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Gavandi TC, Basrani ST, Chougule SA, Patil SB, Nille OS, Kolekar GB, Yankanchi SR, Karuppayil SM, Jadhav AK. Vidarabine as a novel antifungal agent against Candida albicans: insights on mechanism of action. Int Microbiol 2024:10.1007/s10123-024-00565-z. [PMID: 39126447 DOI: 10.1007/s10123-024-00565-z] [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: 09/07/2023] [Revised: 05/11/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
Around 1.5 million mortality cases due to fungal infection are reported annually, posing a massive threat to global health. However, the effectiveness of current antifungal therapies in the treatment of invasive fungal infections is limited. Repurposing existing antifungal drugs is an advisable alternative approach for enhancing their effectiveness. This study evaluated the antifungal efficacy of the antiviral drug vidarabine against Candida albicans ATCC 90028. Antifungal susceptibility testing was performed by microbroth dilution assay and further processed to find the minimum fungicidal concentration. Investigation on probable mode of vidarabine action against C. albicans was assessed by using the ergosterol reduction assay, reactive oxygen species (ROS) accumulation, nuclear condensation, and apoptosis assay. Results revealed that C. albicans was susceptible to vidarabine action and exhibited minimum inhibitory concentration at 150 µg/ml. At a concentration of 300 µg/ml, vidarabine had fungicidal activity against C. albicans. 300 µg/ml vidarabine-treated C. albicans cells demonstrated 91% reduced ergosterol content. Annexin/FITC/PI assay showed that vidarabine (150 µg/ml) had increased late apoptotic cells up to 31%. As per the fractional inhibitory concentration index, vidarabine had synergistic activity with fluconazole and caspofungin against this fungus. The mechanism underlying fungicidal action of vidarabine was evaluated at the intracellular level, and probably because of increased nuclear condensation, enhanced ROS generation, and cell cycle arrest. In conclusion, this data is the first to report that vidarabine has potential to be used as a repurposed antifungal agent alone or in combination with standard antifungal drugs, and could be a quick and safe addition to existing therapies for treating fungal infections.
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Affiliation(s)
- Tanjila C Gavandi
- Department of Stem Cell and Regenerative Medicine, Medical Biotechnology, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Deemed to be University), Kolhapur, 416-003, Maharashtra, India
| | - Sargun T Basrani
- Department of Stem Cell and Regenerative Medicine, Medical Biotechnology, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Deemed to be University), Kolhapur, 416-003, Maharashtra, India
| | - Sayali A Chougule
- Department of Stem Cell and Regenerative Medicine, Medical Biotechnology, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Deemed to be University), Kolhapur, 416-003, Maharashtra, India
| | - Shivani B Patil
- Department of Stem Cell and Regenerative Medicine, Medical Biotechnology, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Deemed to be University), Kolhapur, 416-003, Maharashtra, India
| | - Omkar S Nille
- Department of Chemistry, Shivaji University, Kolhapur, 416-004, Maharashtra, India
| | - Govind B Kolekar
- Department of Chemistry, Shivaji University, Kolhapur, 416-004, Maharashtra, India
| | | | - S Mohan Karuppayil
- Department of Stem Cell and Regenerative Medicine, Medical Biotechnology, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Deemed to be University), Kolhapur, 416-003, Maharashtra, India.
| | - Ashwini K Jadhav
- Department of Stem Cell and Regenerative Medicine, Medical Biotechnology, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Deemed to be University), Kolhapur, 416-003, Maharashtra, India.
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Shahabudin S, Azmi NS, Lani MN, Mukhtar M, Hossain MS. Candida albicans skin infection in diabetic patients: An updated review of pathogenesis and management. Mycoses 2024; 67:e13753. [PMID: 38877612 DOI: 10.1111/myc.13753] [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: 03/15/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024]
Abstract
Candida species, commensal residents of human skin, are recognized as the cause of cutaneous candidiasis across various body surfaces. Individuals with weakened immune systems, particularly those with immunosuppressive conditions, are significantly more susceptible to this infection. Diabetes mellitus, a major metabolic disorder, has emerged as a critical factor inducing immunosuppression, thereby facilitating Candida colonization and subsequent skin infections. This comprehensive review examines the prevalence of different types of Candida albicans-induced cutaneous candidiasis in diabetic patients. It explores the underlying mechanisms of pathogenicity and offers insights into recommended preventive measures and treatment strategies. Diabetes notably increases vulnerability to oral and oesophageal candidiasis. Additionally, it can precipitate vulvovaginal candidiasis in females, Candida balanitis in males, and diaper candidiasis in young children with diabetes. Diabetic individuals may also experience candidal infections on their nails, hands and feet. Notably, diabetes appears to be a risk factor for intertrigo syndrome in obese individuals and periodontal disorders in denture wearers. In conclusion, the intricate relationship between diabetes and cutaneous candidiasis necessitates a comprehensive understanding to strategize effective management planning. Further investigation and interdisciplinary collaborative efforts are crucial to address this multifaceted challenge and uncover novel approaches for the treatment, management and prevention of both health conditions, including the development of safer and more effective antifungal agents.
