In vitro antifungal susceptibility of clinical isolates of Candida spp. obtained from patients with different predisposing factors to candidosis

Development of an Anti-Biofilm Screening Technique Leads to the Discovery of a Peptoid with Efficacy against Candida albicans

Bacteria and fungi can secrete and reside within a complex polysaccharide matrix, forming a biofilm that protects these pathogens from the immune response and conventional antibiotics. Because many microbial pathogens grow within biofilms in clinical settings, there is a need for antimicrobial agents effective against biofilm-protected infections. We report the adaptation of a phenotypic high-throughput assay for discovering antimicrobial peptoids toward the screening of combinatorial libraries against established biofilms. This method, termed the Inverted Peptoid Library Agar Diffusion (iPLAD) assay, required optimization of growth media, reducing reagent, and fungal viability reporter. Once optimized, iPLAD was used to screen a combinatorial peptoid library against Candida albicans, a biofilm-forming fungal pathogen responsible for most hospital-acquired infections. This screening resulted in a lipopeptoid termed RMG9-11 with excellent activity against several species of Candida, including drug-resistant strains of C. albicans and the emerging and dangerous C. auris. Additionally, the cytotoxicity of RMG9-11 against several mammalian cell lines was minimal. This work provides a new method for the identification of compounds effective against biofilm-protected pathogens and demonstrates its utility by identifying a promising anti-Candida peptoid.

ERG11 gene polymorphisms and susceptibility to fluconazole in Candida isolates from diabetic and kidney transplant patients

INTRODUCTION

Candidiasis is the most frequent opportunistic mycosis in humans and can cause mortality, particularly in immunodeficient patients. One major concern is the increasing number of infections caused by drug-resistant Candidas trains, as these cannot be efficiently treated with standard therapeutics. The most common mechanism of fluconazole resistance in Candida is mutation of ERG11, a gene involved in the biosynthesis of ergosterol, a compound essential for cell integrity and membrane function.

METHODS

Based on this knowledge, we investigated polymorphisms in the ERG11 gene of 3 Candida species isolated from immunocompromised and immunocompetent patients. In addition, we correlated the genetic data with the fluconazole susceptibility profile of the Candida isolates.

RESULTS

A total of 80 Candida albicans, 8 Candida tropicalis and 6 Candida glabrata isolates were obtained from the saliva of diabetic, kidney transplant and immunocompetent patients. Isolates were considered susceptible to fluconazole if the minimum inhibitory concentration was lower than 8 μg/mL. The amino acid mutations F105L, D116E, K119N, S137L, and K128T were observed in C. albicans isolates, and T224C and G263A were found in C. tropicalis isolates.

CONCLUSIONS

Despite the high number of polymorphisms observed, the mutations occurred in regions that are not predicted to interfere with ergosterol synthesis, and therefore are not related to fluconazole resistance.

Antimicrobial and Antiproliferative Activity of Bauhinia forficata Link and Cnidoscolus quercifolius Extracts commonly Used in Folk Medicine

BACKGROUND

Bauhinia forficata and Cnidoscolus quercifolius plants are commonly used in folk medicine. However, few studies have investigated their therapeutic potential.

AIM

Herein, we evaluated the antimicrobial activity of B. forficata and C. quercifolius extracts against microorganisms of clinical relevance and their antiproliferative potential against tumor cells.

MATERIALS AND METHODS

The following tests were performed: Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC)/minimum fungicidal concentration (MFC), inhibition of biofilm adhesion, and effects on cell morphology. Antiproliferative tests were carried out with human keratinocytes and six tumor lines.

RESULTS

Bauhinia forficata showed antimicrobial activity only against C. albicans with MIC of 15.62 ug/mL and MFC higher than 2000 ug/mL. It also inhibited biofilm adhesion and caused alterations in cell morphology. Cnidoscolus quercifolius showed no significant activity (MIC > 2.0 mg/mL) against the strains. Bauhinia forficata and C. quercifolius extracts showed cytostatic activity against the tumor cells.

CONCLUSION

Bauhinia forficata has promising anti-Cand/da activity and should be further investigated for its therapeutic potential.

CLINICAL SIGNIFICANCE

The use of medicinal plants in the treatment of infectious processes has an important function nowadays, due to the limitations of the use of synthetic antibiotics available, related specifically to the microbial resistance emergence.

Quantitative investigation of efficiency of ultraviolet and visible light in eradication of Candida albicans in vitro

OBJECTIVE

The aim of this study was to quantitatively investigate the efficiency of the ultraviolet (UV) and visible light in eradication of Candida albicans in vitro; in particular, to determine, for selected wavelengths, the specific eradication coefficients and thresholds in terms of energy density levels required to effect 3.0log10 and 4.0log10 reduction.

