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A. Kumar etal.
identied as a critical player in azole resistance. Developing small molecules or compounds that specically target Tac1p could disrupt the transcriptional machin­ery responsible for multidrug resistance, rendering Candida strains more suscepti­ble to existing antifungal drugs. Similarly, the identication of transcription factors involved in regulating biolm formation, another major contributor to drug resis­tance, opens up opportunities for therapeutic intervention by disrupting the regula­tory pathways that control biolm development and could sensitize Candida species to conventional antifungal treatments. Ultimately, targeting transcription factors also offers a promising avenue to enhance the arsenal of antifungal therapies and address the pressing challenge of drug-resistant Candida infections in clinical set­tings. By comprehending the interplay between genetic and non-genetic elements, we can develop interesting strategies to combat this pressing issue. The eld of epigenetic research in Candida is still in its nascent stage but has already uncovered the intricate interplay between epigenetic mechanisms and antifungal resistance (AFR), particularly in C. albicans and C. glabrata. Furthermore, the emerging eld of epigenetic regulation in drug resistance provides another layer of complexity and potential targets. Histone modications and chromatin architecture are integral parts of the transcriptional regulation machinery in Candida species. Developing compounds that selectively modulate these epigenetic marks could inuence the expression of genes associated with drug resistance. Given the conservation of epi­genetic regulators among eukaryotes, further investigations are imperative to unravel the full extent of epigenetic inuence on drug-resistant Candida and to unlock the potential of epigenetic-based antifungal treatments.
To summarize, in the quest to address drug resistance, a holistic approach involv-
ing a combination of therapies may be necessary. Synergistic strategies that target both transcription factors, drug efux pumps, and other key components of the drug resistance network could enhance treatment outcomes. While challenges remain in translating these ndings into clinically effective therapies, the potential impact on the treatment landscape for Candida infections is substantial. Continued research efforts focusing on the identication and validation of transcription factors as thera­peutic targets, along with the development of innovative compounds, will pave the way for more effective and sustainable strategies to overcome drug resistance in Candida species.
Overall, the key to advancing our understanding of AFR mechanisms in Candida
species lies in the adoption of state-of-the-art technologies, interdisciplinary col­laborations, continuous surveillance, and a holistic perspective on the complex dynamic systems involved. By tackling these challenges, researchers can forge a path towards the development of more efcacious antifungal therapies and drive progress in the eld. To fully comprehend the evolution of resistance, future inves­tigations ought to explore the intricate relationship between host environments, microbial communities, and the evolutionary dynamics of Candida populations. Gaining insight into how these factors are interconnected will enable the develop­ment of more effective strategies for combating resistance that takes into account the broader ecological context.
8 Unravelling Drug Resistance in Candida Species: Genetic, Biolm…
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References

Adams E etal (2018) Candida auris in healthcare facilities, NewYork, USA, 2013–2017. Emerg
Infect Dis 24(10):1816–1824
Ajetunmobi OH et al (2023) Antifungal therapy of Candida biolms: past, present and future.
Biolms 5:100126
Albertson GD etal (1996) Multiple efux mechanisms are involved in Candida albicans ucon-
azole resistance. Antimicrob Agents Chemother 40(12):2835–2841
Al-Dhaheri RS, Douglas LJ (2008) Absence of amphotericin B-tolerant persister cells in biolms
of some Candida species. Antimicrob Agents Chemother 52(5):1884–1887
Al-Fattani MA, Douglas LJ (2006) Biolm matrix of Candida albicans and Candida tropicalis:
chemical composition and role in drug resistance. J Med Microbiol 55(8):999–1008
Amakasu H etal (1993) Isolation and characterization of SGE1: a yeast gene that partially sup-
presses the gal11 mutation in multiple copies. Genetics 134(3):675–683
Anon B etal (2018) Possible association of CAG repeat polymorphism in KCNN3 encoding the
potassium channel SK3 with oxaliplatin-induced neurotoxicity. Cancer Chemother Pharmacol 82(1):149–157
Arastehfar A etal (2020) The quiet and underappreciated rise of drug-resistant invasive fungal
pathogens. J Fungi 6(3):138
Arendrup MC, Patterson TF (2017) Multidrug-resistant Candida: epidemiology, molecular mecha-
nisms, and treatment. J Infect Dis 216(Suppl 3):S445–S451
Atiencia-Carrera MB etal (2022) Evaluation of the biolm life cycle between Candida albicans
and Candida tropicalis. Front Cell Infect Microbiol 12:953168
Avramovska O, Hickman MA (2019) The magnitude of Candida albicans stress-induced genome
instability results from an interaction between ploidy and antifungal drugs. G3 (Bethesda) 9(12):4019–4027
Bachmann SP, Patterson TF, López-Ribot JL (2002) In vitro activity of caspofungin (MK-0991)
against Candida albicans clinical isolates displaying different mechanisms of azole resistance. J Clin Microbiol 40(6):2228–2230
Baginski M, Czub J (2009) Amphotericin B and its new derivatives—mode of action. Curr Drug
Metab 10(5):459–469
Baillie GS (2000) Matrix polymers of Candida biolms and their possible role in biolm resis-
tance to antifungal agents. J Antimicrob Chemother 46(3):397–403
Bauer BE, Wolfger H, Kuchler K (1999) Inventory and function of yeast ABC proteins: about sex,
stress, pleiotropic drug and heavy metal resistance. Biochim Biophys Acta 1461(2):217–236
Becker JM et al (1995) Reduced virulence of Candida albicans mutants affected in multidrug
resistance. Infect Immun 63(11):4515–4518
Bellmann R, Smuszkiewicz P (2017) Pharmacokinetics of antifungal drugs: practical implications
for optimized treatment of patients. Infection 45(6):737–779
Ben-Yaacov R etal (1994) Candida albicans gene encoding resistance to benomyl and methotrex-
ate is a multidrug resistance gene. Antimicrob Agents Chemother 38(4):648–652
Bhattacharya S, Sae-Tia S, Fries BC (2020) Candidiasis and mechanisms of antifungal resistance.
