1
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Quincho-Lopez A, Poma N, José Montenegro-Idrogo J. COVID-19 associated with cryptococcosis: a scoping review. Ther Adv Infect Dis 2024; 11:20499361241232851. [PMID: 38361915 PMCID: PMC10868154 DOI: 10.1177/20499361241232851] [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: 09/14/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
Background There is growing evidence of fungal infections associated with COVID-19. The development of cryptococcosis in these patients has been infrequently reported. However, it can be life-threatening. Objective To identify cases of COVID-19 patients who developed cryptococcosis and to compare baseline characteristics and management between those who survived and those who died. Methods We conducted a scoping review using PubMed, Scopus, Web of Science, and Embase to identify studies that reported patients with COVID-19 and cryptococcosis. No language restriction was applied. Single case reports, case series, and original articles were included. It is important to note that 'n' refers to the total number of individuals with the specified variable. Results A total of 58 studies were included. Among these studies, 51 included individual patient data, detailing information on a total of 65 patients, whereas eight studies reported the proportion of cryptococcosis in COVID-19 patients. One study provided both individual and aggregate case information. From individual patient data, the majority were male (73.9%; n = 48) with a median age of 60 years (range: 53-70). Severe COVID-19 and multiple comorbidities, led by arterial hypertension and diabetes mellitus, were frequently reported, but few had classic immunosuppression factors. On the other hand, HIV status, either negative or positive, was reported in just over half of the patients (61.5%; n = 40). Most were admitted to the intensive care unit (ICU) (58.5%; n = 31), received mechanical ventilation (MV) (50.0%; n = 26), and developed disseminated cryptococcosis (55.4%; n = 36). Secondary infection, mainly bacterial, was reported in 19 patients (29.2%). Mortality was 47.7% (n = 31). Of the studies that reported the proportion of cryptococcosis in COVID-19 cases, the majority were descriptive studies published as conference abstracts. Conclusion Cryptococcosis in COVID-19 patients has been reported more frequently. However, it is still not as common as other fungal infections associated with COVID-19. Few patients have some classic immunosuppression factors. The factors associated with mortality were male sex, age, ICU admission, MV, secondary infections, and lymphopenia.
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Affiliation(s)
- Alvaro Quincho-Lopez
- Unidad de Investigación en Bibliometría, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - Nuvith Poma
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Juan José Montenegro-Idrogo
- Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
- Infectious Diseases and Tropical Medicine Service, Hospital Nacional Dos de Mayo, Lima, Peru
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
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2
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Horn C, Sprute R, Kretschmer AC, Do C, Cornely OA, Jung N, Lehmann C, Fischer J. [Sex in infectious diseases-How sex differences influence the immune response to infections]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:752-757. [PMID: 37016079 PMCID: PMC10072806 DOI: 10.1007/s00108-023-01498-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/05/2023]
Abstract
The humoral and cellular immune responses to antigen stimulation, vaccinations and infections differ between women and men. Genetic, epigenetic and hormonal factors contribute to the sex-specific immunity. The expression of genes on the X‑chromosome and the effect of sex hormones substantially influence the immune defence against infections. Females show stronger cellular and humoral immune responses to infections than males, but the enhanced immune response often leads to aberrant inflammatory reactions and autoimmune diseases. Men are principally more prone to bacterial, viral and fungal infections and more often show severe disease courses. In contrast, a more reactive female immune system results in significantly more adverse reactions to vaccinations. In order to be able to better identify the multiple sex-specific that have an influence on the immune system, sex-specific differences should be investigated in a differentiated way. The better understanding of the sex-specific differences in the immune response will have a long-term influence on the prevention, diagnostics and treatment of infectious diseases, and will ultimately contribute to improving healthcare of both women and men.