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Affiliation(s)
- Sakina Shahabudin
- Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
| | - Nina Suhaity Azmi
- Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
| | - Mohd Nizam Lani
- Faculty of Fisheries and Food Science, Universiti Malaysia Terengganu, Kuala Nerus, Terengganu, Malaysia
| | | | - Md Sanower Hossain
- Centre for Sustainability of Mineral and Resource Recovery Technology (Pusat SMaRRT), Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
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Thambugala KM, Daranagama DA, Tennakoon DS, Jayatunga DPW, Hongsanan S, Xie N. Humans vs. Fungi: An Overview of Fungal Pathogens against Humans. Pathogens 2024; 13:426. [PMID: 38787278 PMCID: PMC11124197 DOI: 10.3390/pathogens13050426] [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: 03/28/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Human fungal diseases are infections caused by any fungus that invades human tissues, causing superficial, subcutaneous, or systemic diseases. Fungal infections that enter various human tissues and organs pose a significant threat to millions of individuals with weakened immune systems globally. Over recent decades, the reported cases of invasive fungal infections have increased substantially and research progress in this field has also been rapidly boosted. This review provides a comprehensive list of human fungal pathogens extracted from over 850 recent case reports, and a summary of the relevant disease conditions and their origins. Details of 281 human fungal pathogens belonging to 12 classes and 104 genera in the divisions ascomycota, basidiomycota, entomophthoromycota, and mucoromycota are listed. Among these, Aspergillus stands out as the genus with the greatest potential of infecting humans, comprising 16 species known to infect humans. Additionally, three other genera, Curvularia, Exophiala, and Trichophyton, are recognized as significant genera, each comprising 10 or more known human pathogenic species. A phylogenetic analysis based on partial sequences of the 28S nrRNA gene (LSU) of human fungal pathogens was performed to show their phylogenetic relationships and clarify their taxonomies. In addition, this review summarizes the recent advancements in fungal disease diagnosis and therapeutics.
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Affiliation(s)
- Kasun M. Thambugala
- Genetics and Molecular Biology Unit, Faculty of Applied Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka; (K.M.T.); (D.P.W.J.)
- Center for Biotechnology, Department of Zoology, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
- Center for Plant Materials and Herbal Products Research, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Dinushani A. Daranagama
- Department of Plant and Molecular Biology, Faculty of Science, University of Kelaniya, Kelaniya 11300, Sri Lanka;
| | - Danushka S. Tennakoon
- Bioengineering and Technological Research Centre for Edible and Medicinal Fungi, Jiangxi Agricultural University, Nanchang 330045, China;
| | - Dona Pamoda W. Jayatunga
- Genetics and Molecular Biology Unit, Faculty of Applied Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda 10250, Sri Lanka; (K.M.T.); (D.P.W.J.)
- Center for Biotechnology, Department of Zoology, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
- Center for Plant Materials and Herbal Products Research, University of Sri Jayewardenepura, Nugegoda 10250, Sri Lanka
| | - Sinang Hongsanan
- Shenzhen Key Laboratory of Microbial Genetic Engineering, College of Life Science and Oceanography, Shenzhen University, Shenzhen 518060, China
| | - Ning Xie
- Shenzhen Key Laboratory of Microbial Genetic Engineering, College of Life Science and Oceanography, Shenzhen University, Shenzhen 518060, China
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Yang Z, Zhang S, Ji N, Li J, Chen Q. The evil companion of OSCC: Candida albicans. Oral Dis 2024; 30:1873-1886. [PMID: 37530513 DOI: 10.1111/odi.14700] [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: 05/18/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Microbial dysbiosis and microbiome-induced inflammation may play a role in the etiopathogenesis of oral squamous cell carcinoma (OSCC). Candida albicans (C. albicans) is the most prevalent opportunistic pathogenic fungus in the oral cavity, and Candida infection is considered as one of its high-risk factors. Although oral microbiota-host interactions are closely associated with the development of OSCC, the interrelationship between fungi and OSCC is poorly understood compared to that between bacteria and viruses. RESULTS We accumulated knowledge of the evidence, pathogenic factors, and possible multiple mechanisms by which C. albicans promotes malignant transformation of OSCC, focusing on the induction of epithelial damage, production of carcinogens, and regulation of the tumor microenvironment. In addition, we highlight the latest treatment strategies for Candida infection. CONCLUSION This review provides a new perspective on the interrelationship between C. albicans and OSCC and contributes to the establishment of a systematic and reliable clinical treatment system for OSCC patients with C. albicans infection.
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Affiliation(s)
- Zhixin Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Shiyu Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Ning Ji
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Jing Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
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Moreira Milhan NV, da Graça Sampaio A, Koga-Ito CY, Bruzzaniti A. Ascorbic acid as a modulator of inflammatory response against Candida albicans. Future Microbiol 2024; 19:585-594. [PMID: 38629904 PMCID: PMC11229584 DOI: 10.2217/fmb-2023-0188] [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: 08/22/2023] [Accepted: 12/08/2023] [Indexed: 06/07/2024] Open
Abstract
Aim: To evaluate the behavior of oral keratinocytes in the presence of Vitamin C (Vit C) and its anti-inflammatory potential. Materials & methods: Oral keratinocytes were initially exposed to 0.1-2.5 mM of Vit C and the metabolic activity and cell migration were evaluated using MTS assay and Ibidi culture inserts, respectively. After, the cells were challenged with Candida albicans and inflammatory markers were analyzed by qPCR. Results: The treatment was not cytotoxic, and the highest concentrations increased the metabolic activity at 24 h. Vit C delayed the cell migration at 48 and 72 h. Interestingly, it downregulated the genes IL-8 and IL-1β. Conclusion: Vit C could be an interesting adjuvant to anti-fungal treatment due to its anti-inflammatory potential.
