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Cárdenas Parra LY, Rojas Rodríguez AE, Pérez Cárdenas JE, Pérez-Agudelo JM. Molecular Evaluation of the mRNA Expression of the ERG11, ERG3, CgCDR1, and CgSNQ2 Genes Linked to Fluconazole Resistance in Candida glabrata in a Colombian Population. J Fungi (Basel) 2024; 10:509. [PMID: 39057394 PMCID: PMC11277825 DOI: 10.3390/jof10070509] [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: 05/29/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION The study of Candida glabrata genes associated with fluconazole resistance, from a molecular perspective, increases the understanding of the phenomenon with a view to its clinical applicability. OBJECTIVE We sought to establish the predictive molecular profile of fluconazole resistance in Candida glabrata by analyzing the ERG11, ERG3, CgCDR1, and CgSNQ2 genes. METHOD Expression was quantified using RT-qPCR. Metrics were obtained through molecular docking and Fisher discriminant functions. Additionally, a predictive classification was made against the susceptibility of C. glabrata to fluconazole. RESULTS The relative expression of the ERG3, CgCDR1, and CgSNQ2 genes was higher in the fluconazole-resistant strains than in the fluconazole-susceptible, dose-dependent strains. The gene with the highest relative expression in the fluconazole-exposed strains was CgCDR1, and in both the resistant and susceptible, dose-dependent strains exposed to fluconazole, this was also the case. The molecular docking model generated a median number of contacts between fluconazole and ERG11 that was lower than the median number of contacts between fluconazole and ERG3, -CgCDR1, and -CgSNQ2. The predicted classification through the multivariate model for fluconazole susceptibility achieved an accuracy of 73.5%. CONCLUSION The resistant strains had significant expression levels of genes encoding efflux pumps and the ERG3 gene. Molecular analysis makes the identification of a low affinity between fluconazole and its pharmacological target possible, which may explain the lower intrinsic susceptibility of the fungus to fluconazole.
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Affiliation(s)
- Leidy Yurany Cárdenas Parra
- Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales 170004, Colombia; (L.Y.C.P.); (J.E.P.C.); (J.M.P.-A.)
- Facultad de Ciencias de la Salud, Universidad Católica de Manizales, Manizales 170001, Colombia
| | | | - Jorge Enrique Pérez Cárdenas
- Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales 170004, Colombia; (L.Y.C.P.); (J.E.P.C.); (J.M.P.-A.)
| | - Juan Manuel Pérez-Agudelo
- Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales 170004, Colombia; (L.Y.C.P.); (J.E.P.C.); (J.M.P.-A.)
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Beardsley J, Kim HY, Dao A, Kidd S, Alastruey-Izquierdo A, Sorrell TC, Tacconelli E, Chakrabarti A, Harrison TS, Bongomin F, Gigante V, Galas M, Siswanto S, Dagne DA, Roitberg F, Sati H, Morrissey CO, Alffenaar JW. Candida glabrata (Nakaseomyces glabrata): A systematic review of clinical and microbiological data from 2011 to 2021 to inform the World Health Organization Fungal Priority Pathogens List. Med Mycol 2024; 62:myae041. [PMID: 38935913 PMCID: PMC11210615 DOI: 10.1093/mmy/myae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/03/2023] [Accepted: 04/27/2024] [Indexed: 06/29/2024] Open
Abstract
Recognising the growing global burden of fungal infections, the World Health Organization (WHO) established an advisory group consisting of experts in fungal diseases to develop a Fungal Priority Pathogen List. Pathogens were ranked based on their research and development needs and perceived public health importance using a series of global surveys and pathogen characteristics derived from systematic reviews. This systematic review evaluates the features and global impact of invasive disease caused by Candida glabrata (Nakaseomyces glabrata). PubMed and Web of Science were searched for studies reporting on mortality, morbidity (hospitalization and disability), drug resistance (including isolates from sterile and non-sterile sites, since these reflect the same organisms causing invasive infections), preventability, yearly incidence, diagnostics, treatability, and distribution/emergence in the last 10 years. Candida glabrata (N. glabrata) causes difficult-to-treat invasive infections, particularly in patients with underlying conditions such as immunodeficiency, diabetes, or those who have received broad-spectrum antibiotics or chemotherapy. Beyond standard infection prevention and control measures, no specific preventative measures have been described. We found that infection is associated with high mortality rates and that there is a lack of data on complications and sequelae. Resistance to azoles is common and well described in echinocandins-in both cases, the resistance rates are increasing. Candida glabrata remains mostly susceptible to amphotericin and flucytosine. However, the incidence of the disease is increasing, both at the population level and as a proportion of all invasive yeast infections, and the increases appear related to the use of antifungal agents.