Antibiotics 9(6):312
Brauner A etal (2016) Distinguishing between resistance, tolerance and persistence to antibiotic
treatment. Nat Rev Microbiol 14(5):320–330
Brown AJP etal (2014) Metabolism impacts upon Candida immunogenicity and pathogenicity at
multiple levels. Trends Microbiol 22(11):614–622
Calabrese D, Bille J, Sanglard D (2000) A novel multidrug efux transporter gene of the major
facilitator superfamily from Candida albicans (FLU1) conferring resistance to uconazole. Microbiology 146(11):2743–2754
Cannon RD et al (2009) Efux-mediated antifungal drug resistance. Clin Microbiol Rev
22(2):291–321
232
Carolus H etal (2021) Genome-wide analysis of experimentally evolved Candida auris reveals
multiple novel mechanisms of multidrug resistance. mBio 12(2):e03333-20
Caudle KE et al (2011) Genomewide expression prole analysis of the Candida glabrata Pdr1
regulon. Eukaryot Cell 10(3):373–383
Cavalheiro M, Teixeira MC (2018) Candida biolms: threats, challenges, and promising strategies.
Front Med 5:28
Chen K-H etal (2007) The bZip transcription factor Cgap1p is involved in multidrug resistance
and required for activation of multidrug transporter gene CgFLR1in Candida glabrata. Gene 386(1–2):63–72
Cheng G, Yeater KM, Hoyer LL (2006) Cellular and molecular biology of Candida albicans estro-
gen response. Eukaryot Cell 5(1):180–191
Chowdhary A, Sharma C, Meis JF (2017) Candida auris: a rapidly emerging cause of hospital-
acquired multidrug-resistant fungal infections globally. PLoS Pathog 13(5):e1006290
Chowdhary A etal (2018) A multicentre study of antifungal susceptibility patterns among 350
Candida auris isolates (2009-17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance. J Antimicrob Chemother 73(4):891–899
Coste A etal (2006) A mutation in Tac1p, a transcription factor regulating CDR1 and CDR2,
is coupled with loss of heterozygosity at chromosome 5 to mediate antifungal resistance in Candida albicans. Genetics 172(4):2139–2156
Coste AT etal (2008) Divergent functions of three Candida albicans zinc-cluster transcription fac-
tors (CTA4, ASG1 and CTF1) complementing pleiotropic drug resistance in Saccharomyces cerevisiae. Microbiology (Reading) 154(5):1491–1501
Cowen LE etal (2014) Mechanisms of antifungal drug resistance. Cold Spring Harb Perspect Med
5(7):a019752
Cuenca-Estrella M etal (2001) Flucytosine primary resistance in Candida species and Cryptococcus
neoformans. Eur J Clin Microbiol Infect Dis 20(4):276–279
de Cassia Orlandi Sardi J etal (2018) Candida auris: epidemiology, risk factors, virulence, resis-
tance, and therapeutic options. Microb Pathog 125:116–121
Decottignies A, Goffeau A (1997) Complete inventory of the yeast ABC proteins. Nat Genet
15(2):137–145
Deng K etal (2021) ALS3 expression as an indicator for Candida albicans biolm formation and
drug resistance. Front Microbiol 12:655242
Desai JV, Mitchell AP (2015) Candida albicans biolm development and its genetic control.