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Affiliation(s)
- Carola Horn
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
| | - Rosanne Sprute
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Lehrstuhl für Translationale Forschung, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Köln, Excellenz Zentrum Medizinische Mykologie (ECMM), Universität zu Köln, Köln, Deutschland
| | - Alina Chloé Kretschmer
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland
| | - Carolin Do
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland
| | - Oliver A Cornely
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Lehrstuhl für Translationale Forschung, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für klinische Studien (ZKS Köln), Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Köln, Excellenz Zentrum Medizinische Mykologie (ECMM), Universität zu Köln, Köln, Deutschland
| | - Norma Jung
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
| | - Clara Lehmann
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland
| | - Julia Fischer
- Medizinische Fakultät und Uniklinik Köln, Klinik 1 für Innere Medizin, Universität zu Köln, Köln, Deutschland.
- Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Köln, Köln, Deutschland.
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Molekulare Medizin (ZMMK), Universität zu Köln, Köln, Deutschland.
- Klinik 1 für Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50931, Köln, Deutschland.
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3
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Chen J, Shao J, Dai M, Fang W, Yang YL. Adaptive immunology of Cryptococcus neoformans infections-an update. Front Immunol 2023; 14:1174967. [PMID: 37251371 PMCID: PMC10213923 DOI: 10.3389/fimmu.2023.1174967] [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: 02/27/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
The fungal genus Cryptococcus comprises a group of pathogens with considerable phenotypic and genotypic diversity that can lead to cryptococcosis in both healthy and immunocompromised individuals. With the emergence of the HIV pandemic, cryptococcosis, mainly meningoencephalitis, afflicts HIV-infected patients with severe dysfunction of T cells. It has also been reported in recipients of solid organ transplantation and in patients with autoimmune diseases who take immunosuppressive agents long-term, as well as in those with unidentified immunodeficiency. The clinical outcome of the disease is primarily determined by the immune response resulting from the interplay between the host immune system and the pathogen. Most human infections are caused by Cryptococcus neoformans, and nearly all immunological studies have focused on C. neoformans. This review provides an updated understanding of the role of adaptive immunity during infection with C. neoformans in human and animal models over the past half-decade.
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Affiliation(s)
- Junsong Chen
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiasheng Shao
- Department of Immunology and Rheumatology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Science, Shanghai, China
- Tulane National Primate Research Center, Tulane University School of Medicine, Covington, LA, United States
| | - Min Dai
- Department of Immunology and Rheumatology, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Science, Shanghai, China
| | - Wei Fang
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ya-li Yang
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
- Department of Dermatology, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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4
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The Pathological Activation of Microglia Is Modulated by Sexually Dimorphic Pathways. Int J Mol Sci 2023; 24:ijms24054739. [PMID: 36902168 PMCID: PMC10003784 DOI: 10.3390/ijms24054739] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/11/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
Microglia are the primary immunocompetent cells of the central nervous system (CNS). Their ability to survey, assess and respond to perturbations in their local environment is critical in their role of maintaining CNS homeostasis in health and disease. Microglia also have the capability of functioning in a heterogeneous manner depending on the nature of their local cues, as they can become activated on a spectrum from pro-inflammatory neurotoxic responses to anti-inflammatory protective responses. This review seeks to define the developmental and environmental cues that support microglial polarization towards these phenotypes, as well as discuss sexually dimorphic factors that can influence this process. Further, we describe a variety of CNS disorders including autoimmune disease, infection, and cancer that demonstrate disparities in disease severity or diagnosis rates between males and females, and posit that microglial sexual dimorphism underlies these differences. Understanding the mechanism behind differential CNS disease outcomes between men and women is crucial in the development of more effective targeted therapies.
