenoble Alpes, CNRS, Grenoble INP, Grenoble, France.,Parasitology-Mycology, CHU Grenoble Alpes, Grenoble, France
| | - Muriel Cornet
- TIMC, Univ Grenoble Alpes, CNRS, Grenoble INP, Grenoble, France.,Parasitology-Mycology, CHU Grenoble Alpes, Grenoble, France
| | | | | | - Cécile Garnaud
- TIMC, Univ Grenoble Alpes, CNRS, Grenoble INP, Grenoble, France.,Parasitology-Mycology, CHU Grenoble Alpes, Grenoble, France
| |
Collapse
|
6
|
Majima H, Arai T, Kusuya Y, Takahashi H, Watanabe A, Miyazaki Y, Kamei K. Genetic differences between Japan and other countries in cyp51A polymorphisms of Aspergillus fumigatus. Mycoses 2021; 64:1354-1365. [PMID: 34558115 DOI: 10.1111/myc.13370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mutations in cyp51A gene are known as main mechanisms of azole resistance in Aspergillus fumigatus, whereas azole-susceptible strains also carry cyp51A mutations (polymorphisms). The polymorphisms found in Europe mainly consist of two combinations of mutations, that is combinations of five single-nucleotide polymorphisms (SNPs) of cyp51A, referred to as cyp51A-5SNPs, and combinations of three SNPs of cyp51A, referred to as cyp51A-3SNPs. Few studies have compared the distributions of cyp51A polymorphisms between different regions. OBJECTIVES The aim of this study was to investigate the regional differences of cyp51A polymorphisms. METHODS We compared the proportions of cyp51A polymorphisms in clinical and environmental strains isolated in various countries, and analysed the strains phylogenetically using short tandem repeats (STRs) and whole-genome sequence (WGS). RESULTS Among the Japanese strains, 15 out of 98 (15.3%) clinical strains and 8 out of 95 (8.4%) environmental strains had cyp51A polymorphisms. A mutation of cyp51AN248K was the most prevalent polymorphism in both clinical (n = 14, 14.3%) and environmental strains (n = 3, 3.2%). Only one environmental strain harboured cyp51A-5SNPs, which was reported to be the most prevalent in Europe. For phylogenetic analyses using STRs and WGS, 183 and 134 strains, respectively, were employed. They showed that most of the strains with cyp51AN248K clustered in the clades different from those of the strains with cyp51A-5SNPs and cyp51A-3SNPs as well as from those with TR34 /L98H mutations. CONCLUSIONS This study suggests that there are genetic differences between cyp51A polymorphisms of A. fumigatus in Japan and Europe.
Collapse
Affiliation(s)
- Hidetaka Majima
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan.,Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Teppei Arai
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Yoko Kusuya
- Division of Bioresources, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Hiroki Takahashi
- Division of Bioresources, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Katsuhiko Kamei
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| |
Collapse
|
7
|
Novak-Frazer L, Anees-Hill SP, Hassan D, Masania R, Moore CB, Richardson MD, Denning DW, Rautemaa-Richardson R. Deciphering Aspergillus fumigatus cyp51A-mediated triazole resistance by pyrosequencing of respiratory specimens. J Antimicrob Chemother 2021; 75:3501-3509. [PMID: 32862231 PMCID: PMC7662182 DOI: 10.1093/jac/dkaa357] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Infections caused by triazole drug-resistant Aspergillus fumigatus are an increasing problem. The sensitivity of standard culture is poor, abrogating susceptibility testing. Early detection of resistance can improve patient outcomes, yet tools for this purpose are limited. Objectives To develop and validate a pyrosequencing technique to detect resistance-conferring cyp51A polymorphisms from clinical respiratory specimens and A. fumigatus isolates. Methods Method validation was performed by Sanger sequencing and pyrosequencing of 50 A. fumigatus isolates with a spectrum of triazole susceptibility patterns. Then, 326 Aspergillus quantitative PCR (qPCR)-positive respiratory samples collected over a 27 month period (January 2017–March 2019) from 160 patients at the UK National Aspergillosis Centre were assessed by cyp51A pyrosequencing. The Sanger sequencing and pyrosequencing results were compared with those from high-volume culture and standard susceptibility testing. Results The cyp51A genotypes of the 50 isolates analysed by pyrosequencing and Sanger sequencing matched. Of the 326 Aspergillus qPCR-positive respiratory specimens, 71.2% were reported with no