Microbiol Spectr 3(3):3.3.04
Dominguez E etal (2018) Conservation and divergence in the Candida species biolm matrix
mannan-glucan complex structure, function, and genetic control. mBio 9(2):e00451-18
Douglas LJ (2003) Candida biolms and their role in infection. Trends Microbiol 11(1):30–36 Dunkel N et al (2008a) A gain-of-function mutation in the transcription factor Upc2p causes
upregulation of ergosterol biosynthesis genes and increased uconazole resistance in a clinical Candida albicans isolate. Eukaryot Cell 7(7):1180–1190
Dunkel N etal (2008b) Mutations in the multi-drug resistance regulator MRR1, followed by loss of
heterozygosity, are the main cause of MDR1 overexpression in uconazole-resistant Candida albicans strains. Mol Microbiol 69(4):827–840
Edlind TD, Katiyar SK (2010) Mutational analysis of ucytosine resistance in Candida glabrata.
Antimicrob Agents Chemother 54(11):4733–4738
Elving GJ et al (2002) Comparison of the microbial composition of voice prosthesis biolms
from patients requiring frequent versus infrequent replacement. Ann Otol Rhinol Laryngol 111(3):200–203
Ene IV etal (2018) Global analysis of mutations driving microevolution of a heterozygous diploid
fungal pathogen. Proc Natl Acad Sci U S A 115(37):E8688–E8697
Escandón P etal (2019) Molecular epidemiology of Candida auris in Colombia reveals a highly
related, countrywide colonization with regional patterns in amphotericin B resistance. Clin Infect Dis 68(1):15–21
A. Kumar etal.
8 Unravelling Drug Resistance in Candida Species: Genetic, Biolm…
Ferrari S etal (2009) Gain of function mutations in CgPDR1 of Candida glabrata not only mediate
antifungal resistance but also enhance virulence. PLoS Pathog 5(1):e1000268
Fling ME etal (1991) Analysis of a Candida albicans gene that encodes a novel mechanism for
resistance to benomyl and methotrexate. Mol Gen Genet 227(2):318–329
Flowers SA etal (2012) Gain-of-function mutations in UPC2 are a frequent cause of ERG11 upreg-
ulation in azole-resistant clinical isolates of Candida albicans. Eukaryot Cell 11(10):1289–1299
Garcia-Effron G etal (2009) Effect of Candida glabrata FKS1 and FKS2 mutations on echinocan-
din sensitivity and kinetics of 1,3-beta-D-glucan synthase: implication for the existing suscep­tibility breakpoint. Antimicrob Agents Chemother 53(9):3690–3699
García-Sánchez S etal (2004) Candida albicans biolms: a developmental state associated with
specic and stable gene expression patterns. Eukaryot Cell 3(2):536–545
Gaur M etal (2008) MFS transportome of the human pathogenic yeast Candida albicans. BMC
Genomics 9(1):579
Godamudunage MP, Grech AM, Scott EE (2018) Comparison of antifungal azole interactions
with adult cytochrome P450 3A4 versus neonatal cytochrome P450 3A7. Drug Metab Dispos 46(9):1329–1337
Goffeau A etal (1997) Multidrug-resistant transport proteins in yeast: complete inventory and phy-
logenetic characterization of yeast open reading frames with the major facilitator superfamily. Yeast 13(1):43–54
Goldway M etal (1995) Multidrug resistance in Candida albicans: disruption of the BENr gene.
Antimicrob Agents Chemother 39(2):422–426
Golin J etal (2003) Studies with novel Pdr5p substrates demonstrate a strong size dependence for
xenobiotic efux. J Biol Chem 278(8):5963–5969
Gomez-Gaviria M etal (2023) Candida haemulonii complex and Candida auris: biology, virulence
factors, immune response, and multidrug resistance. Infect Drug Resist 16:1455–1470
Gömpel-Klein P, Brendel M (1990) Allelism of SNQ1 and ATR1, genes of the yeast Saccharomyces
cerevisiae required for controlling sensitivity to 4-nitroquinoline-N-oxide and aminotriazole. Curr Genet 18(1):93–96
Gong J etal (2023) Emergence of antifungal resistant subclades in the global predominant phylo-
genetic population of Candida albicans. Microbiol Spectr 11(1):e0380722
Gulati M, Nobile CJ (2016) Candida albicans biolms: development, regulation, and molecular
mechanisms. Microbes Infect 18(5):310–321
Gupta V etal (1998) Identication of polymorphic mutant alleles of CaMDR1, a major facilitator
of Candida albicans which confers multidrug resistance, and its invitro transcriptional activa­tion. Curr Genet 34(3):192–199
Harris A etal (2021) Structure and efux mechanism of the yeast pleiotropic drug resistance trans-
porter Pdr5. Nat Commun 12(1):5254
Hawser SP, Douglas LJ (1995) Resistance of Candida albicans biolms to antifungal agents
invitro. Antimicrob Agents Chemother 39(9):2128–2131
Higgins CF (2001) ABC transporters: physiology, structure and mechanism—an overview. Res
Microbiol 152(3–4):205–210
Holmes AR etal (2016) Targeting efux pumps to overcome antifungal drug resistance. Future
Med Chem 8(12):1485–1501
Horton MV, Nett JE (2020) Candida auris infection and biolm formation: going beyond the sur-
face. Curr Clin Microbiol Rep 7(3):51–56
Houst J, Spizek J, Havlicek V (2020) Antifungal drugs. Metabolites 10(3):106 Iguchi S etal (2019) Candida auris: a pathogen difcult to identify, treat, and eradicate and its
characteristics in Japanese strains. J Infect Chemother 25(10):743–749
Jacobs SE et al (2022) Candida auris pan-drug-resistant to four classes of antifungal agents.