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Affiliation(s)
- Justin Beardsley
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Hannah Yejin Kim
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, Australia
- School of Pharmacy, University of Sydney, Sydney, Australia
- Department of Pharmacy, Westmead Hospital, Sydney, Australia
| | - Aiken Dao
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
| | | | - Tania C Sorrell
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | | | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thomas S Harrison
- Institute of Infection and Immunity, St. George's, University of London, London, and MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Valeria Gigante
- Impact Initiatives and Research Coordination Unit, Global Coordination and Partnership Department, Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Marcelo Galas
- Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, USA
| | - Siswanto Siswanto
- World Health Organization, South East Asia Region Office, New Delhi, India
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Felipe Roitberg
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Hatim Sati
- Impact Initiatives and Research Coordination Unit, Global Coordination and Partnership Department, Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - C Orla Morrissey
- Alfred Health/ Department of Infectious Diseases, Monash University, Melbourne, Australia
| | - Jan-Willem Alffenaar
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, Australia
- School of Pharmacy, University of Sydney, Sydney, Australia
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Radwan IT, El-Sherbiny IM, Metwally NH. Synergistic and potential antifungal properties of tailored, one pot multicomponent monoterpenes co-delivered with fluconazole encapsulated nanostructure lipid carrier. Sci Rep 2024; 14:14382. [PMID: 38909063 PMCID: PMC11193721 DOI: 10.1038/s41598-024-63149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 05/24/2024] [Indexed: 06/24/2024] Open
Abstract
Frequent and variant infections are caused by the virtue of opportunistic fungi pathogens. Candidiasis, aspergillosis, and mucormycosis are pathogenic microorganisms that give rise to vast fungal diseases that alternate between moderate to fatal in severity. The use of fluconazole as an antifungal drug was limited due to the acquired resistance in some types of Candida and other fungal species. This study aims to consolidate fluconazole's biological effectiveness against several pathogenic fungi. Six active monoterpenes (MTs) of carvacrol, linalool, geraniol, α-terpinene, citronellal, and nerolidol were selected and encapsulated in nanostructure lipid carrier (NLC) with (NLC-Flu-MTs) and/without (NLC-MTs) fluconazole in one nanoformulation to determine if they will act synergistically or not? The synthesized nanoformulation NLC-Flu-MTs and NLC-MTs exhibited very good particle size of 144.5 nm and 138.6 nm for size and zeta potential values of (- 23.5 mV) and (- 20.3 mV), respectively. Transmission electron microscope investigation confirmed that the synthesized NLCs have regular and spherical shape. The abundance and concentration of the six released monoterpenes were determined, as a novel approach, using GC-MS with very good results and validity. In-vitro antifungal screening was done before and after nano co-delivery against seven pathogenic, and aggressive fungi of Candida tropicalis, Candida krusei, Candida glabrata, Geotrichum Candidum, Candidaalbicans, Aspergillus Niger, and mucor circinelloides. Inhibition Zone diameter (IZD) and the minimum inhibitory concentration (MIC) were measured. Nanoformulations NLC-Flu-MTs and NLC-MTs manifested potential and unique biological susceptibility against all the tested microorganisms with reduced (MIC) values, especially against Candida Tropicalis (MIC = 0.97 µg/ml) which represents 16-fold of the value shown by NLC-MTs (MIC = 15.6 µg/ml) and 64-fold of fluconazole free before nanoformulation (MIC = 62.5 µg/ml). The efficiency of nanomaterials, particularly NLC-Flu-MTs, has become evident in the diminishing value of MIC which affirmed the synergism between fluconazole and the other six monoterpenes.
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Affiliation(s)
- Ibrahim Taha Radwan
- Supplementary General Sciences Department, Faculty of Oral and Dental Medicine, Future University in Egypt, Cairo, 11835, Egypt
| | - Ibrahim M El-Sherbiny
- Center for Materials Science (CMS), Zewail City of Science and Technology, 6th of October, Giza, 12578, Egypt
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Hatami F, Manifar S, Asghari-Paskiabi F, Bagheri Amiri F, Nojoumi SA, Jahanshiri Z. Molecular mechanisms of azole resistance in Candida glabrata isolated from oropharyngeal candidiasis in head and neck cancer patients. Arch Oral Biol 2023; 154:105757. [PMID: 37419061 DOI: 10.1016/j.archoralbio.2023.105757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE The aim of the current work was to assess the molecular mechanisms of fluconazole-resistant Candida glabrata strains isolated from oropharyngeal candidiasis (OPC) in head and neck patients, as well as evaluation of virulence factors. DESIGN Antifungal susceptibility pattern of sixty six clinical isolates of C. glabrata were evaluated by broth-microdilution method. The expression of ERG11, CDR1, CDR2, PDR1 genes as well as ERG11 gene capable of possible mutations was also detected in 21 fluconazol-resistant C. glabrata isolates. Phospholipase and proteinase activity of these isolates was estimated, too. The correlation between the virulence factors, antifungal susceptibility patterns and cancer type was also analyzed. RESULTS Seven synonymous and four non-synonymous mutations were found in 21 fluconazole-resistant C. glabrata isolates; subsequently, four amino acid substitutions including H257P, Q47H, S487Y and I285N were then reported for the first time. High expression of CDR1 and PDR1 in related to other gene findings were tested in these isolates. Additionally, there was no significant difference between stage of cancer and MIC of all antimicrobial drugs. Significant differences between MIC of fluconazole, voriconazole and cancer types were also, found. The proteinase activity (92.4%) was higher than phospholipase activity in the isolates. Further, no significant difference between proteinase (rs: 0.003), phospholipase (rs: -0.107) activity and fluconazole MICs was observed. CONCLUSION C. glabrata isolated from OPC in head and neck patients represented high capacities for proteolytic enzymes activity and high mRNA level of CDR1 and PDR1 gene and ERG11 mutations play an important role in azole drug resistance.
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Affiliation(s)
- Farahnaz Hatami
- Department of Cellular and Molecular Biology, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Soheila Manifar
- Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Cancer Institute of Tehran, Imam Khomeini Hospital Complex, Tehran, Iran
| | | | - Fahimeh Bagheri Amiri
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Ali Nojoumi
- Department of Mycobacteriology and Pulmonary research, Pasteur Institute of Iran, Tehran, Iran; Microbiology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Zahra Jahanshiri
- Department of Mycology, Pasteur Institute of Iran, Tehran, Iran.
