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Messina A, Mariani A, Brandolisio R, Tavella E, Germano C, Lipari G, Leo L, Masturzo B, Manzoni P. Candidiasis in Pregnancy: Relevant Aspects of the Pathology for the Mother and the Fetus and Therapeutic Strategies. Trop Med Infect Dis 2024; 9:114. [PMID: 38787047 PMCID: PMC11125970 DOI: 10.3390/tropicalmed9050114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Vulvovaginal candidiasis (VVC) is a common condition that can lead to significant discomfort, affecting approximately 70-75% of women at least once in their lives. During pregnancy, the prevalence of VVC is estimated to be around 20%, peaking at about 30% in the third trimester, with a number of specific risk factors predisposing to yeast infection being identified and needing elucidation. This review aims to provide updated knowledge on candidiasis during pregnancy, addressing risk factors and maternal and neonatal outcomes, as well as discussing optimal therapeutic strategies to safeguard mothers and newborns. The bibliographic search involved two biomedical databases, PubMed and Embase, without imposing time limits. Among all Candida spp., Candida albicans remains the most frequent causative species. The hyperestrogenic environment of the vaginal mucosa and reduced immune defenses, physiological effects of pregnancy, create conditions favorable for Candida spp. vaginal colonization and hence VVC. Recent evidence shows an association between VVC and adverse obstetric outcomes, including premature membrane rupture (PROM), chorioamnionitis, preterm birth, and puerperal infections. Prompt and effective management of this condition is therefore crucial to prevent adverse obstetric outcomes, maternal-fetal transmission, and neonatal disease. Additional studies are required to confirm the benefits of systemic treatment for maternal candida infection or colonization in preventing premature birth or neonatal systemic candidiasis.
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Affiliation(s)
- Alessandro Messina
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Alessia Mariani
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Romina Brandolisio
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy; (R.B.); (E.T.)
- Department of Maternal, Neonatal and Infant Medicine, University of Torino School of Medicine, 10125 Turin, Italy
| | - Elena Tavella
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy; (R.B.); (E.T.)
- Department of Maternal, Neonatal and Infant Medicine, University of Torino School of Medicine, 10125 Turin, Italy
| | - Chiara Germano
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Giovanni Lipari
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Livio Leo
- Division of Obstetrics and Gynecology, Hopital Beauregard, AUSL Valleè d’Aoste, 11100 Aosta, Italy;
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy (A.M.); (C.G.); (G.L.); (B.M.)
| | - Paolo Manzoni
- Division of Pediatrics and Neonatology, Department of Maternal, Neonatal and Infant Medicine, University Hospital “Degli Infermi”, 13875 Ponderano, Italy; (R.B.); (E.T.)
- Department of Maternal, Neonatal and Infant Medicine, University of Torino School of Medicine, 10125 Turin, Italy
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Sinoca M, Maione A, Gambino E, Imparato M, Galdiero M, de Alteriis E, Galdiero E, Guida M. A Preliminary Evaluation on the Antifungal Efficacy of VT-1161 against Persister Candida albicans Cells in Vulvovaginal Candidiasis. Biomedicines 2024; 12:389. [PMID: 38397991 PMCID: PMC10887314 DOI: 10.3390/biomedicines12020389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Persister cells are a small fraction of the microbial population that survive lethal concentrations of antimicrobial agents. Candida albicans causes vaginal candidiasis, including recurrent vulvovaginal candidiasis, and may survive common antifungal treatments. The triazole VT-1161 is an antifungal agent that specifically targets fungal CYP51, as opposed to the human CYP enzyme. This work illustrates a new role of VT-1161 in eradicating the biofilm created from the persister cells of a primary biofilm of a clinical vaginal isolate of C. albicans. Antifungal activity was determined by the minimum inhibitory concentration (MIC), and the primary biofilm was treated with amphotericin B to obtain persister cells that were able to form a new biofilm. Results obtained using the new azole VT-1161 showed that VT-1161 not only eradicated a secondary biofilm formed from the persister-derived biofilm and counteracted the adhesion of C. albicans in vitro to human cells but also ameliorated C. albicans-induced infection in vivo in Galleria mellonella larvae, suggesting that it could be proposed as an alternative therapeutic strategy for the treatment of recurrent candidiasis.