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Affiliation(s)
- Noala Vicensoto Moreira Milhan
- Department of Environmental Engineering & Sciences Applied in Oral Health Graduate Program, São Paulo State University (Unesp), Institute of Science & Technology, São José dos Campos, São Paulo, 12245-000, Brazil
| | - Aline da Graça Sampaio
- Department of Environmental Engineering & Sciences Applied in Oral Health Graduate Program, São Paulo State University (Unesp), Institute of Science & Technology, São José dos Campos, São Paulo, 12245-000, Brazil
| | - Cristiane Yumi Koga-Ito
- Department of Environmental Engineering & Sciences Applied in Oral Health Graduate Program, São Paulo State University (Unesp), Institute of Science & Technology, São José dos Campos, São Paulo, 12245-000, Brazil
| | - Angela Bruzzaniti
- Department of Biomedical & Applied Sciences, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
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Jakab Á, Kovács F, Balla N, Nagy-Köteles C, Ragyák Á, Nagy F, Borman AM, Majoros L, Kovács R. Comparative transcriptional analysis of Candida auris biofilms following farnesol and tyrosol treatment. Microbiol Spectr 2024; 12:e0227823. [PMID: 38440972 PMCID: PMC10986546 DOI: 10.1128/spectrum.02278-23] [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: 06/01/2023] [Accepted: 02/11/2024] [Indexed: 03/06/2024] Open
Abstract
Candida auris is frequently associated with biofilm-related invasive infections. The resistant profile of these biofilms necessitates innovative therapeutic options, where quorum sensing may be a potential target. Farnesol and tyrosol are two fungal quorum-sensing molecules with antifungal effects at supraphysiological concentrations. Here, we performed genome-wide transcript profiling with C. auris biofilms following farnesol or tyrosol exposure using transcriptome sequencing (RNA-Seq). Since transition metals play a central role in fungal virulence and biofilm formation, levels of intracellular calcium, magnesium, and iron were determined following farnesol or tyrosol treatment using inductively coupled plasma optical emission spectrometry. Farnesol caused an 89.9% and 73.8% significant reduction in the calcium and magnesium content, respectively, whereas tyrosol resulted in 82.6%, 76.6%, and 81.2% decrease in the calcium, magnesium, and iron content, respectively, compared to the control. Genes involved in biofilm events, glycolysis, ergosterol biosynthesis, fatty acid oxidation, iron metabolism, and autophagy were primarily affected in treated cells. To prove ergosterol quorum-sensing molecule interactions, microdilution-based susceptibility testing was performed, where the complexation of farnesol, but not tyrosol, with ergosterol was impeded in the presence of exogenous ergosterol, resulting in a minimum inhibitory concentration increase in the quorum-sensing molecules. This study revealed several farnesol- and tyrosol-specific responses, which will contribute to the development of alternative therapies against C. auris biofilms. IMPORTANCE Candida auris is a multidrug-resistant fungal pathogen, which is frequently associated with biofilm-related infections. Candida-derived quorum-sensing molecules (farnesol and tyrosol) play a pivotal role in the regulation of fungal morphogenesis and biofilm development. Furthermore, they may have remarkable anti-biofilm effects, especially at supraphysiological concentrations. Innovative therapeutic approaches interfering with quorum sensing may be a promising future strategy against C. auris biofilms; however, limited data are currently available concerning farnesol-induced and tyrosol-related molecular effects in C. auris. Here, we detected several genes involved in biofilm events, glycolysis, ergosterol biosynthesis, fatty acid oxidation, iron metabolism, and autophagy, which were primarily influenced following farnesol or tyrosol exposure. Moreover, calcium, magnesium, and iron homeostasis were also significantly affected. These results reveal those molecular and physiological events, which may support the development of novel therapeutic approaches against C. auris biofilms.
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Affiliation(s)
- Ágnes Jakab
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Fruzsina Kovács
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Debrecen, Hungary
| | - Noémi Balla
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Debrecen, Hungary
| | - Csaba Nagy-Köteles
- Department of Molecular Biotechnology and Microbiology, Institute of Biotechnology, Faculty of Science and Technology, University of Debrecen, Debrecen, Hungary
| | - Ágota Ragyák
- Department of Inorganic and Analytical Chemistry, Agilent Atomic Spectroscopy Partner Laboratory, University of Debrecen, Debrecen, Hungary
| | - Fruzsina Nagy
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrew M. Borman
- UK National Mycology Reference Laboratory, UK Health Security Agency, Science Quarter, Southmead Hospital, Bristol, United Kingdom
- Medical Research Council Centre for Medical Mycology (MRCCMM), University of Exeter, Exeter, United Kingdom
| | - László Majoros
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Renátó Kovács
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Vélez N, Argel A, Kissmann AK, Alpízar-Pedraza D, Escandón P, Rosenau F, Ständker L, Firacative C. Pore-forming peptide C14R exhibits potent antifungal activity against clinical isolates of Candida albicans and Candida auris. Front Cell Infect Microbiol 2024; 14:1389020. [PMID: 38601736 PMCID: PMC11004338 DOI: 10.3389/fcimb.2024.1389020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Invasive candidiasis is a global public health problem as it poses a significant threat in hospital-settings. The aim of this study was to evaluate C14R, an analog derived from peptide BP100, as a potential antimicrobial peptide against the prevalent opportunistic yeast Candida albicans and the emergent multidrug-resistant yeast Candida auris. Methods Antifungal susceptibility testing of C14R against 99 C. albicans and 105 C. auris clinical isolates from Colombia, was determined by broth microdilution. Fluconazole was used as a control antifungal. The synergy between C14R and fluconazole was assessed in resistant isolates. Assays against fungal biofilm and growth curves were also carried out. Morphological alterations of yeast cell surface were evaluated by scanning electron microscopy. A permeability assay verified the pore-forming ability of C14R. Results C. albicans and C. auris isolates had a geometric mean MIC against C14R of 4.42 µg/ml and 5.34 µg/ml, respectively. Notably, none of the isolates of any species exhibited growth at the highest evaluated peptide concentration (200 µg/ml). Synergistic effects were observed when combining the peptide and fluconazole. C14R affects biofilm and growth of C. albicans and C. auris. Cell membrane disruptions were observed in both species after treatment with the peptide. It was confirmed that C14R form pores in C. albicans' membrane. Discussion C14R has a potent antifungal activity against a large set of clinical isolates of both C. albicans and C. auris, showing its capacity to disrupt Candida membranes. This antifungal activity remains consistent across isolates regardless of their clinical source. Furthermore, the absence of correlation between MICs to C14R and resistance to fluconazole indicates the peptide's potential effectiveness against fluconazole-resistant strains. Our results suggest the potential of C14R, a pore-forming peptide, as a treatment option for fungal infections, such as invasive candidiasis, including fluconazole and amphotericin B -resistant strains.