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Bilal H, Shafiq M, Hou B, Islam R, Khan MN, Khan RU, Zeng Y. Distribution and antifungal susceptibility pattern of Candida species from mainland China: A systematic analysis. Virulence 2022; 13:1573-1589. [PMID: 36120738 PMCID: PMC9487756 DOI: 10.1080/21505594.2022.2123325] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/07/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
Antifungal resistance to Candida pathogens increases morbidity and mortality of immunosuppressive patients, an emerging crisis worldwide. Understanding the Candida prevalence and antifungal susceptibility pattern is necessary to control and treat candidiasis. We aimed to systematically analyse the susceptibility profiles of Candida species published in the last ten years (December 2011 to December 2021) from mainland China. The studies were collected from PubMed, Google Scholar, and Science Direct search engines. Out of 89 included studies, a total of 44,716 Candida isolates were collected, mainly comprising C. albicans (49.36%), C. tropicalis (21.89%), C. parapsilosis (13.92%), and C. glabrata (11.37%). The lowest susceptibility was detected for azole group; fluconazole susceptibilities against C. parapsilosis, C. albicans, C. glabrata, C. tropicalis, C. guilliermondii, C. pelliculosa, and C. auris were 93.25%, 91.6%, 79.4%, 77.95%, 76%, 50%, and 0% respectively. Amphotericin B and anidulafungin were the most susceptible drugs for all Candida species. Resistance to azole was mainly linked with mutations in ERG11, ERG3, ERG4, MRR1-2, MSH-2, and PDR-1 genes. Mutation in FKS-1 and FKS-2 in C. auris and C. glabrata causing resistance to echinocandins was stated in two studies. Gaps in the studies' characteristics were detected, such as 79.77%, 47.19 %, 26.97%, 7.86%, and 4.49% studies did not mention the mortality rates, age, gender, breakpoint reference guidelines, and fungal identification method, respectively. The current study demonstrates the overall antifungal susceptibility pattern of Candida species, gaps in surveillance studies and risk-reduction strategies that could be supportive in candidiasis therapy and for the researchers in their future studies.
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Affiliation(s)
- Hazrat Bilal
- Department of Dermatology, The second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Muhammad Shafiq
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, China
| | - Bing Hou
- Department of laboratory, Shantou Municipal Skin Hospital, Shantou, China
| | - Rehmat Islam
- Key Laboratory of Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi’an, China
| | - Muhammad Nadeem Khan
- Faculty of Biological Sciences, Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Rahat Ullah Khan
- Institute of Microbiology, Faculty of Veterinary and Animal Sciences Gomal University, Dera Ismail Khan, Pakistan
| | - Yuebin Zeng
- Department of Dermatology, The second Affiliated Hospital of Shantou University Medical College, Shantou, China
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Golestannejad Z, Khozeimeh F, Dehghan P, Najafizade N, Faghihian E, Kheirkhah M, Sadeghalbanaei L, Jamshidi M, Chermahini AA. Comparison of the antifungal effect of voriconazole and fluconazole on oral candidiasis before and during radiotherapy. Dent Res J (Isfahan) 2022; 19:99. [PMID: 36605149 PMCID: PMC9807927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/22/2022] [Accepted: 05/24/2022] [Indexed: 01/07/2023] Open
Abstract
Background Head-and-neck radiotherapy can change oral Candida species and cause candidiasis resistance to common antifungals by making the changes to the oral cavity environment. Voriconazole is a synthetic azole with extensive antifungal activity. The current study aimed at comparing the antifungal activity of fluconazole and voriconazole on Candida species isolated from the oral cavity of patients undergoing head-and-neck radiotherapy. Materials and Methods The present in vitro study was performed on samples isolated from patients undergoing head-and-neck radiotherapy, before and during radiotherapy. After the identification of the species, the antifungal effect of fluconazole and voriconazole was determined by the microdilution method, and the minimum inhibitory concentration (MIC), the minimum fungicidal concentration, and the antifungal susceptibility of the isolated strains were also measured. The data were analyzed by the Chi-squared and then two-sided Fisher's exact tests. P < 0.05 was considered statistically significant. Results The study findings showed no significant difference in the susceptibility of Candida albicans to voriconazole and fluconazole before and during radiotherapy. Before radiotherapy, both voriconazole and fluconazole had similar effects on Candida tropicalis, but after radiotherapy, voriconazole was less effective. However, both before and during radiotherapy, fluconazole had a greater antifungal effect than voriconazole on Candida glabrata strains. The MICs of voriconazole and fluconazole for both Candida parapsilosis and Candida krusei isolates were within the susceptible or dose-dependent range. Conclusion The current study results showed that voriconazole was not more effective than fluconazole in the treatment of oral candidiasis in patients undergoing head-and-neck radiotherapy.