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Affiliation(s)
- Marica Sinoca
- Department of Biology, University of Naples Federico II, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (E.G.); (M.I.); (E.d.A.); (M.G.)
| | - Angela Maione
- Department of Biology, University of Naples Federico II, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (E.G.); (M.I.); (E.d.A.); (M.G.)
| | - Edvige Gambino
- Department of Biology, University of Naples Federico II, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (E.G.); (M.I.); (E.d.A.); (M.G.)
| | - Marianna Imparato
- Department of Biology, University of Naples Federico II, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (E.G.); (M.I.); (E.d.A.); (M.G.)
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy;
| | - Elisabetta de Alteriis
- Department of Biology, University of Naples Federico II, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (E.G.); (M.I.); (E.d.A.); (M.G.)
| | - Emilia Galdiero
- Department of Biology, University of Naples Federico II, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (E.G.); (M.I.); (E.d.A.); (M.G.)
- Center for Studies on Bioinspired Agro-Environmental Technology (BAT Center), 80055 Portici, Italy
| | - Marco Guida
- Department of Biology, University of Naples Federico II, Via Cinthia, 80126 Naples, Italy; (M.S.); (A.M.); (E.G.); (M.I.); (E.d.A.); (M.G.)
- Center for Studies on Bioinspired Agro-Environmental Technology (BAT Center), 80055 Portici, Italy
- National Biodiversity Future Center (NBFC), 90133 Palermo, Italy
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Pan Y, Sun Y, Chen L, Cheng Y, Jin P, Zhang W, Zheng L, Liu J, Zhou T, Xu Z, Li C, Kostoulias X, Watson CJ, McGiffin D, Peleg AY, Qu Y. Candida causes recurrent vulvovaginal candidiasis by forming morphologically disparate biofilms on the human vaginal epithelium. Biofilm 2023; 6:100162. [PMID: 37941804 PMCID: PMC10630605 DOI: 10.1016/j.bioflm.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/11/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023] Open
Abstract
Background Recurrent vulvovaginal candidiasis (RVVC) is a recalcitrant medical condition that affects many women of reproductive age. The importance of biofilm formation by Candida in RVVC has been recently questioned. This study aimed to elucidate the fundamental growth modes of Candida in the vagina of patients with RVVC or sporadic vulvovaginal candidiasis (VVC) and to assess their roles in the persistence of RVVC. Methods Vaginal tissues were sampled from twelve patients clinically and microbiologically diagnosed as RVVC or VVC at a post-antifungal-treatment and asymptomatic period. High-resolution scanning electron microscopy, fluorescence in situ hybridization in combination with Candida-specific 18S rRNA probes and viable fungal burden were used to qualitatively and quantitatively evaluate Candida growth in the human vagina. The presence of Candida biofilm extracellular polymeric substances was examined using confocal laser scanning microscopy and biopsy sections pre-stained with Concanavalin A. Histopathological analysis was carried out on infected vaginal tissues stained with hematoxylin and eosin. Lastly, the susceptibility of epithelium-associated Candida biofilms to fluconazole at the peak serum concentration was evaluated. Results Candida species grew on the vaginal epithelium of RVVC patients as morphologically disparate biofilms including monolayers, microcolonies, and macro-colonies, in addition to sporadic adherent cells. Candida biofilm growth on the vaginal epithelium was associated with mild lymphocytic infiltration of the vaginal mucosa. These epithelium-based Candida biofilms presented an important characteristic contributing to the persistence of RVVC that is the high tolerance to fluconazole. Conclusions In summary, our study provides direct evidence to support the presence of Candida biofilms in RVVC and an important role of biofilm formation in disease persistence.