A. fumigatus growth. Of these, 56.9% (132/232) demonstrated a WT cyp51A genotype and 31.5% (73/232) a resistant genotype by pyrosequencing. Pyrosequencing identified the environmental TR34/L98H mutation in 18.7% (61/326) of the samples in contrast to 6.4% (21/326) pan-azole resistance detected by culture. Importantly, pyrosequencing detected resistance earlier than culture in 23.3% of specimens. Conclusions The pyrosequencing assay described could detect a wide range of cyp51A polymorphisms associated with triazole resistance, including those not identified by commercial assays. This method allowed prompt recognition of resistance and the selection of appropriate antifungal treatment when culture was negative.
Collapse
Affiliation(s)
- Lilyann Novak-Frazer
- Mycology Reference Centre Manchester, ECMM Centre of Excellence, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, UK.,The University of Manchester, Faculty of Biology, Medicine and Health, Division of Infection, Inflammation and Respiratory Medicine, Manchester, UK
| | - Samuel P Anees-Hill
- Mycology Reference Centre Manchester, ECMM Centre of Excellence, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, UK
| | - Darin Hassan
- Mycology Reference Centre Manchester, ECMM Centre of Excellence, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, UK
| | - Rikesh Masania
- Mycology Reference Centre Manchester, ECMM Centre of Excellence, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, UK
| | - Caroline B Moore
- Mycology Reference Centre Manchester, ECMM Centre of Excellence, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, UK.,The University of Manchester, Faculty of Biology, Medicine and Health, Division of Infection, Inflammation and Respiratory Medicine, Manchester, UK
| | - Malcolm D Richardson
- Mycology Reference Centre Manchester, ECMM Centre of Excellence, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, UK.,The University of Manchester, Faculty of Biology, Medicine and Health, Division of Infection, Inflammation and Respiratory Medicine, Manchester, UK
| | - David W Denning
- The University of Manchester, Faculty of Biology, Medicine and Health, Division of Infection, Inflammation and Respiratory Medicine, Manchester, UK.,National Aspergillosis Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, UK
| | - Riina Rautemaa-Richardson
- Mycology Reference Centre Manchester, ECMM Centre of Excellence, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, UK.,The University of Manchester, Faculty of Biology, Medicine and Health, Division of Infection, Inflammation and Respiratory Medicine, Manchester, UK.,National Aspergillosis Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, UK
| |
Collapse
|
8
|
Arai T, Umeyama T, Majima H, Inukai T, Watanabe A, Miyazaki Y, Kamei K. Hmg1 mutations in Aspergillus fumigatus and their contribution to triazole susceptibility. Med Mycol 2021; 59:980-984. [PMID: 34019670 DOI: 10.1093/mmy/myab026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
Triazole-resistant Aspergillus fumigatus is a global health concern. In general, each triazole resistance pattern caused by the specified amino acid substitution of Cyp51A has a typical pattern depending on the mutation site. We evaluated the contribution of both Cyp51A and Hmg1 mutations to atypical triazole resistance in A. fumigatus. We used clinical triazole-resistant A. fumigatus strains collected in Japan and investigated the sequences of cyp51A and hmg1 genes. To delineate the association between the hmg1 mutation and atypical triazole resistance, the mutant hmg1 alleles in clinical multi-azole resistant strains were replaced with the wild-type hmg1 allele by CRISPR/Cas9 system. In our study, the combination of Cyp51A mutation and Hmg1 mutation was shown to additively contribute to triazole resistance. We also demonstrated that the triazole resistance conferred by the Hmg1 mutation showed a different pattern depending on the mutation site, similar to the Cyp51A mutation. Our results indicate that focusing on the phenotypes of multiple genes is essential to clarify the overall picture of the triazole resistance mechanism of A. fumigatus. LAY SUMMARY The number of triazole-resistant Aspergillus fumigatus is increasing. We confirmed thatmutation in a hydroxymethylglutaryl-CoA reductase (Hmg1) in the fungus contributesto the resistance separately from Cyp51A mutation, and that susceptibility patterns aredifferent based on mutation site.