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Affiliation(s)
- Zahra Golestannejad
- Dental Research Center, Department of Oral and Maxillofacial Medicine, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Faezeh Khozeimeh
- Dental Research Center, Department of Oral and Maxillofacial Medicine, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Dehghan
- Department of Mycology and Parasitology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nadia Najafizade
- Department of Radiation Oncology, Isfahan Medical Science University, Isfahan, Iran
| | - Elham Faghihian
- Dental Research Center, Department of Oral and Maxillofacial Medicine, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Kheirkhah
- Department of Mycology and Parasitology, School of Medicine, Isfahan university of Medical Sciences, Isfahan, Iran
| | - Leila Sadeghalbanaei
- Department of Orthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Leila Sadeghalbanaei, Department of Orthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Mina Jamshidi
- Department of Periodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Odiba AS, Durojaye OA, Ezeonu IM, Mgbeahuruike AC, Nwanguma BC. A New Variant of Mutational and Polymorphic Signatures in the ERG11 Gene of Fluconazole-Resistant Candida albicans. Infect Drug Resist 2022; 15:3111-3133. [PMID: 35747333 PMCID: PMC9213107 DOI: 10.2147/idr.s360973] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Resistance to antifungal drugs for treating Candida infections remains a major concern globally despite the range of medications available. Most of these drugs target key proteins essential to the life cycle of the organism. An enzyme essential for fungal cell membrane integrity, lanosterol 14–α demethylase (CYP51), is encoded by the ERG11 gene in Candida species. This enzyme is the target of azole–based drugs. The organism has, however, devised molecular adaptations to evade the activity of these drugs. Materials and Methods Classical methods were employed to characterize clinical isolates sampled from women and dogs of reproductive age. For fluconazole efficacy studies, CLSI guidelines on drug susceptibility testing were used. To understand the susceptibility pattern, various molecular and structural analytic approaches, including sequencing, in silico site-directed mutagenesis, and protein-ligand profiling, were applied to the ERG11 gene and CYP51 protein sequences. Several platforms, comprising Clustal Omega, Pymol plugin manager, Pymol molecular visualizer, Chimera–curated Dynameomics rotamer library, protein–ligand interaction profiler, Charmm36 force field, GROMACS, Geneious, and Mega7, were employed for this analysis. Results The following Candida species distribution was obtained: 37.84% C. albicans, 8.12% C. glabrata, 10.81% C. krusei, 5.41% C. tropicalis, and 37.84% of other unidentified Candida species. Two codons in the nucleotide sequence of the wild-type (CTC and CCA) coding for LEU–370 and PRO–375, respectively, were mutated to L370S and P375H in the resistant strain. The mutation stabilized the protein at the expense of the heme moiety. We found that the susceptible isolate from dogs (Can–iso–029/dog) is closely related to the most resistant isolate from humans. Conclusion Taken together, our results showed new mutations in the heme-binding pocket of caCYP51 that explain the resistance to fluconazole exhibited by the Candida isolates. So far, the L370S and P375H resistance-linked mutations have not been previously reported.
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Affiliation(s)
- Arome Solomon Odiba
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria.,Department of Molecular Genetics and Biotechnology, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria
| | - Olanrewaju Ayodeji Durojaye
- Department of Chemical Sciences, Coal City University, Emene, Enugu State, Nigeria.,Department of Molecular and Cell Biology, University of Science and Technology of China, Hefei, Anhui, 230026, People's Republic of China.,MOE Key Laboratory of Membraneless Organelle and Cellular Dynamics, Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Ifeoma Maureen Ezeonu
- Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria
| | - Anthony Christian Mgbeahuruike
- Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria
| | - Bennett Chima Nwanguma
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria.,Department of Molecular Genetics and Biotechnology, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria
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Chen Y, Wu Y, Lulou K, Yao D, Ying C. Multilocus Sequence Typing and Antifungal Susceptibility of Vaginal and Non-vaginal Candida glabrata Isolates From China. Front Microbiol 2022; 13:808890. [PMID: 35369470 PMCID: PMC8969424 DOI: 10.3389/fmicb.2022.808890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/07/2022] [Indexed: 12/30/2022] Open
Abstract
Candida glabrata is a common cause of Candida infections. In our present study, we investigated the antifungal susceptibility and molecular epidemiology of vaginal and non-vaginal C. glabrata isolates. Seventy-six vaginal C. glabrata strains isolated from patients with vulvovaginal candidiasis and 57 non-vaginal C. glabrata isolates were collected at two hospitals in Shanghai, China. Antifungal susceptibility was examined using a broth microdilution method. Multilocus sequence typing was used for genotyping. Overall, 28 (21.1%), 28 (21.1%), and 29 (21.8%) C. glabrata isolates were resistant to fluconazole, itraconazole, and voriconazole, respectively. Briefly, 18 (23.7%), 18 (23.7%), and 19 (25%) vaginal strains were resistant to fluconazole, itraconazole, and voriconazole. While the resistance to these antifungals were all 17.5% (10/57) in non-vaginal strains. All isolates retained susceptibility to amphotericin B, and only four non-vaginal isolates were caspofungin resistant. Genotyping identified 17 ST patterns. In non-vaginal samples, the same genotypes appear as in the vaginal samples, except for one genotype (ST-182), while in the vaginal samples more genotypes appear (ST8, ST19, ST45, ST55, ST66, ST80, ST138, and ST17). The most common genotype was ST7 (81 strains), followed by ST10 (14 strains) and ST15 (11 strains). The majority of resistant phenotype strains (25/30, 83.3%) correlated to the predominant genotype (ST7), and the rest belonged to ST3 (2/30, 6.7%), ST10 (1/30, 3.3%), ST19 (1/30, 3.3%), and ST45 (1/30, 3.3%). Our survey revealed cross-resistance in vaginal and non-vaginal C. glabrata isolates. Moreover, there is no genotype associated with the resistance phenotype.