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Affiliation(s)
- Yihong Pan
- Wenzhou Medical University-Monash BDI Alliance in Clinical and Experimental Biomedicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, 325000, China
- Department of Obstetrics and Gynaecology, Taizhou Hospital of Wenzhou Medical University, Zhejiang, 318050, China
| | - Yao Sun
- Wenzhou Medical University-Monash BDI Alliance in Clinical and Experimental Biomedicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, 325000, China
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Lanqian Chen
- Department of Pathology, Taizhou Hospital of Wenzhou Medical University, Zhejiang, 318050, China
| | - Yali Cheng
- Department of Obstetrics and Gynaecology, Taizhou Hospital of Wenzhou Medical University, Zhejiang, 318050, China
| | - Panpan Jin
- Department of Obstetrics and Gynaecology, Taizhou Hospital of Wenzhou Medical University, Zhejiang, 318050, China
| | - Weidan Zhang
- Department of Obstetrics and Gynaecology, Taizhou Hospital of Wenzhou Medical University, Zhejiang, 318050, China
| | - Lingzhi Zheng
- Department of Obstetrics and Gynaecology, Taizhou Hospital of Wenzhou Medical University, Zhejiang, 318050, China
| | - Junyan Liu
- School of Food Science and Engineering, Guangdong Province Key Laboratory for Green Processing of Natural Products and Product Safety, Engineering Research Center of Starch and Vegetable Protein Processing, Ministry of Education, South China University of Technology, Guangzhou, 510640, China
- Department of Civil and Environmental Engineering, University of Maryland, College Park, MD, 20742, United States
| | - Tieli Zhou
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Zhenbo Xu
- School of Food Science and Engineering, Guangdong Province Key Laboratory for Green Processing of Natural Products and Product Safety, Engineering Research Center of Starch and Vegetable Protein Processing, Ministry of Education, South China University of Technology, Guangzhou, 510640, China
- Department of Civil and Environmental Engineering, University of Maryland, College Park, MD, 20742, United States
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, 02139, United States
| | - Cheng Li
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, 02139, United States
| | - Xenia Kostoulias
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, 3004, Australia
- Department of Microbiology, Infection Program, Biomedical Discovery Institute, Monash University, Clayton, 3800, Australia
| | - Cathy J. Watson
- School of Population and Global Health, University of Melbourne, Carlton, 3053, Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery, The Alfred and Monash University, Melbourne, Victoria, 3004, Australia
| | - Anton Y. Peleg
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, 3004, Australia
- Department of Microbiology, Infection Program, Biomedical Discovery Institute, Monash University, Clayton, 3800, Australia
| | - Yue Qu
- Wenzhou Medical University-Monash BDI Alliance in Clinical and Experimental Biomedicine, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, 325000, China
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, 3004, Australia
- Department of Microbiology, Infection Program, Biomedical Discovery Institute, Monash University, Clayton, 3800, Australia
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Hastings CJ, Keledjian MV, Musselman LP, Marques CNH. Delayed host mortality and immune response upon infection with P. aeruginosa persister cells. Infect Immun 2023; 91:e0024623. [PMID: 37732789 PMCID: PMC10580972 DOI: 10.1128/iai.00246-23] [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: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/22/2023] Open
Abstract
Chronic infections are a heavy burden on healthcare systems worldwide. Persister cells are thought to be largely responsible for chronic infection due to their tolerance to antimicrobials and recalcitrance to innate immunity factors. Pseudomonas aeruginosa is a common and clinically relevant pathogen that contains stereotypical persister cells. Despite their importance in chronic infection, there have been limited efforts to study persister cell infections in vivo. Drosophila melanogaster has a well-described innate immune response similar to that of vertebrates and is a good candidate for the development of an in vivo model of infection for persister cells. Similar to what is observed in other bacterial strains, in this work we found that infection with P. aeruginosa persister cells resulted in a delayed mortality phenotype in Caenorhabditis elegans, Arabidopsis thaliana, and D. melanogaster compared to infection with regular cells. An in-depth characterization of infected D. melanogaster found that bacterial loads differed between persister and regular cells' infections during the early stages. Furthermore, hemocyte activation and antimicrobial peptide expression were delayed/reduced in persister infections over the same time course, indicating an initial suppression of, or inability to elicit, the fly immune response. Overall, our findings support the use of D. melanogaster as a model in which to study persister cells in vivo, where this bacterial subpopulation exhibits delayed virulence and an attenuated immune response.