Antimicrob Agents Chemother 66(7):e0005322
Jangir P etal (2023) Azole resistance in Candida auris: mechanisms and combinatorial therapy.
APMIS 131(8):442–462
Kanazawa S, Driscoll M, Struhl K (1988) ATR1, a Saccharomyces cerevisiae gene encoding a
transmembrane protein required for aminotriazole resistance. Mol Cell Biol 8(2):664–673
233
234
Katragkou Α etal (2008) Differential activities of newer antifungal agents against Candida albi-
cans and Candida parapsilosis biolms. Antimicrob Agents Chemother 52(1):357–360
Kispal G etal (1997) The ABC transporter Atm1p is required for mitochondrial iron homeostasis.
FEBS Lett 418(3):346–350
Kohli A etal (2001) Specicity of drug transport mediated byCaMDR1: a major facilitator of
Candida albicans. J Biosci 26(3):333–339
Kojic EM, Darouiche RO (2004) Candida infections of medical devices. Clin Microbiol Rev
17(2):255–267
Kuhn DM etal (2002) Antifungal susceptibility of Candida biolms: unique efcacy of amphoter-
icin B lipid formulations and echinocandins. Antimicrob Agents Chemother 46(6):1773–1780
Lee Y etal (2021) Antifungal drug resistance: molecular mechanisms in Candida albicans and
beyond. Chem Rev 121(6):3390–3411
Lewis K (2010) Persister cells. Ann Rev Microbiol 64(1):357–372 Li P etal (2015) Delicate metabolic control and coordinated stress response critically determine
antifungal tolerance of Candida albicans biolm persisters. Antimicrob Agents Chemother 59(10):6101–6112
Li J etal (2021) Novel ERG11 and TAC1b mutations associated with azole resistance in Candida
auris. Antimicrob Agents Chemother 65(5):e02663-20
Lin S-J, Austriaco N (2014) Aging and cell death in the other yeasts, Schizosaccharomyces pombe
and Candida albicans. FEMS Yeast Res 14(1):119–135
Liu Z, Rossi JM, Myers LC (2018) Candida albicans Zn cluster transcription factors Tac1 and
Znc1 are activated by Farnesol to upregulate a transcriptional program including the multidrug efux pump CDR1. Antimicrob Agents Chemother 62(11):e00968-18
Lockhart SR (2019) Candida auris and multidrug resistance: dening the new normal. Fungal
Genet Biol 131:103243
Lockhart SR etal (2017) Simultaneous emergence of multidrug-resistant Candida auris on 3 con-
tinents conrmed by whole-genome sequencing and epidemiological analyses. Clin Infect Dis 64(2):134–140
Logan A, Wolfe A, Williamson JC (2022) Antifungal resistance and the role of new therapeutic
agents. Curr Infect Dis Rep 24(9):105–116
Malani AN, Kauffman CA (2007) Candida urinary tract infections: treatment options. Expert Rev
Anti-Infect Ther 5(2):277–284
Martins M etal (2012) Addition of DNase improves the in vitro activity of antifungal drugs against
Candida albicans biolms. Mycoses 55(1):80–85
Mayr EM etal (2020) A zinc cluster transcription factor contributes to the intrinsic uconazole
resistance of Candida auris. mSphere 5(2):e00279-20
McCarthy M, O’Shaughnessy EM, Walsh TJ (2017) Amphotericin B: polyene resistance mecha-
nisms. In: Antimicrobial drug resistance. Infectious disease, vol 1. Humana Press, Totowa, pp387–395
Melo AS, Colombo AL, Arthington-Skaggs BA (2007) Paradoxical growth effect of Caspofungin
observed on biolms and planktonic cells of ve different Candida species. Antimicrob Agents Chemother 51(9):3081–3088
Mitchell KF etal (2015) Community participation in biolm matrix assembly and function. Proc
Natl Acad Sci 112(13):4092–4097
Mitchell KF, Zarnowski R, Andes DR (2016) Fungal super glue: the biolm matrix and its compo-
sition, assembly, and functions. PLoS Pathog 12(9):e1005828
Modiri M etal (2019) Antifungal susceptibility pattern and biolm-related genes expression in
planktonic and biolm cells of Candida parapsilosis species complex. Curr Med Mycol 5:35
Momin M, Webb G (2021) The environmental effects on virulence factors and the antifungal sus-
ceptibility of Cryptococcus neoformans. Int J Mol Sci 22(12):6302
Morschhäuser J et al (2007) The transcription factor Mrr1p controls expression of the MDR1
efux pump and mediates multidrug resistance in Candida albicans. PLoS Pathog 3(11):e164
Mukherjee PK etal (2003) Mechanism of uconazole resistance in Candida albicans biolms:
phase-specic role of efux pumps and membrane sterols. Infect Immun 71(8):4333–4340