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5
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Kaur H, Gupta P, Pilania R, Suri D, Singh S, Ghosh A, Rudramurthy SM. Trend of pediatric cryptococcosis in a tertiary care centre and review of literature. Indian J Med Microbiol 2022; 43:18-29. [PMID: 36464534 DOI: 10.1016/j.ijmmb.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE Cryptococcosis is one of the most significant systemic fungal infections worldwide. Epidemiological data for pediatric cryptococcosis is very limited. Therefore, we planned this study to determine the burden of cryptococcosis in the pediatric population at our tertiary care center and performed review of literature. MATERIAL AND METHODS In this retrospective study, all the patients less than 18 years of age were diagnosed with cryptococcosis, from January 2015-June 2021 were included. Demographic, clinical, and laboratory details of all the patients were noted. Furthermore, PubMed and MedLine databases were comprehensively searched for cases of pediatric cryptococcosis till June 2021. RESULTS Of the total 5420 samples from suspected cryptococcosis cases processed at mycology laboratory, a total of 21 episodes of cryptococcosis (0.39%) were identified in 15 pediatric patients. The majority of the patients were apparently immunocompetent (10/15). Central nervous system (CNS) cryptococcosis was the most common presentation, followed by disseminated disease. All the isolates were identified as Cryptococcus neoformans (formerly referred to as C. neoformans var grubii), except one that was identified as Papiliotrema laurentii (formerly referred to as Cryptococcus laurentii). A standard treatment regimen inclusive of induction and maintenance therapy was provided in only five patients. The literature review revealed a total of 125 studies describing 1134 cases, of which 76.4% are reported from outside Asia, the majority (65.7%) restricted to CNS with C. neoformans as the commonest species. The management profile divulged a significantly higher use of standard drug regimen in Asia as compared to the rest of the world. Mortality of 13.32% was noted worldwide. CONCLUSION To the best of our knowledge, this is the first clinico-epidemiological study of pediatric cryptococcosis from India and the largest retrospective study worldwide. The rising incidence among immunocompetent individuals, especially in Asia, is a matter of concern. Clinical suspicion and early diagnosis are the cornerstones for the management of cases.
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Affiliation(s)
- Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | - Rakesh Pilania
- Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anup Ghosh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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Egger M, Hoenigl M, Thompson GR, Carvalho A, Jenks JD. Let's talk about Sex Characteristics - as a Risk Factor for Invasive Fungal Diseases. Mycoses 2022; 65:599-612. [PMID: 35484713 DOI: 10.1111/myc.13449] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
Biological sex, which comprises differences in host sex hormone homeostasis and immune responses, can have a substantial impact on the epidemiology of infectious diseases. Comprehensive data on sex distributions in invasive fungal diseases (IFDs) is lacking. In this review we performed a literature search of in vitro/animal studies, clinical studies, systematic reviews, and meta-analyses of invasive fungal infections. Females represented 51.2% of invasive candidiasis cases, mostly matching the proportions of females among the general population in the United States and Europe (>51%). In contrast, other IFDs were overrepresented in males, including invasive aspergillosis (51% males), mucormycosis (60%), cryptococcosis (74%), coccidioidomycosis (70%), histoplasmosis (61%), and blastomycosis (66%). Behavioral variations, as well as differences related to biological sex, may only in part explain these findings. Further investigations concerning the association between biological sex/gender and the pathogenesis of IFDs is warranted.