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Affiliation(s)
- Cody J. Hastings
- Department of Biological Sciences, Binghamton University, Binghamton, New York, USA
- Binghamton Biofilm Research Center, Binghamton University, Binghamton, New York, USA
| | - Maya V. Keledjian
- Department of Biological Sciences, Binghamton University, Binghamton, New York, USA
- Binghamton Biofilm Research Center, Binghamton University, Binghamton, New York, USA
| | | | - Cláudia N. H. Marques
- Department of Biological Sciences, Binghamton University, Binghamton, New York, USA
- Binghamton Biofilm Research Center, Binghamton University, Binghamton, New York, USA
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5
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Lin Y, Yin Q, Zhuge D, Hu Y, Yang X, Tian D, Li L, Wang H, Liu S, Weng C, Zhang X, Wen B, Wang F, Yan L, Chen M, Wang L, Chen Y. Enhanced Targeting, Retention, and Penetration of Amphotericin B Through a Biomimetic Strategy to Treat Against Vulvovaginal Candidiasis. ADVANCED THERAPEUTICS 2022. [DOI: 10.1002/adtp.202200086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yijing Lin
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Qingqing Yin
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Deli Zhuge
- Department of Pharmaceutics School of Pharmaceutical Sciences of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Yiqin Hu
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Xuewei Yang
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Dongyan Tian
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Li Li
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Haonan Wang
- Department of Pharmaceutics School of Pharmaceutical Sciences of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Shuangshuang Liu
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Cuiye Weng
- Laboratory Animal Center of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Xufei Zhang
- Laboratory Animal Center of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Bin Wen
- Laboratory Animal Center of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
| | - Fang Wang
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Linzhi Yan
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Mengchun Chen
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
- Department of Pharmaceutics School of Pharmaceutical Sciences of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
- Department of Pharmacy The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Ledan Wang
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
| | - Yijie Chen
- Department of Obstetrics and Gynecology The Second Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang 325027 P. R. China
- Department of Pharmaceutics School of Pharmaceutical Sciences of Wenzhou Medical University Wenzhou Zhejiang 325015 P. R. China
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Blackman LD, Sutherland TD, De Barro PJ, Thissen H, Locock KES. Addressing a future pandemic: how can non-biological complex drugs prepare us for antimicrobial resistance threats? MATERIALS HORIZONS 2022; 9:2076-2096. [PMID: 35703580 DOI: 10.1039/d2mh00254j] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Loss of effective antibiotics through antimicrobial resistance (AMR) is one of the greatest threats to human health. By 2050, the annual death rate resulting from AMR infections is predicted to have climbed from 1.27 million per annum in 2019, up to 10 million per annum. It is therefore imperative to preserve the effectiveness of both existing and future antibiotics, such that they continue to save lives. One way to conserve the use of existing antibiotics and build further contingency against resistant strains is to develop alternatives. Non-biological complex drugs (NBCDs) are an emerging class of therapeutics that show multi-mechanistic antimicrobial activity and hold great promise as next generation antimicrobial agents. We critically outline the focal advancements for each key material class, including antimicrobial polymer materials, carbon nanomaterials, and inorganic nanomaterials, and highlight the potential for the development of antimicrobial resistance against each class. Finally, we outline remaining challenges for their clinical translation, including the need for specific regulatory pathways to be established in order to allow for more efficient clinical approval and adoption of these new technologies.
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Affiliation(s)
- Lewis D Blackman
- CSIRO Manufacturing, Research Way, Clayton, VIC 3168, Australia.
| | - Tara D Sutherland
- CSIRO Health & Biosecurity, Clunies Ross Street, Black Mountain, ACT 2601, Australia
| | - Paul J De Barro
- CSIRO Health & Biosecurity, Boggo Road, Dutton Park, QLD 4102, Australia
| | - Helmut Thissen
- CSIRO Manufacturing, Research Way, Clayton, VIC 3168, Australia.
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Ye MS, Chen HL, Liu CX, Ren AJ, Yang HW, Wang SS. Caspofungin at Sub-inhibitory Concentration Promotes the Formation of Candida Albicans Persister Cells. J Appl Microbiol 2022; 133:2466-2473. [PMID: 35858676 DOI: 10.1111/jam.15718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
AIMS Low caspofungin exposure is frequently encountered in patients with invasive candidiasis caused by Candida albicans (C. albicans). This study aimed to investigate the effects of caspofungin on C. albicans at sub-inhibitory concentrations. METHODS AND RESULTS First, a comparative transcriptomics analysis was performed on C. albicans receiving caspofungin at sub-minimum inhibitory concentrations (sub-MIC). The results showed that caspofungin significantly changed the mRNA expression profile in DAY185, with DE-mRNAs enriched in the functions of cell wall biosynthesis, metabolism, etc. Subsequently, cellular fitness, cell aggregation, energy metabolism activity, and the proportion of persister cells of C. albicans were quantitatively and/or qualitatively assessed after sub-MIC caspofungin exposure. No significant changes in cell fitness and aggregation formation were observed during treatment of C. albicans with sub-MIC caspofungin. In C. albicans aggregation treated with sub-MIC caspofungin, we observed a decrease in respiratory metabolism and an increase in persister cells; this effect was more pronounced in als1ΔΔ than in DAY185. CONCLUSIONS Pre-exposure to sub-MIC caspofungin suppresses C. albicans respiratory metabolism and promotes persister cell development. SIGNIFICANCE AND IMPACT OF STUDY Caspofungin should be used with caution in patients with C. albicans infections, as anti-infection therapy may fail due to persister cells.