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Affiliation(s)
- Yisheng Chen
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yongqin Wu
- Division of Life Sciences and Medicine, Department of Clinical Laboratory, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Kaiyi Lulou
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Dongting Yao
- Department of Laboratory Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chunmei Ying
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Memon S, Farooqi J, Zafar U, Naqvi SF, Zafar A, Jabeen K. Antifungal susceptibility profile of invasive Candida glabrata isolates (2009-2020) from a tertiary care hospital laboratory in Pakistan. J Med Microbiol 2021; 70. [PMID: 34878377 DOI: 10.1099/jmm.0.001459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction. Invasive infections with Candida glabrata are a global concern due to poor clinical outcomes and propensity to acquire resistance to antifungal agents. Hypothesis/Gap Statement. Monitoring emerging resistance and trends in Candida glabrata, an important agent of candidemia in Pakistan, is critical for patient management; data that is missing from Pakistan. Aim. Thus, this study evaluated antifungal resistance and MICs) distribution in invasive C. glabrata isolates from Pakistan. Methods. This cross-sectional and retrospective study was conducted from January 2009 to March 2020 at a clinical laboratory in Pakistan that has a nation-wide network. Antifungal susceptibility data of 277 candidemia, deep organ and soft tissue (invasive) C. glabrata sensu lato isolates against fluconazole, itraconazole, voriconazole, posaconazole, anidulafungin, micafungin, caspofungin and amphotericin B was retrieved. Susceptibility testing was performed using colorimetric broth microdilution and interpreted using CLSI criteria. Demographics, clinical history and outcome were studied. Chi-square test was used to demonstrate association between antifungal resistance and clinical characteristics of the patients. Results. We identified 277 patients with invasive C. glabrata infection. Of which 48 (18.4%) isolates were resistant to fluconazole (MIC ≥64 mg l-1), one isolate each was resistant to amphotericin (MIC=2 mg l-1), anidulafungin (MIC=1 mg l-1) and micafungin (MIC=0.5 mg l-1). MIC90 for fluconazole was 64 mg l-1 and other triazoles 2 mg l-1, caspofungin 0.12 mg l-1, anidulafungin 0.06 mg l-1, micafungin 0.03 mg l-1 and amphotericin 0.5 mg l-1. Fluconazole MIC ≥64 mg l-1, caspofungin MIC >0.06 mg l-1 and amphotericin MIC >0.25 mg l-1 (above MIC50) were significantly associated with patient being alive at the time of reporting, no use of healthcare devices, nor infection with other fungi. Fluconazole resistance was significantly associated with prior antifungal use by the patient. Conclusion. Surveillance data of antifungal resistance among common Candida species should be monitored closely for identification of resistant strains.
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Affiliation(s)
- Saba Memon
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.,Department of Microbiology, University of Karachi, Karachi, Pakistan
| | - Joveria Farooqi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Urooj Zafar
- Department of Microbiology, University of Karachi, Karachi, Pakistan
| | - Syed Faheem Naqvi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Afia Zafar
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Kauser Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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10
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Szarvas J, Rebelo AR, Bortolaia V, Leekitcharoenphon P, Schrøder Hansen D, Nielsen HL, Nørskov-Lauritsen N, Kemp M, Røder BL, Frimodt-Møller N, Søndergaard TS, Coia JE, Østergaard C, Westh H, Aarestrup FM. Danish Whole-Genome-Sequenced Candida albicans and Candida glabrata Samples Fit into Globally Prevalent Clades. J Fungi (Basel) 2021; 7:jof7110962. [PMID: 34829249 PMCID: PMC8622182 DOI: 10.3390/jof7110962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Candida albicans and Candida glabrata are opportunistic fungal pathogens with increasing incidence worldwide and higher-than-expected prevalence in Denmark. We whole-genome sequenced yeast isolates collected from Danish Clinical Microbiology Laboratories to obtain an overview of the Candida population in the country. The majority of the 30 C. albicans isolates were found to belong to three globally prevalent clades, and, with one exception, the remaining isolates were also predicted to cluster with samples from other geographical locations. Similarly, most of the eight C. glabrata isolates were predicted to be prevalent subtypes. Antifungal susceptibility testing proved all C. albicans isolates to be susceptible to both azoles and echinocandins. Two C. glabrata isolates presented azole-resistant phenotypes, yet all were susceptible to echinocandins. There is no indication of causality between population structure and resistance phenotypes for either species.
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Affiliation(s)
- Judit Szarvas
- Division for Global Surveillance, National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (A.R.R.); (V.B.); (P.L.); (F.M.A.)
- Correspondence:
| | - Ana Rita Rebelo
- Division for Global Surveillance, National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (A.R.R.); (V.B.); (P.L.); (F.M.A.)
| | - Valeria Bortolaia
- Division for Global Surveillance, National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (A.R.R.); (V.B.); (P.L.); (F.M.A.)
| | - Pimlapas Leekitcharoenphon
- Division for Global Surveillance, National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (A.R.R.); (V.B.); (P.L.); (F.M.A.)
| | | | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, 9100 Aalborg, Denmark;
| | | | - Michael Kemp
- Department of Clinical Microbiology, Odense University Hospital, 5000 Odense, Denmark;
| | - Bent Løwe Røder
- Department of Clinical Microbiology, Slagelse Hospital, 4200 Slagelse, Denmark;
| | | | | | - John Eugenio Coia
- Department of Clinical Microbiology, Sydvestjysk Hospital, 6700 Esbjerg, Denmark;
| | - Claus Østergaard
- Department of Clinical Microbiology, Vejle Hospital, 7100 Vejle, Denmark;
| | - Henrik Westh
- Department of Clinical Microbiology, Hvidovre Hospital, 2650 Hvidovre, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Frank Møller Aarestrup
- Division for Global Surveillance, National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark; (A.R.R.); (V.B.); (P.L.); (F.M.A.)
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11
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Araújo D, Mil-Homens D, Rodrigues ME, Henriques M, Jørgensen PT, Wengel J, Silva S. Antisense locked nucleic acid gapmers to control Candida albicans filamentation. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2021; 39:102469. [PMID: 34606999 DOI: 10.1016/j.nano.2021.102469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 11/17/2022]
Abstract
Whereas locked nucleic acid (LNA) has been extensively used to control gene expression, it has never been exploited to control Candida virulence genes. Thus, the main goal of this work was to compare the efficacy of five different LNA-based antisense oligonucleotides (ASO) with respect to the ability to control EFG1 gene expression, to modulate filamentation and to reduce C. albicans virulence. In vitro, all LNA-ASOs were able to significantly reduce C. albicans filamentation and to control EFG1 gene expression. Using the in vivo Galleria mellonella model, important differences among the five LNA-ASOs were revealed in terms of C. albicans virulence reduction. The inclusion of PS-linkage and palmitoyl-2'-amino-LNA chemical modification in these five LNA gapmers proved to be the most promising combination, increasing the survival of G. mellonella by 40%. Our work confirms that LNA-ASOs are useful tools for research and therapeutic development in the candidiasis field.