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Affiliation(s)
- Matthias Egger
- Division of Infectious Diseases, Medical University of Graz, Austria
| | - Martin Hoenigl
- Division of Infectious Diseases, Medical University of Graz, Austria.,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.,Clinical and Translational Fungal - Working Group, University of California San Diego, La Jolla, CA, USA
| | - George R Thompson
- University of California Davis Center for Valley Fever, California, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, California, USA.,Department of Medical Microbiology and Immunology, University of California Davis, California, USA
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's -, PT Government Associate Laboratory, Braga/Guimarães, Portugal
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7
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de Araújo Albuquerque LP, da Silva AM, de Araújo Batista FM, de Souza Sene I, Costa DL, Costa CHN. Influence of sex hormones on the immune response to leishmaniasis. Parasite Immunol 2021; 43:e12874. [PMID: 34309860 DOI: 10.1111/pim.12874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022]
Abstract
The differences in morbidity and mortality patterns and life expectancy between the sexes are well established in different infectious and parasitic conditions, such as in leishmaniases, in which biological, genetic, sexual and hormonal variations can modulate the immune response indicating greater infectivity, prevalence and clinical severity in men. In this regard, in seeking the understanding of factors related to protection and susceptibility to infection, this review aimed to discuss the influence of sex hormones on the immune response to leishmaniases. In the literature, sex hormone variations promote differences in the innate, humoral and cell-mediated immune response, leading to greater susceptibility, mortality and complications in males. Epidemiological estimates confirm these results, showing a predominance of the disease, in its different clinical forms, in men and suggesting that sexual variations influence immunomodulatory mechanisms since the prevalence of cases comprises the post-puberty and adulthood period. In this perspective, the action of sex hormones has been investigated in different clinical models, highlighting the potential of testosterone in immunosuppression, given its association with greater susceptibility and poor control of parasite load and the induction of cell apoptosis and attenuation of pro-inflammatory signalling pathways. Therefore, hormonal variations influence the immune response among males and females against leishmaniases, in which androgens may present immunosuppressive potential, while steroids present immunomodulatory characteristics.
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Affiliation(s)
| | - Amanda Miranda da Silva
- Postgraduate Program in Biotechnology, Northeast Network of Biotechnology, Federal University of Piauí, Teresina, Brazil.,Leishmaniasis Laboratory, Federal University of Piauí, Teresina, Brazil
| | | | | | - Dorcas Lamounier Costa
- Maternal and Child Department, Federal University of Piauí and Intelligence Center in Emerging and Neglected Tropical Conditions (CIATEN, Teresina, Brazil
| | - Carlos Henrique Nery Costa
- Community Medicine Department, Federal University of Piauí and Intelligence Center in Emerging and Neglected Tropical Conditions (CIATEN, Teresina, Brazil
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8
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Associations between Cryptococcus Genotypes, Phenotypes, and Clinical Parameters of Human Disease: A Review. J Fungi (Basel) 2021; 7:jof7040260. [PMID: 33808500 PMCID: PMC8067209 DOI: 10.3390/jof7040260] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 12/11/2022] Open
Abstract
The genus Cryptococcus contains two primary species complexes that are significant opportunistic human fungal pathogens: C. neoformans and C. gattii. In humans, cryptococcosis can manifest in many ways, but most often results in either pulmonary or central nervous system disease. Patients with cryptococcosis can display a variety of symptoms on a spectrum of severity because of the interaction between yeast and host. The bulk of our knowledge regarding Cryptococcus and the mechanisms of disease stem from in vitro experiments and in vivo animal models that make a fair attempt, but do not recapitulate the conditions inside the human host. To better understand the dynamics of initiation and progression in cryptococcal disease, it is important to study the genetic and phenotypic differences in the context of human infection to identify the human and fungal risk factors that contribute to pathogenesis and poor clinical outcomes. In this review, we summarize the current understanding of the different clinical presentations and health outcomes that are associated with pathogenicity and virulence of cryptococcal strains with respect to specific genotypes and phenotypes.