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Affiliation(s)
| | - Hua-le Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Cai-Xia Liu
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Ai-Juan Ren
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Hai-Wei Yang
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Shi-Shi Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
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8
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Wang X, Wang G, Zhao J, Zhu Z, Rao J. Main-Chain Sulfonium-Containing Homopolymers with Negligible Hemolytic Toxicity for Eradication of Bacterial and Fungal Biofilms. ACS Macro Lett 2021; 10:1643-1649. [PMID: 35549147 DOI: 10.1021/acsmacrolett.1c00698] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Antimicrobials against planktonic cells and established biofilms at low doses are in increasing demand to tackle antibiotic-resistant biofilm infections. As a promising alternative to antibiotics, cationic polymers can effectively kill planktonic microbes but usually require high concentrations to eradicate the established biofilms. Herein, we developed a series of sulfonium-based homopolymers with cationic sulfoniums and alkane spacers in the main chain. These polysulfoniums presented effective activity against planktonic fungi (Candida albicans) and bacteria (Escherichia coli and Staphylococcus aureus) with minimum inhibition concentrations (MICs) of 0.5-32 μg/mL, and the optimal composition can provide an 80-90% reduction in biofilm mass and >99% killing of Candida albicans and Escherichia coli cells in 3-day mature biofilms at 2 × MIC as well as steadily low hemolytic toxicity. The influence of amphiphilicity and charge density of polysulfonium homopolymers on their antimicrobial activity against planktonic microbes and mature biofilms was investigated to provide insights for effective antimicrobial polymer design.
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Affiliation(s)
- Xiao Wang
- Hubei Key Laboratory of Material Chemistry and Service Failure, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, Hubei 430074, People’s Republic of China
| | - Guixian Wang
- Hubei Key Laboratory of Material Chemistry and Service Failure, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, Hubei 430074, People’s Republic of China
| | - Jinghua Zhao
- Hubei Key Laboratory of Material Chemistry and Service Failure, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, Hubei 430074, People’s Republic of China
| | - Zhiyuan Zhu
- Suzhou Jufeng Electrical Insulation System Co., Ltd., Suzhou, Jiangsu 215214, People’s Republic of China
| | - Jingyi Rao
- Hubei Key Laboratory of Material Chemistry and Service Failure, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, Hubei 430074, People’s Republic of China
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9
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Fungal Biofilms as a Valuable Target for the Discovery of Natural Products That Cope with the Resistance of Medically Important Fungi-Latest Findings. Antibiotics (Basel) 2021; 10:antibiotics10091053. [PMID: 34572635 PMCID: PMC8471798 DOI: 10.3390/antibiotics10091053] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022] Open
Abstract
The development of new antifungal agents that target biofilms is an urgent need. Natural products, mainly from the plant kingdom, represent an invaluable source of these entities. The present review provides an update (2017-May 2021) on the available information on essential oils, propolis, extracts from plants, algae, lichens and microorganisms, compounds from different natural sources and nanosystems containing natural products with the capacity to in vitro or in vivo modulate fungal biofilms. The search yielded 42 articles; seven involved essential oils, two Brazilian propolis, six plant extracts and one of each, extracts from lichens and algae/cyanobacteria. Twenty articles deal with the antibiofilm effect of pure natural compounds, with 10 of them including studies of the mechanism of action and five dealing with natural compounds included in nanosystems. Thirty-seven manuscripts evaluated Candida spp. biofilms and two tested Fusarium and Cryptococcus spp. Only one manuscript involved Aspergillus fumigatus. From the data presented here, it is clear that the search of natural products with activity against fungal biofilms has been a highly active area of research in recent years. However, it also reveals the necessity of deepening the studies by (i) evaluating the effect of natural products on biofilms formed by the newly emerged and worrisome health-care associated fungi, C. auris, as well as on other non-albicans Candida spp., Cryptococcus sp. and filamentous fungi; (ii) elucidating the mechanisms of action of the most active natural products; (iii) increasing the in vivo testing.