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Affiliation(s)
- Daniela Araújo
- LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, CEB-Centre of Biological Engineering, University of Minho, Braga, Portugal
| | - Dalila Mil-Homens
- iBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Lisbon University, Lisbon, Portugal
| | - Maria Elisa Rodrigues
- LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, CEB-Centre of Biological Engineering, University of Minho, Braga, Portugal
| | - Mariana Henriques
- LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, CEB-Centre of Biological Engineering, University of Minho, Braga, Portugal
| | - Per Trolle Jørgensen
- Biomolecular Nanoscale Engineering Center, Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense M, Denmark
| | - Jesper Wengel
- Biomolecular Nanoscale Engineering Center, Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense M, Denmark
| | - Sónia Silva
- LIBRO-Laboratório de Investigação em Biofilmes Rosário Oliveira, CEB-Centre of Biological Engineering, University of Minho, Braga, Portugal; National Institute for Agrarian and Veterinary Research, Vairão, Vila do Conde, Portugal.
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12
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Vitale RG. Role of Antifungal Combinations in Difficult to Treat Candida Infections. J Fungi (Basel) 2021; 7:731. [PMID: 34575770 PMCID: PMC8468556 DOI: 10.3390/jof7090731] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 01/23/2023] Open
Abstract
Candida infections are varied and, depending on the immune status of the patient, a life-threatening form may develop. C. albicans is the most prevalent species isolated, however, a significant shift towards other Candida species has been noted. Monotherapy is frequently indicated, but the patient's evolution is not always favorable. Drug combinations are a suitable option in specific situations. The aim of this review is to address this problem and to discuss the role of drug combinations in difficult to treat Candida infections. A search for eligible studies in PubMed and Google Scholar databases was performed. An analysis of the data was carried out to define in which cases a combination therapy is the most appropriate. Combination therapy may be used for refractory candidiasis, endocarditis, meningitis, eye infections and osteomyelitis, among others. The role of the drug combination would be to increase efficacy, reduce toxicity and improve the prognosis of the patient in infections that are difficult to treat. More clinical studies and reporting of cases in which drug combinations are used are needed in order to have more data that support the use of this therapeutic strategy.
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Affiliation(s)
- Roxana G. Vitale
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina;
- Unidad de Parasitología, Sector Micología, Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
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13
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Dahiya S, Sharma N, Punia A, Choudhary P, Gulia P, Parmar VS, Chhillar AK. Antimycotic Drugs and their Mechanisms of Resistance to Candida Species. Curr Drug Targets 2021; 23:116-125. [PMID: 34551694 DOI: 10.2174/1389450122666210719124143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022]
Abstract
Fungal infections have shown an upsurge in recent decades, which is mainly because of the increasing number of immunocompromised patients and the occurrence of invasive candidiasis has been found to be 7-15 fold greater than that of invasive aspergillosis. The genus Candida comprises more than 150 distinct species, however, only a few of them are found to be pathogenic to humans. Mortality rates of Candida species are found to be around 45% and the reasons for this intensified mortality are inefficient diagnostic techniques and unfitting initial treatment strategies. There are only a few antifungal drug classes that are employed for the remedy of invasive fungal infections. which include azoles, polyenes, echinocandins, and pyrimidine analogs. During the last 2-3 decades, the usage of antifungal drugs has increased several folds due to which the reports of escalating antifungal drug resistance have also been recorded. The resistance is mostly to the triazole- based compounds. Due to the occurrence of antifungal drug resistance, the success rates of treatment have been reduced as well as major changes have been observed in the frequency of fungal infections. In this review, we have summarized the major molecular mechanisms for the development of antifungal drug resistance.
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Affiliation(s)
- Sweety Dahiya
- Centre for Biotechnology, MaharshiDayanand University Rohtak, Haryana. India
| | - Namita Sharma
- Centre for Biotechnology, MaharshiDayanand University Rohtak, Haryana. India
| | - Aruna Punia
- Centre for Biotechnology, MaharshiDayanand University Rohtak, Haryana. India
| | - Pooja Choudhary
- Centre for Biotechnology, MaharshiDayanand University Rohtak, Haryana. India
| | - Prity Gulia
- Centre for Biotechnology, MaharshiDayanand University Rohtak, Haryana. India
| | - Virinder S Parmar
- Department of Chemistry and Environmental Science, Medgar Evers College, The City University of New York, 1638 Bedford Avenue, Brooklyn, NY 11225. India
| | - Anil K Chhillar
- Centre for Biotechnology, MaharshiDayanand University Rohtak, Haryana. India
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14
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Won EJ, Choi MJ, Kim MN, Yong D, Lee WG, Uh Y, Kim TS, Byeon SA, Lee SY, Kim SH, Shin JH. Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008-2018. Emerg Infect Dis 2021; 27:779-788. [PMID: 33624581 PMCID: PMC7920659 DOI: 10.3201/eid2703.203482] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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15
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Miller R, Harris S, Porter R, Burnett H. Invasive para-aortic Candida glabrata: a multidisciplinary management challenge. BMJ Case Rep 2021; 14:14/6/e240710. [PMID: 34140325 DOI: 10.1136/bcr-2020-240710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 69-year-old man was admitted with recurrent fungal bloodstream infection on a background of abdominal aneurysm, diabetes and chronic obstructive pulmonary disease. Investigations revealed a para-aortic mass, previously thought to be lymphoma, which was culture positive for Candida glabrata on biopsy. Diagnosis and management involved multidisciplinary teamwork, diagnostic uncertainty and significant risk taking.