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Affiliation(s)
- Norida Vélez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Andreys Argel
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | | | - Daniel Alpízar-Pedraza
- Institute of Pharmaceutical Biotechnology, Ulm University, Ulm, Germany
- Biochemistry and Molecular Biology Department, Center for Pharmaceutical Research and Development, Ciudad de La Habana, Cuba
| | | | - Frank Rosenau
- Institute of Pharmaceutical Biotechnology, Ulm University, Ulm, Germany
| | - Ludger Ständker
- Core Facility for Functional Peptidomics, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Carolina Firacative
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
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Correia JL, Fiuza JG, Ferreira G, Almeida MD, Moreira D, Neto VD. Embolic stroke and misidentification candida species endocarditis: Case presentation and literature review. Diagn Microbiol Infect Dis 2024; 108:116133. [PMID: 37984110 DOI: 10.1016/j.diagmicrobio.2023.116133] [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: 08/04/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Fungal endocarditis is a rare but serious form of infective endocarditis associated with high morbidity and mortality. Among fungal pathogens, Candida species are the most frequently isolated and commonly found in individuals with predisposing factors, such as prosthetic heart valves. The clinical presentation of endocarditis is highly variable and nonspecific, often including symptoms and signs of embolization. In this paper, we present a case of fungal prosthetic valve endocarditis in which the initial presentation was an acute ischemic stroke. The initial misidentification of Candida famata was attributed to limitations in the presumptive methodology used through selective chromogenic culture identification. However, the surgical specimen underwent mass spectrometry, leading to the correct identification of Candida guilliermondii instead of Candida famata. Furthermore, we conducted a non-systematic narrative review of the literature on Candida endocarditis. Our findings underscore the importance of considering fungal endocarditis in the differential diagnosis of patients with possible extracardiac complications, particularly those with a history of heart valve replacement. Early diagnosis and a comprehensive treatment strategy tailored by species identification and antifungal susceptibility testing are crucial in improving patient outcomes.
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Affiliation(s)
| | | | | | | | | | - Vanda Devesa Neto
- Tondela-Viseu Hospital Center, Viseu, Portugal; Faculty of Health Sciences - University of Beira Interior, Covilhã, Portugal
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Singh N, Kumari V, Agrawal K, Kulshreshtha M. Molecular Pathway, Epidemiological Data and Treatment Strategies of Fungal Infection (Mycoses): A Comprehensive Review. Cent Nerv Syst Agents Med Chem 2024; 24:68-81. [PMID: 38305394 DOI: 10.2174/0118715249274215231205062701] [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: 08/19/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 02/03/2024]
Abstract
The recent increase in fungal infections is a health crisis. This surge is directly tied to the increase in immunocompromised people caused by changes in medical practice, such as the use of harsh chemotherapy and immunosuppressive medicines. Immunosuppressive disorders such as HIV have exacerbated the situation dramatically. Subcutaneous or superficial fungal infections can harm the skin, keratinous tissues, and mucous membranes. This category includes some of the most common skin disorders that impact millions of people worldwide. Despite the fact that they are seldom fatal, they can have a catastrophic impact on a person's quality of life and, in rare situations, spread to other people or become obtrusive. The majority of fungal infections under the skin and on the surface are simply and quickly cured. An opportunistic organism that preys on a weak host or a natural intruder can both result in systemic fungal infections. Furthermore, it might be exceedingly lethal and dangerous to one's life. Dimorphic fungi may pose a hazard to healthy populations that are not exposed to endemic fungi. Increased surveillance, the availability of quick, noninvasive diagnostic tests, monitoring the emergence of antifungal medication resistance, and research on the pathophysiology, prevention, and management of fungal infections are just a few potential solutions to these new health problems. The goal of this review is to summarize the data available for fungal infections and the different therapies which are involved in their treatment. Additionally, it also summarizes the molecular and scientific data of the plants which contain anti-fungal activity. Data are acquired using Google, PubMed, Scholar, and other online sources.
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Affiliation(s)
| | - Vibha Kumari
- Rajiv Academy for Pharmacy, Mathura (U.P.), India
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10
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Adelakun AO, Awosika A, Adabanya U, Omole AE, Olopoda AI, Bello ET. Antimicrobial and Synergistic Effects of Syzygium cumini, Moringa oleifera, and Tinospora cordifolia Against Different Candida Infections. Cureus 2024; 16:e52857. [PMID: 38274587 PMCID: PMC10808863 DOI: 10.7759/cureus.52857] [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] [Accepted: 01/24/2024] [Indexed: 01/27/2024] Open
Abstract
Introduction The burden of multiple drug resistance in human pathogens has necessitated the search for and development of antimicrobial agents with a wide range of structural classes and potentials to selectively act on the several mechanisms of actions exhibited by the pathogens. However, most synthetic antimicrobial agents have been linked with adverse side effects and high costs, furthering the need to explore more options. Syzygium cumini, Moringa oleifera, and Tinospora cordifolia are three medicinal plants used in traditional medicine systems for various infectious diseases. They contain various phytochemicals that exhibit antimicrobial activities against various bacteria, fungi, and parasites. The mechanisms of their antimicrobial action may involve the disruption of microbial cell walls and membranes, the inhibition of microbial enzyme and biofilm formation, the modulation of microbial gene expression and quorum sensing, and the induction of microbial cell death. Therefore, the present study evaluated the potentials of aqueous and ethanol extracts of S. cumini, M. oleifera, and T. cordifolia in managing infections as measured by their inhibitory effects on species. Materials and method Syzygium cumini, M. oleifera, and T. cordifolia were obtained and authenticated, and their aqueous and ethanol extracts were prepared. The antibacterial properties of the aqueous and ethanol extracts were examined. In addition to broth microdilution and biofilm development experiments, we also employed disk diffusion and agar-well diffusion techniques. The inocula of various species, including krusei, parapsilosis, utilis, albicans, and glabrata, were prepared for these assays. The synergistic effect of plant extracts with fluconazole was also evaluated. Results Syzygium cumini, M. oleifera, and T. cordifolia emerge as promising sources for the development of effective and sustainable antimicrobial interventions. Interestingly, the aqueous and ethanol extracts were effective against the selected species. Also, the synergistic combination of plant extracts with fluconazole was observed to triple the potency of the extracts. Furthermore, the potency of the plant extract as an antifungal and synergistic agent was ranked as S. cumini > M. oleifera > T. cordifolia. Conclusively, the plant extracts are effective in the management of opportunistic fungal infections.