A. Kumar etal.
8 Unravelling Drug Resistance in Candida Species: Genetic, Biolm…
Mukhopadhyay K et al (2004) Membrane sphingolipid-ergosterol interactions are important
determinants of multidrug resistance in Candida albicans. Antimicrob Agents Chemother 48(5):1778–1787
Muzny CA, Schwebke JR (2015) Biolms: an underappreciated mechanism of treatment failure
and recurrence in vaginal infections: Table1. Clin Infect Dis 61(4):601–606
Nagi M etal (2011) Transcription factors CgUPC2A and CgUPC2B regulate ergosterol biosyn-
thetic genes in Candida glabrata. Genes Cells 16(1):80–89
Nett J etal (2007) Putative role of β-1,3 glucans in Candida albicans biolm resistance. Antimicrob
Agents Chemother 51(2):510–520
Noble SM (2013) Candida albicans specializations for iron homeostasis: from commensalism to
virulence. Curr Opin Microbiol 16(6):708–715
Noble SM et al (2010) Systematic screens of a Candida albicans homozygous deletion library
decouple morphogenetic switching and pathogenicity. Nat Genet 42(7):590–598
Noel T etal (2003) Flucytosine-uconazole cross-resistance in purine-cytosine permease- decient
Candida lusitaniae clinical isolates: indirect evidence of a uconazole uptake transporter. Antimicrob Agents Chemother 47(4):1275–1284
O’Kane CJ, Weild R, Hyland EM (2020) Chromatin structure and drug resistance in Candida spp.
J Fungi (Basel) 6(3):121
O’Meara TR etal (2016) Mapping the Hsp90 genetic network reveals ergosterol biosynthesis and
phosphatidylinositol-4-kinase signaling as core circuitry governing cellular stress. PLoS Genet 12(6):e1006142
O’Meara TR, Robbins N, Cowen LE (2017) The Hsp90 chaperone network modulates Candida
virulence traits. Trends Microbiol 25(10):809–819
Oliveira K etal (2001) Differentiation of Candida albicans and Candida dubliniensis by uores-
cent in situ hybridization with peptide nucleic acid probes. J Clin Microbiol 39(11):4138–4141
Olmos Y (2022) The ESCRT machinery: remodeling, repairing, and sealing membranes.