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9
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Tucker JS, Guess TE, McClelland EE. The Role of Testosterone and Gibberellic Acid in the Melanization of Cryptococcus neoformans. Front Microbiol 2020; 11:1921. [PMID: 32922377 PMCID: PMC7456850 DOI: 10.3389/fmicb.2020.01921] [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: 05/24/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022] Open
Abstract
Cryptococcus neoformans, a spore-producing pathogenic yeast, affects immunocompromised individuals causing meningoencephalitis. Once C. neoformans is introduced via the respiratory tract, it is engulfed by macrophages and other phagocytes. One of C. neoformans's primary virulence factors is the pigment melanin, which is formed in the cell wall and protects the yeast against UV radiation and oxidizing agents produced by macrophages during phagocytosis. To better understand the observed sex bias (3:1; male:female) in C. neoformans infections, the phenotype of various virulence factors was determined in the presence of exogenous sex hormones. C. neoformans melanized faster in the presence of testosterone than it did in the presence of estradiol. Using a combination of RNA sequencing analysis and ELISA results, we identified a growth hormone, gibberellic acid (GA), produced in C. neoformans that was highly upregulated in the presence of testosterone. A variety of knockout strains of genes involved in the GA biosynthesis pathway showed significantly reduced melanization in the presence of testosterone. Additionally, inhibitors of GA also reduced melanization in the presence of testosterone. Thus, these data suggest that the gibberellic biosynthesis pathway is involved in melanization in C. neoformans, and the melanization difference observed in the presence of testosterone may be due to increased production of GA, which may partly explain the sex bias observed in C. neoformans infections.
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Affiliation(s)
- Jamila S Tucker
- University of Kentucky, Lexington, KY, United States.,Department of Biology, Middle Tennessee State University, Murfreesboro, TN, United States
| | - Tiffany E Guess
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, United States.,Vanderbilt University Medical Center, Nashville, TN, United States
| | - Erin E McClelland
- Department of Biology, Middle Tennessee State University, Murfreesboro, TN, United States
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10
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Henze L, Schwinge D, Schramm C. The Effects of Androgens on T Cells: Clues to Female Predominance in Autoimmune Liver Diseases? Front Immunol 2020; 11:1567. [PMID: 32849531 PMCID: PMC7403493 DOI: 10.3389/fimmu.2020.01567] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
The immune system responds differently in women and in men. Generally speaking, adult females show stronger innate and adaptive immune responses than males. This results in lower risk of developing most of the infectious diseases and a better ability to clear viral infection in women (1–5). On the other hand, women are at increased risk of developing autoimmune diseases (AID) such as rheumatoid arthritis, multiple sclerosis (MS), systemic lupus erythematosus (SLE), Sjögren's syndrome, and the autoimmune liver diseases autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) (6). Factors contributing to the female sex bias in autoimmune diseases include environmental exposure, e.g., microbiome, behavior, and genetics including X chromosomal inactivation of genes. Several lines of evidence and clinical observations clearly indicate that sex hormones contribute significantly to disease pathogenesis, and the role of estrogen in autoimmune diseases has been extensively studied. In many of these diseases, including the autoimmune liver diseases, T cells are thought to play an important pathogenetic role. We will use this mini-review to focus on the effects of androgens on T cells and how the two major androgens, testosterone and dihydrotestosterone, potentially contribute to the pathogenesis of autoimmune liver diseases (AILD).
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Affiliation(s)
- Lara Henze
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dorothee Schwinge
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Martin Zeitz Centre for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Coelho C, Farrer RA. Pathogen and host genetics underpinning cryptococcal disease. ADVANCES IN GENETICS 2020; 105:1-66. [PMID: 32560785 DOI: 10.1016/bs.adgen.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cryptococcosis is a severe fungal disease causing 220,000 cases of cryptococcal meningitis yearly. The etiological agents of cryptococcosis are taxonomically grouped into at least two species complexes belonging to the genus Cryptococcus. All of these yeasts are environmentally ubiquitous fungi (often found in soil, leaves and decaying wood, tree hollows, and associated with bird feces especially pigeon guano). Infection in a range of animals including humans begins following inhalation of spores or aerosolized yeasts. Recent advances provide fundamental insights into the factors from both the pathogen and its hosts which influence pathogenesis and disease. The complex interactions leading to disease in mammalian hosts have also updated from the availability of better genomic tools and datasets. In this review, we discuss recent genetic research on Cryptococcus, covering the epidemiology, ecology, and evolution of Cryptococcus pathogenic species. We also discuss the insights into the host immune response obtained from the latest genetic modified host models as well as insights from monogenic disorders in humans. Finally we highlight outstanding questions that can be answered in the near future using bioinformatics and genomic tools.
