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Abstract
Fungi are primitive eukaryotes and have adapted to a variety of niches during
evolution. Some fungal species may interact with other life forms (plants, insects,
mammals), but are considered as pathogens when they cause mild to severe
diseases. Chemical control strategies have emerged with the development of several
drugs with antifungal activity against pathogenic fungi. Antifungal agents have
demonstrated their efficacy by improving patient health in medicine. However,
fungi have counteracted antifungal agents in several cases by developing resistance
mechanisms. These mechanisms rely on drug resistance genes including multidrug
transporters and drug targets. Their regulation is crucial for the development of
antifungal drug resistance and therefore transcriptional factors critical for their
regulation are being characterized. Recent genome-wide studies have revealed
complex regulatory circuits involving these genetic and transcriptional regulators.
Here, we review the current understanding of the transcriptional regulation of
drug resistance genes from several fungal pathogens including Candida and
Aspergillus species.
YEAST RESEARCH
Introduction
Fungi are primitive eukaryotes interacting with other life
forms (bacteria, plants, insects, mammals) under specific
relationships known as mutualism, parasitism or commensalism. When causing mild to severe diseases in their hosts,
specific fungal species are categorized as pathogens. Most
of the fungal pathogens in mammals are so-called opportunistic, because they will only cause disease when
host immune defenses are deficient. In recent decades,
opportunistic fungal infections have gained considerable
importance due to an increase in the immunocompromised
population comprising individuals infected with the HIV,
patients undergoing immunosuppressive treatment in
preparation for organ and bone marrow transplantation or
cancer patients receiving cytotoxic agents (Richardson &
Lass-Florl, 2008). Candida albicans is the most frequent
species among the current fungal pathogens, followed by
other Candida species (e.g. Candida glabrata, Candida
parapsilosis, Candida tropicalis), non-Candida species (e.g.
Cryptococcus neoformans) and molds (e.g. Aspergillus
fumigatus, Microsporum canis) (Lass-Florl, 2009). These
fungi are responsible for various forms of diseases, ranging
FEMS Yeast Res 9 (2009) 10291050
Polyenes
The polyenes belong to a class of natural compounds with
an amphipathic nature (one hydrophilic charged side of the
2009 Federation of European Microbiological Societies
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Pyrimidine analogues
5-Fluorocytosine (5-FC) is the only representative of
this class of antifungals. Susceptible fungi have a cytosine
deaminase that converts 5-FC into 5-fluorouracil, which
is then incorporated into DNA and RNA, therefore inhibiting cellular function and division (Polak & Scholer, 1975).
5-FC is usually used in combination with polyenes or
other antifungal agents in the treatment of fungal infections because resistance develops at a high frequency
as monotherapy. 5-FC has poor activity against most
filamentous fungi and dermatophytes (Gehrt et al., 1995;
Sanglard, 2002). This can be attributed to their lack
of a cytosine deaminase, which is also the basis for
the minimal toxicity of 5-FC in mammalian cells (Edlind,
2007).
Azoles
Azoles, together with allylamines, thiocarbamates and morpholines, inhibit ergosterol biosynthesis, a pathway that is
similar in many respects to cholesterol biosynthesis in
mammals, but differs in subtle ways. Azoles inhibit a
cytochrome P450 lanosterol demethylase, Erg11 or Cyp51,
which is an essential step in sterol biosynthesis. Inhibition
of lanosterol demethylase results in the replacement of
ergosterol by methylated sterols in the plasma membrane
(Sanglard, 2002). Azoles may also inhibit another cytochrome P450 responsible for sterol D22-desaturation
(Erg5), a later step in ergosterol biosynthesis (Skaggs et al.,
1996). Because Erg11 precedes Erg5 in sterol biosynthesis,
the former enzyme is most important as an azole target.
There are two classes of azole drugs: (1) the imidazoles,
including ketoconazole, miconazole and clotrimazole,
which have limited use for systemic infections, but
are commonly used topically for mucosal or skin infections,
and (2) the triazoles, including fluconazole, voriconazole,
itraconazole and posaconazole, which are used systemically for both mucosal and systemic infections. Voriconazole, itraconazole and posaconazole have good activity
against most filamentous fungi, in contrast to fluconazole,
whose activity is largely limited to yeast (Sheehan et al.,
1999).
2009 Federation of European Microbiological Societies
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D. Sanglard et al.
Candins
Candins belong to the most recent category of antifungal
drugs. They inhibit b-1,3 glucan synthase, an enzyme
complex that is located in the plasma membrane of fungal
cells. This enzyme is essential to fungi as b-1,3 glucans
represent one of the major components of the fungal cell
wall. Several isoforms of b-1,3 glucan synthase are present in
Candida species; however, the major activity is attributed to
a single isoform (referred to as Fks1). Candins are now
available as three different, but chemically related compounds: caspofungin, micafungin and anidulafungin. Candins are used for the treatment of invasive Candida and
Aspergillus infections, but are not effective for Cryptococcus
and most mold infections (Perlin, 2007).
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Resistance mechanisms to
antifungal agents
Resistance mechanisms that prevail among fungal pathogens
fall into different categories: (1) transport alterations, (2)
target alterations, (3) utilization of compensatory pathways
and (4) presence of complex multicellular structures.
Transport alterations
Transport alterations leading to antifungal resistance are
mediated through several types of transporters in fungi, for
example ATP-binding cassette (ABC) transporters and
major facilitators. ABC transporters are generally made up of
two transmembrane domains (TMDs) and two cytoplasmic
nucleotide-binding domains (NBDs). Typically, the TMDs are
composed of 12 transmembrane a-helices segments (TMS)
(Gaur et al., 2005; Prasad et al., 2006). Transport of ABC
transporter substrates across the membrane requires energy
from the hydrolysis of ATP carried out at the NBDs.
Candida albicans possesses two highly homologous ABC
transporters, Candida drug resistance 1 (Cdr1) and Cdr2,
which are composed of two homologous halves, each made
up of a hydrophilic, cytoplasmic NBD and TMD composed
of six TMS, a so-called (NBDTMD6)2 topology. Cdr1 and
Cdr2 overexpression is responsible for azole resistance in
many clinical isolates recovered from patients receiving
FEMS Yeast Res 9 (2009) 10291050
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Fig. 3. GOF mutations in transcription factors regulating efflux genes. Repartition of the GOF mutations (black bars) identified in the transcription
factors Tac1, Mrr1, CgPdr1, Pdr1 and Pdr3. Hatched bars in Tac1 signify that the GOFs were obtained by random mutagenesis (Coste et al., 2009). The
GOF mutation deleting amino acid positions 962969 is indicated by a rectangle. Data for MRR1, CgPDR1, PDR1 and PDR3 were obtained from
published reports (Kolaczkowski & Goffeau, 1997; Nourani et al., 1997; Kolaczkowska & Goffeau, 1999; Mizoguchi et al., 2002; Vermitsky & Edlind,
2004; Morschhauser et al., 2007; Dunkel et al., 2008a; Ferrari et al., 2009). DBD, DNA-binding domain; ID, inhibitory domain; AD, activation domain.
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Acknowledgements
The authors are indebted to T. Edlind (Drexel University,
Philadelphia) for critically reading this manuscript. D.S. is
supported by a grant from the Swiss Research National
Foundation (3100A0-114131/1) and by a grant from the
European Commission (LSHM-CT-2005-518199) under the
acronym EURESFUN.
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