BACKGROUND DATA

Oral candidosis is the most common infection of the oral cavity and is caused by Candida species. The widespread use of topical and systemic antifungal agents as conventional treatment for oral candidosis has resulted in the development of resistance in C. albicans. Therefore, it has become necessary to develop alternative therapies for the treatment of oral candidosis.

METHODS

C. albicans ATCC(®) 90028(™) was irradiated with 254 nm, 365 nm, 406 nm, 420 nm, and broadband Xe spectrum. For each wavelength, a fit of experimental data (survival fraction vs. applied energy density) with an exponential decay function enabled estimation of the specific eradication coefficients and thresholds.

RESULTS

Based on estimated specific efficiencies (Δ) and eradication thresholds (ET) of the investigated wavelengths, the ranking in eradication efficiency of C. albicans (most to least effective) is: 254 nm (Δ=6.1 mJ/cm(-2), ET99.99=56 mJ/cm(-2)), broadband Xe spectrum (Δ=27.7 mJ/cm(-2), ET99.99=255 mJ/cm(-2)), 365 nm (Δ=4.3 J/cm(-2), ET99.99=39 J/cm(-2)), 420 nm (Δ=0.65 J/cm(-2), ET99.99=6 J/cm(-2)), and 406 nm (Δ=11.4 J/cm(-2), ET99.99=104 J/cm(-2)).

CONCLUSIONS

The results provide insight into the wavelength-dependent dynamics of eradication of C. albicans. For each investigated wavelength, the eradication coefficient and corresponding eradication threshold were estimated. The observed different eradication efficiencies are consequence of different spectrally dependent inactivation mechanisms. The established methodology enables unambiguous quantitative comparison of eradication efficiencies of optical radiation and selection of most effective wavelengths for clinical and therapeutic use.

Photodynamic inactivation of Candida albicans mediated by a low density of light energy

Shorter times and lower energies of application of light sources are desirable to use photodynamic antimicrobial chemotherapy (PACT) to the clinical control of candidiasis, especially among babies and children. Light energies ranging from 39.5 to 100 J/cm(2) were previously applied to kill Candida albicans by PACT. The present study evaluated the efficacy of a combination of 0.05 mg/mL toluidine blue O (TBO) and a short time of application (60 s) and a low density of light energy (18 J/cm(2)) of a red light-emitting diode (LED) in killing C. albicans planktonic cells. Standard suspensions of C. albicans were randomly assigned for four treatment groups: control (L-P-), LED alone (L+P-), TBO alone (L-P+), and PACT (L+P+). After treatments, serial dilutions of suspensions were prepared and streaked on Sabouraud dextrose agar to determine colony-forming units of C. albicans per milliliter (CFU/mL). The results were analyzed by ANOVA and Tukey's post-hoc test (P < 0.05). PACT significantly reduced CFUs of C. albicans in comparison to other three treatments. Our results demonstrated a fungicidal effect of PACT mediated by a shorter time of application of LED on C. albicans planktonic cells. Further in vivo studies are needed to elucidate the efficacy of PACT to treat human fungal infections.

Susceptibilities of Candida albicans mouth isolates to antifungal agents, essentials oils and mouth rinses

Forty Candida albicans strains isolated from patient's mouth with fixed orthodontic appliances were analyzed to their susceptibilities to antifungal agents, mouth rinses and essential oils. Susceptibility to fluconazole, econazole, miconazole and ketoconazole, amphotericin B and nystatin was assessed by the disk diffusion (DD) method based on the Clinical and Laboratory Standards Institute M44-A protocol, and by Etest (fluconazole and amphotericin B). The susceptibilities to mouth rinses and essential oils were also determined by the DD technique. All isolates tested were susceptible (S) to amphotericin B, nystatin and fluconazole. The overall concordance between the DD and the Etest was 100% for amphotericin and fluconazole. One isolate was resistant to econazole (2.5%) and the other to ketoconazole (2.5%). Econazole and ketoconazole had the highest percentages of susceptible dose dependent (SDD), 55 and 95%, respectively. Regarding to the susceptibility isolates profile, seven phenotypes were detected, and the 3 more represented (90% of the isolates) of them were SDD to one, two or three azoles. The study of mouth rinses showed a high variability of efficacy against C. albicans. The results showed that the isolates susceptibility to essential oils differed (P < 0.05). The profile activity was: cinnamon > laurel > mint > eucalyptus > rosemary > lemon > myrrh > tangerine. The main finding was that the susceptibility to cinnamon and laurel varied among the three more representative antifungal phenotypes (P < 0.05). The susceptibility of econazole-SDD isolates to cinnamon and lemon was higher than those of the econazole-S yeasts (P < 0.05). In contrast, econazole-SDD isolates were less affected by laurel than econazole-S counterparts (P < 0.05).