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Affiliation(s)
- Robert Miller
- General Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| | - Susie Harris
- Geriatrics, Royal Devon and Exeter Hospital, Exeter, UK
| | - Robert Porter
- Microbiology, Royal Devon and Exeter Hospital, Exeter, UK
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16
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Pyrogallol and Fluconazole Interact Synergistically In Vitro against Candida glabrata through an Efflux-Associated Mechanism. Antimicrob Agents Chemother 2021; 65:e0010021. [PMID: 33875436 PMCID: PMC8373228 DOI: 10.1128/aac.00100-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Candida glabrata is currently the first or second most commonly encountered non-albicans Candida species worldwide. The potential severity of Candida resistance mandates the discovery of novel antifungal agents, including those that can be used in combination therapies. In this study, we evaluated the in vitro interactions of pyrogallol (PG) and azole drugs against 22 clinical C. glabrata isolates. The potential mechanism underlying the synergism between PG and fluconazole (FLC) was investigated by the rhodamine 6G efflux method and quantitative reverse transcription (qRT)-PCR analysis. In susceptibility tests, PG showed strong synergism with FLC, itraconazole (ITC), and voriconazole (VRC), with fractional inhibitory concentration index values of 0.18 to 0.375 for PG+FLC, 0.250 to 0.750 for PG+ITC, and 0.141 to 0.750 for PG+VRC. Cells grown in the presence of PG+FLC exhibited reduced rhodamine 6G extrusion and significantly downregulated expression of the efflux-related genes CgCDR1, CgCDR2, and CgPDR1 compared with cells grown in the presence of PG or FLC alone. PG did not potentiate FLC when tested against a ΔCgpdr1 strain. Restoration of a functional CgPDR1 allele also restored the synergism. These results indicate that PG is an antifungal agent that synergistically potentiates the activity of azoles. Furthermore, PG appears to exert its effects by inhibiting efflux pumps and downregulating CgCDR1, CgCDR2, and CgPDR1, with CgPDR1 probably playing a crucial role in this process.
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17
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Lotfali E, Fattahi A, Sayyahfar S, Ghasemi R, Rabiei MM, Fathi M, Vakili K, Deravi N, Soheili A, Toreyhi H, Shirvani F. A Review on Molecular Mechanisms of Antifungal Resistance in Candida glabrata: Update and Recent Advances. Microb Drug Resist 2021; 27:1371-1388. [PMID: 33956513 DOI: 10.1089/mdr.2020.0235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Candida glabrata is the second frequent etiologic agent of mucosal and invasive candidiasis. Based on the recent developments in molecular methods, C. glabrata has been introduced as a complex composed of C. glabrata, Candida nivariensis, and Candida bracarensis. The four main classes of antifungal drugs effective against C. glabrata are pyrimidine analogs (flucytosine), azoles, echinocandins, and polyenes. Although the use of antifungal drugs is related to the predictable development of drug resistance, it is not clear why C. glabrata is able to rapidly resist against multiple antifungals in clinics. The enhanced incidence and antifungal resistance of C. glabrata and the high mortality and morbidity need more investigation regarding the resistance mechanisms and virulence associated with C. glabrata; additional progress concerning the drug resistance of C. glabrata has to be further prevented. The present review highlights the mechanism of resistance to antifungal drugs in C. glabrata.
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Affiliation(s)
- Ensieh Lotfali
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Fattahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Ghasemi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Rabiei
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mobina Fathi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Vakili
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirali Soheili
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Toreyhi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Shirvani
- Pediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Arastehfar A, Gabaldón T, Garcia-Rubio R, Jenks JD, Hoenigl M, Salzer HJF, Ilkit M, Lass-Flörl C, Perlin DS. Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium. Antibiotics (Basel) 2020; 9:antibiotics9120877. [PMID: 33302565 PMCID: PMC7764418 DOI: 10.3390/antibiotics9120877] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
The high clinical mortality and economic burden posed by invasive fungal infections (IFIs), along with significant agricultural crop loss caused by various fungal species, has resulted in the widespread use of antifungal agents. Selective drug pressure, fungal attributes, and host- and drug-related factors have counteracted the efficacy of the limited systemic antifungal drugs and changed the epidemiological landscape of IFIs. Species belonging to Candida, Aspergillus, Cryptococcus, and Pneumocystis are among the fungal pathogens showing notable rates of antifungal resistance. Drug-resistant fungi from the environment are increasingly identified in clinical settings. Furthermore, we have a limited understanding of drug class-specific resistance mechanisms in emerging Candida species. The establishment of antifungal stewardship programs in both clinical and agricultural fields and the inclusion of species identification, antifungal susceptibility testing, and therapeutic drug monitoring practices in the clinic can minimize the emergence of drug-resistant fungi. New antifungal drugs featuring promising therapeutic profiles have great promise to treat drug-resistant fungi in the clinical setting. Mitigating antifungal tolerance, a prelude to the emergence of resistance, also requires the development of effective and fungal-specific adjuvants to be used in combination with systemic antifungals.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
| | - Toni Gabaldón
- Life Sciences Programme, Supercomputing Center (BSC-CNS), Jordi Girona, 08034 Barcelona, Spain;
- Mechanisms of Disease Programme, Institute for Research in Biomedicine (IRB), 08024 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies. Pg. Lluís Companys 23, 08010 Barcelona, Spain
| | - Rocio Garcia-Rubio
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
| | - Jeffrey D. Jenks
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA;
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA;
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Martin Hoenigl
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA;
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | | | - Macit Ilkit
- Division of Mycology, University of Çukurova, 01330 Adana, Turkey
- Correspondence: (M.I.); (D.S.P.); Tel.: +90-532-286-0099 (M.I.); +1-201-880-3100 (D.S.P.)