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Affiliation(s)
- Adedayo O Adelakun
- Biological Sciences, Southeast Iowa Regional Medical Center, West Burlington, USA
| | - Ayoola Awosika
- College of Medicine, University of Illinois, Chicago, USA
| | - Uzochukwu Adabanya
- Anatomical Sciences, Edward Via College of Osteopathic Medicine, Monroe, USA
| | - Adekunle E Omole
- Cell Biology and Anatomy, Louisiana State University, Health Science Center, New Orleans, USA
| | | | - Emmanuel T Bello
- Science Laboratory Technology, New Land Polytechnic, Ilorin, NGA
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Naguthevar S, Ravindra A, Kumar D, Meena DS, Bohra GK, Jain V, Garg MK, Deora S, Choudhary R. Emerging trends in fungal endocarditis: clinical complexity, diagnostic challenges, and therapeutic implications - a case series and literature review. Ther Adv Infect Dis 2024; 11:20499361241293655. [PMID: 39524987 PMCID: PMC11550493 DOI: 10.1177/20499361241293655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 10/03/2024] [Indexed: 11/16/2024] Open
Abstract
Background Fungal infective endocarditis (IE) is a rare, yet increasingly recognised condition associated with substantial mortality rates. Candida and Histoplasma are among the notable causative agents, presenting diverse clinical manifestations and complexities in diagnosis and management. Objectives This study was undertaken to examine the clinical profiles, diagnostic challenges, treatment modalities, and outcomes of four compelling cases involving Candida and Histoplasma endocarditis. Methods & Design This was a descriptive case series study conducted from July 2021 to July 2023. All patients with definite/possible endocarditis diagnosed based on modified Duke's criteria were reviewed in this study. Data on demographics, risk factors, clinical signs and symptoms, echocardiography findings, microbiological aetiology, complications, treatment, and outcomes were collected. Results Among 212 suspected IE cases reviewed, 54 met the modified Duke's criteria for possible or definite IE, with four instances identified as fungal endocarditis. Candida species accounted for three cases, while an uncommon instance of Histoplasma Endocarditis (HE) was also observed. Clinical presentations varied, with fever and dyspnoea being prominent symptoms. Risk factors included chronic kidney disease, prior surgeries, prosthetic valves, and immunocompromised states. Diagnosis posed challenges due to the resemblance to bacterial IE, low blood culture yields, and delayed suspicion. Various diagnostic approaches, including blood cultures, serological markers, and imaging, were employed. Therapeutic strategies involved antifungal agents and surgical intervention, where feasible. However, despite prompt treatment initiation, many patients faced rapid clinical deterioration, emphasising the severity and aggressive nature of fungal endocarditis. Mortality rates remained notably high across the cohort. Conclusion This study highlights the criticality of early suspicion, prompt diagnosis, and a multidisciplinary approach to managing fungal endocarditis. While recognising the limitations in current diagnostic tools and therapeutic options, the study underscores the urgent need for enhanced diagnostic modalities and novel treatment strategies to improve outcomes in these challenging cases.
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Affiliation(s)
- Santhanam Naguthevar
- Infectious Diseases Division, Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Akshatha Ravindra
- Infectious Diseases Division, Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepak Kumar
- Department of Medicine & Infectious Diseases, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Durga Shankar Meena
- Infectious Diseases Division, Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Gopal Krishana Bohra
- Infectious Diseases Division, Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - M. K. Garg
- Infectious Diseases Division, Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Shen H, Zhou H, Zhang F, Wang J, Wang R, Wang J. Case Report: Successful Treatment of Recurrent Candida Albicans Meningitis with Kimura's Disease Using Amphotericin B Colloidal Dispersion Combined with Fluconazole. Infect Drug Resist 2023; 16:6905-6909. [PMID: 37915503 PMCID: PMC10617790 DOI: 10.2147/idr.s416040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023] Open
Abstract
Background Candida albicans meningitis is a fungal infectious disease of the central nervous system that most often occurs in immunodeficient populations. Kimura's disease is an IgE-mediated inflammatory reactive disease that is a chronic immune disorder with predominantly lymph node, soft tissue, and salivary gland damage, the treatment of which is hormone-based. The combination of Kimura's disease with C. albicans meningitis is relatively uncommon. Herein, we report a case of C. albicans meningitis in combination with Kimura's disease. Case Presentation The case is a 26-year-old male with a medical history of Kimura, who presented with symptoms of dizziness, headache, and double vision. Lumbar puncture and cerebrospinal fluid examination revealed an increased white blood cell count. Further analysis through cerebrospinal fluid culture and metagenomic second-generation sequencing (mNGS) led to the final diagnosis of C. albicans meningitis. The patient was treated with fluconazole after the onset of C. albicans meningitis and had a good response. During the treatment, changes in the pathogen genome sequences were monitored dynamically using metagenomic next-generation sequencing. After 1 year, the patient had a recurrence of Candida meningitis. Treatment with fluconazole alone was ineffective, while antifungal treatment with amphotericin B colloidal dispersion was effective with no detectable renal injury. Conclusion Candida meningitis can occur in the context of Kimura disease. In patients with mild disease, the possibility of recurrence exists with fluconazole treatment alone, and the efficacy of amphotericin B colloidal dispersion combined with fluconazole is better than fluconazole alone in patients with a recurrence. No nephrotoxicity was observed during amphotericin B colloidal dispersion treatment. The mNGS allows dynamic monitoring of pathogen sequencing reads, and for Candida meningitis, there may be a mismatch between peak sequencing reads and disease during treatment, the basis for which is unclear.