Membranes 12(6):633
Ostrowsky B etal (2020) Candida auris isolates resistant to three classes of antifungal medica-
tions—New York, 2019. MMWR Morb Mortal Wkly Rep 69(1):6–9
Pannanusorn S etal (2014) Characterization of biolm formation and the role of BCR1 in clinical
isolates of Candida parapsilosis. Eukaryot Cell 13(4):438–451
Pao SS, Paulsen IT, Saier MH (1998) Major facilitator superfamily. Microbiol Mol Biol Rev
62(1):1–34
Pasrija R, Prasad T, Prasad R (2005) Membrane raft lipid constituents affect drug susceptibilities
of Candida albicans. Biochem Soc Trans 33(Pt 5):1219–1223
Pasrija R, Banerjee D, Prasad R (2007) Structure and function analysis of CaMdr1p, a major
facilitator superfamily antifungal efux transporter protein of Candida albicans: identication of amino acid residues critical for drug/H+ transport. Eukaryot Cell 6(3):443–453
Pasrija R etal (2008) Multidrug transporters CaCdr1p and CaMdr1p of Candida albicans dis-
play different lipid specicities: both ergosterol and sphingolipids are essential for targeting of CaCdr1p to membrane rafts. Antimicrob Agents Chemother 52(2):694–704
Patra S etal (2022) Epigenetic regulation of antifungal drug resistance. J Fungi 8(8):875 Paul S, Schmidt JA, Moye-Rowley WS (2011) Regulation of the CgPdr1 transcription factor from
the pathogen Candida glabrata. Eukaryot Cell 10(2):187–197
Paul S etal (2022) Mechanisms of azole antifungal resistance in clinical isolates of Candida tropi-
calis. PLoS One 17(7):e0269721
Perfect JR (2017) The antifungal pipeline: a reality check. Nat Rev Drug Discov 16(9):603–616 Perlin DS (2007) Resistance to echinocandin-class antifungal drugs. Drug Resist Updat
10(3):121–130
Perlin DS, Rautemaa-Richardson R, Alastruey-Izquierdo A (2017) The global problem of antifun-
gal resistance: prevalence, mechanisms, and management. Lancet Infect Dis 17(12):e383–e392
Perrine-Walker F (2022) Caspofungin resistance in Candida albicans: genetic factors and synergis-
tic compounds for combination therapies. Braz J Microbiol 53(3):1101–1113
235
236
Prasad R, Singh A (2013) Lipids of Candida albicans and their role in multidrug resistance. Curr
Genet 59(4):243–250
Prasad R etal (2006) Efux pumps in drug resistance of Candida. Infect Disord Drug Targets
6(2):69–83
Prasad R etal (2015) The ABCs of Candida albicans multidrug transporter Cdr1. Eukaryot Cell
14(12):1154–1164
Pristov KE, Ghannoum MA (2019) Resistance of Candida to azoles and echinocandins worldwide.
Clin Microbiol Infect 25(7):792–798
Rabaan AA etal (2023) Psychogenetic, genetic and epigenetic mechanisms in Candida auris: role
in drug resistance. J Infect Public Health 16(2):257–263
Ramage G (2002) Investigation of multidrug efux pumps in relation to uconazole resistance in
Candida albicans biolms. J Antimicrob Chemother 49(6):973–980
Ramage G etal (2012) Fungal biolm resistance. Int J Microbiol 2012:1–14 Reslan L etal (2022) Molecular characterization of Candida auris isolates at a major tertiary care
center in Lebanon. Front Microbiol 12:770635
Revie NM etal (2018) Antifungal drug resistance: evolution, mechanisms and impact. Curr Opin
Microbiol 45:70–76
Robbins N etal (2011) Hsp90 governs dispersion and drug resistance of fungal biolms. PLoS
Pathog 7(9):e1002257
Robbins N, Leach MD, Cowen LE (2012) Lysine deacetylases Hda1 and Rpd3 regulate Hsp90
function thereby governing fungal drug resistance. Cell Rep 2(4):878–888
Robbins N, Wright GD, Cowen LE (2016) Antifungal drugs: the current armamentarium and
development of new agents. Microbiol Spectr 4(5):4.5.19
Rodrigues CF et al (2016) Candida glabrata’s recurrent infections: biolm formation during
amphotericin B treatment. Lett Appl Microbiol 63(2):77–81
Roy S, Gow NAR (2023) The role of the Candida biolm matrix in drug and immune protection.
Cell Surf 10:100111
Rybak JM etal (2019) Abrogation of triazole resistance upon deletion of CDR1 in a clinical isolate
of Candida auris. Antimicrob Agents Chemother 63(4):e00057-19
Rybak JM etal (2020) Mutations in TAC1B: a novel genetic determinant of clinical uconazole
resistance in Candida auris. mBio 11(3):e00365-20
Saier MH (1998) Molecular phylogeny as a basis for the classication of transport proteins from
bacteria, archaea and eukarya. Adv Microb Physiol 40:81–136
Saier MH (1999) A functional-phylogenetic system for the classication of transport proteins. J
Cell Biochem Suppl 32–33:84–94
Sanglard D (2016) Emerging threats in antifungal-resistant fungal pathogens. Front Med 3:11 Sanglard D et al (1995) Mechanisms of resistance to azole antifungal agents in Candida albi-
cans isolates from AIDS patients involve specic multidrug transporters. Antimicrob Agents Chemother 39(11):2378–2386
Sasse C etal (2011) The transcription factor Ndt80 does not contribute to Mrr1-, Tac1-, and Upc2-
mediated uconazole resistance in Candida albicans. PLoS One 6(9):e25623
Schillig R, Morschhäuser J (2013) Analysis of a fungus-specic transcription factor family, the
Candida albicans zinc cluster proteins, by articial activation. Mol Microbiol 89(5):1003–1017
Schubert S etal (2011) Regulation of efux pump expression and drug resistance by the tran-
scription factors Mrr1, Upc2, and Cap1in Candida albicans. Antimicrob Agents Chemother 55(5):2212–2223
Sengupta M, Datta A (2003) Two membrane proteins located in the Nag regulon of Candida albi-
cans confer multidrug resistance. Biochem Biophys Res Commun 301(4):1099–1108
Shahi G etal (2020) A detailed lipidomic study of human pathogenic fungi Candida auris. FEMS
Yeast Res 20(6):foaa045
Shapiro RS, Robbins N, Cowen LE (2011) Regulatory circuitry governing fungal development,
drug resistance, and disease. Microbiol Mol Biol Rev 75(2):213–267
Silva S etal (2009) Biolms of non-Candida albicans Candida species: quantication, structure