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - David S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
- Correspondence: (M.I.); (D.S.P.); Tel.: +90-532-286-0099 (M.I.); +1-201-880-3100 (D.S.P.)
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Akhapkina IG, Glushakova AM, Rodionova EN, Kachalkin AV. Colonization activity of Candida clinical isolates and their antibiotic sensitivity. JOURNAL OF MICROBIOLOGY, EPIDEMIOLOGY AND IMMUNOBIOLOGY 2020. [DOI: 10.36233/0372-9311-2020-97-5-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Anna M. Glushakova
- I.I. Mechnikov Research Institute of Vaccines and Sera; M.V. Lomonosov Moscow State University
| | | | - Aleksey V. Kachalkin
- M.V. Lomonosov Moscow State University; G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, RAS
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20
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Azie N, Angulo D, Dehn B, Sobel JD. Oral Ibrexafungerp: an investigational agent for the treatment of vulvovaginal candidiasis. Expert Opin Investig Drugs 2020; 29:893-900. [PMID: 32746636 DOI: 10.1080/13543784.2020.1791820] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Vulvovaginal candidiasis (VVC) is a common fungal infection caused by predominantly Candida albicans, and is diagnosed in up to 40% of women with vaginal complaints in the primary care setting. Approximately 75% of women experience at least one episode during their reproductive years. AREAS COVERED Ibrexafungerp is an orally active, semi-synthetic triterpenoid glucan synthase inhibitor under development for treatment and prevention of VVC. We present the chemistry, mechanism of action, pharmacology, microbiology, and results from clinical studies with ibrexafungerp in women with VVC. EXPERT OPINION Ibrexafungerp addresses several unmet needs with existing antifungal drugs as a first in a new class of antifungal agents with a novel mechanism of action demonstrating no antifungal cross resistance with azoles, and fungicidal activity against Candida spp., including fluconazole-resistant species. Some of the key attributes of ibrexafungerp related to VVC include oral one-day dosing, high tissue penetration, enhanced activity at low pH seen in the vagina, low risk for clinically significant drug-drug interactions, and a low risk of adverse events. If approved, ibrexafungerp will be the first new antifungal agent available for the treatment of VVC in more than 20 years and the only oral, non-azole antifungal approved for women suffering from VVC.
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Affiliation(s)
- Nkechi Azie
- Clinical Development, SCYNEXIS Inc , Jersey City, NJ, USA
| | - David Angulo
- Clinical Development, SCYNEXIS Inc , Jersey City, NJ, USA
| | - Barbara Dehn
- Clinical Development, El Camino Medical Group , Mountain View, CA, USA
| | - Jack D Sobel
- School of Medicine, Wayne State University , Detroit, MI, USA
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21
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Hosseini SS, Joshaghani H, Shokohi T, Ahmadi A, Mehrbakhsh Z. Antifungal Activity of ZnO Nanoparticles and Nystatin and Downregulation of SAP1-3 Genes Expression in Fluconazole-Resistant Candida albicans Isolates from Vulvovaginal Candidiasis. Infect Drug Resist 2020; 13:385-394. [PMID: 32104010 PMCID: PMC7025901 DOI: 10.2147/idr.s226154] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/17/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose Antifungal resistance and virulence properties of Candida albicans (C. albicans) are growing health problems worldwide. The present study aims to investigate the effect of Zinc Oxide (ZnO) nanoparticles and Nystatin on SAP1-3 genes expression in C. albicans isolates of females with Vulvovaginal Candidiasis (VVC) isolated from Sayad Shirazi Obstetrics and Gynecology Hospital in Northeastern Iran during 2017–2018. Patients and Methods In this descriptive-analytic study, vaginal samples were collected from 280 VVC women. 196 (70%) of C. albicans isolates were identified by phenotypic and ITS genotypic methods. Susceptibility to Fluconazole C. albicans isolates was determined by the disk diffusion method. Detection of ERG11 gene was done by RT-PCR technique. Results It was revealed that PCR amplified the ERG11 gene in all of the Fluconazole-resistant isolates. Real-time PCR was used to survey the effects of 3±1.7µg/mL concentrations of ZnO nanoparticles and Nystatin on expression of SAP1-3 genes before and after treatment. 186 (95%) susceptible C. albicans and 10 (5%) Fluconazole-resistant C. albicans isolates from VVC were exposed to sub-minimum inhibitory concentrations (Sub-MIC) of ZnO-np (range=0.02–12 μg/mL). Sub-MIC concentration was used for each strain, which reduced the expression of SAP1-3 genes to 1.8 MIC in the vaginal swabs. The observed reduction in gene expression was significant for both ZnO nanoparticles and Nystatin (P=0.01 and P=0.07, respectively). Conclusion ZnO as antifungal agent can well reduce the growth and gene expression of SAP1-3 in the pathogenesis of VVC.
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Affiliation(s)
- Seyededeh Sedigheh Hosseini
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran.,Department of Laboratory Sciences, Faculty of Paramedicine, Gorgan University of Medical Sciences, Gorgan, Iran
| | - Hamidreza Joshaghani
- Department of Clinical Biochemistry, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Tahereh Shokohi
- Department of Medical Mycology and Parasitology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Ahmadi
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Mehrbakhsh
- Department of Biostatistics and Epidemiology, School of Health, Golestan University of Medical Sciences, Gorgan, Iran
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