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Affiliation(s)
- Carolina Coelho
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Exeter, United Kingdom
| | - Rhys A Farrer
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Exeter, United Kingdom.
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12
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Costa MC, de Barros Fernandes H, Gonçalves GKN, Santos APN, Ferreira GF, de Freitas GJC, do Carmo PHF, Hubner J, Emídio ECP, Santos JRA, Dos Santos JL, Dos Reis AM, Fagundes CT, da Silva AM, Santos DA. 17-β-Estradiol increases macrophage activity through activation of the G-protein-coupled estrogen receptor and improves the response of female mice to Cryptococcus gattii. Cell Microbiol 2020; 22:e13179. [PMID: 32017324 DOI: 10.1111/cmi.13179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 12/03/2019] [Accepted: 01/26/2020] [Indexed: 11/29/2022]
Abstract
Cryptococcus gattii (Cg) is one of the agents of cryptococcosis, a severe systemic mycosis with a higher prevalence in men than women, but the influence of the female sex hormone, 17-β-estradiol (E2), on cryptococcosis remains unclear. Our study shows that female mice presented delayed mortality, increased neutrophil recruitment in bronchoalveolar lavage fluid, and reduced fungal load after 24 hr of infection compared to male and ovariectomised female mice (OVX). E2 replacement restored OVX female survival. Female macrophages have more efficient fungicidal activity, which was increased by E2 and reversed by the antagonist of G-protein-coupled oestrogen receptor (GPER), which negatively modulates PI3K activation. Furthermore, E2 induces a reduction in Cg cell diameter, cell charge, and antioxidant peroxidase activity. In conclusion, female mice present improved control of Cg infection, and GPER is important for E2 modulation of the female response.
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Affiliation(s)
- Marliete C Costa
- Laboratório de Micologia, Departamento de Microbiologia, ICB-UFMG, Belo Horizonte, Brazil
| | | | - Gleisy K N Gonçalves
- Laboratório de Endocrinologia e Metabolismo, Departamento de Fisiologia, ICB-UFMG, Belo Horizonte, Brazil
| | - Anderson P N Santos
- Laboratório de Micologia, Departamento de Microbiologia, ICB-UFMG, Belo Horizonte, Brazil
| | - Gabriella F Ferreira
- Campus Governador Valadares, Programa Multicêntrico de Pós Graduação em Bioquímica e Biologia Molecular-UFJF, Juiz de Fora, Brazil
| | - Gustavo J C de Freitas
- Laboratório de Micologia, Departamento de Microbiologia, ICB-UFMG, Belo Horizonte, Brazil
| | - Paulo H F do Carmo
- Laboratório de Micologia, Departamento de Microbiologia, ICB-UFMG, Belo Horizonte, Brazil
| | - Jôsy Hubner
- Laboratório de Genes Inflamatórios, Departamento de Morfologia, ICB-UFMG, Belo Horizonte, Brazil
| | - Elúzia C P Emídio
- Laboratório de Micologia, Departamento de Microbiologia, ICB-UFMG, Belo Horizonte, Brazil
| | | | | | - Adelina M Dos Reis
- Laboratório de Endocrinologia e Metabolismo, Departamento de Fisiologia, ICB-UFMG, Belo Horizonte, Brazil
| | - Caio T Fagundes
- Laboratório de Interação Microrganismo-Hospedeiro, Departamento de Microbiologia, ICB-UFMG, Belo Horizonte, Brazil
| | - Aristóbolo M da Silva
- Laboratório de Genes Inflamatórios, Departamento de Morfologia, ICB-UFMG, Belo Horizonte, Brazil
| | - Daniel A Santos
- Laboratório de Micologia, Departamento de Microbiologia, ICB-UFMG, Belo Horizonte, Brazil
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