and matrix composition. Med Mycol 47(7):681–689
A. Kumar etal.
8 Unravelling Drug Resistance in Candida Species: Genetic, Biolm…
Silva S et al (2012) Candida glabrata, Candida parapsilosis and Candida tropicalis: biology,
epidemiology, pathogenicity and antifungal resistance. FEMS Microbiol Rev 36(2):288–305
Silva S etal (2017) Candida species biolms’ antifungal resistance. J Fungi 3(1):8 Singh RP et al (2011) Cap2-HAP complex is a critical transcriptional regulator that has dual
but contrasting roles in regulation of iron homeostasis in Candida albicans. J Biol Chem 286(28):25154–25170
Sipos G, Kuchler K (2006) Fungal ATP-binding cassette (ABC) transporters in drug resistance &
detoxication. Curr Drug Targets 7(4):471–481
Spampinato C, Leonardi D (2013) Candida infections, causes, targets, and resistance mechanisms:
traditional and alternative antifungal agents. Biomed Res Int 2013:204237
Sun J etal (2016) Candida albicans amphotericin B-tolerant persister formation is closely related
to surface adhesion. Mycopathologia 181(1–2):41–49
Sun N etal (2019) Unique, diverged, and conserved mitochondrial functions inuencing Candida
albicans respiration. mBio 10(3):e00300-19
Taff HT etal (2012) A Candida biolm-induced pathway for matrix glucan delivery: implications
for drug resistance. PLoS Pathog 8(8):e1002848
Tsai H-F etal (2006) Candida glabrata PDR1, a transcriptional regulator of a pleiotropic drug
resistance network, mediates azole resistance in clinical isolates and petite mutants. Antimicrob Agents Chemother 50(4):1384–1392
Tscherner M, Kuchler KJM (2019) A histone acetyltransferase inhibitor with antifungal activity
against CTG clade Candida species. Microorganisms 7(7):201
Turner SA, Butler G (2014) The Candida pathogenic species complex. Cold Spring Harb Perspect
Med 4(9):a019778
Vediyappan G, Rossignol T, d’Enfert C (2010) Interaction of Candida albicans biolms with
antifungals: transcriptional response and binding of antifungals to beta-glucans. Antimicrob Agents Chemother 54(5):2096–2111
Vermitsky JP etal (2006) Pdr1 regulates multidrug resistance in Candida glabrata: gene disruption
and genome-wide expression studies. Mol Microbiol 61(3):704–722
Watamoto T etal (2010) Susceptibility of Candida albicans lamentation-defective mutants to
clinical biocides. J Hosp Infect 74(2):189–191
Whaley SG etal (2014) UPC2A is required for high-level azole antifungal resistance in Candida
glabrata. Antimicrob Agents Chemother 58(8):4543–4554
Wuyts J, Van Dijck P, Holtappels M (2018) Fungal persister cells: the basis for recalcitrant infec-
tions? PLoS Pathog 14(10):e1007301
Yang Y etal (2018) Genome-wide screen reveals important roles for ESCRT proteins in drug/ion
resistance of ssion yeast. PLoS One 13(6):e0198516
Yang T etal (2020) The ESCRT system plays an important role in the germination in Candida
albicans by regulating the expression of hyphal-specic genes and the localization of polarity­related proteins. Mycopathologia 185(3):439–454
Yu S-J et al (2018) Deletion of ADA2 increases antifungal drug susceptibility and virulence in
Candida glabrata. Antimicrob Agents Chemother 62(3):e01924-17. https://doi.org/10.1128/
aaC.01924- 17
Zarnowski R et al (2014) Novel entries in a fungal biolm matrix encyclopedia. mBio
5(4):e01333-14
Zarnowski R etal (2018) Candida albicans biolm-induced vesicles confer drug resistance through
matrix biogenesis. PLoS Biol 16(10):e2006872
Zhongle Liu Lawrence, Myers C (2017) Candida albicans Swi/Snf and Mediator Complexes
Differentially Regulate Mrr1-Induced MDR1 Expression and Fluconazole Resistance ABSTRACT. Antimicrobial Agents and Chemotherapy 61(11). https://doi.org/10.1128/
AAC.01344-17
237
Biofilm Formation inCandida Species
MbaIfeanyiElibe andNwezeEmekaInnocent
Abstract
A key factor playing a signicant role in the virulence of Candida albicans is its capacity to produce biolms. Biolm represents a microbial community that attaches to the biotic or abiotic surface. Numerous severe microbial infections arise due to biolms that do not respond to standard antimicrobial treatment. Treating infections associated with biolms involves destroying their extracel­lular matrix and killing the microbe, which is largely more challenging. Biolm formation is a notable aspect of Candida species’ virulence and pathogenicity, serving as a protective shield against external factors like the host’s immune defenses and antifungal medications. Biolms formed by Candida, the most important member of pathogenic fungi, predominantly emerge in the mucosa, contributing to the onset of typical Candida infection. Considering the upsurge of diverse molecular techniques and genomic data in the last two decades, there has been a growing focus on understanding biolm formation mechanisms and regulatory processes in different Candida species. Therefore, in this chapter, we critically reect on biolm formation in Candida spp. to understand the molecu­lar mechanisms and transcriptional factors regulating the process. This chapter also discussed the variations in biolm formation among the Candida species and its association with antifungal resistance. Finally, the chapter explores the creation of mixed-species biolms and their implications for virulence.
