Abstract
Vulvovaginal candidiasis causes sufferers much discomfort. Phytotherapy with garlic has been reported to be a possible alternative form of treatment; however, it is unknown why patients report varying success with this strategy. Fresh garlic extract has been shown to down-regulate the putative virulence gene, SIR2 in C. albicans. Our study aimed to see if previous observations were reproducible for the gene responsible for Candidalysin (ECE1). Two clinical strains from patients with reported variable efficacy of using garlic for the treatment of vulvovaginal candidiasis were compared through biofilm assays and antimicrobial susceptibility. Real-time PCR was used to assess changes in gene expression when exposed to garlic. Treatment with fresh garlic extract and pure allicin (an active compound produced in cut garlic) resulted in a decrease in SIR2 expression in all strains. In contrast, ECE1 expression was up-regulated in a reference strain and an isolate from a patient unresponsive to garlic therapy, while in an isolate from a patient responsive to garlic therapy, down-regulation of ECE1 occurred. Future studies that investigate the effectiveness of phytotherapies should take into account possible varying responses of individual strains and that gene expression may be amplified in the presence of serum.
Highlights
Some virulence factors thought to be responsible for the pathogenicity of C. albicans are expressed when a suitable environment exists to cause disease
The MIC50 and MIC90 are presented in Investigation of the effect of different concentrations of fresh garlic extract (FGE) on biofilm formation of C. albicans with and without 3% fetal bovine serum (FBS)
The inhibitory effect of fresh garlic extract on biofilm formation of the strains was demonstrated over a range of FGE concentrations with and without FBS
Summary
Some virulence factors thought to be responsible for the pathogenicity of C. albicans are expressed when a suitable environment exists to cause disease. C. albicans undergoes a morphogenesis process which is a reversible transformation between the unicellular form (yeast) and the pathogenic filamentous form (hyphae) This morphogenesis process is thought to herald the symptoms of itchiness and result in discharge due to the localised inflammatory response in vulvovaginal candidiasis (VVC). Since the report of garlic down-regulation in SIR2, an additional virulence gene ECE1 (extent of cell elongation) has been shown to be important in one of the crucial steps to the commencement of infection (attachment) and is highly expressed during the invasion of host tissue and during epithelial infection[8,9]. Candidalysin has been demonstrated to be responsible for the immunopathogenesis of C. albicans vaginitis[11] These results suggest that ECE1 is an essential virulence. In this previous study we investigated the use of oral garlic tablets (Garlicin ) for the treatment of VVC
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