Anti-candidal activity of essential oils alone and in combination with amphotericin B or fluconazole against multi-drug resistant isolates of Candida albicans

Therapy for candidiasis is becoming problematic due to the toxicities of currently available antifungal agents and the increasing prevalence of resistance among the etiologic agents. Therefore, new antifungals and alternative approaches are needed. In this study, 20 fluconazole-resistant strains of Candida albicans were found to have varying levels of resistance to other azoles, i.e., itraconazole (MIC of 4-128 μg/ml) and ketoconazole (2-256 μg/ml). In addition, 13 of these isolates appeared resistant to amphotericin B (32-128 μg/ml). A total of 21 plant essential oils were screened for their antifungal activity against these multi-drug resistant isolates. The oils of Cymbopogon martini, i.e., citral and cinnamaldehyde, exhibited strong inhibitory activity with minimum inhibitory concentrations (MIC(50)) ranging from 90-100 μg/ml. The test oils were more effective than fluconazole and amphotericin B in inhibiting azole- and amphotericin B-resistant, as well as amphotericin B-susceptible isolates. The test oils and especially eugenol, exhibited significant synergy with fluconazole or amphotericin B against the test isolates. These findings suggest the possible effective use of certain oils alone or in combination with fluconazole or amphotericin B, against multi-drug resistant isolates of C. albicans.

Synthetic arylquinuclidine derivatives exhibit antifungal activity against Candida albicans, Candida tropicalis and Candida parapsilopsis

BACKGROUND

Sterol biosynthesis is an essential pathway for fungal survival, and is the biochemical target of many antifungal agents. The antifungal drugs most widely used to treated fungal infections are compounds that inhibit cytochrome P450-dependent C14α-demethylase (CYP51), but other enzymes of this pathway, such as squalene synthase (SQS) which catalyses the first committed step in sterol biosynthesis, could be viable targets. The aim of this study was to evaluate the antifungal activity of SQS inhibitors on Candida albicans, Candida tropicalis and Candida parapsilopsis strains.

METHODS

Ten arylquinuclidines that act as SQS inhibitors were tested as antiproliferative agents against three ATCC strains and 54 clinical isolates of Candida albicans, Candida tropicalis and Candida parapsilopsis. Also, the morphological alterations induced in the yeasts by the experimental compounds were evaluated by fluorescence and transmission electron microscopy.

RESULTS

The most potent arylquinuclidine derivative (3-[1'-{4'-(benzyloxy)-phenyl}]-quinuclidine-2-ene) (WSP1267) had a MIC50 of 2 μg/ml for all species tested and MIC90 varying from 4 μg/ml to 8 μg/ml. Ultrathin sections of C. albicans treated with 1 μg/ml of WSP1267 showed several ultrastructural alterations, including (a) loss of cell wall integrity, (b) detachment of the plasma membrane from the fungal cell wall, (c) accumulation of small vesicles in the periplasmic region, (d) presence of large electron-dense vacuoles and (e) significantly increased cell size and cell wall thickness. In addition, fluorescence microscopy of cells labelled with Nile Red showed an accumulation of lipid droplets in the cytoplasm of treated yeasts. Nuclear staining with DAPI revealed the appearance of uncommon yeast buds without a nucleus or with two nuclei.

CONCLUSION

Taken together, our data demonstrate that arylquinuclidine derivatives could be useful as lead compounds for the rational synthesis of new antifungal drugs.

Conventional and alternative antifungal therapies to oral candidiasis

Candida-associated denture stomatitis is the most common form of oral candidal infection, with Candida albicans being the principal etiological agent. Candida adheres directly or via an intermediary layer of plaque-forming bacteria to denture acrylic. Despite antifungal therapy to treat denture stomatitis, infection is reestablished soon after the treatment ceases. In addition, many predisposing factors have been identified as important in the development of oral candidiasis, including malnourishment, common endocrine disorders, such as diabetis mellitus, antibacterial drug therapy, corticosteroids, radiotherapy and other immunocompromised conditions, such as acquired immunodeficiency syndrome (AIDS). These often results in increased tolerance to the most commonly used antifungals. So this review suggests new therapies to oral candidiasis.