Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5219_Библиотеки_им_академика_М_И_Перельмана.pdf
Скачиваний:
0
Добавлен:
31.08.2026
Размер:
24 Мб
Скачать
7 Factors Aecting Drug Resistance andVirulence inFungal Pathogen
179
library was used to complement the Pdr5p null mutant of Saccharomyces cerevisiae and was considered the beginning of the recognition of the role of ABC proteins in drug efux in pathogenic yeasts (Prasad etal. 1995). Similarly, CaCDR1 deletion leads to sensitivity to several unrelated drugs, and the clinically resistant isolates of C. albicans often show overexpression of CaCDR1 (Kumari etal. 2021). Later, another transporter Cdr2p was found in C. albicans involved in resistance to many drugs including azoles (Sanglard etal. 1997). Candida genome database analysis has revealed a total of 26 putative ABC proteins, 19 of which are transporters that exhibit both NBDs and TMDs (Prasad etal. 2015). Other clinically relevant Candida species such as C. auris and C. glabrata have 28 and 25 ABC proteins, respectively (Wasi etal. 2019; Kumari etal. 2018). Similarly, A. fumigatus AtrF is upregulated during culture with itraconazole and is the rst ABC transporter associated with resistance in molds (Slaven etal. 2002).
The MFS transporters also expel a range of substrates and are involved in resis­tance (Drew etal. 2021). MFS transporters are categorized into two drug-related families: H+ antiporter families 1 (DHA1) and 2 (DHA2). The number of transmem­brane spans (TMS) varies between these two families, with the rst family having 12 and the second having 14 (Costa etal. 2014). The C. albicans genome’s compu­tational study revealed 95 putative MFS proteins, grouped into 17 families, includ­ing DHA1 and DHA2. Only a small number of them linked to resistance in pathogenic fungi. DHA1 transporters in C. albicans (CaMdr1, CaNag3, CaNag4, and CaNag6) and C. glabrata (CgQdr2, CgAqr1, CgTpo1_1, CgTpo1_2, and CgTpo3) are involved in resistance to various drugs (Gaur etal. 2008). Interestingly, in addition to resistance, the deletion of CgTpo1_1 and CgTpo1_2 also leads to a reduction in virulence in the Galleria mellonella model and deletion of CgTpo1_2 prevents biolm formation (Santos etal. 2017). In C. glabrata, Qdr2p is found to be necessary for adhesion, biolm formation, and biolm resistance to uconazole (Widiasih Widiyanto et al. 2019). Similarly, deletion of the QDR genes (QDR1, QDR2, and QDR3) in C. albicans results in biolm formation defects such as struc- tural and thickness impairments (Shah etal. 2014). Thus, MFS antiporters, although sometimes not acting as drug transporters, can signicantly inuence virulence.
7.2.2 Mutation intheGenes Coding forDrug Targets (ERG
andFKS)
The fungal sterol ergosterol is unique in the fungal kingdom. Its multistep biosyn­thesis (requiring nearly 20 enzymes) and its accumulated content in the membrane are the targets of many antifungal drugs, including azoles and polyenes. Some pro­teins involved in its synthesis (Erg11p and Erg3p) are either inactivated, mutated, or overexpressed and contribute to resistance (Ksiezopolska etal. 2021). Azoles bind and inhibit 14α-lanosterol demethylase, a cytochrome P450 enzyme (CYP51) encoded by the ERG11 gene, and cause lanosterol accumulation. Although it is not an accumulation of lanosterol, rather its conversion to 14-methylated intermediates via an alternative pathway that is lethal to the fungal cell (Warrilow etal. 2010).