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Affiliation(s)
- Huijun Shen
- Department of Neurology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Hong Zhou
- Graduate School of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Fang Zhang
- Department of Neurology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jing Wang
- Department of Neurology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Rui Wang
- Department of Neurology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jie Wang
- Department of Neurology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
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Abstract
PURPOSE OF REVIEW The increasing incidence of drug-resistant Candida brings a new challenge to the treatment of invasive candidiasis. Although cross-resistance among azoles and echinocandins was generally uncommon, reports of multidrug-resistant (MDR) Candida markedly increased in the last decade. The purpose of this review is to understand mechanisms and risk factors for resistance and how to tackle antifungal resistance. RECENT FINDINGS The paper describes the action of the three main classes of antifungals - azoles, echinocandins and polyenes - and Candida's mechanisms of resistance. The current evolution from cross-resistance to multiresistance among Candida explains the modern glossary - multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) - imported from bacteria. MDR Candida most commonly involves acquired resistance in species with intrinsic resistance, therefore it mostly involves C. glabrata, C. parapsilosis, C. krusei, C guilliermondii or C. auris , which is intrinsically multidrug resistant. Finally, strategies to tackle antifungal resistance became clearer, ideally implemented through antifungal stewardship. SUMMARY Avoiding antifungal's overuse and selecting the best drug, dose and duration, when they are needed, is fundamental. Knowledge of risk factors for resistance, microbiological diagnosis to the species, use of susceptibility test supported by antifungal stewardship programs help attaining effective therapy and sustaining the effectiveness of the current antifungal armamentarium.
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Affiliation(s)
- José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário S. João, Porto, Portugal
- Department of Medicine, Faculty of Medicine of University of Porto, Porto, Portugal
- Grupo de Infeção e Sepsis, Porto, Portugal
| | - José Manuel Pereira
- Intensive Care Medicine Department, Centro Hospitalar Universitário S. João, Porto, Portugal
- Department of Medicine, Faculty of Medicine of University of Porto, Porto, Portugal
- Grupo de Infeção e Sepsis, Porto, Portugal
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Synergistic Interaction of Caspofungin Combined with Posaconazole against FKS Wild-Type and Mutant Candida auris Planktonic Cells and Biofilms. Antibiotics (Basel) 2022; 11:antibiotics11111601. [PMID: 36421245 PMCID: PMC9686983 DOI: 10.3390/antibiotics11111601] [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: 10/18/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Candida auris is a potential multidrug-resistant pathogen able to cause biofilm-associated outbreaks, where frequently indwelling devices are the source of infections. The number of effective therapies is limited; thus, new, even-combination-based strategies are needed. Therefore, the in vitro efficacy of caspofungin with posaconazole against FKS wild-type and mutant Candida auris isolates was determined. The interactions were assessed utilizing the fractional inhibitory concentration indices (FICIs), the Bliss model, and a LIVE/DEAD assay. Planktonic minimum inhibitory concentrations (pMICs) for the caspofungin-posaconazole combination showed a 4- to 256-fold and a 2- to 512-fold decrease compared to caspofungin and posaconazole alone, respectively. Sessile minimum inhibitory concentrations (sMICs) for caspofungin and posaconazole in combination showed an 8- to 128-fold and a 4- to 512-fold decrease, respectively. The combination showed synergy, especially against biofilms (FICIs were 0.033-0.375 and 0.091-0.5, and Bliss cumulative synergy volumes were 6.96 and 32.39 for echinocandin-susceptible and -resistant isolates, respectively). The caspofungin-exposed (4 mg/L) C. auris biofilms exhibited increased cell death in the presence of posaconazole (0.03 mg/L) compared to untreated, caspofungin-exposed and posaconazole-treated biofilms. Despite the favorable effect of caspofungin with posaconazole, in vivo studies are needed to confirm the therapeutic potential of this combination in C. auris-associated infections.
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Barantsevich N, Barantsevich E. Diagnosis and Treatment of Invasive Candidiasis. Antibiotics (Basel) 2022; 11:antibiotics11060718. [PMID: 35740125 PMCID: PMC9219674 DOI: 10.3390/antibiotics11060718] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 02/06/2023] Open
Abstract
Candida species, belonging to commensal microbial communities in humans, cause opportunistic infections in individuals with impaired immunity. Pathogens encountered in more than 90% cases of invasive candidiasis include C. albicans, C. glabrata, C. krusei, C. tropicalis, and C. parapsilosis. The most frequently diagnosed invasive infection is candidemia. About 50% of candidemia cases result in deep-seated infection due to hematogenous spread. The sensitivity of blood cultures in autopsy-proven invasive candidiasis ranges from 21% to 71%. Non-cultural methods (beta-D-glucan, T2Candida assays), especially beta-D-glucan in combination with procalcitonin, appear promising in the exclusion of invasive candidiasis with high sensitivity (98%) and negative predictive value (95%). There is currently a clear deficiency in approved sensitive and precise diagnostic techniques. Omics technologies seem promising, though require further development and study. Therapeutic options for invasive candidiasis are generally limited to four classes of systemic antifungals (polyenes, antimetabolite 5-fluorocytosine, azoles, echinocandins) with the two latter being highly effective and well-tolerated and hence the most widely used. Principles and methods of treatment are discussed in this review. The emergence of pan-drug-resistant C. auris strains indicates an insufficient choice of available medications. Further surveillance, alongside the development of diagnostic and therapeutic methods, is essential.
