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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5219_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Foreword
- •Preface
- •Contents
- •Editors and Contributors
- •About the Editors
- •Contributors
- •1.1 Introduction
- •1.2 Conventional Methods
- •1.2.1 Microscopy
- •1.2.2 Culture
- •1.2.3 Germ Tube Test
- •1.2.5 Carbohydrate Assimilation Test
- •1.2.6 Nitrogen Assimilation Test
- •1.2.7 Carbohydrate Fermentation Test
- •1.2.8 Urease Test
- •1.2.9 Tween 80 Opacity Test
- •1.3 Nonculture-Based Conventional Methods
- •1.3.1 Serological Methods
- •1.3.1.2 ß-d-Glucan
- •1.3.1.3 C. albicans Germ Tube Antibody Assay (CAGTA)
- •1.4 Nucleic Acid-Based Detection
- •1.4.1 Polymerase Chain Reaction (PCR)
- •1.4.3 Peptide Nucleic Acid FISH (PNA-FISH)
- •1.4.4 PCR-Based Innovative Diagnosis
- •1.4.5 FilmArray System
- •1.4.6 Sepsis Flow Chip
- •1.4.7 ePlex System
- •1.4.8 The T2 Candida Assay
- •1.5 Rapid Identification Systems
- •1.5.1 Manual Rapid Identification System
- •1.5.1.1 The API System
- •1.5.1.2 The VITEK System
- •1.5.2 Automatic Rapid Identification System
- •1.5.2.1 MALDI-TOF MS
- •1.5.2.2 The MALDI Sepsityper IVD Kit
- •1.5.2.3 The BioFire FilmArray BCID2 Panel
- •1.5.2.4 The Accelerate Pheno BC Panel
- •1.6 Advanced Diagnostics
- •1.6.2 Biosensor-Based Tests
- •1.6.3 Next-Generation Sequencing (NGS)
- •1.7 Conclusion
- •References
- •2.1 Introduction
- •2.2.1.2 Echinocandins
- •First-Generation Echinocandin
- •Second-Generation Echinocandin
- •2.2.1.3 Other Cell Wall Inhibitors
- •2.2.2.1 Azoles
- •Imidazole
- •Triazole
- •Second-Generation Azole
- •Third-Generation Azole
- •2.2.2.2 Polyenes
- •Other Polyene Under Development
- •2.2.2.3 Allylamines
- •2.2.3 Flucytosine
- •2.3 Conclusion
- •References
- •3.1 Introduction
- •3.2.1 Control Diet
- •3.2.3 Toxification
- •3.2.4 Alternative Treatments
- •3.3.1 Prophylaxis
- •3.3.2 Preemptive Therapies
- •3.3.3 Empirical Therapies
- •3.4 Therapeutic Approach
- •3.4.1 Azoles
- •3.4.2 Echinocandins
- •3.4.3 Polyenes
- •References
- •4.1 Introduction
- •4.3 Eukarya Domain
- •4.4.1 Cryptococcus
- •4.4.2 Aspergillus
- •4.4.3 Mucorales
- •4.4.4 Candida
- •4.5.1 Candida albicans
- •4.5.2 Morphogenesis
- •4.5.3 Pathogenesis
- •4.5.4 Adherence
- •4.5.5 Morphological Switching
- •4.5.6 Invasion
- •4.6 Induced Endocytosis
- •4.7 Active Penetration
- •4.8.2 Biofilm Formation
- •4.8.4.1 Antifungals
- •4.8.4.2 Antifungal Resistance
- •References
- •5.1 Introduction
- •5.2.3.1 Serum
- •5.2.3.2 Low Nitrogen
- •5.2.3.5 Carbon Source
- •5.2.3.6 pH
- •5.2.3.7 N-acetylglucosamine (GlcNAc)
- •5.2.3.8 Quorum Sensing Molecule
- •5.5.5 Surface Colonization Factor1 (SCF1)
- •5.5.6 Other Putative Adhesins
- •5.6.1 Phospholipases
- •5.6.2 Proteinases
- •5.6.3 Hemolysins
- •5.6.4 Lipases
- •5.7 Secreted Cytolytic Peptide: Candidalysin
- •5.5.1 ALS Family
- •5.5.2 HWP Adhesin
- •5.5.3 HYR/IFF Family
- •5.5.4 EPA Family
- •5.9.2 Low Molecular Weight Hsp/Small Heat Shock Proteins
- •5.10.1 Amino Acid/Nitrogen Metabolism
- •5.10.1.1 Amino Acid Sensing Pathway
- •5.12.1.1 Glycolysis
- •5.12.1.2 Gluconeogenesis
- •5.12.1.3 Glyoxylate Cycle
- •5.12.1.4 Fatty Acid Oxidation