180
P. Sharma et al.
Given the importance of the protein for fungal survival, its importance for resistance development in fungi, including C. albicans, is easy to understand. Mutations in ERG11 alter the spatial structure of Erg11p, which reduces the afnity of the protein for azoles (Sardari et al. 2019). Several point mutations in Erg11p have been reported to contribute to the formation of azole resistance (Lamb etal. 2000). Many point mutations, including R467K and T315A, result in a conformational change and a reduction in afnity for uconazole compared to wild-type Cyp51 (Lamb etal. 1997; Akins 2005). A. fumigatus also develops azole resistance either by over- expression or modication of Cyp51A.A single amino acid substitution (G138C, Y431C, and G434C) and the tandem copies in the promoter of the Cyp51A gene have been reported in previous studies (Albarrag etal. 2011). In C. albicans, the ERG3 gene encodes a sterol C5,6-desaturase, which is required for ergosterol pro­duction. Variations in the ergosterol synthesis pathway caused by C5,6-desaturase inactivation are recognized variables leading to azole resistance invitro (Sanglard etal. 2003). Clinical isolates of C. albicans with a homozygous nonsense mutation are highly resistant to uconazole and moderately resistant to Amp B, and the mutants are shown to be less virulent in the murine infection model (Chau etal.
2005). Similarly, a missense mutation (R135I) in ERG3 of C. parapsilosis leads to
azole resistance (Branco etal. 2017).
For invasive candidiasis, echinocandins are the rst line of treatment until the species is identied and veried by clinical diagnosis. The FKS genes encoding glucan synthase, which embed β-(1,3)-D-glucan into the cell wall, are blocked by echinocandins (Fig.7.2). However, echinocandin resistance due to single residue substitutions in the hotspot regions (catalytic domains) of FKS1 and FKS2 has already been reported (catalytic domains) (Lackner et al. 2014). There are two genes, FKS1 and FKS2, in C. glabrata and three in C. albicans. In C. glabrata, S629F and D632Y (in Fks1) lead to an increase in resistance to all three variants of echinocandin drugs (Garcia-Effron etal. 2009). Similar reports of reduced sensitiv­ity of the enzyme in C. auris have been reported following substitution in the FKS gene (Kordalewska and Perlin 2019). In C. auris, the two hotspot regions of the FKS1 gene extend from F635–P643 and D1350–L1357 (Asadzadeh etal. 2022). Many point mutations have already been reported, including S639Y, S639P, D642Y, and R1354S, which are relevant in both invitro and invivo studies and are resistant to echinocandins (Hirayama et al. 2023). However, the role of mutations in the FKS2 gene of C. auris in conferring echinocandin resistance has not yet been eluci- dated. In addition, an F675S amino acid substitution in hot spot 1 (675–684) of A. fumigatus has been reported to alter susceptibility to echinocandins (Jiménez­Ortigosa etal. 2017). However, C. neoformans has intrinsic resistance to echinocan­dins, while no FKS1 point mutations have been found in its genome (Cao etal.
2019), despite the sensitivity of β-(1,3)-D-glucan synthase activity to echinocandins
(Maligie and Selitrennikoff 2005).
7 Factors Aecting Drug Resistance andVirulence inFungal Pathogen
181
7.2.3 Quorum Sensing andBiofilm Formation
Quorum sensing (QS) regulates the metabolic activity of planktonic cells, induces microbial biolm formation and contributes to virulence. In this type of intercellular communication, the microbes communicate via the synthesis and secretion of cell signaling molecules. Once the Secreted signaling molecule reaches a threshold level, the fungus can detect sufcient cell density (Padder etal. 2018). The impor­tance of QS is illustrated by the fact that its inhibition has become a focus in the development of new antifungal drugs. In addition to biolm formation, it also con­tributes to antibiotic resistance, virulence factors, bioluminescence and sporulation (Hogan 2006)