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10
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Blackman LD, Qu Y, Cass P, Locock KES. Approaches for the inhibition and elimination of microbial biofilms using macromolecular agents. Chem Soc Rev 2021; 50:1587-1616. [PMID: 33403373 DOI: 10.1039/d0cs00986e] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Biofilms are complex three-dimensional structures formed at interfaces by the vast majority of bacteria and fungi. These robust communities have an important detrimental impact on a wide range of industries and other facets of our daily lives, yet their removal is challenging owing to the high tolerance of biofilms towards conventional antimicrobial agents. This key issue has driven an urgent search for new innovative antibiofilm materials. Amongst these emerging approaches are highly promising materials that employ aqueous-soluble macromolecules, including peptides, proteins, synthetic polymers, and nanomaterials thereof, which exhibit a range of functionalities that can inhibit biofilm formation or detach and destroy organisms residing within established biofilms. In this Review, we outline the progress made in inhibiting and removing biofilms using macromolecular approaches, including a spotlight on cutting-edge materials that respond to environmental stimuli for "on-demand" antibiofilm activity, as well as synergistic multi-action antibiofilm materials. We also highlight materials that imitate and harness naturally derived species to achieve new and improved biomimetic and biohybrid antibiofilm materials. Finally, we share some speculative insights into possible future directions for this exciting and highly significant field of research.
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Affiliation(s)
- Lewis D Blackman
- CSIRO Manufacturing, Research Way, Clayton, VIC 3168, Australia.
| | - Yue Qu
- Infection and Immunity Program, Department of Microbiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC 3800, Australia and Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Peter Cass
- CSIRO Manufacturing, Research Way, Clayton, VIC 3168, Australia.
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11
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Cordeiro RDA, Aguiar ALR, da Silva BN, Pereira LMG, Portela FVM, de Camargo ZP, de Lima-Neto RG, Castelo-Branco DDSCM, Rocha MFG, Sidrim JJC. Trichosporon asahii and Trichosporon inkin Biofilms Produce Antifungal-Tolerant Persister Cells. Front Cell Infect Microbiol 2021; 11:645812. [PMID: 33968802 PMCID: PMC8100310 DOI: 10.3389/fcimb.2021.645812] [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] [Received: 12/24/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
Persister cells are metabolically inactive dormant cells that lie within microbial biofilms. They are phenotypic variants highly tolerant to antimicrobials and, therefore, associated with recalcitrant infections. In the present study, we investigated if Trichosporon asahii and T. inkin are able to produce persister cells. Trichosporon spp. are ubiquitous fungi, commonly found as commensals of the human skin and gut microbiota, and have been increasingly reported as agents of fungemia in immunocompromised patients. Biofilms derived from clinical strains of T asahii (n=5) and T. inkin (n=7) were formed in flat-bottomed microtiter plates and incubated at 35°C for 48 h, treated with 100 μg/ml amphotericin B (AMB) and incubated at 35°C for additional 24 h. Biofilms were scraped from the wells and persister cells were assayed for susceptibility to AMB. Additionally, we investigated if these persister cells were able to generate new biofilms and studied their ultrastructure and AMB susceptibility. Persister cells were detected in both T asahii and T. inkin biofilms and showed tolerance to high doses of AMB (up to 256 times higher than the minimum inhibitory concentration). Persister cells were able to generate biofilms, however they presented reduced biomass and metabolic activity, and reduced tolerance to AMB, in comparison to biofilm growth control. The present study describes the occurrence of persister cells in Trichosporon spp. and suggests their role in the reduced AMB susceptibility of T. asahii and T. inkin biofilms.
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Affiliation(s)
| | | | | | | | | | - Zoilo Pires de Camargo
- Department of Medicine, Discipline of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Marcos Fábio Gadelha Rocha
- Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil.,College of Veterinary, State University of Ceará, Fortaleza, Brazil
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12
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Ré ACS, Martins JF, Cunha-Filho M, Gelfuso GM, Aires CP, Gratieri T. New perspectives on the topical management of recurrent candidiasis. Drug Deliv Transl Res 2021; 11:1568-1585. [PMID: 33469892 DOI: 10.1007/s13346-021-00901-0] [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] [Accepted: 01/06/2021] [Indexed: 12/24/2022]
Abstract
Candidiasis is a common opportunistic infection caused by fungi of the Candida genus that affects mainly mucocutaneous tissues (e.g., vaginal, oral, and mammary). This condition has been known for a long time; thus, innumerous topical and systemic treatments are already available on the market worldwide. Yet, recurrent superficial candidiasis (RSC) is an expected outcome, still lacking effective and convenient treatments. Although several individual conditions may contribute to disease recurrence, biofilms' presence seems to be the main etiological factor contributing to antifungal resistance. More than proposing novel antifungal agents, current research seems to be focusing on improving the pharmaceutical technology aspects of formulations to address such a challenge. These include extending and improving intimate contact of drug delivery systems with the mucocutaneous tissues, increasing drug loading dose, and enhancing topical drug permeation. This review discusses the current understanding of the RSC and the use of pharmaceutical technology tools in obtaining better results. Even though several drawbacks of conventional formulations have been circumvented with the help of nano- or microencapsulation techniques and with the use of mucoadhesive formulation excipients, many challenges remain. In particular, the need to mask the unpalatable taste of formulations for the treatment of oral candidiasis, and the necessity of formulations with a "dryer" sensorial feeling and improved performances in providing higher bioavailability for the treatment of mammary and vaginal candidiasis.
