Stepwise emergence of azole, echinocandin and amphotericin B multidrug resistance in vivo in Candida albicans orchestrated by multiple genetic alterations.

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Serval ID
serval:BIB_B1093A842DBF
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Stepwise emergence of azole, echinocandin and amphotericin B multidrug resistance in vivo in Candida albicans orchestrated by multiple genetic alterations.
Journal
Journal of Antimicrobial Chemotherapy
Author(s)
Jensen R.H., Astvad K.M., Silva L.V., Sanglard D., Jørgensen R., Nielsen K.F., Mathiasen E.G., Doroudian G., Perlin D.S., Arendrup M.C.
ISSN
1460-2091 (Electronic)
ISSN-L
0305-7453
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
70
Number
9
Pages
2551-2555
Language
english
Notes
Publication types: Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
OBJECTIVES: The objective of this study was to characterize the underlying molecular mechanisms in consecutive clinical Candida albicans isolates from a single patient displaying stepwise-acquired multidrug resistance.
METHODS: Nine clinical isolates (P-1 to P-9) were susceptibility tested by EUCAST EDef 7.2 and Etest. P-4, P-5, P-7, P-8 and P-9 were available for further studies. Relatedness was evaluated by MLST. Additional genes were analysed by sequencing (including FKS1, ERG11, ERG2 and TAC1) and gene expression by quantitative PCR (CDR1, CDR2 and ERG11). UV-spectrophotometry and GC-MS were used for sterol analyses. In vivo virulence was determined in the insect model Galleria mellonella and evaluated by log-rank Mantel-Cox tests.
RESULTS: P-1 + P-2 were susceptible, P-3 + P-4 fluconazole resistant, P-5 pan-azole resistant, P-6 + P-7 pan-azole and echinocandin resistant and P-8 + P-9 MDR. MLST supported genetic relatedness among clinical isolates. P-4 harboured four changes in Erg11 (E266D, G307S, G450E and V488I), increased expression of ERG11 and CDR2 and a change in Tac1 (R688Q). P-5, P-7, P-8 and P-9 had an additional change in Erg11 (A61E), increased expression of CDR1, CDR2 and ERG11 (except for P-7) and a different amino acid change in Tac1 (R673L). Echinocandin-resistant isolates harboured the Fks1 S645P alteration. Polyene-resistant P-8 + P-9 lacked ergosterol and harboured a frameshift mutation in ERG2 (F105SfsX23). Virulence was attenuated (but equivalent) in the clinical isolates, but higher than in the azole- and echinocandin-resistant unrelated control strain.
CONCLUSIONS: C. albicans demonstrates a diverse capacity to adapt to antifungal exposure. Potentially novel resistance-inducing mutations in TAC1, ERG11 and ERG2 require independent validation.
Keywords
Aged, Amphotericin B/pharmacology, Animals, Antifungal Agents/pharmacology, Azoles/pharmacology, Candida albicans/classification, Candida albicans/drug effects, Candidiasis/drug therapy, Candidiasis/microbiology, DNA, Fungal/chemistry, DNA, Fungal/genetics, Drug Resistance, Multiple, Fungal, Echinocandins/pharmacology, Genotype, Humans, Lepidoptera/microbiology, Male, Microbial Sensitivity Tests, Multilocus Sequence Typing, Mutation, Sequence Analysis, DNA, Survival Analysis, Virulence
Pubmed
Web of science
Open Access
Yes
Create date
17/11/2015 17:37
Last modification date
01/10/2019 6:19
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