Collapse
Affiliation(s)
- Teppei Arai
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, 260-8673, Chiba City, Chiba, Japan
| | - Takashi Umeyama
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 162-8640, Shinjuku-ku, Tokyo, Japan
| | - Hidetaka Majima
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, 260-8673, Chiba City, Chiba, Japan.,Department of Respiratory Medicine, Tokyo Medical and Dental University, 113-8510, Bunkyoku-ku, Tokyo, Japan
| | - Tatsuya Inukai
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 162-8640, Shinjuku-ku, Tokyo, Japan.,Department of Microbiology, Tokyo Medical University, 160-8402, Shinjuku-ku, Tokyo, Japan
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, 260-8673, Chiba City, Chiba, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 162-8640, Shinjuku-ku, Tokyo, Japan
| | - Katsuhiko Kamei
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, 260-8673, Chiba City, Chiba, Japan
| |
Collapse
|
9
|
Khalifa HO, Arai T, Majima H, Watanabe A, Kamei K. Evaluation of Surveyor nuclease for rapid identification of FKS genes mutations in Candida glabrata. J Infect Chemother 2021; 27:834-839. [PMID: 33582033 DOI: 10.1016/j.jiac.2021.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Infections with Candida glabrata have recently gained worldwide attention owing to its association with long hospitalizations and high mortality rates. This problem is highlighted when the infection is associated with echinocandin resistance, which is used for first-line therapy. Echinocandin resistance is exclusively attributed to functional mutations in FKS genes, and especially in hot spot (HS) regions. Unfortunately, few studies have focused on the rapid identification of FKS mutations associated with echinocandin resistance in C. glabrata. This study was intended to evaluate and validate the use of Surveyor nuclease assay (SN) for detection of FKS gene mutations. METHODS SN was evaluated against three segments of FKS1 and FKS2 genes including whole gene, regions including all HSs, and the region including only HS1. RESULTS Our results showed that SN results are basically dependent on the type of gene as well as the segment type. Interestingly, SN can detect mutations in the region containing HS1 in both FKS1 and FKS2 genes. Furthermore, SN can detect mutations in the segment containing all HS regions for FKS1 but not FKS2. SN was unable to detect mutations in the whole FKS1 and FKS2 genes. CONCLUSIONS As far as we know, this is the first study to validate SN for rapid identification of FKS gene mutations. This assay could be used as a sample for rapid identification of mutations associated with HS1 region in FKS genes, which have a predominant role for echinocandin resistance induction in C. glabrata.
Collapse
Affiliation(s)
- Hazim O Khalifa
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, 260-8673, Japan; Department of Pharmacology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, 33516, Egypt
| | - Teppei Arai
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, 260-8673, Japan
| | - Hidetaka Majima
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, 260-8673, Japan
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, 260-8673, Japan.