QS begins with the formation of various small molecule signalling molecules, called autoinducers (AIs), with a transcriptional activator protein that regulates their own gene expression and controls pathogenicity in a variety of microorganisms (Tian etal. 2021). Farnesol, a primary signalling substance in C. albicans, controls the transition from yeast to hyphae. Farnesol binds to the Ras1 protein, which acti­vates the adenylate cyclase Cyr1, which further increases the concentration of cAMP necessary for lamentous growth in biolms (Ramage et al. 2002b). Additionally, the plasma membrane of mammalian cells can internalize the quorum sensing molecule (QSM) farnesol, which enhances the ability of C. albicans to weaken host immunity. Here, farnesol considerably reduces the production of the Th1 cytokines, interferon-γ (IFN-γ) and interleukin-12 (IL-12), which affects the protective immunity development against systemic candidiasis (Tian etal. 2021). Farnesol also obstructs the capability of immature dendritic cells to properly initiate the T-cell response and differentiation of monocytes into mature dendritic cells (Cottier et al. 2019). It also masks the pathogen-associated molecular patterns (PAMP) β-glucan of C. albicans, which prevents their recognition and the initiation of the immune response against the pathogen (Cottier etal. 2019). The QSM farne­sol also provides C. albicans with resistance to oxidative stress by increasing the reactive oxygen species (ROS) production in the mitochondria. Raised ROS levels under hypoxic conditions are caused by the cAMP-PKA signalling pathway and mitochondrial signalling, which increases β-glucan masking (Pradhan etal. 2018). In 2007, Kwon-Chung identied Qsp1 as the rst known Cryptococcus QSM (Lee etal. 2007). This QS peptide, Qsp1, is produced from a 24-amino acid pro-peptide precursor, called proQSP1. The cell wall-associated serine protease Pqp1 cleaves proQsp1 and helps to release the mature Qsp1. This Qsp1 activates intracellular signalling cascades by entering fungal cells (Homer etal. 2016). Null mutants of Δqsp1 show reduced infection, slower tissue accumulation, and an increase in mac- rophage engulfment. At high cell densities, Qsp1 facilitates autoregulatory signals that regulate secreted protease activity and improve cell wall integrity. Even mela­nin production, a crucial component of C. neoformans pathogenicity, can be attenu­ated by Qsp1 (Homer etal. 2016).
Some lamentous fungi use QS to control sexual differentiation. For example, QS oxylipins, oxygenated fatty acid derivatives, are important for maintaining the
182
P. Sharma et al.
ratio of ascospore to conidia in A. nidulans (Tsitsigiannis etal. 2005) and A. avus (Horowitz Brown etal. 2008).
After the successful initiation of QS, biolm development begins and culminates in the production of the extracellular matrix. Mature fungal biolms consist of adherent cell communities surrounded by this extracellular matrix. Dimorphism, in which fungal cells morphologically switch between yeast and hyphal forms, is criti­cal for formation of biolm pathogenicity and broadly enables the fungus to transi­tion to a pathogen (Cowen etal. 2015). During initiation, the spherical yeast cells adhere to a solid surface. This phase, commonly referred to as ‘seeding’, is neces­sary for the proper growth of the biolm. In the following steps, the cells multiply and early lament formation begins. This is followed by maturation of the biolm, resulting in a complex network of polymorphic cells coated by an extracellular matrix, including hyphal cells, pseudohyphae, and round yeast cells, which give the biolm a thick and textured appearance and protect it from chemical and physical injuries (Fig.7.3) (Gulati and Nobile 2016). Both yeast adhesion to epithelial cells and hyphal development require hyphal wall protein 1 (Hwp1). The glucans and mannans are important exopolysaccharides (EPS) associated with biolm forma­tion. The agglutinin-like sequence 3 (ALS3) and the EAP1 gene, which encodes a cell surface glycoprotein and a glycosylphosphatidylinositol-anchored glucan­cross- linked cell wall protein, respectively, are essential for biolm adhesion and production (Li etal. 2007). The extracellular polysaccharides form the matrix and the surface-associated microbial population organizes into a three-dimensional
Fig. 7.3 Yeast cells (blue) adhere to the surface (grey) to start biolm formation. In the initial phase of the biolm, hyphal cells develop and the fungal cells multiply. The extracellular matrix is then formed. The extracellular matrix builds up during the development phase. The yeast cells nally disperse to a new location and form a completely new biolm
7 Factors Aecting Drug Resistance andVirulence inFungal Pathogen
183
community. The mechanical scaffold in the biolm defends the cells (Ghannoum etal. 2015).