- •5.12.3.2 Iron Metabolism
- •5.12.3.3 Candida Iron Transport
- •5.12.3.4 Reductive System
- •5.12.3.5 Siderophore Uptake System
- •5.12.3.6 Haemoglobin-Iron Uptake System
- •5.13.2 Zinc Metabolism
- •References
- •6.1 Introduction
- •6.2 Morphological Switching
- •6.3 Phenotypic Switching
- •6.4 Biofilm Formation
- •6.5 Metabolic Flexibility
- •6.8.1 Hemolysin
- •6.8.2 Phospholipases
- •6.8.3 Proteinase
- •6.8.4 Candidalysin
- •6.12 Conclusion
- •References
- •7.1 Introduction
- •7.2.4 Polymorphism
- •7.2.5.1 Secreted Aspartyl Proteinases
- •7.2.5.2 Phospholipase
- •7.2.6 Calcineurin-Signalling Pathway
- •7.2.7 Ion Homeostasis
- •7.2.7.1 Iron
- •7.2.7.2 Copper
- •7.2.8.1 Capsule
- •7.2.8.2 Melanin
- •7.2.8.3 Heat Shock Proteins
- •7.3 Conclusions
- •References
- •8.1 Introduction
- •8.4.1 ATP-Binding Cassette (ABC) Transporters
- •8.4.2 Major Facilitator Superfamily (MFS) Transporter
- •8.5.1 Biofilm Architecture Among Candida Species
- •References
- •9.1 Introduction
- •References
- •10.1 Introduction
- •10.3 Biofilm
- •10.5 Adherence
- •10.6 Maturation
- •10.8 Dispersion
- •10.11 Animal Models
- •10.18 Photodynamic Therapy
- •References
- •11.1 Introduction
- •11.9 Concluding Remarks
- •References
- •12.1 Introduction
- •12.2 Epidemiology
- •12.3.1 Humoral Response
- •12.3.2 Cellular Immunity
- •12.4 Virulence Factors
- •12.6.1 Fluconazole
- •12.6.2 Polyenes
- •12.6.3 Echinocandins
- •12.7 Drug Resistance
- •12.8 Future Prospects
- •12.9 Conclusions
- •References
- •13.1 Introduction
- •13.4 Translation Research
- •13.4.1 Disease-Oriented Translational Research
- •13.4.2 Lab-Oriented Translational Research
- •13.4.3 Patient-Oriented Translational Research
- •13.5 Conclusion
- •References
- •14.1 Introduction
- •14.2.3 Cutaneous Aspergillosis
- •14.2.4 Ocular Aspergillosis
- •14.2.5 Aspergillus Endocarditis
- •14.2.6 Aspergillus Osteomyelitis
- •14.2.7 Sinus Aspergillosis
- •14.3.2 Histopathology
- •14.3.3 Serological
- •14.3.4 Breath Testing
- •14.3.5 Monoclonal Antibody (mAbs)-Mediated Methods
- •14.4.1 Conventional Therapeutics
- •14.4.1.1 Azoles
- •14.4.1.2 Polyenes
- •14.4.1.3 Echinocandins
- •14.4.1.4 Fluoropyrimidines
- •14.5 Nonconventional Therapeutics
- •14.5.1 Vaccine
- •14.5.2 Monoclonal Antibodies (mAbs)
- •14.5.3 Nanotechnology-Based Therapeutics
- •14.5.4 Immune Therapy
- •14.5.5 Combination Therapy
- •14.8 Conclusion
- •References
- •15: Aspergillus Therapeutics: Future Agents
- •15.1 Introduction
- •15.2.1 Fosmanogepix
- •15.2.2 Ibrexafungerp
- •15.2.3 Olorofim
- •15.2.4 Opelconazole
- •15.2.5 Rezafungin
- •15.2.6 MGCD290
- •15.2.7 Tetrazoles (VT-1129/VT-1161/VT-1598)
- •15.2.8 Nikkomycin Z
- •15.2.9 VL-2397
- •15.2.10 T-2307/ATI-2307
- •15.2.11 Encochleated Amphotericin-B
- •15.2.12 SUBA-Itraconazole
- •15.2.13 Immunotherapy
- •15.2.14 Drug Repurposing
- •References
- •16.1 Introduction
- •16.2 Antifungal Agents
- •16.2.1 Azoles
- •16.2.2 Posaconazole
- •16.2.3 Isavuconazole
- •16.2.4 SUBA—Itraconazole
- •16.2.5 Nanovoriconazole
- •16.2.6 Adverse Effects
- •16.3 Liposomal Amphotericin B (LAMB)
- •16.3.1 Echinocandins
- •16.4 Combination Antifungal Therapy
- •16.5 Therapeutic Drug Monitoring (TDM)
- •16.5.1 Azole-Resistant Aspergillus Spp.
