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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

414
Fig. 17.2 Different approaches to overcome antifungal resistance both in planktonic and biolm
of Aspergillus spp., all information presented based on literature and previous suggestions is elabo-
rated in the text
S. K. Shishodia et al.
development of antifungal resistance in Aspergilli. In this context, Gautam etal.
(2008) examined AmB-exposed A. fumigatus protein proling using MALDI.We
observed a decrease in energy metabolism and ergosterol biosynthesis protein
Erg13, increased transitional machinery, and more Hem13 protein, indicating a
higher heme demand. Iron molecules are necessary for ergosterol production, and
iron deciency reduces enzyme activity. AmB increases antioxidant enzymes,
which have been linked to oxidative stress-induced cell damage in A. fumigatus
(Gautam etal. 2008). Catalases are abundant in A. fumigatus, where ITC regulates
54 proteins at different levels, suggesting oxidative response. CAS exposure caused
A. fumigatus protein analysis to show ribosome reorganization. The study also
found that A. fumigatus biolm proteins contain translational regulatory proteins,
which are necessary for biolm formation. The existing understanding of these
pathways and proteins/enzymes provides opportunities for the identication of
novel drug targets, the development of new drug compounds, and the design of vaccines. Moreover, these advancements contribute to the mitigation of drug resistance
and the improvement of therapeutic approaches for drug-resistant isolates.
17.3 Potent Antifungal Molecules Under Investigations
Discovering new chemical compounds and understanding their mechanisms of
action are ongoing to develop effective antifungals. Plants produce important natural compounds that can treat fungal diseases. Novel phytochemicals and improved

17 Drug-Resistance Patterns in Opportunistic Aspergilli: A Molecular…
415
drug formulations with lower toxicity and higher efcacy are needed. Phytochemicals
combined with conventional medications can overcome the limitations of pharmaceuticals. Alternative therapy has made many advances, but phytochemicals have
received signicant attention. However, these chemicals are not yet clinically applicable. Thus, phytochemical compounds must be rigorously tested against Aspergillus
to determine their efcacy and mechanisms of action. This would enable their use
as standalone therapeutic agents or with conventional drugs. Phytochemicals such
as tocopherol phenolic, thiols, avonoids, anthocyanin, and carotenoids showed
promising results (Kumar etal. 2006; Salim et al. 2008). Recently, quercetin was
shown to reduce A. parasiticus and A. avus growth and may be a potential biological agent for managing aatoxin contamination in food crops (Shraddha Tiwari
etal. 2017). Shikonin was effective against uconazole-resistant Candida albicans
(Miao etal. 2012) and also on A. terreus AmB resistance isolate (Shishodia and
Shankar 2020). Artemisinin has been extensively studied in phytochemicals and for
its A. fumigatus inhibitory properties (Gautam et al. 2011). SCD-1, a coumarinderived synthetic compound, was also tested against A. fumigatus (Rivero-Menendez
etal. 2016). These phytochemicals can be used alone or together to improve current
therapeutic methods. Combinatorial therapy could be another possible way to ght
against drug resistance isolates in Aspergilli. The combinations of various existing
drugs with phytochemicals or antioxidants/prooxidants could be explored for
designing combinatorial therapies. Vaccines against fungal infections have been
tested in the past two decades (Bozza etal. 2002; Schmidt etal. 2012). Pre-clinical
trials test some for efcacy and safety. Live attenuated vaccines for yellow fever,
measles, smallpox, and BCG are one of the oldest and most effective vaccines. The
same strategy was successfully tested in mice for candidiasis (Yang etal. 2009) and
other fungal infections, but none have reached clinical trials. Liu etal. (2015) found
that heat-killed Saccharomyces protect against Candidiasis, Aspergillosis, and
Coccidioidomycosis (Liu etal. 2012a; Majumder etal. 2014). Cross-reactive antigens on fungi’s cell walls may explain this. Different morphotypes have different
protein composition, glycoprotein, and polysaccharide compositions, which affect
immunological responses during conidia to hyphae and mycelia. A. fumigatus transcriptome proles showed that Th1 immune responses were activated 3days after
infection and Th2 and Th17 response post5days ofinfections in the mice model of
invasive aspergillosis (Shankar etal. 2018a). In a recent study, it was found that the
cell wall-associated adhesion protein Als3p of Candida albicans protects disseminated, oropharyngeal, and vaginal candidiasis in mice through the activation of Th1/
Th17-mediated immune response (Bär etal. 2012). More recently, oncology and
infectious disease researchers are studying immune checkpoint therapy. This therapy activates the host immune system by targeting the key regulator. Short α-(1, 3)
oligosaccharides effectively inhibit α-(1, 3) glucan-mediated Treg polarization and
promote Th1 response by blocking PD-L1 (Stephen-Victor etal. 2017). Wurster
etal. found that anti-PD-1 inhibitors improve survival and reduce A. fumigatus burden in a murine IPA model (Wurster etal. 2020). In addition, we know that secretory proteins are crucial to fungal infections’ biolm formation, tissue invasion,
immune evasion, and cell wall maintenance (Sorgo etal. 2013). Immunodominant

416
S. K. Shishodia et al.
proteins can be used as infectious disease vaccines. It includes Hsp90& Hsp70(also
Hsp90 inhibitor geldanamycin-a potential drug target), Hyr1, cell wall extracts, and
β-mannan conjugated peptides, are in preclinical stages, in addition to Alsp3 and
Sap2. The recombinant protein Asp 16f and CPG oligonucleotides improved mouse
survival against IA (Bozza etal. 2002; Tiwari and Shankar 2018b; Stevens etal.
2011; Levitz 2016). Similarly, the secretory proteins in A. terreus drug-resistant
isolate have been studied and showed a relation with drug resistant and biolm formation (Shishodia and Shankar 2020). Thus, multivalent vaccines, which contain
multiple antigens/epitopes of more than one pathogen strain/serotype, have garnered attention, including prioritizing the potential candidate through in-silico
approach (Thakur and Shankar 2016b; Tarang etal. 2020).
17.4 Conclusion andFuture Perspectives
There has been a consistent emergence of novel fungal infections over the time, and
the post-COVID-19 era has brought signicant attention to the signicance of fungal infections. In addition, the occurrence of resistant strains of Aspergilli contributes to further exploration of the situation. The understanding of molecular
determinants offers opportunities for the development of innovative therapeutics,
such as novel drug and vaccine candidates in Aspergilli to ght against drug resistance. Recent challenges are in the identication and screening of new drug molecules, and the development of anti-fungal vaccines needs more attention. The
investigation of transitional and biolm phenomena will contribute to the identication of novel therapeutic targets for Aspergilli. The primary focus of contemporary
research groups primarily centers on the investigation of cell wall proteins, adhesion
proteins, secretary proteins, and virulent proteins. This emphasis is attributed to the
fact that these particular protein types are readily accessible to the host immune
system. Therefore, ongoing investigation into the mechanisms of drug resistance
and immunological pathways facilitates the advancement of anti-fungal vaccines
and pharmaceutical interventions.
Acknowledgements The author acknowledges the research facility provided by the Department
of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Solan, India.
Conict of Interest The authors declare that they have no conict of interest.
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