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Synergistic In Vitro Interaction of Isavuconazole and Isoquercitrin against Candida glabrata. J Fungi (Basel) 2022; 8:jof8050525. [PMID: 35628780 PMCID: PMC9147185 DOI: 10.3390/jof8050525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 02/05/2023] Open
Abstract
In vitro interactions of broad-spectrum azole isavuconazole with flavonoid isoquercitrin were evaluated by a broth microdilution checkerboard technique based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) reference methodology for antifungal susceptibility testing against 60 Candida strains belonging to the species Candida albicans (n = 10), Candida glabrata (n = 30), Candida kefyr (n = 6), Candida krusei (n = 5), Candida parapsilosis (n = 4), and Candida tropicalis (n = 5). The results were analyzed with the fractional inhibitory concentration index and by response surface analysis based on the Bliss model. Synergy was found for all C. glabrata strains, when the results were interpreted by the fractional inhibitory concentration index, and for 60% of the strains when response surface analysis was used. Interaction for all other species was indifferent for all strains tested, whatever interpretation model used. Importantly, antagonistic interaction was never observed.
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Schwarz P, Nikolskiy I, Bidaud AL, Sommer F, Bange G, Dannaoui E. In Vitro Synergy of Isavuconazole Combined With Colistin Against Common Candida Species. Front Cell Infect Microbiol 2022; 12:892893. [PMID: 35573795 PMCID: PMC9100415 DOI: 10.3389/fcimb.2022.892893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/31/2022] [Indexed: 12/16/2022] Open
Abstract
Interactions of isavuconazole and colistin were evaluated against 57 common Candida strains belonging to the species Candida albicans (n = 10), Candida glabrata (n = 10), Candida kefyr (n = 8), Candida krusei (n = 10), Candida parapsilosis (n = 9), and Candida tropicalis (n = 10) by a broth microdilution checkerboard technique based on the European Committee on Antimicrobial Susceptibility Testing (EUCAST) reference methodology for antifungal susceptibility testing. Results were analyzed with the fractional inhibitory concentration index and by the response surface analysis. Interpretation by the fractional inhibitory concentration index showed synergy for 50%, 80%, 90%, and 90% of the C. kefyr, C. krusei, C. glabrata, and C. tropicalis strains, respectively. Combination of isavuconazole with colistin against C. albicans and C. parapsilosis exhibited only indifference for 100% and 90% of the strains, respectively. The results were confirmed by response surface analysis for all species except for C. glabrata, for which an indifferent interaction was found for the majority of strains. Antagonistic interaction was never seen regardless of the interpretation model was used.
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Affiliation(s)
- Patrick Schwarz
- Department of Internal Medicine, Respiratory and Critical Care Medicine, University Hospital Marburg, Marburg, Germany
- Center for Invasive Mycoses and Antifungals, Faculty of Medicine, Philipps University Marburg, Marburg, Germany
| | - Ilya Nikolskiy
- Center for Invasive Mycoses and Antifungals, Faculty of Medicine, Philipps University Marburg, Marburg, Germany
- Center for Synthetic Microbiology (SYNMIKRO), Department of Chemistry, Philipps University Marburg, Marburg, Germany
| | - Anne-Laure Bidaud
- Unité de Parasitologie-Mycologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Frank Sommer
- Department of Microbiology, University Hospital Marburg, Marburg, Germany
| | - Gert Bange
- Center for Synthetic Microbiology (SYNMIKRO), Department of Chemistry, Philipps University Marburg, Marburg, Germany
- Max Planck Fellow Group, Molecular Physiology of Microbes, Max Planck Institute for Terrestrial Microbiology, Marburg, Germany
| | - Eric Dannaoui
- Unité de Parasitologie-Mycologie, Hôpital Européen Georges-Pompidou, Paris, France
- Dynamyc Research Group (EA 7380), Faculté de Médecine de Créteil, Université Paris-Est-Créteil-Val-de-Marne, Créteil, France
- Faculté de Médecine, Université de Paris, Paris, France
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Reddy GKK, Padmavathi AR, Nancharaiah Y. Fungal infections: Pathogenesis, antifungals and alternate treatment approaches. CURRENT RESEARCH IN MICROBIAL SCIENCES 2022; 3:100137. [PMID: 35909631 PMCID: PMC9325902 DOI: 10.1016/j.crmicr.2022.100137] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Increasing incidence of fungal infections of recent times requires immediate intervention. Fungal infections are seldom construed at initial stages that intensify the severity of infections and complicate the treatment procedures. Fungal pathogens employ various mechanisms to evade the host immune system and to progress the severity of infections. For the treatment of diverse superficial and systemic infections, antifungal drugs from the available repertoire are administered. However, well documented evidence of fungal resistance to most of the antifungal drugs hampers disease control and poses challenges in antifungal therapy. Several physiological adaptations and genetic mutations followed by their selection in presence of antifungal agents drive the resistance development in fungi. The availability of limited antifungal arsenal, emergence of resistance and biofilm-conferred resistance drives the need for development of novel drugs and alternate approaches for the better treatment outcome against mycoses. This graphical review explicitly shed light on various fungal infections and causative organisms, pathogenesis, different antifungal drugs and resistance mechanisms including host immune response and evasion strategies. Here, we have highlighted recent developments on novel antifungal agents and other alternate approaches for fighting against fungal infections.