In patients, fungal biolms develop on many different medical devices, such as dentures, prostheses, ventricular assist devices, central venous catheters, urinary catheters, and prostheses. In addition, mucosal surfaces in the mouth and vaginal area can also promote the growth of biolms (Ramage etal. 2009). Biolms are resistant to antifungals and host defences and are a protective feature of many fungi. For this reason, they are extensively studied. The cells in biolms are resistant to antifungal drugs and host defences, making biolm infections difcult to treat. Biolms protect the fungi from the various innate immune system components, such as neutrophil and monocyte-mediated death (Kernien etal. 2018). The pre­dominant species, C. albicans, has been used in both invitro and invivo biolm researches. However, non-albicans species, including C. tropicalis, C. parapsilosis, and C. glabrata, also form clinically signicant biolms, although the extent may vary depending on strain and environment (Kojic and Darouiche 2004). In particu­lar, in mature biolms, the genes that produce efux pumps such as ABC and MFS transporters are the reasons for antifungal drugs resistance, including azoles (Kean etal. 2018). Ramage etal. investigated the role of efux transporters Cdr1 and Mdr1in planktonic cells and biolm after 24h. The genes CDR1 and MDR1 are upregulated during biolm development. The mutants lacking CDR1 and MDR1 are hypersensitive to azoles, but the biolms of the mutants maintained the resistant phenotype during biolm development. This directly indicates that resistance in biolms is a complex phenomenon (Ramage etal. 2002a). Since non-albicans spe­cies cannot form true hyphae, their biolms generally consist of yeast cells layers immersed in an extracellular matrix (Silva etal. 2009). The newly discovered patho­gen C. auris also exhibits this pathogenicity characteristic. Differential expression in C. auris shows that 464 and 791 genes are upregulated after 24h in planktonic cells and in biolm development, respectively, compared to 0h (Kean etal. 2018). A. fumigatus also develops a conventional microbial biolm that is resistant to sev­eral azoles, including voriconazole. Within 8–12h of biolm growth, the minimum inhibitory concentration (MIC)90 increases vefold (Morelli etal. 2021). The bio­lms of C. neoformans contained glucuronoxylomannan (GXM), a constituent of its polysaccharide capsule, which plays signicant role in disrupting the host’s immunological defences (Aslanyan etal. 2017). During the development of the cryptococcal biolm, a large amount of capsular polysaccharide is released, form­ing an intricate exopolysaccharide matrix or three-dimensional scaffold that envel­ops the cell population for protection and mechanical stability. The non-pathogenic acapsular mutant strain C. neoformans C536 with a disruption of the CAP59 gene is unable to form biolms, highlighting its role in biolms (Martinez and Casadevall
2015). Biolms formed by Cryptococcus spp. are less susceptible to thermal stress
and UV exposure than planktonic cells (Martinez and Casadevall 2007).