| | - Katsuhiko Kamei
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, 260-8673, Japan
| |
Collapse
|
10
|
周 丽, 叶 颖, 原 海, 吴 超, 吴 淑. [Construction of macrophage RAW 264.7 cells with gsdmd gene knockout by CRISPR/Cas9 system]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:116-122. [PMID: 33509763 PMCID: PMC7867478 DOI: 10.12122/j.issn.1673-4254.2021.01.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To construct a cell model of gsdmd gene knockout in macrophage RAW 264.7 cells using CRISPR/Cas9 system. METHODS Four specific single guide RNAs (sgRNAs) targeting gsdmd were designed to construct pGL3-sgRNA recombinant plasmids, which were identified by PCR amplification and sequencing.Cas9 and the recombinant plasmids were transfected into RAW 264.7 cells in two steps, and the cellular expression of cas9 was detected with real-time quantitative PCR (qPCR).The positive cell clones with gsdmd gene knockout were screened using puromycin and verified by sequencing and Western blotting.Annexin Ⅴ/PI staining and LDH release assay were performed in gsdmd-/-RAW 264.7 cells after being co-cultured with Salmonella Typhimurium. RESULTS qPCR results showed that cas9 gene was stably expressed in RAW 264.7-Cas9 cells (P< 0.01).PCR and sequencing results demonstrated successful construction of the recombinant plasmid pGL3-sgRNA. The results of PCR, sequencing and Western blotting all confirmed that gsdmd -/-RAW 264.7 cells were successfully constructed. Annexin Ⅴ/PI staining and LDH release assay showed that gsdmd gene knockout significantly inhibited macrophage death caused by S.Typhimurium infection (P < 0.01). CONCLUSIONS gsdmd -/-RAW 264.7 cells provide a cell model for studying the mechanisms underlying GSDMD-mediated macrophage death.
Collapse
Affiliation(s)
- 丽婷 周
- 苏州大学医学部基础医学与生物科学学院病原生物学系,江苏 苏州 215123Department of Medical Microbiology, School of Biology and Basic Medical Science, Medical College of Soochow University, Suzhou 215123, China
| | - 颖 叶
- 苏州大学剑桥-苏大基因组资源中心,江苏 苏州 215123CAM-SU Genomic Resource Center, Soochow University, Suzhou, 215123, China
| | - 海波 原
- 苏州大学医学部基础医学与生物科学学院病原生物学系,江苏 苏州 215123Department of Medical Microbiology, School of Biology and Basic Medical Science, Medical College of Soochow University, Suzhou 215123, China
| | - 超逸 吴
- 苏州大学医学部基础医学与生物科学学院病原生物学系,江苏 苏州 215123Department of Medical Microbiology, School of Biology and Basic Medical Science, Medical College of Soochow University, Suzhou 215123, China
| | - 淑燕 吴
- 苏州大学医学部基础医学与生物科学学院病原生物学系,江苏 苏州 215123Department of Medical Microbiology, School of Biology and Basic Medical Science, Medical College of Soochow University, Suzhou 215123, China
| |
Collapse
|
11
|
Recent Advances and Novel Approaches in Laboratory-Based Diagnostic Mycology. J Fungi (Basel) 2021; 7:jof7010041. [PMID: 33440757 PMCID: PMC7827937 DOI: 10.3390/jof7010041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/31/2020] [Accepted: 01/01/2021] [Indexed: 12/16/2022] Open
Abstract
What was once just culture and microscopy the field of diagnostic mycology has significantly advanced in recent years and continues to incorporate novel assays and strategies to meet the changes in clinical demand. The emergence of widespread resistance to antifungal therapy has led to the development of a range of molecular tests that target mutations associated with phenotypic resistance, to complement classical susceptibility testing and initial applications of next-generation sequencing are being described. Lateral flow assays provide rapid results, with simplicity allowing the test to be performed outside specialist centres, potentially as point-of-care tests. Mycology has responded positively to an ever-diversifying patient population by rapidly identifying risk and developing diagnostic strategies to improve patient management. Nowadays, the diagnostic repertoire of the mycology laboratory employs classical, molecular and serological tests and should be keen to embrace diagnostic advancements that can improve diagnosis in this notoriously difficult field.
Collapse
|