9
Keywords
Candida species · Candida albicans · Biolm formation · Transcriptional factor · Antifungal resistance · Polymicrobial infection
M. I. Elibe · N. E. Innocent (*) Department of Microbiology, University of Nigeria, Nsukka, Enugu State, Nigeria e-mail: emeka.nweze@unn.edu.ng
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024 S. Hameed, P. Vijayaraghavan (eds.), Recent Advances in Human Fungal Diseases, https://doi.org/10.1007/978-981-97-4909-6_9
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M. I. Elibe and N. E. Innocent

9.1 Introduction

The predominant growth state for numerous microorganisms is characterized by biolm formation. Biolm is a microbial cell community that adheres to surfaces, possessing distinct properties compared to free-oating (planktonic) cells (Cavalheiro and Teixeira 2018; Eix and Nett 2020). Biolms are commonly linked to solid surfaces. However, they can also develop in different environments. For example, biolm can develop in liquid–air interfaces (Nobile and Johnson 2015; Gulati and Nobile 2016). One widespread feature of biolms is their increased cell resistance to antimicrobial agents and ability to survive in different environments. In fact, in some studies, biolm formation among Candida has been linked to high mortality rates (Vitális etal. 2020). In the last two decades, a growing focus has been on studies involving microbial biolms, reshaping our comprehension of microbial life (Davey and O’toole 2000; Nobile and Johnson 2015) with several recent studies and discussion centering on biolm formation among Candida spe­cies (Fernandes etal. 2023; Junqueira and Mylonakis 2023), including the recently emerging C. auris (de Melo etal. 2023; Oyardi etal. 2023). It is believed that most microbes thrive and grow naturally under a biolm state (Kolter and Greenberg 2006).
Microbial biolms exist in diverse environments, including living and nonliving
environments. For example, most hospital infections are usually due to infections associated with biolm formation in prosthetic devices like catheters. In fact, catheter- associated bloodstream infection has been a signicant issue in hospital settings (Haddadin etal. 2023; Sikora and Zahra 2023). The development and struc­tural architecture of biolms, in addition to their properties, rely on the microbial species forming them. While most microbial cells form biolm in certain environ­ments, others don’t. The formation of biolm also depends on the lineage or evolu­tionary history of the cells (Ramage etal. 2023). A nearly universal trait of cells that form biolms is their increased resistance to antimicrobial agents. They are also associated with persistent colonization and severe infections. Although a single microbial species can create a biolm, invivo formation typically involves a com­bination of different microbes. Thus, most resilient infections caused by microbes in the human hosts are due to biolm formation. Candida species form biolms. Most of the supercial and systemic fungal infections caused by Candida species are associated with biolm formation. The effect is more pronounced in immuno­compromised patients (Sims etal. 2005; Atriwal etal. 2021). Biolm formation is a major contributor to candidemia caused by the use of catheters (Pereira etal. 2021; Zuo etal. 2021; Wijaya et al. 2023), and treating these infections is particularly challenging. Differences in Candida’s resistance pattern to the available antifungal drugs, differences in their biolm-forming ability, and the diversity in virulence genes’ expression patterns make it difcult to treat most infections. Most mucosal infections are due to biolm-forming phenotypes that interact with resident com­mensals and diverse host components (Vestby etal. 2020).
In the United States, Candida ranks as the fourth most common cause of noso-
comial candidemia. This is particularly associated with a high mortality rate of around 50% (Kotey etal. 2021). The importance of pathogenic fungi in community