184
P. Sharma et al.
7.2.4 Polymorphism
Polymorphism, another factor responsible for fungal virulence, can be observed in several fungal species, including C. albicans. Fungus can take the form of parallel­walled true hyphae, long elliptical cells with constricted septa, or ovoid budding yeast. Other morphologies include Aspergillus spp. spores and white-opaque cells that form during switching (Ni etal. 2010). Yeasts and hyphae have different func­tions and are commonly seen during an infection (Mayer etal. 2013). The ‘dimor­phism’ is the transition between the growth forms hyphae and yeast, which is crucial for pathogenicity. Attenuated pathogenicity is typically associated with mutants that cannot form hyphae invitro. Nevertheless, both forms have their advantages, as the hyphae form is more invasive and the smaller yeast form is most responsible for spread. Numerous elements, including nutrient deprivation, serum or N-acetylglucosamine, physiological temperature, and CO2, encourage the growth of hyphae during infection. Quorum sensing, which is required for microbial com­munication, also controls morphogenesis (Sudbery 2011). Factors such as the gene products, TUP1, CPH1 and EFG1, are important transcriptional regulators that regulate lamentous growth. EFG1 and CPH1 are the activators of lamentous growth in C. albicans, as the null mutants of CPH1 show a defect in normal hyphal growth at 37°C (Csank etal. 1997). Similarly, the null mutants of CPH1 and EFG1 show large and smooth colonies. Moreover, the deletion of both copies of the TUP1 gene shows the lamentous form in C. albicans, indicating the role of TUP1 as a negative regulator of lamentous growth (Braun and Johnson 1997). The switch from a budding yeast form to a lamentous form in Candida can be initiated by a MAP kinase cascade (Csank etal. 1997). Hyphal development is associated with the expression of several genes encoding virulence factors. The aspartic proteases Sap4, Sap5, and Sap6, the hyphal wall protein Hwp1, the agglutinin-like sequence protein Als3, and the hyphal-associated proteins Ece1 and Hyr1 are examples of these types of proteins (Mayer etal. 2013). The growth of Aspergillus spp. begins with the germination of the conidium, which leads to the formation of an undiffer­entiated mass of hyphal cells. The hyphal cells form a mycelium during sexual reproduction. On the other hand, these hyphal cells stop growing, which also leads to the formation of spores and conidiophores (Ni et al. 2010). The conidia of A. fumigatus are released into the atmosphere and are so small that they can be ingested by humans as soon as they reach the alveoli. In immunocompromised hosts, the conidia can germinate into invasive hyphae that can invade the blood ves­sels and migrate to distant sites. The hyphal cell wall’s rigidity, the synthesis of different fungal proteins including hydrophobins, melanin, and toxins, as well as the spores’ structural characteristics, all aid in the fungus’s ability to escape the host’s defences and increase A. fumigatus’ virulence (Yu 2010).
7 Factors Aecting Drug Resistance andVirulence inFungal Pathogen
185
7.2.5 Production ofEnzymes
Both saprophytic and pathogenic fungal species require the digestion of lipids or proteins by lipases and proteases in order to survive and grow. In pathogenic fungi, hydrolytic enzymes are crucial for their virulence. Among these enzymes, proteases and lipases are the best known extracellular enzymes that can damage host tissues and promote the spread of infection (Park etal. 2013).
7.2.5.1 Secreted Aspartyl Proteinases
Candida produces several secreted aspartyl proteinases (SAPs) that can degrade host proteins by breaking the peptide bond between two hydrophobic amino acids and damaging the host cells (Mayer etal. 2013). A family of 10 genes encodes SAP proteins. In addition to tissue adhesion, proteases increase the ability of the fungus to colonize and penetrate deeper into the tissue by degrading host proteins (Cowen etal. 2015). In addition to C. albicans, C. tropicalis, Candida dubliniensis, and C. parapsilosis also produce active SAP enzymes invitro (Naglik etal. 2003). The virulence of C. albicans was investigated by targeted disruption of the SAP gene (SAP1 to SAP6). Null mutants of SAP1 to SAP3 (Δsap1, Δsap2, and Δsap3) become less pathogenic and more sensitive to pepstatin, a protease inhibitor, compared to SAP4 to SAP6 null mutants (De Bernardis et al. 1999). Three genes coding for aspartyl acid protease (SAPP1, SAPP2, and SAPP3) were identied in C. parapsi­losis. C. parapsilosis, ΔΔsapp1a- ΔΔsapp1b mutants show less host tissue dam­age, become hypersensitive to human serum, and are more efciently taken up by peripheral blood mononuclear cells (Horváth etal. 2012). SAPP1 and SAPP2 are responsible for host tissue adhesion, phagosome and lysosome maturation, and phagocytosis. SAPP2 can also cleave host complement component 4b (C4b) and C3b and inuences the host’s immune system (Singh etal. 2019). C. tropicalis con- tains four 4-membered SAPT genes, of which SAPT1 plays the main role in the viru­lence of the fungus (Zaugg etal. 2001). It can efciently cleave the lectin pathway components of the complement system, such as mannose-binding lectin (MBL) and collectin-11, and also interfere with the activation of the complement pathway (Valand etal. 2022). Like other Candida spp. C. auris also possesses SAP activity of 25–42°C (Kim etal. 2023). Out of seven identied SAPs (Sapa1 to Sapa7) in C. auris., SAPA3 is mainly involved in virulence. Disruption of SAPA3 (Sapa3Δ) leads to attenuated virulence and a considerable decrease in SAP activity and bio­lm formation (Kim etal. 2023).
