Abstract
BackgroundBiofilm is an accumulation of cells, which are formed on mucosal surfaces of the host as well as on medical devices. The inherent resistance of Candida strains producing biofilms to antimicrobial agents is an important and key feature for biofilm growth, which can lead to treatment failure. This resistance is due to the regulatory increase of the output pumps, the presence of extracellular matrix, and the existence of persister cells. Persister cells are phenotypic variants that have MICs similar to antibiotic-sensitive populations and are able to tolerate high doses of antibiotics. The current study investigated the possible role of EFG1, BCR1, and CAT1 in the establishment or maintenance of persister cells in Candida albicans strains that produce biofilms.MethodsAfter identifying Candida isolates by molecular methods, C. albicans isolates were confirmed by sequencing. Isolation of persister cells and determination of their MIC were performed by microdilution method. Then, RNA extraction and cDNA synthesis were performed from 60 C. albicans isolates under promoting and inducing conditions. Afterward, the mean expression of BCR1, EFG1, and CAT1 genes in both persister and non-persister groups was calculated using real-time qPCR. Phylogeny tree of persister and non-persister group isolates was drawn using ITS fragment.ResultsA total of 77 persister isolates were taken from the oral cavity of HIV patients as well as from patients undergoing chemotherapy. Biofilm intensity in persister isolates separated from HIV-infected patients was different from the non-persister group. The mean fold change of BCR1 (10.73), CAT1 (15.34), and EFG1 (2.41) genes in persister isolates was significantly higher than these genes in isolates without persister.ConclusionIt can be concluded that the most important factor in the production of persister cells is biofilm binding and production, not biofilm development or mature biofilm production, which was found in the expression of BCR1 gene without change in the expression of EFG1 gene in the persister group. Also, catalase plays an essential role in the production of persister in C. albicans biofilm producers with ROS detoxification.
Highlights
Oral candidiasis is known as the most common fungal infection
The aim of this study was to better understand fungal persister cells for comparing biofilm intensity and expression of genes involved in biofilm production pathway (BCR1 and EFG1) as well as oxidative stress response pathway (CAT1) in persister cells of C. albicans isolates taken from patients with HIV who underwent chemotherapy
Forty-three isolates were taken from patients undergoing chemotherapy and 61 C. albicans isolates were identified in HIV patients
Summary
Oral candidiasis is known as the most common fungal infection. It is an opportunistic disease among humans, especially in patients undergoing chemotherapy, transplant recipients, and HIV patients. Aging, uncontrolled diabetes mellitus, broadspectrum antibiotics, corticosteroid, and/or immunosuppressant drug use are predisposing factors for this disease It acts as a prognostic marker for systemic diseases such as diabetes mellitus and a common problem in immunocompromised patients such as HIV patients and those undergoing chemotherapy (Aboualigalehdari et al, 2013, 2020; Taff et al, 2013; Cavalheiro and Teixeira, 2018; Putranti et al, 2018). The inherent resistance of Candida strains producing biofilms to antimicrobial agents is an important and key feature for biofilm growth, which can lead to treatment failure This resistance is due to the regulatory increase of the output pumps, the presence of extracellular matrix, and the existence of persister cells. The current study investigated the possible role of EFG1, BCR1, and CAT1 in the establishment or maintenance of persister cells in Candida albicans strains that produce biofilms
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