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Brankiewicz W, Okońska J, Serbakowska K, Lica J, Drab M, Ptaszyńska N, Łęgowska A, Rolka K, Szweda P. New Peptide Based Fluconazole Conjugates with Expanded Molecular Targets. Pharmaceutics 2022; 14:pharmaceutics14040693. [PMID: 35456526 PMCID: PMC9026428 DOI: 10.3390/pharmaceutics14040693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Infections of Candida spp. etiology are frequently treated with azole drugs. Among azoles, the most widely used in the clinical scenario remains fluconazole (FLC). Promising results in treatment of dangerous, systemic Candida infections demonstrate the advantages of combined therapies carried out with combinations of at least two different antifungal agents. Here, we report five conjugates composed of covalently linked FLC and cell penetrating or antimicrobial peptide: TP10-7-NH2, TP10-NH2, LFcinB(2-11)-NH2, LFcinB[Nle1,11]-NH2, and HLopt2-NH2, with aspects of design, chemical synthesis and their biological activities. Two of these compounds, namely FLCpOH-TP10-NH2 and FLCpOH-TP10-7-NH2, exhibit high activity against reference strains and fluconazole-resistant clinical isolates of C. albicans, including strains overproducing drug transporters. Moreover, both of them demonstrate higher fungicidal effects compared to fluconazole. Analysis performed with fluorescence and scanning electron microscopy as well as flow cytometry indicated the cell membrane as a molecular target of synthesized conjugates. An important advantage of FLCpOH-TP10-NH2 and FLCpOH-TP10-7-NH2 is their low cytotoxicity. The IC90 value for the human cells after 72 h treatment was comparable to the MIC50 value after 24 h treatment for most strains of C. albicans. In reported conjugates, FLC was linked to the peptide by its hydroxyl group. It is worth noting that conjugation of FLC by the nitrogen atom of the triazole ring led to practically inactive compounds. Two compounds produced by us and reported herein appear to be potential candidates for novel antifungal agents.
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Affiliation(s)
- Wioletta Brankiewicz
- Department of Pharmaceutical Technology and Biochemistry, Faculty of Chemistry, Gdańsk University of Technology, Narutowicza 11/12, 80-233 Gdańsk, Poland; (W.B.); (K.S.)
| | - Joanna Okońska
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdansk, 80-308 Gdańsk, Poland; (J.O.); (J.L.); (A.Ł.); (K.R.)
| | - Katarzyna Serbakowska
- Department of Pharmaceutical Technology and Biochemistry, Faculty of Chemistry, Gdańsk University of Technology, Narutowicza 11/12, 80-233 Gdańsk, Poland; (W.B.); (K.S.)
| | - Jan Lica
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdansk, 80-308 Gdańsk, Poland; (J.O.); (J.L.); (A.Ł.); (K.R.)
| | - Marek Drab
- Unit of Nanostructural Bio-Interactions, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Weigla-Street, 53-114 Wrocław, Poland;
| | - Natalia Ptaszyńska
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdansk, 80-308 Gdańsk, Poland; (J.O.); (J.L.); (A.Ł.); (K.R.)
- Correspondence: (N.P.); (P.S.); Tel.: +48-58-523-5092 (N.P.); +48-58-347-2440 (P.S.); Fax: +48-58-523-5012 (N.P.)
| | - Anna Łęgowska
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdansk, 80-308 Gdańsk, Poland; (J.O.); (J.L.); (A.Ł.); (K.R.)
| | - Krzysztof Rolka
- Department of Molecular Biochemistry, Faculty of Chemistry, University of Gdansk, 80-308 Gdańsk, Poland; (J.O.); (J.L.); (A.Ł.); (K.R.)
| | - Piotr Szweda
- Department of Pharmaceutical Technology and Biochemistry, Faculty of Chemistry, Gdańsk University of Technology, Narutowicza 11/12, 80-233 Gdańsk, Poland; (W.B.); (K.S.)
- Correspondence: (N.P.); (P.S.); Tel.: +48-58-523-5092 (N.P.); +48-58-347-2440 (P.S.); Fax: +48-58-523-5012 (N.P.)
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Boswellia serrata Extract as an Antibiofilm Agent against Candida spp. Microorganisms 2022; 10:microorganisms10010171. [PMID: 35056620 PMCID: PMC8778954 DOI: 10.3390/microorganisms10010171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/10/2022] Open
Abstract
The use of antibiotics or antifungals to control infections caused by pathogenic microorganisms is currently insufficiently effective because of their emerging resistance. Thanks to the ability of microorganisms to form a biofilm and thus increase their resistance to administered drugs even more, modern medicine faces the task of finding novel substances to combat infections caused by them. In this regard, the effects of essential oils or plant extracts are often studied. Among the relatively neglected plants is Boswellia serrata, which has a high content of biologically active boswellic acids. In this study, we focused on one of the most common nosocomial infections, which are caused by Candida species. The most common representative is C. albicans, although the number of infections caused by non-albicans species has recently been increasing. We focused on the antifungal activity of Boswellia serrata extract Bioswellix against planktonic and adhering cells of Candida albicans, Candida parapsilosis and Candida krusei. The antifungal activity against adhering cells was further explored by determining the metabolic activity of cells (MTT) and determining the total amount of biofilm using crystal violet. Boswellic acid-containing plant extract was shown to suppress the growth of a suspension population of all tested Candida species. Boswellia serrata extract Bioswellix was most effective in inhibiting C. albicans biofilm formation.
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