In addition, May1 is the primary secreted protease in C. neoformans. This prote­ase is responsible for a variety of tasks, such as altering virulence, invading host tissue, spreading into the central nervous system, and assimilating nitrogen (Kryštůfek etal. 2021). Disruption of MAY1 (may1Δ) in C. neoformans leads to a signicant reduction in virulence (Clarke etal. 2016). A. fumigatus secretes an alka- line protease Alp1 that cleaves brinogen, collagen, and elastin (Davies etal. 2005). Alp1 also inuences the response of the complementary system by cleaving the complement proteins C3b, C4, and C5 and increasing the infection rate. The ALP1
186
P. Sharma et al.
(Δalp1) mutants do not exhibit the cleavage properties and the activity of ALP1 is also inhibited by chymostatin, a serine protease inhibitor (Behnsen etal. 2010).
7.2.5.2 Phospholipase
Phospholipases are a large group that break and cleave ester bonds in glycerophos­pholipids, which are vital components of pulmonary surfactants and cell mem­branes. Five kinds of phospholipases can be distinguished based on the ester bond that is hydrolysed: A1–A2 and B–C–D.Phospholipase B (Plb) and phospholipase C (Plc) are two important phospholipases related to fungal pathogenicity. The Plb enzymes eliminate both fatty acyl chains of glycerophospholipids (Djordjevic
2010). Five potential members of the Plb multigene family are encoded in the
genome of C. albicans. The CaPLB1 gene, the CaPLB2 gene, and the CaPLB5 gene, which encode potential secreted proteins, have attracted the most attention. The only CaPLBs with a known function in virulence are CaPLB1 and CaPLB5. The null mutant of Δcaplb5 shows reduced phospholipase A2 activity and becomes avirulent in the mouse model (Theiss etal. 2006). Moreover, there are extracellular glycosylphosphatidylinositol-linked aspartyl proteases encoded by the YPS gene family in C. glabrata. The YPS gene family consists of 11 putative GPI-linked cell surface proteases (Rasheed etal. 2018). These genes have been found to be involved in cell wall integrity, survival in macrophages, attachment to host cells, and viru­lence (Kaur etal. 2007). The ypsΔ strains of C. glabrata show a signicant increase in the nitric oxide (NO) production, which is involved in macrophage activation (Kaur etal. 2007). YPS genes also inuence the proteolytic processing of the cell wall adhesin protein Epa1. The ypsΔ strains of C. glabarta adhere more strongly to epithelial cells. In addition, these strains are also sensitive to cell wall stressors, highlighting the role of YPS genes in maintaining cell wall integrity (Kaur etal. 2007).
Three recognized PLB gene products, Afplb1, Afplb2, and Afpl3, are present in the genome of A. fumigatus. These three AfPLBs also have a conserved catalytic triad of Ser, Arg, and Asp residues. AfPLB1 and AfPLB3 play an important role in lung infections and enhance the pathogenicity of A. fumigatus. In the presence of lecithin, which is the main component of pulmonary surfactant, Afplb1 and Afplb3 are upregulated (Barman etal. 2018). In C. neoformans, the phospholipase enzyme Plb also exhibits lysophospholipase hydrolase and lysophospholipase transacylase activity. Disruption of PLB1 (Δplb1) in C. neoformans leads to a marked decrease in all three activities. Δplb1 strains show signicant reduction in virulence and sub­stantial developmental defects in a macrophage cell line in inhalation models in mice and meningitis in rabbits. This suggests that the Plb1 enzyme of C. neofor- mans is a virulence factor (Cox etal. 2001). Plb mediates capsule enlargement and intracellular replication and affects the host immune system. PLB1 increases the survival and growth of the fungus in the CNS and enhances its pathogenicity. PLB1 expression impairs glial cell activities and damages brain tissue (Hamed etal. 2023).