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Affiliation(s)
- Ana Carolina S Ré
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, 14040-903, Brazil
| | - Jayanaraian F Martins
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Marcílio Cunha-Filho
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Guilherme M Gelfuso
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Carolina P Aires
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, 14040-903, Brazil
| | - Taís Gratieri
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil. .,Campus Universitário Darcy Ribeiro, Asa Norte, Brasilia, DF, 70910-900, Brazil.
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13
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Qu Y, McGiffin D, Kure C, McLean J, Duncan C, Peleg AY. In vitro Evaluation of Medihoney Antibacterial Wound Gel as an Anti-biofilm Agent Against Ventricular Assist Device Driveline Infections. Front Microbiol 2020; 11:605608. [PMID: 33329497 PMCID: PMC7719625 DOI: 10.3389/fmicb.2020.605608] [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: 09/12/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives: In adult ventricular assist device (VAD) programs in Australian hospitals, Medihoney Antibacterial Wound Gel (MAWG) is routinely used at the skin exit-site of VAD drivelines to prevent infections; however, its effectiveness remains unclear. Our aim was to assess antimicrobial activity of Medihoney wound gel, using in vitro models that mimic clinical biofilms grown at the driveline exit-site. Methods: Antimicrobial susceptibility testing of MAWG was performed for 24 clinical isolates grown under planktonic conditions, and four representative strains grown as biofilms. Different antimicrobial mechanisms of MAWG were assessed respectively for their relative contribution to its anti-biofilm activity. A colony biofilm assay and a drip-flow biofilm reactor assay mimicking the driveline exit-site environment were used to evaluate the activity of MAWG against biofilm growth at the driveline exit-site. Results: MAWG demonstrated species-specific activity against planktonic cultures [minimum inhibitory concentrations (MICs), 5-20% weight/volume (W/V) for Staphylococcus species, 20->40% (W/V) for Pseudomonas aeruginosa and Candida species]. Higher concentrations [MICs, 30->80% (W/V)] were able to inhibit biofilm growth, but failed to eradicate pre-established biofilms. The anti-biofilm properties of MAWG were multi-faceted, with the often-advertised "active" ingredient methylglyoxal (MGO) playing a less important role. The colony biofilm assay and the drip-flow biofilm reactor assay suggested that MAWG was unable to kill biofilms pre-established in a driveline exit-site environment, or effectively prevent planktonic cells from forming adherent monolayers and further developing mature biofilms. Conclusion: Our work suggests a suboptimal effectiveness of MAWG in preventing driveline infections due to biofilm development.