- •16.6 Guideline Recommendations
- •16.10 Conclusion
- •References
- •17.1 Introduction
- •17.3 Potent Antifungal Molecules Under Investigations
- •References
- •19.2 Host–A. fumigatus Interactions
- •19.3.1 Hydrophobicity or Rodlet Layer
- •19.3.2 Conidiation
- •19.3.3 DHN Melanin
- •19.3.5 Siderophores
- •19.3.6 Biofilm Formation
- •19.4 Conclusion
- •References

230
A. Kumar etal.
identied as a critical player in azole resistance. Developing small molecules or
compounds that specically target Tac1p could disrupt the transcriptional machinery responsible for multidrug resistance, rendering Candida strains more susceptible to existing antifungal drugs. Similarly, the identication of transcription factors
involved in regulating biolm formation, another major contributor to drug resistance, opens up opportunities for therapeutic intervention by disrupting the regulatory pathways that control biolm 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 modications and chromatin architecture are integral
parts of the transcriptional regulation machinery in Candida species. Developing
compounds that selectively modulate these epigenetic marks could inuence 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 inuence 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 efux 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 identication 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 efcacious 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, Biolm…
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237

Biofilm Formation inCandida Species
MbaIfeanyiElibe andNwezeEmekaInnocent
Abstract
A key factor playing a signicant role in the virulence of Candida albicans is its
capacity to produce biolms. Biolm represents a microbial community that
attaches to the biotic or abiotic surface. Numerous severe microbial infections
arise due to biolms that do not respond to standard antimicrobial treatment.
Treating infections associated with biolms involves destroying their extracellular matrix and killing the microbe, which is largely more challenging. Biolm
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. Biolms 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 biolm formation mechanisms and
regulatory processes in different Candida species. Therefore, in this chapter, we
critically reect on biolm formation in Candida spp. to understand the molecular mechanisms and transcriptional factors regulating the process. This chapter
also discussed the variations in biolm formation among the Candida species
and its association with antifungal resistance. Finally, the chapter explores the
creation of mixed-species biolms and their implications for virulence.
9
Keywords
Candida species · Candida albicans · Biolm 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
239

240
M. I. Elibe and N. E. Innocent
9.1 Introduction
The predominant growth state for numerous microorganisms is characterized by
biolm formation. Biolm 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). Biolms are commonly linked
to solid surfaces. However, they can also develop in different environments. For
example, biolm can develop in liquid–air interfaces (Nobile and Johnson 2015;
Gulati and Nobile 2016). One widespread feature of biolms is their increased cell
resistance to antimicrobial agents and ability to survive in different environments.
In fact, in some studies, biolm formation among Candida has been linked to high
mortality rates (Vitális etal. 2020). In the last two decades, a growing focus has
been on studies involving microbial biolms, reshaping our comprehension of
microbial life (Davey and O’toole 2000; Nobile and Johnson 2015) with several
recent studies and discussion centering on biolm formation among Candida species (Fernandes etal. 2023; Junqueira and Mylonakis 2023), including the recently
emerging C. auris (de Melo etal. 2023; Oyardi etal. 2023). It is believed that most
microbes thrive and grow naturally under a biolm state (Kolter and Greenberg 2006).
Microbial biolms exist in diverse environments, including living and nonliving
environments. For example, most hospital infections are usually due to infections
associated with biolm formation in prosthetic devices like catheters. In fact,
catheter- associated bloodstream infection has been a signicant issue in hospital
settings (Haddadin etal. 2023; Sikora and Zahra 2023). The development and structural architecture of biolms, in addition to their properties, rely on the microbial
species forming them. While most microbial cells form biolm in certain environments, others don’t. The formation of biolm also depends on the lineage or evolutionary history of the cells (Ramage etal. 2023). A nearly universal trait of cells that
form biolms 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 biolm, invivo formation typically involves a combination of different microbes. Thus, most resilient infections caused by microbes
in the human hosts are due to biolm formation. Candida species form biolms.
Most of the supercial and systemic fungal infections caused by Candida species
are associated with biolm formation. The effect is more pronounced in immunocompromised patients (Sims etal. 2005; Atriwal etal. 2021). Biolm formation is a
major contributor to candidemia caused by the use of catheters (Pereira etal. 2021;
Zuo etal. 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 biolm-forming ability, and the diversity in virulence
genes’ expression patterns make it difcult to treat most infections. Most mucosal
infections are due to biolm-forming phenotypes that interact with resident commensals and diverse host components (Vestby etal. 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 etal. 2021). The importance of pathogenic fungi in community
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