7 Factors Aecting Drug Resistance andVirulence inFungal Pathogen
187
7.2.6 Calcineurin-Signalling Pathway
Various stress signals activate phospholipase C, which increases the cytosolic Ca2+ level, which binds to calmodulin (CaM) and activates the downstream protein calci­neurin. Calcineurin is a heterodimeric complex cytoplasmic protein comprised of a catalytic subunit, calcineurin A (cnA), and a regulatory subunit, calcineurin B (cnB) (Juvvadi etal. 2017). Activated calcineurin, a conserved Ca2+/CaM-dependent ser­ine/threonine phosphatase, dephosphorylates the downstream protein Crz1 (NFAT homolog), a transcription factor that translocates in nucleus and causes expression of the target genes FKS2, PMR1, PMC2, and CHS6, which are crucial for fungal cell sensitivity to drugs and virulence (Lev etal. 2012; Tisi etal. 2016).
The calcineurin pathway (Fig.7.4) inuences cell wall integrity, ion homeosta­sis, virulence, and plasma membrane homeostasis by regulating ergosterol, chitin and glucan synthesis, and drug resistance (Ueno etal. 2011). The essential role of calcineurin in the virulence of fungal pathogens became clear in studies with C. neo- formans when it was found that the immunosuppressive drugs cyclosporin A (CsA) and FK506 inhibit calcineurin signalling and suppress fungal growth (Odom etal.
1997). The deletion mutants of the calcineurin protein are sensitive to various anti-
fungal agents. The Δcna1 mutant of C. neoformans leads to a loss of pathogenicity in animal models (Odom etal. 1997). The Δcna1 strain is degraded faster than the wild-type in an immunosuppressive rabbit model and becomes more temperature­sensitive (Odom etal. 1997). The crz1 mutant of C. neoformans is susceptible to cell wall inhibitors due to the downregulation of the chitin synthase gene CHS6 (Lev etal. 2012). The importance of this gene has also been conrmed in other spe­cies, including Candida and A. fumigatus (Bader etal. 2003; Steinbach etal. 2006).
The pathogenicity and virulence of fungal pathogens, including C. albicans, are strongly dependent on calcium (Ca2+) signalling. CsA and FK506 show synergistic effects with uconazole and the fungistatic effect of azoles becomes fungicidal through calcineurin inhibitors (Uppuluri et al. 2008). In A. niger, the deletion mutants ΔcrzA and ΔcnaA reduce the Ca2+ concentration in the mycelium, reduce biolm formation, lower hydrophobicity, and impair the integrity of the cell wall (Liu etal. 2020). In C. glabrata, calcineurin is responsible for the regulation of the transcription factor Pdr1 and controls the expression of Cdr1p. Disruption of CNA1 in C. glabrata Δcna1 shows a remarkable reduction in PDR1 and CDR1 expression, which is responsible for azole resistance in C. glabrata. The Δcna1 and Δcnb1 mutants become sensitive to caspofungin and uconazole (Vu etal. 2023).
7.2.7 Ion Homeostasis
Ion signalling and transduction networks control gene expression, lamentation, attachment to the host, invasion, pathogen stress response, and survival and are thus essential for fungal growth and virulence (Zhang etal. 2012).
188
P. Sharma et al.
inux is sensed by
2+
ions. The Ca
2+
Fig. 7.4 The role of the calcineurin signalling pathway in fungi: The transporters Cch1 and mid1 regulate the uptake of Ca
the CaM protein, which forms a complex with the calcineurin protein subunits cnA and cnB.The CaM-calcineurin complex dephosphorylates the Crz1 protein,
which migrates into the nucleus and activates the genes involved in the virulence of the fungus