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Affiliation(s)
- Yue Qu
- Infection and Immunity Theme, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery, The Alfred Hospital and Monash University, Melbourne, VIC, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christina Kure
- Department of Cardiothoracic Surgery, The Alfred Hospital and Monash University, Melbourne, VIC, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Janelle McLean
- Transplant Services, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Courtney Duncan
- Transplant Services, The Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Anton Y Peleg
- Infection and Immunity Theme, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
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14
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Wu X, Zhang S, Li H, Shen L, Dong C, Sun Y, Chen H, Xu B, Zhuang W, Deighton M, Qu Y. Biofilm Formation of Candida albicans Facilitates Fungal Infiltration and Persister Cell Formation in Vaginal Candidiasis. Front Microbiol 2020; 11:1117. [PMID: 32582081 PMCID: PMC7289921 DOI: 10.3389/fmicb.2020.01117] [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: 02/01/2020] [Accepted: 05/05/2020] [Indexed: 01/14/2023] Open
Abstract
Background Vaginal candidiasis is an important medical condition awaiting more effective treatment. How Candida albicans causes this disease and survives antifungal treatment is not yet fully understood. This study aimed to establish a comprehensive understanding of biofilm-related defensive strategies that C. albicans uses to establish vaginal candidiasis and to survive antifungal treatment. Methods A mouse model of vaginal candidiasis was adopted to examine the formation of biotic biofilms on the vaginal epithelium and fungal infiltration by laboratory and clinical strains of C. albicans. Histopathological changes and local inflammation in the vaginal epithelium caused by C. albicans of different biofilm phenotypes were compared. Antifungal susceptibility testing was carried out for C. albicans grown as planktonic cells, microplate-based abiotic biofilms, and epithelium-based biotic biofilms. Formation of persister cells by C. albicans in different growth modes was also quantified and compared. Results C. albicans wild-type reference strains and clinical isolates, but not the biofilm-defective mutants, formed a significant number of biotic biofilms on the vaginal epithelium of mice and infiltrated the epithelium. Biofilm formation and epithelial invasion induced local inflammatory responses and histopathological changes in the vaginal epithelium including neutrophil infiltration and subcorneal microabscesses. Biofilm growth on the vaginal epithelium also led to high resistance to antifungal treatments and promoted the formation of antifungal-tolerant persister cells. Conclusion This study comprehensively assessed biofilm-related microbial strategies that C. albicans uses in vaginal candidiasis and provided experimental evidence to support the important role of biofilm formation in the histopathogenesis of vaginal candidiasis and the recalcitrance of the infection to antifungal treatment.
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Affiliation(s)
- Xueqing Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
| | - Sisi Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiying Li
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
| | - Laien Shen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenle Dong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao Sun
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huale Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Boyun Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenyi Zhuang
- Department of Obstetrics and Gynecology, Shenzhen University General Hospital, Shenzhen, China
| | - Margaret Deighton
- School of Applied Sciences, RMIT University, Bundoora, VIC, Australia
| | - Yue Qu
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Wenzhou Medical University-Monash BDI Alliance in Clinical and Experimental Biomedicine, Monash University, Clayton, VIC, Australia
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15
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Michl TD, Hibbs B, Hyde L, Postma A, Tran DTT, Zhalgasbaikyzy A, Vasilev K, Meagher L, Griesser HJ, Locock KES. Bacterial membrane permeability of antimicrobial polymethacrylates: Evidence for a complex mechanism from super-resolution fluorescence imaging. Acta Biomater 2020; 108:168-177. [PMID: 32179195 DOI: 10.1016/j.actbio.2020.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/31/2022]
Abstract
Amphiphilic polymers bearing cationic moieties are an emerging alternative to traditional antibiotics given their broad-spectrum activity and low susceptibility to the development of resistance. To date, however, much remains unclear regarding their mechanism of action. Using functional assays (ATP leakage, cell viability, DNA binding) and super-high resolution structured illumination microscopy (OMX-SR) of fluorescently tagged polymers, we present evidence for a complex mechanism, involving membrane permeation as well as cellular uptake, interaction with intracellular targets and possible complexation with bacterial DNA. STATEMENT OF SIGNIFICANCE: This manuscript details the first study to systematically and directly investigate the mechanism of action of antimicrobial polymers, using super-resolution fluorescence imaging as well as functional assays. While many in the field cite membrane permeation as the sole mechanism underlying the activity of such polymers, we present evidence for multimodal actions including high cellular uptake and interaction with intracellular targets. It is also the first report to show competitive binding of antimicrobial polymers with bacterial DNA in a dose-dependent manner.
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Affiliation(s)
- Thomas D Michl
- School of Engineering, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, SA 5095, Australia
| | - Ben Hibbs
- Materials Characterisation and Fabrication Platform, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Lauren Hyde
- Materials Characterisation and Fabrication Platform, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Almar Postma
- CSIRO Manufacturing, Research Way, Clayton, VIC 3168, Australia
| | - Dung Thuy Thi Tran
- School of Engineering, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, SA 5095, Australia
| | - Aigerim Zhalgasbaikyzy
- School of Engineering, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, SA 5095, Australia
| | - Krasimir Vasilev
- School of Engineering, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, SA 5095, Australia
| | - Laurence Meagher
- Department of Materials Science and Engineering, Monash University, Clayton, VIC 3168, Australia
| | - Hans J Griesser
- Future Industries Institute, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, SA 5095, Australia
| | - Katherine E S Locock
- CSIRO Manufacturing, Research Way, Clayton, VIC 3168, Australia; Department of Chemical Engineering, The University of Melbourne, Parkville, VIC 3010, Australia.
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